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Pre-Hospital Care

Author: Medics Academy

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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.
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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.
Eoin Walker and Rich McGirr are back to discuss the ever growing evidence base and controversial topic of airway management in the pre-hospital setting. How does the reality of managing this urgent, life-or-death part of the body differ from what is taught in the classroom? What are the essential steps in dealing with the prehospital airway? What are the pros and cons of each method?
Eoin Walker and Rich McGirr are back with special guest Martin Mist to talk more about the unique challenges that present themselves to paramedics when dealing with crises brought on by ingestion of illegal substances. When will you need to resort to physical restraint? Why part of a paramedic’s job is to be a detective. How to do proper research on new. What the top 5 hard-hitter drugs are and key nuggets for dealing with each. All this and more on the latest episode of the Pre-Hospital Care Podcast.
Paramedics are constantly in the middle of life and death situations. In the first full episode of the Medics.Academy Pre Hospital Care podcast, paramedics Owen Walker, Richard McGirr, and Martin Mist discuss Club Drugs and Non-Legal Highs and their effects on patients. As paramedics, they’re the first medical professionals to assess a situation before getting them to physicians at the hospital. They see the patients at their lowest point, suffering from anything from a cardiac arrest, a severe allergic reaction or a psychotic episode. Among many other topics, this episode covers the common and uncommon presentations of patients after drug overdoses and what paramedics look for and how to assess the situations.
S01E00: Introduction

S01E00: Introduction

2018-11-0208:47

This podcast is presented by Eoin Walker and Rich McGirr and is a Medics Academy podcast. The purpose of this podcast is to provide paramedics an easy-to-access set of resources and educational materials wherever they are. Feel free to take a look at the description in the footnotes of the podcast. Sign up to Medics Academy today to find out even more about what we do and just how much content we put out there for your education.
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 https://www.parkinson.org -  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: 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.
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