Pre-Hospital Care Podcast

In this conversation, we will examine Patient Liaison and follow-up. Pre-hospital clinicians are often just the first point of medical contact, so checking in throughout the rehabilitation allows clinicians and patients to close the loop on any unanswered questions and often is a chance to learn about things from the patient’s perspective. This fosters continuous improvement by identifying strengths, weaknesses, and areas for improvement. Additionally, ongoing liaison both humanises patients and builds trust & rapport with clinicians and can bring closure for EMS personnel who often only witness the initial phase of patient care. Knowing patient outcomes and recovery status can improve job satisfaction.

To do this we have Stuart Plumbley and Sarita Taneja with me. Stu is the Patient and Family Aftercare lead at Kent Surrey and Sussex (KSS) Air Ambulance Trust, Emeritus HEMS Paramedic, & Critical Care Paramedic (SECAmb). Sarita is the Patient and Family Aftercare Manager at KSS and was awarded Charity Staff Member of the Year at the Air Ambulances UK Awards of Excellence in 2022. KSS as a service can be found here:

https://aakss.org.uk/

Join me in this episode where I speak with Mike Donal. We unpack his journey through growing up, dropping out of school, drug use, mental health, self-harm, suicidal attempts, steroid use, sex, and mental health section in a hospital, all before 21 years old. We also look at Mike’s journey through the gym, alcohol, relationships, tattoos, and steroids.

Mike shares his 180-degree turn to cleaning everything up and influencing others for the better as well as his current revelations on health, faith, and a balanced mindset. We discuss the theme of selfishness and where that comes from, mental health issues such as addiction to pain and torment, self-harming, the gym, self-loathing and coping mechanisms, steroids, and the second-order effects of steroids.

Mike also talks about his children, Amber and Ezra, and how they played a significant role in his change. Join us as we unpack Mike's story and take-home messages.

In this episode, we speak with Professor Mark Wilson about the forthcoming SIS trial. This randomised study aims to compare the safety and patient outcomes of the current spinal immobilisation practice versus a more flexible "movement minimisation" approach for suspected spinal injury patients. The findings could inform future clinical guidelines.

The main concepts of the trial include assessing if "movement minimisation" is no worse than the current standard "triple spinal immobilisation" for patients suspected of spinal injury in pre-hospital and emergency settings. Current practice of triple spinal immobilisation (rigid board, straps, neck collar) may have potential harms like breathing difficulties, skin/brain injury. Movement minimisation allows more flexibility and comfort, but its safety/efficacy compared to triple immobilisation is unknown. Around 8,316 patients will be randomly assigned to either movement minimisation or triple immobilisation groups. Their neurological function, complications, and long-term well-being will be assessed. The study involved spinal injury and trauma patient groups (ASPIRE, Imperial Trauma PPI) in design, emphasising the need for research before guideline changes.

Results will be shared internationally with patients, the public, paramedics, doctors, and nurses through conferences, social media, reports, and publications to inform future NHS guidelines. More information on the trial can be found here: https://warwick.ac.uk/fac/sci/med/research/ctu/trials/sis/

This podcast is sponsored by PAX.

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this conversation, we will look at the relationship between Paramedic theory and practice with Vince Clarke. We will dig into Vince’s doctorate in Education on the subject, various frameworks for the acquisition of skills through simulation, reflective models of learning, the progression from novice to expert, directive versus facilitative learning, theory/practice conceptual frameworks, and finally, student views and where they perceive learning originates.

To do this I have Vince Clarke with me, Vince has been a paramedic since 1998, progressing on to an IHCD tutor. As well as completing an undergraduate degree in Paramedic Science, he has completed a master’s degree in health law and ethics in Practice and a Doctorate in Education.  He is currently the principal lecturer at Hertfordshire University Paramedic Science Program, the trustee for education with the College of Paramedics, and an external advisor to several organisations. Vince's thesis can be found here:

https://uhra.herts.ac.uk/bitstream/handle/2299/21089/99008890%20Clarke%20Vince%20final%20version%20of%20submission.pdf?isAllowed=y&sequence=1

This podcast is sponsored by PAX.

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this conversation, we will look at the life of an Advanced Clinical Practitioner (ACP). We will dig into what the training looks like, the autonomy involved, the various specialisms you can take, what Dan has learnt along the way and much more. As more and more alternative career pathways are opening, we explore if this one is an attractive option. We also look at the alignment to the Royal College of Emergency Medicine (RCEM) curriculum and how this shapes Dan's practice, skills and clinical decision making. ACPs play a vital role in the delivery of emergency care across the UK. They now make up over 10% of the college membership. There are over one thousand ACP members and this number is rapidly increasing. ACPs are represented on all major RCEM Committees.

We also examine some of the educational expectations outside of the RCEM curriculum to fulfil the role as an ACP and also some of the various clinical backgrounds that ACPs come from. To find out more about the ACP role you can visit the RCEM website, menu, - training / careers/ Advanced Clinical Practitioner https://rcem.ac.uk/emergency-care-advanced-clinical-practitioners/ 

This podcast is sponsored by PAX. 

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this episode, I will be speaking with Jay Baldwin. At 26 Jay had suffered bilateral leg amputations from an IED whilst serving in the British army in Afghanistan. He was medically discharged from the UK military at 28, divorced at 32 and battled and won cancer at 33. Since being medically discharged from the Army, the dad of six has learned to walk on prosthetic limbs, has retrained as a fitness instructor and has truly inspired many. He is currently the UK’s only double amputee personal trainer. You can find Jay on social media @

https://twitter.com/NoLeggedNinja1

Join us for an insightful conversation with Robbie Maiden, a lifeboat coxswain, as he shares his journey from being embedded in a culture from a young age to becoming a leader in the austere lifeboat setting. With no formal leadership training, Robbie has developed his skills through experiential learning and personal growth. Robbie has held the position of coxswain for 27 years but has life boating in his blood.

In today’s episode, we will discuss what skill set you need to lead volunteer crews in the austere environment of the North Sea when the chips are down and how previous experiences have formed and morphed Robbie’s leadership style and skill set over the years. Robbie's storytelling skills shine through as he offers listeners words of wisdom from his experiences, both good and bad.

This podcast is sponsored by PAX.

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this conversation we discuss the future of pre-hospital maternity care with three leading consultant midwives from UK NHS ambulance services. Dawn Kerslake, Stephanie Heys, and Camella Main are experts in their field and will provide valuable insights into this critical area of pre-hospital care.

During the podcast we explore the education and training of paramedics in maternal care, current governance systems, and patient follow-up and support mechanisms in place. We also discuss the necessity and dearth of pre-hospital maternity research. This is an excellent opportunity to learn from the best and gain insights into the future of pre-hospital maternity care. The educational resources and research that are mentioned in the episode can be found here:

https://pubmed.ncbi.nlm.nih.gov/36531803/

https://www.promptmaternity.org/pre-hospital-prompt

https://www.ncbi.nlm.nih.gov/books/NBK525996/

This podcast is sponsored by PAX. 

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:
⁠https://www.pax-bags.com/en/⁠

In this conversation, we will examine human performance, some of the fundamental components of performance, models of performance, and how we train versus how we perform. We will also examine the importance of psychological safety, and the interplay between performance, standards, and behaviour. We also speak around the concept of culture as an enabler for performance.

To do this I have Tom Hurst with me. Tom is the Medical Director of London’s Air Ambulance (LAA), he is also a Consultant in Intensive Care Medicine (Critical Care) at King's College Hospital London. He is also a Consultant in Pre-Hospital Emergency Medicine at London HEMS, Bart's Health. Tom’s practice covers a wide range of general critical care as well as neurosciences, cardiovascular, major trauma and ECMO.

To learn more about LAA and its people, please see here: https://www.londonsairambulance.org.uk/

To donate to their cause and work please see here: https://www.londonsairambulance.org.uk/donate

This podcast is sponsored by PAX.

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠⁠https://www.pax-bags.com/en/⁠

In this conversation, we will unpack the International Journal of Paramedicineand the original vision for the journal. We will also look at the reach of the journal and the different sections of the journal yet to launch. We also examine the interaction with the journal as it looks to create discussion and research ideas and how people can get involved in the journal team amongst much more.

To do this I have Mic Gunderson with me. Mic has been involved in EMS since 1975 in various clinical, teaching, leadership, and consulting roles. He is currently the President of the Center for Systems Improvement, the EMS Quality Academy, and the Chief Strategy Officer for the Cambridge Consulting Group. Mic also serves as the Editor-In-Chief of the International Journal of Paramedicine, which is published by the National EMS Management Association in the United States. The journal can be found here:

https://internationaljournalofparamedicine.com/index.php/ijop/index

This podcast is sponsored by PAX.

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this episode we are speaking with London HEMS Paramedic Keiren Rodwell. We dig into Keiren's background from working as a paramedic student in New South Wales, to working for the London Ambulance Service LAS in north east London. Keiren joined London Ambulance Service straight out of university in February 2018. We speak about the death of two of Keiren’s extended family whilst protecting their family from the wild fires in Australia. We dig into what a typical day looks like in London's Air Ambulance (LAA) and also Kerien's journey to this point. We also examine the fundamental differences between pre-hospital care in Australia to the UK.

Around 25 per cent of LAS paramedics are Australian. The Service first began a recruitment campaign to attract Australian paramedics in 2014. At the time a national shortage of paramedics in the UK meant that the LAS looked to Australia because alignment of skills and training to UK practice.

This podcast is sponsored by PAX. 

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this conversation we will examine the current state of play within UK military medicine, the demographics of modern military capability; that of deployable role 1, 2 and 3 hospitals within the field. We will also examine the lessons learnt from recent conflicts and how they might inform the military medicine of the future. We look at analogues of comparison from the last major British involvement in conflict within Iraq and how innovative aero-medical retrieval (MERT) and damage control surgery from seminal cases such as Camp Bastien can inform future care. We look at the increase in trended patterns of non-combatant injury from drone and missile strikes (that of blast injuries), the ever-present risk of IED insult and injury and finally how we might leverage near-term adaptations of pre-hospital/MERT capabilities for future deployment.

To do this we have Major General Tim Hodgetts with us. Tim is the current serving Surgeon General of the United Kingdom Armed Forces, the Master General of the Army Medical Services, and the elected Chair of the Committee of Chiefs of Military Medical Services in NATO. His clinical background is a Professor of Emergency Medicine. Originally qualifying from Westminster Medical School, commissioned in the Royal Army Medical Corps, through to his present-day role of Surgeon General, and is the senior technical authority for all clinical matters in defence. 

This podcast is sponsored by PAX. 

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

⁠https://www.pax-bags.com/en/⁠

In this conversation, we speak with Australian emergency physician Dr. Ben Mckenzie. Ben has developed the AMAx4 algorithm as a streamlined approach to recognising and treating anaphylaxis after the tragic death of his 15-year-old son Max Mckenzie. Ben has helped standardise best practices for this life-threatening emergency. Promptly following the AMAx4 steps is vital for patient survival in the initial minutes of anaphylaxis until emergency medical services arrive.

Anaphylaxis is a severe, potentially fatal allergic reaction that requires prompt adrenaline to optimise survival outcomes. AMAx4 emphasises key steps that should be taken as soon as anaphylaxis is identified. The simplified, structured sequence helps reduce treatment delays, improves outcomes, and has been endorsed by major allergy organisations as an evidence-based protocol.

*** Please note, that you should adhere to local guidelines and protocols and remain compliant to these when practising pre-hospital care. Only practice the above algorithm with the support of your institution.'

For more information please find the protocol here: https://litfl.com/amax4-algorithm/

And here:

https://www.amax4.org/

This podcast is sponsored by PAX. 

Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here:

https://www.pax-bags.com/en/

In this conversation, we will examine how trauma is both managed and reported on throughout Scotland. The Scottish Ambulance Service (SAS) receives over 1.5 million calls a year and responds to over 500,000 emergency incidents per year. In the episode, we will discuss The Scottish Trauma Audit Group (STAG) as a national audit group within the Scottish National Audit Programme of Public Health Scotland. STAG measures and is tasked to improving the quality of care, overall experience, and long-term outcome of patients with significant injuries throughout Scotland. We will also examine the Advanced Practitioner in Critical Care scheme in Scotland and how it has developed, how it is managed and some of the recent adaptations according to need throughout Scotland. We will also look at the need for key interventions when critical care is not available.

  To do this I am speaking with Martin Esposito. Martin is a Consultant Paramedic for Major Trauma within SAS. In this role, he is the lead for all the major trauma work within SAS and also line manages the Advanced Practitioners in Critical Care. As well as trauma, is has a special interest in Pain Management and is the SAS lead for pain management as well as an Honorary Tutor at Cardiff University. More information on STAG can be found here: https://www.stag.scot.nhs.uk/

We look forward to seeing you in 2024. Happy New Year!

Eoin

This is a selection of 10 of the most downloaded episodes of 2023. In this episode, we hear from:

These conversations were the last 5 of the ten most downloaded episodes of 2023. Needless to say, I learnt a lot from every guest on the podcast and feel privileged to have interviewed some great clinicians, guests and professionals on the podcast. Please feel free to reach out to me with feedback on the podcast and also feel free to rate, review and subscribe to the podcast wherever you get your podcasts. My thanks again for a great year and all the engagement along the way. If you have any feedback, suggestions and/or comments, please feel free to reach out to be at eoinwalker@hotmail.com

Happy 2024!

Eoin

6ntc23zu

This is a selection of 10 of the most downloaded episodes of 2023. In this episode we hear from:

These conversations were 5 of the ten most downloaded episodes of 2023. Needless to say, I learnt a lot from every guest on the podcast and feel privileged to have interviewed some great clinicians, guests and professionals on the podcast. Please feel free to reach out to me with feedback on the podcast and also feel free to rate, review and subscribe to the podcast wherever you get your podcasts. My thanks again for a great year and all the engagement along the way. If you have any feedback, suggestions and/or comments, please feel free to reach out to be at eoinwalker@hotmail.com

Merry Christmas to everyone!

Eoin

In this conversation, we will examine some of the contemporary reflections on the Ukraine crisis with David and Shawn. We will examine what it is currently like on the ground, some of the emerging needs and how David and Shawn believe they can be met. We will also dig into David and Shawn’s background in Ukraine and how this has evolved. We will look at our guest's anecdotal reflections on the conflict currently and some of the main factors that have changed and some that have remained over time such as the Ukrainian resiliency and mindset.

To support Medics 4 Ukraine please see here: https://worldextrememedicine.com/blog/humanitarian-medicine-posts/medics4ukraine-fundraising-appeal/

In this conversation, we will be looking at the current guidelines on the pre-hospital management of drowning and the academic research that underpins these principles. We will explore the epidemiology of drowning and examine patient outcomes as a group. We will also discuss the important wider efforts in public awareness and prevention.

To do this, we have Mike Tipton with us. Mike is a household name in the surf lifesaving community and is one of the leading UK academics on drowning. He currently leads the extreme environmental laboratory at the University of Portsmouth. He has spent over 40 years working in thermoregulation, environmental and occupational physiology. This includes as a survival and thermal medicine consultant to the RAF and UK Sport. He has been heavily involved in the RNLI for many years, as a consultant advisor to the medical directorate. In 2018 he was awarded an MBE for services to physiological research in extreme environments. 

