And, you know, we started to have a little bit of the discussion last time that not every intervention belongs inside the vehicle, right? So as we look at post-collision care and resuscitation of those complex trauma victims, how do we decide what has to happen there and what's better deferred for later? outside of that vehicle? I know some of that is dependent on how quickly we can get them out, but what's kind of your thought process for

that? So it's a really complex area.

And one of the attractions to me of pre-hospital medicine is that level of complexity.

And in order to understand that complexity, you need to understand the interaction between the rescue environments, the patients, and the utility of the clinical interventions that we can offer.

And some of that is about understanding rescue well.

Some of that is about understanding things like the crash pulse and injury and what that means to our patients.

Some of that's about accepting the limitations.

Not faulting them for that, but how reliable is mechanism of injury in your experience?

So what made you start to ask that question?

I worked doing pre-hospital emergency medicine and in-hospital emergency medicine for almost 20 years now.

And it's a real privilege to be able to see the patient journey from both perspectives.

and what i noticed from working in the pre-hospital environment and attending these these car wrecks and then from my emergency medicine practice is that when we had patients in our trauma centers we were really interested in doing things quickly we were really interested in getting to through the cat scan interesting getting them to theater resuscitating them giving blood products and everything had a real tempo to it And that was very different from the very first stages of these patients journey, which seemed to be very slow and very steady with this at the time seemed to be an understandable obsession with movement minimization.

The other thing that I was struck by is the injuries that I was seeing as I kind of grew up as a junior doctor.

And I was seeing patients who were coming out of recs and I was seeing brain injury and I was seeing chest injury and I was seeing non-compressible hemorrhage, so bleeding from your internal organs, none of which we can do much about in the pre-hospital environment, particularly whilst people are trapped.

And the rate of spinal cord injury, the reason that we do that slow and steady movement minimization approach seem to be relatively low.

I wonder if you could unpack that just a little bit