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Pre-Hospital Care Podcast

Pre-Hospital Care Podcast

By Eoin Walker

This podcast is designed to have engaging and inspirational conversations with some of the worlds leading experts in or relating to pre-hospital care. We hope you take a lot from the conversations both from a technical and non-technical perspective. Please rate and review the show as feedback helps ensure that the best information gets back to you throughout the project.
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Leadership with Tim Archer

Pre-Hospital Care Podcast Jul 08, 2020

00:00
01:21:01
Life as an Advanced Clinical Practitioner (ACP) with Dan Dutfield

Life as an Advanced Clinical Practitioner (ACP) with Dan Dutfield

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/⁠

Mar 25, 202432:30
Restore Podcast: Overcoming Adversity with Jay Baldwin
Mar 24, 202401:06:57
Leadership lessons learned from a Lifeboat Coxswain with Robbie Maiden
Mar 18, 202446:06
The Future of Pre-hospital Maternity Care with Consultant Midwives Camella Main, Stephanie Heys and Dawn Kerslake

The Future of Pre-hospital Maternity Care with Consultant Midwives Camella Main, Stephanie Heys and Dawn Kerslake

Mar 11, 202401:07:42
Team Performance with London HEMS Medical Director Tom Hurst

Team Performance with London HEMS Medical Director Tom Hurst

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/⁠

Mar 04, 202441:20
The International Journal of Paramedicine with Editor in Chief, Mic Gunderson

The International Journal of Paramedicine with Editor in Chief, Mic Gunderson

In this conversation, we will unpack the International Journal of Paramedicine and 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/⁠

Feb 26, 202438:52
Life as a London HEMS Paramedic in 2024 with Kerien Rodwell

Life as a London HEMS Paramedic in 2024 with Kerien Rodwell

Feb 19, 202401:12:28
The Future of Military Medicine with Major General Tim Hodgetts

The Future of Military Medicine with Major General Tim Hodgetts

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/⁠


Feb 12, 202440:40
Life Threatening Anaphylaxis and the AMAX4 algorithm with Ben Mckenzie

Life Threatening Anaphylaxis and the AMAX4 algorithm with Ben Mckenzie

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/






Feb 05, 202401:04:30
The Scottish Trauma Network with Martin Esposito
Dec 29, 202301:07:12
The best of 2023 part 2

The best of 2023 part 2

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

  • Major Incident Management with Keir Rutherford and Alec Wilding.
  • The future state of Pre-Hospital Care with Jason Killens.
  • Safe Sedation of Acute Behavioural Disturbance with Tim Edwards.
  • Addiction part 3 with Dr Brian Hall.
  • Paramedic Burnout with Liz Thyer

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


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Dec 26, 202346:51
The best of 2023 part 1

The best of 2023 part 1

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

  • The UKISAR deployment to the Turkey earthquake disaster with Deb Swann.
  • The Ten Second Triage Tool (TST) with Claire Park.
  • The Pre-Hospital Airway with John Chatterjee.
  • Pelvic Trauma with Ash Vasireddy.
  • High-Fidelity Training with Neel Bhandari.

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

Dec 24, 202356:18
Update on the Ukraine War: Life in Conflict
Dec 18, 202301:04:05
The Pathophysiology of Drowning with Prof Mike Tipton

The Pathophysiology of Drowning with Prof Mike Tipton

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. 

Dec 11, 202358:54
Major Incidents from a Scottish Perspective with John Paul Loughrey

Major Incidents from a Scottish Perspective with John Paul Loughrey

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/



Dec 04, 202301:16:04
Burnout in Paramedics with Liz Thyer

Burnout in Paramedics with Liz Thyer

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.

Nov 27, 202345:26
Addiction Part 3: The Psychology and Psychiatry of Addiction with Dr Brian Wells

Addiction Part 3: The Psychology and Psychiatry of Addiction with Dr Brian Wells

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.

Nov 22, 202301:01:09
Exercise Associated Collapse and the differentials with Luca Carenzo

Exercise Associated Collapse and the differentials with Luca Carenzo

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 the Istituto 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/


Nov 14, 202342:08
POCUS as a predictor of Traumatic Cardiac Arrest outcome with Tim Harris

POCUS as a predictor of Traumatic Cardiac Arrest outcome with Tim Harris

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.




Nov 06, 202331:08
Safe sedation of Acute Behavioural Disturbance with Tim Edwards
Oct 30, 202323:51
The Innovation of Thrombectomy for Ischemic Strokes with Kunle Ogungbemi

The Innovation of Thrombectomy for Ischemic Strokes with Kunle Ogungbemi

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.

