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Annet Alenyo Ngabirano.

(That's Annet on the right in the photo with Kat Evans on the left and Mulinda Nyirenda in the middle.)

Emergency Medicine in the Uganda, the pearl of Africa.

Annet presented at dasSMACC and has become a huge personality in the the developing community of emergency medicine in the continent of Africa. While we associate Annet with Uganda she is really an Adventurer, on an adventure that goes beyond the borders of any country.

This is a wonderful insight into the curious journey of one special person. It stretches from Mbarara to Berlin, from South Africa to Sydney. There is much to learn and at every step there are surprises.

Annet found out so much about her own system through her normal training (normal for Mbarara) but also through personal tragedies. Her journey has turned her mind to things that she hadn’t thought of, she learned new practical skills and she even learned to ride a bike.

Dr Alenyo Ngabirano is interested in research but she is interested in research that asks the right questions. We all are but I cannot tell you what the right questions are for any sub-specialty and you cannot tell Annet what the right questions are for Ugandan Emergency Medicine.

Uganda is a country in which emergency medicine is only emerging. What exactly do we need to build? What exactly do we have? How do we even find that out?

There seems to be an increased effort by the FOAM / FOAMed community to spread the useful stuff around, spread the love, spread it beyond the big FOAMed three; USA, Australia and UK. That is not as simple as it sounds. We have to try to avoid all the mistakes that have been made in the past, this is not an opportunity to feel good about ourselves and the good thing we do. What we should do is listen to the people on the ground. Listen to the locals. Do the appropriate research. Support the people that are there and that will stay there. Figure out what we know and what we need to find out. Annet realises that even she needs to know more about the system in Uganda and she knows more about it than you ever could.

CODAchange wants to step into this space. It won’t be easy. There will be many opportunities to mess things up. To start with maybe we just need to talk to our colleagues in other places. It is about relationships. Take an interest. Find out more. Maybe even go and see for yourself but go there to learn stuff rather going there with some idea that you can tell people what to do.

Annet and I talk a about AFEM, the African Federation for Emergency Medicine ( aka Fedération Africaine de Médicine d’Urgence ) which is a fast growing pan-African organisation that works to ensure the development of collaborative, comprehensive, and cross-cutting emergency care systems in Africa. Check out their projects. Have look at their Handbook, available from Oxford University Press and everywhere. The second edition is out recently. The first edition had the same look as the legendary Oxford Handbook of Clinical Medicine. (I still have my first copy of that book, feeling a little bit nostalgic just considering that.)

https://afem.africa/what-we-do/

https://afem.africa/project/afem-handbook-of-acute-and-emergency-care/

Their next conference, the African Conference on Emergency Medicine (AfCEM) is in Mombasa, Kenya in November 2020. Why not go there? Why not show these guys respect and contribute to the growth of their conference and federation simply by attending as a delegate? Why not go one step further and Support a Delegate at the same time? The Support a Delegate appeal at dasSMACC was very successful. But it was not a one off. There are still conferences, there are still under-funded delegates. Please do not forget this practical and ultra-tangible way of lending a helping hand.

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The little audio clips at the beginning and the end are topical. The actor and singer Seu Jorge is a Brazilian legend. Having shot to international recognition in the 2002 movie "City of God/Cidade de Deus" he has become a huge figure in Samba. This track is a cover of the Bowie classic "Oh! You pretty things" as performed for the Wes Anderson masterpiece "The Life Aquatic". Both movies are recommended as is the associated album "The Life Aquatic, The studio sessions featuring Seu Jorge".

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At the last SMACC event in Sydney the Brazilians turned up in force. It was impressive. They came to learn but quickly it became apparent that we should be learning from them too. I won’t pretend to be a SoMe expert but I have never come across such sophisticated use of Instagram as a #FOAMed tool. Instagram is pretty huge and it may well be the number one SoMe platform for the generation that is entering medicine now. So if you are interested in things like teaching young nurses, doctors, paramedics then you might learn something really useful from an unusual source. Instagram is not a fringe #FOAMed platform when Nursing Educators have nearly 200000 followers on Instagram. First let’s quickly talk about the weird thing that just happened to you if you listened to the podcast first. Yes the podcast is 80% Português. It starts with that annoying Irish guy and then the Português starts at 6:20 when Henrique Herpich takes over. The English starts again at 24:20, cue laughs and we are done. We immediately went out for drinks and there is a reason that the Irish and the Brazilians get on very well. (My brother in law is Brazilian. He is extremely cool. Olá Gustavo!) But why? Why would I try to alienate the listeners to this podcast by hitting them with a podcast in another language? The Lusophone Commonwealth is why. Brazil, Angola, Mozambique, Portugal, Guinea-Bissau, East Timor, Equatorial Guinea, Macau, Cape Verde and São Tomé and Príncipe. 207 million Portuguese speakers in Brazil alone. Most Portuguese speakers are in countries where medicine is either developing very fast or in need of developing very fast! So they could do with some Português FOAMed. So we need FOAM other than English; #FOAMOTE The hope is that everyone involved with #FOAM and #FOAMed will look to their language-other-than-English colleagues and see opportunities and not barriers. These people want to work together and the fact that YOU don’t speak their language does NOT mean that you cannot work together. (That and the fact that @Sandnsurf speaks Portugueś and wanted to hear more Portugueś podcasts.) 
This PodcastThese are the #FOAMedBRA people that were in the room: Ian, Henrique, Lucas, Jule, Niciole and Daniel. @breakem www.breakem.org Go there and click on “Quem seguimos” (Who we Follow). (Nearly Dr) Henrique Herpich Twitter @H_Herpich Dr Lucas Oliveira J. e Silva @Lucasojesilva12 isaem.net Dr Jule Santos emergenciarules.com Twitter; @julesantosER Instagram; Emergencia Rules and a podcast! https://podcasts.apple.com/au/podcast/emerg%C3%AAncia-rules/id1387183276 Dr Nicole Pinheiro @nicolepin Dr Daniel Schubert Twitter @ducschub So what I want all #FOAMedBRA people to do is spread this around all the nurses, doctors, paramedics in the Portugueś speaking world and get them to visit this post, listen to this podcast because this is a felicitation. This is people like me and people like you saying “HelloMyNameIsXXXX, nice to meet you, how can I help?” to the entire Lusophonic world. There is more that unites us than divides us.
 FOAMbra Links are all on LITFL.com and TheTopEnd.org

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Abnormal Treatment Behaviour.

The stress and trauma associated with what you do is real and it affects how you perform.

Jannie Geertsema is a child and adolescent psychiatrist working at the Hospital Formerly Known as Lady Cilento Children’s Hospital. He was at the last wonderful Don’t Forget The Bubbles Conference in Melbourne. The “doctor patient relationship”. You may work in a ‘gnarly’ emergency room, or an over run ICU but the sort of damage we are talking about can be severe in almost any care-givers role. Jannie is a care giver that works with children/adolescents and their parents and regularly finds himself in the unfortunate space in between parent and child. Think about that sort of dynamic. It’s a dangerous space as Leonardo can tell you. Jannie has become increasingly interested in this and started to dive into the stress and trauma associated with his role. Increasingly he has found that many of his colleagues (psychatrists and others) have similar problems. There is one half of that relationship that we almost certainly have not given the appropriate attention. My half. The providers half, The therapists half. Your half. You! Jannie throws himself on the psychiatrists couch and blows open a rarely considered trap; The Abnormal Therapeutic relationship. This exists for all clinicians in a “therapeutic” relationships with their patients/clients/consumers. Call them “variably autonomous, mostly humanoid, largely organic carbon based therapy consuming units” if you want. (Usually referred to as VAMHLOCBTCU’s). I usually still call them patients but I am not a psychiatrist or a midwife or one of the various other disciplines that have their own good reasons not to call them patients. We talk a lot about the “Doctor-Patient Relationship” in this podcast. But we are not just talking about doctors when we talk about “Abnormal Treatment Behaviour”. There are a few reasons that the “Doctor-Patient” phrase is used; the crucial paper that Jannie refers to is written by an Australian Psychiatrist qualified in the 1960’s; Prof Bruce S Singh. (I mistakenly refer to his paper as being written in the 1960's but it was actually published in 1981.) And both Jannie and I identify as doctors. Jannie expands on this further when you listen to the linked talk from DFTB and is asked a question about it at the end. (There is a link below.) There is not a lot more written, at least not that Jannie has found. That we have only one paper written by a psychiatrist does not dismiss the other variations on this theme. In fact, each variation, be it Nurse-Patient, Psychologist-Patient, Social Worker-Patient…., would surely merit it’s own analysis. I am willing to bet that there is more written about this by experts from the other caring professions than by the physicians. If there is one thing to take away from this it is that I do not exist as an inert perfect practitioner. I do not perform in a perfect space. I am flawed. I have feelings. I barely know what my own feelings are. But if I can just keep in mind that I do have thoughts and feelings, that they do affect my interactions with others, then I am at least cogniscent of the fact that roughly half of the people in the “Doctor-Patient Relationship” are Me. Or You. Or Us. I do not need to have read, or agree with, Freud to benefit from that sort of insight. As Jannie puts it if you can keep in mind that you are anything less than perfect then you are getting somewhere. If you can get to the next DFTB then you are getting somewhere special. If you cannot then you can stream the entire conference for a small fee or for FREE if you are in a lower/middle income country. That is fantastic. Has anyone else done that?

LINKS All the Links are available over on TheTopEnd.org

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Vaccine hesitancy and vaccine refusal. New York is in crisis. Who is hesitant, who is refusing, what should you do? We asked Dr Margie Danchin. She knows.

New York Measles Crisis. This is not a paediatric issue. This affects us all. Margie Danchin has been thinking about vaccines and the related controversy for many years. She is a paediatrician that has researched and worked clinically in this area at the highest level. She shared her knowledge with the lucky punters that came to DontForgetTheBubbles in Melbourne last year. DFTB 2018. If you can go the next DFTB, in London in June, you really should.

THE BLURB

New York City is in a health emergency. Mayor Di Blasio has taken the radical step of making vaccination mandatory and has threatened fines of $1000 for non-compliance. How did we get to this? What are exemptions, who asks for them, who gets them, who gives them and who makes up the rules?

You might have an opinion about vaccination and anti-vaccination. You may have read a bit about it. You have not read as much or thought as much as this woman. Margie Danchin is a researcher and clinician practicing in this area. She was willing to speak to the room at DFTB2018. She was willing to come and talk to the podcast. Margie gives a fantastic insight into the Australian version of this problem and her insights are really valuable in times like this not just for Australian listeners, for us all. A crisis like this is potentially coming to your town, your city and your hospital soon. I strongly recommend you listen to this and check out the wonderful DFTB page which has a bunch of great links and her talk on stage and a great illustrated note (#doodlemed ) by @gracie_leo and more good stuff. You have to be impressed by what Drs Davis, Lawton, Goldstein and Tagg are doing over there. I am. @TessaRDavis @paedsem @henrygoldstein and @andrewjtagg

Go to the conference in London. If you cannot go you should follow the DFTB Podcast and those little Educational Nuggets will literally find their own way to you. Then go to the next conference in 2020. Have you got something better to do?

Margie is a compassionate doctor that reads the hardcore medical research and sits with the real world vaccine refusers and vaccine hesitant people. She spends hours of each week with real people that care for their children in her specialist clinic in Melbourne. Listen to her wonderfully balanced and open-minded words.

The MumBubVax resource is here.

http://www.ncirs.org.au/ncirs-seminarwebinar-series/20319-2019-influenza-program-and-mumbubvax-new-tool-support-midwife

LINKS are good.

@DanchinMargie

http://www.ncirs.org.au/our-work/sharing-knowledge-about-immunisation

https://www.skaiproject.org/about-the-projecthttps://itunes.apple.com/au/podcast/dont-forget-the-bubbles/id1281356948?mt=2

https://dontforgetthebubbles.com/margie_danchin/

The Jellybean Podcast is a funny little thing. We advocate and collaborate. In the coming months there will be a load of new interviews. A very mixed bag of different subjects and different voices from different events and different backgrounds. We kind of need people to subscribe to be able to keep going.

https://thetopend.org/subscribe-to-the-podcast/

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Mwiche Chiluba

TITLE Emergency Medicine in Zambia

At the moment there is only one public emergency department in Zambia that actually has a trained emergency physician. It only has one. That’s the boss. It’s Mwiche Chiluba. (@mwichiluba) A few years back she literally quit her old job, packed her bags and set off to South Africa to learn how they are practicing emergency medicine. Four years later she completed her training and packed her bags again.

This is not a one woman show but it is pretty close. Across the world, in every continent, there are women and men like Dr Chiluba that are in the vanguard at the front line of the expansion of critical care. This is not an African thing, this is not a lower middle income countries thing, this is everywhere. Emergency medicine is still relatively new. We are still developing EM. We have more in common than many appreciate. We can help each other and learn from each other.

Zambia, landlocked nation in southern part of the continent of Africa with a population of approx 17 million people. Health care parameters are improving very fast. Huge recent improvements in maternal mortality and childhood mortality are a great indication of how fast things are developing. Emergency is a new discipline.

One of the nicest things about how Mwiche sees it all is that, with not one single emergency physician to help her, if you ask Mwiche what she is doing to train more doctors, she is immediately careful to emphasise that you cannot deliver a good emergency medical system with emergency physicians alone. She has solid nursing and primary health support but she wants triage systems, paramedics, specialist support. Triage is a developing art in Zambia, in Mwiche’s hospital even with her

Every hospital EP

A great insight into one nations emergency medicine and the huge role that nursing professionals play in healthcare delivery. Nurses carry the weight. Lest we forget.

At the SMACC event in Sydney in 2019 the organising committee invited emergency medicine ambassadors from around the world. The Jellybean Podcast was lucky to be able to catch up with a number of these amazing people. Thank you to Mwiche for coming on the podcast and thank you to the SMACC people for having the foresight to see that we need to hear voices like Mwiches. We have a lot to learn.

Links are good;

Twitter Dr Chiluba @mwichiluba SMACCreach people @aalenyo @mgabin5 @Mulinda_EMalawi @ulovegeorge Societies etc @RECA_RWANDA @EMAT_info BADEM people @bad_EM @craigwylie @Kat__Evans African Journal of Emergency Medicine @AfJEM Developing EM @developingEM

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FOAMed is just not for English speakers. We love a bit of FOAMote (FOAM other than English)

At SMACC I set out to meet the international visitors to find out about their version of Critical Care. And let me tell you, the Chilean version is pretty impressive.

Chile is special. The longest country in the world with the driest desert, the highest lakes, the highest volcano, a huge mountain range making it strangely isolated and then they have Patagonia.

The health system is highly developed. Emergency medicine has been growing for 25 years and there are conspicuous local and imported protagonists to thank.

https://developingem.com/2014/08/14/presenter-profile-billy-mallon/

If you only read one article to accompany this podcast let it be this one:

https://www.sciencedirect.com/science/article/pii/S0716864017300299

These days the home grown talent is taking up the reins and I was lucky to meet 4 of them at SMACC. Chile probably has the most high functioning health system in South and Central America. Based on a solid economy and a long history of professional advocacy the discipline of Emergency Medicine is now formally recognised by the Ministry of Health and by the rest of the world. Chile could become a power house of critical and emergency care in the Spanish speaking world. Do not underestimate these people.

Cesar, Loreto, Manuela and Josefina came to SMACC in Sydney where I was waiting to meet them. Have a listen to what this group have to say.

Challenges do, of course, remain. Chile has long since made the “epidemiological transition” to 1st world pathologies. The delivery of care still varies depending on location. Santiago is very well served but the regional and rural areas less so. They have robust public health and vaccination programs, but there is a resurgence of some infectious diseases in part related to population movement. Their economy is strong and their government has been increasingly willing to take on the responsibilities that go with being a regional power. Their borders are long and they have had a huge increase in asylums seekers, refugees and other immigration in recent years. Not insignificant numbers of French Creole speakers have come from Haiti, perhaps related to the presence of Chilean peace keepers. Mass immigration is new. The challenges it brings are huge.

It’s a steep learning curve. But, let’s face it, we like steep learning curves!

Some links, links are good;

The App Josefina Larraín spoke about is Reanimapp ( @reanimapp )

The city with the large indigenous population is Temuco. The indigenous language spoken in the hospital is Mapudungun. “Do not underestimate the South American countries.” So said a wise woman from Santiago.

Chilean Spanish Language #FOAMed resources;

Mueve www.mue.cl Twitter @MUE_14

Sociedad de Chilena Medicina Urgencias www.socihmu.cl Twitter @Sochimu

MonKeyEM www.MonkeyEM.com Twitter @MonKey__EM

MCU Universidad de Chile www.mdu.cl Twitter @UChileEM

Conferences

Sochimu has its first Congreso Medicina de urgency 21-22 Nov. 2019

https://www.sochimu.cl/noticias/1%C2%BA-congreso-medicina-de-urgencia

The conceptos conference is in 11-14 September 2019

http://www.urgencia.uc.cl/conceptos/

These are not small events; Chris Nickson, Cliff Reid, Amal Mattu and Vic Brazil have spoken there. They know a bit about this sort of thing.

Chile is amazing. But don’t take my word for it.

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Butchery and Ethics.

@mededgene is a flight paramedic from Vancouver with a soft spot for that soft spot on the front of your neck. You know the one. It has the cricothyroid membrane behind it.

Once upon a time there was a nice man called Gene. I didn’t call him Gene though. I called him a Butcher. The rest is history.

Gene Benoit @mededgene is a flight paramedic rom Vancouver. He does have a bit of the Val Kilmer about him and despite the nick-name of Iceman, he is not very icy.

Gene and colleagues have been trying to create an affordable, realistic, cruelty free surgical airway training device. I’m all up for most things that are “affordable, realistic and cruelty free” .

Gene tells the story of his interaction with the drama that surrounds the surgical airway. It really does seem to get people a little bit wound up. It got him wound up. So he set about unwinding that. And the next thing you know he is making 3D trainers that replicate human tissue without requiring the sale of your own human tissue (kidneys etc) to be able to buy one!

