When Teams Perform Part 1: Human Factors, Leadership and CRM

In this compilation episode, we revisit two essential themes in high-performing pre-hospital teams: human factors and leadership with Clare Fitchett, followed by crew resource management (CRM) with Neil Jeffers.Through these conversations, we explore how leadership, communication, situational awareness, and decision-making influence team performance in complex, high-pressure environments. Clare’s insights highlight the human factors that shape how individuals and teams operate, while Neil draws on lessons from aviation to examine how CRM principles can strengthen teamwork, manage threats and errors, and improve patient safety.Originally recorded in February 2023, the conversation with Neil Jeffers remains highly relevant to clinicians working in unpredictable environments, where technical expertise alone is not enough. Effective performance depends on how we communicate, challenge assumptions, share information and learn from experience.Together, these discussions reinforce a central message: safer patient care begins with understanding not only what we do, but how we work together.In this episode, we explore:Human factors and effective leadership.Communication and shared situational awareness.Decision-making under pressure.Crew resource management principles from aviation.Threat and error management, debriefing and continuous improvement.The relationship between team performance and patient safety.

In pre-hospital care, communication is not a soft skill; it is a clinical intervention. The speed, accuracy, and clarity with which information is shared between pre-hospital teams, emergency departments, and specialist services can directly influence clinical decision-making, patient flow, and outcomes in time-critical illness and injury.In this episode of The Pre-Hospital Care Podcast, we are joined by Ashley Voss, Senior Principal, Government Affairs at Pulsara, to explore how modern digital communication systems are reshaping the coordination of emergency care. We examine the limitations of traditional pre-alert pathways, fragmented radio communications, telephone handovers, and inconsistent messaging, exploring how these challenges can contribute to delays, duplication of effort, and avoidable clinical risk.We also discuss the move towards integrated, patient-centric communication platforms that create a shared clinical workspace across organisations. By enabling teams to build and share a real-time picture of the patient's journey, these systems have the potential to support earlier clinical decision-making, improve resource allocation, and ensure receiving hospitals are better prepared before the patient's arrival. The conversation considers the wider role of technology in connecting pre-hospital clinicians, emergency departments, and specialist services, and how better communication can support more coordinated, timely, and effective emergency care. Further Reading and ResourcesLearn more about Pulsara: Explore Pulsara's digital platform for coordinating communication and collaboration across emergency care teams.https://www.pulsara.com/The evidence behind Pulsara: As discussed during the episode, explore a collection of 20 research studies published over the past decade examining Pulsara's impact on healthcare communication, coordination, and clinical processes. A Decade of Proven Results: 20 Research Studies That Demonstrate Pulsara's Impact

What does the future of pre-hospital care look like, and what can we learn from the people leading its development? As we build towards the EMS2027 Congress in Ireland, taking place from 13–15 April 2027, I’m delighted to be joined by Cathal O’Donnell, Clinical Director of Ireland’s National Ambulance Service, for a conversation about the evolution of Irish EMS and the challenges and opportunities shaping our profession.We’ll explore Cathal’s journey in emergency medicine and clinical leadership, the development of advanced paramedic practice, and the importance of governance, research and education in delivering better patient care. We’ll also look beyond Ireland to consider the future of EMS across Europe and how greater collaboration can help move our profession forward.About Cathal O’DonnellCathal is an Emergency Physician who has served as Clinical Director of the National Ambulance Service of Ireland since 2011. A graduate of University College Cork, he trained in Emergency Medicine in Ireland before completing a Fellowship in EMS and Emergency Medicine at the University of Toronto. He also holds an MSc in Leadership from the Royal College of Surgeons in Ireland and is Treasurer of EMS Europe.With EMS2027 on the horizon, this is an opportunity to hear from one of the key clinical leaders in Irish EMS about where we’ve come from, where we are now, and where pre-hospital care needs to go next.🎙️ 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!For Early Bird registration, see here.

Today on the Pre-Hospital Care Podcast, we’re tackling a topic that challenges one of the most deeply embedded concepts across Pre-hospital care. For decades, we’ve taught clinicians to think in binary terms: STEMI or not STEMI. Spot the ST elevation, activate the pathway, and move the patient toward reperfusion. It’s a model that has transformed care and saved countless lives. But what if that framework is also causing us to miss patients?Increasingly, there’s a growing conversation around the idea that acute coronary occlusion doesn’t always read from the textbook. Significant coronary artery blockages may not meet traditional STEMI criteria, while subtle ECG findings, evolving patterns, and clinical context can point toward a patient experiencing a true occlusive myocardial infarction, or OMI. The argument isn’t simply about changing terminology; it’s about changing how we think.So today we’re asking some big questions. Has STEMI become too narrow a lens? Are we over-relying on algorithms and thresholds? And what does this mean for clinicians making real-world decisions in the back of an ambulance, under pressure, with imperfect information and time-critical choices? You can read Mike's Substack piece here: https://emsdrmike.substack.com/p/beyond-stemi-in-ems🎙️ 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!For Early Bird registration, see here.

