Issues on the horizon.

The endless winter, and the winter squared crisis. 24 hours in A&E now a reality.

How we approach PAs - EM won't be dictated by others approaches. A contentious issue that requires objectivity but also to listen. @Emta Emergency Medicine is challenged across the globe. When meeting at the most recent International EM conference, many presidents of EM shared similar themes.

Including professional respect and identity.

Orthopaedic Paeds Trauma Update

Operations carry risk - 7% re-operation and 17% total for K-wiring in distal radial fractures.

Growing evidence base for less intervention and more conservative management with good outcomes. Also saves a lot of theatre time too. Look at this 👇 Parents would typically opt for conservative management if outcomes are thought to be good too.

The Montgomery Ruling - Doctors have a duty to explain the material risks of treatment and explain alternatives.

Significant "Action bias" involved. How do we better balance that?

Concussion Update - #RCEMasc

Neuropathologists struggle to differentiate between brains that have had multiple small traumas vs. singular moderate severe trauma (brains donated for study).

Mild head trauma in sport can accumulate causing Chronic Traumatic Encephalopathy (CTE) Neurodegenerative disease was less likely in Goal keepers than Defenders. Repetitive headers aren't doing no favours. Concussions certainly not.

A controversial subject due to the implications for sports themselves and grass roots.

How do you assess a concussion?

Paediatric Head Injury (NICE Update)

A significant injury + vomiting indicates a 2.5-4% chance of Traumatic Brain Injury.

The trajectory of the patient and therefore observation are important. 4 hours from injury is usually sufficient for a TBI to declare itself. #ascAPEM There is very little data on children on anticoagulants or antiplatelets. There is not enough children with bleeding disorders or medications to currently make evidence-based recommendations for them.

It has been assigned a medium-risk factor in lieu of more specific evidence.

A 🧵,Training competition ratios represent another deteriorating metric adding to the bin fire that is early career doctors and medical student career prospects.

Competition for training numbers is increasing. At least by applicant volume, which has increased by 68% since 2014. Available posts have only increased by 14% over the same period.

This represents a competition ratio increase from 2 to 3 applications per post for entry-level specialist training. It get’s even worse at registrar bottlenecks.

Emergency Medicine is getting more competitive. 1340 applied in 2021, to the same number of posts. Despite the increasing tendency for LTFT, high rates of attrition and staggering ED demand, recruitment numbers are quite restricted. Rota gaps are endemic and locum spend is high. (big) Assumption that most CCTers work 30 FTE years would approximate to RCEM's 1 consultant for every 4,000 attendances with some wiggle room for Maternity, Sebbaticals, LTFT and Leavers. Add in DRE-EM and CERS consultants that the workforce may be ok by that metric.