A HEMS experience from a resident perspective (and a few pictures from my last flight)

This post is being written while on a plane back to Toronto…I’m just settling into some serious jetlag so I figured no better time than put down a few thoughts on my experience in Auckland. For the past 6 months I’ve worked in NZ with the Auckland Rescue Helicopter Trust as the HEMS education fellow and flight physician. Coming from Canada where putting physicians on-board helicopters to work in a pre-hospital environment is about as foreign as …. I came to Auckland with little knowledge about what to expect.

Posing for the photo op. Realized a modeling career isn't in my future.

Posing for the photo op. Realized a modeling career isn’t in my future.

To say the least, the entire experience was amazing and unforgettable! And much of this must be attributed to amazing group who work at ARHT. My supervisor and HEMS medical director, Chris Denny, got me organized and met with me weekly. We set out a plan, established learning outcomes and gradually implemented an advanced simulation plan at ARHT. Amazingly the ARHT facilitated this with the purchase of several brand new simulation manikins which only enhanced the learning possibilities. I worked alongside several talented physicians (Sam Bendall and Scott Orman) who mentored me in advanced simulation techniques, e-learning, integration of social media and blogging into education.

My time at ARHT was divided between educational endeavours and work as the HEMS duty doctor. Both allowed me to work and learn with the entire ARHT team who taught me more than they can imagine! While I can’t possibly thank everyone in this format, I developed great relationships with Barry Watkin (chief paramedic) and Herby Barnes (head crewman) who both worked to help me implement some of our educational objectives!

A view of Auckland at sunset

A view of Auckland at sunset

As the HEMS education fellow, I ran weekly simulations (often based on jobs we had recently done or questions that had come up), case-based learning sessions and finally task training sessions. We described our learning online both through the aucklandhems.com blog and via Twitter. We flew across the Tasman to practice our pre-hospital ultrasound skills at SMACC2013 (an impressive 2nd place…despite our less than optimal subject matter we had to teach)! (link). We implemented new standard operating procedures based on (and tested in) simulation. There was collaboration with teaching and simulation with the Auckland City ED as I worked there part-time as well.

On the west coast outside Auckland

On the west coast outside Auckland

Finally, I had the opportunity to practice pre-hospital & retrieval medicine. This opportunity to learn from some amazing doctors, paramedics, crewmen and pilots in a setting that previously was entirely unfamiliar, was awesome! I gained an entirely new appreciation for ergonomics as practicing medicine in the back of a helicopter is entirely different than even the craziest of emergency departments! I had opportunities to do winch rescues (both practice and operational), jumping from helicopters, rock swims with surf rescue, run resuscitations in remote areas and the list goes on.

What stood out however, was the theme of safety. In medicine, safety is sadly a relatively new topic…but for many of our pilots and crewmen, safety has been a part of their work since they started. In fact, those in aviation who don’t embrace safety…tend not to have very long work careers (for obvious & unfortunate reasons). Working in a helicopter is among the highest risk occupations around so it’s not surprising the ARHT team take safety so seriously. I spoke with the crewmen and pilots as much as a could to better appreciate their perspective…so that perhaps in medicine I can borrow and learn from their obsession. I suspect (as others have as well) that medicine lags in safety management because bad outcomes don’t harm clinicians directly…in a helicopter however, lack of concern for safety does affect everyone onboard. Thus the entire team has a vested interest in promoting and ensuring safe procedures. We run safety briefings, we have an online safety management system in place and just like the rest of aviation we incorporated checklists for both routine & high-risk procedures. As HEMS doctors, we tried to emulate the pilots/crewmen so we also use a checklist for our high-risk procedures like rapid sequence intubation…this is just starting to catch on in the ED but in my opinion there’s much room for improvement! I once asked one of our pilots about checklists and why they use them… I told him that in medicine, people fear checklists because they think it will take away their ability to think…he laughed and replied:

“we have checklists not so that we stop thinking…but so we can start thinking during a crisis and not worry about forgetting small details”.

