Welcome to BASICS Scotland Podcasts - Conversations with a wide range Pre-hospital Emergency Care experts talking about medical topics that relevant to BASICS Scotland Responders and anyone interested in immediate care. Our podcasts are released weekly make sure to subscribe to listen to our latest releases. Do get in touch with your feedback, questions & ideas for future podcasts. More info here:
https://basics-scotland.org.uk
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Johnny chats us through the urgent care section of the ambulance service
Top 3 tips
With Urgent Care Patients, take your time. Ask yourself "What does my patient need, where best can that be achieved, and in what timescale is it required".
Follow the BRAN principles: consider and discuss with the patient the 'Benefits', 'Risks', 'Alternatives' and what likely happens if we do 'Nothing'.
Phone a friend: Professional to Professional conversations enable better decision making, greater access to records, pathways and services and ultimately get patients to the Right Care.
Biography
Jonathon Will started his paramedic journey with London Ambulance Service before becoming the Lead Emergency Care Paramedic for Croydon University Hospital. After the loss of his wife aged just 39 (attributed to poor care in an overrun maternity unit and a strong driver for his passion to make NHS systems better), Jonathon returned home to Scotland and worked first as a Paramedic, then Specialist Paramedic, and Trainee Advanced Paramedic, before moving into the Clinical Directorate. Moving on, Jonathon is about to become an NHS National Improvement Adviser for the Scottish Government as part of the Redesign of Urgent Care program. He is also Tayside Mountain Rescue medical Officer, works with several events and expedition companies and is involved with teaching and assessing for SMR, WEMSI, MRT, UE, Wild Fitness and more. Jonathon is Co-Founder of the 'Healthiest Town' project and is also a Kick Boxing instructor and a single dad - as he puts it... a busy little human!
Bernd Wallner & Hermann Brugger - CPR with restricted patient access. (00:37:37)
Bernd and Hermann talk us through their research into performing CPR with restricted patient access.
Three top tips
1 - In an asphyxiated patient start ventilation as soon as possible
2 - In a situation of restricted patient access, don't think about standard CPR, start ventilation asap, even if in a really awkward or alternative position.
3 - Even minimal training makes a difference so regular training and practice of CPR is crucial and should be included in other training, such as avalanche training courses.
Biographies:
Hermann Brugger MD, born in Bruneck / Bolzano / Italy, December 30th, 1951; married to the painter Elfriede Gangl, 1978; children: Franz, Johanna. MD at the University Vienna, Austria, 1978; Medical assistant at the Hospital Sisters of Charity, Linz, Austria, 1979-1983. General Practitioner at the National Health Service, Bruneck, Italy, from 1983 to 2017.
Emergency physician for the Emergency Medical System and mountain rescue physician of the Mountain Rescue Organization of South Tyrol from 1983 to 2017. Eduard Wallnöfer Prize Tyrolean Industry, 1992; Georg Grabner Prize University Vienna, 1995; Research Award of the Wilderness Medical Society USA, 2012; Paul Auerbach Award Wilderness Medical Society USA, 2016. Member of the Board of the Italian Society of Mountain Medicine, 1999-2005; Member of the Board of the Medical Commission of the Union Internationale des Associations d’Alpinisme UIAA MEDCOM, 2001-2009; President of the International Commission for Mountain Emergency Medicine ICAR MEDCOM, 2001-2009; Member of the Board of the International Society of Mountain Medicine ISMM, from 1999; President of the International Society of Mountain Medicine ISMM, from 2016; Member of the International Commission for Mountain Emergency Medicine ICAR MEDCOM, from 1991; Associate Editor of High Altitude Medicine and Biology, from 2001; Guest lecturer University Padova, from 1999; Associate Professor and lecturer at the Innsbruck Medical University, from 2006; Founder and head of the EURAC Institute of Mountain Emergency Medicine at the European Academy Bolzano, Italy, from 2009. President of the International Society of Mountain Medicine ISMM, from 2016.
Around 60 book chapters, 280 publications (current cumulative IF [2020-10-27]: 869) in emergency medicine.
Peter Lorrain-Smith – Police Scotland (00:22:56)
Responders of all types are focused on saving life but what happens if the scene becomes a crime scene? What is a crime scene and how do we manage this? Peter takes us through the roles, responsibilities of the police and responders at the scene and what might happen post the event.
Key points from this podcast:
Understand that the Police aim is to save life
Carry ID when possible
Don’t touch anything you don’t need to – if you do, admit to it!
