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52 minutes | 13 days ago
Life Under Fire with Jason Fox
In this episode I chat to Jason Fox about his new book ‘Life Under Fire’ for those of you that aren’t familiar with Jason, he is a former Royal Marine Commando and Special Forces Sergeant. Joining at 16 and serving for 20 years; Jason passed the grueling selection process for the Special Forces in 2001, serving with the Special Boat Service till 2012. Jason has planned and led operations including hostage rescue, counter terrorism, counter insurgency, maritime counter terrorism, surveillance, body guarding and counter narcotic missions. He currently features in the channel 4 program - SAS: Who Dares Wins. The book is split into two parts, the first part the battle mind looks at his journey to a resilient life and mental approach. The second part - Strength and Guile looks at the lessons learned from his 20 years as an operator and royal marines commando and inferred learning to the reader. Concepts we explore include: The concept of graded exposure to training. The sense of community and brotherhood from war. Jason's struggles with PTSD and the emotional combat indicators that signify it. The ‘cigar moment’ and how it calms the central nervous system down. Awareness of your own vulnerabilities and how it can help protect you. The preferential mode of de-escalation over aggression (grey man, passive use of the weapon). High performing teams ability to self regulate rather than externally regulate. Reframing negative events and what it can teach us about resilience. The power of debrief also known as Sensitive Site Exploitation/SSE. The concept that there is a flattened hierarchy and everyone can contribute a game changing piece of information. Not resting in the aftermath of success and using failure as a teacher. I hope you enjoy the episode. You can find 'Life under fire' by Penguin books here: https://www.penguin.co.uk/books/111/1119268/life-under-fire/9781787633193.html
59 minutes | 16 days ago
EOLC 4: Grief and bereavement with Julia Samuel MBE
In this episode Julia Samuel and Caroline Phillips discuss grief and the process of bereavement. We discuss important skills for breaking bad news, bereavement by exposure and ways in which we can support our own resilience as healthcare professionals. Julia Samuel is a psychotherapist who has spent the last thirty years working with bereaved families. She has worked both in private practice and in the NHS at St Mary’s Hospital Paddington where she pioneered the role of maternity and paediatric psychotherapist. In 1994 she worked to launch and establish Child Bereavement UK as its Founder Patron, where she played a central role until September 2019. Julia was awarded an MBE in the 2015 New Year’s Honours list for services to bereaved children. She is the author of two books: Grief Works and This Too Shall Pass. We hope you enjoy the episode. Further reading: - Child Bereavement UK https://www.childbereavementuk.org/?gclid=Cj0KCQjw2or8BRCNARIsAC_ppyYXJ4jJ5kW2226C30UnEuOOBqUA8vUbrBPiCuZFHmJ4sh1L8HHhydIaAjssEALw_wcB - Information about Julia Samuel’s books, ‘Grief Works’ and ‘This too shall pass’ can be found here, as well as her ‘Pillars of Strength’ tips - https://juliasamuel.co.uk - Cruse Bereavement UK has practical resources and information for personal and professional use - https://www.cruse.org.uk
44 minutes | 23 days ago
EOLC 3: Advanced Neurological Disease with Diane Laverty
This episode explores advanced neurological conditions with Palliative Nurse Consultant Diane Laverty. Diane has over 30 years experience in palliative care and spent time in her doctorate exploring informal carers needs when looking after those with progressive neurological conditions. Motor Neurone, Parkinson’s and Multiple Sclerosis conditions are discussed, common symptoms and potential exacerbations are covered and the wider social implication on family and carers are discussed. Further reading: - Motor Neurone Disease Association https://www.mndassociation.org - Parkinson’s Foundation https://www.parkinson.org - Multiple Sclerosis Society https://www.mssociety.org.uk/about-ms/what-is-ms - Oxford Handbook of Palliative Medicine (2019) We hope you enjoy the episode.
