Pre-Hospital Care Podcast

In this conversation we will examine the fundamentals of human factors within tasks with Jim Walmsley. We will focus on Human factors from a task perspective refer to the ways in which the design of a task or activity can affect the safety and performance of the individuals performing it. We will examine the concept of task complexity, task variability, task duration and demands, feedback mechanisms in place to learn from, clearly defined goals, and finally task design. We will also discuss some of the mitigation factors involved in environmental design, training and skill development, task analysis to error trap, and teamwork and communication.   To do this I have Jim Walmsley with me, Jim is a specialist paramedic in critical care. He has led expeditions for various Non-Governmental Organisations (NGOs) in and around Europe since 1996, and in 2001 he obtained his carnet as an International Mountain Leader, alongside additional outdoor qualifications in climbing, kayaking, and the rope access industry. As a qualified Critical Care Paramedic, he’s spent the last nineteen years specialising in pre-hospital critical care, after initially training and working in Sheffield. Having completed an MSc in clinical research and a PgDip in critical care, he now resides the Southeast of England. In the conversation we examine: ·      What is human factors from Jim’s perspectives  ·      How task human factors have affected Jim in the past - A case that is seminal and typifies the importance of human factors  ·      The classic offenders - unfamiliarity with the task, inexperience, a shortage of time, inadequate checking, poor procedures. ·      Task complexity & variability  ·      Task duration and demands.  ·      Feedback mechanisms in practice  ·      Defined and clear goal setting  ·      Design flow to mitigate  ·      Training skill and development  ·      Task analysis to error trap  ·      Teamwork and comms  I hope you enjoy this final episode in the series on human factors within practice.

In this conversation we will examine the concept of flash teams with Ben Watts. We will focus on why they can pose such a challenge in highly stressful situations. We examine the concepts and issues of ego, lack of team ethos, lack of shared understanding/clear plan, poor communications, name use, active listening issues, poor followship, anchoring and much more. We also examine when things are working well and some of the core fundamental components of this including collaboration, use of checklists, feedback mechanisms, closed loop communication, affirmation, shared mental models and overt followship and leadership. We also look at one of the key fundamental tenets of flash teams, that of consistently calm cadence of communication.   To do this I have Ben Watts with me, Ben is no stranger to the podcast and has spoken with me on a number of episodes, most recently around the bleeding patient. Ben is a critical care retrieval practitioner working with the Emergency Medical Retrieval Service (EMRS) in Scotland and also works as a World Extreme Medicine (WEM) faculty member. In the conversation we examine:   ·      The concept of flash teams  ·      When it goes right – what this looks like from a flow of communication ·      When it goes wrong and how can we correct it ·      The importance of effective communication  ·      Feedback mechanisms to course correct for future performance ·      Error detection – Ben’s approach to error trapping  ·      Distraction and environmental factors - signal versus noise  ·      Decision making paralysis and the concept of ‘overwhelm’. ·      Correcting poor teams when they are going wrong. ·      Training and education around flash teams  My thanks to Ben for an engaging and interesting conversation

In this session I am speaking with Clare Fitchett as we explore the fundamentals of human factors and the interplay of leadership. In the conversation we examine what human factors mean to Clare and how they affect her practice. We also look at leadership and how Clare perceives leadership can affect human factors for the better. We finally examine the concept and strategies of human factors mitigation and how we can offset the patent safety issues that human factors brings with it.  Clare graduated as a paramedic in 2011 having undertaken her student paramedic training with South Central Ambulance Service. She commenced her Specialist Paramedic (Critical Care) training in 2018 with Thames Valley Air Ambulance (TVAA) and holds the Diploma in Immediate Medical care (DipIMC) from the Royal College of Surgeons in Edinburgh and is completing an MSc in Advanced Clinical Practice. Clare also volunteers as an Expedition Medic with the British Exploring Society and is also a faculty member of World Extreme Medicine. She currently works for Hampshire and the Ilse of Wight Air Ambulance. In the conversation we explore: 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   

In this session, I am speaking with Neel Bhanderi on the advantages of high-fidelity training within clinical practice. In the conversation, we examine the concepts of analogs of reality and how it has multifactorial benefits through the integration of handover simulation, debriefing, stress inoculation, skill acquisition under stress, communication under applied stress, and much more. To do this I have Dr. Neel Bhanderi with me. Neel is the Head of Education and Training at MedSTAR retrieval HEMS service based in Adelaide. He is also a Consultant in Emergency Medicine at the Royal Adelaide Hospital. Neel trained as an Emergency Physician and worked as a Consultant at St George’s Hospital Major Trauma Centre in London for several years and for Kent Surrey and Sussex (KSS) Air Ambulance. In 2016, Neel emigrated to Australia where he works as an Emergency Specialist at the Townsville Hospital in North Queensland and is currently the head of education for MedSTAR retrieval service. In the conversation, we examine: • Why high-fidelity simulation is useful & Neels approach to multi-modal simulation. • What components of training do MedSTAR focus on (Skills based, assessment-based, comms based or all three) – templates of training outcomes used. • How Neel approaches the training debrief. • How Neel creates incremental training stressors within the operational teams. • Environmental stress training methods (operational Task and environmental noise). • Approach to micro versus macro tasks • Comms under pressure within the training environment • Handover and how MedStar simulates this (filming, use of the checklist, analyzing) • Training relationship with case review (identifying training needs from case review). • How Neel is changing training in the short term (other elements such as personality and characterological traits). Please enjoy this wide-ranging conversation with a fantastic guest. For more on MedSTAR and the work they do please see here: https://saambulance.sa.gov.au/work-with-us/who-we-employ/medstar-emergency-medical-retrieval/ * We will resume with the human factors series next week 

