Pre-Hospital Care Podcast

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also look at the sequential approach to bleeding control, second and third generation haemostatics, pharmacological agents, tourniquets, neck zones and injuries, blunt injury and junctional wounds, hypotensive management and finally pain management in the combat arena. We also examine the utility and success of highly interventional skills at or near point of wounding such as REBOA. Finally we will examine Traumatic Cardiac Arrest (TCA) and the utility (or not) of an algorithmic approach to management. To do this, Ed Barnard joins me. Ed is an emergency medicine consultant within Cambridge University hospital and has undergone sub-specialty training in pre-hospital EM, working in more than five EMS systems, educating and mentoring medical students and doctors in training, giving national and international lectures, delivering a national research and clinical innovation meeting, completing a PhD from a top-100 research university, publishing over 30 journal articles, receiving five national-level research awards, and being appointed as a Senior Lecturer for the military. Topics covered:  Sequential approach to arresting bleeding Look at second/third/fourth generation haemostatic compounds (celox, quik-clot) Utility of tourniquets (origins, usage and types) Neck zones and wounds Blunt injury and junctional wounds Hypotensive mx - utility of this Critical Hypovolaemia and tx modality Interventions at point of wounding - REBOA TCA management and algorithmic approaches Ed's reflections and perspectives over the past 5 years on bleeding  Some of the concepts and evidence that Ed mentions in the episode can be found here:  A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526509/ The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry https://militaryhealth.bmj.com/content/164/3/150.abstract Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis https://www.sciencedirect.com/science/article/abs/pii/S030095721630538X  Please enjoy this episode with an insightful and engaging guest.

In this session I will be talking with Carl Betts on the anatomy of quality improvement and some of the pitfalls that occur along the way. Carl is a Paramedic for over 10 years and is a quality improvement lead based in Sheffield working for the ambulance service. In this conversation we will look at the pitfalls we can fall into when examining improvement. We will also look at some of the bias’s that can preclude improvement. We will also be talking about how root cause analysis occurs, data collection, pre and post implementation analysis, some of the quality improvement projects on workflow and hospital delays and how that might translate in practice. In the conversation we examine: The overview of QI. Pitfalls to improvement Bias: The WW2 story  Bias at work RCA – why it’s important and make it relevant to hospital delays Why data collection is important Why pre and post implementation analysis are important Project on hospital delays & ideas that have come from them Final thoughts from Carl and take-home messages. Below is a link to plan, do, study, act cycles that Carl made reference to in the interview.  https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf Please enjoy this episode with an engaging and insightful guest. 

In this episode we will examine how the evolution of public health is migrating through to ambulance services and creating future opportunities within this field of practice. In May of last year AACE (the association of Ambulance Chief Executives) published a discussion paper around developing a public health approach within the ambulance sector. This paper starts by denoting that every 24 hours, the NHS has contact with over a million people, and the ambulance sector is at the fore front of these interactions. So we also know that ill health maps across social deprivation and indeed constitutes a high percentage of pre-hospital work, so I want to dig into all of the above with Dr Andrew Furber. Andrew has been the Regional Director for Public Health England (Northwest) and Regional Director of Public Health NHS NW since May 2020. He was previously Centre Director for Public Health England (PHE) in Yorkshire and Humber. He has worked as a Director of Public Health from 2007 to 2018 and is a past President of the Association of Directors of Public Health UK (ADPH). He was awarded an OBE for services to public health in the Jubilee Birthday Honours List. In this episode we examine: The necessity of taking a population perspective and approach to public health. What the data is telling us about pre-hospital public health. Potential preventative strategies. Looking at the wider, societal determinants of health and wellbeing and focusing on reducing inequalities. The challenge of working in partnership across health systems. Future opportunities for Paramedics in the domain of public health. Final take home points from Andrew.  Please find more information here: https://aace.org.uk/wp-content/uploads/2021/05/Single-pages-Public-Health-Approach-Ambulance-Sector.final_.pdf Finger Tips - Public Health https://healthierlives.phe.org.uk/ Please enjoy this episode with an insightful guest.  This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy.  One of their most innovative recent products is the D heart: D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process. The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes. More information on the D heart can be found here: https://www.bha-medical.com/d-heart-ecg-mobile-device More information on BHA medical can be found here: https://www.bha-medical.com/

