nexus news | August 2017

 

nexus
NEWS, VIEWS AND INFORMATION
FOR APLS MEMBERS
AUGUST 2017

QUICKLINKS: 
President's report
6th edition
 important teaching updates
e-learning comes to PLS
PAC 2017 speakers announced
Educational Skills Development course
PEDs Scholarship for international clinicians
APLS in Cambodia

Spare equipment callout
Vale Cath Sumsky
From the CEO
 

President's report

Welcome fellow APLSers to the first edition of APLS Nexus for 2017!

You may have noticed a new face at the top of this column and a new signature on the APLS certificates: Stuart Lewena stepped down from his role as APLS President in February this year and I have been elected to take over the role.

I have been involved in APLS in various forms since its beginnings in Australia, so I’m sure that I’ve met quite a few of you, but I thought I should let members know a little bit about myself.

I am a Paediatric Emergency Physician (having completed my PEM Fellowship in Australia and Canada) and am currently the Director of Paediatric Emergency Medicine at the new Lady Cilento Children’s Hospital in Queensland. I was a candidate on the first APLS course run with a fully Australian Faculty in 1997, became an APLS Instructor in 1999, and Course Director in 2003. I first joined the APLS Board in 2006 and was Chair of the newly formed PLS Committee. I stepped down in 2009 to take on a role planning for our new children’s hospital (hence my grey hairs) but was re-appointed to the Board in 2016. I have a keen interest in paediatric resuscitation and simulation education and am a member of the Australian Resuscitation Council and St John Ambulance State Council (Queensland).

I also have to admit that APLS has always held a place close to my heart: I enjoy teaching on both the Provider and Instructor courses and greatly value the intellectual and social benefits of mixing it up with such a great group of like-minded and generous volunteers. So when I was approached to take on the President role after Stuart, I felt both humbled and very excited about the future.

I cannot let this opportunity go by without saying something about the outgoing APLS President, Stuart Lewena, and on behalf of the Board and all of the members of the broader APLS family, I would like to thank Stuart for his stellar efforts as President over the last four years.

Stuart has been instrumental in helping to steer the APLS ship during a period of growth and significant change. He has led, fought for, overseen and eventually achieved:

  • the move to our new APLS format (with pre-course online learning) in 2015;
  • introduction of the ALSi simulated monitors to improve scenario fidelity & learning;
  • launch of the APLS smartphone app;
  • redevelopment of the APLS website with Instructor Resources;
  • the development of a much stronger relationship (and better alignment) between APLS, the Australian & New Zealand Resuscitation Councils and ANZCOR; and
  • publication of our new and much improved 6th edition APLS manual (see later in this newsletter)

In all of these endeavours, Stuart has consistently displayed strong & principled leadership, great communication skills, a wicked sense of humour and, on occasions, some pretty impressive singing talent!

And aside from all of that, he is a ‘good bloke’, a good role model and a good friend.

At our upcoming Paediatric Acute Care (PAC) Conference 'PAC to the Future', October 26-28 at the Gold Coast, we will celebrate the 20th anniversary of APLS in Australia & New Zealand. As well as celebrating our past, I plan to update attendees on our exciting plans for APLS in the future. We’ll summarise these in the next edition of Nexus News.

I hope to see many of you at PAC in October. We might have to see if we can get Stuart to sing one more time!

Jason Acworth
APLS President

 

Summarising the 6th edition updates 

Download this summary:
6th edition teaching updates (Word) (PDF) 

All APLS and PLS courses from July 2017 will be using the brand new Australia and New Zealand 6th edition manual.

The manual is based on the recommendations of the International Liaison Committee on Resuscitation 2015, the Australian Resuscitation Council (ARC) and the New Zealand Resuscitation Council (NZRC).

This short overview from the APLS Course Development Committee will guide you through the areas that have been updated in the manual and other teaching materials. It should be noted that it is primarily an international manual so there may be some minor discrepancies between it and local practice. Chapters 18 and 20 were altered to comply with Australian / NZ practice and other key amendments are listed below. 

Instructors will continue to receive a new edition manual three weeks before teaching on a course. Each hard copy manual comes with a code to download an e-book edition. 

PART 1: INTRODUCTION

Structured approach to paediatric emergencies (Chapter 2)
This is a new chapter that includes preparation, communication, teamwork, triage (moved from Appendix G) and pain management (moved from appendix F).

Human factors (Chapter 3)
Moved from appendices (Chapter 25) in 5th edition and expanded. 

