Pre-Hospital Care Podcast

In this conversation I talk with Carl Betts about his reflections on paramedic retention in contemporary practice. Carl is a paramedic and quality improvement lead based in Sheffield working for the ambulance service. He has been a paramedic for 10 years and also has a 10-year extensive history of expeditions across the globe.  We examine this article, Carl’s motivations for writing it, and pull out some of the salient learning points from his reflection in this interview. We examine some of the metaphorical warning lights that Carl describes (demand, resourcing, external management pressure), the spill over of GP work, e-consult and exponential rise of primary care. We also examine current hospital handover times, the central pivot and reason for staying in the role (patients) & the frustration seesaw that clinicians find themselves on. We also explore what the ‘outs’ and opportunities there are at the moment for paramedics, we also look at mental burnout and how should things change to avoid frustration and burn out, and finally a seminal case in reference to the conversation from Carl's experience.  The reflection can be found here: https://wordpress.com/page/prehospitalcarepodcast335905859.wordpress.com/3 The rotational paramedic proposals can be found here: https://www.hee.nhs.uk/our-work/paramedics/rotating-paramedics https://www.hee.nhs.uk/sites/default/files/documents/Feasability%20Study%20of%20the%20Rotating%20Paramedics%20Pilot%20-%20Final.pdf The future proposals from AACE can be found here: http://aace.org.uk/wp-content/uploads/2015/09/Ambulance-2020-and-beyond-the-AACE-vision.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/

In this session we will be talking with Noah Baron Cohen. Noah, now 22, 6 years ago in 2016 had a seminal event whilst exercising at The Jewish Community Secondary School in North London. Noah suffered a cardiac arrest from a primary arrhythmia 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 Noah’s first-hand experience of that cardiac arrest and the events leading up to incident and how it has been a turning point in his life. Erran is Noah’s father and will also tell the sequence of events as he experienced it, both on that day in 2016 and the consequential roller coaster ride of Noah's rehabilitation.  We talk about Noah’s life before the incident, what Noah & Erran remember about that day, we run through sequentially timeline of events. We also speak about the recovery journey that Noah embarked on, the consequential shift in perspectives on life that it has given rise to, and finally take home message from Noah and Erran. 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 an inspiring pair of guests. 

In this session we will examine the recent viral Monkeypox (MPV) outbreak with Professor Kelechi Nnoaham. We dig into the anatomy of the virus, the possibility of local transmission of the virus, the origins of the current outbreak, current prevalence, symptomatology, known transmission pathways, viral genetic adaptation, the R rate, Case Fatality Rate, containment (ring vaccination strategies), whether the MSM data is outlier data, and finally, surveillance of MPV. Professor Kelechi is the Executive Director of Public Health and lead for Research & Development, Innovation and Value-Based Health for Cwm Taf Morgannwg University Health Board, Wales. Kelechi has held Honorary Professorships in Public Health and Epidemiology at Plymouth University (since 2015) and Cardiff University (since 2021) medical schools and previously worked as the Director of Public Health for Plymouth and Bristol City Councils. He has subsequently worked throughout leadership roles in public health and healthcare leadership across the UK. Kelechi has an MPH in Global Health Science (with Distinction) at Oxford University and followed that up with a PhD in Public Health & Epidemiology at Oxford University in 2011. 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. BHA’s latest innovation is a Monkeypox Lateral Flow Antigen Rapid Test. The product is a lateral flow detection of monkeypox virus antigen in human whole blood, serum, plasma, rash exudate, or nasal swab. The product uses a double antibody sandwich method. During the test, a specimen is dropped into the specimen hole, the specimen is superimposed under the capillary effect. If the specimen contains monkeypox virus, a colour band appears in the test area (T) indicating a positive result for monkeypox virus. If the specimen does not contain the corresponding substance, there will be no colour bands in the test area (T), and the result will be negative. The Performance Characteristics show that the positive and negative coincidence rates are 100% Please see the show notes for further details and how to order kits: https://www.bha-medical.com/monkeypox-virus-antigen-rapid-test-kit https://www.bha-medical.com Please enjoy this wide ranging episode with an insightful guest.

