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.

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.

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?