Tag Archives: conferences

Tactical Update – A Report from TacT17

OK it’s a few weeks back, but here’s Greg Brown with the lowdown on a conference about tactical matters. 

Conferences: a formal meeting of people with a shared interest, typically one that takes place over several days; the means by which professionals from around the globe congregate with a view to learning from each other. Sometimes also referred to as junkets, jollies, paid holidays and tax write-offs.

But in all honesty, oftentimes the only way one can be afforded the chance to be surrounded by like-minded professionals with a view to learning from the experience of others, benchmarking your intellectual property against that of other organisations operating in the same “space” and refining your knowledge thanks to the latest in international research is to travel to the other side of the world and attend a conference. So, as one of the few non-government providers of tactical medicine training in Australia, that’s precisely what we did.

In mid-October 2017 two of CareFlight Education’s staff travelled to sunny (well, we assume there was sun above the pouring rain) Sundsvall, Sweden, to attend the inaugural Tactical Trauma conference.  If you are on Twitter, you can search for it using #TacT17. If you are not on Twitter, then join Twitter and search for it using #TacT17….

This post provides a summary of what we found, what we liked, what we didn’t like and some takeaway points.

The words are cool probably, but maybe put a shirt on when you hold Death back buddy.

The Peeps

This was truly an international event. Presenters came from across Europe (with a strong Scandinavian presence, as expected), North America, the Middle East and even Australia. Participants included both hospital and pre-hospital doctors, nurses, paramedics, police medics, retrieval (road and air) clinicians and military folk.

The Stuff to Chew On

As the name “Tactical Trauma” suggests, the conference was focussed on the medical management of trauma with a tactical twist. It should be noted that discussions regarding any tactical imperatives were limited by the realities of operational security. For obvious reasons, nobody wished to describe their unit’s tactics in great detail.  They were enough to paint the scene though.

Therefore, if you were looking to learn how to become the next big thing in SWAT team medicine then this conference probably wasn’t for you – and there certainly were no skill sessions on how to kick in doors, breach a terrorist stronghold or fast rope from a helicopter (although these might be popular sessions next time).

Rather, focus was placed on the provision of “good medicine in bad places”. There were sessions by military doctors discussing what worked (and what didn’t) on recent deployments (including topics such as blast injuries, penetrating chest injuries and rates of injuries in dynamic events), the usefulness (or otherwise) of helicopter emergency medical services in hostile mass casualty events, comparisons of contemporary haemostatic agents versus conventional bandages in wound packing, the perils of acute traumatic coagulopathy, discussions on vascular access options, and the progress over the years in the application of clinical management strategies. It is also worth noting that since this is in fact 2017 no medical conference would be complete without at least one presentation on POCUS (that’s Point Of Care UltraSound – and yes, it is very useful) and one on REBOA (or Resuscitative Endovascular Balloon Occlusion of the Aorta – and no, there is not enough evidence to definitively support it); these were dutifully attended to.

Case studies are always useful; in this instance we were treated to reviews by the Finnish and Norwegians of their tactical emergency medical support systems, the Israelis and their medical response to contemporary domestic contingencies and both the French and Swedish on their responses to recent mass casualty events. There were also a few “closed door” sessions for police medics regarding recent mass casualty events in the USA.

But finally, as most of us already appreciate, being outstanding at your trade is only part of the job; the ability to communicate effectively with your team members whilst managing your own stress levels are also vital in providing optimal patient care. As such, sessions on crew resource management skills, the cognitive revolution, tips for centring one’s self prior to and during a job, and how to get the rollout of good ideas actually rolling were welcome additions to the program.

Things We Liked

  • Firstly, whilst it is obvious that military experiences inform civilian practices, we appreciated the fact that this conference was focussed on civilian (not military) practice. Other conferences of the type claim to do this yet the majority of the auditorium is filled with uniforms of various militaries.
  • Secondly, sessions were kept at a length that were short enough to retain audience attention but long enough to cover the required level of detail for the given topic. If a topic was not floating your boat, a new topic would commence in 20 minutes.
  • Thirdly, at no point did we hear “you must do it this way – if not, you are wrong”. The overall feel of the conference was that no single entity had all the answers but that through collaboration we can all improve. Participants were encouraged to seek out presenters (who were all easy to find) and undertake collaboration.
  • Finally, the focus was on “good medicine in bad places” and not cool Velcro patches, the latest fashion in tactical gear (which would obviously only come in black and be stamped with a label consisting only of numbers) and the liberal application of mutual back-slapping.

