Podcasts about dassmacc

In this episode of the Mastering Intensive Care podcast we replay a previous episode which featured Martin Bromiley (broadcast originally as episode 21). Martin is an airline captain, whose wife Elaine Bromiley sadly died in tragic circumstances, the story of which he describes here and is also documented in the video “Just a routine operation”. Martin used his experience in human factors to found and now lead the Clinical Human Factors Group, the charity working to make healthcare safer, by combining the efforts of academics, clinicians, leaders and policy makers. His work is widely recognised and his many awards include an Order of the British Empire (OBE), the Royal College of Anaesthetists Medal and Fellowship of the Royal College of Surgeons of Edinburgh. In this replayed interview from 2017, Martin tells Elaine’s sorry story, describes how he dealt with it, and the support he received, before going on describe his work and the founding of the Clinical Human Factors Group, what he thinks is required to improve safety in healthcare, what healthcare can and cannot learn from aviation, the importance of honesty about errors, the 3 key lessons in human factors for clinicians, how he uses mental rehearsal in his role as an airline pilot, and a final important tip about listening.   I invite you to listen to this replay episode with Martin Bromiley.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video “Just a routine operation” Video “How to Fail…Part Two” (a talk by Martin Bromiley at DasSMACC conference) Video “Martin Bromiley, a Patient’s Perspective” (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article “The husbands story: from tragedy to learning and action” (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article “Lessons from the Bromiley Case” (by Mike Cadogan on Life In The Fast Lane)   Links to other resources (in order of mentioning) SMACC TED Book “Black Box Thinking” (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 21 with Martin Bromiley Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Annet Alenyo Ngabirano. (That's Annet on the right in the photo with Kat Evans on the left and Mulinda Nyirenda in the middle.) Emergency Medicine in the Uganda, the pearl of Africa. Annet presented at dasSMACC and has become a huge personality in the the developing community of emergency medicine in the continent of Africa. While we associate Annet with Uganda she is really an Adventurer, on an adventure that goes beyond the borders of any country. This is a wonderful insight into the curious journey of one special person. It stretches from Mbarara to Berlin, from South Africa to Sydney. There is much to learn and at every step there are surprises. Annet found out so much about her own system through her normal training (normal for Mbarara) but also through personal tragedies. Her journey has turned her mind to things that she hadn’t thought of, she learned new practical skills and she even learned to ride a bike. Dr Alenyo Ngabirano is interested in research but she is interested in research that asks the right questions. We all are but I cannot tell you what the right questions are for any sub-specialty and you cannot tell Annet what the right questions are for Ugandan Emergency Medicine. Uganda is a country in which emergency medicine is only emerging. What exactly do we need to build? What exactly do we have? How do we even find that out? There seems to be an increased effort by the FOAM / FOAMed community to spread the useful stuff around, spread the love, spread it beyond the big FOAMed three; USA, Australia and UK. That is not as simple as it sounds. We have to try to avoid all the mistakes that have been made in the past, this is not an opportunity to feel good about ourselves and the good thing we do. What we should do is listen to the people on the ground. Listen to the locals. Do the appropriate research. Support the people that are there and that will stay there. Figure out what we know and what we need to find out. Annet realises that even she needs to know more about the system in Uganda and she knows more about it than you ever could. CODAchange wants to step into this space. It won’t be easy. There will be many opportunities to mess things up. To start with maybe we just need to talk to our colleagues in other places. It is about relationships. Take an interest. Find out more. Maybe even go and see for yourself but go there to learn stuff rather going there with some idea that you can tell people what to do. Annet and I talk a about AFEM, the African Federation for Emergency Medicine ( aka Fedération Africaine de Médicine d’Urgence ) which is a fast growing pan-African organisation that works to ensure the development of collaborative, comprehensive, and cross-cutting emergency care systems in Africa. Check out their projects. Have look at their Handbook, available from Oxford University Press and everywhere. The second edition is out recently. The first edition had the same look as the legendary Oxford Handbook of Clinical Medicine. (I still have my first copy of that book, feeling a little bit nostalgic just considering that.) https://afem.africa/what-we-do/ https://afem.africa/project/afem-handbook-of-acute-and-emergency-care/ Their next conference, the African Conference on Emergency Medicine (AfCEM) is in Mombasa, Kenya in November 2020. Why not go there? Why not show these guys respect and contribute to the growth of their conference and federation simply by attending as a delegate? Why not go one step further and Support a Delegate at the same time? The Support a Delegate appeal at dasSMACC was very successful. But it was not a one off. There are still conferences, there are still under-funded delegates. Please do not forget this practical and ultra-tangible way of lending a helping hand.

SMACCMini: It's not okay: culture, communication and conversations in critical care by Nat May.   Note on podcast: unfortunately this recording from #DasSMACC skips in a couple of places. It doesn't impact the exceptional quality of this talk, we just wanted to give you the heads up. SMACC Team.

SMACCMini: The art of induction - how not lose them in the first 15 minutes / Intubating sick kids - small holes, big problems by Charles Larson and Andrew Beck.   Note on podcast: unfortunately this recording from #DasSMACC skips in a couple of places. It doesn't impact the exceptional quality of this talk, we just wanted to give you the heads up. SMACC Team.

Simple…DasSMACC Day 1- me summarising what happened. Great day-fabulous networking. Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases […] The post DasSMACC- Day 1 appeared first on Critical Care Practitioner.

Simple- DasSMACC Day 2! Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with NO extra cost […] The post DasSMACC Day 2 appeared first on Critical Care Practitioner.

Simple…DasSMACC Day 1- me summarising what happened. Great day-fabulous networking. Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases […]

Simple- DasSMACC Day 2! Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with NO extra cost […]

Simple- My take of DasSMACC Day 3! Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with […]

Simple- My take of DasSMACC Day 3! Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with […] The post DasSMACC- Day 3 appeared first on Critical Care Practitioner.

SMACCForce: Bariatric Panel Discussion with Mark Forrest, Jason Van Der Velde, Phil Keating, Cameron O'Leary

What if in just a few short hours we could take all that we have learned about resuscitation from FOAMed and apply it? What if we could turn an average community hospital ED into a high functioning team? What if we could do all of that in 2.5 hours? We’ll see.

