At 10am every morning at Bankstown base, our team discusses cases over coffee. This process is called “Coffee and Cases” (C+C). This blog post is an accompaniment to a presentation at the August ’23 GSA HEMS Clinical Governance Day. The purpose of the talk was to update the service on the Quality Improvement Project I have been leading on. I also recently discussed the QIP on the “HEMS Debrief” podcast. Why is C+C important? There is something to learn from every case – especially when your caseload is predominantly high acuity. In contrast to hospital life, we work in relative isolation in HE ..read more

*Originally posted on the Sydney HEMS blog Uniform fitted. Induction complete. 10-mission milestone reached. It has been a learning frenzy. I’m a UK-trained emergency physician, and am two months into my year as a Sydney HEMS registrar. Some of my early reflections on the experience have had time to crystallise into bloggable form… I’m one half of a tag team Shared leadership has been a consistent theme. The doctor and critical care paramedic that make up a HEMS team both dictate the pace and direction at different phases of the mission. No “team leader” exists, it’s a tag team approach. This ..read more

Hi all, I thought I would share a poster of a QI project I completed (with the help of my QIP team) at the Royal London Hospital earlier this year. It is currently on display at the RCEM Annual Scientific Conference. If you would like to me to send you a pdf of the poster (the font is pretty tiny on here), the full QIP write-up, completed QIAT form (this was my FRCEM QIP for ST6), or any of the resources generated by the project (EDT logbook, poster, directory) just drop me an email – drrobertlloyd@gmail. Many thanks to my team Tom Palmer, Matt Mak, Anne Weaver, Mumtaz Mooncey, David Franklin ..read more

Captain Alexander Jolly and Captain Dave Fielding are commercial airline pilots. I met them through Project Wingman, a pandemic-induced collaboration between the UK aviation industry and the NHS.  For the last few months they (along with a few of their colleagues) have been helping us train. Specifically, they are debriefing and writing up human factors performances (overseen by clinical faculty) in a multi-specialty/disciplinary in situ simulation programme. The project has had a hugely positive impact. This is a recording of Alex, Dave and me discussing the project at our wee ..read more

Here is our latest in situ simulation write-up. This was one was done on the paediatric ward. Included is human factors feedback from our aviation colleagues who were present for the sim. SCENARIO 6 month old baby on paediatric ward Becoming increasingly drowsy, ward paediatric doctor alerted by nursing staff Fulminant sepsis secondary to chest infection x2 failed IV cannulations, IO performed CLINICAL FEEDBACK FROM DR. MUMTAZ MOONCEY (PAEDS TRAINEE) Positives Rapid diagnosis of sepsis Intravenous antibiotics and fluids commenced early Decision-making in keeping with APLS/EPALS guidance Awa ..read more

SCENARIO Case was an acute severe/life threatening asthma episode in a young patient. TECHNICAL FEEDBACK FROM DR. ADAM REID (EM CONSULTANT) Hi all, Thanks to those who participated and observed our acute severe asthma sim the other day. Particular thanks to Dr. Lachlan Robinson for stepping up to the plate at the last minute and leading the team in a calm and collaborative fashion. Main points from my perspective were as follows (more expert and in-depth non-technical feedback to follow from our pilot colleagues!): Important for team to be aware of severity of asthma and declare it  – as ..read more

Here is the write-up of our latest in situ sim. Along with the human factors feedback from our colleagues in aviation (which you can find at the end of the post), I’ve included the “technical” feedback from myself and two of my EM consultant colleagues as I thought it might be of interest. Scenario Young male, cyclist v car just outside hospital, ambulance scooped and ran (and therefore brought to us… not a MTC). A: snoring, vomitus around mouth B: external signs of right sided chest trauma, hypoxic, dull and decreased AE right C: tachycardic and becoming increasingly hypotensive D: GCS7, tole ..read more

“Communication is not like a conveyor belt where the meaning is transferred from one person to another arriving – and being interpreted – exactly the same way it was sent” Redding and Sincoff (1984)  Over the course of the simulation sessions we have observed, the biggest thing that has struck Alex & I has been the way explicit instructions involving patient safety, and specifically requests for medication, are given with no readback for confirmation. No-one has been able to say why this isn’t done: it just seems to be custom and practice. The dangers of misunderstandings would seem ..read more

Last week we my department ran another in-situ sim. It was quite a challenging one from a technical point of view. 62 year old BIBA looking unwell Paramedics hand over he was found on a park bench, blood around his mouth, GCS 13, HR 110, couldn’t get a BP, patient very unwell/periarrest A-E assessment done Haemorrhagic shock, evidence of malaena Major haemorrhage protocol activated First unit of O neg given – patient had anaphylactic reaction to transfusion Transfusion ceased, 0.5mg IM adrenaline (1/1000) given Transient improvement and then further deterioration (refractory anaphylaxis ..read more

Captain Dave Fielding and Captain Alexander Jolly are commercial airline pilots. I met them through Project Wingman, a pandemic-induced collaboration between the UK aviation industry and the NHS. We met up over a coffee in the Whittington Hospital “First Class Lounge” and compared notes on our respective professions. In particular we discussed human factors and simulation training. Alex recently attended a sim in the Emergency Department which you can read about here. This one is a corker! You can also listen on Apple Podcasts and Spotify. Robbie @Ponder_Med (twitter) @ponderme ..read more