This is the orientation lecture given to the Phase 3 medical students rotating through the Shellharbour ED. These slides are to be for easy access for students and staff alike.

1. SHH ED –Orientation
Getting the best out of
your EM rotation..
Dr Bishan Rajapakse
MBChB, PhD, FACEM
Staff Specialist Emergency Physician - Shellharbour ED
Honorary Clinical Lecturer – Graduate School of Medicine
(UOW)
Wed 22nd July 2021 – 13:15 (virtual)

2. Overview
• Official Welcome from SHH ED
• Getting to know they Team
• Expectations
• The set in SHH ED –whats different
• An approach for ED (covered)
• Tips for best Practice/Learning ;
• Goals
• Styles
• Mindset

3. Know “thy” team…
Learning works best when you know what your goals are,
and you know who you are working with;
1. What do you hope to get out of your SHH ED term?
2. What interests in EM or other work ?
3. Communication Strategies?
Emergency Medicine=TEAM

4. Our SHH ED
Consultant TEAM
(and interests)
• Simon Keane – ED Director (Leadership/ Retrieval/
Innovation)
• Angelo Abeywickrema – (DEMT / Ultrasound/ Retrieval )
• Phil Manczac – (Co-DEMT / Paeds / Med ED)
• Bish Rajapakse – (Well-being / Research & Med ED /
International EM)
• Kham Saysana - (Clinical Governance/ Policy / Toxicology)
• Ayman Elattar – (Education & Training/ Simulation
• Brona Geary – (Peripheral Hospital Training / Med ED /
Simulation)
• Kris Yuen – ED / Med ED
• Tom Carrigan– Medical leadership/ Research

5. Key Players
• ED Consultants (also known as FACEMs / EDSSs)
• Nurses (Nurse in charge)
• Nurse Director (Frank Testa)
• NUM1 (Shift Lead for nursing) – keep the place afloat
Sam Mawhinney (Admin Assistant to the Director/Department)
Perhaps say Hello to these people every shift (ie Check in)

6. Make yourself more than a mugshot on our wall
Say hello, get involved
Don’t be shy..
“TeamWork” makes the Dream work

8. EM Approach - a framework
Risk Management
5 Questions (to ask yourself about
every patient)
1) RESUS or Not
2) IN or OUT
3) Stream
(Med/surg/Paeds/OBG)
4) Sub-spec
5) Specific Dx and DDx
Bio-Psycho-Social
approach
• Biological
• Psychological
• Sociological

9. Shellharbour Hospital:
Peripheral Hospital ED
Emergency Department
- 2 resus beds
- 12 Acute Adults+ 2 Acute Paeds
- 5 Subacute treatment spaces
Inpatient Service
- 87 Medical, Surgical and specialty beds
- Close observation Unit (9 beds)
- General Medicine
- Geriatric Medicine
- Surgical (8 Bed day care)
- 69 Mental Health beds
- NO Paeds /OBGYN
Presentations
>30,000 presentations/year
6000 Paediatric presentations

10. Team Interactions
ED
Psych
Gen Med
SSH
Gen Surg
O&G Paeds
ICU
SHH
TWH
AMAU – acute
medical assessment unit

11. UOW P3 students - Expectations
• Attitude - Turn up with your best game
• Professionalism
• Check in with ED Senior (FACEM or In Charge) at the beginning of shift
• Sign in
• Talk to them , clarify expectations for the shift
• Come with some personal Goals
• Calling sick, or other non-attendance
• Let people know in advance (UOW Admin – Sarah Perez, ED secretary Jo Kuvet, and Dr Bishan
Rajapakse – or Dr Ayman Elattar , Dr Phil Manczacs whilst I’m away)
• Learning
• Several styles of learning
• Feedback to Medical lead any problems , or goals not met
• (Dr Bishan Rajapakse – or Dr Ayman Elattar , Dr Phil Manczacs whilst I’m away)

12. Styles of ED
learning
interactions
• “The Shadow” (of EDSS / FACEM/
Consultant)
• Doctor allocation (CMO/SRMO/Nurse
Practitioner)
• Seeing own patients
(Hx/Exam/Presentation)
• Specific task Learning/Training (IV
lines/Plasters/bloods/other procedures)
May depend on
• Who is your consultant/ Patient mix and
staff mix (on the day)
• Your own goals / how well you work in
the team
Or a
“mix”
of
these

13. Department Behaviour Expectations
• We are an ED Team - There is no job that is “beneath” you or I
• Don’t get into arguments with the nursing staff (any staff)
• Discuss conflict with Seniors (Shift Lead or FACEM mentor)
• Maintain patient confidentiality

14. Expectations
• Be Safe (appropriate PPE)
• 8am for morning ward round, 2pm
for Eve round ;
• Check in with ED FACEM of the day,
or evening (or ED senior)
• Email Sam Mawhinney, or myself if
can’t make it
• Have fun and learn, turn out with
some learning goals for the
day/term
• Eg taking histories, procedures
• Be empowered ; but Take
responsibility , act like a resident,
• Get involved, get dirty (with
appropriate PPE; ALWAYS wear
Gloves )
• Be aware of the TEAM, learn the
ED way (adhoc, responsive,
situational awareness, closed loop
communication )
• Hafe FUN, LEARN, make Friends,
and look after yourself

15. SHH ED
Education
Program
• Usu 9-10am
Simulation Education every Wed Morning
• Either Thu or Frid
• 2:30 – 3:30
SHH ED Teaching - FACEM led / SRMO run
ED Training :DEMTs – Dr Angelo Abeywickrema / Dr Phil Manczac
SRMO Teaching program : Dr Ayman Elattar
M&M : Dr Kham Saysana
Research – Dr Bish Rajapakse
Make sure you get added to the Education Whats app group

