nexus news | October 2019
NEWS, VIEWS AND INFORMATION
FOR APLS MEMBERS
2020 course dates announced
Best of PAC: trauma research and the hot debrief
PAC Conference - full program announced
Donate your e-book
Instructors: Teaching updates from the CDC
Your thoughts on an APLS refresher course?
From the education team: instructor development resources
'Teaching interests' - a new APLS profile field
Play soccer for Australia with the Docceroos
Welcome fellow members of our APLS Community to the October edition of APLS Nexus for 2019!
It has been an eventful few months at APLS Headquarters and I’m now really looking forward to one of the highlights of the APLS Calendar: the APLS Paediatric Acute Care Conference which will be held at the Pan Pacific Hotel in Perth from 24th-26th October.
We’ve managed to bring together a fantastic scientific program again this year with lots of updates and controversies on topics at the “pointy end” of acute paediatrics. We’ve also planned a Social Program that combines some great WA food & drink with beautiful sunsets over the ocean (okay … we’ve organised the food & drink, the sunsets were pre-organised). So please quickly get onto the APLS website to REGISTER this week and join us at PAC 2019 “Go West!”
On a different note, the APLS Board held an Extraordinary Board Meeting on October 4th to hear a presentation from our Interim APLS CEO, Rod Wealands.
Rod’s first four weeks have focused on having a look at our organisational processes with a fresh set of eyes. Rod presented his findings and a few of his ideas about how we can improve. Most importantly, however, Rod has already embraced a lot of the great ideas unearthed from discussions with our APLS Office staff. The Board was extremely impressed with the work done so far.
I look forward to us introducing a number of these quick improvements in the way we do things and supporting further ongoing initiatives that will help all of our staff to “work smarter not harder”. Rod’s management style is refreshingly proactive, inclusive and very effective. He has set a high benchmark for what we should expect from our organisational leadership going forwards.
Our recruitment campaign for the permanent APLS CEO role has now closed and we should be conducting interviews within the next few weeks. I look forward to communicating the outcome in the near future.
I hope to see you all at PAC in the next few weeks.
Time to refresh your emergency paediatric skills? Looking to take an APLS course in 2020?
Our course calendar for next year is now open for booking with 67 new dates across the length and breadth of Australia, from downtown Sydney to Darwin.
For instructors, faculty nominations are open for all courses, so head to Choose your Courses to secure your top picks.
Browse our 2020 events via our course calendar here.
New to PAC on Demand this month: care pathways, driving change at a systems level, debriefing and trauma research are in focus.
In the keynote session from PAC 2018, Kate Curtis explores Paediatric injury research: changing policy, changing practice?
If you have an interest in emergency trauma research this session is a must-watch, and was nominated as last year's Toni Medcalf Oration in loving memory of the much-missed APLS instructor.
Elsewhere, Mike Shepherd takes on The Hot Debrief, with tips on how to review major clinical events with emergency department flash teams.
And if you haven't had a bellyful already, Mathie Muthucumaru discusses literature and practice updates in What's new in paediatric abdominal trauma?
Catch up on all this and lots more via vimeo.com/aplsaustralia
Last chance to book your delegate spot for the APLS Paediatric Acute Care Conference in sunny Perth.
The full conference program is available below and registration closes Friday 11th Oct. Catch up on speakers, topics, workshops and social events via our conference information page.
See you out west, we're looking forward to it!
Do you use the e-book edition of your APLS manual?
If not, would you like to pay it forwards to a candidate in a developing country?
Each APLS manual comes with a scratch-off code on the inside cover for a free digital edition of the textbook.
We've noticed that not everyone uses their e-book... and as our international courses rely on donated second-hand manuals which can be a version or two behind, there's no standard e-book available for international APLS candidates.
Our candidates in developing countries like Papau New Guinea would be so grateful for an up-to-date e-book of the latest edition manual.
So, we're collecting unused codes to send to our international candidates.
We're aiming for 50 codes to cover upcoming courses in PNG, Cambodia and Fiji – since 15,000 APLS grads read this email, we're sure we can do it!
If you have a 6th edition APLS manual (from 2017 onwards), have never used your e-book code and would like to donate it, please:
- Find your manual and scratch off the code on the inside cover
- Take a quick snap
- And send us the photo via firstname.lastname@example.org
Lots to report on from the APLS Course Development Committee, with updates to:
1. Safe Emergency Airway Management teaching resources
2. Basic Life Support Assessment Sheet
3. MCQ update
4. Anaphylaxis algorithm
5. Status epilepticus algorithm
6. Cervical Spine Management
7. Sepsis Workshop update
8. Radiology workshop updated
9. Role of HHFNO in bronchiolitis
10. Future projects
1. Safe Emergency Airway Management – An instructor training video has been created as an additional resource to support faculty in facilitating this workshop with a team-based scenario.