About Peter
After working in the leisure industry for 12 years in a variety of locations including London, the West coast of Scotland and Saudi Arabia I joined Northumbria Police in 1997 starting in Newcastle upon Tyne then moving to the Scottish Borders. In 2008, fed up with spending so much time driving to the highlands to spend time in the mountains, I moved house to Perthshire joining Tayside Police, which has since morphed into Police Scotland.
As well as being a Sergeant , I am also involved in training officers in multi-agency response to Chemical, Biological, Radiological and Nuclear (CBRN) incidents. I have also been involved in planning the policing of a number of large events including T in the Park and the Ryder Cup.
I am currently working as Police Scotland Search and Rescue Coordinator, the strategic link between the mountain rescue teams in Scotland and Police Scotland, the coordinating authority for all land based search and rescue in the country. I am also a member of the Police Scotland (Tayside) Mountain Rescue Team, deploying to incidents involving lost, missing or injured members of the public in the hills and other difficult to access areas.
When not a work I can often be found walking my two collie dogs in the hills or paddling on one of Scotland’s many lochs and rivers in an open canoe.
Pam Barker and Duncan McDonald - Role of the Scottish Ambulance Service Special Operations Response Team (SORT) (00:26:33)
Pam and Duncan talk us through the roles, responsibilities and capabilities of the SORTs across Scotland. They detail what and when the SORT team can be of help and what their roles are in the scape of multiagency responses.
Top tips:
1) Gather information and details from the scene, the more information is passed back the more help can be targeted to the situation.
2) Work with other agencies and use their skills and resources
3) Don’t be afraid to ask for advice and help.
Resources:
JESIP Principles
https://www.jesip.org.uk/five-principles
John Aitchison - Scottish Fire and Rescue Service - Who are they and what do they do? (00:20:39)
John chats us through the skills, roles and responsibilities of the Scottish Fire and Rescue Service, what can they do on scene, how they can help with the patients, and how this all fits into the multi-agency working to bring the best care to the patient.
Top tips
1) Visit your local Scottish fire and rescue station and get to know and train with the crews
2) Remember the hierarchy of safety, your safety is paramount. Wear correct PPE and follow any briefs given/discussed
3) Don’t be afraid to ask for help at a job, the crews are trained and willing to help where they can.
Bio:
I have two children, Lewis and Eilidh, and am married to a very understanding wife Alison. I joined Grampian Fire Brigade (later to become Grampian Fire and Rescue Service and eventually Scottish Fire and Rescue service) in January 2003 and was posted to Altens Fire Station. Over the years I have also served at Central Fire Station and North Anderson Drive, all in Aberdeen city. For the past 10 years I have been an Instructor for the service and now run a small team looking after Aberdeen city stations training.
My whole-time job is extremely varied involving many disciplines including Breathing apparatus, Fire Behaviour, road traffic collision, recruitment selection and training for new recruits, Incident command, trauma care, Urban search and rescue, safe working at heights and their assessment, as well as the training and accreditation of new Instructors.
I moved to the village of Gourdon on the north east coast in 2008 and joined the nearest retained duty Fire Station of Inverbervie. I now run this station as Watch Commander and I'm on call to respond to a variety of incidents whenever I'm not performing my whole-time role.
For the past 11 years I have been a member of the United Kingdom International Search and Rescue team, on call 6 months of the year for international disasters deployed by the Foreign Commonwealth Development Office and accredited by the International Search and Rescue Advisory Group which is part of the United Nations. The team specialises in heavy to light urban search and rescue and has been deployed many times all over the world. I was deployed to Nepal after the 2015 earthquake.
I have been involved in the humanitarian aid charity Operation Florian since 2007, delivering Search and Rescue training in Macedonia and Nepal, raising money for projects, and collecting unused fire service kit and sending it to countries that do not have access to fire and rescue equipment.
I have keen interest in trauma care and its advancements, I love learning new techniques and working closely with paramedics, nurses, and doctors to improve my own knowledge on the subject and allow me to pass this on to my colleagues in SFRS and my work overseas.
Damon Powell – Roles, Responsibilities and Capabilities of MRT (00:25:14)
Damon, Chair of Scottish Mountain Rescue, chats us through the roles, responsibilities and skillsets of the volunteer rescue teams that the organisation represents. As part of our multi-agency series, which gives us some insight into the organisations that we may meet as responders in the field.
Top 3 Points from this podcast:
Notify the teams early, don’t delay in asking for the response the teams would much rather be tasked early and stood down when not needed than have a late response.
The teams will bring you the ability to access the most difficult terrain and environments or extract the patient to you from these places. They also bring the manpower and equipment required to move and handle patients in these environments.
As BASICS responders the team members will support your medical requirements in the management of the patient, the teams are focused on the event being patient-centric and will support you wherever possible.
