Podcast – Reflections from the London Trauma Conference 2024: Insights and Inspiration

Welcome to the St Emlyn’s podcast. I’m Iain Beardsell. And I’m Natalie May. And we are at the London Trauma Conference, coming to the end of four great days of education, from which we have recorded many, many podcast episodes, which we will be bringing to you over the coming weeks, and it seems months actually.

Delighted to have so many people come to talk to us. Really grateful to David Lockey and the team at London for inviting us, making us feel so welcome, giving us a room that we can record in, and hopefully, St. Emlyn listeners and readers, you will be the beneficiaries of all of that. But I just thought it would be really nice for Nat and I to tell you a few things that we’ve picked up from this week as a little taster and maybe even some little pearls of education wisdom that we have been able to get from being here in Kensington.

So a little bit about the conference. It’s actually four days worth of education. it finishes in two days of the trauma conference, the London Trauma Conference. Day two is a pre hospital critical care conference and day one, Natalie, which we’re going to start with is the cardiac arrest symposium, which you were able to be at.

Were there some things at that session that you particularly took away? that would be useful for our listeners.

 There was plenty of, content there, lots of really interesting and engaging talks, which you think of cardiac arrest as being relatively straightforward, particularly because there’s an algorithm behind it, but actually there’s the whole world of research going on in the cardiac arrest space, and it was an opportunity for some of those researchers and some real, experts in the field to get together and talk about what they’ve been learning over the last couple of years.

and, One of the first talks was about perioperative cardiac arrest by Prof. Jasmeet Sour so, based on the NAP7 report that was published last year, and that might not on the surface seem to be particularly relevant to emergency medicine, because it’s all about cardiac arrests occurring around theatre time and from data that comes from anesthetists, but actually there was quite a lot of interesting stuff that came out of that report that is relevant, and one of the most marked things to me as a feminist was the data around self reported confidence in managing perioperative cardiac arrest.

and Prof, Jasmeet Soor who was speaking on the subject said that the men who were reporting on that reported themselves as way more confident than the women, but actually this didn’t translate into the outcomes at all. And I think that’s a really interesting lesson for us to take into medicine.

Probably something we know already, but good to have some data behind that.

It has been noticeable that a lot of the speakers at the conference are male. And I did actually askDavid Lockey about this. And I think it’s a complex issue and it’s not just about, we’re not asking enough women to speak at conferences.

I think there’s other things as well. And he did look at me with an air of resignation, which was, I do keep asking for female speakers and I invite them, but for whatever reason, there’s something that stops them wanting to come to this particular conference. It is something that’s pretty obvious from the program, but there have been some incredible women speakers, and I’m sure there’s many more out there.

And the one thing I would say to listeners, that is if you do get invited, these conferences are friendlier than you think they are going to be. It’s very much a sympathetic audience, and despite being in the rarefied atmosphere of the Royal Geographical Society and being in quite an old fashioned lecture theatre, The opinions and the approach of people is quite modern.

And so whatever your stage, whatever your gender, please, if you are invited to speak at something like the London Trauma conference, give it a go, because by giving it a go, you broaden the voices that are being heard. And I think that’s a really important thing that these conferences can do. It’s not just about what we learn.

It’s about developing people and giving them a voice. And I know that Dave Lockie is very, aware of that and I’m sure we’ll see a bit of a trend and a change as time goes on

One talk I’d be interested to hear about Nat is about prognostication after cardiac arrest. This is Jerry Nolan, who’s a name that will be known to many of us from the Resuscitation Council and others.

He’s a professor of intensive care in Bath, and he was talking about how we prognosticate. This is something I really struggle with. When do we stop? When don’t we stop? When do we keep going? Are we only further forward to knowing? which patients might survive cardiac arrest.

Yeah, so that was a really interesting talk that he gave.

 One of the most memorable parts for me was his reference to a study from Korea, where they’ve only recently culturally come to accept withdrawal of life sustaining treatment. So until then, people were just on ICU until they died. And they found that actually people were waking up as late as 72 hours or more after rewarming post cardiac arrest, and that was happening in 24 percent of patients.

So maybe we’ve been pushing our prognostication a little bit too early. He has told us that lots of studies have shown that subjective pupillary reaction is not a reliable or accurate predictor of outcome. He said it was archaic, and there are pupillometry devices that now exist that can be more objective in assessing whether there’s a

pupillary reaction. And corneal reflexes also unreliable. Lots of studies showing that people have good outcomes despite the absence of corneal reflexes when they’re initially tested. Seizures not particularly reliable, although Myoclonus, which is usually a poor prognostic factor, that can fool us as well.

