The St.Emlyn’s Podcast

St Emlyn’s Blog and Podcast
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The St.Emlyn’s Podcast

St Emlyn’s is the premier emergency medicine podcast from the UK. We discuss evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.

  1. 13 HR AGO

    Ep 251 - Bad Behaviours in Teams with Liz Crowe at Tactical Trauma 24

    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

    18 min

  2. 20 NOV

    Ep 250 - Monthly Round Up September 2024 - Patient Experience in the ED, Dirty Adrenaline, and More!

    In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley discuss various facets of emergency medicine. They highlight a study on patient experience in emergency departments, focusing on issues like loss of autonomy, unmet expectations, and vulnerability. Suggestions for improvement include better communication, effective signage, and patient comfort. The podcast also covers a 'dirty adrenaline drip' study from Australia, emphasizing remote inotrope management. Discussions include the use of arterial blood pressure monitoring in pre-hospital settings and the merits of CT scans beyond the traditional six-hour window for diagnosing subarachnoid haemorrhage. The episode wraps up with reflections on the positives of emergency medicine and the importance of maintaining enthusiasm and mastery in the field. 00:00 Introduction 01:08 Patient Experience in the Emergency Department 02:33 Improving Patient Experience: Practical Tips 04:05 Qualitative Studies in Healthcare 06:43 Dirty Adrenaline Drip: A Practical Insight 10:44 Emergency Endoscopy for Caustic Ingestions 14:15 Subarachnoid Hemorrhage Diagnosis: The S.H.E.D. Study 18:14 Arterial Blood Pressure Monitoring in Pre-Hospital Settings 24:18 Reflections on Emergency Medicine as a Career 27:41 Conclusion

    29 min

  3. 14 NOV

    Ep 249 - Care in the Hot Zone with Claire Park at Tactical Trauma 2024

    In this episode, recorded live at Tactical Trauma 2024, Dr Claire Park explores the critical lessons learned from civilian and military incidents, focusing on her extensive experience in the Army and their role as chief investigator in a UK trial examining responses to terrorist attacks.   The talk covers the significance of 'hot zones,' illustrated by detailed analyses of the London Bridge and Fishmongers' Hall attacks and key topics include risk assessment, the importance of rapid medical intervention, the concept of survivability, the need for integrated communication among emergency services, and the human factors influencing decision-making in high-pressure environments. Claire also delves into practical strategies like the 10-second triage and bridging interventions, emphasizing the need for timely and effective medical responses to save lives.   00:00 Introduction to Learning from Incidents 01:52 Setting the Scene: Hot Zones 01:55 Case Study: London Bridge Attack 04:23 Understanding Hot Zones 05:51 Case Study: Fishmongers Hall 07:58 Risk Assessment in Pre-Hospital Care 09:23 Communication and Coordination Challenges 10:16 International Models and Time Management 12:13 Triage and Life-Saving Interventions 15:18 Data and Research on Causes of Death 21:43 Human Factors in Emergency Response 24:00 Conclusion   Dr Claire Park is a consultant in pre-hospital emergency medicine for London's HEMS, as well as anaesthesia and critical care medicine at Kings College Hospital in London. She also is an army consultant with over 20 years of deployed military experience. Claire is the Medical Adviser to the Specialist Firearms teams of the Metropolitan Police Service and has worked closely with all of the emergency services in London on developing the joint response to high-threat incidents, particularly following the attacks of 2017. She is the Chief Investigator on a UK nationally-funded research grant looking at evidence for improving patient outcomes in the hot zone of major incidents. She is also a CTECC Committee member.