In Berlin, in the footlights, with heart in throat. In London, in the headlights, with heart in hands. In her heart, in Kashmir, always in Kashmir. A young woman that rather took the stage by storm at dasSMACC shares a little bit of her own heart and a lot more of someone else’s heart. Sanaah demands attention. She demands attention because attention is required. Not for herself. Attention is demanded on behalf of the disputed territory of Kashmir. On behalf of more than 8000 missing young men attention is demanded. This is the young Medical Student and Poet Sanaah Sultan. Activist. Future pre-hospitalist. SMACC continued to dream up new and imaginative things, new and imaginative ways to get a message across. It might be doctors that can act, paramedics that can defy gravity, film-makers that can do more using one button than you or I could ever do. In Berlin they had a poet. I heard Sanaah speak to a packed room at the SMACCforce pre-conference event. I saw her do it again in front of 3000 odd people in the Tempodrom. There is a kind of bravery required for that sort of thing. She brings that performance to the Jellybean Podcast. It is not my voice that you need to hear, it isn’t even Sanaahs. The voice we need to hear is any one of the disappeared. We need to hear those voices. We demand to hear those voices. It was my pleasure to meet Sanaah. Meeting people like her makes all this podcast business worthwhile. Thank you to Sanaah. @Sanaa_Sultan Thank you also to Mohammad Muneem and his Pune-based Kashmiri band “Alif” for their track Jhelemus from their debut 2017 album “Sufayed”.

The fabulous @eleytherius. You may know her as Dr Johnston, as a long term LIFTL contributor, as a Mega-FOAM performer, as a some-time feline choreographer or as a Fabulous Female of FOAM®. She sings, she dances and she writes books. She is a creative powerhouse. She is an educator extraordinaire. But we’re not going to talk about that. We’re going to talk about Dustfall; a new novel by someone who you can relate to, somewhat works in critical care, someone that has not much more time to spare than you do. Michelle has written a book. It took years. Of course she can write, I am just learning. Check her blog here; http://michellejohnston.com.au/category/dustfall/ It would have to be a labour of love? It was. Love of words. Love of reading. Love of the classics. As Michelle puts it; “I like words and they like me.” Where does a story like this start? It starts, like so many things do, near Port Hedland. In the Pilbara. In Western Australia. In a part of Australia that most Australians will never see. It’s out there, right out there. It starts in Wittenoom. Covered in blue asbestos, dead but still dangerous. Mining happens in dangerous places. Physically and metaphysically. For Dr Johnston, there was not so much writing as there was re-writing, submitting, waiting and getting rejected. Bad feedback. Good feedback. Even when people liked it they told her to re-write it. And here there is a parallel with medicine. Feedback. Feedback. And more feedback. Feedback is sometimes hard but it is something that can make you better. How many medical people do you know that have written a novel, a work of fiction? Not many. Now you know one more. Dustfall by Michelle Johnston. She didn’t want to push it so I will. Find the book here; https://uwap.uwa.edu.au/products/dustfall Go and listen to her speak about it, there will be book launches, promotional tours, lectures and a brand new pen. See Michelle speak; https://www.eventbrite.com.au/e/words-with-wine-michelle-johnston-dustfall-tickets-42452631965 This was recorded at SMACC in Berlin. We had just heard the fantastic talk by Annet Alenyo ( @aalenyo) about #UBUNTU which was a special moment. Have a look for that talk when it is available and please, please, please consider supporting a delegate through @Supadel and maybe help a talented young doctor or nurse attend a fantastic event like #dasSMACC was and like #BadEMfest2018. Read more at www.BadEM.co.za Then read a novel. Big thanks to Tired Lion, Perth Post-Punk Feminist Combo getting us moving with their break out hit I dont think you like me, chosen to introduce Dr Johnston because of the lyrics, the provenance and presence of Sophie Hopes. If your not Australian you’ve probably never heard her before. Now you have. Go and get some Tired Lion on iTunes. Big thanks also to Lloyd Cole for a little clip of the mid-80’s classic Brand New Friend of his second album, chosen for the lyric “am I asking oh for so much, i’m not asking to be understood” but also because the tune jumped into my mind and refused to leave for three days after Michelle used the phrase “Brand New Pen”. You surely have some Lloyd? If not, iTunes again.

Are we truly making healthcare safer? Do we adequately understand human factors in how we work in hospitals? How would you respond if your partner died from a “routine operation”?   These are just 3 of the questions you are likely to ponder as you listen to this interview with Martin Bromiley OBE from the United Kingdom on the Mastering Intensive Care podcast. Whilst many people that we care for in our Intensive Care Units receive excellent care, sadly there are some who end up in our ICUs after something goes unexpectedly wrong during a routine operation. Tragically some of these people die. Not due to anything they did, but from medical error. In the final DasSMACC special episode, I speak to Martin Bromiley, who became a widower when his wife, Elaine, died in such circumstances 12 years ago. In what has been described as “the direct result of human factors and failings in non-technical skills, created by systemic failings in the healthcare system”. Martin didn’t blame, shame or complain. He did his best to move forward by researching the culture in healthcare around safety and human factors. And he recognised that although there were pockets of excellence the UK’s National Health Service was culturally a long way behind most other high risk industries. As a result of his experiences Martin supported the making of a DVD entitled “Just a routine operation” which explored the lessons of his late wife’s death, as well as a BBC Horizon programme about human factors called "How to avoid mistakes in surgery". Professionally Martin works in aviation where he is a pilot for a major UK airline and where he has a background specialising in human factors. Therefore, Martin founded the Clinical Human Factors Group, a non profit-making charitable trust which aims to advise and promote best practice around human factors. Since then the Group has promoted human factors at the highest levels in healthcare, making a significant contribution to current thinking. More significantly though, the terms human factors and system safety are becoming much more commonly understood in healthcare, much of which is due to Martin’s efforts and leadership. His work has been recognised through awards from the Royal College of Anaesthetists, the Difficult Airway Society, and the patient support group “Action Against Medical Accidents”. In the 2016 New Year Honours list Martin was awarded an OBE for his work to further patient safety. Martin was a speaker at the DasSMACC conference in Berlin back in June, and after delivering an enthralling talk entitled “How To Fail”, we went to a quiet room to record an interview. We had an important conversation and touched on: The tragic case of Elaine and her death after a routine operation How Martin dealt with it What support Martin received in and out of the hospital What Martin has been doing to try to improve safety in healthcare What healthcare can and cannot learn from the aviation industry His 3 key messages about human factors How he uses mental rehearsal to be the best airline pilot he can be This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Please also consider making a donation to the Clinical Human Factors Group here. Thanks for listening. Please do the very best you can for your patients.   Andrew Davies   --------------------   Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video “Just a routine operation” Video “How to Fail…Part Two” (a talk by Martin Bromiley at DasSMACC conference) Video “Martin Bromiley, a Patient’s Perspective” (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article “The husbands story: from tragedy to learning and action” (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article “Lessons from the Bromiley Case” (by Mike Cadogan on Life In The Fast Lane)   Links to other resources (in order of mentioning) SMACC TED Book “Black Box Thinking” (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies

