Pre-Hospital Care Podcast

The illicit drug market is evolving faster than ever before. Novel psychoactive substances (NPS), synthetic opioids and increasingly potent club drugs are creating new challenges for pre-hospital clinicians, emergency departments and critical care teams. Patients are presenting with unfamiliar toxidromes, unpredictable physiology, and rapidly deteriorating clinical conditions that demand evidence-based assessment and management.
The episode begins with insights from Dr Caroline Copeland, Senior Lecturer in Pharmacology and Toxicology at King's College London and Director of the National Programme on Substance Use Mortality. Caroline explains how the illicit drug market has transformed over the past decade, discussing the emergence of synthetic opioids, nitazenes, novel benzodiazepines and the ever-expanding range of novel psychoactive substances. Drawing on national surveillance data and forensic toxicology, she highlights the trends every frontline clinician should understand and the public health implications of these rapidly evolving substances.
Building on that foundation, Owen Bowden-Jones, Consultant Psychiatrist and one of the UK's leading experts in club drugs and addiction medicine, takes us into the practical realities of managing patients who have taken MDMA, ketamine, GHB/GBL, synthetic cathinones, synthetic cannabinoids ("Spice"), nitrous oxide and other emerging recreational drugs. The discussion focuses on recognising toxidromes, avoiding common pitfalls and delivering safe, evidence-based supportive care in the pre-hospital and emergency setting.
How the illicit drug landscape has changed over the last decade.
Novel psychoactive substances (NPS) and why they continue to emerge.
Synthetic opioids, nitazenes and the growing public health threat.
MDMA toxicity and serotonin syndrome.
Ketamine: recreational use, toxicity and chronic complications.
GHB/GBL overdose and withdrawal.
Synthetic cathinones ("bath salts") and severe behavioural disturbance.
Synthetic cannabinoids ("Spice") and unpredictable toxicity.
Nitrous oxide misuse and neurological injury.
Recognising toxidromes rather than chasing an exact drug diagnosis.
Managing agitation, hyperthermia and cardiovascular instability.
Harm reduction and communicating with patients who use recreational drugs.
Emerging drug trends every pre-hospital clinician should know.
This episode brings together and expands on two previous conversations from the Pre-Hospital Care Podcast:
Novel Psychoactives and The New Drug Landscape: A Conversation with Dr Caroline Copeland
https://podcasts.apple.com/gb/podcast/novel-psychoactives-and-the-new-drug/id1441215901?i=1000748836782
Club Drugs, Illegal Highs and Novel Psycho-active Substances with Owen Bowden-Jones
https://creators.spotify.com/pod/profile/phcp/episodes/Club-drugs--illegal-highs-and-Novel-Psycho-active-Substances-with-Owen-Bowden-Jones-ejk7rf

You can find excellent online eLearning resources on Club Drugs and NPS here: https://elearninghub.rcpsych.ac.uk/products/Module_1_Introduction_to_club_drugs_and_NPS
These are empirical studies conducted and published by Caroline Copland: https://www.kcl.ac.uk/people/caroline-copeland

Pain is one of the most immediate and universal experiences of trauma, yet in emergency and pre-hospital care, it remains surprisingly under-treated. Despite decades of awareness, oligoanalgesia, the inadequate treatment of acute pain, continues to affect patients in the very moments when compassionate, effective care matters most. Too often, the focus in emergency systems has been on processes: whether a drug was given, which medication was used, or how quickly it was administered. But from the patient’s perspective, the real question is much simpler: did their pain actually get better?
In this episode, we explore a powerful shift in thinking: what if pain management wasn’t something that happened later in care, but something that started immediately, from the very first patient contact? What if analgesia were treated as a core patient-centred outcome rather than an optional add-on?
Joining us today are Luca Carenzo and Urs Pietsch, whose recent editorial challenges us to rethink how and when we deliver analgesia in trauma. We’ll discuss the concept of “pain first,” the growing role of non-intravenous analgesics such as transmucosal fentanyl and inhaled agents, and what this means for paramedics, HEMS teams, and pre-hospital systems worldwide. Find the editorial here: https://pubmed.ncbi.nlm.nih.gov/41673878/

