Rehabilitation on the frontline: Insights from Mike Palmer

Today, we’re diving into a critical yet often overlooked subject: rehabilitation for pre-hospital staff. The physical and mental demands of frontline work are relentless. Paramedics, HEMS crews, and pre-hospital teams operate in high-stress environments, managing unpredictable situations, heavy workloads, and repeated exposure to trauma. But what happens when the body or mind says, “I can’t keep going”? How do we help our colleagues recover and return, not just functioning, but stronger, healthier, and more resilient?I’m joined by Mike Palmer, a highly experienced critical care clinician with lived experience of injury and recovery. Together, we’ll unpack the scale of injury across pre-hospital care, identify gaps in current rehabilitation practices, and explore why a structured, personalised approach is essential for long-term sustainability in this field. We’ll also take a personal look at Mike’s own journey, how he navigated his recovery, the obstacles he encountered, and the insights he gained along the way.But this conversation goes beyond rehabilitation, it’s about reimagining how we care for those who care for others. Whether you're on the frontline, leading a team, or simply passionate about well-being in emergency medicine, this episode offers valuable perspectives on how we can better support, rehabilitate, and retain our pre-hospital workforce. Useful links that Mike mentions in the episode can be found here:https://pubmed.ncbi.nlm.nih.gov/31537564/https://www.sciencedirect.com/science/article/pii/S0925753524000092https://pubmed.ncbi.nlm.nih.gov/33492279/https://pubmed.ncbi.nlm.nih.gov/35000895/https://pubmed.ncbi.nlm.nih.gov/26371071/https://pubmed.ncbi.nlm.nih.gov/34972683/https://pubmed.ncbi.nlm.nih.gov/26371071/https://pubmed.ncbi.nlm.nih.gov/26281820/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 pax-bags.com

Today, we explore the collective experience of trauma among NHS ambulance personnel during the COVID-19 pandemic, a period that tested the resilience and identity of clinicians like never before. In the episode, we’ll uncover the inspirations behind this research, examining how social identity processes provide a profound lens to understand how ambulance teams navigate trauma. Our guest will walk us through their methodology, highlighting the value of a longitudinal qualitative approach and the unique hurdles of conducting research during a global crisis.Jo guides us through her methodology, highlighting the importance of longitudinal qualitative approaches and the challenges of conducting research amid a global crisis. We unpack how group membership shaped emotional and behavioural responses during the pandemic, revealing the cultural forces at play within NHS ambulance services and how these dynamics contributed to collective resilience.We also explore the long-term psychological impact of the pandemic, comparing individual and team-based coping strategies, and discuss what this tells us about building solidarity under extreme strain.Finally, Jo shares practical, evidence-based strategies for leaders in emergency services to foster resilience, mitigate trauma, and apply these learnings to other high-stakes professions.Dr. Jo Mildenhall is a paramedic with over 20 years of experience in operational and leadership roles within ambulance services. She holds a master’s degree in Occupational Trauma Psychology from the University of Nottingham and earned her Doctorate from the University of York, focusing on trauma experienced by NHS ambulance staff during the pandemic. Jo is the National Paramedic Mental Health & Wellbeing Lead for the College of Paramedics and was awarded a Churchill Fellowship in 2019 to study paramedic mental health initiatives in Australasia. You can access Jo's research here: https://etheses.whiterose.ac.uk/id/eprint/35774/

In our previous episode, we explored the meaning and importance of end-of-life care, particularly during the final 12 months of life. We discovered how difficult it is to predict this timeline, especially for ambulance clinicians who often see patients at critical points without a full picture of their medical history.In this episode, we take a closer look at what that final year can involve, focusing on the pre-hospital setting. We’ll explore the unique challenges ambulance clinicians face in making rapid, high-stakes decisions, and how existing documentation—such as care plans or advance directives—can provide valuable guidance in those moments.We'll also discuss the role of shared decision-making and how ambulance services can help balance specialist and generalist palliative care needs. Alongside this, we’ll highlight how the NHS Long Term Plan and other key initiatives aim to improve care coordination and ensure more consistent, compassionate care.Lastly, we’ll examine the barriers to effective advance care planning. These range from cultural sensitivities to systemic and logistical obstacles. Throughout, we’ll consider how we can better support ambulance clinicians to deliver thoughtful, person-centred care during some of life’s most vulnerable and uncertain moments. Please find links to the SPICT Tool that is mentioned in the episode: https://www.spict.org.uk/#:~:text=Supportive%20%26%20Palliative%20Care%20Indicators%20Tool,is%20a%20plain%20language%20version.