I claim no credit at all for inspiring this but I will suggest that one should never under-estimate the power of what you say.

Gene can teach me how to wield a scalpel and get past a troublesome voice-box but I shall have to teach myself how to control myown troublesome voice.

Have a listen and hear about fear & loathing on the airway education trail, how an ethicist might conceivably arrive by helicopter to save your life and where Peter Singer fits into critical care education.

Links:

Twitteriness; @mededgene

https://advancedparamedicine.ca/about/

http://3dcrictrainer.com/

The Jellybean with Prof Julian Savulescu is, in fact, number 49.

https://soundcloud.com/thetopend/jellybean-49-oxford-professor-of-practical-ethics-julian-savulescu

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Welcome to SMACC. This is Dr Pendo George. This is the possibly the best thing about SMACC this year. The SMACC organising committee have run an excellent program this year bringing leaders from countries around the world. These people are creating entirely new specialties in their home countries. These people are heros. Their task is HUGE. Have a listen and learn about.

Check this out; http://emat.or.tz And maybe go to TACEM this in October of this year. www.tacem.or.tz Have you been to Tanzania? Think about it.

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CICMxJellybean 8 (Jellybean 100)

Recorded at CICM ASM 2018 Hobart

Peta Alexander is a Queenslander. A Queenslander mixing it up with the best in the world at the Boston Children’s Hospital. She is a cardiologist and paediatric intensivist working with some of the worlds best surgeons and caring for some of the sickest kids on the planet.

We caught up with Peta towards the end of the ASM in Hobart and despite her efforts she was still up for a chat. We get stuck into the odd subjects of changing cultures and cultural change.

Peta trained in Australia before heading off to the states and has a very interesting perspective on the ways of the critical care world.

You can find Peta’s talks from the ASM on IntensiveCareNetwork.com;

https://intensivecarenetwork.com/congenital-heart-disease-repair-or-palliate/

https://intensivecarenetwork.com/principles-of-management-of-acute-heart-failure/

https://intensivecarenetwork.com/debate-who-should-care-for-guch/

And she was generous enough to talk before the conference at the Trainee Symposium. Legend!

https://intensivecarenetwork.com/paediatric-icu-for-the-adult-intensivist-by-dr-peta-alexander/

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The 100th Jellybean. I'm proud to introduce to you Miss Claire Kerr. Paediatric Intensive Care Nurse at the Royal Children's Hospital in Melbourne. This one is about a change of heart. Claire is from Adelaide and had to go to Melbourne to achieve what she wanted/needed. And thus a short clip from the legendary Adelaide band "The Master's Apprentices" seemed appropriate for the shared story and that is before you get to the lyrics in the chorus which you can hear at the end of the interview.

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CICMxJellybean 7

Recorded at ASM 2018 Hobart

Professor Michael Pinsky, Researcher extraordinaire and on the editorial board of almost every journal in critical care.

Michael Pinsky needs no introduction. Literally none.

Michael is a giant of North American and International Intensive Care research and practice. It is difficult to understate his achievements to date; hundreds of articles, hundreds of chapters and hundreds of lectures delivered at international conferences.

The best person to tell you about Michael Pinsky is Michael Pinsky. Sit back and behold.

Here are Michaels talks from CICM ASM in Hobart available at Intensive Care Network; http://intensivecarenetwork.com/can-we-be-intensive-and-non-invasive-by-professor-michael-pinsky/

http://intensivecarenetwork.com/pathophysiology-of-acute-heart-failure-in-icu/

The CICM ASM 2018 (CICMxJellybean) Podcasts are part of the larger series known as the Jellybean podcast recorded at conferences and meetings all over the world by fast-talking Irish doctor Doug Lynch. Doug was not paid to record, edit and distribute the podcasts. The Jellybean podcast is available through iTunes, Stitcher Radio, Soundcloud and via www.TheTopEnd.org The CICM ASM organisers requested that we interview the main international speakers but that doesn’t stop us doing what we usually do…. interview anyone with a good story. There will be 5 or 6 “normal” Jellybeans coming from the Hobart ASM. Photographs were taken and used with the permission of the interviewee. The Intro and Outro music clips used in this series of Podcasts are courtesy of Swedish artist Ikson. Ikson’s work can be found on Soundcloud; https://soundcloud.com/ikson

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CICMxJellybean 6

Recorded at ASM 2018 Hobart

The GUCH Jellybean with Intensivist and Cardiologist Susanna Price

Dr Susanna Price,Clinical Lead in Critical Care, Royal Brompton Hospital, President Elect of the European Society of Cardiology, published everywhere and part of so many guidelines related to cardiology.

Fresh off the flight from London Susanna stepped up and talked sense to the biggest crowd ever to attend a CICM ASM. The cardiology focussed meeting was a bit of a silo smasher. Perhaps no group of patients bridge across the divide between paediatric and adult intensive care more than the “Grown Up Congenital Heart Disease” (GUCH) patient. These are amazing people with amazing medical histories and they are around in greater and greater numbers. They may have started in a hyper-specialised surgical centres but they might end up in any emergency department anywhere. The catch is that these people will not always know all the details of their past interventions. They were, after all, children at the time. Even if you understand what their original pathology was you may not know what type of surgery was done, where, why, when, who and do we still do that?

Don’t be afraid, be informed. Susanna Price opens a GUCH treasure chest to show us what is in there.

The organisers of the CICM ASM in Hobart worked hard to shine a light on the areas of critical care cardiology that cross the borders between specialities and the borders between paediatric, adolescent and adult intensive care. Dr Price clinical practice crosses borders and she is a Dual Trained UK Cardiologist and Intensivist, which is a rather rare combination in Britain.

(It would be good to have a Different Strokes picture but it seems that all available images are under copyright. There are some great Different Gooch clips here though: http://heliotricity.com/diffrentstrokes.html)

https://www.dailymotion.com/video/x548zhx

Sometimes doing one specialty is not enough. For some it's an intellectual journey, for others it might be a migration. For a few it is a way to make things happen. Important things. Like getting your patient to the cath lab or into theatre.

So not satisfied with just being a good intensivist, Susanna Price also became a cardiologist. That helps when you are working at the Royal Brompton Hospital, the largest specialist heart and lung centre in the UK [http://www.rbht.nhs.uk/#].

Add to the mix that Susanna worked with Adult Congenital Heart Disease pioneer, Dr Jane Somerville [YouTube URL - https://youtu.be/QmrUOK2dhO0]. It turns out that adult intensivists still need to know about paediatric congenital heart diseases and their management, because having survived their childhood, with or without surgery, they turn up as adults in any hospital. This matters. It affects assessment, monitoring and therapies. They may not even know they have or “had” a congenital heart disease.

But there is help. Susanna and her European Society of Cardiology [https://www.escardio.org/] colleagues have decided that this is so important, they built an educational platform and give access away for free: ESC Grown Up Congenital Heart Disease (GUCH) E-Learning - https://www.escardio.org/Education/E-Learning/Clinical-cases/grown-up-congenital-heart-disease-guch

Here is Susanna's talk on ICN; https://intensivecarenetwork.com/guch-a-growing-problem/

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CICMxJellybean 5

Recorded at ASM 2018 Hobart

Professor Jean-Louis Teboul

Professor of Therapeutics and Critical Care Medicine at the University of Paris-South and Editor-in-Chief of Annals of Intensive Care.

Jean-Louis is a huge presence in French, European and International Intensive Care research and practice. It is difficult to understate his achievements to date; hundreds of articles, hundreds of chapters and hundreds of lectures delivered at international conferences.

Yet when we started talking it becomes clear that the first thing Jean-Louis wants to drive home is not some of his rarified research but some of the most sensible and universally applicable advice for not only the critical care physician but perhaps all clinicians.

Individualise Care, conduct a Risk Benefit Ratio Assessment of every intervention and constant Reassessment.

Not only does he push us to focus on the individual in medicine but he has a surprising take on Randomised Control Trials (RCT’s), an enduring respect for the appropriate use of the PA Catheter and a refreshing enthusiasm for one of the safest and cheapest investigations; passive leg raising.

Of course he delivers all this in English. Dealing with the accents of the Kiwi and Australian clinicians is one thing but to make matters worse his interviewer is a fast talking irishman. To illustrate how hard that must be I decided to introduce him in French.

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Jellybean 96; Big Data with Nik Kumar

Big data. It's very big. There's a lot of it. It’s Jellybean time. Matt McPartlin strikes gold in Wollongong.

Moment to moment information on heart rate, respiratory rate, how much urine has come out, how much fluid has gone in, the sodium, the glucose, the pH and what was had for breakfast. And that's just one hour, from one patient in one of sixteen beds, in one ICU, in one hospital, in one city, from one state.

That's a lot of data. It takes machines and algorithm to process. Intelligence of the artificial type. Automated processing.

So who manages the machines? Who decides what patterns to watch for? What can be learned from it.

Big data is a term that has become increasingly tossed around at research meetings and medical conferences. The multi-centre RCT is under attack. It's expensive, restrictive and only ever seems to beget more RCTs. Is Big Data here to replace RCTs or to refine it?

Big data may be more reflective of real world practice and variance. Like a mega-collection of annecdotal evidence - a Megadote, or maybe a Metadote.

Nik Kumar is an ICU registrar who trundled along to the ANZICS Datathon in April to see what all the fuss was about and whether he could use it for some of the projects he had in mind. He went with few expectations. He came back with a whole new perspective on not just data collection and analysis but on collaborative research and future directions for determining trends in practice. He also likes pizza.

Big thanks to Matt for recording another Jellybean. Thanks to Dr Nik Kumar for explaining some high end health focused data science. It is not a main stream thing. (Yet.) It is one of those interesting things that hang around at the edges of our working lives.

Here at the Jellybean podcast, we love the fringes. We love to learn a little more about the stuff that isn’t in the books, that’s not on any syllabus but is relevant. It might seem small but as we should all know; from little things big things grow.

Thanks to Big Data for making the music. We couldn’t resist using one of their tunes. The intro and outro music is from Big Data's track Dangerous

You can find that here; https://itunes.apple.com/us/artist/big-data/614730110

You kind find more info on this big Big Data thing here;

ANZICS Datathon - http://datathon.anzics.com.au/

“SIH research engineer wins ANZICS Datathon” - https://informatics.sydney.edu.au/news/anzics/

Big data analysis - The Basics - Data Science vs. Big Data vs. Data Analytics - https://au.simplilearn.com/data-science-vs-big-data-vs-data-analytics-article (A non-medical overview) - Medical big data: promise and challenges. Choong Ho Lee and Hyung-Jin Yoon. Kidney Res Clin Pract. 2017 Mar; 36(1): 3ñ11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331970/ (Full text) - Big Data And New Knowledge In Medicine: The Thinking, Training, And Tools Needed For A Learning Health System. Harlan M. Krumholz. PMID: 25006142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459394/ (Full text)

Machine learning - The Basics - What is Machine Learning? Andrew Ng. Coursera. https://www.coursera.org/lecture/machine-learning/what-is-machine-learning-Ujm7v - Machine Learning in Medicine. Rahul C. Deo. Circulation. 2015 Nov 17; 132(20): 1920ñ1930. Circulation. 2015 Nov 17; 132(20): 1920ñ1930. (Full text)

Udacity - https://www.udacity.com/

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Teaching teachers about teaching; lets get super-meta.

The Teaching Course. It’s in Alcatraz, Brisbane and Copenhagen. It’s in Melbourne, Manchester and Manila. I’d be exhausted just thinking about it if it didn’t sound like so much fun.

Salim Rezaie is a softly spoken, erudite, talented attention avoider. He want’s to credit someone else, he wants you to be happy, he wants to perfect the next slide for his next talk. He doesn’t want to give his next talk quite as much as make the slides but we, the consumers of his inimitable style, are not complaining. Instead we are signed up subscribers, following and forwarding his work because it’s good, very good.

Salim is a bit of a pro. He started out on ALIEM. He started RebelEM as a blog and then he got a podcast up and running. He got into this whole education thing, the #FOAMed thing, and from his involvement he became increasingly interested in the processes of the whole teaching/training/learning/simulating/feedback thing. So much so that he realised that there was an appetite, a need, for a resource that helps teachers get better at teaching. So we are educators, we are motivated, we know some stuff, but we are often isolated within our various institutions as the education woman or man. We don’t have our own little cadre of education enthusiasts close by to ask for help, to compare notes, to share techniques.

So Salim set one up. He formed a team. He is the leader but he is an incredibly modern type of super-collaborative empathic leader. He is soaking up ideas from all sources. He has gathered a group of super-impressive women and men that help him out. Let’s think for a second about the Teaching Course Faculty. To shed light on this lets bring in my resident philosophical conundrum machine; Cormac.

My son Cormac asks me some very important questions. Last week he asked me a good zombie apocolypse question; “Come the Zombie Apocolypse which of your friends would you bring along to help you survive?” That is an interesting question, it is a thought experiment in utilitarian ethics.

I’d suggest there are a few candidates in the Teaching Course faculty;

Photos

Of course one would have to get into the whole #MetaMoments thing that The Teaching Course is embracing, that means feedback, lots of feedback. The imagined “Flipping MedEd Zombie Apocalypse Survival Team” would be giving and receiving lots of feedback. There would be lots of eye contact and hugs. Hopefully not too much to distract them from the zombies which would give the wrong sort of feed back altogether.

“Whats that noise? Feedback! I hate feedback. No, wait, hang on, I love feedback.” Neil Young.

It is a love hate thing for many of us, but then have you ever been taught how to take feedback? Give it, maybe, but take it? We can tease ourselves for being a bit meta about all this stuff but there is a reason we are talking about it. If we are mentoring young nurses and doctors, if we are running simulation sessions, (and we are), then we do need to think about all this and more.

The Teaching Course is a constantly evolving set of distinct and imaginative units. There’s a presenting skills, simulations skills, there’s mindfulness stuff, there’s an awful lot in there. If you are an educator then this course is definitely worth a look. It is so good you may wish to go more than once.

I would. I’d go just to get more down-to-earth wisdom from probably my favourite Texan. (Apologies to Cordell Walker.)

Accidental old fashioned sage and reluctant FOAMed star, it’s Salim Rezaie @srrezaie

Check out these Jellybean Podcasts with other Teaching Course Faculty;

Victoria Brazil Natalie May Simon Carley Jesse Spur Chris Nixon Liz Crowe Ashley Liebig Chris Hicks Kat Evans Andy Tagg Mads Astvad Sandra Viggers Paul Grinzi Ross Fisher Julie Derrenger Salim Rezaie

It’s like a Jellybean Playlist. I might go and build that Playlist on SoundCloud.

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Scary little people.

Hazel Talbot loves her job. She really does. She works 80% neonatal retrieval around one of the most beautiful parts of the world and does so in a fashion that must light up the lives of everyone that comes in contact with her.

I say this because I had the pleasure of spending a little time with her in Berlin and, in short, if you didn’t think Hazel was fabulous and hilarious I would be consigning you to the “Dubious Judgement” basket. I am proud to say I have met a few men and women over the years that, without even trying, form a litmus test for other humans.

How could anyone not love Hazel Talbot? Seriously?

Hazel works with the littlest sick people. She is good at it. She is so good at it that she may make it look easy but as we all know that is the consequence of hard work and talent. The good news is that she wants to pass on the tricks, the secrets, the knowledge to you and I. She does as much of that for free as possible. ( The main Course she teaches at is called NLS and there will be a version of this near you I hope.) She has spoken at SMACC and more training events than you can imagine about how to get over the biggest hurdle in neonatal critical care; you and your fear.

Heres Hazel giving a SMACC talk in Dublin.

https://www.smacc.net.au/2017/03/small-packages-big-lessons-neonatal-paediatric-retrieval/

There’s another one from Berlin in the pipeline.

Hazel and I chit chat our way through this scary subject with much giggling, once again showing how laughter can help in the scariest moment.

We deal with some of important concepts, for example 100% of people are born. So child birth is pretty common. Almost as common as death. We talk about death a lot in the critical care world but we don’t talk about birth enough. 10% of births are premature. Those little humans need a little help and the good news is that you can deliver it. (Their mothers delivered them and we can deliver the care they both need.)

So if you find this sort thing, a sub 1000 gram sick person, frightening then this one is for you. My personal experience of this is that once you get over the fear this is one of the most beautiful things you could ever be a part of.

Full story on www.TheTopEnd.org

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The CICM ASM is happening next month. It is in Hobart. That’s in Tasmania.

In 2017 the ASM was in Sydney and it was conspicuous for its efforts to bring more young trainees to the forum. Lewis Macken and company did a great job. Bringing youth and energy to the Sydney International Convention Centre. There were podcasts like this one, there were talks recorded and shared on IntensiveCareNetwork.com, there was humour, there was Fast Transit and there was a deliberate effort to get a better gender balance.

One of that team was Naomi Diel.; ebullient, brilliant, and brave. Naomi shook it up a bit with help from her friends, who she constantly gives credit to. And it turns out that the ASM is as much about making friends as anything else.

Have a listen to her insights into running one of these things and then ask yourself: could you do that? I suspect you probably could, I also suspect that the College would like you to think about it.

Get involved, consider putting your hand up for your regional committee.

The ICU Update is already booked out but there are still places for the ASM itself and the trainee symposium ($330). Sara Yong is in the thick of the Trainee Symposium again. There are a bunch of excellent educators in there; Celia Bradford, David Pilcher, Priya Nair, David (Neo) Anderson, Peter Kruger, Ray Raper, Peta Alexander, Sara Allen and more. Sonia Langlais talks about rural ICU and there is a very interesting session on Fellowships years from people that know.

Personally I think we should be making the Trainee Symposium be cheaper, perhaps entirely free. We need a big sponsor that understands the big picture. The sort of trainee that turns up at this sort of thing will be the director of an ICU near you sometime soon. It would surely be a good value item to sponsor in an unobtrusive fashion.