Resources related to this podcast:
Scottish Mountain Rescue
About Damon
Damon grew up to the north of Manchester and, having trained as a mathematician, eventually managed to avoid the repeated Friday night drives up the M6 by moving to Scotland permanently. Since moving to Scotland Damon and his wife have been running a holiday cottage business and an energy conservation consultancy. Damon has been involved in Mountain Rescue in Scotland since he moved here and was Team leader in Oban for 12 years before becoming chair of SMR 4 years ago.
Stuart Braithwaite – RNLI (00:23:11)
Stuart chats us through the roles, responsibilities and skill set of the voluntary emergency service the Royal National Lifeboat Institution (RNLI), including not only their role of saving lives at sea but also their involvement with patient transfer, education and other lesser known about duties.
Key points from this podcast:
Have a look at the RNLI check cards and see how they work and how useful they are in a handover and management of the patient.
If you are involved in working with the RNLI take guidance from the lifeboat crew as they are responsible for you and the patients safety on and around the boat.
Get to know what your local crews can do, how to contact them and utilise the service when and where you can. The crews trained to a very high standard and are keen to help wherever and whenever they can
Resources related to this podcast:
RNLI Website: www.rnli.org
Respect the Water Campaign: https://rnli.org/safety/respect-the-water
RNLI Check Cards
About Stuart
Stuart is a doctor with experience in Anaesthetics and Emergency Medicine. He has worked on Search & Rescue Aircraft in both Alaska and New Zealand. He is a full-time Winchman Doctor and Crew Resource Management (CRM) Trainer with Rescue Bond 1 Search & Rescue Helicopter based in Aberdeen.
He has been involved with the RNLI for over 16 years in various roles as All-Weather & Inshore Lifeboat Crew, All-Weather Lifeboat Mechanic and member of the RNLI National and International Flood Rescue Teams. He has been based predominantly in Aberdeen and North Kessock.
Paddy Morgan – Drowning and cold water immersion (00:45:59)
Dr Paddy Morgan talks us through what happens when your body meets cold water, what to do, not only as a casualty but also if you are called as a responder to deal with a suspected drowning event.
Top 3 Points from this podcast:
Oxygen, Oxygen, Oxygen, Oxygen!!
If you find yourself in the water – FLOAT! Teach this to your nearest and dearest as a crucial survival technique.
Approach the scene as if it were an RTC and follow the simple algorithms of the safety CAcBCDE approach and remember Oxygen!!
Resources related to this podcast:
World sea temperatures
https://www.youtube.com/watch?v=jncVb2onYC4
Management of the Drowning Patient
RNLI cold water shock
About Paddy
Paddy is a Consultant Anaesthetist and Trauma Team Leader based in Bristol (UK), and Consultant with Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, and Great Western Air Ambulance.
Prior to his medical studies, Paddy worked summer seasons as a surf lifeguard and went onto to instruct and mentor at a national level, retaining an active role in flood/swift water rescue. He is the honorary medical advisor to Surf Lifesaving GB, member of the UK governments Search and Rescue (UKSAR) Advisory Medical Group, previously sat on the Royal National Lifeboat Institute’s Medical & Survival Committee, is a member of the International Life Saving Federation’s (ILS) medical advisory committee, an Invited Honorary Member of the International Drowning Research Alliance (IDRA), and is Medical Director for HM Coastguard.
As a postgraduate student and independent medical officer for the Extreme Environment Laboratory at the University of Portsmouth, his areas of research interest include drowning, the cardio-respiratory responses to immersion and submersion in cold-water, hypothermia and the response of the human body in extreme environments. He has lectured internationally and has several publications related to these subjects.
James Stevenson - Major Incidents (00:32:29)
A slight departure from our usual format. This weeks podcast is an excerpt for 2022's virtual conference. The first of twelve experts on the theme of
"THE BASICS OF CHALLENGING SCENES AND SITUATIONS"
If you are interested in hearing further fantastic content from our panels sign up here: https://basics-scotland.org.uk/basics-scotland-virtual-conference-2022/
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James takes a look at Major Incidents, the definition, roles of the first doctor on scene and some case discussions following his involvement as a medical incident officer at two recent major incidents.
Aims of the podcast
1) To define a major incident
2) To consider the expectations for the first doctor on scene
3) To discuss some cases involving major incidents
Biography
James is a consultant in emergency medicine based in Crosshouse Hospital, Kilmarnock. Since 2010 he has also had a sessional commitment as a consultant in pre-hospital and retrieval medicine with the Emergency Medical Retrieval Service (EMRS), the adult component of ScotStar, the National Retrieval Service.
