BASICS Scotland Podcast
Angela Lewis – Peer Support and Debriefing

Angela Lewis – Peer Support and Debriefing

March 31, 2021

This week’s podcast from BASICS Scotland explores the links between post incident support and crew resource management with Angela Lewis. Angela explains the operational improvements that are achievable when organisations develop a menu of different types of support for their personnel. She also looks at the problems with the “can do” mentality that is prevalent in those who work in pre hospital emergency care.

 

Key points from this podcast:
  • Self-care is not selfish and is very important to prioritise
  • Routine is good
  • Keep your social connections, as social support is very important
Resources related to this podcast:

The Sleep Council Website – www.sleepcouncil.org.uk

National Wellbeing Hub – www.promis.scot

LifeLines Scotland Website – www.lifelinesscotland.org

International Critical Incident Stress Foundation – www.icisf.org

PSA Limited Website – www.psa-ltd.com

About Angela

Angela Lewis is the founder and MD of PSA Ltd, delivering training in the principles and practice of Crew Resource Management and post incident support in the UK/Europe.  Serving 16 years in the RN’s Fleet Air Arm, as an Aircraft Commander in Sea King Helicopters, much of her military life was based at HMS Gannet with over 550 call outs on Search and Rescue duties.  With a specialised interest in mitigating the impact of traumatic incidents on teams, Angela has trained extensively in Critical Incident Stress Management with ICISF in Baltimore, US, and Trauma Risk Management with the Royal Navy and Royal Marines.

Angela delivers training regularly to support professionals at all levels in aviation, healthcare, ambulance, fire and police services, charities, staff care departments, education and the private sector in the UK and Europe.  She is delighted to have had the opportunity to support teams from NHS Ayrshire & Arran, Greater Glasgow & Clyde, Lanarkshire, Lothian and Suffolk & Sussex Trust, NATS, Emergency Medical Retrieval Service, Scottish Ambulance Service, Mountain Rescue Service, Yorkshire Police and others.

Catherine Buckland - Diving injuries and insults - The water phase

Catherine Buckland - Diving injuries and insults - The water phase

March 29, 2021

Catherine talks us through some of the physiology to consider if dealing with a diving or post diving incident and chats us through some insults and injuries which may occur during or after a dive trip and how to assess and treat these as well as possible pathways for the patient. 

Key points:  

  

  • A beeping dive computer is bad = means the diver has done 'something wrong' on their dive.  
  • Try and get a 'dive history' uncontrolled ascents/descents will likely result in barotrauma 
  • Don't assume that a shallow dive won't result in an issue - arterial gas embolisms have occurred from as little as 1.2m 

Links and Resources 

 

The Scottish Hyperbaric emergency helpline   0345 408 6008 

 The British Hyperbaric emergency helpline   07831 151 523 

 Both are 24hrs, rescue of course can be initiated through 999/ VHF CH 16.  

 

The UK Hyperbaric association 

https://www.ukhyperbaric.com/ 

 

The British Diving Safety Group, who aim to collaborate with all the agencies on safety matters in diving, have produced this helpful information on Preparation for a return to dive UK sites and seas.  

https://bdsg.org.uk/wp-content/uploads/2021/02/BDSG-Preparation-for-a-return-to-diving-Winter-2021.pdf 

Tom Quinn – The Paramedic 2 Trial

Tom Quinn – The Paramedic 2 Trial

March 24, 2021

This week’s podcast from BASICS Scotland is with Tom Quinn, who explains the findings of the Paramedic 2 trial. Paramedic 2 has been described as a landmark study, the results of which have challenged conventional methods used to prioritise restarting the heart during an out of hospital cardiac arrest.

Key points from this podcast:
  • Basic support of high quality chest compressions and early defibrillation yield the most in case of good patient outcomes
  • The medicines we have do not have strong evidence to benefit whether for adrenaline, amiodarone or lignocaine in terms of sustained positives effects on survival with a good neurological outcome, although adrenaline has now been proven to increase your likelihood of ROSC
  • Neuro protective brain should be the focus of ongoing research
Resources related to this podcast:

PARAMEDIC-2 trial main paper https://www.nejm.org/doi/pdf/10.1056/NEJMoa1806842

Repeated adrenaline doses and survival https://www.resuscitationjournal.com/article/S0300-9572(19)30007-3/fulltext

ILCOR systematic review on vasopressors in cardiac arrest https://www.resuscitationjournal.com/article/S0300-9572(19)30122-4/fulltext

2019 Consensus on Science and Treatment Recommendations (ILCOR) https://www.resuscitationjournal.com/action/showPdf?pii=S0300-9572%2819%2930665-3

Video of a talk I gave on the PARAMEDIC-2 trial https://www.youtube.com/watch?v=6aRd1iB0Hnw

Presentation at the European Society of Cardiology annual Congress, Paris, 2019. https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/New-insights-into-cardiopulmonary-resuscitation/187252-time-to-abandon-adrenaline-in-out-of-hospital-cardiac-arrest

About Tom

Tom is a cardiac nurse with 40 years’ experience (he started training as an orthopaedic nurse in 1979).

