See here for directions
Error: Twitter did not respond. Please wait a few minutes and refresh this page.
CGD served up a mixture of cases discussions, audit, hot off the press journal articles and finished the day with a cracking multiple-casualty scenario.
In his final appearance before sadly leaving Sydney HEMS, Anthony Lewis went through a number of interesting airway cases for the month of July. There were a number of learning points:
The Day Terrorism Arrived in Norway
Christian gave us a fascinating and thought-provoking insight into the terrorist incidents on 22 July 2011 in Oslo and Utøya Island, from his first hand experience working with the Norwegian Air Ambulance on that day.
In the deadliest attack in Norway since World War 2, a car bomb exploded in the government quarter of Oslo, killing eight and injuring 209 people. This was followed hours later by a gunman opening fire on a youth camp on Utøya Island, 40km from Osl0. 69 people were killed on the island, with a further 110 injured.
An excellent summary of the EMS response was published the following year and is well worth a read for anyone involved in pre-hospital care or major incident planning
Cameron Edgar covered several complex pre-hospital cases where winching was required, highlighting some of the logistical challenges involved.
This included a complicated multi-agency mission in the Blue Mountains involving abseiling down to the patient who had fallen 10 metres into a canyon. Following stabilisation of the seriously injured walker, he was extricated in several stages – first by ropes to the top of the canyon and then carried to a safe area prior to an accompanied stretcher winch.
The Warriewood Blowhole close to the northern beaches of Sydney is a popular site for teenagers in the warmer months and has been the scene of several winching operations in recent years. For one of the new HEMS registrars, it proved to be a particularly eventful day when a teenager sustained multiple injuries after falling when climbing down to the blowhole.
While the triage scenario was running, Cliff went through the findings of the recently published ARISE study, the second of three multi-centre studies looking at Early Goal-Directed Therapy (EGDT) in sepsis.
In keeping with the ProCESS trial, there was no difference in all-cause mortality at 90 days between usual care and EGDT. While awaiting PROMISe, the final study in the trio, it seems to be that the fundamental goals in the management of sepsis are early recognition, source control, early antimicrobial therapy, considered use of fluids and vasopressors and close observation.
To end the day the doctors and paramedics were put through their paces in pairs, in a challenging scenario involving the initial assessment of multiple casualties following a minibus crash.
There were many learning points from the subsequent debrief:
Next Clinical Governance Day is on Wednesday 22 October
A very useful CGD with a focus on obstetric emergencies and neonatal resuscitation.
Started off with a comprehensive (and brave) talk by our medical student, Amy, on the physiological changes of pregnancy. A good run through of this can be found here.
We then had a talk from our resident NICU expert Rachel on neonatal resus – the Australian Resucitation Council flowchart can be found here.
Neil Greensmith then took us through some real life Sydney HEMS obstetric cases followed by Rachel (again!) taking us through trauma in the pregnant woman. Here’s a summary from trauma.org.
Finally, after lunch we had a couple of fun obs themed simulations, the first on neonatal resus with a PPH in a remote setting, dealt with superbly by Jamie & Cameron. The video shows how they reprioritised from neonatal resuscitation when they realised how sick the mother was..
This was followed by Mike Culshaw dealing with consummate calm with an eclamptic fit. Our sim expert Morgan has kindly written some valuable learning points on these two scenarios, which can be found here.
Thanks to everyone involved in a successful day.
We started off the new term with a series of interesting presentations based around the theme of drowning and water rescue.
Inland Water Rescue in the UK
Thanks to the wonders of the internet, Matt Ward, Head of Clinical Practice at the West Midlands Ambulance Service presented a very informative talk on inland water rescue in the UK, in particular, the work of the Severn Area Rescue Association and its involvement in the rescue operation following the severe floods affecting Tewkesbury, Gloucester in 2007.
Drowning: pathophysiology and management
Tom talked us through the physiology of drowning and its management
An excellent summary from Life in the Fast Lane can be found here
Role of HEMS physician in water rescue
It seemed fitting that a day focused on water rescue should have a number of water-based simulation scenarios to put the new registrars through their paces.
The standard of practice was excellent with some great examples of teamwork and the sharing of a mental model.
The day was brought to a close with a discussion of a number of interesting cases attended by the new registrars since joining Sydney HEMS. There were many learning points from each case including:
The next Clinical Governance Day is on 24 September 2014, when we hope to be back in the refurbished training building. More details to follow
To make your own escharotomy training model, you will need:
1. A thick foam yoga mat (red or pink). This one was $10 from K-Mart.
3. A roll of thin packing foam — the sort of stuff your new TV comes wrapped in.
4. Some elastic bands.
5. Around 4-5 rolls of white Cloth Tape (similar to Gaffer tape but much cheaper).
6. A pair of trauma shears
7. A resuscitation mannequin.
1. Cut the yoga mat into sections and wrap circumferentially around the torso and limbs of your mannequin. Wrap cling film firmly over the top to secure it in place. This red/pink layer represents the viable tissue beneath the eschar — i.e. the end-point of the escharotomy procedure.
2. Next, simulate subcutaneous tissue by adding 2-3 circumferential layers of packing foam to the torso and limbs. Elastic bands can be applied to the limbs to simulate constrictor bands.
3. Now for the most important part! Wrap white cloth tape circumferentially around the limbs and torso to simulate eschar.
The tighter you can apply this layer, the better! The springy foam layers are now compressed by the restrictive tape and will spring apart when incised.
4. Your escharotomy man is now ready to use! For additional realism you can apply make-up or charcoal to simulate charring, or even lightly burn the top layer to produce an unpleasant burned smell.
5. The mannequin can now be used for simulation or practical skills teaching.
Tutees can be instructed to:
This model was trialled for the first time at our Sydney HEMS team induction and performed very well!
Of course, in real life the procedure is a little bloodier…
If anybody has a clever way to simulate active bleeding without completely destroying the mannequin then please let me know!
Escharotomy Man designed by Dr Ed Burns. Thanks to Dr Fergal McCourt for the escharotomy video.