Latest Advances in Pre-hospital and Retrieval Medicine: what you need to know

Transcription

1 Latest Advances in Pre-hospital and Retrieval Medicine: what you need to know A/Prof Andrew Pearce Clinical Director Education and Training MedSTAR Senior Consultant Emergency Medicine Royal Adelaide Hospital ASA/FNA Expanding Frontiers

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3 topics Social media REBOA ECMO Blood Central coordination and medical retrieval coordination Team Training Detail checklists 3

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8 8 Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma Dec;71(6): doi: /TA.0b013e31823fe90c. Review. PubMed PMID:

9 > Resuscitative Endovascular Balloon Occlusion of the Aorta > aorta three separate zones > Zone I left subclavian artery to coeliac artery (approx 20cm) > > Zone II CA to renal artery (approx 3cm long) > Zone III RA to the aortic bifurcation (approx 10cm long) 9

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11 INDICATIONS adult patients (aged years) PEA arrest exsanguination from sub-diaphragmatic haemorrhage hypovolaemic shock <70mmHg, or agonal state due to non-compressible exsanguinating haemorrhage, non/partial responders to rapid volume resuscitation suspected or diagnosed intra-abdominal haem due to blunt trauma or penetrating torso injuries (Zone I REBOA), or blunt trauma patients with suspected pelvic fracture and isolated pelvic haem (Zone III REBOA), or patients with penetrating injury to the pelvic or groin area with uncontrolled haem from a junctional vascular injury (iliac or common femoral vessels) (Zone III REBOA) 11

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13 Pre-hospital ECMO? post cardiac arrest Sepsis Ventilation issues 13

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15 15 ECMO in the Louvre

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21 therapy with fibrinogen concentrate may reverse a dilutional coagulopathy 21

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23 SARS, EBOLA, NEXT??? 23

24 SARS, EBOLA, NEXT??? 24

25 I want to be a part of that team! Gordon Trinca Lecture ATS/TAC 2009 Dr Andrew Pearce Clinical Director Training and Standards MedStar Emergency Medical Retrieval South Australia

26 teams Required to do our job How much training do we do together? Do you know what training your colleagues have done for their job? How can we effectively communicate without understanding each others backgrounds?

27 Teams Baker, Salas, King, Battles and Barach Teams make fewer mistakes than individuals your responsibilities as well as other team member responsibilities Teamwork not a given, need willingness to cooperate for a shared goal Teams don t have to work together on a permanent basis ie pilots, shift workers

28 Role of Teamwork in Professional Education of Physicians: Current Status and Assessment Recommendations J Quality and Patient Safety 31, Institute of Medicine (IOM) Standards for health care professionals patient safety a priority Team training programs Incorporate proven methods for team management Recertification in safety practices such as functioning effectively in an interdisciplinary health team

29 I want to be a part of a team

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37 Central Clinical Coordination One number 24/7 Immediate access to clinician Telemedicine Teleconferencing One message Paging, radio, sitreps 37

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40 training Meaningful Environment Credibility Constant Feedback stress inoculation Removing the blinkers 40

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48 In Summary Exciting new and emerging technologies Constant change Need to do the basic things well Need to train as a team Need to communicate clearly Need to look after each other 48

49 Thank you 49

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51 McDonalds 2 all beef patties on a sesame seed bun with lettuce, tomato and ketchup 51

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