His NHS career has taken him from the bedside – general medicine and cardiac care units at both secondary and tertiary centres including Bart’s and the National Heart Hospital in London, and in York – to central Government where he was section head of the Department of Health policy team responsible for the National Service Framework for Coronary Heart Disease. Along the way he played a significant role in establishing the Defibrillators in Public Places Initiative and later was involved in the development of England’s national programme to provide primary angioplasty (attending and speaking at the initial meeting with the Prime Minister’s Delivery Unit). He subsequently worked strategically at regional level on cardiovascular issues, including 4 years in an ambulance service as a consultant cardiac nurse/regional head of cardiovascular, stroke and research. During this time he became a visiting professor at Coventry University, subsequently moving to the University of Surrey in 2009 as a full professor.

While at Surrey he was Associate Dean for Health & Medical Strategy, leading development of a 10-year strategy for the institution with NHS partners.

On moving to the Joint Faculty at Kingston & St George’s, University of London as Professor of Nursing, Tom took up a leadership role as Associate Dean for Research & Director of the Centre for Health & Social Care Research. On completing this term he became Professor of Cardiovascular Nursing, leading a new Emergency, Cardiovascular & Critical Care Research Group and is now also a BASICS Scotland trustee.

Ed Barnard Part 2 - What does the research tell us about traumatic cardiac arrest?

Ed Barnard Part 2 - What does the research tell us about traumatic cardiac arrest?

March 22, 2021

In this second episode of two, Ed turns his attention to the use of adrenaline in TCA, and in ROSC (return of spontaneous circulation), when to cease resuscitation and what TCA management might look like in the future 

 

Three top tips 

1. The first is a reiteration from Richard Lyon, which is to know and practice the HOT algorithm - I find a good way to remember the actual components is: oxygenate, decompress, and fill. This gives you an immediate action drill when under stress. 

2. TCA is not futile, but the way that data are reported makes it seem that survival is similar to medical arrest - this is unlikely to be the case, and almost all of the patients who are truly in TCA pre-hospital will be pronounced life extinct at scene. 

3. Form a mental model of when you would and would not perform closed chest compressions - discuss these with colleagues and during training. The time to get this right in your head is not when faced with a TCA. This can be a very difficult situation pre-hospital in terms of working together / human factors; the default is to deliver chest compressions whilst reducing risk to rescuers. 

 

Biography:

Ed Barnard is a military emergency physician at Cambridge University Hospitals, a consultant in pre-hospital emergency medicine at East Anglian Air Ambulance, and a Senior Lecturer in the Academic Department of Military Emergency Medicine. He was previously a BASICS responder in the South West of England.

During deployments to Iraq and Afghanistan, Ed became interested in the pre-hospital management of critical hypovolaemia and traumatic cardiac arrest (TCA). This led onto a PhD in endovascular resuscitation and TCA at the United States Air Force 59th Medical Wing, San Antonio, TX.

Ed's academic interests are in the pre-hospital management of cardiac arrest (medical and TCA), endovascular resuscitation, and traumatic brain injury (including pre-hospital emergency anaesthesia). His twitter handle is @edbarn

Paul Rees – Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Paul Rees – Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

March 17, 2021

This week Paul Rees returns to discuss the trans specialty procedure of REBOA. He looks at why it isn’t commonly used in PHEM but talks about the situations where it could usefully be incorporated into the pre hospital emergency environment.

 

Key points from this podcast:
  • Adopt a whole system approach and deliver the patient to a centre who can help to stabilise them
  • Access, access, access, start training now with Ultrasound. Know how to subtly manage the probe to get vascular access with ultrasound.
  • If in a system employing the REBOA system consider the inflation time carefully
Resources related to this podcast:

Norwegian HEMS REBOA paper (open access) – https://www.ahajournals.org/doi/epub/10.1161/JAHA.119.014394

About Paul

Paul Rees is a military interventional cardioloist at Barts Heart Centre in London, with a special interest in circulatory support and resuscitation. He is also a HEMS consultant, flying for East Anglian Air Ambulance.

As a Surgeon Commander in the Royal Navy, he is their Consultant Advisor in Medicine, as well as Reader in the Academic Department of Military Medicine.  He chairs the Defence Resuscitation Committee, leads the Defence Endovascular Resuscitation Group and has recently designed and delivered a new capability for treating battlefield haemorrhage.

