The St.Emlyn’s Podcast

In this season-ending episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley come together in Zermatt, Switzerland, to discuss recent studies and updates.

They highlight a randomized control trial on early exercise in blunt chest wall trauma, revealing its limited impact on recovery outcomes. Additionally, they explore the long-term safety of intraosseous access based on new evidence from Denmark.

The episode also provides insights into updated imaging guidelines for paediatric trauma and broad considerations on the growing role of AI in healthcare, especially in emergency settings. There are closing remarks on recent blog posts about toxic alcohol poisoning and the Difficult Airway Society meeting, while looking forward to upcoming conferences in Spain and Vienna.

00:00 Welcome to St Emlyn's Podcast

00:31 Exploring the Big Sick Conference in Zermatt

01:25 Evidence-Based Medicine: Early Exercise in Blunt Chest Wall Trauma

04:30 Intraosseous Access: Long-Term Complications

06:37 Imaging Decisions in Pediatric Trauma

09:17 The Promise and Perils of Artificial Intelligence in Healthcare

13:10 Toxic Alcohol Poisoning: A Critical Review

16:17 Conference Highlights and Future Events

19:19 Season 11 Finale and Looking Ahead to Season 12

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe talk with Nathalie Pattyn at TacTrauma24 in Sweden about the phenomenon of skills fade amongst emergency physicians.

Nathalie discusses her extensive background in medicine, psychology, and neuroscience, and shares insights from her research on how skills can deteriorate during low workload deployments, such as her 15-month clinical stint in Antarctica.

They delve into the lack of systemic measures to address returning to practice after long absences, how cognitive and psychomotor skills are affected by skill fade, and the contrast between teaching technical skills and ensuring they become automatic and stress-resilient.

The conversation highlights the need for evidence-based guidelines to ensure healthcare professionals maintain their proficiency, which ultimately benefits patient care and the healthcare system.

00:00 Introduction and Guest Introduction 00:13 Natalie's Background and Expertise 00:38 Skills Fade in Emergency Medicine

01:01 Personal Experience with Skills Fade

02:14 Regulations and Policies on Skills Maintenance

04:19 Imposter Syndrome vs. De-skilling

06:42 Aviation vs. Medical Field: Skills Certification

08:27 Aging and Cognitive Decline in Medical Skills

09:57 Teaching vs. Training in Medical Education

12:42 Future Directions and Systemic Solutions

14:31 Conclusion and Contact Information

The Guest

Nathalie Pattyn, MD, MPsy, PhD, received a degree in medicine from the Université Libre de Bruxelles (magna cum laude, 2001), a Master in Clinical Psychology from the Vrije Universiteit Brussel (cum laude, 2004), a PhD in Psychological Sciences from the Vrije Universiteit Brussel (2007) and a PhD in Social and Military Sciences from the Royal Military Academy (2007).

She also holds a postgraduate degree in Aerospace Medicine; a postgraduate degree in Emergency Medicine; a postgraduate degree in General Practice ; a postgraduate degree in Disaster Medicine ;and a Master in Global and Remote Healthcare.

She completed her Junior Officer Course with the Belgian Defense College in 2005, and her Staff Officer Course in 2008. She has a mixed clinical, research and operational background, having been deployed as a medical officer in various Middle Eastern and African countries, and having completed missions in Antarctica for a total duration of more than two years.

Her longest deployment was 15 months to the Halley VI Research Station in Antarctica, where she worked as the station physician while setting up a new biomedical research laboratory for the European Space Agency. She is currently still working as an emergency physician and a flight surgeon.

Her research interests include the psychophysiological measures of performance in elite populations; and Human Factors approach to isolated and confined environments, ranging from space to submarines.

In 2010, she founded a research unit within the Royal Military Academy, dedicated to the multidisciplinary study of human performance in operational environments. This led her to be the project manager for designing a tailored Human Performance Program for the tier one unit of the SOF community in Belgium.

She is currently an Associate Professor in Physiopathology at the Vrije Universiteit Brussel and in Human Performance at the Royal Military Academy.

You can read Nathalie's excellent book "Handbook of Mental Performace" for free here.

Welcome to our first episode recorded at the London Trauma Conference 2024.

In this episode, hosts Iain Beardsell and Natalie May are joined by Matt Hooper from Adelaide to discuss his unique career path, from emergency medicine to pre-hospital and retrieval medicine, intensive care, and more recently, palliative and end-of-life care.