7 minutes | a month ago
PHCP - house keeping episode
I just wanted to do a house keeping episode to let you know what to expect in this season. We are half way through the mini series on End of Life Care and had 'recognising the dying phase' with Dr Emma Hall and 'oncological emergencies' with Merel a cancer clincial nurse specialist. We have two more instalments of EOLC and these are around advanced neurological disease with Diane Laverty and Grief and bereavement with Julia Samuel MBE. Caroline Philips has done a fantastic job at cataloging some of these essential conversations and really helping us appreciate some of the deeper facets of end of life care. We will have some skill based episodes with myself and Nick Brown. These are looking at the skills undertaken by clinicians and everything that the text books don’t tell you around experiential learning and reflections of performing these on a daily/weekly basis - we will look at IO, splintage, intubation, IV access and other skills. We will look at pain management with a pain specialist and some of the types and methods of acute and chronic pain management that we might face in the pre-hospital environment. We will do a deep dive into one of the prolific drugs in society and that we interact with on a daily basis - that of alcohol. We will look at chronic alcoholism and how it changes physiology. We will also look at acute intoxication and why these patients can be so difficult to look after. We will start with a mini case review series as well - dissecting some challenging cases and what we can learn from these cases. We will also look at urgent care with a GP and urgent care advanced paramedic in more detail and some of the subtitles that we can learn to pick up as clinicians. Finally we will look at some of the diverse range of pre-hospital career options that are available for clinicians (paramedics, doctors and nurses) in the current climate. We hope you enjoy the season.
37 minutes | a month ago
EOLC part 2: Oncological Emergencies with Merel and Caroline Philips
In end of life care we are mindful of respecting patient’s wishes, including those relating to conveyance to acute care settings. However there are some presentations, specifically in relation to cancer, which we need to be aware of and rapidly refer onto either acute or specialist colleagues. In this episode we explore these reversible oncological emergencies based on cases seen in Merel’s clinical experience as a Cancer Clinical Nurse Specialist in a specialist cancer centre in The Netherlands. We review Neutropenic Sepsis, Superior Vena Cava Obstruction, Metastatic Spinal Cord Compression and Hypercalcaemia. Further reading: - AACE JRCALC Clinical Guidelines (2019) – End of Life Care - NICE Guidelines - Metastatic spinal cord compression in adults: risk assessment, diagnosis and management - NICE Guidelines - Neutropenic sepsis: prevention and management in people with cancer - Oxford Handbook of Palliative Medicine (2019) We hope you enjoy the episode.
66 minutes | a month ago
End of Life Care: Recognising the dying phase with Dr Emma Hall
In this episode Caroline Phillips hosts Dr Emma Hall, Palliative Care Consultant and discusses the signs of the final few days and hours of life. We discuss the challenges of recognising the dying phase, the importance of shared decision making and the positive aspects of shared learning between prehospital and palliative care professionals. This is part of a mini series on the Pre-hospital Care Podcast where we will start to look into topics in more depth and involve some of the subject specialists to share their experience. We hope you enjoy the episode. Further reading: Kathryn Mannix – With the End in Mind Oxford Handbook of Palliative Medicine (2019) AACE JRCALC Clinical Guidelines (2019) – End of Life Care
61 minutes | 2 months ago
The Pre-hospital Debrief with Nick, Caroline and Eoin
In this episode we explore some of the fundamental the components what makes a good debrief. The concept of debrief effects everyone within pre-hospital care whether formal or informal. Involvement in a debrief exercise can help to make sense of events and offer the opportunity for learning that can be applied in the future. It’s power, in part, is that it takes place when the events are fresh in the mind and that all experiencers are able to contribute. In this episode we dig a little into the broad benefits of debriefing and what makes for a successful debrief exercise (as well what doesn’t) within the context of prehospital care. How can we optimise the setting and structure in which a productive conversation can be had in order to maximise the outcomes from a debrief? Also, is shared reflection just for those ‘big jobs’ or can we apply it to any experience? We look at: Definitions of debrief. What do we think debriefing is/what purpose it serves. What debriefing is not. How we can optimise the setting for a successful debrief. How to structure a debrief. Relevant content in the context of pre-hospital care. Some of the issues/pitfalls/barriers involved in debriefing. The models we refer to in the episode are here: Gibbs cycle: https://www.mindtools.com/pages/article/reflective-cycle.htm The 3D model of debriefing: https://www.semanticscholar.org/paper/The-3D-model-of-debriefing%3A-defusing%2C-discovering%2C-Zigmont-Kappus/7b63a9876c39340398dedd25b48eddc5f08096b8 Other insightful resources include the book 'Never fly solo' by Rob Waldman: http://www.neverflysolo.com/about-book.html Debriefing tools: https://www.nds.org.au/images/resources/wa-safer-services/Debriefing-Tool.pdf We hope you enjoy this wide ranging conversation.
