Stress Inoculation and Performance: Redefining Resilience with Andy Bell

In this episode, Laura Hall explores Acute Mountain Sickness (AMS) and the underlying physiology that drives altitude illness. As atmospheric pressure falls with increasing elevation, the body struggles to absorb adequate oxygen, triggering symptoms that often begin as headache, nausea, fatigue, and a “hangover-like” malaise. While these early features are common and often benign, Laura highlights how AMS can progress to far more serious and potentially fatal conditions.The discussion moves into High Altitude Cerebral Oedema (HACE) and High Altitude Pulmonary Oedema (HAPE), outlining their distinct pathophysiology and clinical red flags. Listeners are guided through key diagnostic cues such as worsening ataxia, confusion, or altered behaviour in HACE, and breathlessness at rest, cough, and signs of fluid in the lungs in HAPE.Preventative strategies are also covered, including the importance of gradual ascent, appropriate hydration, and the role of pharmacological prophylaxis such as acetazolamide and, in selected cases, steroids. From a management perspective, Laura emphasises that descent and supplemental oxygen remain the cornerstone treatments for severe altitude illness.Crucially, this episode reinforces the need for clinical vigilance: not every unwell patient at altitude has altitude illness. Clinicians must maintain a broad differential diagnosis and avoid anchoring bias, ensuring that other serious medical conditions are not overlooked or misattributed to AMS, HACE, or HAPE. Read the blog post here: https://highadventurehealthcare.substack.com/p/acute-mountain-sicknessThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode of the Pre-Hospital Care Podcast, we delve into the psychology and practice of performing under pressure, examining how we can prepare clinicians not only to survive stress but also to thrive within it.Joining me once again is Andy Bell, Deputy Director of Paramedicine at St John WA, a leading voice in clinical education, leadership, and performance optimisation. Together, we explore how stress inoculation training, cognitive load theory, and deliberate practice can transform the way we teach, lead, and perform in high-stakes environments.We’ll explore why traditional ideas of resilience may be holding us back, how entrenched paradigms limit performance, and how rethinking stress can lead to more adaptive and confident clinicians. From the science of “threat versus challenge” mindsets to the power of realistic simulation and reflective education, this episode offers practical insights foranyone working on the frontline of emergency care.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, we explore “The Circle of Life,” a deeply reflective personal narrative by Dr Sarah Spelsberg. The reflection from Sarah captures a powerful sequence of events during a remote medical assignment that starkly illustrates the emotional and clinical breadth of rural and austere medicine.Sarah begins with the peaceful death of a terminally ill patient, setting a quiet and contemplative tone. Just days later, that stillness is shattered when the medical team is urgently called to manage an unexpected and complex outdoor birth in harsh weather conditions. With limited equipment and no initial obstetric setup, the team is forced to rely on adaptability, teamwork, and clinical fundamentals.The narrative details the emergency care provided to both mother and newborn, including the use of remote peer support as Sarah contacts colleagues for guidance on standard post-delivery care. These moments highlight not only the clinical challenges of remote practice but also the importance of professional networks when working in isolation.Sarah concludes by reflecting on the profound juxtaposition of death and birth, describing the experience as both miraculous and terrifying. She contrasts this rare obstetric event with her more familiar work in trauma and orthopaedic medicine, offering a moving meditation on the privilege, responsibility, and emotional weight of caring for patients across the full spectrum of human life. The original blog post can be found here:https://roguemed.medium.com/the-circle-of-life-7b0d448d0b2eThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, we explore something a little different, but deeply connected to everything we do in medicine, leadership, and human connection: the power of storytelling. Whether it’s patient handover, clinician-to-clinician stories, or the messroom chat, stories fill our everyday lives. My guest today is Clare Murphy, a world-renowned storyteller who has been bringing the ancient art of story firmly into the modern world since 2006. Clare has performed across the globe, sharing stories with audiences as diverse as the All-Blacks coaches, Mission Critical Teams, scientists, schoolchildren, and even Irish