In this conversation, we will explore some of the lessons learned through years of major incident attendance in Scotland from the Emergency Medical Retrieval Services (EMRS). We examine the Scottish Trauma Network, the demographics of healthcare in Scotland, and some of the recent and seminal major incidents that have informed EMRS’s approach. We also include some of the lessons learnt through the Manchester bombings – that of paediatric triage and treatment in Mass Casualty incidents. We examine some of the lessons learnt through using CSCATTT, METHANE, activation and tasking, communications both remotely and at site, preferred triage tools and much more.

To do this I have John Paul Loughrey with me. JP is a Consultant in Emergency Medicine at the QEUH in Glasgow and has worked with EMRS in a variety ous roles since 2011. He is the Major Incident lead for ScotSTAR and is Vice-President of the Royal College of Emergency Medicine. In addition, his other main professional interests include major trauma care, teaching and training and organising large-scale CPD events and conferences.

Reflex Medical

This podcast is sponsored by Relex Medical. Whether you need syringes and steri-strips or Littmann stethoscopes and advanced life support training manikins, Reflex Medical are here to help. When you’re restocking your ambulance or checking your paramedic equipment list there is only one place you need to go for your medical supplies – Reflex Medical. To see more of their innovative diagnostics and medical devices please click here:

⁠⁠https://reflexmedical.co.uk/⁠⁠

Discount Code: PHCP10

The above code will give you 10% off Reflex Medical web prices, this excludes sales items and can't be used in conjunction with other discounts. 

Celox Medical

This podcast is sponsored by Celox Medical. Since 2006 when Celox granules were first introduced, Celox trauma products have been used to save the lives of soldiers and civilians alike. In 2008, the third-generation haemostat Celox Gauze became the UK MoD product of choice and was used to save lives in the recent conflicts in Iraq, Afghanistan and Ukraine.

Now Celox Rapid Gauze takes over as the product of choice and will be used on the front line by all branches of the armed forces. To see more of their innovative haemorrhage control products please click here: ⁠⁠https://www.celoxmedical.com/

In this conversation, we will examine the concept and the reality of psychological burnout among Paramedics. The effects of burnout are estimated to cost over $300 billion annually, with the WHO forecasting a burnout pandemic in the next decade. Within pre-hospital organisations, burnout can generate reduced quality, high absenteeism, increased turnover rates and substandard productivity. In the conversation, we examine the definition of burnout, the factors that increase the risk of burnout, models of burnout, the symptoms of burnout, possible mitigation strategies to avoid burnout, some of the emergent themes from the research and much more. To do this I have Liz Thyer with me. Liz is an Associate Professor in the WSU Paramedicine program and Associate Dean (Learning and Teaching) for the School of Health Sciences.  She was an advanced life support paramedic with Ambulance Victoria for 11 years including roles as a clinical instructor and peer support officer. She has previously worked at Victoria University with the Paramedic programs and at Deakin University in Learning Futures.  She is an active member of the Australasian College of Paramedicine and is the inaugural chair of the ACP Professional Standards Committee. Liz Thyer's work can be found here:

Review article: Prevalence of burnout in paramedics: A systematic review of prevalence studies

https://onlinelibrary.wiley.com/doi/abs/10.1111/1742-6723.13478

Stefan De Hart's work can be found here:

Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257/Reflex Medical

This podcast is sponsored by Relex Medical. Whether you need syringes and steri-strips or Littmann stethoscopes and advanced life support training manikins, Reflex Medical are here to help. When you’re restocking your ambulance or checking your paramedic equipment list there is only one place you need to go for your medical supplies – Reflex Medical. To see more of their innovative diagnostics and medical devices please click here:

⁠https://reflexmedical.co.uk/⁠

Discount Code: PHCP10

The above code will give you 10% off Reflex Medical web prices, this excludes sales items and can't be used in conjunction with other discounts. 

Celox Medical

This podcast is sponsored by Celox Medical. Since 2006 when Celox granules were first introduced, Celox trauma products have been used to save the lives of soldiers and civilians alike. In 2008, the third-generation haemostat Celox Gauze became the UK MoD product of choice and was used to save lives in the recent conflicts in Iraq, Afghanistan and Ukraine.

Now Celox Rapid Gauze takes over as the product of choice and will be used on the front line by all branches of the armed forces. To see more of their innovative haemorrhage control products please click here: ⁠https://www.celoxmedical.com/

*Attention: Products shown on the podcast may not be available in all markets and product indication claim(s) may vary between markets.

In the conversation, we examine the definition of addiction, the meta-substances (stimulants, sedatives, opioids), the time horizon of an addicted person (instant gratification), the triggers of addiction, the diagnosis of dependence, what dependence means, and the types of addictions (work, sex, drugs, diet, exercise).  We explore two of the most addictive substances, alcohol and tobacco, and their second-order effects on health, family, and relationships. We will also look at the complications of addiction and lastly, the modern treatments and monitoring post-treatment that can be beneficial to the individual.

To do this I have Consultant Psychiatrist Dr Brian Wells with me, Brian specialises in Substance Disorders and has an international scope of clients.  He leads a bespoke, discreet, service that works closely with most of the 'quality'​ addiction treatment facilities globally. His specialities include addictive disorders and medical and surgical referrals where appropriate.

A fantastic lecture on addiction from Brian can be found here: http://www.youtube.com/watch?v=VDgNj7x6FSs Dr Wells can be contacted here for his services and consultation:

drbrianwells@gmail.com My thanks to Dr Wells for a fascinating and engaging interview.

Reflex Medical

This podcast is sponsored by Relex Medical. Whether you need syringes and steri-strips or Littmann stethoscopes and advanced life support training manikins, Reflex Medical are here to help. When you’re restocking your ambulance or checking your paramedic equipment list there is only one place you need to go for your medical supplies – Reflex Medical. To see more of their innovative diagnostics and medical devices please click here:

https://reflexmedical.co.uk/

Discount Code: PHCP10

The above code will give you 10% off Reflex Medical web prices, this excludes sales items and can't be used in conjunction with other discounts. 

Celox Medical

This podcast is sponsored by Celox Medical. Since 2006 when Celox granules were first introduced, Celox trauma products have been used to save the lives of soldiers and civilians alike. In 2008, the third-generation haemostat Celox Gauze became the UK MoD product of choice and was used to save lives in the recent conflicts in Iraq, Afghanistan and Ukraine.

Now Celox Rapid Gauze takes over as the product of choice and will be used on the front line by all branches of the armed forces. To see more of their innovative haemorrhage control products please click here: https://www.celoxmedical.com/

Attention: Products shown on the podcast may not be available in all markets and product indication claim(s) may vary between markets.

In this conversation, we will explore some of the nuances and challenges of Exercise Associated Collapse (EAC) with Luca Carenzo. The basis of this interview was the recent publication in the Journal of Science and Medicine in Sport of An Unusual Case of Marathon-related Exercise-associated Collapse: Case Report and Some Considerations for Medical Care at Endurance Mass Participation Events. We will explore the case and some empirically proven treatments that form the mainstay of treatment within EAC. We will also visit some of the reflections on the case and how it has changed Luca’s thinking on the list of differentials within EAC. We also examine patient-focused research, intra-speciality collaboration and EAC collated databases.

To do this I have Luca Carenzo with me. Luca is an Anaesthetic and Critical Care consultant from Milan, Italy. He previously worked at The Royal London Hospital Adult Critical Care Unit and has taken part in some mission work with Doctors without Borders. He is also a World Extreme Medicine faculty member. He currently works in theIstituto Clinico Humanitas IRCCS Humanitas · Department of Anaesthesia and Intensive Care Medicine in Milan. He also works for i-Help, a critical care mass gathering provider.

The paper in the episode can be found here:

An unusual case of Marathon-related exercise-associated collapse: Case report and some considerations for medical care at endurance mass participation eventshttps://pubmed.ncbi.nlm.nih.gov/37919145/#:~:text=This%20article%20presents%20a%20unique,immediately%20with%20CPR%20and%20AED.

This paper is also mentioned in the episode:

Sudden cardiac arrest in a marathon runner. A case report

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484937/

In this conversation, we will examine whether point-of-care ultrasound is a reliable predictor of outcome during Traumatic Cardiac Arrest (TCA). We will dig into the recently published systematic review on the topic with Tim Harris, who is one of the authors of the paper. We will examine why the authors decided to look at TCA and POCUS, the number of studies and patients examined, the type of Mechanism Of Injury (MOI) leading to TCA, what the results showed, and how this is relevant to practice. We also look at the other adjunctive markers in the pre-hospital domain to inform the Termination Of Resuscitation (TOR) based on the results found in this paper. We will also dig into another recently published paper related to the diagnostic performance of POCUS in resuscitative outcomes published in April of this year on a systematic review and meta-analysis of 3265 patients and outcomes with POCUS.  

To do this I have Tim Harris with me. Tim is a Professor of Emergency Medicine and Programme Director for the Emergency and Resuscitation Medicine programme at the Blizard Institute, Queen Mary University of London. He has trained extensively overseas, training in Emergency Medicine and Intensive Care Medicine in the UK, Australia, Africa, India and Samoa. The papers we examine include:

Is point-of-care ultrasound a reliable predictor of outcome during traumatic cardiac arrest? A systematic review and meta-analysis from the SHoC investigators:https://www.sciencedirect.com/science/article/abs/pii/S0300957221003270

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129265/

My thanks to Tim for an engaging and insightful interview.

In this conversation, we will look at the research examining methods of safe sedation by Advanced Paramedic Practitioners within London and examine the research published on this looking at sedation of Acute Behavioural Disturbance (ABD). We will examine; what the retrospective cohort study of pre-hospital agitation management showed regarding the sedation of the ABD patient. Also, the origins of ABD according to the paper, the Sedation Assessment Tool used to measure pre- and post-intervention, the approaches that senior clinicians can take to sedate patients and more. 

To do this I have Tim Edwards with me, Tim is a Consultant Paramedic with the London Ambulance Service NHS Trust and a visiting lecturer at the University of Hertfordshire. Tim has been a paramedic since 2000 and has undertaken various roles including working as a flight paramedic, senior lecturer, and advanced paramedic practitioner and is currently working as a Consultant Paramedic in London. 

The study that the conversation is based on can be found here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730188/#bibr_10

Many thanks to Tim for this conversation.

In this episode, we will explore why Thrombectomy is considered a leading stroke intervention and can contribute to the early rehabilitation and treatment of ischemic stroke. This is especially important if recognised within pre-hospital care. This is due to its effectiveness in rapidly restoring blood flow to the brain and improving patient outcome. In the episode we will explore how this intervention can restore of cerebral blood flow, the time sensitivity of the intervention, the functional recovery of patients undergoing thrombectomy, the minimally invasive approach thrombectomy takes, the collaborative care and finally the positive clinical trials showing it effectiveness. 

To do this I have Kunle Ogungbemi with me. Kunle is the Clinical Lead of interventional Neuroradiology at St George's University Hospitals in London. He has also a named author on a paper examining the Hub-and-spoke model for thrombectomy service in UK NHS practice. So the data suggests that for every 9-minute delay in onset to reperfusion, 1/100 patients will have more severe disability at 90 days. In the hub-and-spoke model, proposes that patients with suspected stroke are initially taken to the nearest hyperacute stroke centre (spoke). Patients with confirmed stroke caused by LVO are then transferred to the thrombectomy centre (hub) with thrombolysis started if appropriate.

In this conversation, we will examine the complex and challenging environment of toxic drug and substance misuse on the streets of Vancouver and across British Columbia. We will explore the issues of concomitant drug ingestion, the use of fentanyl, the complications of mental health and the cyclical pattern of pre-hospital presentation. We will also explore the challenges of bias towards this patient group and how that can both affect care and outcomes. 

Jen Bolster is an Advanced Care Paramedic in British Columbia. She is also a Paramedic Practice Leader (PPL) within BCEHS. She has a portfolio which examines and engages with paramedic-led research into mental health, substance use and the toxic drug crisis. She advocates that paramedics are uniquely positioned to offer patients alternatives to the emergency department. Jen’s research interests include paramedic mental health and resilience, contemporary vs non contemporary leadership styles, women studies, and non-technical skills.

In this episode, we will explore reverse mentoring and challenging the status quo in quality improvement with Carl Betts. We will look at Carl’s reflections on mentorship and reverse mentorship of Quality Improvement fellows within an Ambulance service setting. We dig into how Carl leads these QI fellows but also how they lead him in innovation and ideas. The focus of reverse mentoring is to increase the mentee’s inclusion competencies; however, mentors are simultaneously provided with the opportunity to learn from their mentee’s experience, knowledge and skills so it can be considered as a career development opportunity for both parties. Reverse mentoring is an effective way to build genuine awareness of the barriers faced by ethnically diverse employees and different perceptions of leadership from the mentee’s perspective. We also dig into the assessment process for the fellowship and how Carl has flipped this on its head. 

Carl Betts is the Quality Improvement lead for the Yorkshire Ambulance Service (YAS) and has been a Paramedic for over 10 years. He currently leads the fellowship program for his service. Please enjoy this wide-ranging conversation with Carl Betts, a regular contributor and guest on the podcast.

In this podcast, we will look at the benefit and utility of Methoxyflurane, more commonly known as Penthrox. Penthrox is a volatile, self-administered inhaled analgesic indicated for short-term pain relief. Penthrox is a portable, lightweight, non-invasive inhaler for self-administration of the Methoxyflurane vapour. Penthrox provides analgesia when inhaled at low concentrations giving analgesic therapeutic doses, but can also reduce and mitigate even severe pain yet has a short half-life. We will examine its use and limitations within the expedition environment and how and when it can be optimally used as either a sole adjunctive pain relief agent or as part of a larger pain relief strategy. We also get Will's reflections from use in practice and where and when Penthrox is useful.

Joining me is Dr Will Duffin, Will is the co-medical director of World Extreme Medicine and is an NHS GP. He is also an expedition, TV/film doctor and father of two. He lectures around the UK for NB Medical Education and is a digital host of the World Extreme Medicine podcast. Many thanks to World Extreme Medicine for kindly agreeing to the use of this audio.

You can find more on Penthrox here:

https://penthrox.co.uk/healthcare/simple-to-use/?

You can find more on World Extreme Medicine here:

https://worldextrememedicine.com

In this episode, we examine how to approach systems strengthening in clinical practice within the context of Sierra Leone with Aneesah Peersaib. We will look at her recent deployment to support Continued Professional Development at local, regional and national level and her role in leadership development whilst in post in Sierra Leone. We will examine how she disseminated education & training, policy, and governance and how she approached cultural change from the ground up. Finally, we will examine how she built and maintained safe systems of practice, and how you can embody a culture of educational leadership and empower coproduced with in-country clinicians to provide solutions to wider systems development work.

To do this, I'm speaking with Aneesah Peersaib. Aneesah has recently held the post of Nursing Education Advisor to Chief Nursing and Midwifery in Freetown, Sierra Leone. She collaborates across NGOs to work with the Sierra Leone Ministry of Health and Sanitation to standardise nursing education and support national strategic delivery. She has been a senior Nurse both inside and outside of the UK NHS working for Health Education England as a clinical lead and clinical advisor supporting education and workforce development across London. Aneesah is an Emergency nurse by trade and has experience leading central London Emergency departments before going on to wider systems leadership roles.