The video has practical tips for setting up and running the workshop, along with demonstrations of a workshop in action. You can watch the video here.
As always, you can find supporting resources in the Course Materials & Resources section of the APLS site, and likewise for any other updated materials mentioned below.
The aim for the workshop is to allow candidates to participate in a similar role to their clinical setting and use ‘pause and discuss’ to enable discussion that responds to gaps in candidate’s knowledge while focusing on key learning outcomes. Where possible three instructors will be allocated to teach on this station.
Whilst there was discussion about moving the workshop to Day 2, the benefits of Day 3 are:
- Established group dynamics to support adjustment to team-based scenarios
- Instructor familiarity with candidates to support drawing on candidate prior experience and promote inter-group discussions
- Theoretical basis for greater retention of learning when Day 1 skill stations are reinforced with some ‘space’ before recall
- 40 minutes allocated to session. This section of the program is now called Emergency Skill Stations.
2. Basic Life Support Assessment Sheet – Criteria for effective CPR has been included so that the key outcomes of effective BLS are clear.
3. MCQ review – The end of course MCQ has been reviewed wording and content have been changed to reduce ambiguity.
The CDC continues to consider the value of the MCQ in the APLS program. Currently it primarily offers a support for candidates learning by being a strong motivator to read the manual pre-course. Secondarily it demonstrates to external stakeholders that candidates have a minimum level of clinically relevant knowledge.
4. Anaphylaxis algorithm – APLS courses in Australia and New Zealand will now be using the 2019 ANZCOR algorithm for the treatment of anaphylaxis. This can be found via the APLS site and the APLS app. A laminated version of the ANZCOR algorithm is provided in course kits to support Illness Scenario 2.
5. Status epilepticus algorithm – The status epilepticus algorithm is also going to be updated to include Levetiracetam as one of the options for second-line agents. The APLS website and app which will always have the latest versions and this update will be rolled out within the next few months.
6. Cervical Spine Immobilisation – Given the difference in pre-hospital practice around Australia, APLS has adopted a safe approach to teaching cervical spine immobilisation.
Teaching on the courses will be focused on manual in-line stabilisation, log rolls and criteria for clearing a spine. Foam collars and “sandbags” will now be in kits for trauma scenarios on Day 3.
Candidates should be expected to identify the need to protect the Cx spine in trauma scenarios and use either in-line stabilisation or sandbags to do this.
7. Sepsis Workshop update – Sepsis workshop has been revised. There are now only 3 cases to support/guide candidate discussion. Please refer to notes under the slides for opportunities to adapt content if information is relevant to specific candidate groups.
8. Radiology update – Thanks to Dr Anna Holdgate for her active role in supporting the revision to the radiology workshop that was updated in course materials in March this year.
9. Role of HHFNO (Humidified High Flow Nasal Oxygen) in bronchiolitis – Notes have been updated to support learning conversation discussions for Illness scenario 5. Please note that HHFNO currently does not have a role in oxygen delivery for resuscitation so it is important to put this in context if it is raised during the SEAM workshop.
10. Future projects – what's coming in 2019/2020
• Timing changes – There will be some minor changes to the Provider course programme in 2020. There will be more time allotted for the Welcome and Aims presentation to allow more time for introductions and setting the positive atmosphere of the course. This builds the foundation for establishing a safe container for learning.
In addition, more time will be allowed for the first scenario demonstration, which will include an introduction to the “fiction contract” and setting the ground rules for scenarios in APLS. A video discussing many of these concepts will be available on the website under Instructor Resources shortly.
• Online learning review – This is ongoing. Please note that minor changes can be made quite quickly but reshooting substantial amounts of the videos will take some time and planning.
• Review of Trauma plenary – Instructor notes and the structure of the trauma plenary will be reviewed as there have been comments that it can be difficult to run in a coherent order.
• Putting trauma management into perspective – It has been noted that the fluid management in trauma algorithm in the manual can be confusing as to the volume and type of fluid to be given in a shocked trauma patient.
In addition, there is concern that a child with trauma may be given a blood transfusion who may not have needed it.
Massive haemorrhage in paediatric trauma is unusual and it is important to give candidates some perspective. Most children seen with blunt trauma do not need a large amount of fluid resuscitation and for them saline is a reasonable choice for a fluid bolus.
What should be stressed is the importance of reassessing once a bolus has been given and knowing that, in the rare case of haemorrhagic shock, blood is the first choice for boluses.