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 welcome Dr Abigail Pamich, an experienced Clinical Psychologist with more than 20 years of experience working in mental health and psychological therapy. Dr Abigail leads a private psychology practice in the UK, overseeing a team of 12 highly skilled therapists who provide evidence-based therapy remotely to clients across the UK and internationally.
Together, we explore Eye Movement Desensitisation and Reprocessing (EMDR), one of the most researched and effective psychological therapies for trauma, post-traumatic stress disorder (PTSD), anxiety and other distressing psychological conditions. Dr Abigail explains what EMDR is, how it works, and why it has become an increasingly important treatment within trauma-informed care. We unpack the theory underpinning EMDR, including the Adaptive Information Processing (AIP) model and the role of bilateral stimulation, before discussing what patients can expect during an EMDR session and how traumatic memories can be processed safely and in a structured way.
We also discuss Dr Abigail's journey into EMDR, what first inspired her to specialise in the therapy, and how her clinical experience has shaped her understanding of psychological recovery. The conversation examines the growing empirical evidence supporting EMDR, the conditions for which it is recommended, and how it compares with other established psychological treatments, including cognitive behavioural therapy (CBT) and other trauma-focused therapies.
Using compelling clinical examples and anonymised case studies, Dr Abigail demonstrates how EMDR can help individuals recover from traumatic experiences, reduce anxiety, overcome phobias and process difficult life events that continue to affect everyday functioning. Finally, we discuss the evolution of remote psychological therapy and how EMDR can be delivered effectively through secure online consultations, improving access to specialist trauma care for patients regardless of their location.
Whether you're a healthcare professional interested in trauma-informed care, someone considering EMDR therapy, or simply curious about the neuroscience of psychological recovery, this episode offers an accessible, evidence-based introduction to one of the most influential developments in modern psychotherapy.
What EMDR therapy is and how it works.
The science behind bilateral stimulation and the Adaptive Information Processing model.
The evidence base supporting EMDR for PTSD, trauma, and anxiety.
How EMDR compares with CBT and other psychological therapies.
Common misconceptions about EMDR.
Real-world clinical case examples demonstrating its impact.
Delivering EMDR safely and effectively through remote therapy.
Why trauma-informed care is becoming increasingly important across healthcare.

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/⁠

On today’s episode, we’re diving into a case study that captures the reality of modern prehospital care at its most demanding: a high-speed road traffic collision resulting in major trauma, an evolving shock presentation, and tension between competing priorities in the field. This case comes from Dr Michael DeFilippo, an Emergency Medicine and EMS physician, and it challenges us to think beyond protocols, to physiology, pattern recognition, and decision-making under pressure.
In this episode, we’re going to slow this case down and unpack it, drawing out the key learning points, clinical decision-making frameworks, and practical prehospital strategies that shaped the outcome. From early shock recognition to fluid strategy, analgesia, and transport decisions, this is a case packed with insights for anyone working in high-acuity, time-critical care.
You can read Mike's Substack post here: https://emsdrmike.substack.com/p/c1-dcr-trauma

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/⁠

This special compilation brings together three of our most important episodes exploring the medico-legal aspects of pre-hospital care. From documentation and communication to legal responsibilities and ethical decision-making, this collection provides practical guidance to help clinicians navigate some of the most challenging situations they will encounter in practice.
We begin with Mark Faulkner, who was the Assistant Medical Director at the London Ambulance Service at the time of recording. Drawing on more than a decade of experience supporting and leading the organisation's pre-hospital legal department, Mark shares invaluable insights into the legal principles that underpin safe clinical practice and how clinicians can protect both their patients and themselves.
Across the series, we explore:
High-quality documentation and effective clinical handovers
Duty of care, negligence, and professional accountability
Mandatory reporting and safeguarding
Confidentiality and working alongside law enforcement
Managing legal challenges during major incidents
Patient autonomy, capacity, and refusal of treatment
Advance decisions and end-of-life care
Practical approaches to ethical and legal decision-making
The compilation concludes with Steve Bell, Consultant Paramedic and Consultant HEMS Paramedic, who discusses the complex intersection between ethics and law in pre-hospital care, providing practical strategies for navigating difficult decisions in the field.
Documentation and Communication: Medico-Legal Aspects of Care – Part 1 (Mark Faulkner)
Managing Complex Legal Scenarios: Medico-Legal Aspects of Pre-Hospital Care – Part 2 (Mark Faulkner)
Ethical and Legal Decision-Making: Medico-Legal Aspects of Pre-Hospital Care – Part 3 (Steve Bell)
Whether you're a student, paramedic, critical care practitioner or physician working in pre-hospital care, these conversations offer practical, evidence-informed advice to strengthen your clinical decision-making, improve patient safety and reduce medico-legal risk.

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/⁠