1 00:00:04,880 --> 00:00:07,600 Hello everyone and welcome to the Quorum podcast. 2 00:00:07,640 --> 00:00:11,320 This is where academic medicine meets remote, austere and 3 00:00:11,320 --> 00:00:17,360 resource limited areas. Welcome back to the broadcast, 4 00:00:17,360 --> 00:00:20,840 This is Avico Kelly. This week we are again with 5 00:00:20,840 --> 00:00:24,240 Alfredo Leo who is our clinical coordinator for Quorum. 6 00:00:24,400 --> 00:00:27,000 Alfredo, welcome back to the programme. 7 00:00:27,000 --> 00:00:28,600 Hello everybody. Thank you every. 8 00:00:28,600 --> 00:00:29,680 It's a pleasure to be here again. 9 00:00:30,160 --> 00:00:33,640 So tell us a bit about yourself and what's keeping you busy. 10 00:00:33,760 --> 00:00:37,080 A lot of stuff. So I'm still a firefighter, a 11 00:00:37,120 --> 00:00:41,200 fire officer in Portugal. I joined the fire service in 95 12 00:00:41,200 --> 00:00:45,160 and I started also as AMT and then became a paramedic in my 13 00:00:45,200 --> 00:00:48,080 paramedic course. Just we need of course in 14 00:00:48,080 --> 00:00:52,800 Denmark and then moved to UK when I joined start work with 15 00:00:52,800 --> 00:00:56,400 NHS National Health Services United Kingdom as a paramedic 16 00:00:56,400 --> 00:00:59,320 and then I decided I want to do something else. 17 00:00:59,320 --> 00:01:03,040 After 10 years on and off working with the ambulance, I 18 00:01:03,040 --> 00:01:07,400 decided I want to do initially offshore, spent some time in 19 00:01:07,720 --> 00:01:11,320 vessels and oil rigs like the one I'm currently on. 20 00:01:11,880 --> 00:01:15,840 I'm offshore of also the Mediterranean Sea. 21 00:01:15,840 --> 00:01:18,200 So we're doing some work here and the weather is actually 22 00:01:18,200 --> 00:01:19,880 quite good in comparison to the North Sea. 23 00:01:19,880 --> 00:01:24,880 And did some work in Afghanistan in the work in, in Palestine 24 00:01:24,880 --> 00:01:29,400 slash Israel, also in Gaza and the West Bank with The Who and 25 00:01:29,480 --> 00:01:33,800 also in Ukraine in a place called Severo Donetsk when the 26 00:01:33,800 --> 00:01:36,280 times are not that rough as they are right now. 27 00:01:36,320 --> 00:01:39,680 Currently, I'm working offshore doing some members work in 28 00:01:39,680 --> 00:01:42,400 Portugal and also in the United Kingdom. 29 00:01:42,400 --> 00:01:45,600 And as you said, working with Korum as, as a clinical 30 00:01:45,600 --> 00:01:47,760 placement coordinator. And I think it's me in a 31 00:01:47,760 --> 00:01:50,840 nutshell. So Alfredo, you got a job with 32 00:01:50,840 --> 00:01:53,200 the World Health Organisation as a paramedic. 33 00:01:53,200 --> 00:01:55,040 How, how did that work? How did you get that? 34 00:01:55,040 --> 00:01:59,640 It was not specific as a paramedic was as the title was 35 00:01:59,680 --> 00:02:03,520 pre hospital consultant. So I was hired to go to 36 00:02:04,000 --> 00:02:09,919 Palestine is divided into 3 per SE West Bank, Gaza Strip and 37 00:02:09,919 --> 00:02:12,960 there's another part that it doesn't count as Golden Heights. 38 00:02:13,000 --> 00:02:17,040 But again these two mainly the West Bank and also Gaza Strip. 39 00:02:17,280 --> 00:02:20,480 I was asked to go there for three months and assess the 40 00:02:20,880 --> 00:02:23,840 service over there. Mainly the Palestinian Red Cross 41 00:02:23,840 --> 00:02:27,400 in society and Ministry of Health and other organisations 42 00:02:27,400 --> 00:02:34,120 were working over there. Of course was before the the the 43 00:02:34,120 --> 00:02:37,400 war starts several October. So it was before that it was 44 00:02:37,400 --> 00:02:40,840 some tensions going on, but not as this right now. 45 00:02:40,840 --> 00:02:43,920 So if I'm going back everything that I assess, it could be 46 00:02:43,920 --> 00:02:46,080 completely different. Still a great experience. 47 00:02:46,080 --> 00:02:46,960 It was. It was. 48 00:02:47,040 --> 00:02:49,640 And you've been in the east of Ukraine. 49 00:02:49,640 --> 00:02:52,640 What would you be comfortable discussing about that 50 00:02:52,640 --> 00:02:59,040 deployment? So I was hired to go to Ukraine. 51 00:02:59,400 --> 00:03:05,960 They can call Icarus to work to give support to OSC as an 52 00:03:05,960 --> 00:03:08,880 organisation. This is similar to the United 53 00:03:08,880 --> 00:03:11,120 Nations but different got a different mandate. 54 00:03:11,160 --> 00:03:16,760 The the idea was to you to be there to monitor the peace 55 00:03:16,760 --> 00:03:21,160 agreement, called the Minsk agreement at the time that it 56 00:03:21,200 --> 00:03:25,440 was not having its faults. It was every day we had some 57 00:03:25,440 --> 00:03:28,480 conflicts going on and we're there to monitor it. 58 00:03:28,680 --> 00:03:32,400 And I was there to cover the monitors. 59 00:03:32,400 --> 00:03:36,360 Pretty much all over Europe and other parts of the world were 60 00:03:36,360 --> 00:03:40,480 there monitoring the conflict. And if something happened, I'll 61 00:03:40,480 --> 00:03:47,080 be there to give care and the fire eventually throughout this 62 00:03:47,080 --> 00:03:50,000 mission, before I left, the only person that actually died on 63 00:03:50,000 --> 00:03:53,240 duty was actually paramedic with this kind of strange, but yeah, 64 00:03:53,240 --> 00:03:56,720 it was it was easy job per SE until it isn't. 65 00:03:56,720 --> 00:04:02,280 So if we get caught in a in a fight, firefight be much great 66 00:04:02,280 --> 00:04:03,640 per SE. But again, it's part of the job. 67 00:04:03,800 --> 00:04:07,000 I imagine those jobs will be back again once Ukraine gets 68 00:04:07,000 --> 00:04:08,600 their country back. They're going to have to be 69 00:04:08,600 --> 00:04:10,920 monitors on their border. I presume so. 70 00:04:11,120 --> 00:04:13,640 I presume so. Hopefully it'll it'll happen as 71 00:04:13,640 --> 00:04:16,320 soon as possible. Not I'm not talking about 72 00:04:16,320 --> 00:04:20,160 myself, but for the people of Ukraine and also people of 73 00:04:20,160 --> 00:04:21,440 Russia. I know it's a conflict. 74 00:04:21,440 --> 00:04:24,280 People tend to take sides for what it was. 75 00:04:24,560 --> 00:04:28,680 War is always bad and always give casualty and suffering and 76 00:04:28,680 --> 00:04:31,280 suffering. Ideally we want to get this over 77 00:04:32,120 --> 00:04:34,920 as soon as possible. Not soon enough though. 