This is a repost of an episode I recorded back in the early years of podcasting. It remains the most downloaded episode of the entire podcast. Steve Rashford is the medical director of The Queensland Ambulance Service (QAS) with 5,000 staff and 1,300 response vehicles. In the episode Steve gives some of his perspectives of a pre-hospital careers spanning over 20 years in duration within multiple services. QAS has a contemporary approach to clinical service delivery and innovation in prehospital trauma care. It also operates a tiered system of pre-hospital care with Advanced Care Paramedics (ACPs), Intensive Care Paramedics (ICPs) and a smaller cohort of HARU Paramedics. In this episode we discuss a variety of topics: High Acuity Response Unit (HARU) both its inception and the clinical remit for the HARU. Governance around the HARU program and provider quality assurance for some of the procedures (RSI, on-call advice, blood products and the bleeding patients). Quality improvement and where the program is heading The lessons learnt building the HARU and ICP schemes in QLD. I hope you enjoy this episode as I found it both insightful and helpful to look at how other systems approach high performing teams and continuous improvement. Please feel free to reach out to me at [email protected] as I always welcome feedback.