JC: Peri-intubation cardiovascular collapse in critically ill patients.

Peri-intubation cardiovascular collapse occurred in over 40% of critically ill patients in the INTUBE cohort. Propofol was the only potentially modifiable factor consistently associated with collapse—but this remains observational evidence. What should this mean for emergency and prehospital RSI?

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Epi 289: Refractory VF, Double Sequential Defibrillation, and the Future of Cardiac Arrest

In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.

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Does Sodium bicarbonate improve outcomes for in-hospital cardiac arrest?

Routine sodium bicarbonate has largely disappeared from modern ALS algorithms, but it continues to be used in many cardiac arrests. We review the BIHCA trial and discuss what it means for emergency physicians and prehospital clinicians.

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TTL tips 18: Lead Yourself Before You Lead the Team

Learn practical stress management techniques for Trauma Team Leaders, including I'M SAFE and BTFS, to improve performance under pressure and lead complex resuscitations safely.

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JC: Magnesium for Acute Headache: Maybe, but perhaps not for all..

Does intravenous magnesium improve outcomes for patients with acute non-traumatic headache in the emergency department? We review the latest Annals RCT and discuss whether it should change practice.alo

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TTL tip 17: No chat below 10,000

Learn how trauma team leaders can use the aviation "sterile cockpit" principle to reduce interruptions, improve communication and increase patient safety during high-risk procedures.

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Artifical Intelligence, Assessment and the Future of Training

ChatGPT can now pass many medical examinations with scores that exceed those of average candidates. Does that mean traditional assessments are no longer fit for purpose? We review the evidence and explore what AI means for emergency medicine education, MRCEM examinations and patient safety.

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Corridor care and boarding harm: how much evidence is enough?

Evidence from academic studies, professional bodies, coroners, NHS trusts and patient-safety investigators increasingly links corridor care and prolonged emergency department boarding with avoidable harm. Stevan Bruijns asks whether the evidence now warrants a formal public inquiry.

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Ep 291 – January 2026 Round-Up: RSI Trial, Trauma Leadership, and the Reality of Corridor Care

In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. RSI, Trauma Units. Code red and tough decisions.

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Ep 292 – Leadership, Culture and Psychological Safety in Pre-Hospital Care with Anna Dobbie at Trauma 2030

Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work.

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Ep 287 – Damage Control Pre-hospital Care with Harriet Tucker at Trauma 2030

Recorded at Trauma 2030 at the Royal College of Surgeons, this episode explores a shift in mindset in pre-hospital trauma care, away from maximal intervention on scene and towards rapid recognition of the patient who cannot be fixed pre-hospital. I’m joined by Harriet Tucker , consultant at London’s Air Ambulance, HEMS Governance Lead at Air Ambulance Kent Surrey Sussex, and Trauma Team Leader at St George’s Major Trauma Centre to talk about damage control pre-hospital care.

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Ep 290 – Shock is one of the most used words in emergency medicine. It’s also one of the most misunderstood.

In this episode, recorded at Trauma 2030 at the Royal College of Surgeons, I sit down with one of St Emlyn's own, Rich Carden, former emergency physician, now intensive care trainee and PhD graduate in trauma sciences — to explore what shock actually means beyond the blood pressure reading.

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Ep 294 – Experts Are Made, Not Born: Sara Crager on Mental Models and Rapid Sequence

It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think.

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TTL tips 16: Ketamine in trauma patients.

St Emlyn's practical guide to ketamine use as a Trauma Team Leader, including analgesia, procedural sedation, delayed sequence induction, dosing and monitoring. #FOAMed

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The limits of holding on to realism and hope alone

Great review from Stevan. Emergency medicine clinicians are increasingly asked to balance brutal realities with hope for a better future. Drawing on the Stockdale paradox, NHS Staff Survey data, moral injury research and personal experience, this reflective article explores burnout, leadership, crowding and why surviving difficult systems depends not only on resilience, but on having colleagues who have our back.

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TTL Tip 15: Alternative vascular access

Struggling with vascular access in trauma? Practical tips on IO access, central lines, external jugular access and rapid alternatives for trauma resuscitation.

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JC: Boarding, the crowding tax and a fixable problem

Medical boarding extracts a crowding tax in deaths, delays and bed-days. New research quantifies it, and suggests it is fixable from within.

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RCEM Syllabus Self-Assessment Tool: Map Your Emergency Medicine Profile

We’ve built a simple RCEM syllabus self-assessment tool based on the clinical syllabus domains in the RCEM curriculum. Designed for trainees, consultants and educators in emergency medicine, this interactive radar tool helps identify strengths, knowledge gaps and learning needs across the breadth of emergency medicine practice.

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Speciality Learning Outcomes Self-Assessment Radar (based on RCEM curriculum)

We’ve built a simple SLO self-assessment tool based on the 12 RCEM Specialty Learning Outcomes in the RCEM curriculum. Designed for trainees, consultants and educators in emergency medicine, this reflective tool helps clinicians visualise strengths, development needs and their overall training profile using an interactive radar chart. It's not an RCEM product but relates to the curriculum.

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DFTB26: Doing the Fundamentals Extraordinarily Well

What does excellence in emergency medicine really look like? Less heroics, more reliability, self-awareness, teamwork and doing the basics well. From @dftb26 in Glasgow

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To squeeze or not to squeeze. The ARISE-FLUIDS trial

Does early vasopressor therapy improve outcomes in septic shock? We review the ARISE-FLUIDS trial presented at Critical Care Reviews 2026.

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TTL tips 14: Should I CTA this limb injury?

Arterial injuries can be easy to miss. Learn how trauma team leaders recognise hard and soft signs of vascular injury, identify high-risk injury patterns and expedite limb-saving care.

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ICEM 2026 Hamburg: A Festival of Emergency Medicine

ICEM 2026 in Hamburg brought together more than 3,300 emergency clinicians from around the world. Beyond an excellent scientific programme, the conference fostered connection, collaboration and advocacy. Key themes included crowding, workforce challenges, emergency medicine specialty recognition and the importance of speaking up for patients.

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TTL Tips 13: Set your team specific time goals

TTL Tips 13 Managing time. Effective trauma team leaders don't just manage tasks, they manage time. Learn how clear time targets improve teamwork, tempo and patient flow during trauma resuscitation.

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What does a good emergency physician look like?

What makes an excellent emergency physician? Is it knowledge, technical skill or diagnostic brilliance? Drawing on research, personal experience and lessons from a career in emergency medicine, we explore the qualities that truly define clinical excellence.

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Pre-hospital acute behavioural disturbance — a guest post by Jack Lyon

Pre-hospital acute behavioural disturbance, a guest post by Jack Lyon. What does the evidence say about Ketamine and other sedatives. #FOAMed

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JC: Prehospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out of hospital cardiac arrest: The REBOARREST Trial

A critical appraisal of a RCT comparing REBOA and standard ALS for OHCA

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JC: Ambient AI scribes in the ED

Do AI scribes work in the ED? St Emlyn's reviews the best ED evidence to date on AI scribe adoption, quality and where to pilot safely.

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TTL tips 12: Thinking ahead

Situational awareness is a core trauma team leadership skill. Learn how high-performing TTLs use perception, comprehension, and projection to stay proactive in trauma resuscitation.

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Survival effect of prehospital emergency anaesthesia in major trauma

A St.Emlyn’s review of a major new trauma study examining whether prehospital emergency anaesthesia and intubation improve survival using machine learning and causal inference methods.

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