78 00:04:34,960 --> 00:04:38,800 Alfredo, you and IA Fortune night ago went to Ireland to 79 00:04:38,800 --> 00:04:42,560 take the advanced Medical Life Support course, the AMLS. 80 00:04:42,560 --> 00:04:46,600 And we had to do this in order for you and me to become AMLS 81 00:04:46,600 --> 00:04:50,880 instructors next month during our official NAAEMT site visit 82 00:04:50,880 --> 00:04:53,920 for the college. And I brought you on to the 83 00:04:53,920 --> 00:04:57,000 podcast today because you have years and years of experience 84 00:04:57,160 --> 00:05:01,640 teaching NAMT and now that forum is becoming a training centre. 85 00:05:01,880 --> 00:05:05,440 I wanted to pick your brains. But how was your deployment to 86 00:05:05,440 --> 00:05:07,920 my country? Yeah, it was great. 87 00:05:07,960 --> 00:05:11,720 If into the Republic of Ireland many times it is. 88 00:05:11,720 --> 00:05:15,040 It's a great place and we had the chance to do the advanced 89 00:05:15,040 --> 00:05:18,120 medical life support. For me, it's the third time as a 90 00:05:18,120 --> 00:05:21,240 provider. I think my first time that I did 91 00:05:21,240 --> 00:05:24,080 it was the year 2010. It was back in Portugal, 92 00:05:24,240 --> 00:05:25,760 although the course is older than that. 93 00:05:25,760 --> 00:05:29,400 So I think the course originally was conceived in the year 2000, 94 00:05:29,760 --> 00:05:35,320 and this course kind of changed who I am as a healthcare 95 00:05:35,320 --> 00:05:39,320 professional because it changed me actually, because it gave me 96 00:05:39,320 --> 00:05:42,800 some tools and it changed the way I think. 97 00:05:42,800 --> 00:05:44,040 Every time I look at the patient. 98 00:05:44,120 --> 00:05:47,520 It's like the Dunning Truger effect, you know, this 99 00:05:47,520 --> 00:05:50,440 interesting graphic that goes up and down South at the beginning. 100 00:05:50,600 --> 00:05:54,000 I think I know everything right after finish the course or after 101 00:05:54,000 --> 00:05:55,480 finish paramedic course of the degree. 102 00:05:55,520 --> 00:05:57,440 So your confidence is quite high. 103 00:05:57,720 --> 00:06:01,800 But then you realise that you don't know much yet and even in 104 00:06:01,800 --> 00:06:04,000 the same time you start become complacent. 105 00:06:04,000 --> 00:06:05,760 And why? Because the job that you go, 106 00:06:05,760 --> 00:06:08,880 most of them are medical and it's not trauma so it's not sexy 107 00:06:08,960 --> 00:06:11,880 and that's what sex is not. Mine actually comes from the 108 00:06:11,880 --> 00:06:14,200 MLS. So we go to lots of 109 00:06:14,200 --> 00:06:18,120 non-emergency calls and most of the times the way we approach 110 00:06:18,120 --> 00:06:21,040 another one another call, someone that actually doesn't 111 00:06:21,040 --> 00:06:24,640 need an Amos. However, we never, we normally 112 00:06:24,640 --> 00:06:29,160 don't think about what was the reason for the person to call 113 00:06:29,160 --> 00:06:30,920 us. So they need some support, they 114 00:06:30,920 --> 00:06:33,560 need some help. And we sometimes think, OK, 115 00:06:33,800 --> 00:06:36,120 she's not life threatening, why am I here? 116 00:06:36,280 --> 00:06:38,600 But I think medical emergency is a lot more than that. 117 00:06:38,640 --> 00:06:41,960 At the time, in 2010, I was a technician working in Portugal 118 00:06:41,960 --> 00:06:46,000 and I was always told, OK, it's not your job to think, it's just 119 00:06:46,000 --> 00:06:49,040 to transport the patient from A to B and no questions asked. 120 00:06:49,280 --> 00:06:51,200 If you want to think you need to become a doctor. 121 00:06:51,440 --> 00:06:53,960 That was the mindset. And actually it still is a 122 00:06:53,960 --> 00:06:56,960 little bit nowadays with the course, with MLS course, I 123 00:06:56,960 --> 00:07:00,200 learned that we technicians, now paramedics, learn by pattern 124 00:07:00,200 --> 00:07:03,480 recognition, by experience. So we see a shortness of breath 125 00:07:03,560 --> 00:07:07,160 and then you recognise, you see the patient posture, you know 126 00:07:07,160 --> 00:07:10,600 that patient assessment triangle coming up with the theatrical 127 00:07:10,600 --> 00:07:13,480 assessment triangle, look at the patient, see something wrong and 128 00:07:13,480 --> 00:07:16,280 then years later you're going to go to another shortness of 129 00:07:16,280 --> 00:07:19,280 breath and straight away you're going to recognise that pattern 130 00:07:19,280 --> 00:07:22,640 and you know what's going on. However, you need to recognise 131 00:07:22,640 --> 00:07:25,880 that, confirm what your gut feeling is telling you. 132 00:07:25,960 --> 00:07:30,520 And the AML MLS gave me the tools to process and organise 133 00:07:30,520 --> 00:07:33,880 all these spots in the right way for the best of the patient. 134 00:07:34,000 --> 00:07:37,760 It's not for myself because myself as a clinician, I'm not 135 00:07:37,760 --> 00:07:40,000 important. Import is the patient and if I 136 00:07:40,000 --> 00:07:42,720 can give the best possible assessment and treatment to the 137 00:07:42,720 --> 00:07:44,720 patient, the better. That's true. 138 00:07:44,760 --> 00:07:48,200 And I was just thinking back as you were saying that on my 139 00:07:48,200 --> 00:07:52,240 career since the late 80s and how much focus there is in 140 00:07:52,240 --> 00:07:54,160 trauma. So, so my first trauma course 141 00:07:54,160 --> 00:07:57,040 was in the late 80s with the sheriff's Academy and we didn't 142 00:07:57,040 --> 00:08:00,040 even have a name. There was no PHDLS or Itls or 143 00:08:00,040 --> 00:08:01,400 anything. It's just yeah, blood red 144 00:08:01,400 --> 00:08:02,960 stuff's coming out. Push on the red stuff. 145 00:08:03,240 --> 00:08:05,240 There's no talk of blood or tourniquets or anything like 146 00:08:05,240 --> 00:08:07,120 that. It's all been trauma. 147 00:08:07,120 --> 00:08:08,800 And in the Army, it was all, all trauma. 148 00:08:08,800 --> 00:08:12,080 And then as a paramedic and, and now a critical care paramedic, 149 00:08:12,080 --> 00:08:14,440 it's, it's trauma, trauma. I've taught more trauma than I 150 00:08:14,440 --> 00:08:16,800 have medical. And it's always been the focus. 151 00:08:17,040 --> 00:08:19,760 And you said the word sexy is it's just fun, right? 