In this October issue

Abstract

Intubation is arguably the most important intervention done in an ED. We publish papers that discuss it in some detail. (a) A group from Melbourne conclude that structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety. (b) A group from NSW describe current airway management practices after a failed intubation attempt in Australian and NZ EDs as well as factors associated with second attempt success. (c) A group from Queensland report that implementation of an evidence-based care bundle and audit of practice has created a safe environment for trainees to learn the core critical care skill of rapid sequence intubation in the ED. In an editorial linked to the above paper from Melbourne, Victoria Brazil and her colleagues highlight the importance of hot debriefing in the ED. Staff are enthusiastic about team conversations after clinical encounters – to defuse high emotion, promote learning and reflect on ways to improve future care. They argue that clinical event debriefing should be a cornerstone of healthcare team reflexivity but can only result in change if embedded within a larger ‘improvement ecosystem’ that synthesises, analyses and reacts to the data from the coal face. The topic of debriefing is also discussed in detail in the Trainee Focus section. Every year 25 000 Australians experience a cardiac arrest in the community, but only 12% survive. The faster CPR and defibrillation starts, the greater the chance of survival. Currently, only half of Australian adults are trained in Basic Life Support (BLS). The Australian Resuscitation Council and key stakeholder organisations believe the best way to ensure all Australians know how to save a life is by mandating BLS education and training in schools. We publish an ‘Aussie KIDS SAVE LIVES’ Position Statement outlining a strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum. The August issue profiled this paper on its front cover. In doing so we inadvertently used an acronym for Aboriginal and Torres Strait Islander peoples that is disrespectful and does not embrace cultural diversity. Once we realised the problem, the acronym was changed immediately online; unfortunately, it was too late to change the cover of the print edition. No disrespect or offence was intended. We apologise unreservedly. A group from South Australia give us a retrospective analysis assessing whether the introduction of point of care Rotational Thromboelastometry (ROTEM) influenced blood product transfusion and coagulation management in an Australian level 1 trauma centre. The authors conclude that ROTEM introduced in the ED, altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products. Another paper from South Australia reports the incidence of Acute Traumatic Coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital. The conclusion is that prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma. Since 2018, the Australasian College for Emergency Medicine has collaborated with Swinburne University of Technology on a research project to understand and enhance the leadership capacity of emergency physicians, beginning with Australasian Directors of Emergency Medicine (DEMs). This research has revealed the complexity of leadership in emergency medicine, illuminating the strengths and limitations of extant research and suggesting promising new directions for emergency medicine leadership and leadership development research. This program has also shed new light on the knowledge, skills and abilities that DEMs need to develop to catalyse change in the systems where they work. The authors argue that an approach to leadership development that reflects the complexity of leadership in emergency medicine will go a long way to enhancing the sophistication, effectiveness and impact of leadership in emergency medicine.