Advanced Trauma Life Support (ATLS) 10th Edition: Stemming the Hemorrhage of Misinformation

ATLS was a mandatory course during my emergency medicine training with recertification every few years. One of the greatest benefits was recognizing the need to asign a leader and develop a systematic approach to the trauma patient. There is always controvrsy surrounding proptocols and recommendations but the 10th edition is based on decades of trauma experience.

One of the new changes in the shock and circulation section is an emphasis on tourniquets, packing and the application of pressure; some very basic methods that can quickly control hemorrhage. Where do you focus your attention first? Airway? Hemorrhage control?

Wherever you practice and no matter the resources available you will find something in this podcast to strengthen your skills. Take a listen to the September 2019 EM:RAP podcast or read the PDF called: Trauma Surgeons Gone Wild: ATLS 10th edition update by Stuart Swadron MD, Kenji Inaba MD, and Billy Mallon MD.

 

Morell Wellcome tourniquets. (courtesy WikiMedia Commons)

Who Knew? The first recorded efforts to prevent arterial bleeding has been ascribed to Sushruta, the father of surgical art and science, in 600 B.C At that time, he pressed the arteries with pieces of leather that he made himself and it is said that he had used a device in which we now call the tourniquet. (NCBI)

 

 

 

 

Knowledge Translation

 

On September 2, 2019, Dr. Manoj Thomas, President of TWB, and Dr. Vera Sistenich, an Emergency Medicine physician with HandUp Congo, spoke to the Sydney Development Circle about “Knowledge Translation” (KT). The World Health Organization defines KT as: “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”.

TWB works in the nonprofit sector under the scope of KT via our Continuing Medical Education on Stick (CMES) Project. It provides health practitioners in remote regions access to up-to-date CME using novel delivery methods, which do not depend on fragile infrastructure. This is assumed to translate into improved clinical practices, self-esteem, and patient outcomes.

However what is the price paid for any intervention when for every action there is a reaction. Dr. Manoj explains, “Given that we have technologies to assist with learning, the real question is about Knowledge Translation and ethical dilemmas around it. However, in reality, there are three barriers: political, cultural/social, and financial constraints.”

In the case of the CMES Project, introducing a product which doesn’t depend on local infrastructure points to the governments deficiencies in providing basic services such as electricity and Internet; a cultural consideration in the DRC is that junior doctors taught a specific medical or surgical technique by the senior doctors are unlikely to contradict their superiors and therefore the introduction of up-to-date CME which challenges long-held beliefs can cause staff internal conflict; and a health practitioner may want to use a product but doesn’t have finances for a smartphone or access to a computer.

We strive to recognize the pros and cons of each CMES Project we launch by working with; local practitioners to identify needs and challenges; local partners engaged in similar work; and local Ministries of Health.
What disruptive consequences have you experienced through your knowledge sharing? What was the relevant ethical issue? Share your story in the comments and help us all understand and work better.

 

 

 

Flip the Social Media Switch

Glenda, Community Health nurse, Tena, Ecuador.

Social media metrics provides support when applying for grants and shows our partners and donors that the CME Project is successful. Help us flip the switch for equal continuing medical education opportunity globally for all health providers.

Techies Without Borders is on Facebook, LinkedIn, Twitter and Instagram. Connect and share to support our CMES Project which provides free continuing medical education to doctors and nurses in developing countries.

Facebook: https://www.facebook.com/techieswob/

LinkedIn: https://www.linkedin.com/company/34219833/admin/

Twitter: https://twitter.com/TechiesWB

Instagram: https://www.instagram.com/techieswithoutborders/

More Slices of Pi for the Oceania Region

Dr. Manoj Thomas, TWB Co-founder and President, works at the University of Sydney Business School. He is in the perfect location to expand CMES and CMES-Pi in the Oceania Region this fall.
Presently the CMES Project is in Fiji, Solomon Islands, Tuvalu, Somoa, Tonga and Cook Islands. The doctors and nurses are sharing a limited number of thumb drives. More doctors and nurses working in these remote islands will receive thumb drives and the major hospitals will have CMES-Pi installed.

A Honey of an Idea


Meet Dr. Vera Sistenich, an Emergency Medicine physician from Sydney, Australia. Dr. Vera is the Project Leader for HandsUp Congo, an Australian nonprofit, “Building a Healthy Congo” Project. In collaboration with local partners and the Democratic Republic of Congo’s (DRC) government they are committed to bring Emergency Medicine training and integration to the DRC healthcare system. This is her story on one way she supports their goals.

“I started in 2015 when I lived in a seaside suburb here in Sydney called Coogee. As a child, I grew up in Hong Kong (my Mum is Chinese) but our family spent our summer holidays in Germany (my Dad is from Munich). We had a very rural home in a Bavarian suburb next to a forest. Our neighbour, an old man, used to keep his hives in the forest which I used to pass walking our little sausage dog daily. I was always fascinated, and we could see the old man at night through the window processing wax and honey. I thought to myself as a girl I’d love to keep bees one day. When I moved to Sydney and bought my own home for the first time, I came across The Urban Beehive, a business and movement promoting responsible beekeeping in the urban environment. The owners Doug Purdie and Vicky Brown are Australian beekeeping royalty now! I did a course with them and then started my own hive in the outdoor area of my ground floor unit in Coogee.

