Greater Sydney Area HEMS

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.

Episode 14 of the HEMS debrief series, focused on maternal cardiac arrest and resuscitative hysterotomy.

As we move our the podcast onto both Spotify and Apple Podcasts, we are re-posting this episode originally published in March 2024. In this episode, Nat and Alex join Sam to discuss the Sydney PRECARE pre-hospital ECMO trial as it is just getting under way. Focusing on workflows and team integration, Nat and Alex share their experiences, challenges and successes in these early days for the trial. We hope that the content here may help frame that of other episodes in this cardiac arrest series, as well as flavour future episodes as we reflect on PRECARE several years later.

Welcome back to the Sydney HEMS debrief. We are up to episode 11! Today, we are pivoting towards toxicology. Specifically, we discuss some of the more common toxidromes encountered pre-hospitally, how they cause cardiac arrest, and what providers – in particular pre-hospital providers – may do in order to best resuscitate these patients. In addition to some broader and very applicable learning themes pertinent to any toxidrome, we discuss Beta-blockers Calcium channel blockers Amitriptyline Quetiapine …and more Of course we are not doing discussing this alone. We are so luck to be joined today by a clinical toxicologist, Dr Úna. Dr Úna Nic Ionmhain graduated from Trinity College Dublin, and subsequently trained in Emergency Medicine in Perth. She completed a Pre Hospital and Retrieval Medicine year with CareFlight NSW as well as a poisons fellowship. She is now a staff specialist FACEM at Liverpool Hospital NSW, and a clinical toxicologist with the NSW Poisons Information Centre. She has an academic interest in HIET in toxicology for cardiogenic shock, which was the focus of her masters thesis, and is a passionate educator with a particular interest in cardiotoxicity. We sure hope you enjoy this episode, and until next time, we hope you have a great week. We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.

Hello, and welcome back to the Sydney HEMS debrief podcast. Thank you for your patience – I have been taking the long way home from Canada, but am delighted to be back in Sydney and now ready to go with more episodes of our focused series on cardiac arrest. In this part one of two episodes, we are pivoting away from the technical towards human factors and team performance. In doing this, we are thrilled to be joined by Dr Mike Lauria. Mike is a human factors legend. Prior to becoming a Doctor, Mike served as an elite Pararescueman in the 321st Special Tactics Squadron during which time he won numerous service awards. Then, Mike became the lead instructor of a tactical training group before moving back to New Hampshire to work as a Critical Care and Flight paramedic. If that wasn’t enough, Mike then went to and graduated from Medical School before completing his residency in Emergency Medicine, as well as fellowships in EMS and Critical Care, at the University of New Mexico Health Science Center. Currently, Mike works as an attending critical care and EMS physician at the University of Washington, and is the Associate Medical Director at Airlift Northwest. Suffice to say, Mike brings an exceptional wealth of experience and perspective on what constitutes a high performing team and a high performing individual, and the factors required to maintain operational momentum even during unfavourable circumstances. Nat and Mike discuss this and much more in what are two episodes full of absolute gold. I predict these episodes will become mandatory listening for human factors and team performance enthusiasts, and rightly so. 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.

Hello and welcome back to the Sydney HEMS debrief, focus on cardiac arrest. This week, we are joined by a Sydney local – Prof Jimmy Chien, as we talk about PE in cardiac arrest. Jimmy is a Senior Staff Specialist (Senior Consultant) in Respiratory Medicine, with a sub-speciality focus on pulmonary embolism. Jimmy has been fundamental in the creation of the PE emergency response team at his tertiary facility in Sydney, as well as in the roll-out of similar multi-disciplinary teams across Australia. On a daily basis, Jimmy and his team encounter the most challenging PE patients – those with intermediate or high risk PE, as well as those in arrest. In this episode, Nat, Jimmy and I unpack how a PE causes an arrest, how to ascertain if a patient has arrested secondary to a massive PE, the therapies available to those patients who have arrested due to a known or suspected PE, and the role of mechanical support including ECMO. Too, we quiz Jimmy on where the literature is taking us to help manage this cohort of patients, as well as some of the emerging post-therapy care plans. Jimmy is a wealth of knowledge, and we sure hope you enjoy the episode as much as we did recording it. We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.

Hello and welcome back. As we continue to discuss cardiac arrest, this week we talk with Prof Laurie Morrison from Toronto about: How to integrate cardiac arrest research into an existing systems How to gather and interpret physiologic data during arrest – particularly ventilation data – and what to do with this data to optimise arrest care How to be a leader in this research field Prof Morrison is an academic and Clinical Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Sunnybrook Health Sciences Centre. Her program of research focuses on the evaluation and implementation of time sensitive interventions in acute emergencies, including cardiac arrest. Laurie is a member of ILCOR, where she has been named a ‘Giant in Resuscitation’. Outside of ILCOR, Laurie has led the way establishing ‘Rescu’ – a collaborative prehospital research network wherein investigators conduct randomised controlled trials and outcome validation studies in resuscitation research. Laurie continues to provide leadership to several committees including the network of Canadian Emergency Medicine Researchers, and she has has received honorary membership to the European Resuscitation Council for life time achievement in resuscitation science. We hope you enjoy this episode, and as ever please send us feedback or questions. Please remember to hit subscribe! We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.

Hello, and welcome back to the Sydney HEMS debrief, focus on cardiac arrest. This is episode 3, and today it is all about ventilation during arrest. It is time to put the P back into CPR. Ventilation has been neglected in cardiac arrest management, and this two part episode focuses on how ventilation can not only help achieve a ROSC but the importance of ventilation too in achieving neurologically intact survival We debate 30:2 or continuous ventilation and the merits of LMA vs intubation vs BVM We talk about the complexities of heart lung interactions Where the research is heading in understanding how best to ventilate these patients We are delighted to be joined by an absolute expert in this area, Dr Hans van Schuppen from Holland. Hans is an anesthesiologist and HEMS physician at the Amsterdam University Medical Centre. Hans is a combined researcher, clinician and leader. He is an ERC Advanced Life Support Course Director, co-founder of the ResusNL conference, member of the expert group on national ambulance guidelines on resuscitation and is a member of the jury of the Dutch National Resuscitation Competition. As a member of the Dutch Resuscitation Council, he co-authored the national resuscitation guidelines, and helped to develop and implement a nationwide standard operating procedure for the handover of out-of-hospital cardiac arrest patients. Currently, Hans is the chair of the Medical Committee and board member of the Dutch Resuscitation Council. His research evolved into a formal PhD with the ARREST (AmsteRdam REsuscitation STudies) group and the department of Anesthesiology, resulting in his thesis “Prehospital Advanced Life Support”. He now serves as director of resuscitation science of ARREST and works towards close collaboration between clinical care, education, research and innovation in resuscitation. We could not stop talking to Hans, so please tune back in next week for the second half of our conversation. We are delighted to be sponsored by Corpuls - delivering high-tech and innovative equipment for emergency and intensive care medicine for over 35 years.