How many patients should we see per hour? Clinician productivity depends largely on conditions provided. This blog explains why patients per hour is the last question you should ask and not the first. St Emlyn's

How many patients should we see per hour?

Clinician productivity depends largely on conditions provided. This blog explains why patients per hour is the last question you should ask and not the first. St Emlyn's

Marching Backwards into the Future: Why Healthcare Needs Fewer Modules and More Systems Thinking By Jesse Spurr from the amazing Five Things Nursing Podcast, which and which is co-hosted with our very own Dr Liz Crowe. You should defo subscribe as relevant to all in healthcare. You can find it here or on your favourite podcast platform. “We look at the present through a rear-view mirror. We march backwards into the future.” Marshall McLuhan…

Marching Backwards into the Future: Why Healthcare Needs Fewer Modules and More Systems Thinking

By Jesse Spurr from the amazing Five Things Nursing Podcast, which and which is co-hosted with our very own Dr Liz Crowe. You should defo subscribe as relevant to all in healthcare. You can find it…

IFEM 2026: Will we see you in Hamburg? Join the global emergency medicine community at ICEM 2026 in Hamburg. Explore the programme, St Emlyn’s speakers, and why IFEM still matters.

Join the global emergency medicine community at ICEM 2026 in Hamburg. Explore the programme, St Emlyn’s speakers, and why IFEM still matters. (and Noah Wyle too!)

TTL Tip 9: Chest Drain Before CT? Think, Decide, Communicate Should you insert a chest drain before CT in trauma? A practical guide to managing pneumothorax, balancing risk, delay, and decision-making in the resus room. @stemlyns #FOAMed

Do we always need to place a chest tube before CT in a patient with suspected or known haemo or pneumothorax? TTL tips #FOAMed @stemlyns

Explaining Emergency Department Crowding Using a Cognitive Bridge Emergency Department crowding is hard to explain to non-clinical audiences. A cognitive bridge is a three-step tool to help others understand.

Emergency Department crowding is hard to explain to non-clinical audiences. A cognitive bridge is a three-step tool to help others understand.

TTL tips 8: External Haemorrhage control Keep blood in the patient. Control haemorrhage early. Most external bleeding will have been addressed prehospital, but not all. Patients may self-present, deteriorate, or require reassessment as resuscitation progresses. Effective haemorrhage control remains a core ED skill. D – Direct Pressure First-line treatment for external haemorrhage. Identify the bleeding point Apply firm pressure with a finger or hand Reinforce with a dressing, maintaining focused pressure…

A practical guide to trauma haemorrhage control using the DDIT approach: direct pressure, tourniquets, and haemostatic dressings. Learn how to stop bleeding fast in emergency care. @stemlyns #FOAMed

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Pericardiocentesis for traumatic tamponade: a feasible alternative for low-resource trauma care?

Read more on St Emlyn's:

www.stemlynsblog.org/pericardiocentesis-for-t...

TOE-Guided CPR in Out-of-Hospital Cardiac Arrest: Physiology Over Algorithm? Does targeting the left ventricle during CPR improve outcomes in cardiac arrest? We review the EXECT-CPR trial and explore the shift from algorithm-based to physiologically guided resuscitation.

EXACT-CPR trial TOE-guided CPR improves physiology (↑ETCO₂) but not outcomes in OHCA. Maybe the issue isn’t what we do, but when we do it. Cardiac arrest care is shifting from algorithms to physiology—but we’re not there yet. #FOAMed #Resus

Access to physician-based HEMS in the UK: progress, patchwork or postcode lottery? Physician-based HEMS provision in the UK has expanded significantly since 2009, but variation remains. This St Emlyn’s review examines access, funding models and whether a largely charity-led system can deliver national equity.

Access to physician-based HEMS in the UK: progress, patchwork or postcode lottery?

Physician-based HEMS provision in the UK has expanded significantly since 2009, but variation remains. This St Emlyn’s review examines access, funding models and whether a largely charity-led system can deliver?