16. Top Tips
1. Always wear gloves (and appropriate PPE)
2. Introduce yourself to everyone often
3. Ask “How can I help?” “Is there anything we can do to learn?”
4. Be patient, don’t take it personally if you are ignored
• Be aware of pressures of other staff and department
• Let us know of any bad interactions (with staff, patients, visitors)
5. Talk to and see patients
6. Procedures, procedures, procedures
7. Get involved in resus, critically unwell patients

17. A few
differences
about small
peripheral
ED
Pros
• Cosy cottage feel
• Get to work closely with staff
• Hands on
• Procedures
• Fun atmosphere
• Able to learn about niche
areas due to time (ED
ultrasound / Radiology/
Mental health/ social work
in the ED
Cons
• Sometimes less Patient
Acuity
• Less structure
• Resource limitations

18. Department
Spaces –
Types of
patients
ACUTE
• MED/Surg
• Paeds, Psych
• Spaces
• Resus (2 beds) 1 Paeds
equip (NETS cam)
• Acute Bed (Iso or Non-Iso)
• Paeds Bed (2, Isolation
capable)
• Coridoor 2 spaces – bed and
Chair
• Acute Waiting Room
patients
• Iso Waiting room (up
to 4)
• Rapid Assessment Room
(RAT room) 1 bed, 2 chairs
Sub-Acute
• Fast track waiting
room
• Plaster Room
• Procedure Room
(Nitrous capable)
• Consult Rooms x2
• RAT (room)

19. Medical Roles
in SHH ED &
On site
Services
ED Staff
• ED Senior /Shift Lead
• FACEM
• CMO / MMO
• Registrars (ACEM AT)
• SRMO
• Varying Seniority
• JMO
• Resident
• Intern
Services
Gen Med Reg
- 24 hour cover
Acute Surg Reg
- M-F (8-4pm) elective surgery
TWH
ICU Reg
General Surgery Reg (24 hours)
- All Surgical Subspecialties
GEN Med Sub specialties
PAEDs and O&G

20. SHIFT
STRUCTURE
MAIN SHIFTS FOR
DOCTORS
Day shift 0800 –
1800hrs
PM shift 1400 -
2400hrs
Night shift 2000 (2200)
– 0800hrs
NB PM handover can
be hectic, just check in
with the consultant…
and roll with it

21. Nursing
Roles in ED
Nurse Unit Manger (Frank
Testa)
- Daily Huddle 9:45 M-F
Acute Area
• Num1 (Nurse Shift Leaders) /
Nursing Shift in Charge
• Resus Nurse (R1-2 + Quiet
Room)
• Paeds Nurse (P1-2)
• Acute Bed nurses (A1-11,
Iso)
Triage
• Triage Nurse
• CIN nurse (looks after
Acute waiting room
patients – high load)
Fast Track
• Nurse Practitioner
• FT Nurse
• Physio Practitioners

22. Acute Waiting
Room Patients
• Patient’s who need acute
work up but do not warrant
a bed (or no beds available)
• Challenges and Pitfalls
• Get Missed
• Often don’t get
picked up due to
not being in bed
• Decreased care
• High patient to
Nurse(CIN) ratio
• Observations (less
frequent)
• Haven’t had
medications/anal
gesia
• Strategies
• SAS (senior assessment
• Investigations ordered at
triage
• JMOs and SMOs
• To pick up acute patients by
”Length waiting” not
convenience (ie patients in
bed)
• Ensure investigations are
taken and medications
given
• Support nurses where
possible
• Escalate concerns; Medical
Shift lead & NUM1

23. Allied Health
& Other
Services
• PACE Nurse (Amy Purkiss,
Jenny Larson)
• Clinical Nurse specialist
• Part of Emergency
Response team
• Nurse Educator (Ryan
Klogger)
• ASET
• Aged care nurse
• Social Worker
• M-F 8-5pm
• On Call from TWH
• LAB
• 8am - 8pm, onsite (leave at
9pm)
• TWH lab overnight >9pm –
regular collections & Courier
• Radiology (Xrays and CT)
• 8am-11pm on Site
• >11pm Radiographer Call back
• Ultrasound
• 8am-4:30pm
• >4:30pm on call Radiographer
(check with Shift lead before
making call back)

24. Top Tips
1. Always wear gloves (and appropriate PPE)
2. Introduce yourself to everyone often
3. Ask “How can I help?” “Is there anything we can do to learn?”
4. Be patient, don’t take it personally if you are ignored
• Be aware of pressures of other staff and department
• Let us know of any bad interactions (with staff, patients, visitors)
5. Talk to and see patients
6. Procedures, procedures, procedures
7. Get involved in resus, critically unwell patients

25. BE SAFE /
ALWAYS WEAR
GLOVES
• COVID checks
• Daily Temp Check/symptom check
each shift
• Scrubs available (encouraged)
• Protection from Aggressive
patients/agitated patients (SAFETY
FIRST)

26. Think like a
resident = work
like a resident
1) Safe & efficient patient care
2) Communicate and collaborate
3) Look after yourself (meal breaks)
& learn
Feedback/Debrief at the end of
shift to improve for the next one 
My ED Shift Vision/Mantra…

27. Humility is a
virtue..
EXPECT TO MAKE MISTAKES
AND LEARN FROM THEM

28. Don’t forget to enjoy your time with us –
WELCOME!

29. Summary
• Getting to know each other
• Layout of SHH ED
• Tips for best Practice/Learning ;
• Goals
• Styles
• Mindset
• Words from your predecessors
• Innovation & Experimentation?