Before the Hospital

About Before the Hospital

Before the Hospital is a podcast for the people building emergency medical systems where they are needed most. Each episode brings together practitioners, researchers, and health system leaders working on the frontline of prehospital care in resource-constrained settings — sharing what works, what does not, and what it takes to build systems that save lives. Produced by EMS Global Foundation. emsglobalfoundation.substack.com emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast)

Publisher

EMS GLOBAL FOUNDATION

Category

health & fitness · society & culture

Language

en

Explicit

No

First episode

12 May 2026

Latest episode

25 Aug 2026

Latest episodes

14 episodes in the feed.

1. 

   25 Aug 2026

   Building an Ambulance Service with no funds

   Connect with us (https://www.buzzsprout.com/2624539/fan_mail/new) In 2014, Andrew Hodgetts left a paramedic career in Victoria with a set of keys, an empty bank account and a mandate to start an ambulance service on Espiritu Santo, Vanuatu's largest island. There was no funding for equipment or vehicles. That came later through cold-calling ambulance commissioners, a chance conversation at a trade stall that filled his car boot with donated gear, and an unsolicited vehicle donation from Queensland Ambulance Service. In this episode, Hamish McLean talks with Andrew about what it actually took to build ProMedical Santo from nothing: recruiting and training two Ni-Vanuatu nurses as the service's first paramedics, funding operations through business sponsorship and a subscription model, and the slower, harder job of teaching a community what an ambulance is and why they should call one rather than load a patient into the back of a ute. The conversation moves from the practical (no street names, no central dispatch, directions given by mango tree) to the systemic: why Andrew now believes importing a high-income paramedic model into a low-resource setting was, in his own words, naive; how a near-mutiny over cutting CPR from a first-aid course taught him that "what works" and "what the community needs" aren't always the same question; and why his PhD research into community first responder programmes has led him to conclude that context - culture, infrastructure, geography, trust in the profession - has to shape the model, not the other way around. The episode closes on a comparison that speaks directly to EMS Global's work in Mongolia: what happens when first-responder models designed for dense, road-connected populations meet nomadic, geographically dispersed communities — and why the answer isn't always more training, but a different question altogether. In this episode How a volunteering trip turned into founding a new ambulance station on Santo Funding a charity ambulance service door-to-door: sponsorship tiers, raffles and a free fuel deal that kept the service running Training two Ni-Vanuatu nurses as the service's first paramedics Teaching a community what "call an ambulance" means and why visibility mattered as much as clinical capability The Village First Aid Responder (VIFA) programme, and the community pushback that changed Andrew's approach to CPR training Why he now questions transplanting a paramedic-level, high-income model into a low-resource context The gap between prehospital and hospital-level care, and what happens when an ambulance service outpaces the system it delivers into Aeromedical retrieval without air traffic control, on grass runways, at dusk What his PhD research into community first responder models is finding and why most existing programmes are taught in isolation from the wider health system Parallels with nomadic, dispersed communities in Mongolia About the guest Andrew Hodgetts is a Victorian-trained paramedic who founded ProMedical Santo, a charity ambulance service on Espiritu Santo, Vanuatu, in 2014, supported through the Australian Volunteers for International Development (AVID) programme. He is now a PhD candidate researching how community first responder programmes can be integrated into established health systems in low- and middle-income countries. For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts (https://www.youtube.com/@ems-global2048/podcasts) Our website: https://emsglobalfoundation.org/ (https://emsglobalfoundation.org/) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

2. 

   10 Aug 2026

   They called an ambulance. A hearse arrived.

   Connect with us (https://www.buzzsprout.com/2624539/fan_mail/new) Decades ago in the United States, if you called an ambulance, the vehicle most likely to arrive was a hearse. For much of the 20th century, more than half of the country's ambulance service was run by funeral homes — not because it was profitable, but because they had the only vehicle in town built to carry someone lying down, and no one else stepped up. In this episode, host Dr Hamish McLean talks with Police Chief (Ret.) Scott Reinbolt — 25 years in law enforcement, now an adjunct professor of law enforcement at Ohio University — about the era he documents in his book, Humble Heroes: The History of Funeral Home Operated Ambulance Service. We cover how the system actually worked, why it finally collapsed under a convergence of new labour law, a landmark federal report, and a reimbursement system that never covered the real cost of care — and why the funeral directors who built it were largely excluded, blamed and forgotten once it changed hands. This isn't just American history. The same questions - who builds an EMS system when no one else will, and what happens to that knowledge when the system finally changes - are ones EMS Global Foundation works through today in Mongolia, Central Asia, and the Pacific. In this episode: • Why funeral homes ended up running American EMS, and how the model actually worked • The regulatory and financial convergence that ended the era • What happened when incumbent providers were excluded from EMS reform • What today's EMS system-builders can take from this history About Before the Hospital: a podcast from EMS Global Foundation examining the governance, financing, and workforce decisions that determine whether prehospital emergency care systems succeed — particularly in low- and middle-income settings. Read the companion essay and subscribe: emsglobalfoundation.substack.com/ (http://emsglobalfoundation.substack.com/) Learn more about our work: emsglobalfoundation.org (http://emsglobalfoundation.org) For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts (https://www.youtube.com/@ems-global2048/podcasts) Our website: https://emsglobalfoundation.org/ (https://emsglobalfoundation.org/) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

