Pre-Hospital Care
In this episode, we welcome Victoria Lebrec, London Traffic Justice Campaign Coordinator for RoadPeace. Victoria has been fighting for road safety in London since losing her leg after a collision with a skip lorry in 2014. Others have lost limbs on the same section of road since the incident, and it is only one of many places in London where accident rates are disproportionately high. Victoria’s work is focused on raising awareness of the need for improvements for cyclist safety across London.
In this episode of the pre-hospital care podcast, we welcome Mark Faulkner, an advanced paramedic practitioner, to unpack the often daunting legal world that paramedics are exposed to.
You never know when that "nightmare job" or patient is going to appear and put you to the test. As clinicians, we should be always attempting to push our push our skills closer to perfection. In this episode, Ben Clarke shares his insights into deliberate practice, in-time learning, and meta-cognition.
In part 1 of our conversation with Ben Clarke (Assistant medical director of London Ambulance Service), we talk about leadership in pre-hospital care. What's more important - a good leader, or a good team willing to follow? Can you teach leadership or does it only come from experience? Can you be born a leader? How do you empower different types of staff on-scene? Join us as we explore the nature of leadership in pre-hospital care.
Have you ever been working, and all sense of time and self melts away, and you find yourself in perfect sync with what you’re doing? There’s a word for that. It’s called the Flow State.
In part 2 of our conversation with Dr Esther Murray, we explore Flow and how to put yourself in hyper productive mindsets more often using specific techniques anyone can implement in their work.
Dr Murray is a Senior Lecturer in Health Psychology and an expert in the subject of moral injury and self-care.
Update: Due to a technical hiccup, this episode was cut short by about 15 minutes during the first day of it's being published. It's now updated, so If you listened to it then and would like to catch the rest of this conversation, you can re-download the episode now. Thank you for your patience.
We're back with the second season of the Pre-Hospital Care podcast! Our first episode is a fascinating conversation with a cardiac arrest survivor and long friend of Eoin's, Zoe Hitchcock. They met when Zoe suffered a heart attack and Eoin happened to be sent out to treat her. Tune in for a fascinating and unique perspective on pre-hospital healthcare from the patient's perspective.
We end the first season of The Pre-Hospital Care Podcast by finishing up Eoin and Rich’s conversation with Dan Davis as they talk about dealing with the emotional trauma that is, unfortunately, part and parcel of pre-hospital care.
Thanks so much for being a part of this journey into healthcare podcasting. Keep an eye out for season 2! It’ll be out before you know it.
On this episode of Pre Hospital Care Podcast, Eoin and Rich continue their discussion with Nick Brown to tackle the non-technical skills necessary in controlling a tragic and highly emotional scene. In 96% of cardiac arrest cases, the patient doesn’t make it. When that happens, they are not the only patient.
Losing a loved one is traumatic and a genuine health risk over time. If we take our oath as clinicians seriously, therefore, we must be well prepared and skilled in not adding any further stress and trauma, as well as set up avenues for ongoing help and support.
Medics.Academy is dedicated to educating health professionals on every aspect of medicine, both technical and non-technical.
Go to www.Medics.Academy to browse our library of healthcare education.
On this episode of Pre Hospital Care Podcast, Eoin and Rich talk tackle perhaps the toughest topic in pre-hospital care. Delivering bad news to family members. Health professionals are not usually well taught about how to deliver the news of the death of a patient in a suitable and tactful way. This episode explains the four stages of delivering bad news, words to avoid, and how to remain professional but give support as much as you and your team can. Medics.Academy is dedicated to educating health professionals on every aspect of medicine, both technical and non-technical. Go to www.Medics.Academy to browse our large library of CPD-ready courses.
In this week’s podcast, we continue to discuss the crucial topic of pre-hospital airway management. How can we maximise the chances of patients with airway problems when time and circumstance are not on our side?
Eoin Walker and Rich McGirr walk through different procedures and both technical and non-technical aspects of managing the airway in the field.
For CPD-relevant content about pre-hospital care and many other healthcare fields, sign up at www.Medics.Academy.
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
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:
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.
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:
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.
