It’s been a month since the Irish EMS Gathering conference that I had the pleasure of speaking at. This was the second year and it’s a pretty unique event. It’s main focus is naturally pre hospital care and it’s great to see a medical conference that isn’t just doctors talking about how awesome doctors are… Plus, Carley was there so it was nice to catch up.
Here’s just 3 (of many) highlights.
Gareth Davies [London HEMS]
Absolutely lovely bloke with brain the size of the a planet and clearly very, very good at what he does. My take home message was his talk on impact brain apnoea. This is a new phenomenon to me and to be fair I think the London HEMS guys have coined the term. It is based on some wonderful rat models from a long time ago though. The basic idea is that the massive trauma of high speed motor vehicle accidents leads to some form of brainstem event that results in transient apnoea and blown pupils. This is associated with a massive surge of catecholamines and resultant cardiovascular instability and collapse. You only see this if you do prehospital care, and even more so if you’re a doc on the scene of something like the Isle of Man TT or the North West 2oo, both designed to allow young crazy, northern irish men try to kill themselves in as dramatic a way as possible. The key, Davies says, is early intervention not nihilism. The reason these guys do so badly is not because of the their structural brain injury but from prolonged prehospital apnoea. Davies, like the wonderful Mark Wilson advocates that if these guys are oxygenated early then they need aggressive neurosurgical intervention and never mind the blown pupils. The poor outcomes that people quote are self-fulfilling prophecies – if you do not intervene then it’s no surprise they do poorly.
He always goes down in history for his nuanced critique of the PK format of talks as Pokemon talks.
[Impact Brain Apnoea also here on Resus.ME]
I made the mistake of not going to their simulation workshop but chatting to Mark Forrest and Jason you get an idea of how much these guys are passionate about improving prehospital trauma care. They have made the ATACC manual available as a FOAMed resource and I’m about half way through and loving it so far. Alan Watts, one of my fellow trainees and FOAMed connoisseur told me it was the best course he’s ever been on so it’s on my wish list.
Conor Deasy and the Trauma audit
I’ve bemoaned our lack of a functional trauma system in Ireland on twitter before but I suppose it’s worth mentioning again. We only have one hospital in the country with all the requisite specialties but as Karim Brohi has noted, a hospital of specialties is not a specialist hospital. Ireland has a population of less than 5 million. It’s not clear how many trauma centres we might need, but it’s going to be a lot less than the current 28 EDs we have that have the potential to receive major trauma. Trauma remains an inconvenience to hospitals in Ireland. No one is really planned and prepared for it and there is no systems wide approach to making it efficient, effective and seamless. At present we have no data to show that we’re not very good at trauma. Hopefully trauma audit (no matter what issues there may be with TARN) will give us a basis for something like the NCEPOD report that seemed (to me as a very junior doc at the time) a big deal in improving UK trauma care.