Pre-Hospital Care Podcast

In this conversation, we will look at the research examining methods of safe sedation by Advanced Paramedic Practitioners within London and examine the research published on this looking at sedation of Acute Behavioural Disturbance (ABD). We will examine; what the retrospective cohort study of pre-hospital agitation management showed regarding the sedation of the ABD patient. Also, the origins of ABD according to the paper, the Sedation Assessment Tool used to measure pre- and post-intervention, the approaches that senior clinicians can take to sedate patients and more.  To do this I have Tim Edwards with me, Tim is a Consultant Paramedic with the London Ambulance Service NHS Trust and a visiting lecturer at the University of Hertfordshire. Tim has been a paramedic since 2000 and has undertaken various roles including working as a flight paramedic, senior lecturer, and advanced paramedic practitioner and is currently working as a Consultant Paramedic in London.  The study that the conversation is based on can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730188/#bibr_10 Many thanks to Tim for this conversation.

In this episode, we will explore why Thrombectomy is considered a leading stroke intervention and can contribute to the early rehabilitation and treatment of ischemic stroke. This is especially important if recognised within pre-hospital care. This is due to its effectiveness in rapidly restoring blood flow to the brain and improving patient outcome. In the episode we will explore how this intervention can restore of cerebral blood flow, the time sensitivity of the intervention, the functional recovery of patients undergoing thrombectomy, the minimally invasive approach thrombectomy takes, the collaborative care and finally the positive clinical trials showing it effectiveness.    To do this I have Kunle Ogungbemi with me. Kunle is the Clinical Lead of interventional Neuroradiology at St George's University Hospitals in London. He has also a named author on a paper examining the Hub-and-spoke model for thrombectomy service in UK NHS practice. So the data suggests that for every 9-minute delay in onset to reperfusion, 1/100 patients will have more severe disability at 90 days. In the hub-and-spoke model, proposes that patients with suspected stroke are initially taken to the nearest hyperacute stroke centre (spoke). Patients with confirmed stroke caused by LVO are then transferred to the thrombectomy centre (hub) with thrombolysis started if appropriate.  

In this conversation, we will examine the complex and challenging environment of toxic drug and substance misuse on the streets of Vancouver and across British Columbia. We will explore the issues of concomitant drug ingestion, the use of fentanyl, the complications of mental health and the cyclical pattern of pre-hospital presentation. We will also explore the challenges of bias towards this patient group and how that can both affect care and outcomes.    Jen Bolster is an Advanced Care Paramedic in British Columbia. She is also a Paramedic Practice Leader (PPL) within BCEHS. She has a portfolio which examines and engages with paramedic-led research into mental health, substance use and the toxic drug crisis. She advocates that paramedics are uniquely positioned to offer patients alternatives to the emergency department. Jen’s research interests include paramedic mental health and resilience, contemporary vs non contemporary leadership styles, women studies, and non-technical skills.

In this episode, we will explore reverse mentoring and challenging the status quo in quality improvement with Carl Betts. We will look at Carl’s reflections on mentorship and reverse mentorship of Quality Improvement fellows within an Ambulance service setting. We dig into how Carl leads these QI fellows but also how they lead him in innovation and ideas. The focus of reverse mentoring is to increase the mentee’s inclusion competencies; however, mentors are simultaneously provided with the opportunity to learn from their mentee’s experience, knowledge and skills so it can be considered as a career development opportunity for both parties. Reverse mentoring is an effective way to build genuine awareness of the barriers faced by ethnically diverse employees and different perceptions of leadership from the mentee’s perspective. We also dig into the assessment process for the fellowship and how Carl has flipped this on its head.  Carl Betts is the Quality Improvement lead for the Yorkshire Ambulance Service (YAS) and has been a Paramedic for over 10 years. He currently leads the fellowship program for his service. Please enjoy this wide-ranging conversation with Carl Betts, a regular contributor and guest on the podcast.

In this podcast, we will look at the benefit and utility of Methoxyflurane, more commonly known as Penthrox. Penthrox is a volatile, self-administered inhaled analgesic indicated for short-term pain relief. Penthrox is a portable, lightweight, non-invasive inhaler for self-administration of the Methoxyflurane vapour. Penthrox provides analgesia when inhaled at low concentrations giving analgesic therapeutic doses, but can also reduce and mitigate even severe pain yet has a short half-life. We will examine its use and limitations within the expedition environment and how and when it can be optimally used as either a sole adjunctive pain relief agent or as part of a larger pain relief strategy. We also get Will's reflections from use in practice and where and when Penthrox is useful. Joining me is Dr Will Duffin, Will is the co-medical director of World Extreme Medicine and is an NHS GP. He is also an expedition, TV/film doctor and father of two. He lectures around the UK for NB Medical Education and is a digital host of the World Extreme Medicine podcast. Many thanks to World Extreme Medicine for kindly agreeing to the use of this audio. You can find more on Penthrox here: https://penthrox.co.uk/healthcare/simple-to-use/? You can find more on World Extreme Medicine here: https://worldextrememedicine.com