In this episode, we dive into a critical challenge: how to embed meaningful, lasting change within ambulance services. With increasing demand, stretched resources, and ongoing operational pressures, creating improvements that truly stick is no easy task.To unpack this, I’m joined by Carl Betts, an expert in quality improvement, leadership, and change management within the ambulance sector. Carl has been instrumental in transforming clinical practices, enhancing patient care, and fostering a culture of continuous improvement at Yorkshire Ambulance Service and beyond. Aspects we cover in the episode include:🔹 The challenges of implementing change in high-pressure environments🔹 Engaging frontline staff to drive meaningful improvements.🔹 Moving beyond short-term fixes to create sustainable change.🔹 Overcoming resistance to change and managing change fatigue.🔹 The role of innovation and technology in shaping the future of pre-hospital care.

Welcome back to the Pre-Hospital Care Podcast. In this episode, I’m joined by Stephen Wood, emergency nurse practitioner, educator, and host of Tac Medic Whiskey: The Tactical Medicine Podcast. Steve brings a wealth of experience from pre-hospital care, the emergency department, and the tactical environment, and he’s become a prominent voice in the evolving landscape of high-threat medicine. His podcast dives deep into the challenges and innovations of tactical pre-hospital care, blending clinical insight with real-world operational experience.In our conversation, we explore everything from the use of TXA and calcium chloride in trauma to the nuanced decisions between needle decompression and finger thoracostomy. We’ll talk about the importance of team cohesion, the mental toll of working in high-stress environments, and how to build resilience in the field. We also examine emerging technologies, training innovations, and what the future might hold for tactical medics across the globe. Whether you're on the frontline, training the next generation, or just curious about the realities of medicine in hostile or austere environments, this episode offers invaluable insights from an educator and Nurse Practitioner, Steve Wood. You can find the Tac Medic Whiskey Podcast here: https://podcasts.apple.com/il/podcast/tac-medic-whiskey-the-tactical-medicine-podcast/id1777426233** This podcast is for information purposes only and should not replace clinical guidelines or your local service policies. **This podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

In today’s episode, we’re honoured to be joined by John Martin, a trailblazer whose career is a testament to innovation, leadership, and an unwavering dedication to patient care.John’s journey began at just 18 in a microbiology lab, but his passion for healthcare quickly led him to the world of emergency medicine. Today, he serves as the Chief Executive of South Western Ambulance Service NHS Foundation Trust (SWASFT). With a wealth of experience across ambulance, acute, and community healthcare settings, John has also been the President of the College of Paramedics, advocating for the advancement of the paramedic profession. As a Visiting Professor in Paramedic Science, he’s helping shape the future of paramedic education and training.In this episode, we’ll dive into John’s leadership transition from London Ambulance Service to SWASFT, the biggest challenges facing pre-hospital care, and the role of technology in modernising emergency response. We’ll also touch on the importance of mental health, interdisciplinary collaboration, and John’s forward-thinking vision for the future of paramedic practice. A link that John mentions in the interview to the Harvard Business School Negotiation Mastery course can be found here: https://tinyurl.com/2f8pdbkcThis podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

