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The Critical Debrief

The Critical Debrief

Written by: Dr Caroline Wilson Dr Kit Rowe Dr Pramod Chandru Dr Samoda Mudalige Dr Shreyas Iyer
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The team from Network Five Emergency Medicine present a fresh new podcast with clinical updates, analysis and deep dives into the world of Emergency Medicine!© 2025 Network Five Emergency Medicine Group Inc Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • DEEP DIVE - Clinical Event Debriefing with Prof Walter Eppich and A/Prof Andrew Coggins

    DEEP DIVE - Clinical Event Debriefing with Prof Walter Eppich and A/Prof Andrew Coggins
    Jul 1 2026
    (AI) What is clinical event debriefing, how does it differ from the simulation debriefing we all know, and how do you actually make it routine in a busy ED? Emergency clinicians Prof Walter Eppich and A/Prof Andrew Coggins join host Kit Rowe and the team for a deep dive.The panel works through what "clinical event debriefing" (CED) really means and how it differs from simulation debriefing: it follows a real patient event, is rarely planned, and often happens when the team is most emotionally activated. A central thread is aligning intention with impact — distinguishing debriefing to learn, to manage, and to treat, and the risks of drifting into psychological treatment without the training for it. The bigger missed opportunity, they argue, is reserving debriefing only for catastrophic events, when routine, brief, learning-oriented debriefs build the skills and psychological safety a team needs before the critical case arrives.Along the way: who should facilitate (and why it shouldn't default to the team leader), end-of-shift check-ins, "coffee and cases," M&M as after-action review, retrieval-medicine debriefing, and the support gap facing senior clinicians — "who debriefs the debriefers?" The consistent takeaway: pick a simple framework and use it, keep it short, lead with shared understanding and humility, and just start debriefing.Host: Kit Rowe | Panel: Pramod Chandru, Caroline Wilson | Guests: Prof Walter Eppich (University of Melbourne), A/Prof Andrew Coggins (Westmead)⏱️ Episode timestamps00:00 – Disclaimer00:13 – Intro music00:30 – Welcome and panel introductions02:08 – Opening question: what is clinical event debriefing?03:04 – CED vs simulation debriefing; the after-action review and its origins04:36 – Key differences: a real patient, usually unplanned, compressed time09:09 – Is CED only for "sinister" events? Reconciling experience with its potential role11:05 – Learning vs caring for traumatised staff; aligning intention and impact14:51 – Support at 3am without a psychologist: psychological first aid (look, listen, link)16:59 – The learn–manage–treat spectrum; the COVID-era genesis of the BMJ paper21:46 – Who should lead a debrief? Charge-nurse facilitation; self-led teams27:34 – Debriefing the shift rather than the single event; translational simulation30:16 – The STOP5 hot-debrief tool30:47 – What to ask in a routine end-of-shift debrief32:08 – Pramod's case (fat embolus, cardiac arrest); "who debriefs the debriefers?"33:21 – Andrew's observational study; check-ins and building psychological safety35:44 – Peer support and the loss of community on becoming a consultant38:53 – Making sense of an event with a trusted colleague41:28 – Preparing peers to debrief each other; ongoing research collaboration43:46 – Community of practice; separating coaching/mentorship from debriefing46:03 – Walter's case story: an overnight paediatric tragedy and an informal debrief48:35 – Structure and frameworks: use one, keep it simple; humility as a leader51:01 – Shared understanding and ground rules as the core of a safe debrief52:00 – M&M as after-action review; "outcome review" and ground rules54:11 – Debriefing in retrieval medicine; "coffee and cases"56:02 – "Just start debriefing"; systematic review of tools; the INFO tool; the seatbelt analogy58:56 – Wrap-up: take-home messages from the panel59:47 – Briefing and debriefing synergy; team reflection research1:01:14 – Sign-off📚 References & resources (in order of discussion)Kolbe M, Schmutz S, Seelandt JC, Eppich WJ, Schmutz JB (2021). Team debriefings in healthcare: aligning intention and impact. BMJ. 2021;374:n2042. https://doi.org/10.1136/bmj.n2042 (~11:05)Keiser NL, Arthur W Jr (2021). A meta-analysis of the effectiveness of the after-action review (or debrief) and factors that influence its effectiveness. Journal of Applied Psychology. 2021;106(7):1007–1032. https://doi.org/10.1037/apl0000821 (~11:44)Keiser NL, Arthur W Jr (2022). A meta-analysis of task and training characteristics that contribute to or attenuate the effectiveness of the after-action review (or debrief). Journal of Business and Psychology. 2022. https://doi.org/10.1007/s10869-021-09784-x (~11:54)Rose S, Cheng A (2018). Charge nurse facilitated clinical debriefing in the emergency department (the INFO tool). CJEM. 2018;20(5):781–785. https://doi.org/10.1017/cem.2018.369 (~22:24)Walker CA, McGregor L, Taylor C, Robinson S (2020). STOP5: a hot debrief model for resuscitation cases in the emergency department. Clinical and Experimental Emergency Medicine. 2020;7(4):259–266. https://doi.org/10.15441/ceem.19.086 (~30:16)Coggins A, De Los Santos A, Zaklama R, Murphy M (2020). Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes. BMC Emergency Medicine. 2020;20(1):79. https://doi.org/10.1186/s12873-020-00370-7 (~33:21)Petrosoniak A, ...
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    1 hr and 2 mins
  • The Pitt S1E03 Debrief

