BASICS Scotland Podcast

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 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.   

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/ ------------ 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.     

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 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 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 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.       

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 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     

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. 

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 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 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 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.  

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.  

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  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.  

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 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 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.  

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. 

Jonathan chats us through head injuries, focusing on concussion, what to look for, how to assess, how to treat.   Top 3 tips: “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. Look for concussion education resources. Either the Sport-Scotland concussion document or NES PBSGL modules require good places to start.  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 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 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 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 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:  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. 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.  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. 

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:  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. 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.  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. 

Stuart chats us through the Scottish Trauma network, what a major trauma centre is and the major trauma triage tool, helping us get the right patient to the right place at the right time.    BIOGRAPHY   Stuart is a Paramedic with the Scottish Ambulance Service (SAS) based in Paisley and is currently the Project Lead Major Trauma Triage Tools (MTTT). Stuart started his SAS career as a Community First Responder with Neilston and Uplawmoor First Responders who were awarded the Queen's Award for Voluntary Service in 2018. Stuart has been involved since the group was established and is still hugely involved with their work. Stuart was appointed as Project Lead Major Trauma Triage Tools (MTTT) at the start of the year to roll out the MTTTs. “The Scottish Ambulance Service is a fundamental part of the STN and this is a really exciting time for us as the MTTTs will allow paramedics and technicians to triage patients to definitive care wherever possible”.   3 TOP TIPS   Utilise the MTTT where applicable. Apply the MTTT to all significantly injured patients or those involved in high mechanism incidents. If you need any support contact the Trauma Desk. Whether it is clinical, logistical or requesting the support of advanced teams contact to Trauma Desk when needed. Documentation of the MTTT when used is key. If the MTTT is applied to any patient whether they are major trauma positive, negative or whatever hospital they are conveyed to document the use of the MTTT.

Fiona talks us through our responsibilities to the child in the community, what red flags to look for and what we can do about our concerns.    Bio  I am a Registered Mental Health Nurse.  I specialised in adult addiction and the impact this has on children and young people.  I have worked across both statutory and non-statutory agencies including Youth Justice and was the lead nurse for child protection across Glasgow city addiction services and then the Lead Officer for Glasgow Child Protection committee. My focus of keeping children safe from harm began over 20 years ago when I took on the role of working with children and families affected by substance misuse.  I am currently a consultant in Child Protection with a children's charity in Scotland and recently became a short-break foster carer and Independent Foster Panel Member.  Top 3 tips  Do not be worried about getting it wrong, better to get it working than do nothing at all.  Seek advice, do not feel you are one your own.  Remember that children and young people need adults to keep them safe from harm and abuse.  It is everyone job.      Resources/links  Getting it right for every child (GIRFEC) https://www.gov.scot/policies/girfec/ 

Aebhric focuses on some aspects and some hints and tips for delivering prolonged field care in remote areas    Biography   Aebhric is a former US Army Green Beret, a Psychologist and a board-certified Critical Care Paramedic. He is the dean for the College of Remote and Offshore Medicine Foundation which offers medical education programmes for the remote, austere and offshore industries. Aebhric taught on the NATO Special Operations Combat Medic course in Pfullendorf, Germany and taught Battlefield Advanced Trauma Life Support (BATLS) for the MoD. He has earned the Diploma Tropical Nursing from LSHTM and is currently writing a clinical doctorate from the University of Stirling.    Top tips  Be. Here. Now. This is a survival technique from the bookDeep Survival. It forces you to be in the moment and not be blinded by the stress of the situation.  I always strive to be the dumbest person in the room. If I am in a room where I am the smartest person, I am in the wrong room. I need people around me who challenge me to be better.  Always be hungry. Hungry for learning. Hungry to continually better yourself.  

