London Trauma Conference 2015: Air Ambulance & Pre-hospital Care Day

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N-bomb of NBOMe zijn legaal verkrijgbare hallucinogenen, 25I-NBOMe, 25C-NBOMe en 25B-NBOMe. De stof hecht zit aan serotonine-receptoren in het brein. Deze stoffen zijn vele malen potenter dan LSD.

Uiterst kleine hoeveelheden veroorzaken:

*epileptische insulten
*ritmestoornissen
*hartinfarcten
*ademhalingsstilstand
*hartstilstand
*dood

Tim Horeczko @EMtogether

Tomaszewski drops the "en-bomb": NBOMe abuse #PEM16

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Video: https://www.periscope.tv/w/abmqcDF4a2pEYXBkQnBFem18MUx5eEJtTlpXYVlKTtrgonC3yS-zSwMzZf4nj8yZ3GjHnqo1NsXQmoWO-eE3

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Barts and the London Prehospital Care Programme invite you to an exciting day of workshops and talks on mass casualties and major incidents. With sessions lead by the London Ambulance Service, London's Air Ambulance, and London's Fire Brigade, it is sure to be a valuable learning experience for anyone with an interest in prehospital care.

For more details and to book tickets please visit our website:

http://www.pcpsymposium2016.com/

***Tickets on sale Saturday 27/02/16 at 5:00pm***

Early Bird: £12
Regular Price: £15
Tickets are inclusive of lunch and drinks reception.

Get rid of the orange blob: HEMS Paramedic experience on 7/7
Lee Parker, Flight Paramedic HEMS an Motorbike Paramedic London Ambulance Service

PCP @The_PCP

Opening the day with @lardyc7 speaking on his experience of 7/7! #PCP16

PCP @The_PCP

Not a single patient was transferred by air on 7/7, @LDNairamb helicopter was used to move teams and kit #PCP16

Jack @MrJackDJones

Lee Parker recalling his experiences as a HEMS paramedic during the 7/7 bombings #PCP16 @The_PCP pic.twitter.com/73pLNCFNBd

PCP @The_PCP

Lee Parker @lardyc7 giving some incredible insight into the steps taken during 7/7, including commandeering vehicles to get there! #PCP16

Nicole Loi @NicoleLoi

Paramedic Lee Parker describing stealing a van (w/ permission) on 7/7 to get to Edgware Road bombing #PCP16 @The_PCP

PCP @The_PCP

Incredible speed of activity at Edgware Road - 09:10 on scene, by 12:00 the casualties were cleared #Inspirational #PCP16

PCP @The_PCP

Some tube lines are exceptionally narrow, meaning blast energy travels throughout the carriage #PCP16

PCP @The_PCP

During 7/7, many people were blown out if carriages, creating even more access problems - scene management key in major incidents #PCP16

PCP @The_PCP

Another huge problem in the tube tunnels includes the lack of light; first on scene often working in pitch black #PCP16

Nicole Loi @NicoleLoi

Paramedic Lee Parker talking logistic practicalities inc. how to move the deceased if you need to get to survivors #PCP16 @The_PCP

PCP @The_PCP

1 doctor and 1 paramedic dealt with 200-300 potential casualties; luckily 20+ good samaritans to help on scene! #PCP16

Jack @MrJackDJones

Pro tip for helping at a mass casualty scene: don't offer to triage if you don't know how to triage #PCP16 @The_PCP

PCP @The_PCP

All three major incidents @lardyc7 has been to have had comms failures, a huge problem when trying to coordinate events #PCP16

Nicole Loi @NicoleLoi

Paramedic Lee Parker says all 3 major incidents he's attended comms has failed - do simulations include this 2 b realistic? #PCP16 @The_PCP

PCP @The_PCP

Luckily 7/7 coincided with a @LDNairamb governance day, allowing quicker dispatch of teams already on the helipad! #PCP16

PCP @The_PCP

Longest scene clearance time was 2hrs 25 - amazing work from all medical teams at 7/7 #PCP16

PCP @The_PCP

Key learning points from @lardyc7 - major incidents have so much going on, crews return to base instincts #PCP16

Nicole Loi @NicoleLoi

Just overcome instinct to treat pts 2 triage, report, manage scene first b4 backup arrives @The_PCP #PCP16

PCP @The_PCP

Most injured patients take 30 mins to get off scene and into hospitals - don't underestimate what's coming through the ED doors #PCP16

PCP @The_PCP

An incredibly raw talk from @lardyc7, opening #PCP16 with an amazing presentation on his experience of 7/7 as a major incident.

