London Trauma Conference 2012

The London trauma conference took place between the 4 and 7 December 2012 at the Royal Geographical Society in Kensington, West London.

Though the author only managed to attend a part of the conference, they would fully condone any advanced paramedic, or paramedic with a particular interest in trauma to attend the conference in the future due to the invigorating, enlightening and thoroughly engaging talks and lectures delivered there.

Mr Ross Davenport’s lecture titled Coagulation Coagulopathy in Pre– hospital Care emphasised the benefits of the delivery of blood on-scene and how patient recovery is vastly improved in cases of severe trauma by administering transfusions on-scene after the accident rather than transporting them to hospital. This, as Davenport purported, called for more education and training for paramedic and first responders so that they are aware of any potential coaulopathic disorders that may arise or develop while treating trauma on-scene.

One such complication highlighted by Davenport included the level of the glycoprotein fibrogen, which is converted by thrombrin into fibrin during the clotting process (the substance that creates the ‘mesh’ that acts as a plug, preventing blood loss) and its role in blood loss after trauma. Davenport stated that in cases of septic shock, the levels of fibrogen are affected, which can result in slow or poor haemostasis and subsequently, greater blood loss to the patient, therefore significantly reducing their ‘recovery odds’ following a significant incident. Davenport also noted the amount of blood used by first responders and emergency departments in the first 72 hours post-incident was key (after which both demand and use falls rapidly) and therefore the importance of transporting blood on-scene and that expedient transportation, as well as the delivery of blood to the patient is a vital factor their recovery.

Keeping on the topic, Dr Simon Glasgow’s talk Blood in Major Incidents ran through the history of blood transfusions and of the modern blood bank from the unsuccessful (and often fatal) transfusions of the 17th century using sheep’s blood, through the discovery of blood groups by Karl Landsteine in 1907 to the invention of the modern blood bank by Oswald Hope Robertson during the First World War. Glasgow called for a heightened sense of awareness of blood transfusion in first responders not just in administration, but in the recording of blood loss at major trauma events, stating that there was a need to increase the means and scope of collected information concerning blood transfusion and delivery.

Dr Julian Thompson’s talk on Safety at Terrorist Incidents and The Terrorist Chemical Threat: Lessons of the Recent Past by Dr Mark Byers took the audience through the dangers and perils of terrorist incidents to both the public and the practitioner on-scene.

Thompson’s shocking statistics showed that paramedics faced equivalent dangers (and injury/mortality) rates, at terrorist incidents as the police and fire service, but that training and safety for paramedics was streets behind other emergency responders.

Thompson also spoke at length of the use of blood at terrorist incidents and pointed out the fact that nonterroist and ‘human-error’ accident or attacks tend to use less blood on-scene than accidental ‘traditional’ traumas such as car accidents. However, terrorist incidents require the use of more blood on-scene per person due to the nature of the injuries sustained and the intention of weapons to cause maximum blood loss to the casualty.

Thompson continued to explain that that during all major terrorist attacks over the past 20 years, the shortage of potentially available blood for patients on-scene was practically nonexistent, and this was a factor commonly exacerbated by the media and the public. Bryer’s talk on the chemical terrorist threat to the UK and worldwide was truly eye opening, and though Bryer stressed the low casualty-rate and relativly lesser threat of such incidents in the past, he made it clear that this was primarily due to the incompetence of those delivering and manufacturing the chemical attack and not because of any relative or mitigated risk.

Biological threat was deemed to be a terrifying prospect, but also, as Bryer said, not a hugely probable as biological attacks are very hard to deliver even in by the most trained individual, however, the potential damage remains high, and furthermore, biological attacks, as well as chemical and radioactive attacks can be used by terrorists to draw out emergency personnel for subsequent attacks rather than intending to cause initail large scale civilian casualties—a theme that was becoming more and more prominent in perceived terrorist attacks in recent years.

Bryer named several key points to be considered by paramedics in such incidents based around the ‘Confirm, Clear, Cordon and Communication (CCCC) practice. Almost all advice was elementary, though no less invaluable because of it such as awareness of secondary attacks in the form of stray packages (potential chemical or explosive device) left at the scene, radio silence in certain attacks (which may trigger further devices in the area), retracing steps when exiting a dangerous area (to avoid potential explosive triggers) and caution when using lights in perpetually dark environments (another potential device trigger).

Polonium: Lessons from London, a lecture delivered by Dr Jim Down, spoke about the diagnosis of the polonium poisoning incident of Alexander Litvinenko in London in 2006, and, though running through a series of medical terminology that even the most adept medical practitioner would struggle to understand and perhaps somewhat out of the remit for those concerned purely with pre-hospital care, it is certainly worthy of mention for its sheer entertainment value. By giving a blow-by-blow account of the admission and diagnosis of Mr Litvinenko, not only was the talk enthralling (indeed, it was like watching an episode of House without the gentrified doctor having to adopt an uncomfortable American accent) but the lecture also raised the important need for a media-sensitive mind within all sectors of the NHS and the requisite for perpetual vigilance from healthcare workers when dealing with any case or call-out that captures (or that could potentially capture) the public’s attention—certainly advice many paramedics would condone given the profession’s misportrayal by the British media in recent years.