THE MINIBLURB ED people doing house visits? Medical retrieval teams having a cup of tea and taking a detailed social history? Emergency doctors going to someone's home before they come to the ED and recommending treatment at home? Including End of Life treatment? Sound Crazy? Ever been to Maribor? Slovenia? THE BLURB I spoke with Slovenian Emergency Physician and Pre-Hospital Gregor Prosen at dasSMACC. He talks like an emergency physician. He curses like an emergency physician. Gregor just exudes a type of ultra-competent critical care cool. He can do some fantastic shit and he does do it. He also goes on home visits. He gets in a car or 4wd and heads out into the country to see little old ladies, big old men, kids and strudel-makers. That part represents fantastic shit too. Listen to what Gregor considers So here I am in Australia, in western emergency medicine. We are struggling with this and that. We are struggling with end of life care. We are struggling with the filter, or lack of a filter, between primary care and the so-called critical care service that emergency personality types all signed up for. We wanted to be intubating vomiting people, with no blood pressure, while upside down in a straitjacket and wrapped in chains and underwater. In a crater lake. Over an active volcano. Using an expensive machine. Any expensive machine really. That’s what we call rewarding. It’s just not fair. Whinge. Whinge. So you go and try a bit of retrieval medicine. It looks very cool. Especially in the promo videos. (To quote Alex Psirides; “Helicopters!!!”) However, when you are getting around in one of those helicopters or some other platform there is a certain pressure on your use of that platform. How many times have aeromedical retrieval teams gotten out to the “scene” and decided to NOT bring that patient back to the hospital? Maybe that's the best thing to do? And if it is the best thing to do then will your service get paid as much? Will your service get paid at all? How much does it cost to run an aeromedical retrieval helicopter anyway? (Clue; shit-loads.) So at the end of the day it’s hard to use your judgement for some of the most important decisions. It’s hard not to get into the “You Call we Haul” trap. We actually use “Time on Scene” as a KPI. The pilot, the crew, the co-ordinator and even the helicopter itself seems to want you to get back to base ASAP. It might be whirring overhead or if it has landed just sits there and bristles. I do love these women and men. I love working with them. I love flying around over Slovenia clearly has a different history, different culture, different healthcare system, but maybe it has some seriously useful different perspectives. Gregor Prosen is pretty bloody cool. He does cool stuff. He has a cool job and some of that cool stuff is done really very differently. Let’s learn. I like FOAMed. I like it a lot. I would really like it to continue to facilitate knowledge transfer. We can learn something from the Slovenians. We can learn from the South Africans and Ugandans. We can learn something from the New Yorkers. It is not a one-way street. Long live FOAMed. Long live non-english speaking FOAMed. Long live FOAMed from everywhere for everyone. Long live the legendary Slovenian accordion player Bratko Bibič and thanks to him for the wonderful tune ”In the family garden” or “Na Domačem Vrtu” from the eponymous album by Bratko Bibič & the Madleys. You can find that on iTunes but if you find it in on vinyl it would be more impressive. If Slovenian music is your thing check this out; https://lifeinthefastlane.com/jellybean-050-with-sara-nikolic/

Do you play the role of the exemplary leader in the ICU? Are you charming, funny, friendly and extroverted – even when these aren’t your natural personality characteristics? Do you throw yourself into your series of consecutive days in the ICU like you are going away to adventure camp? Do you outline specific objectives that a patient should meet over a timeframe of a few days to decide whether treatment should continue? And how regularly do you talk to your patient’s family when you are pretty sure the patient is dying? These are some of the questions you may ask yourself after listening to this episode of the Mastering Intensive Care podcast with American intensivist Jack Iwashyna. This is the fifth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Jack is Associate Professor of Pulmonary and Critical Care Medicine at the University of Michigan where he is a practicing medical intensivist at both the University of Michigan and the VA Ann Arbor Health System. He also devotes significant energy to training clinician scientists and is best known for his work defining the concept of “survivorship” after ICU and measuring aspects of the post-intensive care syndrome. Jack’s keynote talk at DasSMACC was entitled “Persistent Critical Illness” and as you’ll hear in this podcast he is the perfect person to talk about this given he does 14 day blocks in his ICU allowing him ample opportunity to understand what happens in the evolution of a patient’s critical illness. Despite Jack self-proclaiming he is introverted, this episode of the podcast reveals him to be a diverse conversationalist with well-matured thoughts, views and reflections on his own experience about how a consultant intensivist should act, whether that be in throwing ourselves 100% into our clinical service, playing a specifically crafted leader’s role, wisely mentoring less experienced clinicians, regularly communicating to patient’s families, simply having fun doing our job with our colleagues and respecting our spouses and families for supporting the work that we do. We cover a myriad of topics including: Jack’s powerful answer as to why he loves his job How invigorating it can be to talk to people he has only just met How he has previously done 30 day stretches of continual clinical service As a researcher he tries not to study his own ICUs too closely Our fixation on short-term survival is inadequate for most patient families His use and the benefits of time-limited trials of life support How he uses a school-like A-F range grading to mark patient’s progress The benefits of taking his children away on academic trips His somewhat raw reflections about not feeling as good a father and husband as he is a doctor The difference between mentoring in research and in clinical practice Our role is to try to help all trainees to improve, however good we perceive them to be Burnout is a systems issue – where the system is being run too hard The importance of sleep and afternoon naps This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies   Show notes (people, organisations, resources or links mentioned in the episode): Jack Iwashyna at University of Michigan: http://ihpi.umich.edu/our-experts/tiwashyn Jack Iwashyna on Twitter: @iwashyna DasSMACC: www.smacc.net.au

