Responding to Mental Health Crises with the London Ambulance Service (LAS). Mental Health Part 1

Mental health crises are one of the most complex and sensitive challenges faced in pre-hospital care. The London Ambulance Service (LAS) plays a critical role in responding to these emergencies, from the moment a 999 call is made to frontline crews delivering urgent interventions. But how does the system work as a whole? How are these calls assessed in the control room, and what role do specialist paramedics and mental health professionals play in shaping patient outcomes?In this episode, we dive deep into Pre-Hospital Mental Health Response, exploring how the LAS manages real-time mental health incidents, the operational and clinical decision-making that happens behind the scenes, and the challenges of coordinating care across multiple agencies. We’ll hear about the evolving role of mental health-trained paramedics, case studies of successful interventions, and the key lessons learned from high-risk situations.Joining us are colleagues from the London Ambulance Service Mental Health Team, who will share their experiences from both the frontline and the Emergency Operations Centre (EOC), giving us a full picture of how pre-hospital mental health care is delivered in one of the busiest ambulance services in the world.This episode is a deep dive into how mental health services are integrated and embedded within an ambulance service as a fundamental part of emergency care service delivery to the population. 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/

This blog is a personal reflection from Advanced Paramedic Wayne Auton, who shares how he has recently embraced what he describes as a “position of yes.” This mindset involves being open and willing to accept opportunities as they arise, often at short notice, and focusing on the positive potential that each opportunity may bring. Wayne acknowledges that it is a fortunate position to be in, but one that has significantly transformed his outlook and boosted his overall positivity.For many years, Wayne found himself caught in a cycle of negative thinking. He often focused on what might go wrong, rather than what could go right. This tendency led to decreased confidence, increased caution, and a general reluctance to take risks. It was a mindset he found restrictive and disheartening.He reflects on how he used to default to worst-case scenarios, frequently overlooking the possible benefits of a situation. Research supports this pattern; negative events tend to be more intense and memorable because they require greater mental effort to process (Taylor, 1991). Recognising this has helped Wayne shift his focus. By choosing to say yes more often, he has created space for growth, confidence, and optimism.You’ll also hear an AI-narrated summary of this blog, bringing Wayne’s reflections to life through audio. You can read the blog here: https://wayneauton.blogspot.com/2021/03/say-yes-to.htmlThis 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/

Today, we're diving into the high-stakes intersection of tactical medicine, crisis negotiation, and pre-hospital care with Eric Acevedo, a seasoned professional operating at the front lines of some of Virginia's largest emergency response operations. Eric brings a rare blend of experience across tactical EMS, hostage negotiation, and field-based crisis response, offering a unique perspective on how communication, psychology, and calmness under pressure can save lives.In this episode, we'll explore the foundational principles of crisis and the wider art of negotiation and how those same tools can be applied by EMS providers in their daily work, especially when it comes to de-escalating tense situations, communicating effectively with patients in distress, or persuading someone to accept lifesaving treatment.We’ll also look at the human side of this work: emotional regulation, interdisciplinary collaboration, and lessons learned from real-world case studies where negotiation and medicine intersected in critical moments. 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/

In this special series, we’re bringing insightful and thought-provoking blog posts to life in audio form, exploring the human side of pre-hospital and emergency care. Today’s piece reflects on Esprit de Corps, the pride, loyalty, and belonging that exists within high-performing teams, and how it is built, tested, and lived out in some of the most demanding environments.Wayne Auton reflects on a career spent in small, high-performing teams, from the Royal Marines to Search and Rescue to the Emergency Medical Retrieval Service (EMRS) in Scotland. Across these roles, one constant has been trust: the ability to rely on teammates, get the job done, and know that everyone has each other’s backs.When asked recently about Esprit de Corps, it prompted reflection. Often associated with the military, it is more broadly defined as “a feeling of pride and mutual loyalty shared by the members of a group.” For the author, it is about belonging.As a Royal Marine, that sense of belonging was immediate. From day one of training, recruits inherit over 350 years of history and pride. The Corps was more than a job; it was a culture and a way of life. Paradoxically, it also provided psychological safety, acceptance, trust, and respect within a close-knit family.These bonds often form in vulnerability, particularly under threat. Research shows such conditions can strengthen Esprit de Corps across dangerous professions. The author recalls a helicopter mission where a suspected tail rotor failure forced the crew into emergency decision-making. They landed safely, closer than ever. That experience captured the essence of Esprit de Corps: resilience, unity, and unshakable trust forged in challenge. You can read the blog post here: https://wayneauton.blogspot.com/2021/03/espirit-de-corps.htmlThis 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/

