Pre-Hospital Care Podcast

I just wanted to do a house keeping episode to let you know what to expect in this season. We are half way through the mini series on End of Life Care and had 'recognising the dying phase' with Dr Emma Hall and 'oncological emergencies' with Merel a cancer clincial nurse specialist.  We have two more instalments of EOLC and these are around advanced neurological disease with Diane Laverty and Grief and bereavement with Julia Samuel MBE. Caroline Philips has done a fantastic job at cataloging some of these essential conversations and really helping us appreciate some of the deeper facets of end of life care. We will have some skill based episodes with myself and Nick Brown. These are looking at the skills undertaken by clinicians and everything that the text books don’t tell you around experiential learning and reflections of performing these on a daily/weekly basis - we will look at IO, splintage, intubation, IV access and other skills. We will look at pain management with a pain specialist and some of the types and methods of acute and chronic pain management that we might face in the pre-hospital environment. We will do a deep dive into one of the prolific drugs in society and that we interact with on a daily basis - that of alcohol. We will look at chronic alcoholism and how it changes physiology. We will also look at acute intoxication and why these patients can be so difficult to look after. We will start with a mini case review series as well - dissecting some challenging cases and what we can learn from these cases. We will also look at urgent care with a GP and urgent care advanced paramedic in more detail and some of the subtitles that we can learn to pick up as clinicians. Finally we will look at some of the diverse range of pre-hospital career options that are available for clinicians (paramedics, doctors and nurses) in the current climate.  We hope you enjoy the season.

In end of life care we are mindful of respecting patient’s wishes, including those relating to conveyance to acute care settings. However there are some presentations, specifically in relation to cancer, which we need to be aware of and rapidly refer onto either acute or specialist colleagues. In this episode we explore these reversible oncological emergencies based on cases seen in Merel’s clinical experience as a Cancer Clinical Nurse Specialist in a specialist cancer centre in The Netherlands. We review Neutropenic Sepsis, Superior Vena Cava Obstruction, Metastatic Spinal Cord Compression and Hypercalcaemia. Further reading: -  AACE JRCALC Clinical Guidelines (2019) – End of Life Care -  NICE Guidelines - Metastatic spinal cord compression in adults: risk assessment, diagnosis and management -  NICE Guidelines - Neutropenic sepsis: prevention and management in people with cancer -  Oxford Handbook of Palliative Medicine (2019) We hope you enjoy the episode.

In this episode Caroline Phillips hosts Dr Emma Hall, Palliative Care Consultant and discusses the signs of the final few days and hours of life. We discuss the challenges of recognising the dying phase, the importance of shared decision making and the positive aspects of shared learning between prehospital and palliative care professionals. This is part of a mini series on the Pre-hospital Care Podcast where we will start to look into topics in more depth and involve some of the subject specialists to share their experience.  We hope you enjoy the episode. Further reading: Kathryn Mannix – With the End in Mind Oxford Handbook of Palliative Medicine (2019) AACE JRCALC Clinical Guidelines (2019) – End of Life Care

In this episode we explore some of the fundamental the components what makes a good debrief. The concept of debrief effects everyone within pre-hospital care whether formal or informal. Involvement in a debrief exercise can help to make sense of events and offer the opportunity for learning that can be applied in the future. It’s power, in part, is that it takes place when the events are fresh in the mind and that all experiencers are able to contribute. In this episode we dig a little into the broad benefits of debriefing and what makes for a successful debrief exercise (as well what doesn’t) within the context of prehospital care. How can we optimise the setting and structure in which a productive conversation can be had in order to maximise the outcomes from a debrief? Also, is shared reflection just for those ‘big jobs’ or can we apply it to any experience? We look at: Definitions of debrief. What do we think debriefing is/what purpose it serves. What debriefing is not. How we can optimise the setting for a successful debrief. How to structure a debrief. Relevant content in the context of pre-hospital care. Some of the issues/pitfalls/barriers involved in debriefing. The models we refer to in the episode are here:  Gibbs cycle: https://www.mindtools.com/pages/article/reflective-cycle.htm The 3D model of debriefing: https://www.semanticscholar.org/paper/The-3D-model-of-debriefing%3A-defusing%2C-discovering%2C-Zigmont-Kappus/7b63a9876c39340398dedd25b48eddc5f08096b8 Other insightful resources include the book 'Never fly solo' by Rob Waldman: http://www.neverflysolo.com/about-book.html Debriefing tools: https://www.nds.org.au/images/resources/wa-safer-services/Debriefing-Tool.pdf We hope you enjoy this wide ranging conversation.

