Ep 300 - Decisions under pressure from Tactical Trauma

Making decisions with incomplete information is part of everyday emergency and trauma care. But when the stakes are particularly high, how do you know when you have enough information to act? Waiting too long may cost lives. Acting too soon may put patients, colleagues or yourself at unnecessary risk.

For our 300th St Emlyn’s podcast, Iain Beardsell revisits conversations he and Liz Crowe recorded at Tactical Trauma in Sweden. Drawing on interviews with Claire Park, Sean Brayford-Harris, Alice Hutin and Chris Bishop, he explores how clinicians and first responders make difficult decisions under pressure, from major incidents and mass casualty triage to prehospital eCPR and ECMO in trauma.

In this podcast:

• How Claire Park uses the 40–70 rule to explore when we have enough information to act, while recognising the risks of entering potentially dangerous scenes.

• Lessons from the London Bridge terrorist attack about delayed treatment, casualty evacuation and the difficult balance between responder safety and patient survival.

• Why the Ten Second Triage tool was designed without physiological measurements, allowing non-clinical responders to prioritise casualties and deliver immediate lifesaving interventions.

• How simple, familiar frameworks can reduce cognitive load when responders are frightened, overwhelmed or working outside their usual clinical role.

• Why the availability of prehospital extracorporeal CPR (eCPR) does not mean every patient should receive it, and the challenges of explaining decisions not to proceed.

• The value of discussing decisions aloud, seeking colleagues' views and debriefing after difficult cases.

• Why veno-arterial ECMO remains controversial after major trauma, particularly because of anticoagulation and bleeding risks, and how multidisciplinary decision-making can help identify potential candidates.

About the contributors

Claire Park is a consultant in prehospital emergency medicine with extensive experience of high-threat incident response. Sean Brayford-Harris is a London Ambulance Service paramedic who helped develop Ten Second Triage. Alice Hutin is an emergency physician working with the prehospital eCPR service in Paris. Chris Bishop is a clinical perfusionist and research fellow investigating VA-ECMO for cardiogenic shock following major trauma.

Links and resources

You can explore the original conversations and their accompanying St Emlyn’s articles:

• Care in the Hot Zone with Claire Park

• Ten Second Triage with Sean Brayford-Harris

• Prehospital eCPR with Alice Hutin

• ECMO in Trauma with Chris Bishop

• NHS England: Ten Second Triage tool and major incident guidance

• Tactical Trauma Conference 2026 – Sundsvall, Sweden, 2–4 November 2026.

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