PCP @The_PCP

Promote safety, calm, connectedness, self-efficacy, and hope during a major incident #PCP16 @lardyc7

PCP @The_PCP

Finishing with a heartbreaking memorial to the victims of 7/7. Rest in peace. #PCP16

Jess Foulkes @_JRFoulkes_

A raw, honest and powerful talk by HEMS paramedic Lee Parker about the 7/7 bombings - excellently presented and a great start to the #PCP16

PCP @The_PCP

Lee Parker @lardyc7 now taking questions from the audience #PCP16 pic.twitter.com/WcxY9XOodT

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How is the Royal London Hospital prepared, and what did we learn from 7/7
Dr. Karim Ahmad, Emergency Medicine Physician, Barts Health NHS Trust

PCP @The_PCP

Karim Ahmad is our next speaker, the major incident lead for the Royal London Hospital #PCP16 @NHSBartsHealth

PCP @The_PCP

When a major incident is declared at the Royal London there can be a feeling of anger; we all feel personally attacked #PCP16

Nicole Loi @NicoleLoi

EM consultant Karim Ahmad says now Royal London ED is seeing up to 600 patients in 24hr period. ED pressure is real #PCP16 @The_PCP

PCP @The_PCP

500+ patients in 24 hours in average at the Royal London; on 7/7 over 200 arrived in 5 hours #PCP16

PCP @The_PCP

Major Incidents need to be able to run without a leader; if the leader leaves you've lost your plan! #PCP16

PCP @The_PCP

ED, theatres, ITU, and wards all have their own plans and know what to do during major incidents, so everyone prepares independently #PCP16

Peter J Hollely @PJ85RN

Karim makes a good point! We are ready function in #masscasualty situations #PCP16 pic.twitter.com/dhpfTqYXa0

Nicole Loi @NicoleLoi

Dr Ahmad describes RLH plan 4 major incidents - each dpmt has own plan, don't need to communicate to get plan underway #PCP16 @The_PCP

hareef Mahdi @Shareef_Mahdi

RLH major incident plan is cellular, so is independent of comms failing between different teams eg ED, Theatres and ITU #PCP16 @The_PCP

PCP @The_PCP

It's important to clear the ED of patients who don't require emergency treatment during major incidents #PCP16

PCP @The_PCP

Elective surgeries need to be stopped once the operations happening are finished, to free up for victims of the major incident #PCP16

PCP @The_PCP

HART = hazardous area response team (for anyone at #PCP16 who's not come across them yet; you will later!)

PCP @The_PCP

CBRN = chemical, biological, radiological, nuclear #PCP16

Peter W Walker @PeterWWalker

#PCP16 For a Major Incident there are challenges when the MTCs run at over 100% capacity routinely.

PCP @The_PCP

Triage in hospital is different to prehospital; need to provide definitive treatment rather than focusing on life-threatening or not #PCP16

PCP @The_PCP

Triage in hospital decides who goes to resus, who goes to majors, and who goes to minors for their injuries #PCP16

Peter W Walker @PeterWWalker

Finesse of Hospital Triage @The_PCP @NHSBartsHealth #PCP16 pic.twitter.com/nWAyZfv7HW

Shareef Mahdi @Shareef_Mahdi

Karim Ahmad: ED use P1/2/3 category for #triage + primary survey to put patients in Resus/Majors/Minors #varyinginjuries #PCP16 @The_PCP

PCP @The_PCP

There are 8 resus bays at RLH for 30-40 P1 casualties coming in; need to use experience to decide who actually needs resus #PCP16

Shareef Mahdi @Shareef_Mahdi

I.e scoring P1 doesn't automatically = resus bay. You need to have problem with ABCDE (P1+) #triage #PCP16 @The_PCP

Nicole Loi @NicoleLoi

Dr Ahmad has own P1+ category 4 pts who urgently need resus bed - only 8beds in RLH, just being P1 does not guarantee a bed #PCP16 @The_PCP

PCP @The_PCP

Do you need intubating/have you been intubated? Do you need immediate circulatory support? Have you got a major neurological problem? #PCP16

Jayne Usher @UsherJayne

Great talk Dr Karim:don't let the mist of a major incident cloud/confuse your clinical choices 'do what you do everyday' #PCP16 @The_PCP

The Ginger Paramedic @GingerMedic999

C problems are 'Code Reds'
D problems are 'Code Blacks'
A problems are intubated
B problems look like they need to be

Karim @The_PCP #PCP16

Shareef Mahdi @Shareef_Mahdi

Important to use nearby hospitals for ED and bed spaces for P3 pnts- rarely utilised in #majorincident #PCP16 @The_PCP