Thanks to Naomi for talking to us.

Thanks to Low and The Dirty Three for two tiny grabs from their utterly brilliant "In The Fishtank 7" EP recorded in 1999 and produced by Zlaya Hadzic for the "In The Fishtank" series on Konkcurrent Records.

Excerpt from full article on www.TheTopEnd.org

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Let’s talk about Cambodia. Let's talk to a young man born in Australia as a result of war. Let’s appreciate what just one asylum seeking family can achieve.

Sometimes curiosity can take you on an expected journey. Sometimes a mixture of fortune and fate (if such things truly exist) throw opportunities at your feet, though you may not know it at the time.

A journey of self discovery. An offer of help to a group of strangers. An appreciation of one’s own good fortune alongside the humility to be the ladder for others when needed.

Sethy Ung is the first Cambodian to have been born in Australia. And he counts himself lucky as a result. We met and worked together as emergency medicine trainee registrars in Liverpool Hospital in the south west suburbs of Sydney. While the rest of us took annual leave to go surfing or head off to exotic locations, Sethy quietly flew over to Cambodia to help a paediatric critical care facility with their staffing and training. Over time a few of the ED staff followed him over for a week or two.

But what happens when you leave? What benefit then has your presence been outside of the duration of you physically being there? How much can one person really achieve when there is so much to be fixed?

Quietly, Sethy found a way.

Relax. Listen. And then think about that idea that has been tapping away in the corner of your mind and ask yourself “What is stopping me?”

It starts with a decision.

For more on the origin story of the Angkor Hospital for Children visit the Friends Without A Border site - https://fwab.org/ahc/

Thank you to Sethy for sharing his story and thank you to Matt McPartlin for another thought provoking jellybean. Thank you also to Kong Bun Choeun who wrote the 1968 Khmer classic Mloup Snae Derm Sraulav ( ម្លប់ស្នេហ៍ដើមស្រឡៅ ) (Lovely Shadows) sung here by Sinn Sisamouth and Ros Serey Sothea. I rudely cut the duet in half but you can find this tune and many more at the Soundcloud page of Cambodian Vintage Music where they kindly allow free downloads. (How about that!)

https://soundcloud.com/cambodianvintagemusic

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In Berlin, in the footlights, with heart in throat.

In London, in the headlights, with heart in hands.

In her heart, in Kashmir, always in Kashmir.

A young woman that rather took the stage by storm at dasSMACC shares a little bit of her own heart and a lot more of someone else’s heart. Sanaah demands attention. She demands attention because attention is required. Not for herself. Attention is demanded on behalf of the disputed territory of Kashmir. On behalf of more than 8000 missing young men attention is demanded.

This is the young Medical Student and Poet Sanaah Sultan. Activist. Future pre-hospitalist.

SMACC continued to dream up new and imaginative things, new and imaginative ways to get a message across. It might be doctors that can act, paramedics that can defy gravity, film-makers that can do more using one button than you or I could ever do. In Berlin they had a poet.

I heard Sanaah speak to a packed room at the SMACCforce pre-conference event. I saw her do it again in front of 3000 odd people in the Tempodrom. There is a kind of bravery required for that sort of thing. She brings that performance to the Jellybean Podcast.

It is not my voice that you need to hear, it isn’t even Sanaahs. The voice we need to hear is any one of the disappeared. We need to hear those voices. We demand to hear those voices.

It was my pleasure to meet Sanaah. Meeting people like her makes all this podcast business worthwhile. Thank you to Sanaah. @Sanaa_Sultan

Thank you also to Mohammad Muneem and his Pune-based Kashmiri band “Alif” for their track Jhelemus from their debut 2017 album “Sufayed”.

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Over simulated? Simulation; surely one of the fastest growing parts of health education in recent times. There is much more to simulation than a plastic mannequin and healthcare is but a small part of the bigger picture. Matt McPartlin went along to the Australasian Simulation Congress and spoke to ICU nurse and co-convenor Jessica Stokes-Parish.

We sent Matt McPartlin off to pretend to be a submariner, a jet pilot and an ICU Nurse. He wasn’t qualified for any of these difficult tasks but he is qualified to talk about it. Here is Matt’s report:

“War, video games and virtual hospital beds. There are links. Many links. The ever present threat and application of war in various parts of the world have throughout history led to advances in healthcare. (Some see this as a benefit but arguably, at best war has pressed the need rather than generated the the benefit itself, but that’s not the point of this particular podcast.)

One of those links is training. And simulation has been an integral part of training. The military uses simulation in many forms – tabletop exercises, part task trainers, in situ simulation and more recently virtual reality. Video gaming is essentially entertainment through simulation. Industries such as engineering, logistic supply chains and motorsport use simulation too. And so does healthcare.

So it would seem that each of these areas might be able to contribute something to eachother’s development. A group of simulation enthusiasts certainly think so. They organised a big simulation congress to help that process along. And they threw in research themes, expert-led workshops and DIY self help sessions.

It’s called the Australasian Simulation Congress and it happened for the third year over 4 days at the end of August in Sydney’s International Conference Centre on Darling Harbour.

Jessica Stokes-Parish is a critical care nurse who has spent time running and developing simulation training at both Newcastle and Tamworth Hospitals in New South Wales. She is also one of the convenors of the Australasian Simulation Congress (Website link: https://www.simulationcongress.com)

Australasian Simulation Congress 2017 program: http://www.simulationcongress.com/wp-content/uploads/2016/02/ASC17-Program-230817.pdf

We talk about the origins of the Congress, the development of simulation based training, take a peek into the near future and try to solve the lack of surfing opportunities in Tamworth.” MMcP

For more information or to get involved in a simulation community, check out Simulation Australia: http://www.simulationaustralia.org.au/divisions/about-assh

Please check out the excellent podcast on all things health and Simulation; “Simulcast” starring @injectableorange and @SocraticEM. You can find it on iTunes and all good purveyors of podcastery. Have a listen to their special shows from September 2017 which were the “Official Broadcasts” from the Congress that Matt and Jessica mention during their chat.

Thanks to Matt for going along and playing with the expensive toys. More thanks to Jessica for taking the time to talk to us. She was very busy and we are very appreciative.

Thanks also to Róisín Murphy, formerly of Moloko, for the clips from her solo disco throwback “Simulation” from 2012. This is the Mano Le Tough remix. You can find that on iTunes and somewhere out there is the 12 inch EP on vinyl.

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The fabulous @eleytherius. You may know her as Dr Johnston, as a long term LIFTL contributor, as a Mega-FOAM performer, as a some-time feline choreographer or as a Fabulous Female of FOAM®. She sings, she dances and she writes books.

She is a creative powerhouse. She is an educator extraordinaire. But we’re not going to talk about that. We’re going to talk about Dustfall; a new novel by someone who you can relate to, somewhat works in critical care, someone that has not much more time to spare than you do. Michelle has written a book. It took years.

Of course she can write, I am just learning. Check her blog here;

http://michellejohnston.com.au/category/dustfall/

It would have to be a labour of love? It was. Love of words. Love of reading. Love of the classics. As Michelle puts it; “I like words and they like me.”

Where does a story like this start? It starts, like so many things do, near Port Hedland. In the Pilbara. In Western Australia. In a part of Australia that most Australians will never see. It’s out there, right out there.

It starts in Wittenoom. Covered in blue asbestos, dead but still dangerous.

Mining happens in dangerous places. Physically and metaphysically.

For Dr Johnston, there was not so much writing as there was re-writing, submitting, waiting and getting rejected. Bad feedback. Good feedback. Even when people liked it they told her to re-write it. And here there is a parallel with medicine. Feedback. Feedback. And more feedback.

Feedback is sometimes hard but it is something that can make you better.

How many medical people do you know that have written a novel, a work of fiction? Not many. Now you know one more. Dustfall by Michelle Johnston. She didn’t want to push it so I will.

Find the book here;

https://uwap.uwa.edu.au/products/dustfall

Go and listen to her speak about it, there will be book launches, promotional tours, lectures and a brand new pen.

See Michelle speak;

https://www.eventbrite.com.au/e/words-with-wine-michelle-johnston-dustfall-tickets-42452631965

This was recorded at SMACC in Berlin. We had just heard the fantastic talk by Annet Alenyo ( @aalenyo) about #UBUNTU which was a special moment. Have a look for that talk when it is available and please, please, please consider supporting a delegate through @Supadel and maybe help a talented young doctor or nurse attend a fantastic event like #dasSMACC was and like #BadEMfest2018. Read more at www.BadEM.co.za Then read a novel.

Big thanks to Tired Lion, Perth Post-Punk Feminist Combo getting us moving with their break out hit I dont think you like me, chosen to introduce Dr Johnston because of the lyrics, the provenance and presence of Sophie Hopes. If your not Australian you’ve probably never heard her before. Now you have. Go and get some Tired Lion on iTunes.

Big thanks also to Lloyd Cole for a little clip of the mid-80’s classic Brand New Friend of his second album, chosen for the lyric “am I asking oh for so much, i’m not asking to be understood” but also because the tune jumped into my mind and refused to leave for three days after Michelle used the phrase “Brand New Pen”. You surely have some Lloyd? If not, iTunes again.

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Dan Davis. The art of ART.

I was at Luna Park in Sydney last year. It is an aging un-reconstructed theme park with rickety roller coasters, a whole bunch of noisy rides and fairground attractions. It is all very retro to the point of being almost ironically cool. There is a reason I am telling you about Luna Park which I will come back to in a moment.

My last visit had a different silver lining. Instead of reluctantly buying toxic candy floss for my progeny I was getting a whole load of educational goodness at the “Resus @ the Park” conference. 3 days of creative teaching and some very cool pre-conference workshops. It was at on of those that I met Dan Davis. I am very glad I did.

Dan is the brains behind ART. Advanced Resuscitation Training; born by accident in San Diego and a very interesting initiative. Dan Davis was a geneticist looking for a magical gene. One thing led to another and BOOM, it is CPR for grown ups. (I am counting YOU as that sort of grown up.)

Now many of my favourite people in the FOAMed world are trying to push this all resus stuff forward. We know BLS/ALS/ACLS is a bit of a cookie cutter approach, one size fits all, don’t ask questions just follow the protocol stuff. We know why that is useful, we also know where it fails. It is very like the ATLS/EMST approach to trauma. In fact its a bit like Luna Park. It still works. There are much better ways of doing it but it still works. So do we want to fix it? Yes we do. Can we fix it? Yes we can.

Many people are trying to fix it in many ways. Dan’s story is a great example of one of the ways to try and fix it. This being a FOAMed podcast we would like it to be fixed for free. We like free things. Most people do.

Dan was working in University of California and he was researching and he came up with a cool thinking wo/man’s version of advanced resuscitation training and it seems to work. Very well.

That would be interesting enough. But what happened next when he started giving it away for free is another story. Have you ever heard of Students T-Test? Rack your brains, it probably came up in your high school years. Basically a smart scientist, working for Guinness 110 years ago in Dublin, came up with a clever statistical tool for small samples. You don’t know the scientists name. It was Gosset. Guinness forbade their employees from publishing and so he published under a pseudonym. A statistics paper published under a pseudonym. Hilarious.

Dan found out that, as an employee of University of California, he didn’t own the intellectual property. They did. They could have sued him for giving it away for free. (Take note all you disruptors, innovators, inventors and revolutionary bio-statisticians.)

Dan is a laid back, chilled out, relaxed dude from California. That doesn’t stop you being sued though. The good news is that his employers were pretty laid back about things too and the next thing you know his career has taken a very significant turn. Now he has a start up company and he doesn’t pay himself. I think that’s progress. I’m not sure though.

Hidden in this podcast is a lesson for us all, a lesson about innovation, intellectual property, accelerometers and stout. A good idea is a beautiful thing but it is not always enough. There are lots of ways to improve things. I liked Dan’s teaching, I liked his system, I like him. It is less anarchic than FOAMed as we know, he is working within the system, but he is a disruptive influence in there. Go Dan. International educationalist and intellectual resuscitationist.

Dan, like us here at the Jellybean Podcast, likes to talk. He also likes to listen. If you want to get in touch with him drop him a line at DanielDavisMD@gmail.com

Thanks to Dan for coming along to the podcast. And thanks to the legendary west coast surf bands the Dimensions for making the excellent track Firewater. Find that on iTunes. Find Dan at the University of California.

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Flying into an airport or television studio near you it’s @FLTDOC1

Dr Mike Abernethy is one of the longest-serving flight physicians in the world today. He is a bit of a legend in his own lifetime. There is something about Mike’s story that reminds me of the golden age of flying, all glamour, sharp suits and Eero Saarinen’s fabulous TWA terminal at the JFK International Airport.

Maybe it’s his dashing good looks, maybe it’s his dress sense or maybe it’s his part-time gig as a TV star!

In truth, Mike is too young to have been swanning around when flying was still stylish. He is too young in all sorts of ways. He gets on like a kid. He has a child’s enthusiasm for what he does. He is an example to us all.

Mike has spent his life involved in what most of us consider a risky business and, for laughs, he spends his spare time involved in something most of us consider even riskier; messing with the mass media. Mike has appeared on the semi-reality show “Untold Stories of the ER”. Find it on Netflix or the Discovery Channel. So what was that like?

How do his peers view all this? I know more than a few of them do take the piss. Mike’s ability to laugh along with those that tease him is a bit like a secret superpower.

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Chris Hicks is @HumanFact0rz He is into Human Factors. He is reading about Human Factors. He is writing about Human Factors. He is on stage, he is on EMCrit, he is on fire. But it’s a smouldering kind of fire, a nice fire, not a raging forest fire.

A raging forest fire would be a better metaphor for what drove Chris into Human Factors; a bunch of over heated but talented egos coming together, with the all the poise of a conflagration, in a trauma bay.

I met Chris first in Dublin, with a bunch of other erudite, humorous and well grounded Canadians. There does seem to be a rich vein of talent up there. What’s happening in Canada? Is it all as good as it looks from afar? Or does Justin Trudeau just look handsome and apologise a lot? Maybe its just the contrast to that orange person to the south that some people call Mr President?

Either way I keep meeting charming gifted Canadians. So that bit is good. The orange guy is a worry.

In an effort to improve those trauma bay infernos Chris and his chum Andrew Petrosoniak have recently edited/curated a special EMClinics of North America. It is a trauma special and being Chris, you know the Human Factors stuff will be good. That’s just the start of it too. He has people from all over the place in there. Amal Mattu, George Kovaks, Katrin Hruska, Brian Burns, Paul Engels, Karim Brohi and Captain America. That’s a lot of FOAMed types and a few superheroes too.

Some of the EMClinics chapters will available for free until the end of December 2017. You can get free PDF’s from https://www.sciencedirect.com/science/journal/07338627

I reckon we should all download it. If the EMClinics of North America that was free for a while gets double or triple the downloads that it normally achieves then the publishers would surely sit up and take notice.

That might cause a little disruption. Chris is good at that disruptive stuff. It is worth remembering that all this #FOAMed stuff is not necessarily safe from harm. If we lost a few major protagonists for whatever reason then how would FOAMed change? It is all happening because a relatively small number of people put a relatively huge amount of effort in. I don’t think we can get complacent. We certainly have not achieved universally free medical education have we? #FOAMed is great but conventional medical education is not getting any cheaper.

Meanwhile if you’re reading this on Lifeinthefastlane, Intensive Care Network or TheTopEnd.org you’ll hopefully appreciate that you couldn’t possibly get any thing any cheaper. F is for Free.

House keeping; the CVC Checklist guy I couldn’t remember was Peter Pronovost from John Hopkins.

More housekeeping; the tunes are provided by Mood Ruff, a Hip Hop crew from Winnipeg. You can find them on iTunes but you won’t find that track, No Hooks. (12 inch vinyl from 1989.)

You can get more Hicks at EMCrit.org and @HumanFact0rz on twitter.

You can get more Jellybeans on iTunes and Stitcher Radio. (Links Below) You can find collections on www.lifeinthefastlane.com and www.IntensiveCareNetwork.com

Special interest playlists (emergency, pre-hospital, intensive care etc) are put together on www.soundcloud.com/TheTopEnd and they all live happily together at www.TheTopEnd.org

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Talking about the quadruple burden of disease in South Africa with Victoria Stephen.

You don’t want a triple burden never mind a quadruple burden.

Trauma, Lifestyle Diseases, Communicable Disease, peri-natal morbidity and mortality

It’s not all trauma in South Africa, it’s worse than that. The Rainbow nation unfortunately gets a rainbow of pathology too. Which makes for challenging work and interesting medicine. It means that South Africa is a bit different and that’s where www.BadEM.co.za comes in.

This is the 4th in a series of Jellybeans with members of the BadEM team because we love BadEM. It is the very impressive Victoria Stephen

Victoria Stephen ( @EMCardiac ) is a consultant emergency physician with a special interest in Ultrasound and Cardiac stuff. She works in a new hospital named after the last anti-apartheid activist that was sentenced to death under the brutal failing regime, Thelle Mogoerane. Gone. Not forgotten.

Of course like all of us she had to work hard to develop her talents and Victoria credits Lifeinthefastlane and Steve Smiths ECG blog with improving her ECG skills. She has benefited from #FOAMed and she is giving back. BadEM is working hard to try to create a new flavour of #FOAMed for their world, which is just not the same as Manchester or Melbourne. That said there is plenty of good will and support for BadEM all across the FOAMed world which will be demonstrated at one of the worlds most ambitious medical conferences ever; #BadEMFest18

The BadEM crew are creating a very African conference; glamping in the bush 90 minutes from Cape Town with all food, accommodation, activities taken care off. And for a pleasant change your partner or kids will be more than welcome and well taken care off. These things are hard to put together. Support BadEMfest18 if you can. Bring your entire family if you can. But if you cannot go then please consider supporting a delegate from within South Africa or nearby through the #Supadel initiative.

