Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

SMACC Chicago 2015 : A Different (and very personal) Perspective

Crystal Upshaw RN

EHS LIFEFLIGHT Nova Scotia Canada
I have read many excellent summaries of the SMACC Chicago experience. They included wonderful synapses and learning points from the conference. I have nothing to add in that regard-all the best points have been covered.
Ever since returning from Chicago and the conference SMACC I have been wanting to sit down and write about it. Not to just try and describe it to others but to really try and sort out what I personally gained from the experience, and what did I want to share with my colleagues back home.

First, where did I come from, and how did I get there?

I am a RN, first and foremost . My entire career has been in critical care, first the ICU, then some extra shifts in the ED to improve my assessment skills( I knew really sick, it was those on the fence patients I needed to figure out) and finally my dream job as a Flight Nurse. I still do all three. I believe it is one of the reasons, after eighteen years, I still love my job…that and the “by chance” introduction to FOAMed and SMACC.
A co-worker told me about Life in the Fast Lane, EMCRIT and PHARM. Shortly after I had to spend 3 days in bed sick, and I had this twitter account which I had absolutely no idea how to work. The rest is history. I followed Minh Le Cong and a FOAMed convert was born.

This lead me to SMACC and the talks posted on line. Then it snowballed. Cliff Reid making me cry, talking about not giving up, making things happen, muppets and propofol assassins…Liz Crowe swearing up a storm, Victoria Brazil eloquent, funny, passionate, and on and on. Their messages and stories connected. They were talking about things we all experience, but are never really spoken about. I learned we are all clinicians. The SMACC talk were so well done that you could relate regardless of profession – paramedic, nurse, resident, student, experienced physician . Begone tribalism!
But it was more, and the more clicks, the more people I followed, the more links I opened. They lead to literature, evidence, and fierce debate. So what ? My consumption of research to that point consisted of reading an abstract and the conclusion. I am an old fashioned diploma nurse. I have no degree, I didn’t take any statistics courses, I had no idea how to critically appraise a paper. I kept reading. Through others, I began to understand to some degree how to properly read a paper and how not to blindly follow. (despite concerns regarding blind devotion and lack of clinical governance)
Eventually I had the nerve to start interacting with the people I was learning from. Minh Le Cong was the first to encourage me to state my opinion and stand my ground (thank you). It is scary putting yourself out there, especially with the experts, the educators, the pioneers,the researchers, the bloggers , the experienced people you look up to and admire. Nicholas Chrimes, Tim Leeuwenburg, Mike Abernathy, Brian Burns, Richard Levitan , Bill Hinkley to name a few, now all just a click away, to question, to challenge, to receive support and encouragement from.

Then, the unthinkable happened. I received an invitation to be involved with the prehospital workshop SMACCFORCE. This was an unbelievable honour and opportunity to sit on a panel with those very same people I admired so much. P.S. IMPOSTER Syndrome is real.

As excited as I was to be involved, I was just as terrified to let those who invited me down, to not be the same in real life as I am as CanadianLFrn, that I wouldn’t belong or fit in.

The morning of the workshop was nerve-wracking.

Then I saw Minh. A hug, like old long lost friends, not a hand shake, and all was well, he put me at ease.

The workshop went great, no nerves. I am comfortable when I know what I am talking about.

What was really the highlight for me though?

Besides the insightful talks by Stephan Mazur, Bill Hinkley, Ashley Liebig, Geoff Healey, Cliff Reid, the late John Hinds, there were the people, as people, not Medical Directors , Flight physicians, or researchers.

Those I have admired, looked up to, respected from afar. They are real people, and they are kind, open, welcoming, encouraging, and brilliant .

My favourite speaker that day was John Hinds. I had never watched his previous SMACC talks and I instantly was drawn to his presentation style, message and presence. I was crushed to hear of his passing, and saddened thinking about all of his friends and family. Since then i have had moments of feeling guilty that we had been consuming his knowledge and enjoying his presentations when he could have been home…wavering back and forth between grief, laughter, guilt, sadness. Inspired to do better, with honourable intentions, always.
After SMACCFORCE I was able to relax and just enjoy the conference. The panels, talks, head to head debates, did not disappoint. Too many concurrent sessions with topics and speakers I wanted to attend, not wanting to miss anything, but reassured knowing, eventually I could catch anything i would miss online later.

The talks that stood out were done in true SMACC fashion. The TED talk style, with a story; limited, interesting slides, a common catchy message, but most of all humanity and vulnerability . Liz Crowe, stunning us with her talk on, gasp, God! This, for me, was one of the most important things I took from the conference. The humanity, resilience, and vulnerability we all in critical care experience, and need to maintain.

I was shocked to hear the personal tales of failure, defeat, misdiagnosis, addiction. The courage to discuss and share these stories inspired me more than any single thoracotomy or intubation ever could, and I understood why these men and women were so respected, and why we all sat on the edge of our seats, sometimes on the verge of tears, with bated breath. Watching the metamorphosis, from down and out, defeated to risen again, having learned, grown and now sharing and empowering others through their experience, all while making us realize we can and will do the same. The challenge lies in what will we do after these experiences – grow or stagnate? Push on, or give up? Train harder or simply maintain the status quo?
The second phenomena i noticed was less obvious. I observed it over and over, at the conference, during drinks, at dinners, watching and listening to the speakers and delegates interact with each other. Apparently, although we were not in a rescus room, egos had been checked at the door. The amount of professional and personal respect I witnessed between many was admirable. I saw so much sharing of information, genuine respect, congratulations, laughter and curiosity. Leaders, innovators, sharing and collaborating, not hoarding information, not competitive, just sincerely enjoying each others company and what each had to offer, whether it was a piece equipment (good old vomit simulator comes to mind) an algorithm , or SIM training methods. They were lifting each other up..not climbing over each other to be the best. A lesson reinforced to take home – to continue to foster, encourage and support new staff, co-workers, young docs and to celebrate the success of others, rather than be threatened by it.
I heard rumblings of “cliques” and celebrity. Of course people who knew each other, who travelled together, who work together, will also hang out. We all have our ‘people’, this conference can not be expected to change that . It is human nature to be with those that we have the most in common with. SMACC has at least, brought the concepts of the tribe out into the open. The SMACC concept is based on breaking down walls, mutual respect, regardless of position, and if you are willing to engage, you will be heard. The rest is up to us. I wish I had been more willing to approach others, to put myself out there, it is my biggest SMACC regret.

The last thing that I brought home from SMACC was a healthy dose of inspiration to do more.

I signed on to be involved in a research project, and before the conference I was feeling like I had really got in over my head. Then on the first day, from Cliff Reid was this slide-one of the first talks . Over and over the message of the importance of quality assurance and research was reinforced, and it strengthened my resolve to move forward, keep learning, and to continue to strive for excellence.

I have asked for, suggested, and whined for change. That is not going to cut it.

Inspired, motivated, and moved by lessons shared by others from around the world, I came home ready to keep pushing forward for all that I think our program and ICU can be. Its time to stop waiting for others to do it…bottom line..you don’t have to be Cliff Reid to make things happen or be a hero, but listening to the presenters of SMACC will push you in the right direction. We can all “Be like that guy”, if we choose to .
A special thanks to Minh for helping me to find my inner courage and strength , and the doors that have opened because of it.
See you in Dublin …