Over the next few weeks we will run a series of podcasts on Major incidents.  Throughout the series Dr JP Loughrey talks through how the services prepare, what resources are available, some of the lessons learned from major incidents and communication and triage.   Top tips   Communicate effectively, using a recognized framework for consistency (METHANE)  Realistic Medicine is an accurate representation of what we should strive for, even in a Major Incident  Practice, train, drill, tabletop - anything you can do to ensure you've looked at the plan and action cards and know the principles will help when the pressure (and stakes) are high.   Resources and links    Twitter handle @Jploughrey    Stephen pinker The better angels of our nature  https://stevenpinker.com/publications/better-angels-our-nature   EMRS app  https://www.emrsscotland.org/news/2015/5/14/emrs-app   Prometheus app  https://www.prometheusmedical.co.uk/news/prometheus-methane-app-now-free   OS locate app  https://shop.ordnancesurvey.co.uk/os-locate-faq/    JESSIP app  https://www.jesip.org.uk/jesip-app    National Ambulance Resilience Unit - Triage sieve  http://naru.org.uk/wp-content/uploads/2014/02/NARU-TRIAGE-SIEVE-JU5A304D.pdf      NHS England - Clinical Guidelines for Major Incidents  https://www.england.nhs.uk/publication/clinical-guidelines-for-major-incidents-and-mass-casualty-events   Biography JP is a Consultant in EM in the QEUH Glasgow, and Retrieval Medicine with EMRS in the West of Scotland, with a particular interest in major incidents, As the ScotSTAR lead for Major Incident planning he has been involved in several large-scale incidents and training exercises. He keeps himself exceedingly busy, between his working life and his energetic young family! 

Over the next few weeks we will run a series of podcasts on Major incidents.  Throughout the series Dr JP Loughrey talks through how the services prepare, what resources are available, some of the lessons learned from major incidents and communication and triage.   Top tips   Communicate effectively, using a recognized framework for consistency (METHANE)  Realistic Medicine is an accurate representation of what we should strive for, even in a Major Incident  Practice, train, drill, tabletop - anything you can do to ensure you've looked at the plan and action cards and know the principles will help when the pressure (and stakes) are high.   Resources and links    Twitter handle @Jploughrey    Stephen pinker The better angels of our nature  https://stevenpinker.com/publications/better-angels-our-nature   EMRS app  https://www.emrsscotland.org/news/2015/5/14/emrs-app   Prometheus app  https://www.prometheusmedical.co.uk/news/prometheus-methane-app-now-free   OS locate app  https://shop.ordnancesurvey.co.uk/os-locate-faq/    JESSIP app  https://www.jesip.org.uk/jesip-app    National Ambulance Resilience Unit - Triage sieve  http://naru.org.uk/wp-content/uploads/2014/02/NARU-TRIAGE-SIEVE-JU5A304D.pdf      NHS England - Clinical Guidelines for Major Incidents  https://www.england.nhs.uk/publication/clinical-guidelines-for-major-incidents-and-mass-casualty-events   Biography JP is a Consultant in EM in the QEUH Glasgow, and Retrieval Medicine with EMRS in the West of Scotland, with a particular interest in major incidents, As the ScotSTAR lead for Major Incident planning he has been involved in several large-scale incidents and training exercises. He keeps himself exceedingly busy, between his working life and his energetic young family! 

David Lauritsen wears multiple hats living in a very rural community, in this podcast, he chats through the skills, communication strategies, teamwork and other aspects of the management of patients involved in a road traffic collision.   Top 3 Points from this podcast: If a Firefighter offers to do a removal from the car to create space and uses jargon that you don't understand, ask for a time scale for the job, there are many terms such as B-post removal, roof flap, or dashboard roll we might not be sure of, but everyone knows 3-4 minutes. There are usually more than one appliance on scene at RTC's, if manpower allows, ask one of the fire services to provide inline stabilisation and to continually talk to the casualty. They are great at knowing what's going on and reassuring the patient prior to loud noises like metal being cut or glass breaking. Try to take a minute to discuss plans for the deteriorating patient, if everyone knows the game plan they all work towards the same goal. Resources related to this podcast: Fire Scotland Website About David David works in a remote and very beautiful area in the North of Scotland and wears a number of hats in his community.  He has been a member of the Scottish Fire and Rescue Service team for 22 years and has also worked for The Scottish Ambulance Service for 10 years, 5 of these as a paramedic.  As well as being a married father of 2 David also volunteers as a BASICS responder in his spare time.

