EMS Gathering Review

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]

Gareth Davies

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]

The ATACC guys

ATACC

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

Conor Deasy

To me Conor Deasy was always the lead singer in this band but turns out he’s a researcher, EM consultant and now the trauma audit lead for Ireland

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.

(Yet more) reflections on SMACC Gold

Lots of other folk have put their reflections on SMACC Gold online and I’m here to join the crowd.

I missed the first SMACC as purse strings were a little tight. They’re a little tight this year too but I really wasn’t going to miss two SMACCs…

It was great to have an opportunity to come and speak though I’ll confess I was much more comfortable teaching neuroanatomy than being on the airway panel with Levitan, Weingart, John Hinds and Brent May. But it was all good really.

levitan 1

I was very impressed that they chose to devote a 2 hr main area session on end of life issues that incorporated a live integrated twitter discussion.

SonoWars in particular caught my eye as one of the most creative and slickly ran sessions on education I’ve ever seen. Those guys (ultrasoundpod and the sonocave guys) are the best in the business.

The highlight though, without doubt, was the people. This is why you come to SMACC, to meet and be inspired by people. You can throw this off as soft and fluffy and no relevance to medicine but this was the key thing.

smacc gold audience

Ireland has a small EM community and it’s a tough place to do EM. We have a very small number of trained EPs and our departments are crowded, understaffed and morale is frankly pretty low at times. It’s hardly surprising that so many of our trainees or EPs have moved to Oz or New Zealand.

As a result #FOAMed has been an inspiration and an revelation to me. To know the imaginative possibilities of EM out there is what gets me excited about the job. I get to discuss online with some fascinating, interesting and passionate clinicians from whom I can learn. SMACC gold gave me the chance to meet these people in person. And meeting people in person beats twitter hands down.

People who engage in #FOAMed tend to be a little bit off the spectrum in terms of our enthusiasm. We love the medicine, we love to talk about  medicine and we just can’t get enough of talking about medicine so much so that our spouses, our friends and even our medical colleagues get bored of us. SMACC is a conference for all these enthusiastic, excitable little puppies to get together and bond with all the other freaks and geeks.

All these people, the passion, the enthusiasm and the relationships are an inspiration to be a better doctor and a better team member.

So my thanks for SMACC gold are to the people. In particular the committee for being mad enough to invite me and Rob Rogers for being a great roomie – that man rocks!

Here’s some more reflections on SMACC gold so you can check out the love.

I Teach EM

Manu Et Corde

REBEL EM

Injectable Orange

LITFL

Jess

KI Docs

Doug Lynch (with a fascinating set of interview)

Damian Roland

AmboFOAM

Nomadic GP

Bishan

[Let me know if I missed any]

And here’s the opening ceremony

We’ll be in Chicago next year in May 2015 and I for one plan on being there. Be sure and check out the SMACC podcast to catch up on all the talks.

[Images via Oli Flower]

PK Talk for SMACC 2014

Here’s my PK talk for SMACC for 2014. The PK talks for those who can’t remember are short, snappy focused presentations on anything – the SMACC ones are of course focused on critical care.

I presented the same material at our  joint ICU/ED meeting a few days ago so I figured I may as well share it as a PK.


Genuinely intersted as to whether people are aiming for the higher MAPs in SCI. Was news to me and no one in our department was that impressed by it. The studies aren’t wonderful after all.

For those interested here’s last years PK too.

See you at SMACC Gold people!

Respond 2014

I had the pleasure of running a couple of very brief social media workshops at respond 2014 a few days ago. This was the first national conference for community first responders and got off to a great start with more than 300 people.

Community first response was an alien idea to me until a fee months ago. I expected a rather amateurish bunch of enthusiastic civilians but was pleasantly surprised to find a highly motivated and enthusiastic group of volunteers who were well trained under a national structure.  The main aim is of course to provide high quality CPR and early defibrillation as soon as possible in the event of cardiac arrest. Given the often rural nature of Ireland the concept of first responders is valuable.

If you’re in Ireland and interested in more about CFR then check out the conference web page, the hashtag and a few of the local groups.

If you’re here because of the social media workshop looking for more tips  then I suggest you check out this video (aimed at prehospital professionals) and this post.

Congrats to all for a great conference.

Severn Deanery 2014 Social Media Workshop

This is the post I created for the guys who attended the Social Media workshop at the Severn Deanery meeting in January 2014. It is based loosely on material from the Irish EMS gathering that I took part in last year Hopefully something from the 2 hrs stuck in your brains so that you’re not seeing all this as entirely new material. Hopefully I’ve included all the services and apps mentioned during the workshops.

Remember that there are lots of useful links and all the audio from the day over at the Severn Deanery Website. Kudos to Tom Mitchell for that.

For more info on the day itself check out the EMJ Blog that has an article outlining the day.

Twitter

Firstly we got everyone to join Twitter. Or at least we tried to until the Hotel wifi started playing silly buggers. There was some kind provision of personal hotspots that enabled access.  You access twitter via the website or via an app on your computer or phone. For interest sake I use  TweetDeck  through  Chrome on my computer and use Twittelator Pro on my iPhone. There are lots of different apps available that allow you to access twitter so feel free to experiment a little.

I suggested that when you join twitter you should put a little of biographical information about yourself. People are more likely to interact with you if they know something about you. There are a lot of fake, spam Twitter accounts and having some info on someone helps people to trust you. I think it’s worth describing whether you’re a trainee or a fully trained physician on here too.