45 minutes | 2 months ago
Club drugs, illegal highs and Novel Psycho-active Substances with Owen Bowden Jones
This is a wide ranging conversation on club drugs, illegal highs and Novel Psycho-active Substances (NPS) with Dr Owen Bowden Jones. Owen is a Consultant Psychiatrist with over 20 years' experience in general and substance misuse psychiatry in both the NHS and private practice. In 2010 he founded the Club Drug Clinic, offering treatment specifically for those using 'club' drugs such as cocaine, ketamine, MDMA, GHB/GBL and novel psychoactive substances. In the conversation we discuss: The definition of Club drugs and illegal highs/Novel Psychoactive substances Define the problem by age and top 5 commonly seen drug presentations (differentiate between prevalence and problem – i.e. seeking help) Examine traditional vs emergent drug trends Look at groupings of drugs – Sedatives/dissociates, stimulants, synthetic cannabinoids, hallucinogens Examples of each and on common presentations & adjunctive use (concomitant use of these drugs) Ask about sourcing & trends in where people acquire drugs presently Look at first line staff engagement – who sees these groups of patients first (not always acute presentations) Examine new harms & clinical challenges Reference project Neptune – Novel Psycho-active Treatment Uk Network There is free e-learning on club drugs, illegal highs and NPS that Owen has put together, please find it at: http://neptune-clinical-guidance.co.uk/e-learning/ Feel free to reach out to Dr Bowden-Jones here: Owen.email@example.com • Clubdrugclinic.firstname.lastname@example.org • www.clubdrugclinic.com • @ClubDrugClinic @OwenBowdenJones www.neptune-clinical-guidance.co.uk
56 minutes | 3 months ago
Bonus episode: Depression & Micro-adventure - Restore Podcast
In this wide ranging conversation with Will Duffin - a passionate GP, educator, adventurer, innovator and polymath we define the current problem around depression and then examine different states of depression. We also look at why people get caught in the cycle of depression and current modalities of treatment for depression (chemical intervention, groups, social prescribing, referral pathways). We then look at the concept of micro-adventure & the benefits of these together with Will’s perspective on optimising mental health and balance (work/life). We look at how do Will achieve's balance in his life and regimes that works for him. We also examine ways in which he has changed his mindset and approach to mental health over the past 10 years both as a GP and as an adventurer. We dig down into some of the statistics on Mental Health and why this is such an important topic - such as (Figures from MIND and MHFA England 2020): 1 in 4 people experience mental health issues each year 792 million people are affected by mental health issues worldwide At any given time, 1 in 6 working-age adults have symptoms associated with mental ill health Mental illness is the second-largest source of burden of disease in England. Mental illnesses are more common, long-lasting and impactful than other health conditions Men aged 40-49 have the highest suicide rates in the UK 70-75% of people with diagnosable mental illness receive no treatment at all Half of mental ill health starts by age 15 and 75% develops by age 18 I hope you enjoy this conversation with an insightful and thoughtful colleague and friend.
60 minutes | 3 months ago
Thames Valley Air Ambulance (TVAA) with Ben Watts and Iain Edgar
In this wide ranging conversation with Critical Care Paramedic Ben Watts and ED Consultant Iain Edgar we look at an overview of the TVAA service in providing critical care to the community. We also look at how expedition and military domains that they both practice can be used within the pre-hospital critical care environment. Other aspects of the conversation includes: The patient target group and demographics of the service. Examine traditional vs emergent pre-hospital presentations that Iain and Ben have seen over their time in pre-hospital care. Interventions and decision-making and how these are approached within TVAA. Critical care training approaches, quality assurance and quality improvement within the service. Frontline staff engagement and how the service both encourage and incorporate them within the scheme. Innovations that the scheme has embedding and medium to long-term innovations that may improve the program Non-technical aspects of care Vs technical skills & utilisation rates Incremental gains when orchestrating flash teams Personal learnings over the last >2 years I hope you enjoy the last of these critical care service review sessions with two insightful friends and colleagues.
