Pre-Hospital Care Podcast

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-sickness

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 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-7b0d448d0b2e

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 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_Paramedics

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 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