Things That Were Not the Business For Us

  • Despite the fact that the conference was aimed at civilian practice, the majority of presenters referred to TCCC (Tactical Combat Casualty Care) and not TECC (Tactical Emergency Casualty Care). It is possible that the presenters were using the term TCCC out of habit, but when one considers that the latest review of TCCC by the Committee has lead to their terms coming closer into line with that of TECC (and not vice versa), it is time that the world started embracing the correct terminology.
  • Having a single track makes it hard to keep everybody interested, and at times we felt sorry for certain members in the room. These folks included frontline police officers who have a secondary role of medical response – whilst the clinicians were riveted by the maps of clotting cascades and stories of roadside REBOA, the Police Medics just wanted to know (a) how best to plug the hole, and (b) how fast to drive.

[Note: we got the impression that the conference convenors were victims of their own success – we are not sure they realised just how popular it might be when they originally floated the idea on social media. We are confident that this issue will be alleviated next time.]

The Takeaways

If you had to sum up the content of a jam-packed two-day conference in just a handful of points then these would be them [note: these are more paraphrases than quotes]:

  • “Learn from the experiences of others. Recognise that no single agency has all the answers, so work with and not against each other.” Matt Libby, flight paramedic with Boston Med Flight, USA
  • “In resuscitation, the most effective therapies are those that can be applied quickly. Time is blood.” Dr Richard Dutton, trauma anaesthetist, USA
  • “You can possess all the best haemorrhage control devices in the world, but if you are not using them properly then they are worthless. Training is key.” Dr Mark Forrest, medical director of ATACC, UK
  • “Battlefield medicine is like plumbing: if it’s blocked, clear it; if it’s leaking, plug it.” Gary Grossman, CSAR paramedic, Israel
  • “In a high risk or major incident, it makes sense to have all rescue agencies working together under a common SOP that has been tested prior.” Dr Stephen Sollid, medical director and retrievalist, Norway
  • “REBOA has a place in pre-hospital care; we are just not quite sure what that place is. Blood will still be lost from backflow.” Dr Tal Hörer, vascular surgeon, Sweden
  • “Medics in the hot zone should focus on not getting themselves killed and not endangering the mission. Cross training is vital.” Dr (LTCOL) Ishay Ostfeld, IDF and cardiothoracic surgeon, Israel
  • “In a critical patient, performance of life saving interventions should take precedence over applying rigid protocols around immobilisation.” Dr Thomas Dolven, intensivist and retrievalist, Norway
  • “People only improve if they actually want to. You cannot force improvement.” Michael Lauria, former USAF PJ and current medical student, USA
  • “When it comes to vascular access, there should not be different hospital standards and prehospital standards. There should just be standards.” Dr Knut Taxbro, anaesthetist and retrievalist, Sweden.

The Recommendation

So I guess the big question that remains for everyone is “was 50+ hours of travel from Australia to central Sweden for a 17 hour conference really worth it?” Given that we were able to assess the content of our training against that which other like-minded organisations from around the world provide in an open and non-threatening forum, tweak our content in line with the latest evidence, build contacts with groups and individuals that have the same struggles as we do in Australia, and provide some guidance to participants who were looking to develop their own tactical medicine training – the answer is obvious.

Look it’s hard to respect an animal mascot that doesn’t spend most of its time sleeping like a koala but good effort I guess.

Wait, I almost forgot the really vital lessons

These things:

  • The Swedish love speed cameras. I mean, seriously, they are everywhere!
  • Reindeer is actually quite tasty.
  • Moose is a bit, well, meh….
  • When it comes to rivalries, Norway is to Sweden what New Zealand is to Australia.
  • The Australian TV shows “Prisoner” and “Flying Doctors” are compulsory viewing for Swedes.
  • And 50+ hours of travel by air is in fact a very long way – but it beats driving.



Hey, are you interested in this stuff?

Well you could choose to read our previous posts about TECC here, here, or here. If you do you’ll find heaps of references and further reading on all things tactical.

CareFlight does have courses on that sort of stuff (it’s one of the bits you can find here) so you might find a bit of interest in that or, [looks shy, kicks dirt] y’know, do whatever. If you were interested (but no pressure) it runs pretty regularly (like in 2018 it’s happening on 12 February, 26 May, 20 August and 24 November).

Meanwhile if you like the stuff on the site you could always share it around. Or even sign up to get the emails whenever things hit.



Reports from the Top End – ASA Highlights Reel

Continuing the posts arising from the ASA conference (not the anaesthetics one, the Aeromed one), we share thoughts from just a few attendees with th esessions that proved to be a highlight. 

The Northern Territory is known for many things. Even some things that aren’t related to crocodiles. Just recently it also hosted the annual conference for the Aeromedical Society of Australia. It’s a good choice as host location because retrieval around the Top End tests clever professionals in very particular ways.

There’s also a good proportion of the year where the northern climes of Australia are weighed down with the collected sweat of tropical sauna season. So any visit outside those times is well worth it.