In this session we will examine the importance and art of dispatch with Jerry Overton. Jerry Overton serves as the President of the International Academies of Emergency Dispatch, the organisation charged with setting standards, establishing curriculum, and conducting research for public safety dispatch worldwide. Established in 1988, the International Academies of Emergency Dispatch (IAED) is the international standard setting and certification body for emergency dispatch. Currently, its protocols are in use in over 2800 dispatch centres in 38 countries. As the President of the IAED, Jerry leads the Academy, which allows advanced call taking, clinical assessment, and patient management by evidenced based telephone algorithms. Jerry has established international relationships for IAED and assists in the development of EMS systems worldwide. The importance of dispatch as a concept and model. Origins of targeted dispatch and how far we’ve come. Modelling – dispatch systems support tools (MPDS, ProQA). The four historical priority symptoms - chest pain; difficulty breathing; change in level of consciousness; serious haemorrhage. Importance of compliance to pre-arrival instructions. Paramedic/CCP additional dispatch – Silent interrogation, active interrogation, crew requests, advice to crews on the ground. Pre-arrival dispatch instructions (importance and nuances of these). Breathing diagnostic tools and the integration of software into the call taking script. Take Home Massages and reflections from Jerry 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 most recent devices they sell is the D-Heart; D-Heart is the first smartphone ECG device that is simple to use, clinically reliable, portable and affordable. It allows anyone to perform a hospital-level ECG in total autonomy and to send the results to the 24/7 telecardiology service or to your trusted doctor. ·  The app guides you to perform a professional ECG ·  Bluetooth ECG streaming in real time ·  Medical grade ECG (12 to 60 seconds of recording) ·  Telecardiology service available 24/7 ·  Charge the device directly in the case ·  Italian design and manufacturing The D heart ECG device can be found here: https://bha-medical.com/medical-products/d-heart/ For further information on BHA medical please see here: https://bha-medical.com Please enjoy this wide ranging conversation with an insightful and engaging guest. 

In this session we will examine the fundamentals of head injury with consultant neurosurgeon Mark Wilson. We will dig into the details of brain injury, primary and secondary injury, the importance of venous drainage, and optimising the pre-hospital management. Mark is a Consultant Neurosurgeon and Pre-Hospital Care Specialist working at both Imperial College (mainly St Mary's Major Trauma Centre) and as an Air Ambulance doctor. He is also a Clinical Professor specialising in Brain Injury at Imperial and Honorary Professor of Pre-Hospital Care (the Gibson Chair) at the Faculty of Pre-Hospital Care, Royal College of Surgeons, Edinburgh. Marks’ specialist areas are acute brain injury (mostly traumatic brain injury) and its very early management. He is also  co-director of the Imperial Neurotrauma Centre and co-founder of GoodSAM, a revolutionary platform that alerts doctors, nurses, paramedic and those trained in basic life support to emergencies around them. He has worked extensively overseas (India, Nepal, South Africa, as a GP in Australia, Researcher for NASA and as an expedition doctor on Arctic and Everest expeditions). In the episode we examine:  Incidence of brain injury TBI Vs NTBI pathology Doctor/Paramedic teams within neurological injuries Accuracy of our pre-hospital diagnoses with head injury Do we triage patients to the right places. Pre-hospital Anaesthesia and transfer to neurological units The importance of the basics done well even before formative PHC. Pupils and wider, lesser-known symptomatology Seminal case from Marks experience. Final thoughts from Mark and take-home messages. 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 the fundamentals of Mountain Rescue with Paramedic Jamie Patterson and Emergency Nurse Practitioner Ben Cooper. This will include a look at the demographics and diversity of rescues within the Mountain Rescue Team (MRT). We will also examine the different specialist domains that constitute being a member of the MRT such as navigation, search strategies, team dynamics, Immediate Medical Care (IMC), casualty evacuation and much more. Finally, we will examine some seminal cases where all of Ben and Jamie’s training has come to use. Both World Extreme Medicine colleagues examine the following topics: Why is the MRT a fundamental part of an emergency response out on the hill? What a MRT comprises of (the size, the diversity of background and profession)? Domains of practice that are relevant What the education and training looks like from the inside. Internal governance and debrief. Risk management and mitigation Search strategies Importance of team dynamics The immediate medical care and ceilings of care on scene. Casevac Seminal cases from both guests Further resources recommended by the guests include: Go outside. Sit down. Wait. https://dmbins.com/blog/go-outside-sit-down-wait/ Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature https://www.amazon.co.uk/Mountain-Rescue-Doctor-Wilderness-Medicine-ebook/dp/B000V770NC Mountain Rescue: History and Development in the Peak District 1920s-Present Day https://www.amazon.co.uk/Mountain-Rescue-Development-1920s-Present-1920s-2007/dp/0752440918 Cairngorm John: A Life in Mountain Rescue https://www.amazon.co.uk/Cairngorm-John-Allen/dp/1905207573 Call-out: A climber's tales of mountain rescue in Scotland https://www.amazon.co.uk/Call-out-climbers-mountain-rescue-Scotland/dp/1911342215 World Extreme Medicine - Fundamentals of Search & Rescue | Northumberland | October 2022 https://worldextrememedicine.com/products/search-rescue/sar/ If you have any specific Mountain Rescue questions, Jamie Patterson is available to take these at: jamie.pattison90@gmail.com I hope you find this episode both engaging and insightful. 

