A really interesting first day in the Berlin Tempodrom at #dasSMACC. You will of course be familiar with the Social Media and Critical Care conferences. They’ve done a huge amount of work to bring together people from around the world under the vague umbrella of #FOAMed and critical care (with lots of other stuff too).
This year it’s a single track, which I must admit I was sceptical about, conferences almost always have multiple tracks addressing niche interests, but here we are all together. Thius far I think it works. The conference is now a shared experience for the delegates and the speakers and I like that. I also like the interleaving principles around the program. Interleaving means that topics rapidly change, going from different topics, to different styles and different experiences. There is good evidence that mixing things up makes learning stick, although at the time it can feel more difficult.
What about the day?
Arguably the best opening ceremony we’ve had at a SMACC conference. I know modern dance and acrobats are not popular with everyone, but this was tremendous, incredble skill, graphics and music that got the tribe of SMACC up and running. When it comes out on the SMACC website it’s well worth a look.
Jon Hinds memorial lecture. Brian Burns
Then we were into the talks starting with an ambitious and challening mixed media presentation from Brian Burns who took on the John Hinds memorial lecture with an insight into the possible near future of prehospital and critical care. The talk was based around a simulation in the conference hall involving the extrication of a patient from a car. It touched on many of the ideas we put forward at SMACC in Dublin when I talked about the future of emergency medicine. Much of the technology demonstrated in the sim is already out there, for example accelerometers and personal health monitoring in wearable tech (e.g. apple iWatch), but we’ve not yet understood or maximised the potential of the technology to help us understand and improve patient care. This session inspired me to go back to Virchester and think about how we can value and utilise information from the scene better and to personally get a little more experience around the prehospital management of the trauma patient.
Jonathan’s story – Jess Mason
Jess Mason talked us through a tragic case of a young man with Sickle Cell disease. The talk used audio clips from Jonathan, recorded a few months before his death, to illustrate how patients with sickle disease have a true life limiting condition. Average life expectancy is in the 40s and those years a commonly peppered wuth admissions to hospital when the disease is poorly controlled and towards the end of life. The main learing points were that we need to understand why patients with sickle come to the ED, and how they feel about us as care givers. In all honesty many of their experiences are poor and they don’t always think that we are there to help them. Analgesia is essential for our sickle patients and in many cases they will already have had lots of analgesia at home. We need to take this into account when we think about how much analgesia to prescribe. There was also some general revision around sickle management (Ed – read more here), but perhaps the final point is that we might considersickle cell disease to be a life limiting and terminal illness. Perhaps we might think about changing our attitude towards sickle disease in the same way that we think about cancer or heart failure. I’m not entirely sure that this is correct, but perhaps once significant complications start occuring then maybe we should.
Voice in my head. – Sara Gray
This was not a talk on psychiatry as I had originaly thought, but rather about the voices in your head that induce feelings of doubt and a lack of self worth. Sara talked us through a case when she was struggling with an airway and a colleague paged, across the entire hospital, for anyone, yes anyone, with any airway skills to attend to help. I guess you can also feel the utter heart sink at that event, and if you’re like me you know exactly how this feels. A few weeks ago a senior anaesthetist rocked up in my resus room asking who needed help putting an IV in. One of our locum team (good guy, but did not know our systems) had failed twice and then called anaesthetics, we politely thanked them for coming and then sorted ourselves, but there is no doubt that we felt awful, humiliated even, but that’s crazy. Such feelings are own construction and we can control and understand them. Sara took us through her experiences and advocated that we should have particular people that we go to after bad events. She called them failure fruends, and I think that resonated with the audience (Ed – note that on day two Liz Crowe suggested that this was a good idea but we should take the failure out and just call them friends).
“Everything” at the End of Life – Alex Psirides
One hour of a difficult conversation can save you two weeks of ICU. We all die. The overall mortality of life is 100%. These three statements were real take home points from this amazing talk from Alex. End of life care is a vital theme that has emerged at SMACC conferences and is something that we all need to think about. Alex talks about the futility of much of what we do and how the selection and honest assessment of patient’s suitability for intensive care interventions is so important if we are to do the best for our health economies, but also for our patients. This final point was so well articulated. Often when we have conversations about selecting patients for ICU we think that we are restricting access for economic reasons, but Alex really demonstrated that this is not the case. We do serious and significant harm on the ICU if we chosse to medically intervene in the wrong patients, and that’s the key message I’m taking away. It’s often better not to do things, than to do everything.