As CareFlight provides retrieval services around Darwin, there were plenty of the crew who got along. We asked three to nominate a couple of the bits that most tickled their interest.


Dr Toby Fogg, CareFlight Medical Director

Amongst lots of great talks, the talks from Dr Russell McDonald, who hails from Canada and works with ORNGE, were particularly fascinating.

One of these, with the title “The Glue That Binds – Patient Transport in Regionalised, Rural and Remote Healthcare” looked at the pros and cons of regional services vs centralized services with more retrieval. There was a lot that felt familiar about the description of a big country with vast spaces between people.

Russell made the point that regionalisation reduces duplication of expensive infrastructure and increases case load in those centres, thus improving outcomes. Having big centres means patients who are very ill will need to be transferred. He quoted a figure for errors on these transfers – 1 in 6. (Those are Russian roulette numbers.)

1 in 6 is a very high number (though he didn’t define exactly what the errors were, which would have been a bit of extra detail I would have liked). These errors are more common and potentially more likely to result in big problems where the transport involves inotropes, intubated patients, haemodynamic instability or longer transport times. I guess that only covers pretty much every retrieval in the remote top end.

The potential downside of regionalization is seen in the smaller communities. Building up big centres can easily lead to loss of local services. This makes a safe and timely transport service critical. For such a service to work, it really needs to be fully integrated into the system.


One of the other highlights was a talk from Dr Andrew Pearce. Andrew is the Clinical Director of Education and Training at MEDSTAR (operating in South Australia). His topic du jour was “Advances in Prehospital and Retrieval Medicine” and he took it as a chance to sample broadly from the smorgasbord that offered.

He opened up with a bit of chat about the role of social media in education. In particular he spoke a little on the need to apply a bit of critical reasoning in the social media space like any other area we learn medicine. There’s some good information out there but it’s not universally excellent (disclaimer: except for everything on this site – everything here is top notch). A key question he left behind: are our trainees accessing the right information and following up by going back to the source?

Andrew also touched on prehospital REBOA in the MEDSTAR context. As many reading this (yes, via social media) would know this is already in use by London HEMS. For remote spots in Australia though it’s less clear if there is much of a role. In pig models the ischaemic time in pig models is a maximum of 50—60 minutes. In humans it seems to be 20-30 minutes. For many operating in the Australian space, there is no prospect of completing the journey to hospital within this time frame. All of that before you even get to the issues of adequate case load and how to train.



Jodie Martin, Clinical Educator, CareFlight NT Operations

If there was one thing I took away from this conference it was the continuing focus on human factors and CRM. Everyone seems to have taken the message that we can’t forget the human bit in medicine and make it integral to what they do.

When it came to the talks my highlight was Dr Andrew Pearce talking about advances in prehospital medicine. He talked about fancy stuff but emphasised that if you don’t do the basics well and compliment that with great team work all the shiny stuff is worthless. The basics. Do them and do them well. (I am a big fan of basics.)

I also found the talk from Andrew Duma, Senior Base Pilot with Air Ambulance NSW thought provoking. He broached a topic about clinical currencies of medical crews. That was fairly game of a pilot I thought. He pointed out that aviators have a range of currencies to update and proficiency tests to reaffirm that those core elements of the job are up to scratch. Should there be an agreed approach to make this stuff universal for clinical staff across all jurisdictions as well? (More educators to deliver on that would also come in handy of course.)

It just seemed like there had to be a crocodile in here somewhere.
It just seemed like there had to be a crocodile in here somewhere.


Jodie Mills, Senior Flight Nurse/Midwife (Research and Quality), CareFlight NT Operations

I also really enjoyed the “doing the basics better” approach from Dr Andrew Pearce. It’s the cornerstone of good practice in my book.

The other standout presentation for me was from SAAS MedStar Kids on the topic of thermoregulation of outborn neonates. Obviously I’m partly interested because it can be directly related to our practice in Darwin.

The incidence of neonatal complications due to hypothermia is most likely underreported. Temperature is a good KPI for neonatal retrieval, as was covered by Naomi Spotswood.

SAAS MedStar Kids conducted an audit and were able to implement measures to decrease the incidence of outborn neonates arriving at their destination hypothermic. By instituting core temperature measurement (which they did via rectal temperature monitoring) and charging cots at 350C they were able to ensure 100% of outborn neonates were delivered to the receiving centres normothermic. 100% success is what we all want from our targets.



So there you go. Did you see a theme? No, not the Pearce-related theme, though that was sort of a theme too. When it comes to delivering the best health across the vast tracts of space we deal with in Australia, it is vital to do the basic stuff right, every time. The tech that does so much more than bing goes nowhere without good basics.

And of course the team. All delivered by a good team. Relevant to med. Probably relevant to dealing with crocodiles at a guess.



