Month: November 2012

The Royal London Museum

Today, I visited the The Royal London Museum, the…erm…Museum attached to The Royal London. Stop me if I’m stating the obvious here.

The museum documents the hospitals history through the 18th, 19th and 20th centuries; from the idea behind the building it in the first place (1740), carrying through to the future.
It’s an interesting concept: The hospital was built as a voluntary hospital, meaning it was funded by donations only, and available to the sick and the poor. Quite remarkable I believe – we’re talking over two hundred years before the National Health Service (NHS) was born. East London was (is) the poor part of town with a health record lagging behind the rest of the city (and country). Healthcare for the population, mainly made up of immigrants, was direly needed. The Royal London was one of five voluntary hospitals built at the time, and it was only after they were built that the birth rate once again exceeded the death rate in the city; London began to grow and prosper again (now there’s a good argument for public healthcare!).

I won’t rattle on about the whole history – it is already available in book and exhibition form, plus I wouldn’t want to take the experience away from you.

If you’ve got half and hour to an hour, it is well worth a visit to learn about the development of healthcare over the past 300 odd years, what it has achieved, and what we owe to our forefathers (and -mothers). Exciting, interesting, gruesome…you’ll find it there.

Visiting Information
Where: St Augustine with St Philip’s Church, Newark Street, London E1 2AA.
When: Opens weekdays 1000-1630, except Christmas, New Year, Easter and Public Holidays. It’s worth calling ahead, as staff shortage can affect opening hours.
How much: FREE, as all good museums in the UK. (I feel sorry for you American folk). Donations are welcome, though

The Royal London Museum is a part of the “London Museums of Health and Medicine“. It is my goal to visit all 25 of them

Emergency Services Show 2012

I will be at the Emergency Services Show 2012, held this week Wednesday and Thursday (21st and 22nd of November). Looking forward to meeting new people, catching up on the latest technological developments and getting some CPD from the College of Paramedics.

There will be a couple of us meeting up on Wednesday at 1215hrs outside the College of Paramedics stand (Hall 3, stand E71, floorplan here). I’ll be live-tweeting together with a bunch of fellow tweeters – be sure to follow the #ESS2012 hashtag.

Hope to see you there!

M.A.N.E.R.S.

[youtube http://www.youtube.com/watch?v=BScY-ojApA8]

The above video was recently posted on the International Paramedic google group.

Recommended viewing for all Paramedic and related staff – suggestions on how to deal with psychological trauma.

  • Minimise Exposure
  • Acknowledge the impact of the event
  • Normalise the experience
  • Educate as required
  • Restore or refer
  • Self care

M.A.N.E.R.S. was developed by the Victorian Ambulance Counselling Unit (didn’t realise that vehicles needed counselling…).

Some more information can be found here (search for M.A.N.E.R.S.)

GTN as a diagnostic tool

Last year, I posted about a presentation at the Paramedics Australasia Conference:

[click on picture to download full PDF]

According to the authors reviewing the literature, GTN is rubbish as a diagnostic tool.

I received some comments (on- and offline) of astounded people about this. I followed up with the authors, but forgot to post the reply. Many apologies.

A big thanks to the authors, Lynsey Smit and Laura Roberts (both from Monash University), for allowing me to post their presentation online. They can be contacted via email address: larob7 [at] student.monash.edu & lsmi19 [at] student.monash.edu.

ISBAR Clinical Handover App

I came across this whilst browsing through the web: ISBAR, a joint effort from the New South Wales and South Australian Heath Services.

What is it? A surprisingly simple iPhone and iPad app for clinical handovers, which I wish I had as a student: ISBAR stands for Introduction/Identify, Situation, Background, Assessment and Recommendation. Here are some in-app screenshots:

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As you can see, there are specific handovers for different types of patients, and you can even save custom handovers. Brilliant, can’t wait to try it out myself.