64 minutes | 3 months ago
Conflict Resolution with Ray Goodall
In this episode we explore conflict resolution with Ray Goodall. Ray is an accomplished ex-military senior officer who is skilled in developing cohesive teams and has a vast operational background. He is Internationally acclaimed War College Faculty and a military institute instructor. He is also a liaison and advisor to Presidents, Ambassadors and Generals in complex multinational combat environments. Ray has extensive Combined Joint Force and Air Component Crisis Planning experience. He is an internationally recognized expert of the Command and Control of Air Power. In this wide ranging conversation we explore: · The definition of Conflict resolution · Leadership in conflict situations (enemy and colleague conflict) · Models of conflict resolution - Strategy of Conflict and Game theory · De-escalation techniques used (aviation/inter-personal) · Optimisation of physiology - whether you use breathing techniques or tools to focus · Mentoring Vs Coaching · Rapid Decision making under stress and/or incomplete information · Failure (anecdotal examples of how you've learnt through failure) · Debrief & how to harness the best out of the debrief I hope you enjoy this episode with an extremely insightful and interesting guest.
38 minutes | 4 months ago
Trauma with Karim Brohi
Karim is a Professor of Trauma Sciences in the Blizzard Institute, Barts and the London School of Medicine & Dentistry, and Consultant Trauma & Vascular Surgeon at Barts Health NHS Trust. He is also the director of the pan London trauma system. In this episode we look at: Monitoring modalities and diagnostics (the advent of pre-hospital and in-hospital US, in-hospital CT & MRI) that have led to an improvement in outcome. Whether front loading pre-hospital critical care teams with more interventions had a net positive impact on survival to discharge. The benefit of numerical targets for physiology such as blood pressure in resuscitation or more organic end-points such as mentation/AVPU or pallor/diaphoresis/respiratory rate are more useful? The adverse effects of complex interventional involvement in pelvic blunt injury (such as REBOA or ECMO) are worth the investment at point of injury or whether they are better placed in centres of specialism? What we can do to prevent penetrating trauma as the upward trend in penetrating disease continues? Look at the advances in rehabilitation services Vs impact on survival to discharge in comparison to pre-hospital, & surgical intervention? Some of the more common injury patterns that exist more-so now compared to when Karim first started as a surgeon. The recent challenges faced within the Pan London Trauma Networks. The advent of Acute Traumatic Coagulopathy (ATC) in the early 2000’s and its consequential impact on survival since. Where Karim sees the largest gains that can be made in pre-hospital care? What Karim looks for potential in other junior clinicians Advice that Karim would pass on to someone starting their medical career. Aspects of mindset and approach that have changed in Karim's practice over the last 10 years I hope you enjoy the episode.
33 minutes | 4 months ago
Advanced Paramedic Practitioners (Critical Care) in London with Mark Faulkner
This is a wide ranging conversation with Mark Faulkner - the clinical development manager for critical care (advanced practice) within the London Ambulance Service NHS Trust, Mark is also the clinical advisor for Major Trauma within the LAS and as such sits on the Pan London Trauma Steering Group, as well as number of national trauma groups. In this episode we examine a variety of topics that encompass decision making, experience & empirical background, additional clinical interventions, leadership & non-technical skills and support/pastoral functionalities of advanced practice. We discuss: Overview of the APPCC Scheme The patient target group & demographics Added value of interventions Vs decision making. Training, quality assurance and quality improvement within the scheme. First line staff engagement – who sees these groups of patients first Innovations that the scheme has just embedding and medium to long-term innovations that have improved the program Non-technical aspects of care Vs technical skills & utilisation rates Incremental gains when orchestrating flash teams Personal learnings over the last >6 years I hope you enjoy the episode
81 minutes | 5 months ago
Leadership with Tim Archer
In this conversation I talk with Tim Archer. Tim is a former Group Captain, he held a number of senior appointments in the RAF during which time he gained an MA in Leadership Studies from the Centre for Leadership Studies at Exeter University, a Post Grad Certificate in Executive Coaching from Lancaster University Business School and was awarded a full-time 12-month Fellowship back at the Centre for Leadership Studies. After a spell as Director Public Sector at the Leadership Trust in the UK, he moved to the United Arab Emirates for 8 years where he was a government advisor during which time he developed, designed and taught experiential leadership development and coaching programmes. He currently works for Cardiff University developing their leadership modules for the MSc in Public Health. We have a wide ranging conversation that touches on: The definition of leadership Mission command - military doctrine (what to do, not how to do it - no disseminated responsibility) myth of military leadership - Constructive decent Vs destructive concept The OODA loop (Observe, Orient, Decide, Act) Leadership Vs Management (Kotter) Trust and cohesion – Peak rapport Homeostatic leadership Compassionate Leadership Situational leadership Leadership in conflict Leader as a coach Systems leadership - NHS Model - leading when not in charge I hope you enjoy this episode with a fascinating guest and friend.