Simon suggest having a profile picture as well rather than the default, anonymous egg.

Twitter EGG

For example here’s mine:Andy Neill Twitter Profile

Follow People 

When you get started I suggest you follow a few key people to start with. Here’s 5 to get you started:

@sandnsurf

@precordialthump

@cliffreid

@broomedocs

@M_Lin

@EMManchester

and of course everyone’s favourite, Cliff, the college president

@CEMpresident

The more interact, post and reply to people, the better your twitter experience will be. We don’t bite honestly, we loved being asked questions on Twitter.

Follow Lists

You can also follow lists, either other peoples or your own that you create. This is a good way to ensure that you’re spending your time well on Twitter. If you make a list of people who consistently tweet high value info then you’ll not be bored by dross about people’s dinner…

Here’s a list I have of “medical tweeters

And here’s the list of all the tweeters from the conference.

Follow Hashtags

Hashtags [words beginning with the '#' symbol] are good ways to join conversations together. My favourite hashtag is #FOAMed, this is a consistent conversation about FOAM resources. You can type #FOAMed into the twitter website or onto your twitter app to find it.

Of note there is also a #FOAMcc stream for more critical care topics and #FOAMped stream for kiddies. Or rather it’s about paeds EM, it’s not really for kids to read…. that would be just silly.

NB, on a mac the # symbol is produced by pressing the ‘option/alt’ key and ’3′ together.hash key

If you want more twitter basics then check out momthisishowtwitterworks.com

Podcasts

I think the key is to get your podcasts on your smartphone. That way wherever you are yo can listen to them. It’s much more important to have them on your phone your computer in that sense. I suggest turing off podcast sync between itunes on your computer and your phone. You’ll only really use them on your phone anyhow.

The basic ‘podcasts‘ app from apple on the iphone is a reasonable place to start. Downcast is a great alternative.

podcast 1

Once downloaded, start the app and click the ‘store’ button.

podcast 2

Once you’re in the store, search for whatever it is you’re interested in.

podcast 3

 

Once you find a podcast you want to subscribe too, just click on the subscribe button. Every time a new podcast is released it should download automatically to your phone.

podcast 4

LITFL have a great list of podcasts and a searchable database too, if you need to find more. The Severn 2014 Website has a pretty good list too.

Feed Reader

Most of the FOAM websites produce new material on a regular basis. To save you having to visit the site to check if new amterial has been released, you can use something called a feed reader that will collect all the new material from all your favourite websites in one place. I used to recommend Google Reader but it’s shutting down in July 2013 and I’m now suggesting feedly as a good alternative.

feedly

Once you’ve added feedly to your internet browser (usually as an ‘extension’) or downloaded the app to your phone or tablet then you can add the websites you’re interested by either clicking on the RSS symbol on the website

RSS

 

or copying and pasting the website URL into the search box

feedly search

The mobile app is kept in sync with your computer and is set out in a similar easy to use way.

If you’re looking for one place to look for all the best in FOAM then check out Kane Guthrie’s LITFL review or the list on the Severn website.

Blogs

So say you’re keen to start putting out your own FOAM material, then starting a blog is a good way to start. Here’s the website we set up at the workshop in 15 minutes.

This is what the ‘dashboard’; the construction site of the website looks like.

wordpress

This is all free and easy to do via wordpress. I would strongly encourage you to get a wordpress account and fiddle around with it.

Google Plus

We only mentioned this briefly but I said I thought it was a brilliant platform for FOAMed but unfortunately under utilised. Its best features are probable communities [check outECG+ and the EMCrit community] and the google hangouts. Here’s a nice example of google hangouts being used to stream a conference live.

 

Or here as a conversation between experts discussing some medical papers. Saves all the hassle (but not quite as much fun) of actually meeting up.

Google plus does the cool thing of recording these video calls for you and storing them as a (private) YouTube video that you can then post on whatever website you want.

There is also the rather nifty community feature on google plus that can function in the same way as the #FOAMed hashtag but allows much more substantial conversation and response rather than the 140 characters of twitter. Here’s two examples

1) FOAMcc

2) ECG+

Screencasts

Due to technical issues we couldn’t quite pull this off live at the workshop but a screencast is typically a recording of what’s on your screen with a voice over. It’s a great way to share a lecture you’ve prepared with lots of other people. Once the video file is made you can upload it to YouTube, Vimeo or even better GMEP for other people to see.

Screenr.com let you record screencasts without having to download a separate app but I do a fair bit of this so I use one called screenflow. If you have a mac you can do this very easily by using quicktime on your mac. It comes free bundled with the operating software.

To do this:

1) Open QuickTime Player

QuickTIme

2) Start a new screen recording [File>New Screen Recording]

New Screen Recording

3) Choose Mic and Quality

Choose Mic

4) Make your screen selection or if recording a screen presentation, just start recording full screen then make your presentation full screen

Choose what you want to record

At the end just press stop (there’ll be a stop symbol at the top of your screen) and then you’ll have a nice little video file of your screencast. Upload this to YouTube, put the link on Twitter and Robert is indeed your Mother’s Brother.

As an example here’s a screencast of a talk similar to the one I gave at the severn conference. The audio from the Severn Conference is available here.

[If anyone wants the slides for the talk they're available as a keynote presentation.]

Lastly the app I used for displaying my iPhone screen was one called Reflector which is $12 but a really, really well put together app that lots of people recommended but I first found via Haney Mallemat and my brother the software developer.