The conversation centres around the principles of end-of-life care, particularly in acute and traumatic scenarios, and how these can be integrated with life-saving efforts. Key points include the challenges of shifting focus from survival to quality of death, the importance of recognizing and supporting witnesses and caregivers, and the concept of 'compassionate resuscitation.'

Practical tools such as the 'pause' are also explored, aiming to humanize highly charged medical environments and potentially prevent burnout and PTSD among healthcare providers.

00:00 Introduction and Guest Welcome

01:00 Key Messages on Death and Palliative Care

02:12 Challenges in End-of-Life Care

03:20 Improving Quality of Death and Relationships

04:32 Emotional Impact on Care Providers

06:41 Navigating End-of-Life Conversations

12:17 Practical Applications in Intensive Care

16:41 The Pause: A Tool for Reflection 21:58 Conclusion and Final Thoughts

The Guest - Matt Hooper

Matt is an accomplished intensive care specialist with a diverse background in emergency medicine, prehospital & retrieval medicine, and palliative care.

Notable for his leadership in developing critical care service models, he founded South Australia’s MedSTAR Emergency Medical Retrieval Service. He has also co-authored a highly regarded case-based text book and held key teaching and examining roles nationally and internationally in prehospital and retrieval medicine.

With a strong focus on high-performance teams working within high acuity, high consequence environments, Matt's expertise has also extended to human factors in healthcare, cardiothoracic intensive care, ECMO, and clinical ultrasound. More recently however, he has pivoted towards palliative and end of life care, pursuing a Master's degree at Cardiff University and consulting at Mary Potter Hospice in Adelaide. He is passionate about exploring new and innovative ways to prevent potentially avoidable suffering and enhance end of life outcomes for patients in acute care clinical environments.

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe speak with Sean Brayford Harris, a paramedic and interoperability development officer with the London Ambulance Service, about the development of the 10 second triage tool—a new, streamlined method for triaging casualties in high-stress environments like major incidents.

They discuss its creation and implementation, including collaboration with the Metropolitan Police and other emergency services. Key points include the shortcomings of the previous 'sieve and sort' system, the challenges of developing a simplified tool, and the benefits of this new approach for non-medical first responders.

The episode emphasizes the importance of cross-team collaboration in emergency scenarios and the potential impact of the tool on reducing distress and improving outcomes for both responders and patients.

00:00 Introduction

00:37 Background on Major Incident Triage

01:01 Challenges with Existing Triage Systems

01:15 Designing the 10 Second Triage Tool

05:16 Implementing the Triage Tool

06:50 How the 10 Second Triage Tool Works

13:48 Real-World Applications and Benefits

18:54 Conclusion and Final Thoughts

During Winter's Challenges, Iain Beardsell and Simon Carley reviewed the November 2024 blog posts for St Emlyn's podcast, marking the start of 2025. They discuss the busy state of emergency departments, critical incidents, and the importance of maintaining a learning culture.

They highlight the upcoming Big Sick Conference in Zermatt and the IncrEMentuM in Spain, noting their potential benefits for networking and education.

Simon emphasizes creating a psychologically safe environment and fostering curiosity, growth, and knowledge-sharing among emergency department staff. They also review a range of medical studies, including those on small bore vs. large bore chest tubes for haemothorax, intra-arrest arterial blood pressure monitoring, and the new GLP-1 receptor antagonists for obesity treatment.

Lastly, they address the importance of handling bad behavior in the team and maintaining kindness and professionalism, even during high-stress periods.

00:00 Introduction and New Year Greetings

00:35 Current State of Emergency Departments

01:17 Upcoming Conferences: The Big Sick and IncrEMentuM

03:43 Building a Learning Culture in Emergency Medicine

12:24 Pre-Hospital ECPR and ECMO

13:58 Small Bore vs Large Bore Chest Tubes

17:37 Intra-Arrest Arterial Blood Pressure Monitoring 24:01 New Drugs and Toxicology

24:47 Care in the Hot Zone

27:12 Addressing Bad Behaviour in Emergency Departments

30:42 Conclusion and Future Plans for St Emlyn's

In this episode of the St. Emlyn's podcast, Rick Body and Greg Yates delve into the concept of likelihood ratios, an advanced yet practical tool for diagnosing patients in the emergency department. Building on the previous episode about predictive values, they explain how likelihood ratios help compare the probability of test results between diseased and non-diseased patients. They provide examples, like evaluating chest pain and using the Smith Calculator for Anterior ST Elevation, to show how likelihood ratios can change clinical decision-making.

Rick and Greg also discuss Bayesian reasoning and how pretest and post-test probabilities are used in practice.

