SMACC Day 1 Morning Sessions: St Emlyn’s

It’s great to be back in Sydney for the final SMACC conference. The team have travelled from across the world to join the SMACC family back where it all started at the ICC in Darling Harbour.

This SMACC already feels different. It really does feel like a positive and inclusive environment where people are here to learn and share their experiences and knowledge.

This year we are going to keep the blog posts brief. Partly because all the content will be released later in the year, but also because we want to spend as much time meeting and working with all the delegates and speakers who have gathered here.

Opening plenary.

A really powerful start with Brian Burns remembering John Hinds and asking us remember his work and ethos of trauma care. That led wonderfully into a funny, poignant and powerful talk from Gill Hicks on her experience of surviving the London bombings. It was clear that there was a link here. John’s belief in the patient at the centre of care together with Gill’s story of how much that made a difference to her.

It was poignant to read tweets from Josephine Hinds, John’s mother who is an inspiration in herself. She’s following the conference from back in Ireland and her presence, like that of her son is felt here. It was lovely to read this.

Laura Rock spoke on how emotion should precede facts when dealing with complex issues on the ICU. We really liked the GIVE acronym to summarise a kinder and more in-depth approach to complexity and error.

Dara Kass, one of the most amazing people I know in the world, told her story of how she donated part of her liver to her child. The wrestle between all the roles she had to play, wife, mother, doctor, patient, was incredible. You can read more about her story here. https://well.blogs.nytimes.com/2016/05/13/donating-an-organ-to-my-son/?mtrref=www.google.com&gwh=BD3FBDCF585DEB6340910D2014C80260&gwt=pay

Liz Crowe spoke about the management of grief and found a lot of agreement with the audience that it is not up to us to tell people how to grieve, how to respond or how to act. Her phrase that we should not tell people what to do with grief, but rather sit in the rubble with them had real resonance.

Bedside Critical Care

Led by Scott Weingart this panel looked at the emerging evidence base for cardiac care. Lots of debate about what a low intubation rate is….. maybe 50%???

More on the ILCOR guidelines here from @EMCRIT. He has put together a great blog post on this that encompasses the evidence here.

Pacific Island Playlist

The ever impressive Peter Brindley is running a sort of ‘Desert Island Discs’ for SMACC to bring forward colleagues who might not be established speakers, but who have interesting and important stories to tell.

Bedside Critical Care part 2

Kat Evans kicked us off with the management of obstetric emergencies in South Africa. It’s scary to think about the frequency and severity of severe pre-eclampsia and eclampsia in low and middle income countries. It’s a useful reminder of the luck that we have in working in places like the UK or Australia. I can think of only 10-12 patients that I’ve seen with eclampsia in my career. For Kat this is a weekly event, with fewer resources, fewer drugs and fewer staff.

David Carr presented on Turning a Zebra into a Car. A story of how to deal with a patient who presents with odd behaviour. Introduced us to the concept of the ‘confusogram’ when you just order everything, but don’t get the answer you want or need!

This talk was a bit similar to his last talk on endocarditis in that it’s not common, but it is something that we need to be aware of to spot. Great presentation as always.

Sono Slam: Should we TEE or TTE for ECHO? A bit of a debate between when Aiden Baron was helped to decide by the angelic Claire Heslop and the devilshly handsome Haney Mallemat.

Although the conclusion here was that TOE/TEE is the way forward I’m somewhat sceptical. It was nice to articulate the debate, but on a cost basis I don’t think it’s coming to Virchester anytime soon.

Road to Resus

This section will be running throughout the conference. Starting with a other and baby in an RTC. Questions from the speakers on how to manage the prehospital airway and patient who’s child has died. Nice use of video links to experts from around the world.

The major debate here was about prehospital airway management. Is an LMA enough or should we do a definitive RSI? The summary of the audience will dictate the next part of the journey, and the answer was for this audience…………..

Next question is whether we should give blood to the patient who now appears to be in shock. Nick Crombie from the RePHILL trial joined to say no (interestingly). Also seemed to appear in an office – in a flight suit – with a load of diplomas on the wall. Not sure what that meant!

Brian Burns spoke in favour of blood and perhaps there is no surprise that the audience went for blood, although Nick did point out that the evidence for it is fairly weak at the moment. Hopefully the RePHILL trial will tell us whether it really makes a difference to longer term outcomes.

Final thoughts

Please follow the links and ideas from this morning if you’re watching from afar. This morning was an inspirational start with follow up presentations on a range of clinical topics which have been quite challenging. Lots to think about as we go forward from here.

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Posted by Simon Carley

Professor Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester

  1. […] into the auditorium for the afternoon session. The morning was absolutely incredible (you can see Simon’s post here) and a great introduction to the last SMACC so expectations were high for an equally impressive […]

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