Pre-Hospital Care Podcast

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 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/

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