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um So we're gonna have Elizabeth, Miss Elizabeth Westwood up here, and she is the winner of the oral presentation for the S A prize. So while she makes her way up, we've got Elizabeth, who is a CT to surgical trainee with an interest in sustainable surgery. She's currently working in West Yorkshire. She campaigns with medic leads on health, equality and social justice issues, both locally and nationally. And we can give you an email address if you want to get in touch with her. So well done, Elizabeth. Hello, everyone. I'm really honored to be able to speak here after such an incredible day yesterday and today. Speakers. So thank you very much. And although I can't speak from direct experience of pre hospital care or lower middle income country work, I've learned a lot about the challenges that face prehospital care. And I think that's left with a lot of respect for the work that colleagues are doing in that area. And so I'm hoping to do them justice in a bit of a whistle stop tour of what they faced with you. Um, so looking at the hospital care through the lens of global health and sustainable development. It's clear to see how central is to a functioning and holistic health care system and improvement in neonatal mortality, death from communicable disease and injuries from road traffic accidents, a really key indicators for the W. H. O s and sustainable development goals. So it goes without saying that management of things like postpartum hemorrhage, strokes and polytrauma a hugely reliant on time sensitive interventions so good pre hospital care is really essential for that, given that the morbidity and mortality globally falls heaviest on the most resource deplete areas. And it's really important that as hospital care and and healthcare services developed generally, that pre hospital care isn't left behind. And so I think something that's been mentioned. A lot has been funding, and it's one of the most frequently cited barriers for pre hospital care services between upfront investments like buildings and vehicles, as well as recurrent cost such as fuel wages training. It actually takes a huge amount to run a service like this, um as well as the sum of money that's needed. The means of generating that is also really important. Um, so the commerce method of financing globally as taxation but who is taxed and how varies quite a lot. And so large investment and infrastructure often covered by loans and grants from governments and NGOs, um, as well as banks and operational costs often footed by the public themselves through combinations of taxation, core payment insurance schemes and these kind of the point abuse, um, costs the past to the public have to be really carefully considered so that they don't become a deterrent to access to care. And while philanthropy and international aid a an incredibly important, well meaning and gladly received, they are not dependable, longer term income source, and they sometimes risk shifting autonomy away from the target population themselves. However, um, however, money is generated, um, cash strapped systems need to create maximum impact for minimum cost. Um so cost effective initiatives are really important, and they often focus on pre existing resources and behavior patterns. So, for example, in pre hospital care, there's been a lot of initiatives around education projects for a taxi and bus drivers who are already the by proxy first responders. In a lot of these situations, um, at the other end of the scale, there's things like hospital helicopter emergency services, which obviously offer a huge amount in terms of access to geographically challenging areas. But they are hugely costly, and if they're not carefully triage and coordinators, then they can become more of a burden than a benefit. Um, so making critical decisions around big budgets is a really huge responsibility, and it it kind of follows the governance and clear working structures would be necessary to facilitate that. And yet many countries lack a unified organization or kind of one leader to grapple with those problems and the responsibilities kind of distributed through kind of individual localities, private firms n G. O. S. And that kind of patchwork of coverage can lead to gaps, duplications and confusion. And actually around the third of countries don't have access to one designated free emergency number to call if they need help uniting organizations in the shared governance and, as Mike has shown, can pool resources. It creates accountability and it simplifies services. And it also opens the door for establishing kind of national guidelines and standardization for dispatches in the emergency providers themselves. And so far I've spoken a lot about the intrinsic issues to pre hospital services. But much of the difficulties that arise from providing that services. The fact that it's usually dependent on factors direct outside it's direct control. And and for that reason it's really important that we think about kind of the wider development goals. And if the hospital care is to flourish and unrest threatens the continuity of basic foundations like funding and supply chains. And it also increases demand for services and creates casualties of workers themselves, as well as being caught in the crossfire. Too often, healthcare workers are direct targets in conflict, and although these atrocities are really difficult to quantify when they are, I think the the human impact and violence can be lost in kind of scale and statistics. Um, so I would really highly recommend, um, Mohammed. Yeah, please documentary ambulance, because I think it's a really great depiction of the true human impact of that. They can't really be conveyed inwards and figures, Um, sadly, violence against healthcare workers is not limited the confines of war and despite the protection of medical personnel and infrastructure under international law, very, very few of these crimes actually get brought to justice. And it's been shown that for every 10% further that a patient is from hospital, then all cause mortality increases by around 2%. And remote and rugged geography combined with poor infrastructure infrastructure and causes critical increases in transfer times, as well as posing a direct threat to it as kind of in itself and danger and access issues are only exacerbated when an extreme weather can make roads impossible. Formal recording and naming of roads is not a kind of universal convention, so locating patients can be quite difficult and heavily reliant on local knowledge. And while populations might be, uh, closer to a hospital and traffic congestion and lack of convention, um can be problematic, I think I'm coming to time, but I'll skip quickly through the next slides. But, uh, the next slide kind of talked a bit about kind of mass casualty events, which I think Michael lead to a little bit with the earthquakes and kind of core did. Um, it puts a huge test of resilience on already strained system, and it kind of relies on all the components that we've already talked about, kind of coming together for a proper response to be put forward, and I think Although you can have kind of preparedness exercises and to refine the responses to those disasters, often they're unpredictable. And I think that's all the more reason why our kind of steady progression towards climatic and ecological collapses all the more tragic and unacceptable. And when I was writing this essay, Pakistan was experiencing some of the worst floods it's ever seen and 33 million people were displaced, and at that time there was around 2000 immediate immediate casualties, with many more people now so coming to kind of communicable diseases and malnutrition as a result of the aftermath. And despite being the fifth largest population in the world, Pakistan contributes 1% to the emissions. And so inequality is really at the heart of that issue. And I think that I mean, it's clear that as a for a livable future, we need to rapidly dick are benign eyes. And but as professionals in the health sphere, I think we have an obligation to take both personal responsibility for our own impacts as well as communicating and advocating kind of professionally for avoiding pouring more fuel on the fire. Um, yeah. Uh, last like these, I think I'm running out of time. So I won't talk as much as I was on this last side. But I'm very happy to answer any questions that I've spoken a lot about barriers which can be quite negative. There are lots of success stories that I can tell as well for the research that I've done. So thanks very much. Yeah, I'm going to get right to that. So we do have two other winners of the S A competition. As Mike said there were There were so many amazing essay. So I'd like to invite up Doctor Brenda. Maurice, she's getting here. Take your time, and then we'll also have Doctor Holly. It's forth. Congratulations. Thank you. Amazing. Congratulations to all the winners. So that comes to the end of our prize giving session. We do now have Dr Phil Macau knee. Who is the director of medal. Um, so he'll be coming up to give you a talk on medal and all of the amazing work that he's done. Bill