Tag Archives | basics

BASICS Scotland videos now available

BASICSlogoIn an exciting move for the organisation, BASICS Scotland have released the first batch of online video-tutorials, to cover a wide range of pre-hospital care training.

A significant amount of time and investment has been made into these videos, which can be accessed by any members of BASICS Scotland at no additional charge.

Currently, the following topics are available:

  • Airway – Cricothyroidotomy
  • ALS – Shockable
  • Chest Assessment
  • 2 Person Helmet Removal
  • 2 Person Log Roll
  • Introduction to the Sandpiper Bag
  • Full Patient Assessment (stable patient)
  • Airwave Refresher
  • IO Vascular Access

And further videos are due to follow on topics such as C-spine collar fitting, scoop stretchers/vacuum mattress use, and Sam sling application.

They do not seek to replace the ever-popular residential courses, but will be a welcome source of teaching material for responders around the time of the courses, or for refresher training afterwards.

For more information, visit the BASICS Scotland website.  You can find out more about BASICS Scotland membership by visiting the ‘Members’ tab.

See a sample video below… Graeme Ramage introducing the ever-popular Sandpiper Bag, which is issued to all BASICS Scotland responders…

 

 

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Paediatric emergency medicine… learn by videoconference

BASICSlogoBASICS Scotland is offering another opportunity to get up-to-date with paediatric prehospital emergency medicine – delivered by internet-based teleconferencing.

The 9-session course, delivered by expert speakers, will be delivered weekly on Thursdays from 11th April 2013.   The same topic will be delivered in two separate sessions each day – 1300-1400 and 1500-1600.  This time it’s possible to link in from any computer with a webcam, microphone and broadband connection, and it’s also possible to view the sessions in your own time.

The topics include:

  • child with fever
  • meningitis
  • asthma
  • epiglottitis & croup
  • seizures
  • head injury
  • allergy & anaphylaxis
  • gastroenteritis & dehydration
  • pain relief
  • lower respiratory infections and pneumonia

Previous courses have received excellent feedback.

Very informative, execptionally useful and well delivered

Really helpful course, well worth attending!

The cost of all 9 sessions is £135 (BASICS Scotland members) or £150 (non-members).

More information is available from Kirsty at klaird@basics-scotland.org.uk – or download this poster.

 

 

 

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Update: Tranexamic Acid in Children

The Royal College of Paediatrics and Child Health have recently published an Evidence Statement, regarding the use of tranexamic acid (TXA) in children who have suffered traumatic injuries. The guidance recognises the strong evidence for the use of TXA in the context of trauma in adults.  However, a degree of caution needs to be exercised in the extrapolation of this to the treatment of paediatric injuries.

The following key points have been stated in the guidance:

  • Tranexamic acid reduces mortality in adult trauma
  • Early administration is vital for efficacy
  • Due to the lack of published data on the use of tranexamic acid in paediatric patients who have undergone major trauma there is no evidence for a specific dose in this situation
  • The RCPCH and NPPG Medicines Committee recommend a pragmatic dosage schedule – 15mg/kg tranexamic acid loading dose (max 1g) over 10 minutes followed by 2mg/kg per hour

RCPCHThe full guidance can be downloaded here from the RCPCH website.

 

 

 

 

 

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Tranexamic Acid update

red_blood_cellsSince the CRASH2 trial was published in 2010, there has been a huge amount of work to ascertain how best to deliver tranexamic acid practically, particularly in the prehospital environment.

The benefits of tranexamic acid almost seemed too good to be true.  It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects.  It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years.  In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.

Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:

>> Blood-clot promoting drugs for acute traumatic injury

It appears that it is now at a point that many practitioners can and should be considering its use.  Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.

Administration is relatively straightforward.  Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:

  • Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline.  Give this IV over 10-20 minutes (loading dose).
  • Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline.  Give this IV over 8 hours (maintenance dose).

Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.

httpv://www.youtube.com/watch?v=7oekncvAXGs

 

Crash 3 Trial

The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury.  They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.

httpv://www.youtube.com/watch?v=7jdjSAiiCmc

 

 

 

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Making Good Progress: Driving for BASICS

You’ve got your kit sorted, you’ve established a link with Ambulance Control and are keen to get your first call.  What about transport?  For many responders, this is an area which has little guidance, and yet it’s often the bit that puts responders at most risk.  Driving to an incident requires skill whether it’s with or without emergency lights.

There are several different courses available for “response driving”, but most will draw heavily on the principles of Roadcraft – the driving bible of the police.  The essential elements are hazard awareness and making good progress and the principles can be useful to driving in general, whether it’s to pick the kids up from school or on an emergency call.  The book is inexpensive and easy to read.  Further experience can be gained through completion of advanced driving certificates from bodies such as RoSPA and the Institute of Advanced Motoring.  If you are required to use blue lights, you are likely to require a more lengthy training course organised via your local ambulance service.

There are however some key points which may be of interest, especially to new BASICS responders.  These are listed below.  If you can suggest any more, you can leave a comment.

