In the late 1960s, trauma surgeon R. Adams Cowley became obsessed with a question that refused to leave him alone: why were patients still dying even when everything seemed to be done “right”?

By tracking cases minute by minute, Cowley uncovered a brutal truth. The most lethal enemy in trauma care wasn’t always the injury itself, but the time lost before definitive treatment. Quiet injuries were being missed. Patients were waiting. And once shock took hold, even perfect care often came too late.

In this episode, we follow Cowley from his early years in thoracic surgery to the bedside patterns that led him to define the Golden Hour. Along the way, we trace how highways replaced battlefields as the primary source of trauma, how Maryland built the first true shock trauma network, and how helicopters, dispatch, and paramedics were reorganized around one ruthless priority: speed.

We also meet Peter Safar, whose work on CPR and airway management tackled the minutes before the hospital, proving that the Golden Hour could only be won if someone kept patients alive long enough to reach it.

This is the story of how emergency medicine stopped reacting to injuries and started racing the clock.

As unarmed helicopters flew into active combat zones, pilots and medics made a radical commitment: they would go wherever the wounded were, no matter the danger. At the center of that promise was Major Charles Kelly, commander of the 57th Medical Detachment, whose final radio transmission... “When I have your wounded”... became the creed of Dustoff.

This episode traces the evolution of helicopter medical evacuation from its earliest experiments in World War II, through Korea, and into the Vietnam War, where Dustoff crews transformed battlefield survival. Flying into “hot” landing zones without weapons, these crews proved that speed was the most powerful medical intervention of all.

We follow the rise of the Huey, the birth of airborne rescue medicine, and the staggering survival rates that validated what would later be known as the Golden Hour. From the jungles of Southeast Asia to highways and trauma centers back home, the legacy of Dustoff reshaped emergency medicine forever.

This is the story of courage, innovation, and the moment when time became the true enemy of survival.

In this week’s aftershow, we take you behind the creation of The Scalpel in the Storm and into the world of Dr. Michael E. DeBakey in a way the main episode didn’t have room for. This is a bit of a deeper push into the wild details, the human moments, and the medical drama you won’t believe is real. Plus, a bit of the showrunner's thoughts and creative insights into creating the audioscape.

If Episode 3 was about confronting suffering, Episode 4 is about outpacing it. In this aftershow, we explore how that theme resonates with anyone who has ever worked in emergency or critical care medicine.

Before he became one of the most influential surgeons in modern history, Michael DeBakey was just a fourteen-year-old boy in New Orleans holding the wrist of a dying neighbor and learning how fast life can slip away. That moment became the engine that drove him through lecture halls, operating rooms, and eventually into the largest war the world had ever seen.

This episode follows DeBakey from the humid streets of Louisiana to the chaos of WWII, where he transformed battlefield medicine, redesigned evacuation systems, and planted the seeds that would become MASH, helicopter evacuation, trauma centers, and the Golden Hour itself.

A story of relentless innovation, quiet grief, and the surgeon who dared to fight time.

PMHX: No FX is the official aftershow for Past Medical History: The Story of EMS.

Each week, creator and co-hosts Sophie, Evan, and some occasional special guests break down the episode in a raw, unscripted conversation about the story, the research, the decisions, and the creative process behind the scenes. No sound design. No effects. Just the humanity, the history, and the craft that shape every chapter of the season.

If you love the cinematic episodes and want to dive deeper into how they’re built — and why these stories matter — No FX is your place.

When the guns stop firing, the dying doesn’t end.

In this episode, we follow the story of a wounded Union lieutenant left to perish on the field at Second Bull Run. He is abandoned not by fate, but by a broken system. That single tragedy may have become the turning point for a quiet, analytical surgeon named Jonathan Letterman.

From the coal-smoked streets of Pennsylvania to the cholera-ridden wards of Philadelphia, Letterman grows into the one mind capable of diagnosing the Army itself. And on the battlefields of Antietam, Fredericksburg, and Gettysburg, he builds the first true American trauma system, a blueprint that will shape EMS for the next 160 years.

This is the story of how one man changed the fate of the wounded… long after the guns fell silent.

In 1793, the French Revolution burned across Europe. Amid the chaos, a young surgeon named Dominique Jean Larrey refuses to stand idle as wounded soldiers bleed and die where they fall. Against orders and tradition, he builds a system that will change the fate of the injured forever... a flying ambulance that brings care to the battlefield itself.

Through Larrey’s defiance and innovation, Past Medical History: The Story of EMS explores the birth of organized emergency medicine, where compassion met ingenuity, and where the first principles of triage were forged in the smoke and fire of war.

This is where mercy began to move.

In 1783, a young merchant’s son lies dying on a frozen Scottish road, his leg shattered, his lifeline severed, and no help in sight. Before ambulances, before medicine as we know it, survival depended on luck, distance, and the kindness of strangers.

Through one man’s struggle to survive, Past Medical History: The Story of EMS traces the origins of emergency care from rural folk healers to the first anatomy theaters of Edinburgh to a battlefield surgeon who refused to accept that dying in the dirt was inevitable.

This is where it all began: the moment humanity realized that help had to come.