152 00:08:19,760 --> 00:08:22,360 It's easy. It's, it's CNBC push for the red 153 00:08:22,360 --> 00:08:24,720 stuff is give more red stuff. All right, we're good. 154 00:08:24,840 --> 00:08:29,240 And there are a few courses out there that focus on medical. 155 00:08:29,360 --> 00:08:32,200 And of course, corn had to design a bunch like the eye care 156 00:08:32,200 --> 00:08:34,159 and things like that because there was a deficiency. 157 00:08:34,159 --> 00:08:38,520 But AMLS focuses on this. And you took this, what, 50, 15 158 00:08:38,520 --> 00:08:39,960 years ago? 16 years ago? 159 00:08:40,200 --> 00:08:44,120 So what is it about AMLS that made you a better medic? 160 00:08:44,120 --> 00:08:48,520 So it's still really assess the patients and how to play with 161 00:08:48,520 --> 00:08:50,720 sample. For instance, now we call 162 00:08:50,720 --> 00:08:55,360 sampler the last R risks associated and with Coral Way 163 00:08:55,440 --> 00:08:57,640 recent travels, it's also important. 164 00:08:57,720 --> 00:09:00,720 But again, imagine if someone is taking beta blockers, right? 165 00:09:00,880 --> 00:09:03,960 We know that probably that person is not going to have a 166 00:09:03,960 --> 00:09:06,680 tachycardia if he goes into shock set to shock, for 167 00:09:06,680 --> 00:09:09,520 instance, and you know that the beta block is going to prevent 168 00:09:09,520 --> 00:09:13,400 the patient goes to tachycardia. If he that thing that 169 00:09:13,400 --> 00:09:18,000 information gives you this false sense of of comfort is that the 170 00:09:18,000 --> 00:09:21,160 patient's stable and you don't understand what's going on with 171 00:09:21,160 --> 00:09:24,320 the map arterial pressure. You don't give much importance 172 00:09:24,320 --> 00:09:27,640 to the entitle CO2, even the pulse pressure if he's less than 173 00:09:27,640 --> 00:09:30,880 1/3. You don't normally those inputs 174 00:09:30,880 --> 00:09:35,680 that the monitor tells you that it looks all right, but it 175 00:09:35,680 --> 00:09:37,320 isn't. And then all of a sudden the 176 00:09:37,320 --> 00:09:40,600 patient crashes and you don't know why. 177 00:09:40,760 --> 00:09:45,640 So I think MLS put everything together all together and made 178 00:09:45,640 --> 00:09:49,880 you think, OK, things can't go wrong due to XY and Z. 179 00:09:50,200 --> 00:09:53,760 So playing with medication and past medical history I think was 180 00:09:53,760 --> 00:09:58,080 the most take home stuff, the most important thing for me to 181 00:09:58,080 --> 00:10:02,360 become a medic and to work probably as a medic medication 182 00:10:02,360 --> 00:10:05,760 and past medical history. Another one patient got asthma 183 00:10:05,760 --> 00:10:10,120 and taking a non selective beta blocker for headaches and it's 184 00:10:10,120 --> 00:10:12,800 got asthma attack. Albuterol will work because 185 00:10:12,840 --> 00:10:16,800 patient is taking Propranolol. So those tiny things that's made 186 00:10:16,800 --> 00:10:19,040 all the difference because then you need to change your 187 00:10:19,120 --> 00:10:21,920 strategy, how to treat the patient. 188 00:10:22,320 --> 00:10:25,800 And then all there's something else at the ends of the course 189 00:10:25,800 --> 00:10:28,520 called differential diagnosis or field diagnosis. 190 00:10:28,840 --> 00:10:31,280 We need to come up with three probable causes. 191 00:10:31,440 --> 00:10:33,440 Again with the college. This is something that we do 192 00:10:33,440 --> 00:10:36,080 commonly do to our courses. OK, what's the differential 193 00:10:36,120 --> 00:10:38,560 diagnosis? However, in countries that I 194 00:10:38,560 --> 00:10:43,280 used to work, if you use the words diagnose, this is 195 00:10:43,280 --> 00:10:46,200 considered a blasphemy by if you're another doctor. 196 00:10:46,440 --> 00:10:51,000 So you need to be very careful the the words that you use or 197 00:10:51,000 --> 00:10:54,320 else it starts looking you and who are you to sign the word 198 00:10:54,320 --> 00:10:55,800 diagnosed? Are you a doctor? 199 00:10:56,000 --> 00:10:58,480 So no, I'm a paramedic and this is what I have. 200 00:10:58,720 --> 00:11:02,320 This is what I think it is. I cannot fully say this is 201 00:11:02,480 --> 00:11:05,360 definitely diagnosed because I don't have all the tools on the 202 00:11:05,360 --> 00:11:08,000 roads. But this is my rationale to 203 00:11:08,000 --> 00:11:11,280 treat the patient as it is and to take the patient this 204 00:11:11,280 --> 00:11:14,480 specific hospital and not the the other one across the street. 205 00:11:14,560 --> 00:11:18,160 That's, that's a good point that we push heavily on five 206 00:11:18,160 --> 00:11:20,400 differential diagnosis. And, and we teach this to 207 00:11:20,400 --> 00:11:22,400 students. And I haven't spent a lot of 208 00:11:22,400 --> 00:11:25,520 time thinking about what are our graduates going to do in a 209 00:11:25,520 --> 00:11:27,440 country where they're not allowed to say the word 210 00:11:27,440 --> 00:11:29,480 diagnosis and it's just a word in it. 211 00:11:29,480 --> 00:11:33,440 So we can just say what are the five possible ailments that your 212 00:11:33,440 --> 00:11:36,040 man's going to have? Yeah, it's, it's a question of 213 00:11:36,040 --> 00:11:40,120 wording of course, but you're treating a patient with a 214 00:11:40,640 --> 00:11:43,920 fracture, an open fracture, different for a patient having 215 00:11:43,920 --> 00:11:46,440 heart attack from the patient having a stroke. 216 00:11:46,560 --> 00:11:51,720 So you have to to do some sort of diagnose was suspicious of to 217 00:11:51,920 --> 00:11:53,320 give the patient the right treatment. 218 00:11:53,800 --> 00:12:01,160 I understand 20-30 years ago that was a specific profession 219 00:12:01,160 --> 00:12:04,560 that's got the rights and is protected to just to do diagnose 220 00:12:04,560 --> 00:12:07,480 and the paramedics and nurses cannot use that port, at least 221 00:12:07,480 --> 00:12:10,080 in Portugal is how it is still today. 222 00:12:10,200 --> 00:12:14,640 But actually pre hospitally you need to make a decision in order 223 00:12:14,640 --> 00:12:16,560 to give the best treatment for the patient. 224 00:12:16,760 --> 00:12:19,000 If a patient have a patient with a heart attack, you're going to 225 00:12:19,000 --> 00:12:20,800 take him to a hospital with a cat lab. 226 00:12:21,120 --> 00:12:25,200 You're not going to take to the to the GP surgery across the 227 00:12:25,200 --> 00:12:28,240 street for all the opposite is to have a a broken fracture or a 228 00:12:28,400 --> 00:12:31,880 or the other way around. The chassis infection probably 229 00:12:32,040 --> 00:12:35,800 could be dealt with the doctor with the General practitioner. 