In this conversation we will examine the concept of the performance pizza. This is a concept which examines three main domains of performance within pre-hospital care; the predictable routine, the predictable emergencies and the unpredictable emergencies. We will dig into each of these domains and examine what each constitutes, how you train for each state and how to navigate each.     To do this I have Stephen Hearns with me. Stephen is a consultant in emergency and aeromedical retrieval medicine. He works with Scotland’s Emergency Medical Retrieval Service (EMRS). This aeromedical retrieval service delivers pre-hospital critical care for major trauma patients, rural hospital secondary retrievals and major incident responses. Inspired by experience gained working on London’s air ambulance and in Queensland Australia, Stephen led the establishment of this team from a small voluntary service in 2004 to what is now a fully government funded aeromedical retrieval organisation with an international reputation. In the episode we discuss: ·      The three performance domains – how did Steve come to rest on these domains and how do they look in practice. ·      The predictable routine – Patients and/or skills that are executed everyday and are commonplace within practice. ·      The predictable emergencies – The High Acuity High Occurrence skills or patient presentations (RSI for example)  ·      The unpredictable emergencies – the High Acuity Low Occurrence (HALO) skills that might fall into the unpredictable spectrum (Surgical Airway) ·      Putting it all together in training and how simulation and case review plays into this. ·      How Core Cognition seeks to educate these areas within high performance teams. You can find more on Steve's Core Cognition website here: https://corecognition.co.uk/ The performance pizza can be seen here: https://corecognition.co.uk/performance-infographics/performance-pizza My thanks to Steve for an insightful and educational discussion.