In this episode I chat to Jason Fox about his new book ‘Life Under Fire’ for those of you that aren’t familiar with Jason, he is a former Royal Marine Commando and Special Forces Sergeant. Joining at 16 and serving for 20 years; Jason passed the grueling selection process for the Special Forces in 2001, serving with the Special Boat Service till 2012. Jason has planned and led operations including hostage rescue, counter terrorism, counter insurgency, maritime counter terrorism, surveillance, body guarding and counter narcotic missions. He currently features in the channel 4 program - SAS: Who Dares Wins.
The book is split into two parts, the first part the battle mind looks at his journey to a resilient life and mental approach. The second part - Strength and Guile looks at the lessons learned from his 20 years as an operator and royal marines commando and inferred learning to the reader. Concepts we explore include:
The concept of graded exposure to training. The sense of community and brotherhood from war. Jason's struggles with PTSD and the emotional combat indicators that signify it. The ‘cigar moment’ and how it calms the central nervous system down. Awareness of your own vulnerabilities and how it can help protect you. The preferential mode of de-escalation over aggression (grey man, passive use of the weapon). High performing teams ability to self regulate rather than externally regulate. Reframing negative events and what it can teach us about resilience. The power of debrief also known as Sensitive Site Exploitation/SSE. The concept that there is a flattened hierarchy and everyone can contribute a game changing piece of information. Not resting in the aftermath of success and using failure as a teacher.
I hope you enjoy the episode. You can find 'Life under fire' by Penguin books here:
https://www.penguin.co.uk/books/111/1119268/life-under-fire/9781787633193.html
In this episode Julia Samuel and Caroline Phillips discuss grief and the process of bereavement. We discuss important skills for breaking bad news, bereavement by exposure and ways in which we can support our own resilience as healthcare professionals.
Julia Samuel is a psychotherapist who has spent the last thirty years working with bereaved families. She has worked both in private practice and in the NHS at St Mary’s Hospital Paddington where she pioneered the role of maternity and paediatric psychotherapist. In 1994 she worked to launch and establish Child Bereavement UK as its Founder Patron, where she played a central role until September 2019. Julia was awarded an MBE in the 2015 New Year’s Honours list for services to bereaved children. She is the author of two books: Grief Works and This Too Shall Pass.
We hope you enjoy the episode.
Further reading:
- Child Bereavement UK https://www.childbereavementuk.org/?gclid=Cj0KCQjw2or8BRCNARIsAC_ppyYXJ4jJ5kW2226C30UnEuOOBqUA8vUbrBPiCuZFHmJ4sh1L8HHhydIaAjssEALw_wcB
- Information about Julia Samuel’s books, ‘Grief Works’ and ‘This too shall pass’ can be found here, as well as her ‘Pillars of Strength’ tips - https://juliasamuel.co.uk
- Cruse Bereavement UK has practical resources and information for personal and professional use - https://www.cruse.org.uk
This episode explores advanced neurological conditions with Palliative Nurse Consultant Diane Laverty. Diane has over 30 years experience in palliative care and spent time in her doctorate exploring informal carers needs when looking after those with progressive neurological conditions.
Motor Neurone, Parkinson’s and Multiple Sclerosis conditions are discussed, common symptoms and potential exacerbations are covered and the wider social implication on family and carers are discussed.
Further reading:
- Motor Neurone Disease Association https://www.mndassociation.org
- Parkinson’s Foundation
- Multiple Sclerosis Society
https://www.mssociety.org.uk/about-ms/what-is-ms
- Oxford Handbook of Palliative Medicine (2019)
We hope you enjoy the episode.
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:
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:
•
•
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@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
In this conversation I talk with Tim Archer. Tim is a former Group Captain, he held a number of senior appointments in the RAF during which time he gained an MA in Leadership Studies from the Centre for Leadership Studies at Exeter University, a Post Grad Certificate in Executive Coaching from Lancaster University Business School and was awarded a full-time 12-month Fellowship back at the Centre for Leadership Studies.
After a spell as Director Public Sector at the Leadership Trust in the UK, he moved to the United Arab Emirates for 8 years where he was a government advisor during which time he developed, designed and taught experiential leadership development and coaching programmes. He currently works for Cardiff University developing their leadership modules for the MSc in Public Health.
