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.

For more podcasts visit: https://emsglobalfoundation.substack.com/podcast