ANZCA BulletiN Evolution of a great Perth meeting Plus: how the New PrimAry exAmiNAtioN will work still iNveNtiNg: Dr DuNCAN CAmPBell, ortoN meDAl reCiPieNt our overseAs AiD Committee’s work iN PAPuA New guiNeA June 2012 3574 advertisement TO FIND OUT MORE ABOUT ANZCA 2013 ASM, REGISTER YOUR INTEREST AT: WWW.ANZCA2013.COM E: [email protected] 1 20 Curriculum update The primary examination will take on a new format under the revised curriculum. 24 Still inventing Robert Orton medal recipient, Dr Duncan Campbell is still innovating. 12 Perth ASM a great success More than 1500 Fellows and trainees attended the Perth meeting. ANZCA Bulletin Medical editor: Dr Michelle Mulligan Editor: Clea Hincks Production editor: Liane Reynolds Sub editors: Kylie Miller and Meaghan Shaw Design: Christian Langstone Advertising manager: Mardi Mason The Australian and New Zealand College of Anaesthetists (ANZCA) is the professional medical body in Australia and New Zealand that conducts education, training and continuing professional development of anaesthetists and pain medicine specialists. ANZCA comprises about 5000 Fellows and 2000 trainees across Australia and New Zealand and serves the community by upholding the highest standards of patient safety. 2 ANZCA Bulletin June 2012 Submitting letters and other material We encourage the submission of letters, news and feature stories. Please contact ANZCA Bulletin Editor, Clea Hincks at [email protected] if you would like to contribute. Letters should be no more that 300 words and must contain your full name, address and a daytime telephone number. Advertising inquiries To advertise in the ANZCA Bulletin please contact Mardi Mason, ANZCA Marketing and Sponsorship Manager, on +61 3 9510 6299 or email [email protected] Contacts Head office 630 St Kilda Road, Melbourne Victoria 3004, Australia Telephone +61 3 9510 6299 Facsimile +61 3 9510 6786 [email protected] www.anzca.edu.au Faculty of Pain Medicine Telephone +61 3 8517 5337 [email protected] Copyright: Copyright © 2012 by the Australian and New Zealand College of Anaesthetists, all rights reserved. None of the contents of this publication may be reproduced, stored in a retrieval system or transmitted in any form, by any means without the prior written permission of the publisher. Please note that any views or opinions expressed in this publication are solely those of the author and do not necessarily represent those of ANZCA. 32 Titanic challenge 54 Museum treasures Victorian anaesthetist Dr Ashley Webb explains the effectiveness of a quit smoking program at Peninsula Health. The Geoffrey Kaye Museum of Anaesthetic History has three new items of historical significance. 28 Teaching in PNG The Overseas Aid Committee is doing a lot of work in Papua New Guinea. Contents 4 President’s message 37 NZ Anaesthesia ASM 62 5 Chief Executive Officer’s message 38 6 Acknowledging Professor Kate Leslie ANZCA and government: building relationships The Anaesthesia and Pain Medicine Foundation 64 New Zealand news People and events 8 Letters to the editor 40 Quality and safety 67 9 Awards 45 68 Australian news 11 News The dangers of self-inflating resuscitation bags 78 ANZCA Council meeting report 12 Perth ASM wrap up 46 80 Faculty of Pain Medicine 19 New Fellows’ Conference ANZCA Trials Group meets at the annual scientific meeting in Perth Successful candidates Library update ANZCA’s revised training program 50 86 20 89 Future meetings Australia and New Zealand 28 ANZCA contribution helps improve patient care in Papua New Guinea Anaesthetic history: Museum receives valuable historical gifts from South America Obituary A mad idea – or several – is just what the doctor ordered 54 88 24 55 ANZCA history and heritage update 91 32 Tobacco and surgery: Issues of Titanic importance 56 The early development of anaesthesia practice in Queensland 34 Lessons abound on a Dili adventure 60 ANZCA in the news life&leisure: “Savvy professionals can reap tax rewards”, “Crossing the South Island the hard way” and “Rug up and explore with a wintry European adventure” 3 President’s message Dr Lindy Roberts President, ANZCA 4 ANZCA Bulletin June 2012 There are two particularly special aspects for me in taking over as president of the College at this time. The first is that the handover occurred at the recent successful ASM in my hometown, Perth. The second is that this year marks the 20th anniversary of ANZCA and it is also 20 years since I first joined the College as a trainee. As the incoming president, I am like all our Fellows, driven by the notions of excellence, care and collaboration. An example of this is through leadership of the curriculum review process where we used a coalface-up approach, seeking the views of Fellows and trainees about the existing training program, to build a world-class curriculum that is nearly ready to be rolled out. We have another opportunity at this time as the College and its Faculty of Pain Medicine define the plans and direction for the five years from 2013 to 2017. It is important that College leaders seek the views of Fellows and trainees and use that feedback wisely – the best leaders I have known have forged the directions of their organisations from listening to their constituents. As part of the planning for the next five years, there has been a series of ways in which Fellows and trainees have had a voice. These include the consultation process and hospital visits being undertaken by ANZCA Chief Executive Officer Linda Sorrell, the outcomes of the 2010 Fellowship survey, the 2011 New Zealand roadshow undertaken by Dr Vanessa Beavis, and the 2012 curriculum survey targeting heads of department, regional/national education officers, supervisors of training and trainees. Thank you to all who have shared their views. So what are you saying? These are some of the key messages: • Our core purposes remain training, education, accreditation, standards of clinical service delivery for all sections of our communities; services for Fellows such as continuing education, continuing professional development, the library and other resources; advocacy to the wider community and government in the interests of high quality patient care and safety; and promotion and support for evidence-based practice through research and education. • As a College we have many strengths. These include the training program and the quality of our graduates, our growing educational resources, and publications. We are a credible, professional organisation that has the tremendous benefit of Fellows’ capabilities and contributions; along with staff knowledge and resources. • We can improve in a number of areas, particularly in our relationships with and services to our Fellows and trainees, including acknowledgement of and support for their contributions. Our main challenges over the next few years will be those of health sector and workforce reform; implementing the revised curriculum; ensuring that we remain an organisation that continues to deliver optimal value to its members; and fostering relationships with important partners. In some quarters, we need to strengthen our profile and role. I am inspired by the call from Fellows for the College to remain a world leader, an organisation committed to excellence with a profile and membership services to match, using new technologies and communications to best effect. All these aspirations ultimately underpin the high standards of care we provide our patients. Past presidents, deans and councils as well as the many Fellows and trainees who have contributed so much up to this point have given us all a solid foundation on which to continue building. I know we can respond to challenges and we will aspire towards an even stronger organisation over the next five years. We need to promote and maintain strong standards through successful rollout of the revised curriculum, and grow support for innovative research and ongoing development of resources for Fellows. We need to work on building a sense of unity and ownership in our College through strengthening relationships between the ANZCA Council and the regions, ensuring a service-oriented approach throughout the College, and seizing ongoing opportunities for collaboration between the College and the Faculty of Pain Medicine. We must continue to foster strong relationships and strategic collaborations with governments, other colleges and the societies, and with training organisations in Hong Kong, Singapore and Malaysia. And we must ensure our organisation is sustainable into the future by continually developing efficiencies, relevance and effectiveness, the best staff and the best systems. I am confident that we will move from strength to strength. Of course, there would be no College without the efforts of the many Fellows, trainees and staff who contribute at so many levels. The past 20 years has been marked by many significant achievements for the professions of anaesthesia and pain medicine, and I feel privileged to be taking over as the leader of a college that is in excellent shape. I have a great sense of optimism about our next 20 years and beyond. Chief Executive Officer’s message The development of our ANZCA Strategic Plan for 2013-2017 is continuing apace. Much feedback has been obtained through high-level consultation with internal stakeholders, including councillors, committees (including regional) and staff; and with external stakeholders such as other colleges, departments of health, universities and relevant government agencies. Other sources of information have included recent fellowship and trainee surveys, the New Zealand hospital road show by former New Zealand National Committee chair and new ANZCA councillor, Dr Vanessa Beavis, and key points raised during my recent visits to hospital anaesthesia departments in Australia. A total of 58 separate sets of feedback were received to six questions used to guide discussions and help inform ANZCA’s strategic priorities for the five years from next year. Of these, 43 came from groups and individuals within ANZCA and 15 from external agencies, including from within departments of health, universities, and other colleges. Following are the questions and the themes resulting from the responses. What is ANZCA’s core business? Training, education, standards; advocacy; research; communication. What are ANZCA’s strengths? Quality of services and graduates; communications and profile; Fellows’ capacity and capability; organisational capacity and ways of working. What are ANZCA’s weaknesses? Relationships with and services to Fellows and trainees; reliance on pro bono work of Fellows; profile and perceptions of ANZCA; organisational structure and ways of working. Where should ANZCA be in five years’ time? The leader in anaesthesia training, recognised expert agency; a capable and innovative user of IT and communications technologies; provider of excellent services to members; good communicator with a strong profile. What are ANZCA’s main challenges in the next five years? Engagement with Fellows and trainees; good business practice in a tough environment; managing external influences (other providers, political change); curriculum implementation and continuing medical education/continuing professional development services; improving structure and ways of working. There were also a number of themes that appeared across most or all of the questions including: • The revised curriculum: An essential component in ongoing core business; a strength; a challenge, and critical to where ANZCA will be in 2017. • Workforce: Mal-distribution of anaesthetists; training places, number of trainees, projected increase in demand, and funding changes for training. • A need for support for rural anaesthetists and GP anaesthetists. The ANZCA Council held a workshop in April and will be discussing the strategic plan again this month. History and heritage At the recent Perth annual scientific meeting, we filmed the first of several interviews with key College figures. These will form a collection of oral histories that will be available to the wider fellowship via the website. This is part of our commitment to history under our History and Heritage Strategy, which was signed off by the ANZCA Council earlier this year. The strategy aims to meet 10 objectives over the next few years including actively capturing and documenting the history of the College and using information technology to improve accessibility. We also have plans for a strong historic presence at next year’s ANZCA annual scientific meeting in Melbourne and are committed to a new “anaesthetic history” section in each edition of the ANZCA Bulletin. Other activities being undertaken include updating a booklet about the historic ANZCA-owned building, Ulimaroa, and other publications that highlight the history of the College. For further information about the History and Heritage Strategy please see page 55. Ms Linda Sorrell Chief Executive Officer, ANZCA 5 Acknowledging Professor Kate Leslie It is my pleasure to acknowledge our immediate past president Kate Leslie and her work as the leader of the College from May 2010 to May 2012. Kate’s presidency has been marked by a clear vision, exceptional attention to process and outcomes, coupled with strong and decisive leadership. Kate’s efforts have been tireless and her style courageous. Through the vision of ENGAGE she urged us to embrace, negotiate and influence, get involved, advocate, give our support and educate. There have been many achievements under Kate’s leadership: • Delivering a plan with our former CEO Mike Richards to strengthen our capability in areas such as education development, fellowship affairs, policy and communications. • Recruiting our new CEO, Linda Sorrell, and putting in place a forward-looking relational and collaborative agenda. 6 ANZCA Bulletin June 2012 • Leading the organisation to be ready for the rollout of the revised curriculum, ANZCA Curriculum Revision 2013. • In collaboration with others, achieving a critical Medicare schedule change to fund trainees in private. • Building activities and collaborations in overseas aid. • Setting new standards of clarity for Fellows and trainee participating in College activities through terms of reference for ANZCA committees and leaders. • Leading the charge for improving our approach to indigenous health. • Confirming and codifying the crucial relationship between ANZCA and the Faculty of Pain Medicine by constitutional review. • Strengthening relationships with our important partners notably the College of Intensive Care Medicine, the College of Surgeons and the Society for Paediatric Anaesthesia in New Zealand and Australia. • Overseeing two highly successful annual scientific meetings – in 2011 held jointly with the Hong Kong College of Anaesthesiologists and this year in Perth. • Reinforcing the College’s commitment to preserving our history and heritage. Through her ENGAGE strategy, Kate has achieved much. I, along with the ANZCA Council, am committed to continuing to work in all of these areas, as they are strengths for our College that are worth building upon. Kate, on behalf of all Fellows, trainees and staff, thank you. We wish you well in your future endeavours. Dr Lindy Roberts ANZCA President Director of Professional Affairs (IMGS) ANZCA is seeking to engage a senior anaesthetist of high standing to the position of Director of Professional Affairs (International Medical Graduate Specialists). This position reports to the Chief Executive Officer and works closely with the Dean of Education/Executive Director of Professional Affairs and other Directors of Professional Affairs and with ANZCA Council members. This position advises on clinical and professional issues of importance to the College, particularly in relation to international medical graduate specialists and may be asked to represent the College at external meetings. The position involves working closely with College staff. ANZCA is seeking expressions of interest from Fellows including former councillors of the College who have had clinical experience in the past two years. An attractive remuneration package will be negotiated with the successful candidate. For information on key selection criteria or a position description please contact Linda Sorrell, Chief Executive Officer, ANZCA by telephoning +61 3 9510 6299 or email [email protected] The closing date for applications is July 9, 2012. ANZCA Training Scholarships for 2013 ANZCA makes available 20 scholarships each year to assist anaesthesia trainees who are suffering severe financial hardship. Each scholarship will be awarded in the form of a 50 per cent reduction in the annual training fee for the following year. Applicants must be registered trainees of ANZCA. Applications must be submitted on the prescribed 2013 ANZCA training scholarship application form, copies of which are available from the College. The closing date for applications for 2013 is Friday August 10, 2012. Successful applicants will be notified in November 2012. Please note: If your financial circumstances improve during the training year for which the ANZCA Training Scholarship is awarded, you must notify the College. Your application will be reviewed and you may be asked to relinquish all or part of your scholarship. Please contact: Janelle Talty Phone: +61 3 9093 4913 Email: [email protected] 7 Letters to the editor Rich history of anaesthesia depicted Originally the mace was developed during medieval times as a weapon wielded by one arm from horseback. Therefore the shaft was long with a heavily studded head, and such maces developed a fearsome reputation, which made them an excellent symbol for power. Following the introduction of gunpowder the usefulness of the mace as a weapon declined but its symbolism for power and authority survived. Ceremonial maces became larger with more decoration and were made of precious metals such as silver and gold. The ANZCA mace was gifted to the College by the Royal Australasian College of Surgeons (RACS) at our College’s first annual scientific meeting in 1994, when their then president, Dr David Theile said, “as a demonstration of our part in your history and a permanent expression of our good wishes for your future”. The design of the mace was greatly assisted by Joan Sheales, the then College Registrar (now titled chief executive officer), and is based around a lily to symbolise the creation of the new college of anaesthetists, as the lily in Greek lore symbolises birth. The mace design also incorporates much of the symbolism from the College’s armorial bearings which were designed to represent the Australian and New Zealand origins of the College; its “The Duke of Norfolk as Earl Marshall of Her Majesty’s College of Arms authorised the armorial bearings on December 1, 1992.” geographical region and the domicile of its headquarters; its derivation from the Faculty of Anaesthetists, Royal Australasian College of Surgeons, and the links particularly in intensive care with the Royal Australasian College of Physicians; its closeness to the basic sciences of anatomy, physiology and pharmacology; and the relationships which exist between the new and old worlds. The armorial bearings were designed by a College’s Coat of Arms Subcommittee, which met between September 1991 and September 1992 and consisted of Barry Baker (chair), Peter Livingstone (dean/president), David McConnel (councillor), Peter Jones (RACS) and Joan Sheales (registrar/CEO), and later Michael Hodgson (president). The Duke of Norfolk as Earl Marshall of Her Majesty’s College of Arms authorised the armorial bearings on December 1, 1992, and they were officially granted on May 10, 1994. The subcommittee members were very pleased to be notified that, because of the design and its detailed justification, these arms were granted in the minimum time – an exceedingly rare occurrence. The armorial bearings consist of the “supporters”, which were chosen as famous historical figures whose work was vitally important in changing not only medical knowledge, but the way in which people thought about that knowledge. 2004 Curriculum 2004 commences Michael Cousins appointed ANZCA President Anaesthetists in Management Special Interest Group established Online journals available to Fellows 18 ANZCA Bulletin March 2012 Clinical Teacher Course piloted ANZCA website created ANZCA Trainee Committee established In 2008, ANZCA commissioned the design of a contemporary corporate logo to complement the College coat of arms on ANZCA livery. The logo is now used, along with the crest, on all ANZCA hard-copy and electronic documents, and on our website. The two symbols presented together signify the historical and contemporary values of ANZCA and the confidence of our organisation as we move forward. The logo was inspired by the triangular board room table at ANZCA House in Melbourne, but the overall design is abstract and open to wide interpretation. The designers, Streamer, commented that the overall effect of the overlapping geometrical shapes is one of precision and exactitude, reflecting the sciences that underpin the profession. The two sets of overlapping forms may reflect our two countries and the three sets the foundations of our College - anaesthesia, intensive care medicine and pain medicine. The multiple and connecting triangular elements pointing in different directions allude to the multidisciplinary nature of the College. The “triangles” remind me of a high mountain range reflected in a deep ocean, requiring us to be courageous, intrepid and visionary in all the things we do. They evoke a journey where the summit will be reached through careful steps and by dogged persistence. The rich burgundy colour denotes quality, authority and a link to the traditions of our past, but in essence the logo is modern and forward-looking and that’s what I like about it! Professor Kate Leslie President, ANZCA The place of pharmacology, which is the third scientific base for the specialty, is addressed by use of the botanical specimens in the “charges of the shield”. The supporters stand on land separated by water, which forms the “compartment of the arms”. These separate lands signify not only the countries of Australia and New Zealand, but also the separation of the new world of Australasia from the old world of Europe (and the not-so-old world of North America where anaesthesia was first demonstrated and broadcast to the world in the mid-19th century). The sea also indicates the significance of sea travel in the transmission of the introductory news about anaesthesia from North America to Europe and eventually to Australia and finally New Zealand. The Cootamundra wattle (Acacia baileyana) illustrated on the land on which Vesalius stands represents Australia and the silver fern or ponga (Cyathea dealbata) on the land on which Harvey stands represents New Zealand. The shield contains two parts. The “chief of the shield” contains the Southern Cross indicating the College’s geographical place in the Southern Hemisphere because the constellation is at 600 S and therefore not visible from most of the Northern Hemisphere. The five stars are represented with the number of points representing their real brightness in the night sky starting at the base of the cross with the brightest star and moving clockwise: alpha – eight points; beta – seven points; gamma – seven points; delta – six points; epsilon – five points. This representation is also that taken by the state of Victoria and is not taken by any other state or country using the Southern Cross. Thus this representation symbolises the College’s founding and headquarters in Victoria. The lower part of the shield contains the Cross of St George indicating the links between the College and its British counterpart, the Royal College of Anaesthetists, as well as the Christian heritage of the College. The “torch of glory” imprinted on the upright of the cross symbolises the direct derivation of the College from the Faculty of Anaesthetists of the Royal Australasian College of Surgeons. The College of Surgeons has the torch of glory in its arms and has also the motto Fax mentis incendium gloriae – “The torch that illuminates the mind is the fire that consumes vainglory”. The charges in the four quadrants symbolise the plants that together form the basis for the pharmacology fundamental to anaesthesia. In the upper left quadrant is the opium poppy (Papaver somniferum) signifying analgesia, and in the upper right quadrant is the mandrake plant (Mandragora officinarum) signifying sedation and anaesthesia. These charges also symbolise the old world plants. The new world plants are depicted in the lower charges. In the lower left quadrant is the curare vine (Chondrodendron tomentosum) signifying neuromuscular paralysis, and in the lower right quadrant the cocaine leaf and fruit (Erythroxylum coca) signifying local anaesthesia. The crest consists of the helmet, which is unusually affronté (or facing forward) with a closed visor to indicate alertness and readiness for any urgent action. This type and position of helmet is similar to the Royal College of Anaesthetists again linking the College to this