  • Get into the habit of regular car checks.  We should really all do this, but do you really check your tyre pressures & oil level, top up your windscreen washer fluid and inspect your lights on a weekly or monthly basis?  It’s up to you what schedule you follow, but the more that you get into the habit, the more likely you are to detect any problems early on – and not whilst driving to an incident.
  • Think “red mist” before setting off to attend a call.  And be very conscious of when the perceived urgency of the call starts to affect your driving.
  • Plan your route before leaving.  By having a clear driving plan in mind you will make progress more quickly, and  focus on driving and not the directions.
  • Put your PPE on before setting off – many seasoned responders will confirm that once on scene you can quickly become drawn into the situation and miss the opportunity to don PPE (personal protective equipment) at this point.  Wear your jacket, and if going to a road accident or similar, keep your helmet accessible.
  • Consider doing an Advanced Driver certificate, for example with IAM or RoSPA.  These are all about “making good progress” and you will benefit from having a systematic approach to your driving.  
  • Learn about limit points and how they can help you to corner safely.  If the concept is new, see this article and watch this video.
  • Speak a running commentary to yourself whilst driving normally, as this helps to practice advanced driving skills and focus your attention.  You’ll find yourself running a similar but internal commentary when tasked to an incident, which also helps improve self-awareness.
  • Be aware that sometimes it is safer to switch off your emergency lights if they are making a driver overly nervous or resulting in their driving more erratically.  The elderly are particularly at risk of stopping suddenly or making panic manoeuvres that can put you both at risk.  Many drivers don’t understand the significance of green lights.
  • Learn to overtake confidently using the “triangle method” and practice this when it is safe and effective to do so when driving normally.
  • Whilst driving, focus on driving.  Don’t get distracted by the call details – instead focus on getting there safely and quickly.  Some find it helpful to play relaxing music whilst responding to control the “red mist”.
  • Consider ways of making other road users aware of your presence.  You may wish to obtain a flashing green light.  Blues and sirens are a whole different ball game and need to be discussed with your Ambulance Control.  Use of headlights and magnetic strips for your car can also be useful.
  • When getting close to the scene, slow down.  One way not to arrive on scene, is to collide with other emergency vehicles, or even the crashed vehicles, by not anticipating the scene and turning corners too quickly.  It has been done.  Think ahead and approach cautiously.
  • Be familiar with the “fend off position” and know that this position increases visibility of your warning lights as well as providing physical protection.
The use of emergency lights and sirens is governed heavily by law.  Green lights can be used only when carrying a GMC-registered doctor, but don’t allow any standard traffic regulations to be broken.  Use of blue lights & sirens now requires specific training in line with your local ambulance service or police force.
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Tranexamic Acid in Major Haemorrhage

The CRASH-2 trial was published in the Lancet in June 2010, and presents strong evidence for the use of tranexamic to reduce haemorrhage in the context of major trauma.  The fact that tranexamic is cheap, seems to be safe, and is easy to obtain & administer makes it an attractive drug for general use. The study used a 1g IV bolus over 10 minutes (within 8 hours of injury), followed by 1g IV infusion over eight hours.

It would seem that tranexamic acid may have the particular potential to benefit patients who have suffered major trauma in rural areas, where the logistics of transfer/retrieval can result in prolonged time to definitive surgical care.  Permissive hypotension is standard practice, with a similar rationale to avoid destabilising clot formation that has already occurred.  The question now is whether it can be used routinely in rural community hospitals, or even by emergency responders such as  BASICS GPs, or is there a need to wait until more specific guidance?  In a bid to gauge its current use, a discussion has been start on the RuralGPNetwork, and any relevant updates will be posted here.  In the meantime comments are welcomed below too.

  • The original article (PDF;  The Lancet).  CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with signifi cant  haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; published online June 15. DOI:10.1016/S0140-6736(10)60835-5.
  • The associated editorial (PDF; The Lancet) by J Levy.

Dr Levy has also issued a YouTube video on this paper:

httpv://www.youtube.com/watch?v=YXPU_MEd5vg

… and The Lancet has recorded its press conference when the paper was published: you can listen to it here.

[podcast]http://download.thelancet.com/flatcontentassets/audio/lancet/2010/crash2.mp3[/podcast]

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The Sandpiper Trust

Many visitors to RuralGP will be very familiar with the service that the Sandpiper Trust is providing to rural GPs across Scotland.  Set up in 2001 in memory of Sandy Dickson, the charity provides fully-equipped emergency bags to enable GPs, nurses and other healthcare professionals to provide immediate medical care in rural Scotland.

Each bag costs in excess of £1000, however this reflects the fact that much-needed medical equipment is included, such as bag and valve masks, neck collars, intraosseous needles and chest drains.  The bag itself has recently been redesigned in association with Tiso outdoor equipment, and has attracted international acclaim for its innovative layout and durable construction.

Over 750 bags have been distributed across Scotland, providing a vital network of equipment to rural communities, especially when ambulance response times are prolonged.  Additional projects by the Sandpiper Trust include vehicle locator units and training equipment for use on BASICS Scotland courses.

Further information on the bags can be found at the new Sandpiper Trust website, where it’s also possible to make a donation to allow existing bags to be updated, and new bags to be delivered.

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