If you want to reach out to Aneesah about the episode please contact her through LinkedIn here: https://www.linkedin.com/in/aneesah-peersaib-9153725a/?originalSubdomain=uk

In this next period, we will be recording a mini-series on addiction starting with this first episode with Specialist Addiction Therapist Mark Dempster. In 2013, the Centre for Social Justice determined that the level of addiction in the UK made it the “addiction capital of Europe.” This includes the use of legal substances, mainly ⁠alcohol⁠, and the use of Class A drugs, which include ⁠heroin⁠, ⁠cocaine⁠, ⁠meth⁠, and ⁠hallucinogens⁠. £36 billion is spent by the nation every year on treatment relating to drug and alcohol abuse. At the time of filing their report, titled 'No Quick Fix', the UK had the highest rate of addiction to ⁠opioids⁠ and the highest lifetime use of amphetamines, cocaine, and ⁠ecstasy⁠ across Europe. Many view addiction as something that only affects the users themselves but, in reality, casualties from substance abuse are taxing entire communities and society as a whole. Addiction in the UK affects everyone from loved ones to clinicians and the everyday public.

In the conversation, we examine the five stages of addiction, common cognitive pitfalls, habit Vs. addiction, and Mark's organic story through his lived experience with addiction. We also look at the 12-step process of Narcotics Anonymous (NA). Mark is a specialist addiction therapist and a recovery coach within a Harley Street Counselling Practice. He has witnessed chemical and behavioural addictions both personally and within his circle of family and friends.

Learning the practice of psychotherapy for addiction helped Mark reach out to all types of addicts, from programmes working with prisoners, helping at homeless shelters, and to wealthy bankers from Canary Wharf.  According to Mark, the addict’s circumstances varied but their addictions had a lot in common. In the conversation, we also cover:

You can find out more about Mark here:

https://markdempstercounselling.com/about/

You can find out more about Narcotics Anonymous here:

https://ukna.org

You can find out more about Alcoholics Anonymous here:

https://www.alcoholics-anonymous.org.uk

In this conversation, we will examine the various types of trauma scores that feature both out-of-hospital and in-hospital to measure trauma – those of anatomical, physiological and combined trauma scores. We will look at why these are important, the three broad types of trauma scores, the origins, reliability and sensitivity of these. We will also examine the pros and cons of the GCS together with the history behind the GCS. We will examine the trauma score, revised trauma score, APACHE and CRAMS scales, Abbreviated Injury Score, Injury severity score, New Injury Severity Score (NISS), TRISS (Trauma and Injury Severity Score), and finally the ASCOT (A Severity characterisation of trauma). We will also examine the limitations to these scores and also some of the more long-term reasons for use. 

Mark Faulkner is a Consultant Paramedic and associate medical director with the London Ambulance Service NHS Trust, Mark is also the clinical advisor for Major Trauma within the LAS and as such sits on the Pan London Trauma Steering Group, as well as number of national trauma groups.  Mark has been involved in major trauma for over 12 years, since the inception of the London Trauma System and has developed and refined the London Trauma Triage Tool. In the conversation, we examine:

1.     Why we look at and create these scores.

2.     The three broad types 

3.     The GCS – origins, sensitivity/specificity & the limitations  

4.     Trauma Score & revised trauma score 

5.     APACHE & CRAMS scales 

6.     AIS 

7.     ISS

8.     NISS & TRISS score 

9.     ASCOT 

10.  Final thoughts 

My thanks to Mark for an insightful and engaging conversation.

In this conversation, we will examine the current state of NHS ambulance service delivered care and how we can approach this with a different perspective. We will examine the current models of operation and how over the next 10 to 20 years this needs to be flipped on its head. We will explore the numbers of See, treat and convey versus see, treat and refer, versus telephone consult and close and how this can be flipped on its head. We will also explore how the adage of modern technology can we can meet these needs througg technology and how the progressive Paramedic Career Framework supports this through advanced urgent care practitioners & more pathways to refer patients to. We will also explore some of the innovations that Jason has initiated to work toward this goal.

Jason Killens is the Chief Executive of the Welsh Ambulance Services NHS Trust, which is the national provider of 999, 111 and non-emergency patient transport services for Wales. Jason has spent his career working in Ambulance Services in the UK and Australia. He progressed through the ranks in London Ambulance Service from an Emergency Medical Technician to Executive Director of Operations. He was appointed as the Chief Executive of the South Australia Ambulance Service in 2015 before joining the Welsh Ambulance Service as Chief Executive in September 2018. In the conversation, we examine:

My thanks to Jason for his reflections and thoughts on this topic. To see more of the inverted pyramid of care, please see here:

https://www.linkedin.com/posts/jasonkillens_nhs75-teamwast-activity-7082261899463028736-DDTJ?utm_source=share&utm_medium=member_desktop

In this conversation, we will examine the challenges of exposure to high-stress situations, the principle of ‘psychological stunning’ and how to deal with the concepts of ‘amygdala highjack’. We will reflect with Tash on a seminal case that she experienced and her reflections on it. We will also reflect on how to harness and control these psychological and physiological stressors in practice to get the best out of yourself in a situation such as this. We will also look at the cognitive switches that Tash uses to de-escalate from the stress of the shift and finally how she approaches self-care within her practice. 

Natasha Adams is a Senior Critical Care Paramedic (CCP) with the Queensland Ambulance Service, working on the Woodridge CCP POD and with the High Acuity Response Unit (HARU).  Her clinical interests include progressive out-of-hospital care clinical education, and leadership development. Natasha is currently working on a project with graduate paramedic induction programs but will soon progress into a full review of Queensland Ambulance Services' clinical education and operational areas. In the conversation, we examine:

My thanks to Tash for an engaging and insightful interview.

In this conversation, we will examine the utility and functions of ultrasound within air ambulance services. We look at how the aggregation of data and familiarity with ultrasound is narrowing down and assisting time to intervention and time to definitive care. We look at the scans of preference and some of the data around pneumothoraces, tamponade and positive findings under ultrasound in the critical care patient. Importantly we will get Dan’s perspective on where ultrasound is affecting patient care and where he sees the future of ultrasound going within pre-hospital care. 

Dan Nevin is a PHEM consultant with London’s Air Ambulance and an Anaesthetist with Barts and the Royal London NHS Trust. Dan has years of experience working in pre-hospital care in both South Africa, where he originally trained, and in the UK. His special interests include trauma, critical care anaesthesia and PHEM. Dan is also the ultrasound lead for LAA and has been leading the use of POC ultrasound within the service. In the conversation we exam:

-making.

My thanks to Dan for an insightful and engaging interview.

In this conversation we will examine the anatomy of the Advanced Paramedic Practitioner in Urgent Care (APPUC) scheme as it currently stands within London. We will examine the discharge to the community rate, Alternative Care Pathway referral rates and where they are being referred to, commonly seen pathology for the group, advances in the scheme (innovation and where they are looking to innovate), and finally aligned training that the scheme receives. 

 Kate Hardy is an advanced paramedic practitioner in urgent care working in London. She gives us insights into what the anatomy of work looks like, the types of pathology, and the Multi-Disciplinary Team (MDT) approach that the scheme takes. The range of topics in the conversation include:

Please find a link to the Multi-professional framework for advanced clinical practice in England here:

https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf

My thanks to Kate for an engaging and insightful interview.

In this conversation we will examine the recent recommendations and development of a national out-of-hospital transfusion protocol for critical care services. We will unpack the recent modified RAND Delphi study that sets out the guidance of clinical governance and recommendations for out of hospital transfusion services. We will dig into the recommendations on the initiation of transfusion, the types of blood components and products, the delivery and monitoring of out of hospital transfusion, the Indications for and use of transfusion adjuncts and finally the resuscitation targets to halt ongoing transfusion. 

Adam Greene is a Unit Chief and Critical Care Paramedic working at British Columbia Emergency Health Service. He is also an honorary lecturer at Cardiff University on the Masters in Critical Care. He amongst others has recently published the Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study which will form the basis of our discussion. 

The study can be found here: https://www.cmajopen.ca/content/11/3/E546

Adam's contact details can be found here: Adam.Greene@bcehs.ca

This is the second instalment of the conversation on the approach to major incidents with Keir Rutherford & Alec Wilding. We examine triage tools which have just come into practise which is around the TST - 10 second triage algorithm and the MITT - major incident triage tool and also look at enhanced levels of care on scene and what should be done in the casualty clearing station. We also examine at how we manage our emotions as senior clinicians both on scene and retrospectively and work we work with interdisciplinary teams around the fire brigade and the police on scene.

Here are more resources from the conversation:

London Bridge article: https://www.magonlinelibrary.com/doi/abs/10.12968/jpar.2017.9.12.512

Ten second triage: A novel and pragmatic approach to major incident triage: https://t.co/LXdO1MFRX4

New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT: https://emj.bmj.com/content/39/11/800.long

NARU app: https://naru.org.uk/jesip-launched-free-app-emergency-responders/

Jesip aid memoir : https://jesip.org.uk/uploads/media/pdf/Aide_Memoires/JESIP_Aide_Memoire_2022.pdf

In this conversation we will examine some of the lessons learnt from anecdotal experiences in major incidents, together with the reflections from previous recommendations in major incident enquiries such as the Manchester bombings. We will examine the differentiation of terrorist attacks at point of call from an otherwise normal RTC or ‘typical’ incident. We also look at the initial approach to triage, who and how this should be done as well as the integration and relationship of the Ten Second Triage (TST) algorithm, the Major Incident Triage Tool (MITT) and levels of enhanced care at the scene. Also, the concept of casualty clearing and when and how this should be performed. We also examine the level/ceiling of intervention that is beneficial from the empirical research in such events and how this should be approached. We also examine inter-disciplinary working with other services such as police responders and fire brigade. 

Keir Rutherford is an Advanced Paramedic Practitioner in Critical Care and also a flight paramedic with London’s Air Ambulance. Alec is also an Advanced Paramedic Practitioner in Critical Care and the Emergency Planning Resilience and Response (EPRR) lead for Festival Medical Services, who are a charity providing event medical cover including at Glastonbury and also a Specialist Paramedic for Hampshire Isle of Wight Air Ambulance.

To read more on some of the information referred to in the Manchester Bombing inquiry please see here: https://manchesterarenainquiry.org.uk/

This is part 1 of a 2 part conversation as we felt there was too much to include in just one episode.

In this conversation we will examine the latest in non-invasive ventilation via the helmet interface. Recent empirical research has shown that ventilation via helmet can mean faster recovery time, shortening an ICU stay, reduces the need to intubate, lowers ICU mortality, and can result in minimal or no sedation of the patient. 

Aurika Savickaite is a registered based in Chicago and was involved in the successful testing of the helmet ventilator in the ICU at the University of Chicago during a three-year trial study. Aurika has worked as a registered nurse and patient care manager at the University of Chicago Medical Centre, Medical Intensive Care Unit, and as a staff nurse at Vilnius University Hospital, in the intensive care unit. She earned a Bachelor of Rehabilitation and Nursing at Vilnius University Faculty of Medicine in 2001.

Aurika is a recognized expert in noninvasive ventilation via the helmet interface and has garnered widespread respect within the medical community for her passionate work in this area. She was involved in a successful three-year trial study at the University of Chicago Medical Center that tested the effectiveness of helmet-based ventilation in the ICU. Drawing on this experience, Aurika founded HelmetBasedVentilation.com, a website that has become a valuable resource for medical professionals seeking to learn more about the benefits of helmets and their use in treating patients with respiratory distress. In the episode we cover:

The paper that Aurika refers to in the interview can be found here: https://jamanetwork.com/journals/jama/fullarticle/2522693

Online course: https://www.helmetbasedventilation.com/Cesarano, M., Grieco, D.L., Michi, T. et al. Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application. Ann. Intensive Care 12, 94 (2022). https://doi.org/10.1186/s13613-022-01069-7

In this conversation we will examine the principles of coagulopathy and novel approaches to coagulopathy within pre-hospital care. We will examine the utility of fibrinogen concentrate, the distinct features of fibrinogen concentrate with cryoprecipitate, its longevity of use compared to other blood products, how you constitute fibrinogen concentrate for use in the pre-hospital environment amongst other topics. 

To do this I have Ross Davenport with me, Ross is a Consultant Trauma & Vascular Surgeon at the Royal London hospital in the UK. He is also a Senior Lecturer in Trauma Sciences and has previously worked in prehospital care for both London and Essex & Herts Air Ambulance. His research has focused on trauma-induced coagulopathy, acute response to injury and the treatment of major trauma haemorrhage. His work in traumatic coagulopathy and massive transfusion, inflammation and organ dysfunction has had international renown. In the episode we examine:

·      Coagulation and the pre-hospital evidence 

·      Are we getting a handle on hypothermic induced coagulopathy 

·      What is fibrinogen concentrate and its mechanism of action?

·      How it differs from cryoprecipitate and whether we still need cryoprecipitate.

·      What the initial empirical research shows from CRYOSTAT 2 research.

·      It’s robustness within pre-hospital environments and how you reconstitute it for pre-hospital use. 

·      Current trials with Fibrinogen concentrate and early indications of effectiveness. 

·      ROTEM/thromboelastometry markers of effectiveness 

·      When to give it in the patient journey? 

Please enjoy this episode.

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.

In this conversation we will examine the career progression of Vicki Brown, who is an Advanced Practitioner in Critical Care, and is the first person in the country to get on the Faculty of Pre Hospital Care (FPHC) Register of Consultant Practitioners by qualifying from a purely paramedic background. We will trace her career pathway and the steps that have been taken by her to achieve such a pivotal role within pre-hospital critical care. 

Vicki joined the ambulance service in 2002. And has had roles in management, learning and development and working on HEMS. She became the first ACP-CC for SWAST in 2020 and the first person to register as a Consultant (Level 8) Practitioners in Pre-Hospital Emergency Medicine in 2021. 

·      The start of Vicki's career – 2002 and what Vicki was doing previously to Paramedic Practice.  

·      What Vicki learnt on the road as a Paramedic 

·      What management taught her and she carried through

·      How training and education played a role in her progression 

·      The adage of learning every-day  

·      The educational pathway (DIMC, higher education, FIMC)

·      What working at GWAAC has taught her 

·      How governance looks within the team at GWAAC.

·      What responsibilities Vicki undertakes now as an Advanced Practitioner in Critical Care.

·      How she has changed over the years through her positions.

·      Where the profession is going, the pillars of advanced practice within the UK. 

To see more on Vicki please see here:

https://greatwesternairambulance.com/apcc-vicki-brown-breaks-barriers/

To see more on GWAAC please see here: https://greatwesternairambulance.com/

This episode is sponsored by MEQU.

THE °M WARMER SYSTEM is a portable blood and IV fluid warming system. °MEQU has developed an IV-blood warmer for emergency transfusions. It’s a portable fluid warmer which warms up blood from cold to body temperature within seconds. The set-up time is less than 30 seconds, and the user-friendly design ensures that the °M Warmer System cannot be assembled incorrectly. Blood and other infusion fluids can be heated from 5°C to 37°C at flowrates up to 150 ml/min. One charged battery can heat up to 2 liters of cold fluids (5°C) or 4 liters of fluids at room temperature (21°C) to body temperature.