The weather here is so good that my one hive was producing around 100kg of honey a year. There are only so many birthday and Christmas presents you can make with all this honey! This volume would give around 300 jars a year, so I tried my hand at a little social enterprise, creating a label called “Coogee Bees for Congo” and selling each jar for AUD $15 and putting all the profit towards our Congo EM Project. There is a famous building in Coogee right by the beach called The Coogee Pavilion. It has a blue and white dome, which is what inspired the blue and white bee of my label, set within the contour of the landmass of the DRCongo. I changed the sting of the bee into a little heart, a reminder to myself of our duty to translate compassion into practice towards those in need everywhere. 

I now have 2 hives, producing about 200kg per year. I have raised over AUD $ 10,000 since the start of the project with the honey.

Beekeeping is very successful in the city. The Sydney Bee Club, of which I’m a committee member, has partnered with several universities here for research, providing dead bees and honey samples from our members from numerous suburbs. It turns out that the honey produced in cities is less contaminated with chemicals and pesticides than a lot of rural honeys and the flavours more complex due to the diversity plants and lack of monocultures in the urban setting. Heavy metals from the city environment are stored within the bodies of the bees themselves and secreted somewhat into the wax, but not into the honey. This came as a big and welcomed surprise to us all. Challenges, though, included minimising swarming in the urban environment so our hives don’t become a public nuisance, and adhering to rules and regulations regarding safety towards our neighbours. The practice is popular here and encouraged by our local counsellors. 

I don’t do any formal marketing as such. I work at two hospitals here in Sydney and just by word of mouth, colleagues, family and friends buy out the honey every time. I post on Facebook when I have a new batch and also on the HandUp Congo Facebook page. I also make candles from the wax as gifts.

In addition to raising funds for the EM project, one year, we chanced upon the only beekeeper training collective in the whole of the Congo whilst traveling to one of our teaching sites by road. From that, a completely separate Be A Honey Project was born – we have raised funds to bring these experts to the remote village of Lotumbe, where Lucy of HandUp Congo grew up, to train them in sustainable beekeeping, in particular to empower the Pygmy population there.”

What’s the Buzz About Honey?

Manuka honey (Wikipedia)

The May edition of Emergency Medical Reviews and Perspectives (EM:RAP), your CME sponsor for the Continuing Medical Education on Stick (CMES) Project, has an article on the use of honey in the emergency department or outpatient clinic. The commonly known medical uses for honey include cough suppression and skin wound antibacterial agent. Other uses that can be life saving are cited in the article titled, Honey for Everything by Ilene Claudius MD and Sol Behar MD. Buzz on over to your thumb drive or CMES-Pi and take a listen or read. It’ll sweeten your day.

 

Five-petaled white flowers and round buds on twigs bearing short spiky leaves. A dark bee is in the centre of one of the flowers.

Manuka bloom (Wikipedia)

Who Knew? The antibacterial effects of honey vary widely depending on the type and production location as cited by Willix et al. of the University of Waikato in New Zealand. Manuka honey found in New Zealand is reported to have high antibacterial activity.

 

CMES-Pi Participant Highlight: Mount St. John’s Medical Center, Antigua

Meet Dr. Vonetta George who works at Mount St. John’s Medical Center (MSJMC) in Antigua. Dr. Vonetta works in all critical care areas of the hospital including supervising the 15 doctors and 2 dozen+ nurses in the Emergency Department.

Antigua is located in the West Indies, a Leeward Island in the Caribbean. Mount St. John’s serves the population of Antigua and also Barbuda. Working on an isolated island directly affects the doctors and nurses ability to access current continuing medical education in a cost effective manner. Dr. Vonetta was the gail force hurricane behind getting the CMES-Pi Project installed in her hospital. MSJMC installed a CMES-Pi in June last year. Using our smart phone apps the staff can look up CME current practice topics at bedside. The CME is provided by our partner Emergency Medicine Reviews and Perspectives. The PDF files provide helpful bullet points and take seconds to read. The MP3 files are providing topics for weekly group CME conferences and discussions. The CMES-Pi Project directly impacts access to CME for 101 doctors and 179 nurses at the hospital. Thank you Dr. Vonetta!

Who Knew? The first inhabitants were the Siboney, who can be dated back to 2400 BCE. Arawaks settled subsequently, around the 1st century CE. The Caribs arrived later, but abandoned Antigua around the 16th century, due to the shortage of fresh water. Christopher Columbus sighted the larger island in 1493, and named it after a church in Seville, Santa Maria de la Antigua. (Commonwealth)

Thumbs Up for Victoria Hospital, Castries, St. Lucia

Victoria Hospital, Castries, St. Lucia

Dr. Lisa Charles, ED Director

Welcome and meet Dr. Lisa Charles, Director of Victoria Hospital Emergency Department. Dr. Charles and her team of eight ED physicians joined the Continuing Medical Education on Stick (CMES) project this month. CMES is a collaborative initiative to improve access to cme for medical practitioners in resource-challenged areas.

Victoria Hospital is located in Castries, St. Lucia, an island in the eastern Caribbean Sea. It is the main public healthcare facility for the northern part of the island. Mr. C. Felix St. Hill, Permanent Secretary of the Department of Health and Wellness granted permission for Dr. Debra Stoner, from Techies Without Borders (TWB), to present the project to the ED staff and train them how to use the CMES thumb drives. CMES is an education project of TWB.

Dr. Charles plans to use the lectures to meet some of the St. Lucia Medical Council’s cme requirements as traveling off the island to attend cme conferences can be challenging for her staff.

Who knew? Maybe you know of colleagues in challenging clinical practices who would benefit from the CMES Project? Please put them in contact with Dr. Debra Stoner: debra@himanchal.org