WEMcast

Building an ‘extreme career’ from the RMC to CCP to Mountaineer

In this conversation we talk with Wayne Auton about his journey through three domains of practice; the military, pre-hospital care, and mountaineering. We examine the concept of High Performing Teams (HPT) in all three domains and some of the features of HPT that unite the different practices.

 

Wayne initially joined the military/Royal Marine Commandos and through time specialised as a sniper. He then transitioned through into pre-hospital care as a paramedic, progressing on to become a Critical Care Paramedic or CCP within a different high-performing team and pre-hospital HEMS service. Finally, we look at his recent transition to mountaineering and alpinism in Chamonix, French Alps. We examine some of the uniting HPT concepts around kit husbandry, homeostatic teamwork, community, debrief, commitment to continual improvement, and feedback. We also examine the attention to detail and mentoring as part of working within these teams and the vital concept of adaptation to the environment and situational awareness required to transcend disciplines.

 

Wayne has also published a blog around his experience with high-performing teams (Espirit de corps). This blog and his reflections on the ‘position of yes’, the ‘dislocation of expectation; and ‘cohesion within homogenous teams’ can be found here https://bio.site/WayneAuton

 

 

In the session we examine:

 

1. Wayne’s journey through the RMC and his role as a sniper.
2. Some of the fundamental elements Wayne took from being involved in a high-performing team within the RMC.
3. Wayne’s transition into the ambulance service and key elements he brought through from his time in the military.
4. Working within a pre-hospital high-performing team and the fundamental elements of these teams.
5. Wayne’s latest transition into the French Alps, climbing, and again being part of a high-performing team.

Interview with a Snake Catcher

Host Stephen P. Wood follows up with Luke Huntley, Australian snake catcher, after their discussion during the WEM 2021 conference. Stephen and Luke discuss the training that goes into snake catching as well as the legal requirements to be a certified snake catcher in Australia. Carpet pythons and Eastern Brown snakes are the most common snakes encountered in Luke’s work and Stephen and Luke discuss these animals and Luke’s approach to catching these beautiful creatures. Stephen and Luke explore the relocation of these snakes and some of the scientific data surrounding repatriation. Lastly, Stephen and Luke converse about some of the biggest threats to their survival, which is somewhat of a surprise. The pair finish off with a suggestion of a new side job for Luke, venomous snake wrestling in the UK.

 

Snake catcher Luke Huntley shares what it’s really like working as a snake catcher in QLD Australia. Snake calls come in at all hours of the day and night, from easy calls when there’s a sleeping python to very dangerous eastern brown snakes that have been riled up by a person or animal. Luke describes how handling technique and experience play such an important role in making the job safer. People’s attitudes towards snakes and how full on this lifestyle can be! Luke has been catching snakes for a large part of his life but has made a career out of it for 6 years now. It's lead to filming opportunities on shows like Bondi vet and of course having an exceptional local reputation and knowledge. All of this and then coming home for a cup of tea with his own collection of Australia’s and indeed the world’s most deadly snakes.

 

https://www.snakecatchernoosa.com.au/

https://www.dailymail.co.uk/news/article-9899587/Snake-catcher-Noosa-Luke-Huntley-removes-carpet-python-Doonan-backyard.html

https://whatsnew2day.com/snake-catcher-noosa-luke-huntley-removes-carpet-python-from-doonans-backyard/

https://www.9news.com.au/national/queensland-news-snake-catcher-wrangles-carpet-python-in-noosa-toilet/b6cae767-9296-49d0-a87a-c024a29ba938

Critical Analysis Causing Critical Mental Health

In this conversation, we talked with Carl Betts about his reflections on critical analysis in paramedic practice. Carl is a Paramedic and quality improvement lead-based in Sheffield working for the ambulance service. He has been a Paramedic for 10 years and has a 10-year extensive history of expeditions featuring multiple trips to Everest base camp, K2, Mongolia, South Africa, Swaziland, Kangchenjunga, Toubkal, Aconcagua, Pakistan, Oman and many more. 

He has recently written a piece of reflection that is about to be published in the College of Paramedics Hindsight magazine. The piece is titled ‘Where critical analysis becomes critically unhealthy’. In this episode, we examine this article, Carl’s motivations for writing it, and pull out some of the salient learning points. We examine some of the salient learning points around; unpacking the concept of disequilibrium in critical analysis that turns into critical self-appraisal. Also, examining the aspects of challenging debrief that leads to balanced learning and does not omit due affirmation. We also explore examples of where this has gone wrong in the past to put it into clinical context.