fraternal organisation. The colours of the College gown (black and gold) are incorporated into the wreath on the helmet and its lambrequin (or cape). The rising sun behind the helmet indicates the geographical place of the College in the east next to the international date line; and also symbolises links with the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians both of which have similar rising suns for the same symbolic reason. “Vesalius also was the first to show that an animal... could be resuscitated by using artificial respiration through a reed inserted into the windpipe.” The “hand of the carer” (physician) rising from the Lord’s cloud representing Almighty guidance links the College back to the Parisian medical influence and to the foundations of the modern European medical tradition in 12th century Paris, and symbolises the Fellow’s hand guided by the Lord caring for the patient’s life. The hand holds an ankh, the Egyptian hieroglyph for life, which links the major responsibility of College Fellows – the preservation of life – to the roots of western medicine in Egypt in the 5th to 3rd millennia BCE. The snake of Asclepius (Aesculapius) entwines the Ankh to symbolise the links with the heritage of Greek medicine and the ethics of doctor-patient relationships, which derive from that time. The motto reads Corpus curare spiritumque which translates as “To care for the body and its breath of life” and which aptly summarises the main aim for Fellows of the College. There is an intended pun in the motto, which uses the Latin word curare (to care). This is also a word, derived differently from Macusi Indians in Guyana (wurari), used daily in the specialty for the drug curare or its analogues, which cause the state of neuromuscular paralysis or curarisation. Originally the College mace had been designed to have a timber shaft made from Australian jarrah and an unspecified New Zealand timber, but this timber shaft was replaced with gold plated sterling silver when the RACS offered to gift the mace to ANZCA. The aspects of the armorial bearings that have been translated into the design for the mace are: The butt: This is now the larger end of the mace and is in the shape of a half opened lily containing the motto “Corpus curare spiritumque” engraved on the inner lip. Within the open lily cusp, like a stamen, the crest is reproduced in full with the torch of glory placed below the crest in a sense holding the crest aloft. This repositioning of the torch was deliberately designed to represent the gift of the mace by the RACS to the College, and to symbolise the growth of the College of Anaesthetists from the Faculty of Anaesthetists. The shaft: Embossed on the shaft (stem of the lily) is a representation of the shield containing the four quadrants and with the chief containing the Victorian Southern Cross stars represented by Argyle champagne-colour diamonds sized in proportion to the stars’ brightness (1x20pt, 2x16pt, 1x11pt, and 1x6pt). The charges are represented more boldly and larger than in the arms to emphasise their differences, and for artistic relief on the shaft. The head – Australia and New Zealand are represented in the head (another half open but smaller lily) by a wattle in silver-gilt and a fern in silver. Around the “The motto reads Corpus curare spiritumque which translates as “To care for the body and its breath of life”.” lip is engraved “Presented by the Royal Australasian College of Surgeons 1994”. The mace is 960 millimetres long, weighs approximately 2.75 kilograms, and was cast in 19 separate pieces at Flynn Silver’s workshop in Kyneton, Victoria, using the lost wax technique. Dan and John Flynn commented at the time (May 17, 1994) that “we consider it to be the most significant commission undertaken by ourselves to date”. The cost of the mace was $A34,500. Every council meeting is conducted with the mace on its jarrah rest in open display to symbolise the authority of council, and again at the College annual general meeting. The mace is also ceremonially carried in the procession of the president and council to the opening of each annual scientific meeting. If you have not looked closely at either the coat of arms or the mace, you should do so, as they are each rich in a heritage that you share with your colleagues, not only in anaesthesia but more widely across the breadth of medicine and science. Professor Barry Baker Dean of Education and Executive Director of Professional Affairs ANZCA 20 Roger Goucke appointed Dean, Faculty of Pain Medicine 2005 Mike Richards appointed ANZCA CEO Acute Pain Management: Scientific Evidence (second edition) published ANZCA Trials Group formed Richard Lee appointed Dean, Joint Faculty of Intensive Care Medicine Regional Anaesthesia Special Interest Group established New Fellow first elected to Council 2007 ANZCA Foundation officially launched YEARS 1992-2012 Airway Management Special Interest Group established Leona Wilson appointed ANZCA President 2008 (continued) Penelope Briscoe appointed Dean, Faculty of Pain Medicine Trauma Special Interest Group established Vernon Van Heerden appointed Dean, Joint Faculty of Intensive Care Medicine ANZCA Code of Conduct introduced Review of the curriculum commenced ANZCA CELEBRATING 20 YEARS 1992-2012 2010 2008 Continuing Professional Development Program introduced 19 Celebrating our Coat of Arms It is no exaggeration to say I was thrilled to see Professor Baker’s exposition of the College Coat of Arms (ANZCA Bulletin, March 2012). Every feature rich with history and significance; their appearance, colour, position, shape, size, all telling the story of the College and our traditions of anaesthesia and intensive care in a spectacular symphony of colour and images. As the logo for a learned college I believe our Coat of Arms stands head and shoulders above every other Australian and Australasian professional college and is something of which every Fellow can be proud. I turn to the article about the triangles. What contrived symbolism that is. The triangles have no soul and the many Fellows I have spoken to appear to have a similar view and are baffled by the supposed symbolism of the triangles. Can I appeal to the new Council to review the decision to adopt the triangle logo? Let us make the most of what we have, our truly magnificent and inspiring Coat of Arms. Let us use the coloured version at every opportunity. Trainees should be made aware of its nature and design so they can draw inspiration from it. Let us proudly display our inspirational Arms whenever and wherever possible. Dr John Paull MB BS, Dip Ed, FANZCA Consultant Anaesthetist (Retired) Honorary Research Associate School of History and Classics, University of Tasmania, Launceston, Tasmania. 20 2009 Dr Ray Hader Trainee Award for Compassion established Continuing Professional Development Program became mandatory First ANZCA E-Newsletter distributed ANZCA begins producing podcasts ANZCA Bulletin March 2012 ANZCA CELEBRATING 20 YEARS 1992-2012 Independent College of Intensive Care Medicine (CICM) formed replacing JFICM. Vernon Van Heerden inaugural CICM President Kate Leslie appointed ANZCA President David Jones appointed Dean, Faculty of Pain Medicine 2012 (to March) Lindy Roberts announced President-elect, ANZCA 2010 Acute Pain Management: Scientific Evidence (third edition) published 2011 Perioperative Medicine Special Interest Group established Linda Sorrell appointed ANZCA CEO Online in-training assessments start Online Clinical Teacher Course piloted Brendan Moore announced Dean-elect, Faculty of Pain Medicine Number of Fellows – 5300 and 2000 trainees ANZCA Curriculum Revision 2013 learning outcomes approved 21 Why does the College need two logos? I was intrigued to read the descriptions of the armorial bearings or “crest”, and the corporate logo, “the triangles”, in the March 2012 ANZCA Bulletin. Barry Baker’s exemplary article should be compulsory reading for all current and aspiring Fellows of the College. The description of the logo, however, leaves a number of questions unanswered. That the logo design is “abstract and open to wide interpretation” reminded me of an occasion when I met with a senior staff member at Melbourne University. Without prompting, she commented on a College business card that depicted the corporate logo, saying that it appeared to represent an organisation that was unsure of its direction! Why did the ANZCA Council feel the need to commission a new logo in 2008 in addition to one that was widely recognised and had been developed through a rigorous and well established process? Contemporary values are not obtained through the acquisition of a pretty design; they are obtained by action and achievements, thereby bestowing integrity on the name and reputation of the organisation. We now have the confusion of two logos. The original armorial bearings, with so much embodied meaning, has been deliberately downgraded by the imposition of an abstract design of uncertain foundation. The “rich burgundy colour” of the corporate logo supposedly denotes “quality, authority and a link to the traditions of the past”. I find it difficult to ascribe such a range of attributes to a colour, more so as the logo appears in a range of colours in the same issue of the Bulletin. Other Australian and New Zealand medical colleges use a single crest or shield, and display it proudly. It is time for the council to reconsider the merits of having two logos. Dr Rod Westhorpe OAM, FRCA, FANZCA Honorary Curator, Geoffrey Kaye Museum of Anaesthetic History 8 ANZCA Bulletin June 2012 Western Australia’s foundation Fellows and the establishment of the Western Australian State Committee The first annual business meeting of the Western Australian State Committee took place at the British Medical Association council room on June 9, 1956. Members of the committee could review the achievements of the past year with satisfaction. At this time the committee comprised two foundation Fellows of the Faculty of Anaesthetists, Drs Gilbert Troup and D R C (Bunny) Wilson, and Dr L G B (Graham) Cumpston, a foundation member of the Faculty who had been elevated to fellowship in January 1956.1 The first honorary secretary’s report of the WA State Committee included the following: “In a country the size of ours it is impossible for the Board of Faculty to maintain satisfactory contact with Fellows and Members in the various states of the Commonwealth and the Dominion of New Zealand. The Board therefore exercised the powers given to it under additional Regulations (1955) and appointed State and Dominion Committees whose functions are to carry out duties delegated by the Board, to convene at least one scientific meeting each year and to advise the Board of any matters which may concern the interests of the Faculty. “In July last year the Board appointed Drs G.R. Troup, Douglas Wilson and L.G.B. Cumpston to constitute the Western Australian State Committee. On 8th September 1955 this committee held its first meeting at which Dr Troup was appointed Chairman and Dr Cumpston Honorary Secretary. The committee has 2 met on five subsequent occasions.” The inaugural meeting lasted 30 minutes and took place at Dr Troup’s rooms in Yorkshire House, 194 St CELEBRATING (continued next page) Walter Thompson appointed ANZCA President Jack Havill appointed Dean, Joint Faculty of Intensive Care Medicine 2003 Corporate logo – “the Triangles” 2006 One Grand Chain (volume two) published Milton Cohen appointed Dean, Faculty of Pain Medicine Andreas Vesalius is on the left. He published his seminal work De Humani Corporis Fabrica in 1543 from Padua, Italy. This publication changed anatomy because it overthrew, after 1400 years, Galen’s dogma (largely based on the anatomy of apes and monkeys) with human cadaver dissection, and by instituting the scientific approach of challenging dogma with direct experience. Vesalius also was the first to show that an animal that had ceased to breathe could be resuscitated by using artificial respiration through a reed inserted into the windpipe – in the coat of arms he is holding a bellows to signify this act. The bellows also signifies the experimental scientific basis of the specialty following Vesalius’ lead. His view is outward looking to signify his broad academic outlook, and to indicate the widespread place of artificial ventilation in anaesthesia and intensive care. William Harvey, who lived in England but who had studied in Padua, is the other supporter and is depicted holding a book with a heart etched on the cover. The heart and book represent the contribution made by Harvey in 1628 when he published De Motu Cordis, which for the first time described the circulation of blood through the lungs and around the body. The book also symbolises the College’s respect for academic learning. Harvey looks towards Vesalius to explain that the discovery of the circulation depended on prior anatomical description by Vesalius and others (that is physiology followed anatomy), and also because Harvey studied in the Italian medical schools. These two supporters represent the heritage of the specialty based as it is on respiratory and cardiovascular physiology together with anatomy. 70 Georges Terrace, Perth. The first matter discussed was the Faculty scientific meeting. Were these meetings to be exclusively for Fellows and members, or did the committee have the right to invite the profession at large? The committee was keen to involve Fellows of the Faculty of Anaesthetists of the Royal College of Surgeons in England and sought advice from the board as to whether these professionals would first seek membership of the Australasian Faculty or would be entitled to fellowship outright. With only nine members and Fellows in WA there was insufficient time and resources to organise a scientific meeting during 1955 and it was suggested at the second committee meeting in October that March or April 1956 would be regarded as the earliest possible date. In fact the committee did not meet again until March 1, 1956, and at this time planning for the scientific meeting began in earnest. It was decided to hold the meeting on an evening in June at approximately the same time as the College (Royal Australasian College of Surgeons – RACS) scientific meeting. The meeting was to take the form of a symposium entitled “Controlled respiration in anaesthesia and in medical conditions with respiratory embarrassment or paralysis” and anticipated the presentation of papers by an anaesthetist, a physiologist, a physician and a surgeon. Three more meetings of the WA committee were held before the annual scientific meeting on June 7, 1956. The Faculty symposium commenced at 8pm and was now titled “The management of respiratory paralysis in anaesthesia and disease”. The meeting opened with a short address by Dr L Souef, chair of the State Committee of RACS. Dr Douglas Wilson presented the subject from the anaesthetic aspect and Dr Beech, also a foundation Fellow of the Faculty of Anaesthetists, RACS, from the medical angle. Discussion was opened by Dr Thorburn (by invitation), from the physician’s point of view, and Dr Peter Gibson discussed the thoracic surgical approach. The meeting closed at 10.30pm. The honorary secretary’s report of June 9, 1956, concluded with the following: “College Meeting – Perth – 1958. It is anticipated that the Annual Meeting of the College will take place here in 1958. This will undoubtedly include the Faculty and will be a function of great importance to us all.” Heading Sample The men who made it happen Dr Gilbert Troup Gilbert Troup was one of the outstanding figures in anaesthesia practice in Australia. He led a rich career in medicine prior to his work during the early 1950s in helping to establish the 3 Faculty of Anaesthetists, RACS. Born in Christchurch, New Zealand in 1896, he was educated in Melbourne and graduated in medicine from the University of Melbourne in 1922. He settled in Perth in the same year, working first at the Children’s Hospital and then at the Perth Hospital, becoming a junior honorary physician in 1924 while maintaining a private practice in Subiaco. A long and distinguished career in anaesthesia began when Dr Troup was appointed honorary anaesthetist to the Perth Hospital in 1927. He followed in the footsteps of William Nelson (who served from 1918 to 1926) and Bruce Burnside (served 1918 to 1923), who were the first honorary anaesthetists appointed to the hospital. Dr Troup was a member of the Faculty’s WA Committee from 1955 until 1959, serving twice as chair, from 1955 to October 1956, and from November 1957 until June 1959. He died in August 1962. ANZCA Bulletin December 2011 Dr D R C Wilson D R C “Bunny” Wilson was perhaps best known for his contribution to paediatric and neonatal anaesthesia, particularly 4 his pioneering work in WA. Born in 1906 in Perth, he graduated MBBS at Melbourne University in 1931. After a year as a resident medical officer at Perth Hospital he entered general practice in Dowerin, which continued until 1939. He served with distinction in World War II and was awarded an MBE, Military Division, for his service in Syria in 1941. Dr Donald Stewart wrote in 2010 that it was Gilbert Troup who nurtured Bunny Wilson’s interest in anaesthesia after the period of hostilities ended, and he soon became the first full-time anaesthetist in Western Australia, with posts at Royal Perth Hospital, Hollywood Repatriation Hospital and Princess Margaret Hospital, where he was director of anaesthesia from 1945 5 until 1956. Dr Wilson served on the WA Committee of the Faculty of Anaesthestists, RACS, from 1955 to 1966. He was chair twice, from November 1956 to September 1957 and from June 1960 to August 1961. He also served as Australian Society of Anaesthetists (ASA) Executive Committee state representative for WA from 1947 to 1951. Dr Wilson died in January 1970. Dr Ernest Beech Ernest Beech was born in Adelaide in 1908 and studied medicine at the University of Adelaide, gaining his MBBS there in 1932. He relocated to Western Australia in 1933 to become a resident medical officer at Perth Hospital. Dr Beech was appointed medical registrar in 1934. He then spent two years in postgraduate studies in England at the Royal Chest Hospital and the Queen’s Square Hospital. Dr Beech obtained his MRCP in 1936 and, on his return to Perth, was appointed honorary outpatient physician and honorary anaesthetist to the Perth Hospital in 1938. He maintained this dual role until 1950, and was also in general practice until 1946. Dr Beech also served as anaesthetist to the neurosurgery unit at Perth Hospital. He contributed to postgraduate education in Western Australia as the secretary of the ASA Postgraduate 6 Committee for two years. Above from left: Dr Gilbert Troup, Dr D R C Wilson, Dr Ernest Beech. ANZCA Bulletin December 2011 71 Perth Hospital records Thanks to Fraser Faithfull and Professor Garry Phillips for the article on the early days of the Faculty of Anaesthetists in Western Australia (ANZCA Bulletin, December 2011). For the sake of the historical record I offer some minor corrections. The records of the Perth Hospital contradict the statement in the Bulletin that Dr B Burnside and Dr WH Nelson were the first honorary anaesthetists appointed to the hospital, commencing in 1918. Although the record is incomplete, the minutes of the Perth Hospital Board1 as early as 1906 record the nomination of a Dr Thurston to the post of honorary anaesthetist. In 1924 Gilbert Troup was appointed as an honorary assistant physician (not junior physician) to the Perth Hospital, and he was first appointed as an honorary anaesthetist in 1930 (not 1927)2. It is not clear when Dr Troup first worked at the Perth Children’s Hospital; his own “personal information” held by the Australian Society of Anaesthetists gives the date as 1922 (the year of his graduation from Melbourne University), but according to the records of the hospital, his initial appointment there was in 19243. Dr Toby Nichols Department of Anaesthesia Royal Perth Hospital References: 1. Minutes of board meetings of the Perth Hospital (held by Royal Perth Hospital Museum). 2. Annual reports of the Perth Hospital (held by Royal Perth Hospital Medical Library). 3. Jeanette Robertson, archives facilitator, Princess Margaret Hospital (personal communication). Awards Letters to the editor s to itor “In-flight medical emergencies are relatively common occurring at approximately one per 10,000 – 40,000 passengers.” One of the main issues raised in the debriefing is who had authority in the emergency. According to the Cathay Pacific protocols, the cabin crew retains control and will run the emergency within their abilities. Cabin crew personnel are trained in first aid, cardiopulmonary resuscitation and the use of the AED. They will be guided by the medical advice of their ground medical support. Cathay Pacific use Medlink, which is a 24-hour service based at the Trauma Centre of Banner Hospital, Phoenix in Arizona, US. The doctors on board are to follow the instruction of the ground medical support and to communicate patient information to them. The decision for diversion ultimately rests with the captain of the aircraft in liaison with the flight control. This surprised a number of the anaesthetists on board who assumed they had autonomy in decision-making for patients under their care. However, the cabin crew withheld the medical responders from administering medications until it was approved by Medlink. Communication with Medlink is by satellite phone, which may be interrupted. We noted during both scenarios that the participant who communicated with Medlink was not the leader of the medical response team. A decision for flight diversion was made in both scenarios. During debriefing, the leader of the medical response team disagreed with the decision for diversion but was not involved in the decision. One of the observers was involved in another ground support medical service and noted that there may be communication issues during an emergency. The cockpit simulations showed how the aviation industry uses checklists before and after takeoff and landing, and the use of standard operating procedures together with memory items in an emergency. We discussed how we can adapt these principles to anaesthesia. We received many encouraging comments on the way back in the coach. I heard a number of times that this was the highlight of the CSM for some participants. This workshop was the result of collaboration with Cathay Pacific and they generously provided their simulation facilities, aviation medical specialists, flight instructors and flight attendant trainers. They also learned a great deal from the encounter. Dr Tim Brake, FANZCA United Christian Hospital, Hong Kong Dr Tim Brake was the “Is there a doctor on board?” workshop co-ordinator at the 2011 Hong Kong Combined Scientific Meeting. References 1. Cocks R., Liew M. Commercial aviation in-flight emergencies and the physician. Emergency Medicine Australasia (2007) 19, 1–8 2. Gardelof B. Inflight medical emergencies. American and European viewpoints on the duties of health care personnel. Lakartidningen 2002; 99 (37): 3596–9. 