- RT @ClareHBradley: Help please. How long do other retrieval services keep prefilled Rocuronium syringes out of the fridge? @drricha… 2 days ago
- RT @EMManchester: Top 10 Trauma Papers for Trauma UK conference. 2020-2021. No doubt COVID affected the number of clinical trials publishe… 2 days ago
- RT @cliffreid: This weekend a #COVID press conference by the State Government included @HawkmoonHEMS outlining the response by State Retrie… 1 week ago
- RT @RFDS_CO_EGMMRS: Retrieval in full #COVID19 PPE is no joke. Eapecially over long haul. Keep up the great work @cliffreid, @SydneyHEMS an… 3 weeks ago
- RT @cliffreid: Start of night shift personal kit checks. Our cognitive aids are unequivocal. https://t.co/3Evg6hqWoF 1 month ago
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Sydney HEMS registrar Dr Jonny Morris takes us through the impact of flight on patients and the things we should consider for patients we are transporting by air.
Providing exceptional critical care to a severely injured patient and kicking the winning goal in World Cup Rugby to most will seem many worlds apart. Dr Nathan Trist, one of our current senior PHRM registrars, is a former professional rugby player who has insight into both of these worlds and highlights the lessons learnt across both of these fields.
In this talk he discusses high performance with Australian Wallaby player, Bernard Foley. Known as the “Iceman”, the goal kicker uses positive self talk, exceptional training and intense focus on the task at hand to perform at his best. Performing with pressure requires an understanding of how you react to these factors and developing triggers to centre yourself when this pressure arrives.
Have a process and rehearse these skills in training, trigger process activation in missions and reflect on not just actions, but thoughts in mission review.
“Keep your head down and stay tall to the kick” – Bernard Foley
The team at Sydney HEMS wanted to express our appreciation to Bernard for taking the time to talk with Nathan and the team at our recent Sydney HEMS Education day.
Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart SD. Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress. Ann Emerg Med. 2017 Dec;70(6):884-890. doi: 10.1016/j.annemergmed.2017.03.018. Epub 2017 Apr 29. PMID: 28460863.
Attendance at CGD is open to NSW Health employees – dial in details are available on request.
Over recent years self-talk and self-compassion have been increasingly explored; notably they are key components of performance psychology. These two aspects can influence performance not just of elite athletes but also of medical professionals; while under pressure and following high-stress events as we process and reflect on our decision making. So what are self-talk and self-compassion all about and why are they relevant to us in prehospital and retrieval medicine?
Self-talk: the internal voice in which we all speak to ourselves. It can be positive or negative. There is evidence to show that self-talk can influence performance – Louise Harvey
Self-compassion: a sense of kindness, care and understanding for yourself, versus judgement, alongside a sense of mindfulness. Self-compassion has less impact on performance than on emotional wellbeing – Kristin Neff
Positive and negative self-talk are the two sides of our internal narrative. Self-talk is a mixture of our conscious and unconscious thoughts and might be better recognised as our inner voice. You can think of it as an amalgamation of your values, norms and expectations. Most significantly, it can impact performance and mental wellbeing.
NSW Aeromedical division is incredibly fortunate to have a staff psychologist, Louise Harvey; as part of our Mindhacks series she recently ran session on education day, which she began by asking us what we had said to ourselves that day. Had we reprimanded ourselves for a silly mistake? Complimented ourselves for our efforts? Recognised our own mood and expectations for the day?
The concept of self-talk, whether positive or negative, is well known and utilised; prominent applications include the world of elite sport and the ongoing management of eating disorders and body dysmorphia. Louise highlighted that there is application and relevance to the practice of prehospital and retrieval medicine too.
The way we think about situations, about experiences and about ourselves influences how we feel and respond. This is a bidirectional relationship; the way we feel also influences how we think. If we can strengthen helpful thoughts and feelings, and acknowledge and choose what to do with unhelpful thoughts/feelings, we’ll feel more empowered, confident and tend to perform better. Often the way we speak to ourselves follows unconscious patterns. It is helpful to get to know and pay attention to how we talk to ourselves. Awareness of our thinking patterns gives us the chance to build on what is working and change what is not. Practices that build insight and awareness such as mindfulness help with this.
Helpful positive self-talk has several qualities: it’s balanced, realistic, believable, compassionate, clear and individual – it’s not about ignoring the unpleasant things or sugar coating. Helpful positive self-talk acknowledges the stressful, unpleasant and uncomfortable aspects of life, but with kindness and compassion. Examples of this could be:
• Unhelpful: That was really bad, everyone saw me fail. Helpful: Attempting to do this took courage and I am proud of myself for trying.