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.  

Murdo explains the reason effective Search Management is vital when looking for missing people. Discussing the rational and some of the techniques behind the decisions that are made supported by in-depth research. Additionally, the role that BASICS and other medical responders may find themselves playing.    Tips    People are often nearer their place last seen than the lay-person would think they are - put yourself in the casualties shoes Missing persons are often time critical incidents in terms of survivability, search IS an emergency - effective search is a meshing together of good command and control and detailed low level search tactics. Define the parameters of your search ASAP, always look for information to support your hypothesis – don't be afraid to stop and re-evaluate.” Biography    “I'm Murdo Macaulay and I'm the Coastal Operations Area Commander for Western Isles, Skye and Lochaber. My role is to lead the Coastguard Rescue Service in this area and, in conjunction with the rest of my small full time team ensure that teams are trained and operationally ready to respond as HM Coastguard's land based response to those in distress on the coastal areas and also inland in support of other emergency services. I am an operational Search and Rescue practitioner and Coastguard Search Adviser, providing incident command and direction on scene as tasked. I hold the portfolio for the implementation of our revised Lost & Missing Persons procedures within the service.      

Paul Watson, project lead for end of life care at the Scottish Ambulance Service talks about how the service is striving to bring better palliative care to patients across Scotland with some discussion around the areas of non-technical skills, “just in case” boxes, and the other tools that can be used to support these patients.   Key points from this podcast: Remember to check the patients emergency care summary, key information summary.  This holds a wealth of useful information. Don't feel you need to make decisions on your own.  Speak to the patients wider team. Don't be afraid to ask your patient directly about their wishes. Resources related to this podcast: https://www.spict.org.uk/ https://www.ec4h.org.uk/ https://www.palliativecareguidelines.scot.nhs.uk/ https://www.resus.org.uk/respect/ About Paul Paul is a Paramedic working for the Scottish Ambulance Service and is based in Glasgow. In July 2019 Paul was appointed to Project Lead for a joint partnership project between the Scottish Ambulance Service and Macmillan. The aim of this project was to pilot the requirements to improve our ability to deliver better End of Life Care for the patients attended to as part of normal practice. The project workload has included development of education packages, clinical guidelines and joint working with various Health Boards and palliative care interest groups. Paul looks forward to further developing the project nationally with a particular interest on how technology can be used to support both patients and clinicians.

Mark talks us through the process of managing ROSC in the paediatric patient.    Bio:  Mark is a Paediatric Intensivist at Royal Hospital for Children in Glasgow, a consultant in Paediatric Critical Care Transport at ScotSTAR and a responder support clinician for BASICS Scotland. His interests include the management of critically unwell children anywhere.       Top Tips:    1) Do the basics well and use the ABCDE approach you would in the adult approach and  just tweak the equipment and maneuvers to suit  2) IO access may be very valuable in children where IV access can be more tricky to gain and think about the needle sizes  3) Phone a friend for top-down cover and discuss the pathway and help available     Resources:  EasyIO Intraosseous vascular access system  https://www.teleflex.com/usa/en/clinical-resources/ez-io/index 