Prior to starting with EMRS James also worked as a consultant in Emergency Medicine for a 3-year period in Adelaide, South Australia, working both in the Emergency Department of the Royal Adelaide Hospital and with the South Australian Retrieval Service.
Following his return from Australia James successfully completed a Masters degree in Aviation Medicine incorporating a Postgraduate Diploma in Aeromedical Retrieval and Transport Medicine at the University of Otago, New Zealand.
Caitlin Wilson - Prehospital Feedback (00:28:14)
Top 3 points:
Seek feedback
Use feedback
Give feedback
About Caitlin:
Caitlin Wilson (Twitter: @999_Caitlin) is a paramedic for North West Ambulance Service NHS Trust and is currently undertaking a PhD on prehospital feedback at the University of Leeds funded by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Her final PhD study is an online diary study exploring predictors and effects of prehospital feedback for patient-facing ambulance staff in the UK. The study is open to recruitment until end of August 2022 and more details can be found at http://bit.ly/prefeed-diary
Relevant publications:
Wilson, C., Howell, AM., Janes, G and Benn, J. (2022) The role of feedback in emergency ambulance services: a qualitative interview study. BMC Health Services Research, 296 (2022).https://doi.org/10.1186/s12913-022-07676-1
Wilson, C., Janes, G., Lawton, R. and Benn, J. (2021) The types and effects of feedback received by emergency ambulance staff: a systematic mixed studies review with narrative synthesis. British Paramedic Journal, Vol. 5 No. 4, pp. 68-69. https://doi.org/10.29045/14784726.2021.3.5.4.68
Wilson, C., Janes, G., Lawton, R. and Benn, J. (2021) The types and effects of feedback received by emergency ambulance staff: protocol for a systematic mixed studies review with narrative synthesis. International Journal of Emergency Services, Vol. 10 No. 2, pp. 247-265. https://doi.org/10.1108/IJES-09-2020-0057
Wilson C, Janes G, Lawton R and Benn, J. (2021) PP24 Prehospital feedback in the United Kingdom: protocol for a review of current practice using a realist approach. Emergency Medicine Journal 2021;38:A10-A11.
Caitlin Wilson
PhD Student & Paramedic
University of Leeds / North West Ambulance Service NHS Trust
Email: hc15c2w@leeds.ac.uk
Twitter: @999_Caitlin
Recent Publications
Wilson, C., Howell, AM., Janes, G. et al. The role of feedback in emergency ambulance services: a qualitative interview study. BMC Health Serv Res 22, 296 (2022). https://doi.org/10.1186/s12913-022-07676-1
Mark Worrall - Seizures in the Paediatric Patient (00:21:05)
Mark chats us through seizures in the paediatric patient from febrile convulsions to status epilepticus
Top Tips:
Follow your ABCDE
Don’t ever forget glucose
Buccal midazolam or if you are really stuck intranasal midazolam if you can't get it in the mouth and they have been seizing for more than 5 minutes
Biography:
Mark is a Paediatric Intensivist at Royal Hospital for Children in Glasgow, a consultant in Paediatric Critical Care Transport at ScotSTAR and a responder and Co -Director for pre-Hospital care for BASICS Scotland. His interests include the management of critically unwell children anywhere.
Mark Worrall - Paediatric Respiratory Emergencies part 2 (00:20:02)
Mark chats us through commonly occurring respiratory disorders such as wheezing, asthma, breath stacking, pneumonia and COVID in the paediatric patient
Top Tips:
Take your time and ask questions to try and work out where in the respiratory tract the problem is. A good history will aid this
Keep it simple
Try and keep the child and family calm
Resources:
Resuscitation council UK Paediatric basic life support guidelines
Paediatric basic life support Guidelines | Resuscitation Council UK
Biography:
Mark is a Paediatric Intensivist at Royal Hospital for Children in Glasgow, a consultant in Paediatric Critical Care Transport at ScotSTAR and a responder and Co-Director for pre-Hospital care for BASICS Scotland. His interests include the management of critically unwell children anywhere.
Mark Worrall - Paediatric Respiratory Emergencies part 1 (00:22:49)
Mark chats us through the commonly occurring respiratory disorders of choking, epiglottitis, croup and bronchiolitis.
Top Tips:
Take your time and ask questions to try and work out where in the respiratory tract the problem is. A good history will aid this
Keep it simple
Try and keep the child and family calm
Resources:
Resuscitation council UK Paediatric basic life support guidelines
Paediatric basic life support Guidelines | Resuscitation Council UK
Biography:
Mark is a Paediatric Intensivist at Royal Hospital for Children in Glasgow, a consultant in Paediatric Critical Care Transport at ScotSTAR and a responder and Co-Director for pre-Hospital care for BASICS Scotland. His interests include the management of critically unwell children anywhere.