Furthermore, we look at:

1. Why critical analysis is an important skill both empirically and anecdotally.
2. Bring into focus how to reframe challenging incidents to provide a net positive effect for the clinician.
3. Understand how damaging it can be when it is critical self-appraisal/appraisal by others.
4. Reframing techniques in debrief and reflection 
5. Understanding the wider investment in this concept from senior management, frontline clinicians and educational institutions. 

We hope you enjoy this episode with an engaging and insightful guest.

Diners, Drive-Ins and Dives with Great Whites featuring Mike Hudson

In this episode podcast host Stephen Wood and adventure paramedic Mike Hudson talk about Mike's experience as a paramedic and lead safety specialist for the Discovery channel's Shark Week production team.

Steve and Mike talk about Mike's background as both a paramedic and diver and how he brought this experience to develop a unique opportunity as the lead dive safety and remote medical specialist for the Discovery Channel, National Geographic, as well as other production teams. Mike talks about how he prepares for these very challenging programs, including working in very remote and resource-limited areas.

Steve and Mike discuss equipment needs and dealing with local governments and medical systems, which can be very challenging. They discuss practising within the appropriate scope of practice as well as resources that are available to remote teams, like the DAN network. Mike regales several stories of crocodile and shark attacks and lessons learned from these critical events.

 

Mike Hudson Bio:

Mike Hudson is a Colorado native and nationally registered Paramedic with over 25 years on the streets. Mike is a former Navy Hospital Corpsman, San Diego City EMT-P, Denver City and County Paramedic, and Rocky Mountain flight medic. Mike currently works as a street-level MICP and EMS educator in central New Jersey. In the winter, Mike works for Discovery Channel’s Shark Week production teams as their lead dive safety & remote medical specialist. During the summer, Mike commands two municipal USLA certified ocean and swift water lifeguard programs for separate coastal towns along the Jersey Shore. He also serves as the supervising ocean rescue specialist for a nationally recognized combination fire department/lifeguard aquatic rescue response team; SRT 43-88, serving the entire north shore of Monmouth County and the waterways that lead to NYC.  For more information about Sea Bright Ocean Rescue please go to seabrightoceanrescue.com.

@medicmikehudson

https://seabrightoceanrescue.com/

https://www.youtube.com/watch?v=OEVtwlNZnu0

https://www.jems.com/author/mike-hudsonclarionevents-com/

Swapping Medicine for the Mountains with Anna Wells

In this episode, Dr Jen Sherman is joined by Anna Wells. Having qualified as a Doctor in the Scottish Highlands. Anna has successfully undergone a career change and now runs her own adventure guiding company in Scotland.

Anna is passionate about the mountains. The freedom of wide-open spaces and the rush of trying hard is where she is happiest. Her favourite activities are rock climbing, summer alpinism, skimo and running, with her happiest moments including completing a winter traverse of the Cullin ridge in one day, climbing El Capitan, summiting 37 4000ers in one summer, and having been fortunate to travel the world as part of the GB Ice Climbing Team.

In this episode Jen and Anna discuss:

• How her interest in climbing and mountains began
• Her academic career and how she came to study Medicine
• Her experience of being a Junior Doctor
• Why she decided to take a career break from Medicine
• How this career break evolved into a career transition
• The mental and emotional challenges of undergoing this transition
• The importance of surrounding herself with like-minded people during this time
• How she followed her passion and re-trained as an outdoor instructor
• What it’s like being a female outdoor instructor
• How and why she came to set up her own business
• Her experience of summiting 37 4000ers over one summer
• How she prepares for a big adventure
• What adventure means to her
• What adventurous experiences have taught her more generally
• Why she loves the Cullins on the Isle of Skye
• Are transferable skills always transferrable?

