SonoWars at SMACC – the Auckland HEMS Team perspective

This past week, several of the Auckland HEMS team travelled across the Tasman to attend the first conference on social media & critical care (SMACC)

Our fearless leader Dr. Chris Denny entered us into the ultrasound competition (SonoWars) on day 2 of the conference. Following a qualifying round of 8-10 teams, the two finalists were chosen for a 2 hour ultrasound competition in front of the entire conference. The 2 teams competed in what can only be described as madness/awesome all rolled into one.

We entered the competition not thinking that we would have much chance advancing beyond the first round but thought the process would be fun regardless.  Somehow, despite our efforts, we managed to make our way to the finals of the competition. Our team comprised of our Auckland HEMS personnel included Scott Orman, Chris Denny & me (Andrew Petrosoniak). We also had participation from Rossi Holloway.

The SonoWars competition involved a combination of skills including speed tests performing ultrasound, image review, teaching an ultrasound technique and finally performing procedural skills.

Each team was given an ultrasound topic that we had to teach to the audience. We were graded on teaching styles, content and ability to captivate the audience. Our competitors were assigned to teach ocular ultrasound while our job was to teach transvaginal ultrasound. In our unbiased opinion, we had the harder job! Transvaginal ultrasound is not a skill we use in pre-hospital ultrasound which instead focuses on abdominal, cardiac and lung imaging. Though we were up to the challenge and set forth with our plan!

Pictures can often tell a better story than words so below is a sequence of photos from the event with some commentary.

First, both teams received a 30min pre-briefing for the event. Shown here is the coordinator demonstrating ocular ultrasound using oversized teaching tools!

First, both teams received a 30min pre-briefing for the event. Shown here is the coordinator demonstrating ocular ultrasound using oversized teaching tools!

 

Our team was introduced to the teaching props we were required to use. The red figure represents a uterus with yellow ovaries while the ultrasound probe is in the foreground. We were required to incorporate these into our teaching session.

Our team was introduced to the teaching props we were required to use. The red figure represents a uterus with yellow ovaries while the ultrasound probe is in the foreground. We were required to incorporate these into our teaching session.

 

A view from the back of the auditorium as the audience was introduced to Sonowars for the first time!

A view from the back of the auditorium as the audience was introduced to Sonowars for the first time!

The ref with the flag in the air as I completed a lung exam. Once the red flag dropped I could move on to a different view

The ref with the flag in the air as I completed a lung exam. Once the red flag dropped I could move on to a different view

Going into the teaching event we were in the lead.

Our team teaching the skill of transvaginal ultrasound on stage. A challenging topic.

Our team teaching the skill of transvaginal ultrasound on stage. A challenging topic. The screen in the background has ultrasound images which correspond to what we’re teaching on stage

We gave up a few points in the teaching event but still had a 2 point lead in the final event. It was a procedural skills race that required ultrasound use to perform several procedures directly competing against the other team. Unfortunately we were so focused on the event that we didn’t take pictures and sadly we gave up 3 points and lost to our deserving opponents.

Immediately after we came 2nd...my disappointment in the refs was captured! All in good fun.

Immediately after we came 2nd…my disappointment in the refs was captured! All in good fun.

 

A team pic after the event. A great experience!

A team pic after the event. A great experience!

Overall, this was a great event with lots of learning, fun and ingenuity. The organizers should be proud as they set a standard for combining entertainment with education. It was extremely well organized which allowed it to go smoothly. We’ll be looking forward to redeeming ourselves next year at SMACC!

 

 

SMACC Sonowars – E-FAST race

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Yours truly in action

(video from prehospitalmed.com)

 

 

SMACC and the power of FOAM

I have just had the pleasure of attending the SMACC (Social Media And Critical Care) conference in Sydney – wow!

