CRASH-4: Can Early TXA Save Lives After a Fall with Prof Ian Roberts

A fall from standing height can have devastating consequences in an older adult. In this episode, Professor Ian Roberts joins the Pre-Hospital Care Podcast to discuss CRASH-4, a major randomised trial investigating whether giving intramuscular tranexamic acid (TXA) within three hours of injury can reduce intracranial bleeding, disability and death following symptomatic mild traumatic brain injury in older adults.The trial is particularly relevant to pre-hospital clinicians because TXA can be administered by paramedics at the scene or during transport, before the presence of intracranial haemorrhage is known. CRASH-4 follows on from the findings of CRASH-3 and addresses an important unanswered question: could giving TXA even earlier, before the CT scan, improve outcomes? In this interview, Ian discusses the rationale behind CRASH-4, the evidence that led to the trial, the practicalities of administering IM TXA, what the study has learned so far, and what the results could mean for the future management of older patients with head injury.CRASH-4 Trial: Official CRASH-4 study websiteStudy protocol – Version 3.0: Read the full CRASH-4 study protocolThis Episode is Sponsored by PAXIn pre-hospital and emergency medicine, your clinical equipment is only as effective as your ability to access it when it matters. That’s why healthcare professionals in some of the world's most demanding environments trust PAX Bags.Designed specifically for emergency and rescue professionals, PAX combines durability, intelligent organisation and practical functionality to create equipment bags that work with you, not against you.Whether you’re operating from a helicopter, responding on the road, working in remote environments or managing a complex clinical situation, PAX bags are designed to keep essential equipment protected, organised and immediately accessible.For professionals who rely on their equipment every day, that attention to detail matters. It can mean knowing exactly where something is, being able to access it quickly, and having confidence that your kit will perform when the environment is anything but predictable.PAX Bags: Professional equipment solutions, designed for the reality of emergency care.Find out more about PAX and explore their range of professional medical and rescue bags at PAX-Bags.com🎙️ EMS2027 – European EMS CongressThe Pre-Hospital Care Podcast is heading to Ireland.I’m excited to announce that I’ll be in Killarney in April 2027 as the official podcast host for EMS2027, the European EMS Congress.📅 13–15 April 2027📍 The Gleneagle, Killarney, Ireland🎯 Theme: “Connecting Care Across Communities”EMS2027 will bring together clinicians, researchers, educators and leaders from across Europe and beyond to explore the future of EMS, with a programme covering innovation, technology, sustainability, human factors, research and the future of integrated emergency care.I’ll be there with the Pre-Hospital Care Podcast, bringing you interviews and conversations with speakers, clinicians, researchers and EMS leaders — capturing the ideas, experiences and discussions shaping contemporary pre-hospital care.If you work in EMS, emergency medicine, pre-hospital care or healthcare, make sure you have 13–15 April 2027 in your diary.I’ll see you in Killarney!Find out more and register with EMS Europe – EMS2027.