Mark Worrall - Anaphylaxis in the paediatric child (00:19:26)
Introduction:
Mark chats us through anaphylaxis in children and how we can treat them
3 Top Tips:
When you are assessing a child, think could this be anaphylaxis in your differential
Always look up the dose
Hydrocortisone and chlorophenamine are not now initial satges of children in anaphylaxis
Resources:
Resuscitation council Guidance for healthcare proifessionals : anaphylaxis
Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers | Resuscitation Council UK
Biography:
Mark is a Paediatric Intensivist at Royal Hospital for Children in Glasgow, a consultant in Paediatric Critical Care Transport at ScotSTAR and a responder and Co -Director for pre-Hospital care for BASICS Scotland. His interests include the management of critically unwell children anywhere.
Caitlin Wilson - Hyperventilation Syndrome (00:30:26)
Caitlin Chats us through hyperventilation syndrome, classically referred to as “panic attack” and how we can spot it and treat the syndrome
Top 3 tips:
Keep an open mind – Hyperventilation Syndrome (HVS) is a diagnosis of exclusion!
Use your diagnostic tools & clinical judgement - Don’t guess what findings might be!
Be cautious when diagnosing HVS in older patients or when you’re uncertain in HVS being the sole diagnosis + safety net the patient when considering non-conveyance!
Biography:
Caitlin Wilson is a paramedic for North West Ambulance Service NHS Trust and conducted a research study on Hyperventilation Syndrome (HVS) as part of her MSc Clinical Research Methods in 2015/16. Caitlin went on to publish findings from her research and was involved in updating the JRCALC guidelines for HVS. Currently, Caitlin is undertaking a PhD in prehospital feedback at the University of Leeds funded by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre.
Links and resources:
Wilson, C., Harley, C., & Steels, S. (2020). How accurate is the prehospital diagnosis of hyperventilation syndrome?. Journal of Paramedic Practice, 12(11). doi:10.12968/jpar.2020.12.11.445
Wilson, C. (2018). Hyperventilation syndrome: diagnosis and reassurance. Journal of Paramedic Practice, 10(9), 370-375. doi:10.12968/jpar.2018.10.9.370
Wilson, C., Harley, C., & Steels, S. (2018). Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies. Emergency Medicine Journal, 35(12), 757-764. doi:10.1136/emermed-2018-207588
Gail Topping - Are you OK? (00:27:48)
Top 3 tips
Put your own oxygen mask on first. Take the time to look after yourself first - you can’t help anyone else if you’re running on empty. Even if it’s just 5 mins for a cuppa and a chance to unwind, take that time.
Don’t be afraid to talk about mental health. If you’re concerned about someone else, ask them if they’re okay, but make sure to ask them twice because most people’s first response will be something like “I’m fine, just tired”.
Always be kind. None of us know what anyone else is coping with, either at work or in their personal life. We could all benefit from people being kinder to each other. It could be the little bit of light in someone’s day that helps them keep going.
Resources
https://www.lifelines.scot/
https://www.ruok.org.au/
https://www.samh.org.uk/
https://www.mind.org.uk/news-campaigns/campaigns/blue-light-programme/
https://royalfoundation.com/mental-health/
https://drdavidhamilton.com/the-5-side-effects-of-kindness/
Books
The Mental Health And Wellbeing Of Healthcare Practitioners - Esther Murray and Jo Brown (includes a chapter on our campaign)
The Little Book Of Kindness - Dr David Hamilton
Biography
I've worked in the SAS for over 22 years, initially in ACC before moving to operational duties and I've been based in West Lothian ever since. My mental health has been negatively affected by some harrowing incidents I have responded to and I became frustrated by the lack of support sometimes being offered afterwards, so Ruth Anderson and I developed a campaign for informal peer support. It was called “R U OK?”, based on the Australian mental health charity, and I hope it helped promote conversations about mental health and well-being within the SAS.