In this episode, we examine how to approach systems strengthening in clinical practice within the context of Sierra Leone with Aneesah Peersaib. We will look at her recent deployment to support Continued Professional Development at local, regional and national level and her role in leadership development whilst in post in Sierra Leone. We will examine how she disseminated education & training, policy, and governance and how she approached cultural change from the ground up. Finally, we will examine how she built and maintained safe systems of practice, and how you can embody a culture of educational leadership and empower coproduced with in-country clinicians to provide solutions to wider systems development work. To do this, I'm speaking with Aneesah Peersaib. Aneesah has recently held the post of Nursing Education Advisor to Chief Nursing and Midwifery in Freetown, Sierra Leone. She collaborates across NGOs to work with the Sierra Leone Ministry of Health and Sanitation to standardise nursing education and support national strategic delivery. She has been a senior Nurse both inside and outside of the UK NHS working for Health Education England as a clinical lead and clinical advisor supporting education and workforce development across London. Aneesah is an Emergency nurse by trade and has experience leading central London Emergency departments before going on to wider systems leadership roles. If you want to reach out to Aneesah about the episode please contact her through LinkedIn here: https://www.linkedin.com/in/aneesah-peersaib-9153725a/?originalSubdomain=uk

In this next period, we will be recording a mini-series on addiction starting with this first episode with Specialist Addiction Therapist Mark Dempster. In 2013, the Centre for Social Justice determined that the level of addiction in the UK made it the “addiction capital of Europe.” This includes the use of legal substances, mainly ⁠alcohol⁠, and the use of Class A drugs, which include ⁠heroin⁠, ⁠cocaine⁠, ⁠meth⁠, and ⁠hallucinogens⁠. £36 billion is spent by the nation every year on treatment relating to drug and alcohol abuse. At the time of filing their report, titled 'No Quick Fix', the UK had the highest rate of addiction to ⁠opioids⁠ and the highest lifetime use of amphetamines, cocaine, and ⁠ecstasy⁠ across Europe. Many view addiction as something that only affects the users themselves but, in reality, casualties from substance abuse are taxing entire communities and society as a whole. Addiction in the UK affects everyone from loved ones to clinicians and the everyday public. In the conversation, we examine the five stages of addiction, common cognitive pitfalls, habit Vs. addiction, and Mark's organic story through his lived experience with addiction. We also look at the 12-step process of Narcotics Anonymous (NA). Mark is a specialist addiction therapist and a recovery coach within a Harley Street Counselling Practice. He has witnessed chemical and behavioural addictions both personally and within his circle of family and friends. Learning the practice of psychotherapy for addiction helped Mark reach out to all types of addicts, from programmes working with prisoners, helping at homeless shelters, and to wealthy bankers from Canary Wharf.  According to Mark, the addict’s circumstances varied but their addictions had a lot in common. In the conversation, we also cover: 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    

In this conversation, we will examine the various types of trauma scores that feature both out-of-hospital and in-hospital to measure trauma – those of anatomical, physiological and combined trauma scores. We will look at why these are important, the three broad types of trauma scores, the origins, reliability and sensitivity of these. We will also examine the pros and cons of the GCS together with the history behind the GCS. We will examine the trauma score, revised trauma score, APACHE and CRAMS scales, Abbreviated Injury Score, Injury severity score, New Injury Severity Score (NISS), TRISS (Trauma and Injury Severity Score), and finally the ASCOT (A Severity characterisation of trauma). We will also examine the limitations to these scores and also some of the more long-term reasons for use.  Mark Faulkner is a Consultant Paramedic and associate medical director with the London Ambulance Service NHS Trust, Mark is also the clinical advisor for Major Trauma within the LAS and as such sits on the Pan London Trauma Steering Group, as well as number of national trauma groups.  Mark has been involved in major trauma for over 12 years, since the inception of the London Trauma System and has developed and refined the London Trauma Triage Tool. In the conversation, we examine: 1.     Why we look at and create these scores. 2.     The three broad types  3.     The GCS – origins, sensitivity/specificity & the limitations   4.     Trauma Score & revised trauma score  5.     APACHE & CRAMS scales  6.     AIS  7.     ISS 8.     NISS & TRISS score  9.     ASCOT  10.  Final thoughts  My thanks to Mark for an insightful and engaging conversation.

In this conversation, we will examine the current state of NHS ambulance service delivered care and how we can approach this with a different perspective. We will examine the current models of operation and how over the next 10 to 20 years this needs to be flipped on its head. We will explore the numbers of See, treat and convey versus see, treat and refer, versus telephone consult and close and how this can be flipped on its head. We will also explore how the adage of modern technology can we can meet these needs througg technology and how the progressive Paramedic Career Framework supports this through advanced urgent care practitioners & more pathways to refer patients to. We will also explore some of the innovations that Jason has initiated to work toward this goal.   Jason Killens is the Chief Executive of the Welsh Ambulance Services NHS Trust, which is the national provider of 999, 111 and non-emergency patient transport services for Wales. Jason has spent his career working in Ambulance Services in the UK and Australia. He progressed through the ranks in London Ambulance Service from an Emergency Medical Technician to Executive Director of Operations. He was appointed as the Chief Executive of the South Australia Ambulance Service in 2015 before joining the Welsh Ambulance Service as Chief Executive in September 2018. In the conversation, we examine: 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

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.