3. 

   19 Jul 2026

   The Death of Paramilitary Culture: Fixing EMS Leadership

   Connect with us (https://www.buzzsprout.com/2624539/fan_mail/new) In this episode of the Before the Hospital Podcast, host Hamish McLean interviews Joe Acker, CEO of the EMS Global Foundation, who brings 35 years of experience in running emergency medical services across Australia and Canada. Joe discusses the critical need for EMS leadership to balance high professional standards with a "leading with love" approach. He explores the challenges of shifting EMS culture from traditional paramilitary structures toward a modern healthcare-focused model, emphasizing the importance of transparency, showing up for staff, and building strong collaborative partnerships rather than operating in isolation. For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts (https://www.youtube.com/@ems-global2048/podcasts) Our website: https://emsglobalfoundation.org/ (https://emsglobalfoundation.org/) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

4. 

   18 Jul 2026

   How Uzbekistan rebuilt Soviet‑era EMS

   Connect with us (https://www.buzzsprout.com/2624539/fan_mail/new) When I sat down in Brisbane to record this Before the Hospital conversation with Dr Khikmat Anvarov in Uzbekistan, I expected a discussion about ambulances and equipment. What I heard instead was a thirty‑year story of how Uzbekistan has tried to rebuild emergency care as a national system rather than a collection of services. For colleagues working on EMS in resource‑constrained systems, this episode offers a rare, first‑hand account from one of the architects of reform – and a reminder that emergency care is built through governance, pathways and people long before the hospital door. We talk about: •Why buying more ambulances and equipment is not enough in post‑Soviet and LMIC settings. •How inter‑district emergency hospitals were designed to serve around one million people each. •What telemedicine and “expertise travelling faster than the patient” now look like in practice. •The political and practical realities of long‑term EMS reform in Uzbekistan, and why honest reporting of delays and gaps matters more than perfect metrics. For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts (https://www.youtube.com/@ems-global2048/podcasts) Our website: https://emsglobalfoundation.org/ (https://emsglobalfoundation.org/) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

5. 

   20 Jun 2026

   40 patients on one EMS shift

   Connect with us (https://www.buzzsprout.com/2624539/fan_mail/new) Dr Biyamba graduated from medical school in Mongolia and went straight to the ambulance. No transition, no supervised ramp-up - just the dispatch system in Ulaanbaatar and whatever came next. In a single summer shift, he treats 30 to 40 patients. In winter, that volume climbs to 90. Of those, roughly half genuinely require an emergency ambulance. The rest receive assessment, advice, and whatever treatment can be provided at the door. Nine to fifteen patients are transported; the others stay home. This is not a gap in the system. This is the system. In this episode of Before the Hospital, Dr Biyamba describes what it actually takes to run emergency care in Mongolia's capital - the caseload, the equipment, the training he received, and the structural reforms needed for workforce development. His account raises a critical health policy question that applies well beyond Ulaanbaatar: when a health system cannot afford to ease new doctors in gradually, what does that do to clinical confidence, patient safety, and amenable mortality? In this episode: What a 24-hour ambulance shift looks like in Ulaanbaatar across seasons. How the 103 system triages who gets transported and who stays home. What equipment a Mongolian ambulance doctor carries—and what is missing. Why new doctors in Mongolia start on the ambulance rather than a supervised hospital ward. The specific training Dr Biyamba found most valuable, and the operational gaps that remain. The question this episode leaves open: If the ambulance is where new doctors learn under pressure, what does that mean for the patients who are part of that learning - and is there a more sustainable model for low-to-middle-income countries? For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts (https://www.youtube.com/@ems-global2048/podcasts) Our website: https://emsglobalfoundation.org/ (https://emsglobalfoundation.org/) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

6. 