Dave Strachan - Suspension Trauma (00:26:42)
Our own Dave Strachan become the interviewee and discusses suspension trauma
Top 3 tips
1 Suspension trauma happens quickly so be aware!
2 We, the rescuers, are potentially the cause of some of this so in an MRT or technical rescue think about patient position and getting patients to move their limbs where possible
3 Look at the data! Understanding of this condition is changing rapidly as more research is carried out.
Resources and links
https://www.wemjournal.org/action/showPdf?pii=S1080-6032%2820%2930070-3
https://www.wemjournal.org/action/showPdf?pii=S1080-6032%2819%2930164-4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346344/pdf/cureus-0012-00000008514.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602116/pdf/ham.2018.0089.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658225/pdf/237.pdf
Biography:
Dave started working in pre hospital care in 2006 as an event medic and member of Tayside Mountain Rescue. When he finally graduated from Dundee in 2014 he had spent just enough of the intervening years not having fun in the hills to actually qualify as a Doctor. Currently a Captain in Royal Army Medical Corps, he now holds diplomas in Leadership, the Management of Conflict and Catastrophe and Immediate Medical Care. He has climbed and led expeditions on 5 continents and spent most of the past few years deployed on operational tours and military exercises around the world.
At home in Pitlochry, Dave can be found responding for BASICS, playing ‘hide and seek’ with the rescue team or running (slowly) around the hills looking for things to climb.
April Lochhead - Falls in the community (00:28:56)
April talks us through falls in the community, how we can treat and refer these patients ensuring the right care at the time in the right place
Top 3 tips:
Always establish a patient's baseline and compare this to their presenting complaint for realistic assessment
Consider potential detrimental impacts to patients with an unnecessary ED admission
Engage with local falls pathways and use Prof to Prof links.
Biography:
April has 31 years of clinical background in NHS Scotland. April is a a trained Occupational Therapist and has worked in a variety of areas. Starting off in mental health then in-patients, stroke and care of the elderly and laterally her career has been in the evolution of discharge teams to community care and then with Health and Social care partnership Greater Glasgow and Clyde.
Her interest in frontline services started with a specialist role in trauma orthpaedics , addressing supported discharge and admission avoidance. This work developed into A&E patient assessment, intermediate care and projects with the Scottish Ambulance Service.
April is presently with The Scottish Ambulance Service on a 2 year secondment and believes that she is the first Occupational Therapist within the service. It is her hope to establish a sustainable model to support patients and crews to utilise and embrace all components of health and social care that can provide best outcomes to patients who present to the ambulance teams with falls and frailty.
April is passionate about patients having the right care at the right place with informed choice, and embracing new and innovative options and models of practice.
Winston de Mello - Prehospital management of burns (00:39:45)
Winston chats to us about burns and the treatment of these in the prehospital environment
Top 3 tips:
Take a SAFE approach
Stop the burning process
Cool the burn but not the patient
Biography:
Dr de Mello undertook his medical training at Guy’s Hospital and Southampton. He served in the RAMC as a Regular and Reservist from 1976 to 2013 ending his military career as Colonel TA BATLS from 2007-2013. His NHS employment as an Anaesthetist and Pain Medicine Physician was at Mid Yorkshire and Manchester University Hospital. His clinical interests include pelvic pain, burns, pre-hospital care and trauma. He is a Founding Member of the Pre-Hospital Care Faculty at the Royal College of Surgeons Edinburgh and the College of Remote & Offshore Medicine at Malta. He retired in 2020 and is Trustee at the Vulval Pain Society UK and Chair of the Pre-hospital SIG at the British Burns Association.
Links and resources:
Clinical Pearls:
Take a SAFE approach: Shout for help, Approach with care, Free from danger and Evaluate the ABCs
Stop the burning process by getting the victim to drop to the floor and roll, remove clothing and jewelry
Provide supplemental oxygen after clearing the airway
Check both radial pulses
If a burn patient is hypotensive within a couple of hours of the injury look for another source of blood loss – check the mechanism of injury
Stop the burning process
Cool the burn for a minimum of 20 minutes using cool water for up to 3 hours post burn
Keep patient warm
Loosely cover the burn with clingfilm
Sit up (if permissible) especially in burns involving the head and neck to minimize the swelling
Clingfilm also provides analgesia
Beware circumferential burns
The normal oximeter cannot detect carbon monoxide – and will falsely give a high saturation reading
Fluid resuscitation in adults in pre-hospital burns can be simplified by adopting the “small man, small burn small bag; big burn, big man big bag” – which simplifies to either a 500 ml or 1000 ml bag of Hartmann’s Solution intravenously/intraosseously per hour
TBSA calculation in the pre-hospital can be difficult and is usually overestimated
Electrical burns may need 24hour ECG monitoring in vulnerable patients
Chemical contamination needs copious irrigation with water ideally within 10 minutes of contact except for elemental sodium, potassium or lithium
Alkali burns are worse than acid
Lucy Powls - Obstetric Emergencies in the Pre-hospital Environment (00:23:02)
Lucy talks us through the obstetric emergencies of shoulder dystocia and cord prolapse, and how to treat these in the pre-hospital environment.