Are you receiving elderly intubated patients where someone else says they want “everything” done? Are the doctors who refer patients to intensive care finding out what their patients really want towards the end of life? Does this frustrate you on a daily basis?   This is a huge topic in intensive care. Finding out the wishes of our patients before they end up on a ventilator with no one to speak for them is vital if we wish to deliver optimal healthcare. Yet so often we intensivists are left to deal with this situation. And whilst in most cases we do this very well, many of us like Dr Alex Psirides, a UK, New Zealand and Australian-trained intensivist, feel the despair as we hold another lengthy meeting with a patient’s family. In this episode I spoke with Alex about this topic, which he had just delivered a brilliant TED-like talk on at the DasSMACC international conference in June. Alex has a great perspective to share as two of his specific clinical interests are managing dying patients and rapid response systems for deteriorating patients. This is the fourth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Alex is an Intensive Care specialist at Wellington Regional Hospital in Wellington, New Zealand. His work and research in the area of rapid response systems has led to an appointment as the clinical lead for the New Zealand Health Quality & Safety Commission’s 5-year national ‘Deteriorating Patient’ programme. He is also the clinical lead for Wellington’s aeromedical retrieval service, which covers the lower North and upper South Islands of New Zealand. In his spare time, when not walking his dog or children, he builds websites & designs logos for Wellington ICU’s prodigious research department, as well as sending a few tweets via Twitter handle @psirides. Given Alex has been an ICU consultant for less time than most of my other guests, I had to talk him into doing an interview, but I’m really glad he agreed. There is so much to like about this conversation. Alex is honest and humble enough to say he’s not so sure he’s that good at predicting patient outcomes, at least in neurosurgical patients, which is the precise reason he has something to teach us on the podcast. We also cover topics including: Why Alex loves intensive care (with a great answer) How his consultant team work so cohesively The need to respect co-worker’s opinions and to avoid tribalism How a team of intensivists meeting with a team of neurosurgeons away from the patients can make practice more consistent and evidence-based How his team uses simulation to reduce rudeness and lack of respect How efficiently his hospital ran when there was a 3 day doctors strike A good ward round requires asking for and addressing the nurse’s concerns but also finishes with a clear plan to move the patient forwards Bringing his best self to work requires feeling loved at home and having a great team to work with Some of the non-textbook medical books Alex has been enjoying reading Hobbies allow him to escape from work and to use his creativity How far away he feels right now from burnout What he can get better at over the next 5 years How palliative care physicians can be helpful in teaching us and our trainees about end of life discussions This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues or posting on social media. Feel free to leave a comment or a question. I hope we can build community through Mastering Intensive Care so colleagues can share their thoughts and tell us how they are mastering their own skills. Leave a comment on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies     Show notes (people, organisations, resources or links mentioned in the episode): Wellington Intensive Care medical team: http://www.wellingtonicu.com/AboutUs/Staff/SMO/ DasSMACC: www.smacc.net.au Alex Psirides talk on “Doing everything at end of life”: http://wellingtonicu.com/Data/Doing%20Everything%20DasSMACC.pdf Book “Being Mortal” by Atul Gawande: http://atulgawande.com/book/being-mortal/ Book “Do No Harm” by Henry Marsh: https://henrymarshdonoharm.wordpress.com/reviews/ Alex Psirides on Twitter: @psirides

Do you say “I don’t know” when you really don’t have an answer? Might seeking that knowledge help your patients? This is just one component of a wonderful conversation I held with Professor Flavia Machado when I interviewed her at the recent DasSMACC conference in Berlin. Flavia is doing a great job at raising the awareness of sepsis globally but her other great job is in running a large Intensive Care department in Sao Paolo, Brazil, where she told me that the resources are quite limited. To deal with this challenge she believes optimal communication is vital. How does Flavia lead her ICU on the issue of communication? She does this (1) by having an environment where her team members can ask important questions, (2) by using the WhatsApp messenger app on smartphones, (3) by teaching trainees using courses on how to break bad news, how to speak with families, and how to deal with doctors who have different clinical opinions, and (4) by saying “I don’t know” when finding the knowledge will help the patient. Flavia is the Professor of Intensive Care at the Federal University of São Paulo in São Paulo where she is Head of the Intensive Care Section of the Anesthesiology, Pain and Intensive Care Department. Flavia has trained in Internal Medicine, Infectious Diseases and Critical Care, making the field of sepsis something she has become a world leader in. She is one of the Founders of and now the CEO of the Latin America Sepsis Institute (LASI), having been its President. LASI is devoted to quality improvement in Brazilian hospitals as well as to coordination of multicenter studies in the field of sepsis. She is part of the executive board of the Global Sepsis Alliance and the executive committee for the World Sepsis Day. Flavia has served on the board of the Surviving Sepsis Campaign International Guidelines. She is also a member of both the Executive and Scientific Committee of the Brazilian Research in Intensive Care Network-BRICNET. Finally, Flavia is the editor-in-chief of “Revista Brasileira de Terapia Intensiva”, the official journal of the Brazilian Critical Care Association and the Portuguese Critical Care Association. In this conversation we also cover topics including: Raising awareness of sepsis through the Global Sepsis Alliance Mentoring and being mentored The need for a multi-professional program in ICUs with a multi-disciplinary ward round Setting goals and using checklists How the limited resources in Brazilian healthcare require strict admission rules The use of simple and short protocols based on the evidence How to best deal with conflict with another doctor Using dinner time to connect with family How running is good for the mind The joys of reading books With this podcast please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you have a comment or a question, let’s engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care.

Dr. Paul Young from DasSMACC talks about the righting the wrongs of modern critical care research.