230 00:12:36,080 --> 00:12:38,400 So we are doing diagnosis regardless. 231 00:12:38,520 --> 00:12:40,880 But sometimes the wording is yeah. 232 00:12:41,400 --> 00:12:44,040 Each country has their way of doing things. 233 00:12:44,040 --> 00:12:46,960 In the UK you can't call yourself paramedic unless you're 234 00:12:46,960 --> 00:12:48,680 a CPC. I completely agree with that. 235 00:12:49,320 --> 00:12:52,520 So for this AMLS and, and mainly because we have an assessor 236 00:12:52,520 --> 00:12:55,520 coming to to grade us to make sure that we're up to an AEP 237 00:12:55,520 --> 00:12:57,680 standards. I spent a tonne of time learning 238 00:12:57,680 --> 00:13:01,240 the AMLS patient assessment. Did you you and we didn't hardly 239 00:13:01,240 --> 00:13:04,840 use it at all during the course. Do you find that useful or or is 240 00:13:04,840 --> 00:13:07,320 that something that you just look through like yes, yes, I 241 00:13:07,320 --> 00:13:09,640 cover that in my own assessment and I'm going to do it my own 242 00:13:09,640 --> 00:13:12,520 way. What AMLS in most of the courses 243 00:13:12,560 --> 00:13:16,200 are telling us, telling us they're showing us a structured 244 00:13:16,200 --> 00:13:21,040 way to do our assessment, but in reality is not how it works. 245 00:13:21,160 --> 00:13:26,240 So sometimes you go to a job, you arrive at the door, it's got 246 00:13:26,240 --> 00:13:29,240 a relative bombarded with information about the patient's 247 00:13:29,240 --> 00:13:32,120 past medical history and the patient is the other side of the 248 00:13:32,120 --> 00:13:34,320 house. So you're not yet seen the 249 00:13:34,320 --> 00:13:36,560 patient. You're already doing sample 250 00:13:36,640 --> 00:13:39,600 approaching the the the patient, the patient. 251 00:13:39,920 --> 00:13:41,560 Bear in mind you're not seeing the patient yet. 252 00:13:41,720 --> 00:13:44,360 On the left hand side, you see an oxygen cylinder. 253 00:13:44,600 --> 00:13:47,600 In your mind, you're just saying probably the patient's got COPD. 254 00:13:47,920 --> 00:13:51,160 And again, you're not yet seen the patient and you're doing 255 00:13:51,160 --> 00:13:54,640 sample and there's scene safety. So everything is dynamic. 256 00:13:54,800 --> 00:13:59,040 So the MLS schematic, right approach to the patient, like 257 00:13:59,040 --> 00:14:04,360 the PHLS, they're nice tools for us to not forget some elements. 258 00:14:04,400 --> 00:14:08,400 So at the ends, right before we leave the scene, everything 259 00:14:08,400 --> 00:14:11,040 needs to be fulfilled. But the way we gather 260 00:14:11,040 --> 00:14:14,400 information has to be dynamic because we're going to be 261 00:14:14,400 --> 00:14:17,160 bombarded information and there's some information that 262 00:14:17,160 --> 00:14:21,040 you know is not right. And sometimes the relatives give 263 00:14:21,040 --> 00:14:23,680 us the wrong or less correct information. 264 00:14:23,720 --> 00:14:26,160 I'm not saying they're from to lie, but there's sometimes 265 00:14:26,160 --> 00:14:30,400 information gives us not correct and we need to all say dance 266 00:14:30,400 --> 00:14:33,280 with all the information, make sure that we get them the 267 00:14:33,280 --> 00:14:35,840 correct information to give the appropriate treatment. 268 00:14:36,040 --> 00:14:39,080 That's the beauty of of AMS. That's a valid point. 269 00:14:39,240 --> 00:14:42,040 Like PHT less is linear. Well, to be fair, we do jump 270 00:14:42,040 --> 00:14:46,040 around from CABC back to A to put it's linear CABCEF. 271 00:14:46,280 --> 00:14:48,760 Well, and we do G&H for we won't get into that. 272 00:14:48,920 --> 00:14:52,520 Well, AML S and all medical if you just jump around a bit and 273 00:14:52,520 --> 00:14:54,880 and it's harder to. So when I was looking at that 274 00:14:54,880 --> 00:14:57,600 AML S assessment there, there's five categories. 275 00:14:57,640 --> 00:15:01,440 There's a lot of jumping around and it's, it's not as easy to 276 00:15:01,440 --> 00:15:04,720 remember all the aspects where I'm finding the, the quorum 277 00:15:04,720 --> 00:15:08,360 chart mnemonic or in, in the US Army, we called it SOAP and I 278 00:15:08,520 --> 00:15:12,640 expanded that SOAP and created chart because I'm, I'm a knuckle 279 00:15:12,640 --> 00:15:15,440 dragger and it's easy for me to remember that for our medical 280 00:15:15,440 --> 00:15:18,040 that I, we do get everything within the AMLS system 281 00:15:18,040 --> 00:15:21,960 eventually, but trauma is just, you just follow your CABCS. 282 00:15:22,040 --> 00:15:25,640 Absolutely. Trump is it's kind of easy 283 00:15:25,640 --> 00:15:33,080 because going to do CABC or XABC and then DE and follow, follow 284 00:15:33,080 --> 00:15:36,920 college, the rest of alphabet up to Hitman and then beyond 285 00:15:37,120 --> 00:15:39,680 Hitman. So there's a lot of is isn't 286 00:15:39,680 --> 00:15:42,320 mnemonic is a schematic. And as you rightly said, 287 00:15:42,320 --> 00:15:45,960 sometimes you need to jump around if the place is, is it's 288 00:15:45,960 --> 00:15:48,600 in shock, right? But their way is not. 289 00:15:49,760 --> 00:15:52,280 It's not clear. We need to secure the airway 290 00:15:52,280 --> 00:15:54,760 first. But sometimes their way now the 291 00:15:54,760 --> 00:15:56,280 patient is breathing is not great. 292 00:15:56,440 --> 00:16:00,040 We come up down to C and then they need to go back to A to fix 293 00:16:00,040 --> 00:16:03,840 and then put an advanced airway because at the moment the MPA is 294 00:16:03,840 --> 00:16:07,560 there, but the patient is vomiting and you know, vomiting 295 00:16:07,560 --> 00:16:09,600 blood and you know, there needs to be section again. 296 00:16:09,880 --> 00:16:15,360 So it's dynamic such as MLS, you need to get the information that 297 00:16:15,360 --> 00:16:19,600 you can and and sometimes the patient on purpose don't tell 298 00:16:19,600 --> 00:16:22,480 the information because they want to give this specific 299 00:16:22,480 --> 00:16:25,640 information that is a more quite sensitive in front of the the 300 00:16:25,640 --> 00:16:28,280 relatives. But any ambulance on the way to 301 00:16:28,280 --> 00:16:32,320 the hospital, if you ask again, you're going to have a 302 00:16:32,320 --> 00:16:36,600 completely different answer. And Speaking of the CABC quorum, 303 00:16:36,600 --> 00:16:40,400 we we adopted to CABC and I, I taught that on battles with the 304 00:16:40,400 --> 00:16:42,880 British military and I just kind of brought that on board to make 305 00:16:42,880 --> 00:16:47,880 sense. The NAMT uses XABCDE for the 306 00:16:47,880 --> 00:16:50,120 Amls and PHTLS. What are your thoughts? 