Here is another guest post by my colleague James. This is an excellent piece on the importance of approaching scenarios in a cohesive, standardised manner that still allows some flexibility. Emergency medicine is actually based on some pretty simple concepts as James discusses.

As an ALS clinical instructor who also dabbles in teaching at university, the one single concept I harangue all my students with is the idea of having a good clinical approach. Teaching many students in one form or another has shown me that this is the single most useful thing that anyone can learn in paramedicine. Unfortunately it’s one of the most unevenly applied and its importance is poorly understood. So today I want to try to get across why it’s critical that the student paramedic gets this straight in their head.

OK, thanks to all who answered CASE#6 ‘Find the bleeding, stop the bleeding’

Plenty of good ideas, although some of the options are more realistic than others given the inevitable constraints of rurality. Glad that none followed the EMST mantra to the letter and killed him…

The setting of rural Australia poses a challenge, especially for those used to working in larger centres. James and Casey are used to this kind of stuff (although Casey’s mostly in-hospital and has even got a CT scanner…James is used to working out of a tent wearing just rabbit skins). Credit to Derek & Hildy for having a bash with spot on answers – but with kit we just don’t have!

You can read the case and initial comments here

Case discussions like these can be useful to reinforce what we already know and perhaps look at things from a new perspective. I chose…

I was just given a fantastic reminder of just how excellent social media can be for those of us in the medical fields.  That’s right, it’s not just for drunken rambling or posting photos of your lunch/cat/alcohol/genitals…

I was browsing twitter when I came across the following tweet

Clicking through to the article I found that the first part of the article referred to Victorian Paramedics “failing” diabetics due to gaps in our training…. What the?!

Critical illness is part of the remit of rural doctors, albeit encountered relatively infrequently – which of course makes it all the more challenging! Moreover rural doctors have to deal with such cases with limited staff, no backup and paucity of lab tests and definitive care.

Perhaps one of the most commonly encountered true emergencies in the bush is dealing with major haemorrhage. Our patients work on farms, in heavy industry, or are involved in road crashes.

Let’s consider a hypothetical case and see how FOAMed could help.

THE SCENARIO

It’s Tuesday morning and you are busy working through a routine Primary Care Clinic in anticipation of the afternoon off. The local Rotary are hosting a BBQ at the nearby football oval and you’ve been invited as a guest speaker on the pros & cons of prostate cancer testing.

Clinic is rudely interrupted by a loud “BANG” from the direction…

It’s been a pleasure having former KI Doc, Dr James Doube back on Kangaroo Island for a short locum stint, but also a chance to catch up and talk about various schemes.

Jamie is a rare breed – a former career as paramedic and wildlife conservationist, he’s also a GP-surgeon, recent JCCA-graduate GP-anaesthetist and has carved out a niche career in truly remote & austere medicine with the Australian Antarctic Division & other organisations.

Dr Doube is also a wonderful experimental test subject.

He is WAY to modest to mention his award of the 2012 Australian Antarctica Medal for his services as both expedition medical officer but also conservationist – read more about his exploits here. He’s been involved in eradicating rabbits from Macquarie Island & with TEAM RAT on South Georgia.

In this brief podcast we discuss his work with AAD and particularly the potential for FOAMed…

Recently I had the pleasure of attending a superb AWLS course in Queenstown. The course was run by a group of intrepid clinicians who decided several years ago to import AWLS from the United States. You can read about the group (and more importantly, book a place on the course!) here:

Wilderness medicine is in may ways the ultimate in prehospital care – it involves providing care to patients in an frequently austere environment with often very limited personnel, equipment, and communications. For emergency department doctors like myself, it also separates us from the security of readily accessible diagnostic investigations.

At its core wilderness medicine represents the same pathologies as emergency medicine, although environmental issues are obviously more common than in our urban ED and regional HEMS (check out this article about some recent lightning strike patients treated in Waikato ED!). The challenges encountered by treating clinicians however are…