In this special Pre-Hospital Care Podcast tactical medicine compilation, we explore the clinical, operational and human challenges of providing care in high-risk and austere environments.Steve Woods examines the management of ballistic trauma, including whole blood administration, pleural drainage and recognising injury patterns, before discussing an equally important topic: clinician self-care and resilience.We then turn to Eric Acevedo, who explores conflict negotiation and de-escalation techniques. From hostage and conflict situations to everyday pre-hospital encounters, these skills can help clinicians build rapport, reduce confrontation and work with patients who may be reluctant to accept treatment or attend hospital despite significant illness or injury.A compilation exploring the reality that tactical medicine isn't just about procedures and equipment, it's about clinical judgement, communication, resilience and making good decisions under pressure.🎙️ EMS2027 – European EMS CongressThe Pre-Hospital Care Podcast is heading to Ireland!I’m excited to announce that I’ll be in Killarney in April 2027 as the official podcast host for EMS2027, the European EMS Congress.📅 13–15 April 2027📍 The Gleneagle, Killarney, Ireland🎯 Theme: “Connecting Care Across Communities”EMS2027 will bring together clinicians, researchers, educators and leaders from across Europe and beyond to explore the future of EMS, with a programme covering innovation, technology, sustainability, human factors, research and the future of integrated emergency care.I’ll be there with the Pre-Hospital Care Podcast, bringing you interviews and conversations with speakers, clinicians, researchers and EMS leaders — capturing the ideas, experiences and discussions shaping contemporary pre-hospital care.If you work in EMS, emergency medicine, pre-hospital care or healthcare, make sure you have 13–15 April 2027 in your diary.I’ll see you in Killarney!Find out more and register with EMS Europe – EMS2027.🎙️ GWAAC Symposium 2026 – Innovation in Pre-Hospital Care, hosted by the Great Western Air Ambulance Charity (GWAAC).📅 Friday 16 October 2026📍 Pravha Lounge, Ashton Gate Stadium, Bristol🎯 Theme: InnovationThe symposium will bring together leading clinicians, practitioners and experts to explore innovation and the future of pre-hospital care, with six expert speakers sharing their experience and perspectives.If you work in pre-hospital care, emergency medicine, critical care or the wider healthcare community, this is an event not to miss. Sign up here.

Few presentations generate more uncertainty, anxiety, and clinical challenge than the febrile child. Every day, paramedics, emergency clinicians and critical care teams are faced with one of the most difficult questions in medicine: is this simply a self-limiting viral illness, or the early stages of a life-threatening condition?The challenge lies not in recognising the obviously sick child, but in identifying the child who still appears relatively well while quietly deteriorating. It demands an understanding of paediatric physiology, pattern recognition, clinical judgement and the ability to make decisions with incomplete information.Joining us is Professor Damian Roland, Professor of Paediatric Emergency Medicine at the University of Leicester and Honorary Consultant at University Hospitals of Leicester NHS Trust. An internationally recognised researcher and educator, he has dedicated his career to improving the assessment, recognition and management of acutely unwell children.Together we'll discuss recognising serious illness, avoiding common diagnostic pitfalls, balancing sepsis screening with sound clinical reasoning, and why conditions such as Kawasaki disease, meningococcal disease and others must remain on every clinician's differential diagnosis.We also explore the challenge of recognising clinical deterioration in children outside hospital, including emerging work on developing a consensus-based definition of paediatric out-of-hospital clinical deterioration.📄 Further reading: Consensus-based definition of paediatric out-of-hospital clinical deterioration: a modified Delphi studyRead the research paper on ResearchGateGWAAC Symposium 2026The Great Western Air Ambulance Charity (GWAAC) Symposium takes place on Friday 16 October 2026 at the Pravha Lounge, Ashton Gate Stadium, Bristol. This year’s theme is Innovation, with six expert speakers exploring developments in pre-hospital emergency medicine, team performance and clinical practice. The event offers a day of learning, discussion and networking for those working in pre-hospital and emergency care. Find out more and book your place: GWAAC Symposium 2026