The image here was on the flickr Creative Commons area and is an amazing image (which is here in an unaltered format) by Alexander Cahlenstein.

Reports from the Top End – The TriClinicians Cup

Recently the Aeromedical Society of Australia had their annual conference up in Darwin. This is the first of a few posts arising from people who got there – Dr Sam Bendall with a report from sim land. 

I love the way simulation brings people together. All aeromedical services use simulation as a training tool and that familiarity allows fun to be had and challenges to be set in the form of the 3rd annual ASA & FNA Simulation Cup.

The Getting Ready

It’s quite tricky putting together scenarios that will work for different team configurations and will be fun but enough of a challenge. We also had to be super careful to keep everything under wraps to keep it fair, so only 4 of us from NSW knew anything about it. I have enormous respect for my predecessor in organizing the Simulation Cup – Ben Meadley from Ambulance Victoria. He was unfortunately unable to make it this year but he was always on hand to provide guidance and advice in putting together this challenge. Thanks a million Ben! Kate Smith, the conference organiser, and her team were incredibly flexible and happy to work around the simulation craziness…. you want to what…. where ….. and with THAT??? allllrrriiight 🙂

Our logistics team was once again truly awesome – they are completely unflappable. Despite doing 3 training events in 2 weeks in different states, they not only transported several tonnes of gear to and from Darwin, but also helped in the scenarios and sorted out transporting it all back! Legends (and a double 🙂 for that).

We do a great deal of simulation at CareFlight and we are lucky enough to have some pretty cool toys, dreamed up and provided by our amazing Logistic and Events team. The newest addition to the stable is the NT crash car simulator. We have had version 1 and 2 in NSW for some time, but this one is new to the NT team so it had to have an outing.

It's cool and all but the engine could use some work.
It’s cool and all but the engine could use some work.

The Teams

Three teams competed in the heats – Cheah and his team from Malaysia (who did their scenario in English AND their native tongue), MedSTAR and CareFlight NT. The CareFlight NT and MedSTAR teams went through to the finals that were held at the end of the conference on Friday. Spectators grabbed a cold beverage and most of the delegates came down to support the two teams – a fantastic audience turnout.

Four members of the Northern Territory Emergency Service came to help out and add fidelity to the final scenarios. Gary and his team were happy to help out and be the rescue service in both scenarios. Many of the NTES folks have done the CareFlight Trauma Care Workshops so it was great to have another opportunity to train together.

Game Time

The first scenario saw the CareFlight NT team managing two patients in a Motor Vehicle crash. Their CRM was awesome and they were so calm it was amazing. They even found Chelsea, the puppy!

The second scenario saw the MedSTAR team managing a patient who was impaled on a construction site and bleeding heavily, and another injured construction worker. They too had great communication skills and did a good job of managing their patients. At the end of the day, the scores were close but the MedSTAR team was the winner on the day – NICE WORK TEAM 🙂

It takes an enormous amount of courage to get up in front of your peers and compete in a simulation challenge. It tests your CRM skills, your ability to function under pressure and your ability to treat patients as a team. Thank you to all three teams to stepped up to the plate. You are all incredible and it was a privilege to see you all in action.

Till next time …… bring on Queenstown (which btw, is my FAVOURITE place on earth!)…

QT copy

It Takes a Team

This entry could not pass without a big thanks to the following people who helped us out enormously with the Simulation Cup:

  • Kate Smith and her team – for everything!
  • Ben Meadley – for all his support and advice
  • Melinda Riall from Limbs and Things – provided the Suture Tutor prize for the Simulation Cup Final
  • Anthony Lewis – for providing an iSimulate unit for use in the scenarios
  • Stacey Williams from Zoll – for providing a defibrillator for use in the scenarios
  • NTES – Mark Fishlock, Gary and their team
  • The judges (some of whom were co-opted at very short notice – thank you J:
    • Mary Morgan – Hunter & New England Retrieval Service
    • Anthony De Wit – Ambulance Victoria
    • Paul Gallagher – NET
    • Andrew Pearce – MedSTAR
    • Emmeline Finn – CareFlight QLD
    • Andrew Duma – RFDS Sydney
    • Lachlan Beattie – NSW Ambulance
    • Lindsay Court – NSW Ambulance
  • Martin Dal Santo – CareFlight Logistics Team – he made EVERYTHING work!
  • Don Kemble – Manager Facilities and Logistics CareFlight – Enormously helpful with planning and logistics.
  • Ken Harrison – outstanding confederate performances – thank you
  • Richard Potts – AV guru from Kate’s team
  • Kellie Robertson, Danny Hickey and the AV team from the Darwin Convention Centre
  • Sarah and Ursula – fabulous coordinators from the DCC
  • Justin Treble, Elwyn Poynter and the rest of our fabulous education team – for all your help at the last minute making technology work and packing up!