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?

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?