In this episode of the Pre-Hospital Care Podcast, we’re joined by Critical Care Practitioner Mike Palmer to explore the evolving role of ultrasound in trauma care outside the hospital setting.We dive into the realities of training, drawing on insights from a bespoke HEMS hybrid ultrasound program that bridges classroom learning with frontline application. Our discussion covers the translation of emergency ultrasound skills into the unpredictable pre-hospital environment, with a focus on simulation training, image recognition, logbook development, and internal image review. We explore how services are addressing the challenges of competency, governance, and quality assurance when deploying ultrasound in the field. We also tackle the practical and operational hurdles, how to obtain clear, actionable images in chaotic or resource-limited environments, manage the risks of false positives and missed diagnoses, and use ultrasound findings to guide critical decisions around triage and treatment.Finally, we hear personal and professional reflections from years of frontline experience. From the traditional model of “see one, do one, teach one” to knowing when it’s better to keep the probe in your pocket, this episode offers real-world insights into the benefits, limitations, and evolving role of ultrasound in pre-hospital emergency care.This episode is brought to you by IndieBase.IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers.Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/

In this episode, we speak with Carl, one of our podcast co-hosts, about his deeply reflective article, ‘Normal or numb – that is the question, but what is the answer!’  Carl shares the personal experience that inspired the piece, attending a call to a deceased patient, which triggered a cascade of questions about emotional detachment, coping strategies, and the long-term impact of repeated exposure to trauma in paramedicine.We unpack the central dilemma: are we becoming resilient or simply numb? Carl reflects on the gradual shift in his emotional responses and the silent build-up of stress that so many frontline clinicians experience. We explore how this detachment can protect us in the short term but risks leading to burnout, fractured personal lives, and professional disengagement.The conversation also delves into the importance of early recognition, peer support, and thoughtful leadership responses. Carl’s reflections have also been transcribed into an AI-narrated blog post so that you can listen to his story word-for-word.This is a powerful and honest conversation about the emotional cost of the job and an urgent call to reflect before the pressure boils over.This episode is brought to you by IndieBase.IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers.Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/

In this episode, we explore the expanding role of ultrasound in pre-hospital trauma care. Once limited to hospital settings, ultrasound is now a vital tool in frontline emergency response, helping clinicians make rapid, informed decisions on scene. We begin by unpacking the physics of ultrasound, how concepts like frequency and resolution influence what can be detected, from internal bleeding to lung collapse.Next, we get hands-on with practical applications. We’ll cover probe selection and key sonographic indicators for conditions such as pneumothorax, haemothorax, and haemoperitoneum. Real-life case studies, including stab wounds, hangings, and traumatic cardiac arrests, highlight how ultrasound shapes critical interventions in the field.We’ll also address essential questions around training: What level of skill is needed? How can we ensure ongoing competency? As pre-hospital ultrasound becomes more common, we must confront these challenges head-on.Finally, we’ll examine the ethical and operational dilemmas posed by point-of-care imaging. When ultrasound findings support high-stakes decisions like performing a thoracotomy or ceasing resuscitation, what responsibilities do clinicians carry? Join us as we delve into the promises and complexities of ultrasound in pre-hospital trauma care. This episode is brought to you by IndieBase. IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers. Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/