Top 3 tips:
1. Be aware of the signs and symptoms of shoulder dystocia and cord prolapse
2. Call for help as soon as possible and make sure the receiving maternity unit is pre-alerted to the emergency you are bringing in
3. The debrief is very important for these emergencies, considering the parents, the responders and the hospital staff in this emergency
About Lucy
Lucy is currently the Educational Lead for the Scottish Multiprofessional Maternity Development Programme (SMMDP)
Lucy qualified as a midwife in 1984 and has worked in a variety of clinical posts throughout the UK and joined SMMDP in June 2017.
SMMDP are part of NHS Education for Scotland and are Scotland’s leading provider of maternity and neonatal clinical skills training. SMMDP provide affordable, post-registration courses to any professional group who request training.
Lucy is married to Andrew and they have a daughter Samantha who is studying at Glasgow University. Lucy also has a greyhound called Indy, who keeps her fit and active whatever the weather.
Dr Martin McCallum – How to treat stage 1 and 2 hypothermia in the pre-hospital environment (00:16:13)
Martin chats us how to deal with those with more common and less severe Hypothermia at Stages I and II - in a presentation given as part of our International Hypothermia Conference
Resources:
BASICS Scotland Hypothermia Conference videos
https://basics-scotland.org.uk/hypothermia/
About Martin:
Martin is currently running Artemis Outdoors, a small company providing bespoke Safety and Medical Cover for outdoor and indoor events and Outdoor Instruction.
He was previously a Field Guide with British Antarctic Survey and worked for several organisations who provided medical and safety cover in hostile environments.
He is currently Deputy Leader of Lomond Mountain Rescue Team, was previously the National Training Officer for Scottish Mountain Rescue and has been involved in Mountain Rescue for over twenty years.
Tim Leeuwenburg – What Basics/Sandpiper are doing in Oz (00:27:21)
Tim chats us through what it is like to be a rural doctor in Australia
Top 3 Points from this podcast:
Know your local teams. Train with them, support them and practice sim scenarios.
Know your equipment. The Sandpiper clinician is really there to perform a limited suite of meaningful interventions (do the basics, well). Making sure you know where your equipment is packed and how to use it is vital
Be an advocate for change, whether at local level, State or Nationally. Harness the good news stories from patient outcomes to help generate awareness, support and funding for Sandpiper Australia
Resources:
Kangaroo island doctor blogging about rural medicine in Australia
https://kidocs.org/
SANDPIPER AUSTRALIA
sandpiperaustralia.org
ACRRM PHEC
https://www.acrrm.org.au/courses/face-to-face/pre-hospital-emergency-care-phec
About Tim:
Tim Leeuwenburg is a Rural Generalist on Kangaroo Island, South Australia – he started off as an ED/ICU trainee in Adelaide before realising the heady mix of medicine that an RG encompasses. For the past twenty years he’s been in probate practice on Kangaroo Island, providing primary care, emergency medicine and anesthetic services through clinic and hospital, as well as prehospital care of SA’s Rural Emergency Responder Network (RERN)
Now semi-retired, he and partner Trish spend time rehabilitating orphaned wildlife and sea kayaking; Tim still collects pocket money working as a retrieval consultant for the Central Australian Retrieval Service and doing the odd anesthetic locum. More importantly he now has time to help out as Chair of Sandpiper Australia in the hope that we can overcome the ’tyranny of distance’ by establishing rural responder networks across the various States & Territories in Australia.
twitter @kangaroobeach
Kevin Rooney – Sepsis (00:20:36)
Kevin chats us through what sepsis is and how to treat and manage sepsis patients.
Top 3 Points from this podcast:
Follow your A to E approach
For a septic patient if you have the ability and can’t get blood cultures then deliver antibiotics
Give fluid and continually reassess and consider the sepsis 6.
About Kevin:
Kevin Rooney was appointed as a consultant in Intensive Care and Anaesthesia at the Royal Alexandra Hospital in Paisley in July 2003. He is the Clinical Director for Critical Care in Clyde Sector of Greater Glasgow & Clyde Health Board.
Between January 2011 and February 2020, Kevin was Professor of Care Improvement at the Institute for Research in Healthcare Policy and Practice within the University of the West of Scotland. He continues to practice in Intensive Care & Anaesthesia at the Royal Alexandra Hospital where he can pursue his interests of patient safety, clinical critical care research and healthcare quality improvement. Between 2012-17, Professor Rooney was the Clinical Lead for the Acute Adult Workstream of the Scottish Patient Safety Programme for Healthcare Improvement Scotland and led their breakthrough series collaborative on Sepsis, which resulted in a sustained relative risk reduction of 21% in sepsis mortality across Scotland, as well as a 27% reduction in cardiac arrests.
