Debate: The ICU is no place for the elderly Francesca Rubulotta argues in favour of the ICU being no place for the elderly. She describes the ICU as a horrible monster, a very dangerous place. Furthermore, she suggests the ICU is on par with climbing a mountain in terms of risk and exposure to catastrophise.…
Dealing with Chronic Stress in Critical Care Ashley Liebig is a senior flight nurse and helicopter rescue specialist with STAR Flight. She talks with passion about her job, her vocation. Ashley divulges a deeply personal and deeply traumatic story from the SMACC stage. Pre-hospital medicine, emergency medicine and critical care are difficult jobs. There is…
Critical Care in Humanitarian Emergencies: Nikki Blackwell Nikki Blackwell provides an insight into critical care in humanitarian emergencies. Through her experiences in hunger emergencies, epidemics, natural disasters and conflict zones, Nikki has gained a wealth of wisdom and lessons. She shares these from the SMACC stage. Nikki talks about some of the practical things she…
Debate: Prehospital Doctors add little value in Trauma Anthony Holley and Marietjie ‘MJ’ Slabbert debate the value of prehospital doctors in trauma. Anthony argues that doctors in the prehospital setting add little value. He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that…
Debate: It Is Time To Throw Away The Hard Cervical Collar Darren Braude and Karim Brohi debate over the utility of hard cervical collars. Darren argues that it is time to do away with hard cervical collars. He raises some assumptions. The first being that movement of the spine is bad. As he explains, movement…
Debate – Neurocritical Care Improves Outcomes in Severe TBI by Martin Smith and Mark Wilson Martin Smith and Mark Wilson debate whether neurocritical care improves outcomes in severe TBI. Martin argues in favour of neurocritical care. He concedes that longstanding and established practices are not as efficacious or innocuous as previously believed. Very few specific…
Debate: ‘Do Not Resuscitate’ Should Be The Default Alex Psirides and Sara Gray debate over whether ‘Do Not Resuscitate’ (DNR) should be the default choice for all patients. Alex contends that application of ‘CPR-for-all’ is the ultimate evidence drift. A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no…
Challenges in pre-hospital management of children James Tooley discusses the sheer terror that comes with the challenge of managing children in the pre-hospital environment. As James explains, although many clinicians may think that they do not need to (or may not want to) think about the paediatric population, it is something that every clinician would…
Submassive PE should be Thrombolysed: Anand Swaminathan and Iain Beardsell Anand Swaminathan and Iain Beardsell debate the use of thrombolytics in the treatment of submassive pulmonary embolism (PE). PE is a spectrum of disease. Patients should be treated differently depending on where they are on the spectrum. Subsegmental PE may need no treatment at all,…
The Standards in Helicopter EMS (HEMS) Ryan Wubben discusses the standards in Helicopter HEMS. He asks the question, what standards? The development of Helicopter EMS (HEMS, or as the Federal Aviation Administration recently coined it: “Helicopter Air Ambulance” or “HAA”) services in the United States has taken a different path in recent years compared to…