3. DeJohn C, Veronneau S, Wolbrink A, Larcher J, Smith D, Garrett JS. Evaluation of in-flight medical care aboard selected US air carriers. Cabin Crew Safety 2000; 35 (2): 1–19. Above from left: Dr Phillipa Hore and Dr Michelle Mulligan in the cockpit; the flight simulator controls; the Flight Training Center at Cathay Pacific, Hong Kong; anaesthetists taking part in the in-flight medical emergency simulation workshop. ANZCA Bulletin September 2011 41 r on board? e on in-flight n training at the M prompts me to relay pened only a month hat happens in the a flight from Fiji, hthalmic surgical here was a call ss system of the doctor. The four ad been working with ted at me and firmly made myself known was ushered to the re a man was lying ery narrow corridor wo rear toilets. en from his wife a man in his mid-50s bidities including e, liver cancer and a ad been on holiday nwell for the past few minal pain, nausea d been unable to keep n. difficult but he was . He looked pale, pulse and his systolic lpation, (there was no mm.Hg. I concluded d as a result of ary to dehydration. edical kit was ugh somewhat old a litre of Hartmann’s set. ember 2011 I managed to cannulate a vein, although there was no tape available and we had to secure it with Band-Aids. His condition improved somewhat with the fluid and when the captain called to ask if he needed to divert the plane I informed him that this would not be necessary. However, I requested that an ambulance be ready at the arrival of the plane and that a stretcher be waiting as soon as we disembarked as I considered that he needed urgent hospital care. I was assured that this would be done. Re: NZ anaesthetic technicians can On arrival in Sydney all the passengers now register as health professionals were let off before us but when I got to (September 2011) the door I found that there was neither I was delighted to read the article by stretcher nor any thought of one. Finally Susan Ewart, describing the “11-year an airport employee arrived with a process” that has resulted in anaesthetic wheelchair and all we could do was technicians in New Zealand now bundle the patient into this. No one in being able to register under the Health Editor’s note sight was aware of a medical emergency, Practitioners Competence nor seemed to care much. We wheeled In the December edition ofAssurance the ANZCA Act. I congratulate all those involved in the patient to passport control where Bulletin, we a quote a letterprofessional submitted by achieving thisin important did get some priority in the queue but goal Professor for our operating room colleagues. Associate Michael Davis on then had to wait for bags to be collected Throughout my anaesthetic career, I before he was finally wheeled out to New Zealand anaesthetic technicians was valued highly the support of the many the concourse where I expected the inadvertently leftwomen out. This is the letter, fine men and who have worked ambulance to be waiting. No one knew alongside in this capacity. inme full with the missing, anything about it and the patient, hisrepublished However, thequote processincluded. of developing wife and myself were dumped rather slightly abridged, the professional role of anaesthetic unceremoniously in the cold and draughty technicians to where it is today is, in fact, arrivals hall. I inquired about the medical NZ anaesthetic technicians much longer than the 11 years since the centre at the airport but it was midday on a I was delighted to read the article NZ Anaesthetics Technicians Society by Susan Saturday and it was closed. “theirthe wish“11-year to be covered by Ewart, expressed describing process” that Finally, in desperation, I phoned 000 this legislation”. The first anaesthetic and spoke to the NSW ambulance who saidresulted has in anaesthetic technicians in technicians training course in New no call or arrangement had been made. New Zealand now being by able to in register Zealand was developed myself Nonetheless they sent an ambulance and 1978, 33 years ago, soon after I arrived three quarters of an hour later the patient in Christchurch as a full-time specialist was finally on his way to hospital. for the then North Canterbury Hospital Aviation is often held up to we Board. In order to complete the early anaesthetists as model of practice but history of technician training in NZ, it is a doctor in this instance a serious breakdown Is there worth quoting from a 1990 Department of communication between the air and on board? of Anaesthesia internal publication that the ground led to sub-optimal care of covered the history of anaesthesia in this patient. 1 A funny thing happened on Christchurch from 1974 to 1990. the way back from the Hong As far as I know, at least two of those Kong Combined Scientific Dr Terry Clarke Meeting (CSM). original five graduates were still working Director, Department of Anaesthetics On one flight, an asthmatic astookanaesthetic technicians in Christchurch inadvertently some and Pain Management peanut snacks and developed until very recently. anaphylactic shock. His Nepean Hospital, Penrith, NSW sister was frantic and called under the Health Practitioners Competence Assurance Act. I congratulate all those involved in achieving this important professional goal for our operating room colleagues. Throughout my anaesthetic career, I valued highly the support of the many fine men and women who have worked alongside me in this capacity. However, the process of developing the professional role of anaesthetic technicians to where it is today is, in fact, much longer than the 11 years since the NZ Anaesthetics Technicians Society expressed “their wish to be covered by this legislation”. I developed the first anaesthetic technicians training course in New Zealand in 1978, 33 years ago, soon after I arrived in Christchurch as a full-time specialist for the then North Canterbury Hospital Board. In order to complete the early history of technician training in NZ, it is worth quoting from a 1990 Department of Anaesthesia internal publication that covered the history of anaesthesia in 1 Christchurch from 1974 to 1990. “In the late 1970s...a national training committee was formed under the auspices of the Department of Health, on which Doug Chisholm [Medical Director, Anaesthesia Services, CAHB] was invited to sit. Anticipating the establishment of proper training programmes, a pilot course was commenced...in Christchurch modelled on the anaesthetic and basic sciences components of the UK Operating Department Assistants training programme. This Christchurch course became the basis for the development of the NZ programme. [Dr] Jim Clayton from Dunedin was the first examiner.” As far as I know, at least two of those original five graduates were still working as anaesthetic technicians in Christchurch until recently. “Oh, you can’t; they’re the men who bring the stairs to the plane,” was the reply. In-cabin phone communication to the front of the plane achieved two important objectives: the pilot requested stairs urgently and the senior cabin crew announced my imminent urgent egress. I now know how a sheep dog feels as it runs along the backs of a flock of sheep all “In-flight medical emergencies trying to flee the barking dog! are relatively common occurring approximately per 10,000 I was off theat– plane asonesoon as the stairs 40,000 passengers.” hit the fuselage, to find the gent had been rolled into an unconscious-patient position. To my serious consternation, he exhibited no response, deepest cyanosis and no palpable pulses. My silent private response could be summed up in one word. With an earnest request for formal help to the man in the yellow jacket with the secret service device in his ear, I proceeded with expired air mouth-to-mouth and a thump that should have woken something. “Get the fire-ies” was my catch cry, assuming that they would arrive with flashing lights and oxygen, at least. As I learned at an informal debriefing, the man with the secret service device in his ear could communicate with only the pilot of the aircraft to which his device was attached. [I thought that he could talk to the world]. Nevertheless that instigated a chain of communication from him to aircraft cockpit to Melbourne, to Hobart and finally to Launceston and thence to on-airfield Launceston Airport Fire Response. After what seemed like 24 hours, the fire truck arrived and Deo Gratias, along with the senior medical emergencies instructor for Tasmania, and oxygen. [When he offered to take over holding the face mask I said something like, “Sure, I’ve been practising for about 35 years if you could just help with the other bits.” He was so calm, “Okay”, and proceeded with the other bits.] Meanwhile, the patient was responding and I could hear Ambulance Tasmania wailing up the highway. Never was I so glad to greet an ETT, and skilled paramedics. A young plastics surgeon kept shaking my hand with congratulatory exuberance and a local ED RMO was delegated to brief them. The next day in the intensive care unit [as a retrievalist/hanger on in ICU] I expressed to the gentleman patient, “K…. I’ve kissed you once and I’m not doing it again … Give up the fags!” Lesson: Smash the closest fire alarm for oxygen-to-go at an airport! Associate Professor (retired) Michael Davis, MB, BChir, MA (Cantab.), FRCA(Eng.), FANZCA, MD(Otago), DipDHM, CertDHM(ANZCA) Reference: 1. Davis FM, editor. Department of Anaesthesia 1974–1990. The changing face of anaesthesia in the public health system. Christchurch: Canterbury Area Health Board; 1990. Anaesthetic technicians in New Zealand For the sake of accuracy, I wish to expand on what Dr Michael Davis has written about early anaesthetic technician training in New Zealand (ANZCA Bulletin, March 2012). Efforts to institute formal training began in the 1960s and began at Christchurch Hospital and Green Lane Hospital, Auckland, in April 1977. The first examination for the Certificate of Proficiency was held in March 1979. Six candidates presented, four from Christchurch and two from Auckland. All passed. Training extended to other centres after that. for the flight attendant. The flight attendant responded, informed the cockpit and their ground medical support while putting out a call on the intercom: “Is there a doctor on board?” Associate Professor (retired) Michael Davis, MB, BChir, MA (Cantab.), FRCA(Eng.), FANZCA, MD(Otago), Re: “IsDipDHM, there aCertDHM(ANZCA) doctor on board?” Fortunately there were six anaesthetists Table 1. Example of aviation It is likely that doctors who travel returning from the CSM, and the emergency medicaland kit regularly will receive a call for help Christchurch (ANZCA Bulletin, September 2011), the patient responded to treatment that was during their careers. In-flight medical subsequent letter from Dr Clarke (ANZCA Reference Bulletin, December prompts me to 1. Davis FM, editor.2011) Department of Anaesthesia face of anaesthesia relate an1974–1990. accountTheofchanging my own. the public health system. Christchurch: I wasin seated at the window in the end Canterbury Area Health Board; 1990. row on board an A330-220, which had just nosed into park on the tarmac in Launceston. Looking out the window, I notice three men in yellow and, as I watch, one of them gracefully slides from walking to prone-onconcrete position. Oddly, my first thought was, “Must be difficult for that person working around aircraft with epilepsy …” As I watched, he did not move from the assumed prone-on-concrete position as his two comrades rallied. The more I watched the less he moved. I indicated to the cabin crew that I wished to offer assistance. available in the emergency medical kit. Soon after, on another flight a young man had a grand mal convulsion, another group of anaesthetists responded to the call “Is there a doctor on board?” Meanwhile, in the cockpit things were not much better with takeoff aborted due to windshear and the “fire engine one” alarm occurring four times. These scenarios took place at the Flight Training Center at Cathay Pacific in Hong Kong as an offsite workshop of the CSM. We ran in-flight medical emergency simulations for 24 participants to familiarise them with the emergency medical equipment available on board, to appreciate the unfamiliar and confined environment and to understand the airline protocols in medical emergencies. We used a mockup of the Boeing 777 cabin, a Sim-man 3G high fidelity mannequin, actors and a team of flight attendant trainers to set up the scenario for in-flight medical emergencies. Cockpit simulation was done with a flat screen simulator with flight instructors from Cathay Pacific. 40 emergencies are relatively common occurring at approximately one per 10,000 -40,000 passengers, with one death per 3-5 million passengers and medically related diversion of aircraft in 7-13 per cent of cases1. There will be a medical person on board in 83 per cent of flights2. The most common diagnose are vasovagal syncope (22.4 per cent), cardiac (19.5 per cent) and neurological 3 (11.8%) . Resuscitating a patient in the confined space of an economy seat may be difficult. The seats will not lie flat and there will be other passengers crowded around who may need the flight attendant. In this scenario the mannequin was moved from the economy seat to the galley area. We had been briefed on the contents of the emergency medical kit by Cathay Pacific’s aviation chief medical officer but it was still difficult in the emergency to find the correct drugs and equipment. An oxygen cylinder was used and the automated external defibrillator (AED) was available but not used. The contents of emergency medical kits may vary between airlines but is being standardised in the aviation industry. Table 1 gives an example. ANZCA Bulletin September 2011 Kit Specification – European Joint Aviation Authorities (JAA) Regulation: JAR-OPS 1.755 – Emergency Medical Kit Contents: - Sphygmomanometer - Syringes and needles - Oropharyngeal airways (two sizes) - Tourniquet - Disposable gloves - Needle disposal box - Urinary catheter - A list of contents in at least two languages (English and one other) Drugs: Adrenocortical steroid, antiemetic, antihistamine, antispasmodic, atropine, bronchial dilator (inhalation and injectable forms), coronary vasodilator, digoxin, diuretic, adrenaline (epinephrine) 1:1000, major analgesic, medication for hypoglycaemia, sedative/ anticonvulsant, uterine contractant. Note that there is no requirement for an IV kit, although some carriers including Qantas will have IV fluid. There is no intubation equipment although a laryngeal mask may be included. One of the main issues raised in the debriefing is who had authority in the emergency. According to the Cathay Pacific protocols, the cabin crew retains control and will run the emergency within their abilities. Cabin crew personnel are trained in first aid, cardiopulmonary resuscitation and the use of the AED. They will be guided by the medical advice of their ground medical support. Cathay Pacific use Medlink, which is a 24-hour service based at the Trauma Centre of Banner Hospital, Phoenix in Arizona, US. The doctors on board are to follow the instruction of the ground medical support and to communicate patient information to them. The decision for diversion ultimately rests with the captain of the aircraft in liaison with the flight control. This surprised a number of the anaesthetists on board who assumed they had autonomy in decision-making for patients under their care. However, the cabin crew withheld the medical responders from administering medications until it was approved by Medlink. Communication with Medlink is by satellite phone, which may be interrupted. We noted during both scenarios that the participant who communicated with Medlink was not the leader of the medical response team. A decision for flight diversion was made in both scenarios. During debriefing, the leader of the medical response team disagreed with the decision for diversion but was not involved in the decision. One of the observers was involved in another ground support medical service and noted that there may be communication issues during an emergency. The cockpit simulations showed how the aviation industry uses checklists before and after takeoff and landing, and the use of standard operating procedures together with memory items in an emergency. We discussed how we can adapt these principles to anaesthesia. We received many encouraging comments on the way back in the coach. I heard a number of times that this was the highlight of the CSM for some participants. This workshop was the result of collaboration with Cathay Pacific and they generously provided their simulation facilities, aviation medical specialists, flight instructors and flight attendant trainers. They also learned a great deal from the encounter. Dr Tim Brake, FANZCA United Christian Hospital, Hong Kong Dr Tim Brake was the “Is there a doctor on board?” workshop co-ordinator at the 2011 Hong Kong Combined Scientific Meeting. References 1. Cocks R., Liew M. Commercial aviation in-flight emergencies and the physician. Emergency Medicine Australasia (2007) 19, 1–8 2. Gardelof B. Inflight medical emergencies. American and European viewpoints on the duties of health care personnel. Lakartidningen 2002; 99 (37): 3596–9. 3. DeJohn C, Veronneau S, Wolbrink A, Larcher J, Smith D, Garrett JS. Evaluation of in-flight medical care aboard selected US air carriers. Cabin Crew Safety 2000; 35 (2): 1–19. Above from left: Dr Phillipa Hore and Dr Michelle Mulligan in the cockpit; the flight simulator controls; the Flight Training Center at Cathay Pacific, Hong Kong; anaesthetists taking part in the in-flight medical emergency simulation workshop. ANZCA Bulletin September 2011 41 Dr George Waters FFARCS Acting Director, Anaesthetics and Intensive Care Mount Isa, Queensland Submitting letters We encourage the submission of letters to the editor of ANZCA Bulletin. They should be sent to [email protected] Letters should be no more than 300 words and may be edited for clarity and length. 10 ANZCA Bulletin March 2012 Dudley Buxton Medal of the Royal College of Anaesthetists Professor Teik Oh has been awarded the Dudley Buxton Medal of the Royal College of Anaesthetists in recognition of his estimable services to the specialty. The medal was established in 1967 to provide an annual award of a prize for meritorious work in anaesthesia or in a science contributing to the progress of anaesthesia. Australia Day Honours Dr Andrew Kenneth Bacon has been awarded the Ambulance Service Medal (ASM), Victorian Ambulance Service, in the 2012 Australia Day Honours List. New Zealand Queen’s Birthday Honours Sir Roderick Deane has been made a Knight Companion of the New Zealand Order of Merit (KNZM) for his contribution to business and policymaking, and for supporting the arts and disability sector for more than 30 years. Sir Roderick is on the board of ANZCA’s Anaesthesia and Pain Medicine Foundation. Dr James Judson, FANZCA, FCICM, received an MNZM (Member of the New Zealand Order of Merit) for services to intensive care medicine. Dr Judson works as an intensive care specialist at Auckland City Hospital’s Intensive Care Unit. ANZCA CELEBRATING 20 YEARS 1992-2012 Dr Basil Hutchinson, FANZCA, Auckland (Former chair, Anaesthetic Technicians’ Board, NZ) Australian Queen’s Birthday Honours Associate Professor Malcolm Wright has been appointed a Member of the Order of Australia in the General Division, for service to intensive care medicine, as a clinician, teacher and administrator, and through advanced medical training programs in developing countries. Dr David Henry McConnel has been awarded the Medal of the Order of Australia in the General Division, for service to medicine, particularly as an anaesthetist, through a range of executive and professional roles. Dr Drew James Wenck has been awarded the Medal of the Order of Australia in the General Division, for service to intensive care medicine through advisory roles, and to the community. Submitting letters We encourage the submission of letters to the editor of ANZCA Bulletin. They should be sent to communications@ anzca.edu.au. Letters should be no more than 300 words and may be edited for clarity and length. Would you like a 2013 ANZCA Diary? If you did not receive an ANZCA diary last year and would like a 2013 ANZCA Diary, please email [email protected] with your name and ANZCA ID number. PLEASE NOTE: If you received a 2012 ANZCA Diary last year, you will automatically receive a 2013 diary. 9 Heading Sample The Dr Ray Hader Trainee Award for Compassion Nominations are sought from ANZCA trainees and Fellows within three years of fellowship by examination for the Dr Ray Hader Trainee Award for Compassion. The deadline for nominations is October 11, 2012. Dr Ray Hader was an ANZCA trainee who grew up and lived in Victoria. He died in 1998 of an accidental drug overdose after a long struggle with drug addiction. To mark the 10-year anniversary of his death, a friend, Dr Brandon Carp, established an award that promotes a compassionate approach to the welfare of anaesthetists, their colleagues, patients and the community. Details of the Award Eligibility At the deadline for submissions, the nominee will be an accredited ANZCA trainee resident in any ANZCA training region or an ANZCA Fellow within three years of admission to fellowship by examination. The nominee will have made a significant contribution to the welfare of an individual, a group or a system that promotes welfare and compassion. The individual, group or system will be preferentially related to anaesthesia, but may alternatively be related to other colleagues, patients or the community (locally or internationally). Nomination Nominees will be nominated and seconded by accredited ANZCA trainees resident in any ANZCA training region or ANZCA Fellows within three years of admission to fellowship by examination. The nominator will describe in 1000 words or less how the candidate has made a significant contribution. The description will be accompanied by a covering letter signed by the nominator and seconder. Deadline Nominations must be received by ANZCA Chief Executive Officer Linda Sorrell by 5pm on October 11, 2012. Prize The winner will receive $A2000 to be used for training or educational purposes, and a certificate. If you are concerned about yourself or a colleague contact Australia: The Doctors’ Health Advisory Service Australian Capital Territory +61 407 265 414 Hotline nearest to you New South Wales/Northern Territory +61 2 9437 6552 Queensland +61 7 3833 4352 Victoria +61 3 9495 6011 Western Australia +61 8 9321 3098 Tasmania 1300 853 338 South Australia +61 8 8273 4111 New Zealand: 0800 471 2654 Professional documents – update The professional documents of ANZCA and the Faculty of Pain Medicine are an important resource for promoting the quality and safety of patient care for those undergoing anaesthesia for surgical and other procedures, and for patients with pain. They define the requirements for training and for hospitals providing such training, provide guidance to trainees and Fellows on standards of anaesthetic and pain medicine practice, define policies, and serve other purposes that the College deems appropriate. Professional documents are also referred 10 ANZCA Bulletin June 2012 to by government and other bodies, particularly with regard to accreditation of healthcare facilities. Professional documents are subject to regular review and are amended in accordance with changes in knowledge, practice and technology. PS31 Guidelines on Checking Anaesthesia Delivery Systems and PS37 Guidelines for Health Practitioners Administering Local Anaesthesia have been revised. These documents and newly developed background papers are now being piloted. Queries or feedback regarding professional documents can be directed to [email protected] The complete range of ANZCA professional documents is available via the ANZCA website, www.anzca.edu.au. Faculty of Pain Medicine professional documents can be accessed via the FPM website, www.fpm.anzca.edu.au. News New College office-bearers Dr Genevieve Goulding has been appointed ANZCA Vice-President and Professor Ted Shipton has been appointed FPM Vice-Dean. Dr Goulding has been Chair of the Education and Training Committee since 2010. She is a deputy director in quality and safety for the department of anaesthesia at the Royal Brisbane and Women’s Hospital. Her anaesthesia interests include obstetric anaesthesia, medical education, welfare issues and patient safety. Professor Shipton is Chair of the FPM Trainee Affairs Portfolio and Education Committee. He is Clinical Director of the Pain Management Centre at the Canterbury District Health Board in Christchurch and Academic Chair of the Department of Anaesthesia, Christchurch School of Medicine at the University of Otago. ANZCA accreditation ANZCA representatives met the Australian Medical Council (AMC) Assessment Committee in Melbourne on June 1 for a preliminary meeting to clarify key issues arising from both the ANZCA and FPM submissions for accreditation with the AMC and Medical Council of New Zealand. The assessment committee were satisfied with the overall quality of the documentation and discussion centred on the implementation of the revised curriculum, among other issues. The assessment is scheduled to begin on October 8 with site visits to representative hospitals across the two countries followed by meetings at ANZCA House during the week beginning October 15. Overseas aid trainee scholarship Australasian Anaesthesia (the Blue Book) Dr Steven Smith, from the Mater Mothers Hospital in Brisbane, has been awarded the 2012 ANZCA Overseas Aid Trainee Scholarship. Dr Smith will travel to the Vila Central Hospital in Vanuatu in August and September to help provide clinical anaesthesia services while local anaesthetists attend the Pacific Society of Anaesthetists Conference. He also will help teach junior healthcare providers about obstetric anaesthesia and the investigation of obstetric anaesthesia referral of high-risk patients and audit processes. For more information about the work of the Overseas Aid Committee, see page 28. The 2011 edition of the Australasian Anaesthesia publication, more commonly known as the Blue Book, is now available to download via the ANZCA website in an electronic flipbook format. The flipbook format enables downloading of the Blue Book direct to PC, laptop, smartphone and tablet. The flipbook features navigation and search functions to help find topics of interest faster, and includes zoom and full-screen modes for ease of reading. For Fellows and trainees who prefer a hard copy of the publication, please email the ANZCA Continuing Professional Development (CPD) team at [email protected] edu.au, citing your ANZCA College ID number and full name, and a copy will be sent to you. Any queries, please contact the ANZCA CPD team on [email protected] or + 61 3 9510 6299. An introduction to anaesthesia New Zealand ANZCA Fellow Dr Aidan O’Donnell has written a book called Anaesthesia: A Very Short Introduction. The book is a short introduction to anaesthesia for the lay reader and is expected to be valuable for new-start trainees, medical students, nurses, technicians, midwives and the general public. It covers the whole spectrum of modern anaesthetic practice, including general and local anesthesia, anaesthesia for childbirth and intensive care, as well as equipment and agents. It also provides a detailed breakdown of anaesthetic risks, side effects and complications. It is published by Oxford University Press. More information can be found at: http://ukcatalogue.oup.com. Lifebox donations Fellows and trainees raised $46,142 at the Perth annual scientific meeting for Lifebox to provide developing countries with about 200 pulse oximeters. For $US250, Lifebox provides a robust pulse oximeter and educational material to hospitals in developing countries that will ensure safe anaesthesia and save the lives of patients undergoing surgery. The first of the ANZCA-donated pulse oximeters will go to Papua New Guinea. For more information, see page 16. Vic Callanan award The inaugural Townsville Hospital Vic Callanan Award, named after one of the pioneers of anaesthetics in Australia, has been awarded to resident medical officer Dr Ben Shepherd for his skills in resuscitation. Dr Callinan stepped down last year as the hospital’s director of anaesthetics after 36 years in the role. The award is presented to the hospital’s best performer in simulated resuscitation. The award was reported in the local newspaper, the Townsville Sun. 11 Perth ASM wrap up More than 1500 Fellows and trainees attended the Perth Annual Scientific Meeting in May.inThe scientific program Perth Annual Scientific Meeting May. The scientific included included 13 plenary 195 concurrent session program 13sessions, plenary sessions, 178 concurrent presentations, 56 workshops, 42 small42 group session presentations, 47 workshops, smalldiscussions group and 59 ePoster andsessions, was complemented discussions andpresentations quality assurance and 59 ePoster by an excellentand social and other presentations wasprogram complemented by important an excellent ANZCAprogram events, such as theimportant College Ceremony. social and other ANZCA events, such as the College Ceremony. 