Chris Smith @retrocoldplay

Amazing spirit that security need to control entry to resus as so many @NHSBartsHealth staff want to help in a Major Incident #PCP16

PCP @The_PCP

Important to establish a follow up protocol for the patients who have been injured during a major incident #PCP16

Peter W Walker @PeterWWalker

You can't walk in to ITU and ask patients to leave. ITU is full. Where does capacity come from ? Theatre Recovery? Transfer? @The_PCP #PCP16

Peter J Hollely @PJ85RN

#businesscontinuity is key following a #MajorIncident how do we get back to #business as usual, #trauma networks are key #PCP16

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Plastic Surgery and reconstruction after a mass casualty incident
Miss Hasu Patel, consultant Plastic and Reconstructive Surgeon, St Bartholomew’s and The Royal London Hospitals

PCP @The_PCP

And we're back with Miss Hasu Patel, discussing plastics and reconstruction following major incidents; she coordinated 7/7 response #PCP16

Shareef Mahdi @Shareef_Mahdi

Looking forward to yet another inspiring talk by Miss Patel on her experiences of 7/7 #plasticsurgery #PCP16 pic.twitter.com/xpOYsLcsbD

PCP @The_PCP

Miss Patel has done extensive research into blast injuries, and is taking us through how bombs detonate and the blast wave occurring #PCP16

PCP @The_PCP

770 injured and 52 deceased following 7/7 #PCP16

PCP @The_PCP

Miss Patel is now talking through some if the horrific injuries found in blast attacks - they follow a pattern that can be studied #PCP16

PCP @The_PCP

Primary blast injury will cause major damage to multiple organs - patients do not survive primary injuries #PCP16

PCP @The_PCP

Primary fragments come from the bomber and bomb themselves: secondary fragments from the environment and victims #PCP16

PCP @The_PCP

Quarternary blast injuries are burns, either from the bomb itself, or from fireballs that occur #PCP16

PCP @The_PCP

Facial burns can cause swelling - always beware of the need for intubation! #PCP16

PCP @The_PCP

Never underestimate quinary blast injuries - PTSD. A HUGE issue in major incidents #PCP16

PCP @The_PCP

Miss Patel still meets with her 7/7 patients every 7th July - "an uplifting celebration of the human spirit" #PCP16

PCP @The_PCP

Miss Patel will also be telling us about a police officer at Aldgate who saved a number of lives @MedicCop @PoliceMedics @PolMed9586 #PCP16

Nicole Loi @NicoleLoi

Eg. of excellent burns treatment by Miss Patel's colleague mister Greg Williams. Amazing recovery and end result @The_PCP #PCP16

PCP @The_PCP

"Open injuries can be very deceptive; always been mindful about compartment syndrome" - Miss Hasu Patel #PCP16

Shareef Mahdi @Shareef_Mahdi

Miss Hasu Patel: Blast patients can't undergo long and intricate plastic surgery, they need quick release and damage limitation surgery #PCP16

Shareef Mahdi @Shareef_Mahdi

"Never overlook minor injuries" - could be very insidious and could easily deteriorate #PCP16 @The_PCP

PCP @The_PCP

"Civilian doctors have not seen blast injures, they don't know what to expect of them" - Miss Patel #PCP16

PCP @The_PCP

A mention of another incredible @NHSBartsHealth consultant, Miss Swee Ang, and her work on 7/7 as well #PCP16

Shareef Mahdi @Shareef_Mahdi

Salvage sometimes not an option for traumatic blast injuries, can show inexperience of civilian docs/surgeons in such situations #PCP16

Nicole Loi @NicoleLoi

Miss Patel talking through the importance of not overlooking minor injuries which can become infected - then more serious @The_PCP #PCP16

PCP @The_PCP

"Blast injuries are *evolving* injuries" - they require further debridement repeatedly until the wound is clean and bleeding #PCP16

Nicole Loi @NicoleLoi

Miss Patel says lessons from military on blast injuries not passed into civilian medicine yet... very interesting #PCP16 @The_PCP

Jess Foulkes @_JRFoulkes_

Highlighting the importance of passing on the lessons learnt by military surgeons to their civilian counterparts #PCP16

PCP @The_PCP

An upper limb injury = a likely chest and abdomen injury too #PCP16

PCP @The_PCP

Miss Patel's talk is going through each patient in the Aldgate bombing, showing their location in the train and injuries sustained #PCP16

Nicole Loi @NicoleLoi

Several speakers today emphasised that in suicide bombings injuries can be caused by human shrapnel.. horrifying concept #PCP16 @The_PCP