In this conversation we will examine the fundamentals of human factors with Matt Edwards. We will focus on Human factors from an individual perspective. We will examine some of the seminal cases that Matt has experienced in practice and the concept of routine versus crisis from a checklist perspective. We will also examine how human interactions in healthcare change outcomes, from civility to risk aversion and the concept of trust. We will also examine the mitigation strategies that exist around the way an individual understands their environment can affect their ability to detect and respond to hazards from attention and perception. Also the mitigation of distraction, how to avoid decision-making paralysis, the limitations of memory, the regular attenders of stress and fatigue, and finally the effects of communication on the individual, task and team.  To do I'm speaking with Matt Edwards, Matt is a consultant in Adult and Paediatric Emergency Medicine at Kings College Hospital, London and the lead for major trauma and education in Kings. He is also a HEMS Physician with Kent Surrey Sussex (KSS) Air Ambulance and the Polar Medicine course director for World Extreme Medicine. He has held positions as a HEMS Registrar with London’s Air Ambulance, a Flight Physician with AMREF Flying Doctors, Nairobi, and a Medical Officer with the British Antarctic Survey. In the conversation we examine: ·      What are human factors from Matt’s perspective  ·      How task and individual human factors have affected Matt in the past ·      How checklists work - routine vs crisis & the limitations of short term memory.  ·      Trust as a concept in healthcare teams and organisations - how human interactions in healthcare change outcomes - civility to risk aversion. ·      Fatigue, the regular attender in every clinicians journey ·      Distraction and how that affects performance ·      Decision making paralysis and how to break this ·      Teamwork and communication Please enjoy this wide ranging conversation with Matt.

In this episode we kick off a mini-series on human factors in practice. I will be speaking with a cross section of clinicians on what human factors means to them and the impact it can and has had on their practice. In this episode I discuss the fundamentals of human factors including; a working definition of human factors, why human factors are important, the history of human factors, the main domains of human factors, Individual Human factors & mitigation, task human factors & mitigation, environmental/System human factors F& mitigation, NASA's approach to human factors and finally three seminal cases in human factors. Medical errors can have significant costs both in terms of patient health outcomes and financial costs. While it is difficult to estimate the precise global costs of medical errors, studies have suggested that they can be substantial. In the United States alone, medical errors have been estimated to cost between $17 billion and $29 billion annually in direct costs, such as additional medical expenses, lost income, and disability. This figure does not include the indirect costs associated with lost productivity or quality of life. A study in the UK estimated that preventable medical errors cost the National Health Service (NHS) around £1 billion each year. On a global scale, a report by the World Health Organization (WHO) estimated that 10% of hospital admissions worldwide result in adverse events, and around half of these are due to errors. These errors are estimated to cause between 6 and 10% of hospital admissions in developed countries, and up to 20% of admissions in developing countries. The report also estimated that medication errors alone affect at least 1.5 million people globally each year, resulting in 100,000 deaths annually.  Here are the links mentioned in the episode: REMOTE MEDICAL EMERGENCIES RGS - https://www.rgs.org/CMSPages/GetFile.aspx?nodeguid=6643dce6-a321-4002-b117-28d26897ab59&lang=en-GB   https://www.youtube.com/watch?v=5C59910SWyw  To err is human documentary    https://emcrit.org/wp-content/uploads/ElaineBromileyAnonymousReport.pdf  – Elaine Bromiley report https://www.theverge.com/2019/5/2/18518176/boeing-737-max-crash-problems-human-error-mcas-faa  - The Boeing 737 human factors   https://sma.nasa.gov/sma-disciplines/human-factors  https://www.dmp.wa.gov.au/Documents/Safety/MSH_TB_HOF_Woodside_HOFOilnGas.pdf Please feel free to reach out to me on eoinwalker@hotmail.com for future content and feedback