12 ANZCA Bulletin June 2012 Counting the many successes of the ANZCA ASM The College has much to celebrate as the curtain goes down on an innovative and interesting annual scientific meeting in Perth. We have put our glad rags in to be dry cleaned, filed away another conference handbook and reacquainted ourselves with our children. Now there is a chance to reflect upon the product of so many hours of planning; the days from May 12-16 during which the ANZCA Annual Scientific Meeting 2012 was held. We selected the theme “Evolution: Grow, Develop, Thrive” a little over two years ago driven by the desire of the Regional Organising Committee to put together a meeting that had elements of old and new, in addition to practical aspects that would appeal to clinicians looking to develop and refine their practice. Delegates were treated to the relaxing jazzy tones of songstress Nicki Pelecanos as the meeting kicked off with welcome drinks in the Riverview foyer of the Perth Convention and Exhibition Centre overlooking the Swan River. The welcome drinks are always a great way to reconnect with friends and colleagues and this year was no exception. Beautiful blue skies greeted us on the opening day of the meeting, and we were welcomed by a representative of the Whadjuk Noongar people, Ms Ingrid Cumming, in a moving ceremony acknowledging the traditional owners of the land. The academic program blasted off with interesting and thought-provoking plenary lectures delivered by the first female ASM Visitor, Professor Ruth Landau, and FPM Visitor Dr Daniel Bennett. They set the tone for the excellent plenary sessions over ensuing days. As the first session came to a close, a gasp of delight arose from the 1500 delegates as the curtain at the back of the stage drew back to reveal a healthcare industry exhibition, allowing access for delegates over the stage into the pavilion where morning tea was served. Trainee delegates were joined by councillors and members of the academic fraternity from ANZCA and the Faculty of Pain Medicine at the Trainees’ Luncheon at the Metro bar and bistro. The casual, relaxed mood gave a perfect opportunity to mingle. Saturday night saw 177 new Fellows welcomed into the specialties while watched by family and friends at the College Ceremony. Always a special occasion, the 2012 ceremony will stand out in the minds of those present as they recall the personal and touching oration delivered by Australia’s first indigenous surgeon, Associate Professor Kelvin Kong, who emphasised the importance of kinship within our profession by recounting the stories of three influential women in his life. The College Ceremony Reception, which followed, was a fitting way to congratulate the graduands, and showcased the exceptional food and wine that Western Australia has to offer. Sunday started bright and early with a run into King’s Park for about 40 fit and eager delegates and heralded another sunny day chock full of concurrent sessions, workshops and small group discussions, including the final day of the FPM program. Plenary sessions by Professor Patrick Wouters exploring the wonders of the right ventricle and renowned pain expert and perioperative physician Professor Henrik Kehlet on the troublesome transition from acute to chronic pain set the scene. Internationally renowned communication experts, TRIAD, commenced a series of sold-out workshops focusing on difficult conversations and negotiation, which were well received by the attendees. (continued next page) 13 Several heavily pregnant friends and family members gave up part of their Mother’s Day to volunteer for the specialist echocardiography workshop by Professor Alicia Dennis, and Dr Alex Swann and his group ran a successful difficult airway workshop with true to life road-traffic trauma scenarios. The healthcare industry was welcomed and thanked with a cocktail reception that evening as we mingled among our 61 exhibitors. We were entertained by local acoustic musicians 2fiveSoul as delegates socialised and browsed the exhibition. The artworks displayed in the rear of the area provided a pleasant diversion from an entertaining and informative exhibition hall. Special thanks go to Philips and all delegates for their patience as we awaited the untimely arrival of the USB keys containing the abstracts! The short academic program on Monday included presentations by the Gilbert Brown Prize contenders and was followed by a plethora of choices for the delegates to experience some of the local Perth culture. A round of golf, a swim with the dolphins, a ride around the river or a day at Rottnest Island were enjoyed by families and partners. Our delegates were able to recoup, plan for the next couple of days and enjoy some the local attractions during an afternoon and evening of unplanned time. This also gave some of the Regional Organising Committee a chance to debrief and troubleshoot any issues for the final days of the conference and others to enjoy the fabulous wine dinner at Chez Pierre with 50 delegates and partners. The last full day of the meeting presented a final opportunity to soak up the innovations of the meeting. The moderated ePoster sessions concluded in the morning and the Masterclass series reached a finale with excellent sessions on airways, coagulation and regional anaesthesia. Anticipation mounted with the promise of glamour, mystery and Bond filling the twilight skies with the commencement of the gala dinner. Attended by 1000 delegates and their partners, social convenors Dr Charlotte Jorgensen and Dr Priya Thalayasingam outdid themselves in providing a night to remember; highlights include Professor Landau’s movie-inspired toast and Dr Alan (Evil) Millard’s entertaining mastering of the ceremonies. We were feeling a little nostalgic by the time the final morning rolled around. The meeting concluded in great style (and with a great turnout) with TRIAD’s Stevenson Carlebach delivering a session on the “neuroscience of negotiation” followed by a thought-provoking hypothetical session, chaired by medico-legal expert Dr Andrew Miller. The closing ceremony saw the College presidency handed over by Professor Kate Leslie to Dr Lindy Roberts, both of whom epitomise Dr Robert’s message of our College moving “from strength to strength”. Now, a few weeks later, the dust has settled and we haven’t had to allocate rooms for any business meetings, troubleshoot menu disasters, or massage any budget figures. We have had a chance to reflect on what a privilege it has been to help co-ordinate such an extraordinary event; how lucky we’ve been to have enjoyed the tremendous support and goodwill of attendees, facilitators, volunteers and exhibitors; and what a fantastic team of people we have had the pleasure to work with over the last few years. A huge and sincere thank you to you all. Dr Tanya Farrell and Dr David Vyse, Co-convenors, Perth ASM This page Clockwise from top: Perth ASM signage; Perth ASM Co-convenors Dr David Vyse and Dr Tanya Farrell; lunch in the healthcare industry area; the Opening Ceremony audience; view of the Opening Ceremony from the audio visual control area. Opposite page Clockwise from top: Question time in a plenary session; participants in the laryngoscope workshop; viewing an ePoster; Retired Fellows Lunch attendees. 14 ANZCA Bulletin June 2012 “Our aviator had a simple answer for the problem of fatigue – ‘Get more sleep!’ Scientific program hits the mark with interest and innovation The largest anaesthesia conference yet to be held in Perth, the 2012 ANZCA Annual Scientific Meeting offered 13 plenary presentations, 178 concurrent session presentations, 47 workshops, 42 small group discussions and QA sessions and 59 ePoster presentations. It was gratifying to receive a great deal of positive feedback about the scope and quality of the scientific program from both the overseas invited speakers and delegates, the few complaints from the latter relating to the fact that they could not attend all the sessions that attracted them! challenged and enriched our thinking in dealing with difficult conversations and the complexities of human behavioural responses. The other key factor lay in the exceptional quality of the presentations. All credit is due to the more than 250 presenters and facilitators, starting with our featured invited speakers – Professor Ruth Landau, Professor Patrick Wouters, Professor Henrik Kehlet, Professor Joseph Neal, Associate Professor Andrew Davidson and Dr Dan Bennett – and finishing with a outstanding hypothetical session hosted by Dr Andrew Miller, the medical equivalent of Geoffrey Robertson and Billy Connolly. Much of the success resulted from the diversity of the program, which deliberately included many speakers from other medical specialties and non-medical disciplines, including intensivists, cardiologists, haematologists, microbiologists, surgeons, maternal and fetal medicine specialists, paediatricians, scientists and pilots. In line with the theme of our meeting – Evolution: Grow, Develop, Thrive – we sought contributions from our invited speakers that covered new and developing areas of practice: pharmocogenetics, point-of-care monitoring, the application of ultrasound and echocardiography and advances in the management of acute and chronic pain. The Masterclass series met the needs of those wishing to update or learn about current best practice; the Patient Blood Management sessions covered both new science and the successful Western Australian initiative into improved perioperative care of anaemia and evidence-based blood transfusion practices; and the Harvard-based TRIAD group The program emphasised the importance of our training and non-technical skills, with lectures and workshops devoted to the new ANZCA curriculum, research, communication skills, simulation and welfare. Our aviator had a simple answer for the problem of fatigue – “Get more sleep”! and our negotiation counsellor had a similar message – “Listen”! The ANZCA ASM plays an important role in showcasing the growth of our understanding and knowledge through scientific endeavour. To this end, the Lennard Travers Professor, Associate Professor Andrew Davidson, clarified what is meant by “translation research” and the Gilbert Brown Prize session showcased our young achievers. These were complemented by the ANZCA Formal Project session, the Open Poster and Trainee Poster prizes; and the FPM Dean’s Prize and Free Paper session. Congratulations to respective ANZCA prize winners Dr Mary Hegarty, Dr Rohan Mahendran, Dr Paul Stewart and Dr Stanley Tay; and to the FPM Best Free Paper winner, Dr Sarika Kumar. The introduction of ePosters appeared well received and offers greater scope to presenters than the traditional poster format. Finally, we thank our colleagues who worked tirelessly to run a smooth meeting bursting with information and entertainment. Special mention goes to our amazing convenors, Dr Tanya Farrell and Dr David Vyse, and organising committee members Dr Soo Im Lim, Dr Liezel Bredenkamp, Dr Markus Schmidt and Dr Ed O’Loughlin, who were heavily involved in organising the scientific program. Clinical Professor Tomas Corcoran and Professor Michael Paech, Scientific Program Co-convenors 15 Pain medicine meeting shapes evolution of healthcare In a world where we are bombarded by negativity in the form of phrases such as “terrorism”, “global financial crisis”, “massacre”, “religious extremism”, “arms race”, “global warming”, “conflicts” and “power struggle”, one can take solace in occasions such as the recent 2012 ANZCA Annual Scientific Meeting, where the focus was “evolution”. Evolution encapsulates the very purposes of existence and unites all living things, including human beings, irrespective of genetic background, upbringing socioeconomic status, beliefs and occupation. Conceived by Charles Darwin and popularised by Richard Dawkins, the concept of evolution challenges us to think rather than to believe and to never cease to question. Pain medicine lends itself to the foundation of evolution, as all creatures will adapt to their environment to avoid and overcome pain. Pain, in an essence, drives us to better ourselves. In the 2012 ASM, the pain component was designed to introduce new concept and to ask the hard questions – What are we doing now? Is it working? How do we decide what direction we need to take? – by focusing on outcomes. The concepts were spearheaded by individuals who are the champions of asking these hard questions, including our invited speakers Dr Dan Bennett and Professor Henrick Kehlet. Such gatherings of dedicated scientists and visionaries alike represent a common ground of the desire to better ourselves and to engage in exchange of ideas without prodigious and bias, engaging in purposeful debate, to shape the future of pain medicine and the propagation and evolution of healthcare. Dr Max Majedi FPM Scientific Convenor Delegates raise $50,000 for Lifebox Delegates at the ASM raised $A46,142, including $A35,654 at the Gala Dinner, for the Lifebox charity through the ANZCA ASM Global Lifebox Initiative that ran throughout the meeting, Delegates were given a pledge form in their satchels that could be used to make donations and at the Gala Dinner, each table was given a pledge envelope and guests were encouraged throughout the evening to donate to the cause. The money will be used to buy pulse oximeters and education kits worth $US250. Each year, tens of thousands of lives are lost during surgery because operating rooms in many hospitals around the world don’t have this simple piece of equipment that is standard in Australia and New Zealand. An estimated 77,000 operating rooms in developing countries around the world don’t have access to pulse oximeters, putting at risk about 35 million patients each year. “Delegates at the ASM raised $A46,142, including $A35,654 at the Gala Dinner, for the Lifebox charity This page Clockwise from top: Dr David Jones with invited speaker, Dr Daniel Bennett; FPM new Fellows; Professor Henrik Kehlet presenting at an FPM session; (top) Dr Jones with FPM Free Paper winner Dr Sarika Kumar; (bottom) Immediate past Dean Dr David Jones with new Dean, Associate Professor Brendan Moore; Dr David Jones with invited speaker Professor Henrik Kehlet. Opposite page Clockwise from top: The College Ceremony; the College mace; a new Fellow is photographed; Robert Orton Medal winner, Dr Duncan Campbell; Orator, Associate Professor Kelvin Kong. 16 ANZCA Bulletin June 2012 Snapshot Full registrants: 1125 Day registrants: 68 Total attendees: 1782 New Fellows: 177 Sessions: 58 ePoster sessions: 6 Masterclass sessions: 12 Workshops: 47 Small group discussions (SGDs): 38 Quality assurance sessions: 4 Prize winners Robert Orton Medal Dr Duncan Campbell – For positively affecting the professional life of thousands of anaesthetists and the care of millions of patients by the invention of a fluidic ventilator that is widely known as “The Campbell Ventilator”. Gilbert Brown Prize Dr Mary Katherina Hegarty – “Does takehome analgesia improve post-operative pain after elective day case surgery? A comparison of hospital versus parentsupplied analgesia” ANZCA Formal Project Prize Dr Rohan David Mahendran – “Measuring cardiac output in the setting of different intra-abdominal and positive endexpiratory pressures: Comparison of trans-cardiac and trans-pulmonary thermodilution in a porcine model” ASM 2012 Open Poster Prize Dr Paul Anthony Stewart – “Ipsilateral comparison of acceleromyography and electromyography during recovery from non-depolarising neuromuscular blockade under general anaesthesia in humans” ASM 2012 Trainee Poster Prize Dr Stanley Tay – “Reduce volatile agent usage following introduction of Et-control system” Renton Prize Dr Katrina Pamela Pirie, May 2011 Dr On Yat Wong, September 2011 Cecil Gray Prize 2012 named lectures Mary Burnell Lecture Professor Ruth Landau (ANZCA ASM Visitor), Seattle, US – “Pharmacogenetics and anaesthesia: not yet ready for prime time?” Michael Cousins Lecture Dr Daniel Bennett (FPM ASM Visitor), Colorado, US – “Opiophobia, regulation and risk management: developments in the USA, a cautionary tale” Ellis Gillespie Lecture Professor Patrick Wouters (ANZCA WA Visitor), Ghent, Belgium – “The right ventricle: more than a passive conduit?” FPM WA Visitor Lecture Professor Henrik Kehlet (FPM WA Visitor), Copenhagen, Denmark – “Progression from acute to chronic pain: what do we know and need to know?” Australasian Visitors Lecture Associate Professor Andrew Davidson (Lennard Travers Professor), Victoria, Australia – “Translational research in anaesthesia” Regional Organising Committee Visitor’s Lecture Professor Joseph Neal (Western Australian Organising Committee Visitor), Seattle, US – “Ultrasound – guided regional anaesthesia: a game-changer or just steady progress?” Dr Jai Nair LePoer Darvall, May 2011 Dr Stuart Lachlan Hastings, September 2011 17 Spreading the ASM word Media activities occurred both internally and externally at the annual scientific meeting – via daily multimedia ASM E-Newsletters sent to meeting delegates and Fellows and trainees not at the ASM and through a very successful media program, which resulted in widespread coverage in print, on radio and TV in Australia and New Zealand. The ASM E-Newsletter was distributed on the Friday before the ASM started (on the FPM Refresher Course Day) and each day of the meeting including Wednesday, the final day. It featured a video interview with every keynote speaker plus audio recordings of each plenary lecture. Additional interviews with selected speakers also ran as well as photo galleries and media updates. All ASM E-Newsletters can be found on the ANZCA website under “Events/ANZCA annual scientific meetings”. A total of 347 ASM-related media reports mentioned ANZCA, reaching a potential cumulative audience of more than six million in Australia and New Zealand with a value of more than $700,000 in equivalent advertising dollars, according to a report from our media monitoring service, Media Monitors. Nine media releases were issued, resulting in interviews with 17 speakers. Highlights included coverage of neurotoxicity for newborns, a possible genetic link to anaesthesia awareness, an update on oxytocin, new data on pregnancy complications associated with extremely obese women, the use of hypnosis in pain management, and developments in artificial blood. The attendance of medical reporters from The Australian (News Ltd), The Age (Fairfax Media) and the Australian Associated Press wire service at the meeting resulted in 18 reports that were widely syndicated throughout Australia and New Zealand. This proved invaluable in terms of building our relationships with key media organisations not to mention raising the College’s profile – and that of anaesthesia and pain medicine – in the community. For more details, please see “ANZCA in the news” on page 60.. Clea Hincks General Manager, Communications ANZCA “media 347 ASM-related reports mentioned ANZCA, reaching a potential cumulative audience of more than six million Clockwise from top: Gala Dinner pre-dinner drinks; dancing at the Gala Dinner; more scenes from the Gala Dinner; the WA Regional Organising Committee. 18 ANZCA Bulletin June 2012 New Fellows’ Conference Leaders – born or made? Leadership earned or learned? These were just some of the questions we wanted to explore during the 2012 New Fellows’ Conference (NFC). “Team Leadership in Anaesthesia” took place on May 9-11, prior to the Perth ASM. Our aim was to put together a thoughtprovoking program, showcasing aspects of anaesthetic leadership outside the usual theatre setting and, in the process, providing delegates with some new skills and ideas about leadership. After gathering at the Perth Convention and Exhibition Centre, we had a three hour bus ride in the rain to the beautiful surrounds of Caves House in Yallingup, Western Australia. To get tired legs moving, and to get to know each other, our first session was a series of team challenges. Figuring out the strengths and weaknesses in our teams to solve the various puzzles culminated in the teams having to cross an imaginary crocodile-infested ravine with two short planks, two milk crates and an iron bar. Everyone made it out alive to the other side. The “time machine challenge” record time previously set by the AFL Eagles team was well and truly smashed by our anaesthetists, a feat to remember by all. This was followed by a relaxed sundowner, which included a wine tasting run by Howard Park Winery, before an informal sit-down dinner in front of a roaring fireplace strengthening new acquaintances. Our second day commenced with early morning jogging and swimming for the superfit. The next workshop, presented by Anveeta Shrivastava and Wynand Hamman from Deloitte Consulting, took us through understanding cognitive types, and how individuals respond to different motivators and inspirations. We were able to type ourselves into the four categories of the Hermann-Brain Dominance Instrument, which were colour-coded, resulting in the group referring themselves by their “colour” for the remainder of the conference. After a scenario role play, we learnt about leadership and followership archetypes, and how an understanding of these allows for successful team interactions. This stimulating workshop was followed in the afternoon by an interactive panel discussion session, with the aim of debating issues requiring anaesthesia leadership outside the theatre environment. Our esteemed panel consisted of Dr Mary Pinder, FICM Examinations Chair, Dr Justin Burke, New Fellows’ Councillor, Dr Prani Shrivastava, Welfare SIG Chair, Dr David Scott, ANZCA councillor and councillor in residence at the 2012 NFC and Dr Emily Wilcox, the representative from the 2011 NFC. Topics covered included how we deal with being a role model, a position of unconscious and unchosen leadership (leading to a discussion thread on the need to improve mentoring of new Fellows); how we deal with ethical issues arising from our responsibilities to act in our patients’ best interest and be nice to our surgical colleagues; and whether we have created unrealistic expectations in the community regarding the role of the anaesthetist. This was successful in stimulating debate and discussion, which continued after David Scott’s talk relating the journey of his involvement in the College, into the Conference Dinner held at Cullen’s Winery. Cullen’s Winery is a renowned organic winery in the region, with a long association with the medical community. Dinner was one of the highlights of the meeting, with a short talk from Vanya Cullen, Chief Winemaker at Cullen’s, showcasing leadership in the winemaking industry with their sustainable biodynamic cultivation. A special tasting of some of their premium wines pre-empted a fantastic meal showcasing local produce. Nearly everyone made it out of bed in time the next morning for Mary Pinder’s workshop on debriefing after medical disaster. This involved small groups working together on various hypothetical scenarios to identify issues and learning how to design a debriefing plan. After concluding the conference with the election of a representative for next year’s NFC, we embarked on the bus trip back to Perth, with many noisy and excited conversations taking place among new friends and associates across the Australasian regions. Dr Angeline Lee Dr Irina Kurowski New Fellows Conference Co-convenors Above from left: New Fellows Conference delegates; Teamwork was needed to cross the (imaginary) “crocodile-infested ravine”. 