PART 2: THE SERIOUSLY ILL CHILD

The child in shock (Chapter 6)
The algorithm for treatment of anaphylaxis has been amended and includes the option of giving either 10mcg/kg of adrenaline or 150mcg if <6 years of age, 300mcg if 6-12 yrs, and 500mcg if >12 yrs IM.

The convulsing child (Chapter 9)
The Status Epilepticus (SE) algorithm has changed a little and no longer mentions IN midazolam. Intranasal Midazolam is mentioned in the text discussing the medications used for SE.

PART 3: THE SERIOUSLY INJURED CHILD 

Introduction to the seriously injured child (Chapter 10)
Update on epidemiology with sections on trauma systems and injury prevention (moved from appendix D).

Structured approach to the seriously injured child (Chapter 11)
Many changes from the previous edition  important to read. 

  1. Fluid management of shock in trauma more cautious with initial boluses of 10ml/kg of blood (if available) or warmed saline.
  2. Early use of Tranexamic acid 15 mg/kg if haemorrhagic shock present.
  3. Use of massive transfusion protocol if repeated blood/fluid boluses are required, with use of other blood products to optimise clotting and attention to calcium and avoidance of hypothermia.
  4. “Trauma Series of X-rays” no longer routinely advised for all traumas. 

The child with traumatic brain injury (Chapter 14)
The Table with Indications for performing an emergency head CT scan within 1 hour (p143) has been updated.

The child with injuries to the extremities or spine (Chapter 15)
Changes to the section on spinal injuries (15.7)  recommended reading. Also read Chapter 24- Trauma imaging.

The burned or scalded child (Chapter 16)
Fluid therapy is now:

Percentage burn x Weight (kg ) x3 = Total fluid replacement for burn in 24 hours.

New section on toxic shock syndrome (16.6).

PART 4: LIFE SUPPORT

Basic life support (Chapter 18)
Universal BLS algorithm included.

Rate of chest compressions now 100-120.

If patient is intubated ventilation rate of 10-12 is recommended.

Support of the airway and ventilation (Chapters 19, 21)
Significant changes made with emphasis on ventilation without intubation and more details about RSI. Recommended reading.

NB: Insert oropharyngeal airway either upside down (“usual way”) or right way up.

Cardiac arrest (Chapter 20)
No mention of precordial thump. 

PART 5: PRACTICAL APPLICATION OF APLS

Practical procedures: airway and breathing (Chapter 21)
New paragraph on Emergency Tracheostomy. 

Note that the procedure for surgical cricothyroidotomy is different in the manual to the method that is to be taught in the F2F course.

Practical procedures: circulation (Chapter 22)
Use of ultrasound recommended for attempting central venous access. 

Practical procedures: trauma (Chapter 23)
23.3 New paragraph on clamshell thoracotomy. 

23.6 Cervical spine immobilisation  recommended reading as many changes have been made.

Section on helmet removal omitted.

Imaging in trauma (Chapter 24) replaces “Interpreting trauma X-rays” –recommended reading.

Principals of safe transfer and retrieval (Chapter 25)
New paragraph on the differences between static and transport medicine.

PART 6: APPENDICES

Acid-base balance (Appendix A)
This chapter has been extensively rewritten and includes discussion of hyperchloremic acidosis. 

Fluid and electrolytes (Appendix B)
0.9% Saline replaces 0.45% saline as recommended fluid.

Section on DKA  insulin to be commenced 1-2 hours after commencement of IV fluid therapy.

Poisoning and envenomation (Appendix E)
Includes more information about Organophosphate poisoning and button battery ingestion. 

Resuscitation of the baby at birth (Appendix F)
Some sections have been expanded but there is less information about methods of providing ventilation. Use of T-piece device removed.

ON THE COURSE: 

Materials and course content
All lectures, skill stations, workshops, scenarios and testing materials are in the process of being updated to ensure consistency with the APLS ANZ 6th edition manual. Please use updated teaching material for the face-to-face course.

Scenarios
Changes made to fluid resuscitation and use of Tranexamic acid in trauma scenarios. Minor adjustments made to other scenarios with emphasis shifting away from intubation towards establishing effective ventilation and oxygenation and considering a definitive airway when indicated.

Calculation sheets modified to reflect the different fluid resuscitation in the trauma scenarios and include glucose.

 

e-learning comes to PLS courses

2017 has been an exciting year for the one day Paediatric Life Support Course committee with the introduction of e-learning, a new course program finalised and two pilot courses completed.