 

Oct 23, 202330:28
Addiction part 2: The Toxic Drug Crisis with Jen Bolster

Addiction part 2: The Toxic Drug Crisis with Jen Bolster

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.

Oct 16, 202342:36
Reverse Mentoring with Carl Betts

Reverse Mentoring with Carl Betts

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.





Oct 09, 202338:10
Penthrox in the Pre-hospital environment
Oct 02, 202319:09
Global Health Systems strengthening with Aneesah Peersaib

Global Health Systems strengthening with Aneesah Peersaib

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

Sep 25, 202347:44
Addiction Part 1 - Specialist Addiction Therapist Mark Dempster

Addiction Part 1 - Specialist Addiction Therapist Mark Dempster

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:

  • Defining Addiction & UK stats  - The health burden & impact on the individual and extended families 
  • Origins – how people become addicted (habit Vs addiction) 
  • Dual diagnosis 
  • The 5 stages of addiction 
  • The NA & AA 12-step model (origins and application)
  • Common cognitive pitfalls 
  • Breaking the cycle – different types of therapy (CBT, DBT, ACT, +/- PET for PTSD) 
  • Anecdotal experiences and cases from Mark’s perspectives 

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

 

 

Sep 19, 202353:08
Trauma Outcome Scores with Mark Faulkner

Trauma Outcome Scores with Mark Faulkner

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.

Sep 12, 202345:39
The future state of Pre-hospital Care with Jason Killens

The future state of Pre-hospital Care with Jason Killens

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:

  • Jason’s journey through healthcare 
  • The current state of activity 
  • The future state of activity 
  • Why hear and treat has come to the fore. 
  • Risks of this proposed model 
  • How modern tech supports this vision
  • The Paramedic Career Framework and how this also supports future state operations (urgent care ambassadors) 
  • New innovations that Jason is looking at 
  • What happens if we don’t adopt this flipped model of care?
  • Final thoughts

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





Sep 04, 202343:40
Dealing with Stress with Natasha Adams from HARU

Dealing with Stress with Natasha Adams from HARU

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:

  • The case & reflections on the case 
  • Why and how a ‘state of startle & overwhelm’ occurs. 
  • The senses that shut down – hearing, vision, spatial awareness, concept of time    
  • Mental imagery and rehearsal   
  • Metacognition on the scene (thinking about thinking and mental awareness on the scene) 
  • The trajectory of the HPT when the rails are coming off 
  • Cognitive triggers (end of shift cognitive switching – going home mindset) 
  • The hot debrief – contextualising the scene and emotions – permission to exhale 
  • Nuances of NTS – permission to fail/miss information (self and crew) 
  • Reflection on care and Self-care 


My thanks to Tash for an engaging and insightful interview.

Aug 28, 202348:15
Point of Care Ultrasound in Critical Care with Dan Nevin

Point of Care Ultrasound in Critical Care with Dan Nevin

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:

  • Why ultrasound has become a useful tool in trauma.
  • Data collected on scans and relationship with intervention (surgical or otherwise).
  • The protocol that LAA prescribe to in practice.
  • The governance around image acquisition and decision
  • -making.

  • USS within Standard Operating Procedures (SOPs) and where it should sit in practice.
  • KPIs and frequency of scanning.
  • Where ultrasound is going and the future of USS within critical care.
  • Take home messages


My thanks to Dan for an insightful and engaging interview.


Aug 21, 202348:02
Pre-hospital Urgent Care with Kate Hardy

Pre-hospital Urgent Care with Kate Hardy

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:

  • The concept of Urgent Care Advanced Paramedics  
  • What a day in the life of an APPUC looks like 
  • The discharge rate of the scheme 
  • Commonly seen pathologies for the scheme 
  • Training that the Advanced Paramedics receive.
  • Master’s level training and what that brings in terms of critical thinking ability. 
  • Clinical governance and how that looks on an individual and collective level.
  • How Kate has changed as a clinician through the scheme.
  • Alignment with the Multi-professional framework for advanced clinical practice in England


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.


Aug 14, 202328:14
A pre-hospital blood transfusion protocol with Adam Greene
Aug 07, 202343:33
Part 2 - Reflections on major incident management with Keir Rutherford & Alec Wilding
Jul 31, 202301:32:35
Reflections on Major Incident Management with Keir Rutherford and Alec Wilding

Reflections on Major Incident Management with Keir Rutherford and Alec Wilding

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.