He went into some evidence around particular biomarkers, so neuron specific NLAs, that’s showing some promises of biomarkers, so there might be some more stuff that comes out around that. in the literature and a paper was looking at neurofilament light chains.

So all new stuff for me. they were useful biomarkers for discriminating potential poor outcomes. And essentially what it boils down to was the European resuscitation council has suggested a combination method, with the key being caution. If any of the things that they’re looking at are favorable at all, so they were saying that if the patient’s still unconscious at more than 72 hours after they’ve been re warmed, and they have at least two of absent pupillary reaction, absent corneal reflexes, bilaterally absent electrical activity, malignant EEG, This, neuron specific NLAs, or the, neurofilament light chain biomarker, or status myoclonus, or a diffuse and extensive anoxic brain injury on CT, then their poor outcome might be likely.

And he gave us some really practical tips about making, translating that knowledge into real world treatment. practice in medicine, which I’ve put in the blog post of all the notes I wrote up at the time.

It’s fascinating, isn’t it? Sometimes you come to a conference and you find out what we don’t know rather than what we do know.

 Managing cardiac arrest hasn’t really changed hugely in the last, well, in my career, which is what’s 30 years long or so. The basics are still the basics and are really important. but there are definite changes and it’s so delightful to hear that there’s people looking into these things.

Charles Deakin, who’s a professor with me down in Southampton and has been involved in Pre Hospital Care Resuscitation Council for many years and is an expert in the field. He talked a bit about defibrillation strategies and also a bit about mechanical adjuncts. Were there things in that, because those are things that we’ve covered in the blog before about dual sequence defibrillation.

Is Charles on board with that in the same way that we have been in the blog, that perhaps this is a way forward?

 It was interesting. His main take home around defibrillation was that we should probably make sure we put the pads on in the right place in the first place. So lots of the studies that have been undertaken, show images of where the pads were supposedly placed and found that putting them in a different, orientation was better for the patient.

But actually, it’s not. if you’re not putting particularly that lateral pad that really has to be up in the axilla, so you get that shock going right across the myocardium, which is how it’s designed to work. If it’s not positioned that way in the first pace, then it’s probably not a good comparator in the study because you should just do the good stuff well.

And that was a, that’s been a theme throughout the whole of the conference, from the cardiac arrest day, all through to the trauma days is, Let’s do the basics well, So things to learn there.

But again, that, as you say, that message of doing the basics well, and there’s lots more in that cardiac arrest day. For me, it’s a real. morale booster, that something that can seem so hopeless is something that we’re continuing to try to strive to do better and worth it. If you’re into cardiology, cardiac arrest type things, look out for that day next year.

You can attend individual days of the conference. You don’t need to come for all four days. You can pick and choose, but it does sell out. So bear that in mind when you’re thinking about these things.

I want to talk a little bit about a podcast that we’ve got coming up from Richard Lyon. I only really want to skirt over that and also to talk a little bit about something that was talked about by

Rod McKenzie, which is really about our own wellness. And this is another theme that we’ve had. We’ve had doing the basics well. We’ve also had looking after yourself and being aware of your own vulnerability and Richard, we are grateful, gave us some time and there’ll be a podcast about his talk coming up.

Rod also spoke about wellness at the sharp end. And this was on day two, the pre hospital day. And in this, Rod being very open and honest, he’s a senior emergency physician, senior man in the pre hospital environment, has been involved with the training networks and helped introduce specialty training for pre hospital physicians, but was able to give us a vulnerability of how he has been and his journey through post traumatic stress disorder with all that he’s seen.

And that for me was a properly strong message about what we need to do, particularly looking after ourselves when we’re more senior. In that bit of the career where, hey, everything’s supposed to be fine and we’re supposed to be able to coping brilliantly.

 It really resonated with me as someone who’s been very open about my journey with postnatal anxiety and my psychiatric hospital stay in that period.

I think it’s really good that we’re talking about this more openly because. In my experience, being the person who has said that this thing is now part of my life and has been part of my life, I find that people come to me as the person to talk about their experiences with. And that’s a great honor for me, but it just shows that sometimes people just want somebody to So it was really powerful to hear Rod’s experiences, as well as the very practical stuff he shared.