   14 Jun 2026

   No One Is Fixing Dead Time. Until Now.

   The call has started. The patient is waiting. And the clinician is alone with their thoughts ... until now. Every ambulance call begins the same way. A dispatch notification. A vehicle moving. A clinician alone, working through what might confront them and what they will do when they arrive. That window — from dispatch to arrival — is what Joe Acker calls dead time. It is largely unexamined in the research literature, inconsistently used in practice, and quietly one of the most consequential periods in prehospital care. Simon Grosjean is an EMS physician in Aosta Valley, northern Italy. He encountered that silence on a night call - a routine case that became a breech presentation, no specialist reachable, searching the internet on his phone when his EMT partner raced him to the scene. The delivery went well. Simon was honest about why: physiology, not preparation: “This time I was lucky.” He spent the following year building something so he would not have to rely on luck again. EMSy is the AI-powered clinical decision support tool Simon developed not a diagnostic engine nor to replace clinical judgement. What it does is act as what Simon calls “a good librarian”: drawing together dispatch information, medication histories, ECG findings, and prehospital literature into a structured summary a provider can scan while their hands are already working. Voice-prompted. One app. No switching between tabs. In this episode, Joe and Simon work through what dead time actually is, why dispatch framing creates tunnel vision before the clinician even arrives, and why paramedics so often leave calls without ever knowing what their patient’s diagnosis turned out to be. They then road-test EMSy against a chest pain scenario - not for the clinical content, but for what it reveals about how much cognitive preparation is possible in that pre-arrival window, and how little of it currently happens by design. The episode closes on a question that matters for every service, everywhere. EMSy is about to be piloted in Mongolia - a place with different languages, different systems, and the same fundamental problem: a clinician, alone, moving, deciding. This is not a conversation about technology replacing people. It is about what fills the silence before you arrive. Thanks for reading! Subscribe for free to receive new posts and support our work. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

7. 

   26 May 2026

   You Can't Clone Doctors. So She Found Another Way.

   When Dr Suvd Nugui returned to Mongolia after training in the United States, she came back to a system where most of her colleagues had never heard the word “paramedic.” Neither had her parents. Her solution was simple and radical: if she could not be everywhere, she could train people who could. Seven years later, she is training more than 80 clinicians and drivers annually with a team of international paramedics. One result: Mongolian EMS doctors are performing ECG interpretation on monitors that sat unused for months because no one knew how to operate them. In this episode, Dr Suvd speaks with podcast host Hamish McLean about what sustained prehospital capacity-building actually looks like from the inside - the cultural barriers, the equipment gaps, the communication challenges and why a team that keeps coming back changes everything. About Dr Suvd Nugui Dr Suvd Nugui is a Mongolian cardiologist and in-country director of the EMS Global Foundation’s Mongolia programme, where she has led training delivery and local stakeholder engagement since 2018. Before the Hospital is produced by EMS Global Foundation. We examine how resource-constrained emergency care systems are built, funded, and reformed before the patient reaches hospital. Learn more at ems-global.org. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

8. 

   25 May 2026

   He came from a Yorkshire air ambulance. Then this

   Paramedic James Stubley comes from one of the most advanced prehospital aeromedical platforms in the UK. Double-crewed, doctor-qualified, critical care at altitude. He is now teaching Mongolian on-road ambulance doctors and coming back for a second year to finish the job he started. This episode is a short, direct answer to this question: can you deliver emergency care with basic equipment, or does complexity save lives? James has now worked in both environments. His answer matters. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

9. 

   19 May 2026

   Why these doctors are learning from paramedics

   Dolly McPherson is an aeromedical paramedic with the Hampshire and Isle of Wight Air Ambulance (UK). Her normal shift involves a helicopter, a doctor, advanced airway and trauma equipment and closed-loop communication rehearsed to the point of instinct. When something goes wrong, she has everything she needs within arm’s reach. In Mongolia, she has her hands and whatever the team can improvise. In this conversation, Dolly reflects on what it means to teach emergency care fundamentals to doctors whose clinical knowledge is exceptional but whose prehospital environment offers almost nothing to work with - no heated blankets in minus 40 degrees, no oxygen saturation monitors when batteries die in the cold, no protocols for safely leaving a patient at home when 75% of calls end exactly that way. But the more searching questions run the other direction. What does it mean that a flight paramedic from the UK is teaching doctors emergency medicine and learning something back? What does Mongolian ingenuity look like when the equipment fails and the patient still needs help? And what does a system built on doing the basics exceptionally well have to teach well-resourced EMS? This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

10. 

