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)
Sydney Nightlife
A babble of boys
Hell hath no fury like a bird in a mall
Is that my mother's bum?
Night sky bullseye
Cure for the hiccups?
George Street
Timepiece
The Strand Mall
Sydney makes me form the letter X
Glowing Fountain
Multichromatic
The opera house dance
Sails from a distance, U of L cement up close
Quintessential Sydney
L'entrance du l'hotel
Bed at The Vibe
Will you be my valentine?
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.
(this man survived a piece of shrapnel making a hole in his brain)
Prettier view than most campgrounds, but the toileting situation wasn't quite so convenient.
And now for the hike. Look at us at the beginning of the hike. I'm all relaxed, enthusiastic, and snap-happy. My grump-o-meter was in the negatives. For now...
Lowell was also pretty excited:
(Jumping off of something was not an option at this point because that "something" would be a cliff.)
This is me saying "WHAT AM I??!"
(The answer she was looking for was apparently "a dinosaur". Sad, isn't it? hehe)
A lot of the trail was not so much a path as it was a giant cluster of ROCKS. Julie successfully completed a mini section of rock climbing ...
Lowell had a little fun with a Kea bird (this one was extra special... it had TWO legs!).
And Marc had fun photographing Lowell with the lucky two-legged Kea bird...
Throughout the hike, the peach sticks were our life line. Follow the peach sticks. ALWAYS FOLLOW THE PEACH STICKS. Either that, or walk off the edge of the earth.
While beautiful, this hike was also slightly depressing because of all the deceiving "peaks". We kept thinking we were climbing the main peak, then we'd get to the top and notice that a cloud was mostly covering the next "peak".
Fake peak number 6. This was particularly depressing as I really thought I HAD reached the very top (and my grump-o-meter was also on the rise, good thing everyone else thinks I'm fun even when "grumpy")...
Marc & I walking a ridge between fake peaks... I think this is where I started having the very under-diagnosed shaky knee syndrome - affecting people at high altitudes on ledges when there are shear drop offs on either side. Solution - panic and grab your husband. Works every time!
After 3 hours of continual INCLINE, we finally arrived at the real peak (I think) :
Unforunately, the view (which was reportedly several beautiful peaks, valleys, and glaciers) was virtually non-existent. Oh wait, we had a lovely view of a big ol' cloud.
And then came the decline. The brutal brutal 3.5 hour decline.
This is Julie in pain? Excited? Sneezing? Goofy? I couldn't tell you...
Li'l resty rest on the way down...
Getting closer to the bottom...
Marc assessing the look/feel of a completely ridiculous mustache:
By the time we reached the bottom, we had never been so happy to see a road. Julie's lips, in fact, carressed the glistening pavement with a gentle kiss, so happy was she to be reacquainted with it.