    25 min

  4. 6 NOV

    Ep 248 - Prehospital eCPR with Alice Hutin at Tactical Trauma 2024

    Join Iain Beardsell and Liz Crowe in an engaging discussion with Alice Hutton, an emergency physician from Paris, at Tactical Trauma 24 in Sundsvall, Sweden. The episode delves into the implementation and logistics of pre-hospital eCPR (Extracorporeal Cardiopulmonary Resuscitation) by SAMU in Paris. Alice shares insights from her PhD research on refractory cardiac arrest and discusses the use of therapeutic hypothermia, including experimental approaches like total liquid ventilation. Key topics include team composition, decision-making for patient eligibility, real-time management strategies, bypassing traditional emergency rooms for specialized facilities, and the challenges of scene management, family communication, and post-event debriefing. This conversation offers a comprehensive look at the latest innovations that could transform pre-hospital emergency medical services. Read more here... 00:00 Introduction and Guest Introduction 01:29 eCPR in Paris: Current Practices 02:35 Dispatch and Response Protocols 03:32 On-Scene Procedures and Challenges 04:23 Decision Making and Scene Management 05:53 Training and Handling Difficult Situations 06:59 Challenges of eCPR Decision-Making 08:07 Importance of Team Debriefing 08:52 Post-Resuscitation Procedures 10:12 Operational Logistics and Success Rates 11:20 Innovative Research in Therapeutic Hypothermia 13:13 Future of Pre-Hospital Cooling Techniques 13:46 Conclusion and Final Thoughts

    14 min

  5. 30 OCT

    Ep 247 - August 2024 Round-Up - Goldilocks Moments, Nasal Analgesia, and Public Health in the ED

    In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Simon Carley share their insights from recent conferences, including Gateshead's RCEM scientific conference, Tactical Trauma 24 in Sweden, and the Premier Conference. They explore 'Goldilocks moments' for executing life-saving procedures in critical care, emphasizing optimal timing for interventions like thoracotomies. The episode also discusses innovative training methods like shadowboxing to enhance decision-making in high-stress medical scenarios. In addition, they review a significant trial on smoking cessation in emergency departments, highlighting its potential role in broader public health initiatives, including sexual health and HIV screening. Discussions also cover various pain management strategies, such as the use of intranasal vs. intravenous Ketorolac for renal colic. The hosts critique the traditional peer review process in medical research and advocate for open peer review to support equitable and accessible scientific publishing. 00:00 Introduction and Catching Up 02:07 The Goldilocks Moment in Critical Care 05:25 Training and Decision-Making in Emergency Procedures 07:23 Smoking Cessation in Emergency Departments 10:07 Challenges in Implementing Preventive Health Strategies 10:38 Successful Public Health Projects in Emergency Medicine 11:19 Exploring Alternative Interventions in Emergency Departments 11:52 Highlights from the Premier Conference 12:54 Intranasal Ketorolac for Pain Management 15:46 The Future of Peer Review in Medical Research 20:09 Concluding Thoughts and Upcoming Content

    21 min

  6. 23 OCT

    Ep 246 - Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024

    In this episode, recorded at Tactical Trauma 2024, Andrew Petrosoniak discusses real-world experiences in trauma care, and the innovative use of simulation to resolve systematic issues in blood delivery and overall trauma resuscitation protocols. Key takeaways include the concept of intelligent failure, reducing cognitive overload for medical staff, and the creation of efficient medical environments. Moreover, the episode delves into the significant improvements achieved through simulation, such as a 50% reduction in blood delivery times, and the integration of performance data to enhance CPR and clinical space design. Emphasizing the importance of using data to drive improvements, the conversation explores the implementation of roles like a CPR coach and the scalable application of these practices across individual, team, and systemic levels. Listeners are encouraged to view failures constructively and leverage simulations and data for better patient outcomes and team performance. 00:00 Introduction to Simulation in Emergency Medicine 01:05 A Real-Life Trauma Case 02:18 Identifying Systemic Issues 02:46 Implementing and Testing Solutions 05:45 The Concept of Intelligent Failure 09:41 Scaling and Impact of Simulation 10:22 The Power of Simulation in Experimentation 10:56 Data Integration in Healthcare and Sports 11:29 Evaluating CPR Quality Through Simulation 12:14 Using Data to Improve Clinical Performance 13:47 Designing Clinical Spaces with Simulation Data 15:28 Scaling Impact with Simulation 18:02 Efficient Team Communication in Trauma Bays 19:04 Broadcasting and Recording Simulations for Education 19:39 Conclusion and Future Directions The Speaker Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital and an Assistant Professor in the Department of Medicine at the University of Toronto. He has completed a Master of Science in medical education where he focused on the use of in situ simulation (practice in the actual workplace) in procedural skill acquisition. Andrew’s field of research includes in situ simulation and simulation-based technical skill acquisition. His work focuses on usability testing and the identification of personnel- and systems-based safety threats within acute care medicine. He is the principal investigator of the TRUST study (Trauma Resuscitation Using in Situ simulation for Team Training) that includes a partnership with human factors experts to evaluate systems and processes during high-stakes trauma simulations.

