Crisis Resource Management – from ALiEM

Posted on August 19, 2013 by Scott Orman

“CRM and SBT… just another set of acronyms in the world of medical education? Don’t we already have enough??

Not quite! Rather, Crisis Resource Management (CRM) is a complementary approach to Simulation Based Training (SBT). It can enhance current ongoing medical simulations or provide foundation for a vigorous curriculum when launching new simulation programs.

WHAT IS IT?

Crisis Resource Management is the ability to translate medical knowledge to real world actions, in the setting of an emergency.

Rather than a separate entity from medical simulation, CRM principles can be looked at as a way to focus and shape medical simulation curriculum and especially the objectives of each case to focus upon development of critical skill-sets that contribute to optimal team function and success during crisis.”

Read the rest HERE…

Advanced Wilderness Life Support

Posted on August 18, 2013 by Scott Orman

Recently I had the pleasure of attending a superb AWLS course in Queenstown. The course was run by a group of intrepid clinicians who decided several years ago to import AWLS from the United States. You can read about the group (and more importantly, book a place on the course!) here:

Wilderness medicine is in may ways the ultimate in prehospital care – it involves providing care to patients in an frequently austere environment with often very limited personnel, equipment, and communications. For emergency department doctors like myself, it also separates us from the security of readily accessible diagnostic investigations.

At its core wilderness medicine represents the same pathologies as emergency medicine, although environmental issues are obviously more common than in our urban ED and regional HEMS (check out this article about some recent lightning strike patients treated in Waikato ED!). The challenges encountered by treating clinicians however are very different, and solutions rely on communication, improvisation, adaptation, clinical judgement, and common sense… plus (of course!) duct tape and a pocket knife.

The course itself included a variety of teaching formats including interactive lectures, group discussions, practical skill stations, and in-situ simulation. The organizers successfully arranged significant rainfall on one of the simulation afternoons – ever tried running a trauma resuscitation in the rain under a tarpaulin? (Credit is also due here to some of the local medical students, who were quite willing to become hypothermic for the sake of medical education)

Without giving away too much of the detail on the course, here are some examples of the material covered:

Single rescuer rolling a trauma patient with cervical spine control:

Improvised rope sling carry for patient unable to walk

Improvised cervical collar

C-spine immobilization with Sam splint/backpack, alternatively device for restraining combative ED consultant – Logan Stuckey from Nambour

$Splinting of fractured femur with ski pole$

Splinting of fractured femur with ski pole

In situ simulation: Body on the shore – what will you do?

Pre-hospital external warming device (at least, that was the explanation given)

Resuscitation team in the rain!

‘Oxylog 3000 plus’ resources

Posted on August 14, 2013 by Scott Orman

AED will shortly be transitioning from the venerable Oxylog 2000 to the Oxylog 3000 plus.

The video below is a superb introduction to the Oxylog 3000 series, covering anatomy, settings, and connections:

The Oxylog 3000 plus has some additional features, including embedded capnography and a feature called Autoflow – you can read the official Draegar infomation about Autoflow HERE, or you can read the Sydney HEMS take on it HERE – ‘PRVC isn’t a country in Sout East Asia’.

Prior to testing your newfound knowledge on real live patients, you can have a go at the Draegar Oxylog Simulator by clicking HERE. (This page takes a while to load, select ‘manual simulation‘ from the ‘simulation‘ menu once the page has loaded)

George Douros (Emergency Physician from the Austin Hospital in Melbourne, ) has created these charts to help you ‘own the Oxylog 3000’ (sourced from the superb lifeinthefastlane.com) – click the images to enlarge:

Ultrasound Credentialing

Posted on August 13, 2013 by Scott Orman

By Dr Owen Doran – FACEM, AED lead for ultrasound

Credentialing for bedside ultrasound is essential for the safe and trusted use of ultrasound by Emergency doctors. The ACEM provides guidance for credentialing a practitioner to become an Emergency Medicine Sonologist, and policies can be found on the college website:

Policy on use of bedside ultrasound – click HERE

Policy on use of echo in life support – click HERE

This involves attending a course and performing a minimum number of proctored, documented and acceptable exams in that module, of which at least 50% are indicated and 5 are positive for pathology.

15 for AAA
25 for other modules
Basic echo module also requires you to view 25 echocardiograms on ‘file’, some with demonstrated pathology.

You also have to pass an ‘exit exam’ per ACEM & ASUM guidelines, which consists of performing a focused scan on a patient/volunteer while observed by an examiner (radiologist, ultrasonographer or previously accredited EM sonologist).

Each individual department is responsible for adopting and implementing this process.

In practical terms, this usually means a member of the specialist team is identified as the ultrasound champion for the department, and they help to coordinate this process.

Scans can be reviewed realtime, with direct supervision, or more commonly with a review of images. To have reviewed images accepted, they have to be of good quality, with labelling and patient information complete, and a confirmatory imaging or treatment modality must be available. This can be departmental ultrasound, CT or operative findings. The fact that a patient went home and did not come to further harm is not enough.

The easiest way is to keep a log of your scans- I have given an example of this below. This can be done as paper copy, or computer file. I have given an example of a file that might be compiled for review of a FAST scan below:

Ultrasound Credentialing Log – click HERE

FAST images and correlating CT report:

CT report – Owen Doran – click HERE