We have a wide ranging conversation that touches on:
The definition of leadership Mission command - military doctrine (what to do, not how to do it - no disseminated responsibility) myth of military leadership - Constructive decent Vs destructive concept The OODA loop (Observe, Orient, Decide, Act) Leadership Vs Management (Kotter) Trust and cohesion – Peak rapport Homeostatic leadership Compassionate Leadership Situational leadership Leadership in conflict Leader as a coach Systems leadership - NHS Model - leading when not in charge
I hope you enjoy this episode with a fascinating guest and friend.
This has been the most downloaded episode of all time on the Restore Podcast and very relevant to the pre-hospital community. I have decided to re-post it on the PHCP as it affects every aspect of life and of blue light personnel.
In this episode I interview a senior Detective Inspector within the police who works within the Modern Slavery and Child Exploitation Unit in London. English born and raised, of African decent and operating for 14 years within the police through the hierarchy of leadership he has a unique perspective into the contemporary climate. I first met Henk as a friend about 8 years ago and have valued his perspectives and insights as a friend and colleague battling shift-work, the reality of London and everything in-between.
We discuss some of the fundamental assumptions, biases and racism within society and aspects of law that need to be re-considered. We also discuss his standing as a leader within the institution and how we can all model progress and address the bias and racism. We also talk about representation of black and ethnic minorities within the emergency services and how this can be addressed. We also talk about the institution of the police and how the concepts of trust and of 'Non-maleficence' (do no harm) needs to be restored from the community towards the police.
I hope you enjoy this episode.
In this episode I talk to Wayne Auton and Tom Archer who work respectively for the Scottish and Welsh Air Ambulances (EMRS & EMRTS). Wayne is a former Royal Marine and currently a Specialist Paramedic in retrieval and transfer medicine as well as pre-hospital critical care. Tom is a Critical Care Practitioner & lecturer on the Critical Care MSc in Cardiff University. In this episode I talk with Wayne and Tom about innovation within the domain, advice to aspiring critical care colleagues, top tips in leadership & group dynamics. I also ask then about how they have navigated the past 6 months both personally and as a service.
The Emergency Medical Retrieval Service (EMRS) provides critical care and transfer to definitive treatment for patients in remote healthcare locations across Scotland. They provide Consultant and Retrieval Practitioner delivered aeromedical retrieval from rural health care facilities throughout Scotland and well as pre-hospital critical care of major trauma patients, telemedicine advice to rural health care colleagues, rural facility outreach training and research in pre-hospital medicine and major incident support across the country.
The Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru is an aeromedical retrieval service that provides Consultant and Critical Care Practitioner-delivered pre-hospital critical care across Wales. It was launched at the end of April 2015 and is a partnership between Wales Air Ambulance Charity, Welsh Government and NHS Wales. EMRTS provide pre-hospital critical care for all age groups (i.e. any intervention/decision that is carried outside standard paramedic practice) and undertake time-critical, life or limb-threatening adult and paediatric transfers from peripheral centres (inc. Emergency Departments, Medical Assessment Units, Minor Injury Units) for patients requiring specialist intervention at the receiving hospital.
I hope you enjoy the episode with these two great friends.
You can find out more about them both here:
Wayne:
https://www.wayneauton.com/blog-1/https/wwwwayneautoncom/blog-page-url/new-post-title
Tom:
https://www.linkedin.com/in/tom-archer-857b2354/?originalSubdomain=uk
In this conversation I talk with Andrew Latimer. Andrew is an Acting Assistant Professor in the the Department of Emergency Medicine. He is involved with quality improvement, education, and clinical and operations research in Emergency Medical Services including involvement with Seattle Fire Medic One, King County EMS, and Airlift Northwest. His research interests are in the pre-hospital care of critically ill and injured patients, pre-hospital airway management, and air medical retrieval medicine.
In this episode we look at the concepts of 'measure and improve' which have proven to make Seattle one of the world's leading institutions on cardiac arrest survival. Their main domains of practice around out-of-hospital cardiac arrest and advanced airway management (inclusive of drug-assisted intubation).
The Medic One Program began in 1970 when the first group of firefighters were trained as paramedics in cooperation with Harborview Medical Center and the University of Washington. Since then, the Medic One Program has gained notoriety due to the training and pre-hospital emergency patient care paramedics deliver within the community. Medic One provides the community with Advanced Life Support (ALS) activities that, in the past, could only be performed by physicians. In addition to responding to medical emergencies, medic units respond to all working fires, hazardous materials and rescue responses.