PCP @The_PCP

Days after 7/7 Miss Patel ended up alone in theatre due to a visit from the Queen! The little things you don't think about... #PCP16

PCP @The_PCP

Miss Patel's dedication to her patients is #inspirational, even being a guest of honour at s patient's wedding 😢 #PCP16

Shareef Mahdi @Shareef_Mahdi

Lesson for students: "Missing compartment syndrome in pnts who already lost a limb is absolutely not an option" @The_PCP @blsurgical #PCP16

Nicole Loi @NicoleLoi

Miss Hasu Patel speaking of her relationship with one pt from 7/7 who is now a Paralympian. Wonderful story #PCP16 @The_PCP

Russell @Medic_Russell

From the front row of #PCP16 I can see Miss Hasu Patel has tears in her eyes talking about her patients. Wow. An inspiration 😢

jordan @jordantud

Absolutely awe-inspiring talk by Miss Patel at #PCP16 about plastic surgery treatment for 7/7 victims. Amazed by the results.

PCP @The_PCP

Miss Patel is using fantastic technology to recreate the scenes during 7/7, taking us through the mechanisms of injury #PCP16

Nicole Loi @NicoleLoi

Miss Patel's persistence+determination in researching injuries seen on 7/7 is inspiring. She makes it sound v normal+easy #PCP16 @The_PCP

PCP @The_PCP

Some walking wounded can have bony projectiles - evidence of a high velocity injury, predicting future problems for patients #PCP16

PCP @The_PCP

Also need to be wary about blood born viruses during blast injuries - risk of cross-contamination with human tissue projectiles #PCP16

Jack @MrJackDJones

Miss Hasu Patel talking about the various mechanisms of injuries inflicted during suicide bombings #PCP16 @The_PCP pic.twitter.com/XjmIuojcuq

PCP @The_PCP

1 out of 19 traumatic upper limb amputations survived; a huge marker for massive internal injury #PCP16

Nicole Loi @NicoleLoi

Research into mechanism of blast injuries contributes 2 design of military gear for @BritishArmy. E.g. of lessons shared @The_PCP #PCP16

PCP @The_PCP

Blast lung was not known about in civilian practice at 7/7 - important for military and civilian collaboration #PCP16

Nicole Loi @NicoleLoi

Miss Hasu Patel singles out a particular lesson learnt from 7/7 - blast lung then classified as "inhalation injury" @The_PCP #PCP16

Shareef Mahdi @Shareef_Mahdi

"Blast injury management should be in Med school curriculum- absolutely essential for future" and maybe for paramed students too? #PCP16

Nicole Loi @NicoleLoi

Miss Patel's list- what needs to be done in the future. Also says military data is a wealth of info @The_PCP #PCP16 pic.twitter.com/85UmggYyD8

PCP @The_PCP

An inspirational, captivating, and educational talk from Miss Hasu Patel - incredible research regarding blast injuries and #PCP16

PCP @The_PCP

Miss Patel reiterating @lardyc7 earlier - "the limits of the human spirit are boundless" #PCP16

Lee Parker @lardyc7

@The_PCP genuinely gutted to have missed this talk as it covers

The Ginger Paramedic @GingerMedic999

All @NHSBartsHealth 7/7 survivors of traumatic amputation had improvised/prehospital tourniquets

Don't fear the BIG <C>

@The_PCP #PCP16

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Nicole Loi @NicoleLoi

Question posed to panel on how mass casualty incidents may be dealt with in other areas of the UK #PCP16 @The_PCP pic.twitter.com/9wy0Zppw67

Peter J Hollely @PJ85RN

The @The_PCP Symposium Q&A Panel have reps from @LondonFire @NHSBartsHealth @Ldn_Ambulance @metpoliceuk #PCP16

Shareef Mahdi @Shareef_Mahdi

"London can only cope with 4 out of 6 Paris-like incidents if an attack like that happened" #PCP16 @The_PCP

Nicole Loi @NicoleLoi

Panel agrees command centre in Ldn could deal with up to 4 major incidents, but not a Paris attack in scope and scale (6) @The_PCP #PCP16

Nicole Loi @NicoleLoi

Army medics likely 2 be deployed in mass cas incidents? Met armed police says it would have 2 be in "catastrophic" circs @The_PCP #PCP16

Nicole Loi @NicoleLoi

LFB's Alaistair Hislop says potential for fire brigade to act as medical co-responders, but needs much more work @The_PCP #PCP16

Peter J Hollely@PJ85RN

The_PCP Panel think #firstaid is the early key to managing #critical casualties initially @stjohnambulance have a really good app #PCP16