00:00 Introduction to the Podcast

00:34 Understanding Likelihood Ratios

02:05 Practical Example: Chest Pain Case

03:53 Calculating Likelihood Ratios

07:17 Applying Bayesian Reasoning

09:50 Recap and Conclusion

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley provide a comprehensive update for October 2024. They discuss key blog posts covering diverse medical topics, including highlights from the Royal College of Emergency Medicine's academic science conference focusing on toxicology, high-potency opioids, novel benzodiazepines, and the use of flumazenil.

They also explore the Green ED project and the impact of climate change on healthcare. Additionally, they delve into recent research on ventricular fibrillation pad positions, the use of tranexamic acid (TXA) in trauma care, and the importance of maintaining a positive outlook amidst winter challenges by seeking small wins and engaging in enjoyable aspects of emergency medicine. The episode offers valuable insights and updates for emergency medicine professionals.

00:00 Welcome and Introduction

01:27 Highlights from the Royal College of Emergency Medicine Conference

01:50 Toxicology Insights: High Potency Opioids and Benzodiazepines

05:11 Climate Change and Healthcare: The Green ED Project

08:23 Medical Conferences: A Phoenix from the Ashes

10:38 Ventricular Fibrillation and Pad Position: New Insights

17:22 Tranexamic Acid (TXA) in Trauma Care

24:01 Maintaining Positivity in Challenging Times

In this episode of the St Emlyn's podcast, Iain Beardsell and Natalie May reflect on their experiences at the London Trauma Conference, a four-day event covering various aspects of trauma and pre-hospital care.

They discuss key takeaways from sessions on cardiac arrest, including talks on perioperative cardiac arrest and the prognostication of cardiac arrest patients.

The episode also delves into wellness in the medical field, featuring insights from senior emergency physician Rod McKenzie and pre-hospital expert Matt Hooper on practical psychosocial care. Additionally, the podcast highlights advancements in trauma care, defibrillation strategies, and the importance of correct pad placement and basic practices.

The episode underscores the holistic approach to patient care and the significance of personal well-being for medical professionals.

00:00 Welcome to the St Emlyn's Podcast

00:52 Highlights from the London Trauma Conference

01:13 Cardiac Arrest Symposium Insights

03:53 Prognostication After Cardiac Arrest

06:44 Defibrillation Strategies and Basics

08:29 Wellness and Mental Health in Emergency Medicine

11:10 Palliative Care in Pre-Hospital Settings

12:32 Trauma Conference Highlights and Innovations

16:48 Poster Presentations and Stand-Up Science 17:58 Key Takeaways and Reflections

18:43 Closing Remarks

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe are joined by Chris Bishop, a clinical research fellow at the Centre for Trauma Sciences at Queen Mary University of London. Chris discusses his PhD research on veno-arterial ECMO support for cardiogenic shock following major trauma haemorrhage and explains the principles and applications of ECMO, particularly in trauma patients. The conversation covers the current practices, challenges, and future directions in the use of ECMO for trauma care, including multidisciplinary decision-making, patient selection criteria, and pioneering techniques like selective aortic arch perfusion and emergency preservation and resuscitation.

00:00 Introduction

01:12 Understanding ECMO and Its Applications

02:20 ECMO in Trauma Patients

04:17 Challenges and Resistance in ECMO Adoption

05:36 Current Research and Practices

11:31 Future Directions in Trauma Resuscitation

13:28 Conclusion

This episode, recorded live at Tactical Trauma 24 explores the concept of bad behaviour within high-performing medical teams. Liz Crowe, who will be well known to regular listeners, discusses what constitutes bad behaviour, its impacts on team dynamics and patient safety, and the importance of self-awareness among medical professionals.

Key findings from recent research highlight that even subtle actions like eye-rolling can negatively affect patient safety as much as overt harassment. The speaker emphasises the importance of psychological safety, trust, competence, authenticity, consistency, and empathy in maintaining a healthy team environment. Practical advice includes assessing one's own behaviour and seeking honest feedback from colleagues and loved ones.

Comprehensive show notes are available here

00:00 Introduction: Addressing Bad Behaviour

01:18 Defining Bad Behaviour

01:49 Impacts of Bad Behaviour

03:15 Psychological Safety and Team Dynamics

04:24 Personal Experiences and Observations

05:46 Types of Bad Behaviour

07:19 Research Findings on Workplace Behaviour

09:10 Self-Awareness and Behavioural Impact

14:21 The Karpman Drama Triangle

17:29 Conclusion and Final Thoughts