Please paste the following link over the words “consider supporting a delegate”. https://badem.co.za/fest/#1509569976605-aadd5e62-53c9

I cannot reveal all the speakers but I understand you’ll hear from the cream of Manchester, Melbourne and the rest of the world, by which I mean St. Emlyn’s, Don’t Forget the Bubbles, The Teaching Course and more. There will be MSF types and crazed Canadians, they may even have speakers from all continents returning to the birthplace of humanity. Check out the website and then check in to a flight in March. It may be one of the best trips of your life.

Victoria is a very good speaker. It is impressive that she had no preparation for this interview yet she summarised and presented so many varied medical and peri-medical issues so coherently. Another embarrassment for yours truly.and another talented doctor working to unburden South Africa. When you meet people like Victoria you begin to believe that, with time, that quadruple burden will be lifted.

Thanks to Victoria for being Victoria and thanks to Victoria for coming and talking to me on the Jellybean Podcast.

Thanks also to the late great Miriam Makeba, whose 1967 classic Afro-Pop song Pata Pata graces this podcast, the first song most people heard from her and the very last song she ever sang. What a woman.

What a pair of women.

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Jellybean 84 with Dr Steve Philpot

Talking about talking about dying with Dr Steve Philpot, Master of Communication.

In the week that the one of the states in Australia has pretty much managed to pass assisted dying legislation I had to reach for this Jellybean recorded at the College of Intensive Care Medicine ASM in Sydney this year. The state of Victoria, where I personally reside, has almost passed the assisted dying bill. It has been a fractious and bitter process at times. But it is all but done. I have been waiting patiently for this. I have been very sad to watch patients waiting for this. Patients that couldn’t be patient.

As you can imagine this law will impact ICU medicine. We, by which I mean anyone nursing/doctoring etc that’s directly or indirectly involved in intensive care medicine, will be having difficult conversations about this with our peers, our bosses, our friends, our patients and their families. We had better get our heads around this. Communication is key and it will extremely important not to f**k it up! So we need to learn what to do, practice doing it and get feedback on how we are doing it. Given that ICU consultants need to be brilliant at communication how do we manage to keep supporting and training ourselves and our colleagues in this area.

Charlie Corke, President of the CICM of Australia and New Zealand has been a pioneer in this area. The person that has succeeded him is Dr Steve Philpot.

So how do you train an intensivist, with maybe 30 years of medical experience, to improve their communication. In fact, how do you even suggest to such a character that they would benefit from some training in the area. Let’s face it, it is not that easy to tell an ICU consultant what to do at the best of times.

So I asked Steve, because this is a big part of what he does. He ran a series of workshops at the CICM ASM for Consultants around communication skills. It was really very good. He also runs the “How to run an effective family meeting” course available through CICM. (You can find it under “Communication Course” through the members portal on www.cicm.org.au .)

Of course Donate Life also run an excellent course which has a lot of communication training embedded and Steve has been very involved in Donate Life too.

All this earnest, breaking bad news, family talk stuff can be very serious but refreshingly the people leading the way are not afraid of a bit of humour. You can’t help but notice this with people like Charlie Corke, Stephen Warrilow and Steve Philpot. Brilliant!

Having said that some of the questions that I ask Steve really require a cool and calculated answer so the humour switch needs to be flipped. There is a conspicuous moment in this Jellybean when Steve had to fend off one question with an entirely appropriate “you didn’t tell me we would be talking about (that)”. Which is true! I didn’t tell him, in fact I never really tell people because I rarely ever know. The conversations are always spontaneous and real. I wasn’t trying to catch Steve out here and I apologise for putting him on the spot. That’s just the way a Jellybean Podcast goes.

Other fun stuff that came up includes ‘faith based health services’, 'doctors that are also actors’, ‘medical ethics at Monash Uni.’ and the bizarre news that empathy levels in medical students drop from first year to final year before they even get unleashed on the real world. So the way we are preparing future doctors actually decreases their empathy. What? Really? Steve is actually trying to to do something about that too.

Thanks to Xavier Rudd for his tune Time to Smile and indeed thanks to his instrument technician James Looker who got to play the banjo part that dominates the intro you heard. You can find more by Xavier Rudd on iTunes but I don’t know where you can hear more James Looker. (Sorry James.)

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THE MINIBLURB

ED people doing house visits? Medical retrieval teams having a cup of tea and taking a detailed social history? Emergency doctors going to someone's home before they come to the ED and recommending treatment at home? Including End of Life treatment? Sound Crazy? Ever been to Maribor? Slovenia?

THE BLURB

I spoke with Slovenian Emergency Physician and Pre-Hospital Gregor Prosen at dasSMACC. He talks like an emergency physician. He curses like an emergency physician. Gregor just exudes a type of ultra-competent critical care cool. He can do some fantastic shit and he does do it. He also goes on home visits. He gets in a car or 4wd and heads out into the country to see little old ladies, big old men, kids and strudel-makers. That part represents fantastic shit too. Listen to what Gregor considers

So here I am in Australia, in western emergency medicine. We are struggling with this and that. We are struggling with end of life care. We are struggling with the filter, or lack of a filter, between primary care and the so-called critical care service that emergency personality types all signed up for. We wanted to be intubating vomiting people, with no blood pressure, while upside down in a straitjacket and wrapped in chains and underwater. In a crater lake. Over an active volcano. Using an expensive machine. Any expensive machine really. That’s what we call rewarding. It’s just not fair. Whinge. Whinge.

So you go and try a bit of retrieval medicine. It looks very cool. Especially in the promo videos. (To quote Alex Psirides; “Helicopters!!!”) However, when you are getting around in one of those helicopters or some other platform there is a certain pressure on your use of that platform. How many times have aeromedical retrieval teams gotten out to the “scene” and decided to NOT bring that patient back to the hospital? Maybe that's the best thing to do? And if it is the best thing to do then will your service get paid as much? Will your service get paid at all? How much does it cost to run an aeromedical retrieval helicopter anyway? (Clue; shit-loads.)

So at the end of the day it’s hard to use your judgement for some of the most important decisions. It’s hard not to get into the “You Call we Haul” trap. We actually use “Time on Scene” as a KPI.

The pilot, the crew, the co-ordinator and even the helicopter itself seems to want you to get back to base ASAP. It might be whirring overhead or if it has landed just sits there and bristles. I do love these women and men. I love working with them. I love flying around over

Slovenia clearly has a different history, different culture, different healthcare system, but maybe it has some seriously useful different perspectives.

Gregor Prosen is pretty bloody cool. He does cool stuff. He has a cool job and some of that cool stuff is done really very differently. Let’s learn.

I like FOAMed. I like it a lot. I would really like it to continue to facilitate knowledge transfer. We can learn something from the Slovenians. We can learn from the South Africans and Ugandans. We can learn something from the New Yorkers. It is not a one-way street.

Long live FOAMed. Long live non-english speaking FOAMed. Long live FOAMed from everywhere for everyone.

Long live the legendary Slovenian accordion player Bratko Bibič and thanks to him for the wonderful tune ”In the family garden” or “Na Domačem Vrtu” from the eponymous album by Bratko Bibič & the Madleys. You can find that on iTunes but if you find it in on vinyl it would be more impressive.

If Slovenian music is your thing check this out;

https://lifeinthefastlane.com/jellybean-050-with-sara-nikolic/

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Wisam Al-Basaam

Extraordinary tales of ordinary heroism.

While at the CICM ASM in Sydney I was introduced to a gentleman called Wisam Al-Basaam and he had a story to tell. When I say gentleman I really mean gentleman. Wisam is a consultant intensivist at the Austin Hospital. That is a pretty good job. It’s a very good hospital and most of us would be very happy to get a gig there. For Wisam the road to the Austin was serpentine, three countries, three systems, war, death, terror, trauma, uncertainty, adversity, hard work and ultimately a new start.

A new start here in Australia. Wisam is very highly respected by his peers in a super high performing clinician in an elite ICU. (I know this because those peers told me as much.) Australia is lucky to have him. He feels lucky to be here but the people that access his public hospital ICU are also lucky. Every moment that I experience the best of the free services we have here in Australia I feel lucky. Free emergency and intensive care services are common and usually excellent here in Australia. It is not the same for every specialty and I am proud to work in the part of a system that does not require people to pay up front just because they are sick and need healthcare.

I get paid. Wisam and all the other doctors and nurses that worked like him in Iraq often didn’t get paid. He shares just a few stories from his early post-graduate years when his country didn’t even have a government. No one got paid. And yet they worked. They worked in a dangerous environment with little or no support and little or no equipment.

Wisam didn’t think of his story as exceptional. Unfortunately his story is not exceptional. But that doesn’t stop him being a hero. A role model.

He is the sort of Australian that makes me feel like I want to be part of this country.

Thank you Wisam. Thanks for sharing your talents, your story and your hard earned wisdom.

Thank you also to Rahim Alhaj and Amjad Ali Khan, playing the aptly named Common Destination from their album Ancient Sounds. You can find that on iTunes. I found it on Soundcloud.

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Jellybean 81 Sandra Viggers Of ScanFOAM.org by Doug Lynch @TheTopEnd

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Physician and Intensivist Steve Warrilow, Director of the Austin Hospital ICU, talks about everything from Physician Generalism to Surgical Super Specialisation. Stephen is a man that can communicate.

Stephen Warrilow is in many respects my ideal Intensivist. Trained as a physician (aka Internal Medicine), a generalist by anyones standards, he specialised in ICU and was good enough to become the Director of the same unit that brought you Rinaldo Bellomo. He brings a calm, measured, intelligent voice to all he does. He makes people like me look bad. I sat down and chatted to Stephen at the CICM ASM and was hoping to find some sort of flaw, something that I could use against him, but no. I liked him even more after we talked.

We did get stuck into some important stuff starting with Stephens own path from Physician Trainee to Intensive Care. He would know a little bit about it too as he not only ran the regional physicians training consortium for 7 years but he still examines for the Royal Australian College of Physicians.

Having completed the RACP process himself he had to deal with the rather important fact that he doesn’t really like out-patient clinics. Hmmmm. So Stephen was one of those brave people that starts in an ICU even though, in his own words, he “couldn’t intubate, couldn’t do lines”.

Stephen is in a great place to compare and contrast RACP and CICM training.

At the CICM ASM Stephen was one of the leaders of the Consultant Only ICU Update Pre-Conference workshop which was about communication. So he was teaching the supposed experts how to do what they are supposedly experts at! That sounds a bit difficult. We get into paternalism,

(The College also ran a Trainee Only Pre-conference event. Have a listen to Jellybean 62 Sarah Yong speaking about that and there is a soon to be released Jellybean with one of her co-co-ordinators, Naomi Diel.)

Despite the physician back story we end up talking about surgical hyper specialisation and what it might mean.

The Jellybean Podcast is about the stories in between the obvious stuff in Medicine, nursing and paramedicine. It's good to talk.

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Stephen Warrilow CICM ASM 2017 by Doug Lynch @TheTopEnd

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“ipsa scientia potestas est” This is FOAMed. Thus there are a lot of people that are nothing short of obsessed with airways. It’s as if humans were primarily a giant "Pass the Parcel" game with a super difficult intubation inside. This will allow us individually to be the airway super-hero that we dream we could be. But we don’t have super powers. None of us do. We do have some information though and information is power. NAP-4 out of the UK was the product of information collected by the College of Anaesthetists in the UK. Before that was published Toby Fogg had already started collecting airway data at the Royal North Shore Hospital in Sydney, Australia and beyond. Toby spoke to Minh Le Cong on his PHARM podcast 5 years ago. This rather helped get the word out and he followed up with a post on Lifeinthefastlane.

https://lifeinthefastlane.com/do-you-know-if-you-really-own-the-airway/

5 years later we caught up with him to find out how it is all going. Toby is still collecting the data. Some people collect stamps, some collect beer glasses. Toby collects airway data. He's been at it for about 7 years now with the cooperation of a significant number of hospitals around the country. He has been able to see the changing trends in Australian airway management from the publication of the NAP-4 audit to emerging practices such as Delayed Sequence Intubation, Apnoeic Oxygenation and the increasing use of ketamine and rocuronium for RSI. He has also had to learn the intricacies of setting up a database for potentially sensitive information. In the background Luna Park was in full swing with music playing and rides running, which reflected the rollercoaster ride that Toby has undertaken. Sounds like a laugh. The Airway Registry - http://www.airwayregistry.org.au/airway-heros.html 
The Emergency Care Institute - https://www.aci.health.nsw.gov.au/networks/eci https://lifeinthefastlane.com/do-you-know-if-you-really-own-the-airway/ Musical inspiration today is the reggae classic “Give me Power” by Lee “Scratch” Perry & The Upsetters. (I don’t think Lee was thinking of airway data though.)

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In Australia alone thousands of people have an out of hospital cardiac arrest each year. Only 10% survive. It’s a very scary and dangerous rollercoaster. No better place to talk about that than under a real rollercoaster under the Sydney Harbour Bridge with Paul Middleton.

Matt went to Luna Park in Sydney a few weeks back. Not to ride the roller coaster nor knock coconuts off their stands for a teddy bear, but to attend the Resus@ThePark conference. He took a few minutes to sit down outside in the sunshine with Paul Middleton the conference convenor. Of course there was hammering and drilling as some adjustments were made to the Vivid Sydney Festival set up. Which was quite fitting as Paul Middleton (@Scientosis) is building something too. A future in which anyone who has a cardiac arrest in Australia is likely to get effective bystander CPR and defibrillation.

We know this stuff is important. We know that early CPR and defib makes a difference. As a former Australian Resuscitation Council (New South Wales) Chair Paul understands that this is a team sport. A big team. So now he is trying to drive change in the greater community through the charity Take Heart Australia. This means getting almost everyone in the country to realise that cardiac arrest affects everyone and that everyone has a role in helping. Everyone is a responder.

We also know that even as nurses, doctors and paramedics it’s just not that easy to ‘shock’ someone, especially the first time you do it. So whats the first thing Paul needs to do to get 24 million Australians over the fear of stepping in, the fear of electrocuting people? Ask for help of course!

It is no small thing trying to bring about change on a huge scale. This is a public health initiative with parallels with what Mark Wilson is trying to do with the GoodSam App. (See Jellybean 55 with Mark Wilson from SMACCdub) Mark spoke ‘via satellite’ to the audience at Luna Park. Such imaginative approaches are to be encouraged. Or would you rather sit back and wait for a government funded public health campaign to sort it all out? Nothing wrong with a grass roots movement.

Resus@ThePark will be back next year. Check it out.

Resus@ThePark - http://resusatthepark.org.au Take Heart Australia - http://www.takeheartaustralia.com.au

All Jellybeans are available on iTunes, Stitcher and SoundCloud. Check out the links below.

Big thank you to David Gedge and the Wedding Present with their version the Cockney Rebel Classic “Make Me Smile” from their 1990 Corduroy EP

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What is the future of Artificial Intelligence and critical care medicine? I ask Rinaldo Bellomo who, for the past 30 years, has been at the pointy end of critical care research including high technology and predictive algorithms.

I managed to get Rinaldo Bellomo to talk to me at SMACC in Berlin. It was a bit of an intellectual mismatch. If you work in intensive care then you know who this man is. If you don't work in intensive care you may somehow be unaware of the 1000+ articles he has authored, the gazillions of dollars of research grants he has won, the 150 conferences he has given talks at. From where I am standing it looks like he invented the kidney before he invented renal replacement therapy, before he invented every study ever about CRRT. I may be exaggerating there, there were some studies by other people.

The great thing about Rinaldo is that he got to where he is with a child like enthusiasm and a wicked sense of humour. That is the sort of thing that makes a good Jellybean. So what do you talk to a man who has over 1000 PubMed citations about, I mean if I try to reference any studies he may well have published them as editor of Critical Care and Resuscitation, he may have reviewed them or he may have mentored the researcher. Otherwise he wrote almost all the remaining contents of PubMed.

So I thought I might need to artificially enhance my own intelligence to be able to stand up to this bloke. Artificial Intelligence in medicine is a thing at the moment, we hear about Google investing in it and apps replacing GP consultations. As it happens Rinaldo has been working and publishing on this from the critical care stand point.

https://www.wired.com/2017/06/googles-ai-eye-doctor-gets-ready-go-work-india/

http://www.techradar.com/news/creating-the-google-of-medicine-meeting-the-human-ceo-behind-the-ai-doctor

Now if I was running Google I would have tried to interact with Rinaldo already. I presume organisations with those sorts of resources are constantly looking at research like his and seeing how they can use it.

So I asked the Professor about artificial intelligence in medicine. I asked him how you deal with an approach from these enormous companies because he has had them.

Then he gets going. I can hardly get a word in edge-ways. Which is a good thing.

We try to get all Aldous Huxley about it. It is an interesting chat

It’s all about humans at the end of the day.

Rinaldo is just human too, how does he keep the studies coming, why does he keep working at it? Turns out it’s the voices in his head, this is his hobby, his passion and if you try to take this away from him he will at least be grumpy and possibly a lot more than grumpy.

To finish off we started talking about dasSMACC and his debate with Peter Brindley on MeSearch vs Research. Trying to keep up with Peter Brindley without tripping up is pretty hard. Rinaldo nailed it. We pick apart the risks of doing that and the risks of using risqué humour.

There was one joke which missed the mark about Irish people but in truth that moment really just spurred me on to get Rinaldo in on the podcast. This is a good one. He thinks and talks faster than me so see if you can get it on iTunes or any podcast player that you allows you to play it at half speed.

Rinaldo Bellomo; living legend.

Crit Care Med. 2012 Aug;40(8):2349-61. doi: 10.1097/CCM.0b013e318255d9a0. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Bellomo R et al Vital Signs to Identify, Target, and Assess Level of Care Study (VITAL Care Study) Investigators.

Crit Care. 2017 Mar 14;21(1):52. doi: 10.1186/s13054-017-1635-z. Effect of an automated notification system for deteriorating ward patients on clinical outcomes. Subbe CP, Duller B, Bellomo

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Jellybean 075 with Aidan Baron; @ALittleMedic Government #FOAMed Warning; Life in the Fast Lane is apparently addictive. You have been warned.

