Pre-Hospital Care Podcast

In this episode I examine critical care communication and why this is so important within clinical practice. I look at definitions & statistics, the communication problem, the anatomy of communication, the patient, team and individual, leadership communication, empathetic communication, conflict management communication and finally crisis communication. I examine the approach to individual communication that can optimise both sent and received communication, the main facets of non-verbal, verbal and tonality that is needed to confer vital information.  I also look at a number of theories that have deconstructed the problem of communication, these are; communication theory, Millers Magic number 7, The communication triangle, signal detection theory, and finally meta-cognition. I break down some of the central concepts of the main aspects of critical care communication that are used on a day-to-day basis, that of, leadership, empathy, conflict and crisis. I hope you enjoy this topic. We are going to start mixing up the content on the podcast and feature more educational content, lecture sets as well as more traditional interviews and conversations with experts within their field of practice.  To apply for the Medics Academy Fellowship please apply here quoting 'PHC' for Pre-Hospital Care to let the team know you'd want to work with the podcast team.  https://www.medics.academy/courses/medics-academy-fellowship-programme-application You will acquire the digital skills to both create and harness cumulative attention to knowledge domains and speakers through the podcast platform and co-aligned spaces. As a Fellow you also gain access to Medics.Academy workshops, courses, resources, discounts and masters level accreditation. We are continuously developing the programme to make it a robust and exciting experience for those that are successful in joining. The Fellowship Programme is for a duration of 18 months and comprises three phases: ·  skill training and learning, ·  skill development ·  skill application The phases progress the fellow from a stage of independent working to small group and eventually large group production of a project. In each phase you will be mentored and guided by a specific individual within the company who has experience in producing aspects of the project. On average a fellow will spend 3-6 hours a week in producing the task and the timeframe for tasks will become more independently governed by the fellow as they progress into the next phases. This programme is ideal for individuals with other commitments as it provides a flexible working environment. As a Fellow you can enrol in the post graduate certification programme (PG Cert) in Clinical Practice, Management and Education. This programme is run by Medics.Academy and accredited by the University of Central Lancashire (UCLan) Medical School. The work you do as a Fellow will count towards the overall requirements of the PG Cert. For the joint Medics.Academy Fellowship Programme with postgraduate certificate we require the programme to be completed in 18 months with a potential for a six-month extension to complete programme assessments and elements.

In this session we examine some of the ways in which we have seen paramedics diversify through a multitude of roles within the healthcare economy. We chat with Gary Strong; Paramedic and CPD lead from the College of Paramedics and Caroline Phillips; my co-host, Paramedic and Palliative care Paramedic. The session is intended to unpack, examine our roles and journey through pre-hospital care and finally give insight into some of the positive and challenging aspects of diversification we have seen within paramedic practice in the contemporary climate. In the episode we discuss: The variety of roles that are open to Paramedics & ways in which Paramedicine is changing. We examine Gary’s path through Paramedicine, how he has got to where he is now and what got him there (education, roles and reflections). Caroline’s path through Paramedicine, from education, roles and reflections on current and past job titles within paramedic practice. My own (Eoin’s) path through Paramedicine, how I have got to where I am now and what got me there (education, roles, reflections) Final thoughts on pathways, education and the future of diversity and the role of a paramedic itself. As we see the diversity of roles within our expansive field of practice we reflect on where the profession has come from and how quickly it has adapted to new eco-systems of healthcare. We also reflect on some of the fundamental traits of paramedics around adaptability and flexibility as the DNA of what makes a paramedic so integrated and embedded within various domains of practice.  I hope you enjoy this wider ranging conversation on the evolution of the 'paramedic'.