I hope you enjoy this episode with a fascinating clinician & individual.
Stephen left the military in 2012 after serving 14 years in the Royal Marines and the SBS. At the age of 27 Stephen was awarded the Military Cross (MC) by Her Majesty the Queen for his work in Afghanistan in 2008. The MC is granted in recognition of "an act or acts of exemplary gallantry during active operations against the enemy on land" to all members of the British Armed Forces of any rank. Since 2015 he has mentored youth in schools, executives, budding sports stars, professional athletes and delivered the Limitless Programme to diverse audiences, veterans charities and public services.
In this conversation we have an honest talk about his challenges with mental health through his military service and beyond. Stephens honest and open recital of his challenges with self harm and victim mindset and how he broke this are both insightful and refreshingly honest. Through his revelations of seeking like minded community he recently started an online community (10,000) of military and blue light personnel to support, encourage and offer opportunities to like minded individuals.
His story is both encouraging and a voice of hope that despite the depths of suffering you can overcome any level of adversity with healthy community and a healthy mindset.
Please find the charity that is fundamental to Stephen's story here:
rock2recovery.co.uk
The online community of OpSpartan can be found here:
More on Stephen can be found here:
In this episode we interview Matt Masson ex-extreme sports and ski instructor. In November 2011 Matt sustained a life changing head injury when he fell 26 ft through a plastic roof onto his head. He has had to re-build his life completely from re-learning to talk, to walk, to ski amongst many other things. Matt's inspirational story is a true testament to his mental determination, engagement with rehabilitation and timely pre-hospital care.
His story and YouTube video can be found here:
https://www.thewobblyjourno.com
and
We re-unite him with Mike Nolan the Flight Paramedic on the night (a friend and colleague) who walks him through his injury load, the sequential interventions and his initial presentation on the night. Matt is just about to release his first book together with his Mother titled 'Road to the top of the mountain'. Please enjoy this truly inspirational story told in first person.
Our thanks also goes out to the Nurse liaison team at the Royal London Hospital that initially put both Mike and Matt in contact.
In this conversation I chat to Ben Meadley. Ben has extensive experience in prehospital critical care, and is an operational Intensive Care Flight Paramedic (MICA) with Air Ambulance Victoria. Ben has a keen interest in prehospital critical care, advanced clinical assessment, pre-hospital critical care interventions and developing clinical judgement in critical care practitioners. MICA paramedics’ training goes beyond practical skill precision to include more detail in anatomy, physiology, pathophysiology and pharmacology to greater increase capacity to make independent complex clinical decisions and interventions. MICA paramedics operate either as part of a two person crew or as a single responder.
We look at many facets of the MICA system and the differentiation between land MICA and flight MICA systems. We dig down into Ben's experience and empirical knowledge and look at the fundamentals of high performance within the MICA system, why they exist and how they continually improve.
I hope you enjoy this conversation.
Steve is the medical director of The Queensland Ambulance Service (QAS) with 5,000 staff and 1,300 response vehicles. QAS has a contemporary approach to clinical service delivery and innovation in prehospital trauma care. It also operates a tiered system of pre-hospital care with Advanced Care Paramedics (ACPs), Intensive Care Paramedics (ICPs) and a smaller cohort of HARU Paramedics.
In this episode we discuss a variety of topics:
- High Acuity Response Unit (HARU) both its inception and the clinical remit for the HARU.
- Governance around the HARU program and provider quality assurance for some of the procedures (RSI, on-call advice, blood products and the bleeding patients).
- Quality improvement and where the program is heading
- The lessons learnt building the HARU and ICP schemes in QLD.
I hope you enjoy this episode as I found it both insightful and helpful to look at how other systems approach high performing teams and continuous improvement.
Eoin
In this conversation with Piers Carter we examine the fundamentals of high performing individuals - the birth place of high performing teams. Piers has an eclectic background. Since 1997 he has been working with businesses; coaching, facilitating and helping them have better conversations – as individuals, teams and leaders.
Prior to this, he was paid by the government to throw petrol bombs at the Police – as a riot control, Public Order & self defence instructor. Piers then began expedition-leading, giving him some incredible experiences all over the world working with adults and young people in developing countries and challenging environments. I have always found Piers to be an inspirational character with insight into some of the foundational pearls of wisdom that has changed my world on a day-to-day basis.