The °M Warmer System has a compact design and weighs only 760 grams making it portable and ideal for prehospital use. The single-use warmer’s small size (10cm x 5cm x 2cm) allows it to be attached to the patient close to the infusion site, using its integrated adhesive pad. This secures infusion site and reduces heat loss in the tubing. The °M Warmer System is approved for use in ambulances, helicopters and fixed wing air frames. Please see here for further details:

https://mequ.dk/product/?gclid=Cj0KCQjwy9-kBhCHARIsAHpBjHjgsgSlJ0bzKpZmNAs_OFdOEgYeeFKj0-Q-5XDJU5v-D5G15r23o_8aAoddEALw_wcB

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:

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 eoinwalker@hotmail.com as I always welcome feedback.

In this conversation we will examine the fundamentals of human factors within tasks with Jim Walmsley. We will focus on Human factors from a task perspective refer to the ways in which the design of a task or activity can affect the safety and performance of the individuals performing it. We will examine the concept of task complexity, task variability, task duration and demands, feedback mechanisms in place to learn from, clearly defined goals, and finally task design. We will also discuss some of the mitigation factors involved in environmental design, training and skill development, task analysis to error trap, and teamwork and communication.  

To do this I have Jim Walmsley with me, Jim is a specialist paramedic in critical care. He has led expeditions for various Non-Governmental Organisations (NGOs) in and around Europe since 1996, and in 2001 he obtained his carnet as an International Mountain Leader, alongside additional outdoor qualifications in climbing, kayaking, and the rope access industry. As a qualified Critical Care Paramedic, he’s spent the last nineteen years specialising in pre-hospital critical care, after initially training and working in Sheffield. Having completed an MSc in clinical research and a PgDip in critical care, he now resides the Southeast of England. In the conversation we examine:

·      What is human factors from Jim’s perspectives 

·      How task human factors have affected Jim in the past - A case that is seminal and typifies the importance of human factors 

·      The classic offenders - unfamiliarity with the task, inexperience, a shortage of time, inadequate checking, poor procedures.

·      Task complexity & variability 

·      Task duration and demands. 

·      Feedback mechanisms in practice 

·      Defined and clear goal setting 

·      Design flow to mitigate 

·      Training skill and development 

·      Task analysis to error trap 

·      Teamwork and comms 

I hope you enjoy this final episode in the series on human factors within practice.

In this conversation we will examine the concept of flash teams with Ben Watts. We will focus on why they can pose such a challenge in highly stressful situations. We examine the concepts and issues of ego, lack of team ethos, lack of shared understanding/clear plan, poor communications, name use, active listening issues, poor followship, anchoring and much more. We also examine when things are working well and some of the core fundamental components of this including collaboration, use of checklists, feedback mechanisms, closed loop communication, affirmation, shared mental models and overt followship and leadership. We also look at one of the key fundamental tenets of flash teams, that of consistently calm cadence of communication. 

 To do this I have Ben Watts with me, Ben is no stranger to the podcast and has spoken with me on a number of episodes, most recently around the bleeding patient. Ben is a critical care retrieval practitioner working with the Emergency Medical Retrieval Service (EMRS) in Scotland and also works as a World Extreme Medicine (WEM) faculty member. In the conversation we examine:  

·      The concept of flash teams 

·      When it goes right – what this looks like from a flow of communication

·      When it goes wrong and how can we correct it

·      The importance of effective communication 

·      Feedback mechanisms to course correct for future performance

·      Error detection – Ben’s approach to error trapping 

·      Distraction and environmental factors - signal versus noise 

·      Decision making paralysis and the concept of ‘overwhelm’.

·      Correcting poor teams when they are going wrong.

·      Training and education around flash teams 

My thanks to Ben for an engaging and interesting conversation

In this session I am speaking with Clare Fitchett as we explore the fundamentals of human factors and the interplay of leadership. In the conversation we examine what human factors mean to Clare and how they affect her practice. We also look at leadership and how Clare perceives leadership can affect human factors for the better. We finally examine the concept and strategies of human factors mitigation and how we can offset the patent safety issues that human factors brings with it. 

Clare graduated as a paramedic in 2011 having undertaken her student paramedic training with South Central Ambulance Service. She commenced her Specialist Paramedic (Critical Care) training in 2018 with Thames Valley Air Ambulance (TVAA) and holds the Diploma in Immediate Medical care (DipIMC) from the Royal College of Surgeons in Edinburgh and is completing an MSc in Advanced Clinical Practice. Clare also volunteers as an Expedition Medic with the British Exploring Society and is also a faculty member of World Extreme Medicine. She currently works for Hampshire and the Ilse of Wight Air Ambulance. In the conversation we explore:

went well and one which was challenging and valuable learning.

Please find some valuable empirical research that underpins Clare's perspectives:

Interventions to improve team effectiveness within health care: a systematic review of the past decade

https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-0411-3

A standardised approach to pre-hospital RSI in the UK; utility, governance and content of current pre-induction checklists

https://link.springer.com/article/10.1186/1757-7241-23-S2-A16 

My thanks to Clare for an insightful and engaging interview

In this session, I am speaking with Neel Bhanderi on the advantages of high-fidelity training within clinical practice. In the conversation, we examine the concepts of analogs of reality and how it has multifactorial benefits through the integration of handover simulation, debriefing, stress inoculation, skill acquisition under stress, communication under applied stress, and much more. To do this I have Dr. Neel Bhanderi with me. Neel is the Head of Education and Training at MedSTAR retrieval HEMS service based in Adelaide. He is also a Consultant in Emergency Medicine at the Royal Adelaide Hospital. Neel trained as an Emergency Physician and worked as a Consultant at St George’s Hospital Major Trauma Centre in London for several years and for Kent Surrey and Sussex (KSS) Air Ambulance. In 2016, Neel emigrated to Australia where he works as an Emergency Specialist at the Townsville Hospital in North Queensland and is currently the head of education for MedSTAR retrieval service. In the conversation, we examine:

• Why high-fidelity simulation is useful & Neels approach to multi-modal simulation. • What components of training do MedSTAR focus on (Skills based, assessment-based, comms based or all three) – templates of training outcomes used. • How Neel approaches the training debrief. • How Neel creates incremental training stressors within the operational teams. • Environmental stress training methods (operational Task and environmental noise). • Approach to micro versus macro tasks • Comms under pressure within the training environment • Handover and how MedStar simulates this (filming, use of the checklist, analyzing) • Training relationship with case review (identifying training needs from case review). • How Neel is changing training in the short term (other elements such as personality and characterological traits).

Please enjoy this wide-ranging conversation with a fantastic guest. For more on MedSTAR and the work they do please see here:

https://saambulance.sa.gov.au/work-with-us/who-we-employ/medstar-emergency-medical-retrieval/

* We will resume with the human factors series next week 

In this conversation we will examine the fundamentals of human factors with Matt Edwards. We will focus on Human factors from an individual perspective. We will examine some of the seminal cases that Matt has experienced in practice and the concept of routine versus crisis from a checklist perspective. We will also examine how human interactions in healthcare change outcomes, from civility to risk aversion and the concept of trust. We will also examine the mitigation strategies that exist around the way an individual understands their environment can affect their ability to detect and respond to hazards from attention and perception. Also the mitigation of distraction, how to avoid decision-making paralysis, the limitations of memory, the regular attenders of stress and fatigue, and finally the effects of communication on the individual, task and team. 

To do I'm speaking with Matt Edwards, Matt is a consultant in Adult and Paediatric Emergency Medicine at Kings College Hospital, London and the lead for major trauma and education in Kings. He is also a HEMS Physician with Kent Surrey Sussex (KSS) Air Ambulance and the Polar Medicine course director for World Extreme Medicine. He has held positions as a HEMS Registrar with London’s Air Ambulance, a Flight Physician with AMREF Flying Doctors, Nairobi, and a Medical Officer with the British Antarctic Survey. In the conversation we examine:

·      What are human factors from Matt’s perspective 

·      How task and individual human factors have affected Matt in the past

·      How checklists work - routine vs crisis & the limitations of short term memory. 

·      Trust as a concept in healthcare teams and organisations - how human interactions in healthcare change outcomes - civility to risk aversion.

·      Fatigue, the regular attender in every clinicians journey

·      Distraction and how that affects performance

·      Decision making paralysis and how to break this

·      Teamwork and communication

Please enjoy this wide ranging conversation with Matt.

In this episode we kick off a mini-series on human factors in practice. I will be speaking with a cross section of clinicians on what human factors means to them and the impact it can and has had on their practice. In this episode I discuss the fundamentals of human factors including; a working definition of human factors, why human factors are important, the history of human factors, the main domains of human factors, Individual Human factors & mitigation, task human factors & mitigation, environmental/System human factors F& mitigation, NASA's approach to human factors and finally three seminal cases in human factors.

Medical errors can have significant costs both in terms of patient health outcomes and financial costs. While it is difficult to estimate the precise global costs of medical errors, studies have suggested that they can be substantial. In the United States alone, medical errors have been estimated to cost between $17 billion and $29 billion annually in direct costs, such as additional medical expenses, lost income, and disability. This figure does not include the indirect costs associated with lost productivity or quality of life. A study in the UK estimated that preventable medical errors cost the National Health Service (NHS) around £1 billion each year. On a global scale, a report by the World Health Organization (WHO) estimated that 10% of hospital admissions worldwide result in adverse events, and around half of these are due to errors. These errors are estimated to cause between 6 and 10% of hospital admissions in developed countries, and up to 20% of admissions in developing countries. The report also estimated that medication errors alone affect at least 1.5 million people globally each year, resulting in 100,000 deaths annually. 

Here are the links mentioned in the episode:

REMOTE MEDICAL EMERGENCIES RGS - https://www.rgs.org/CMSPages/GetFile.aspx?nodeguid=6643dce6-a321-4002-b117-28d26897ab59&lang=en-GB  

https://www.youtube.com/watch?v=5C59910SWyw  To err is human documentary   

https://emcrit.org/wp-content/uploads/ElaineBromileyAnonymousReport.pdf  – Elaine Bromiley report

https://www.dmp.wa.gov.au/Documents/Safety/MSH_TB_HOF_Woodside_HOFOilnGas.pdf

Please feel free to reach out to me oneoinwalker@hotmail.com for future content and feedback

In this episode I am speaking with Debs Swann on her recent deployment to the Turkey Earthquake disaster. It is the deadliest earthquake in what is present day Turkey since the 526 Antioch earthquake, making it the deadliest natural disaster in its modern history. As of 20 March 2023, more than 57,300 deaths were confirmed: more than 50,000 in Turkey, and more than 7,200 in Syria. In Turkey alone there were at least 50,096 deaths and 107,204 injured across 11 provinces of Turkey. By 23 February 2023, the Ministry of Environment, Urbanization and Climate Change conducted damage inspections for 1.25 million buildings; revealing 164,000 buildings were either destroyed or severely damaged. A further 150,000 commercial infrastructure were at least moderately damaged. At least 15.73 million people and 4 million buildings were affected. About 345,000 apartments were destroyed. More than 2 million residents in the affected provinces were evacuated to nearby provinces including Mersin, Antalya, Mardin, Niğde and Konya. More than 20 percent of Turkey's agriculture production was damaged. The United Nations said crops, livestock, fisheries, aquaculture and rural infrastructure were also heavily damaged. The international organisation for migration estimated about 2.7 million people were made homeless.

In the conversation we examine her anecdotal experience of deploying with the UK international Search and Rescue Team near the cities of Nurdağı and Gaziantep in Gaziantep Province, just outside the regional capital. We examine the reflection on cases she witnessed, the pattern of injuries, the use of search and rescue dogs, the hot and cold brief of the group, the near death experiences that she had and much more. Debs Swann is an Advanced Clinical Practitioner (ACP) working in the Cambridge area, she is also a PHEM practitioner working with the Birmingham care teams. Debs is also a World Extreme Medicine faculty member and is an active member of the UKISAR team. In the episode she reflects on her time both within the deployment and her reflections afterward. She also reflects on her near death experiences and how that translates to her perspectives on time horizons.

My thanks to Debs for this candid and honest interview and her overall insights.

In this conversation we will examine the recent changes in spinal immobilisation within pre-hospital practice. We will look at the historic literature, prevalence of spinal injury in reality, the RCSEd recommendations, and other international guidelines and also the current practice of C-spine collars and extrication advice. To do this I have Jim Walmsley with me, Jim is a Critical Care Paramedic at South East Coast Ambulance Service NHS Foundation Trust. Jim has a 19-year history with the ambulance service and has focussed his career on clinical practice, research, under-graduate teaching, as well as managerial duties. In the episode we discuss: • The culture and historic research of spinal immobilisation. • Pre-hospital prevalence & cultural shift • What are the main considerations in the pre-hospital phase of care • Pre-hospital assessment (sensitive? Valid?) main information to take note of (MOI & other factors) • Immediate treatment options – to immobilise or not immobilise • Latest recommendations • Seminal cases where the application of the above has worked well • Final thoughts & take-home messages.

Some of the references that Jim referred to can be found here:

https://fphc.rcsed.ac.uk/media/1757/pre-hospital-spinal-immobilisation.pdf

Canadian C spine rules:

https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/for-professionals/whiplash-resources/SIRA08109-Canadian-C-Spine-Rule1117-396476.pdf

NEXUS guidelines:

https://www.ebmedicine.net/media_library/files/Trauma-Imaging-Resuscitation-CD.pdf

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494329/

My thanks to Jim for an engaging and insightful interview.

In this conversation we will examine the immediate, mid-term and long-term effects of sexual assault. We will also examine the short-term treatment that pre-hospital clinicians should consider. We will also examine some of the long-term support that is available for victims of sexual assault. We will also examine elements of safeguarding, care pathways, and forensics that work on a co-aligned basis with psychological support mechanisms. To do this I have Jayne Butler with me. Jayne is the CEO of Rape Crisis and an experienced voluntary sector leader with a strong background in frontline service delivery. Jayne has worked in social justice-focused organisations for almost 20 years. These include organisations working on asylum and immigration, mental health, child sexual exploitation and access to justice. Before moving into infrastructure and influencing work, Jayne was involved in designing, fundraising for and managing a range of frontline services. She has worked strategically as a consultant in a range of voluntary sector organisations, and as a staff member or trustee in a number of membership and infrastructure organisations. These include The Comfrey Project, North East Law Centre, Relate Northumberland and Tyneside, Newcastle United Foundation and The Children’s Society. Prior to joining RCEW, Jayne was Head of Income and Development for Law Centres Network, the national membership body for Law Centres. During her time there, she led on the Network's response to the Covid-19 pandemic. Jayne is a Fellow of the RSA. In the conversation we discuss:

• The need for psychological support as an immediate intervention • The pre-hospital prevalence • What are the main considerations in the pre-hospital phase of care • Pre-hospital assessment when a patient has been sexually assaulted • Forensic assessment • Immediate treatment options, midterm, and long term • Safeguarding needs of this patient group • Care pathways available for these patients • Example case of when services work well together. • Final thoughts & take-home messages from Jayne.

Services that Jayne sign posts to in the episode includes:

24/7 help line: https://247sexualabusesupport.org.uk/

Rape Crisis website: https://rapecrisis.org.uk/

Statistics on sexual assault & rape: https://rapecrisis.org.uk/get-informed/statistics-sexual-violence/

My thanks to Jayne for an informative and insightful interview.