In this episode, I’m joined by Marc Watson, a distinguished pharmaceutical physician and passionate advocate for mental health. Marc’s journey spans from working as a frontline GP to holding senior leadership roles in pharmacovigilance and global medical affairs, where he has been instrumental in ensuring patient safety, meeting regulatory demands, and supporting the launch of transformative medicines. Yet, behind these professional achievements lies a deeply personal story: Marc’s own experience of managing a bipolar diagnosis while navigating high-pressure, high-stakes environments.We’ll explore his shift from clinical practice to the pharmaceutical sector, the emotional toll of leadership, and the practical tools he uses to safeguard his mental well-being. Marc also opens up about his drive to raise mental health awareness, offering honest reflections from his life.This episode is a candid conversation about leadership, resilience, and the power of vulnerability. It highlights the urgent need to normalise mental health discussions, especially in professions where the pressure is relentless. Whether in healthcare, leading teams, or seeking perspective on mental wellness, this episode offers meaningful insight. You can read more on Marc's mental health journey here: https://www.fpm.org.uk/blog/from-surviving-to-thriving-with-my-mental-health/This podcast is sponsored by PAX.Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovative designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

In this episode of the Pre-Hospital Care Podcast, we explore the evolving role of ambulance clinicians in palliative and end-of-life care. We’re joined by a dedicated team working to improve how prehospital services support patients in their final months, ensuring care is compassionate, coordinated, and patient-centred.We introduce the team and their roles before breaking down the key concepts of palliative and end-of-life care. We discuss the differences between generalist and specialist palliative care, the challenges of identifying patients in the last year of life, and the critical role ambulance services play in this journey.The conversation then moves to the service gaps and educational challenges identified within prehospital care. We examine referral pathways, tools like SPICT for early identification, and how technology shapes advanced care planning (ACP) to help inform decision-making. The team also highlights the importance of education in building clinician confidence when navigating these complex cases.Looking ahead, we discuss the future of prehospital palliative care, including the role of simulation training, national collaboration, and addressing healthcare inequalities. We also explore opportunities for joint learning, debriefs, and improved care pathways to strengthen the connection between ambulance services and specialist palliative care teams.The SPICT tool can be found here: https://www.spict.org.uk/the-spict/This podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

Today, we're honoured to host Professor Deborah Harding, a distinguished figure in the field of advanced clinical practice. Professor Harding serves as the Supervision Lead for the NHS England for Advancing Practice, where she has been instrumental in developing supervision frameworks that support advanced practitioners across various healthcare disciplines. ​With a rich background as a registered speech and language therapist, Professor Harding has extensive experience in multi-professional management and leadership within the NHS. Her academic pursuits led her to complete a PhD focusing on supervision for allied health professions, culminating in a constructivist grounded theoretical perspective on the subject. ​In her role at City St George's University of London, Professor Harding has led curriculum development for the MSc and integrated degree apprenticeship in advanced clinical practice. Her work emphasises the importance of clinical supervision in supporting the development of advanced clinical practitioners, ensuring they are equipped to navigate the complexities of modern healthcare environments. ​In this episode, we'll explore the critical role of supervision in advanced practice, discuss the challenges practitioners face in pre-hospital care, and gain insights from Professor Harding's extensive research and experience. Stay tuned for an enlightening conversation that sheds light on the future of advanced practice in pre-hospital care. See and read more here: https://advanced-practice.hee.nhs.uk/And here: https://thepermeablepractitioner.com/

In this episode, we explore the challenges and contrasts of implementing innovation across the NHS and the private healthcare sector with expert guest Hannah Browning. As the founder of Beyond Excellence, Hannah brings a rare dual-sector insight, having held senior leadership roles in major private providers including Nuffield Health, Spire Healthcare, and HCA, as well as leading on transformative projects like the £120m development of KIMS Hospital.Innovation within the NHS often grapples with structural rigidity, limited funding, and bureaucratic hurdles, whereas the private sector—while faster-moving and more agile—must navigate investor expectations, profitability, and intense market competition. Hannah discusses how both sectors have unique strengths: the NHS offers scale, consistency, and population-wide data, while the private sector excels in responsiveness, customer-centric models, and speed of delivery.She reflects on what each can learn from the other: the NHS could benefit from private-sector pace and accountability, while the private sector might adopt some of the NHS’s commitment to equity and long-term population health outcomes. With real-world examples, including her strategic role in the acquisition and launch of Sevenoaks Medical Centre, Hannah brings a grounded, commercial, and compassionate view on how healthcare systems can evolve—together—for better patient care. You can read more of Hannah's consultancy business here: https://www.alphahealthpartners.co.ukhttps://www.getbide.co.uk