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Workshop: Spree-shootings
Dr. Marius Rehn, registrar in Anaesthetics and Intensive Care and HEMS spec. registrar at London's Air Ambulance

PCP @The_PCP

Now we're in a workshop with @DrRehn from @LDNairamb discussing decision making in shootings. Starting with horrific video footage #PCP16

Nicole Loi @NicoleLoi

Sobering footage of mass shootings across the world from Dr Marius Rehn @The_PCP #PCP16

PCP @The_PCP

@DrRehn will be giving a sobering talk on shootings, including his own experiences of the Brevik shooting #PCP16 pic.twitter.com/sqnEPFaosQ

Shareef Mahdi @Shareef_Mahdi

Marius Rehn: should be equity in critical care irrespective of geography- difficult to deliver bc major incidents are heterogeneous #PCP16

Shareef Mahdi @Shareef_Mahdi

Interesting how definition of major incidents is heterogenous. How do we define mass shootings? Terrorist attacks?  @The_PCP #PCP16

Nicole Loi @NicoleLoi

An example of primary prevention... we are lucky to have strict gun laws in the UK @The_PCP #PCP16 pic.twitter.com/oyHstSb11V

icole Loi @NicoleLoi

Group brainstorming how 2 manage major incidents. More kit (tourniquets, etc), more training 4 ALL (Inc schools), intel @The_PCP #PCP16

Nicole Loi @NicoleLoi

Dr Marius Rehn giving his personal emotional account of the Anders Breivik attack, while he and his family were in Oslo @The_PCP #PCP16

Nicole Loi @NicoleLoi

Dr Marius Rehn makes the point that violent extremism is not only religious but can also be political - Breivik v rightwing @The_PCP #PCP16

PCP @The_PCP

@DrRehn reminding us major incidents are also natural (or man made in the case of climate change events) not just terrorism etc. #PCP16

Nicole Loi @NicoleLoi

Dr Rehn stresses need 4 major incidents reports 2be collated & investigated 4 research, produce more sophisticated protocols @The_PCP #PCP16

Peter J Hollely @PJ85RN

@DrRehn gave a good overview and introduced the THREAT concept #PCP16 pic.twitter.com/3sfqjftxHO

PCP @The_PCP

THREAT:
Threat suppression
Haemorrhage control
Rapid Extrication
Assessment
Transport
#PCP16

PCP @The_PCP

Audience in @DrRehn's workshop can list more and more shootings; horrendously common event #PCP16

PCP @The_PCP

The team are now getting into groups to discuss the recommendations for how to prevent shooting events #PCP16

PCP @The_PCP

Recommendations from the crowd - protect the EMS teams, keeping zones where it's safe or not, suppress the threat #PCP16

PCP @The_PCP

Important for all responders to carry basics kit such as tourniquets and dressings to treat patients as they go #PCP16

PCP @The_PCP

Anatomical triage is done by high-level medics. Physiological triage can be done with basics skills and knowledge #PCP16

Peter J Hollely @PJ85RN

A little review on #Triage by @The_PCP Symposium #PCP16 #prehospitalcare pic.twitter.com/f7ngzg2Izb

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Mass casualty and Major Incidents: A military perspective
Lt. Col. Claire Park, consultant in Pre-hospital Care with London’s Air Ambulance and in Intensive Care and Anaesthesia at King's College Hospital

PCP @The_PCP

Our final speaker will be @ClairePark01! Due to the nature of the talk we will not be tweeting until after for the closing of #PCP16

Nicole Loi @NicoleLoi

The talk I have been looking forward to most! @The_PCP #PCP16 pic.twitter.com/YQ1l7r7u1D

Nicole Loi @NicoleLoi

Lt Col Claire Park describes a trauma team working in Camp Bastion with up to 25 observers (Mil medics)! Daunting prospect @The_PCP #PCP16

Shareef Mahdi @Shareef_Mahdi

"Trauma is a disease of exclusion- have to exclude all possible injuries" @ClairePark01 @The_PCP #PCP16

Nicole Loi @NicoleLoi

Lt Col Claire Park talks high and low velocity bullets and difference in energy transfer and trauma caused by each @The_PCP #PCP16

Shareef Mahdi @Shareef_Mahdi

High velocity GSW designed to injure and low velocity/"soft" designed to kill #PCP16

PCP @The_PCP

Fantastic talk on military approach to prehospital medicine and multiple casualties from @ClairePark01 - a wonderful finish to #PCP16!

PCP @The_PCP

@ClairePark01 finishing the conference with a thank you and well done from @LDNairamb! #PCP16 pic.twitter.com/9JZtJPABzn