What is the future of Artificial Intelligence and critical care medicine? I ask Rinaldo Bellomo who, for the past 30 years, has been at the pointy end of critical care research including high technology and predictive algorithms. I managed to get Rinaldo Bellomo to talk to me at SMACC in Berlin. It was a bit of an intellectual mismatch. If you work in intensive care then you know who this man is. If you don't work in intensive care you may somehow be unaware of the 1000+ articles he has authored, the gazillions of dollars of research grants he has won, the 150 conferences he has given talks at. From where I am standing it looks like he invented the kidney before he invented renal replacement therapy, before he invented every study ever about CRRT. I may be exaggerating there, there were some studies by other people. The great thing about Rinaldo is that he got to where he is with a child like enthusiasm and a wicked sense of humour. That is the sort of thing that makes a good Jellybean. So what do you talk to a man who has over 1000 PubMed citations about, I mean if I try to reference any studies he may well have published them as editor of Critical Care and Resuscitation, he may have reviewed them or he may have mentored the researcher. Otherwise he wrote almost all the remaining contents of PubMed. So I thought I might need to artificially enhance my own intelligence to be able to stand up to this bloke. Artificial Intelligence in medicine is a thing at the moment, we hear about Google investing in it and apps replacing GP consultations. As it happens Rinaldo has been working and publishing on this from the critical care stand point. https://www.wired.com/2017/06/googles-ai-eye-doctor-gets-ready-go-work-india/ http://www.techradar.com/news/creating-the-google-of-medicine-meeting-the-human-ceo-behind-the-ai-doctor Now if I was running Google I would have tried to interact with Rinaldo already. I presume organisations with those sorts of resources are constantly looking at research like his and seeing how they can use it. So I asked the Professor about artificial intelligence in medicine. I asked him how you deal with an approach from these enormous companies because he has had them. Then he gets going. I can hardly get a word in edge-ways. Which is a good thing. We try to get all Aldous Huxley about it. It is an interesting chat It’s all about humans at the end of the day. Rinaldo is just human too, how does he keep the studies coming, why does he keep working at it? Turns out it’s the voices in his head, this is his hobby, his passion and if you try to take this away from him he will at least be grumpy and possibly a lot more than grumpy. To finish off we started talking about dasSMACC and his debate with Peter Brindley on MeSearch vs Research. Trying to keep up with Peter Brindley without tripping up is pretty hard. Rinaldo nailed it. We pick apart the risks of doing that and the risks of using risqué humour. There was one joke which missed the mark about Irish people but in truth that moment really just spurred me on to get Rinaldo in on the podcast. This is a good one. He thinks and talks faster than me so see if you can get it on iTunes or any podcast player that you allows you to play it at half speed. Rinaldo Bellomo; living legend. Crit Care Med. 2012 Aug;40(8):2349-61. doi: 10.1097/CCM.0b013e318255d9a0. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Bellomo R et al Vital Signs to Identify, Target, and Assess Level of Care Study (VITAL Care Study) Investigators. Crit Care. 2017 Mar 14;21(1):52. doi: 10.1186/s13054-017-1635-z. Effect of an automated notification system for deteriorating ward patients on clinical outcomes. Subbe CP, Duller B, Bellomo

Whilst the skills of applying life support and resuscitation take up most of our training, they are relatively easier to master than the skills that allow us to become good at diagnosis, good at communication, and most of all good at being resilient over a whole career so we can satisfactorily work with others and deal with the stress of working in intensive care. Peter Brindley, a Canadian intensivist from Edmonton, thinks that these “human factors” are crucial for us to master, especially in the second half of our careers, when we should be striving to be simply “a good person”. In this episode Peter reflects, tells some stories, and invites us to consider many important topics that will help us become better people. These include reflection, simulation, mental rehearsal, debriefing, dealing with upset people and the feeling of being an “imposter”. Peter is a full-time critical care doctor at the University of Alberta Hospital. He is a Professor of Critical Care Medicine, Anaesthesiology, and Medical Ethics. He has published papers and given talks widely. He was a founding member of the Canadian Resuscitation Institute; and was previously Medical-Lead for Simulation, Residency Program Director, and Education Lead at the University of Alberta. He is proudest of his two children, neither of whom care one iota what titles he may or may not possess. He is convinced that happiness rests in finding meaning and showing gratitude - he occasionally succeeds. This is the second in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. In addition to the human factors described above, we also spoke at length about burnout, its relationship to resilience, and the potential benefits of both working less (like part-time) and of having eccentric hobbies or passions. Peter spoke on several other topics including: His life journey from growing up in the United Kingdom to becoming a Canadian for all of his adult life The country of Canada, it’s national identity and it’s intensive care system The hallmarks of good teams Rudeness and its iatrogenic effects (including when family members are rude) The components of communication – including verbal, paraverbal and non-verbal A situation when Peter was accused of unprofessional behaviour and how he dealt with that How Peter has used a mini-sabbatical to reflect and to think about the next part of his career Exercise and the risk that it, other hobbies and material things can become like fetishes How our careers can be broken into thirds of “learning, earning and returning” but that we should consider all three in even the smaller periods like weeks or months The benefits of having an identity that is more than simply being a doctor His time on a cruise ship where he worked as an anonymous doctor How he is more proud of his writing of poetry and travel-writing than some of the medical papers he has published. With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. You can send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrew@masteringintensivecare.com.   Show notes (people, organisations, resources or links mentioned in the episode): Dr Peter Brindley: https://www.ualberta.ca/medicine/about/people/peter-brindley DasSMACC website: https://www.smacc.net.au/ Dr Sara Gray: https://saragray.org/ Dr Chris Hicks: http://stmichaelshospitalresearch.ca/researchers/christopher-hicks/