More information and download links can be found on the official website: http://www.archi.net.au/resources/safety/clinical/nsw-handover

Hero Revisited

Kelvin Crocker (@yellowspanner) emailed me in response to my recent post “I am not a Hero“. With permission, I quote:

Just to begin by saying that I don’t consider myself a hero in any way. My father was a firefighter and whenever the hero tag was bandied about he always said he was just an ordinary guy doing his job. I also believe that. But what about public perception? We drop in and out of people’s lives in extremis. We just get on with things when others would run away. Does this make us heroes? Maybe we are just the tip of the spear and all that back us up, the call takers, the trainers the vehicle mechanics are just as important and heroic in their own ways. But we get seen by the public and to be called a hero is something we should take and pay it back to those that support us on the front line. My kids are proud of what I do and also just as proud of their Mum – a nurse. Sometimes I think the word hero is misused – should we take the good meaning and ditch the bad?

Kelvin has a point, and a very good one too. I have a part of me that wholeheartedly agrees with him. We might not see ourselves as heroes, but if others would like to apply that label to us, we could and should use this positive description for the benefit of our profession.

I am not a Hero. I don’t see myself as a Hero.

But if you (genuinely) call me a hero – I will humbly accept the honour with gratitude, and share it with the profession.

USOZUK

A chilly, bright and clear night. A cuban bar, Mojitos, fireworks.

Reminiscing…past, present and future.

What was initially going to be a catch up after work turned in to a fair bit more. Having a drink with Lysa Walder always takes you places (previous adventure here). Last night we were joined by Thaddeus Setla, Tom Bouthillet and crew, during their visit from the States here in London to film their Code STEMI project.

Drinks, ideas, opinions, information flowed freely. I got ‘caught’ in between Ted and Lysa (who hadn’t met before), which was quite an experience, with some flashback for me: On my left an American paramedic-turned-filmmaker, with whom I had done a shift with last year and had a great time. On my right an English paramedic and author, with whom I had done a shift with three years ago. and me, an (ex) Aussie Paramedic, in the middle. US-OZ-UK.

It is always interesting to see the impression that places leave with visitors…in this case: what is stereotypical British? I’ll leave you with Tom’s thoughts of a typical 999 call between an Emergency Medical Dispatcher (EMD) and a Proper British Gentleman (PBG – spoken in a very posh accent):

EMD: “999, what’s your emergency?”

 

PBG: “Good afternoon. We seem to have this slight issue. You know this whole breathing thing that we all generally do? Well, she’s not really doing it much. Not at all really.”

 

EMD: “OK sir, you’ll need to check her pulse, and if no pulse is there, commence CPR. Open her airway by tilting the head back, and start by giving two breaths via mouth to mouth…”

 

PBG: “Her mouth? (with a hint of disgust). Sounds rather troublesome.”

Clearly he’s been watching too much Monty Python. I’ll leave you with fireworks instead!

(thanks to Lysa for taking the photo!)

Report, part 3

Last ‘Report’, I introduced you to the Ambulance Service of New South Wales of 2006. That was six years ago.

2012 saw the broadcast of a new show, again with New South Wales Service, dubbed: “Recruits: Paramedics”

[youtube http://www.youtube.com/watch?v=Vb3KtF5HMxg]

The series follows a selected number of Paramedic Students on their pathway from the classroom to the road. An interesting insight, and a reminder for many of us how we were when we were fresh…

Compared to the 2006 ‘Help’, this is a little more jazzed up – it’s for a commercial TV channel after all (not generally a fan…). All in all not bad. It must be advised though that most Paramedic Students in Australia now are degree qualified – this vocational training pathway is a dying breed (unfortunately that is not mentioned anywhere in the series).

I have linked the first episode only in this post. I you want to see more (there is plenty more available on YouTube), you will find them in the suggested section, or you can perform a search for “Recruits Paramedics”.

Happy viewing!

Ormskirk

Yes, Ormskirk. A little town in the North West of England, 14 miles north of Liverpool. Bus driver, pub owner, town locals…all asking me the same question: “What are you doing here?!” It seems visitors, be it from London or from Mars, are a rarity. Ormskirk is not a place that prides itself on tourism.

Doesn’t matter to me, I didn’t get to see much of the place anyway. I was here for the Continuing Professional Paramedic Development – a one day conference put on by the UK College of Paramedics.