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also examine the SWIFT Study which is a study of Whole blood In Frontline Trauma A multi-centre randomised controlled trial of the clinical and cost-effectiveness of pre-hospital whole blood administration versus standard care for traumatic haemorrhage. To do this I am speaking with Surgeon Capt Jason Smith. Jason is currently the Defence Professor of Emergency Medicine at the Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham. He was also appointed Royal College of Emergency Medicine Professor in 2013, and is an Honorary Professor at Plymouth University Peninsula Schools of Medicine and Dentistry. He was Consultant Advisor in Emergency Medicine to the Medical Director General (Navy) from 2010-2014. He is a Fellow of the Royal College of Emergency Medicine, the Royal College of Physicians of London, and the Royal Geographical Society. He undertook a doctorate in the management of patients with blast lung injury, and his current research interests include the treatment of pain in emergency patients and the management of traumatic cardiac arrest. In the episode we examine: Sequential approach to arresting bleeding The utility of TXA Pharmacological agents - TXA, FFP, FDP, blood, cryo-p, RePHILL The RePHILL trial Pain mx and preferential agents Freeze Dried Plasma and Fresh Frozen Plasma and part of the array of intervention The SWIFT trial To find more on the SWIFT trial please see here: https://www.nhsbt.nhs.uk/clinical-trials-unit/current-trials-and-studies/swift/ This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs. NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here: https://bha-medical.com https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

In this session we will be talking with Zoe Hitchcock. Zoe, 9 years ago in 2013 had a seminal event whilst walking on Oxford St in London. Zoe suffered a cardiac arrest from a cardiac myopathy causing a VF cardiac arrest. The adage that it takes a system to save a life truly came into focus that day. In this episode we will hear from Zoe’s first-hand experience of that cardiac arrest and the events leading up to incident and how it has been a turning point in her life. What Zoe remembers about that day The wider picture around Zoe’s husband and reason she was in Oxford St The incident on the pavement and challenges for pre-hospital team HEMS team and transfer to St Marys The recovery and life now  The perspective change to life and family  Take homes messages The episode below is the initial conversation I had with Zoe to give you more details of the incident and the surrounding conditions:  https://podcasts.apple.com/gb/podcast/s02e01-zoe-hitchcock-cardiac-arrest-survivor/id1441215901?i=1000437344052 Please enjoy this episode with a true legend.  This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs. NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here: https://bha-medical.com https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app

In this episode we will examine the true story of the tragic death of a Search and Rescue medic Dave VanBuskirk. On the evening of the 22nd of July, 2013 Dave fell approximately 200 ft to his death whilst on a winching mission to save another person at Mt Charleston in the Las Vegas region of the US. To tell the story I interview SAR pilot Dave Callan. Dave Callen is a retired Sergeant from the Las Vegas Metropolitan Police Department. He spent most of his career in the Air Support unit, where he flew patrol, search and rescue, surveillance, short haul/long line and tactical missions. Dave is certified as a rescue pilot a variety of airframes and holds an airplane and helicopter instrument rating with over 4,000 hours of flying experience. Dave unpacks the incident back in 2013, its wide-ranging impacts on the wider team and some of the lasting lessons learnt from the tragedy. In the episode we examine: The anatomy of the Las Vegas Police Police Dept – The service Dave VanBuskirk was flying in. What regular operations would look like and the span of area covered by the service. Who Dave VanBuskirk was as a person and professional. The immediate impacts of the death on Dave Callen and the wider team. Dynamic rollout – what it is, why lips on winch hooks can pose a risk. The risk mitigation strategies Dave has taken from the incident Dave VanBuskirk’s principle of getting a little bit better everyday and commitment to excellence. Safety audits – the principles and lessons learnt. Final thoughts and take-home messages. To learn more about Dave VanBuskirk, see here: https://sr3rescueconcepts.com/about To learn more about SR3 Rescue Concepts please see here: https://sr3rescueconcepts.com/ This podcast is brought to you in association with BHA Medical. https://bha-medical.com/about-us/ BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. There most recent product is the Vitalstream: https://bha-medical.com/medical-products/vitalstream/ The Vitalstream is the world’s most innovative wireless non-invasive patient monitor, using a simple disposable finger cuff to measure Continuous Beat-by-Beat Blood Pressure “CNIBP,” Heart Rate, Respiration Rate, and other physiological parameters. This unique technology enables safe, secure, and accurate patient monitoring from virtually anywhere, including remote patient monitoring from a secure cloud portal. This solution provides real time data, enabling healthcare staff to provide early intervention and rapid response to a patient’s changing health conditions. Using a low-cost, disposable finger cuff, the VitalStream patented Pulse Decomposition Analysis (“PDA”) algorithms process the arterial pulse waveform to derive CNIBP, Heart Rate, Respiration Rate, and other hemodynamic parameters. Please also check out further devices and services offered by BHA medical here: https://bha-medical.com I hope you enjoy this episode with an insightful and engaging guest.