In this episode, Deb Swann and Roger Alcock take us behind the scenes of humanitarian medicine, sharing their experiences of working in two very different global health emergencies: the 2023 Türkiye–Syria earthquake response and the 2014–2016 West African Ebola outbreak.On 6 February 2023, a series of devastating earthquakes struck southern Türkiye and northern Syria. More than 59,000 people were killed, including over 53,500 in Türkiye and around 5,900 in Syria. The humanitarian medical response involved emergency trauma care, field hospitals, medical evacuations and international Emergency Medical Teams. Within the first year, 38 national and international Emergency Medical Teams from more than 25 countries carried out almost 100,000 medical consultations in Türkiye. The episode also looks back at the West African Ebola crisis of 2014–2016: The largest Ebola outbreak since the virus was discovered in 1976. Beginning in Guinea and spreading to Liberia and Sierra Leone, the outbreak ultimately infected more than 28,600 people and caused 11,325 deaths. WHO declared it a Public Health Emergency of International Concern in August 2014. Deb and Roger discuss what it is like to work in these extraordinary circumstances, the challenges of providing healthcare when normal systems have been overwhelmed, and the human experiences that stay with medical teams long after they return home.In this episode:Humanitarian medicine in the aftermath of the 6 February 2023 earthquakeThe international medical response in TürkiyeWorking during the 2014–2016 Ebola outbreak The realities of working on the humanitarian frontlineThe personal experiences and human stories behind the statisticsWhat these crises can teach us about emergency medical responseNEAS Specialist Capabilities Conference 2026The North East Ambulance Service Specialist Capabilities Conference 2026 takes place on 3 November 2026 at The Glasshouse International Centre for Music, NewcastleGateshead.Under the theme “Collaborate, Innovate, Excel,” the conference brings together professionals working across specialist emergency care, with sessions covering Emergency Preparedness, Resilience and Response (EPRR), critical care and HART.The keynote speaker is Adam Desmond, the 7/7 Kings Cross paramedic, who will deliver a no-holds-barred talk on human factors and bandwidth saturation during major incidents.Other speakers include Lee Thompson, who will discuss regional critical care, alongside specialists from EPRR and HART. Dräger supports the conference and focuses on collaboration, innovation, excellence, resilience and the communities we serve.The closing date to register your interest is 11 October 2026.👉 Register your interest for NEAS Specialist Capabilities Conference 2026Date: 3 November 2026Venue: The Glasshouse International Centre for Music, Newcastle, Gateshead

In pre-hospital care, we spend a great deal of time preparing for the moments that matter most: cardiac arrest, major trauma, difficult airways, and emotionally challenging conversations. We train, rehearse, and work hard to achieve technical excellence. But what happens after the event may be just as important as what happens during it. Debriefing is a familiar concept in healthcare. We often think of it as a chance to review what happened, identify what went well, and consider what we could do differently next time. But for some of the world’s highest-performing teams, debriefing is much more than a learning exercise. It is a fundamental part of how they operate. Few organisations demonstrate this better than the Blue Angels. Their debriefing culture is immediate, structured, honest, and uncompromising. Every action can be examined, every assumption challenged, and every team member is expected to contribute. The goal is not to assign blame but to understand performance, learn quickly, and get better. So, what can healthcare learn from a team where the margin for error is measured in milliseconds? To explore that question, David and I are joined by John Hiltz, who brings firsthand experience of the Blue Angels’ debriefing culture, leadership, and approach to developing high-performing teams. John offers a unique perspective on what exceptional teams do differently, and how the principles of aviation debriefing could help pre-hospital teams build greater trust, accountability, learning, and performance. In this episode, we explore whether debriefing is simply a tool for learning from what has already happened or one of the most powerful mechanisms we have for building better teams.NEAS Specialist Capabilities Conference 2026The North East Ambulance Service Specialist Capabilities Conference 2026 takes place on 3 November 2026 at The Glasshouse International Centre for Music, NewcastleGateshead.Under the theme “Collaborate, Innovate, Excel,” the conference brings together professionals working across specialist emergency care, with sessions covering Emergency Preparedness, Resilience and Response (EPRR), critical care and HART.The keynote speaker is Adam Desmond, the 7/7 Kings Cross paramedic, who will deliver a no-holds-barred talk on human factors and bandwidth saturation during major incidents.Other speakers include Lee Thompson, who will discuss regional critical care, alongside specialists from EPRR and HART. Dräger supports the conference and focuses on collaboration, innovation, excellence, resilience and the communities we serve.The closing date to register your interest is 11 October 2026.👉 Register your interest for NEAS Specialist Capabilities Conference 2026Date: 3 November 2026Venue: The Glasshouse International Centre for Music, Newcastle, Gateshead

