State of the art in urban hems
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John Chatterjee's talk at The Big Sick 2018 in Zermatt. Rest of talks: https://scanfoam.org/bigsick18/
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State of the art in urban hems
- 1. John Chatterjee Consultant London’s Air Ambulance (Barts Health NHS) , Anaesthetics Guy’s and St Thomas’ NHS FT & Major Incident Advisor London Ambulance Service NHS State of the Art - Urban HEMS
- 2. Declaration of Interests John Chatterjee MBBS, FRCA, Dip Aero RT (RCS Ed), PG Dip RTM (Otago) MACAP Consultant Anaesthetist Guy’s and St Thomas’ NHS FT London Consultant Bart Health NHS, London’s Air Ambulance Faculty Institute of Pre Hospital Care Major Incident Medical Advisor London Ambulance Service Medical Advisor Remote Medic
- 3. Is London’s Air Ambulance unique anymore? ✤ Yes and No ✤ Medically led ✤ Experience/Exposure - ✤ Just Major Trauma for over 25 years ✤ Tasking - Independent of the healthcare economy ✤ Small group (more people have been to space*) *LAA Approx 350 Doctors vs 536 Persons 6/11/2013 Federation Aéronautique Internationale
- 4. ✤ Apps ✤ Youtube ✤ Twitter ✤ FOAM Ed ✤ Sharing should be with credit ✤ Data Smog Reinvention occurs less frequently….. Citizen Aid and Goodsam APPs
- 5. Expert vs. Opinion Let’s hope medicine doesn't enter a post factual era! Just making stuff up works for some….Prof Mark Wilson, Neurosurgeon
- 6. Elizabeth Foster, HEMS Patient Development Sister London's Air Ambulance: Mechanism of Injury, All 2017 Other = 16% Penetrating Trauma = 31% Traffic Incidents = 30% Falls = 23%
- 7. Who are the survivors of 2028? How do we get there?
- 8. Pushing the survival envelope The difference between who should survive and who can survive….. Catastrophic haemorrhage Cardiac Tamponade Abdominal Visceral Injury Pelvic trauma Cardiac contusion/stunning Lung trauma Impact Apnoea
- 9. Learning from others? Despite mechanical CPR, APPs Current LAS survival rates from Cardiac arrest - less than 10% (20% at best cf. 40% in hospital) SAMU proof of concept CHEER study increase up to 54%
- 10. Blending best practice…… Pre Hospital ECMO sub 30 mins Refractory Arrest for 20 mins Cath Lab ECMO ICU
- 11. What else? ✤ Better REBOA - Zone 1 SAAP ✤ Blood Products - whole blood ✤ Emergency Preservation Resuscitation ✤ but how do we find direction………
- 12. Who SHOULD survive in 2028? ✤ Collaborate ✤ Question ✤ Research ✤ Challenging to do trials - e.g. HIRT, EPR CAT ✤ The next generation ✤ e.g. Institute of Pre Hospital Care
- 14. Whats the knock on of all this innovation? ✤ It used to be simple ✤ Turn up > get the basics right ✤ But now ✤ Interventions can do harm (if our judgements are wrong) ✤ Live with clinical uncertainty Experience and exposure is needed to make these decisions
- 15. Whats the solution? Put a consultant on every shift? Make teams 3-4 clinicians? Big Data VR consultant presence?