Helene chats us through the physiological changes in the pregnant women and post-partum haemorrhage assessment and management   Top 3 Points from this podcast: Consider the 4 T's: Tone, Tissues, Trauma, Thrombin (and coagulation) If you have a woman than tells you she is at high risk for a post-partum haemorrhage you should consider giving her the 600mcg of misoprostol after she has had her baby. Think about the blood volume that the woman has and how she is able to tolerate a greater blood loss before she shows any signs of deterioration, this is why you need your large bore cannulas and you need to replace the fluids that she has lost and do this quickly with quite large amounts of fluid. Resources related to this podcast: MBRRACE- UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK Scottish Multi-professional Maternity Development Programme (SMMDP) BASICS Scotland Portfolio Project The animation discussed in the podcast(Requires download) Postpartum-haemorrhage About Helene   Helene has been a midwife since 1982 and has held several clinical roles, she has been the Director of the Scottish Multiprofessional programme (SMMDP) for the last 13 years. She worked in Zambia (Africa) as a midwife in the early 80's and met her husband a fellow scot there, she has 3 grown-up children. She has on the SAS clinical advisory group for maternity and has a great interest for remote and rural services and pre-hospital care. Helene was on the board of directors for the Royal College of midwives for 6 years. She and her husband have a boat on Loch Linnhe so is often seen in those parts with Dougal an intrepid sea dog 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.  

Les talks us through the primary survey in some special circumstances, some kit considerations and some human factors to think about.   Top 3 tips    1)  Most importantly  when you are delivering the primary survey don't get side tracked to non-life threatening issues  2) Expect to repeat the primary survey at least once and probably more times, reassessment is crucial  3) Practice, practice, practice    Resources and links    Experience in Prehospital Intubation Significantly Influences Mortality of Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis  https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0141034.t003    Prehospital endotracheal intubation vs extraglottic airway device in blunt trauma  https://pubmed.ncbi.nlm.nih.gov/25963681/    The Impact of Prehospital Endotracheal Intubation on Outcome in Moderate to Severe Traumatic Brain Injury  https://journals.lww.com/jtrauma/Abstract/2005/05000/The_Impact_of_Prehospital_Endotracheal_Intubation.10.aspx    Prehospital intubations and mortality: a level 1 trauma center perspective  https://pubmed.ncbi.nlm.nih.gov/19608824/    Difficult Intubation due to Penetrating Trauma from a Crossbow Bolt  https://pubmed.ncbi.nlm.nih.gov/32690309/    Management of the Traumatized Airway  https://pubmed.ncbi.nlm.nih.gov/26517857/    Resident manual of Trauma to the Face, Head and Neck  https://www.entnet.org/content/resident-manual-trauma-face-head-and-neck      Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma  https://academic.oup.com/bja/article/117/suppl_1/i49/1744426    Hypothermia in trauma victims at first arrival of ambulance personnel: an observational study with assessment of risk factors  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402666/    When do trauma patients lose temperature? - a prospective observational study  https://pubmed.ncbi.nlm.nih.gov/29315468/    Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method of Casualty Rewarming  https://www.wemjournal.org/article/S1080-6032(17)30097-2/fulltext#:~:text=Battlefield%20Trauma%2DInduced%20Hypothermia%3A%20Transitioning%20the%20Preferred%20Method%20of%20Casualty%20Rewarming,-Brad%20L.&text=For%20centuries%2C%20cold%20and%20wet,foot%2C%20frostbite%2C%20and%20hypothermia.    Predictors of Hypothermia upon Trauma Center Arrival in Severe Trauma Patients Transported to Hospital via EMS  https://www.researchgate.net/publication/332214670_Predictors_of_Hypothermia_upon_Trauma_Center_Arrival_in_Severe_Trauma_Patients_Transported_to_Hospital_via_EMS    Biography:  Les Gordon is an experienced anaesthetist, whose special interest is in difficult airway management, and he instructs on the national Training in Emergency Airway Management course for this.  He started Mountain Rescue eleven years ago in the Lake District and has attended about 450 rescues.  His special interest is accidental hypothermia, about which he has published several papers, written chapters in two books, given presentations at National and International conferences, and has drawn up and regularly updates Mountain Rescue England & Wales Hypothermia protocols 

Lucy Powls describes the process of normal birth, including the mechanisms of labour. She then looks at newborn assessment and takes us through the neonatal resuscitation algorithm.   Top 3 Points from this podcast: Remember in most cases, pregnancy and childbirth are normal physiological processes  Try to keep calm as this will reassure the woman (she doesn't need to know whether you have delivered a baby before!)   With newborn babies it is a respiratory issue – most babies will respond to simple A and B of resuscitation when done well  Resources related to this podcast: Resuscitation guidelines app I-Gel Insertion Video 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.

