The St.Emlyn’s Podcast

What do we really know about treating refractory ventricular fibrillation?
And why are we still waiting to use strategies that might actually work?

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.

This is not just about adding another shock.
It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.

We also discuss:

The difference between refractory and recurrent VF — and why it matters

What DSED and vector change actually do in physiological terms

Why guidelines have been slow to move despite emerging evidence

The role of antiarrhythmics, adrenaline, and sequence of care

Practical considerations for introducing DSED into real systems

What comes next — from smarter detection to post-arrest recovery

This is a conversation grounded in real-world resuscitation.
It challenges current practice without overselling the evidence.

Key Learning Points

Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications

Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation

Timing matters — waiting too long to escalate may reduce the chance of success

Current guidelines remain cautious, reflecting the balance between evidence and implementation risk

Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care

Why This Matters
Cardiac arrest survival remains low.

Small improvements in early resuscitation can have large system-wide effects.
Understanding when standard care is failing — and what to do next — is where expertise matters.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.

The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.

You’re about to hear a conversation that ranges widely — from training reform and trauma leadership to ondansetron, paracetamol protocols, and artificial intelligence.

But it isn’t really about any single topic - It’s about where emergency medicine is heading. And whether we are ready for it.

This is our November and December 2025 round-up, and revisits the blog posts from the end of last year. A pause. A reset. A chance to look again at ideas that still matter on shift.

We explore

The Medical Education Training Review and what it might mean for emergency medicine in the UK

Flexibility, bottlenecks, and the portfolio route

Why culture and team matter more than workload alone

Trauma Team Leader tips — from missed wounds to managing presence in the room

Ondansetron in paediatric gastroenteritis — symptom control or over-medicalisation?

The SNAP protocol for paracetamol overdose in children

How long it can take for good data to become everyday practice

AI in the consultation room — and what happens when patients arrive with ChatGPT

What this means for trainers, medical schools, and the future of clinical judgement

This episode closes Season 12 of the St Emlyn’s podcast. Season 13 is coming — including London 2030 content and more from recent conferences.

Upcoming events

Tactical Trauma returns 2–4 November in Sundsvall, Sweden. It remains one of the most focused and practical trauma meetings in Europe — small faculty, serious discussion, no fluff. If you are interested in pre-hospital and in-hospital trauma care, it is worth your time.

IncrEMentuM is approaching fast, with limited places remaining. If you’ve heard us talk about it before, you’ll know why people come back.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.

The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.

More conversations from recent meetings — including Trauma 2030 — will follow in upcoming episodes.

Thanks for listening

You’re about to hear a conversation about doing less. But it isn’t really about doing less. It’s about time.

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.

We discuss:

Using time as a treatment

Recognising non-compressible haemorrhage

Why one line may be enough

Moving interventions into the ambulance

Changing the pre-alert

The “pit stop” resus

Taking patients straight to theatre

Cultural resistance to doing less

Governance, debrief, and looking after teams

This approach focuses on a small but critically unwell group of patients — often penetrating trauma with rapidly exsanguinating haemorrhage — where the only definitive treatment is surgical control of bleeding.

The key intervention is speed.

Harriet also discusses the governance work behind this change, the importance of reviewing every case, and how to bring ambulance services and in-hospital teams along with the shift in thinking.

This episode is part of a series recorded at Trauma 2030. More conversations from the meeting will follow in upcoming episodes. 

Upcoming events

Harriet will be speaking at Tactical Trauma, 2–4 November, Sundsvall, Sweden.

IncrEMentuM is now only eight weeks away, with limited tickets remaining.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

In this episode of the St Emlyn’s Podcast, we’re joined by Nigel Ruddell, Medical Director of the Northern Ireland Ambulance Service, recorded live at the BASICS Conference.

This is a conversation about Helicopter Emergency Medical Services (HEMS) — but not in the way you might expect.

It’s not really about aircraft. It’s about people.

Nigel talks us through the long, often uncomfortable journey to building Air Ambulance Northern Ireland. From early fundraising attempts in the 2000s, through the influence and legacy of Dr John Hinds, to the eventual partnership between charity and the statutory ambulance service that made a doctor–paramedic HEMS model possible.

We explore:

• Why the helicopter isn’t the intervention — the team is
• The charity–NHS partnership model in Northern Ireland
• Geography, rurality, and the realities of serving 1.9 million people
• Dispatch challenges and the use of video triage (including the GoodSAM platform)
• Cross-border working with the National Ambulance Service of Ireland
• The cultural work required to convince colleagues that HEMS is not a “Cinderella service”
• Humility, leadership, and the people who quietly build systems

We also reflect on John Hinds's legacy and how his passion catalysed change, including the significance of the Delta 7 callsign.

This is a thoughtful conversation about system design, pre-hospital care, and what it actually takes to introduce enhanced critical care capability into a region that has never had it before.

If you enjoy thinking about pre-hospital medicine, trauma systems, and the future of emergency care, you may also want to look at: the IncrEMentuM Conference and Tactical Trauma

And if you want to go deeper into the evidence behind the conversations we have on this podcast, explore MedPod Learn — now hosting nearly 5,000 medical podcast episodes with linked multiple-choice questions to support structured learning.

As always, thanks for listening.

In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest.

This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right.

What we cover

Why the term resuscitative hysterotomy has replaced perimortem caesarean section

The physiological rationale: relieving aortocaval compression to improve maternal resuscitation

What the evidence actually shows about timing, maternal survival, and neonatal outcomes

Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy

Why the “4–5 minute rule” does not reflect real-world pre-hospital care

Neonatal survival at far longer timelines than traditionally taught

Practical decision-making in pre-hospital and emergency department settings

Who should perform the procedure, and why speed matters more than seniority

Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it)

Team cognitive load, role allocation, and when termination at scene is appropriate

The emotional and professional impact on clinicians and families

Key takeaways

Maternal survival after out-of-hospital arrest is rare, but not zero

Neonatal survival is higher than often appreciated, even with prolonged timelines

Delaying purely to reach hospital or a specialist may reduce benefit

The hardest part is not the incision — it is the decision, coordination, and aftermath

Training should focus as much on judgement and communication as on technical skill

This episode is not about heroics.
It is about realism, evidence, and being prepared for one of the most confronting moments in emergency care.

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IncrEMentum 2026 - April 22 - 24
IncrEMentuM was born to revolutionise how we approach emergency medicine. It’s not a traditional conference — it’s an immersive experience that pushes professionals to act, think, and make decisions in real time.

Our mission is to bring together healthcare providers, experts, and emergency personnel from around the world to share experiences, train in realistic scenarios, and test their skills under extreme pressure.

In 2026, we return with an even more intense and lifelike edition — all with one clear goal: to prepare you for what cannot be predicted.

Tactical Trauma - April 22 - 24
This is an international conference covering various aspects of working in high-stakes environments, primarily related to pre-hospital trauma and critical care, with a tactical twist.

Our program is rich and diverse, featuring state-of-the-art lectures from world-class speakers. We aim to bring together all organisations working with pre-hospital trauma in tactical/hostile environments, including physicians, HEMS, EMS, police anti-terror units, military, fire and rescue services and more.