What sort of things do you tell yourself when you are resuscitating a patient? Are you self-critical about your ability to deal with the situation? Is your inner voice so loud that you can’t concentrate on the task? This is a topic we don’t speak enough about in intensive care. The inner dialogue, which can often be very negative, is commonly going on in the background as we do our work. And as Associate Professor Sara Gray, a dual-trained intensive care and emergency physician from Canada points out, it can become louder and more critical as we become more stressed with the situation in front of us (eg. a difficult resuscitation). In this episode Sara talks about how observing the inner voice and trying to make it kinder is a form of self-compassion which can lead to improvements in our performance, thereby helping us to bring the best outcomes to our critically unwell patients. Such self-compassion can also provide the additional benefits of making us happier, more mentally healthy, and helping us to perform better in other areas of life. But it’s not easy to change these voices in our heads. And we need to slowly begin to develop the ability to simply observe them before we can do the more difficult work of making the voices kinder. This is the first of a series of DasSMACC special episodes, where I interview speakers from the recent DasSMACC conference held in Berlin. This was the third SMACC conference I have attended, and I enjoyed it for its international and multi-disciplinary flavour, as well as the excellent speakers and the exceptional program including topics from resuscitation and critical care interventions to communication and our own health and well-being. Dr Sara Gray is cross-trained in Emergency Medicine and Critical Care. She works in both areas at St. Michael’s Hospital in Toronto, Canada, and is an Associate Professor at the University of Toronto. She is also the Medical Director for Emergency Preparedness at St Mike’s. Her academic interests include knowledge translation and optimizing performance; specifically how to improve the care of critically ill patients in the Emergency Department. Her most important achievements are her kids, who don’t care what she does at work all day, and who remind her of what really matters in life. Sara spoke in the opening plenary session with a talk entitled “Voices in my head”. In this podcast interview, we discuss the premise of her talk, which is mainly about developing self-compassion by noticing our inner voice. We speak about some resources Sara has used to develop her own self-compassion, including the use of mindfulness meditation, which she now regularly practices. Sara is insightful, thoughtful, a true leader, a caring doctor, and above all a woman blazing a path to helping us to look after ourselves, our work colleagues, and indeed our patients. She is really helping to modernize the thinking in intensive care and emergency medicine circles. We covered several other topics including: Sara’s own career combining emergency medicine and intensive care The potential benefits to the organisation of having doctors trained in both specialties How intensivists can develop better relationships with their emergency department colleagues The potential benefit of teaching our children to meditate so that it becomes a normal part of an adult’s life Sara’s attitude to sleep, how she is not a good napper, and how she benefits from getting an even number of hours sleep How getting away by herself to read a book for just 30 minutes twice a week can revitalise her How doctors need to listen more and talk less – and some techniques to do that better How the ICU ward round in the St Michael’s Hospital is structured Some of the phrases she uses when talking with colleagues and patient’s families How being a patient in her own hospital reminds her to approach patients with what may seem minor complaints in a more engaged manner How burnout is not a binary outcome, and more something that she swings closer to or further from depending on the circumstances With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media (using #DasSMACC, #SMACC or #FOAMed) If you want to send a comment or respond to something Sara said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using #masteringintensivecare. I’d love to hear what you think are your major take-aways. Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too. ____________________________________________________________________________________________ Show notes (people, organisations resources or links mentioned in the episode): Dr Kristin Neff’s website: www.selfcompassion.org MBSR course: Mindfulness-based stress reduction Jon Kabat-Zinn: Founder of MBSR program Headspace meditation: www.headspace.com Sara Gray’s previous SMACC talk on “Optimising critical care in the emergency department”: https://itunes.apple.com/au/podcast/optimising-critical-care-in-emergency-department-by/id648203376?i=1000359000551&mt=2 Scott Weingart’s SMACC talk on “Kettlebells for the Brain”: https://itunes.apple.com/au/podcast/kettlebells-for-the-brain/id648203376?i=1000375455720&mt=2 DasSMACC website: www.smacc.net.au Dr Sara Gray: https://saragray.org/

The RAGE team talks to Peter Brindley about a new, free crisis resource management book and CRM Brindley-style, and we reflect on the recent dasSMACC conference. The usual stuff is there too: what's bubbling up?, a blast from the past about John Scott Haldane, and some Words of Wisdom from Peter Brindley to finish. Show notes available at: http://ragepodcast.com/rage-talks-crm-brindley-style-dassmacc/

  The dasSMACC (social medial and critical care) conference was recently held in Berlin. Simulation was a theme woven throughout the conference, and we thought a simulcast episode recapping on some of the messages and themes was timely. Smacc has arguably redefined the way we think about medical conferences – great speakers, great messages, hard core critical care in an engaging format. This year, simulation activities were embedded in main stage talks, workshops, panel discussions and the ‘Sim Haus’ we previewed in a recent Simulcast episode. A series of linked main stage talks from Clare Richmond, Chris Hicks and Jon Gatward gave us a framework for thinking about simulation modalities and matching method to objective. Following the journey of a head injured patient, we saw performances by actor Renee Lim, the incredibly realistic manikin made by Lifecast, and how end of life discussions, organ donation, cognitive biases can be addressed using simulation just as well as the action sequences involving airway management of a head injury. Also on the main stage - Brian Burns opening talk wasn’t about simulation, but rather was a futuristic trauma simulation in which he demonstrated the ways technology might improve our pre-hospital trauma care in the not too distant future, including drone delivered blood products. Jenny Rudolph gave us a practical insight and skills for dealing with ‘WTF’ moments, by seeking out the underlying frames for behaviour we find annoying or disappointing. She led a whole of audience exercise in resetting our response from unhelpful emotion to curiosity, bringing to life her longstanding work in double loop learning and debriefing using advocacy inquiry.     The interprofessional panel discussion (aka ‘the tribalism panel’) sparked conversations about how simulation can be an agent of culture change, but also how deliberate our strategies need to be in making our educational outcomes truly interprofessional. Both Jesse and I were involved in the education panel on Day 3 where simulation was again a core theme, especially as it pertains to preparing learners for the future, connecting with quality improvement in hospitals, and integrating into everyday work. Walter Eppich’s work on how to take our debriefing skills into the clinical area through coaching conversations received a lot of attention. As the Twitter moderator, Jesse wonderfully captured some audience questions and responses in this storify. Pre-conference workshops on Debriefing, Leave the Sim Lab behind and Stress Inoculation were a chance for attendees to deep dive with internationally respected faculty. Jan Schmutz presented his recent work on team reflexivity in the debriefing workshop (an enlightening read, but you will need to concentrate). The last of those workshops connected with a presmacc meeting in London – the Performance Psychology in Medicine Seminar. This fantastic program connected the worlds of high performance in pre-hospital care, other healthcare, elite sport and on stage. The event highlighted work like Mike Lauria’s Psychological skills to improve emergency care providers performance under stress, and others like Vicki Leblanc.   The Sim Haus was a dedicated physical space within the conference venue, which housed industry displays and ‘meet the experts’ session. There was some fascinating new technology and an atmosphere of sharing sim ideas and challenges.   Where to for more? Feel free to go back to #dasSMACC and also #simHaus, and of course wait for the talks and podcasts to be released on the smacc website and podcasts over the year. Next smacc conference is in Sydney February 2019

A ripper of a journal club episode.  Recorded live in Berlin at the DasSMACC conference last week.  Justin and I invited a cast of superstars to share a drink over the mike and discuss an eccectic bunch of papers.  

