Very sad to hear of the death of Douglas Chamberlain. A visionary, founder of paramedic training, tireless advocate for better prehospital care, founder of the Resuscitation Council and a great (if a bit scary!) teacher.

Extraordinary book. Written 1947. Describes precisely both the government and public reactions to the #COVID_19 pandemic.
Should have been read by those in charge in 2019/20!

Agree not an isolated case. The intersection of violent personality, drugs and mental health is hard to mitigate.
Most on the emergency front line know people who are highly likely to seriously harm someone (or, more commonly, themselves).

Hey guys. I’ve got a great new test. It has 60% false positives. Can I sell it to you?

Prevalence of midline cervical spine tenderness in the non-trauma population Objective The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-...

Just reminded of this great paper.
59.8% of non-trauma patients have midline cervical spine tenderness - such a non-specific sign.
Seems more likely to mislead than help in trauma secondary survey. So why do I still feel the neck?

emj.bmj.com/content/39/4...

Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: retrospective observational cohort study Background Initial ED assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Sco...

Do we place too much reliance on NEWS2 score in our risk stratification in emergency care?
Pretty poor ability to predict individual need for time critical treatment (or death).
Maybe it’s a "one score cannot be right for all patients" problem?

emj.bmj.com/content/earl...

Interesting suggestion of changing ‘significance level’ from 5% to 2.3% or 0.5%! Needed to counteract p-hacking?

It’s such a nice day. Lots of smiles, enthusiasm, families and children.
With great organisation from the @rcemevents.bsky.social team.

So nice to see Ffion Davies receive a RCEM medal today.
Setting the intercollegiate framework for PEM in the UK. Writing paeds EM standards. Designing PEM training.
Mentoring and supporting EM development in many countries around the world as IFEM president.
Always awesome @rcem.bsky.social

Ambulance ramping smashes previous record in SA as war of words erupts over election Record ramping statistics in South Australia prompt an extraordinary outburst from the SA Opposition Leader about Labor’s 2022 campaign, with David Speirs accusing the government of winning the electi...

A great article for anyone who thinks that the EM situation in Australia is all sunshine. www.abc.net.au/news/2024-06...

Hmmm. The usual admission rate is just above 20% so I suspect that a 66% admission rate is screwy data.
Maybe 66% of ambulance arrivals rather than all patients?

No. People with minor conditions are pretty simple to see, treat and send. Doesn’t take much time.
It’s people who have to wait hours or days for a ward bed that are the cause of crowding.

(PS: I know data systems can reconstruct this info. That’s just so much less powerful than an individual comment. A general picture feels more like an excuse than individual patient evidence).

We are not documenting crowding in individual patient notes. Makes it difficult to give context around delayed care for coroner, solicitor etc

Do you document crowding in clinical notes? If so what phrases do you use?

Feels like personal risk to the clinician for slightly better (but still awful) care for the patient.
Do you have any ‘stock’ phrases to write in the notes to provide your defence?

Is it better for ED staff to provide inadequate care in the ambulance car park than no care?
Problem is coroner and solicitor hold staff accountable for inadequate care - but if you haven’t seen the patient you cannot be personally held liable.

Should we put limits on car park care?

Send blood tests?
IV antibiotics in sepsis?
IV morphine in hip fracture?
Into X-ray, then back to amb?
Into CT, then back to amb?

Horrible discussion, but is a reality.

Agree emergency systems should be optimised by matching whole hospital resources to predicted patient arrival times.

BUT matching to average numbers means you are under-resourced 50% of the time!

Also matching to predicted variation (as well as predicted numbers) is absolutely key.

I remember many years of arguments that we should put more staff in ED at night when in fact the data says we should focus resources in the evening.

1) Good proof of concept, but no practical implications yet.
2) Sound basis for grant application for next stage development.
3) Outcomes should not just be falls (mobilisers may have better quality of life despite falls).
4) Maybe needs a wearable sensor rather than iPhone

Interesting - but.
7 day follow up. More falls with a higher step count.

So if you try and get around early you are more likely to fall (of course). But maybe early mobilisers have better long term outcomes.

Interesting use of tech - conclusions:
doi.org/10.1111/jgs....

We keep pumping money into the NHS. Is it good value? Critics complain that our health service is bloated and inefficient — but the diagnosis is complex, and how does it compare with other countries?

Diagnosis based on the data: The NHS is run too lean to be efficient. Every word of this rings true from the frontline.

www.thetimes.com/comment/colu...

Seems like usual Xmas in ED. Lots of elective beds become available on Christmas Eve. Means flow problems ease over holiday period.
These beds have to be released when elective activity starts.
So I predicted bad times week beginning 6th Jan.

Anyone solved the problem of major incident call out at night?
In the olden days land lines and pagers worked 24/7.
Now most people have only mobiles - and have them silenced at night?
How does your HMIP approach this? (And has anyone done a 2am rest?)

OK. The TraumaCare webinar was fun!
So many questions and I am sorry that there was not time to answer them all.
If I couldn’t get round to you - post here (or the other) and I will continue the conversation.