Pre-Hospital Care Podcast

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 Resources
Learn 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’Donnell
Cathal 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 Congress
The 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 Congress
The 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 Miss
Second: Posterior Circulation Stroke
FAST 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 Walker
The 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.

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