RCEM day 1

#RCEMasc 2019 Day 1: St Emlyn’s goes north!

If it only seems like a year since the last Royal College of Emergency Medicine Annual Scientific Conference, that’s because… erm… it is.

The St Emlyn’s team put on our big coats and ventured further north to the frozen wastelands of Gateshead, filled with joy and excitement for three days of learning, reflection, and self-fulfilment. Here’s the knowledge we gained from day 1.

Starting the conference off was Taj Hassan, who is the current and outgoing president of the Royal College of Emergency Medicine. He reflected on the last few years at the head of the ship and the journey we’ve all taken (and are still taking) as a college. There have been lots of improvements and change going on behind the scenes but also visibly, and Taj has done a great job at trying to improve things for the workforce so thank you to him from all of us here at St Emlyn’s.

(The above tweet is from the RCEM President Twitter account and was written by Taj, but the account has since been taken over by the new president Katherine Henderson!)

From one president to another, the next speaker was Simon Judkins, who is the president of the Australian College of Emergency Medicine (ACEM). For all those of you considering a move to Australia, his talk would probably have made you think twice. Even with the glorious weather down under, they still face many of the problems we do here in the UK, so it’s not all green grass, sunshine and roses like we may believe!

It was reassuring to hear that we’re not the only ones facing long waiting times, long trolley waits, and difficulties with workload and burnout.

The last talk of the introductory session focused on the story of Krishan, a 3 year old who died from pneumonia and sepsis in 2015. I’m not going to go into the clinical details here, and neither did Sam Jones. Together with Krishan’s parents, she instead told the story of the emotions, feelings, and communication issues around the case. It was so amazing to hear how his parents felt and what was going through their minds at the times, as well as how they felt they were reliving his death through the coroner’s court hearing. The big take home message here was to ensure we listen to the parents when they are concerned about their child. If they are worried, don’t brush them off, take more time to explore their concerns, and always discuss the case with a consultant before you send a worried parent (and their child) home.

I ventured into the paediatric stream after the break and had a great session. Niccolò Parri is a huge ultrasound aficionado and spoke on how the Italians are far keener to utilise ultrasound as part of their clinical assessment of the patient than we seem to here in the UK. We’re a bit behind the times (possibly). He talked about scenarios where ultrasound could potentially help (as part of a pathway or protocol) to avoid radioation such as XR or CT scanning. Examples he gave included skull fracture assessment in head injury in the very young, or assessment of consolidation by scanning kids’ lungs.

I certainly haven’t done much ultrasound in kids, though I can see it would probably be fun for both me and them! We’ll need to make sure it’s an adjunct to our assessment and in areas that are evidence-based, but certainly something to go away and read more on.

There is an association (not a causation) between concussion in kids under 5, and behavioural problems later in life. Mark Lyttle spoke on how we could change our practice looking after children with concussion to try to improve their outcomes. Some key steps include:

  • Using a concussion assessment tool
  • Taking the time to explain things thoroughly to the child and their family
  • Providing a leaflet for spaced repetition
  • Linking this YouTube video from England Rugby for them to watch at home, and show their coaches/teachers as well
  • Follow them up in a clinic a few weeks down the line

For me this was one of the more useful talks of the day, and going forward I’ll be doing some more reading and learning around this – expect a separate blog on this in the near future…

After lunch, the sepsis stream was largely a discussion about NEWS (National Early Warning Score) and whether it’s a) valid, and b) useful. Researchers pre-hospitally are looking at whether NEWS can be used to risk stratify patients, whether it affects patient oriented outcomes such as mortality, and if it can be incorporated into other systems such as hospital pre-alerts or referrals to inpatient specialties from ED or the community. Findings look like they’ll be published soon so we can look forward to those.

Over in the other stream our own Stevan Brujins chaired discussions on getting involved with global health.

Following what was going on on Twitter it looked like a great session, and Stevan is hugely passionate about improving access to research in LMICs through collaborative working and open-access research. Please take the time to read his blog here on global health advocacy, which covers some of the themes being discussed here at the conference. Stevan has also written for RCEMlearning and this blog around open access publishing to promote global equity in access to research and other information may change the way you help to change the world.

The final session of the day comprised talks on research in military trauma. Sarah Watts spoke on the difficulties of modelling trauma as it’s hard to do this in humans, and comes with ethical challenges doing this in animals (not to mention that animals and humans are different species). Tom Woolley continued the discussion by talking on how catastrophic haemorrhage resuscitation hasn’t changed much from the first World War – tourniquets and blood products, with a potential move back to whole blood in the UK in the near future (but only if we start asking for it).

Over in the other sessions there were a lot of trials being presented, however we were all asked not to publish any results here as they aren’t in the public domain yet. You’ll just have to wait for the results of trials such as CAP-IT and NOPAC!

So those were the key messages from day 1. A good jaunt through the worlds of paediatrics, global health, resuscitation and research, to mention just a few. Join us again tomorrow for a review of day 2!



Cite this article as: Chris Gray, "#RCEMasc 2019 Day 1: St Emlyn’s goes north!," in St.Emlyn's, October 3, 2019, https://www.stemlynsblog.org/rcemasc-2019-day-1-st-emlyns-goes-north/.

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