Aidan Baron is not really that little when you meet him. If you do twitter you will have noticed this man before. I had doubts that he really existed. Was he something like Max Headroom or Ultron? No! He is a lovely man! He is a lovely man that has been enthusiastic about Para-medicine since, like, forever! Being a self confessed social media nerd he was way ahead of the curve when he caught up with all the #FOAMed fuss! He reached out to some of the people that he really admired, people like Cliff Reid (@cliffreid) and the rest is history.

So lets get stuck in to some of his areas of interest because, basically, they are interesting. Even before paramedic training Aidan had a strong focus on ultrasound and #POCUS. He is a proper enthusiast too, he brought an ultrasound machine with him to Nepal just after he left school.

Then it started to snow ball and ultrasound seems to have become a great partner in his training journey. The next thing you know he is writing a Masters on U/S and paramedics. He is pushing paramedic forward and using the SoMe skills he has gained to contribute. https://paramedicresearch.org/

He has also recently spoken at the DFTB17 conference on the matter of LBGTQIA access to healthcare. “Communicating with every colour of the rainbow.” is the title. The DFTB People are releasing talks from next month so see if you can find it, follow the blog or put www.dontforgetthebubbles.com in “Feedly” or whatever you do.

It is topical stuff as the Liberal-National Australian Government is presently trying to stir up homophobia to complement their established excellence in the areas of racism and the multi-modal torture of asylum seekers.

Aidan is one of the good guys. Check him out and check out Fake Thom too.

www.aboutme/aidanbaron

@FakeThom (Thom O’Neill) www.youtube.com/ThomONeill http://dontforgetthebubbles.com/the-identity-of-youth-lgbtq/

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Professor Lars Lundell

College of Intensive Care Medicine x Jellybean

Number 4 in a special series of 4 Co-Branded Podcasts

Professor Lars Lundell. Professor of Surgery Karolinska University Hospital Stockholm. What this man doesn’t know about the oesophagus is probably not worth knowing. What he knows about so many other things is worth knowing. Professor Lundell's visit to Australia will not soon be forgotten. His distinct style and his willingness to grasp controversial issues made his multiple lectures at the ASM memorable. From his first talk about critical care aspects of GI surgery to his last asking “Is obesity a surgical disease?” Lars repeatedly surprised the audience. During this recording he again surprises with his commentary upon obesity, bariatric surgery and its future. The talk turns to the real public health problem we have to face and thus to global politics. Lars’ talks are worth seeking out via the CICM website. Indeed Lars had so much interesting stuff to say that this podcast, at 30 minutes, is twice the usual length. Sit back and listen.

Each year the CICM holds its Annual Scientific Meeting. The Meeting has always been focused upon a single issue or organ system. This year the theme was Gastroenterology entitled “A Gut Reaction; ICU Gastroenterology from beginning to end.”

The lectures presented at the meeting have been recorded and will all be shared among the delegates and some will also be shared with all comers via the Intensive Care Network (www.IntensiveCareNetwork.com), the celebrated “#FOAMed” website. (Free Open Access Medical Education.)

The organisers of the ASM invited #FOAMed podcaster/interviewer Dr Doug Lynch to come along to engage some of the leading lights of the meeting in conversation and record them. These recordings are the latest in a series of podcasts/blogcasts playfully called “Jellybeans”. They are entirely spontaneous chats with interesting people; short, completely unscripted, 100% unedited and recorded in one take. It is essentially an uninterrupted live recording. The focus is unapologetically on the quality of the conversation rather than the quality of the audio recording.

The host of the interview is a fast talking Irish doctor, a jack of all trades but a master of none, a perpetual student and a trainee of the CICM. The “Jellybean” is an itinerant podcast that regularly appears on www.LifeinTheFastLane.com, www.IntensiveCareNetwork.com and many other websites. Over 100 conversations have been recorded with persons of interest. They will appear on iTunes and Google play once the 100th episode is published later this year.

The CICM ASM Jellybean series each start with a biographical component and then the conversation follows its own path. The subject matter is usually that which dwells upon the fringes of intensive care medicine; human factors, education, ethics, equality, gender, personal histories, possible futures and all the other challenges that we so often face. Being so they compliment the lectures but do not attempt to repeat them.

We hope you enjoy finding out a little more about the people behind the CICM Annual Scientific Meeting. The four CICM x Jellybean co-branded recordings are part of a larger collection. It is only these four that are formally associated with the College. Doug Lynch is not a representative of the college and any views expressed are his own.

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Professor John Marshall

College of Intensive Care Medicine x Jellybean

Number 3 in a special series of 4 Co-Branded Podcasts

John Marshall has been at the pointy end of research, in particular sepsis research, for many years. That has been a rather controversial area in recent times. John has navigated those waters with charm and grace. So we took him aside and tried to find out more about his journey and what it journey it is. From Ingmar Bergman to Baragwanath, from working in local occupational health and safety to InFACT; a global network of huge critical care clinical trial groups. Impressive stuff. Impressive personality. Impressive story. (And caterpillars.)

Each year the CICM holds its Annual Scientific Meeting. The Meeting has always been focused upon a single issue or organ system. This year the theme was Gastroenterology entitled “A Gut Reaction; ICU Gastroenterology from beginning to end.”

The lectures presented at the meeting have been recorded and will all be shared among the delegates and some will also be shared with all comers via the Intensive Care Network (www.IntensiveCareNetwork.com), the celebrated “#FOAMed” website. (Free Open Access Medical Education.)

The organisers of the ASM invited #FOAMed podcaster/interviewer Dr Doug Lynch to come along to engage some of the leading lights of the meeting in conversation and record them. These recordings are the latest in a series of podcasts/blogcasts playfully called “Jellybeans”. They are entirely spontaneous chats with interesting people; short, completely unscripted, 100% unedited and recorded in one take. It is essentially an uninterrupted live recording. The focus is unapologetically on the quality of the conversation rather than the quality of the audio recording.

The host of the interview is a fast talking Irish doctor, a jack of all trades but a master of none, a perpetual student and a trainee of the CICM. The “Jellybean” is an itinerant podcast that regularly appears on www.LifeinTheFastLane.com, www.IntensiveCareNetwork.com and many other websites. Over 100 conversations have been recorded with persons of interest. They will appear on iTunes and Google play once the 100th episode is published later this year.

The CICM ASM Jellybean series each start with a biographical component and then the conversation follows its own path. The subject matter is usually that which dwells upon the fringes of intensive care medicine; human factors, education, ethics, equality, gender, personal histories, possible futures and all the other challenges that we so often face. Being so they compliment the lectures but do not attempt to repeat them.

We hope you enjoy finding out a little more about the people behind the CICM Annual Scientific Meeting. The four CICM x Jellybean co-branded recordings are part of a larger collection. It is only these four that are formally associated with the College. Doug Lynch is not a representative of the college and any views expressed are his own.

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College of Intensive Care Medicine x Jellybean

Number 2 in a special series of 4 Co-Branded Podcasts

Professor Jules Wendon

Jules Wendon is the Professor of Hepatology and Executive Medical Director at Kings College London.

When it comes to the intensive care hepatology there are few people that have done more to shape our knowledge and practice than Jules Wendon. Jules travelled to Australia to share her knowledge at the CICM Annual Scientific Meeting. Sharing is a key theme in this interview as Jules insists on crediting her team, all of her team, for their part in the success of Kings. Humble yet inspirational, modest yet brilliant. Have a listen to this short conversation recorded in between her lectures at the CICM ASM in Sydney 2017.

The other jellybeans referred to in this interview are Sarah Yong (#62) and Penny Stewar (#13);

https://soundcloud.com/thetopend/sarah-yong-cicm-asm-2017 https://soundcloud.com/thetopend/jellybean-13-with-penny-stewart

Each year the CICM holds its Annual Scientific Meeting. The Meeting has always been focused upon a single issue or organ system. This year the theme was Gastroenterology entitled “A Gut Reaction; ICU Gastroenterology from beginning to end.”

The lectures presented at the meeting have been recorded and will all be shared among the delegates and some will also be shared with all comers via the Intensive Care Network (www.IntensiveCareNetwork.com), the celebrated “#FOAMed” website. (Free Open Access Medical Education.)

The organisers of the ASM invited #FOAMed podcaster/interviewer Dr Doug Lynch to come along to engage some of the leading lights of the meeting in conversation and record them. These recordings are the latest in a series of podcasts/blogcasts playfully called “Jellybeans”. They are entirely spontaneous chats with interesting people; short, completely unscripted, 100% unedited and recorded in one take. It is essentially an uninterrupted live recording. The focus is unapologetically on the quality of the conversation rather than the quality of the audio recording.

The host of the interview is a fast talking Irish doctor, a jack of all trades but a master of none, a perpetual student and a trainee of the CICM. The “Jellybean” is an itinerant podcast that regularly appears on www.LifeinTheFastLane.com, www.IntensiveCareNetwork.com and many other websites. Over 100 conversations have been recorded with persons of interest. They will appear on iTunes and Google play once the 100th episode is published later this year.

The CICM ASM Jellybean series each start with a biographical component and then the conversation follows its own path. The subject matter is usually that which dwells upon the fringes of intensive care medicine; human factors, education, ethics, equality, gender, personal histories, possible futures and all the other challenges that we so often face. Being so they compliment the lectures but do not attempt to repeat them.

We hope you enjoy finding out a little more about the people behind the CICM Annual Scientific Meeting. The four CICM x Jellybean co-branded recordings are part of a larger collection. It is only these four that are formally associated with the College. Doug Lynch is not a representative of the college and any views expressed are his own.

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College of Intensive Care Medicine x Jellybean

Number 1 in a special series of 4 Co-Branded Podcasts

Associate Professor Charlie Corke

President of the College of Intensive Care Medicine of Australia and New Zealand (CICM).

The CICM is the worlds first stand alone College of Intensive Care Medicine. A/Prof Charlie Corke is the President. It is not an easy job to do. It is not an easy job to get. Charlie got there by a path less travelled and he talks about that path, among many other things, in this short interview recorded at the Annual Scientific Meeting of the College.

Each year the CICM holds its Annual Scientific Meeting. The Meeting has always been focused upon a single issue or organ system. This year the theme was Gastroenterology entitled “A Gut Reaction; ICU Gastroenterology from beginning to end.”

The lectures presented at the meeting have been recorded and will all be shared among the delegates and some will also be shared with all comers via the Intensive Care Network (www.IntensiveCareNetwork.com), the celebrated “#FOAMed” website. (Free Open Access Medical Education.)

The organisers of the ASM invited #FOAMed podcaster/interviewer Dr Doug Lynch to come along to engage some of the leading lights of the meeting in conversation and record them. These recordings are the latest in a series of podcasts/blogcasts playfully called “Jellybeans”. They are entirely spontaneous chats with interesting people; short, completely unscripted, 100% unedited and recorded in one take. It is essentially a live recording. The focus is unapologetically on the quality of the conversation rather than the quality of the audio recording.

The host of the interview is a fast talking Irish doctor, a jack of all trades but a master of none, a perpetual student and a trainee of the CICM. The “Jellybean” is an itinerant podcast that regularly appears on www.LifeinTheFastLane.com, www.IntensiveCareNetwork.com and many other websites. Over 100 conversations have been recorded with persons of interest. They will appear on iTunes and Google play once the 100th episode is published later this year.

The CICM ASM Jellybean series each start with a biographical component and then the conversation follows its own path. The subject matter is usually that which dwells upon the fringes of intensive care medicine; human factors, education, ethics, equality, gender, personal histories, possible futures and all the other challenges that we so often face. Being so they compliment the lectures but do not attempt to repeat them.

We hope you enjoy finding out a little more about the people behind the CICM Annual Scientific Meeting. The four CICM x Jellybean co-branded recordings are part of a larger collection. It is only these four that are formally associated with the College.

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Fraud and Counter-Fraud. NGO’s like Oxfam are now a huge part of the international healthcare system. When you look at the environments these organisations work in, from Oxford to South Sudan, there are corruption issues everywhere. Corruption! We need a cop, a super cop, a stylish sleuth, a sort of crime-buster for NGO’s. It’s @OliverBMay of @2ndMarshmallow

Have you have ever had a dream of going and working for Médicins Sans Frontières or something similar? I did. I was idealistic. It was all heroic images, making a difference, not in it for the money and the moral high ground.

I went off and did a Masters of Public Health and Tropical Medicine. Then I did a Post Grad Cert in Disaster Management and Refugee Health. When I studied it I also saw the other side of the story; the colonial flavour to it all, questions about efficacy, undermining local capacity, a possible lack of standards/the Sphere Project, money badly spent and the fraud.

The fraud. Oh God the fraud. There is an impression that there are back handers and bribes going down everywhere to get anywhere. But is that correct? Is it that bad? Can nothing be done? I don’t know. So I asked a man who does. It’s Oliver May, formerly Counter-Fraud Czar for some very big Non-Governmental Organisations (NGO’s) and author of a book on the whole crazy circus.

We got talking and next thing you know it’s all Machiavelli, bribes, nepotism, corruption and this was recorded before the Donald became the President of a country in North America.

Oli knows enough about all this to go and write a book. So he did.

“Fighting Fraud and Corruption in the Humanitarian and Global Development Sector”. A snappy title indeed but it does tell you what it is all about.

Thats the book, you can find it any where serious or go to Routledge the publishers.

please paste the following link over the word “Routledge”

https://www.routledge.com/Fighting-Fraud-and-Corruption-in-the-Humanitarian-and-Global-Development/May/p/book/9781472453143

Or visit www.SecondMarshmallow.org which is interesting not only because of the rather excellent name but also because its a slick blog with well written content.

Oli is a real live criminal investigator starting out in the police service and ending up in a highly specialised area. One that is relevant to persons interested in working for NGO’s, persons that might donate directly (or indirectly through Governments) to NGO’s and indeed anyone that may be affected by the work of NGO’s. Which, if you think about it, covers almost all of us.

So I ask him about what it’s really like on the inside of all this business. I mean there has to be a film script or two in there? I asked if it’s like the “Whiskey Tango Foxtrot” movie? He dodges that one rather well. (Strictly speaking I asked him about the “Whisky Foxtrot Tango” Movie. But thats the Jellybean Format for you. Totally live, uncut, unscripted and in the case of this interviewer uncouth. WTF does WFT stand for anyway?)

Whats also interesting is the whole; “what was it like writing a big grown up book?” question. Oli has a few tips on that one too. Some productivity hacks for writers. The name he wanted to share with you is “Nicholas Carlson”

And there it is; a Jellybean about a charming super sleuth investigating evil bastards screwing up NGO’s that you might want to work for with obscure references to the Hobbit, Tina Fey, Yahoo and Virchester. What’s not to like?

And that discount code; FLR40.

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Matt McPartlin (aka @RollCageMedic) interviews Frank Gailard, the Frank Gailard, the one who created Radiopedia.

Frank Gaillard started Radiopedia as an exercise in pre-exam procrastination. And it has become an educational juggernaut in freely available radiological education. Pre-dating the formalisation and explosion in FOAMed resources, Radiopedia embodies what FOAMed is all about.

Despite its success, Frank is a humble guy and an altruist at heart. Listening to him recount the origins and evolution of Radiopedia and peek into the near future of where it might go, you'd be forgiven for drawing comparisons with entities such as the Khan Academy.

So no more teasing radiologists about lurking in dark rooms and maintaining an aloof distance from patients (well, maybe just a little bit). Turn on, tune in and rad out.

Links

Radiopedia - http://radiopedia.org

(This is a little bit of a departure for the Jellybean podcast in that Frank and Matt were not in the same place!)

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The Africans are coming. BadEM are surfing a #FOAMed wave at the moment and they are doing it with style, which isn’t that surprising when Kirsten Kingma is one of the team.

The Jellybean Podcast is a big fan of the www.BadEM.co.za bunch. Of course we are. Why wouldn’t we be? They are a great cohesive team of fabulously varied individuals. We like that sort of team. If you were at #dasSMACC you won’t have forgotten the BadEM team standing up with their friend and colleague Annet Alenyo @aalenyo introducing the whole room to #UBUNTU and @Go_Supadel. On the BadEM website the team members have pen portraits. We have already talked to The Logic and The Braun. Today we speak to The Adventurer.

I got into medicine for many reasons but one of them was that I would have my profession in my head and no matter what shit went down I would still have all that stuff in my head. Given the nonsense coming from the White House these days I still think it was the right idea. It isn’t easy to squeeze all that stuff in there and I had to make some sacrifices. I had to let some stuff go, sporty stuff, arty stuff, academic stuff and so on. That’s what I thought I had to do. Or did i? Did I have to give those other things away?

@SurferKirst wanted to become a doctor. She saw the adventure in medicine. She wan’t willing to let the other adventuring go. Surfing scholarships, paragliding study groups and thats just the start.

I’m hoping she sets up the first zero-carbon aeromedical retrieval service using tandem solar-powered para-motors. You’ve got to think big. Otherwise BadEM wouldn’t have put together the totally free conference in Stellenbosch last year. Or the #badEMfest18 next year!

badEMfest18 is a whole new concept; glamping, mountains, learning and if Kirsten has anything to do with it some nutty adrenaline sports! They have a knock-out local faculty and some international blow-ins from St. Emlyn’s and The Teaching Course. And I can reveal that there will be a South African Teaching Course in Cape Town just before #badEMfest18 (March 2018)

If you’ve never been to South Africa or the continent of Africa then I have a question for you; “why?”

I have another question for you “why not in March 2018?”

After that there are only 54 more countries in Africa to visit. They say this is the ‘Asian century’. I wouldn’t be surprised if it ended up being a close run thing.

The #badEMfest18 is on from March 22-25 2018. I know I want to go.

go to www.TheTopEnd.org for all the show notes and links.

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Jonah Roche wants to volunteer the entire police service in Ireland for an extra job. You’d think that wouldn’t be a popular idea but think again. Jonah cut through the crap at dasSMACC with his summary of the Code of Conduct and he talks more sense here trying to stop people dying and possibly making the job of a policeman more rewarding.

