Intro :

This week Paul Rees discusses ROSC and post resuscitation care, including post cardiac arrest syndrome and prognostication after cardiac arrest.

• Train and talk through these events. They are fairly rare and so practicing and talking through the motions is important to keep skills, roles and plans refreshed, thinking through all roles and likely challenges and outcomes

Resus Council post-ROSC care – https://www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/#circulation

Paul Rees is a military interventional cardioloist at Barts Heart Centre in London, with a special interest in circulatory support and resuscitation. He is also a HEMS consultant, flying for East Anglian Air Ambulance.

As a Surgeon Commander in the Royal Navy, he is their Consultant Advisor in Medicine, as well as Reader in the Academic Department of Military Medicine.  He chairs the Defence Resuscitation Committee, leads the Defence Endovascular Resuscitation Group and has recently designed and delivered a new capability for treating battlefield haemorrhage.

He co-leads the new British Cardiovascular Intervention Society group looking at out of hospital cardiac arrest, and teaches as invited faculty on a number of international endovascular resuscitation workshops. Paul’s military background includes active service with submarines, combat deployment with Commando forces, being the airborne MERT consultant in Afghanistan and numerous humanitarian and disaster relief missions including work in an Ebola treatment unit in Africa.

In this podcast Duncan explains the role of Coastguard operations including the interaction with the Emergency Services and BASICS Scotland Responders.

Key points from this podcast:

• Escalate early via trauma desk to the ARCC

Duncan spent 35 years in the RAF in various roles mainly as a Winchman Paramedic in the UK SAR Force. During this time he was a Qualified Helicopter Crewman Instructor and Winchman Training Officer responsible for the training and standards of UK SAR Winchman both in their operational and medical roles. As a member of the RAF Mountain Rescue Service he took part in various worldwide expeditions, some as Medical Director or Expedition Leader.

With the responsibility for the UK SAR Force transferring to the MCA in 2015, Duncan left the RAF and continues to operate as a Winchman Paramedic, Instructor trainer and Base Clinical Lead.

He has a long-standing involvement with BASICS Scotland going back to 1996. Duncan is the Vice-Chair of BASICS Scotland, an Instructor, Responder and a member of the Clinical Governance Working Group. He is married to a very tolerant and forgiving wife.

Ian Scott discusses Extracorporeal Membrane Oxygenation (ECMO) and its role in hypothermia.  Ian looks at the severe end of hypothermia and the management and pathways for these patients.

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Combined Pre-Hospital PDF

Hypothermia Protocol Hospital PDF

Ian is currently a critical care consultant and director of the respiratory ECMO service for Scotland. He is based in Aberdeen.  He became a consultant in 2015. He graduated from Dundee University and undertook most of his training in the North East of Scotland.  He has also spent time in the Brompton in London and worked for Sydney HEMS just after he finished his training.

Ian has an interest in pre-hospital care and also spent some time working for EMRS North. During his training, he became interested in using ECMO as a way to rewarm hypothermic patients.  He has had several near misses while winter climbing as a student.

Ian’s spare time is spent with his family. His 2 young daughters and my his understanding wife Kim. Ian also enjoys cycling and being in the mountains when time allows.

Paul chats us through the theory behind using checklists in the prehospital environment, why it is an important culture shift we should be moving to and how and why this method can reduce the pressure when you are operating under demanding conditions. 

Top 3 tips: 

1) Be robust, don’t be scared, don’t be scared to champion it and don’t be scared to defend it. 

2) Try it, draw up your own check sheet and if you find it works for you, then champion it with your organisation.

3) Don’t be scared to use it on scene and revise it as you go along to make it work and honed to best version you can. 

Resources: 

https://www.saviourmedical.com/ 

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. 

As a longstanding member of Cairngorm Mountain Rescue Team, Eric Pirie talks through the issues arising from rescues that are protracted, and particularly focuses on prolonged care in the field, which may not be particularly familiar to BASICS Scotland Responders, but occurs fairly regularly in Mountain Rescue.

• Think about carrying and using a bothy bag (group shelter) to help protect your patient from the environment.

St Emlyns Blog for the H.I.T.M.A.N mnemonic and other useful info.

ProlongedFieldCare.org  – A useful website, very military in nature, excellent principles.

SHEEPVOMIT nursing mnemonic described in the NSOCM Manual (NATO Special Operations Combat Medic) Course run by the ISTC SOF – International Special Training Center

Eric is an International Mountain Guide (IFMGA), Mountain Instructor Certificate holder, Wilderness EMT and Paramedic, who has 25 years of experience working to the highest levels in the outdoors worldwide.