• Unhelpful: I’ll never be any good at this. Helpful: If I keep practicing and ask for support, I can grow my skills and confidence.
• Unhelpful: I got that procedure wrong, I’m the worst clinician here. Helpful: I made a mistake and I’m taking responsibility for it.
Looking at some evidence:
This systematic review looked at 47 articles exploring self-talk and its impacts on performance. Interestingly, whilst negative self-talk wasn’t proven to impede success, motivational and instructional self-talk were shown to enhance it.
Physician wellness is an area of developing interest but there is not a lot of research as yet. This article highlights the importance of self-care and self-compassion, and suggests the more compassion we can show ourselves, the more we show our patients too.
Focussing on developing self-compassion amongst health care work has the potential to reduce perceived stress and increasing effectiveness of clinical care.
Anita Alexander is a psychologist and strength finding coach as well as being a Coordinator of the NSW Ambulance Wellbeing & Resilience Program. She also spoke recently at one of our education days about self-compassion, outlining a few simple mind hacks we can all use.
Start off by taking this simple self-compassion quiz to gauge your starting point:
In her talk to us, Anita referenced Dr. Kristin Neff as the leading researcher in self-compassion. Dr. Neff defines self-compassion as having three key components: mindfulness, self-kindness, and awareness of the shared humanity that we are all a part of (an understanding that we all go through difficult phases and to recognise that this is usual). The compassion discrepancy refers to the difference between how we would speak to or comfort others, compared to how we speak to and judge ourselves.
Top tips for increasing self-compassion:
- Identify your own personal stress trigger factors so you can better anticipate them.
- Avoid catastrophic thought processing and worst-case scenarios
- Watch your body for the early signs of stress individual to you.
- Set aside time to let yourself worry and try not to carry it further into your day
- Breathing exercises- there are many online and some modern smart watches will even talk you through these.
- Planning positive or exciting things in your day to focus towards- these don’t have to be grand or epic. Small things have the same benefit.
- Reduce caffeine and alcohol intake
- Plan your time management to empower you at each step. Achievable goals can re-enforce a sense of success.
Self-talk influences our performance but our self-talk is likely to be influenced by our level of self-compassion, so the two very quickly overlap. As clinicians we need to remember to look after ourselves as well we each other and our patients. Self-compassion doesn’t come easily to many of us but we can try to remember to treat ourselves the way we would treat someone we care about. Our work comes with intense challenges – be kind to yourself.
Resources you can turn to if you need any help or support within NSW Ambulance and Aeromedical: Please follow the links to pages on the intranet.
- Peer Support Officers
- Staff Psychology Service
- Employee Mental Health
- Wellbeing Resources on the Sydney HEMS website
Kristin Neff – Ph. D. Associate Professor, Human Development, Culture, and Learning Sciences. Educational Psychology Department, The University of Texas at Austin. https://self-compassion.org/
For further support within NSW Aeromedical Services:
Louise Harvey – NSW aeromedical Senior Psychologist and Clinical Psychologist
Anita Alexander – NSW ambulance Wellbeing & Resilience Program Coordinator
It’s been a few months since the latest cohort of HEMS registrars completed their induction; they’ve found their feet and been part of some incredible missions so far.
One of our latest additions, Dr Fran Arnold, wanted to share some of their thoughts, experiences and expectations as they venture into the sometimes daunting, challenging and extremely exciting world of prehospital and retrieval medicine.
What is induction all about?
Without a doubt, we’re hugely lucky to have just completed one of the most impressive, thorough and brilliant inductions of our careers. After some introductory activities to get to know each other, week 1 took us straight into our inter-hospital training week. From simulations, workflow training, a triage and tasking exercise, ultrasound storm, obstetric revision, meeting Wallace-the NSWAS therapy dog, organisational induction and the first of many of pack checks, we hit the ground running and induction was off to a strong start.
A weekend of recovery led into week 2 and straight into pre-hospital week, with guests from Canberra and the Royal Flying Doctor Service joining us. Pig lab procedure training, a major incident drill, more excellently delivered high fidelity simulation, more pack checks and the most fun OSCE most of us have ever done, all too soon, the full team graduated with our wings and week 3 was upon us.
