HEMS Education Day – Wednesday 31st May

May HED Flyer

The next HEMS Education Day (HED) will be an exciting opportunity for the organisation to examine our role in Major Incidents. The day will primarily revolve around a Major Incident Exercise which is being put together by our education team. However, we will still kick off the day with a talk from JP Favero that follows the Diploma of Retrieval and Transfer Medicine which will touch on the role that other services play in major incidents. Before launching into our exercise, we will also hear from Cameron Edgar and Gary Tall about the role our service plays in such events. As for the rest of the day – well you’ll just have to turn up to find out!

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Clinical Governance Day – Wednesday 17th May

May CGD Flyer

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Vomit control at Sydney HEMS

Karel Habig rigged up a SALAD simulator (Suction Assisted Laryngoscopy and Airway Decontamination – the brainchild of Airway Master Educator Jim DuCanto) and ran a vomit-control workshop at our recent HEMS Education Day.

Here are the learning points as summarised by Karel:

Management of massive emesis/Upper GIT Haemorrhage

Prevent – head-up position for all intubations to reduce passive regurgitation as specified in the Prehospital Emergency Anaesthesia Checklist

Plan – where apparent/likely – Double suction tested, briefed Airway Assistant, PPE esp eye protection for all staff – as specified in Prehospital Emergency Anaesthesia Checklist

Considerations
Prehospital Laerdal Compact Suction Unit – very effective BUT fills at 330mL and stops working if filter wet – ALWAYS use alternative suction from vehicles/venturi first

Understand the sucker – Yankauer with hole takes up one person’s hand and doesn’t work unless the hole is occluded. Not ideal.

Large bore suction with no hole is ideal or just use tubing (esp where vomitus is chunky or large clots)

A size 6.0 tracheal tube without airway adaptor can be inserted into all of our suction tubing – good alternative “suction catheter”

IF unexpected Massive Emesis/GIT Haemorrhage post induction:

Initial steps
1. Take a deep breath. Expect to become extremely task focused and lose situational awareness. Verbalise this. ALL staff running through SALAD noticed this

2. Consider log-roll to toilet airway immediately

3. Once returned to supine position – Suction to the cords (don’t try to clean the entire oropharynx) and intubate trachea with bougie (standard intubation)

4. Double suction – place fixed suction along left-hand side of laryngoscope, lock into groove of DL blade and use second device to suction to cords.

5. If not able to control rapidly then deliberately intubate oesophagus (blind placement) inflate cuff (may need 20mL air) and divert flow (take care to avoid spraying assistants)

6. Suction to cords and intubate

7. Large bore suction catheter or Size 6 tube attached to suction can be used to suction down to and then intubate the trachea. Tube change over bougie may be needed in large patients

8. Digital Intubation is an option for those who have practised it

9. Some airways are surgically inevitable.

Haven’t had enough vomit? Listen to EMCrit’s Having a Vomit SALAD with Dr. Jim DuCanto

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HEMS Education Day – Wednesday 3rd May

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HEMS April Education Day Summary

Cold & Hypothermia

Shital Patel presented a challenging case which outlined the importance of early detection of hypothermia pre-hospital trauma missions. She reviewed the topic of hypothermia in detail and to list a few of her many valuable pearls:

  • Reduce drug doses in hypothermic patients
  • Use only a single adrenaline and a single defibrillation in hypothermic patients in arrest. If no response, wait until core temperature is over 32C before repeat doses and shocks
  • Take great care when moving hypothermic patients as their myocardium is unstable and they can easily go into ventricular fibrillation.

 

Transport of Infectious Patients & PPE

Clare Richards gave an excellent presentation on the difficulties of transporting infectious patients. This is a good reminder to make sure you get your flu shot this year and know what size P2 mask you wear (small, regular, large). If in doubt about whether it is safe to transport an infectious patient, don’t hesitate to contact the DRC or ACC for advice. Road crews carry a card that lists the type of precautions for each infectious illness.

 

Literature Review

Kiran Somani gave an excellent review the following 2 articles:

Wafaisade A, Lefering R, Bouillon B, Böhmer AB, Gäßler M, et al. Prehospital administration of tranexamic acid in trauma patients. Critical Care. 2016 May 12;20(1):S3.

Lansom JD, Curtis K, Goldsmith H, Tzannes A. The Effect of Prehospital Intubation on Treatment Times in Patients With Suspected Traumatic Brain Injury. Air Med J. 2016 Sep;35(5):295–300.

 

Practical Environmental Temperature Control Workshop

Paul Kernick gave an interactive session on protecting both the medical team and patients from cold and wet temperatures. He covered the safety concerns when using a warming blanket, the importance of layering, and ways to stay warm using items in your pack if you have to spend the night in the bush.

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Simulation

Our immersive simulation for the day covered the initial assessment and stabilization of an unstable patient requiring a P1 interhospital transfer. This simulation highlighted the many priorities of care and considered how we might assign tasks during a time critical inter hospital retrieval. Themes covered included patient assessment, verbal prioritization of tasks (do this early and thoroughly), how to move an already sited ETT, double pumping inotropes, and the scenario rehearsed interacting with our hospital colleagues.

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Non-Technical Skills Bingo

The day ended with a presentation by Laurence Boss, a guest from St George hospital, with a fun learning exercise about non-technical skills.

 

The next HEMS Training Day will be on Wednesday 3rd of May 2017

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Vascular & Osseous Access in Resuscitation

Cliff Reid and Geoff Healy discuss challenges in prehospital intraosseous and intravenous access, covering how to avoid pitfalls and what their own individual practice preferences are in the prehospital and in-hospital settings (22 mins).

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Clinical Governance Day – Wednesday 22nd March

The next GSA-HEMS Clinical Governance Day is on Wednesday 22nd March at the new NSW Ambulance / Toll base.  This month we’re lucky to welcome Luke Regan who will be talking about the challenges of prehospital care in the Scottish highlands and the Highland PICT project.  Check out the website https://highlandpict.wordpress.com for more information.  In addition we have a review of a challenging vertical access and winch job by Marty Pearce as well as our regular mortality & mortality, learning from excellence, airway audit and review of winch operations.  All this and a BBQ lunch!

March 2017 CGD

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