As Simon, Iain and Nat had to return to the real world the St.Emlyn’s team have adopted a Virchester alumnus to keep us up to date at the London Trauma Conference. Take it away Chris……….
Helicopters abound in the third day of the London Trauma Conference, which is dedicated to Air Ambulances and Pre-Hospital Emergency Medicine and organised in part by the Norwegian Air Ambulance, or Norsk Luftambulanse. Ian, Nat and Simon have gone off to do something called work so there is no podcast, sadly!
Prof Morten Lossius opened the day with the note that as advances are made in hospital management of emergencies, it is increasingly more vital to get patients transported as quickly as possible. Survival depends on decreased time to definitive management, particularly in conditions such as stroke, heart attack, and traumatic cardiac arrest.
After a fantastic talk yesterday on the medical response to the recent attacks in Paris, Prof Pierre Carli returned to the stage to talk about pre-hospital ECMO. Current use shows promise, and he hopes that other countries will start to take it on board to gain a better understanding of how it will impact cardiac arrest care.
— David McCreary (@dmccreary85) December 10, 2015
With the increasing attention given to the concept, and it making it into the new ALS guidelines, it will be interesting to see who takes the lead in the UK and where and when we will see the first use of ECMO in a pre-hospital cardiac arrest setting. I’m sure it’s coming, however starting ECMO pre-hospitally necessitates continuation in hospital and only 5 centres in England have this capability at present.
68% of London’s Air Ambulance responses are actually attended in the car, rather than the helicopter. There are many safety protocols for the heli, particularly surrounding take-off and landing, but is the car as safe? Marius Rehn talked through some of the safety systems implemented to ensure it is, such as advanced driving instruction to match clinical ability, review of internal and external camera footage, dual navigation with sat nav and moving maps, daily checks, and even weight calculations!
— James Tooley (@jamestooley) December 10, 2015
With a third of Australia’s citizens living outside the major cities, it’s a challenge to ensure these folk have access to timely critical care. Prof Andrew Pearce explained how they have tried to overcome these challenges in South Australia, with initiatives such as a regional cardiology network providing a telemedicine service and point of care testing, which has reduced mortality from acute MI by 22%. Before this, Thomas Lindner reaffirmed the message of minimising interruptions in high quality chest compressions for cardiac arrest through recognising what holds us up and training with specific aims. The agitated patient is difficult to manage at the best of times, even tougher in pre-hospital trauma. Andy Thurgood, a consultant nurse who is also the clinical director for MARS BASICS, gave some solid advice on dealing with such patients. It’s important to realise that the patient may just be scared, without a medical cause for agitation (though don’t forget glucose!). He also highlighted the need to do the best thing for the patient, rather than the easiest thing for us, which is quite often analgesia rather than a tube. His slides will be on the MARS website soon.
— London Trauma Confer (@LDNtrauma) December 10, 2015
Leif Rognås and Rhys Thomas explored the difficulties of setting up national retrieval services in Denmark and Wales (respectively, in case you couldn’t work it out by their names!). The main challenges seem to be getting the management on board, which can be difficult as this requires collaboration from several organisations, and then keeping up to date with advances in pre-hospital management and technology once you are set up. No conference is complete without exploring the controversy of spinal immobilisation, and Per Kristian Hyldmo provided a presentation stuffed full of photos of hard collars and long boards, touching on the idea that a protocol for immobilisation where you look at the patient and weigh up the risks and benefits would be best.
Norway has guidelines for spinal immobilisation based on consensus and evidence and not on fear, do you? #LTC2015
— Stephen J M Sollid (@airdoc) December 10, 2015
After lunch, Tom Judge, a critical care transport paramedic from Maine, spoke on the difficulties of implementing an air ambulance system in the US where patients are charged for the use, and there is wide competition to set up programs, such that several groups compete for patients in the same area. This creates a supply driven demand. The keynote speaker for the day, Professor Sir Simon Wessely, gave an insightful talk into the psychology and psychiatry involved in a major incident. Health and welfare providers are keen to debrief, but it has been shown not to work, and can increase the risk of PTSD. Immediately after incidents, people need communication, information, and security. Those who do want to talk, should do it when they want to, and with the people they want to talk to.
— John Wood (@johnboy237) December 10, 2015
For the last part of the day Prof Kai Zacharowski spoke on pre-hospital sepsis, emphasising a need for early suspicion, and ensuring this is handed over to the hospital to ensure they can prioritise the patient effectively. His next short talk on point of care testing in pre-hospital haemorrhage focused on the limited role of lab testing in trauma, with POCT the way forward.
The day finished with further quick fire talks, on implementing pre-hospital CRM and SOPs – such as these from UK HEMS and London’s Air Ambulance in hospital (Julian Thompson), REBOA one year on (Samy Sadek), a highly amusing talk on why PALM is a good plan B, but not such a good plan A (Matt Thomas – with a recommendation to listen to this PHEMCAST), and Prehospital Videolaryngoscopy (Tom Judge).
There were other sessions going on during the day, which from all the tweeting that went on looked amazing, and you can relive the REBOA and thoracotomy demonstrations from the masterclass session on Periscope.
Thanks, and look forward to the podcasts coming from the last two days.