307 00:16:50,120 --> 00:16:51,720 Cuz you've used both haven't you? 308 00:16:51,720 --> 00:16:54,960 So which is there any benefit on either one? 309 00:16:54,960 --> 00:16:56,960 Sorry, say again. CABC and XABC. 310 00:16:57,440 --> 00:17:01,160 Yeah, right. Actually that's an interesting 311 00:17:01,160 --> 00:17:06,079 story because you go back to got PHDLS that is getting 312 00:17:06,079 --> 00:17:09,240 information from Atls that was created a long time ago, right, 313 00:17:09,240 --> 00:17:14,280 was Doctor Norman Mcswain that creates APHDLS in 84 I think. 314 00:17:14,359 --> 00:17:17,240 And then all the information that we have nowadays with PHDLS 315 00:17:17,240 --> 00:17:19,640 came from Atls. However, there's some 316 00:17:19,640 --> 00:17:24,720 competitors and it was one time that a competitor came up with 317 00:17:24,720 --> 00:17:28,040 the sea for catastrophic bleeding and it was adopted and 318 00:17:28,040 --> 00:17:31,040 then the, I think it was a 90 edition, 8 or 90 edition. 319 00:17:31,120 --> 00:17:35,120 PHDLS brought the X for xanguination because they need 320 00:17:35,120 --> 00:17:37,480 to put something else and it cannot be catastrophic bleed at 321 00:17:37,480 --> 00:17:39,920 the same time. So the the rationale is there. 322 00:17:40,000 --> 00:17:44,960 However, if you go and do PHDLS in the United Kingdom, the 323 00:17:44,960 --> 00:17:48,640 British version, they're going to use CABC, but you're going to 324 00:17:48,640 --> 00:17:51,120 use, you're all going to buy the American version, you're going 325 00:17:51,120 --> 00:17:54,400 to see XABC. So it's exactly the same. 326 00:17:54,560 --> 00:17:57,560 Even the course is the same, just that the word is different. 327 00:17:57,600 --> 00:18:01,440 One other thing I noticed on our Amls is is there wasn't a lot of 328 00:18:01,440 --> 00:18:04,720 discussion on map and it was just systolic and it's for 329 00:18:04,720 --> 00:18:07,360 medical course. So in eye care we teach MAP 330 00:18:07,440 --> 00:18:09,160 pretty strictly. MAP and urine output. 331 00:18:09,400 --> 00:18:11,520 Those are the things that you really need to keep an eye on 332 00:18:11,760 --> 00:18:14,520 and there there was little discussion on either in the 333 00:18:14,520 --> 00:18:15,440 AMLS. True. 334 00:18:16,600 --> 00:18:21,640 MLS mapped military pressure with PHDLS, we always think 335 00:18:21,640 --> 00:18:26,600 about patient going to hypothalamic shock and we've got 336 00:18:26,720 --> 00:18:32,040 a minimal of 65 to to make sure that the the brain is profused 337 00:18:32,240 --> 00:18:36,760 in your 65 of minimal pressure MLS. 338 00:18:36,960 --> 00:18:38,880 We're dealing with medical patients. 339 00:18:38,880 --> 00:18:43,880 This is also important, but because we can have hypothalamic 340 00:18:43,880 --> 00:18:46,840 shock in medical patients, that is diarrhoea and vomiting. 341 00:18:47,040 --> 00:18:50,400 We talk about cholera and malaria and then patients become 342 00:18:50,400 --> 00:18:52,840 dehydrated. It's even burns, again, burns 343 00:18:52,840 --> 00:18:57,440 going towards trauma. But the map it is important. 344 00:18:57,760 --> 00:19:01,640 I think we need to consider about what is about the blood 345 00:19:01,640 --> 00:19:03,440 pressure. The blood pressure means to 346 00:19:03,520 --> 00:19:07,160 refuse the normal organs, mainly the brain and heart and you need 347 00:19:07,160 --> 00:19:10,680 to have a mean of 65. If he goes below that, you're 348 00:19:10,680 --> 00:19:13,960 going to have problems. Something that MLS brought as 349 00:19:13,960 --> 00:19:18,160 well and PHLS also covers is the pulse pressure, the systolic 350 00:19:18,280 --> 00:19:22,320 minus the diastolic and if the systolic diastolic become too 351 00:19:22,320 --> 00:19:25,480 close, it means that the heart is not pumping as it should. 352 00:19:25,560 --> 00:19:30,600 So it means that the flood flow, the flow is not is not going and 353 00:19:30,640 --> 00:19:34,880 the risk of the patient goes downhill and goes into cardiac 354 00:19:34,880 --> 00:19:37,640 arrest is also real. So those those are things that 355 00:19:37,640 --> 00:19:41,480 we need to monitor to see if the patient actually is improving or 356 00:19:41,480 --> 00:19:45,200 deteriorating. Alfredo, you've been an NEMT 357 00:19:45,200 --> 00:19:48,960 instructor for a very long time. What courses have you taught? 358 00:19:49,080 --> 00:19:54,320 Right PHLS was my my main course again. 359 00:19:54,320 --> 00:19:58,320 I first PHLS as a provider was 2005, that became a start 360 00:19:58,320 --> 00:20:02,120 afterwards and run courses in Portugal and UK and now. 361 00:20:02,800 --> 00:20:04,440 Going to run to my first in Malta. 362 00:20:04,440 --> 00:20:09,600 There's other courses MLSI never actually run the MLSI run one of 363 00:20:09,600 --> 00:20:14,240 the similar, but now I'm glad I'm going to finally became an 364 00:20:14,240 --> 00:20:19,560 instructive MLS after my third or fourth third third provider 365 00:20:19,560 --> 00:20:22,480 course. This other courses and AMT also 366 00:20:22,480 --> 00:20:25,920 teach one is is quite dear to me. 367 00:20:25,920 --> 00:20:31,200 It's called all other disaster response, the RDSDRAHDR, that's 368 00:20:31,200 --> 00:20:35,720 the one all others disaster response and it covers more mass 369 00:20:35,720 --> 00:20:39,360 casual incidents. As you know, I focus in last 370 00:20:39,720 --> 00:20:44,440 2011 onwards in mainland triage. Of course, this course got dear 371 00:20:44,440 --> 00:20:50,960 to me because it shows how we're supposed to manage mass casual 372 00:20:50,960 --> 00:20:55,840 incidents and what kind of what type of of incident it is 373 00:20:56,720 --> 00:20:59,160 actually. You can stapulate to from from a 374 00:20:59,280 --> 00:21:04,840 house fire to even to to have a problem cholera problem in the 375 00:21:04,840 --> 00:21:09,480 middle of of a village in a country a little bit far away. 376 00:21:09,640 --> 00:21:12,480 So we need to have multiple casualties. 