In this episode I am speaking with Debs Swann on her recent deployment to the Turkey Earthquake disaster. It is the deadliest earthquake in what is present day Turkey since the 526 Antioch earthquake, making it the deadliest natural disaster in its modern history. As of 20 March 2023, more than 57,300 deaths were confirmed: more than 50,000 in Turkey, and more than 7,200 in Syria. In Turkey alone there were at least 50,096 deaths and 107,204 injured across 11 provinces of Turkey. By 23 February 2023, the Ministry of Environment, Urbanization and Climate Change conducted damage inspections for 1.25 million buildings; revealing 164,000 buildings were either destroyed or severely damaged. A further 150,000 commercial infrastructure were at least moderately damaged. At least 15.73 million people and 4 million buildings were affected. About 345,000 apartments were destroyed. More than 2 million residents in the affected provinces were evacuated to nearby provinces including Mersin, Antalya, Mardin, Niğde and Konya. More than 20 percent of Turkey's agriculture production was damaged. The United Nations said crops, livestock, fisheries, aquaculture and rural infrastructure were also heavily damaged. The international organisation for migration estimated about 2.7 million people were made homeless. In the conversation we examine her anecdotal experience of deploying with the UK international Search and Rescue Team near the cities of Nurdağı and Gaziantep in Gaziantep Province, just outside the regional capital. We examine the reflection on cases she witnessed, the pattern of injuries, the use of search and rescue dogs, the hot and cold brief of the group, the near death experiences that she had and much more. Debs Swann is an Advanced Clinical Practitioner (ACP) working in the Cambridge area, she is also a PHEM practitioner working with the Birmingham care teams. Debs is also a World Extreme Medicine faculty member and is an active member of the UKISAR team. In the episode she reflects on her time both within the deployment and her reflections afterward. She also reflects on her near death experiences and how that translates to her perspectives on time horizons. My thanks to Debs for this candid and honest interview and her overall insights.

In this conversation we will examine the recent changes in spinal immobilisation within pre-hospital practice. We will look at the historic literature, prevalence of spinal injury in reality, the RCSEd recommendations, and other international guidelines and also the current practice of C-spine collars and extrication advice. To do this I have Jim Walmsley with me, Jim is a Critical Care Paramedic at South East Coast Ambulance Service NHS Foundation Trust. Jim has a 19-year history with the ambulance service and has focussed his career on clinical practice, research, under-graduate teaching, as well as managerial duties. In the episode we discuss: • The culture and historic research of spinal immobilisation. • Pre-hospital prevalence & cultural shift • What are the main considerations in the pre-hospital phase of care • Pre-hospital assessment (sensitive? Valid?) main information to take note of (MOI & other factors) • Immediate treatment options – to immobilise or not immobilise • Latest recommendations • Seminal cases where the application of the above has worked well • Final thoughts & take-home messages. Some of the references that Jim referred to can be found here: https://fphc.rcsed.ac.uk/media/1757/pre-hospital-spinal-immobilisation.pdf Canadian C spine rules: https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/for-professionals/whiplash-resources/SIRA08109-Canadian-C-Spine-Rule1117-396476.pdf NEXUS guidelines: https://www.ebmedicine.net/media_library/files/Trauma-Imaging-Resuscitation-CD.pdf Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494329/ My thanks to Jim for an engaging and insightful interview.

In this conversation we will examine the immediate, mid-term and long-term effects of sexual assault. We will also examine the short-term treatment that pre-hospital clinicians should consider. We will also examine some of the long-term support that is available for victims of sexual assault. We will also examine elements of safeguarding, care pathways, and forensics that work on a co-aligned basis with psychological support mechanisms. To do this I have Jayne Butler with me. Jayne is the CEO of Rape Crisis and an experienced voluntary sector leader with a strong background in frontline service delivery. Jayne has worked in social justice-focused organisations for almost 20 years. These include organisations working on asylum and immigration, mental health, child sexual exploitation and access to justice. Before moving into infrastructure and influencing work, Jayne was involved in designing, fundraising for and managing a range of frontline services. She has worked strategically as a consultant in a range of voluntary sector organisations, and as a staff member or trustee in a number of membership and infrastructure organisations. These include The Comfrey Project, North East Law Centre, Relate Northumberland and Tyneside, Newcastle United Foundation and The Children’s Society. Prior to joining RCEW, Jayne was Head of Income and Development for Law Centres Network, the national membership body for Law Centres. During her time there, she led on the Network's response to the Covid-19 pandemic. Jayne is a Fellow of the RSA. In the conversation we discuss: • The need for psychological support as an immediate intervention • The pre-hospital prevalence • What are the main considerations in the pre-hospital phase of care • Pre-hospital assessment when a patient has been sexually assaulted • Forensic assessment • Immediate treatment options, midterm, and long term • Safeguarding needs of this patient group • Care pathways available for these patients • Example case of when services work well together. • Final thoughts & take-home messages from Jayne. Services that Jayne sign posts to in the episode includes: 24/7 help line: https://247sexualabusesupport.org.uk/ Rape Crisis website: https://rapecrisis.org.uk/ Statistics on sexual assault & rape: https://rapecrisis.org.uk/get-informed/statistics-sexual-violence/ My thanks to Jayne for an informative and insightful interview.

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