Every critically ill newborn represents one of the most demanding moments in healthcare. Within seconds of birth, teams may need to assess, communicate, prioritise, and intervene in an environment where the margin for error is extraordinarily small. Technical expertise is fundamental, but safe and effective resuscitation depends on much more than clinical knowledge alone. Communication, leadership, teamwork, situational awareness, and other human factors can profoundly influence how teams perform under the highest pressure.My guest today is James Yates, Critical Care Paramedic, educator and instructor on the Advanced Resuscitation of the Newborn Infant (ARNI) programme from the Resuscitation Council UK. ARNI is a specialist two-day programme that combines advanced clinical skills with communication, human factors, structured simulation and debriefing for clinicians caring for critically ill and sick newborns.James brings extensive experience in teaching clinicians how to perform effectively under pressure, not simply by developing technical competence, but by strengthening the non-technical skills that underpin high-performing teams.In this episode, we explore what high-performing teams do differently, why communication can break down during complex emergencies, and how structured simulation and expert debriefing can transform both individual clinicians and the wider systems in which they work.We discuss psychological safety, cognitive overload, shared mental models, leadership, communication, and the challenges of facilitating meaningful debriefs with experienced clinicians. Most importantly, we consider what neonatal resuscitation can teach us about team performance more broadly, and why these lessons extend far beyond the delivery room into pre-hospital medicine, HEMS, emergency care and critical care.If you are interested in how teams develop, adapt, and perform under pressure, this episode offers lessons well beyond neonatal resuscitation.NEAS Specialist Capabilities Conference 2026The North East Ambulance Service Specialist Capabilities Conference 2026 takes place on 3 November 2026 at The Glasshouse International Centre for Music, NewcastleGateshead.Under the theme “Collaborate, Innovate, Excel,” the conference brings together professionals working across specialist emergency care, with sessions covering Emergency Preparedness, Resilience and Response (EPRR), critical care and HART.The keynote speaker is Adam Desmond, the 7/7 Kings Cross paramedic, who will deliver a no-holds-barred talk on human factors and bandwidth saturation during major incidents.Other speakers include Lee Thompson, discussing regional critical care, alongside specialists from EPRR and HART. The conference is supported by Dräger and focuses on collaboration, innovation, excellence, resilience and the communities we serve.The closing date to register your interest is 11 October 2026.👉 Register your interest for NEAS Specialist Capabilities Conference 2026Date: 3 November 2026Venue: The Glasshouse International Centre for Music, Newcastle, Gateshead

Major haemorrhage remains one of the most time-critical emergencies in pre-hospital care. When a patient is bleeding to death, stopping the haemorrhage is the immediate priority, but what happens next is equally important. What are we actually replacing?In this special compilation of The Pre-Hospital Care Podcast, we explore the evolving science and practice of blood-based resuscitation in major trauma. In Part One, Professor Ross Davenport explores the science of bleeding and coagulation in trauma, examining trauma-induced coagulopathy, fibrinogen, haemostasis, and why conventional fluid-based resuscitation may fail to address the underlying physiological problem.In Part Two, we move from physiology to practice in Blood Administration in Haemorrhagic Shock within EMS Systems. We examine the evidence for pre-hospital blood administration, lessons from military and civilian systems, the RePHILL trial, and the practical challenges of introducing blood products into emergency medical services.Together, these conversations explore a fundamental shift in trauma resuscitation: moving beyond simply replacing volume, towards replacing the components the patient has actually lost. Because when someone is bleeding to death, the question isn't simply “How much fluid do they need?” It is “What does this patient need us to put back?”NEAS Specialist Capabilities Conference 2026The North East Ambulance Service Specialist Capabilities Conference 2026 takes place on 3 November 2026 at The Glasshouse International Centre for Music, NewcastleGateshead.Under the theme “Collaborate, Innovate, Excel,” the conference brings together professionals working across specialist emergency care, with sessions covering Emergency Preparedness, Resilience and Response (EPRR), critical care and HART.The keynote speaker is Adam Desmond, the 7/7 Kings Cross paramedic, who will deliver a no-holds-barred talk on human factors and bandwidth saturation during major incidents.Other speakers include Lee Thompson, discussing regional critical care, alongside specialists from EPRR and HART. The conference is supported by Dräger and focuses on collaboration, innovation, excellence, resilience and the communities we serve.The closing date to register your interest is 11 October 2026.👉 Register your interest for NEAS Specialist Capabilities Conference 2026 Date: 3 November 2026Venue: The Glasshouse International Centre for Music, NewcastleGatesheadThis episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠⁠https://www.pax-bags.com/en/⁠