377 00:21:12,560 --> 00:21:17,280 So we need to or casualty or injuries or I'll, I'll, we need 378 00:21:17,280 --> 00:21:21,040 to classify them, come up with a destination for them. 379 00:21:21,160 --> 00:21:23,480 What do we actually need? What kind of hospital they need 380 00:21:23,480 --> 00:21:29,040 and and how can we manage the scene, especially with not much 381 00:21:29,240 --> 00:21:31,760 many resources. Sometimes we think and 382 00:21:31,760 --> 00:21:34,480 especially in new case, it's common to think about that. 383 00:21:34,560 --> 00:21:38,480 I'm getting deployed to a site that I know eventually I'll have 384 00:21:38,480 --> 00:21:40,720 20 ambulance in the next half an hour. 385 00:21:40,880 --> 00:21:44,480 But if your work on island for instance, you only have two, 386 00:21:44,480 --> 00:21:48,320 three ambulances, if you have 15 patients, that's it. 387 00:21:48,400 --> 00:21:51,720 You need to find a way to classify them using the. 388 00:21:52,120 --> 00:21:55,480 The triage system that is implemented will be a 10 second 389 00:21:55,480 --> 00:22:01,680 triage or a or any others and transport the patient, the 390 00:22:01,680 --> 00:22:10,320 patient in terms of of condition and also if they're able to 391 00:22:10,320 --> 00:22:14,920 survive the trip. Because if you allocate an 392 00:22:14,920 --> 00:22:18,000 ambulance to take a patient is is going to die. 393 00:22:18,000 --> 00:22:20,720 You know that the patient is expected and is going to take 394 00:22:20,720 --> 00:22:25,040 this patient and ask about 1/2 an hour drive an ambulance. 395 00:22:25,120 --> 00:22:26,800 What's going to happen? Probably the patient going to 396 00:22:26,800 --> 00:22:30,160 die on the way and you lost an ambulance and now we don't know 397 00:22:30,160 --> 00:22:31,680 when the ambulance is going to come back. 398 00:22:31,680 --> 00:22:35,320 And you still have about 10 patients on scene to go to 399 00:22:35,320 --> 00:22:36,920 hospital get the the the they need. 400 00:22:37,080 --> 00:22:40,840 This is 1 course. Another one is what also to me 401 00:22:40,840 --> 00:22:46,520 is the emergency of the course. The EPC is similar to a course 402 00:22:46,600 --> 00:22:50,200 and I will say competitor, but they work hand by hand called 403 00:22:50,200 --> 00:22:52,200 paediatric education professionals. 404 00:22:52,400 --> 00:22:55,640 And I'm saying that because sometimes the EPC use the PEP 405 00:22:55,840 --> 00:23:00,400 manual, they use the same language per SE. 406 00:23:00,640 --> 00:23:05,120 How to assess the patient, the paediatric patient, the 407 00:23:05,480 --> 00:23:07,200 something that I already mentioned, the paediatric 408 00:23:07,200 --> 00:23:10,400 assessment triangle, look at the appearance work of breathing 409 00:23:10,400 --> 00:23:14,440 circulation to the skin and in seconds, even without talking to 410 00:23:14,440 --> 00:23:16,880 the mother to see what's going on or get information 411 00:23:16,880 --> 00:23:19,040 whatsoever. Just looking at the child can 412 00:23:19,160 --> 00:23:22,400 confidence say if the child is critical or not critical and 413 00:23:22,400 --> 00:23:25,720 from that moment on act upon what what you're saying. 414 00:23:25,880 --> 00:23:30,840 So those two courses, there are other such as Ms Safety is also 415 00:23:30,840 --> 00:23:34,480 a good course that they give you some tools to prevent accidents 416 00:23:34,480 --> 00:23:37,720 from happening especially in the pre hospital environment. 417 00:23:37,720 --> 00:23:41,960 The ambulance work ergonomics and seatbelts and driving 418 00:23:41,960 --> 00:23:45,520 assessment, the dual conditions of the ambulance and many other 419 00:23:45,640 --> 00:23:47,400 things that we need to take in consideration. 420 00:23:47,720 --> 00:23:52,600 But these two, AHDR and EPC, are, as I mentioned, dear to me. 421 00:23:52,760 --> 00:23:54,920 So you're already an instructor for those, so we're we'll be 422 00:23:54,920 --> 00:23:56,600 able to get those pretty easily, is that right? 423 00:23:56,800 --> 00:23:58,360 Yes, I am. I'm also looking at the 424 00:23:58,480 --> 00:24:03,600 geriatric, the gems, gems course that might be beneficial, but 425 00:24:03,920 --> 00:24:07,720 we're starting with PhD less and AMLS, the two big hitters. 426 00:24:07,720 --> 00:24:11,200 And as I was discussing things within AMTI, was looking around 427 00:24:11,200 --> 00:24:13,360 Europe. There's not a lot of people that 428 00:24:13,520 --> 00:24:15,560 offer AMLS. Oh, here in Germany, I live in 429 00:24:15,560 --> 00:24:18,120 Germany, there's tonnes, but it's all in German, 430 00:24:18,120 --> 00:24:20,480 unfortunately. But every other country there, 431 00:24:20,480 --> 00:24:22,400 there's very few and very if you in English. 432 00:24:22,560 --> 00:24:27,720 So I'm hoping that maybe we can create a centre of excellence of 433 00:24:27,840 --> 00:24:31,720 AMLS there in Malta. I hope so that you mentioned I 434 00:24:31,720 --> 00:24:34,680 came across I'm always looking for how dangerous tree is in 435 00:24:34,680 --> 00:24:39,640 terms of jobs and a job offer passed again my my least for a 436 00:24:39,640 --> 00:24:42,800 offshore nurse in Norway. I'm not a nurse, I'm paramedics. 437 00:24:42,800 --> 00:24:46,760 I will never apply to that job, but again for similar role as as 438 00:24:46,760 --> 00:24:49,720 I am as an offshore medic. They were asking for that 439 00:24:49,720 --> 00:24:51,880 specific role, the MLS, of course. 440 00:24:52,080 --> 00:24:56,560 So it's it's something that it comes up depending on the robot 441 00:24:56,560 --> 00:24:59,840 for offshore nurses in Norway, at least that particular 442 00:24:59,840 --> 00:25:02,960 contract, the client was asking for MLS. 443 00:25:03,040 --> 00:25:06,000 So it's something that's could be an option in the future. 444 00:25:06,000 --> 00:25:09,480 And this will be your again. Some offshore nurses may be 445 00:25:09,480 --> 00:25:12,160 interested to the MLSI. Think it's going to be a good 446 00:25:12,160 --> 00:25:15,720 benefit for a paramedic students, your 1° paramedic 447 00:25:15,720 --> 00:25:18,520 students to to get PhD less than AMLS. 448 00:25:18,520 --> 00:25:22,080 Currently they're getting IT less and we are now looking at 449 00:25:22,080 --> 00:25:26,120 offering PHDLS, so we'll see if Doctor Tom Mallinson will accept 450 00:25:26,120 --> 00:25:29,680 PHDLS and AMLS into his paramedic students. 