Pecha-kucha SMACC 2013

Well my three ‘pecha kucha’ talks have been uploaded to the SMACC website at http://smacc.net.au/category/pk-talk

Quite a novel format – only 20 slides, 20 secs each – 400 sec only for each talk

Better than ‘death by powerpoint’ @ffolliet would be proud.

SMACC2013 looks to be fun as well as bringing together critical care enthusiasts. Even though a humble rural doctor, I am mindful that critical care does not respect geography. So managing critical care comes under our remit.

Too often we see a divide between super-specialist tertiary centres and the reality of delivering healthcare in rural Australia. Rural docs are often resource limited, and we deal with critical illness relatively infrequently.

Casey Parker and I had a natter about this in Perth at the ACRRM 2012 conference…both committed to rrying to help bring ‘quality care, out there’ – neither of us is prepared to accept a lesser standard of healthcare in the country, purely because of geography.

So my three PK-talks are

– a rant on affordable difficult airway equipment options for bush doctors (but equally applicable to small EDs and ICUs

– a rant on the failure of Australia to adopt an immediate care scheme akin to the UK’s BASICS … Whilst we have outstandingly good retrieval services in Oz, the tyranny of distance means that there is inevitably a gap in the bush, especialy when paramedics in the bush may be volunteers. Rural docs with airway skills are well-placed to fill the gal – but if involved in prehospital work they need to be equipp, trained and audited. I may get drummed out of EMST directorship for some of my comments on this entry-level course…

– a rant on wildlife-vehicle collisions on Kangaroo Island and a novel strategy to reduce the trauma. Classic prevention, not cure – ultimately primary care applied to trauma

Enjoy!

There’s an App for that…

Medicos often have a pendant for gadgetry. Anaesthetists and others involved with machines that go ‘bing’ (I’m thinking critical care and EM) have a reputation for being “propellor heads“.

But there’s an advantage to being tech-savvy. I was reading a post on the excellent BroomeDocs this week, concerning the possibility of awake fibreoptic intubation and remembered ‘there’s an App for that’.

So here’s a collection of some Apps that I reckon are useful for rural docs.

(i) awake fibreoptic intubation

Well-written and succinct guide to AFOI and topicalisation of the airway from FANZCAs. Useful.

(ii) Pain tricks

Brilliant app for kids and their parents, prior to painful procedures. Recommended

(iii) iSimulate

Brings high-fidelity scenario-learning to your rural hospital – great for encouraging teamwork and troubleshooting problems in logistics-over-strategy in both ED and Theatre. Inspired work!

(iv) DrawMD Anesthesia/CriticalCare

DrawMD have made several modules available for free. I use the anaesthesia one to explain LMA and ETT pre-op, as well as talk through spinal vs epidural for my parturients.

(v) FlipBoard

Awesome. Much better if you import all RSS feeds to Google reader, then import the GoogleReader feeds to FlipBoard. Et voila – LITFL, Weingart, Resus.ME, BroomeDocs, the PHARM etc all in one place.

(vi) Patient.co.uk

Well, I’d prefer it if there was an Australian version, but this allows me to pull up patient information leaflets quickly to aid explanations

(vii) Numbers, Keynote, Pages

Slimmed down versions of the OSX classics. Easy import/expore from the flaky MS Office suite. I use Numbers to generate invoices for my in-patient and theatre fee-for-service billings, Keynote to play around with presentations and Pages to write angry letters to the Health Minister.

(viii) Perry?

Where’s Perry the Platypus? Brilliant game for kids and (ahem) older kids.

(ix) PocketMBS

For all those hard-to-remember MBS item numbers

(x) GoodReader

Where would I be without it? All my favourite documents & papers in one place, easily categorised and available in seconds. Got a dispute over contracts and can’t remember the terms of clause 13.2.1? GoodReader provides. Want to stash that interesting paper on apnoeic pre-pxygenation somewhere for quick reference for sceptical anaesthetic colleagues? GoodReader is the place.

Of course, the iPad makes a perfect vehicle for all this. I’ve begin to collate all my emergency resources into GoodReader along with my previous ‘Rural Theatre Checklists‘ so that information I need is always at my fingertips and easily updated.

Any other suggestions?