THE BLURB

Jonah Roche is an Resuscitation Enthusiast. Qualified Paramedic and Emergency Response Unit Gardai (Irish for policeman).

Jonah Roche is one of the guys that is responsible for scaring the shit out of everyone at the SMACCforce live shooter event in Dublin last year. He is a gun toting paramedic from Ireland. In Ireland the police don't usually carry guns. Even less of the paramedics carry guns. This fellow is a special case.

Jonah and I met in Berlin, we tried the local beverages and we talked. We talked and talked and laughed and laughed. In fact I wish I had recorded that conversation but there really was an awful lot of colourful language.

One of the things we got stuck into is the whole issue of trained first responders. We have a great bank of first responders that we are not accessing. I didn’t realise that in Ireland (and many other countries) the police are not fully utilised in. The Garda Síochána do not routinely deliver CPR even though they have all done at least one CPR course.

There are at least 10 times as many police men as there are paramedics and 10 times as many police vehicles as there are ambulances. And we are not using them. Why not?

There won’t be too many better placed than Jonah to comment on this.

Jonah is a straight talker. He is a good man. He is a big supporter of Dr John Hinds. As such he tells it like it is and he is funny while doing it. In fact he managed to really reign in the creative use of language during this conversation. It is almost a pity but he did want to get a message across.

Here is that study from Zurich.

"Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest."

http://www.resuscitationjournal.com/article/S0300-9572(17)30260-5/fulltext?rss=yes

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Under Siege. Under fire. Undergraduate. The remarkable journey of Dr Hanna Kaade; from Aleppo to Berlin and from the Red Crescent to #dasSMACC.

This is an ordinary tale. An accidental tale of everyday heroism. There are many tales like this. Every one worth telling, worth hearing, worth learning from.

Hanna Kaade is a Syrian born and trained doctor. He completed his medical training in a town under siege, in a hospital under fire, in the centre of a civil war at the centre of a giant ugly geo-political maelstrom.

We know about Aleppo. But we don’t know Aleppo like Hanna does. Hanna and I took some time to talk a little about what it was like to exist in such a conflict, to be a medical student delivering battle field trauma care in between basic medical training. From the mundane to the horrible, from studying under candles to working for the WHO. If you got a chance to get out, what would you do? If you had to start your medical training again what would you do? Hanna had to re-train in Germany. Germany has welcomed more Syrians than any country not bordering Syria. By UN estimates Germany has more registered Syrian refugees than every other country in Europe (not just the E.U.) and Canada and the USA and Australia combined. Now he is one of many, many doctors and nurses repeating his training and looking for a new start in Germany. Imagine how hard it will be for people like Hanna to get a start. When you hear him speak and when you see his smile you can believe that he will manage it. But it will be hard to get a break. Much harder than it was for most of us.

There are many tales like this from Aleppo, from Syria, from Iraq, from every conflict zone. We are increasingly saturated with images of war but we cannot let these bombed homes, shattered lives or lost loved ones become anything other that the unique tragedy that they represent. We are speaking about some mothers son, some fathers daughter, someone like you and I. In different circumstances it could have been you or me, your sister, your child. Hanna’s story is one of hope, hope in the face of great adversity.

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Its a laugh a minute as SMACC gets going.

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From Medical Students, through random missives to Men about the house and tattoos. @HenryGoldstein talks to @TheTopEnd about many, many things.



Don’t, whatever you do, just don’t forget the bubbles.

I get a chance to chat to stylish, charming, and generally very hard to dislike Henry Goldstein.

I knew of Henry through his work on the rather excellent www.Dontforgetthebubbles.com Paediatric FOAMed but when I got to talk to him I found out he started out with his own anonymous Medical student Blog. Now theres a funny business. So we get stuck into what it was like being students on other sides of the world and a generation apart. And we delve into some of the less fun parts of being a medical student. Henry, being a lovely fellow, turns the conversation around and reminds me of some of the really beautiful bits.

Henry speaks much more quietly than I do which is probably part of why he doesn’t scare little children.

But then next thing you know we are talking about adolescent medical research in Franco-phonic Switzerland while wearing lycra and shaving your legs. (Sort of.) Which leads us to trying to muddle your way through medical work in a second language. Which is basically bloody hard and makes me respect all my “english as a second language” nursing and medical peers even more!

All this happened before we talk about babies. Our own babies. And the interesting matters around maternal versus paternal experiences in modern western medical systems. Henry has managed to work part-time and be at home with his baby girl in a partial reversal of the more common gender roles. Three cheers for that.

It’s a SNAG riot. (Sensitive New Age Guys.) One has to laugh at ones self. I know I do.

And speaking of laughing at ones self we finish off with a chat about a tattoo and a cool t-shirt. (It makes more sense when you listen to it. So go and listen to it. And go and look at www.dontforgetthebubbles.com

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An Adventure that never ended. You thought you were just trying to pass a medical exam but then you ended up in the Australian version of the Paris-Dakar Rally. Sounds like another Gonzo-Medical-Jounrnalism moment.

Options. Options. Options. Rotation options. Where do you want to go to further your training? What informs your choices? Is it the specialties available? Is it a certain person that you want to learn from? Is it the real estate prices? Is it the commute?

Do you take the safer option or do you look for a bit of adventure? Michelle Withers chose the adventurous option and she is still on that adventure. Michelle started in Zimbabwe and ended up in Alice Springs via a few ivory towers. Taking the adventurous option may seem like the risky one but maybe staying in your comfort zone is risky too.

All over rural and remote areas there is often a lack of medical/nursing/para-medical skills. Yes there are opportunities to see new things, opportunities to be exposed to new things. If you are thinking about one of the off the beaten track jobs then you need to research it. Even though somewhere might look very exciting on a map you don’t want to end up Smolensk like Bulgakov did. (Although that did usefully inspire a collection of short stories; “A Country Doctors Notebook”.)

Here on the Jellybean Podcast we are big fans of little places. Thus in order to shed some more light on the less illuminated parts of the world, to help you decide if you want to go and work there, we go and talk to the people that have done these weird and wonderful jobs.

It turns out that Alice is hardly a secret anymore. We might think of it as the middle of nowhere but the folks from the Alice think of it as the middle of everywhere. 1500 klms from nearest referral centre and 1500 klms from the nearest anything. No interventional cardiology. (Stick that in your guidelines and see what happens.)

We have spoken to Penny Stewart from the Alice Springs ICU before and it turns out that for a town of approx 25000 people Alice has quite a lot going on.

It is an interesting combination of the worlds oldest civilisation and some of the worlds most recent trends. You may be a fly in fly out miner, you may be a well paid government consultant, you may be a displaced aboriginal elder living in a “town camp” but everyone, absolutely everyone, ends up in the same emergency department if they get sick. That is one of the best things about emergency medicine. You meet everyone. No selecting the type of person you work with/for, the door is open, anyone can come in.

Alice Springs ED has a fascinating aeromedical retrieval position as a referral centre and referring centre. The retrieval service has been very closely associated with the emergency department. It could all be a bit crazy but the calm way Michelle describes it makes it almost seem normal. (Calm sounding people like Matt McPartlin and Michelle Withers make people like me seem a bit nutty.)

Michelle and Matt talk about Tennant Creek and how the Emergency department collaborates with smaller emergency services that are too small to have emergency specialists. Michelle refers to “Rural Generalists” at remote locations and mentions FACRRM which stands for Fellow of the Australian College of Rural and Remote Medicine. Never forget how much excellent emergency care is delivered by persons other that card carrying emergency specialists. It’s a great big spectrum, all the way from REBOA to Finke.

Whats Finke? Well, Fine is a small remote aboriginal community but it also the end of a big and very dangerous car and bike race. Think of the Paris-Dakar with lots of macropods and better snakes!

Sound scary? The medical folks in the centre sensibly use it like a big annual disaster planning exercise. With real injuries and real drama.

(Photo Credit Justin Brierty)

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Matthew Harris and I help each other through an emotional morning at SMACC when we remembered everyones favourite motorcycle medic/maniac/comedian; Doc John Hinds.

Some of us are off to SMACC in Germany. Some aren’t. Fear not though. The lectures will be shared for free on SMACC podcasts in the future. You may miss out on some of the fun but you don't have to miss out on the learning. It is a #FOAMed thing. Long live #FOAMed.

The atmosphere was electric in Dublin even if the WiFi was steam powered. The whole thing started off with us remembering a departed friend; Dr John Hinds; a man with an insane hobby, a man with an immense sense of humour and a man that inspired people.

This Jellybean with Matthew Harris captures a little of the feel of the first morning. It is a classic Jellybean. Two people that really just met but liked each other. Lots of background noise. Lots of fast talking. And quite a bit of emotion.

Matthew shares a wee story about John and how he was inspired by the long haired Ulsterman to get into this funny world of pumping out educational stuff for no financial reward.

Matthew Harris has continued putting stuff out. Have a look at http://harriscpd.co.uk and please note that the website name is slightly different now to what Matthew was calling it when we spoke in Dublin.

We will be celebrating Doc John Hinds again in Berlin. Am I the only one that would like to hear how John Hinds would view things like Brexit and Trump? John did see things differently; let’s call it “Hinds-Sight”.

If there was one person in #FOAMed that could get you to remember something very serious by making you wet yourself, it was John.

https://soundcloud.com/thetopend/john-hinds-docjohnhinds-smacc?in=thetopend/sets/pre-hospitalists-paramedics

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Sarah Yong is an impressive person. Advocacy, Training, Representation and being a new fellow of the College of Intensive Care to boot.

Theres a lot to talk about when you sit down with Dr Sarah Yong. Let’s make it easy by focussing on three big issues;

Gender issues; Women in Intensive Care Network. www.womenintensive.org Training issues; The Critical Care Collaborative and the Victorian Primary Examination Course for CICM. www.vpecc.com Representation issues; New Fellows Rep on the Board of the College of Intensive Care Medicine. www.cicm.org

Where to start?

Women in Intensive Care Network www.womenintensive.org @WomenIntensive

If my sources are correct there pretty much the same number of women and men out there in the world. Further it seems that there are roughly the same number of women and men presenting to intensive care units. This pattern does not repeat itself in terms of the Intensive Care doctors.

Let’s talk about this. Let’s listen to the people that are raising awareness about this. The Women in Intensive Care are talking about it and publishing about it too. You may have heard about the Medical Journal of Australia article; “Female representation at Australasian specialty conferences”.

But they have not stopped proving their point. Next there was “Women in Leadership in Intensive Care Medicine” published in Jean-Louis Vincents open access e-journal “ICU Management and Practice” There have been only four presidents of the College of Intensive Care, all male. However the pre-cursor to the College was the Joint Faculty of Intensive Care Medicine (JFICM), which was the body that actually created the college. The first leader of JFICM was the one and only Dr Felicity Hawker.

Hopefully soon to be published will be a presentation from the Noosa ANZICS CTG (Australia & New Zealand Intensive Care Society Clinical Trials Group) by Dr Naomi Yarwood about the lack of women in the ANZICS CTG studies over the last 20 years.

Next Issue; Training. After competing her Fellowship exams Sarah got involved in the Critical Care Collaborative and went on to found the Victorian Primary Examination Course for CICM (VPECC). Running that is a big job in itself. It’s popular too and the July 2017 edition is already full. Sort of. Importantly the candidate stream is full for 2017 but there is a teaching stream too. Have a look at this if you are an aspiring educationalist; http://www.vpecc.com/teaching-stream.html

At the time of our conversation the teaching stream not yet full for 2017. It is on in July. Get in touch with Sarah or the other guys at VPECC.com, if not this year maybe next year?

Then she is on the Board of the College of Intensive Care Medicine trying to contribute and trying to gently help the college progress. I’m exhausted already.

Have a listen. Be inspired. Get involved.

List of speakers at Trainee Symposium

Dr Yasmine Ali Abdehamid Dr Michael Ashbolt Dr Bronwyn Avard Dr Celia Bradford Dr Michaela Carter Dr Naomi Diel Dr Kelly Jones Dr Fiona Miles Dr Nhi Nguyen Dr Nudrat Rashid A/Prof Ian Seppelt Dr Li Huey Tan Dr Sarah Yong Dr Paul Young

One might notice the slightly different gender imbalance there. A bunch of interesting people who have experience of medical training stretched from Zaria, Nigeria through Leicester, England to Auckland, New Zealand.

Which reminds me; may I offer an apology to all New Zealanders for all the times I manage to say Australian rather than Australasian or Australia-New Zealand.

References;

Women in Leadership in Intensive Care Medicine Modra LJ, Yong SA, Austin DE ICU Management and Practice; 16 (3): 174-6

Female Representation of Australasian specialty conferences. Modra LJ, Austin DE, Yong SA, Chambers EJ and Jones D. MJA 2016; 204(10) 385

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Emergency Medicine is a different beast in different places. What kind of beast would it be in South Africa? A big, bad and scary one? I ask Craig Wylie, brave South African Paramedic and #FOAMed star, to introduce us to his world.

You might think your Emergency Medicine world is Bad. You might think its “Bad Ass”. But is it as Bad or “Bad Ass” as South African Emergency Medicine?

BadEM (www.badEM.co.za) are one of the rising stars in the entire #FOAMed universe. They ere not bad. They are really rather good. BadEM is short for “Brave African Discussions in Emergency Medicine”. Sounds good. Is Good! It is conspicuous for the multiple different professionals that contribute; when I spoke to Craig BadEM had 3 paramedics, one medical student and one doctor. (That was Kat Evans; see Jellybean #44) Since then they have added another emergency physician with a strong cardiology interest and an paediatrician. This is a multi-disciplinary game after all.

Emergency Medicine is a different beast in different countries and in South Africa it is a quite an impressive beast indeed. A big beast. With big teeth!. It is the trauma that we all hear about but the resources, the patient load, the infectious diseases and the entire public health system are different. I ask Craig about his clinical background, his training, his practice and the complex public-private system in which he works.

It seems that clinical manager of a large private ambulance service wasn’t enough to keep him busy so he got himself mixed up in the #FOAMed game. And the elephant in the #FOAMed room was that a lot of the subject matter in the #FOAMed world is focussed on the resource rich world. USA, Australia, UK, Scandinavia et cetera. South Africa is health resource poor by comparison. The reality of resource poor practice is different. So while the BadEM team loved the #FOAMed they could access the fact was that they needed a different flavour. They couldn’t find it so they made their own “FOAM”. Brilliant.

Even better they have managed to create an entirely free (FREE) symposium held in September 2016 at Stellenbosch Medical School. 400 people got a load of face to face education for free. Wow!

The rate of change in South Africa is very marked. There are new challenges every day. There are difficult matters to discuss. It takes brave men and women to do it. These are those women and men and they are doing it.

Go visit their site www.BadEM.co.za and follow these guys:

@craigwylie @kat__evans @SurferKirst @jJParkRoss @willem_stassen @PaedCapeTown

@EMCardiac

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Ready for a laugh? We take two fast-talking and sleep-deprived Irish people and lock them in a shed. They talk. Fast. They tackle the big issues. From Nursing Home Patients in Emergency Departments to the great Sectarian Potato Snack debate. (Try to guess who had had coffee and who hadn’t.)

Dave Hartin is from Northern Ireland (or “Norn Iron”) and from East Anglia too. Ipswich seems to have a bit going on. They arranged for a stall at the last SMACC to make people aware of this.

Enough medicine already! Lets talk about the more serious matters, possibly the major diplomatic elephant in the room. They didn’t sort it out in the Good Friday Agreement. They pretended this problem wasn’t there when they handed out the Nobel Prizes. One of the most troubling problems since the troubles revolves around potatoes. There is a thing called Tayto. They are the best crisps in the world. Irish people need them to survive and have them shipped to every where an irish accent can be heard.

I shall let Dave explain but it’s important that you know that there is a Northern Ireland Tayto and another Tayto from the Republic of Ireland.

Some conflicts are just too difficult. Dave is from near Tandragee. (He is from Banbridge, less than 10 miles from Tandragee, which in Ulster terms is actually not that close.) Tandragee is not Ashbourne. It nearly comes to blows.

I distracted Dave from his potato fuelled patriotism by moving the conversation onto Anglia where he was distracted by the Ipswich versus Norwich debate. (Phew.)

In no time we race through Emergency training in Ulster/Anglia and the huge drain of doctors out of Emergency in the UK to places like Australia. (Can’t see that improving with Brexit.)

And in the end we show that human doctors all seem to have caffeine issues and should clearly not be trusted with fish.

(Good luck to Rosie. Rest in Peace Teabag.)

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You probably have something like a Wednesday afternoon education session at your place of work.

You probably have to present at it sometimes.

You probably do it pretty well. You may not feel that. You may be your own worst critic and see all the areas that need improvement. That is an important insight which you can use for constructive good rather than destructive evil.

Just by being a #FOAMed consumer you are already in a subset of your profession that is motivated to learn and improve you clinical work. It follows that you may well already be developing your teaching skills. In fact I am willing to bet that almost anyone reading this is above average in terms of their presentation skills.

Here’s the bad news; the average is poor. You want to be way above that average. You don't get to be way above average without working at it. But how? I mean we don't get our own personal Mr Miyagi to get us to “wax on’ and ‘wax off’ until our presentations are optimally polished.

Heres the good news. There is a FOAMed version of Mr Miyagi to help you with the wax. It is Ross Fisher, the presentation guy, @ffolliet, inventor of the P cubed concept and one of the nicest humans you may ever meet.

Ross talked at SMACC dub and will be at dasSMACC in Berlin. He is softly spoken, calm and collected. Unlike most people I like there would be little concern introducing him to my mum. In fact he is the sort of person you could trust to do surgery on your children!

Ross has his own Mr Miyagi; Prof Garr Reynolds. Garr Reynolds is big time. You can buy his books and attend his workshops but it will cost you.