Eric joined the Cairngorm Mountain Rescue Team in 1982 and is still an active team member. Whilst working as an Instructor at Glenmore Lodge, The Scottish National Outdoor Training Centre, Eric was head of Rescue for 10 years. He also worked as a senior ski patroller, on Cairngorm for 7 seasons, when there was snow! He has been involved in numerous rescues both in Scotland and worldwide, gaining experience in longer term patient care whilst seconded to the National Park Service as a mountaineering/medical volunteer ranger, on patrol for a season, on Denali, Alaska. Eric now works full time for The Scottish Ambulance Service based from home in Grantown-on-Spey.

Alison chats us through cave rescue in Scotland, what are the team skills, capabilities and responsibilities and how are they tasked?

Top 3 Points from this podcast:

• Work within what you are comfortable with

About Alison

Alison is a GP based in Dundee, and also works in Ninewells ED as a GP with a specialist interest in emergency medicine.

She is a team doctor for Tayside Mountain Rescue and medical officer for the Scottish Cave Rescue Organisation. 

She enjoys adventures above and below ground, often with her husband and two sons. 

Dr Paddy Morgan talks to us about accidental hypothermia, what is it? How can we recognise it and how can we treat it in the prehospital environment.

• Keep yourself safe, keep your team safe and that means you can effect rescue for your casualty

ICAR Guidelines

Original hypothermia

Accidental Hypothermia – an update

Accidental hypothermia Part 1- an update

Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 update

Comparison of three different prehospital wrapping methods for preventing hypothermia – a crossover study in humans

Effect of Hypoglycaemia on Thermoregulatory Responses

Severe Hypoglycaemia Reduces the Shivering Threshold

Termination of resuscitation

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.

In this week’s podcast Martin Esposito talks about pain assessment and management. The discussion explores the definition of pain, and the biological and psychological complexities associated with something that is physical yet subjective in perception. Martin looks at the importance of ongoing pain assessment and explores the options in pre hospital pain relief; after discussing analgesia he sets out why pain control is more than medication administration.

• Remember that pain is more than a just physical symptom

Transition from acute to chronic pain – BJA Education – https://academic.oup.com/bjaed/article/15/2/98/248869

Chronic Pain – Is it All in Their Head? – Daniel J. Clauw M.D – https://www.youtube.com/watch?v=B0EhNajqkdU

Martin is the Clinical Effectiveness Lead for Major Trauma for the Scottish Ambulance Service. He has worked within ambulance services in the UK for over 23 years gaining a wealth of experience in a variety of roles.

Since qualifying as a paramedic in 2000 he has worked as an Emergency Care Practitioner, was seconded to the Physician Response Unit in London as well spending time as a flight paramedic for London’s Air Ambulance.

He has also spent a number of years in education and is an examiner on the Diploma in Immediate Care.

Martin has a special interest in pain management and in 2018 completed an MSc in pain management at Cardiff University and has since become an Honorary Tutor on the Pain Management programme at Cardiff.

Consultant Paediatric Anaesthetist, Jon McCormack, explores the rare occurrence of paediatric cardiac arrest; he talks through the CRASH algorithm and emphasises the importance of cognitive aids and good airway positioning.

He also explains why, with a couple of caveats, in these situations it’s ok to see children as small adults.

• Cognitive aids are really important, know what cognitive aids you have available, become familiar with where they are and how you use them……. and use them.

Paediatric TCA paper: https://emj.bmj.com/content/35/11/669.long

30/60/90 reference guideline for resus in drowning (Credit: National Operation Guidance on Water Rescue & Flooding)

Jon is a Consultant Paediatric Anaesthetist at the Royal Hospital for Sick Children in Edinburgh.

He graduated from Dundee University in 1998 before completing his Anaesthetic training in South East Scotland and a Paediatric Anaesthetic Fellowship in Vancouver.

He is a Clinical Lead for Paediatric Trauma in the South-East Scotland Trauma Network and a member of the Scottish Trauma Network Paediatric Core Group and the national Mass Casualty-Major Incident planning group.

Jon is also the Deputy Lead Examiner for the Diploma in Retrieval and Transfer Medicine (RCSEd) and is on the EMRS organising committee of the annual Retrieval Conference.

His three children, generally keep him busy out of work but whenever time allows Jon is a keen cyclist and whenever snow allows, a very keen skier.