451 00:25:29,680 --> 00:25:32,560 Perfect, looking forward to it and looking forward to to run 452 00:25:32,560 --> 00:25:34,960 the the courses in in Malta next month. 453 00:25:35,240 --> 00:25:37,920 So, Alfredo, you've been with an EMT for ages. 454 00:25:38,080 --> 00:25:39,840 Tell me, what do you like about them? 455 00:25:39,840 --> 00:25:44,200 What do they do well? An AMT the National Association 456 00:25:44,200 --> 00:25:45,800 of of Emergency medical Technicians. 457 00:25:45,880 --> 00:25:49,960 They were created to cut paramedics together and start 458 00:25:50,480 --> 00:25:54,080 producing knowledge. I know paramedics don't tend to 459 00:25:54,120 --> 00:25:58,000 dedicate much time on research and there are always some 460 00:25:58,000 --> 00:26:03,320 courses that start feeding an AMT with knowledge for them to 461 00:26:03,360 --> 00:26:05,040 adapt to the press with the world. 462 00:26:05,280 --> 00:26:08,480 So PHDLS is an example. You've got the advanced internal 463 00:26:08,480 --> 00:26:12,520 life support that feeds all the information to PHDLS to pass 464 00:26:12,520 --> 00:26:14,920 towards the pre hospital environment. 465 00:26:15,000 --> 00:26:17,920 T triple C is the military version. 466 00:26:18,000 --> 00:26:21,800 We also have not just ATLS but other arts, especially the 467 00:26:21,800 --> 00:26:25,240 experience in the recent, most recent wars are feeding the 468 00:26:25,240 --> 00:26:28,280 course because it's not just for the pre hospital professional 469 00:26:28,280 --> 00:26:32,200 paramedics per SE, but for the tactical medics, the soldiers to 470 00:26:32,200 --> 00:26:36,200 go out and need to deal with, with wooden soldiers. 471 00:26:36,360 --> 00:26:41,280 And then we have the TCC. It's the the version civilian 472 00:26:41,280 --> 00:26:45,560 version of T Triple C for imagine for police or if we have 473 00:26:45,560 --> 00:26:48,240 a tactical operation, a police tactical operation, active 474 00:26:48,240 --> 00:26:50,800 shooter. So we've got a few people got 475 00:26:51,360 --> 00:26:56,800 shots and now we need to have their paramedics or or EMT's, 476 00:26:56,960 --> 00:27:00,960 police MTS to intervene. So we receive all that knowledge 477 00:27:01,040 --> 00:27:06,400 and apply and train the right stuff, stuff to give, provide 478 00:27:06,400 --> 00:27:09,680 the right care is mainly that because if you think about the 479 00:27:09,680 --> 00:27:12,080 timeline, right, it's got several branches. 480 00:27:12,080 --> 00:27:16,720 So for medical is a MLS for the paediatrics will be EPC and and 481 00:27:16,720 --> 00:27:20,400 then many others. So it kind of cover, it does 482 00:27:20,480 --> 00:27:23,200 what used to call emerges 360 degrees. 483 00:27:23,360 --> 00:27:29,000 So he covers pretty much most of the patients that we attend in 484 00:27:29,000 --> 00:27:32,720 the pre hospital setting, including some of us that go 485 00:27:32,960 --> 00:27:36,800 out, go abroad to attend wars. And then and that place it will 486 00:27:36,800 --> 00:27:41,560 also give us those skills for example, three people see to 487 00:27:41,920 --> 00:27:44,880 deliver the right care where we are. 488 00:27:45,000 --> 00:27:48,760 So we'll be the civilian or a battlefield or whatever. 489 00:27:48,920 --> 00:27:51,440 Let me throw you a wee bit of a curveball. 490 00:27:51,440 --> 00:27:56,160 So you are now CEO of NAEMT for a day. 491 00:27:56,360 --> 00:27:59,680 You have God's status with an NAMT. 492 00:27:59,680 --> 00:28:03,280 What programme would you add to their portfolio? 493 00:28:03,280 --> 00:28:05,080 Mean question. There's a few. 494 00:28:05,440 --> 00:28:06,880 There's a few. I just mentioned that the 495 00:28:06,880 --> 00:28:11,080 emergency 360° is an exercise I tend to do to cover the patient 496 00:28:11,080 --> 00:28:13,160 the moment they were born until they die. 497 00:28:13,320 --> 00:28:16,800 So we almost covered the moment they die with gems genetically. 498 00:28:16,800 --> 00:28:21,160 For AMS, I think there's a few areas that already exist with 499 00:28:21,160 --> 00:28:24,120 American Art Association. That's an AMT. 500 00:28:24,160 --> 00:28:26,480 Never want to go in, but they'll link. 501 00:28:26,480 --> 00:28:29,280 They'll link. So the newborn life support 502 00:28:29,480 --> 00:28:33,080 advances life support and theatric life support. 503 00:28:33,360 --> 00:28:37,560 Again, the life support is briefly covered with the APC, so 504 00:28:37,760 --> 00:28:42,840 it's not neglected, but the resuscitation part, I think 505 00:28:43,120 --> 00:28:45,600 that's something that AMT could consider. 506 00:28:45,720 --> 00:28:48,200 There's some other part of course, it's quite dear to us is 507 00:28:48,200 --> 00:28:51,880 the wilderness and remote applications that the remote 508 00:28:51,880 --> 00:28:56,280 area is something that NAMT not as far as I'm aware not yet 509 00:28:56,400 --> 00:28:58,560 approach, but I don't know who knows in the future. 510 00:28:58,640 --> 00:29:01,280 Yeah, they've kind of steered cleared of the the whole ACLS 511 00:29:01,280 --> 00:29:05,120 option, even though on the NAMT website they do have the 512 00:29:05,360 --> 00:29:09,840 ECSIACLS options. So they they've kind of steered 513 00:29:09,840 --> 00:29:12,320 near it, but they haven't embraced that at all. 514 00:29:12,440 --> 00:29:14,680 I don't know how it is at the moment. 515 00:29:14,680 --> 00:29:17,880 There's a few organisations, they were running advanced 516 00:29:17,880 --> 00:29:21,040 cardiac life support and also theatric advanced life support, 517 00:29:21,080 --> 00:29:24,360 but they're kind of moving, slowly moving away. 518 00:29:24,400 --> 00:29:29,120 The other one is HSI, another organisation is to run, I think 519 00:29:29,120 --> 00:29:31,960 they still running ACLS, but that's moving away. 520 00:29:31,960 --> 00:29:35,360 And I think American Association is, are the ones who actually 521 00:29:35,360 --> 00:29:40,160 have that niche in terms of, of, of delivering training and 522 00:29:40,160 --> 00:29:42,560 knowledge. Again, every five years the 523 00:29:42,560 --> 00:29:45,480 guidelines change that we need to adopt ourselves, especially 524 00:29:45,480 --> 00:29:47,840 with the, with the ILCOR. If you're European, you need to 525 00:29:47,840 --> 00:29:50,080 follow the European guidelines with the European Research 526 00:29:50,080 --> 00:29:52,840 Council. If you're AmeriCorps, dealing 527 00:29:52,840 --> 00:29:55,160 with the American guidelines will be the American Art 528 00:29:55,160 --> 00:29:57,720 Association. And there are five other 529 00:29:57,720 --> 00:30:00,760 organisations worldwide that also create their own guidelines 530 00:30:00,880 --> 00:30:03,280 in conjunction in synchrony with ILCOR. 