I spent the beginning of December in London enjoying reasonable winter weather, revisiting landmarks, meeting family and friends, and, of course, attending and speaking at the fantastic London Trauma Conference. Held again at the Royal Geographical Society, this conference brings together established leaders and up-and-coming speakers from both the UK and internationally, who really pushed us to think about our own approach to managing injured patients. Exactly what you need to enter 2025 with some renewed vigour towards trauma care delivery.
What did we learn on day 1?
The morning sessions focused on neurologic trauma. In line with global trends, neurosurgeon Mark Wilson highlighted the significant contribution of head injury to our overall geriatric or silver trauma population. We must continue to remain vigilant on early, appropriate investigation and management if we are to return these patients to as close of their pre-injury baseline as possible. Professor Brindley from Canada reminded us that basic measures to prevent secondary brain injury work and should be addressed quickly! Both NICE and the American College of Surgeons have relatively recently updated guidance on these measures. Monitoring patient physiology (not only blood pressure but also blood gas information in our ventilated patients) can be early markers to the need to tweak our management.
Andrew Pearce from Adelaide’s MedStar retrieval service was up next. He reviewed the importance of a robust prehospital care service as part of a region’s effective response to trauma management. This requires looking both inwards (ensuring a high-performing, reliable and retainable team that comprises diverse individuals who can challenge one another rather than be an echo chamber) and outwards (coordinating with specialty colleagues involved in the entire patient journey to optimize patient care). He made a key point that to ensure continued excellence, leaders should listen to those who work for them and adjust both clinical issues and working conditions.
It is no secret that there remain challenges in providing optimal surgical care to trauma patients in the UK. Reasons include variable exposure between trauma units and major trauma centers, overall trauma volumes in the UK, and variable operative opportunities within a surgical training program. Trauma surgeon Kate Hancorn gave an excellent talk on the challenges and opportunities surrounding this. She highlighted that a prior national trainee survey showed that almost two-thirds of respondents felt they were not suitably qualified to cover trauma on completing their training. Challenges related to maintaining an elective practice, providing appropriately supervised trauma cases, and maintaining currency in operative skills were highlighted. To counter this, the development of training interface group (TIG) trauma fellowships were created to bridge the gap between clinical need and workforce sustainability. Several graduates from this program are now coming into the workforce, and may be a key solution to ensuring there are appropriately trained clinicians operating on major trauma. You can read more here.
Elika Kashef reviewed the role of interventional radiology for trauma. IR remains an important but sometimes underutilized player within trauma systems, and discussion with your friendly local IR specialist can provide key solutions to diagnosis and management. She reviewed several challenging cases where close communication and coordination between the ED, trauma service, and IR led to positive outcomes for the patient without the need for open surgery.
Dr. Peter Baskett was an anesthetist who played key roles in many parts of trauma care development, not least of which was building on and improving the field of paramedicine. The keynote lecture at LTC holds his name, and was delivered by another MedStar retrieval and emergency physician, Dan Ellis. He spoke on optimizing our clinical teams, paying attention to the details, and avoiding decision-inertia, reminding us that we work in a world where we will rarely have 100% of the information we need to make a decision – often times this will be too late for our patient. “Once you reach the 40-70% range, go with your gut!” He highlighted those values like insight, humility, leadership, and looking at medicine as a vocation are not ones that can be learnt, but they can be nurtured and developed.
Is AI after our jobs? Zane Perkins addressed this question that likely comes into people’s minds more often these days than ever before. He highlighted that while there is certainly potential for AI to support clinical decision-making (and particularly decision inertia as Dr Ellis highlighted), the current systems are really dependent on the quality of the data that is input to develop the models. The focus therefore should be on improving accruing that data so that when we do develop these models, then we will have ones that we can trust. So rest assured, we’re still a ways away to AI replacing us, so please do go back to work tomorrow!
Dr Elma Wong was up next. She is an anesthetist who has worked for Medecins Sans Frontières for a number of years. She highlighted the challenges of working in this environment, from not being able to openly discuss some of the current conflicts, to maintaining neutrality, and constantly reassessing personal risk in this line of work. 2023 and 2024 proved to be the deadliest for aid workers. A significant amount of work is being put in to minimizing the development of antibiotic resistance. Overall, she reminded us of both the tremendous personal satisfaction of this work, and the need for us to continue to remember the plight faced by people living in these areas.
Up next was Major General Tim Hodgetts – who retired that morning from a highly productive and decorated time in the military. He reminded us of the ongoing challenges of both actual and proxy conflicts occurring around the world today, and the uncertainty related to the transition of new governments on global security. The rise of irregular warfare and the increasing disregard by some for international law pose unique challenges. Even sharing lessons learned can work against us as opposing forces start strategizing against those factors. Finally, from a civilian perspective, capacity for high levels of casualties requiring ongoing care and rehabilitation is currently limited, and this must be addressed quickly to prepare for any escalation that may occur.
The final session of the day covered both clinical topics and a broader overview of what the future of haemorrhage control may look like. Vascular surgeon Anna Sharrock reviewed how the non-vascular surgeon can tackle critical vascular injuries. This was a nice corollary from Miss Hancorn’s earlier talk on surgical training and I am sure provided those surgeons without immediate access to a vascular surgeon some tips they can draw on when faced with these injuries.
Matt Martin, a trauma surgeon from the University of Southern California, reviewed a new approach to penetrating neck injuries. Traditionally, the neck has been divided into 3 zones, with injuries to each dictating different investigative and/or operative strategies. Dr Martin reviewed how multiple zones can be involved regardless of the zone of entry, and that modern imaging techniques can be applied to any zone of injury leading to improved outcomes. Regardless of injury zone, hard signs such as shock, airway compromise, and expanding hematomas, dictate the need for rapid surgical intervention. Something to bring into the discussion with your surgical colleagues the next time you’re faced with a penetrating neck injury.
A very informative day one at LTC – the crowd dispersed either to the pub or to the amusing and informative “Stand Up Science” session, where aspiring investigators had a chance to present their findings to a discerning (and progressively inebriated) audience. My StEmlyn’s friends Natalie May and Iain Beardsell were busy in the meanwhile recording a number of what I’m sure will be fantastic podcasts with speakers from the conference.
I’ll be back with some reflections from day 2 of LTC soon.
Till then, stay well.
Zaf