He co-leads the new British Cardiovascular Intervention Society group looking at out of hospital cardiac arrest, and teaches as invited faculty on a number of international endovascular resuscitation workshops. Paul’s military background includes active service with submarines, combat deployment with Commando forces, being the airborne MERT consultant in Afghanistan and numerous humanitarian and disaster relief missions including work in an Ebola treatment unit in Africa.

 

Ed Barnard - What does the research tell us about traumatic cardiac arrest?

Ed Barnard - What does the research tell us about traumatic cardiac arrest?

March 16, 2021

In this first episode of two, Ed delves into the difficulties in engaging with the survival rates in traumatic cardiac arrest (TCA), the thinking behind chest compressions, the HOT (Hypovolaemia, Oxygenation, Tension Pneumothorax) algorithm and the use of fluid resuscitation in TCA.

Biography:

Ed Barnard is a military emergency physician at Cambridge University Hospitals, a consultant in pre-hospital emergency medicine at East Anglian Air Ambulance, and a Senior Lecturer in the Academic Department of Military Emergency Medicine. He was previously a BASICS responder in the South West of England.

During deployments to Iraq and Afghanistan, Ed became interested in the pre-hospital management of critical hypovolaemia and traumatic cardiac arrest (TCA). This led onto a PhD in endovascular resuscitation and TCA at the United States Air Force 59th Medical Wing, San Antonio, TX.

Ed's academic interests are in the pre-hospital management of cardiac arrest (medical and TCA), endovascular resuscitation, and traumatic brain injury (including pre-hospital emergency anaesthesia). His twitter handle is @edbarn

Paul Rees – ROSC – Post Resuscitation Care

Paul Rees – ROSC – Post Resuscitation Care

March 10, 2021

This week Paul Rees discusses ROSC and post resuscitation care, including post cardiac arrest syndrome and prognostication after cardiac arrest.

Key points from this podcast:
  • Train and talk through these events. They are fairly rare and so practicing and talking through the motions is important to keep skills, roles and plans refreshed, thinking through all roles and likely challenges and outcomes
  • Deliver slick, effective ALS and get help coming fast
  • Have an exit strategy and have all the relevant phone numbers to hand
Resources related to this podcast:

Resus Council post-ROSC care – https://www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/#circulation

About Paul

Paul Rees is a military interventional cardioloist at Barts Heart Centre in London, with a special interest in circulatory support and resuscitation. He is also a HEMS consultant, flying for East Anglian Air Ambulance.

As a Surgeon Commander in the Royal Navy, he is their Consultant Advisor in Medicine, as well as Reader in the Academic Department of Military Medicine.  He chairs the Defence Resuscitation Committee, leads the Defence Endovascular Resuscitation Group and has recently designed and delivered a new capability for treating battlefield haemorrhage.

He co-leads the new British Cardiovascular Intervention Society group looking at out of hospital cardiac arrest, and teaches as invited faculty on a number of international endovascular resuscitation workshops. Paul’s military background includes active service with submarines, combat deployment with Commando forces, being the airborne MERT consultant in Afghanistan and numerous humanitarian and disaster relief missions including work in an Ebola treatment unit in Africa.

 

John Aitchison - Scottish Fire and Rescue Service - Who are they and what do they do?

John Aitchison - Scottish Fire and Rescue Service - Who are they and what do they do?

March 8, 2021

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. 

Peter Lorrain-Smith – Police Scotland

Peter Lorrain-Smith – Police Scotland

March 3, 2021

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.

 

Duncan Tripp - UK SAR

Duncan Tripp - UK SAR

March 1, 2021

In this podcast Duncan explains the role of Coastguard operations including the interaction with the Emergency Services and BASICS Scotland Responders.

Key points from this podcast:

  • Escalate early via trauma desk to the ARCC
  • Look at the online ISAR resource ahead of time
  • Follow up any jobs and feedback
About Duncan

Duncan spent 35 years in the RAF in various roles mainly as a Winchman Paramedic in the UK SAR Force. During this time he was a Qualified Helicopter Crewman Instructor and Winchman Training Officer responsible for the training and standards of UK SAR Winchman both in their operational and medical roles. As a member of the RAF Mountain Rescue Service he took part in various worldwide expeditions, some as Medical Director or Expedition Leader.

With the responsibility for the UK SAR Force transferring to the MCA in 2015, Duncan left the RAF and continues to operate as a Winchman Paramedic, Instructor trainer and Base Clinical Lead.

He has a long-standing involvement with BASICS Scotland going back to 1996. Duncan is the Vice-Chair of BASICS Scotland, an Instructor, Responder and a member of the Clinical Governance Working Group. He is married to a very tolerant and forgiving wife.

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