19 ANZCA’s revised training program How the new primary examination will work General overview The broad aim of the new primary examination is to provide an integrated approach to learning. While the candidate will still be learning about individual topics via the reference texts, the examination process, especially with regard to the oral examination, will not specifically aim to examine individual subject areas in isolation. Rather the examination will aim to present candidates with a broad range of questions covering the scope of the various major topics. The exam can no longer be thought of as being distinct subject areas that will be examined individually. Subsequently, there will be no “passing” of individual subject areas possible in the new exam. A satisfactory performance in the examination overall is needed to ensure a pass in the primary examination. The allocation of marks will remain as it is now with the written and oral sections each worth 50 per cent toward the final mark. Eligibility to sit One of the crucial changes will be that only trainees occupying accredited training posts, who have completed six months of anaesthetic training, will be allowed to sit the primary examination. This will make the exam process much more relevant for candidates since, in the past, no experience in anaesthesia was required. This meant examiners had to be very cautious in framing questions so they did not have a specific clinical anaesthetic focus to ensure no candidate was disadvantaged. Now that has changed and questions will tend to have a more clinical focus wherever possible. That does not mean the examination is changing focus – it is not – it will remain an assessment of basic sciences applicable to the conduct of clinical anaesthesia and pain management. Syllabus in general The examination team has been through the new learning objectives, which are collected together in appendix three of the master curriculum document (found at www.anzca.edu.au/trainees/ 20 ANZCA Bulletin June 2012 curriculum-revision-2013) and matched them to the old primary examination syllabus. Statistics have been removed from the new curriculum, although the format in which they are to be assessed is still to be determined. There have been other minor changes but, in general terms, most of the other components of the old primary examination syllabus have been translated into the new learning objectives. There has been additional material added in the form of about 30 learning objectives dealing with anatomy, equipment and safety. These have been transferred, as it were, from the final examination program and are all appropriate for early year trainees. While this extra material may at first seem daunting, it is all very applicable to the conduct of anaesthesia and mirrors many of the procedures that basic trainees will be involved in. Written The written component, consisting of a multiple-choice question paper and a short-answer question paper, will remain. However, the format will change to bring it in line with the style of the final examination and consist of a single multiple-choice question paper of 150 items, and a single short-answer question paper of 15 questions. Each of these will cover physiology, pharmacology, clinical measurement, safety, anatomy and equipment. In order to be invited to the oral examination, the candidate must achieve a minimum of 40 per cent in each paper. Oral This is where the major changes will occur. To start, there will be three vivas, each with two examiners lasting 20 minutes each. While this may appear to candidates as making life even harder than before, in fact, the opposite is the case. By having three vivas, each of which will cover four subject areas, the candidate will have a chance to talk about 12 different topics. This change is necessary in order to assess the additional material that has been added to the learning objectives while, at the same time, maintaining the depth of knowledge needed. It also means that if a candidate performs poorly in one, or even two topic areas, there is still a good chance of being able to pass the vivas overall. Each viva will be integrated in format. The material being covered in the vivas will be examined in detail each day to ensure that candidates are being assessed on a wide range of topics and the candidate is not being re-assessed on the same material during the different viva sessions. Each of the vivas will differ in content. While the vivas will indeed be “integrated”, there should be no expectation that each viva will contain equal amounts of material from all parts of the syllabus. Indeed some vivas may have a leaning towards one broad aspect, such as physiology with some questions on other learning objectives included throughout, while others may be broader, for example covering pharmacology, physiology and anatomy topics in the one viva. Resources and feedback One of the strengths of the primary examination has been that examinable material has always been based on the objectives provided in a syllabus (or what are now learning objectives) coupled with a prescribed set of recommended texts. Every question asked in the primary examination must have a direct reference back to one of the recommended texts. This will continue into the new primary examination. The list of recommended texts will soon be published on the College website, once approval has been obtained. It is also our intention to post on the website a selection of integrated viva questions, written by the current examination panel, which can be used for practise in trial viva settings, so candidates can get a feel for the new oral examination format. Lastly, the Primary Examination Sub-Committee is aware that the College has placed a limit on the number of attempts that may be made to sit the primary examination. We are looking at ways to provide high quality feedback to unsuccessful candidates so they can improve their performance in subsequent attempts. Associate Professor Ross MacPherson Chairman, Primary Examination Sub-Committee ANZCA Curriculum Revision 2013 Sample viva questions for the new format primary examination A number of sample viva questions have been written by members of the Primary Examination Sub-Committee. These questions are available on the College website in the Curriculum Revision 2013 section - www. anzca.edu.au/trainees/curriculumrevision-2013. The viva questions are designed to give candidates some practice in the type of integrated vivas that will be used in the new primary examination. The best way to utilise the sample questions when preparing for the examination is outlined online. The College aims to increase the number of sample questions over time. Fundamental to anaesthesia: the ANZCA Clinical Fundamentals Among a number of innovations in ANZCA Curriculum Revision 2013 will be the introduction of seven ANZCA Clinical Fundamentals. These fundamentals have been developed to define the range of clinical knowledge and skills required for specialist anaesthetic practice, and will be taught and experienced throughout the curriculum, particularly within the first four years of training, in parallel with the ANZCA Roles in Practice. The seven ANZCA Clinical Fundamentals consist of: • General anaesthesia and sedation. • Airway management. • Regional and local anaesthesia. • Perioperative medicine. • Pain medicine. • Resuscitation, trauma and crisis management. • Safety and quality in anaesthetic practice. These areas define the fundamental aspects of anaesthetic practice, and clearly indicate the major areas of expertise that are required by all anaesthetists for specialist practice as an anaesthetist regardless of the clinical areas in which they work. The specific learning outcomes, expected to be achieved for these ANZCA Clinical Fundamentals, have been defined and grouped to the various periods of training (introductory, basic and advanced training) where they build from basic knowledge and skills to more advanced levels as the trainee progresses. Log on to the ANZCA website to read more about these learning outcomes: www.anzca.edu.au/trainees/curriculumrevision-2013/pdfs/anaesthesia-trainingprogram-curriculum.pdf. The development of the ANZCA Clinical Fundamentals derived from a desire to define more accurately the core elements that make up and distinguish the practice of anaesthesia regardless of the areas in which anaesthetists work. “No longer is (pain medicine) a subject to be ticked as Module 10 and forgotten!” Past emphasis on surgery Previously, considerable emphasis had been placed on describing anaesthesia according to the surgery for which it is used. This has under-emphasised many important expert contributions made by anaesthetists to other areas of medicine, as well as failing to recognise the universal application of many aspects of anaesthetic knowledge and skills. Airway management Airway management is a good example of where all branches of medicine readily acknowledge the pre-eminence of anaesthetic skills and knowledge. Training and education in airway management in the revised curriculum will no longer be somewhat haphazard by “association” with anaesthesia for surgery. As a clinical fundamental it will become the focus of the training itself. The curriculum review undertaken in 2008-10 recommended that there be improved emphasis on other core areas of anaesthesia, including perioperative medicine, pain medicine and regional anaesthesia. These areas were perceived to be under-represented in the training program. This particularly applies to perioperative medicine and to pain medicine. Pain medicine In the existing ANZCA curriculum, pain medicine was included as a specific module (10), which could be experienced as a single block of activity, as well as a component of another module (1). It was commonly not perceived by trainees as being integral to their training as anaesthetists. By incorporating pain medicine as an ANZCA Clinical Fundamental, the revised curriculum emphasises the intrinsic importance of pain medicine to all activities undertaken by anaesthetists. It thus demonstrates that the knowledge and skills of pain management are learned and applied across the whole training period and cannot be studied in isolation. (continued next page) 21 ANZCA’s revised training program continued No longer is it a subject to be ticked as Module 10 and forgotten! The importance of early, adequate and ongoing management of acute pain to minimise the development of chronic pain syndromes must be integral to every anaesthetic; and the ability to provide the best clinical care for chronic pain patients who need concurrent therapy through the perioperative period is essential. Perioperative medicine Similarly, perioperative medicine is emphasised throughout training to enable the whole patient to be managed as part of the perioperative process, and not just to be swotted up for the final examination! This ability to assess and medically manage patients throughout the perioperative period is what provides the most compelling argument as to why anaesthesia is best managed by medical graduates. Regional anaesthesia Patients will benefit from recognition in the revised curriculum that regional anaesthesia is a very important alternative or adjunct to general anaesthesia in many areas of practice. The advent of good compact ultrasound imaging has improved the safe application of regional anaesthesia, and this technology has helped in the resurgence of this form of anaesthesia, which has considerable benefits for the perioperative care of patients. Crisis management Anaesthetists have been integral to the development of the team management of the critically ill, especially in advanced life support and trauma teams. Anaesthesia itself can be associated with the management of life-threatening crises such as anaphylaxis and malignant hyperthermia. The knowledge and skills required of anaesthetists to manage the crises that may occur in their practice, and to contribute to the team management of the critically ill have been defined in the resuscitation, trauma and crisis management fundamental. Safety and quality in anaesthetic practice The issues of safety and quality in anaesthetic practice have not previously been gathered together and highlighted for training, though anaesthetists have for over 60 years led the medical profession in these aspects of practice. Anaesthetists were the first to systematically investigate deaths that may have been due to their own clinical management of the patients; anaesthetists were also the first to introduce knowledge generated from aviation experience to improve crisis management and implement safety algorithms; and similarly anaesthetists were the first within the medical profession to use high fidelity team simulation exercises to improve the safety and high quality of anaesthetic delivery. It is appropriate to acknowledge this role in anaesthetic practice by introducing the safety and quality in anaesthetic practice fundamental. Thus the ANZCA Clinical Fundamentals were developed to expand on areas where there were perceived deficiencies in the 2004 curriculum. Most importantly, they focus the attention of trainees, supervisors, Fellows and other Colleges on the main areas where anaesthetists are trained and educated to be clinical leaders. Tutors To implement these clinical fundamentals, the College plans to have clinical fundamental tutors within teaching departments for each ANZCA Clinical Fundamental. In small departments, some Fellows may need to tutor more than one fundamental. We hope that there are enthusiastic anaesthetists with particular interests and expertise for each of the ANZCA Clinical Fundamentals in each department. These tutors will lead the way in making the learning experience for trainees satisfying and educational. Above all, they will support their trainees so that they obtain the best possible clinical experience to develop essential knowledge and skills in these clinical fundamentals. This support may require greater opportunity for regional anaesthesia in hospitals where this activity is not strong; the development of simulation situations, for example, for specific rare airway management scenarios; improved perioperative assessment procedures prior to and following anaesthesia; and carefully supervised acute pain rounds with strengthened links to services for patients with persisting pain. Enhanced curriculum There are many challenges in developing the full potential of these ANZCA Clinical Fundamentals, but the enthusiasm that Fellows have displayed for this concept means we are confident this initiative will considerably enhance the curriculum. The ANZCA Council is extremely proud and excited to be part of the delivery of ANZCA Curriculum Revision 2013 with its innovative ANZCA Clinical Fundamentals. We believe it will enhance considerably the training and education of our trainees. Professor Barry Baker Dean of Education, ANZCA 22 ANZCA Bulletin June 2012 OTSAN Supporting anaesthetists from abroad to achieve fellowship in Australia The Overseas Trained Specialist Anaesthetists’ Network (OTSAN) assists international medical graduate specialist (IMGS) anaesthetists in their quest to start a successful life in Australia. OTSAN was established by Fellows who have passed ANZCA’s professional accreditation process. It supports international medical graduate specialists through many facets of the process, including education and social networking as well as liaising with national and local structures and industrial relations. Join us in Melbourne on 14 & 15 July for our first ever ‘Exam Boot Camp’. During this 2-day workshop you will learn ‘correct exam technique’ as well as participate in mock medical clinical and anaesthesia vivas. For information see our website www.otsan.org or contact Renee McNamara ([email protected]). Our website also offers a virtual meeting place to help IMGS anaesthetists overcome social and educational isolation. It supplements OTSAN activities such as meetings and workshops. The Australian and New Zealand College of Anaesthetists has received Australian Government funding under the Specialist Training Program. This funding will be used to support the activities of OTSAN. Chair of the Scholar Role Panel An exciting opportunity is available for an ANZCA Fellow of high standing to take a leadership role in the development of research and teaching within the ANZCA Training Program. The Chair of the Scholar Role Panel will lead a key committee of 20 Fellows appointed to develop, assess and evaluate the scholar role activities in the revised 2013 ANZCA curriculum. The scholar role activities include teaching skills: critical appraisal and evidence-based practice; audit research manuscripts; and relevant post-graduate programs. The Scholar Role Panel will make assessment decisions on formal audit reports, research manuscripts and on the suitability of postgraduate study proposals. The panel will have at least one face-to-face meeting per year and three teleconference meetings. The Chair will fulfil the following criteria: • Hold a FANZCA or equivalent. • Be appropriately qualified and experienced to assess the learning outcomes of the scholar role activities. • Have enthusiasm, credibility and commitment. • Demonstrate leadership abilities. For an outline of scholar role activities, the terms of reference of the Scholar Role Panel and the roles and responsibilities of ANZCA chairs of committees and subcommittees please contact Daniela Doblanovic ([email protected]). For any other inquiries please contact Associate Professor Jennifer Weller ([email protected]). The Chair will sit on the Assessments Committee and contribute to the overall assessment strategy of ANZCA. The Assessments Committee meets three times a year in Melbourne and reports to the Education and Training Committee. 23 A mad idea – or several – is just what the doctor ordered Dr Duncan Campbell proves ageing is no barrier to a lifetime of medical innovation. He spoke to Meaghan Shaw. Remarkably, Dr Duncan Campbell, 81, who nearly 40 years ago invented the Campbell ventilator which became the standard for hospitals around Australia and New Zealand, is still inventing. In January this year, he took out a patent for a non-invasive cardiac output monitor that can determine cardiac output using optical sensors. It’s the latest in a stream of inventions by the indefatigable octogenarian, who last month was presented with the Robert Orton Medal at the ANZCA Annual Scientific Meeting in Perth for his contribution to anaesthesia, in particular for the invention of his eponymous ventilator. “I thought they had forgotten about me long ago!” was his initial response when learning he was to be honoured. With a wry sense of humour and turn of phrase, Dr Campbell recounts a remarkable life from a childhood in Iran and India, to serving in the army during the Malayan Emergency, working with IVF and laparoscopy pioneer Dr Patrick Steptoe, and creating a series of anaesthetic-related innovations. An interest in the wireless at a young age, and a desire to take things apart to see how they worked, perhaps can be seen as the spark that set off his passion for invention. He was conceived in India, born in Britain, and spent his infancy in India and early years in Iran, where his Scottish father was the vice consul. Incredibly, he knows the date of his conception because his mother, from Yorkshire, was quite the correspondent and wrote to a friend the day he was conceived saying: “Today, I started Duncan”. His earliest memories are from Zahedan, Iran, near the border of Pakistan and Afghanistan, where his father once fired a revolver into the air to frighten an intruder in the dead of the night. 24 ANZCA Bulletin June 2012 “The anaesthetists were wandering around having a whale of a time, chatting to everybody and laughing. And I thought perhaps that’s the life!” He recalls the intruder tearing around the compound in distress because his accomplice, waiting on the consular wall to pull him up with a rope, disappeared at the sound of gunshots, taking the rope with him. By the beginning of World War II, Dr Campbell was back in Britain and educated in London, the Lake District and the Kings School in Canterbury, before delaying national service by studying for an intermediate bachelor of science degree in agriculture – an interest prompted by his parents running a farm. His agricultural studies led to a desire to study medicine – his father was delighted – and his first job after qualifying was as a house surgeon at Charing Cross Hospital, where he contemplated his future. “I didn’t really relish the idea of going into general practice,” he recalls. “I thought something hospital orientated would be more interesting. And I was always intrigued by the fact that while I was stuck holding retractors and things for the surgeons, the anaesthetists were wandering around having a whale of a time, chatting to everybody and laughing. And I thought perhaps that’s the life!” At his second house job at the Metropolitan Hospital, London, Dr Campbell became friendly with the registrar anaesthetist who took him under his wing until the registrar had a confrontation with the night porter and was dismissed. “He was marched in front of the administrator who said, ‘Good night porters are far more difficult to get than anaesthetists. Goodbye!’” Dr Campbell says, saddened at the memory. His second attempt to defer national service failed when he told the army board the reason was to study anaesthetics. “They laughed and laughed and said, ‘The army’s short of anaesthetists. You’ll have no trouble at all getting an anaesthetic job in the army. Off you go.’” Doubtful he’d be posted as a trainee anaesthetist anywhere more exotic than the north of Scotland, Dr Campbell suggested the Far East and ended up in Singapore, where he was also appointed blood transfusion officer. His ploy to encourage commanding officers and adjutants to set an example and give blood proved highly effective as well as entertaining for the troops. After only a year’s training, he was promoted to captain, graded clinical officer in anaesthetics and sent as the sole anaesthetist to the Kluang military hospital in (then) Malaya, about 120 kilometres north of Singapore. “The parting words were, ‘We’re only a phone call away’, which wasn’t much help,” he says. In Kluang, Dr Campbell met his wife, Mary, who was a nursing sister at the military hospital. They subsequently had two sons – one of whom is an anaesthetist and the other a dentist. Kluang was also where he played his part in a hospital-inspired truce between the British and communist terrorists, which perhaps led to a cessation of hostilities in that area. At that time, injured terrorists who were sent to the civilian hospital didn’t survive the night because the locals detested them so much they slit their throats. As part of a goodwill gesture, the military hospital started taking problem cases from the civilian hospital, including the terrorists. The first time this happened, only Dr Campbell and the surgeon were on duty. Short of staff and wards, they patched up the unarmed terrorists, and sent them to share the ward where the British were recovering. The terrorists were astonished to wake up as they expected to be given a lethal injection and were discovered the next day by the returning commanding officer playing a card game, pontoon, with the injured British soldiers. Dr Campbell says the terrorists were reluctant to return to their jungle units after their recovery and apparently told their comrades they didn’t want to fight the British, who had become their friends. “And do you know, there was one other skirmish when another lot of terrorists came in and after that, none. Absolutely nothing. We never had any more terrorists,” he says. “And I wonder very much whether it was to a large extent associated with the fact that we actually demoralised them with our treatment.” Returning to England, Dr Campbell did his formal anaesthetic training after which, for interview practice, he applied for a job as an anaesthetist in charge of the anaesthetic services for the Oldham group of hospitals on the outskirts of Manchester. “So absolutely blasé, I went up for this interview,” Dr Campbell recalls, expecting to be roasted for wasting the interview panel’s time by applying for such a senior job when he wasn’t even a consultant. At the interview, he was asked by panelist Dr Patrick Steptoe what he knew about pneumoperitoneum and if he, like other anaesthetists, would