    20 min

  7. 18 OCT

    Ep 245 - Leading through failure with Kevin Cyr at Tactical Trauma 2024

    Recorded at Tactical Trauma 2024, in this episode of the St. Emlyn’s podcast, Iain Beardsell and Liz Crowe sit down with Kevin Cyr, commander of a SWAT-like unit in the Royal Canadian Mounted Police, to discuss leadership, failure, and resilience in high-stakes environments. Kevin shares the powerful story of a tragic hostage situation that resulted in the unintended death of the hostage by the police, a failure of the highest order. Through this  tragedy, Kevin highlights the importance of visible leadership, team resilience, and learning from failure in both law enforcement and healthcare settings. Key Themes: 1. Handling Failure in High-Pressure Situations:Kevin discusses a significant incident where a hostage was killed by his SWAT team during a rescue attempt, describing it as the “epitome of failure.” This tragic event not only made national news but left an indelible mark on the team. The podcast dives into the lessons learned from this event and how the team used it to drive growth and improvement. In healthcare, much like in policing, failure can feel devastating and highly public, but it’s also a critical aspect of development for teams and leaders. 2. Visible Leadership and Unwavering Support:In the aftermath of a traumatic event, Kevin emphasizes the importance of leadership being present and supportive. He recounts how he and his commanding officer went to visit the officers involved in the shooting immediately after the event, providing what he calls “unwavering support.” In healthcare, leaders should adopt similar strategies, offering visible and sustained support to their teams in the immediate aftermath of difficult cases. 3. Sustained Support Over Time:While initial support following a traumatic event is crucial, Kevin points out that it’s often after 48 hours, or even weeks later, that people start feeling isolated. Leaders must continue to check in with their teams weeks after the event, when the immediate crisis may have passed, but the emotional toll is still present. This ongoing visibility and emotional support are key to retaining staff and ensuring their well-being in both law enforcement and healthcare. 4. Debriefing to Learn, Not to Blame:Kevin advocates for a debriefing process that focuses on learning from failure rather than assigning blame. After their tragic event, his team didn’t just move on; they dissected the event to understand what went wrong and how to prevent similar failures in the future. In healthcare, this process is equally valuable—debriefs should aim to identify learning opportunities and reinforce positive actions, not to point fingers. 5. The Role of Organizational Culture:Kevin touches on how organizational apathy, or a lack of emotional and psychological support, can cause more damage than the actual traumatic event itself. He highlights the importance of developing a high-trust environment where team members feel safe to express vulnerability. In healthcare, fostering a culture of open communication and mutual support is essential to prevent burnout and moral injury. 6. The Value of Failure in Team Growth:One of the most profound insights Kevin shares is the idea that failure is a necessary part of growth. Three years after their tragic hostage situation, his team was called to a similar event, but this time they were successful in rescuing both hostages. Kevin attributes this success directly to the lessons learned from their earlier failure, emphasizing that failure, when handled correctly, can lead to transformational change. 7. Selection and Resilience in High-Performance Teams:Kevin discusses the importance of selecting team members with high emotional intelligence and the humility to ask for help when needed. He explains how his team differentiates between rank and role, giving autonomy to those with the most subject matter expertise, regardless of their rank. In healthcare, this is a critical point—leaders must recognize that true leadership is