76 minutes | 5 months ago
Black Lives Matter: A conversation with senior Detective Inspector Ahenkora Bediako. Restore Podcast Collaboration
This has been the most downloaded episode of all time on the Restore Podcast and very relevant to the pre-hospital community. I have decided to re-post it on the PHCP as it affects every aspect of life and of blue light personnel. In this episode I interview a senior Detective Inspector within the police who works within the Modern Slavery and Child Exploitation Unit in London. English born and raised, of African decent and operating for 14 years within the police through the hierarchy of leadership he has a unique perspective into the contemporary climate. I first met Henk as a friend about 8 years ago and have valued his perspectives and insights as a friend and colleague battling shift-work, the reality of London and everything in-between. We discuss some of the fundamental assumptions, biases and racism within society and aspects of law that need to be re-considered. We also discuss his standing as a leader within the institution and how we can all model progress and address the bias and racism. We also talk about representation of black and ethnic minorities within the emergency services and how this can be addressed. We also talk about the institution of the police and how the concepts of trust and of 'Non-maleficence' (do no harm) needs to be restored from the community towards the police. I hope you enjoy this episode.
70 minutes | 5 months ago
EMRS & EMRTS Critical Care & Retrieval Services with Wayne Auton and Tom Archer
In this episode I talk to Wayne Auton and Tom Archer who work respectively for the Scottish and Welsh Air Ambulances (EMRS & EMRTS). Wayne is a former Royal Marine and currently a Specialist Paramedic in retrieval and transfer medicine as well as pre-hospital critical care. Tom is a Critical Care Practitioner & lecturer on the Critical Care MSc in Cardiff University. In this episode I talk with Wayne and Tom about innovation within the domain, advice to aspiring critical care colleagues, top tips in leadership & group dynamics. I also ask then about how they have navigated the past 6 months both personally and as a service. The Emergency Medical Retrieval Service (EMRS) provides critical care and transfer to definitive treatment for patients in remote healthcare locations across Scotland. They provide Consultant and Retrieval Practitioner delivered aeromedical retrieval from rural health care facilities throughout Scotland and well as pre-hospital critical care of major trauma patients, telemedicine advice to rural health care colleagues, rural facility outreach training and research in pre-hospital medicine and major incident support across the country. The Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru is an aeromedical retrieval service that provides Consultant and Critical Care Practitioner-delivered pre-hospital critical care across Wales. It was launched at the end of April 2015 and is a partnership between Wales Air Ambulance Charity, Welsh Government and NHS Wales. EMRTS provide pre-hospital critical care for all age groups (i.e. any intervention/decision that is carried outside standard paramedic practice) and undertake time-critical, life or limb-threatening adult and paediatric transfers from peripheral centres (inc. Emergency Departments, Medical Assessment Units, Minor Injury Units) for patients requiring specialist intervention at the receiving hospital. I hope you enjoy the episode with these two great friends. You can find out more about them both here: Wayne: https://www.wayneauton.com/blog-1/https/wwwwayneautoncom/blog-page-url/new-post-title Tom: https://www.linkedin.com/in/tom-archer-857b2354/?originalSubdomain=uk
38 minutes | 5 months ago
Medic One - Seattle Fire Department with Andrew Latimer
In this conversation I talk with Andrew Latimer. Andrew is an Acting Assistant Professor in the the Department of Emergency Medicine. He is involved with quality improvement, education, and clinical and operations research in Emergency Medical Services including involvement with Seattle Fire Medic One, King County EMS, and Airlift Northwest. His research interests are in the pre-hospital care of critically ill and injured patients, pre-hospital airway management, and air medical retrieval medicine. In this episode we look at the concepts of 'measure and improve' which have proven to make Seattle one of the world's leading institutions on cardiac arrest survival. Their main domains of practice around out-of-hospital cardiac arrest and advanced airway management (inclusive of drug-assisted intubation). The Medic One Program began in 1970 when the first group of firefighters were trained as paramedics in cooperation with Harborview Medical Center and the University of Washington. Since then, the Medic One Program has gained notoriety due to the training and pre-hospital emergency patient care paramedics deliver within the community. Medic One provides the community with Advanced Life Support (ALS) activities that, in the past, could only be performed by physicians. In addition to responding to medical emergencies, medic units respond to all working fires, hazardous materials and rescue responses. I hope you enjoy this episode with a fascinating clinician & individual.
