David Ben Ari

Trauma Anesthesia | CSAR | Prehospital | Passionate bout Trauma/ Military Med / PHARM / Resus / Meducation

[David Ben Ari @davbenari]

This ✓
Thank you Sky News

[TacticalTrauma @TacTrauma]

#TacTrauma24 has some jawdropping workshops as well for all the #phem #phcc people joining us in Oct!
ECPR workshop w @alice_hutin @PrehospitalCC ⭐️ @krixmann
We also are joined at the conf. by experts in ECMO,REBOA,trauma & resus like @Pipes_n_pumps @adampowermd @frontlinecobra

[David Ben Ari @davbenari]

Case Fatality Rate of 6.3% in Operation Iron Swords d/t far far forward WB & advanced medical personnel close to POI

[Fredrik Granholm @TotalResus]

Join us October 7-9 in Sundsvall, Sweden for a conference like no other. https://t.co/hPaSSJBvF7 is back and this time we focus on ”Performance, Stress and Mental Health in High Stakes Environments”. Like before also lots on #phem , trauma , MCI , CTM. Only 71 tickets left!

[Karim Brohi @karimbrohi]

OK that went well, I think 😎.

Here are my reading of the sessions:

SESSION 1: UK-REBOA

Most would say REBOA as currently delivered does not have a place in ED phase of care of major trauma patients thought to have non-compressible haemorrhage.

BUT:
? - Does it have a niche in the right patients - if only we could recognise them?
? - Would the results be the same for new techniques like partial REBOA
? - Has the right place always been prehospital / deployed situations? (given the caveats above)

We still don't have answers for non-compressible torso haemorrhage, and although there are other devices out there/on the horizon, they come with their own issues and are (far far) less rigorously evaluated.

SESSION 2: THE BLEEDING PATIENT

TIME came up again and again.
Are we fast enough. Are we as fast as we think we are (no).
There are clear differences between different systems.
We need to consistently examine what we do and identify the opportunities to be faster.
If we had been faster - if we could be faster - would REBOA have worked?

Do we need a way to physically separate these patients from the wider ED/trauma population?

SESSION 3: CRYOSTAT2

There was general acceptance that high-dose cryoprecipitate (or fibrinogen concentrate) should not be given to all trauma patients on arrival.

Cryoprecipitate remains indicated when there is low fibrinogen, and is likely safe and effective when given empirically later in bleeding (eg after 8+ units RBCs).

Again patient selection is key. Point of care fibrinogen or equivalent ROTEM/TEG could guide treatment.

Probably a case now for all UK MTCs to have immediate point of care access to ROTEM & TEG.

Processes and human factors are as important if not more important than what we are giving.

Again hospital design and planning important.

We should examine/research moving away from blood-bank based therapies.

How do we audit and quality improve coagulation therapies. What should we be measuring to drive improvements?

DAY 2: DECISION MAKING IN TRAUMA

(I am going to do this day a disservice by summarising it so succinctly, but...)

Again and again on Day 1, the issues of patient selection came up, and the recognition that we don't have the tools to consistently do this, even in expert hands.

Decision making in trauma care is complex and nuanced and not easily explainable by the people who made those decisions. Uncertainty is higher at the times when the most critical decisions must be made.

There's a real opportunity for AI decision support. AIs (or SOFTWARE as we are encouraged to refer to these tools) cannot MAKE decisions. But they can potentially integrate multiple data points to "expose" the current state of the patient.

There are many many aspects to consider in moving from an in-solico prediction model to a real world widely used and trusted decision support tool, and no one has done this as yet, really, for anything in medicine.

The team @nigeltai and @ZBPerkins have put together at @QMULBartsTheLon are on their way to doing this.

PUBLIC ENGAGEMENT & INVOLVEMENT

There was a lot of enthusiasm for a programme of work to develop a "roadshow" of sorts that could be used locally in MTCs, TUs etc to showcase to the public how trauma care has improved over the last 15 years, especially through research-led changes an interventions. An opportunity as well to highlight local injury prevention activities, successes and innovations, and to highlight the important of things like bystander bleeding control training (first aid!). Check in with James @thepiercy if you have ideas / want to get involved.

THAT'S IT from the meeting - but the conversations will continue and we will explore how we can develop these into recommendations and policy (so good to hear everyone else's take-homes too). Thank you to everyone who attended and contributed, in person and online.🙏

[Max Marsden @MaxMarsden83]

Really looking forward to this meeting!

[David Ben Ari @davbenari]

@doctimcook Would like to ask- 1)is this mantra also true when there is no ventilation, only compressions? 2) is this true also in animals? (live tissue simulations?)

[David Ben Ari @davbenari]

@IofPHC @Pipes_n_pumps Actually, we do do reboa

[David Ben Ari @davbenari]

@traumakhan Mabrook

[David Ben Ari @davbenari]

@TacTrauma @NoobieMatt @OperationalEMS Yes it is!!

[David Ben Ari @davbenari]

Beware sneaky diaphragm injuries - consider diagnostic laparoscopy if suspect. @traumakhan @LDN_TC

[David Ben Ari @davbenari]

@HumanFact0rz @cliffreid @petrosoniak @DrCarolynSnider @KariLynWhite @pamelodrama @SocraticEM @purdy_eve @UnityHealthTO @Sim_StMikes @grade1view Looks terrific. Is your standard TXA dose 2gr with no infusion?

[David Ben Ari @davbenari]

To properly understand the pathology of trauma, you should be including your pathologists in the discussion. Dah! #goldenhour @IofPHC

[David Ben Ari @davbenari]

@NicholasChrimes It should be called "COCO", can't oxygenate, can't oxygenate. Take intubation out of the equation and focus on oxygenation question yes or no.

[David Ben Ari @davbenari]

@SophJHenderson @IofPHC @LDNairamb @HEMSRLH Still going...only 3/7 done. Sims slowly but surely increasing complexity

[David Ben Ari @davbenari]

A vast amount of collective knowledge and experience at London's Air Ambulance Prehospital Care Course with passionate faculty and great atmosphere! @IofPHC @LDNairamb @HEMSRLH

[David Ben Ari @davbenari]

Fantastic & highly experienced faculty at 2nd day of Atacc course! Van der Velde, @FLTDOC1 @traumakhan @mjslabbert @Obidoc @ATACCGroup @ATACCFaculty

[David Ben Ari @davbenari]

https://t.co/b0LFRLu6lX

[David Ben Ari @davbenari]

Incredible fully immersive simulations at #IBTPHEM #PHEM National Induction Course 2019!

[David Ben Ari @davbenari]

@FTeranMD @cliffreid @ResusTEEproject @SydneyHEMS Thank you and faculty team for supplying us another valuable tool to help benefit our precious patients, they deserve the best we can offer them!

[David Ben Ari @davbenari]

@ResusTEEproject Lots of hands on TEE experience at London's first #ResusTEE course! So brilliant that even @SydneyHEMS are here to learn..