Minor musings on a Major Incident 

This week, London experienced the type of incident some would say we have been anxiously dreading, having watched our European neighbours in Paris, Berlin and Nice suffer similar senseless violence in recent months. A vague unease that ‘something might happen here’ suddenly became realised, the picture pulled into focus as an anticipated nebulous threat materialised into a set of concrete events.

Five people (at the time of writing) have lost their lives. Many others have suffered unimaginably; some lives will never be the same, and it is impossible to say where the ripple effects of this incident will stop. What shone though the chaos, though, was the calm, professional response that demonstrated how well prepared our emergency services are to step up and respond. This is what we train for and it shows.

The following thoughts are a few reflections on being (very) peripherally involved in a professional capacity – some notes to myself to keep filed away in memory for a future disaster that hopefully won’t come.

Read. Your. Major. Incident. Plan. Like they told you to at induction. One day, you might need it at short notice.

Look after yourself. If you are concerned that friends or family may be involved in an incident, make a quick phone call and check they’re OK. You won’t be able to concentrate on your job – and you won’t be doing the best for your patients – if you are preoccupied with worry.

Look after each other. No one came to work today expecting this; everyone is working outside their comfort zone. Be on the alert for people struggling.

Keep off social media. The media are instantly on the hunt for facebook quotes and tweets from anyone medically involved. And if you answer the desk phone to someone asking for information (journalists try this trick) – politely direct them to the hospital website or communications team.

Waiting… is the worst. Nervous energy is contagious in the calm before the storm. Where we were, one of the consultants did an impromptu teaching session on the history of the triage system – which not only kept everyone’s mind busy, but stopped us from pacing the department waiting for patients to arrive.

Stay informed… one screen with a reputable news source for live updates. Don’t speculate, and remember ‘fake news’ spreads fast. If media was graded like evidence based medicine, anonymous twitter sources would be sub-level 5.

What are the patients seeing? In paediatric ED, children are normally carefully separated from the adult waiting room to shield them from what can be very scary sights and sounds. If the department ‘flow’ has to change as patients are triaged to different areas, how will you shield vulnerable patients from seeing things they shouldn’t have to?

Be the small cog in the machine. A department which runs smoothly in a crisis is as much (if not more) down to the people reliably performing the simple day to day tasks, than those who are sprinting from one code red to another. The baseline workload is still there and still needs to be seen to safely.

Thoughts of solidarity, sympathy and respect to patients, families and colleagues affected by the events of this week.


Minor musings on a Major Incident 

This week, London experienced the type of incident some would say we have been anxiously dreading, having watched our European neighbours in Paris, Berlin and Nice suffer similar senseless violence in recent months. A vague unease that ‘something might happen here’ suddenly became realised, the picture pulled into focus as an anticipated nebulous threat materialised into a set of concrete events.

Five people (at the time of writing) have lost their lives. Many others have suffered unimaginably; some lives will never be the same, and it is impossible to say where the ripple effects of this incident will stop. What shone though the chaos, though, was the calm, professional response that demonstrated how well prepared our emergency services are to step up and respond. This is what we train for and it shows.

The following thoughts are a few reflections on being (very) peripherally involved in a professional capacity – some notes to myself to keep filed away in memory for a future disaster that hopefully won’t come.

Read. Your. Major. Incident. Plan. Like they told you to at induction. One day, you might need it at short notice.

Look after yourself. If you are concerned that friends or family may be involved in an incident, make a quick phone call and check they’re OK. You won’t be able to concentrate on your job – and you won’t be doing the best for your patients – if you are preoccupied with worry.

Look after each other. No one came to work today expecting this; everyone is working outside their comfort zone. Be on the alert for people struggling.

Keep off social media. The media are instantly on the hunt for facebook quotes and tweets from anyone medically involved. And if you answer the desk phone to someone asking for information (journalists try this trick) – politely direct them to the hospital website or communications team.

Waiting… is the worst. Nervous energy is contagious in the calm before the storm. Where we were, one of the consultants did an impromptu teaching session on the history of the triage system – which not only kept everyone’s mind busy, but stopped us from pacing the department waiting for patients to arrive.

Stay informed… one screen with a reputable news source for live updates. Don’t speculate, and remember ‘fake news’ spreads fast. If media was graded like evidence based medicine, anonymous twitter sources would be sub-level 5.

What are the patients seeing? In paediatric ED, children are normally carefully separated from the adult waiting room to shield them from what can be very scary sights and sounds. If the department ‘flow’ has to change as patients are triaged to different areas, how will you shield vulnerable patients from seeing things they shouldn’t have to?

Be the small cog in the machine. A department which runs smoothly in a crisis is as much (if not more) down to the people reliably performing the simple day to day tasks, than those who are sprinting from one code red to another. The baseline workload is still there and still needs to be seen to safely.

Thoughts of solidarity, sympathy and respect to patients, families and colleagues affected by the events of this week.


PEM Review 022 – NEW FOAMed // LISFRANC INJURY // TEG // TRAUMA // BRUEs //

foamcross           PAEDIATRICFOAM.COM

Firstly, an unashamed plug for a new project I am excited to be involved with. The London School of Paediatrics is venturing into the FOAMed world, and our new site is launching this month – you can see it here http://www.paediatricfoam.com. Take a look at @jround999’s brilliant ‘Inotropes made simple’ or this post by yours truly on Kawasaki Disease.

lisfranc.jpg   DON’T PUT YOUR FOOT IN IT…

A Lisfranc injury is an injury resulting from fractures of bones of the midfoot, or rupture of ligaments. (Eponym fans – Jacques Lisfranc was an 18th century surgeon who described this injury in soldiers falling from horses trapping their foot in a stirrup, and dislocating the midfoot). On X ray you’ll see a widening in the space between 1st and 2nd metatarsals. The patient must be strict non-weight bearing, and orthopaedics need to see ASAP. @CoreEM are here with a short podcast to explain more.

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teg-report TEG

Major haemorrhage in paeds trauma is not common – so when someone clever asks for a TEG (thromboelastogram) in the middle of a paeds trauma call, the more paediatric orientated amongst us are left blankly staring at a colourful diagram hoping it will miraculously reveal its meaning. Luckily @EMdocsdotnet are here to help with a guide to interpreting the TEG – a point of care test which provides ‘an assessment of near real-time, in-vivo clotting capacity, providing information regarding the dynamics of clot development, stabilization, and dissolution’.

Bonus: Characteristic TEG waveforms (TEG for dummies):

teg

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top-secret1          FOAMed CONFIDENTIAL

We live our lives online, and increasingly for some doctors, this includes work life – with huge potential learning benefits but also big risks if confidentiality is not respected. @EMdidactic has a piece of essential reading for consumers and creators of FOAMed, dealing with confidentiality and de-identification of patient information.

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brue         TROUBLE BRUE-ING?

Listen to this two-part podcast on Brief Resolved Unexplained Episodes on @pedscases (which are NO LONGER called Acute Life Threatening Events or ALTEs, take note!) then test yourself on your knowledge. Good for anyone new to the paeds ED.

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hernia  TIME IS TESTICLE

Learn how to reduce hernias in babies – it is not OK to ‘wait for a surgeon’ to try, and you will do more harm by waiting than having a go (the swelling increases fast and venous obstruction is a real possibility). Thanks @stemlyns for this first piece in a series of paeds surgery topics.