BASICS Scotland Podcast

Dr Martin McCallum – How to treat stage 1 and 2 hypothermia in the pre-hospital environment

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

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

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

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?

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. 

Dr Jonathan Hanson - Head Injuries

Jonathan chats us through head injuries, focusing on concussion, what to look for, how to assess, how to treat.

 

Top 3 tips:

1. “If in doubt sit them out”- if you suspect concussion treat it as such, remove the player and don’t let anyone return to play on the same day.
2. Look for concussion education resources. Either the Sport-Scotland concussion document or NES PBSGL modules require good places to start. 
3. Learn to take a concussion history - most concussions do well but recent past history is really important and may need more conservative advice.

Biography:

As a teenager I was a pool lifeguard and played every sport going so I have always combined sports and emergency medicine. 

Sport and Exercise medicine became a speciality in 2007 and I am one of a handful of Consultants in Scotland where I work both in the NHS and for SportScotland with high performance athletes preparing for major games.  I am based in the Emergency department in the Victoria hospital in Kirkcaldy having worked in remote and rural emergency medicine for 12 years on Skye.  

I have had an apprenticeship in rugby medicine over 15 years from Dr James Robson and currently look after Glasgow Warriors. I wrote and ran sports prehospital care courses for Scottish Rugby, Premier League football and World Rugby. I’m lucky enough to have worked with Team GB at three Olympics and travelled with England to the FIFA World Cup in Russia in 2018 - particularly to work on managing head injury and human factors around emergency situations where up to 300 million people could be watching! 

Finally I am the current chair of the Scottish Government Concussion advisory group who produced the first nation in the world to have a single concussion guideline for all grassroots sport. 

 

Links and resources:

 

Scottish common concussion guidance for all sport.

https://sportscotland.org.uk/media/3382/concussionreport2018.pdf

 

Second impact case story 

https://www.google.co.uk/amp/s/amp.belfasttelegraph.co.uk/life/health/i-will-know-ben-did-not-die-in-vain-if-i-never-hear-a-player-being-asked-if-they-want-to-carry-on-after-a-head-injury-37935260.html

 

Berlin concussion consensus document 

https://bjsm.bmj.com/content/51/11/838

 

NES PBSGL

https://www.cpdconnect.nhs.scot/courses/

 

Andy Elwood – It’s Good to Talk

Andy is an experienced paramedic who predominately worked on search and rescue helicopters, where he encountered many experiences that had a significant effect on his mental health. In this podcast he discusses his journey through PTSD which led him to head up a mental health first aid campaign, Andy’s Landie, designed to stamp out the stigma of mental health issues and improve the well-being of those in the emergency services and responder community.

Andy talks about his challenges and motivators, and gives really useful information on developing coping strategies and listening skills. He is optimistic that the barriers to discussing mental health are receding – the overall message is its good to talk!

Top tips from this podcast:

• Put your own oxygen mask on first- give yourself some focus
• Use the ‘5 a day’ for Mental Health (connect, be active, mindfulness, keep learning, give)
• It is OK to talk…

Resources related to this podcast:

Find out more at www.AndyElwood.com

5-a-day for #mentalstrength blog – https://www.andyelwood.com/2020/05/01/lockdown-survival-kit/

Other resources

http://lifelinesscotland.org/

https://www.nhsinform.scot/healthy-living/mental-wellbeing

https://breathingspace.scot

http://www.promis.scot

SHOUT UK and you can text BLUELIGHT to 85258

Samaritans 116123

About Andy

Andy saves lives. His approach is different, refreshing and unique. He campaigns, speaks and is a Mental Health First Aid instructor.

Andy sparks conversations which enables culture change regarding Mental Health and Wellbeing for individuals and organisations. He creates safety and trust by sharing his own vulnerability and gives a unique ‘behind the scenes’ insight into life and death situations on Search and Rescue helicopters, on the Afghanistan battlefields during military service and to the potential downward spirals due to 21st Century pressures.

Andy has a male focus and believes that mental health deserves parity with physical health. His unique approach to communicating with men is driven by the fact that men are three times more likely than women to end their life by suicide.

After 18 years working on rescue helicopters around the world, he believes that focusing on mental health will save more lives than continuing to dangle under helicopters, as a paramedic. Andy’s Search and Rescue career began with the Royal Air Force and was completed in the Coastguard, where he led Clinical Governance for half of the UK. Despite Andy’s various awards for physical courage, he believes his bravest action has been to talk openly about his own struggles and vulnerability, in order to find a way through three very different challenges during his lifetime.