Les chats us through some interesting aspects of the primary survey   Top 3 Points from this podcast: Most importantly when you are delivering the primary survey don't get sidetracked to non-life-threateningissues Make sure you document everything as thoroughly as you can You have to play the hand you have been dealt, in the prehospital environment resources and environment can be limiting, do your best and remember the conditions are not optimal Resources: Evolution and Development of the Advanced Trauma Life Support (ATLS) Protocol: A Historical Perspective  https://pubmed.ncbi.nlm.nih.gov/22495839/  The Birth of Advanced Trauma Life Support (ATLS)  https://pubmed.ncbi.nlm.nih.gov/16764202/  Battlefield Trauma Life Support: Its Use in the Resuscitation Department of 32 Field Hospital Dring the Gulf War  https://pubmed.ncbi.nlm.nih.gov/8840795/  ABC to ABC: Redefining the Military Trauma Paradigm  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579588/  About Les: Les Gordon is an experienced anaesthetist, whose special interest is in difficult airway management, and he instructs on the national Training in Emergency Airway Management course for this.  He started Mountain Rescue eleven years ago in the Lake District and has attended about 450 rescues.  His special interest is accidental hypothermia, about which he has published several papers, written chapters in two books, given presentations at National and International conferences, and has drawn up and regularly updates Mountain Rescue England & Wales Hypothermia protocols 

Adrian Kay, Senior Coastal Operations Officer for H.M. Coastguard, explains more about the 3 sections of the coastguard service, and how the 3000 volunteers make up the 400 UK crews. Understanding how these crews fit into the responder network, and what their roles, responsibilities and capabilities are, will allow BASICS Scotland Responders to make better use of these resources in the future. Top tips from this podcast: Call early- via ambulance control to the Coastguard Ops Room rather than local contacts Think creatively – HMCG can provide an adaptive rescue 'toolbox' to assist in remote areas Given all of the assets the Coastguard coordinates (air, sea and land), keep them in mind as a resource if you are stuck with a job Resources related to this podcast: Maritime & Coastguard Agency YouTube Channel HM Coastguard Operations Centres HM Coastguard website – www.mcga.gov.uk About Adrian Adrian initially moved to the West Highlands in 2000, to work for SNH on the Isle of Rum (population 25). This also give him his first experience of contact with HM Coastguard, as a volunteer on their small response team. He then joined Northern Constabulary, in various policing roles including CID, child protection and wildlife crime.  He also served for four years on Benbecula and the Uists, which gave him a great insight into the challenges of remote rural policing. In 2006, he joined HM Coastguard as a Senior Coastal Operations Officer, training and supporting volunteer Coastguard Rescue Teams across the Argyll coast and islands.  He ensures the teams maintain a high level of operational readiness, and is a technical instructor in water rescue, land search, casualty care and rope rescue techniques. Adrian has a particular interest in casualty care, and as well as introducing the enhanced Coastguard CERCC course locally and providing training support elsewhere on the coast, he is currently involved in the introduction of a robust clinical governance framework across the organisation.

