what i learned in sydney

austrauma 2009. the reason we are in sydney, australia right now. looking for courses to take while on this trip, i was ecstatic to find one was that was right up my alley. the cheesy powerpoint font and unwieldy website provoked some minor misgivings, but the lineup of topics seemed interesting. "humanitarians as targets in warzones", "the iraq experience", "hurricane katrina", "disaster response" were some of the more eclectic topics, mixed in with the more standard goal directed therapy, transfusion protocols, emergency airway and pelvic fracture lectures. i wasnt sure what to expect and felt a bit like a resident or medical student again, walking into a huge conference centre full of smart, confident intimidating medical professionals i didnt know.

to sum up: i loved it! what an awesome conference. the first 2 hours of each day where filled with 3rd world med/warzone topics and disaster relief/preparedness. we heard from the doctor responsible for coordinating the medical care of the hurricane katrina refugees, 2 trauma surgeons from iraq, one of the heads of disaster preparedness in the USA, as well as numerous other eminent trauma surgeons and emergency doctors from all over the world. the speaker who made the biggest impact on me was a canadian named dr. chris giannou who trained in canada and the middle east and has worked as a war surgeon for the red cross for 30 years in almost every publicized warzone in the world, as well as working on palestinians in lebanon during the intifada in israel in the '80s.
what a lineup!

so... without further ado, an incomplete list of what i learned in sydney. i'll try to stick to the high points:

1. a sampling of medical developments that will change my practice (i'll get these out of the way first b/c most people won't care... feel free to skip to number 2)
a) ringers lactate is a pro inflammatory agent. 1-2L is probably OK, but receiving 5L in a resus is likely to cause ARDS. i suppose i always use NS anyways, but now i have a reason.
b) permissive hypotension in trauma resuscitation (MAP of 50) is not only allowable, but possibly optimal management. clots tend to blow loose at 80 systolic. i will need to do some more reading about this one.
c) ketamine is a good agent for pain control in the acute setting. i have never done this but i am going to try, as i really enjoy the effects of ketamine, and after working in kenya i am very comfortable with its use.

2. when bought in bulk, the price of a simple landmine is 50 cents US. they are so cheap that before landmines became a political issue, companies like fiat would often give away 100,000 of them as a sweetener when a government or rebel group bought X number of RPGs or antitank missiles.

3. at their production peak, fiat was making more from landmines than they were from selling vehicles.

4. blast waves from high energy explosives dissipate the least energy into your body when you are lying down in an empty space, and dissipate the most energy into your body when you are lying down next to a wall or solid object (which is a common defensive reaction).

5. after hurricane katrina, the US govt. sent a military mobile hospital out from baltimore to new orleans at an operational cost of $1 million US/day. after a week or so, when they realized that it was absolutely useless, it quietly made its way back to baltimore, having treated almost no patients.

6. in a disaster scenario, the hospital's first and most important priority is to keep almost everyone who arrives in the first hour OUT. anyone who is able to make it to the hospital that quickly does not urgently need to be there and will only clog up the system for those who will actually benefit from urgent care. imagine the chaos and frustration that would cause!

7. australians really believe in climate change. they have had several years of severe droughts, multiple hurricanes, heat waves and floods. they are currently dealing with the biggest bushfire in the history of the country, and a major flood at the same time. it has also been rainy in sydney the entire time we have been here and it shows no signs of stopping. :-( apparently this is not normal in the summer and people are not happy.

8. i have to remember to think through what i say in front of large groups of people. i think i developed a bit of a reputation at this conference. i think this b/c towards the end of the conference random people were coming up to me and saying, "so you're from canada eh?" or "i really agreed with your point in that last lecture" or "what the heck were you thinking??" (nobody asked that last one, but they were probably just too polite).
the way my brain works i would always have multiple questions buzzing through my head after the lectures, and then the moderator would invite questions from the audience for the panel and there would be this uncomfortable pause while no one got up, and all the presenters looked like "really? were we THAT boring?" so i would get up and ask my questions in front of 400 trauma surgeons and ER docs and residents and mid way through my questions i would realize that perhaps i was coming off a little cheeky, but it would be too late to pull out. i think most attendees over 35 probably thought i was a punk and most attendees under 35 thought i was ballsy, but i am sure they have all forgotten about me by now. i did have some good conversations with the presenters themselves between lectures and they seemed happy to discuss things with me.
the availability under one roof of all these globally important researchers and policy makers was my favourite thing about this conference. why look stuff up when you can ask the people who wrote the textbooks and authored the papers? why fly into warzones to see what our political priorities should be when you can just ask someone who has lived in warzones for the past 30 years?

a big thank you to the organizers of austrauma 2009 for putting together such a great opportunity.
(this man survived a piece of shrapnel making a hole in his brain)