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Going international – reflections from The Big Sick 2019

21 Feb 2019

The focus of the development of the trauma app is firmly on Scotland but understanding how trauma systems work globally will be critical to success. Reading journals, scouring policy documents and opinion pieces will only you get so far. The app must reflect the nuances of care across different centres but also enable cutting edge care.

I attended The Big Sick, a small conference with an informal vibe but with extraordinarily high quality speakers focusing on trauma, resuscitation and prehospital care. Highlights included Dr Richard Lyon reviewing the papers of the year that influenced his practice.

Dr Richard Lyon

Dr Zach Shinar talked about implementation of new technology and the role of being a Maven within the context of extracorporeal membrane oxygenation (ECMO) but there are huge corollaries with adoption of clinical decision support. Sophie Hamada talking about trauma leadership. She has set up Trauma Base which is similar to the Scottish Trauma Network in that they are focused on improving outcomes for major trauma. Hopefully we will be able to collaborate in the future with high quality data linkage.

The Big Sick 2019

A huge amount of learning was offline chats with a group of exceptional clinicians who are motivated to improve their own trauma systems but who were willing to explain their own challenges and needs. Many of these are shared especially with the Nordic countries where geography adds an extra level of complexity to provision of care. Interestingly in a number of countries Emergency Medicine is a new specialty with an evolving role in delivering and leading trauma care. Who leads the trauma team and team composition is key consideration for the apps development. A number of requirements to support trauma system evolution emerged:

The standard of care delivery, protocols and decision making for critical interventions is universal but with subtle changes depending on resources in different centres. A central theme of discussion during the conference was the provision of whole blood rather than packed red cells with the addition of platelets and fresh frozen plasma (FFP) which is the current standard in Scotland for major haemorrhage. This will be an aspect that the trauma app will have to incorporate to enable its use in some systems, and Scotland may change… Watch this space!

Some strong connections were made with clinicians in France, Sweden, Finland and the US that will enable us to get early user feedback. Crucially the data structures used in Sweden and Finland are built to the same standards as Scotland’s National Digital Platform. This will be a huge enabler to support international adoption.

Attending The Big Sick has not only enhanced the trauma app team’s thinking but personally my approach to trauma care delivery and leadership. I’m looking forward The Big Sick 2020 and getting feedback on the trauma app as a finished product.

Dr David Lowe