In this conversation we talk about the power of choice, paying attention to somatic signals, how we gain better insight into personal triggers, the concept of centring, broadening our exposure to failure and many other things. I hope you enjoy this episode with a true legend and friend.
You can find out more about Piers here:
For more content from the Restore Podcast please head over to:
In this episode I interview Karim Ahmed the clinical lead for the emergency department of the Royal London Hospital (RLH) in Whitechapel. We examine the impact of MTCs across the health economy and why they can add a survival benefit to the patient. We also look at the utility of overlaying fundamental and essential patterns of care to complex scene's and how this deconstructs some extremely challenging pathology. We also examine the social deprivation that tracks trauma & some of the outliers that can present to the RLH.
We also get some pearls of wisdom from Karim in relation to trauma and the wider population of undifferentiated trauma patients that constitute the case load seen on any given day in London.
I hope you enjoy this episode with an insightful friend and colleague.
In this episode I chat to Jason Fox - a former Royal Marine Commando and Special Forces Sergeant. Joining at 16 and serving for 20 years; Jason passed the grueling selection process for the Special Forces, serving with the Special Boat Service. Jason has planned and led operations including hostage rescue, counter terrorism, counter insurgency, maritime counter terrorism, surveillance, body guarding and counter narcotic missions. He currently features in the channel 4 program - SAS: Who Dares Wins.
We look at the similarities between the Special Forces (SF) and critical care (paramedic) practice. We examine the principles of high performing teams, relationship with failure, and communication amongst other aspects. We also look at self care and what it means on a practical level and the power of not taking yourself too seriously. I have always found Jason to be honest and open person which is why having conversations with him is so refreshingly real.
This episode will feature on the Restore Podcast (self-care non-clinical) and the Pre-hospital Care Podcast (clinical conversations) as it relates to both.
I hope you enjoy this episode.
In this episode Nick Brown and Jo Shaw deconstruct the definitions, challenges and nuances of research within pre-hospital care. They examine the history of research and the differences between research, audit and service evaluation. They look some of the results of the contemporary bigger research studies that have recently been published & also the origins of funding through the national governmental bodies such as the National Institute of Health Research (NIHR).
They also differentiate some of the various methodologies within empirical research and make reference to how this can affect the outcome data and inference to the clinical bottom line. This episode illustrates that it is important to be driven by the data especially in an information light environment when on scene with patients.
We hope you enjoy the episode
In this episode myself and Mark Falkner look at the origins of the trauma tree & why it was created. We also look at the origins and utility of GCS, heart rate and respiratory rate. We also discuss the mapping of social deprivation onto trauma & the exposure that paramedics see in regards to trauma. We also look at some of the outliers within trauma that don't fit the historical picture of trauma. We also look at the most useful vital sign - that of respiratory rate.
I hope you enjoy the episode.
For more content by me head over to the Restore Podcast with Eoin Walker:
https://podcasts.apple.com/gb/podcast/restore-with-eoin-walker/id1505391534
In this episode I interview Mark Falkner the Critical Care Scheme lead in London. We look at a cross section of critical care concepts from Traumatic Brain Injury to which are the most essential vital signs to pay attention to. We also look at some of the empirical literature of the above topics and examine the trauma tree in relation to this. I hope this episode imparts some key take home messages for you all as clinicians in the pre-hospital domain of practice.
Please also find more content from me around inspiring stories in mental health and well-being from a whole cross section of society on the Restore Podcast with Eoin Walker here:
https://anchor.fm/eoin-walker1/episodes/Episode-3---Reboot-your-life-with-Dan-Richards-ec8ep2
I hope you enjoy the episode
In this episode we explore the various domains of medicine away from an ambulance or hospital setting. Roger Alcock is an Emergency Medicine and Paediatric Emergency Medicine consultant in Scotland and was involved in the 2014 UK response to the West Africa ebola crisis. Myself and Roger explore the facets of humanitarian and expedition medicine that can add to your career and add depth and breath to experience as a pre-hospital clinician. We explore some of the details of Roger's Sierra Leone deployment for the ebola crisis and some of his expedition endeavours all of which have added to his career and perspectives.