And that brings me to the end of my last blog post at ARHT. A huge thanks to the entire team at HEMS & ARHT for inviting me to Auckland, helping me learn and trying new things! I will continue blogging but likely with a shift towards simulation and education. I’ll still be collaborating with the HEMS team at ARHT and hopefully posting some stuff on aucklandhems.com. So that’s it for now…back to my inflight movie, Argo.

A reflection on SMACC (Social Media and Critical Care Conference) in Sydney!

The past 3 days has been a whirlwind experience in Sydney, Australia where I attended the Social Media and Critical Care Conference (@smacc2013).

smacc-big

I joined a group of several of my colleagues at Auckland HEMS to participate in the inaugural conference. It combined two seemingly unrelated things – social media & critical care. Making it probably the among the first (if not the first) medical conference to have social media as a key theme. Over the past few years, physicians in critical care, emergency medicine and prehospital medicine have become leaders in social media and using the internet as a learning tool. The creators of the conference started the innovative website Lifeinthefastlane which is a blog read by thousands of acute care physicians around the world. They decided to extend their scope and create a conference which in my opinion was a huge success! This conference was a natural extension of the relatively new concept that highlights “medical education for anyone anytime, anywhere” – this concept is known as FOAM or “free access open meducation” (#FOAMed on twitter). I won’t describe it fully here as others have already done so. But it’s the way in which we use social media and the internet to share, disseminate and collaborate within medical education.

As a reflection on the conference I’d like to share a couple highlights and concepts that emerged. What was unique about the conference was the use of Twitter. There was heavy emphasis on live tweeting during each session with a designated twitter coordinator who would pose questions to the speakers directly from those asked on Twitter. There was constant discussion on Twitter with both conference attendees and even those clinicians half-way around the world. Let me provide a brilliant demonstration of this in action. In one session about coagulation in trauma, the session facilitator (Dr. Minh Le Cong from the blog PHARM) tweeted asking for comments from those in the twittersphere. Within minutes there were comments coming in from Dr. Karim Brohi, a trauma surgeon in London, England who is a world expert in coagulation in trauma. A discussion among the speaker and the audience resulted based on his comments. Never before had I seen such interaction at a global level occur during a conference. The power in capturing ideas and facilitiating live discussion among both those attending the conference and leading experts sitting in a room across the world is amazing!

When I would look around the room in each session, there was a barrage of tweeting with many sending out comments made by conference speakers as they happened. This is incredibly powerful. It allowed for an immediate online commentary for those not attending the conference. But it also allowed those of us in other sessions to hear some highlights and really get an idea of what was happening especially if there were controversial topics being discussed.

Every talk was videorecorded and posted online for free viewing by anyone in the world. This represents a huge step in promoting free open access medial education (FOAM). Why we restrict education to those who can afford or arrange travel to these conferences is mindboggling. Our business is to improve patient care and if we can collaborate and share ideas that emerge from great meetings like this then our patients will definitely benefit.

Imagine a speaker says something quite controversial. Previously it might never really be discussed again. Or perhaps it might be misrepresented several weeks or months later in a report. At this conference, speaker comments could be disseminated rapidly with the opportunity for rapid responses and discussion.

Unlike many academic conferences, speakers were introduced based on their blog (and not their publication count or number of academic achievements). While the merits of publications should not be diminished, it highlighted that an online presence where your ideas are shared, exposed and subject to review from people around the world is a new way to gain status within the medical world.

Finally, the conference started to address how FOAM, social media and asynchronous learning can be incorporated within medicine. There were enthusiastic talks that demonstrated the power of online education but also some excellent perspectives that online learning is not a learning panacea. These sessions were humbling since we must remember that despite all this technology, we still treat people. Our job requires human interaction and without reflection we can begin to forget this. Those on blogs and twitter drive the curriculum because topics are interesting, but sometimes the less sexy topics deserve discussion. There’s no curriculum to guide us online and this may not always benefit learners.

As long as we can appreciate these limitations we can maximize the potential of a asynchronous learning using an online platform. Never before can we collaborate, share, discuss and even criticize. It’s an exciting time for medical education and SMACC did a great job making it a reality!