Rural GP Anaesthetists – a ‘special needs’ mob?

As a rural doc I’m very lucky to have a job that is varied. I tell students and junior doctors that rural medicine offers all the stimulation and challenges of all the ‘best bits’ of medicine.

Currently I practice primary healthcare, emergency medicine and anaesthetics (I gave up obstetrics last year).

So this weekend just gone was a highlight – a chance to attend an annual GP-anaesthetics conference at one of the mainland tertiary hospitals. I’ve had this date ruled off in my diary for 12 months now…so you can imagine my disappointment when the ferry to/from Kangaroo Island sustained damage in the recent storms and the replacement therapy had to be hurriedly re-surveyed, launched and pressed into service. Needless to say all Rex flights were booked out days ahead and despite lots of people needing to get to/from KI, Rex declined to put on extra flights.

Noone can control the weather, but the lack of a contingency plan was disappointing. Not that Rex have a strong history of customer service…

Anyway, I missed the first day of the two day conference. But although I made it to the second, I was somewhat underwhelmed by what I did attend, cementing further my belief that there needs to be content tailored to the rural GPA delivered by people who ‘get’ rural medicine.

To backtrack, I went to my first rural GP-anaesthetist in NSW last year. It was really good, a day and a half of lectures, plus a half day in the sim lab doing emergency scenarios. But what struck me there was the disparity in equipment and resources available between city and rural anaesthetists…as well as between rural GPAs in different parts of the State. Lectures by some of the FANZCAs were all very interesting…but often they did not realise the conditions in which rural GPAs work (isolated, minimal equipment, no backup, cash-starved). At the same time I was getting increasingly inspired by blogs such as Resus.me, BroomeDocs.com, Prehospitalmed.com and LifeInTheFastLane – all of which seemed highly relevant to my practice.

So I resolved to look at some quality improvement in my own practice on my return to SA, mindful of the fact that it made sense to have commonalities in equipment and protocols available to rural anaesthetic providers. Setting up a GoogleDocs survey was relatively easy, and I was gratified to get a 2/3 response rate from rural GP-anaesthetists around Australia on my topic of difficult airway equipment availability. I’ll be talking about this at the Fremantle Rural Medicine Australia conference and my paper should be out in the Oct-Dec volume of Rural & Remote Health. Stay tuned…

So, a year down the track I had really high hopes of further upskilling in SA. Whilst most of the content was good, there was an alarming propensity of some lectures to cover topics like cell salvage, lab-markers in major transfusion and the like – all very interesting, but not translatable to the rural practice environment where such resources aren’t available. Questions on topics such as delayed sequence intubation and whole blood live donor panels were unfamiliar ground for the FANZCA experts, although very pertinent to many of the rural doctors.

Small group sessions made up for it, with hands on experience and chances for case discussion.

But a common theme amongst the people I spoke to was that city anaesthetists task with lecturing had very little idea of the resource limitations in country areas. The vast majority of us don’t have remifentanil..or desflurane..or BIS…or access to FFP/cryo/platelets…or labs..or $15K videolaryngoscopes. The FANZCAs who visit rural hospitals, whether for elective lists or retrieval, did at least have an idea of our circumstances Yand ‘special needs’

So, what does the rural GPA really need?

– lectures from experienced anaesthetists? Hell yes.
– small group sessions and case discussions? Even better.
– topics targetted to the audience and suggestions for improvement. Absolutely!

…and to top it off, perhaps consideration be given to sharing the knowledge base by holding two sessions per year (allows more docs to attend…as if one doc is at the conference, the other needs to be oncall)

…and even better, consider delivering content in rural areas by taking some of the ideas on the road.

The other thing that concerns me is the lack of communication between rural docs. Locally the RDASA has a ‘rural anaesthetists’ email group, but it has been inactive for a few years. It seems that many of us have the same issues with respect to equipment procurement, training and upskilling – yet operate in silos. Moreover there is little ‘top-down’ direction – certainly I have no sense of direction from the ‘Country Health SA Anaesthetic Consultant’ and it would be nice to see some more dynamism.

Maybe next year will be better…I’m going to keep pushing the barrel for local delivery of leading edge concepts in EM/anaesthesia that are rurally relevant for myself and other doctors.

Email me if you have any thoughts on this.