This is a wide ranging conversation on club drugs, illegal highs and Novel Psycho-active Substances (NPS) with Dr Owen Bowden Jones. Owen is a Consultant Psychiatrist with over 20 years' experience in general and substance misuse psychiatry in both the NHS and private practice. In 2010 he founded the Club Drug Clinic, offering treatment specifically for those using 'club' drugs such as cocaine, ketamine, MDMA, GHB/GBL and novel psychoactive substances. In the conversation we discuss: The definition of Club drugs and illegal highs/Novel Psychoactive substances Define the problem by age and top 5 commonly seen drug presentations (differentiate between prevalence and problem – i.e. seeking help) Examine traditional vs emergent drug trends Look at groupings of drugs – Sedatives/dissociates, stimulants, synthetic cannabinoids, hallucinogens Examples of each and on common presentations & adjunctive use (concomitant use of these drugs) Ask about sourcing & trends in where people acquire drugs presently Look at first line staff engagement – who sees these groups of patients first (not always acute presentations) Examine new harms & clinical challenges Reference project Neptune – Novel Psycho-active Treatment Uk Network There is free e-learning on club drugs, illegal highs and NPS that Owen has put together, please find it at: http://neptune-clinical-guidance.co.uk/e-learning/ Feel free to reach out to Dr Bowden-Jones here: Owen.bowdenjones@nhs.net • Clubdrugclinic.cnwl@nhs.net • www.clubdrugclinic.com • @ClubDrugClinic @OwenBowdenJones www.neptune-clinical-guidance.co.uk

In this wide ranging conversation with Will Duffin - a passionate GP, educator, adventurer, innovator and polymath we define the current problem around depression and then examine different states of depression. We also look at why people get caught in the cycle of depression and current modalities of treatment for depression (chemical intervention, groups, social prescribing, referral pathways). We then look at the concept of micro-adventure & the benefits of these together with Will’s perspective on optimising mental health and balance (work/life). We look at how do Will achieve's balance in his life and regimes that works for him. We also examine ways in which he has changed his mindset and approach to mental health over the past 10 years both as a GP and as an adventurer. We dig down into some of the statistics on Mental Health and why this is such an important topic - such as (Figures from MIND and MHFA England 2020): 1 in 4 people experience mental health issues each year 792 million people are affected by mental health issues worldwide At any given time, 1 in 6 working-age adults have symptoms associated with mental ill health Mental illness is the second-largest source of burden of disease in England. Mental illnesses are more common, long-lasting and impactful than other health conditions Men aged 40-49 have the highest suicide rates in the UK 70-75% of people with diagnosable mental illness receive no treatment at all Half of mental ill health starts by age 15 and 75% develops by age 18 I hope you enjoy this conversation with an insightful and thoughtful colleague and friend.

In this wide ranging conversation with Critical Care Paramedic Ben Watts and ED Consultant Iain Edgar we look at an overview of the TVAA service in providing critical care to the community. We also look at how expedition and military domains that they both practice can be used within the pre-hospital critical care environment. Other aspects of the conversation includes: The patient target group and demographics of the service. Examine traditional vs emergent pre-hospital presentations that Iain and Ben have seen over their time in pre-hospital care. Interventions and decision-making and how these are approached within TVAA. Critical care training approaches, quality assurance and quality improvement within the service. Frontline staff engagement and how the service both encourage and incorporate them within the scheme. Innovations that the scheme has embedding and medium to long-term innovations that may improve the program Non-technical aspects of care Vs technical skills & utilisation rates Incremental gains when orchestrating flash teams Personal learnings over the last >2 years I hope you enjoy the last of these critical care service review sessions with two insightful friends and colleagues.