    The Pitt S1E03 Debrief
    Jun 8 2026
    Three rapid clinical updates — tenecteplase for stroke, the danger of overshooting blood pressure after ICH, and the new Surviving Sepsis guidelines ACEP won’t endorse — then The Pitt S1E03 on death, grief, hot debriefs and caring for culturally diverse patients in the ED.Hosts: Dr Shreyas Iyer, Dr Caroline Wilson, Dr Pramod Chandru, Dr Mariez Gorgi🎞️ Episode Synopsis (AI)The team opens with three rapid clinical updates. Caroline covers the shift in acute ischaemic stroke care towards tenecteplase as the preferred thrombolytic in place of alteplase, prompted by the NSW ACI clinical practice guide, and discusses the extended 4.5–9 hour and wake-up stroke windows, the role of perfusion imaging, and the value of the Telestroke service in regional NSW. Pramod presents a recent paper showing that overshooting blood pressure targets after intracerebral haemorrhage is associated with worse outcomes, using it as a springboard into a broader, sceptical discussion of evidence standards, trial design, and the harms of overzealous blood pressure lowering. Pramod closes the updates with breaking news: the release of the 2026 Surviving Sepsis Campaign guidelines and ACEP’s decision not to endorse them, unpacking the three stated concerns.The conversation then turns to The Pitt’s third episode, which the team uses to explore death and grief in emergency practice — first deaths, the weight of decision-making as a junior, and the experiences that stay with clinicians for years. They examine the role and limits of the hot debrief, how senior and junior staff draw different value from it, and practical ways to look after a team after a difficult case. The episode finishes on the show’s portrayal of an interpreter transforming care for a culturally and linguistically diverse patient, and the team’s reflections on advocating for diverse communities in a time-pressured ED.⏱️ Episode Timestamps00:00 — Disclaimer & intro00:28 — Welcome & introductions (first-time guest Mariez Gorgi)01:06 — Update 1: Stroke thrombolysis — Tenecteplase replacing alteplase (Caroline)11:43 — Update 2: Blood pressure control after ICH — overshooting and harm (Pramod)21:30 — Update 3: 2026 Surviving Sepsis guidelines & ACEP non-endorsement (Pramod)25:48 — The Pitt S1E03 — episode recap (Mariez)27:51 — Death & grief in emergency medicine42:31 — Hot debriefs: value, pitfalls, and looking after staff57:12 — Interpreters & culturally and linguistically diverse patients62:20 — Wrap-up & what’s coming📚 References & Resources (in order of discussion)NSW Agency for Clinical Innovation (February 2026) — Intravenous thrombolysis for adult patients with acute ischaemic stroke: clinical practice guide.🔗 ACI clinical practice guide (PDF)⏱️ ~01:06Names tenecteplase as the preferred first-line IV thrombolytic; alteplase remains an effective TGA-approved alternative. Also addresses the extended 4.5–9 hour / wake-up window (beyond 4.5 h is outside TGA approval and reserved for specialist-led decisions). Primary source for Caroline’s update, including the small functional-outcome benefit cited from its underpinning evidence base.Shi AC, Taylor T, Huang C-C, Singhal AB, Goldstein JN, Bevers MB, Hou PC (2025) — Early Intensive Blood Pressure Reduction After Intracerebral Hemorrhage Is Associated With Worse Functional Outcome: The Risk of Overshooting Blood Pressure Goals. Annals of Emergency Medicine.🔗 Annals of Emergency Medicine⏱️ ~11:43Retrospective cohort (two academic centres, 2017–2023). Overshooting to <120 mmHg systolic associated with worse functional outcome — the paper Pramod presents.Anderson CS, et al. (2013) — Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage (INTERACT2). New England Journal of Medicine.🔗 NEJM⏱️ ~15:24Foundational RCT on early intensive BP lowering in ICH. INTERACT3 (Lancet 2023) and the Moullaali et al. preplanned pooled individual-patient-data analysis (referenced as “a pooled analysis”) extend this evidence base.Préterre C, Gaultier A, Obadia M, et al. (2025) — Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. The Lancet Neurology.🔗 The Lancet Neurology⏱️ ~16:40The trial Pramod uses to illustrate trial-design and power pitfalls. Visual-acuity improvement was 66% with alteplase vs 48% with oral aspirin — an ~18-point difference that did not reach significance, in a trial the authors judged underpowered (improvement in both arms ran well above the ~40% vs ~10% the study was designed to expect).Surviving Sepsis Campaign (2026) — Prescott H, Antonelli M, Alhazzani W, et al. International Guidelines for Management of Sepsis and Septic Shock 2026. Critical Care Medicine / Intensive Care Medicine.🔗 Surviving Sepsis ...
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    1 hr and 4 mins
  • The Pitt S1E02 Debrief