In this episode Caroline Philips interviews Sarah Aldington; a Consultant Emergency Physician in Sydney, she is also a pre-hospital & retrieval specialist with Sydney HEMS. Sarah formerly worked in respiratory medicine in the UK before studying her PhD in New Zealand focusing on the prevalence of cannabis smoking induced COPD and lung cancer. Whilst in Wellington Sarah established a choir for COPD patients called 'Sing Your Lungs Out (SYLO)'.  In this interview Sarah gives a fantastic insight into advanced lung disease and a patient focused approach to this life limiting illness. Sarah recounts this amazing initiative that took on a life of its own and instilled a community of like minded sufferers. Sarah and Caroline share insightful perspectives on what truly matters to patients and how this initiative changed Sarah's perspectives on her approach to medicine. Please enjoy this episode with a fantastic guest. More on the choir they speak about can be found here: https://pubmed.ncbi.nlm.nih.gov/27650768/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294022/ https://pcnnz.co.nz/wp-content/uploads/2016/05/Health-Happiness-Community-Gayle-Williams.pdf https://givealittle.co.nz/org/sylo#:~:text=The%20Sing%20Your%20Lungs%20Out,living%20with%20chronic%20lung%20disease.&text=Neighbourhoods%20Fun%20Awareness-,The%20Sing%20Your%20Lungs%20Out%20(SYLO)%20Choir%20is%20a%20community,of%20life%20and%20lung%20function.

In this session Caroline Philips interviews two of the advanced paramedics in urgent care. The conversation includes; their role on a day to day basis, this structure of the scheme and how there time is spent. They also examine how previous pre-hospital roles (such as clinical advise, team leader/manager roles) have helped with the senior clinical role as an APPUC. Nikki and Andrew also catalogue the variety of patients that they see and the in-depth patient focussed history taking and nuanced risk/benefit analysis undertaken. They also discuss some of the skills that the scheme supports such as wound care assessment and closure methods, point of care tests, additional medications and utilisation of alternative referral pathways. Nikki and Andrew also denote the adjunctive education and skills that have been fostered within the APPUC scheme. As the prevailing percentage of demand within pre-hospital care are medical pathologies, this scheme has had bilateral benefit of supporting frontline paramedics and managing patients in the community and avoiding the transfer through to the emergency department where possible. They also denote the change in communication skills that Nikki and Andrew have both witnessed within their practice.  Please enjoy this fantastic episode with two insightful practitioners.

Claire is a registered Nurse and Paramedic working as a frailty coordinator at Brook Green Medical Centre, London (HAFP Primary Care Network) with Dr Anna Wilson (Lead GP) and Dr Emily Eve as part of a frailty team. She also sits on the College of Paramedics Committee for primary and urgent care specialist interest group. Claire works as a part community matron as well as a registered paramedic and receives referrals to both support and link the patient into appropriate care pathways.  In this episode Claire and Caroline discuss the definition of frailty, contributing factors and the sequelae of neurological disorders contributing to frailty. Clare also discusses baselines of health and the phenotype model and the cumulative deficit model. Caroline also talks about the fall decision tool and frailty syndrome. Please enjoy this episode with an insightful guest.  For more on frailty please see the links below: https://www.bgs.org.uk/ British Geriatric Society https://podcasts.apple.com/gb/podcast/the-mdtea-podcast/id1073719746 MDTea Podcast https://www.rcem.ac.uk/ Royal College of Emergency Medicine

Tony Underwood is a former English Rugby Union professional who played as a winger for both country and at club level. He made his England debut in October 1992 against Canada, and went on to win a total of 27 English performances/caps. Having trained as an airline pilot, went on to fly for Easy jet, Virgin Atlantic and Emirates. In this conversation we talk about resilience, high performing teams, relationship with failure and success, continual improvement & feedback mechanisms, transitioning & adaptation to change, meta-programs, co-aligned lessons with aviation and medicine and finally human factor mitigation. I hope you enjoy this interview with an insightful and interesting guest.  To find out more about Tony please head to: wordplaygroup.com Twitter: @underwood_tony

In this conversation with Ben Watts we look at the sequential approach to arresting bleeding. We also examine the second/third generation haemostatic compounds (celox, quik-clot), pharmacological agents such as TXA, FFP, FDP, blood, cryoprecipitate. We also examine the utility of tourniquets (origins, usage and types), neck zones and wounds, Blunt injury and junctional wounds, Hypotensive management and Pain management modalities and preferential agents. Ben is a specialist retrieval practitioner/CCP working in Scotland and previously as a CCP in the Thames Valley and before this in South West of England. He also has an extensive history of expedition work in various international locations, I first met Ben whilst working for World Extreme Medicine as a fellow paramedic and he has been a contributor to both WEMcast and to the College of Paramedics podcast.  I hope you enjoy this wider ranging conversation as much as we did. 

