Pre-Hospital Care Podcast

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

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.