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.

• 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

• 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.

MedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.

Available on the App Store and Google Play.

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.

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.

In this (rather delayed!) October round-up, Iain Beardsell and Simon Carley catch up on recent St Emlyn’s blog posts and papers that continue to shape emergency and resuscitation practice.

The discussion moves across trauma, analgesia, cardiac arrest physiology, emergency department systems, and antimicrobial stewardship—less about novelty, more about what actually holds up on shift.

The episode opens with a discussion of the FIRST-2 trial, examining fibrinogen concentrate and prothrombin complex concentrate versus fresh frozen plasma in severe traumatic haemorrhage. Despite promising physiological theory, the trial shows no meaningful reduction in blood product use compared with standard care, reinforcing the ongoing role of FFP in early trauma resuscitation.

The team explore the SUPERB trial comparing supraclavicular brachial plexus blocks with Bier’s blocks for upper limb reductions. Both techniques provide excellent analgesia. The conversation reflects on changing practice, procedural sedation pressures, ultrasound access, and how physical space—not evidence—often dictates what we do.

Three recent cardiac arrest papers are reviewed, focusing on physiological markers rather than new devices:

• End-tidal CO₂ as a CPR quality target

• Ventilation strategies during arrest, including chest-compression-synchronised ventilation

• Cerebral oximetry as a potential prognostic signal

These are not definitive answers, but they point towards cardiac arrest management that is more physiological and less ritualistic.

A reflective discussion on “designer repair” challenges the idea that emergency departments need constant transformation. Instead, the focus shifts to recognising and supporting the clinicians quietly holding fragile systems together every day—and why fixing small, broken things often matters more than grand redesigns.

The episode closes with a critical look at broad-spectrum antibiotic use in suspected sepsis. Observational data suggest significant overtreatment and real harm, reinforcing the need to pause, think, and choose the right antibiotic—not just the fastest one.

This episode is a reminder that good emergency medicine is rarely about silver bullets. It’s about judgement, physiology, and paying attention to what actually works in the real world.

MedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal. Available on the App Store and Google Play.

This bonus episode is a quick-fire collection of clinical pearls drawn from across the St Emlyn’s podcast in 2025.

Short, practical, and deliberately focused, these are the moments that make you stop and think: “That’s useful — I want that in my head.”

There’s minimal commentary and no deep dives. Each clip stands on its own as a clear takeaway, designed to be listened to in one go or dipped back into when needed.

• Practical triage language that lowers thresholds and prompts earlier action

• Time-critical decision-making in pre-hospital thoracotomy

• Resuscitation physiology and why diastolic pressure matters

• Intraosseous access and the reality of long-term complications

• Analgesia strategies for rib fractures, including posterior injuries

• Hydrofluoric acid burns and why improvised treatment is a trap

• Recognising and acting on decompression illness

• Cognitive HALOs and preparing for rare, high-load decision moments

• Building excellence in teams, not just avoiding failure

• Compassionate resuscitation and the value of the pause

This episode is designed to be saved, revisited, and shared — the kind of learning that pays off later.

Clips in this episode are taken from the following full St Emlyn’s episodes:

• Episode 257 — Ten Second Triage with Sean Brayford-Harris

• Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more

• Episode 266 — Monthly Round Up (February 2025): Skills Fade and Resuscitation Targets

• Episode 260 — Monthly Round Up (December 2024): IO Access and Chest Trauma

• Episode 268 — Top Papers of 2024 from The Big Sick Conference

• Episode 275 — Targeted Resuscitation and Hydrofluoric Acid Burns

• Episode 263 — Hyperbaric Medicine with Jeff Kerrie

• Episode 277 — Cognitive HALOs and Advanced Simulation Training

• Episode 264 — High Performance Teams with Dan Dworkis

• Episode 258 — Compassionate Resuscitation with Matt Hooper

All full episodes are available in the podcast feed.

MedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal. Available on the App Store and Google Play.