In this conversation we will examine the prevalence, types, and challenges of pelvic trauma. We will also look at some of the pre-hospital and Emergency Department management of pelvic trauma and why it can be such a critical injury to treat. To do this I am speaking with Ash Vasireddy. Ash is a fellowship-trained Orthopaedic Trauma Surgeon specialising in the management of complex upper limb, lower limb, pelvic and acetabular fractures. He works at King’s College Hospital (Major Trauma Centre) in London. He completed further specialist Orthopaedic Trauma training at The Royal London Hospital, as well as Orthopaedic Trauma Fellowships at Queen’s Medical Centre in Nottingham and King’s College Hospital in London. In addition, Ash has also completed travelling fellowship visits to multiple major trauma centres in America, including the Shock Trauma Centre in Baltimore and Harborview Medical Centre in Seattle. Ash also has extensive experience in Emergency Medicine, Intensive Care and Anaesthesia. He is also a Consultant at Essex and Herts Air Ambulance (EHAAT) and research lead for EHAAT. In the conversation we examine:

In the conversation Ash mentions the two common types of Pelvic classification, these are:

TILE: https://litfl.com/classification-of-pelvic-fractures/

Young and Burgess classification of pelvic ring fractures: https://radiopaedia.org/articles/young-and-burgess-classification-of-pelvic-ring-fractures?lang=gb

My thanks to Ash for an insightful and engaging interview. 

In this session I am speaking with Robbie Lendrum on the Myocardial Hypoperfusion & injury in Trauma.We examine the Windkessel concept of pulsatile flow to constant flow, reservoir pressure as an analogue of diastolic pressure, coronary perfusion in diastole. We also explore blood pressure targeted intervention, the disparity between NIBP and IBP, the precision of diagnostics versus intervention, and individually patient centred intervention. We finally fundamentally drill down into the true importance of diastolic blood pressure in trauma care and how this is a succinct shift in mindset and teaching to traditional systolic blood pressure measurements and cut offs.

To do this I have Robbie Lendrum with me. Robbie is a consultant in cardiac anaesthesia and critical care. He is also a consultant in Pre-Hospital Care working with London’s Air Ambulance. Robbie is an honorary senior lecturer at Queen Mary university London and an Endovascular Resuscitation Researcher within the UK. Within the conversation we also examine:

My thanks to Robbie for this interview. This is a fundamental shift in teaching and mindset and is seminal in how we see and approach trauma care in the future. The key pieces of research that Robbie mentions in the interview includes: 

Importance of the aortic reservoir in determining the shape of the arterial pressure waveform. The forgotten lessons of Frank.https://www.sciencedirect.com/science/article/abs/pii/S187293120700155X

The Underlying Cardiovascular Mechanisms of Resuscitation and Injury of REBOA and Partial REBOA

https://pubmed.ncbi.nlm.nih.gov/35615678/

Trauma Laparotomy in the UK: A Prospective National Service Evaluation

https://pubmed.ncbi.nlm.nih.gov/34015456/

My thanks to Robbie for his insights and reflections. 

In this session I am speaking with Mark Hannaford, Luca Alfatti, and Alione Hlivco around the current logistical aid efforts, implementation, climate and anecdotal reflections in Ukraine. We also want to dig into the cadence of change in the current climate from an infrastructural perspective, logistical effort and the real need on the ground from the guest’s experience. Our guests include Mark Hannaford, Mark is the CEO and founder of World Extreme Medicine. Since its inception WEM has trained over 20,000 medics in extreme medicine and has a global platform that also hosts the first MSc in extreme medicine at Exeter University in the UK. Welcome Mark to the podcast. We also have Alione Hlivco, Alione is a former MP in Ukraine. She is a regular contributor at Chatham House, Monocle24, CapX and is a TEDx Speaker. Finally, Luca Alfatti. Luca is the Head of Operations for #Medics4Ukraine, who has delivered over 1.7 million pounds worth of medical aid to Ukraine, as well as several trauma medical courses to frontline soldiers and medics. He is also an advanced paramedic in the UK. Aspects of the conversation include: 

·  The current climate & significant elements of recent change

·  Multi-factorial risk profile of the country currently

·  The existing and emergent needs as seen by the guests

·  Cross section of clinical cases

·  Recent education delivered & aspirations

·  Recent activity within the #Medics4Ukraine initiative within the UK

·  Information governance

·  Aspirations within the next few months (broad & not area specific)

·  Logistical challenges

·  Diversity of medical distribution

World Extreme Medicine can be found here: https://worldextrememedicine.com/

The Medics4Ukraine initiative can be found here https://www.gofundme.com/f/medics4ukraine

This episode is published with kind permission from World Extreme Medicine

In this session we will examine the latest perspectives and insights into recreational drug toxicology with Dima Abdulrahim. I wanted to unpack some of the recreational drug toxicology with reference to drugs that seem to be in favour with youth and have pre-hospital touch points from an acute perspective. Dima Abdulrahim has been working in the field of substance use treatment for 30 years. She is currently the Quality Lead in the Addictions department of CNWL NHS Trust. Dima was the Principal Researcher and Programme Manager of the NEPTUNE Project, based in the Club Drug Clinic. She is the author of two books on novel psychoactive substances and club drugs and other publications and has developed as a series of e-learning and mobile-learning modules, with co-author Owen Bowden-Jones. Dima was a council member of the Advisory Council for the Misuse of Drugs (ACMD) for many years. Topics covered include a deep dive into:

• Some of the most addictive recreational substances Dima has seen in practice 

• Poly-pharmacy and the associated incremental risk profile to the user

• The combined use of sildenafil with other drugs within the chem-sex context

• GHB addiction and profile and the narrow therapeutic window and GABA-B stimulation/sedation (and over sedation) in overdose

• The half-life of GHB 

• Serotonin linked harms and syndromes, mainly within MDMA and ecstasy

• The incumbent fentanyl crisis (unwarranted and unregulated cutting of drugs with fentanyl)

• The false economy of safety around drugs bought online

• The contemporary issue around fake ketamine distribution

• The circulation of fake pregabalin and benzodiazepines and the related deaths

• Take home Naloxone campaigns 

• Other emergent synthetic recreational drugs seen within the clinic

Resources that Dima has written include: 

Books: 

Abdulrahim D and Bowden-Jones O: Textbook of Clinical Management of Club Drugs and Novel Psychoactive Substances Cambridge University Press Medicine. October 2022 (book)

Bowden-Jones and Abdulrahim: Club Drugs and Novel Psychoactive Substances. The Clinical Handbook. Cambridge University Press Medicine. November 2020 (book)

Resources (available free of charge)

NEPTUNE e-learning modules on club drugs and novel psychoactive substances

http://neptune-clinical-guidance.co.uk/e-learning/

Neptune guidelines and resources http://neptune-clinical-guidance.co.uk/

ATOMIC- Addiction to Medication: Improving Care. Mobile-learning modules on the harms and management of non-medical prescription drug use. https://addiction-to-medication.org/atomic/

My thanks to Dima for an engaging and insightful interview.

In this session I will be talking with Neil Jeffers on CRM or Crew Resource Management. We will examine a working definition of CRM, why it’s of fundamental importance to Neil, the history of CRM, the symbiotic link between human factors and CRM, and the detrimental aspects of collective agreement. In the conversation we will also examine some of the theory, threat and error management, CRM tools that Neil uses and advocates, and finally how debrief can be a fundamental tool to improving CRM.

Neil has been a Pilot with London’s Air Ambulance for 16 years and has been Chief Pilot for the last 8 years. Neil has flown over 8,000 hours since he started flying in 1997 and has over a 5,000-hour track record in instructing and examining. Neil was also an experienced crew resource management instructor and a certified first responder and has been a volunteer emergency responder with London Ambulance Service for 5 years. In the interview we cover:

Some of the concepts that Neil mentions includes:

Threat/error management:https://www.easa.europa.eu/en/downloads/22642/en

Dunning-Kruger effect: https://thedecisionlab.com/biases/dunning-kruger-effect

Cognitive Dissonance: https://www.verywellmind.com/what-is-cognitive-dissonance-2795012

My thanks to Neil for an insightful and engaging interview. 

In this session we will examine the fundamentals of the pre-hospital airway from airway assessment all the way through to the difficulties posed in practice. We will also look at the management from a stepwise concept all the way through to the use of invasive surgical techniques to manage the airway. We will also examine some of the optimal methods used to monitor the respiratory effort and when and when not to intervene. We will also examine the current utility and debate around Direct Laryngoscopy (DL) and Video Laryngoscopy (VL) and whether VL is around to stay within practice. 

To do this I have with me John Chatterjee.  John is a consultant anaesthetist with an interest in pre-hospital care and difficult airway, thoracic and high-risk anaesthesia. He has worked with and educated clinicians around the world in various ambulance and hospital services including places like New Zealand, Sydney, Liberia, Ethiopia, Ukraine and in the UK where he has worked with HEMS and BASICS. John is as an anaesthetist at Guys and St Thomas', and a Consultant with London's Air Ambulance at the Royal London. In the episode we examine: 

John mentions these two papers within the conversation:

Difficult Airway Society (DAS) 2015 guidelines for management of unanticipated difficult intubation in adults:

https://aimeairway.ca/userfiles/26556848_Difficult_Airway_Society_2015_guidelines_for_management_of_unanticipated_difficult_intubation_in_adults.pdf

Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians

https://academic.oup.com/bja/article/113/2/220/1745948

My thanks to John for an insightful and engaging conversation. 

In this session I am speaking with Claire Park on a new primary triage tool developed by Claire and a research team. It has been accepted and agreed by NHS England for use by all UK ambulance services and prospectively by National Police and Fire Services. It has also been adopted by the UK MOD to roll out across all UK military personnel internationally.

Claire Park is a Consultant in Pre-hospital Emergency Medicine for London HEMS, and Anaesthesia and Critical Care Medicine at Kings College Hospital in London. She also is an army consultant with over 20 years of deployed military experience. Claire is the medical adviser to the Specialist Firearms teams of the Metropolitan Police Service (MPS), and has worked closely with all of the emergency services in London on developing the joint response to high threat incidents, in particular following the attacks of 2017. She is also the Chief Investigator on a UK nationally funded research grant looking at evidence for improving patient outcomes in the hot zone in major incidents and has developed relationships in this area with many members of the Committee Tactical Emergency Casualty Care CTECC over the last 4 to 5 years. In the conversation we examine:

1.  Definition of triage as a fundamental baseline.

2.  Why need for change - Current standards (START and SMART triage) and the existing and emergent needs from a triage tool.

3.  Empirical literature

4.  Changes to current practices - Challenges in design/Physiology or not physiology/Bleeding not bleeding/talking/breathing.

5.  Design considerations and the inclusion of penetrating injury.

6.  Testing of the tool 

7.  Adoption - Adoption of the tool by various institutions.

8. Improvements expected to be seen on the ground.

8.  What’s next - Future projects for Claire.

The new TST tool can be found here: https://twitter.com/seanharris999/status/1582382980902723584

My thanks to Claire and the team for this insightful interview. 

In this episode we are examining the recent strikes and pay freeze that frontline paramedics have been experiencing. This is on the background of increased cost of living and operational pressures across the emergency care system. We will focus both on Carl’s recent reflections of the issue and also the sense of community within the current strikes. We will also examine how this strike is different to others and indeed how the climate of the NHS is vastly different to that ever seen before.

Carl Betts is no stranger to the podcast, he has been a paramedic for over 10 years and currently working in Quality Improvement. He has also written a recent blog on his reflections of the strike action, the sense of unity and the multi-factorial climate of pressures that paramedics work in within the UK.

This was an episode recorded for World Extreme Medicine (WEM) and aired with kind permission from WEM. World Extreme Medicine are providers of specialist environment and expedition medical education and can be found here:https://worldextrememedicine.com/

In this session I am speaking with Andrew Pearce on the concept of the trauma handover. We examine the definition of the handover, the commonly expected barriers to effective handover, and the recall of handover information. We will also examine where the handover occurs, standards and recommendations, tools and templates, how we can measure effectiveness, and finally whether it works in practice. We will also dig into some of the empirical literature to examine some of the evidence behind the handover.

Andrew Pearce is an Emergency Physician and pre-hospital retrieval medicine specialist. He is currently the Clinical Director and a Medical Retrieval Consultant coordinator at MedSTAR Emergency Medical Retrieval Service based in Adelaide, Australia. In the episode we examine:

1.  Definition of the clinical handover.

2.  Commonly expected barriers to information handover.

3.  Recall of information and some of the errors in recall. 

4.  Empirical findings on handover from the literature. 

5.  Where the handover occurs and bias attached to handover information.

6.  Current standards & recommendations (Standard 6, ACSQHC)

7.  Templates and Tools used and advocated. 

8.  Measuring effectiveness/quality assurance of handover.

9.  Summary from Andrew. 

Some of the empirical papers and standards mentioned in this episode can be found here:

Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members

https://pubmed.ncbi.nlm.nih.gov/20702445/

Expectations differ between senders and receivers of patients in transition - Joint commission centre for Transforming Healthcare 2017

https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_58_hand_off_comms_9_6_17_final_(1).pdf?db=web&hash=5642D63C1A5017BD214701514DA00139&hash=5642D63C1A5017BD214701514DA00139

Clinical handovers between prehospital and hospital staff: literature review

https://emj.bmj.com/content/32/7/577.short

Australian Commission on safety and quality in healthcare: Standard 6: Clinical Handover 

https://www.safetyandquality.gov.au/sites/default/files/migrated/Standard6_Oct_2012_WEB.pdf

My thanks to Andrew for an engaging and insightful interview. 

In this session I am speaking with Aggie Rice on the concept and tool of Schwartz rounds and her journey of implementation within the NHS. Schwartz rounds can be described as a structured forum where all staff, clinical and non-clinical, come together regularly to discuss the emotional and social aspects of working in healthcare. In the session we wanted to explore the purpose of Schwartz Rounds and some of the potential benefits to staff that participant in them. We also wanted to look at the evidence and staff feedback as to their utility and ability to flatten the hierarchies of management within an organisation. The underlying premise for Rounds is that the compassion shown by staff can make all the difference to a patient care, but also in turn, make staff feel supported in their work. We want to dig into this principle and get the thoughts from Aggie who is implementing them at a local and national level.

Aggie Rice is a mentor and trainer on the Schwartz Rounds and Team Time programmes. After working for the Point of Care Foundation for a few years as an Associate, Aggie joined the Foundation in this full-time role in 2021. Aggie has worked on the Schwartz Round programmes since 2016 and has a keen interest in organisational culture, storytelling and the emotional wellbeing of health and social care staff. 

In the episode we cover: 

1.  Why Schwartz rounds are important in the contemporary healthcare climate. 

2.  The power of narrative and the anatomy of the Schwartz round

4.  The principle of psychological safety

5.  Whether they can be used as a surrogate for counselling 

6.  Opening up and flattened hierarchy

8.  Adoption and rate limiting steps/barriers to participation

9.  Progress within the Ambulance Service versus other healthcare settings

10.Take home messages

You can learn more about Schwartz Rounds here:

https://www.pointofcarefoundation.org.uk/our-programmes/staff-experience/

You can learn more about Aggie Rice here:

https://www.pointofcarefoundation.org.uk/about-us/people/aggie-rice/

I hope you enjoy this episode with an insightful and engaging guest. 

In this session we will examine the latest research to emerge from Zane Perkins and Mike Christian around Resuscitative Thoracotomy (RT). The research has been led by Zane and Mike examined over 600 retrospective thoracotomy cases from the LAA database spanning 20 years, looking at the survivors, the pathology (exsanguination versus tamponade), the pre-arrest rhythms, the morbidity and mortality, the time of intervention versus outcome as well as other markers. I wanted to explore the results of this research and the potential implications on practice.