Jul 24, 202359:34
Innovations in Non-Invasive Ventilation with Aurika Savickaite

Innovations in Non-Invasive Ventilation with Aurika Savickaite

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 story of exploration into NIV for Aurika and what did the covid pandemic reinforce? 
  • The benefits of NIV in general.
  • What are the benefits of helmet ventilation over NIV mask ventilation (greater alveolar recruitment). 
  • The study - Effect of Non-invasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome - A Randomized Clinical Trial.
  • Commonly seen pathologies that benefit from NIV and the onward benefit.  
  • What are some of the pre-hospital benefits in transport and retrieval.
  • The indications and contraindications of NIV.
  • What the masters program taught Aurika (level of critical analysis) 


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


Jul 17, 202339:05
Bleeding and coagulation in Trauma with Ross Davenport

Bleeding and coagulation in Trauma with Ross Davenport

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.



Jul 10, 202329:37
The performance pizza with Stephen Hearns

The performance pizza with Stephen Hearns

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.







Jul 03, 202335:46
Breaking ground with Consultant Paramedic Vicki Brown

Breaking ground with Consultant Paramedic Vicki Brown

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


Jun 25, 202327:34
 The most downloaded episode - The High Acuity Response Unit (HARU) & Critical Care with Stephen Rashford
Jun 15, 202301:01:57
Human Factors within practice part 3: Task & patient safety with Jim Walmsley

Human Factors within practice part 3: Task & patient safety with Jim Walmsley

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.



Jun 05, 202301:00:19
Flash Teams with Ben Watts

Flash Teams with Ben Watts

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


May 29, 202301:01:14
Human factors and leadership with Clare Fitchett

Human factors and leadership with Clare Fitchett

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:


  • Overview of HF- why it is important to Clare and holistically
  • How leadership can affect HF - the interplay between human factors and leadership
  • Seminal leadership points that are useful/attributes of a good leader
  • How we support more junior clinicians to lead in critical care circumstances
  • Peer review and/or shared mental models
  • Some of the mistakes and misconceptions that people make when relying on their own memory versus checklists
  • Aspects of Clare's leadership that has changed over time
  • Managing stressful environmental human factors on scene
  • Some of the great leaders Clare has learnt the most from in regard to human factors mitigation
  • Examples cases; seminal cases from Clare’s experience - 2 cases, one which
  • 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

  

May 22, 202336:51
High Fidelity Simulation with Neel Bhanderi

High Fidelity Simulation with Neel Bhanderi

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 

May 15, 202354:35
Human factors and crisis management with Matt Edwards

Human factors and crisis management with Matt Edwards

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.





May 03, 202301:08:35
Human Factors in practice

Human Factors in practice

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:

Apr 20, 202356:15
The Turkey Earthquake UKISAR deployment with Debs Swann

The Turkey Earthquake UKISAR deployment with Debs Swann

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.

Apr 05, 202335:09
Spinal immobilisation with Jim Walmsley

Spinal immobilisation with Jim Walmsley

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.



Mar 30, 202349:34
How to deal with sexual assault with CEO Jayne Butler

How to deal with sexual assault with CEO Jayne Butler

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.




Mar 24, 202332:45
Pelvic Trauma with Ash Vasireddy

Pelvic Trauma with Ash Vasireddy

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:

  • Why a pelvic fracture is so critical
  • The pre-hospital prevalence
  • What are the main types / classifications
  • The spectrum of injury – pain to life threatening blood loss
  • Pre-hospital assessment of the pelvis 
  • Some of the common issues seen as an Orthopaedic Trauma Surgeon
  • IR vs OR
  • Possibilities of REBOA within the Air Ambulance Service
  • Lessons learnt from practice (pre-hospital and in-hospital)
  • Seminal cases 
  • Final thoughts & take-home messages.

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. 

Mar 13, 202339:17
Myocardial Hypo-perfusion in Trauma with Robbie Lendrum

Myocardial Hypo-perfusion in Trauma with Robbie Lendrum

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:

  • Cardiac hypoperfusion – pathophysiology
  • The Windkessel concept – converting pulsatile flow into constant flow, the generation of pressure.
  • Reservoir pressure equal to diastolic pressure
  • Coronary perfusion in diastole and the fundamental importance of diastole in trauma 
  • Arterial injury and respective diastolic hypotension – wide pulse pressures  - Effect on coronary perfusion pressure & flow
  • CVD – Cardiovascular Dysfunction with early death/72 hour boundary.
  • Physiological targets (targeted intervention)
  • Why should we move on from blood transfusion and drive faster to hospital. 
  • The secondary effects on the heart & essentially outcome.
  • Arterial shock and the proximal thoracic aorta.
  • The two main types of patient and how we approach these (Tamponade and exsanguination)

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. 


Mar 07, 202348:09