    34 min

  8. 6 OCT

    Ep 244 - July 2024 Monthly Update - Chest Pain, REBOA, Lidocaine patches and lots of paediatric emergency medicine

    Welcome back to the St. Emlyn’s podcast. This episode covers some of the most important developments in emergency medicine and critical care from July 2024. Whether you're practicing on the frontlines or keeping up with the latest research, this episode has something for you. From coronary risk scoring tools to cutting-edge AI in ECG interpretation, and the management of non-fatal strangulation, it’s packed with insightful updates. Here's a breakdown of the key topics: The Manchester Acute Coronary Score (MACS Rule) is a valuable tool for risk-stratifying patients presenting with chest pain in the emergency department (ED). MACS uses both clinical characteristics and biomarkers like troponin to assess a patient's likelihood of experiencing an acute coronary event. A recent systematic review found that the T-MACS model (which uses troponin) has a sensitivity of 96%, making it highly effective at ruling out serious coronary events. Though the specificity is lower, MACS’s real strength lies in its ability to drive clinical decisions and patient referrals. This tool is already integrated into the Electronic Patient Record (EPR) in Manchester, where it helps streamline the decision-making process for patients with chest pain. If you’re looking for a reliable method to quickly and accurately stratify risk, MACS could be the answer. Artificial intelligence (AI) is revolutionizing healthcare, and its application in ECG interpretation is particularly exciting for emergency medicine. In this episode, Steve Smith joins us to talk about how AI can enhance the detection of occlusive myocardial infarction (OMI)—a concept that might one day replace the traditional ST-elevation and non-ST-elevation classifications. By integrating AI into rapid assessment areas (like pit-stop zones in the ED), clinicians can benefit from real-time ECG analysis. This reduces the burden of interruptions and helps detect subtle abnormalities that might be missed in high-pressure environments. AI-driven ECG tools could dramatically improve patient outcomes, particularly in cases of high-risk cardiac events. Non-fatal strangulation (NFS) is an often underdiagnosed condition in emergency medicine, but it carries significant risks, including carotid artery dissection. A new guideline from the Faculty of Forensic and Legal Medicine emphasizes the importance of detecting these cases and suggests that clinicians use contrast angiography to rule out vascular injuries. Beyond the medical consequences, non-fatal strangulation is also a major indicator of future violence, including homicide. The guideline highlights the ethical challenges clinicians face when deciding whether to involve law enforcement, especially when patient consent is lacking. Safeguarding and appropriate referrals are essential for these high-risk patients. REBOA has been evolving in recent years, and now it’s moving from the emergency department into the pre-hospital setting. In the latest advancements, partial REBOA—which allows for some blood flow below the balloon—is being used to resuscitate patients in traumatic cardiac arrest. This partial occlusion technique may be more effective in maintaining coronary perfusion, essentially resuscitating the heart in cases of extreme hemorrhage. Early data from a feasibility study shows promise, with an 18% survival rate in patients who otherwise would have had little chance of survival. REBOA could become a life-saving pre-hospital intervention for trauma patients in the near future. Paediatric eating disorders, particularly anorexia and diabulimia, remain under-recognized in emergency medicine. In this episode, we explore some of the red flags—such as rapid weight loss, bradycardia, and postural hypotension—and why emergency clinicians need to be more attuned to the signs of eating disorders. Of all mental health disorders, anorexia has the highest mortality rate, and in cases of diabulimia, patients intentionally stop taking insulin t

    27 min
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About

St Emlyn’s is the premier emergency medicine podcast from the UK. We discuss evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.

Information

  • Creator
    St Emlyn’s Blog and Podcast
  • Years Active
    2012 - 2024
  • Episodes
    253
  • Rating
    Clean
  • Copyright
    © Attribution-NonCommercial-ShareAlike CC BY-NC-SA
  • Show Website
    The St.Emlyn’s Podcast

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