Zane Perkins is a consultant Trauma and General Surgeon at the Royal London Hospital, a consultant Physician for London's Air Ambulance, and an Honorary Senior Lecturer at the Centre for Trauma Sciences, Queen Mary’s University London.

The study has yet to be published but we will publish the results as they are published. My thanks to Zane for an engaging and insightful interview. 

This is the second part of the lecture series on building effective teams and dealing with difficult people. The concepts taught here involve models of teamwork (Action centred Leadership, the five dysfunctions of a team), trust - both as a concept and a pre-requisite, culture, homeostatic teams and finally tools and techniques for fostering good team work. 

In the second half of the podcast we examine dealing with difficult people from the perspective of understanding the triggers, root cause analysis, rapport building, the energy investment model, the ELCR framework, self awareness, humility and insight. Some of the resources and models can be found here: 

Energy investment model: https://careerresilience.wordpress.com/2021/06/03/how-are-you-investing-your-energy-in-times-of-change/

Action Centred Leadership: https://www.businessballs.com/leadership-styles/action-centred-leadership-john-adair/

The Five Dysfunctions of a team: https://tomorrowsleadership.nl/how-to-overcome-the-5-dysfunctions-of-virtual-teams/

Empathic communication: https://hbr.org/2022/08/4-ways-to-communicate-with-more-empathy

I hope you get something from this episode that you can use either within clinical practice or within general work-based situations. I'm always keen for feedback on sessions, please feel free to reach out to me at eoinwalker@hotmail.com - please also rate, review and subscribe to the podcast. This episode will be aired across the Pre-hospital Care Podcast and Restore Podcast platforms. 

Many thanks,

Eoin

In this session we will examine Exertional Heat Injury (EHI) within individuals undertaking endurance races, military exercises, or extreme activity. We will draw contrast and parallels to acute behavioural disturbance, what is happening both at the physiological level and some of the autonomic positive feedback mechanisms within EHI. To do this I have Harvey Pynn with me, Harvey is a Lieutenant colonel within the British Military and an Emergency Medicine and air ambulance consultant with GWAAC. In the episode we examine: 

·  Definitions, spectrum of disease – EHI as a broad definition and spectrum of states

·  How are thinking has changed on heat illness and what is happening on a physiological level

·  Incidence of EHI; anecdotal and empirical

·  The hierarchy of ‘exercise-state’ heat loss – evaporative, convective, conduction, then radiation.

·  Heat acclimatisation: Salt concentration (aldosterone mediated), sweating initiation and rate.

·  Risk factors (individual, environmental)- concomitant disease or drugs (dehydration, alcohol, co-morbid disease, medication)

·  Subtle and not so subtle prodromal signs and symptoms of heat injury & why urine colour isn’t a great marker (lack of micturition during     dehydration).

·  Preventative measures and treatment modalities in severe EHI 

·  Analogues of comparison and symptomatology – ABD, drug induced hyperthermia.

·  Differential diagnosis and an anecdotal case from Harvey 

Please find some related research produced by Harvey pertaining to measuring dehydration and the sequlae of EHI:

https://www.researchgate.net/publication/327822126_The_Compensatory_Reserve_Index-potential_uses_in_a_military_context

Please also see relevant empirical literature that is congruent with the podcast:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819979/

Please enjoy this episode with an engaging and informative guest. 

In this episode I examine the art of active listening. It is a slightly different episode and one of a number to come where I give a series of lectures. In this episode I wanted to do two things:

1. Build awareness of the factors that affect our listening ability.

2. Build and create the conditions that can produce good listening habits.

One of the main problems is caused by the fact that we think much faster than we talk. The average rate of speech for most of us is around 125 words per minute. In contrast we process and think at about 800 words a minute. This is a fundamental mis-match which can cause a deficit in receiving information. The human brain is made up of more than 13 billion cells and operates in such a complicated but efficient manner that it makes any comparison to computers seem insignificant. It might seem logical to slow down our thinking when we listen so as to coincide with the 125-word-per-minute speech rate, but slowing down thought processes seems to be a very difficult thing to do. When we listen, therefore, we continue thinking at high speed while the spoken words arrive at low speed. In the act of listening, the differential between thinking and speaking rates means that our brain works with hundreds of words in addition to those that we hear, assembling thoughts other than those spoken to us. The latency of this mis-match is often taken up by internal dialogue rather than integration of the spoken, but more importantly inferred meaning behind words. In this episode I examine: 

Please let me know what you think of the content at eoinwalker@hotmail.com and also feel free to recommend future topics. Please also feel free to rate and review the podcast and I always welcome feedback. 

In this session we will examine one of the common greatest human factors challenges within pre-hospital care, that of acute fatigue within clinical practice. The ambulance services are trying out different ways of working to help staff feel less tired at work and safer on scene, but these actions are often localised and have no empirical underpinning, and also we don’t know whether they are making working environments safer.

Kristy is investigating whether patient and staff outcomes can be improved through development and implementation of a fatigue risk management system (FRMS), as is done in other safety-critical industries like aviation and transport.  The evidence suggests individual components of a FRMS which may be effective, Kristy is currently investigating the optimal packaging of these interventions. Kristy believes that FRMS adoption in the NHS needs local tailoring and understanding of barriers and facilitators. Kristy is looking at a way to integrate a comprehensive fatigue risk management system for the UK NHS ambulance sector that is acceptable, feasible, and likely to improve patient outcomes and staff wellbeing and experience.

Within the episode we will examine:

1.  Kristy’s research approach toan agreed set of evidence-based and emerging components of a FRMS for the UK ambulance sector that are considered feasible and acceptable.

2. The wider CATNAPS study and its wide ranging primary and secondary outcomes. 

2.  The components of a comprehensive FRMS that are in use and why.

3.  The ways in which front-line staff and patients experience current fatigue actions and potential to improve safety culture and reporting.

4.  Development and usability testing of the FRMS and its implementation guide that allows tailoring to organisational and local context and is underpinned by a new theory of change and logic model.

5. The 12 hour day and and night shift, both pros and cons of this pattern of working. 

6. Fatigue mitigation and how the FRMS may serve to support this.

7. Second and third order effects of fatigue. 

More on CATNAPS and Kristy's research can be found here: https://arc-eoe.nihr.ac.uk/research-implementation/research-themes/mental-health-over-life-course/catnaps-fighting-fatigue-nhs

Please enjoy this episode with an engaging guest. 

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also look at the sequential approach to bleeding control, second and third generation haemostatics, pharmacological agents, tourniquets, neck zones and injuries, blunt injury and junctional wounds, hypotensive management and finally pain management in the combat arena. We also examine the utility and success of highly interventional skills at or near point of wounding such as REBOA. Finally we will examine Traumatic Cardiac Arrest (TCA) and the utility (or not) of an algorithmic approach to management.

To do this, Ed Barnard joins me. Ed is an emergency medicine consultant within Cambridge University hospital and has undergone sub-specialty training in pre-hospital EM, working in more than five EMS systems, educating and mentoring medical students and doctors in training, giving national and international lectures, delivering a national research and clinical innovation meeting, completing a PhD from a top-100 research university, publishing over 30 journal articles, receiving five national-level research awards, and being appointed as a Senior Lecturer for the military.

Topics covered: 

Some of the concepts and evidence that Ed mentions in the episode can be found here: 

A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526509/ The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry https://militaryhealth.bmj.com/content/164/3/150.abstract Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis https://www.sciencedirect.com/science/article/abs/pii/S030095721630538X 

Please enjoy this episode with an insightful and engaging guest.

In this session I will be talking with Carl Betts on the anatomy of quality improvement and some of the pitfalls that occur along the way. Carl is a Paramedic for over 10 years and is a quality improvement lead based in Sheffield working for the ambulance service. In this conversation we will look at the pitfalls we can fall into when examining improvement. We will also look at some of the bias’s that can preclude improvement. We will also be talking about how root cause analysis occurs, data collection, pre and post implementation analysis, some of the quality improvement projects on workflow and hospital delays and how that might translate in practice. In the conversation we examine:

Below is a link to plan, do, study, act cycles that Carl made reference to in the interview. 

https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf

Please enjoy this episode with an engaging and insightful guest. 

In this episode we will examine how the evolution of public health is migrating through to ambulance services and creating future opportunities within this field of practice. In May of last year AACE (the association of Ambulance Chief Executives) published a discussion paper around developing a public health approach within the ambulance sector. This paper starts by denoting that every 24 hours, the NHS has contact with over a million people, and the ambulance sector is at the fore front of these interactions. So we also know that ill health maps across social deprivation and indeed constitutes a high percentage of pre-hospital work, so I want to dig into all of the above with Dr Andrew Furber.

Andrew has been the Regional Director for Public Health England (Northwest) and Regional Director of Public Health NHS NW since May 2020. He was previously Centre Director for Public Health England (PHE) in Yorkshire and Humber. He has worked as a Director of Public Health from 2007 to 2018 and is a past President of the Association of Directors of Public Health UK (ADPH). He was awarded an OBE for services to public health in the Jubilee Birthday Honours List.

In this episode we examine:

Please find more information here: https://aace.org.uk/wp-content/uploads/2021/05/Single-pages-Public-Health-Approach-Ambulance-Sector.final_.pdf

Finger Tips - Public Health https://healthierlives.phe.org.uk/

Please enjoy this episode with an insightful guest. 

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. 

One of their most innovative recent products is the D heart: D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process. The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes.

More information on the D heart can be found here: https://www.bha-medical.com/d-heart-ecg-mobile-device

More information on BHA medical can be found here: https://www.bha-medical.com/

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also examine the SWIFT Study which is a study of Whole blood In Frontline Trauma A multi-centre randomised controlled trial of the clinical and cost-effectiveness of pre-hospital whole blood administration versus standard care for traumatic haemorrhage.

To do this I am speaking with Surgeon Capt Jason Smith. Jason is currently the Defence Professor of Emergency Medicine at the Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham. He was also appointed Royal College of Emergency Medicine Professor in 2013, and is an Honorary Professor at Plymouth University Peninsula Schools of Medicine and Dentistry. He was Consultant Advisor in Emergency Medicine to the Medical Director General (Navy) from 2010-2014. He is a Fellow of the Royal College of Emergency Medicine, the Royal College of Physicians of London, and the Royal Geographical Society. He undertook a doctorate in the management of patients with blast lung injury, and his current research interests include the treatment of pain in emergency patients and the management of traumatic cardiac arrest.

In the episode we examine:

To find more on the SWIFT trial please see here: https://www.nhsbt.nhs.uk/clinical-trials-unit/current-trials-and-studies/swift/

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs.

NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here:

https://bha-medical.com

https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

In this session we will be talking with Zoe Hitchcock. Zoe, 9 years ago in 2013 had a seminal event whilst walking on Oxford St in London. Zoe suffered a cardiac arrest from a cardiac myopathy causing a VF cardiac arrest. The adage that it takes a system to save a life truly came into focus that day. In this episode we will hear from Zoe’s first-hand experience of that cardiac arrest and the events leading up to incident and how it has been a turning point in her life.

The episode below is the initial conversation I had with Zoe to give you more details of the incident and the surrounding conditions: 

https://podcasts.apple.com/gb/podcast/s02e01-zoe-hitchcock-cardiac-arrest-survivor/id1441215901?i=1000437344052

Please enjoy this episode with a true legend. 

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs.

NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here:

https://bha-medical.com

https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

In this episode we will examine the true story of the tragic death of a Search and Rescue medic Dave VanBuskirk. On the evening of the 22nd of July, 2013 Dave fell approximately 200 ft to his death whilst on a winching mission to save another person at Mt Charleston in the Las Vegas region of the US. To tell the story I interview SAR pilot Dave Callan.

Dave Callen is a retired Sergeant from the Las Vegas Metropolitan Police Department. He spent most of his career in the Air Support unit, where he flew patrol, search and rescue, surveillance, short haul/long line and tactical missions. Dave is certified as a rescue pilot a variety of airframes and holds an airplane and helicopter instrument rating with over 4,000 hours of flying experience. Dave unpacks the incident back in 2013, its wide-ranging impacts on the wider team and some of the lasting lessons learnt from the tragedy.

In the episode we examine:

To learn more about Dave VanBuskirk, see here: https://sr3rescueconcepts.com/about

To learn more about SR3 Rescue Concepts please see here: https://sr3rescueconcepts.com/

This podcast is brought to you in association with BHA Medical.

https://bha-medical.com/about-us/

BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. There most recent product is the Vitalstream:

https://bha-medical.com/medical-products/vitalstream/

The Vitalstream is the world’s most innovative wireless non-invasive patient monitor, using a simple disposable finger cuff to measure Continuous Beat-by-Beat Blood Pressure “CNIBP,” Heart Rate, Respiration Rate, and other physiological parameters. This unique technology enables safe, secure, and accurate patient monitoring from virtually anywhere, including remote patient monitoring from a secure cloud portal. This solution provides real time data, enabling healthcare staff to provide early intervention and rapid response to a patient’s changing health conditions. Using a low-cost, disposable finger cuff, the VitalStream patented Pulse Decomposition Analysis (“PDA”) algorithms process the arterial pulse waveform to derive CNIBP, Heart Rate, Respiration Rate, and other hemodynamic parameters.

Please also check out further devices and services offered by BHA medical here:

https://bha-medical.com

I hope you enjoy this episode with an insightful and engaging guest.

In this session we will examine a new pathway which is emerging within Scotland and north of England. The Chronic Obstructive Pulmonary Disease (COPD) pathway has been designed to both specialise treatment and expedite specialist care to this cohort of patients. NHS data shows that in 2020/21, approximately 1.17 million people in England have been diagnosed with COPD, which is around 1.9% of the population. 

To host the conversation I have Jonathon Will with me. Jonathon is a registered Paramedic working with the Scottish Ambulance Service (SAS), he has also worked as an Emergency Care Paramedic within various Emergency Department Resuscitation units. His last two years has been spent working as the Clinical Effectiveness Lead within SAS and a National improvement Advisor for urgent and unscheduled care within NHS Scotland. Tom Fardon is a Respiratory Consultant within NHS Tayside, with a specialist interest in airways disease (COPD, Asthma and Bronchiectasis). Tom is also the clinical lead for the managed clinical network within Tayside and the chair of the national advisory group for respiratory medicine, also the lead for respiratory care action plan within NHS Scotland. He also leads the Scottish Respiratory advisory committee to initiate the recommendations within the respiratory care action plan. In the conversation we talk about: 

* The pathology of COPD; what’s going on with these patients and how these patients normally present to the ambulance service. 

* Physiological tolerance and adaptation over time. 

* Why this pathway has been designed? (what is the current problem)

* How the key clinicians and specialisms have been brought together * End points that the pathway serves 

* Improvements to the current services

* What tiers of patients this pathway serves 

* What happens to the life-threatening COPD patients 

* What a patient could expect when they go through the pathway. 

* What the future holds 

* Take homes messages  

Please find more about the pathway here: https://www.consultantconnect.org.uk/copd-pathway-tayside/

Consultant Connect are partly responsible for supporting this pathway and can be found here: https://www.consultantconnect.org.uk/ 

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of their most innovative recent products is the D heart: D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process. The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes. 

