BASICS Scotland Podcast

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)
  

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

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.

• Remember in most cases, pregnancy and childbirth are normal physiological processes 

Resuscitation guidelines app

I-Gel Insertion Video

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

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/ 

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.

• Call early- via ambulance control to the Coastguard Ops Room rather than local contacts

Maritime & Coastguard Agency YouTube Channel

HM Coastguard Operations Centres

HM Coastguard website – www.mcga.gov.uk

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.

• 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.

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

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. 

Cliff, based in Australia, talks us through the zero-point survey, why it is important and how we use it for the emergency setting.

• There are multiple opportunities to optimise how a prehospital mission goes that present themselves long before you set eyes on the patient(s).

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/

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

• Use sodium bicarbonate more, if this is a drug you carry and is within your scope of practice, for sodium channel blocking drug overdoses.

Toxbase Website: www.toxbase.org.uk

Edinburgh Clinical Toxicology: www.edinburghclinicaltoxicology.org

National Poisons Information Service: http://www.npis.org

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.