Greater Sydney Area HEMS

G'day and welcome back. In this episode, we are fortunate to be joined by three senior paramedics. Together, we discuss how practices and attitudes towards out-of-hospital cardiac arrest management have changed. Specifically, the curiosity and practice of personalised cardiac arrest care, out of hospital.  Too, we delve into the mindset of the paramedic, learning how a paramedic balances clinical, teamwork and logistic priorities - hospital practitioners can learn a lot from this! Stay tuned in for more episodes - coming up we have chats on brain injury associated shock, neuroprognostication following cardiac arrest, REBOA and much more.    We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.  

G'day and welcome back. We are currently editing new episodes of the podcast, they will be coming out soon - episodes on brain injury associated shock, post-ROSC care and more.  In the meantime, here is a re-post of an episode with the pre-hospital ECMO (Pre-Care) team in conversation with senior road paramedics. In this episode, the team discuss the challenges and successes of rolling out this trial in the Greater Sydney basin - but more crucially, also discuss the flow-on effect personalised resuscitation care has on 'standard' ALS care.   This episode was very well received the first time around, and so we re-post it now as the technical learning points provided by the team also nicely summaries lots of the learning from subsequent episodes.  Chat soon.   We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.

Welcome back! We are busy recording new episodes, in the meantime here is a re-post of an episode prior to our move to Spotify/podcasts with Emergency and Pre-Hospital Consultant Dr Ian Ferguson. Ian is the lead author on a published randomised control trial assessing the haemodynamic effects of adding fentanyl to an induction regime of ketamine and rocuronium for rapid sequence intubation in the emergency department. The FAKT study. This multicenter study conducted in New South Wales, Australia, has yielding some thought-provoking results, and may change your in- or out-of-hospital anaesthesia practice in future.   Below is a link to the full and free text: Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study-A randomized clinical trial Ferguson I, Buttfield A, Burns B, Reid C, Shepherd S, Milligan J, Harris IA, Aneman A; Australasian College for Emergency Medicine Clinical Trials Network. Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study-A randomized clinical trial. Acad Emerg Med. 2022 Jun;29(6):719-728. doi: 10.1111/acem.14446. Epub 2022 Mar 15. PMID: 35064992; PMCID: PMC9314707. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314707/   We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years. 

G'day, and welcome back.  Pre-hospital clinicians are used to working under pressure. Teams work in often austere environments, with limited resources caring for some of the most severe patient pathologies at their most undifferentiated.  Within all this, individuals and teams must perform at their peak. But this is easier said than done. So how, in this most niche of clinical areas, can an individual, a team and an organisation promote, harness and maintain peak performance? Dr Stephen Hearns is an Emergency and Pre-Hospital Physician from Glasgow, Scotland. Stephen has spent most of his career working out-of-hospital, both in the UK and around the world. Throughout, Stephen has reflected on his own journey of peak performance, and has dedicated more recent years to the study and deep dive into what contributes to an individual and team functioning most highly in the pre-hospital space.  In this episode, we discuss Stephen's research and published work to inform this topic. Stephen has spent time with other peak-performing groups including but not limited to Armed Forces and sporting teams, and has developed a package of learning to inform daily optimal performance. We talk about communication strategies, cognitive aids, team selection and organisational leadership - all of which, and more, contribute to peak performance.  This episode is a must-listen for all pre-hospital clinicians intent on optimising their attainment, that of the team and that of their organisation.    Learn more here: https://corecognition.co.uk/   Chat soon!

Hello and welcome back. This is part two of our chat with Dr Matt Hooper, continuing our conversation on emergency last aid. In this episode, we discuss the hows and whens involved when informing a family of their loved one's death, as well as the setting in which to do this. Too, we discuss the importance of maintaining space and safety for one's self and the team, and how a system can encourage psychological safety in this regard.  As with part one, please ensure this episode is the right one for you - this is a challenging and emotionally-charged topic and whilst very important, please make sure it is the right episode at the right time for you. Chat soon.

