Pre-Hospital Care Podcast

In this episode we will examine the various ways in which paramedic education has evolved over the past 20 years both conceptually and the skills taught within the profession. Alan Rice and Lisa Burrell join me in this conversation,  Alan is the lead for post-registration paramedic education at St Georges University, London. His role is predominately designing and organising the delivery of education for specialist and advanced paramedic roles in both urgent and critical care. He also oversee’s the work force development of all qualified paramedics that are studying towards a higher education award. Alan also works as a consultant paramedic advising ambulance trusts. Lisa Burrell is both an Advanced Paramedic Practitioner in London and a senior lecturer at St Georges university. Lisa teaches on both the post and undergraduate cohorts and spends time teaching CCPs from different services. She has also spent over 8 years as a flight paramedic within London and has split her time between teaching and critical care. In the episode we talk about: ·  The concept of critical thinking & analysis - a central concept of education.  ·  The diversity of care pathways and how this has changed over 20 years. ·  Non-technical skills taught and emphasised throughout the curriculum and course. ·  Mentoring - the importance of this. ·  Monitoring and the use of monitors within pre-hospital care.  ·  Engagement with technology for current practitioners.  ·  Skills that have evolved – USS, thrombolysis for VTE, prescribing, Abx, ·  Anecdotal thoughts on evolution of both the profession and the paramedic practice curriculum.  The undergraduate Paramedic Science course at St Georges University London can be found here: https://www.sgul.ac.uk/study/courses/paramedic-science Please enjoy this conversation with two fantastic guests. 

In this episode we will examine the various pathologies related to psychosis and neurosis in mental health that clinicians can see within practice. We also examine some of the key aspects of these pathologies so that clinicians can construct both meaningful and targeted treatment to this extremely difficult cohort of patients. To do this am am joined by Anna Basquil, a special mental health practitioner who joined the ambulance service in January 2020, seconded by her mental health trust to provide and help embed the 'dual assessment model' on patients. She works on the 'Mental Health Joint Response Unit' together with a Paramedic. Prior to this Anna was working in an 'early intervention service' with patients experiencing their first episode of psychosis. Anna worked in patients early years of diagnosis to help them both integrate and cope with their symptoms to help normalise and stabilise their lives.  In the interview we discuss:  Some of the fundamental differences between psychoses and neuroses. The demographics of each pathology Deep dive into Psychoses – definition, types, signs and symptoms. Examine schizophrenia as the most common type of psychosis. Brief look at prodromal phase, acute phase and recovery phase of psychotic episodes. Deep dive into Neuroses – definition, types, signs and symptoms. Examine depression and anxiety as the most common types of neuroses. Brief look at triggers for neuroses. Managing episodes of neurosis Managing psychotic episodes More information on the 'Mental Health Joint Response Unit' can be found here: https://aace.org.uk/initiatives/mental-health-joint-response-car/ I hope you enjoy this episode with an engaging and informative guest. 

In this session we will examine some of the prevailing educational learning from a colleague who has just qualified as a critical care paramedic in London. We will unpack some of the revelations, nuances, and comparisons that critical care has brought from their perspective from other roles. In the episode we dig into Adam’s background and why the Advanced Paramedic Practitioner in critical care career pathway was appealing to him. We also examine what has it brought Adam from a wider perspective and the nuances in care compared to standard paramedic practice. We then unpack Adam's personal revelations that were previously unknown and what he took from the mentoring aphase of his critical care training. We finish off by looking a few seminal cases and how that both inspired him and helped him learn along the way.  I hope you enjoy this episode with both an honest and insightful guest. 

In this session we will examine the varied pathology of Transient Loss of Consciousness (TLOC), the definition, the causes, the sequalae, and the management. I wanted to also examine some of the key aspects of TLOC that are red flags and should be examined further within clinical practice. To do this I have Consultant Cardiologist and Honorary Senior Lecturer, Dr Nicholas Gall with me.  In the episode we look at an established definition of TLOC, Nick's efforts to start a blackout pathway, the fundamental problem of TLOC in unpacking why undifferentiated TLOC can be a clinical minefield. We then examine the aetiology of TLOC and the diagnostic tools with which to differentiate the pathology (USS and ECG nuances). We then look at red flags warning signs and subtle information cues with TLOC, treatment of TLOC patients (broad take home messages) and clinical examples from practice. I hope you enjoy this episode with a fascinating and insightful guest. 

In this session I speak with  Professor Kelechi Nnoaham. We examine the prevailing themes of public health within the contemporary pandemic. We examine some of the key aspects of public health necessary to overcome one of the most challenging public health issues since the inception of the NHS. We dissect some of the fundamental principles of public health, the info-demic war of information, the contemporary evidence-based research, decentralised leadership and more. 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. In the conversation we examine:  The current public health climate – acute versus chronic needs, secondary infection rates. Collaboration – joined up working versus independent initiative The information war – The ‘info-demic’ ‘Press release’ medicine – effectiveness and impact. The principles of public health - The big 5 - population health management, prevention, population health research, knowledge mobilisation and collaborative working with communities. The 4, 4, 54 principles within a public health context Empirical research in the current climate; disaggregation of data (lack of sub-group analysis), action with absence of published data, equity of authorship, retraction of papers, robustness of evidence, retraction of studies, increase in corrections in 2020, decrease in RCTs & Meta analysis, decrease in ethics and consent. Decentralised ownership of health (internal locus of control). Professor Kelechi can be contacted through the following platforms;  • Twitter - @CwmTaf_DPH, @KelechiNnoaham • LinkedIn - linkedin.com/in/kelechi-nnoaham-1649937 Please enjoy this interview with an insightful and fascinating guest. 