Karyn chats us through the deteriorating patient, what to look for and how to treat these patients and the PEWS score system and function    Top Tips     1) Remember that you are assessing a point in time   2) Be very aware of where they have been and where you think they are going when carrying out the examination  2) If you think the child is ok to return home, coach the family so that they know what to look for and how to access the necessary healthcare if things change    Resources and links:  Paediatric Early Warning Score (PEWS)  https://www.clinicalguidelines.scot.nhs.uk/nhsggc-paediatric-clinical-guidelines/nhsggc-guidelines/surgery/paediatric-early-warning-score-pews/  ScotSTAR paediatric Retrieval Service  https://www.snprs.scot.nhs.uk/    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  

In this week's podcast Alastair Beer talks about the role of the RAF Mountain Rescue; how it differs from the civilian Mountain Rescue and what capabilities it has. He highlights the dangers of air crash sites and the hazards that face responders who are tasked to air accidents. Key points from this podcast: If it is a military aircraft always assume it is armed and with a civilian aircraft consider the ballistic recovery systems therefore always assume you are working under a high level of risk at any aircraft crash site. Only enter the crash sites if you have to save life or for recognition of life extinct for anything else stay out of the crash site.  If you have to go into the site consider preservation of evidence while working on scene A crash site will be a really confusing, hazardous and unpleasant place and if first on scene you could be dealing with multiple casualties which is a very difficult situation to find yourself in. Take a moment, take a deep breath and have a think about the scene and make sure you are safe before approaching. Quickly declare a Major incidence and accurately report a METHANE report about the incident back to ambulance control before you start to treat patients, especially if you are first on scene. Resources related to this podcast: Guidance publication for Aircraft Post Crash Management – https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/919973/Guidance_Pub_version_High_amend.pdf About Alastair Alastair joined the RAF regiment in Oct 1999. Initially based at RAF Waddington as Ground Based Air Defence. In this role he was deployed to Oman, Kuwait and the Falkland Islands. Following that tour he spent 6 years at RAF Leeming in the Force Protection role in which he completed several tours of Iraq and Afghanistan and Belize. In 2010 he was posted to RAF Kinloss and Lossiemouth as a Force Protection instructor and his final tour with the RAF Regiment was as the machine gun specialist on 51 Squadron at Lossiemouth. His RAF Mountain Rescue career started in 2003 at RAF Leeming as a part time member of the team and continued following his posting to RAF Kinloss. Throughout this period his MRT and RAF Regiment careers ran in parallel. He was released from the RAF Regiment in 2017 and posted as Permanent Staff to RAF Lossiemouth MRT as the Medical Co-ordinator. In 2018 he became the Deputy Team Leader. His time in MRT has seen him conduct training across the UK, Norway, Europe and Hong Kong. Operational callouts have been very varied from responding to a helicopter crash in Devon through to recovering the bodies of 2 climbers on Scotland's most northerly Munro, Ben Hope.

Return podcast guest Paul Savage talks to the BASICS about the benefits of moulage in training scenarios. https://www.saviourmedical.com/  Twitter / Instagram : @saviourmedical  Savour Medical Simulation Service – Wound Catalogue Saviour Medical – Zero-Hero Medical Moulage and Simulation Course   BIOGRAPHY Mr Paul Savage OBE BSc SRP – Managing Director Saviour Medical Ltd with a mixed portfolio.   Paul walked into a Lifeboat station on his 17th birthday and never left, initially volunteering at Poole and now at Tower Lifeboat in London.   With his interest in remote and maritime paramedical medicine he joined the RNLI full time in 2005 as the Clinical Operations Manager and Head of Operational Medicine. He was responsible for the operational medical response of all of the UK and Eire's Lifeboat crew, Lifeguards and Flood Response teams, as well as the architect and custodian of the Clinical Governance of the RNLI. He advised on all matters casualty care related - from kit carried, casualty care course design to casualty-friendly boat design.   For a complete step change of maritime medicine around the UK, Paul was awarded an OBE in December 2013.   Since 2014 as a self employed consultant, Paul has a mixed portfolio of pre-hospital medical related work, including check card based learning resources, Clinical Governance of HM Coastguard and University Lecturing.   Paul is Chairman of the UK Search and Rescue Medical Group which shapes the future and direction of UK SAR medicine, and is a member of the Main Advisory Board and the Training and Standards Board of the Faculty of Pre-Hospital care of the Royal College of Surgeons (Edinburgh). He is also an instructor for specialist elite sections of the UK Military.   