Ross is sharing what he has learned for free at www.prezentationskills.blogspot.com or www.ffolliet.com

I certainly can learn from Ross. When you listen to the two of us speak it is like chalk and cheese. If theres any waxing with me its “waxing lyrical”; barely contained enthusiasm coupled with pressure of speech.

Apparently my desire to improve this is a very important step.

If you want to be better at the next departmental education session, or if you have your eye on an educational role in the future, I recommend you have a look at what Ross has been doing. You will find all sorts of goodies over there including the TEDX talk (in videos), his own podcast (slicker than this one of course) and much more.

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Half way up the stairs is the stair where we stop.

To talk to a peer. About peers. About peer reviews.

I know next to nothing about Journals, Editing, Peer Reviewing. Kirsty Challen does. She is an Emergency physician and an EMJ sub-editor. She talks to Matt McPartlin about the journal article review process and the debate surrounding peer review. In a stairwell. (Seriously, they really were in a stairwell.) They also ate jellybeans. It's really quite good.

(What they don't talk about (at all) is another Kirsty Challen talent; graphic design. She has an interesting practice in what she calls #paperinapic, the distillation of an educational message into a graphic image. I prefer picture books. Something to do with my poor reading skills.)

Matt once again shows that he has a much more logical approach to this Jellybean Caper when he asks Kirsty for three top tips for the aspiring writer AND three more for the aspiring editor.

This conversation came after the very interesting and thought provoking group discussion entitled “Publishing and the future of critical care knowledge dissemination.” You can access that here.

https://www.smacc.net.au/2016/11/publishing-and-the-future-of-critical-care-knowledge-dissemination/

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Tor Ercleve is an arty farty kind of guy. It’s ok. He knows it.

You could call him a frustrated artist but it turns out he is not really very frustrated. He is just an artist. Anyone can be an artist. I recommend you try it. Tor did and he is a happy guy now.

He may have already touched your life by creating educational gold dust that you can sprinkle on your ECGs or your neuro examination. Maybe art is the way to approach these things because they both initially feel as intuitive as an interpretive dance performance.

Being a doctor is all well and good but Jellybeans are partly about keeping dreams alive. If your dream is being the Special Effects Guy that builds the Death Star then the doctoring might feel a little less than creative. Or you could cross germinate wildly.

That immediately makes me think of a Health Service with a Death Star feel to it. In fact I think I used to work in a service with all the warmth and caring of your average planet destroying Space Station.

In Tors case he has brought the art to work. He has deconstructed it and reconstructed it and now people like me and you can benefit from it. He spends hours perfecting an image that saves you hours of headaches. It is a neurological therapy in itself. There is a place in our weird Critical Care world for the arty farty types. In fact there is a need for art and beauty even in “Death Star Health”. There is a need for Gin and Tonics too. And penne a la arrabbiata.

Language warning on this one. (As if I had to tell you.)

And some one walked into the cupboard I was recording this in in the bowels of the SMACC venue in Dublin. Hopefully we can find a better room in Berlin.

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Mark Wilson; Neurosurgeon, Retrieval Physician, App Designer, Sceptic and Gentleman. It is hard not to like this chap.

Mark Wilson somehow found time to talk to Matt McPartlin at SMACC. He really had an awful lot to do in Dublin too. Mark was presenting, fighting, drinking, dancing, facing his PhDemons and listening to @Kangaroodoc, all of which are frankly exhausting. But then he was asking for trouble by being so good at everything and even better at certain sexy media friendly matters.

Mark knows concussion like very few people ever will. He is a neurosurgeon that gets down and dirty in the streets of London with the paramedics as a Retrieval Physician. He invents apps that go huge and actually save people lives. He has essentially created a way of real-time crowd-sourcing a medic when you really really want one.

I wish I could do that.

Mark is the main person behind the GoodSAM app which as been reviewed by Tessa Davis here on LITFL.

(Link to be pasted over” GoodSAM app which as been reviewed by Tessa Davis” http://lifeinthefastlane.com/techtool-thursday-050-goodsam/ )

Lots of us have little moments of App inspiration but Mark has done it. It is free so it is genuine #FOAMed. It is also much more in that; it mobilises an entire community of volunteer responders which crosses the divide between clinician and non-clinician. The follow up is interesting too. Mark released this App back in 2014. Being one of the more successful Apps it really didn’t end there. The app is now in version 5. It has a life of its own and Mark still maintains it, updates it, promotes it, fixes it up when problems arise. It is an ongoing concern.

Have a listen to Mark and Matt, have a look at https://goodsamapp.org and have a think about getting involved.

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Twenty years of schooling and they put you on the day shift. And then some one says: “Sorry….. but are you really a doctor?”

Penny Wilson burst onto the scene a few years back when an article that she wrote on her NomadicGP blog hit a nerve. The nerve in question is about sexism and misogyny. It was about people not believing that Penny was a doctor because she was a young woman. She wrote about it and a lot of people read it. She had only been writing the blog for 6 months and BANG she is on the Huffington Post. Then comes the back lash. Only a few months later she is back in the Huffington Post wrestling with another significant prejudice. “Are you a specialist or are you just a GP?”

Jenny and I have a talk about her life being “just a GP” in which she does almost no work at all that most folks would recognise as “just a GP” kind of work. She is some sort of Obstetrician/Emergency Physician Hybrid about 8 hours flight from the ivory towers of Perth in Western Australia. It is frightening stuff. I am certainly a bit scared of obstetric emergencies. Maybe you are? Maybe you’re not? Maybe you know everything there is to know about it? Maybe you don’t? Penny has tried to get a #FOAMed resource up and running for O&G, ObGyn, Obs & Gobs, Obstetrics & Gynaecology; the fabulously named https://bitsandbumps.org

I hate the phrase “just a GP”. It underestimates the work of GPs. It undermines the specialty of General Practice. It has undertones of elitism and snobbery. Being a good GP is one of the hardest jobs in Medicine. There is no limit to what you need to know. There is no way you can be an expert in everything. Ask any specialist who has retrained as a GP? Ask yourself if they are one of the good GP’s I am talking about?

I have tried it and I can tell you that almost every time you see a patient with a given problem something will have changed from the last time you dealt with it. Either the tests have changed, or the medications have changed, or the guidelines have changed, or the support services have changed, or the referral destinations have changed, or the government forms you have to fill out have changed or the way you and your practice gets paid has changed.

As Heraclitoris said; “No woman ever steps in the same river twice.”

When you meet Jenny you don’t get the impression that she is out to cause trouble. She is just commenting on this stuff from a personal and important perspective. That didn’t mean that she didn’t get attacked though.

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There is a lot of knowledge out there. Whats the bottom line? Alright. You’ve decided to specialise in some fantastically sexy area of medicine. You need to learn the craft. You need to get through each night shift. You need to stay alive. You need to maintain your relationship with your man/woman/dog/cat/ mother/ father/ children...... You also need to know about a million research papers that were done over the last 30 years. The guys you are working with have been absorbing this knowledge over years. They may even have been involved in the studies. Worse still the woman that is examining you for your Fellowship/Board may have written that crazy bit of evidence based medicine. Not everyone gets to do a Masters of Public Health or a Epidemiology/Biostats qualification so where do you start? What does this study mean? Is there some biostats faux pas that makes this paper useful only for personal hygiene? What is the “Bottom Line”? The good news is that there often is a bottom line and a bunch of your peers (some pretty cool peers like Steve Mathieu, Celia Bradford, Duncan Chambler and Charlotte Summers) have set up the snappily named www.thebottomline.org.uk (It does exactly what it says on the tin.) Steve Mathieu @stevemathieu75 is a very likeable chap. We had a good giggle and the conversation slipped sideways (as usual) into other FOAMed issues, why podcasting is a funny beast, theres a significant bit of bro-love for Scott Weingart and we deal with our own insecurities about not being that pretty. A big shout out to a #FOAMed hero of mine Mark Crislip the man that has now produced over 900 Gobbets’o’pus! Look out for Dr Crislip, and any gobbets associated with him, on iTunes and many other places on the “interweb”. (Prepare thyself for weirdness.) www.thebottomline.org.uk
http://www.wessexics.com
www.emcrit.org
and The Prince of Pus; Mark Crislip at www.edgydoc.com

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Punching above your weight. In the first post bare knuckle fight interview for the Jellybean Podcast we talk to the victor, nay, the newly crowned Heavyweight Champion of South African Aeromedicine. She was, of course, graceful in her moment of triumph. It’s @mjslabbert

Dr Slabbert went into the ring with a proper heavy weight @AnthonyDHolley and won. A bit like a butterfly and a bit like a bee. More like a bee really in that she recruited an entire swarm of prehospitalists, SMACCforce-types and the EMS Wolf Pack to come along and give her South African Compatriot hell. That’s SMACC Bare Knuckle Fighting for you. No-one said it was supposed to be pretty.

Marika Slabbert comes out her corner with and wades into the debate about prehospital care. But while she did well the fact remains that our prehospital practice is lacking a robust evidence base. It’s true. No point in pretending. So we get stuck into that for a while.

Beyond her bare knuckle prowess Dr Slabbert seems to be super competent at almost everything as a Trauma Critical Care Anesthetist and Critical Care Physician. Her own journey has brought her across multiple countries and continents.

She is an interesting woman. Have a wee listen. (Keep your hands up though.)

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Do Something that outlives you.

Jim Du Canto just keeps making stuff. @RollCageMedic caught up with him in Dublin and chewed the cud, the fat and the kids toys.

I have kids. You might have kids. Even if you don’t have kids you probably were a kid at some point in the past. Kids chew up and spit out plastic toys. Plastic can be recycled but that is perhaps better called downcycling. Jim DuCanto however is upcycling left over smashed up Star Wars toys to make me and you better at what we do.

Jim is a well known anaesthetist (aka anaesthesiologizer) and inventor of the SALAD (Suction Assisted Laryngosopic Airway Decontamination) simulator as well as the Hi-D Airway Suction Catheter, the intubatable Wookie head and the Uescope Intubating Stylet. Jim talks about what drives him to make these airway toys and openly discusses the commercial and altruism balance of airway device development. We also dip toes in the emerging area of 3D printing for task simulators and clinical equipment.

As Maz Kanata said; “I like that Wookie.”

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Okay. This is not going to be what you are expecting.

Last week we spoke about Ethics with the Oxford Professor of Ethics. The week before we spoke about Ultrasound saving the world with Resa Lewiss. This week we are singing from a different song sheet.

I speak to Sarah Nikolić who was a student in Slovenia when I contacted her, then she qualified before I met her, then she danced around the virtual intrapleural space in front of 2000 people at SMACCdub and then she danced some more at St. James Gate where Guinness is brewed and where #FOAMed was named.

Beware; this Jellybean starts off rather differently to usual. It sounds an awful lot better but then returns to a more recognised and less beautiful format.

Congratulations Sarah on getting through your exams. This one is a tribute to every paramedic, nurse or doctor that has worked their way through those hard times.

You’re awesome. Don’t forget it. Sing it from the rooftops. Keep painting. Grow vegetables. Climb mountains. Make stuff. Create wonderful children. Whatever! You are more than your job description, you are unique and that probably makes you a better carer anyway!

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I have a dilemma. It is this; almost all of my ethics are a bunch of poorly thought out lies and assumptions. What am I going to do about it? Perhaps I should ask the Uehiro Chair of Practical Ethics from Oxford, Professor Julian Savulescu.

My ethics are crap. Your ethics are probably crap too. If you think your ethics are definitely not crap then the aforementioned probability just shot up to somewhere very near 1. If you think Ethics in Medicine are very simple, or even dull, you haven’t thought about them enough. The more you think about them the harder they get. When I was taught ethics as a student it wasn’t too inspiring. As I butted up against ethical issues as a clinician it was inspiring. How can I not care about a right to life or a right to death, a right to choose or the lack thereof?

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Ultrasound. Point of Care. What is the point of care? The patient. Aha! Here we have the artist formally known as @RollCageMedic interviewing interesting people for the Jellybean Podcast.

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Denmark. There is very little rotten in the state of Denmark. I got Mads Astvad of www.scanfoam.org to come and chat to me about everything Danish. He didn’t do that. He had his own ideas. Brilliant.

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A sensible but sports mad woman. She turned down free beer, paid for by @precordialthump, in order to talk to me and thus talk to you. It’s @DrRuthBird

THE BLURB

Sport! More sport! The Rio Olympics are in full flow. The European Football season has started. That means thousands and thousands of people all crammed into stadia all over England, Spain, Italy and so on. (Mostly men & not necessarily the fittest blokes.)

If you put thousands and thousands of people in a big concrete bowl and get them stressed things happen. Ruth Bird has been the Crowd Doctor at Fulham FC for 4 years. She is not responsible for the team and thus not even slightly responsible for them getting relegated in 2014. So whats that like? And how? And why?

Turns out this sport mad doctor has a far from mad plan. She has been building her contacts and experience in the Pre-Hospital Medicine world. Ruth has branched out into the motorsport world. She has been mixing business and pleasure by finding ways to use her skills in many different environments. It is all much more sensible than you might think. Ruth gives us a bit of an insight into the fun things she does and the very serious things that she is hoping to do. Ruth is applying for one of the very few UK Pre-Hospital Emergency Medicine Specialty Training Posts in one of the many great Aeromedical/Pre-Hospital Medical Services.

Coming to a major event near you and possibly by helicopter; it’s a bird, it’s a plane... it’s... no I was right the first time its a Bird. Dr Ruth Bird.

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Worse things happen at sea. A charming man. A dapper chap. An adventurous fellow. It’s Andrew Tagg from www.dontforgetthebubbles.com in one of the funnier Jellybeans.

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Jellybean Two for One Deal. @Kat__Evans shares two interesting stories. #BOGOF #FOAMed !

South Africa. Trauma. Resource Limited.

And a sick mum.

www.BADEM.co.za

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A Paramedic Afloat. A man with energy. A man with some alternative energy. Michael Stanley has taken a slightly different route.

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It is official; Donald Trump is the Republican Candidate for the Presidency on the United States of America. What does that mean? What does that mean for Healthcare in the USA? (Or world peace?) I don’t know so I asked someone who might. It’s Liam Yore. a.k.a. @MovinMeat

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Hi I'm Rusty. Hello this is Rusty. Hello my name is Rusty. Paramedic. Educator Team Leader. And a different type of leader too. A special one. Have a listen. This Podcast is closely linked to two podcasts that have been released on St. Emlyns; www.stemlynsblog.org or via their iTunes podcast feed. Look for "Wellbeing" by Iain Beardsell and Liz Crowe and "Handover" which has Rusty mixed in with a bunch prehospitalists talking about Critical Care Handovers.

Rusty refers to a conference which had passed before I even got back to Australia. But they will have more events, have a look at; http://www.cardiacsmart.nwas.nhs.uk

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Expect the unexpected in this Brave #Jellybean recorded at #SMACC in Dublin. There are so many different types of bravery. Big and obvious or small and subtle. Different flavours. Different arenas.

This is one for the Paramedics, the #EMS Providers and everyone else in critical care too.

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So SMACC Dublin is nearly upon us.

I wouldn’t like to be organising it.

Paul Young is going and he is hilarious. And very smart. And a research rising star. I certainly have all his mind maps via LITFL.

He knows how to put a meeting together having recently been the Medical Convener of the ASM of the worlds first College of Intensive Care Medicine. (He is, however, rather humble about how hard it was to dream it all up.)

And he controls the weather. Is there anything he cannot do? Well, he couldn’t comment when he was asked comment on the goings on at the notorious Boogie Wonderland Night Club late one night in Wellington. The plot thickens.

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Derek Angus; 15/15 on the Glasgow Conversational Scale.

Derek is the lead author of the PROCESS trial. You may have heard him on EMCrit talking about that study. http://emcrit.org/podcasts/process-trial/

You may have heard that he is one of the Heavyweights invited to SMACC CHICAGO.

So where does he come from, how did he get here, is he the right fit for that SMACC scene and will he be singing until 3am at FOAMaoke?

I caught up with Derek in Wellington, New Zealand at the Paul Young curated “Down with Dogma” College of Intensive Care Medicine Annual Scientific Meeting and I won’t pretend; I really like him.

Angus is a Prince of research. Do a Pubmed search for him if you don't believe me; there are literally hundreds of papers.

He started out at Glasgow University. (I seem to have a thing for Glaswegians a.k.a. “Weegies”) He was aiming at neurosurgery but after his MRCP and became the first Commonwealth citizen to work for MSF back when MSF were much, much smaller.

This conversation was just too interesting to stop around 10 minutes as Jellybeans usually are.

Have a listen. I think you’ll like it.

Derek went from MSF to working with Peter Safar no less.

From his early papers co-authored by Safar he has gone onto publish nearly 300 article of all shapes and sizes. These do not focus on the minutiae of some esoteric area, they seem to cover almost everything. Can you be a research generalist?

Talking to Scott Weingart he gave a restrained epidemiologically tight representation of what the PROCESS trial tells us. Many of the questions and comments on EMCrit.org blog were focusing upon “what should we do with our septic patients?” My understanding of the ProCESS trial is that it tries to answer a specific question; what part of this bundle actually works. Anthony Delaneys understanding is rather more important than mine though. http://www.intensivecarenetwork.com/index.php/icn-activities/icn-podcasts/906-process-delaneys-take

Sepsis is just one small part of what he does; he has fingers in all sorts of pies from Social Justice to Disaster Management. But what I should have asked him was what he was doing when he worked at “Reanimation Medicale” Hopital Cochin in Paris?

One of the best things that we talked about was heros, mentors and role models. Don't be afraid of these guys.

If you've got a hero out there at least send them an email!

This guy is seriously impressive; apparently you or I could be him!

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Jellybean Redux with Rob MacSweeney of www.CritCareReviews.com 

It's a very Irish Jellybean.

Rob MacSweeney & Matt MacPartlin in Fairy-Land with one of the greatest punk bands of all time; The Undertones. (It makes sense when you listen to it.)