Andy brings people together by normalising the conversation and encouraging others to join his eye-catching campaigns, such as #itsoktotalk ‘Big22’ video (45,000 views), founding #MenDoLunchDay 2018, & driving his 1973 Land Rover around Northern England and Scotland promoting a Wellbeing and Resilience Framework for a national organisation. (A short film of this tour will be released 2020). Future projects include ‘Chinwag Curry Club’ & retreats for men.

Since HRH Duke of Cambridge attended Andy’s Mental Health workshop, at the UK Search and Rescue National Conference in 2018, he has been engaged as a speaker by organisations such as University of Cambridge Medical School; Jacobs (construction industry); Scottish Mountain Rescue; Emergency Services Show (NEC) and Mind Blue Light Programme.

Other interests: College of Paramedics National Mental Health & Wellbeing Steering group; Human Factors training to provide increased safety & efficiency, from the aviation industry into a healthcare setting; delivering face-to-face and online medical training for responders treating civilian casualties in the Syrian crisis.

 

LisaJane Naidoo - Scottish Ambulance Services pathways around child protection

LisaJane chats us through the pathways for identifying and supporting children at risk, how this fits into the Getting it Right For Each Child (GIRFEC) model and how this fits into a multi-agency approach for that child. 

 

Biography

Lisa Jane is the clinical effectiveness lead for child protection at the Scottish ambulance service.   

 

Top 3 tips 

1) Go with your gut, if you are feeling stressed or intimidated in an environment, imagine how a child feels within that environment 

2) Don’t ever assume that someone else will escalate a concern on your behalf.  It doesn’t matter how many refferals are made they are still all relevant and there is power within those referrals 

3) If you have any dubiety then escalate it, don’t ever disregard your own feelings in any situation. 

 

Resources/links 

Child Protection Guidance for Health Professionals (www.gov.scot) 

 GIRFEC National Practice Model - gov.scot (www.gov.scot) 

 Contextual Safeguarding Network – The Contextual Safeguarding programme, and the team who deliver it, are part of the International Centre: Researching child sexual exploitation, violence and trafficking (IC) at the University of Bedfordshire 

Mary Munro - Drug harm reduction and the naloxone - take home project

Mary chats to us about the interface between the emergency 999 services and the day to day problems associated with drugs and addiction 

 

Top 3 tips 

1) By understanding why someone may use substances, the importance of our use  of language and knowledge of what services are available to support we can  help people into a journey of recovery and stop preventable drug related   deaths. 

2) Harm Reduction is not about encouraging drug use, but allows people to use  drugs in a safer way.  

3) Take Home Naloxone saves life’s, you can’t recover if your dead! By carrying  and providing a THN kit, we can keep people alive, create connections and help  people to treatment and support services to help them into a journey or recovery. 

 

Biography

Mary Munro is the clinical effectiveness lead for drug harm reduction in the North of Scotland, for the Scottish Ambulance Service.  Mary came to the Scottish Ambulance Service with experience in various substance use settings including: research, education, third sector and clinical inpatient and community nursing roles. People who use substances can often be seen and treated by society and health services as “less than” human, and we all have a part to play in changing these attitudes and cultures. 

 

Pete Davis - Damage control resuscitation

Pete talks us through the definition of damage control resuscitation and the application of this concept to critically injured patients in the pre-hospital setting. The discussion ranges from the practicalities of delivery to novel therapies sitting on the horizon. 

Top 3 tips: 

1. Remember that the classic ABC algorithm has morphed into CABC and that C stands for the control of catastrophic haemorrhage. This has to be immediate and concurrent with managing the airway, breathing and circulation.
2. Nail your IV lines!  If a red team is on the way but you are on scene, you may be the one who has the best chance to place the IV cannula which is going to facilitate further resuscitation.  Place it and make sure it is really secure. 
3. You can extend the classic algorithm from "ABCDE" to "CABCDEF" where “F” stands for forward planning.  So immediately you are activated and en-route, start planning ahead and consider what other services you may need.  If on scene you recognise a severe derangement in physiology activate the red or HEMS team as appropriate; the earlier these teams and the receiving facility receive patient information - the better they are able to allocate their resources. 

 

Biography: 

Pete qualified in medicine in 1987 and has served in the UK Defence Medical Services ever since, apart from a nine-year sabbatical in New Zealand during which time he trained in helped to produce three children, trained in Emergency Medicine and explored the Southern Alps. He is a Consultant in Emergency Medicine and Retrieval Medicine, working between the Queen Elizabeth University Hospital in Glasgow and the Emergency Medical Retrieval Service (a component of the Scottish Specialist Transfer And Retrieval Service - ScotSTAR) when not deployed on Regimental duties. A climber and skier since his teenage years, these sports have taken him on adventures throughout the world and continue to foster his passion for Wilderness Medicine.