More information on the D heart can be found here: https://www.bha-medical.com/d-heart-ecg-mobile-device 

More information on BHA medical can be found here: https://www.bha-medical.com/

In this interview we will examine the emerging research priorities within pre-hospital care from the perspective of priority and importance. I will be speaking with Sarah McLaughlin – a senior research fellow with affiliations with Essex & Herts Air Ambulance (EHAAT) and Anglia Ruskin University. I will also be speaking with Lisa Ramage, Lisa is a PHEM trainee in the East of England and the chair of PHOTON. PHOTON is a group of non-consultant grade, pre-hospital, doctors with an ambition to expand the quality and reach of research within pre-hospital care. In this conversation we are going to examine a national Delphi study which is defining the national research priorities within pre-hospital care in the contemporary climate. We will also:

You can find out more about PHOTON and Lisa Ramage here: https://fphc.rcsed.ac.uk/about/photon-group

You can find out more about EHAAT here: https://www.ehaat.org/about-us/our-people/

You can find the EHAAT Delphi study that is mentioned in the interview here: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-021-00835-z

You can find some of Sarah McLaughlin's publications here: https://www.researchgate.net/profile/Sarah-Mclachlan-5

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs.

NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here:

https://bha-medical.com

https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

Please enjoy this episode with two insightful and engaging guests 

In this session we will examine the latest research and approaches to traumatic cardiac arrest with Richard Lyon. We will examine the demographics and diversity of pathology that clinicians see day to day within TCA. We will also examine survival rates, empirical research, blood products, the utility of high-fidelity simulation, and the importance of governance & debrief. We will also examine the usefulness of ultrasound and application in practice.

Richard Lyon is a Consultant in Emergency Medicine and Pre-hospital Care at the Royal Infirmary of Edinburgh and Clinical Lead for the Medic One team. He is a HEMS Consultant and Director of Research for Kent, Surrey & Sussex Air Ambulance. He studied at Edinburgh University where he developed close research links with the Scottish Ambulance Service. He undertook a unique doctorate thesis on out-of-hospital cardiac arrest, a project that has developed into a national strategy for cardiac arrest in Scotland.

In the episode we examine:

These are some of the latest algorithms related to TCA:

https://www.resus.org.uk/sites/default/files/2020-05/G2015_Traumatic_Cardiac_Arrest_Treatment.pdf

https://rcem.ac.uk/wp-content/uploads/2021/10/RCEM_Traumatic_Cardiac_Arrest_Sept2019_FINAL.pdf

https://fphc.rcsed.ac.uk/media/2577/tca-submission-oct-2018.pdf

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of their most innovative recent products is the D heart:

D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process.

The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes. More information on the D heart can be found here:

https://www.bha-medical.com/d-heart-ecg-mobile-device

More information on BHA medical can be found here:

https://www.bha-medical.com/

Please enjoy this episode with both an insightful and fascinating guest.

In this interview we will examine some of the prevailing issues and incremental rise of Alzheimer’s disease within the global healthcare system. Cognitive decline is a major concern of the aging population. Already, Alzheimer’s disease affects approximately one in 14 people over the age of 65, rapidly becoming the third leading cause of death in the UK behind cardiovascular disease and cancer.

To do this I have with me Jennifer Bute. Jennifer was a GP in a large clinical practice, whose patients included those with dementia. Then she began to notice symptoms in herself and was finally given a diagnosis of young-onset dementia in 2009. After resigning as a GP, she resolved to explore what could be done to slow the progress of dementia. Jennifer has written a new book titled ‘Dementia from the inside’ and in this interview we will dig into some of the concepts form the book and speak around the wider aspects of the disease. 

Jennifers website and book can be found here: https://www.gloriousopportunity.org/resources.php

More from Jennifer can be found here: https://www.gloriousopportunity.org/

Concepts she advocates including Japanese Memory Groups can be found here: https://www.gloriousopportunity.org/japanese-memory-groups.php

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs.

NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here:

https://bha-medical.com

https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

In this conversation I talk with Carl Betts about his reflections on paramedic retention in contemporary practice. Carl is a paramedic and quality improvement lead based in Sheffield working for the ambulance service. He has been a paramedic for 10 years and also has a 10-year extensive history of expeditions across the globe.  We examine this article, Carl’s motivations for writing it, and pull out some of the salient learning points from his reflection in this interview. We examine some of the metaphorical warning lights that Carl describes (demand, resourcing, external management pressure), the spill over of GP work, e-consult and exponential rise of primary care. We also examine current hospital handover times, the central pivot and reason for staying in the role (patients) & the frustration seesaw that clinicians find themselves on. We also explore what the ‘outs’ and opportunities there are at the moment for paramedics, we also look at mental burnout and how should things change to avoid frustration and burn out, and finally a seminal case in reference to the conversation from Carl's experience. 

The reflection can be found here:

https://wordpress.com/page/prehospitalcarepodcast335905859.wordpress.com/3

The rotational paramedic proposals can be found here:

https://www.hee.nhs.uk/our-work/paramedics/rotating-paramedics

https://www.hee.nhs.uk/sites/default/files/documents/Feasability%20Study%20of%20the%20Rotating%20Paramedics%20Pilot%20-%20Final.pdf

The future proposals from AACE can be found here:

http://aace.org.uk/wp-content/uploads/2015/09/Ambulance-2020-and-beyond-the-AACE-vision.pdf

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of their most innovative recent products is the D heart:

D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process.

The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes. More information on the D heart can be found here:

https://www.bha-medical.com/d-heart-ecg-mobile-device

More information on BHA medical can be found here:

https://www.bha-medical.com/

In this session we will be talking with Noah Baron Cohen. Noah, now 22, 6 years ago in 2016 had a seminal event whilst exercising at The Jewish Community Secondary School in North London. Noah suffered a cardiac arrest from a primary arrhythmia causing a VF cardiac arrest. The adage that it takes a system to save a life truly came into focus that day. In this episode we will hear from Noah’s first-hand experience of that cardiac arrest and the events leading up to incident and how it has been a turning point in his life. Erran is Noah’s father and will also tell the sequence of events as he experienced it, both on that day in 2016 and the consequential roller coaster ride of Noah's rehabilitation. 

We talk about Noah’s life before the incident, what Noah & Erran remember about that day, we run through sequentially timeline of events. We also speak about the recovery journey that Noah embarked on, the consequential shift in perspectives on life that it has given rise to, and finally take home message from Noah and Erran.

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs.

NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here:

https://bha-medical.com

https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

Please enjoy this episode with an inspiring pair of guests. 

In this session we will examine the recent viral Monkeypox (MPV) outbreak with Professor Kelechi Nnoaham. We dig into the anatomy of the virus, the possibility of local transmission of the virus, the origins of the current outbreak, current prevalence, symptomatology, known transmission pathways, viral genetic adaptation, the R rate, Case Fatality Rate, containment (ring vaccination strategies), whether the MSM data is outlier data, and finally, surveillance of MPV.

Professor Kelechi is the Executive Director of Public Health and lead for Research & Development, Innovation and Value-Based Health for Cwm Taf Morgannwg University Health Board, Wales. Kelechi has held Honorary Professorships in Public Health and Epidemiology at Plymouth University (since 2015) and Cardiff University (since 2021) medical schools and previously worked as the Director of Public Health for Plymouth and Bristol City Councils. He has subsequently worked throughout leadership roles in public health and healthcare leadership across the UK. Kelechi has an MPH in Global Health Science (with Distinction) at Oxford University and followed that up with a PhD in Public Health & Epidemiology at Oxford University in 2011.

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy.

BHA’s latest innovation is a Monkeypox Lateral Flow Antigen Rapid Test.

The product is a lateral flow detection of monkeypox virus antigen in human whole blood, serum, plasma, rash exudate, or nasal swab. The product uses a double antibody sandwich method. During the test, a specimen is dropped into the specimen hole, the specimen is superimposed under the capillary effect. If the specimen contains monkeypox virus, a colour band appears in the test area (T) indicating a positive result for monkeypox virus. If the specimen does not contain the corresponding substance, there will be no colour bands in the test area (T), and the result will be negative. The Performance Characteristics show that the positive and negative coincidence rates are 100%

Please see the show notes for further details and how to order kits:

https://www.bha-medical.com/monkeypox-virus-antigen-rapid-test-kit

https://www.bha-medical.com

Please enjoy this wide ranging episode with an insightful guest.

In this session we will examine the importance and art of dispatch with Jerry Overton. Jerry Overton serves as the President of the International Academies of Emergency Dispatch, the organisation charged with setting standards, establishing curriculum, and conducting research for public safety dispatch worldwide.

Established in 1988, the International Academies of Emergency Dispatch (IAED) is the international standard setting and certification body for emergency dispatch. Currently, its protocols are in use in over 2800 dispatch centres in 38 countries. As the President of the IAED, Jerry leads the Academy, which allows advanced call taking, clinical assessment, and patient management by evidenced based telephone algorithms. Jerry has established international relationships for IAED and assists in the development of EMS systems worldwide.

This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the most recent devices they sell is the D-Heart; D-Heart is the first smartphone ECG device that is simple to use, clinically reliable, portable and affordable. It allows anyone to perform a hospital-level ECG in total autonomy and to send the results to the 24/7 telecardiology service or to your trusted doctor.

·  The app guides you to perform a professional ECG

·  Bluetooth ECG streaming in real time

·  Medical grade ECG (12 to 60 seconds of recording)

·  Telecardiology service available 24/7

·  Charge the device directly in the case

·  Italian design and manufacturing

The D heart ECG device can be found here: https://bha-medical.com/medical-products/d-heart/

For further information on BHA medical please see here: https://bha-medical.com

Please enjoy this wide ranging conversation with an insightful and engaging guest. 

In this session we will examine the fundamentals of head injury with consultant neurosurgeon Mark Wilson. We will dig into the details of brain injury, primary and secondary injury, the importance of venous drainage, and optimising the pre-hospital management.

Mark is a Consultant Neurosurgeon and Pre-Hospital Care Specialist working at both Imperial College (mainly St Mary's Major Trauma Centre) and as an Air Ambulance doctor. He is also a Clinical Professor specialising in Brain Injury at Imperial and Honorary Professor of Pre-Hospital Care (the Gibson Chair) at the Faculty of Pre-Hospital Care, Royal College of Surgeons, Edinburgh. Marks’ specialist areas are acute brain injury (mostly traumatic brain injury) and its very early management. He is also  co-director of the Imperial Neurotrauma Centre and co-founder of GoodSAM, a revolutionary platform that alerts doctors, nurses, paramedic and those trained in basic life support to emergencies around them. He has worked extensively overseas (India, Nepal, South Africa, as a GP in Australia, Researcher for NASA and as an expedition doctor on Arctic and Everest expeditions).

In the episode we examine: 

This podcast is brought to you in association with BHA Medical. 

https://bha-medical.com/about-us/

BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. There most recent product is the Vitalstream:

https://bha-medical.com/medical-products/vitalstream/

The Vitalstream is the world’s most innovative wireless non-invasive patient monitor, using a simple disposable finger cuff to measure Continuous Beat-by-Beat Blood Pressure “CNIBP,” Heart Rate, Respiration Rate, and other physiological parameters. This unique technology enables safe, secure, and accurate patient monitoring from virtually anywhere, including remote patient monitoring from a secure cloud portal. This solution provides real time data, enabling healthcare staff to provide early intervention and rapid response to a patient’s changing health conditions. Using a low-cost, disposable finger cuff, the VitalStream patented Pulse Decomposition Analysis (“PDA”) algorithms process the arterial pulse waveform to derive CNIBP, Heart Rate, Respiration Rate, and other hemodynamic parameters.

Please also check out further devices and services offered by BHA medical here: 

https://bha-medical.com

I hope you enjoy this episode with an insightful and engaging guest. 

In this session we will examine the fundamentals of Mountain Rescue with Paramedic Jamie Patterson and Emergency Nurse Practitioner Ben Cooper. This will include a look at the demographics and diversity of rescues within the Mountain Rescue Team (MRT). We will also examine the different specialist domains that constitute being a member of the MRT such as navigation, search strategies, team dynamics, Immediate Medical Care (IMC), casualty evacuation and much more. Finally, we will examine some seminal cases where all of Ben and Jamie’s training has come to use. Both World Extreme Medicine colleagues examine the following topics:

Further resources recommended by the guests include:

Go outside. Sit down. Wait.

https://dmbins.com/blog/go-outside-sit-down-wait/

Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature

https://www.amazon.co.uk/Mountain-Rescue-Doctor-Wilderness-Medicine-ebook/dp/B000V770NC

Mountain Rescue: History and Development in the Peak District 1920s-Present Day

https://www.amazon.co.uk/Mountain-Rescue-Development-1920s-Present-1920s-2007/dp/0752440918

Cairngorm John: A Life in Mountain Rescue

https://www.amazon.co.uk/Cairngorm-John-Allen/dp/1905207573

Call-out: A climber's tales of mountain rescue in Scotland

https://www.amazon.co.uk/Call-out-climbers-mountain-rescue-Scotland/dp/1911342215

World Extreme Medicine - Fundamentals of Search & Rescue | Northumberland | October 2022

https://worldextrememedicine.com/products/search-rescue/sar/

If you have any specific Mountain Rescue questions, Jamie Patterson is available to take these at: jamie.pattison90@gmail.com

I hope you find this episode both engaging and insightful. 

In this session I will be talking with Allistair MacSorley around his journey through pre-hospital care as a paramedic and then a day in 2018 that changed his life forever and left him paralysed from the waist down. We will also be examining his tenacity, drive and attributes that separate him from the crowd. He is currently still working as a registered Paramedic and part of the maternity team within London Ambulance Service. He is also part of the Irish paracycling development squad in hand cycling. He is training for and focussed on the next hand cycling World Cup in May in Belgium, aiming towards ParaOylpmics Paris 2024 and then the LA games 2028. He has adapted and employed a coach from September 2021 which has fundamentally changed his training program and diet. The carbon fibre cycle bike is a £15,000 specialised bike with adaptations and enables Ali to compete at elite level. 

In the conversation we discuss: 

Ali's story can also be found here:

https://www.irishnews.com/news/northernirelandnews/2019/07/29/news/-flying-doctor-left-paralysed-after-motorcycle-crash-returns-to-circuit-a-year-later-to-complete-lap-1672238/

https://www.bbc.co.uk/sport/motorsport/49140461

Please enjoy this episode with a truly inspiring professional and friend.

In this session we examine the importance of governance and the main facets that constitute robust governance. This includes a look at why governance is important, the different domains that constitute good governance and finally how it is applied in practice. We will also look at the fundamentals of risk management within governance and the symbiotic relationship between the two. To do this I have Intensive Care, Anaesthetic and Pre-hospital care consultant Pete Sherren with me. In the conversation we unpack: 

Links to the Delphi study that we mention in the conversation can be found here: 

Consensus on research priorities for Essex & Herts Air Ambulance: a Delphi study: https://sjtrem.biomedcentral.com/track/pdf/10.1186/s13049-021-00835-z.pdf

Please enjoy this conversation with an engaging and insightful guest. 

I'm pleased to release this recently recorded episode with ED consultant Dr Amy Hughes. Amy has launched the 'Portfolio Medical Careers' Podcast which details interesting narratives and career paths from various medical careers. This series will cover doctors, paramedics, nurses, and other allied healthcare professionals with different stories and paths within and outside of the National Health Service (NHS). She has some fantastic interviews lined up and really gets to the heart of emphasising the 'journey and not just the destination'. The podcast also denotes that various experiences can feed into the wider clinician and person and give more rounded and diverse experience from which to draw. 