In this session I will be talking with Allistair MacSorley around his journey through pre-hospital care as a paramedic and then a day in 2018 that changed his life forever and left him paralysed from the waist down. We will also be examining his tenacity, drive and attributes that separate him from the crowd. He is currently still working as a registered Paramedic and part of the maternity team within London Ambulance Service. He is also part of the Irish paracycling development squad in hand cycling. He is training for and focussed on the next hand cycling World Cup in May in Belgium, aiming towards ParaOylpmics Paris 2024 and then the LA games 2028. He has adapted and employed a coach from September 2021 which has fundamentally changed his training program and diet. The carbon fibre cycle bike is a £15,000 specialised bike with adaptations and enables Ali to compete at elite level.  In the conversation we discuss:  The introduction to Alistair’s life growing up His father’s influence and motorbikes His training as a Paramedic What he took his training and facets of his career The career break and what he learned whilst away The incident and injuries sustained The recovery The adaptations to life His current role (LAS and cycling) Ali's story can also be found here: https://www.irishnews.com/news/northernirelandnews/2019/07/29/news/-flying-doctor-left-paralysed-after-motorcycle-crash-returns-to-circuit-a-year-later-to-complete-lap-1672238/ https://www.bbc.co.uk/sport/motorsport/49140461 Please enjoy this episode with a truly inspiring professional and friend.

In this session we examine the importance of governance and the main facets that constitute robust governance. This includes a look at why governance is important, the different domains that constitute good governance and finally how it is applied in practice. We will also look at the fundamentals of risk management within governance and the symbiotic relationship between the two. To do this I have Intensive Care, Anaesthetic and Pre-hospital care consultant Pete Sherren with me. In the conversation we unpack:  What is governance and why it is a vitally important feature of a culture of improvement.  The facets of good governance and cultural commitment.  Education and Training. Clinical audit. Clinical effectiveness. Research and development. Openness Information Management Finally Risk management and how this is important for the patient clinician, and institution. Links to the Delphi study that we mention in the conversation can be found here:  Consensus on research priorities for Essex & Herts Air Ambulance: a Delphi study: https://sjtrem.biomedcentral.com/track/pdf/10.1186/s13049-021-00835-z.pdf Please enjoy this conversation with an engaging and insightful guest. 

I'm pleased to release this recently recorded episode with ED consultant Dr Amy Hughes. Amy has launched the 'Portfolio Medical Careers' Podcast which details interesting narratives and career paths from various medical careers. This series will cover doctors, paramedics, nurses, and other allied healthcare professionals with different stories and paths within and outside of the National Health Service (NHS). She has some fantastic interviews lined up and really gets to the heart of emphasising the 'journey and not just the destination'. The podcast also denotes that various experiences can feed into the wider clinician and person and give more rounded and diverse experience from which to draw.  This month we join Paramedic Eoin Walker. Eoin has been a practising paramedic for over 20 years and journied through a fascinating career including the LAS cycle response unit, Physician Response Unit, London's Air Ambulance (HEMS), LAS Advanced Paramedic Practitioner, Expedition Medicine and, most recently,  a role with the International Committee of the Red Cross (ICRC). The podcast can be found here:  https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5saWJzeW4uY29tLzQwMDc3NS9yc3M/episode/YTlhYTI3NjktYWFkNS00MDBlLWEzODctM2FhZjIwZjBjNGUz?hl=en-HU&ved=2ahUKEwjMi4nizsX2AhXUiP0HHY46DecQjrkEegQIBhAF&ep=6

In this session we will examine some of the prevailing issues and difficulties of paediatric pain management. To do this I have Will Broughton, an associate professor of paramedic science at Buckinghamshire New University, Paramedic with specialist interest in Paediatric Emergency Medicine and Paramedic Education. He continues to practice clinically with London Ambulance Service (LAS) and South Central Ambulance Service (SCAS). We will unpack some of the nuances, challenges, and evidenced based approaches that Will has found from being both a pre-hospital practitioner and studying his MSc in this domain of practice. In the conversation we discuss:  Definitions of pain and what it means to children. Physiological consequences of pain in paediatrics Difficulties of pain management in Paediatrics Pain relief routes available and advocated (NICE) Pain assessment - Wong and Baker, visual analogue scales.  The utility of the FLACC score Monitoring difficulties and challenges  Human factors with Pain - Parents, stressful environment Tx/Pain Mx strategies - NICE, preferences, nuances. Take homes messages. Resources that are mentioned in the episode include:  CRIES pain scale http://geriatricphysio.yolasite.com/resources/CRIES%20Scale%20for%20Neonatal%20Postoperative%20Pain%20Assessment.pdf WHO pain ladder https://professionals.wrha.mb.ca/old/professionals/files/PDTip_AnalgesicLadder.pdf Children in painhttps://rcem.ac.uk/wp-content/uploads/2021/11/Pain_in_Children_2017_18_National_Report_Oct_2018.pdf Wong and Baker faces https://wongbakerfaces.org I hope you enjoy this episode with a fantastic guest. Will Broughton can be reached on Twitter at @WilBroughton