In this episode we explore conflict resolution with Ray Goodall. Ray is an accomplished ex-military senior officer who is skilled in developing cohesive teams and has a vast operational background. He is Internationally acclaimed War College Faculty and a military institute instructor. He is also a liaison and advisor to Presidents, Ambassadors and Generals in complex multinational combat environments. Ray has extensive Combined Joint Force and Air Component Crisis Planning experience. He is an internationally recognized expert of the Command and Control of Air Power.  In this wide ranging conversation we explore: ·  The definition of Conflict resolution ·  Leadership in conflict situations (enemy and colleague conflict) ·  Models of conflict resolution - Strategy of Conflict and Game theory ·  De-escalation techniques used (aviation/inter-personal) ·  Optimisation of physiology - whether you use breathing techniques or tools to focus ·  Mentoring Vs Coaching ·  Rapid Decision making under stress and/or incomplete information ·  Failure (anecdotal examples of how you've learnt through failure) ·  Debrief & how to harness the best out of the debrief I hope you enjoy this episode with an extremely insightful and interesting guest.

Karim is a Professor of Trauma Sciences in the Blizzard Institute, Barts and the London School of Medicine & Dentistry, and Consultant Trauma & Vascular Surgeon at Barts Health NHS Trust. He is also the director of the pan London trauma system. In this episode we look at: Monitoring modalities and diagnostics (the advent of pre-hospital and in-hospital US, in-hospital CT & MRI) that have led to an improvement in outcome. Whether front loading pre-hospital critical care teams with more interventions had a net positive impact on survival to discharge. The benefit of numerical targets for physiology such as blood pressure in resuscitation or more organic end-points such as mentation/AVPU or pallor/diaphoresis/respiratory rate are more useful? The adverse effects of complex interventional involvement in pelvic blunt injury (such as REBOA or ECMO) are worth the investment at point of injury or whether they are better placed in centres of specialism? What we can do to prevent penetrating trauma as the upward trend in penetrating disease continues? Look at the advances in rehabilitation services Vs impact on survival to discharge in comparison to pre-hospital, & surgical intervention? Some of the more common injury patterns that exist more-so now compared to when Karim first started as a surgeon. The recent challenges faced within the Pan London Trauma Networks. The advent of Acute Traumatic Coagulopathy (ATC) in the early 2000’s and its consequential impact on survival since. Where Karim sees the largest gains that can be made in pre-hospital care? What Karim looks for potential in other junior clinicians  Advice that Karim would pass on to someone starting their medical career. Aspects of mindset and approach that have changed in Karim's practice over the last 10 years  I hope you enjoy the episode.

This is a wide ranging conversation with Mark Faulkner - the clinical development manager for critical care (advanced practice) within the London Ambulance Service NHS Trust, Mark is also the clinical advisor for Major Trauma within the LAS and as such sits on the Pan London Trauma Steering Group, as well as number of national trauma groups. In this episode we examine a variety of topics that encompass decision making, experience & empirical background, additional clinical interventions, leadership & non-technical skills and support/pastoral functionalities of advanced practice. We discuss: Overview of the APPCC Scheme The patient target group & demographics Added value of interventions Vs decision making. Training, quality assurance and quality improvement within the scheme. First line staff engagement – who sees these groups of patients first Innovations that the scheme has just embedding and medium to long-term innovations that have improved the program Non-technical aspects of care Vs technical skills & utilisation rates Incremental gains when orchestrating flash teams Personal learnings over the last >6 years I hope you enjoy the episode