In this session we will examine a new pathway which is emerging within Scotland and north of England. The Chronic Obstructive Pulmonary Disease (COPD) pathway has been designed to both specialise treatment and expedite specialist care to this cohort of patients. NHS data shows that in 2020/21, approximately 1.17 million people in England have been diagnosed with COPD, which is around 1.9% of the population.  To host the conversation I have Jonathon Will with me. Jonathon is a registered Paramedic working with the Scottish Ambulance Service (SAS), he has also worked as an Emergency Care Paramedic within various Emergency Department Resuscitation units. His last two years has been spent working as the Clinical Effectiveness Lead within SAS and a National improvement Advisor for urgent and unscheduled care within NHS Scotland. Tom Fardon is a Respiratory Consultant within NHS Tayside, with a specialist interest in airways disease (COPD, Asthma and Bronchiectasis). Tom is also the clinical lead for the managed clinical network within Tayside and the chair of the national advisory group for respiratory medicine, also the lead for respiratory care action plan within NHS Scotland. He also leads the Scottish Respiratory advisory committee to initiate the recommendations within the respiratory care action plan. In the conversation we talk about:  * The pathology of COPD; what’s going on with these patients and how these patients normally present to the ambulance service.  * Physiological tolerance and adaptation over time.  * Why this pathway has been designed? (what is the current problem) * How the key clinicians and specialisms have been brought together * End points that the pathway serves  * Improvements to the current services * What tiers of patients this pathway serves  * What happens to the life-threatening COPD patients  * What a patient could expect when they go through the pathway.  * What the future holds  * Take homes messages   Please find more about the pathway here: https://www.consultantconnect.org.uk/copd-pathway-tayside/ Consultant Connect are partly responsible for supporting this pathway and can be found here: https://www.consultantconnect.org.uk/  This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of their most innovative recent products is the D heart: D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process. The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes.  More information on the D heart can be found here: https://www.bha-medical.com/d-heart-ecg-mobile-device  More information on BHA medical can be found here: https://www.bha-medical.com/

In this interview we will examine the emerging research priorities within pre-hospital care from the perspective of priority and importance. I will be speaking with Sarah McLaughlin – a senior research fellow with affiliations with Essex & Herts Air Ambulance (EHAAT) and Anglia Ruskin University. I will also be speaking with Lisa Ramage, Lisa is a PHEM trainee in the East of England and the chair of PHOTON. PHOTON is a group of non-consultant grade, pre-hospital, doctors with an ambition to expand the quality and reach of research within pre-hospital care. In this conversation we are going to examine a national Delphi study which is defining the national research priorities within pre-hospital care in the contemporary climate. We will also: Examine what is a Delphi study Why is it an important time for empirical research and audit at the moment within pre-hospital care Sarah’s EHAAT Delphi study as an analogue of the national PHOTON study The process of a Delphi study in terms of rounds and refinement of the questions. How does it achieve consensus? What are the advantages to a Delphi study? Ethical approval (the panel and process) Topics that have emerged from the process Why is it important to study end points that don’t always involve mortality (look at 30 day outcome, CPC neurological outcome, discharge data, and patient centred outcomes) How does this inform national strategic direction and focus Final thoughts from Sarah and Lisa & take-home messages. You can find out more about PHOTON and Lisa Ramage here: https://fphc.rcsed.ac.uk/about/photon-group You can find out more about EHAAT here: https://www.ehaat.org/about-us/our-people/ You can find the EHAAT Delphi study that is mentioned in the interview here: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-021-00835-z You can find some of Sarah McLaughlin's publications here: https://www.researchgate.net/profile/Sarah-Mclachlan-5 This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs. NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here: https://bha-medical.com https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app Please enjoy this episode with two insightful and engaging guests 