be worried about pushing gas into the peritoneal cavity. “I said, ‘Well I’d be worried if it was air, but if it was carbon dioxide or oxygen, I’d be quite happy because you wouldn’t get an air embolus with that,’” he replied. (continued next page) “An interest in the wireless at a young age, and a desire to take things apart to see how they worked, perhaps can be seen as the spark that set off his passion for invention.” Opposite page from left: Dr Duncan Campbell; Dr Campbell and his son, Dr David Campbell, who was presented as a Fellow at the Perth ASM; and Dr Campbell inspecting the latest ventilators at the Ulco stand at the Perth ASM. 25 A mad idea – or several – is just what the doctor ordered continued Astonished to get the job, he worked alongside Dr Steptoe as the specialist developed the technique of laparoscopy. Dr Campbell was still working at the hospital as Dr Steptoe began procuring human eggs from ovaries using a laparoscope, a precursor to IVF treatment, but moved to Australia nearly a decade before the first live birth in 1978. Living along the Pennines, where it gets cold, wet and windy, Dr Campbell got fed up with the miserable weather. One day, having dug out the snow that had blocked his driveway and garage, only to have the wind fill it up again, he turned to his wife and said: “Mary, where can we go where it doesn’t snow?” Her response was “What about Australia?” and a glance through the British Medical Journal revealed an anaesthetic staff specialist job advertised at the Royal Prince Alfred Hospital in Sydney. He got the job and moved in 1969. One of his first duties was to design an anaesthetic tray that could store the daily supply of anaesthetic ampoules. Flicking through the Yellow Pages, he found an advertisement for Ulco Engineering, which made specials to order and was willing to do medical work. They took on the production of the anaesthetic tray, and so began Dr Campbell’s long and productive association with the company and its managing director, John Uhlir. His next invention was a pneumatic lifting trolley, operated by two carbon dioxide cylinders, which could lift patients off the bed, transport them, and lower them onto the operating table. It could tilt patients up and down, and also had a radiotranslucent sheet to enable X-rays to be taken. Ulco made a prototype, trials were conducted and a few were sold to Australian hospitals, but demand and profit margins were low and production ceased. But his next invention hit the jackpot. For some time, even before he came to Australia, Dr Campbell had been frustrated with the ventilators available and wanted to design a robust and versatile ventilator for theatre use that could be used on all ages, with the parameters – pressure, volume, flow and time – all controlled by the anaesthetist. First he needed to find an alternative 26 ANZCA Bulletin June 2012 McKr Scan LR to an electronic control system as, at that time, there was considerable concern about the dangers of micro and macro shock in the operating theatre, as well as possible explosive hazards from flammable anaesthetics. His breakthrough came when, literally inspired by rocket science, he learnt that long-range rockets used a system of fluidic controls to withstand severe vibrations and magnetic forces. Having sourced through Ulco some miniature fluidic control modules, in 1973 Dr Campbell made his first prototype. “It took up a lot of space with a mass of spaghetti-like tubing connecting the various components, but it worked,” he says. He crammed all the workings into a plastic lunch box and took it to Ulco and various manufacturing companies to gauge their interest. Commonwealth Industrial Gases (CIG) was tempted and said they’d get back to him. He’s still waiting. The main obstacle to production was that the mass of tubes made assembly too complicated. But inspired by transistor radios, where all the wiring was replaced by circuit boards, he designed a template so that channels could be engraved on a board for mounting the fluidic elements. The channels could then be sealed with a back plate to eliminate connecting errors. He returned to Ulco and Mr Uhlir was hesitant but said he would make a prototype for $1100 – a substantial amount of money – during the company’s quieter periods. “I scratched my head and thought about it, and said, ‘Ok’,” Dr Campbell recalls. With the manufacture of the first machine under way, he went to the Australian Society of Anaesthetists’ (ASA) meeting in Hobart in 1974 to present a paper on the ventilator. On the plane back to Sydney, he sat beside Dr John Keneally, who was working at the Children’s Hospital, then at Camperdown. He was interested in a ventilator that was suitable for both children and adults. “I said, ‘We’re making it so that it’ll ventilate anything from a mouse up to an elephant’,” Dr Campbell says. Unknown to him, Ulco was captured by his enthusiasm and made a second machine at the same time as the first, which was completed in April 1975. The first was used by Dr Campbell and has since been donated to the ASA’s Harry Daly Museum. The second was trialed and then sold to the Children’s Hospital. Associate Professor Greg Knoblanche was then a registrar at the Children’s Hospital and the Royal North Shore. He told Royal North Shore’s director of anaesthetics Dr Ted Morgan about the ventilator, and the hospital promptly ordered four. The Children’s Hospital bought another, and the soon-to-beopened Baulkham Hills Private Hospital also bought four. “All without any advertising at all,” Dr Campbell proudly explains. His description of the ventilator was published in Anaesthesia and Intensive Care in February 1976. Improvements were made to the ventilator over the years: negative expiratory pressure was eliminated as it was never used; the bellows configuration was changed from hanging to rising; a disconnect alarm was incorporated; and the fluidic controls were replaced by improved and more manageable electronics with a visual display. The absence of mechanical moving parts, precision engineering and attention to detail resulted in a ventilator with longterm reliability and legendary success. By the time Mr Uhlir retired and sold the company in 2003, more than 3400 of the ventilators, including the updated electronically controlled EV500, which is still affectionately known as the Campbell ventilator, had been made and sold. A recent inquiry to the company revealed the figure is now more than 4000 and, despite a trend toward integrated anaesthesia machines and ventilators, they’re still being sold, with more than 1000 units still in use in Australia, New Zealand, throughout the Asia Pacific, the Middle East, Africa and Greece. Spin-offs included a horse ventilator; an anti-DVT system using an inflatable sleeve to perfuse legs, which was not commercially viable; a kidney perfusing system, which was successful until research showed kidneys left on ice did better than perfused kidneys; a system for measuring airways resistance; a new ventilator alarm giving almost immediate indication of a disconnect; and a project for recycling volatile anaesthetics for hospitals. His last project with Ulco was for a system of working out cardiac output, but Mr Uhlir reluctantly pulled the plug on the proposal because he was selling the company and the project would take a further two-to-three years to get to market. Dr Campbell sold the patent for the system to Edwards Laboratories in the US. But he kept thinking about it. “At the back of my mind I was always a bit worried about the fact that this was an invasive procedure requiring arterial cannulation in order to get cardiac output. And I suddenly realised that it could be done entirely non-invasively. You could do it optically, with optical sensors. I tried it out, and it worked.” He took out a new patent in January and the project is in the pipeline, but he’s wary about talking about it because he thinks people will say he’s mad – although he’s used to that. “They told me I was pretty mad about the ventilator,” he recounts. “I said, ‘I’m going to have a ventilator with no moving parts whatsoever’. They said, ‘Oh, you’re mad’. I said, ‘No. There will be not a single mechanical moving part’. They said, ‘How will it work?’ I said, ‘Very nicely!’” Meaghan Shaw Media Manager, ANZCA “The absence of mechanical moving parts, precision engineering and attention to detail resulted in a ventilator with long-term reliability and legendary success.” Opposite page: A younger Dr Duncan Campbell with a Campbell ventilator. This page: Dr Campbell taking possession of the first Campbell ventilator. 27 ANZCA contribution helps improve patient care in Papua New Guinea The Overseas Aid Committee is working to assist the delivery and quality of anaesthetic services in Papua New Guinea (PNG), writes Meaghan Shaw. Papua New Guinea has so few anaesthetists you can count them. There are only 15 consultant anaesthetists working in government hospitals, for a population of seven million. In addition, there are about 100 nonmedical trained anaesthetic scientific officers providing the rest of the country’s anaesthetic services. Coupled with health spending of about $A50 per person and a paucity of basic anaesthetic equipment and drugs, the contrast with Australia and New Zealand couldn’t be starker. For Dr Lisa Akelisi-Yockopua, one of PNG’s few consultant anaesthetists, a recent visit to Perth’s annual scientific meeting was an “eye opener”, giving her an insight into the latest anaesthetic advances and exposing her to an array of new equipment in the healthcare industry exhibition area. “Obviously we do need a lot of equipment up in Port Moresby,” she says at the Perth meeting. “Seeing the display of different equipment here, it’s like, ‘Oh, wow. It’s so different’.” 28 ANZCA Bulletin June 2012 Dr Akelisi-Yockopua is in her second year out of training and came to Australia as a guest of ANZCA’s Overseas Aid Committee. She has been selected for the ANZCA International Scholarship and is hoping to pass her English language test soon so she can come back to Australia and work with Adelaide anaesthetist, Dr Chris Acott, who specialises in head and neck surgery. She also wants to specialise in anaesthesia for head and neck surgery – an area of need in PNG, which has a high incidence of head and neck cancer due to betel nut chewing and smoking. PNG also has other developing country health problems such as chronic tuberculosis, leprosy and HIV. The sessions Dr Akelisi-Yockopua attended at the ASM – including a resuscitation update, difficult airway session, updates on opioids and reversal drugs, and a fibreoptic intubation workshop – were incredibly useful. “I just can’t express how appreciative I am,” she says. “This is a great opportunity for any of us who haven’t been to such a conference. It will be very nice for my other colleagues who (can learn from me). I’m very fortunate to come to this conference where I’m exposed to so many things which I didn’t expect, and also meeting up with the other consultants from overseas.” Since 1993, ANZCA has been involved with training in PNG through the efforts of Professor Garry Phillips and a PNG senior lecturer in anaesthesia, Dr Harry Aigeeleng. This has included funding two educational visits to PNG each year, at the invitation of the University of PNG. Dr Michael Stone, from the Royal Prince Alfred and St Vincent’s hospitals in Sydney, went to PNG earlier this year for a week to train the anaesthetic scientific officers and anaesthetic registrars. The anaesthetic scientific officers typically start their careers organising equipment for anaesthetists and doing general cleaning duties before undertaking a one-year diploma in anaesthetic science. Often they have a nursing background. They provide the bulk of the anaesthetic services in the country, especially in the provincial hospitals. The anaesthetic registrars undertake a four-year masters in medicine course to become consultant anaesthetists. Dr Stone provided tutorials and lectures on subjects such as airway skills, rapid sequence induction, failed intubation, defibrillation, advanced life support, paediatric syndromes and crisis management, aided by mannequins donated by the College. It’s the second trip to PNG for Dr Stone, who was encouraged to do the teaching visit by new Overseas Aid Committee Chair, Dr Michael Cooper, who had previously taken part. Both were partly inspired to work in PNG having been to school with native Papua New Guineans. Dr Stone says of the 100 kina (about $A50) per capita spent on health each year by the PNG government, only a miniscule amount ends up in the anaesthetic budget. “Consequently, there is a shortage of simple things like drugs such as suxamethonium and analgesics; halothane is the only volatile anaesthetic agent; there’s shortages of simple equipment like spinal needles, so spinal anaesthesia is provided using a standard cannula to give a spinal injection; and the gas supply runs out frequently,” he says. Coupled with this, the standard of secondary school education in PNG is lower than Australia, mortality rates are high, and any death can potentially lead to the risk of payback from disgruntled relatives due to the country’s strong wantok system of allegiance and obligation to extended family. Given this, Dr Stone is impressed with the students who he finds to be conscientious, motivated and hard working. “They make up for educational and resource deficits through enthusiasm,” he says. “I take my hat off to them that, despite working under incredibly difficult circumstances and often having high anaesthetic morbidity and mortality, they still come back to work each day and continue to work hard for their patients and the community.” A former chairman of the Overseas Aid Committee, Dr Wayne Morriss, says ANZCA supports a range of initiatives for PNG, with the other annual educational trip to PNG undertaken by fellow committee member Dr Roni Krieser, who provides basic science teaching for trainee medical anaesthetists. In addition, ANZCA helps organise an anaesthetic refresher course in Port Moresby in September every second year, when a large proportion of anaesthetic staff from PNG can gather in one place. At the upcoming course this year, the committee will distribute about 40 Lifebox pulse oximeters provided through a $10,000 ANZCA donation to the Lifebox initiative, which provides low-cost oxygen monitors to developing countries, alongside associated resources and training to raise the safety of surgery. ANZCA also will provide about 40 packs of textbooks and electronic learning resources sourced by Dr Cooper as part of ANZCA’s educational initiative. A further 10 packs will be distributed to other developing countries supported by ANZCA. “For a small investment, we can make quite large changes in anaesthetic practice, patient safety, all these things.” Above from left: Dr Lisa Akelisi-Yockopua, from Port Moresby, who came to Australia and attended the ASM as a guest of the Overseas Aid Committee; Port Moresby General Hospital; Training in PNG; A tray of drugs. 29 ANZCA contribution helps improve patient care in Papua New Guinea continued Dr Morriss says small donations of this kind can help reduce the gap between anaesthetic practice in Australia and New Zealand, and our closest neighbours, such as PNG. “For relatively little expenditure or little resource, we can make a huge benefit,” he says. “We work very hard to get maximum bang for buck. So for a small investment, we can make quite large changes in anaesthetic practice, patient safety, all these things.” Beyond PNG, the committee is also looking at overseas development opportunities in other countries. This includes a new initiative, the inaugural ANZCA Overseas Aid Trainee Scholarship, which was recently awarded to Dr Steven Smith from the Mater Mothers’ Hospital in Brisbane. This scholarship provides support for a final year ANZCA trainee to accompany a visiting team to a developing country and improve their knowledge and understanding of the challenges of providing anaesthesia and pain medicine in the developing world. Dr Smith plans to visit Vanuatu later this year. The committee also supports the teaching of the Essential Pain Management course, which aims to improve knowledge of pain in developing countries, provide a simple framework for managing pain, and explore ways of overcoming local barriers which include lack of staff, inadequate pain knowledge and the scarcity or absence of analgesic drugs. 30 ANZCA Bulletin June 2012 The course was developed and piloted by former Faculty of Pain Medicine dean Dr Roger Goucke and Dr Morriss in PNG in 2010, and has been taught in Fiji, the Solomon Islands, Vanuatu, Micronesia, Cook Islands, Mongolia, Vietnam, Rwanda and Tanzania, with plans to introduce it to Spanish-speaking Central America later this year and other parts of Asia. It has been translated into Mongolian, Vietnamese and Spanish. Dr Morriss says the Essential Pain Management course is an example of starting with important principles and building on the basics of practice. “The message of the course is extremely simple so that facilitates early hand-over to local instructors,” he says. “But the course is also very flexible so people can layer on as much complexity as they like.” Overall, he says the Overseas Aid Committee has achieved a lot in its two years of operation, ensuring ANZCA is “an outward-looking rather than inwardlooking College” and providing benefits for all areas of the College. “It increases the relevance and profile of the College internationally and ensures people are gaining skills from an anaesthetic and teaching point of view,” Dr Morriss says. “From an individual point of view, people often do it for altruistic reasons. And, from a regional point of view, we think that it’s also good to be good neighbours.” Meaghan Shaw Media Manager, ANZCA “We work very hard to get maximum bang for buck. So for a small investment, we can make quite large changes in anaesthetic practice, patient safety, all these things.” Above from left: Learning to use equipment; An emergency trolley. advertisement Before prescribing, please refer to Product Information and to State and Federal regulations. Product Information is available from Mundipharma Pty Limited. PBS 1st DECEMBER 2011 31 On April 15, 1912, the RMS Titanic sank with loss of more 1 than 1500 lives . A century later, it remains one of the worst peacetime maritime disasters, caused by failings that continue to both shock 1 and fascinate the world . In Australia and New Zealand, 20,000 people die annually from tobacco-related disease, equivalent to the RMS Titanic sinking in the Tasman Sea every month2. Like the Titanic disaster, regulatory failure contributes to this tobacco death toll. For example, some tobacco products contain additives, such as ammonia, that increase the addictiveness of nicotine (by increasing its unionised fraction) without the manufacturers being required to state this on the packaging3,4. Gender and class inequity occurred in the Titanic death toll. Ninety two per cent of second-class male passengers died compared to 3 per cent of the female passengers in first class1. Class and gender inequity occurs with the tobacco death toll too. The poorest 20 per cent of Australian men are 1.8 times more likely to face premature death compared with the wealthiest 20 per cent. This is due largely to socio-economic differences in smoking prevalence5. Many patients quit smoking before surgery, particularly those having cardiac surgery, cancer surgery and other major operations6. Surgery can promote quitting and quitting itself improves surgical outcome, including significant reductions in wound infection and cardiovascular complications7. Despite this, evidence suggests that preoperative clinics do not systematically provide adequate smoking cessation care to patients having elective surgery8,9. Such organisational failures may be costing lives in the same way that systemic failings led to unnecessary deaths in the icy Atlantic waters more than 100 years ago. Clinicians dropping the ball on smoking cessation TOBACCO AND SuRGERy: ISSuES OF TITANIC IMPORTANCE 32 ANZCA Bulletin June 2012 Prior to August 2011, Peninsula Health provided little organisational support to encourage smokers to quit before elective surgery. A survey of pre-admission services in Victoria, NSW and the ACT showed we were not unusual in this regard9. Our waiting-list patients were sent a brochure entitled “About your anaesthetic”, which included just two lines about smoking on page three: “Give up smoking at least six weeks before your surgery to give your lungs and heart a chance to improve. You need to let the surgeon and anaesthetist know if you smoke.” The “chance” for cardiovascular improvement appeared not to motivate most patients, who continued to smoke until the day of surgery. Perhaps many believed their lungs and heart were fine. Perhaps others would be motivated if told their chance was increased by 30 to 100 per cent for a range of major morbidity including surgical site infection, pneumonia, myocardial infarction, stroke and septic shock10. Whether patients “need to let the...anaesthetist know” about their smoking or whether it is our responsibility to ask is a point that could be argued. However an audit of preoperative assessments in the UK showed smoking status was documented in less than 25 per cent of cases so perhaps there is a need for smokers to volunteer the information11. The existing brochure was weak and 50 per cent of surgical patients who smoke did not recall receiving this limited advice12. Fewer than 40 per cent of smokers were aware that smoking increased anaesthetic complications or made wound infections more likely13. Clinicians were not talking to their patients about smoking either. Only 9 per cent of smokers were told to stop by an anaesthetist and 25 per cent by a surgeon12. Surgeons advised quitting smoking in only 6.5 per cent of patients in a previous study at a Melbourne teaching hospital14. Clinician behaviour in this regard may be influenced by concerns that cessation just prior to surgery increased respiratory complications, although this is increasingly recognised as medical myth that has persisted far too long2,7,15. In taking advantage of the “teachable moment” that surgery provided for smoking cessation, it appeared that clinicians had dropped the ball. Stop before the op From August 2011, all smokers entering the Peninsula Health waiting list were sent a locally developed quit pack, which addressed the deficiencies identified above. This was marketed as the “Stop before the op” program. It consisted of a colour brochure detailing how quitting before surgery could reduce postoperative morbidity/ mortality and improve long-term health if staying quit. A referral form for Quitline was included together with a reply-paid envelope to our anaesthetic department. The brochure advised signing and posting this form, which would be faxed to Quitline. It advised that Quitline is staffed by smoking cessation specialists who offered a standard service of six free telephone counselling sessions that would at least double the chances of long-term abstinence compared with trying alone2. Quitlines in all Australian states and New Zealand offer a similar service. Prior to “Stop before the op” less than 2 per cent of smokers having surgery had used Quitline in the past year. The new brochure included links for other support options such as face-to-face counselling offered by Peninsula Health Community Health. During the six-month pilot program, 650 quit packs were posted to smokers entering the waiting list, resulting in 83 requests (12.8 per cent) for Quitline services. Other patients contacted the anaesthetic department to say they had quit without Quitline or saw a GP for help. Data was collected prior to the pilot shows that although some patients did quit while on the waiting list, this mostly occurred within a few weeks of surgery when there may be little benefit (see figure below). “Stop before the op” increased Quitline use more than fivefold and transformed quitting to clinically meaningful times of a month or more. Following this success, the program is now permanent with a slightly modified quit pack being sent to every waitinglist patient (smokers and non-smokers) as identification of smokers was timeconsuming and sometimes difficult. More lifeboats on the Titanic Since 1944, there have been more than 300 papers showing the adverse effects of smoking on surgical outcome, including increased risks of perioperative myocardial infarction10,16. While it is appropriate to explore risk reduction strategies through research on beta-blockers (POISE), clonidine/aspirin (POISE-2) or nitrous oxide avoidance (ENIGMA-2), smoking cessation is a life-boat that is here and now. Our responsibility is to ensure that all patients are offered the chance to get in the lifeboat if they choose. Dr Ashley Webb Frankston Hospital, Victoria Distribution of quit durations before surgery following implementation of “stop before the op” quit pack: increased % of clinically meaningful quit times (>1 month) <1 week 1-6 months 1-3 weeks >6 months 31.8 27.3 29.5 11.4 11.1 16.7 72.2 5.6 Before quit packs After quit packs References: Links: Australian Quitline referral form: www.quitnow.gov. au/internet/quitnow/publishing.nsf New Zealand Quitline referral form: www.quit.org.nz/94/helping-others-quit/healthprofessionals 1. Spignesi SJ. The Titanic For Dummies. Hoboken: John Wiley & Sons; 2012. 