Week 3 and 4 were flight school, and faced with the task of following a phenomenal medical induction, the team at Toll (the aviation providers to the NSW aeromedical service) rose to the challenge to deliver a really high quality training programme.
Human factors, aviation training, winch training – both simulated and in the (literal) field – and the basics of helicopter crewmanship. It was all so well delivered and inspiring, and under the watchful guidance of our Toll Mentors, we all survived winch insertions, stretcher winch extrications and the dreaded dunk in our HUET training. A few crazy folk even climbed out with smiles on their faces!
So it’s been a huge welcome and epic privilege to go through this level of training, but what did we take from it all?
For some of us, this world is new and daunting, for others, a return to a familiar environment, but the key messages that will stick with us are as follows:
- Cross-training roles together; some of our critical care paramedics completed induction with us and it was great to get to know them.
- The power of well-delivered safe-space simulation and practicing what good looks like.
- The power of a wellbeing-enlightened organisation & culture
- Don’t have a helicopter crash! But if we do….we now know what to do
- Be an active part of the crew, not just a passenger.
- Always do what the aircrew tells you.
- We all come from around the world with a huge range of lived experiences and different skills. But most importantly, we’re all in it together (and we all love the beach!)
Huge thanks to Karel Habig, Clare Richmond, Rob Scott, Daniel Schmidt, James Koens and the massive team of consultants, CCPs, aircrew, flight nurses, paramedic educators and paramedic student volunteers for getting us to this point.
A consultant colleague in my last job, Dr Grimsmo, whom I was lucky to work alongside for the RFDS, introduced me to the idea of ‘setting people up for success‘ and how powerful it can be. The induction we’ve been through is testament to this and we’re eager to get out there and do our bit to serve our population and deliver the best standards of care we can. Look up to the skies – we’re on our way! And if you’re joining us this coming August – you have a lot of fun ahead 🙂
Understanding the prehospital and retrieval system is core knowledge for all Emergency Registrars, whether you undertake a special skills post during your training or not.
We are collaborating with HETI to provide PHRM education for Emergency and Critical Care registrars of all grades.
This year’s topics are – “Life, Limb, Sight saving Procedures” with Fergal McCourt – how do you make the decision, and what do you do! “Paramedic Profiles” – Learn about what paramedics do before they arrive in the Emergency Department with Critical Care Paramedic Katie Stucken. “Transfer Teams” – thinking about transferring patients across the state or across the hospital, and how those teams prepare and work together with Clare Richmond. Nathan Trist, one of our senior registrars will lead “Coffee and Cases” our case based deep dive into PHRM with the team. You will also have a chance to talk to the ACEM staff about the diploma of PHRM and get tips on how to work in PHRM in the future.
We are offering this as an online event, and will aim to post some of the talks following the event. Sign up on the link on the flyer!
We were pleased to host the Out of Hospital Cardiac Arrest Symposium on base back in February, and we are delighted to be able to bring you the recorded talks that featured on the day. Unfortunately we weren’t able to share the prehospital ECMOcpr demonstration due to the quality of the recording but there’s plenty more goodness here.
Born in London, UK, Dr. Yannopoulos received his M.D. from the University of Athens in Greece. He completed his medicine residency and general-cardiology fellowship at the University of Minnesota. Following an interventional-cardiology fellowship at Johns Hopkins University in Baltimore, Maryland, Dr. Yannopoulos joined the University of Minnesota faculty in 2008. In March 2010, he became the research director for interventional cardiology.
Dr. Yannopoulos is board-certified in internal medicine, cardiology, and interventional cardiology. His clinical interests include emergent cardiac care, coronary-artery disease, and congenital and peripheral intervention.
Dr. Yannopoulos’s research involves cardiopulmonary resuscitation, hypothermia, and myocardial salvage during acute coronary syndromes. He is considered an authority in cardiorespiratory interactions and hypothermia during CPR. His work in the laboratories of Dr. Keith Lurie (at the University of Minnesota) and Dr. Henry Halperin (at Johns Hopkins University) has helped change current CPR practices.
