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
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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
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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

In this talk I will summarize the pearls, pitfalls, and lessons shared by leaders in my own life, both inside and outside of medicine. In my experience, leadership is not a particularly male or female quality. It is a trait of an individual. Individuals tend to dichotomize into leaders and into followers. And people know good leaders “You know the way you know about a good melon” When Harry Met Sally

I will share with the audience my lessons and personal examples on leadership. Some of these include 1. There is never a need to publicly embarrass someone. Always give the person an out and speak in private. 2. Make a decision. Being indecisive is perceived worse than making a wrong choice. 3. Know your strengths and build on those. Know your weaknesses and identify people for whom those are strengths and bring them onto your team 4. “People may forget what you say, they may forget what you do, but they will never forget the way you make them feel.” Maya Angelou 5. Leaders must be comfortable with solitude 6. Leaders are not afraid to ask for what they need.

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

Medical journals have many possible functions, but the main one for most is publishing science. They are actually better at campaigning and agenda setting, rather like the mass media. Journals are now beset with problems, including failing to include data, publishing lots of poor quality material, being slow to publish, publishing research that is either not reproducible or fraudulent, encouraging waste in the system, failing to be transparent, and exploiting academics. New ways of publishing science are appearing, and a better system would be for the grant proposal, protocol, and full data to be published on a database with the whole process transparent.

Category:general -- posted at: 7:00am AEST

Sepsis is incredibly dangerous for our patients and very topical in ICU and Emergency. In intensive care and emergency medicine we rightly dissect and discuss extensively how best to resuscitate patients, Airway, Breathing, Circulation – the ABC! Our training focuses on the urgency and adequacy of resuscitation and the provision of excellent supportive care. However, for the critically ill, especially in sepsis, we have very few therapies available that actually change the natural history of illness and can cure our patients. Surely that is what being a doctor is all about – helping people and changing the course of their illness – giving the patient a chance to survive!

Over 75% of patients in ICU will receive antibiotics and the choice, timing and dose will directly influence your patients chance of surviving. Antibiotics are one of the few truly disease modifying therapies we have available and by far the one we utilize the most.

In addition, no other therapy is important to not only get right for the patient you are treating but, in the case of antibiotics, the therapy for one patient may influence other patients. Attention to correct antibiotic use might save the patient in front of you. However thoughtless antibiotic use might make it harder to save the next patient by increasing antibiotic resistance in your unit.

How and why must we get antibiotics right?

Direct download: 04_Steve_McGloughlin.mp3
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Inhaled nitric oxide, iNO, is usefull for retrieval and transport of the critical respiratory failure patient. Also, there is a well documented role in the retrieval of the newborn with pulm HT, PPHN or resp failure. Its used in retrieval as well as ICU settings.

Direct download: 03_Per_Bredmose.mp3
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In Critical Care we deal with death on a regular basis and although it seems an ‘on or off’ issue where you are either dead or you are not, nothing is more true. Not only physicians but scientists, philosophers, writers and theologians have been debating about the subject for as long as we have become aware of the concept of death.
To try to create order from chaos I divide the deceased in 5 categories:
The soon to be dead,
The reversibly dead,
The irreversibly dead
The walking dead (although this group I will leave to Hollywood to educate us about)
and the most curious group
The reversibly, irreversibly dead.
They are the patients of whom we think they are irreversibly dead, we stop our resuscitation efforts, and then they have return of spontaneous circulation. This is known as the Lazarus phenomenon and although many case reports have been published about this phenomenon over the years, presumably it’s only the tip of the iceberg.
In providing Critical Care we sometimes need to make immediate decisions on who’s dead and who’s not. Yet decisions about whether further treatment of patients is futile or not can only be made when one is aware of the limits of extremes in physiology that are survivable. Although not every patient should be treated up to these physiological limits, knowing these extremes can help in making an informed decision of whether to continue treatment.

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