Every resuscitation is different. Different patients, different teams, different environments, and often very different outcomes. But one thing remains constant: every clinical encounter has the potential to teach us something. The challenge, particularly in pre-hospital and acute care, is creating the time, space, and culture needed to turn those experiences into meaningful learning and sustained improvement. Debriefing is often viewed as something that happens after the event, a chance to review what happened, identify what went well, and consider what could have been done differently. But effective debriefing is far more than a post-event checklist or a quality improvement exercise. Done well, it can strengthen psychological safety, build trust, improve communication, and help teams develop the shared mental models and expertise needed to perform under pressure.In this episode, David and I are joined by Dr Bridgid Joseph, whose work across resuscitation practice, in-situ simulation, and interprofessional education has given her a unique insight into how teams learn in high-stakes clinical environments. She brings a practical perspective on what makes debriefing effective, and what prevents teams from getting the most from it. Together, we explore whether debriefing is simply a way of learning from what has already happened, or something much more powerful: a mechanism for developing better teams, improving performance, and ultimately delivering better care to patients.This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠⁠https://www.pax-bags.com/en/⁠

Artificial intelligence is advancing rapidly in healthcare, but what could it mean for pre-hospital care? In this compilation episode, we bring together two conversations exploring how AI could support clinicians, improve decision-making, and transform the way emergency care is delivered.We begin with Zane Perkins, exploring AI-TRiPS, an AI Risk Prediction and Decision Support System for trauma care. We discuss how AI and Bayesian networks could support clinical reasoning, identify risk and reduce cognitive burden in high-pressure environments such as major trauma and air ambulance care.But with that potential comes important questions around trust, cognitive bias, human factors and clinical responsibility. What happens when clinicians disagree with an algorithm? And could we become too reliant on technology?We then broaden the discussion with Nico Preston, exploring the wider applications of AI across pre-hospital care, from dispatch and demand prediction to diagnostics, risk stratification and clinical decision support.Across both conversations, one theme becomes clear: the future of AI in emergency care is unlikely to be about replacing clinicians. Instead, the opportunity may be to create human–AI systems that combine computational power with clinical experience, judgement and contextual awareness. But getting that balance right will be critical. Can AI make us better clinicians, and how do we ensure we use it safely?This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠⁠https://www.pax-bags.com/en/⁠

The most dangerous part of an intubation is often not the moment the laryngoscope goes in; it’s the ten minutes before it ever leaves the tray.In this episode of the Pre-Hospital Care Podcast, we focus on The Last 10 Minutes Before Intubation: the critical phase where outcomes are often decided long before airway instrumentation begins. Joining us is Cosmo Scurr, Consultant Anaesthetist, bringing extensive experience in managing critically ill patients and high-risk airway emergencies. Cosmo brings an anaesthetist’s perspective to the physiology, preparation, decision-making and team behaviours that underpin safe airway management.This is not a discussion about laryngoscopy technique. Instead, we explore the preparation, physiology and human factors that shape success or failure before the first attempt is made.We’ll examine how experienced clinicians approach pre-oxygenation in sick, hypoxic patients, and why seemingly small decisions can dramatically influence peri-intubation oxygen reserve. We’ll explore the physiology of induction and the pitfalls of hypotension, including why cardiovascular collapse during airway management is often predictable rather than sudden.The conversation also examines role allocation in high-acuity environments, failed-airway planning and cognitive load management when the room is under pressure. What does good preparation actually look like? How should teams approach equipment preparation, briefing, task allocation and contingency planning? And how can we create shared mental models before the situation becomes time-critical?Ultimately, this episode is about recognising that airway management begins before the airway is touched. The quality of those final ten minutes may determine what happens in the ten minutes that follow.Through a case-based lens, we’ll ask: what do experienced HEMS and critical care clinicians do differently in those final minutes? What habits, checks, and assumptions separate smooth intubations from catastrophic ones?This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠⁠https://www.pax-bags.com/en/⁠