He shared a paper called Practical Psychosocial Care for Providers of Prehospital Care, that outlines a whole summary of valuing staff and how to look after us and get us from struggling. through to thriving at work. And that stuff’s really important, even if you’re not showing any symptoms of burnout or anxiety or any of the other manifestations of not being quite where you should be.

He also shared that when he was having psychotherapy, it took his therapist an awfully long time to quite understand what it was that he was talking about and the uniqueness that we find ourselves in with our jobs and our roles. That is something that I think is important to recognize, what we do can be unique, and many people have unique jobs.

We’re not special in that way, but finding somebody who can understand what it is that you’re going through. may be the key to your successful recovery and ongoing health as you try and practice in your career. But also that career may change, Rod’s now given up pre hospital emergency medicine primarily because of this diagnosis and wanting to find a way to, to continue to work and be valuable, which he is very successfully doing.

But there does come a time when you need to say enough is enough. This is hurting me. It’s hurting those around me. I need to change. And that is okay. That’s not weakness. That’s okay.

That same afternoon, Matt Hooper, who again we will have a full podcast with, talked a bit about death on scene and what that means and really about palliative care in the pre hospital environment and the resuscitation room.

There’s many things to take from the conversation we had with Matt and I encourage you to look out for that podcast when it comes. But to just give a flavor of what that was about, it was really about allowing people a good death. And that actually sometimes it’s easier to do more with patients, but the braver decision is sometimes to do less.

 He said it’s easy to do everything and it’s easy to do nothing. And we sometimes have to owe it to our patients to find that space in between, but also to let go of our own expectations on our own lenses that we’re seeing that patient situation through. One of the most memorable things for me was him saying that the patient is going to let us know.

They’re going to let us know if they’ve got the capacity to survive whatever it is they’re going through and I think that was really powerful.

The other key message for me was that we all practice palliative care. Palliative care is about caring. It’s not just about dying. So every time you think about what you’re doing with a patient, almost regardless of their age, that’s part of a palliative care process because to be palliated is to look after somebody.

And that’s quite a strong message, isn’t it? That stopping somebody’s medication when they’re older to prevent them falling. Something which we talked about at great length with Mark Wilson. That could be part of a palliative process. Not because they’re dying, but just because you’re caring. So day two is about pre hospital emergency medicine, and then we got into the two days of the London Trauma Conference proper, if you like, where it is proper trauma. And the thing that struck me mostly, Nat, was the number of people who were here to hear those talks. The idea that the conference is dead is most certainly untrue.

It is making a comeback post COVID, and the energy in the room and the enthusiasm to learn and be part of that learning was palpable. We’ve had many good talks and been really lucky. to speak to many of the speakers. Mark Wilson, as I’ve mentioned, was talking about head injury in the elderly. He also talked to us about the Good Sam app, which is part of his big project outside of his normal clinical work.

There’ll be more to come on that. Were a particular highlights from you, from Mark and others.

 Mark is always a pleasure to listen to because he’s such a wonderful person and he’s got a great way of explaining his very complex neurosurgical approach to things in a way that we Emergency Physicians can understand.

 We’ve had a great opportunity to hear a whole breadth of talks. So if you compare that Mark was talking very clinically about head injury management in the elderly, but then you have Peter Brindley talking about social media and AI and the world that we’re practicing medicine in. So those talks really couldn’t be more diverse.

And then we got that opportunity to catch up with a colorectal surgeon who is also a trauma surgeon, Kate Hancorn, who gave us some fantastic insights into a training program that’s It’s being used to upskill surgeons to make them more ready to be trauma surgeons. And you can hear more about that in the podcast that we recorded specifically with her.

Yeah, Kate was fascinating, not least because it opened my eyes to the fact that most people in most centers in their training programs are not doing a huge amount of trauma care. And so when you’re in a Resus room with a colleague and they’re trying to make really difficult decisions about whether a patient needs to go to theatre, that could be the very first time they’ve been encountered by that.

So don’t be surprised if they need some support to make those decisions. Don’t be surprised if it’s not a simple binary yes or no. Because there is a gap. Mainly because there’s just not that many patients who need this care, but this is one of the gaps that Kate and the team at the Royal London and actually nationwide are filling with this specialist training programme.

Much more about that in the podcast. If you are interested, it’s a training programme that’s not only open to surgeons, but emergency physicians as well. The deadline for the applications is a good while away though, so you can wait for the podcast to hear more details.

We also had a chance to catch up with our St Emlyn’s colleague, Zaf, who’s here.