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.

Cliff, based in Australia, talks us through the zero-point survey, why it is important and how we use it for the emergency setting. Top 3 Points from this podcast: There are multiple opportunities to optimise how a prehospital mission goes that present themselves long before you set eyes on the patient(s). No matter how good you are (or think you are), it's the output of the TEAM that ultimately determines patient outcome. Effective scene management / environmental control is the key determining factor between expert and non-expert prehospital care. Resources: Zero Point Survey: A Multidisciplinary Idea to STEP UP Resuscitation Effectiveness. REID, C., BRINDLEY, P., HICKS, CARLEY, S., RICHMOND, C., LAURIA, M., & WEINGART, S., 2018.  Clinical and Experimental Emergency Medicine. 5(3), pp 139-143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166036/ About Cliff: Cliff works for New South Wales Ambulance as one of the retrieval physicians with Sydney HEMS. He also works in emergency medicine and intensive care. He is fascinated by the factors that optimise team performance in resuscitation.

Today Aravindan discusses the best way to approach and treat patients who may be experiencing overdoses, poisonings and/or drug-related agitation Top 3 Points from this podcast: Use sodium bicarbonate more, if this is a drug you carry and is within your scope of practice, for sodium channel blocking drug overdoses. Antidotes for the sedatives e.g. naloxone should only be used for protection of the airway and/or ventilation and a clear record of the reason for giving this antidote made.  If an antidote is used, give enough to protect from ventilation National Poisons and Information service is always happy to be contacted for information, use toxbase as a good resource too. Resources related to this podcast: Toxbase Website: www.toxbase.org.uk Edinburgh Clinical Toxicology: www.edinburghclinicaltoxicology.org National Poisons Information Service: http://www.npis.org About Aravindan Arvind is a Consultant in Acute Medicine and Toxicology at the Royal Infirmary of Edinburgh. In his toxicology role, he manages toxicology patients in a dedicated poisons ward and also reviews them in the Emergency Department and Intensive Care. He also provides telephone advice on the National Poisons Information Service (NPIS) and has an active role in editing TOXBASE, the online poisons information service of the NPIS. He has been involved in collaboratively developing protocols and guidance for the management of agitated and poisoned patients in all of the above roles. He also teaches about clinical pharmacology, toxicology and quality improvement.   

The second in a series of two, Joel continues his chat on the role of the Advanced Practitioner in Critical Care (APCC) and what they can bring to help you at different scenes and conditions.    Top tips  1)   Maintain dialogue with the incoming APCC and make any stand down decisions a discussion  2)  APCC are not just there for incidents you would consider a red team for, instead think of  them as supporting you with any incidents that perhaps push your own boundaries and you  need some help and support  3)  When you meet the team, please engage, ask questions, have a look and kit and have a chat,  they are there to support you in any way they can. About Joel Joel Symonds is an Advanced Practitioner in Pre-hospital Critical Care from Edinburgh.  On leaving school he worked as a nanny, a pyrotechnician, a children's actor and a civil servant.  He joined the Ambulance Service in 2005 and was promptly told by a burned-out colleague – “The problem with joining the ambulance service is once you've become a paramedic there's nowhere else to go”.  Choosing to ignore this nihilism, Joel has spent his career exploring the opportunities available to staff with pre-hospital management skills.  Since then, he has worked in international motor racing, desert search and rescue, hostile environment industrial health care, governance consultancy, education and research. He is regularly asked where he'll be in five years' time: he has no idea, but can't wait to find out. Joel has a special interest in human factors, interactions and experience within emergency care, believing that everything we do ultimately hinges on the patients, care providers and bystanders involved.  Joel lives in Edinburgh with his family, plays geeky board games and emerged from the 2020 pandemic as a runner and baker.  He'll probably have found something different next week.