Matt and Rob meet up in a simulated Fairy-Land in Illinois. When this was recorded Rob had just debated Paul Marik (Mr Fluid) at SMACC Chicago and lost despite being one of the best read people in medicine. Maybe the most conspicuous reader around at the moment given his work on www.criticalcarereviews.com

Ok, lets do a Checklist;  Read EVERYTHING. Check. Figure how to be a New Consultant in Belfast. Check. Organise SMACC Dublin. Check. And that wasn't enough to keep him occupied so he has set up a new breed of journal in the form of www.criticalcarehorizons.net

This is something I had been waiting for a while. It's a fantastic concept and it's free. Actually it is free x free x free. Which means they are proposing to do it all for free. (That sounds like a lot of work.)

The idea is fantastic but it requires buy in from all #FOAMed types. A lot of us are educators and a few of us are researchers. Rob and Andrew Ferguson are doing the heavy lifting but check out the team behind them. It is a balanced "who's who?" of #FOAMed and established world leaders. Rob and Andrew are relaunching the site before SMACC Dublin. Have a dig around the site. Have a think about what it might mean to the anarchic #FOAMed community. Have a think about what it might do for you. Then, perhaps, put your research where your mouth is and submit.

Why shouldn’t new research or reviews not be put out for free and immediately on the web? Why Not have original Research on www.LifeintheFastLane.com ? 

It is a difficult thing they are trying to do. Not a penny is being made. Plenty of pennies have to be spent.

"We are all in the gutter, but some of us are looking at the stars" Bird? Plane? Superman? Nope.

(Watch out for the correct pronunciation of the word "Super" at the end. Always good to keep up with the Gold Standards of Elocution while you're having some Jellybeans.)

Thanks to the peerless Northern Irish Punk Band The Undertones for making the track “Here comes the summer” and recording it with John Peel in 1989.(Sir John Peel, Saint John Peel, The John Peel.)

www.criticalcarereviews.com/index.php www.criticalcarehorizons.net

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Yeah, but, it's not rocket science is it? So one super long training period is enough for most of us. Most. Not Charles. Charles studied aerospace engineering at MIT. (Yes that MIT.) Having literally engineered rockets Charles retrained as an physician. (Critical Care Medicine and Emergency Cardiology no less!) (Nutter.) Engineers make things happen. That’s almost the job description.

Matt MacPartlin gets a chat going about the engineering mind set and how it fits into the medical world.

We are confronted with problems all the time. Patient problems we can usually deal with, although its a curious type of logic we have learned to use. But have you ever been confronted by a system problem. Have you ever been in a meeting where some bright spark suggests a solution for that problem only to be sucked into the black hole of cynicism.

Have you ever had the depressing moment where someone says; “Oh, we tried that once and it didn’t work.”? (Funny how we didn’t abandon Activated Protein C a bit quicker eh?)

Charles looked at medicine and was fascinated. How he is looking at what we are doing is not necessarily the same as the way I am looking at it. Or how you are looking at it. I’m curious to see where he goes.

I don’t know many successful engineers have made this career jump but it cannot be many.

And Charles loves an old Series 2B Land Rover too. (Nutter.)

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The White Haired Doctor. A different kind of pioneer.

I had the pleasure of speaking to one of the heroes of indigenous critical care at the CICM ASM a while back in Wellington, New Zealand, Dr Penny Stewart. Director of Alice Springs ICU.

The “white haired doctor” in the “land of the long white cloud”. Red Hot Medicine in the Hot Red Centre of Australia. Alice Springs Hospital, in the Northern Territory of Australia, is one of the worlds most remote Intensive Care Units. It cares for some of the worlds most spectacular people in one of the worlds most spectacular environments. Penny calls them the Central Desert Mob. Sick people but reversible causes. The ICU experience in Alice is distinct from most other centres. The ability of the population around Alice Springs to recover from the insults thrown at them is legendary. Not just verbal insults, not just colonial insults but also physical insults. These are tough people. They would have to be. Penny has published previously on the differences in the presentation of, and recovery from, severe sepsis in the indigenous western desert population that visit her unit. Severe sepsis, pancreatitis, haemophilus, humorous, human.

Have a listen to Penny “yarning” at the CICM ASM. Some of the details and data in this Jellybean Flashback may have been updated. If you are interested in Alice, and why wouldn’t you be, then consider getting in touch and getting the up to date information about a sojourn in the centre.

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David Rigg is an intensivist working in Hobart. Hobart is Cool. Hobart hosted the ANZICS ACCCN ASM October 2013. A big meeting thats equally medical and nursing. I didn't make it but I love Hobart so I am bigging that up anyway. David and I chew the cud at the CICM ASM in New Zealand. Predictably he knows more stuff about ICU than I do. However he didn’t know who Rip Torn is. I’m calling that a draw.

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Bula! So Anne Creaton is knee deep in Fiji. Knee deep in another culture. Knee deep in Government Bureaucracy. Knee deep in the most beautiful water in the world. What a woman! I worked with Anne a few years ago when she helped start up the Ambulance embedded aeromedical service called Adult Retrieval Victoria in Melbourne. That wasn’t hard enough for her. So she headed off to Fiji to try to bring some of what she had learned to the Pacific. Now I don’t know what you know about Fiji. It is an incredibly interesting place with an incredibly interesting mix of people.I know that I don’t know enough about the history of Fiji, the story of native Fijians and indo-fijians, “Indentured Labour” and the relatively recent political complexity/instability. I am willing to bet that out of the few of us that have visited Fiji 99% will have visited the 3 biggest islands or a resort island. There are 330 islands in Fiji and about 500 islets. It is the biggest and most developed of the remote independent pacific island nations. It has the biggest campus of the fascinating University of the South Pacific and a newer second University of Fiji.

There also exists something called Pacific Time or Fiji Time.

(“It’s Time, Jim, but not as we know it.”)

Anne is humble about what she is trying to do but I am less reserved. I looked at doing something like Anne is doing about 15 years ago. I wasn’t brave enough. She was.

Heres a few questions for you; What does the Australasian College of Emergency Medicine (ACEM)do outside Australia and New Zealand? Should they do more? Have you ever heard of their Special Interest Group called IEMN?

Have a listen and get in touch with Anne if you want to know more. @AnneCreaton

Thanks again to @rollcagemedic for offering to do some #Jellybeans in #Chicago

I am resetting the Jellybean numbers to fit with @sandnsurf and @precordialthump at www.LifeintheFastLane.com so this is called Jellybean 33. I'll rename the others later.

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Fear, Flight, Fight.

Ashley Liebig is a Screaming Eagle. So at SMACC Chicago you had a 101st Airborne Division Medic talking about feelings.

SMACC Star Ashley Liebig, now a Texan Flight Nurse rocked one of the Pre-SMACC US Workshops with a difficult subject, talking about dealing with critical events as a human inside a big & nasty world.

Ashley was also one of the Conference Organisers and did a lot to get the show on the road.

This is the first of 4 guest interviewer Jellybeans. I want to thank my friend and countryman Matt McPartlin ( aka @RollCageMedic ) who, like Ashley, has been instrumental in a lot of pretty cool things, but usually without being the guy up front. I really appreciated him offering to do this.

I’m calling Matt my Doppelschwätzer rather than Doppelgänger. (Our walk isn’t that similar but out talk is.)

I wasn’t at SMACC Chicago. I could tell you where I was but you wouldn’t believe me

I will be at SMACC Dublin. Will you?

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The straight talking Di Stevens from the very interesting Darwin ICU.

The F Word. Feminism and Intensive Care. Women and Intensive Care.

Di was asked to talk at the CICM ASM about women in ICU. Di got up on stage and danced to “Sisters are doin’ it for themselves” in front of a crowd of predominantly male intensivists. Guts were not lacking. Her talk was more wide ranging than the title suggested, covering more than just half of humanity. The greatest controversy however came from an unexpected source. During her talk she questioned the future of “Dual-Trainees" in ICU which got the Social Media world rather excited. Upset really. Di and I got together and went over that and other controversies in a great JellyBean that could have gone on for hours touching on Retrieval Medicine, Indigenous Healthcare, Remote Area Intensive Care, Tele-Health and Intensive Care. It’s on.

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David Anderson floats gracefully around the Twitterverse as @expensivecare

David Anderson is an eloquent and erudite individual that shares my interest with end of life care in the critical care world. He has a conspicuous interest in both Intensive Care and Palliative Care and the overlap. In fact this is possibly the person that I would most like to glide into my own ICU cubicle to tell me that I was about to die. (That’s a compliment.) We sat down and chatted with our respective comedy celtic accents while over in Middle Earth a while back. We are not promoting cigars. Really.

I love this guy. It’s not his sartorial elegance. It’s not his gorgeous accent. It’s not the fact that he has a very cool career; from Paramedic to Intensive Care. It’s his interest in the educational nirvana that is Lego.

https://www.youtube.com/watch?v=Sv5iEK-IEzw

(We’re not promoting penne alla arrabbiata either.)

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Jellybean #34; Andrew Peacock at Blue Mountains, NSW, Australia by Doug Lynch @TheTopEnd

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The utterly brilliant and inspiring Hills family; Tamara Hills wins the SMACC PK Oscar and breaks hearts while spreading knowledge. Have a look at this: http://www.smacc.net.au/2014/03/17-minutes/

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Softly spoken. Well balanced. As an anaesthetist and intensivist you might be forgiven for thinking that Dr John Hinds would be a little risk averse.

But not if you’d been to his utterly hilarious talk about madness and mayhem on the very small roads of Ireland.

John Hinds is a jack of all trades. I like those kinds of jacks.

This is a brilliant example of the sort of extremely cool thing that you can do with a medical, nursing or paramedic qualification. John carries about 25Kg strapped to himself and sends himself along stone walled irish lanes at eye-watering speeds. John puts his life at risk in order to take a little risk out of one of the worlds most dangerous sports. He doesn't see his riding as a risky thing. Why? Because he races too. When he is an ambulance on a 4 cylinder rocket he shaves a few percentage points of the level of performance that he applies when he is actually racing rather than being the doctor! So apparently that means its easy for him.

The guys he races after on his ‘chase’ bike (or races ahead of on his ‘race’ bike) become his friends. And being one of the most dangerous sports some of these friends end up being his patients.

But it’s about more than just the bike. The jack of all trades status was betrayed by the fact that he spoke on 4 different subjects on the day I caught up with him. As John says; “I’ll talk about anything.”

Available for weddings and bar mitzvahs and bat mitzvahs and funerals and a variety of events involving crazy adrenaline sports; John Hinds is “yer man.” @DocJohnHinds Just don't expect him to break into a sweat doing any/all of it.

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Jellybean #28; Liz Crowe Swearing In The Face Of Death. Brilliant (Parental advisory!) at SMACC gold by Doug Lynch @TheTopEnd

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Jellybean #27; Andy Neill of Emergency Medicine Ireland at Smacc GOLD by Doug Lynch @TheTopEnd

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Tim is what is known in Australia as a Larrikin.

Defined by the Oxford dictionary as “A boisterous, often badly behaved young man” or “A person with apparent disregard for convention; a maverick”.

Tims not that young so I am going with the second one.

Tim is, like many great Australians, not Australian (by birth). He is irreverent. He uses “colourful” language. He is a stirrer. He can’t help himself. I can’t help but like him. And that's not just because he has an adventure sport alter ego; http://ki-yak.blogspot.com.au (Nice blog site title.)

So out in “the bush” in Australia has many flavours; its not just Red Dirt, for Tim it's the cold Southern Ocean. Tim was born in England. He is one of the small number of doctors on Kangaroo Island and thus one of those remote doctors that has “Nowhere to run and Nowhere to hide.”

Our Tim has had courted controversy what with his “soft, strong and very long” Fellowship of the Ring Certificate. (You’ll understand when you listen.) Idealists! Don't you hate them.

Tim and I got into a natter and for whatever reason we started to organise each others death. (I mean “end-of-life” planning.)

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Jellybean #25; Karim Brohi, of Trauma.org, The Royal London & Barts, and other cool stuff! by Doug Lynch @TheTopEnd

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Jellybean #24; Damien Roland and NHS Change Day at SMACC GOLD at SMACC GOLD, Gold Coast, Australia. by Doug Lynch @TheTopEnd

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Injectable Orange. That's an interesting one.

Jesse Spurr is one of the FOAMed/FOANed talents that I have had the pleasure to meet through all this social Social Media stuff.

With an interesting past in sport, sports science, Jesse hit ICU nursing with a bang and became a simulation trainer really very quickly. (He must have been good at it.)

Jesse’s site www.injectableorange.com started out as a journal. On a Wordpress blogging website. It’s more than that now. Jesse has an interest in cross germinating multi-disciplinary education. And an interest in the changing dynamics of interactions between different professions. And an interest in the curious nature of nursing training and career courses. And in the phenomenon of “N=1” as an influence of thinking in medical teams. He has a lot of interests.

We natter a bit about how the hell you get into this sort of thing and a few other nurse blog start-ups. If all that seems like a bit too much hassle you could be a guest contributor on Jesse’s site.

What a lovely bloke.

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SMACC! More SMACC.

There are 10 Jellybeans from SMACC Gold on the way.

There are some gems in there.

One of the first is with Simon Carley.

@emcrit of http://www.emcrit.org is innovation.

@cliffreid of http://www.resus.me.com is inspiration.

@socraticEM is poise.

Simon Carley of @EMManchester and http://www.stemlynsblog.org is balance.

Unashamed bro-love warning; Simon is fantastic. There is valid criticism within Critical Care and #FOAMed of the rock and rollers, the emotive speakers, the super aggressive interventionalists.

Its worth noting that people like Simon are keeping a lid on the whole bubbling pot of wonderful madness.

First you have to sweep the floor as @karimbrohi trauma.org puts it.

Check out Simons post on the super good St. Emlyns Blog about marginal gains, published on the 19th of March while I sat beside him listening to a great session on palliative care.

He listened to the speakers, was repeatedly interrupted by me and banged out a chunky blog post. See? Some men can multi-task!

Simon Carley; I am not worthy.

I have a Jellybean coming with the Prof but I know it doesn’t do him and his work justice. So I’ll be Beanboozling him again and trying to delve into the multiple other aspects of him and his work.

“It’s time to sweat the small stuff.”

It’s not all about airways and helicopters.

There are some issues turning everything up to 11.

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Jellybean #20; Dr Tim Duncan at Sydney by Doug Lynch @TheTopEnd

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Jellybean #31; Matt Eckersley at Sydney by Doug Lynch @TheTopEnd

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Back in the very early days I just went out wandering with my mic. I still do that but I get better audio now. This was Chris Nickson and I sat in what was basically a Bar at the first SMACC.

This wasn't the first Jellybean though.

This was the first one published on www.lifeinthefastlane.com and so I am sticking with the numbers as they were on the LITFL Jellybean Collection.

Confused?

Me too. It will get easier.

Foamed FOAM Podcast SMACC Sydney RAGE Intensive Critical Medicine Emergency Paramedic Nurse Education.

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Jellybean #37; Jaine Morris; Remote Area Nursing and More at Lockhart River by Doug Lynch @TheTopEnd

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Jellybean #22; Ben Stanton & Dave Tingey at ASA/FNA by Doug Lynch @TheTopEnd

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Jellybean #21; Michael Parr at Shangri La by Doug Lynch @TheTopEnd

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Jellybean #39; The Ballad Of Casey Parker at Poolside, Shangri La, BCC4, Cairns by Doug Lynch @TheTopEnd

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Jellybean #41; Jon Gatward; From Bristol to Public Lycra Wrestling in Cairns? BCC4, Cairns by Doug Lynch @TheTopEnd

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Jellybean #38; Shaun Walsh; a Very Content Medical Officer at Poolside, BCC4 Cairns by Doug Lynch @TheTopEnd

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Jellybean #16.1; Anthony Tzannes; Dual Training And Dealing With Pressure. Cairns by Doug Lynch @TheTopEnd

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Who is Roger Harris? Where did all this SMACC and BCC and controversy start? Whats with all this iconoclastic, humour in medicine, party animal business? This man curses like, well, like a real person. Is he in fact the Frank Zappa of Critical Care? Misunderstood? Perhaps. Talented? Certainly. That's Roger wearing the fetching Yellow Specs and challenging the rules of Fashion with Oli Flower.

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Oddly Oli was not thrown off the stage at the CICM ASM. Its what I was hoping for. Here we chat about his remarkable work on ICN (www.intensivecarenetwork.com) and education in the post-FOAM-world. (and New Zealand a bit)

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The sound was just too poor to publish this one on LITFL etc but these guys were great. Bummer. I really want to catch them again. They had literally just dropped from the ceiling at the SIM wars feature at the end of the SMACC.

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Jellybean #10.1; Sarah Webb of the Royal North Shore ICU; Nurse Leadership in Advanced Life Support by Doug Lynch @TheTopEnd

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Jellybean #9; Steve Carroll of EM Basic; Hanging out at SMACC at Darling Harbour by Doug Lynch @TheTopEnd

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I like Domhnall.

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Does humour have a place in Medicine? If not, it seems Alan and I will be out of a job. This was a failed recording on technical but not content grounds. So the recording dropped out and thus you missed some of the most incredible revelations. I suspect the C.I.A. Bummer. It's important to realise that most of this stuff isn't serious.

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Genius.

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Jellybean #10.2; Christine Bowles FACEM. SMACC Twitter conductress! at Bayside Lounge by Doug Lynch @TheTopEnd

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Some kind of hero.

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First Responders. (To almost everything.) One of my favourite Jellybeans ever.

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Jellybean #5; Natalie May of St Emlyns at SMACC by Doug Lynch @TheTopEnd

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Another innovative Scot. Why are scottish so good at inventing stuff?

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Jellybean #2; @keeweedoc Andre Bonny at SMACC by Doug Lynch @TheTopEnd

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JellyBeans. Jelly Belly Jelly Beans. Bean Boozled Jelly Belly Jelly Beans. Lead Belly and David Klein. This was the basic idea behind the Jelly Beans that started at #smacc2013 A handful of super short vox pop type moments with some of the interesting people at the conference.