He’s speaking today on blunt cerebrovascular injury, but we were able to have a separate chat with him about his REBOA practice, because that’s something that they do in his department in Philadelphia. And that was really enlightening for me.

We’re quite ahead in a lot of ways, I think, in the things that we do in our pre hospital practice in emergency and trauma in Australia, where I’m working in New South Wales. But REBOA is not something that we are doing pre hospital, in ED, and so it’s useful for me to hear the perspective of another side of the REBOA coin and where it can be applied in his practice.

And there’s been many clinically relevant talks. We’ve had Karim Brohi today talking about ECMO in trauma. Again, we’ve already had the pleasure of having Chris Bishop on the podcast to talk about how that might be useful. That’s the idea that this myocardial stunning, this overwhelming threat to the patient that trauma presents in an inflammatory response, sometimes it means that the organs just simply won’t work, the heart and lungs particularly.

And so the use of ECMO post trauma might be something that’s useful. Also, Johnny Wilkinson. who’s a big advocate for ultrasound in the emergency department. Talk about regional blocks for chest injury. Nat, is that something you’re seeing in Australia? Are you getting people who are having erector spinae blocks and others?

Not so much erector spinae blocks from our side, but at Sydney HEMS, we use serratus anterior plain blocks. That’s something that we teach our registrars to do and they’re available to us as an within our spectrum of skills that we can take to a pre hospital scene or an inter hospital scene.

And we actually have quite a good setup both in the emergency department I work in and the trauma service I work in for a chest injury protocol known as a CHIP protocol that will activate certain analgesic . pathways, including getting patients thoracic epidurals to help manage their pain. So we’re quite well set up for that.

And it sounds that’s a bit unique. That’s a bit different from the way that medicines practiced here at the moment. But Johnny was great in covering off all the anesthetic, regional anesthesia options. And he shared a QR code with all of the links to how to do all of these things under ultrasound guidance, which we can definitely put in the show notes.

Another part to the conference has been the poster displays. And as ever, the enthusiasm of those poster presenters was great to see. We’ve had medical students presenting at the stand up science. We’ve had medical students not only with their poster presentations, but standing up in front of a room full of senior physicians and others to present their research findings from their intercalated research years.

And as ever, that enthusiasm from medical students to learn and to be part of this is so heartwarming to see and for an old codger like myself, that lack of cynicism and that belief and that want to do things is just great. And so this conference itself, it’s not just about the people who stand up on stage.

There are many other aspects to it to. Multiple posters with all sorts of bits of information that you can pick up wandering around and having a read and obviously they encouraged the people who’ve written the poster to stand there and I’ve had some really enlightening conversations with people from all levels about the work that they’ve been doing.

And then stand up science, which took place on the Thursday evening, an opportunity where people can stand and almost do a dragon’s den type pitch about what their research shows and get asked questions. And there is that interactivity, which we’ve said is always so important at conferences. Natalie, what are the main things you’re going to take back to Australia from these last four days?

I think I’ve got lots of little nuances of clinical care that I might think about differently, but the main things for me was the importance of wellness and that focus on our well being and how that translates into being able to provide better care for ourselves. And then also just the holistic approach that the talks that have really stayed with me, Richard’s talk and Matt Hooper’s talk were really focused on the patient experience as well.

And I’m maybe as I’m getting old, I’m getting more of a hippie, wouldn’t surprise me, but I really like the fact that the whole conference that would traditionally be thought of a trauma conference is going to be very macho, just wasn’t like that at all. There’s been so much humility and humanity represented here.

And I’ve really enjoyed that aspect of it.

It’s been a great week and thanks again to Prof. David Lockey, who invited us and has given us this unique opportunity. Keep watching your podcast feed for more episodes from the London Trauma Conference, where we’ve been able to delve in depth with some of the speakers about some of the fascinating topics.

And it’s a lovely thing to be part of. Thanks again for listening to St Emlyn’s podcast. We hope you’ve enjoyed this podcast and all the other ones we’ve been bringing you recently. Please do remember to like and subscribe. Tell your friends, tell your colleagues. Hopefully we’re bringing you stuff that’s useful.

We’ll We’re very grateful to all of our people who’ve contributed to the podcast. If you’d like to be involved, don’t hesitate to get in touch. We’re always looking for people to talk to and people to write blog posts, and we’d love to hear from you. Nat, as ever, a joy to see you over from Australia.

Please don’t make it so long until we see you again next time. And to all our listeners, take care and we’ll speak to you soon.

Thanks for listening.