BASICS Scotland Podcast

Dr Karyn Webster - Recognising and managing possible child abuse and children at risk

Karyn talks us through what constitutes child abuse and what we can do to assess and manage the situation. 

  

Top Tips: 

1)  If you think there is something wrong, think why  

2)  communicate these concerns early 

3)  Know your local procedures and pathways 

  

Resources: 

National Guidance for child protection in Scotland 

https://www.gov.scot/publications/national-guidance-child-protection-scotland/pages/3/ 

Getting it right for every child 

https://www.gov.scot/policies/girfec/ 

 

Biography

Dr Karyn Webster is a GP primarily; she works in Forth Valley Emergency Department as a Senior Specialist and is the current Forth Valley GP Out of Hours clinical lead. She also teaches regularly with Basics Scotland and has developed the Adult and Paediatric Tele-education program. 

In addition to this she is the current Chair for the Pre-hospital Paediatric Life Support Group run by ALSG and is a course director for both PHPLS and APLS. Passionate about education and support for our Pre-hospital providers.  

Her career started off in Grampian and quickly evolved into a mix of general practice and emergency medicine with an interest in remote and emergency care. Heavily involved in tele-medicine delivering healthcare to the remote areas of Grampian without the need for travel and later supporting Oil Rig platforms and Ship to Shore work.  

Her twitter handle is @kittyabdn  

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.

Lisa Artis – The importance of Sleep

Lisa Artis discusses sleep: the importance of it, the differences in individuals when it comes to the ability to have a good, restful sleep, as well as busting myths around caffeine!

Key points from this podcast:

• Make the time for a wind down routine, even if it is just for 30 mins before bed.  Use this time wisely to do something that is relaxing for you
• Write down any worries or thoughts before bed time, this helps to clear the mind before sleep
• Aim for a cool, quite, uncluttered, dark bedroom space with a good quality bed

Resources related to this podcast:

The Sleep Council – https://sleepcouncil.org.uk/

About Lisa

Lisa is a qualified children’s sleep practitioner and experienced sleep advisor, and has worked in the realm of sleep for more than nine years.

Heading up the day to day running of The Sleep Council, Lisa has a passionate interest in sleep, how it affects health and wellbeing and is campaigning for sleep to be taken seriously on the Public Health agenda.

She shares advice and tips through the Sleep Council website, on the radio and at workshops / events and plays a proactive role in awareness raising campaigns.

Peter Aitken - How do we manage patients with counterintuitive behaviour?

Peter talks us through managing patients that display counter intuitive behaviours. How can we look at causes but, more importantly, how can we safely manage patients who are violent, want to run away or who do not look at the responder as help. 

  

Top tips 

 

1) Always have and practice an exit strategy, identify who can help and where that person needs to be 

 

2) Can you upskill to recognise a person who is vulnerable 

 

3) Can you ask the right questions? 

 

4) Listen well, this is an art but is fundamental in helping people with counterintuitive behavior 

 

Biography

 

Dr Peter Aitken MRCGP FRCPsych is Director of Research & Development and executive lead for suicide prevention at Devon Partnership NHS Trust and Honorary Associate Professor, University of Exeter Medical School.  

He is chair of the Medical Committee at the RNLl, mental health adviser to the National Association of Primary Care, trustee at the Lions Barber Collective, and member of the steering group for Zero Suicide Alliance. He is a past chair of the Faculty of Liaison Psychiatry at the Royal College of Psychiatrists and Psychiatrist of the Year in 2016 for his work with NHS England leading the design and delivery of Core24 Liaison Psychiatry Services for all English Hospitals with an Emergency Department.  

As an executive and clinical leader, he trained in quality improvement with the US Institute for Health Improvement Patient Safety Program and the NHS program for Advanced Improvement in Quality & Safety. He has published in suicide prevention and has an experience of drawing learning from the national confidential inquiry into effective action for change in services and hard to reach communities.  

Angela Lewis – Peer Support and Debriefing

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 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

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?

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)

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?

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