G'day, and welcome back. In today's episode, we are delighted and privileged to be joined by South Australia's Dr Matt Hooper. The practice of medicine - including pre-hospital medicine - often focuses on life preservation. But, as acute care clinicians we often also find ourselves caring for patients at the end of their life. Too, we find ourselves caring for their relatives and loved ones, and the wider medical team. It can be really challenging to provide this care in such an acute, unexpected and unstable setting - so how do we do it, how do we stabilise the moment and continue to deliver compassionate care? This is the work of Dr Matt Hooper, who together with colleagues has created the 'emergency last aid' program - designed to teach the foundational skills needed to deliver compassionate end-of-life care in high-pressure environments. Drawing on his experience as a pre-hospital, intensive care and palliative care physician, Matt talks us through his approach to these challenging, rewarding circumstances.  Before listening to this episode, please ensure it is the right episode for you: talking about death, dying and grief can be triggering for some, so please ensure that this episode is what you need, at the right time, and that you have support around you.    Part two coming soon, chat then.   

G'day and welcome back. Damage control resuscitation - what is it, why should a pre-hospital provider do it, what does it look like in real life, and what are the results.  These are but some of the questions asked in this episode of Dr Dan Nevin and Mr Zane Perkins, Consultants with London's Air Ambulance. In conversation with Sydney's Dr Ian Ferguson, we explore this approach to the care of the bleeding trauma patient, focusing on the key tenants of this method and some of the mandated actions required when a patient is declared a damage control resuscitation case.  To be clear - these are patients requiring a modified approach to even a 'code crimson/red' patient - these are the absolute most sick of all pre-hospital bleeding trauma patients.  Too, as ever we discuss the effect on the wider system of this novel approach as well as the potential associated modifications to conventional trauma care.  Thanks for listening, chat soon.

G'day and welcome back to the podcast. ECMO....in trauma? Today, we are talking about a more general emergency medicine / intensive care medicine topic, that of advanced trauma care. It is fair to raise an eyebrow at 'advanced trauma care' and 'ECMO' in the same sentence - these patients are anatomically disrupted, prone to bleeding and suffering huge multi-system injuries. So placing them onto a heparinised ECMO circuit seems counterintuitive.  But, Chris Bishop and the team from London offer a different perspective.  Chris is a Senior Clinical Research Fellow at the Centre for Trauma Sciences at Queen Mary University of London, UK. His PhD research focuses on the potential utility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to treat cardiac dysfunction associated with major trauma haemorrhage. Indeed, as we have discussed elsewhere in the podcast, these patients often have refractory cardiogenic shock secondary to an unfavourable metabolic storm following massive acute trauma - and it is partly this which ECMO may help bridge.  Too, we discuss with Chris the benefit of ECMO as part of a neuro-protection package of care in patients with severe lung injury who are challenging to ventilate.  This is real cutting edge medicine, and we are delighted to share with you our chat with Chris.  Speak to you soon.

G'day and welcome back into part two of our conversation with Prof Sheldon Cheskes from Toronto, Canada. Here we continue our discussion about refractory cardiac dysrhythmias with the Sheldon, the principal investigator of 'The dose VF' study.  In this part two, we talk to Sheldon about chemical strategies to overcome these dysrhythmias, as well as ask Sheldon about this best case ever - its a cracker! Thanks for listening, chat soon.   We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.

G'day and welcome back to the HEMS debrief podcast.  We are back with part one of a two part episode with Professor Sheldon Cheskes from Toronto, Canada. Sheldon is a Professor of Emergency Medicine by trade, a clinical scientist and a medical director for ambulance services within the Canadian province of Ontario. Perhaps, though, Sheldon is best known for his work as the principal investigator in the 'Dose VF' study, during which Sheldon and the team demonstrate the effectiveness of double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators) and vector-change (VC) in patients suffering from shock refractory ventricular fibrillation. This ground-breaking out-of-hospital trial has been the subject of great interest amongst pre-hospital and in-hospital clinicians alike, and demonstrates very promising data supporting these two defibrillation strategies.  We are delighted, then, to talk to the man himself on the podcast today. Sheldon shares with us data from the study, and talks with us about the underlying physiology and pathology of this patient cohort, as well as how a health care system needs to best accommodate this potential salvageable group of cardiac arrest sufferers.  A link to the New England Journal of Medicine paper is below, and as ever we hope you enjoy listening to this and part of of Sheldon's episode.  Chat soon!   https://www.nejm.org/doi/full/10.1056/NEJMoa2207304   We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.