Right off the heels of dasSMACC, I got Ben Smith (@ultrasoundjelly) to give us a 5minsono on the 60/60 sign for PE.  This echocardiographic sign was found to have 94% specificity in patients with suspected PE (Reference) Come hang out with us in Versailles, Kentucky at Castlefest 2018! Do you feel like Versailes, Kentucky not beachy enough? Come to Cabofest instead! Offer code "5MINSONO10" gets you 10% off!

https://www.smacc.net.au/   Anne Creaton – An Emergency Physician & retrievalist HQ’d in Melbourne Australia. She spent the last 4 years in Fiji establishing emergency medicine training in a low resource environment while building capacity in pre-hospital care and disaster response. While living in Fiji she experienced Cyclone Winston first hand and was part of the in-country response. She is an educator in mass gathering medicine and the MIMMS system and was part of the instructor team for a multiagency tabletop simulation of a multi-site terrorist attack in Melbourne.    Lionel Lamhaut – An anesthetist with critical care and emergency training and an associate professor of the SAMU de Paris (excuse my French - Service d'Aide Médicale Urgente), Dr. Lamhaut is not only a disaster response physician but an academician of the highest caliber with recent publications on the prospective deployment of ECPR for refractory cardiac arrest in the Paris area with a multicenter study well underway.  He responded directly to the deadly terror attack of Charlie Hebdo and was instrumental in the after action analysis in the coordinated multi-site terror attack that struck Paris on Friday the 13th of 2015.   Raed Arafat – Put a warm round of applause together for the Secretary of State and Minister of Internal Affairs of Romania! Tasked with development of emergency medical care in the country, he is the founder of SMURD – the Mobile Emergency Service for Resuscitation and Extrication. In his current position he leads the Department for Emergency Situations including fire and rescue, civil protection, prehospital emergency medical services, air rescue as well as emergency departments.  Ladies and gentleman… a Knight and Grand Officer of the National Order of Merit in Romania, he has overcome both politics and prejudice in his sterling career as a champion of the highest quality prehospital care.   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

The Africans are coming. BadEM are surfing a #FOAMed wave at the moment and they are doing it with style, which isn’t that surprising when Kirsten Kingma is one of the team. The Jellybean Podcast is a big fan of the www.BadEM.co.za bunch. Of course we are. Why wouldn’t we be? They are a great cohesive team of fabulously varied individuals. We like that sort of team. If you were at #dasSMACC you won’t have forgotten the BadEM team standing up with their friend and colleague Annet Alenyo @aalenyo introducing the whole room to #UBUNTU and @Go_Supadel. On the BadEM website the team members have pen portraits. We have already talked to The Logic and The Braun. Today we speak to The Adventurer. I got into medicine for many reasons but one of them was that I would have my profession in my head and no matter what shit went down I would still have all that stuff in my head. Given the nonsense coming from the White House these days I still think it was the right idea. It isn’t easy to squeeze all that stuff in there and I had to make some sacrifices. I had to let some stuff go, sporty stuff, arty stuff, academic stuff and so on. That’s what I thought I had to do. Or did i? Did I have to give those other things away? @SurferKirst wanted to become a doctor. She saw the adventure in medicine. She wan’t willing to let the other adventuring go. Surfing scholarships, paragliding study groups and thats just the start. I’m hoping she sets up the first zero-carbon aeromedical retrieval service using tandem solar-powered para-motors. You’ve got to think big. Otherwise BadEM wouldn’t have put together the totally free conference in Stellenbosch last year. Or the #badEMfest18 next year! #badEMfest18 is a whole new concept; glamping, mountains, learning and if Kirsten has anything to do with it some nutty adrenaline sports! They have a knock-out local faculty and some international blow-ins from St. Emlyn’s and The Teaching Course. And I can reveal that there will be a South African Teaching Course in Cape Town just before #badEMfest18 (March 2018) If you’ve never been to South Africa or the continent of Africa then I have a question for you; “why?” I have another question for you “why not in March 2018?” After that there are only 54 more countries in Africa to visit. They say this is the ‘Asian century’. I wouldn’t be surprised if it ended up being a close run thing. The #badEMfest18 is on from March 22-25 2018. I know I want to go. go to www.TheTopEnd.org for all the show notes and links.

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait. We cover... One of the major themes of #dasSMACC has been - we are more overconfident in our knowledge, skills, ability, and good behavior than we actually demonstrate. We cover the Dunning-Kruger effect and how to help combat the notion that "this happens to other people, not me."  Drs. Jacob Avila and Ben Smith on Airway Ultrasound Dr. James Rippey on Point of Care Ultrasound Incidental Findings Dr. Jack Iwashyna on Critical Care Prognosis Thanks for listening! Jeremy Faust and Lauren Westafer