Mark Dempster is an addiction specialist working with patients with drug addiction, gambling addiction, sex addiction, alcohol addiction, internet addiction, and more. He is a counsellor dedicated to helping people regain control and turn their lives around.  In the conversation we look at some of the statistics around the health burden & impact on the individual and extended families, how people become addicted (habit Vs addiction), the 5 stages of addiction, common cognitive pitfalls and finally breaking the cycle. We also explore some of therapies that are evidence based and are commonly practised such as CBT, DBT, ACT, and PET. In 2013, the Centre for Social Justice determined that the level of addiction in the UK made it the “addiction capital of Europe.” This includes the use of legal substances, mainly alcohol, and the use of Class A drugs, that include heroin, cocaine, meth, and hallucinogens. £36 billion is spent by the nation every year on treatment relating to drug and alcohol abuse. At the time of filing their report, titled No Quick Fix, the UK had the highest rate of addiction to opioids and the highest lifetime-use of amphetamines, cocaine, and ecstasy across Europe. Many view addiction as something that only affects the users themselves but, in reality, casualties from substance abuse are taxing on entire communities, the NHS and society as a whole. It has a direct affect on healthcare workers and on the frontline of the emergency services on a daily basis. Please enjoy this interview with Mark, his clinic and work can be found here: http://markdempstercounselling.com/

In this interview I interview Johannes von Vopelius-Feldt, Johannes is an emergency physician currently working in South West England. He has written and undertaken extensive research into the utility and demographics of critical care teams. He has also empirically examined the impact of critical care within certain patient presentations to examine the benefit that these teams can bring.  In the conversation we examine; the overall proven benefit of critical care versus standard care within pre-hospital care. We also examine skill mix versus intervention, intervention versus outcome, the wider utility to critical care outside of cardiac arrest and some of the prospective studies which may benefit transparency into the usefulness of CCTs. We also examine the shift in mindsets and underlying concepts that are now well known and accepted around human factors and mitigation strategies compared to 10 years ago.  Johannes' research can be found below - please enjoy this conversation with an insightful and engaging guest as he brings an inquisitive and research based perspective to the domain of critical care.  J von Vopelius-Feldt, JR Benger - European Journal of Emergency Medicine 20 (6), 382-386 45, 2013 Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians J von Vopelius-Feldt, J Benger - Emergency Medicine Journal 31 (12), 1009-1013 40, 2014 Critical care paramedics: where is the evidence? A systematic review J von Vopelius-Feldt, J Wood, J Benger Emergency Medicine Journal 31 (12), 1016-1024, 18 2014 Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest J von Vopelius-Feldt, J Brandling, J Benger - Resuscitation 114, 40-46 17 2017 The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest J von Vopelius-Feldt, A Coulter, J Benger Resuscitation 96, 290-295 15 2015  Critical care paramedics in England: a national survey of ambulance services J von Vopelius-Feldt, J Benger - European Journal of Emergency Medicine 21 (4), 301-304 13 2014  Prehospital critical care for out-of-hospital cardiac arrest: An observational study examining survival and a stakeholder-focused cost analysis J von Vopelius-Feldt, J Powell, R Morris, J Benger - BMC emergency medicine 16 (1), 1-7 11 2016 Should physicians attend out-of-hospital cardiac arrests? J von Vopelius-Feldt, JR Benger - Resuscitation 108, A6-A7 4 2016  Response to: influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation

In this session we interview Lucy Grimwade who works as an Advanced Clinical Practitioner (ACP) and Matron in an Emergency Department in Manchester. Lucy gives a fantastic perceptive on the current climate within the emergency department throughout the first and second spike of Covid-19. She gives an honest and insightful first hand recollection of her clinical and personal experiences around the effects in patients physical and mental health. She also provides an insightful commentary on the mental health of the shared ED community and habits that have served her well during the lockdown period. Please enjoy this interview providing a unique cross-section of life on the frontline of the NHS during the greatest health crisis it has ever faced.