President Mary Robinson. Her work also transcends entertainment. Clare teaches storytelling as a tool for connection, communication, and meaning-making, working with diverse communities that include asylum seekers, climate scientists, social entrepreneurs, firefighters, and veterans who have lost limbs.Her client list speaks volumes: NASA, the All-Blacks, the Mission Critical Team Institute, The Drive Project, Social Entrepreneurs Ireland, Routes Collective, and NHS England. Together, we’ll unpack how story shapes the way we understand the world, how it can help us connect with our teams, our patients, and ourselves in the moments that matter most. You can find Clare's work here: https://claremurphy.org/Empirical research suggests that Paramedics routinely recount emergency calls during downtime to make sense of their work. This storytelling functions as a form of tactical resilience to managers, other services, patients, bystanders, and each other, and often involves strong language. The paper can be found here:https://www.researchgate.net/publication/251772924_Heroes_and_Lies_Storytelling_Tactics_among_ParamedicsThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit:www.worldextrememedicine.com

In this blog audio, Radu Venter emphasises the importance of developing a holistic understanding of the healthcare system, particularly for paramedics whose roles often exist at its edges. Drawing on the experience of observing an organ harvest, Venter highlights the intricate collaboration required among multiple hospital departments and specialists. This complex interplay contrasts sharply with the paramedic’s more focused role, centred on rapid assessment, immediate intervention, and safe patient transport.He argues that this necessary specialisation can sometimes limit paramedics’ appreciation of the broader system. For example, misunderstandings may arise when paramedics expect nurses or doctors to recall every detail of a patient’s journey, not realising that hospital staff manage multiple cases simultaneously within an interconnected network of care.Venter describes paramedics as “transport specialists,” whose strength lies in stabilising patients and bridging the gap between scenes and hospitals rather than delivering definitive treatment. However, he stresses that greater communication and collaboration between pre-hospital and in-hospital teams would benefit both sides. By fostering shared understanding and respect for each role’s context and constraints, the healthcare system can function more cohesively, ultimately leading to better coordination, improved patient outcomes, and a stronger sense of collective purpose across all areas of care. You can read the blog post here: https://theparamedicphilosopher.substack.com/p/seeing-the-forest-beyond-the-tree

Today on the Pre‑Hospital Care Podcast, we welcome Dr Maren Ranhoff Hov, a leading figure in the evolving field of pre-hospital stroke medicine. With a unique background that spans both paramedicine and neurology, Maren brings a rare and powerful perspective to the conversation. From her early days working in the ambulance service in Northern Norway, she witnessed firsthand the critical challenges of recognising and treating stroke in the field. This passion would later form the foundation of her research career.Maren has been at the forefront of several groundbreaking projects: most notably, the Norwegian ParaNASPP trial, which explored how paramedics using the NIH Stroke Scale (NIHSS) can improve pre-hospital stroke triage. She has also contributed to pioneering studies on mobile stroke units, pre-hospital CT, and novel telemedicine pathways. Her work has not only shaped stroke protocols in Norway but has also earned international recognition, including a major quality award from the Norwegian Medical Association.On this episode, we’ll explore how Maren thinks about the “pre-hospital stroke spectrum” from TIA to large-vessel occlusion and haemorrhagic stroke, and discuss how early decisions in the field can meaningfully change patient outcomes.This is Maren's initial interview on the PHCP in July 2024: https://www.youtube.com/watch?v=v_U8YAmEpncThis is Maren's work on the ParaNASPP trial: https://pubmed.ncbi.nlm.nih.gov/37596006/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 blog audio, Radu Venter challenges the popular narrative that labels paramedics as “heroes,” arguing that while the term may appear respectful, it ultimately does more harm than good. He contends that calling paramedics heroes strips away their humanity, placing unrealistic expectations on their emotional resilience, availability, and ability to cope with trauma. This perception risks normalising overwork and burnout, as it implies that sacrifice and self-neglect are inherent parts of the job.Radu also highlights a key distinction between heroism and professionalism. Heroism, he argues, is by