Jonah Roche wants to volunteer the entire police service in Ireland for an extra job. You’d think that wouldn’t be a popular idea but think again. Jonah cut through the crap at dasSMACC with his summary of the Code of Conduct and he talks more sense here trying to stop people dying and possibly making the job of a policeman more rewarding. THE BLURB Jonah Roche is an Resuscitation Enthusiast. Qualified Paramedic and Emergency Response Unit Gardai (Irish for policeman). Jonah Roche is one of the guys that is responsible for scaring the shit out of everyone at the SMACCforce live shooter event in Dublin last year. He is a gun toting paramedic from Ireland. In Ireland the police don't usually carry guns. Even less of the paramedics carry guns. This fellow is a special case. Jonah and I met in Berlin, we tried the local beverages and we talked. We talked and talked and laughed and laughed. In fact I wish I had recorded that conversation but there really was an awful lot of colourful language. One of the things we got stuck into is the whole issue of trained first responders. We have a great bank of first responders that we are not accessing. I didn’t realise that in Ireland (and many other countries) the police are not fully utilised in. The Garda Síochána do not routinely deliver CPR even though they have all done at least one CPR course. There are at least 10 times as many police men as there are paramedics and 10 times as many police vehicles as there are ambulances. And we are not using them. Why not? There won’t be too many better placed than Jonah to comment on this. Jonah is a straight talker. He is a good man. He is a big supporter of Dr John Hinds. As such he tells it like it is and he is funny while doing it. In fact he managed to really reign in the creative use of language during this conversation. It is almost a pity but he did want to get a message across. Here is that study from Zurich. "Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest." http://www.resuscitationjournal.com/article/S0300-9572(17)30260-5/fulltext?rss=yes

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait. We cover... Dr. Leanne Harnett on Pulmonary Embolism with Right Heart Thrombus (PE with RHT) Dr. Michele Domico on Pediatric Cardiology Emergencies Dr. Haney Mallemat (@CriticalCareNow) on Transesophageal Echocardiography (TEE) during Cardiac Arrest   Thanks for listening! Jeremy Faust and Lauren Westafer

Under Siege. Under fire. Undergraduate. The remarkable journey of Dr Hanna Kaade; from Aleppo to Berlin and from the Red Crescent to #dasSMACC. This is an ordinary tale. An accidental tale of everyday heroism. There are many tales like this. Every one worth telling, worth hearing, worth learning from. Hanna Kaade is a Syrian born and trained doctor. He completed his medical training in a town under siege, in a hospital under fire, in the centre of a civil war at the centre of a giant ugly geo-political maelstrom. We know about Aleppo. But we don’t know Aleppo like Hanna does. Hanna and I took some time to talk a little about what it was like to exist in such a conflict, to be a medical student delivering battle field trauma care in between basic medical training. From the mundane to the horrible, from studying under candles to working for the WHO. If you got a chance to get out, what would you do? If you had to start your medical training again what would you do? Hanna had to re-train in Germany. Germany has welcomed more Syrians than any country not bordering Syria. By UN estimates Germany has more registered Syrian refugees than every other country in Europe (not just the E.U.) and Canada and the USA and Australia combined. Now he is one of many, many doctors and nurses repeating his training and looking for a new start in Germany. Imagine how hard it will be for people like Hanna to get a start. When you hear him speak and when you see his smile you can believe that he will manage it. But it will be hard to get a break. Much harder than it was for most of us. There are many tales like this from Aleppo, from Syria, from Iraq, from every conflict zone. We are increasingly saturated with images of war but we cannot let these bombed homes, shattered lives or lost loved ones become anything other that the unique tragedy that they represent. We are speaking about some mothers son, some fathers daughter, someone like you and I. In different circumstances it could have been you or me, your sister, your child. Hanna’s story is one of hope, hope in the face of great adversity.

We deliver pearls from the first day of #dasSMACC in Berlin. We cover talks by Dr. Brian Burns on trauma, Dr. David Carr on endocarditis, Dr. Paul Young on statistics, and Dr. Jess Mason on sickle cell vaso-occlusive crisis. Check out foamcast.org for show notes and pictographic summaries. Thanks for listening and for the Rosh Review for sending us! Jeremy Faust and Lauren Westafer

Its a laugh a minute as SMACC gets going.

Country-fiedMD interviews DasSMACC volunteer, @thenursealyx, about her introduction into FOAMed (Free Open Access Medical Education) and SMACC  (Social Media and Critical Care) as well as her experience at 2016 SMACCDUB.  We also get a little preview of the 2017 DasSMACC in Berlin, Germany!!  The source of #INFOAMATION

Sara-Catrin Cook joined me for short chat about all things sim at smacc.   Sara is part of a group who has put together a comprehensive simulation theme woven through the conference, including the SIMHaus – a showcase within the Tempdrom where attendees can meet and talk to other simulation enthusiasts ad experts.  The SimHaus will be physically set up next to the main arena, and Sara tells us what to expect. Simulcast will be there covering the event for those who can’t make it.   See you in Berlin

You probably have something like a Wednesday afternoon education session at your place of work. You probably have to present at it sometimes. You probably do it pretty well. You may not feel that. You may be your own worst critic and see all the areas that need improvement. That is an important insight which you can use for constructive good rather than destructive evil. Just by being a #FOAMed consumer you are already in a subset of your profession that is motivated to learn and improve you clinical work. It follows that you may well already be developing your teaching skills. In fact I am willing to bet that almost anyone reading this is above average in terms of their presentation skills. Here’s the bad news; the average is poor. You want to be way above that average. You don't get to be way above average without working at it. But how? I mean we don't get our own personal Mr Miyagi to get us to “wax on’ and ‘wax off’ until our presentations are optimally polished. Heres the good news. There is a FOAMed version of Mr Miyagi to help you with the wax. It is Ross Fisher, the presentation guy, @ffolliet, inventor of the P cubed concept and one of the nicest humans you may ever meet. Ross talked at SMACC dub and will be at dasSMACC in Berlin. He is softly spoken, calm and collected. Unlike most people I like there would be little concern introducing him to my mum. In fact he is the sort of person you could trust to do surgery on your children! Ross has his own Mr Miyagi; Prof Garr Reynolds. Garr Reynolds is big time. You can buy his books and attend his workshops but it will cost you. Ross is sharing what he has learned for free at www.prezentationskills.blogspot.com or www.ffolliet.com I certainly can learn from Ross. When you listen to the two of us speak it is like chalk and cheese. If theres any waxing with me its “waxing lyrical”; barely contained enthusiasm coupled with pressure of speech. Apparently my desire to improve this is a very important step. If you want to be better at the next departmental education session, or if you have your eye on an educational role in the future, I recommend you have a look at what Ross has been doing. You will find all sorts of goodies over there including the TEDX talk (in videos), his own podcast (slicker than this one of course) and much more.