Dr. Yannopoulos is a member of the American Heart Association’s CPR guidelines-writing committee, and of the basic life support and research working-group subcommittees. He also serves on the organization committee for the AHA’s Resuscitation Science Symposium (ReSS), the largest international conference addressing CPR and emergent cardiac/trauma care. Find him on Twitter here: @DYannopoulos
Prehospital and retrieval specialist, CareFlight, NSW. Cardiac anaesthetist and ECMO lead Westmead Hospital Sydney. Flight lieutenant, Australian Defence Force. Find her on Twitter here: @nattiejpk
Dr Mark Dennis is a Visiting Medical Officer at Royal Prince Alfred Hospital (RPAH), Clinical Senior Lecturer in Cardiology – University of Sydney (USyd), and Clinical Imaging Specialist at Macquarie University Hospital. Mark completed his graduate medical degree (MBBS) with Honours at the University of Sydney where he was a University Medallist. He then completed his cardiology training at RPAH and subsequently went on to complete his PhD in congenital heart disease for which he was awarded a Research Training Program Scholarship and CSANZ Paediatric & Congenital Council Travelling Scholarship.
Mark has active clinical and research interests in cardiovascular imaging and acute cardiovascular care with mechanical circulatory support. He has completed advanced training in Cardiac Magnetic Resonance (CMR) obtaining Society of CMR Level III Accreditation and Fellowship with the Society of Cardiac Magnetic Resonance (FSCMR). He has also completed the European Advanced Cardiovascular Imaging (EACVI) CMR Congenital Heart Disease Examination and additional training in Structural Heart CT for Valvular Heart Interventions both within Australia and internationally. He holds further advanced qualifications in Echocardiography (Diploma of Diagnostic Ultrasound) and has completed the American Society of Echocardiography structural heart program. He is a member of, and provides imaging support for, the RPAH Structural Heart Team.
Co-Chief Investigator EVIDENCE trial (OHCA trial) commencing July 1st 2021 in Sydney, NSW. Find him on Twitter here: @DrMDCardio
Specialist Intensive Care Medicine, St. Vincent’s Hospital, Sydney. ECMO Research Lead St. Vincent’s Hospital. Specialist for Anaesthesia, Intensive Care and Preclinical Emergency Medicine (Germany), Conjoint Senior Lecturer University of NSW and an ECMO Retrieval Physician. Find him on Twitter here: @HerxxAU
Dr. Richard Totaro graduated from UNSW and trained at Royal North Shore Hospital, The Princess Alexandra Children’s Hospital, Camperdown and Rush Presbyterian-St Lukes Hospitals in Chicago, Illinois. Dr. Totaro is the Director of the Intensive Care Unit at the Chris O’Brien Lifehouse and is Co-Director of the Intensive Care Service at RPAH, a leader of the ECMO service at RPAH and a VMO at Strathfield Private Hospital. He is a member the General Clinical RCA Review Committee of the NSW CEC. Dr Totaro has an interest in extracorporeal respiratory and cardiac support and is an ECMO Retrieval Physician.
Emergency Physician at Westmead Hospital in Sydney. He is a Senior Lecturer in Emergency Medicine at the University of Sydney and frequently involved with the supervision of medical and nursing staff as well as the teaching of medical students. He is a Fellow of the Royal College of Physicians (UK) and the Australasian College of Emergency Medicine. He is interested in free open access medical education (FOAM) and started the popular website http://www.emergencypedia.com in 2013. His particular interests include teamwork in healthcare, simulation based medical education, medical systems and development of the postgraduate Emergency Medicine curriculum.
Dr Coggins is currently working on the following strategic priorities as part of his role in Simulation in Western Sydney: A sustainable and evidence based simulation curriculum for junior doctors at Westmead Hospital; and Training of Skilled Facilitators to improve the future of training at Westmead, in particular in the area of healthcare ‘debriefing’. ED ECMO CPR lead at Westmead Hospital. Find him on Twitter here: @coggi33
Critical care paramedic GSA-HEMS, NSW Ambulance. Critical care paramedic educator. Clinical Senior Lecturer, Sydney University. Adjunct Lecturer, School of Biomedical Science, Charles Sturt University. Vice-chair Australasian College of Paramedicine. Find him on Twitter here: @martynichols9
Associate Director, NSW Ambulance. After graduating from the University of Oxford in Mathematics, Sophie worked as an actuary in the UK and Australia for 20 years, focusing on health care financing and funding since 2001. She completed a Bachelor of Paramedic Practice at the University of Tasmania (Rozelle campus) in 2017 and currently works as a paramedic.
Research Director GSA-HEMS, NSW Ambulance. Prehospital and retrieval specialist, NSW Ambulance. Emergency Physician, Northern Beaches Hospital. A/Prof Emergency Medicine, Sydney University. Resuscitology Faculty. Co-Chief Investigator EVIDENCE trial. Find him on Twitter here: @HawkmoonHEMS