Hello again from the London Trauma Conference!
If you haven’t listened to the day one podcast yet, catch up here.
We’ve managed to catch up with a couple more speakers for an in-depth chat about their talk topics at the conference and we’ll be bringing you those podcasts over the next couple of weeks – and we are really grateful to those who gave their time to chat to us so we could ask those important probing questions and bring some of their wisdom to you.
So, what happened on Day Two?
The day kicked off with Conor Deasy talking about trauma team performance, bringing some cutting-edge concepts from technology to improve performance in the resus room and some wider tips on using in-situ sim to explore and enhance team behaviours (more from him in an upcoming podcast).
Next up, Prof Wolfgang Voelckel tackled decision-making in trauma, reminding us that emotions can challenge our ability to make good decisions. ED decisions, unlike ideal methodical decision-making, are often fast and emotional. The answer? Prioritise, make trade-offs, improve as you go.
Next up, our very own Simon Carley challenged clinical judgement (yes, he talked about gestalt too) with an excellent adapted version of his recent talk from the RCEM conference – have a read of his thoughts here.
The later morning featured the paediatric trauma session, chaired by Ross Fisher who spoke first on the challenges of paediatric trauma and led us to the conclusion that children should be looked after wherever the best care could be delivered, with a challenge to work on increasing the number of people who can actually deliver the best care.
He was followed by paediatric radiologist, Caren Landes, who took us neatly through the recent RCR guidelines for imaging in paediatric trauma, and Kirsti Soanes, an EM nurse, who shared her experiences of the importance and challenges of parental (and carer) presence in the resus room; messages applicable far beyond major trauma presentations.
7.5mSV radiation exposure in abdominal CT, equivalent to 400-500 chest X-Rays-Know what you are asking for & consider riskvsbenefit #LTC2015— Leo Salm (@SalmLeo) December 9, 2015
Caren Landes says don't just scan kids for the sake of it, think about it and justify radiation exposure. Don't forget NAI. #LTC2015— Chris Gray (@cgraydoc) December 9, 2015
Then I talked about paediatric trauma, trying to answer whether children are just small adults. I’ll put my talk into a separate blog post and maybe a podcast but (spoiler alert!) the answer is YES… and also, NO :-).
After lunch, we welcomed back Jeffry Upperman who took us through lessons learned from recent US major incidents. I particularly liked the “THREAT” acronym for immediate response to terrorist threats; Threat suppression, Haemorrhage control, Rapid Extrication, Transport to definitive care.
Immediately afterwards, Prof Carli (no, not Simon – the co-author of this open-access Lancet paper) explained the intricacies of the French response to recent terrorist attacks with very moving reflections including the loss of a healthcare colleague, Stella, a GP. He urges us to think about what will happen tomorrow – sadly, the Paris attacks and other recent events are likely just the beginning. We have time to prepare ourselves and our departments right now and it’s important that we do that. You can hear more about the Paris attacks and the immediate ED responses here.
The talk was moving and sobering, for a variety of reasons, including the possibility of dealing with our own grief alongside our clinical practice, something Liz and Iain talked about on the podcast not too long ago.
In the later sessions of the day we split to increase our coverage; Simon and I went to the paediatric trauma breakout session, where Ffion Davies provided some terrifying detail on non-accidental injury; these patients are, in the majority, under a year old (the median age was 3.6months) and often present in ways other than major trauma – as the infant who isn’t feeding, or just isn’t right.
76.3% of severe child abuse (ISS>15) occurs <1yr; median 3.6months; may present as illness, not injury. Consider NAI! Ffion Davies #LTC2015— Natalie May (@_NMay) December 9, 2015
Whether we are accurately capturing trauma data about this cohort, who may be diagnosed sometime later, is really unclear but what is clear is that we have to consider non-accidental injury for all the children we see, especially the under-one-year-olds. Ffion was followed by Ross Fisher who, in his second talk of the day, explored the evolving role of the paediatric surgeon within the paediatric trauma team.
Iain, meanwhile, went to the mass casualty panel talk, where a team with a frightening amount of field experience described how they have dealt with some of these frankly horrifying events. I am sure the panel session will have delegates dusting off their major incident protocols for a refresher.
We rejoined the main session in time to catch Jan Jansen on neck trauma – yes, the actual neck, not the cervical spine – if the patient is exsanguinating, take them to theatre, if it’s superficial (just a scratch) don’t do anything, for everyone else CT angiogram seemed to be a fair summary of the management of penetrating neck trauma according to his talk.
The day closed with some quick fire talks on barriers to trauma care (Conor Deasy – podcast coming!), blind manipulation of spinal injuries (Mark Wilson – NOT RECOMMENDED was Mark’s take-home message), tranexamic acid (Karim Brohi with a substantially less sarcastic version of his talk from smaccUS) and heparins in trauma (Jan Jansen).
Thanks for joining us for the conference, keep an eye out for more podcasts soon!
Before you go please don’t forget to…