Welcome back to The Sydney HEMS Debrief, now on episode 13.

Today we are talking about the PreCare trial, currently underway here in Sydney. This feasibility trial – a first for Sydney – concerns placing patients suffering out of hospital cardiac arrest onto potentially life-saving extracorporeal membrane oxygenation (ECMO) therapy in the field, before transporting them to definitive care.

To discuss more, we are joined again by Dr Nat Kruitt, Staff Specialist here at Sydney HEMS and Specialist in Cardiac Anaesthesia and ECMO, as well as Alex Peters, one of the Sydney HEMS Critical Care Paramedics. We will discuss how and why the trial came about, the practical application and workflow considerations of placing an eligible patient onto pre-hospital ECMO, as well as some future considerations for this innovative therapy.

This episode is a must listen for other pre-hospital providers in the greater Sydney basin who may come into contact with the ECMO team, as well as those interested in eCPR and ECMO more broadly.

I hope you enjoy it!

Welcome back to The Sydney HEMS Debrief. After an extended New Year break, we return with episode 12.

We are joined this week by Sydney HEMS Staff Specialist Dr Ian Ferguson. Ian is the lead author on a recently 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. 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.

Join us here in episode 12 to hear it live from chief investigator himself.

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/

Welcome to episode 11 – likely our last episode of the year!

The feedback has been fantastic – thank you to all who have taken the time to let me know your thoughts, and for helping to shape the episodes into what they are.

In this end of year episode, we are joined by Sydney HEMS Staff Specialist Dr Ruby Hsu. Ruby and I sat down for a chat with no real agenda, but knowing that she had a fantastically varied and colourful pre-hospital career across several countries, I thought it valuable to hear Ruby’s thoughts on – amongst other things – safe systems, career building, and luck.

I hope you enjoy it, and speak to you in the New Year.

Sam

Join for the second part of Dr Brian Burns’ episode, as we continue to discuss mimics of shock in our trauma population.

See some show notes below for more resources.

Thanks for listening!

Show notes:

Reference on pulmonary embolism: https://emcrit.org/pulmcrit/eight-pearls-for-the-crashing-patient-with-massive-pe/

Reference on pulmonary contusion: https://pubmed.ncbi.nlm.nih.gov/30906578/

Reference on pulmonary contusion lung ultrasound: https://coreultrasound.com/pulmonary-contusions/

In the ninth episode of the Sydney HEMS Debrief series, we have the first half of a two-part episode!

Join us as Sydney HEMS Senior Staff Specialist Dr Brian Burns discusses the recognition, aetiology and treatment of different types of shock in our pre-hospital trauma patients. Whilst pre-hospital clinicians may have a natural bias towards hypovolaemic shock secondary to blood loss, Dr Burns discusses the many mimics of hypovolaemic shock, and how it is crucial we remain mindful of other causative acute and subacute pathologies.

See some show notes below for more resources.

Thanks for listening!

Show notes:

Reference on impact brain apnoea: https://pubmed.ncbi.nlm.nih.gov/27211834/

Reference on spinal cord injury: https://www.nature.com/articles/nrdp201718

Reference on blunt cardiac injury: https://www.aast.org/resources-detail/blunt-cardiac-injury

Welcome back to the Sydney HEMS debrief! In this episode 8, we are joined by the extraordinary Dr Nat Kruit. Dr Kruit is a Sydney HEMS Consultant, Cardiac Anaesthetist, and ECMO Specialist. Given the increasing global chatter around ECMO, and to give it its full name, extracorporeal membrane oxygenation is going to be the focus of this episode. Join us as Dr Kruit takes us through the physiology, patient selection, and retrieval considerations of this fascinating – and very specialised – area of medicine.

In the seventh episode of the Sydney HEMS Debrief series, Sydney HEMS CCP and Educator Jackie Buckthought shares a challenging case from her training. Jackie discusses how this case has affected her work flow, resilience, and more recently her perspective as an educator. It’s a cracker!

As ever, any feedback is welcome – please get in touch, and until the next time, have a great week.

Enjoy.

In episode six of the debrief series, NSW Aeromedical Retrieval Staff Specialist Dr Sarah Aldington discusses a formative experience, highlighting the profound impact cases may have on clinicians and the importance of a dedicated debrief. 

Click to access STOP5.pdf

Welcome back to the Sydney HEMS debrief – this is episode 5. Dr Robbie Lloyd has spent his past 12 months as a Sydney HEMS Registrar, and has been intent on making quality assurance and clinical governance ‘cool’. By harnessing the learning from our daily ‘coffee and cases’ team chat, he has led a fantastic project wherein snippets of learning are disseminated widely around the organisation. Find out more on this episode, as well as the blog post linked below.

Enjoy!

Find out more about his Quality Improvement Project here.

In Episode 4 of the series, Sydney HEMS Critical Care Paramedic Sam Immens joins HEMS Physician Dr Samuel Bulford to discuss a pragmatic and practical reflection tool which has helped him navigate his clinical workflow.

Working as a Critical Care Paramedic with NSW Ambulance and the Toll Rescue Helicopter has been a lifelong personal and professional goal for Sam, who describes himself as “genuinely humbled by the professionalism and expertise displayed by the Pilots, Aircrew, Doctors, Engineers, Managers, Support Staff, and his fellow CCPs, in delivering critical care to anyone, in any place, at any time across New South Wales.”

Sam had some further reading recommendations he wanted to share here too:

1. Rolfe’s adaptation to the reflective model we use in clinical practice today.

Rolfe., G et al. (2001) Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke, Palgrave Macmillan

1. Rolfe credits Terry Borton with the genesis of the terms and concept in his 1970 book 

Borton, T. (1970). Reach, touch, and teach; student concerns and process education. New York, Mcgraw-Hill

1. Thanks for the Feedback, by Stone and Heen – essential reading for those that are in the position of giving feedback and mentoring as it nicely delineates coaching, feedback, and appreciation.