Any thoughts that this conference was going to be the same as many college scientific meetings were rapidly dispelled when the (alleged) ‘welcome’ speaker, who was delivering a tedious stuttering analysis of statistical irreleventia was picked up and thrown from the stage (with his lectern) by a masked wrestler wearing the SMACC logo.

wrestler

Another one bites the dust! Photo from prehospitalmed.com

From the first sessions of the conference it became rapidly apparent that most of the audience were far more Twitter-literate than I was. At first I thought it was a sign of rudeness that over half the audience were tapping away on various mobile devices while speakers were delivering their talks; I then realized that most of the activity was people sending out ‘tweets’.

Each person was tweeting to several hundred people at once.

Tweets contained the speaker’s key ‘take home messages’ and pearls of wisdom, complete with pictures, slides, and links to resources.

It dawned on me that this was instantaneous dissemination of cutting-edge medical information and ideas across oceans and borders.

(plus, of course, the presumably drunken tweet from the Gala Dinner: “F@#$ yeah! This vegan dinner is the s#!t!”)

AucklandHEMS in action: Chris Denny competing in Sonowars

AucklandHEMS in action: Chris Denny competing in Sonowars

The power of social media for medical use was brought home to me in a talk delivered by Minh Le Cong about airway management.

He played a video of a recent intubation he performed in the retrieval setting., involving a combative patient with a predicted difficult airway, hypoxia despite high flow oxygen via a non-rebreather, and bilateral pneumonia.

This is the sort of clinical scenario that gives acute care doctors and paramedics nightmares, but Minh navigated it successfully with a delayed sequence intubation (premedication with fentanyl allowing enough behavioral control to pre-oxygenate), pre-oxygenation with BiPAP instead of a traditional BVM, providing apneic ventilation with nasal cannulae during the period of paralysis, and placing a Fast-Track (an intubating LMA device) prior to passing a tube through it.

Some of the key elements of airway management listed above have been disseminated largely through social media over the last year. They have been blogged, tweeted, podcasted, vodcasted, and facebooked – not just the techniques themselves but people’s experiences, cautions, and refinements. The end result is that changes in practice have occurred in a timeframe that five years ago would not have been possible. Relying on traditional media (peer-reviewed journals and textbooks) places the timescale for changes in clinical practice into years.

Scott Weingart explains why patients drop their blood pressure once anaesthetised

Scott Weingart explains why patients drop their blood pressure once anaesthetised

Clearly there are risks associated with this sort of process. The internet represents pure anarchy when it comes to information dissemination, and it would be very easy for dangerous misinformation to be presented as gospel, aided by slick-looking multimedia pieces (have a look at some of the NZ anti-immunization websites if you want to see misinformation presented in a nice-looking pseudo-scientific form!). A considerable proportion of the conference involved discussions around ways dealing with the uncontrolled nature of FOAM (free open-access meducation) via social media – whether regulation and oversight is needed, how to deal with disputes and misinformation, and how academic colleges (which rely heavily on  preset curriculums and traditional media).

The answers to these questions are far from clear.

Having spent the SMACC conference observing the power of social media (specifically for FOAM), I came to the following conclusions:

1)   Social media for FOAM is tremendously powerful, and it is here to stay. We should embrace it as a teaching tool.

2) The power of FOAM lies in the ability to transmit not just medical information, but EXPERIENCE – i.e valuable lessons that you would otherwise learn the hard way in resus or on the road.

3)   Although there are risks in using FOAM, the benefits vastly outweigh them.

4)   There is a moral (but possibly not legal) responsibility on the part of someone producing/disseminating FOAM material to ensure that it is as accurate as possible.

5)   The legal responsibility for translating FOAM material into clinical care ultimately lies with the clinician who provides care to the patient

Conclusion 5 is potentially vexatious for clinicians – how do we know what is valid/safe and what is not? Stating “I got this technique from a blog’ is not a defence in the setting of a medicolegal disaster.

The way I have reconciled this is that before applying FOAM material in clinical care, I must make a judgement as to the safety of information, the validity (or otherwise), how and whether it applies to the patient in front of me, how to manage the risk, what the accepted standard of care (and the supporting evidence) is in similar situations, and whether my decision would be defensible in the event of a poor outcome.

Sounds like a complicated and risky process, doesn’t it?

It’s called the Art of Emergency Care, and whether FOAM is involved or not, we are ALREADY doing it every day.