Day oneFollowing a welcome from the morning's chair, Prof Fiona Lecky, ScHARR, University of Sheffield and honorary consultant in emergency medicine, Taunton and Somerset NHS Foundation Trust, the conference began with a discussion of the state of emergency medicine services in the UK by Dr Clifford Mann, president, College of Emergency Medicine and consultant in emergency medicine, Taunton and Somerset NHS Foundation Trust. Dr Mann alluded to the media attention surrounding emergency care professionals in 2013, which arose as a result of widespread concern regarding delays in ambulance handovers, breaches of the four hour target and incidents of poor care. In response to the competing challenges of rising patient attendances, the College of Emergency Medicine published 10 priorities for resolving the crisis in Emergency Departments (also referred to as ‘CEM 10’), which clearly sets out the action which needs to be taken to address the current crisis in A&E.Prof Lecky then delivered a talk on the Head Injury Transportation Straight to Neurosurgery (HITS-NS) Trial, for which she is the chief investigator. The study aimed to assess the feasibility of conducting a clustered randomised clinical trial of early neurosurgery in patients with traumatic brain injury.After morning coffee, Prof Christoph Redelsteiner, scientific director, Emergency Health Services Management Program, Danube University, Austria, addressed the question: is there a need to standardise paramedic practice throughout Europe? Considering differences in the delivery of pre-hospital care of European nations and comparing commonalities, Prof Redelsteiner discussed criteria for a future pre-hospital care provider in a larger European context, that might help to deliver a more equal and balanced system.Drew Wemyss, head of strategy implementation, Scottish Ambulance Service, then discussed different alternative systems of care offered by the Scottish Ambulance Service as a result of strategic aims outlined in their framework document: Working together for better patient care. Focusing on the pre-hospital management of older frail people, Mr Wemyss highlighted the role of the ambulance service in providing high-quality clinical care and navigating patients to the right care, either through telephone or face-to-face clinical assessment.Following lunch, Dr Anil Hormis, consultant in anaesthesia, critical care and pre-hospital emergency medicine, Rotherham NHS Foundation Trust, gave a talk on simulation training and non-technical skills in pre-hospital emergency medicine. Outlining the importance of simulation training in the pre-hospital environment, Dr Hormis explained how it can be used to help cement skills such as decision making and task management in an environment where many different teams are required to work together. Dr Gareth Grier, consultant in emergency medicine and pre-hospital care, the Royal London Hospital and London's Air Ambulance, also delivered a talk on simulation, instead outlining the Royal London Hospital approach. Reiterating the difficulties faced by pre-hospital clinicians when placed in challenging environments, Dr Grier highlighted the benefit of high-fidelity scenario simulation. Perhaps the most thought-provoking take home message of the talk came when he said: ‘you get an expert and change them to a non-expert just by changing the environment.’The final talk of this session was delivered by Dr Kudakwashe Dimbi, mental health clinical lead, London Ambulance Service NHS Trust, on mental health difficulties in the pre-hospital environment. Given that patients suffering from mental health disorders make up a notable portion of the London Ambulance Service's workload, Dr Dimbi highlighted some of the considerations to take into account when providing care to patients suffering from a mental health disorder.The remaining talks of the day were intended as interactive treatment case studies; however, due to a somewhat apprehensive room of delegates, seemed to lack the ‘interactive’ element. That being said, this did not detract from the engaging content that was presented. Dr Mark Bloch, consultant anaesthetist, Aberdeen Royal Infirmary and Aberdeen Royal Children's hospital spoke on difficult airway management; Gareth Mallon, paramedic, East Midlands Ambulance Service NHS Trust, spoke on sudden cardiac arrest; and Dr Ron Daniels, chair, UK Sepsis Trust and chief executive, Global Sepsis Alliance closed the day with a talk on the management of sepsis.