Coda Change

ECMO is alife-saving intervention for critically ill patients, but patients describe a recovery period that can take months to years.

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What can Prehospital and Retrieval Medicine teach us about life? Natalie May reflects on lessons learned at Sydney HEMS - from the practical to the philosophical.

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Being able to open any mobile phone camera enables triage of scene (mechanism of injury) and patient (physiology). This enables better resource allocation and can start treatment sooner.

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PHEM is a male dominated speciality but why is that? Caroline Leech takes us through the reasons why this inequity exists and how we can breakdown barriers.

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Simon Carley, Natalie May, Ash Leibig and Libby Hanrahan discuss how we can take the ideas, inspirations and thoughts from SMACCFORCE and put them into practice. How do we combat the attitude of "that's not how we do it" to open ourselves up to new ideas and processes?

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Nuanced trauma care by the Queensland Ambulance Services High Acuity Response Unit (HARU). A brief outline of the capabilities of HARU and some key principles that make it successful. Could this be a model for other ambulance services to follow in the future?

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Wendy Chang takes us through the use of ultrasound for lumbar puncture and how this should be used consistently, not just for difficult cases and field cases. Recent reviews have shown that using ultrasound for lumbar puncture has the potential to improve our success rate, decrease the rate of traumatic taps, decrease time to success, decrease needle passes and ultimately decrease the patients pain scores.

Cardiac arrest physiology is an emerging field of research that may allow us to better understand why clinical trials of cardiac arrest have been so frustrating, why epinephrine doesn't work, and how we can potentially do better in the future by augmenting blood flow and programming the cells with ischemic conditioning.

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Mark Forrest, Halden Hutchinson-Bazely & Jason van der Velde talk to us about 21st century simulation. They discuss how tools such as augmented reality are advancing medicine and assisting clinicians.

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Traditional selection of clinicians (nurses, paramedics and doctors) relies upon standard assessments. Or does it? Many clinicians are selected on the basis of their curriculum vitae, plus an interview and reference check. Is this the best approach to selecting high-performing clinicians to work in austere settings?

Performance equals capability plus behaviour. If we are to select clinicians to perform in a high-stakes, high-hazard environment, then what criteria should we use? What individual mental and physical attributes predict reliable performance? Should we perform psychological testing? Personality inventories? If so, should we select for a specific personality? Or is there strength in diversity? Given we provide health care in interdisciplinary teams, how might we select clinicians for their performance within a team? Are we selecting for leadership? Or followership? Or both?

Resilience is important. We think. So how might we select resilient clinicians? Some describe this process as 'weeding out the dreamers.' Yet might we require dreamers? And as our services grow and develop, do our teams have the agility to adapt to complexity and uncertainty? What are the barriers to selection? And are we the best selectors; is there a role for external human resource support? We will explore techniques used in the selection of other high-performing groups, ranging from astronauts to bankers to the All Blacks.

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