We also examine some of the non-technical skills that these deployments and expeditions can foster which both add to resourcefulness and situational awareness of clinical demand and innovation in low resource settings.
I hope you enjoy the episode.
This episode focuses on a vital part of pre-hospital care; that of end of life care. Dan Davis explores this area with Caroline Philips, Diane Laverty, Georgina Murphy Jones. As all three guests work in various capacities for Macmillan they explore both the similarities and variations of palliative and EoLC and the subtle changes in approach to these patients. They look at the mindset change of approach to these patents in de-emphasising resuscitation and focusing on rapport building, supporting documented wishes and multi-agency engagement to facilitate the best care in the last period of a patient's life.
- Diane Laverty works as a Macmillan Nurse Consultant and is passionate about specialist palliative care and EoLC patients having a voice and receiving high quality care across all domains of practice.
- Caroline Philips and Georgina Murphy Jones work as paramedic clinical tutors and Macmillan specialist clinicians helping embed both EoLC training and practice across London and to fellow colleagues.
They examine the difficulty of not having prior rapport with these patients & families and some of the variations we would expect to see when looking at the physiology and clinical findings. This episode is especially important in the current climate and Dan brings this into focus talking about his own experiences with EoLC with his own father.
Please enjoy this episode which discusses this relevant and important narrative within pre-hospital care.
In this episode Dan Davis explores the wider aspects of TBI with Alice Kershberg, a clinical nurse specialist in traumatic brain injury. Alice plays a vital role in not only looking after patients who have suffered a traumatic brain injury, but acts as the bridge between the hospital and the community and between the neurosurgery team and the family. In this episode we explore many facets of the pathology but also shine a light on the pastoral role of acting as a liaison supporting patients and family after surgery, helping them to navigate their recovery in what can be a life changing injury.
Alice's role is fundamentally key to linking medicine to the lives of those affected in the community and gives an insight into the patient journey after pre-hospital care has passed the baton onto the hospital and into rehabilitation - we hope you enjoy the episode.
In this episode Nick Brown examines a cross section of perspectives from staff that have recently qualified to staff that have progressed through to fully qualified. We get their thoughts on education and mentoring through various routes into pre-hospital care. We also look at some of the support mechanisms for clinicians and the diverse range of presentations that pre-hospital care throws at you.
It is a fascinating insight into various levels of experience, clinical grades & thoughts through fresh eyes in what can sometimes be one of the most challenging roles within the NHS.
In this episode we take a look at the components of high performing teams and what differentiates these from teams that fail to perform. We examine the concepts of ownership, humility, checklists, communication and non-technical skills. We also look clinicians relationship with failure and how that can either be a tool for positive change or compound the failure and associated implications. We take examples across domains and relate them back to pre-hospital care - looking at themes of successful teams from a technical and non-technical perspective. We hope you enjoy the episode.
At the recording of this podcast episode, the world is in the midst of the coronavirus pandemic. Eoin welcomes a special guest to go through the facts of the global crisis with Will Duffin, education lead and content director at the World Extreme Medicine.
In part 1 (of 2) of our conversation with Dr Esther Murray, we explore the concept of a moral injury, and how paramedics can spot warning signs that they've suffered one, as well as tips on how to restore a good mental state. Dr Murray is a Senior Lecturer in Health Psychology and an expert in the subject of moral injury and self-care.
In this episode, we welcome Victoria Lebrec, who fights for road safety in London after losing her leg being run over by a skip lorry in 2014. Others have lost limbs on the same section of road since her incident, and it is only one of many places in London where accident rates are disproportionately high. Victoria’s work is focused on raising awareness for the need for improvements for cyclist safety across London.
Meet Dan Richards, an ex-patient of Eoin’s who lost his right arm and shoulder in a traffic accident 9 years ago. His story of recovery and his imperturbable attitude is inspiring. He summed it up perfectly with, “…whatever you want in life, you must work hard for it. Even if you don’t get it, you can still hold your head high and say, ‘Well, at least I did not give up,’ and while there is no shame in giving up, there is no success in it either.”
The paramedic field is much more fast-tracked than it once was. It's such an established path that many new paramedics have come straight from the classroom, and are being thrown into situations that a professional of any seniority would find it difficult to handle.
Perhaps it's no surprise, then, that the mental health of people working in emergency healthcare is getting worse over time. What can be done?