2. Webb A. Smoking and surgery: time to clear the air. In: Riley R, ed. Australasian Anaesthesia 2011. Melbourne: ANZCA; 2012:115-124. 3. Henningfield J, Pankow J, Garrett B. Ammonia and other chemical base tobacco additives and cigarette nicotine delivery: issues and research needs. Nicotine Tob Res. Apr 2004;6(2):199-205. 4. Heydon NJ, Kennington KS, Jalleh G, Lin C. Western Australian smokers strongly support regulations on the use of chemicals and additives in cigarettes. Tob Control. May 2012;21(3):381-382. 5. AIHW. Australia’s Health 2010. Australia’s health series No. 12. In: Welfare AIoHa, ed. Vol Cat. No 122. Canberra: AIHW; 2010. 6. Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology. Jan 2010;112(1):102-107. 7. Myers K, Hajek P, Hinds C, McRobbie H. Stopping Smoking Shortly Before Surgery and Postoperative Complications: A Systematic Review and Metaanalysis. Arch Intern Med. Jun 2011;171(11): 983-989. 8. Wolfenden L, Wiggers J, Knight J, et al. Increasing smoking cessation care in a preoperative clinic: a randomized controlled trial. Prev Med. Jul 2005;41(1):284-290. 9. Lee B, Webb A. Smoking cessation strategies at public hospital preadmission clinics in Victoria, NSW and ACT. ANZCA Annual Scientific Meeting 2012; www.anzca.edu.au/events/ANZCA per cent20annual per cent20scientific per cent20meetings/2012anzca-annual-scientific-meeting/epostersessions-2012/asm-2012_435.pdf. 10. Turan A, Mascha EJ, Roberman D, et al. Smoking and perioperative outcomes. Anesthesiology. Apr 2011;114(4):837-846. 11. Simmonds M, Petterson J. Anaesthetists’ records of pre-operative assessment. Clin Perform Qual Health Care. 2000;8(1):22-27. 12. Webb A, Robertson N, Sparrow M, McCormack M, Connell G. Smoking cessation before elective surgery: who is telling patients to stop before the operation? ANZCA ASM 2012; www.anzca. edu.au/events/ANZCA per cent20annual per cent20scientific per cent20meetings/2012-anzcaannual-scientific-meeting/eposter-sessions-2012/ asm-2012_382.pdf. 13. Webb A, Robertson N, Sparrow M, McCormack M, Connell G. Elective surgical patients who smoke have low awareness of their increased perioperative risks. ANZCA ASM 2012; www.anzca.edu.au/events/ ANZCA per cent20annual per cent20scientific per cent20meetings/2012-anzca-annual-scientificmeeting/eposter-sessions-2012/asm-2012_381.pdf. 14. Myles PS, Iacono GA, Hunt JO, et al. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology. Oct 2002;97(4):842-847. 15. Shi Y, Warner DO. Brief preoperative smoking abstinence: is there a dilemma? Anesth Analg. Dec 2011;113(6):1348-1351. 16. Peters MJ, Morgan LC, Gluch L. Smoking cessation and elective surgery: the cleanest cut. Med J Aust. Apr 2004;180(7):317-318. 33 Lessons abound on a Dili adventure Volunteer anaesthetist, Dr Jane McDonald, in Timor Leste I flew into Dili from Darwin at 8am on Saturday. When we landed, a blast of warm and humid air hit me as I stepped off the plane. I noticed immediately the smell of burning wood from hundreds of outdoor cooking fires, reminding me of bushfires back in Australia. This was my first trip to Timor Leste and I was travelling with ear nose and throat surgeon Dr John Curotta and nurse Danielle Doughty. We were volunteers coming to provide specialist ear nose and throat surgery through the Royal Australasian College of Surgeons (RACS). I carried a large padlocked bright orange case with me, containing a smorgasbord of anaesthetic drugs provided by RACS. 34 ANZCA Bulletin June 2012 We were cleared through customs and then met by Dr Eric Vreede, a specialist anaesthetist and team leader of the Australia-Timor Leste Assistance for Specialised Services (ATLASS) program, which is funded by AusAID. Timor Leste is a small country only 640 kilometres north-west of Darwin, and is one of Australia’s nearest neighbours. Colonised by the Portuguese in the 16th century, the predominantly Catholic population is made up of people of Malayo-Polynesian and Papuan descent. The population is just over one million, though a high birth rate means it is increasing rapidly. In 1974 Timor Leste was invaded by Indonesia and years of violence followed, culminating in a massacre of Timorese in 1991. This was a turning point, and an international peacekeeping force was sent in until order was restored. In May 2002, Timor Leste became an independent sovereign state. Years of fighting have destroyed much of the country’s infrastructure. The new president was military-fatigues-wearing and bearded ex-Fretilin guerrilla leader Jose Xanana Gusmao. In 2003, Gusmao met Fidel Castro at a non-aligned nations meeting in Kuala Lumpur and on hearing of the young nation’s poor social indicators of life expectancy and infant mortality, Castro offered “a thousand doctors”. Timorese students have since been training in Cuba on scholarships and more than 200 doctors have graduated and returned to Timor. Also the Cuban Government has set up a faculty of medicine within the University of Dili, which has been running since 2005. This has been the biggest Cuban health assistance program outside Latin America. Since 2001 RACS has been providing surgical services through the Australian East Timor Specialist Services Project (AETSSP). This has included facilitating a continuous surgical service at Dili’s Hospital Nacional Guido Valadares (HNGV) through the provision of a long-term general surgeon, anaesthetist and emergency medicine physician. Local doctors have had their training strengthened in areas of general surgical practice and there has been the development and implementation of a certified 12-month training course for 15 nurse anaesthetists. ATLASS is building on these achievements. After arrival, Dr Vreede looked after our team. We collected a hire car and headed towards our hotel. The roads were chaotic and crowded with tooting cars, buses, motor scooters, pedestrians and dogs, competing with each other for right of way over the narrow and rough roads. We left our bags at our accommodation and made our way to Dili’s hospital to find a large crowd of almost 500 patients waiting to be seen by the ear, nose and throat team from Australia. Communication is difficult in Timor. The official languages are Portuguese and Tetum though few people speak Portuguese. Many people also speak Bahasa Indonesian. There are many Cuban-trained doctors who speak Spanish, and some Chinese doctors who speak only Mandarin. An interpreter helped us with the patients at the ear, nose and throat clinic. Mr Samento Faus Correia, the local co-ordinator and interpreter for RACS, wore a bright red Mao cap, which gave him an appropriate air of authority. He controlled the crowd and organised the patients efficiently so Dr Curotta could see as many as possible. I became an “acting ear, nose and throat registrar” making notes and writing prescriptions. Australian volunteer and ear-care nurse Julie Sousness was able to triage patients with the help of a surgical registrar trained in Fiji who worked at the hospital. There was a high incidence of chronic ear infection and associated complications. There were also patients with chronic sinusitis, various untreated congenital abnormalities, sensorineural deafness, vocal cord problems and allergic rhinitis. Several patients had oropharyngeal cancers caused by chewing betel nut, and one patient had juvenile nasopharyngeal angiofibroma causing severe epistaxis. We managed to see 280 of the patients and identified 65 that would benefit from surgery. Unfortunately, we could not see the rest. Prioritisation is difficult. We chose to concentrate on ear surgery and gave priority to younger patients, those with bilateral tympanic membrane perforations, and those needing mastoidectomies. (continued next page) “Several patients had oropharyngeal cancers caused by chewing betel nut.” From top left: A view of Dili Harbour; Dr Jane McDonald (left) puts a patient to sleep with the help of local Ear Care Nurse Julie Sousness acting as interpreter; Halothane vapouriser; Dr John Curotta reviews a patient on the ward post-operatively. 35 Lessons abound on a Dili adventure continued We operated on 20 patients over the next week, aged from two to 32 years, performing mostly mastoidectomies for cholesteatoma, and myringoplasties. The average age of patients treated with surgery was 14 years. All surgical patients were in otherwise good health, though they were notably small in stature compared with the Australian population. The heaviest patient was a man of 30 who weighed just 52kg. Oxygen and halothane were available, but no other gases or volatile agents. Suction was provided by means of a portable electric pump. Drugs and some anaesthetic airway equipment came with us, provided by RACS. Nearly all patients I left to breathe spontaneously. The available monitoring was pulse oximetry, ECG and BP. There was no capnography. My anaesthetic assistants were Timorese trained, but did not speak English, so communication was a problem. Medical students attended many of the sessions, though teaching was also handicapped by language difficulties. The cost of our trip was assisted by the generous efforts of the Rotary Club of Balwyn Victoria. We hope we have improved the lives of a few Timorese people by our visit. It has definitely provided an opportunity to mentor Timorese trainees. “All surgical patients were in otherwise good health, though they were notably small in stature compared with the Australian population. The heaviest patient was a man of 30 who weighed just 52kg.” Dr Jane McDonald Westmead Hospital and Children’s Hospital at Westmead Above from left: Final year Timor Leste medical students, trained in Cuba, watching Australian ENT surgeon Dr John Curotta do a mastoidectomy. Danielle Doughty (volunteer with the ENT team) is scrub nurse; Dr John Curotta (back to camera) examining patients at the ENT clinic. To the left is Danielle Doughty. A patient who had surgery on a previous trip, in the green shirt, named Colito, acts as interpreter. 36 ANZCA Bulletin June 2012 NZ Anaesthesisia Annual Scientific Meeting By combining with a specialist international conference, this year’s NZ Anaesthesia Annual Scientific Meeting is able to offer an exceptional line up of about 100 international speakers covering a wide range of generalist and specialist topics. Scientific Co-Convenor Professor Alan Merry says the combined conference has attracted the best anaesthesia faculty yet seen in New Zealand – and one that means there will be something of interest for all anaesthetists and trainees. The usual NZ Anaesthesia ASM is being held in Auckland between November 14-17 along with the 2012 International Congress of Cardiothoracic and Vascular Anesthesia (ICCVA). “Combining with ICCVA has enabled us to attract an excellent international and Australasian faculty,” Professor Merry says. “I consider it the best we have ever had for a New Zealand conference, and they will be providing a first-class generalist stream.” Speakers in the general stream come from the US, New Zealand, Australia, Germany and Canada. Professor Merry is one of a team of scientific program advisors who have put together a comprehensive program under the theme “What becomes of the broken hearted? Outcomes and how to change them”. It has a broad-ranging general stream, a specialist ICCVA stream and a third stream that straddles the two. Registrants are able to attend any session in any stream. The combined conference is being hosted by ANZCA and the New Zealand Society of Anaesthetists in association with the Society of Cardiovascular Anesthesiology (SCA), which is US-based but with an international membership of over 6000 cardiac, thoracic and vascular anaesthesiologists. Its ICCVA congress is held in different venues around the world every two years. This is the first time it has been held in Australasia. Topics in the general stream include perioperative management of stents, transthoracic echo for non-cardiac anaesthetists, dynamic monitoring for non-cardiac surgery, goal-directed therapy in non-cardiac surgery, and fast track anaesthesia and outcome. Some of the other subjects covered include airway management, trauma, obstetrics, paediatrics, acute and high risk patients, risks in older patients, operating room efficiency, simulation and outcome, intubation skills and perioperative assessment. Professor Merry says the quality of the faculty overall is exemplified by the keynote speakers – Dr Richard Dutton from the US, Professor Scott Beattie from Canada and the NZSA Visiting Speaker, Dr Paul Baker, from Auckland. Dr Dutton is an attending anaesthesiologist at the University of Chicago and the newly-appointed Executive Director of the Anaesthesia Quality Institute, which runs the National Anesthesia Clinical Outcomes Registry. Dr Dutton has been involved in myriad research endeavours for the past two decades and has shared his professional expertise at more than 200 grand rounds and national and international symposiums, specifically addressing such issues as haemostatic resuscitation, massive transfusion and factor VIIa in civilian practice. Dr Dutton will present a Saturday morning plenary session on “Outcomes: how to measure them and change them: perspectives from AQI”, as well as speaking on “Trauma – anaesthesia and outcomes” in one of the concurrent sessions. In his plenary session, Professor Scott Beattie from Canada will present on “What becomes of the broken hearted – angina: stents, coronary surgery and modern medical management”. In a human factors concurrent session, he will speak to “Perioperative assessment – how does it change outcome?” Dr Beattie is a professor in the Department of Anesthesia, University of Toronto, Faculty of Medicine and works in the Department of Anesthesia and Pain Management at the Toronto General Hospital, University Health Network . He is recognised internationally as an expert in the area of cardiac anaesthesia. The NZSA Visiting Speaker, Dr Paul Baker, has 25 years’ experience as a consultant anaesthetist at Starship Children’s Health in Auckland. He is also a senior lecturer in the Department of Anaesthesiology, University of Auckland. His research interest and MD thesis is “Improving the safety and management of the difficult airway”. In 1996, Dr Baker founded the AirwaySkills course, which has taught hundreds of anaesthetists, intensivists and emergency physicians in New Zealand and Australia. He is also the developer of the Orsim bronchoscopy simulator. Dr Baker will present a plenary session on “Education in airway management” and a paper on the “Quality and safety of airway equipment”. The combined NZ Anaesthesia ASM/ ICCVA conference begins on Wednesday November 14 with various satellite symposiums covering general and cardiac topics during the day, and the welcome reception in the evening. It opens formally on Thursday morning, with the conference dinner held on Friday evening. For the full program and other speaker details, and to register, go to www. iccva2012.com. Early bird registration is open until September 5. Abstract submission for the moderated poster session, NZSA Ritchie Prize and NZSA Trainee Prize is open until July 31. The NZ Anaesthetic Technicians Society conference is running in parallel with the NZ Anaesthesia ASM/ICCVA conference. Susan Ewart NZ Communications Manager, ANZCA 37 ANZCA and government: building relationships ANZCA continues to work with the Australian and New Zealand governments which both handed down their budgets in May. Australia Aged-care boost in budget The Australian government’s 2012-13 budget, released in May, was consistent with previous commitments made to the healthcare system. The biggest ticket item in the recent budget was a $3.7 billion dollar aged-care package, with additional support for dental health, the National Bowel Cancer Screening Program, health infrastructure projects, as well as ehealth. The government’s commitment to ehealth was expanded with additional funding to support the roll out of the Personally Controlled Electronic Health Record (PCEHR) over the next two years. Health Minister Tanya Plibersek has taken a number of opportunities to promote the PCEHR as a cost-effective method for managing the health information of Australians, in the lead up to the system’s launch on July 1. 38 ANZCA Bulletin June 2012 Recent ANZCA submissions ANZCA continues to advocate on behalf of Fellows, providing submissions to government and health stakeholders in a variety of areas. ANZCA has recently made submissions to the: • Medical Board of Australia’s consultation on the board funding external doctors’ health programs. • The Australian Institute of Health and Welfare’s consultation on National definitions for elective surgery urgency categories. • The Australian Health Workforce Ministerial Council’s Development of National Criteria under the National Registration and Accreditation Scheme. • Health Workforce Australia in response to its proposed Health Professionals Prescribing Pathway in Australia. ANZCA’s past submissions, including the College’s accreditation submission to the Australian Medical Council, can be found at www.anzca.edu.au/communications/ submissions. ANZCA recently met with representatives from Health Workforce Australia regarding the ongoing health workforce 2025 study into the supply and demand of medical practitioners with a focus on the data on the anaesthesia workforce. The College is providing input into a report for Australian health ministers due later in the year. Specialist Training Program The Specialist Training Program (STP) has made significant achievements over the past four months. All funding agreements with hospitals have been finalised, most hospital reports have been received, and payments have been made to support the training positions. ANZCA has been developing systems to streamline the processes involved in managing the 37 training positions across anaesthesia, pain medicine and intensive care medicine. The College has made it a priority to develop networks with STP staff from other colleges, in order to share knowledge and experience, in addition to continuing to engage with government on training in expanded settings. The 2013 STP application round has recently closed. ANZCA, including the Faculty of Pain Medicine, received 23 applications, which were assessed for funding. The Australian Department of Health and Ageing will assess the College’s assessment, as well as those made by the relevant health jurisdictions. The results of the application round are expected later this year. ANZCA is working with regional/ rural/remote area sites through the Rural Support Loading Grant (RSL) to assist these sites to meet costs of supporting trainees. All inquiries regarding the RSL and the 2013 STP application round should be directed to the STP project manager at [email protected] New Zealand Health in the 2012/13 budget The New Zealand government’s 201213 budget was delivered on May 23. Health Minister Tony Ryall announced an increase of $101 million for elective surgery and cancer services. One of the goals of the funding is an increase in 4000 elective surgeries per year. Other areas of interest include directing funding to reduce the waiting time for imaging and diagnostic tests, and IT improvements to support faster access to results. The government also earmarked an additional $143 million for disability services. In a so-called “zero budget”, the reallocation of funding still favours Vote:Health. Physician assistants Health Workforce New Zealand (HWNZ) has released the summative evaluation from its demonstration of the physician assistant (PA) role at Middlemore Hospital, where two PAs trained in the United States joined surgical teams for one year. Based on the results of that demonstration, HWNZ is now progressing with the trial of the PA role in primary care. The New Zealand office is working with HWNZ to ensure that the College is kept up-to-date with the PA project, and is providing advice to HWNZ on the new role from an anaesthesia perspective. This project is an example of HWNZ’s approach of rapid project development and implementation. ANZCA is developing a position statement on physician assistants and other alternative providers. The results of the Middlemore Hospital trial and other trials will be used to inform this process. CPD for general registrants The Medical Council of New Zealand (MCNZ) has developed a continuing professional development (CPD) program for doctors who are not vocationally registered or who are not participating in a vocational training program, known as “general registrants”. The program is designed to strengthen the CPD requirements and monitoring of general registrants’ ongoing education. The Chair of the New Zealand National Committee, Geoff Long, ANZCA’s Chief Executive Officer, Linda Sorrell, and the New Zealand General Manager, Heather Ann Moodie, met with MCNZ to propose that general registrants working only in a specialist area (such as anaesthesia) and participating in an accredited college program are able to fulfil MCNZ’s requirements. Following agreement by MCNZ, work is now underway to ensure the CPD program meets MCNZ’s requirements by March 2014. Submissions New Zealand’s drug purchasing agency, Pharmac, has sought the input of the New Zealand National Committee into the development of its Preferred Medicines List. Submissions have been compiled on anaesthetic, analgesic and antiemetic agents, and on fluids and electrolytes. Recent submissions also include advice to the Health Quality and Safety Commission, the Ministry of Health, and Health Workforce New Zealand on technical workforce planning and development, including anaesthetic technicians. John Biviano General Manager, Policy ANZCA 39 Quality and safety Australian and New Zealand Anaesthetic Allergy Group Anaesthetists know that anaphylaxis during anaesthesia is a potentially life-threatening crisis. The event is often traumatic both for patient and anaesthetist. It is also clear that anaesthesia is increasingly delivered in a wide variety of settings. Busy anaesthetists need readily available information regarding management and referral centres for these patients to ensure subsequent anaesthesia is safe. Furthermore, anaesthetists involved in subsequent care need clear guidelines about which anaesthetic agents can safely be used. The Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) was established in response to these challenges. ANZAAG members are specialists with an interest in the management and diagnosis of allergy to anaesthetic agents. Members have been recruited through the network of specialists regularly working in this area. ANZAAG comprises 68 members, including 50 anaesthetists, 15 immunologists, one technical specialist and one perioperative physician, to date. The group represents 28 testing centres throughout Australia, New Zealand and Hong Kong. ANZAAG arose from a concept developed by New Zealand anaesthetists involved in the management and investigation of patients who experienced anaphylaxis during anaesthesia. 40 ANZCA Bulletin June 2012 The New Zealand group first met in the early 1990s and rapidly demonstrated the benefits of a network of specialists including anaesthetists, immunologists and technical/laboratory specialists involved in this area of care. It was apparent that a similar Australasian group could deliver benefits throughout the region. ANZAAG has since developed a structure to reflect the inter-collegiate nature of the members of the group. The executive members of ANZAAG will form a sub-committee of ANZCA’s Quality and Safety Committee to ensure a close working relationship between the two bodies. The current executive of ANZAAG includes the chair, Dr Michael Rose (specialist anaesthetist, Sydney), ANZAAG co-ordinator Dr Helen Crilly (specialist anaesthetist, Gold Coast), immunologist representative Dr Katherine Nichols (consultant immunologist and pathologist, Melbourne) and anaesthetist representative Dr Peter Cooke (specialist anaesthetist, Auckland). The group first met in May 2010 and has met twice a year since. ANZAAG meetings focus on education and developing resources to aid colleagues in the event of allergic reactions associated with anaesthesia. ANZAAG is finalising a number of draft documents that will be available from a website that will launch at the ANZCA annual scientific meeting in Melbourne next year. The aims for ANZAAG are: 1. To work towards best practice and safety in relation to the treatment, investigation and prevention of anaesthesia related anaphylaxis, working with other agencies nationally and internationally. 2. To foster information exchange, standardisation of practice and good working relationships between anaesthetists, immunologists, allergists and technologists involved in the follow up and investigation of patients who experience perioperative anaphylaxis in Australasia. 