Pre-Hospital Care Podcast

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. 

In this episode I talk with Bram Connolly. Bram is former special forces operative with the Australian Special Forces with 20 years of experience on the frontline. Bram was was awarded the Distinguished Service Medal for leadership in the Australia Day awards 2012. Bram is the Managing Director and founder of Hindsight Leadership and Resilience. He is the author of "The Fighting Season" and "Off Reservation" and the leadership book "The Commando Way" published in 2020. In the conversation we talk about: Resilience, leadership, values and optimisation. We explore various facets of the book 'The Commando Way' and dig into some of the 20 years experience that taught Bram the lessons he depicts in the book. I hope you enjoy this interview with an inspirational leader. Bram also has a podcast:  https://podcast.warrioru.com.au/podcasts/ Hi book 'The Commando Way' can be found here: https://www.amazon.co.uk/s?k=the+commando+way&adgrpid=55975240794&gclid=Cj0KCQiA0-6ABhDMARIsAFVdQv-06UsRi2ZQL-Obrchizx8P0WYzCaepcjXf-70TtIPFVkJAksF7S0IaAtPbEALw_wcB&hvadid=259062984695&hvdev=c&hvlocint=9046009&hvlocphy=21468&hvnetw=g&hvqmt=e&hvrand=11852429682160879921&hvtargid=kwd-302016437038&hydadcr=24402_1816050&tag=googhydr-21&ref=pd_sl_39q7xnnmde_e

In this episode we speak with Lloyd Evans a GP in Wales around his experiences of the second wave of the pandemic. We explore some of the fundamental issues that have led to a rise in demand and stress both within the general population and the frontline NHS staff. We explore some of the second and third order effects of the covid pandemic, together with the unintended positive aspects that it has incurred.  I hope you enjoy this episode with an insightful and honest practitioner as it gives a rounded cross-section of accounts from the frontline of the largest health crisis that has befallen the NHS since its inception in 1948.

In this mini-series I talk to Alec Wilding who is an Advanced Paramedic Practitioner (APP) on the frontline of the healthcare system within the UK. Alec gives me an honest and transparent perspective of life tackling the second wave of the covid pandemic and his thoughts on how it is impacting the mental and physical health of both the population and the staff. Alec gives an honest and insightful recollection into the incremental effects of the pandemic and is the second of four accounts from the frontline - I hope you get as much out of it as I have.

In this mini-series I talk to a cross section of individuals at the frontline of the healthcare system within the UK. In this episode I speak with friend and colleague Lucy Gough. Lucy is an Emergency Medical Dispatcher (EMD) within London. She gives me an honest and transparent perspective of life in the Emergency Control Room and her thoughts on the contemporary demand profile within the pandemic in London. Lucy is both honest and insightful into the unique challenges that she and colleagues face on a day-to-day basis and the overall challenge that the ambulance service faces in response to the largest health demand since the creation and inception of the NHS. This is the first of four accounts from the frontline - I hope you get as much out of it as I have.

This has been a unique and challenging year for everyone. It has been a real privilege to have over a 100 conversations on various podcasts and platforms (PHCP, Restore and WEM). I have included this recording of the best of Restore as mental health has taken a central spotlight in this pandemic and has been an inescapable facet to manage for all of us as things have become difficult in work and personal lives.  My hope for 2021 is that a continued narrative both encourages you and gives everyone listening to these podcasts a sense of hope in a time that has required every clinician to engage with difficult times. I hope to help encourage every healthcare professional in this time of demand and great need, these conversations are designed to hopefully give back to you - I sincerely hope they serve this function at this time. My thanks also goes out to everyone that has contributed to the PHCP in 2020, platforms like this will always benefit from a plenary of perspectives rather than just individual ones. Eoin 

In this episode we explore the initiative of pre-hospital co-responding mental health nurses working alongside paramedics within London, UK. We look at the prevalence of mental health within the capital and how Anna and Dan have seen the initiative add benefit to pre-hospital assessment, management and the resultant access to healthcare.  We look at some of the current prevailing mental health statistics (MIND 2020), such as: 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. We also look at anecdotal commonalities in acute MH presentations within the community and the interplay between the Mental Health Act and the Mental Capacity Act in assessment and treatment of mental health patients. Lastly, we look at case studies to understand the dual assessment model that Anna and Dan use to assess patients within the pre-hospital environment.  I hope you enjoy the episode.