In this episode I speak with Dr David Stehlik on leadership, followership and organisations. Dr Stehlik is the programme director for the Keith Bussey School of Business and entrepreneurial leadership at the University of St Francis in Fort Wayne in the US. He is also the the founder of a strategy and business education consultancy ‘Fourscene’ related to the field of strategic foresight. He is a strategist, an educator and team developer, he has also published a book called ‘Integrated delivery - innovating leadership for outstanding healthcare outcomes’ that was released at the beginning of 2021. In this episode we speak about what constitutes ‘great leaders’, and then dissecting the antithesis of this in the anatomy of failing leaders. We also examine: Self-awareness and tools to help get there (SWOT analysis, Johari’s window) Great followers and failing followers The consequences model & Role-playing model & conflict resolution The AI model Great organisations & failing organisations You can contact David at https://www.foursceneventures.com/about.html You can also read the article that the interview is based on here: https://www.regent.edu/acad/global/publications/jpc/vol5iss1/3-stehlik.pdf I hope you enjoy this episode with a fantastic guest. 

In this session we will examine a recent publication by Clinical Practice Development Manager of the Advanced Paramedic Practitioner for critical care scheme in London Ambulance Service, Mark Faulkner, which is featured in the Scandinavian Journal of Trauma, resuscitation and emergency medicine. The case study involved the resuscitation of a VF cardiac arrest in a 3-month-old infant.  The link to the case report can be found in the show notes and in this episode, we will be speaking with Mark (one of the authors) to both explore the case and some of the essential learning points that surround cases like this.  We explore the following themes: The current statistical climate of cardiac arrest and infant cardiac arrest Prodromal symptoms of sick infants The utility of sense checks with a clinician in the control room Use of standard and extended diagnostics to recognise ROSC such as USS  Deviation from protocol (post shock pause) for good reason Differentiating recurrent from refractory VF from the download Underlying causes of structural and electrical abnormalities and cardiac myopathies The utility of a HOT debrief in these cases as an intrinsic benefit. The article from the interview can be found here: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-021-00871-9 References to articles that Mark mentions throughout the interview can be found here:  https://pubmed.ncbi.nlm.nih.gov/19913971/ https://www.sciencedirect.com/science/article/pii/S1521689620301087 https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2021.13.6.232 I hope you find this episode insightful and useful.

In this session, we interview Gaynor Prince. Gaynor is an emergency physician based in New Zealand and has developed a subspecialty interest in ultrasound in ED. We take a look at point of care ultrasound, its utility and its limitations. We will be especially focussing on the EFAST and how it has been adaptive and progressive in point of care treatment in the past 5 years.  We also take a look at ultrasound probes and the positive and negative interaction with tissue. Gaynor unpacks some of the fundamental advantages and disadvantages of POCUS and how it has been adapted, been made portable and democratised amongst clinicians in recent years. We unpack the principles of EFAST, what we are looking for, when to look and where. We examine the difference image representations of fluid, blood, ascites, urine, intestinal contents, lungs, air.  Gaynor them looks at the anatomical variations and how to optimise the view, interplay with clinical questioning, repetition of scans and preferential windows to see the anatomy. We go sequentially through the EFAST and look at tips and tricks from Gaynor's practice and how these can be related to everyone's ultrasound practice and decision making. We finally look at a prime example of when USS has been really useful to Gaynor's practice in one of the remotest and most extreme environments - Antarctica. She recalls a story of when ultrasound greatly assisted her decision making, illustrating some of the unique examples of this modality in remote and austere locations. You can see more from Gaynor here: https://www.wem.academy/videos/extreme-medicine-research/ultrasoundinextremeenvironments/ This episode has been kingly re-shared from WEMcast. World Extreme Medicine provide courses, resources, training and conferences and can be found at: https://worldextrememedicine.com Please enjoy the episode.

Caroline Philips is back for the fourth instalment of the maternity mini series. Caroline is joined by Stacey Robinson the LAS practice lead midwife and Sarah Brown the LAS practice lead paramedic. In this episode they focus the on management of various pathologies, including bleeding, cord prolapse, shoulder dystocia, and all types of other maternal emergencies and treatment modalities seen within the pre-hospital environment. They dig into the technical and non-technical elements of care for the above pathologies and some of the different manoeuvres that optimise the mother and baby’s health in difficult deliveries. In this final episode we hear from these two specialists as they draw upon their experience, knowledge and oversight to relay some of the most essential aspects of care in maternal emergencies.  Our thanks goes to London Ambulance Service for allowing these professional perspectives to be shared and for being a forerunner in recruiting midwives and specialist paramedics with a maternal pre-hospital care focus to support the wider frontline staff. We hope you enjoy this episode with two fantastic clinicians. 

In this episode we explore late pregnancy complications