CarlBetts, a co-host of this podcast, authored a reflective piece titled "Where Critical Analysis Becomes Critically Unhealthy," published in 2023 in the College of Paramedics’ Hindsight magazine. In this episode, we delve into Carl’s motivations for writing the article and examine its central themes. The piece discusses how critical analysis, while an essential skill, can become counterproductive when it slips into harsh self-appraisal, leading to emotional disequilibrium and eroding clinician confidence.We unpack how debriefs and reflective practices must be thoughtfully structured to include both challenge and affirmation, creating space for growth without causing harm. Using real clinical examples, Carl helps illustrate where reflection can go wrong and how to avoid those pitfalls.We also discuss the importance of reframing difficult experiences to support a net positive impact on clinicians, and how critical feedback, whether from oneself or others, can be damaging if not delivered constructively. The episode outlines practical strategies, including reframing techniques, to make reflection a healthier, more sustainable process.To bring Carl’s insights to life, we’ve transcribed his original article into an AI-narrated blog post, allowing you to listen to the word-for-word reflections from his piece, offering another way to engage deeply with his message. This episode is brought to you by IndieBase. IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers. Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/

Today’s episode dives into lived experience with cystic fibrosis through the remarkable journey of Paul  Butler. Diagnosed at two and warned he wouldn’t reach twenty. Paul’s childhood revolved around twice-daily chest physiotherapy, three-daily nebulisers, and a mass of hospital admissions for infections that chipped away at his fragile lungs. By his late teens, the odds felt fixed: average life expectancy for CF hovered around 30, and Paul’s lung capacity was already tumbling. Yet everything changed the day he cradled his newborn daughter, Amelia. Faced with a future he refused to miss, Paul overhauled his life, embracing rigorous medication adherence, evidence-informed nutrition, and a training regimen that turned a patient into a personal trainer who now deadlifts triple his body weight.At 45, Paul hasn’t been hospitalised in seven years and views fitness not as vanity but as respiratory medicine performed in a gym. In this conversation, we ask: What mindset shifts sustain adherence when statistics feel fatalistic? And what can pre-hospital professionals learn about goal-setting, communication, and empathy from someone who quite literally trains to breathe? You can find Paul Butler on Instagram here: https://www.instagram.com/paulbutler.coach/?hl=enYou can find Paul's website here: https://paulspeakphysique.co.uk/given-just-weeks-to-liveYou can find the inspiration for this interview on the Grind Diaries Podcast here: https://podcasts.apple.com/gb/podcast/episode-16-paul-butler-the-personal-trainer-living/id1736072345?i=1000682838118This episode is brought to you by IndieBase. IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers. Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/

In this episode, we dive into The PITT, a powerful new medical drama that lays bare the raw, unfiltered reality of life in the emergency department. This conversation serves as a commentary on an AI-generated adaptation of Dr. Sarah Spelsberg’s original blog post, and it began with an interview. We first sat down with Sarah to gain deeper context and personal insight behind the post, ensuring that the AI-generated version remained true to her voice, values, and lived frontline experience.Sarah, a seasoned wilderness medic and co-host at World Extreme Medicine, shares how The PITT resonates with emergency clinicians by portraying the often-overlooked struggles of ED life, boarding crises, staff shortages, burnout, and the layers of bureaucracy that hinder care.Unlike polished hospital dramas like Grey’s Anatomy or House, The PITT hits closer to home. It reflects the chaos and moral weight providers carry daily, and helps the public understand what really happens behind the scenes. Sarah explains how this visibility can build empathy, reduce aggression toward staff, and shift public expectations.She also reflects on how wilderness medicine re-centers her purpose, offering a stark contrast to hospital bureaucracy. Ultimately, this episode is both a tribute and a call to action for better systems, better support, and honest storytelling in healthcare. You can read the blog here: https://roguemed.medium.com/the-pitt-a-lifeline-for-emergency-medicine-providers-7ba1f8b2b045The PITT offers a raw and authentic look at the challenges confronting healthcare professionals in today's America, told through the experiences of frontline workers at a contemporary hospital in Pittsburgh, Pennsylvania. Watch The PITT here: https://www.primevideo.com/detail/The-Pitt/0ORZ2LIN9JTFLLUK8UKR33DZPXThis 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