55 minutes | 5 months ago
Life after the SBS with Stephen Burns
Stephen left the military in 2012 after serving 14 years in the Royal Marines and the SBS. At the age of 27 Stephen was awarded the Military Cross (MC) by Her Majesty the Queen for his work in Afghanistan in 2008. The MC is granted in recognition of "an act or acts of exemplary gallantry during active operations against the enemy on land" to all members of the British Armed Forces of any rank. Since 2015 he has mentored youth in schools, executives, budding sports stars, professional athletes and delivered the Limitless Programme to diverse audiences, veterans charities and public services. In this conversation we have an honest talk about his challenges with mental health through his military service and beyond. Stephens honest and open recital of his challenges with self harm and victim mindset and how he broke this are both insightful and refreshingly honest. Through his revelations of seeking like minded community he recently started an online community (10,000) of military and blue light personnel to support, encourage and offer opportunities to like minded individuals. His story is both encouraging and a voice of hope that despite the depths of suffering you can overcome any level of adversity with healthy community and a healthy mindset. Please find the charity that is fundamental to Stephen's story here: rock2recovery.co.uk The online community of OpSpartan can be found here: https://www.opspartan.com More on Stephen can be found here: https://www.wioh.co.uk/about
58 minutes | 6 months ago
How to survive and thrive from a life threatening head injury: With Matt Masson and Mike Nolan
In this episode we interview Matt Masson ex-extreme sports and ski instructor. In November 2011 Matt sustained a life changing head injury when he fell 26 ft through a plastic roof onto his head. He has had to re-build his life completely from re-learning to talk, to walk, to ski amongst many other things. Matt's inspirational story is a true testament to his mental determination, engagement with rehabilitation and timely pre-hospital care. His story and YouTube video can be found here: https://www.thewobblyjourno.com and https://youtu.be/xnJExrygdSk We re-unite him with Mike Nolan the Flight Paramedic on the night (a friend and colleague) who walks him through his injury load, the sequential interventions and his initial presentation on the night. Matt is just about to release his first book together with his Mother titled 'Road to the top of the mountain'. Please enjoy this truly inspirational story told in first person. Our thanks also goes out to the Nurse liaison team at the Royal London Hospital that initially put both Mike and Matt in contact.
53 minutes | 6 months ago
The Mobile Intensive Care Ambulance (MICA) program with Ben Meadley
In this conversation I chat to Ben Meadley. Ben has extensive experience in prehospital critical care, and is an operational Intensive Care Flight Paramedic (MICA) with Air Ambulance Victoria. Ben has a keen interest in prehospital critical care, advanced clinical assessment, pre-hospital critical care interventions and developing clinical judgement in critical care practitioners. MICA paramedics’ training goes beyond practical skill precision to include more detail in anatomy, physiology, pathophysiology and pharmacology to greater increase capacity to make independent complex clinical decisions and interventions. MICA paramedics operate either as part of a two person crew or as a single responder. We look at many facets of the MICA system and the differentiation between land MICA and flight MICA systems. We dig down into Ben's experience and empirical knowledge and look at the fundamentals of high performance within the MICA system, why they exist and how they continually improve. I hope you enjoy this conversation.
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