531 00:30:03,440 --> 00:30:07,800 So it's a niche, but again, it all depends if an Ant wants to 532 00:30:07,880 --> 00:30:11,640 go down that route or not. So it's it's it's political. 533 00:30:11,760 --> 00:30:13,920 So you mentioned about CEO, that's all I'll do. 534 00:30:13,920 --> 00:30:17,280 But as I said is a mean question because it's many information 535 00:30:17,280 --> 00:30:20,640 I'm not aware and CEO needs to see everything. 536 00:30:20,800 --> 00:30:22,920 Yeah, that is a challenge. And, and you're right, it's 537 00:30:22,920 --> 00:30:25,040 interesting that they haven't touched the wilderness and 538 00:30:25,040 --> 00:30:28,120 remote at all. Yep, the option, the option who 539 00:30:28,120 --> 00:30:31,320 knows Rome, it's is expert in that area. 540 00:30:31,320 --> 00:30:33,400 So who knows? Eventually a partnership with 541 00:30:33,400 --> 00:30:37,680 AMT and could produce a course for AMT to run Worldwide 542 00:30:38,160 --> 00:30:41,120 Challenger. And in all fairness, IBSC has 543 00:30:41,400 --> 00:30:44,240 cornered that market with their Wilderness Paramedic Board 544 00:30:44,240 --> 00:30:47,440 certification, which a lot of us at Quorum has has helped to 545 00:30:47,440 --> 00:30:50,320 write that and help create that. But that's the only thing at the 546 00:30:50,320 --> 00:30:51,080 moment. Correct. 547 00:30:51,080 --> 00:30:54,400 Doctor Mollison produced that that manual and actually it was 548 00:30:54,480 --> 00:30:56,520 very good. I managed to to certify this 549 00:30:56,640 --> 00:30:59,840 Wellness paramedic with IBSC and thanks to that manual. 550 00:31:00,120 --> 00:31:03,280 So it means that Quorum is producing knowledge. 551 00:31:04,360 --> 00:31:07,160 Alfredo, my final question for you is this. 552 00:31:07,160 --> 00:31:10,120 What advice do you have for the pneumatic, the new nurse, The 553 00:31:10,120 --> 00:31:14,480 new Doctor who is just starting out from their career in austere 554 00:31:14,600 --> 00:31:18,480 medicine? It is to adapt and to learn as 555 00:31:18,480 --> 00:31:22,240 much as you can before going to the field and prepare yourself 556 00:31:22,240 --> 00:31:24,640 before going to the field. Because depending where you're 557 00:31:24,640 --> 00:31:29,240 going, if he's Amazon or the Arctic Circle or the desert, you 558 00:31:29,240 --> 00:31:33,640 need to understand what going to be your challenges, what kind of 559 00:31:33,640 --> 00:31:37,960 disease or trauma or what kind of the emoji that you want to 560 00:31:37,960 --> 00:31:40,440 find over there. So it means that you need to 561 00:31:40,680 --> 00:31:44,560 come up with a pack of medication that's going to be 562 00:31:44,560 --> 00:31:47,200 appropriate over there and your own kit. 563 00:31:47,280 --> 00:31:50,920 So it's pointless to bring loads of clothing to the desert, but 564 00:31:50,920 --> 00:31:53,400 you need to bring appropriate clothing to the desert. 565 00:31:53,480 --> 00:31:56,200 The same thing goes worse for for the Arctic Circle. 566 00:31:56,360 --> 00:31:59,560 So you need to adopt yourself to protect yourself and try to 567 00:31:59,560 --> 00:32:01,720 understand what are you going to find over there? 568 00:32:01,720 --> 00:32:03,760 Who you going to cover to prepare? 569 00:32:03,880 --> 00:32:07,960 Because I think the keyword in wilderness environment is 570 00:32:07,960 --> 00:32:09,920 preparedness. If you're not prepared, you're 571 00:32:09,920 --> 00:32:11,800 gonna fail. And if you're gonna fail, you're 572 00:32:11,800 --> 00:32:14,280 not just fail yourself, you're gonna fail the ones that are 573 00:32:14,280 --> 00:32:16,840 counting on you. And also there's another 574 00:32:16,840 --> 00:32:22,080 problem, another detail about meant. 575 00:32:22,080 --> 00:32:25,600 So you need to prepare yourself mentally for what you're going 576 00:32:25,600 --> 00:32:27,960 to find times, third world countries going to find a 577 00:32:27,960 --> 00:32:30,400 different culture. You're going to see things that 578 00:32:30,400 --> 00:32:33,960 you're not expecting to see. And you need to prepare yourself 579 00:32:33,960 --> 00:32:38,880 to cope with that information that that's those scenarios to 580 00:32:38,880 --> 00:32:42,160 not regret afterwards. I think it's what I think. 581 00:32:42,200 --> 00:32:44,240 This is my advice. That's, that's good advice, 582 00:32:44,360 --> 00:32:46,840 Fredo. It's great to have you back on 583 00:32:46,840 --> 00:32:50,000 our podcast. I'm sure you'll be back for your 584 00:32:50,000 --> 00:32:53,280 third time eventually. I also personally, I would like 585 00:32:53,280 --> 00:32:58,800 to appreciate the push you've had for an AMT programme. 586 00:32:58,800 --> 00:33:01,880 So you went out of your way, you got your AMLS along with me in 587 00:33:01,880 --> 00:33:05,960 Ireland fortnight ago and you are coming to visit. 588 00:33:05,960 --> 00:33:10,200 So you're there to support us and as a course, as clinical 589 00:33:10,200 --> 00:33:15,040 manager, you are making our students have a, a better option 590 00:33:15,040 --> 00:33:16,240 as they go through the programme. 591 00:33:16,240 --> 00:33:20,400 So Alfredo, everything you touch within the college has been 592 00:33:20,400 --> 00:33:22,720 golden and I appreciate your time. 593 00:33:22,720 --> 00:33:24,600 Always a pleasure, thank you for having me. 594 00:33:25,640 --> 00:33:29,400 This has been a presentation from the College of Remote and 595 00:33:29,400 --> 00:33:32,560 Offshore Medicine. If you would like to earn CPD 596 00:33:32,560 --> 00:33:36,440 credits for this podcast, you can join the Council of Members. 597 00:33:36,840 --> 00:33:40,640 Being a member of the College gives you free CPD credit, free 598 00:33:40,640 --> 00:33:43,840 access for a virtual field guide, and discounts on our 599 00:33:43,840 --> 00:33:47,000 e-learning courses. You can join the team on our 600 00:33:47,000 --> 00:33:51,200 College website at quorum.edu dot Mt.