    18 May 2026

    When less teaches more: What Mongolia's EMS reveals about Western systems

    Canadian paramedic Joe Acker watched a Mongolian ambulance doctor suture a head laceration on the roadside in the capital Ulaanbaatar, write a prescription and send the patient home. In Canada, the UK or Australia, that patient goes to hospital. No question. That moment has stayed with him - not because Mongolia got it wrong, but because they got something right that well-resourced Western systems are just starting to replicate. Joe Acker has spent 35 years at the senior executive level of EMS in Canada and Australia - Chief Executive of Ambulance Tasmania, Provincial Director of Clinical Practice for BC Emergency Health Services, Executive Director of EMS for Alberta Health Services. He is also a working critical care paramedic, registered in both countries. He knows what a high-income ambulance system looks like from every angle. He keeps coming back to Mongolia anyway. On his own time. In this conversation, Joe reflects on two years of training Ambulance 103 doctors and drivers in Ulaanbaatar - what has changed, what the training has produced, and where Mongolia goes from here. But the more searching questions run the other direction: what should the systems he came from be learning from a city doing 40 calls per ambulance per 24-hour shift with a fraction of the resources? This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

11. 

    17 May 2026

    Mongolia's doctors know medicine. This is what they're missing.

    Mongolia’s ambulance doctors are qualified physicians. They know the medicine. What most of them have never been taught is what to do with that knowledge before the patient reaches hospital. That is the problem international paramedic Leon Baranowski flew to Ulaanbaatar to help solve - for the third time. This conversation was recorded mid-programme at the 103 Ambulance Service, while the training was still running. Leon is Operations Director for EMS Global and Senior Lecturer in Paramedicine at Monash University, and he has spent close to two decades working across paramedic systems in the UK, Canada, and Australia. But what he talks about in this episode is not his career. It is what happens when you try to build prehospital capability inside a system that was never designed around it. The gap he describes - between clinical knowledge and prehospital application - is not unique to Mongolia. It recurs across health systems that rely on doctors and drivers rather than a paramedic workforce. Teamwork under pressure, communication on scene, decision-making before the hospital rather than inside it: these are not things medical school teaches, and they are not things that transfer automatically from hospital to ambulance. What EMS Global is attempting in Ulaanbaatar is also not a short-term training visit. The harder question this episode sits with is whether you can build something that lasts after the instructors get on the plane home. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

12. 

    14 May 2026

    What a genuine thank you means when you're running forty calls a shift

    Dr Judy is an ambulance doctor with the Ulaanbaatar Ambulance Centre, one of the frontline clinicians EMS Global Foundation has been working alongside since 2017. During the 2025 mission, she did something that captures the programme’s direction exactly: she participated as a trainee, contributed as a translator for the international instructor team, and helped bridge the gap between what was being taught and what her colleagues needed to understand. She also agreed to sit down with us and talk about her work. The conversation is short, unscripted and worth your time. Dr Judy describes what it is like to run forty calls in a single shift, the difference between the critical patient and the patient who simply has to wait. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

13. 

    13 May 2026

    What minus 40 teaches you about priorities

    Jarrod Bell is a wilderness intensive care paramedic from Tasmania (Australia) - and a two-year EMS Global Foundation volunteer instructor in Ulaanbaatar. In this episode, Jarrod reflects on what draws a Tasmanian paramedic back to Mongolia for a second year: the adaptability and workload of Mongolia's ambulance doctors, the overlooked importance of environmental control in extreme cold and what a negative 40 degrees car rollover scenario teaches you about prehospital priorities. He also shares how working here has changed his sense of what paramedicine can achieve. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

14. 

    12 May 2026

    Why Tania came back to Mongolia

    Tania Johnston is an intensive care flight paramedic, emergency nurse, and academic based in British Columbia - and a two-year EMS Global Foundation volunteer in Ulaanbaatar. In this episode, Tania reflects on what she observed between her first and second mission: the strengths of Mongolia’s ambulance doctors, the opportunity to bridge contemporary prehospital practice with operational reality, and why teaching doctors when you are a paramedic works better than you might expect. She also shares the memory that brought her back for year two. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit emsglobalfoundation.substack.com (https://emsglobalfoundation.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

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