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In this episode of the Before the Hospital Podcast, host Hamish McLean interviews Joe Acker, CEO of the EMS Global Foundation, who brings 35 years of experience in running emergency medical services across Australia and Canada. Joe discusses the critical need for EMS leadership to balance high professional standards with a "leading with love" approach. He explores the challenges of shifting EMS culture from traditional paramilitary structures toward a modern healthcare-focused model, emphasizing the importance of transparency, showing up for staff, and building strong collaborative partnerships rather than operating in isolation.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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When I sat down in Brisbane to record this Before the Hospital conversation with Dr Khikmat Anvarov in Uzbekistan, I expected a discussion about ambulances and equipment. What I heard instead was a thirty‑year story of how Uzbekistan has tried to rebuild emergency care as a national system rather than a collection of services.

For colleagues working on EMS in resource‑constrained systems, this episode offers a rare, first‑hand account from one of the architects of reform – and a reminder that emergency care is built through governance, pathways and people long before the hospital door.

We talk about:
•Why buying more ambulances and equipment is not enough in post‑Soviet and LMIC settings.
•How inter‑district emergency hospitals were designed to serve around one million people each.
•What telemedicine and “expertise travelling faster than the patient” now look like in practice.
•The political and practical realities of long‑term EMS reform in Uzbekistan, and why honest reporting of delays and gaps matters more than perfect metrics.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Dr Biyamba graduated from medical school in Mongolia and went straight to the ambulance. No transition, no supervised ramp-up - just the dispatch system in Ulaanbaatar and whatever came next.

In a single summer shift, he treats 30 to 40 patients. In winter, that volume climbs to 90. Of those, roughly half genuinely require an emergency ambulance. The rest receive assessment, advice, and whatever treatment can be provided at the door. Nine to fifteen patients are transported; the others stay home.

This is not a gap in the system. This is the system.

In this episode of Before the Hospital, Dr Biyamba describes what it actually takes to run emergency care in Mongolia's capital - the caseload, the equipment, the training he received, and the structural reforms needed for workforce development.

His account raises a critical health policy question that applies well beyond Ulaanbaatar: when a health system cannot afford to ease new doctors in gradually, what does that do to clinical confidence, patient safety, and amenable mortality?

In this episode:

• What a 24-hour ambulance shift looks like in Ulaanbaatar across seasons.
• How the 103 system triages who gets transported and who stays home.
• What equipment a Mongolian ambulance doctor carries—and what is missing.
• Why new doctors in Mongolia start on the ambulance rather than a supervised hospital ward.
• The specific training Dr Biyamba found most valuable, and the operational gaps that remain.

The question this episode leaves open: If the ambulance is where new doctors learn under pressure, what does that mean for the patients who are part of that learning - and is there a more sustainable model for low-to-middle-income countries?

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/