TXA is a useful adjunct but should be given within 3 hours of the trauma. The CDC intends to produce a brief video outlining this perspective.
• Work is continuing on the development of a neonatal online learning module so watch this space. Improved learning aids for the chest skills session are also still on the CDC agenda.
• Respondents to the 2019 APLS Big Survey indicated that they would like the option of an APLS refresher course. The committee is exploring the aims and therefore content and format of a shorter face-to-face program. Please feel free to contribute to these discussions by sending through your thoughts and ideas to the committee via email@example.com.
• The Course Development Committee values the instructor feedback received via course reports. Data from course reports is collated and reviewed by the CDC every 3-4 months. This enables the committee to prioritise and plan course program changes.
• In other CDC news, Sarah Jamison from NZ has joined the committee this year, facilitating the reciprocal sharing of ideas and knowledge between APLS Australia and APLS New Zealand.
Hope you are all going OK.
On behalf of the Course Development Committee
We’re currently developing a 2 or 3 day refresher course for APLS, an overwhelmingly popular choice in our Big Survey earlier this year.
We are looking at the possible scope of this course and thinking about the big questions: what should be in it, what could we leave out, and what format should the course take?
Thanks to the 300+ past candidates and instructors who have already completed these surveys. Got some ideas you'd like to share?
If you're an APLS instructor, please fill in this survey.
And if you're a candidate past or present, or just interested in our work, please use this version of the survey.
There are new instructor resources being added and developed regarding scenarios, debriefing/learning conversations and the safe airway emergency management workshop.
- 'Scenarios and Debriefing, A Shared Learning Experience' is a conversation between Jane Stanford (APLS Educator) and Ben Symon (GIC, ESDC Instructor) covering philosophies and approaches to optimising scenario learning. Soon to be added to GIC resources.
- 'Running a Scenario, Tips and Tricks' through a demonstration outlines a practical structured approach to running scenarios.
- 'Scenarios and the Learning Conversation, a Structured Approach' demonstrates a practical, structured approach to debriefing for optimal learning. These resources should all be available by December.
- 'Safe emergency airway management: Tips and tricks for running this workshop' demonstrates and gives advice on running this workshop in its new team-based format. Available now in workshops, APLS course material and instructor resources.
Thanks to all the APLS crew in Brisbane: Julia Slykerman, Katie Rasmussen, Louise Dodson, Jason Acworth, Kate Trenoweth, Marissa Alexander, Ben Symon and Dylan Siu who helped make this happen.
We've also been looking at ways we can better support PLS providers who support APLS instructors on the PLS courses. Development of online resources for PLS providers is in full swing, with the first tranche of filming completed and content writing in progress. You'll hear more about this in the new year.
For those instructors coming along to the PAC 2019 instructor day, we're very lucky to have Ben Symon presenting on Simulation Self Sabotage, and Chris Webber and Jane Stanford will run an interactive session on calibrating assessments. We look forward to seeing you there.
Keen-eyed instructors will have noticed a new field for 'Teaching interests' on your APLS website profile.
So what are 'Teaching interests' and why should I fill it in?
We want to help you teach the sessions you're most passionate about on an APLS course. Putting together a course program is one of the hardest parts of a course director's job, and it's even harder when you don't know anything about your fellow faculty members.
We added the 'Instructor bio' field to profiles to learn more about you. Directors get this info before putting together teaching allocations - so if you haven't yet filled it in, please do!
For 'Teaching interests' we'd like to know more about your specialities and fields of clinical interest.
Are you fanatical about fluids but don't like going near airways? Want to try the new safe airway emergency management workshop? Do you give a great transport lecture? Let us know via this field.
The best thing about 'Teaching interests' is that it's not fixed: you can go in at any time and update with your likes and dislikes, and if you're happy for the director to slot you in anywhere, that's great – but please let us know that too.
To find 'Teaching interests', log into the APLS site, click 'My APLS', and you can edit your profile from there.
Fancy yourself as a medical Messi? Ever dreamed of scoring the winning goal in a World Cup Final for your country?
The Australian Medical Football Team – the Docceroos – are holding trials for players to join their squad for the 2020 World Medical Football Championships.
All doctors are welcome from 2020 interns and beyond. 24 lucky players will be selected for the Doctor's World Cup, to be held in the home of the Hand of God himself, Argentina, in September next year.
Trials take place on Nov 2nd in Sydney. APLS is already well represented in the Docceroo dressing room by Paul Bloomfield, softly-spoken course director turned uncompromising hardman centre back. Drop Paul a line on firstname.lastname@example.org if you have any questions.