London Trauma Conference 2015

The 9 th London Trauma Conference (#LTC2015) and London Cardiac Arrest Symposium (#LCAS2015) built on the previous meetings with an emphasis on innovation, research, and enthusiasm for the medical care of major trauma, cardiac and critically ill patients. From the 8-11 th December 2015 delegates from over 20 countries attended The Royal Geographical Society for the four days of the conference. The opening two days of the conference focussed on current issues in major trauma, with air ambulance and pre-hospital critical care on day three, and the London cardiac arrest symposium returning as the fourth and final day. Concurrent breakaway sessions ran alongside the main conference including; trauma haemorrhage research, paediatric trauma, and masterclasses on cardiac ultrasound and resuscitation, thoracotomy, REBOA, and an introduction to ECLS and ECMO. The major trauma programme consisted of two days of lectures, keynote lectures and short 'quickfire' sessions. Professor Tim Coats opened the conference by talking about the role of the highly performing trauma unit in trauma networksoutlining the problems of maintaining high levels of care in systems which increasingly bypass to major trauma centres but bring severely injured irregularly to trauma units. Professor Kjetil Sreide then addressed the topic of iatrogenesis in trauma, giving examples from different points in the patient pathway. The prevention of iatrogenesis is based on acceptance of it's presence and then promoting prevention with a culture of safety, training and focus on the team approach. Dr Matt Thomas finished up by summarising the landscape of research in trauma over the previous year, as well as outlining what can be expected in the year ahead. The following sessions approached key issues in neurotrauma, opened by a seasoned London Trauma Conference speaker Mr Mark Wilson. He spoke on current early neurological imaging, with mobile CT scanning already a reality in mainland Europe and the trialling of near infrared spectroscopy (NIRS) as a potential pre-hospital imaging modality. Professor Geoffrey Raisman followed with a fascinating talk on spinal cord regeneration, outlining how nerve regeneration to replace damaged portions has already been trialled with some success. He related a moving case where olfactory nerve fibres were used to repair spinal cord injury with one of the ultimate medical triumphsmaking a paraplegic patient walk again. Professor Andrew Maas then lectured expertly on why he sees head injury as a silent epidemic with potentially life-changing consequences. Dr Markus Skrifvars closed the session with a sobering presentation on the link between alcohol consumption and the vast number of traumatic brain-injured patients that are intoxicated when they present. Lunch was followed by Professor Karim Brohi, who delivered a talk on the early immune response to trauma and novel potential approaches to ameliorate this genomic storm. Other speakers in the afternoon included Professor Marc Turner delivering his vision for the trauma transfusion pack of 2025, and discussed whether stem cells may in the future become our source of blood for emergency transfusion. Professor Susan Brundage challenged the trauma myths of today, dismissing the Golden Hour as ancient history, with the platinum five minutes more relevant to 21 st century trauma. She concluded that our cultural understanding of context is crucial in understanding why myths occur and therefore how they can be dispelled. Two overseas speakers addressed key issues in major incidents. Professor Jeff Upperman from Los Angeles spoke with passion, knowledge and experience on the challenging topic of paediatric penetrating trauma and the staggering gun violence statistics he faces in the US, with 355 mass shootings in less a year. The complexities of the gun lobby in the US are one of the many difficulties faced, and he emphasized the urgent need for action to reduce the current 3000 deaths in children from firearms injuries. Dr Ishay Ostfeld presented the Israeli approach to mass casualty events. 'Scoop and run' has replaced the concept of 'stay and play' , with triage occurring in hospital rather than in a pre-hospital setting. They aim to have all severely injured patients evacuated within 30 minutes and most receive operative intervention within 90 minutes. The day two morning session heard Dr Conor Deasy speak about trauma team performance, highlighting the advantages that can be gained from 'in situ' simulation and the use of video. Professors Wolfgang Voelckel and Simon Carley spoke about the fascinating complexities of decision-making and clinical judgement in the resus room. The latter encouraged delegates to analyse and utilise their feedback, reflect on case notes and be disciplined in learning about ones thinking processes. Mr Ross Fisher began a paediatric themed series of talks by arguing the case for specialised paediatric trauma units. This was supported by Dr Natalie May who reiterated the challenges faced when treating these patients. An informative summary of how to approach paediatric imaging was provided by Radiologist Dr Caren Landes, who referred to the revised NICE guidelines for the indications for CT head and c-spine imaging. A personal and reflective account by Kirsti Soanes addressed how best to manage the parents of a child during paediatric resuscitation. Dr Jeff Upperman provided a dynamic introduction to the afternoon session on major incidents. He spoke about preparedness, the importance of recovery and resilience, and argued that planning for children tends to be inadequate. The Peter Baskett memorial lecture was given by Professor Pierre Carli who gave an insightful and impressive account of France's response to the recent terrorist attacks in Paris. This was followed by an international panel discussion with representatives from the US, Norway, Israel and France. They highlighted the importance of lessons that can be learnt from the experiences of others, and discussed topics that included triage systems, the proximity of EM personnel to the 'hot zone' and how best to recognise when a system is overwhelmed. Professor Anders Oldner then spoke about the post resuscitation phase of care in trauma patients and the significant challenge posed by post injury sepsis. Mr Jan Jansen provided a surgeon's insight into penetrating and blunt cerebrovascular neck injuries. He advocated the strength of CT angiogram in detecting injuries and the use of selective non-operative management when indicated. The final session

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