JC: Prehospital Whole Blood in Traumatic Haemorrhage – The SWIFT Randomised Controlled Trial A critical appraisal of a RCT comparing whole blood vs blood component transfusions for bleeding trauma patients

Learn about the Swift trial of whole blood vs components with Halden and Zaf. Really interesting appraisal and lessons for real world practice. @stemlyns

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NHS England’s Model Emergency Department guidance asks trusts to model demand and capacity. The real challenge is residual demand, supply-induced demand and unmet need.

www.stemlynsblog.org/model-ed-capacity-and-de...

2026 PE Guidelines Pulmonary embolism (PE) is one of those diagnoses that finds its way into a lot of differential diagnoses. In the era of reasonably easy-but-occasionally-argue-with-radiologist to get CTPAs, the diagnosis has increased. An old study now, but in 2011 Wiener et al showed that the use of CTPA has increased the diagnosis but with no difference in mortality. Unsurprisingly PE and, more broadly, venous thromboembolic diseases are a vast area of research and innovation.

2026 PE Guidelines

Pulmonary embolism (PE) is one of those diagnoses that finds its way into a lot of differential diagnoses. In the era of reasonably easy-but-occasionally-argue-with-radiologist to get CTPAs, the diagnosis has increased. An old study now, but in 2011 Wiener et al showed that the…

TTL tips 7: Log rolls. Top tips on log rolls for trauma patients.

TTL tips 7: Log rolls.

Top tips on log rolls for trauma patients.

Everything You Need to Know About Making Feedback More Than Just Noise Simon and I have been talking about better feedback since I first joined the St Emlyn's crew more than a decade ago (check this out if you don't believe me - this audio file appears in a link at the end of this blog post, which Simon published in July 2012!) and in the intervening years I've loved the opportunity to speak about feedback at conferences and to run feedback workshops alongside him.

How to make feedback work for those receiving and giving it. Top tips from Natalie May. #FOAMed

TTL tips 6: CT reports TTL tips 6. How to manage your CT reports in trauma. #TTLtips #FOAMed

TTL tips 6. How to manage your CT reports in trauma. #TTLtips#FOAMed

TBS 2026: Best Intensive Care Medicine Papers A focused review of the most important intensive care medicine papers from 2025–2026, discussed at The Big Sick conference. TBS @stemlyns

A focused review of the most important intensive care medicine papers from 2025–2026, discussed at The Big Sick conference. TBS @stemlyns

TBS 2026: Best Emergency Medicine Papers Emergency medicine research rarely provides certainty, but it can guide decisions. At The Big Sick (TBS) conference 2026, we presented papers challenging assumptions around trauma, airway management, resuscitation systems and rare high-stakes decisions. This post reviews the best emergency medicine papers from 2025–2026, focusing on what they mean for clinicians working at the front door.

TBS 2026: Best Emergency Medicine Papers

Emergency medicine research rarely provides certainty, but it can guide decisions. At The Big Sick (TBS) conference 2026, we presented papers challenging assumptions around trauma, airway management, resuscitation systems and rare high-stakes decisions.…

TBS 2026: Key Prehospital Emergency Medicine papers A critical review of the most important prehospital emergency medicine papers from 2026, covering RSI, oxygen therapy, ECPR, thoracotomy and trauma access. From the TBS conference in Zermatt.

TBS 2026: Key Prehospital Emergency Medicine papers

A critical review of the most important prehospital emergency medicine papers from 2026, covering RSI, oxygen therapy, ECPR, thoracotomy and trauma access. From the TBS conference in Zermatt.

TTL tips 5: Non time critical trauma handovers part 1. Top tips for TTLs managing a non time critical hand over of a trauma patient into resus.

Trauma Team Leader Tips to make your non-time critical handovers work as well as they can. #FOAMed @stemlyns

Trauma – getting the TU trauma team right Advice on planning for trauma in Trauma Units. How does it differ to MTCs? James, Rory and John take us through some tips and ideas.