This month we join Paramedic Eoin Walker. Eoin has been a practising paramedic for over 20 years and journied through a fascinating career including the LAS cycle response unit, Physician Response Unit, London's Air Ambulance (HEMS), LAS Advanced Paramedic Practitioner, Expedition Medicine and, most recently,  a role with the International Committee of the Red Cross (ICRC).

The podcast can be found here: 

https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5saWJzeW4uY29tLzQwMDc3NS9yc3M/episode/YTlhYTI3NjktYWFkNS00MDBlLWEzODctM2FhZjIwZjBjNGUz?hl=en-HU&ved=2ahUKEwjMi4nizsX2AhXUiP0HHY46DecQjrkEegQIBhAF&ep=6

In this session we will examine some of the prevailing issues and difficulties of paediatric pain management. To do this I have Will Broughton, an associate professor of paramedic science at Buckinghamshire New University, Paramedic with specialist interest in Paediatric Emergency Medicine and Paramedic Education. He continues to practice clinically with London Ambulance Service (LAS) and South Central Ambulance Service (SCAS).

We will unpack some of the nuances, challenges, and evidenced based approaches that Will has found from being both a pre-hospital practitioner and studying his MSc in this domain of practice. In the conversation we discuss: 

Resources that are mentioned in the episode include: 

CRIES pain scale http://geriatricphysio.yolasite.com/resources/CRIES%20Scale%20for%20Neonatal%20Postoperative%20Pain%20Assessment.pdf

WHO pain ladder https://professionals.wrha.mb.ca/old/professionals/files/PDTip_AnalgesicLadder.pdf

Children in painhttps://rcem.ac.uk/wp-content/uploads/2021/11/Pain_in_Children_2017_18_National_Report_Oct_2018.pdf

Wong and Baker faces https://wongbakerfaces.org

I hope you enjoy this episode with a fantastic guest. Will Broughton can be reached on Twitter at @WilBroughton

In this session we will be interviewing flight paramedic Paul Swinton, to talk about how to optimise the RSI in the pre-hospital environment. We will unpack some of the nuances, challenges, and approaches that Paul has found from being both a pre-hospital practitioner and in innovating the layout and design for an RSI in creating the SCRAM bag. SCRAM™ (Structured CRitical Airway Management) is an innovative solution for enhancing the performance of emergency airway management. It involves the systemisation, standardisation, cognitive offloading, human factors and good governance are core principles to the design and philosophy of SCRAM.

Paul has been a paramedic for the past 20 years. He joined the Scottish Ambulance Service Special Operations Response Team, based in Glasgow, in 2010, after re-locating from the West Midlands Ambulance Service. He is currently an Air Ambulance Paramedic for the Scottish Air Ambulance Division, involved in critical care and retrieval medicine, working alongside the trauma teams and medical retrieval services of Scotland (ScotSTAR). He is originally from South Africa, where he qualified and worked as a paramedic on the road, in Emergency Departments and as a flight paramedic.

This podcast is brought to you in collaboration with Scottish Health Innovations Limited, also known as SHIL, who work in partnership with NHS Scotland to identify, protect, develop and commercialise healthcare innovations to improve patient care. SHIL uses specialised knowledge to help bring new ideas and innovations from healthcare professionals to life, with a multidisciplinary team providing expert services including intellectual property advice and protection, regulatory expertise, project management, idea incubation, funding advice, development, commercialisation, and post-commercialisation monitoring. 

You can follow SHIL’s work on Twitter, @ScotHealthInno

You can find out more about SHIL here: https://www.shil.co.uk/

You can find SHILs products here: https://www.shil.co.uk/browse/products

This podcast is also brought to you in association with Openhouse. Openhouse take a unique approach to creating products in focussing on a ‘Fit For Purpose’ end product. Their focus on creating truly bespoke products along with the best possible purchasing experience which means they have strong working relationships with customers from all sectors of industry. 

Openhouse products can be found here:openhouseproducts.com

You can follow Openhouse on twitter @OHproducts

You can find out more about Openhouse here: https://www.openhouseproducts.com/about-us/

You can see the SCRAM range as mentioned in the episode here: https://www.openhouseproducts.com/?s=SCRAM&post_type=product

You can find out more about the guest here: https://paulswinton.com

I hope you enjoy this episode with an engaging and insightful guest. 

In this session we will examine the epidemiology of OHCA. We will look at the frequency and trends of OHCA together with the causes and risk factors. We will examine the concept of a registry of cardiac arrest and appreciation of baselines to work from. We will also look at the current mitigation strategies that are available to prevent OHCA such as policy, and Public Access Defibrillation (PAD) amongst others. We will also look at our guest's PhD (Dr Katherine Pemberton) and how that both informs the current climate and the future of how we tackle OHCA.

We examine:

These are links to Dr Pemberton's literature review:

https://ajp.paramedics.org/index.php/ajp/article/view/752

https://ajp.paramedics.org/index.php/ajp/article/view/753

These are the pubmed links. 

https://pubmed.ncbi.nlm.nih.gov/31352680/

https://pubmed.ncbi.nlm.nih.gov/31352690/

https://pubmed.ncbi.nlm.nih.gov/33219108/

Please enjoy this episode with two insightful and engaging guests 

The best of the 'Restore Podcast 2021' is here. This conversation features accounts with Consultant psychologists, psychiatrists, special forces operatives, professional rugby stars turned drug addicts turned pastors, inspirational leadership coaches, accounts on NLP, Neuroplastic Somatic Practice, EMDR therapy, CBT, and much, much more.

The mandate is…raw and inspirational conversations with the application of deep understanding and revelation. In the world of memes and brief captions that sound good in the moment, we need real, raw, and deep accounts and tools to navigate one of the most difficult segments of time in life. Instead of falling for a brief caption that means nothing and lasts only a moment, instead try leaning into these life accounts of how people have turned around their lives from truly testing times. Wisdom is the life application of knowledge. It is found in a deep understanding and fostered through narrative and tools most of which don’t lay within our own capacity and rely on us being willing to hear others survive and thriving through adversity.

My thanks to all the guests that have featured across the podcast in 2021. I look forward to taking you with me into 2022 for more inspirational conversations and truly revelationary accounts.

In this episode we look at the debrief in its entirety; why we debrief, when, how and where. We examine the evidence behind debriefing and the institutions that use debrief such as the military, pre-hospital practitioners, ward based staff, sports teams, athletes and others. We then look at the types of debrief such as the hot & cold debrief, Schwartz rounds, Critical Incident Stress Debriefing, the After Action Review amongst others. We then examine 6 tools of debriefing that can be used in practice. We briefly also touch on the disparity of evidence around mitigation of psychiatric pathology such as PTSD. 

Here are some of the tools mentioned:

TAKESTOCK https://www.rcemlearning.co.uk/foamed/take-stock-hot-debrief/ STOP5 https://www.stemlynsblog.org/wp-content/uploads/2018/10/Hot-Debrief-Poster-V2-April-2018.pdf PLUS DELTA https://fhop.ucsf.edu/sites/fhop.ucsf.edu/files/custom_download/ACPS_Plus_Delta_Template.pdf MODIFIED PLUS DELTA https://leanconstruction.org/media/learning_laboratory/Plus_Delta/Plus-Delta.pdf ITRUST Debrief https://www.bmsc.co.uk/course/itrust-debriefing/ PEARL debrief https://debrief2learn.org/pearls-debriefing-tool/

I hope you enjoy this episode 

In this episode, we are going to examine a story of one of the key innovations in pre-hospital care in the last 20 years and how it came into existence. We will look at the Cycle Response Unit or CRU that see’s Paramedics respond to emergency calls via mountain bikes across the nation. To do this we have the creator and founder of the CRU Tom Lynch MBE, MStJ.

Tom Lynch has channeled his excellent cycling and coaching skills, his self-belief, and his competitive spirit to develop and deliver the CRU.traveled the world as a BMXer, won numerous trophies and titles several times over, appeared on the front page of magazines, had fans on every continent and lived a life people can only dream of. In 1999 Tom got the go-ahead for a trial to set up the Ambulance Cycle Response Unit (C.R.U.) to answer 999 calls in the West End of London. He still had friends in the bike industry from BMX days and he made sure he got the best equipment available. The bike was fitted with the latest pre-hospital equipment and the all-important lightweight defibrillator. This marked the beginning of a legacy of paramedics on mountain bikes, but it wasn’t always an easy ride. we examine the history and background, Tom’s struggles and battles to get the project off the ground, some of the seminal cases in which the CRU has been involved, and some of Tom’s best moments.

In the conversation we examine:

I hope you enjoy this episode with two fascinating guests.

In this session we will examine the recently published in the Journal of Paramedic Practice on 'Focused ultrasound in out-of- hospital cardiac arrest by Advanced Paramedics'.To do this I have Advanced Paramedic Practitioner, author and lecturer Nick Brown. 

In the episode we discuss why ultrasound is used, what device is used and what APPs use it for. We also discuss the primary and secondary outcomes of the study, the population the study focusses on (OHCA) and the problem/question they are seeking to address (cardiac arrest management/termination). We also explore the study's methodology, the differentiation of results, the conclusion, the clinical relevance to practice, what Nick took from performing the audit and the salient take home messages from the study. 

The research article can be found here: https://www.magonlinelibrary.com/doi/abs/10.12968/jpar.2021.13.1.26

Please enjoy this episode and feel free to rate and review the podcast. 

In this episode we will examine the various ways in which paramedic education has evolved over the past 20 years both conceptually and the skills taught within the profession. Alan Rice and Lisa Burrell join me in this conversation,  Alan is the lead for post-registration paramedic education at St Georges University, London. His role is predominately designing and organising the delivery of education for specialist and advanced paramedic roles in both urgent and critical care. He also oversee’s the work force development of all qualified paramedics that are studying towards a higher education award. Alan also works as a consultant paramedic advising ambulance trusts.

Lisa Burrell is both an Advanced Paramedic Practitioner in London and a senior lecturer at St Georges university. Lisa teaches on both the post and undergraduate cohorts and spends time teaching CCPs from different services. She has also spent over 8 years as a flight paramedic within London and has split her time between teaching and critical care.

In the episode we talk about:

·  The concept of critical thinking & analysis - a central concept of education. 

·  The diversity of care pathways and how this has changed over 20 years.

·  Non-technical skills taught and emphasised throughout the curriculum and course.

·  Mentoring - the importance of this.

·  Monitoring and the use of monitors within pre-hospital care. 

·  Engagement with technology for current practitioners. 

·  Skills that have evolved – USS, thrombolysis for VTE, prescribing, Abx,

·  Anecdotal thoughts on evolution of both the profession and the paramedic practice curriculum. 

The undergraduate Paramedic Science course at St Georges University London can be found here:

https://www.sgul.ac.uk/study/courses/paramedic-science

Please enjoy this conversation with two fantastic guests. 

In this episode we will examine the various pathologies related to psychosis and neurosis in mental health that clinicians can see within practice. We also examine some of the key aspects of these pathologies so that clinicians can construct both meaningful and targeted treatment to this extremely difficult cohort of patients. To do this am am joined by Anna Basquil, a special mental health practitioner who joined the ambulance service in January 2020, seconded by her mental health trust to provide and help embed the 'dual assessment model' on patients. She works on the 'Mental Health Joint Response Unit' together with a Paramedic. Prior to this Anna was working in an 'early intervention service' with patients experiencing their first episode of psychosis. Anna worked in patients early years of diagnosis to help them both integrate and cope with their symptoms to help normalise and stabilise their lives. 

In the interview we discuss: 

More information on the 'Mental Health Joint Response Unit' can be found here: https://aace.org.uk/initiatives/mental-health-joint-response-car/

I hope you enjoy this episode with an engaging and informative guest. 

In this session we will examine some of the prevailing educational learning from a colleague who has just qualified as a critical care paramedic in London. We will unpack some of the revelations, nuances, and comparisons that critical care has brought from their perspective from other roles. In the episode we dig into Adam’s background and why the Advanced Paramedic Practitioner in critical care career pathway was appealing to him. We also examine what has it brought Adam from a wider perspective and the nuances in care compared to standard paramedic practice.

We then unpack Adam's personal revelations that were previously unknown and what he took from the mentoring aphase of his critical care training. We finish off by looking a few seminal cases and how that both inspired him and helped him learn along the way. 

I hope you enjoy this episode with both an honest and insightful guest. 

In this session we will examine the varied pathology of Transient Loss of Consciousness (TLOC), the definition, the causes, the sequalae, and the management. I wanted to also examine some of the key aspects of TLOC that are red flags and should be examined further within clinical practice. To do this I have Consultant Cardiologist and Honorary Senior Lecturer, Dr Nicholas Gall with me. 

In the episode we look at an established definition of TLOC, Nick's efforts to start a blackout pathway, the fundamental problem of TLOC in unpacking why undifferentiated TLOC can be a clinical minefield. We then examine the aetiology of TLOC and the diagnostic tools with which to differentiate the pathology (USS and ECG nuances). We then look at red flags warning signs and subtle information cues with TLOC, treatment of TLOC patients (broad take home messages) and clinical examples from practice.

I hope you enjoy this episode with a fascinating and insightful guest. 

In this session I speak with  Professor Kelechi Nnoaham. We examine the prevailing themes of public health within the contemporary pandemic. We examine some of the key aspects of public health necessary to overcome one of the most challenging public health issues since the inception of the NHS. We dissect some of the fundamental principles of public health, the info-demic war of information, the contemporary evidence-based research, decentralised leadership and more.

Professor Kelechi is the Executive Director of Public Health and lead for Research & Development, Innovation and Value-Based Health for Cwm Taf Morgannwg University Health Board, Wales. Kelechi has held Honorary Professorships in Public Health and Epidemiology at Plymouth University (since 2015) and Cardiff University (since 2021) medical schools and previously worked as the Director of Public Health for Plymouth and Bristol City Councils. He has subsequently worked throughout leadership roles in public health and healthcare leadership across the UK. Kelechi has an MPH in Global Health Science (with Distinction) at Oxford University and followed that up with a PhD in Public Health & Epidemiology at Oxford University in 2011. In the conversation we examine: 

Professor Kelechi can be contacted through the following platforms; 

• Twitter - @CwmTaf_DPH, @KelechiNnoaham

• LinkedIn - linkedin.com/in/kelechi-nnoaham-1649937

Please enjoy this interview with an insightful and fascinating guest. 

In this episode I speak with Dr David Stehlik on leadership, followership and organisations. Dr Stehlik is the programme director for the Keith Bussey School of Business and entrepreneurial leadership at the University of St Francis in Fort Wayne in the US. He is also the the founder of a strategy and business education consultancy ‘Fourscene’ related to the field of strategic foresight. He is a strategist, an educator and team developer, he has also published a book called ‘Integrated delivery - innovating leadership for outstanding healthcare outcomes’ that was released at the beginning of 2021.

In this episode we speak about what constitutes ‘great leaders’, and then dissecting the antithesis of this in the anatomy of failing leaders. We also examine:

You can contact David at https://www.foursceneventures.com/about.html

You can also read the article that the interview is based on here: https://www.regent.edu/acad/global/publications/jpc/vol5iss1/3-stehlik.pdf

I hope you enjoy this episode with a fantastic guest.