Mix of PHEM and Major incident sessions today
- Mental Resilience – Professor Richard Williams
Resilience – a process linking a set of adaptive capabilities to a positive trajectory of functioning and adaption after a disturbance.
Compared to the reference population ED and Pre-hospital staff have higher levels of fatigue, poor sleep, depression and anxiety.
Stress levels tend to be higher when the care involves children, collegues, older people or disabled people. Psychological impact tend to be worse if patients die, we feel we should have done more, there is little percieved support from colleagues, family or friends or the incident follows other stressful events.
Improving patient care can only be done by increasing the care of staff as they deliver the care.
Caring for the personal needs of staff reduces clinical errors.
Things that affect staff experience are Organisational culture, workload intensity, relationships with peers, emotional intelligence, length of experience, injury, abuse, Role at work, and social support,
Secondary stressor can be worse than the primary incident and can be these things that prevent people from coping.
The primary mental disorder in relation to stress is substance misuse not ptsd.
It is OK to be upset it does not mean you are not resilient.
Social support and social integration are the most important factors in life expectancy…we need to turn groups of collegues into
- Field Amputation – Professor Sir Keith Porter @TCUK_KeithP
Like many things we do in Emergency Medicine the technique is not difficult and uses basic kit; it is the decision making that is the difficult part. Phone a friend and get someone else there with you for those difficult decisions.
- Mechanism of injury and new car design– Dr. Gareth Davies
Understanding Mechanism of Injury can help predict injury patterns.
Every mechanism gives a predictable pattern of injuries, what happens to the patient depends on speed of vehicle, shape of vehicle, rigidity of vehicle, presence of advanced protection,speed of pedestrian, size of pedestrian and age of pedestrian. Ask a 1st hand witness if possible to prevent Chinese whispers.
Injuries come from change in velocity and exchange of energy over time.
Low speed deceleration causes less injury than sudden stop.
- Organisational Leadership – Mrs Jane Gurney @janegurney5
Be passionate about what you do.
Engage with all members within your organisation.
Lead by example.
The right decisions are not always the easy decisions.
- Learning From Traumatic Deaths –Professor Guy Rutter
Post-mortum CT gives the cause of death for most patients, medical or traumatic. It can also tell us if our attempts at life saving interventions were done correctly.
Analysis of post-mortem images and injuries can help confirm the mechanisms of injury.
- Emergency Planning for Major Incidents @qehbham
Casualty regulation and capability chart determines how many pts (go to MTC) P2 go to TU. P3 go to other hospitals.
Recent major incidents have higher numbers of P1 casualties – previously assumed 10% in a major incident…recent incidents have all have been considerably more than this; trauma units will get some P1 patients. Trauma Units therefore need to declare what sort of patients they can take… P1 but with specific injuries.
When trying to clear the ED patients don’t necessarily leave ED even when told it is a Major incident they need to be individually redirected.
NHS England have produced clinical guidelines for major incidents and mass Casualty incidents in an easy to read format.