Advice on planning for trauma in Trauma Units. How does it differ to MTCs? James, Rory and John take us through some tips and ideas.

Early Blood Pressure Targets in Acute Spinal Cord Injury Background It's pretty well agreed that management of blood pressure is really important in neurological injury. We usually think about this in terms of brain injury, but the general teaching is that the same applies to spinal cord injury too. It's neurological tissue and connected to the brain, so it makes sense. It's something we've talked about a lot on St Emlyn’s over the years, in the context of traumatic brain injury (TBI), stroke, and post–cardiac arrest care.

Interesting trial on BP targets in spinal cord injury. The authors conclude no difference, but how robust??? #FOAMed

Perimortem C-section from Incrementum: how to do it Video from the perimortem c-section at Incrementum in 2025. #FOAMed @stemlyns

Amazing video from the perimortem c-section session at Incrementum in 2025. #FOAMed @stemlyns

Learn how to do it here

Making Sense of the Latest Corridor Care Update: Red Lines and Resources If you have worked an ED shift over the last year, you will almost certainly have faced this dilemma: an ambulance crew arrives with an elderly, frail, confused patient who needs a Majors space. But with no room available, and increasing pressure to release the crew, a trade-off becomes inevitable. What happens next currently defines the quality and safety landscape of emergency care - and reveals the tussle between…

Expert analysis of NHS England's latest corridor care guidance: exclusions, accountability, constraints and practical implementation for EDs.

TTL tips 4: Code Red TTL tip 4 is about getting your CODE RED instructions right, by developing the right mindset about what you want to achieve and why.

TTL tips 4: Code Red

TTL tip 4 is about getting your CODE RED instructions right, by developing the right mindset about what you want to achieve and why.

Ketamine vs Etomidate for Intubating Critically Ill Adults: What Does the RSI Trial Tell Us?

Background For as long as I can remember emergency and critical care clinicians have debated the optimal induction agent for tracheal intubation in the critically ill. When I started my anaesthetic…

Cough remedies: what actually works? This is a festive break from my usual offerings on emergency toxicology, although you will note I lapsed a bit with dextromethorphan. My last post was on the SNAP regimen in teenagers, and can be found here. I am currently recovering from pneumonia. It is not pleasant. Like Tiny Tim himself, I have been struggling with a cough. And if the information I give in ED is correct, it will be weeks before I feel better.

Cough remedies: what actually works?

This is a festive break from my usual offerings on emergency toxicology, although you will note I lapsed a bit with dextromethorphan. My last post was on the SNAP regimen in teenagers, and can be found here. I am currently recovering from pneumonia. It is not…

TTL tips 3: Giving Blood products? Think Calcium! Check these five areas in penetrating trauma. Trauma Team Leader tips from @stemlyns #FOAMed

TTL tip number 3 reminds us to manage Calcium levels in all trauma patients, and especailly those receiving blood products.

Your Patient Already Asked ChatGPT Patients are consulting AI more and more before attending ED. What does the research say, and how should clinicians respond? Some great advice on what to do when this happens.

Patients are consulting AI more and more before attending ED. What does the research say, and how should clinicians respond? Some great advice on what to do when this happens.

Is post-induction hypotension harmful in traumatic brain injury? How bad is hypotension in TBI? What's the real world impact in a high quality PHEM service. Rich Carden reviews a recent paper that helps us understand the impact. #FOAMed @stemlyns

How bad is hypotension in TBI? What's the real world impact in a high quality PHEM service. #FOAMed @stemlyns

Make it SNAPpy! Paracetamol overdoses in teenagers Paracetamol poisoning is an uncommon, but not rare, event in children. The treatment of choice is NAC. Should we be giving them the SNAP protocol?

Make it SNAPpy! Paracetamol overdoses in teenagers

Paracetamol poisoning is an uncommon, but not rare, event in children. The treatment of choice is NAC. Should we be giving them the SNAP protocol?