We also ran a well-attended PLS coordinator and director day in June where the new program and course materials were introduced. We received positive feedback from the group and have incorporated many of the changes suggested.

The new PLS program includes: 

  • A pre-course online learning component modified from the three day course e-learning, with new modules on teamwork and intra-osseous access.
  • Replacement of the lectures with plenary sessions covering recognition of the seriously ill and injured child and basic/advanced life support.
  • Introduction of group scenario teaching.
  • Following the successful implementation of ALSi into the 3 day course, ALSi will also be introduced to PLS as more units are purchased and become available.

The new course materials have been finalised and will be available for PLS courses from now on. We would welcome any questions or feedback on the new course. The PLS committee will also be considering training issues and credentialing for PLS instructors. 

 

I would like to thank the APLS board for the ongoing support of this important sub-committee and the committee members listed below for their hard work implementing these significant updates:
 

Justine Dawson

Margie Lane

John Craven

Stephen Teo

Jenny Martens

Amanda Stock

Sally Guthrie

David Watton

Jane Stanford
Phil Davies

 

To find out more about PLS online learning and the new course program, please contact the APLS head office. 

 

Malcolm Higgins

Chair, PLS Committee

 

PAC 2017 speaker program launched

Just 10 weeks left until our showpiece event of the year, the PAC Conference in Surfers Paradise. 

Celebrating the 20th anniversary of APLS in Australia with a scientific program built around the theme of 'PAC to the Future', we're proud to announce a speaker line-up of APLS friends old and new. 

Delegate passes start at $190 for nurses and $420 for APLS instructors. You can book your place via apls.org.au/pac-2017-conference 

 

Develop your teaching skills with our ESD course 

Been a while since your GIC? Keen to improve your teaching skills?

A unique two day program exclusive to APLS instructors, Educational Skills Development with Kate Denning (ALSG UK Educator), is coming to Australia this October. 

Why is APLS running a two day course for instructors?

Healthcare professionals who teach are rarely given feedback. It is often assumed that with medical knowledge comes an implicit ability to teach others. However, many nurses and clinicians report a thirst for developmental opportunities for their educational skills.

This October, APLS has a rare opportunity to provide Australian APLS instructors with access to a visiting educational expert, ALSG UK Educator Kate Denning. The ALSG course features a unique model of peer-peer learning where clinicians learn from each other. By acknowledging clinicians' prior knowledge and expertise, further development is empowered through teaching of new educational theories that are relevant to realistic clinical practice.

With these principles in mind the ESD course has been designed to support current instructors to further develop their facilitation skills for discussion groups, skills teaching and scenario teaching.

Do you wonder if you could facilitate sessions so they are more interactive? What measures do you look for to assess if you’ve facilitated a session well?

If these are questions you ask yourself or if you'd like to workshop new teaching methods with support from leading educators, the ESD course will offer an APLS-specific masterclass in medical teaching skills. 

With a faculty and candidate group of experienced APLS instructors, the course provides the opportunity to learn from others, practise delivering sessions, reflect on individual practice and receive personalised feedback.

What is unique about this program?

  • Learn new educational theories from passionate educators.
  • A safe environment to run discussion groups, skill stations and scenarios with time for reflection and focused feedback sessions.
  • A small group model for teaching to allow personalised feedback within an efficient time frame. 

The Educational Skills Development course takes place 16th-17th October 2017 at APLS Head Office, Melbourne. Fees are $1300 for APLS instructors and $700 for nurse / paramedic instructors.

Book your place via apls.org.au/esd-course/educational-skills-development

 

Applicants wanted for the 2017 PED Scholarship

Applications are now open for this year's Paediatric Emergency Development (PED) Scholarship, offering mentorships and APLS / GIC courses to practitioners from developing countries. 

The aim of this scholarship is to support the development of paediatric emergency systems in countries where these are currently in their infancy and where funds for such activities or for overseas education are limited.

The scholarship involves a two week hospital attachment in a nominated specialty area (generally a Paediatric Emergency Department), followed by attendance at an APLS Provider +/- Instructor course. The recipient will be teamed with a local mentor for support and guidance. Applicants from the Asia-Pacific region are invited to apply. 

Applications close October 1st, 2017 and please forward to anyone you think may be interested in this opportunity. You can download an application form here. 

 

Growing Cambodia's APLS curriculum

As APLS in Cambodia now enters its second decade, its leaders and senior instructors are evolving the curriculum to match the country's blossoming paediatric acute health care system. 

