How, when and why to make the call…

The pre-alert is one of the most powerful and sometimes most painful parts of emergency care. It can feel like the Spanish Inquisition, trigger tension between pre-hospital and ED teams, or drop another challenge into an already overflowing department. But done well, a pre-alert isn’t an irritation; it’s an opportunity to line up critical care for the next patient and genuinely improve outcomes.

In this episode, Simon, Rob and James break down The UK NHS Ambulance Services and Emergency Department Pre-Alert Guideline, jointly released in July 2025 by RCEM and the Association of Ambulance Chief Executives. It’s the first national attempt to give clear, shared expectations on who to pre-alert, what to say, and how to receive those calls, it’s full of practical recommendations for both sides of the phone.

We kick things off with a review of the evidence base, including brand-new studies showing just how varied pre-alert practice is across the UK. From inconsistent criteria and mixed training to the problem of “pre-alert fatigue”, the data make a strong case for standardisation.

We then walk through the new guideline’s key principles: pre alerting for pre-specified physiological parameters or specific conditions.

We finish off with top tips for making and taking better pre-alerts - selling a story, leading with the headline, and understanding what the other side actually needs. This episode combines frontline pragmatism with real-world research and might just make your next pre-alert smoother, faster, and better received.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

This month we’ve got three really interesting papers that shine a light on aspects of cardiac arrest management that many of us will recognise from clinical practice.

First up, we look at the feasibility of arterial line placement during ongoing cardiac arrest in the Emergency Department. In our SPEAR episode we talked about the balance between securing invasive monitoring versus the potential distraction from other essential parts of resuscitation. This paper takes a pragmatic look at whether arterial access is achievable in that critical period in the Emergency Department, the success rate and the time required.

Next up, we look at a paper that helps to give us a more accurate feel for the rate and predictors of high-risk adverse events for Emergency Department paediatric ketamine sedation.

Our final paper looks at ultrasound during cardiac arrest. Specifically, whether the hands-off time during the pulse check are longer with traditional manual checks or with ultrasound. This systematic review and meta-analysis puts some numbers to the best way to minimising hands-off time.

So whether you’re a regular on the arrest team, sedating children, or supporting resuscitation from the periphery, these papers provide some useful food for thought on where our focus should be in those critical minutes.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

a focus on its acute presentations and the care we can deliver to improve outcomes for our patients.

Sickle cell disease (SCD) is a lifelong inherited blood disorder that affects over 15,000 people in the UK, and millions worldwide. It’s caused by the production of abnormal haemoglobin molecules, which distort red blood cells into a crescent, or “sickle,” shape. These rigid cells can block small blood vessels, leading to painful vaso-occlusive crises and organ damage.

While the condition has long been most prevalent in parts of Africa, the Middle East, the Mediterranean and India, today it’s a global health issue, and one we encounter regularly in UK emergency care. Tragically, failings in care have too often led to avoidable harm. The 2021 parliamentary report “No One’s Listening” laid bare some of these cases, highlighting missed opportunities, poor awareness, and systemic issues that cost lives, such as the death of Evan Nathan Smith.

So why are we revisiting this now? In 2024, RCEM published new Best Practice Guidelines on managing sickle cell disease in the ED. These provide clear, evidence-based standards for recognition, triage, analgesia, infection control, and safe discharge. In this episode, we take you through the key elements;

• Pathophysiology – how a genetic mutation drives sickling, vaso-occlusion and inflammation.
• Clinical presentations – from painful crises and acute chest syndrome, to stroke, anaemia, infection, priapism and pregnancy-related complications.
• Recognition and triage – why timely pain control within 30 minutes is a must, and how to spot red flags.
• Investigations and treatment – including the role of reticulocytes, the importance of knowing a patient’s baseline haemoglobin, and principles of analgesia, transfusion, oxygen, and supportive care.
• Discharge and ongoing care – ensuring safe, joined-up planning, and involving haematology and specialist pathways wherever possible.

The take-home message? Every sickle cell crisis is a medical emergency. We need to listen to patients, escalate early, involve haematology, and deliver care that meets the standards they deserve.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James