The day started off with Dr John Freese, Chief Medical Director of New York City Emergency Medical Services. A rather good speaker with an interesting background (John started as a basic EMT in the rural US, worked his way up to Paramedic, then turned to medicine). His talk was based around trauma care in the US, its history and direction of the future. Some interesting points I picked up:

  • Skill decay is a big problem amongst NYC paramedics. Intubation success rate is approximately 30%, many paramedics don’t even get a chance of intubating, and their average training is far less than that of an average UK paramedic.
  • For severe trauma patients, definitive care is needed. Where this care is provided best (i.e. what is the most suitable hospital), NYC EMS has developed a simple reductive flow chart based on patient presentations, events and mechanism in order to determine if a patient should be taken to a trauma centre, and if so, what level. An important note was emphasised: the clinicians decision. The chart could not indicate any need for higher care, but the paramedic must still be allowed to take a patient to the highest care facility if judged so by their clinical experience.
  • Then the big one: “Spineboards: they need to go”. NYC EMS has realised that far too many patients are immobilised for no good reason. Research is proving that immobilisation is possibly doing more harm than good. Currently, new guidelines are being written in order to drastically lower numbers of spineboard usage in NYC. Personally, I applaud this. A big step in the right direction.
This talk was particularly interesting for me, as I had just visited New York last year (if you’ve been reading this blog recently, I am just putting up the stories now). Very nice having seen NYC EMS, then hearing all about it from the Chief MD.
Up next was Professor Kevin Mackway-Jones, Medical Director of the North West Ambulance Trust (NWAS). The presentation was similar to the previous, but this time from the NWAS perspective – a much more diverse landscape with urban, regional and rural settings (something you wouldn’t find in NYC!).
  • To provide a similar level of care that urban area enjoy everywhere in the NWAS catchment area, another 14 full time helicopters and anaesthetist would need to be employed. Far too expensive and ridiculous, he explored the alternatives: Full time HEMS, vs on call residential doctors, vs volunteer doctors (e.g. BASICS), vs full time specialised (critical care) paramedics. The last option won – cost effective, good exposure means good quality, experienced, available and a good skill set.
  • Kevin agreed with John about spineboards, and repeated the overuse of the device, stating that many UK services are re-evaluating their use. Additionally, he stated he is not convinced by pelvic splints; there is not enough evidence to support them.
Next speaker was Professor Andy Newton, Chair of the College of Paramedics and Clinical Director of South East Coast Ambulance Service. After some information update from the College itself, Andy got us in the right mood with a clip from the Simpsons: Homer as an Ambulance Driver (could unfortunately only find it online in Italian). Some points Andy talked about:
  • The history of Paramedicine, especially with regards to the “founder” of out of hospital care, Dominique Jean Larrey.
  • The specialisation of the workforce. The police have a very specialised workforce: General duties, traffic, homicide, fraud…certain cops target certain crime. Paramedicine should (and is) heading int he same direction: Paramedic Practitioners for minor issues that can bypass the A&E department, Critical Care Paramedics for very serious cases.
  • Apparently providing Ambulance Services in the United Kingdom costs 2 billion Pounds annually (surprising actually, since London’s Metropolitan Police alone have an annual budget of 3.5 billion Pounds. Compared to the 282 million Pound London Ambulance annual budget).
  • Then a great point: “Paramedics as a disruptive technology“. Adapted from the business world, the point was made how Paramedicine is influencing healthcare, changing the way care is delivered (e.g. via Paramedic Practitioners), together with potential ways Paramedicine may influence the provision of healthcare in the future.
  • Another video, this time from a cardiac arrest in London from the early 1980’s. Horrible grey uniforms, ghastly hairstyle, but the intubation was spot on (unfortunately nobody cared about chest compressions…). Nothing how an arrest is run in 2012, thirty years later.
After lunch, there were two more presentations; Sudden Arrhythmic Death, and Obstetric emergencies.

In other words: Quite a good event. Interesting speakers, decent venue, and a good attendance. Can’t ask for much more! For those who would like an online summary, I did tweet most of the event under the #ParaUKCPD hashtag on twitter (should be visible on my timeline, dated 19th October).

Couldn’t make it? I will be visiting the Emergency Services Show in Coventry on the 21st and 22nd of November, tweeting and blogging again. Hope to see you there!