    The Pitt S1E02 Debrief
    Mar 18 2026

    🎙️ The Critical Debrief – The Pitt S1E02 Debrief

    Duration: ~65 minutes


    Hosts: Shreyas Iyer, Pramod Chandru, Caroline Wilson


    Topic: Clinical updates in cardiology, antimicrobial stewardship, and febrile infants, followed by a case-based discussion of The Pitt Episode 2.


    Show notes generated with AI assistance.

    🎞️ Episode Synopsis (AI)

    In Episode 2, the team explores ACS updates, AI ECG interpretation, antibiotic stewardship, and febrile infant risk stratification. The second half applies these principles through a discussion of The Pitt Episode 2, focusing on ethical decision-making, paediatric toxicology, mandatory reporting, and airway management in trauma.

    ⏱️ Episode Timestamps

    00:00 – Intro / housekeeping

    02:04 – Cardiology update: ACS, OMI concepts

    10:28 – AI ECG (Queen of Hearts)

    18:42 – Antibiotic duration

    26:10 – Febrile infants (61–90 days)

    35:23 – The Pitt Episode 2 recap

    39:50 – End-of-life care

    46:30 – Paediatric THC ingestion

    54:40 – Mandatory reporting

    1:02:10 – Airway management in trauma

    📚 References & Resources (in order of discussion)

    1. Heart Foundation & CSANZ (2025) – ACS Guideline

    - https://www.heartfoundation.org.au/for-professionals/acs-guideline-overview

    - Referenced during ACS discussion; outlines modern troponin and risk pathways.

    2. Meyers HP et al. (2025) – Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio)

    - https://pubmed.ncbi.nlm.nih.gov/40763602/

    - Validation study of Queen of Hearts AI detecting occlusion MI.

    3. Zahavi A et al. (2025) – Short vs. long antibiotic treatment for pyelonephritis and complicated urinary tract infections: a living systematic review and meta-analysis of randomized controlled trials

    - https://pubmed.ncbi.nlm.nih.gov/40228579/

    - Short-course antibiotics non-inferior for pyelonephritis.


    4. Aronson PL et al. (2025) – Prediction Rule to Identify Febrile Infants 61–90 Days at Low Risk for Invasive Bacterial Infections

    - https://publications.aap.org/pediatrics/article-abstract/156/3/e2025071666/203219/Prediction-Rule-to-Identify-Febrile-Infants-61-90?redirectedFrom=fulltext

    - Low-risk stratification for febrile infants.


    5. Aronson PL et al. (2025) – Risk of Bacterial Infections in Febrile Infants 61 to 90 Days Old With Respiratory Viruses

    - https://publications.aap.org/pediatrics/article-abstract/156/1/e2025070617/202105/Risk-of-Bacterial-Infections-in-Febrile-Infants-61?redirectedFrom=fulltext

    - Lower bacterial infection risk in viral-positive infants.


    6. Pantell RH et al. (2021)

    - https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783

    - Foundational AAP febrile infant guideline.

    7. Wang GS et al. (2016)

    - https://jamanetwork.com/journals/jamapediatrics/fullarticle/2534480

    - Paediatric cannabis toxicity data.


    8. NSW Mandatory Reporter Guide

    - https://dcj.nsw.gov.au/children-and-families/protecting-our-kids/mandatory-reporters/mandatory-reporters--what-to-report-and-when/the-mandatory-reporter-guide--mrg-.html

    - Framework for reporting child safety concerns.

    9. Difficult Airway Society Guidelines

    - https://das.uk.com/guidelines/das_intubation_guidelines/

    - Principles of difficult airway management.

    10. ATLS – American College of Surgeons

    - https://www.facs.org/quality-programs/trauma/atls/

    - Trauma airway management principles.

    📬 Contact the Team

    📧 hello@n5em.com

    We’d love your feedback or suggestions!
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    1 hr and 2 mins
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