The Brindley Sessions – Reuben Strayer and Rinaldo Bellomo
Peter Brindley has revealed himself as a fabulous and rather cheeky interviewer. He’s taking on some key speakers in short light hearted sessions. Reuben Strayer was invited to defend his precious statement that ‘The answer is always Ketamine’. Clearly it’s not and we get that, but we also touched on the importance of interpreting and challenging anything that you hear on traditional or social media. Rinaldo Bellomo defended the need to conduct good quality research. A no brainer for the whole of St.Emlyn’s.
The future of publishing panel discussion.
So I was on this panel and thus have a conflict of interest. In large part it was a re-run of last year in Dublin and I’d have liked more time for the panel to talk between themselves but I think we got across the idea that the current model of pubishing doesn’t really make sense. In terms of access things like SciHub are already the NAPSTER of unregulated access that is already disrupting the current model.
I’m still perplexed at why we permit journals to control science in the way that they do, not just in terms of the access and paywalls, but in the decision on whether to publish at all, whilst they also demand that they have exclusive access to content. I’m not sure that we got to the end of this, but stop and think, why should journals prevent publication of science. In my head I really can’t see why we can’t have open publishing of data on any website (personal or research group) and that the data can then be published by a journal at a later date. Why don’t we do it now? Arguably Rob MacSweeney talked about how things like impact factors are the equivalent of tulipmania in that we ascribe a huge vale to things that really don’t cost anthing at all.
In advance of the session I sought advice from #FOAMed friends in Canada, the US and Africa. We discussed in advance, but not in the debate the ideas of moving from Ego-centric to Eco-centric models of publishing, the problems of researchers working in Lower and Middle Income Countruies (LMIC) countries (but then publishing in HIC), post publication review, how social media has changed how we critique and how we might actually persuade organisations to break away from the current model. Someone, somewhere is going to have to be brave enough to break the cycle and we heard how organisations such as WELCOME might be on the verge of doing so. I also really wanted to talk about the idea of a Spotify model for publishing and how we might use that to encourage us all to read and learn more. Maybe that’s a future for us all, maybe not.
As resuscitationists we are designed to cope with the unexpected and the quote about the relationship between researchers and publishers being arguably unethical drew a breath. It was not worded in a way that was ever intended to hit a conference (something about suckling I think), the point is true. In essence the statement was that researchers and publishers are in a symbiotic relationship that excluded the patient. Would patients consent for us to use their data, time and in some cases their lives if they knew that the data that comes out of their study is not freely available to all. Personally I find this ethically and morally challenging and I think it’s wrong. Patients need to know how their contributions will be made available to others. I’m not sure the panel agreed with me, but that’s what a debate is for.
Rinaldo Bellomo. It’s too easy to be seduced by chasing normal physiology and numbers in critical care. What matters is the outcome for the patient and to determine that we need high quality science and an ability to interpret and apply it to the patient at the bedside. Illustrated through the insane approach to using fluid boluses, this was a great talk.
David Carr. Endocarditis is a rare disease, but it’s important to look for it. Most of the worrying cases you will know about and there was a useful reminder of the really high incidence in IVDU and heart valve patients. I was interested to see the data on chemo patients though. The incidence there seems higher than we see in Virchester.
Michelle Johnston talked about the complexities of clotting and deep dived into the difficulties in knowing how to reverse thrombolytics like tPA (Ed – we basically don’t know). Another great talk from Michelle who always brings literature, style and substance to every presentation she gives. Key learning point was that tPA is an incredibly complex drug and that reversal requires a multidisciplinary approach. I also learned a lot about lobsters….
Finally the best 15 minutes of the day belonged to Suman Biswas who brought songs and music to lighten the mood with an professional and axcomplished performance on the piano. If you’ve not heard Suman before check this out. With the SMACC audience he found a lot of common ground and I wonder if some of the songs were written just for us (probably not, but I’d like to think so).
See you tomorrow.
- @aoifeabbey has some amazing notes here
- FOAMcast have great notes and podcasts here
- Our friend Salim on rebelEM
- day 1 a review at @stemlyns
- day 2 review at @stemlyns
- day 3 review at @stemlyns
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