nature extraordinary and temporary, while paramedicine is a lifelong, skilled profession requiring expertise, discipline, and teamwork. Romanticising the work as heroic can discourage sound risk assessment, leading practitioners to take unnecessary risks in the name of perceived bravery.Instead of glorifying paramedics as superhuman, Radu urges society to recognise them as dedicated professionals who deserve proper support, fair working conditions, and respect for their boundaries. He concludes that true appreciation lies not in idolising paramedics but in acknowledging the reality of their role, ordinary people performing extraordinary, often difficult tasks with compassion and competence every day. You can read the blog here: https://theparamedicphilosopher.substack.com/p/paramedics-arent-heroes-and-its-timeThis 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 explore one of the most powerful yet often misunderstood drivers of excellence in emergency medicine: the culture of clinical leadership. From the early evolution of paramedicine to today’sIn complex, multidisciplinary systems, leadership has never been just about titles or hierarchy; it’s about influence, mindset, and the ability to create environments where individuals and teams can perform at their very best.Joining me is Andy Bell, Deputy Director of Paramedicine at St John WA, an internationally recognised educator, clinician, and advocate for evidence-based leadership development. Andy has spent years shaping how we think about high-performance clinical frameworks, embedding human factors, and challenging the fixed thinking that can hold emergency response teams back.Together, we’ll unpack the historical context, the challenges and barriers to success, and the practical steps needed to build a culture where clinical leadership thrives. Whether you’re a student paramedic, a team leader, or an experienced clinician, this episode will give you actionable insights to strengthen your leadership mindset and help build the next generation of high-performing, compassionate, and adaptive clinical teams.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 episode, we discuss an article by Dr. Sarah Spelsberg titled “HOCUS POCUS, the Magic of Point of Care Ultrasound in Remote and Rural Medicine.” The piece explores the transformative impact of Point of Care Ultrasound (POCUS) in austere, remote, and rural healthcare environments, with a particular focus on the Butterfly Ultrasound device.Dr. Spelsberg outlines the persistent barriers to wider POCUS adoption, including limitations around funding, access to equipment, and adequate training. She then shares her personal journey of fundraising to secure a Butterfly device for her clinic in Unalaska, Alaska, highlighting the practical realities of delivering frontline care in isolated settings.Through a series of powerful clinical case examples, the article demonstrates how POCUS enabled early and accurate diagnoses of serious conditions such as pneumonia, an acute myocardial infarction, and cholecystitis—situations where access to advanced imaging was not available. These cases underscore the device’s role in improving diagnostic confidence, expediting care, and directly influencing patient outcomes.Dr. Spelsberg concludes that POCUS is intuitive, accessible, and an essential tool for clinicians working in remote and rural medicine. Its use not only improves patient care but can also help avoid unnecessary, costly, and high-risk medical evacuations.The original blog post can be found here:https://roguemed.medium.com/hocus-pocus-the-magic-of-point-of-care-ultrasound-in-remote-and-rural-medicine-96465b0ba700This 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 on the Pre-Hospital Care Podcast, we’re diving into one of the most critical and often misunderstood areas of pre-hospital care: defibrillation and the future of cardiac arrest management. We’re all familiar with the mantra of “shock early,” but how much of what we believe about defibrillation is grounded in evidence, and how much is myth carried forward through tradition and training?To help us separate fact from fiction, I’m joined by Michael Heller, Chief Commercial and Strategy Officer for Corpuls, a company at the forefront of resuscitation technology. Michael brings a unique perspective, not just from the engineering and innovation side, but also from working closely with clinicians worldwide to understand what truly makes a difference at the roadside.In this conversation, we’ll explore the enduring myths of defibrillation, the technologies shaping the next generation of devices, and how data, AI, and post–cardiac arrest strategies could redefine survival over the next five years. This is about challenging assumptions, sharpening our practice, and looking ahead to what’s possible in saving lives. You can find out more about Corpuls here: https://corpuls.world/en/