The St.Emlyn’s Podcast

Iain Beardsell and Simon Carley return for the April 2026 St Emlyn’s podcast update, talking through another busy month of posts from the St Emlyn’s team and guest authors.

This month brings trauma, systems thinking, public health and pulmonary embolism, with plenty of practical ideas to take back to your next shift.

Iain and Simon start with three more of Simon’s Trauma Team Leader Tips.

The first looks at external haemorrhage control. Tourniquets save lives, but they are not the answer to every bleeding wound. Simon describes a practical escalation from accurate direct pressure, through additional dressings and indirect pressure, to haemostatic agents and tourniquets when they are genuinely needed.

The wider lesson applies well beyond major trauma: expose the wound, find where the blood is coming from and apply effective pressure.

They then discuss Simon’s post on chest drains before CT.

A pneumothorax or haemothorax does not automatically mean that a stable trauma patient needs a drain before leaving resus. The important question is whether the intervention is needed immediately, or whether putting in a chest drain will simply delay the CT that defines the patient’s injuries.

As ever, physiology matters more than reflex protocols.

Simon’s final Trauma Team Leader Tip is deceptively simple: put major trauma patients straight onto a portable monitor.

Most major trauma patients will soon be leaving resus for CT, theatre or another clinical area. Preparing for that move from the moment they arrive can remove avoidable delays. Portable monitoring, oxygen, transfer equipment and a consistent transfer checklist all help maintain momentum.

Iain and Simon then turn to two posts from Stefan about some familiar emergency department problems.

The first considers how we explain ED crowding to colleagues who do not work in our environment. Stefan introduces the idea of a “cognitive bridge”: using an anchor, span and landing point to translate an emergency medicine problem into something meaningful to the person you are speaking to.

The second tackles the perennial question of how many patients an emergency clinician should see per hour.

The discussion moves away from simply measuring individual productivity and towards the systems in which people work. Crowding, poor IT, interruptions, inadequate space and dysfunctional processes all affect what clinicians can achieve.

Before blaming the individual, look at the system around them.

That theme continues with a guest post from Australian critical care nurse and educator Jesse Spurr.

Jesse asks why healthcare so often responds to problems by adding yet another piece of mandatory training. His argument is that many failures are fundamentally system problems. Retraining one person, or thousands of staff, will not fix a badly designed system.

Next, Iain and Simon discuss Greg Yates’ appraisal of the evidence for smoking cessation interventions in the emergency department.

The important distinction is between simply advising someone to stop smoking and offering a structured intervention that includes nicotine replacement. The evidence reviewed in the post suggests the latter is considerably more useful.

The ED also sees groups who may have relatively little contact with other healthcare services, creating opportunities for worthwhile public health interventions when they are properly designed and resourced.

Finally, they look at Dan Horner’s post on one of the more difficult areas of pulmonary embolism management.

What should we do with the patient who is not peri-arrest, but has evidence of right heart strain and physiological compromise?

Dan reviews the HI-PEITHO trial, which examined ultrasound-facilitated catheter-directed thrombolysis in higher-risk PE. Iain and Simon discuss what the results might add to decision-making in this difficult intermediate group and the potential role of multidisciplinary PE response teams.

There are plenty of practical messages from this month’s posts:

• Control external bleeding thoughtfully rather than automatically reaching for a tourniquet.
• Do not let an unnecessary procedure delay definitive trauma imaging.
• Prepare trauma patients for transfer from the moment they arrive.
• When performance is poor, examine the system as well as the individual.
• Think carefully before responding to every healthcare problem with more mandatory training.
• Public health interventions in the ED need proper systems behind them.
• High-risk pulmonary embolism remains an area where physiology, evidence and multidisciplinary judgement all matter.

If you enjoy St Emlyn’s and have an idea you would like to share, we would love to hear from you.

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Thanks for listening to the St Emlyn’s Podcast. Subscribe wherever you get your podcasts, and we’ll be back with the May update soon.