To connect with Anna

Website: https://rocksandtrails.com/

Email: anna@rocksandtrails.com

Instagram: @annawells89

Facebook: facebook.com/rocksandtrails

Standards and Developments in HEMS Across the Globe with Dr Vidar Magnusson

Dr. Vidar Magnusson is an anesthesiologist, intensivist and EMS physician in Reykjavik, Iceland. He is the current National Medical Director for pre-hospital services in Iceland, a post he held both between 2011- 2014, and again from 2016 to the present. He has extensive EMS and air-medical experience including serving as a medical officer with the British Army NATO coalition forces, ground EMS in Iceland and the Icelandic Coast Guard Medevac helicopter. He has worked in several air-medical systems in Europe including London HEMS, KSS HEMS and the Norwegian Air Ambulance. He represents Iceland in the Scandinavian Society for Anaesthesiology and Intensive Care Medicine (SSAI) prehospital guidelines group as well as the SSAI Critical Emergency Medicine (CrEM) postgraduate training program. In addition, he holds a master of business administration from Reykjavik University.

 

In this episode host Stephen Wood, a former HEMS paramedic, discusses the differences between air-medical systems in several parts of the world. The conversation starts with the London HEMS system, considered one of the best in the world. Vidar discusses the extensive training program, research and quality assurance that goes into this system. Stephen and Vidar discuss some of the differences of the U.S. based programs that less often feature physician-led teams and how the two compare. The Norwegian system was next on the agenda, another robust program but with a different crew configuration and design. Lastly, the pair chatted about the Icelandic system, which is new and up and coming, but still in a growth stage. Vidar and Stephen discussed some of the differences in HEMS requests, flight and weather operations. The conversation closes with a view of HEMS in the future, particularly for the Icelandic program, and how each would envision a robust HEMS program.

 

Links:

VIdar's Twitter @HEMSonICE

KSS HEMS https://www.aakss.org.uk/

London HEMS https://www.londonsairambulance.org.uk/

Norwegian Air Ambulance http://www.luftambulanse.no/about-national-air-ambulance-services-norway

ICG SAR/medevac helicopter team https://www.lhg.is/english/search-and-rescue/

SSAI Critical Emergency Medicine (CrEM) postgraduate training program

https://ssai.info/education/critical-emergency-medicine/

Healthcare in Ghana – The harsh reality of a developing country with Trixton May

In this conversation, we talk with Trixton May about his clinical experiences in Takoradi, Ghana. Trixton took himself to Ghana as a second-year paramedic student with aspirations to serve in areas less fortunate and developed contexts than his reality back in the UK. In the discussion, we explore the variety of experiences and revelations he had in this developing healthcare system.

Trixton has written a reflection 'Healthcare in Ghana – The Harsh Reality of a Developing Country'. In the reflection, Trixton denotes the socio-economic demographics of Ghana and the social deprivation that healthcare serves in the region. He also recalls his anecdotal experience in each domain of emergency care. We examine some of the patients and pathologies that he observed in his time within the emergency department. We also examine the challenges of working in a low resource environment and the innovation that is required at certain times due to the overwhelming clinical need. We then examine the utility of being exposed to extreme poverty and the consequential reframing of the NHS in light of this. We delve into the advantages of debriefing in some of the more traumatic cases and reprocessing the narrative to ensure there is some cognitive reprieve. We also examine the adaptation that has to occur in the absence of diagnostics and equipment and drugs. We finally look at the utility of going with an established organisation that has both in-country presence, security environment scanning and channels of support as required.

 

Trixton’s reflective piece can be found here: https://4c9ccd6e-1304-4bf0-9df0-58cabce7c308.filesusr.com/ugd/7fc531_5aa29fdd01a84ec3b9d18e451d62bef5.pdf

The organisation that Trixton went to Ghana with can be found here: https://www.worktheworld.co.uk/

Teaching Wilderness Medicine in the Virtual World with Dr Sanjey Gupta

Host Stephen Wood and Dr Sanjey Gupta discussed wilderness medicine in the virtual world. Forced to switch content from live and in situ to Zoom, Dr Gupta and his colleagues had to get creative. Most of Gupta’s teaching is in the environment that they are teaching to; the woods, mountains or fields and is mostly hands-on. Having to switch to the virtual environment, Dr Gupta and his colleagues flipped the narrative and used the Texas heatwave to have conference attendees try to “survive” by making potable water, cooking without electricity or gas and making a battery. Participants were creative and did everything from bleach dilutions to filter systems. In another scenario, Dr Gupta and his students acted as laypersons who were involved in a bike crash. They called “medical control” via telemedicine and were walked through examining patients and treating them using the equipment they had on them. Stephen and Dr Gupta discussed the challenges of teaching wilderness medicine using virtual technology, how to engage the audience and some of the technical requirements to make sure are in place before bringing the course live.

