Pre-Hospital Care Podcast

This is the second part of the lecture series on building effective teams and dealing with difficult people. The concepts taught here involve models of teamwork (Action centred Leadership, the five dysfunctions of a team), trust - both as a concept and a pre-requisite, culture, homeostatic teams and finally tools and techniques for fostering good team work.  In the second half of the podcast we examine dealing with difficult people from the perspective of understanding the triggers, root cause analysis, rapport building, the energy investment model, the ELCR framework, self awareness, humility and insight. Some of the resources and models can be found here:  Energy investment model: https://careerresilience.wordpress.com/2021/06/03/how-are-you-investing-your-energy-in-times-of-change/ Action Centred Leadership: https://www.businessballs.com/leadership-styles/action-centred-leadership-john-adair/ The Five Dysfunctions of a team: https://tomorrowsleadership.nl/how-to-overcome-the-5-dysfunctions-of-virtual-teams/ Empathic communication: https://hbr.org/2022/08/4-ways-to-communicate-with-more-empathy I hope you get something from this episode that you can use either within clinical practice or within general work-based situations. I'm always keen for feedback on sessions, please feel free to reach out to me at eoinwalker@hotmail.com - please also rate, review and subscribe to the podcast. This episode will be aired across the Pre-hospital Care Podcast and Restore Podcast platforms.  Many thanks, Eoin

In this session we will examine Exertional Heat Injury (EHI) within individuals undertaking endurance races, military exercises, or extreme activity. We will draw contrast and parallels to acute behavioural disturbance, what is happening both at the physiological level and some of the autonomic positive feedback mechanisms within EHI. To do this I have Harvey Pynn with me, Harvey is a Lieutenant colonel within the British Military and an Emergency Medicine and air ambulance consultant with GWAAC. In the episode we examine:  ·  Definitions, spectrum of disease – EHI as a broad definition and spectrum of states ·  How are thinking has changed on heat illness and what is happening on a physiological level ·  Incidence of EHI; anecdotal and empirical ·  The hierarchy of ‘exercise-state’ heat loss – evaporative, convective, conduction, then radiation. ·  Heat acclimatisation: Salt concentration (aldosterone mediated), sweating initiation and rate. ·  Risk factors (individual, environmental)- concomitant disease or drugs (dehydration, alcohol, co-morbid disease, medication) ·  Subtle and not so subtle prodromal signs and symptoms of heat injury & why urine colour isn’t a great marker (lack of micturition during     dehydration). ·  Preventative measures and treatment modalities in severe EHI  ·  Analogues of comparison and symptomatology – ABD, drug induced hyperthermia. ·  Differential diagnosis and an anecdotal case from Harvey  Please find some related research produced by Harvey pertaining to measuring dehydration and the sequlae of EHI: https://www.researchgate.net/publication/327822126_The_Compensatory_Reserve_Index-potential_uses_in_a_military_context Please also see relevant empirical literature that is congruent with the podcast: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819979/ Please enjoy this episode with an engaging and informative guest. 

In this episode I examine the art of active listening. It is a slightly different episode and one of a number to come where I give a series of lectures. In this episode I wanted to do two things: 1. Build awareness of the factors that affect our listening ability. 2. Build and create the conditions that can produce good listening habits. One of the main problems is caused by the fact that we think much faster than we talk. The average rate of speech for most of us is around 125 words per minute. In contrast we process and think at about 800 words a minute. This is a fundamental mis-match which can cause a deficit in receiving information. The human brain is made up of more than 13 billion cells and operates in such a complicated but efficient manner that it makes any comparison to computers seem insignificant. It might seem logical to slow down our thinking when we listen so as to coincide with the 125-word-per-minute speech rate, but slowing down thought processes seems to be a very difficult thing to do. When we listen, therefore, we continue thinking at high speed while the spoken words arrive at low speed. In the act of listening, the differential between thinking and speaking rates means that our brain works with hundreds of words in addition to those that we hear, assembling thoughts other than those spoken to us. The latency of this mis-match is often taken up by internal dialogue rather than integration of the spoken, but more importantly inferred meaning behind words. In this episode I examine:  The definition of active listening.  The 'classic' example - one which we all fall prey to.  The anatomy of the received message. The why and what of ‘Active Listening’. Triple A listening (what triple A listening actually is).  Kinesthetics of listening – what it feels like to be heard amongst other aspects.  Models of active listening: Four ears of communication, the communication triangle.  The power of silence The quality of listening - The hierarchy of active listening  Chunking information as an adjunct to active listening  Closed loop communication  The power of agreement Please let me know what you think of the content at eoinwalker@hotmail.com and also feel free to recommend future topics. Please also feel free to rate and review the podcast and I always welcome feedback. 

In this session we will examine one of the common greatest human factors challenges within pre-hospital care, that of acute fatigue within clinical practice. The ambulance services are trying out different ways of working to help staff feel less tired at work and safer on scene, but these actions are often localised and have no empirical underpinning, and also we don’t know whether they are making working environments safer. Kristy is investigating whether patient and staff outcomes can be improved through development and implementation of a fatigue risk management system (FRMS), as is done in other safety-critical industries like aviation and transport.  The evidence suggests individual components of a FRMS which may be effective, Kristy is currently investigating the optimal packaging of these interventions. Kristy believes that FRMS adoption in the NHS needs local tailoring and understanding of barriers and facilitators. Kristy is looking at a way to integrate a comprehensive fatigue risk management system for the UK NHS ambulance sector that is acceptable, feasible, and likely to improve patient outcomes and staff wellbeing and experience. Within the episode we will examine: 1.  Kristy’s research approach to an agreed set of evidence-based and emerging components of a FRMS for the UK ambulance sector that are considered feasible and acceptable. 2. The wider CATNAPS study and its wide ranging primary and secondary outcomes.  2.  The components of a comprehensive FRMS that are in use and why. 3.  The ways in which front-line staff and patients experience current fatigue actions and potential to improve safety culture and reporting. 4.  Development and usability testing of the FRMS and its implementation guide that allows tailoring to organisational and local context and is underpinned by a new theory of change and logic model. 5. The 12 hour day and and night shift, both pros and cons of this pattern of working.  6. Fatigue mitigation and how the FRMS may serve to support this. 7. Second and third order effects of fatigue.  More on CATNAPS and Kristy's research can be found here: https://arc-eoe.nihr.ac.uk/research-implementation/research-themes/mental-health-over-life-course/catnaps-fighting-fatigue-nhs Please enjoy this episode with an engaging guest. 

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.