Some of the most important diagnoses in pre-hospital care are the ones we least expect, conditions that challenge our assumptions, present outside familiar clinical patterns, and can be missed when we rely too heavily on traditional assessment tools.In this episode, we revisit two important conversations from the Pre-Hospital Care Podcast that highlight the consequences of diagnostic overshadowing and the need for clinical curiosity.First: Spontaneous Coronary Artery Dissection (SCAD)SCAD is an important, often under-recognised cause of acute coronary syndrome. It can affect patients, particularly women, who may have few or none of the traditional cardiovascular risk factors associated with myocardial infarction. Through the perspectives of a survivor, the clinician who treated her, and an advocate raising awareness, we explore how SCAD presents, why it can be overlooked, and how pre-hospital clinicians can improve recognition.🎧 Listen to the original episode: Spontaneous Coronary Artery Dissection (SCAD): The Condition We Often MissSecond: Posterior Circulation StrokeFAST has an important role in stroke recognition, but it does not identify every presentation. Posterior circulation strokes can manifest through dizziness, imbalance, visual disturbance, impaired coordination, and difficulty walking, sometimes without the classic signs of facial weakness, arm weakness or speech disturbance.Joining us in the original conversation, paramedic and researcher Shane Devlin explores the clinical and research challenges of recognising posterior circulation stroke. My brother, Ronan Walker, also shares his experience of suffering a posterior stroke in his late thirties, highlighting what can happen when symptoms don't fit the expected picture.🎧 Listen to the original episode: Not So FAST: Rethinking Stroke Recognition in Pre-Hospital Care with Shane Devlin and Ronan WalkerThe key message: The patient doesn't have to fit the textbook for the diagnosis to be real. Whether we're assessing a potentially life-threatening cardiac event or a stroke that falls outside traditional screening criteria, careful assessment, clinical curiosity, and a willingness to challenge our initial impression can make a critical difference.This 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 https://www.pax-bags.com/

Today, we’re exploring a critical challenge in stroke care: identifying patients with large vessel occlusion (LVO) and getting them to the right hospital as quickly as possible.Mechanical thrombectomy can transform outcomes, but access depends on rapid identification and appropriate prehospital triage. Current clinical assessment and stroke severity scales have limitations, making it difficult to reliably distinguish LVO from other strokes and stroke mimics.Professor Christopher Price, Professor of Stroke and Applied Health Research at Newcastle University, has been investigating whether rapid, lateral-flow blood tests detecting stroke biomarkers could complement paramedic assessment and improve prehospital identification of patients suitable for thrombectomy.Could point-of-care testing help clinicians make better destination decisions, reduce delays from inter-hospital transfers, and get the right patients to treatment sooner? We’ll explore the evidence, the limitations, and what this technology could mean for the future of prehospital stroke care.Could the next major advance in stroke care happen before the patient reaches hospital?Find out more about the research: https://www.ncl.ac.uk/press/articles/latest/2026/07/standardtemplate/This 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 https://www.pax-bags.com/Event Spotlight: GWAAC Clinical Symposium 2026 – Innovation in Pre-Hospital CareThe Great Western Air Ambulance Charity (GWAAC) Clinical Symposium returns on Friday 16 October 2026 at Ashton Gate Stadium, Bristol, bringing together clinicians and experts to explore innovation in pre-hospital emergency medicine (PHEM).With a programme of expert speakers covering topics including advanced practice, cardiac arrest management, team performance, military medicine and clinical education, the symposium offers an opportunity to challenge established thinking, share experience and take practical ideas back into clinical practice.Whether you work in pre-hospital critical care, emergency medicine or frontline ambulance services, this is an opportunity to connect with colleagues and explore new approaches to improving patient care.📍 Venue: Pravha Lounge, Ashton Gate Stadium, Bristol📅 Date: Friday 16 October 2026, from 09:00🎟️ Tickets: £18–£35Register and find out more: https://greatwesternairambulance.com/support-us/events/special/gwaac-symposium-2026/

A good clinical handover sounds simple. But when the environment is noisy, time is limited, cognitive load is high, and the stakes are significant, communicating the right information and ensuring it is understood becomes much harder.In this compilation episode, we explore the relationship between trauma handover, human factors, simulation and performance under pressure, bringing together two conversations that approach the problem from different perspectives.We revisit our conversation with Andrew Pearce to explore what makes an effective trauma handover and the challenges of transferring critical information between pre-hospital and hospital teams. We look at communication, structure, information loss and the human factors that can influence how information is delivered and received.We then turn to Neel Bhanderi and the science of high-fidelity simulation. Neel explores how we can move beyond simply practising clinical skills and instead create training environments that reproduce the cognitive, environmental and interpersonal pressures clinicians experience in the real world. His discussion takes us into stress, task loading, communication, handover, environmental distraction, and the importance of effective debriefing.High Fidelity Simulation with Neel BhanderiOriginally released 15 May 2023.Listen to the original episode on Apple PodcastsTrauma Handover with Andrew PearceListen to the original episode on CastroThis 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!For Early Bird registration, see here.

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