The first APLS Provider course in Cambodia was held at the Angkor Hospital for Children (AHC) in Siem Reap with a full Australian faculty. With the support of many Australian APLS instructors donating time and teaching resources between 2005-2015, the AHC holds three day APLS Provider – and more recently one day PLS – courses throughout the year to ensure the highest standard of acute paediatric resuscitation is provided across the country.

With now over 500 trained APLS providers and over 50 Khmer APLS instructors, Cambodia has developed the faculty base to ensure training continues well into the future. And as a consequence, the lives of many children saved from acute reversible causes.

In 2005 when APLS training began, Cambodia had 65.4/1,000 livebirths die under the age of five years. In 2015, that figure was reported to be 28.7. Although many factors including ongoing economic development have contributed, one would ponder whether the APLS movement in Cambodia played at least a small role in this improvement.

During the inception of APLS in 2005 the defibrillation module of the APLS curriculum was purposely omitted  as at the time, the level of acute health care in the country was not compatible with it. However, as cardiac surgery has become a regular service performed at the AHC and the growth of a fully equipped post-operative cardiothoracic services in its PICU, the need for the introduction of defibrillation into the Cambodia curriculum finally came to pass.

The defibrillation component was introduced into the Cambodia curriculum first by re-training the senior Khmer instructors, many of whom achieved their initial APLS accreditation in Australia. Secondly, I ran an intensive one-day workshop for predominantly its senior faculty to be trained in the elements of the skill, and how to teach defibrillation utilising the four stage technique. Thirdly, I supervised the senior Khmer instructors teach the remainder of the Khmer instructors. Lastly, the most recent APLS Provider courses have included defibrillation to bring it on par with other APLS courses run internationally. 

Dr Setthy Ung
APLS International

 

Got any spare equipment? 

Did you know that APLS welcomes donations of expired medical equipment to be used in our teaching kits?

Ray and Frank, who manage our equipment requirements have gratefully accepted donations in the past and suggested we do a callout to all instructors to let them know.

On their wish list are expired chest drains, cuffed ETT's, bags of IV fluids, gauze, dressing or anything else you know that we use in our training. 

Donations can be brought along to your next APLS course and given to your coordinator who will send them back to head office. 

 

Vale Cath Sumsky

All of us at APLS would like to extend our sincerest condolences to the family and friends of Cath Sumsky, who very sadly passed away in June. 

Many of you will know Cath for her warmth, dedication and significant contributions to APLS both as an instructor and committee member for many years. In Cath's honour, APLS has made a donation to the Kids with Cancer Foundation Australia

 

2017 marks the 20 year anniversary of APLS running courses in acute paediatric care in Australia.

Not bad for a small company that had its genesis out of the bottom draw of a filing cabinet somewhere in RCH.

There have been many champions of APLS over the last 20 years but in my opinion every one of our volunteers past and present who have taught on a faculty and have represented the company with distinction are champions. Our volunteers are the lifeblood of our company. Without their passion, commitment, knowledge and exemplary teaching skills, APLS would not be in a position it is today nor would it be able to continue in the future to carry out its important work and mission. 

Also, I should give a shout out to the APLS staff, past and present who have worked very hard over the years and have also contributed to the evolution and development of APLS and to the success of the company in achieving its mission to date.

PAC 2017 at the Gold Coast on 26-28 October 2017 will be one tangible way of us all celebrating our achievements and sharing the memories of the last 20 years.

We are seeking to have as many as possible of our faculty past and present at PAC 2017. We have a fabulous scientific program for PAC 2017 but also plenty of time set aside for networking and enjoying each other company. 

Whilst celebrating at PAC 2017 we will also look forward to the future, to continue for the next 20 years to provide acute paediatric training courses around Australia and in the Asia-Pacific Region.

To that end, the APLS Board is looking forward in its vision and strategies, and have over the last 3-4 months conducted due diligence on various premises in the city and suburbs considering various alternatives to having its headquarters at Level 5 505 Little Collins Street. The original lease at Level 5 505 Little Collins Street is up in a few months’ time.  

In short, the conclusion of the due diligence process was that the deal at Level 5 505 Little Collins was better than the others proposed and we have now negotiated a new lease for another 6-year period with the present landlord on a more preferable basis than the existing one. Therefore, the lease of Level 5 505 Little Collins Street by APLS will continue until 2024.

See you all at PAC 2017 in October.

Phillip Davies
CEO
APLS Australia

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