Mary chats us through aspects of the autistic conditions, shining a light on the challenges but also some providing top tips on how to help manage patients from this group in an emergency situation including approach and communication strategies. Top 3 Points from this podcast: Keep calm and use a confident demeanour Use short sentences and try to create a good rapport Consider who is there or are contactable, someone who knows the patient and can assist with communications Resources related to this podcast: Sign national guidance 145 The Scottish strategy for autism brain and hand app Part 5, adults with incapacity act Mental welfare commission About Mary Mary is a Nursing Officer for the Mental Welfare Commission Scotland. She has many years of experience in both learning disability and mental health nursing. One of her specific areas of interest is working with autistic people. Mary has been involved in Supporting families of autistic children, working with both the child and parents, she has worked jointly with a Speech and Language therapist in the provision of Social Skills training for young autistic adults. The most recent project involving her interest and passion for autism was ” The Mental Welfare Commissions Autism themed visit” across Scotland. This was Mary's first time that the Commission had undertaken a visit specifically looking at support for people with autism. This project generated recommendations to improve care and treatment for this population. In her spare time, she enjoys walking in the great outdoors, running and yoga. she is an accomplished cook and loves to eat too!  

The first in a series of two podcasts, Joel talks us through the roles, responsibilities, skills and capabilities of the APCC team, where they can be found and why and when we should use them.     Top tips  1)   Maintain dialogue with the incoming APCC and make any stand down decisions a discussion  2)  APCC are not just there for incidents you would consider a red team for, instead think of  them as supporting you with any incidents that perhaps push your own boundaries and you  need some help and support  3)  When you meet the team, please engage, ask questions, have a look and kit and have a chat,  they are there to support you in any way they can.     About Joel Joel Symonds is an Advanced Practitioner in Pre-hospital Critical Care from Edinburgh.  On leaving school he worked as a nanny, a pyrotechnician, a children's actor and a civil servant.  He joined the Ambulance Service in 2005 and was promptly told by a burned-out colleague – “The problem with joining the ambulance service is once you've become a paramedic there's nowhere else to go”.  Choosing to ignore this nihilism, Joel has spent his career exploring the opportunities available to staff with pre-hospital management skills.  Since then, he has worked in international motor racing, desert search and rescue, hostile environment industrial health care, governance consultancy, education and research. He is regularly asked where he'll be in five years' time: he has no idea, but can't wait to find out. Joel has a special interest in human factors, interactions and experience within emergency care, believing that everything we do ultimately hinges on the patients, care providers and bystanders involved.  Joel lives in Edinburgh with his family, plays geeky board games and emerged from the 2020 pandemic as a runner and baker.  He'll probably have found something different next week.

David “Heavy” Whalley with his plethora of civilian and military search and rescue experience chats us through the effects events such as the Lockerbie disaster has had on him.  He discusses the culture and attitude change to the effects these incidents have on the responder, what to look for and how to create healthy coping systems and networks. Key points from this podcast: Look after your team and know and look out for the signs that things are not going so well Its good to talk, never be ashamed to talk.  Look after your families Resources related to this podcast: Personal Website – www.heavywhalley.com About David David's love of the mountains was inspired by his parents, a member of the RAF Mountain Rescue (MR) for 37 years in the roles of Team Leader of RAF Leuchars, RAF Kinloss and Deputy Team leader at RAF Valley in North Wales. He spent his last four years working in the ARCC Aeronautical Rescue Co-ordination Centre at RAF Kinloss.  With over 1000 mountain and 80 aircraft incidents, David was also the Senior team leader at the Lockerbie disaster.  As a member of the Scottish Mountain Rescue Executive Team for over 20 years, he fulfilled roles as the Chairman, Accident Statistician and Torridon Mountain Rescue Team member. He was awarded the BEM, MBE and the Distinguished Service Award for Service to Mountain Rescue Heavy is retired now and is in the process of writing a book and lecturing on Mountain Rescue and Mountain Safety in the UK and overseas.