SMACC

What can hospital specialties learn from teaching and training in prehospital and retrieval medicine? A medical education enthusiast's thoughts on the application of educational theory to the challenges of the prehospital environment, based around experiences at Sydney HEMS. Reflections on teaching and learning about patients, the environment, the team and the clinician herself - and how this educational experience will shape future challenges as an educator.

Direct download: Taking_Outdoor_Education_Indoors_Natalie_May.mp3
Category:general -- posted at: 7:00am AEST

Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Come and learn what the literature suggests, and join the global debate about this controversial topic.

Prefer a paper to a podcast?

Find solid overviews here:

1. Devereaux A V. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S - 66S.
2. Christian M et al. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36 Suppl 1:S55-S64. doi:10.1007/s00134-010-1765-0.

And nice reviews of the ethics here:

1. Upshur R SP. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza: a report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. Univ Toronto Jt Cent Bioeth. 2005;(November).
2. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood). 2006;25:1053-1060. doi:10.1377/hlthaff.25.4.1053.

Direct download: 01_Sara_Gray.mp3
Category:general -- posted at: 7:00am AEST

Does love have any place in critical care? If we love and care are we more vulnerable to burnout and compassion fatigue? Will we be identified as weak leaders, too ‘soft’ for the area? Are we supposed to love an environment full of carnage and suffering? Are we meant to ‘love’ our colleagues and see our team as an extended family? Should we ‘love’ our patients or is that a ‘boundary crosser’? Critical Care consistently looks internally to resolve the past and emerging problems when there is research across disciplines that will assist critical care environments to adapt to the changing landscape of ethics, new technologies, issues with teams and a need for leaders to be more than skilled clinicians. Love and humanism may hold the key? Drawing on theories and models that hold love and compassion at their core this talk will draw examples from couples counselling, family therapy, development of teams, acceptance and commitment therapy and some of the greatest leaders in history to provide an innovative framework that can create flourishing and wellbeing within critical care for both the patient and professional. Discover where love can take us in critical care. Exploring the developmental phases of love and critical care we can learn to use our passion and energy for the job as strength instead of as an allergen. We will be reminded from the greatest leaders of our time how to transform health care and working relationships into an environment of love, support and resilience. That if we can negotiate relationships with partners, in-laws, children and friends we have the skills and resources to manage, love and thrive at work. Love, connection and compassion have much to teach us, it is time we learned to listen

Direct download: 04_Liz_Crowe.mp3
Category:general -- posted at: 7:00am AEST

A voyage through the darkest places, sharing doubts and fears.

Direct download: 02_Ross_Fisher.mp3
Category:general -- posted at: 7:00am AEST

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Direct download: 03_Reuben_Strayer.mp3
Category:general -- posted at: 9:00pm AEST