In this session we will examine the latest research and approaches to traumatic cardiac arrest with Richard Lyon. We will examine the demographics and diversity of pathology that clinicians see day to day within TCA. We will also examine survival rates, empirical research, blood products, the utility of high-fidelity simulation, and the importance of governance & debrief. We will also examine the usefulness of ultrasound and application in practice. Richard Lyon is a Consultant in Emergency Medicine and Pre-hospital Care at the Royal Infirmary of Edinburgh and Clinical Lead for the Medic One team. He is a HEMS Consultant and Director of Research for Kent, Surrey & Sussex Air Ambulance. He studied at Edinburgh University where he developed close research links with the Scottish Ambulance Service. He undertook a unique doctorate thesis on out-of-hospital cardiac arrest, a project that has developed into a national strategy for cardiac arrest in Scotland. In the episode we examine: A working definition of TCA Current thinking / acceptance of TCA algorithm differentiation Survival rates - Who are the survivors? Current empirical research What are the main domains of pathology Blood products in TCA High fidelity training. Internal governance and debrief. HF & Team dynamics within TCA Utility of USS Seminal cases. Final thoughts and take-home messages. These are some of the latest algorithms related to TCA: https://www.resus.org.uk/sites/default/files/2020-05/G2015_Traumatic_Cardiac_Arrest_Treatment.pdf https://rcem.ac.uk/wp-content/uploads/2021/10/RCEM_Traumatic_Cardiac_Arrest_Sept2019_FINAL.pdf https://fphc.rcsed.ac.uk/media/2577/tca-submission-oct-2018.pdf This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of their most innovative recent products is the D heart: D-Heart is the first portable ECG device that is simple to use, clinically reliable, affordable and makes use of a smartphone. It allows anyone to perform a hospital-level ECG in total autonomy with the option to send the results to the 24/7 tele-cardiology service or to your trusted doctor. D-Heart allows you to track your heart health, explain possible unclear symptoms or to monitor the efficacy of medication. D-Heart will allow you to become an engaged partner in the management of your health. You can record an ECG whenever you have symptoms and share it with your trusted physician and to establish a shared decision-making process. The image-processing and artificial intelligence will guide you to the correct electrode placement by showing you an image of your own chest with virtual marks placed where you should apply the electrodes. More information on the D heart can be found here: https://www.bha-medical.com/d-heart-ecg-mobile-device More information on BHA medical can be found here: https://www.bha-medical.com/ Please enjoy this episode with both an insightful and fascinating guest.

In this interview we will examine some of the prevailing issues and incremental rise of Alzheimer’s disease within the global healthcare system. Cognitive decline is a major concern of the aging population. Already, Alzheimer’s disease affects approximately one in 14 people over the age of 65, rapidly becoming the third leading cause of death in the UK behind cardiovascular disease and cancer. To do this I have with me Jennifer Bute. Jennifer was a GP in a large clinical practice, whose patients included those with dementia. Then she began to notice symptoms in herself and was finally given a diagnosis of young-onset dementia in 2009. After resigning as a GP, she resolved to explore what could be done to slow the progress of dementia. Jennifer has written a new book titled ‘Dementia from the inside’ and in this interview we will dig into some of the concepts form the book and speak around the wider aspects of the disease.  Jennifers website and book can be found here: https://www.gloriousopportunity.org/resources.php More from Jennifer can be found here: https://www.gloriousopportunity.org/ Concepts she advocates including Japanese Memory Groups can be found here: https://www.gloriousopportunity.org/japanese-memory-groups.php This podcast is brought to you in association with BHA Medical. BHA medical source, supply and implement innovative medical technology and solutions across the globe. BHA provide market leading services in covid 19 testing kits, medical products, smart technology and consultancy. One of the latest solutions that BHA medical offer is the iMed end-to-end Covid-19 testing and monitoring solution. NPH iMed is an end-to-end Covid-19 testing and monitoring solution, developed in partnership with BHA Medical Limited to assist in collating and managing test results, reopen travel, leisure, events and entertainment. One of the first independent online test verification systems in the world, NPH iMed is a leading solution for testing, managing and monitoring all of your Covid-19 needs. NPH Group has simplified the process of reporting test result data for you through our online platform which makes capturing the required data for submission easy, while easily recalling individuals for repeat testing and submissions. NPH have created a fully compliant and automatic upload capability, so you don’t have to worry about it, with a cost-effective solution. More can be found here: https://bha-medical.com https://www.bha-medical.com/imed-self-testing-monitoring-covid-19-app