Kevin is a Fellow for the Scottish Patient Safety Programme and a Founding Member of the Q initiative for the Health Foundation and the National Health Service. As critical care faculty for the Institute for Healthcare Improvement (IHI) he has taught quality improvement for IHI in the Hospitais da Universidade de Coimbra project (Portugal), “Patientsikkert Sygehus” (Danish Patient Safety Programme), the Improvement Science in Action Course for the National Guard Health Affairs in Saudi Arabia, the Best Care Always Programme for the Hamad Medical Corporation in Qatar and finally the Salus Vitae programme in Brazil.
Recent awards include Doctor of the Year Award in the Scottish Health Awards 2015, the Scottish Health Award 2014 for Innovation and a NHS Greater Glasgow & Clyde Chairman’s Gold Award for excellence in clinical practice in 2014. In April 2018, Kevin was recognised by The Herald newspaper as one of the 70 NHS heroes to commemorate 70 years of NHS Scotland.
James Hale - Permissive Hypotension (00:38:29)
James clarifies what the process of permissive hypotension is and how and why to use it as a temporary management strategy.
Top 3 tips:
1. Try not to think about a specific number in these patients but look at the bigger picture. Assess for multiple signs of shock when deciding how to treat these patients.
2. Think about the patient’s journey - how far do they need to go, how you are going to get there and how long will it take? Patient’s requiring a longer journey may require more resuscitation that those undergoing a shorter journey.
3. Think carefully before giving large amounts of crystalloid to these patients, it may be the only option in some patients but there are negative effects to its use.
Biography:
James is an anaesthetic registrar based in Edinburgh. He has worked for a number of pre-hospital organisations around the UK and is currently a fellow with the Emergency Medical Retrieval Service in Glasgow. He has completed sub-speciality training in Pre-hospital Emergency Medicine (PHEM) and holds the Fellowship in Immediate Medical Care (FIMC). His main interests inside medicine include trauma, from scene to theatre, and retrieval medicine. Outside of work he spends most of his time baking bread, enjoying mountains and looking after his 3 children.
Links and resources:
RCT comparing immediate vs delayed fluid resuscitation for patients with penetrating torso trauma.
Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. New England Journal of Medicine 1994;331(17):1105-9.
Cochrane Review relating to timing and volume of fluid resuscitation in patients with bleeding.
Kwan I, Bunn F, Chinnock P, Roberts I. Timing and volume of fluid administration for patients with bleeding. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002245. DOI: 10.1002/14651858.CD002245.pub2.
Systematic Review of animal trials regarding fluid strategies in trauma.
Mapstone J, Roberts I, Evans P. Fluid resuscitation strategies: a system- atic review of animal trials. J Trauma. 2003;55:571–589.
Correlation of SBP and pulse location in hypovolaemic shock.
Charles D Deakin, J Lorraine Low. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ 2000;321:673–4.
Rat model of TBI and Haemorrhage comparing no fluid vs fluid.
Talmor D, Merkind V, Artru AA, et al. Treatment to support blood pressure increases bleeding and/or decreases survival in a rat model of closed head trauma combined with uncontrolled hemorrhage. Anesth Analg. 1999;89:950–956.
Secondary analysis of PAMPER trial showing benefit of FFP over crystalloid in TBI.
Danielle S. Gruen, Francis X. Guyette, Joshua B. Brown et al. Association of Prehospital Plasma With Survival in Patients With Traumatic Brain InjuryA Secondary Analysis of the PAMPer Cluster Randomized Clinical Trial. JAMA Netw Open. 2020;3(10):e2016869. doi:10.1001/jamanetworkopen.2020.16869.
Dr Paul Perry – What is NHS 24 and how can it help in prehospital care? (00:19:58)
Paul chats us through some of the services available on the NHS 24 service and how it all fits into the prehospital world.
Top 3 Points from this podcast:
Remember the telephone number 111 for NHS 24
NHS 24 has lots of services outside of the telephony line 111. Go to NHS inform – Scottish health information you can trust | NHS inform to find out more
NHS 24 is on Social Media too
Resources:
NHS Inform
About Paul:
Dr Paul Perry works as an Associate Medical Director at NHS 24, and also as an Out of Hours GP for NHS Lothian. Prior to this he taught postgraduate students at the University of Dundee, worked as a GP Partner in General Practice in Edinburgh, and was a Remote and Rural Fellow on the Isle of Skye. Outside of work he has a young family which keeps him on his toes, and if he’s not in the hills walking and climbing can be found on his road bike cycling around Edinburgh.