 

Dr Sanjey Gupta is a Professor of Emergency Medicine at the Zucker School of Medicine at Hofstra/Northwell and is the Chairperson of Emergency Medicine at South Shore University Hospital/Northwell Health.  He is a Fellow in the Academy of Wilderness Medicine of the Wilderness Medical Society.  He is a wilderness medicine educator and frequently speaks on the topics of environmental injuries, poisonous vegetation, wilderness medicine improvisational skills, and wilderness educational techniques. 

What exactly is a space nurse? with Starr Schroeder

In this episode, WEMCast host Dr Shawna Pandya dives deep into this very question with none other than AstroRN Starr Schroeder, a nurse passionate about pioneering, defining, and developing the role of nursing in the commercial space industry as well as advocating for the continued development of space medicine in current and future space exploration. Listen in as Shawna and Starr talk about the rise of space nursing, the commercial space sector, Starr’s research on a myriad of topics including space nutrition and medical guidelines for commercial suborbital spaceflight.

 

Starr Schroeder is a nurse with experience in critical care, emergency nursing, and nursing management. She has since become an active participant in the space medicine community incorporating her experience in medicine into her love for space by pioneering, defining, and developing the role of nursing in the commercial space industry as well as advocating for the continued development of space medicine in current and future space exploration.

Starr is a member of the Association of Spaceflight Professionals where she was co-lead for research involving medical guidelines in commercial space flight participants, currently published in Acta Astronautica. Her additional publications include chapters on Spaceflight Nutritional Support, Future Trends in Spacesuits, and The Lunar Environment in the Handbook of Life Support Systems for Spacecraft and Extraterrestrial Habitats. She currently serves as a PoSSUM 13 chair, an organization dedicated to increasing opportunity and representation for women and students in STEM. Starr graduated from Indiana University with a Bachelor of Science in Nursing in 1999. She is currently a Masters candidate in the Human Factors in Aerospace program at Embry-Riddle Aeronautical University.

 

Links: 

IIAS

PoSSUM

PoSSUM13

Climate Change and Patient Outcomes: How We Can Make an Impact

In this session host Stephen Wood speaks with Dr Louis Nguyen and Dr Liz Yates, surgeons and researchers at the Brigham and Women’s Hospital in Boston discuss the impact of climate change on healthcare and patient outcomes. Dr Yates and Dr Nguyen discussed the large carbon footprint of the healthcare industry, especially in developed nations. This includes the large amount of waste that stems from pre-made kits as well as other disposables. Similarly, the amount of energy that is dedicated to healthcare accounts for a large carbon footprint among industries. This leads to a discussion on the impact of climate change on patient accounts. The focus was on surgical patients and how issues like heat islands and lack of access to air conditioning can result in higher morbidity and mortality. This extends to other patient populations including OBGYN patients, pulmonary patients as well as the vulnerable young and elderly. More concerning is how this impact seems greater for marginalized and underserved populations. The group spent the remainder of the conversation discussing how everyone can make an impact with even small, local actions.

Louis Nguyen Bio: Dr Louis Nguyen is a vascular and endovascular surgeon at Brigham & Women’s Hospital and Associate Professor of Surgery at Harvard Medical School. Within the Department of Surgery, he serves as the Vice-Chair for Digital Health Systems; and within the Division of Vascular & Surgery, he is the Director of Clinical and Outcomes Research, as well as the Director of Quality, Safety, and Value. His interest in Environmental Sustainability focuses on minimizing the environmental impact from healthcare through education and implementation programs

Liz Yates Bio: Elizabeth Yates, MD, MPH is a general surgery resident at Brigham and Women’s Hospital.  She has completed three years of clinical training and is currently completing a research fellowship at the Center for Surgery and Public Health, focusing on sustainable surgical care delivery and the impact of climate change on surgical outcomes.

Show Notes:

Matthew J. Eckelman, Kaixin Huang, Robert Lagasse, Emily Senay, Robert Dubrow, Jodi D. Sherman. Health Care Pollution And Public Health Damage In The United States: An Update. Health Affairs, December 2020

Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The Carbon Footprint of Surgical Operations: A Systematic Review. Ann Surg. 2020 Dec;272(6):986-995.