3. To foster critical inquiry and other research in the area of perioperative allergy and in the long term, to support these endeavours by establishing a research database of anaestheticrelated allergy within Australasia. 4. To provide and maintain web based resources including Australasian guidelines for the management and investigation of anaesthesia related anaphylaxis and to advise on referral and investigations after such an event. 5. To seek opportunities to keep anaesthetists, immunologists and allergists updated regarding the subject of anaesthesia related anaphylaxis. ANZAAG will hold its annual general meeting and educational symposium from March 16-17, 2013 at the Princess Alexandra Hospital in Brisbane. The educational component will be open to all anaesthetists and immunologists and will focus on areas of interest in anaesthetic drug allergy. Anaesthetists with a special interest in anaesthetic drug allergy management are invited to join the group. For further information please contact Dr Helen Crilly at [email protected] Dr Helen Crilly ANZAAG Co-ordinator Anaphylaxis to drugs during anaesthesia From January 1993 to December 2011, the Victorian Consultative Council on Anaesthetic Mortality and Morbidity (VCCAMM) reviewed 164 cases of adverse drug reaction. The actual number of cases may be higher and the true frequency for any drug is unknown in the absence of accurate denominator data. 1. Reactions to neuromuscular blockers: • Life threatening anaphylactic reactions to muscle relaxants comprises the highest risk. It is suggested that whenever unexpected hypotension is encountered during induction, it is wise to consider anaphylaxis and institute treatment with adrenaline, even if the diagnosis is in doubt. • Hypotension may be the only clinical feature but cutaneous signs (rash, blanching, pallor) coughing or bronchoconstriction (increased airway pressure, difficulty with ventilation, hypoxia) may also occur. • All anaesthetists should be prepared to initiate an emergency call to obtain immediate support for co-ordinated crisis management in any case of suspected anaphylaxis. • Review of these cases revealed that delayed diagnosis, failure to rapidly escalate adrenaline dose and co-existent cardiac disease were associated with increased risk of mortality. 2. Reactions to intravenous antibiotics can also be severe and life-threatening. In the case of cephazolin, careful inquiry should be made about previous hypersensitivity reactions to cephalosporins and penicillin. A history of major allergy to penicillin should be a contraindication to the use of cephalosporins as there is some evidence of cross reactivity. Associate Professor Larry McNicol Chair, VCCAMM Figure 1: Intraoperative Drug Anaphylaxis 1993-2011 41 Quality and safety continued Comment on VCCAMM Report on Anaphylaxis • The total number of cases investigated is almost certainly a fraction of those occurring over the period 1993-2011. This number of cases would be seen by a single busy anaesthetic allergy investigation clinic in approximately 18 months rather than 18 years. This is probably due to the lack of mandatory reporting of anaesthetic anaphylaxis. • There is no doubt that muscle relaxant anaphylaxis has been and remains the principle cause of anaesthetic anaphylaxis. The proportion of reactions to each relaxant is dynamic and will have changed during the investigation period. It is unusual that all muscle relaxants (for example vecuronium and pancuronium) are not listed here, presumably due to imperfect reporting of these events although by 1993 many anaesthetists had changed to rocuronium in preference to older agents. Thus it is important that this table is not seen as a true reflection of the relative risk for perioperative anaphylaxis. • The statement that “it is wise to consider anaphylaxis and institute treatment with adrenaline, even if the diagnosis is in doubt” is excellent, and could easily be bolded. 42 ANZCA Bulletin June 2012 • Hypotension may be the only feature, but it is also worth noting that bronchospasm may be the only feature. Anaphylaxis should be considered in cases of severe and/or unexpected hypotension, bronchospasm, as well as when one or more of these is present with skin signs (rash, erythema, urticaria) or angioedema. In cases when the diagnosis is unclear, treatment should be instituted and mast cell tryptase assays taken to help investigations later. • The statement “All anaesthetists should be prepared to initiate an emergency call to obtain immediate support for co-ordinated crisis management in any case of suspected anaphylaxis” is excellent. Training/drills for anaphylaxis management should be routinely practised. • It should be noted that it is the treating anaesthetist’s responsibility to arrange follow-up testing by an expert in anaesthetic allergy investigation. Significant morbidity, including further episodes of anaphylaxis, have occurred with failure of referral and investigation of perioperative anaesthetic anaphylactic reactions. • Cross-reactivity between cephalosporins and penicillins has been the subject of great misunderstanding over the years. While cross-reactivity does exist (particularly between penicillins and first generation cephalosporins) it is uncommon. Cross-reactivity is related more to similarities between the side chains of antibiotics than the beta lactam ring itself. It should be remembered that there is potential morbidity involved with the avoidance of the most appropriate antibiotic. The best approach in patients with allergy to penicillins or cephalosporins is to obtain clarification of exact antibiotic sensitivity by an immunologist with expertise in this area of testing. In a setting where such an opinion is unavailable and delay inappropriate, cross reactivity should be assumed if the reaction to the penicillin or cephalosporin was anaphylactic, involved evidence of angioedema, or significant cardiovascular or respiratory compromise. Dr Michael Rose Chair, Australia and New Zealand Anaphylaxis Allergy Group Methylene blue and serotonin reuptake inhibitors – an update Mixing methylene blue and SRIs triggers severe toxicity An informed understanding of serotonin toxicity with methylene blue has not changed since my previous comment in 20081. The seriousness and accuracy of the previous warning has been borne out by subsequent international reports of severe reactions and a few deaths. For those who wish to refresh their memory about methylene blue and serotonin toxicity there is a summary in my most recent review 2, as well as updated information on my website (Google “Gillman methylene blue”). The story of interactions between monoamine oxidase inhibitors (MAOIs), which includes methylene blue, and drugs that possess significant serotonin reuptake inhibitor (SRI) capacity, mostly antidepressants,3 has confused not only the profession, but also the regulatory authorities. For instance, various sources incorrectly warn against mirtazapine, nortriptyline, bupropion etc, which do not have any SRI action and pose no risk. That is confusing and may precipitate unnecessary disruption or rescheduling of operations. One particular aspect of the (usually postoperative) presentation of serotonin toxicity warrants attention. Anaesthesia itself is not only an effective treatment for the central nervous system and core hyperthermia of serotonin toxicity, but also tends to modify and disguise signs and symptoms in the immediate postoperative period. Body temperature tends not to be elevated for a few hours postoperatively, but can then rapidly rise. In one recent case such a patient died of hyperthermia, despite energetic cooling efforts4. Monitoring of core temp is essential, and judicious use of 5-HT2A antagonists to treat hyperthermia may sometimes be required as a life-saving measure. There is no firm evidence as to which of the available 2A antagonist candidates is best. The choice may depend on the history and condition of the patient, the required speed of onset (sub-lingual, IMI or IV) and the experience of the doctor. The possibilities are cyproheptadine (PO only), chlorpromazine (IMI/IV), risperidone (IM), olanzapine (sublingual), droperidol (IMI/IV), but not ziprasidone, because it has significant SRI potency). As a guide, all these drugs would be expected to produce significant blockade at the 5-HT2A receptor in “usual clinical” doses 5. Evidence supports the proposition that in Australia, in contrast to other countries, we have been successful in avoiding the toxic drug interaction of serotonin toxicity. No cases have been reported to the Therapeutic Goods Administration (personal communication, March 2012), and all inquiries to me about methylene blue toxicity have been from Europe and USA. There have been none from Australia. I would like to think that it is at least partly because of the attention that Australian anaesthetists have given to the evidence that has been presented. Congratulations are due not only to the medical profession, but also to the manufacturers of methylene blue in Australia (Phebra), who included a specific warning about serotonin toxicity on my advice. In contrast, warnings from national agencies (US Food and Drug Administration and the British Medicine and Healthcare Products Agency), and in the package inserts, are either absent or imprecise. Conclusions Mixing methylene blue with serotonin reuptake inhibitors predictably and frequently causes severe and potentially fatal serotonin toxicity: discontinuation of SRIs, with appropriate washout periods before using intravenous methylene blue, is a high priority and should probably be considered mandatory. The situation with smaller doses of methylene blue via other routes is uncertain. Oral absorbency is good and proposed uses of methylene blue, such as chromo-endoscopy, may generate blood levels sufficient to provoke serotonin toxicity6. Dr P Ken Gillman, MRC Psych Dr Gillman is a retired clinical psychiatrist with a special interest in neuropharmacology. References 1. Gillman, PK, Methylene Blue: A Risk for Serotonin Toxicity. ANZCA Bull, 2008. 17: p. 36. 2. Gillman, PK, CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity. J Psychopharmacol (Oxf), 2011. 25(3): p. 429-3. 3. Gillman, PK, Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. Br. J. Anaesth., 2005. 95: p. 434-441. 4. Top, W, Gillman, PK, de Langen, C, and Kooy, A, Fatal methylene blue associated serotonin toxicity. 2012: p. [in preparation]. 5. Kapur, S, Zipursky, RB, Remington, G, Jones, C, et al., 5-HT2 and D2 receptor occupancy of olanzapine in schizophrenia: a PET investigation. Am J Psychiatry, 1998. 155: p. 921-928. 6. Repici, A, Di Stefanob, AFD, Radicionib, MM, Jasc, V, et al., Methylene blue MMX® tablets for chromoendoscopy. Safety tolerability and bioavailability in healthy volunteers. Contemporary Clinical Trials, 2011. 33: p. 260–267. 43 Quality and safety continued ECRI alerts The ECRI Institute is a non-profit organisation that issues alerts from four sources: the ECRI International Problem Reporting System, product manufacturers, government agencies including the US Food and Drug Administration (FDA) and agencies in Australasia, Europe and the UK as well as reports from client hospitals. Some alerts may only involve single or small numbers of cases, there is no denominator to provide incidence and there is not always certainty about the regions where the equipment is supplied. This section can only highlight some of the alerts that may be relevant. It is the responsibility of the hospitals to follow up with the manufacturer’s representatives if they have not already been contacted. Flow rate inaccuracy in Bayer MR tubing sets used with Continuum pumps (designed for use in MRI environments) Bayer MEDRAD Continuum MR infusion system tubing may exhibit variations in flow when used with Continuum infusion pumps. There has been a recall of the tubing and continuum pumps that have been calibrated with the tubing. Accurate delivery of critical medications in the MR environment is difficult without appropriate pumps. Although it is possible to the use “regular” volume or syringe pumps sitting outside the field and to connect to the patient with several extension tubing sets, the compliance and length of tubing may affect rate accuracy and responsiveness to rate changes. Other MR conditional pumps are available. Cassette test failure alarm on loading of Hospira PlumSet Administration Set onto pump Hospira has recalled its 104-inch Lifeshield Primary PlumSet Administration Sets. A cassette failure alarm may occur when these sets are loaded onto the pump, possibly due to failure in welding of the cassettes. The cassette cannot and should not be used. The main potential adverse outcome is a delay in administration of the required therapy. 44 ANZCA Bulletin June 2012 Luer connection leak in COBE spectra blood warmer systems (Caridian BCT) Green armbands in ophthalmic surgery If specific directions are not followed, a leak may occur at the return luer connection to an elevated blood warmer potentially resulting in air entrainment into the system. Caridian BCT has inserted an addendum to the labelling: “When connecting a blood warmer tubing set to the return line, ensure that the tubing connection is tight. Put the luer connection no higher than 50cm above the return access to prevent the possibility of air entering the tubing”. Australian anaesthetists should be aware patients who have vitreo-retinal surgery get a green wristband if they have had gas instilled in the globe of the eye. The band remains on until the surgeon considers the gas has completely gone, usually 4-6 weeks. The administration of nitrous oxide under these circumstances may be a potential risk to the eye and should be avoided. Dr Phillipa Hore Communications and Liaison Portfolio Quality and Safety Committee General alerts Coronial alert An Australian coroner investigating the death of a patient undergoing repair of a clavicle recently highlighted his findings that a screw had been inadvertently inserted into the right subclavian vein. There was considerable haemorrhage, which was aggressively managed, but the patient did not improve and could not be resuscitated. The possibility of concomitant air embolism was a late diagnosis, probably due to the concentration of the surgical and anaesthetic team on managing the haemorrhage. While not critical of the team, the coroner sought to highlight the possibility that whenever a large vessel is perforated, other causes of refractory resuscitation such as air embolism should be considered as well as the hypovolaemia that results from massive haemorrhage. Dr Patricia Mackay Communications and Liaison Portfolio Quality and Safety Committee Safety of Anaesthesia latest report ANZCA’s Safety of Anaesthesia, a review of anaesthesia-related mortality reporting in Australia and New Zealand 2006-2008 is now available on ANZCA’s website under resources. A web booklet version will be available soon and publicised in an upcoming ANZCA E-Newsletter. For queries please contact ANZCA’s Quality and Safety Officer on [email protected] The dangers of self-inflating resuscitation bags Self-inflating resuscitation bags are essential but rarely used adjuncts to the anaesthesia machine, a vital back up when the oxygen supply or anaesthesia machine fails. They are also essential items of equipment in the postanaesthesia care unit (PACU), on cardiac arrest trolleys and in emergency departments. However, a number of hazards are associated with the use of these bags, both re-usable and disposable models, many of which will be well known to anaesthetists and intensivists. Dr Jane Torrie, the Director of the Simulation Centre for Patient Safety in Auckland, has identified an issue with one particular bag and reports: “Our usual bag valve mask product stocked in our university medical simulation centre was recently replaced with the L670 BVM single use product made by Allied Healthcare, Missouri, and imported by Care Medical.” “During teamwork research over three days in late February 2012, we videoed 25 teams (anaesthetist, post-operative care nurse and anaesthetic assistant) managing highly-realistic simulated cases of deteriorating patients in a post-operative care area. All team members were clinically experienced and work in large local medical institutions where similar bag valve mask systems are stocked and used. “The research team observing the cases noticed that in 11 out of 25 cases (44 per cent), a member of the team disconnected oxygen tubing from the manikin’s oxygen face mask and connected it to the manometer port of the L670 BVM after removing the white port cap. In all 11 cases, none of the team members detected the error during the remainder of the simulated case, and the oxygen was delivered at maximum flow rate (12-15 lpm) into the port for several minutes. “The research team felt that barotrauma was a possibility in these cases, so at the end of the research simulations we connected a two-litre test lung bag to the L670 BVM, connected oxygen tubing to the manometer port and turned gas flows to 12 lpm. “It was apparent that the test lung bag expanded alarmingly to a volume of several litres and that there was no pressure relief system functioning to protect patient lungs from O2 supply pressure in this device configuration. A photo is attached. This behaviour could also be reproduced using a brand new L670 BVM found in an operating room at Auckland City Hospital, but not consistently. There is no visible difference between the two BVMs. “Patients whose lungs are ventilated via a closed system (endotracheal tube) would be at high risk of life-threatening lung barotrauma if the L670 manometer port was connected to oxygen tubing. “It is obvious that this connection error will also reduce the inspired O2 in most cases, as the reservoir bag does not fill despite high O2 flow rates. A second photo is attached demonstrating this. “While we are aware that this is not the intended configuration of the L670, we observed a large proportion of experienced healthcare professional teams, who were using it for the intended purpose, actually assemble it in a hazardous configuration. Even more concerning, the error was not apparent to them and thus was not corrected.” The problem was reported to Medsafe (the authority responsible for regulating therapeutic products in New Zealand), which did not think it appropriate to take formal action as it understood this particular product had already been withdrawn from the market; the issue was one of incorrect use rather than device failure; and there had been no adverse events arising from such incorrect use of this or similar products. Despite this, MedSafe is keen that word of this potential hazard is distributed to all anaesthetists. This is a timely reminder that there are many hazards associated with these bags. Some hazards – such as the facility for incorrect assembly rendering them useless and foreign material such as vomit accumulating in the old black Ambu bags – have largely been eliminated, or at least reduced by improved design. A further series of problems is associated with the use of a filter between the bag and the patient. This is, of course, unnecessary if a disposable bag is used but several brands of re-usable bag are still available. This is not the forum to discuss the pros and cons of disposable devices but some of the hazards are as follows: • High pressure oxygen could be connected to the CO2 monitoring port of the filter resulting in exactly the same issues that Dr Torrie had in the simulation centre. • The same port can be left open or even broken off, resulting in a large leak and totally inadequate ventilation. • The filter can be blocked by patient secretions. • There are other disposable devices with ports between the bag and the patient. All anaesthetists should be aware of these problems and take the following actions: • Check the self-inflating resuscitation bags in your clinical area frequently. • Never use a filter with a disposable device. • Make sure the O2 tube is connected to the end of the bag away from the patient. (It should be stored in this configuration, which will prevent the last minute incorrect assembly experienced by Dr Torrie’s subjects.) • Educate nursing and other staff at every opportunity on the safe use of these devices. Dr Joe Sherriff, FANZCA ANZCA’s National Quality and Safety Officer, New Zealand 45 ANZCA Trials Group meets at the annual scientific meeting in Perth Perth meeting One of the important core activities for the ANZCA Trials Group is the annual scientific meeting. This year, the Perth meeting included two trials group scientific sessions, the annual trials group lunchtime meeting and a trials group executive committee meeting. For the first time since the 2011 Palm Cove research workshop, the newly formed ANZCA Research Co-ordinators’ – Special Interest Group (ARC-SIG) met at lunchtime on May 12 at the Perth Exhibition and Conference Centre. The 11 participants, led by Sofia Sidiropoulos, discussed terms of reference for future meetings and a program for the breakout sessions for the forthcoming ANZCA Trials Group Strategic Research Workshop in Palm Cove on August 10-12. All co-ordinators were partially supported to attend by the National Health and Medical Research Council grant for the Peri-operative Ischaemic Evaluation-2 Trial (POISE-2 trial). Associate Professor David Story chaired the first ANZCA Trials Group scientific session on Saturday morning. Professor Steve Webb, the chair of the Australian and New Zealand Intensive Care Society-Clinical Trials Group (ANZICS-CTG), opened the session with a talk on what is new in intensive care research. Professor Matthew Chan followed with a presentation on his work with the neuro-vision pilot study. Professor Julia Fleming wrapped up the session with a presentation on intraguanethidine for Raynaud’s syndrome: a pilot study. Both Professors Chan and Fleming were recipients of the ANZCA Trials Group Pilot Grant Scheme, and were awarded grants of $5000 last year. The chair of the ANZCA Trials Group, Associate Professor Tim Short, chaired the second session, “Methods and 46 ANZCA Bulletin June 2012 madness in clinical trials”, on Tuesday afternoon. Professor Paul Myles gave an informative talk on equipoise in clinical research. Professor Myles was followed by Dr Nolan Mc Donnell, who demystified the mysterious with a presentation on superiority, non-inferiority and equivalence trials. The ANZCA Trials Group sessions at the annual scientific meeting follow an update/methodology/results format and Professor Stephen Schug finished the session with a presentation on measurement tools in acute pain research: is there room for improvement? The annual ANZCA Trials Group lunchtime meeting followed and was attended by more than 30 participants from Australia, New Zealand and Hong Kong, including research co-ordinators associated with trials group research. Professor Tim Short chaired the meeting. Professor Myles opened the discussion on how future research could be better funded especially for investigatorinitiated research, as well as updating the attendees on research activity associated with ANZCA multicentre research. Most of the lunchtime meeting was assigned to a POISE-2 investigator meeting, chaired by the national coordinator for Australia and New Zealand, Professor Kate Leslie. She informed the meeting that POISE-2 is engaged with 33 sites across Australia, 10 are activated and 27 patients have been recruited to date. Professor Leslie thanked the investigators and co-ordinators at the meeting for their hard work and persistence in getting POISE-2 up and running in a difficult research environment. The Royal Adelaide Hospital (Dr Tom Painter and Sue Lang, and colleagues) was identified as having made an outstanding contribution to POISE-2, with 16 patients recruited to date. This site is also the largest contributor to the Aspirin and Tranexamic Acid for Coronary Artery Surgery Trial (ATACAS Trial). Congratulations to Tom and Sue and their colleagues! Pilot grants The ANZCA Trials Group is pleased to announce that the first pilot grant of $A5000 for 2012 has been awarded to Dr Ben Olesnicky, Royal North Shore Hospital, NSW, for his project “Effect of Analgesic Regime on Outcomes Following Major Hepatobiliary Surgery – A Comparison of Epidural Analgesia and Intrathecal Morphine”. For more information of the ANZCA Pilot Grant Scheme, which is open to applicants all year, see: www.anzca.edu. au/fellows/Research/trials-group/pilotgrant-scheme.html Publications Leslie K, Myles PS, Chan MTV, Forbes A, Paech M, Peyton P, Silbert BS, Williamson E. Nitrous oxide and long-term morbidity and mortality in the ENIGMA Trial. Anesth Analg 2011; 112:387-393. Graham AM, Myles PS, Leslie K, Chan MT, Paech MJ, Peyton P, E I Dawlatly AA. A cost-benefit analysis of the ENIGMA trial. Anesthesiology 2011 Aug;115(2):265-72 Myles PS; the ENIGMA Trial Investigators. Correspondence. Anesthesiology. 2012 Mar; 116(3):736 Leslie K. Myles P.S. Halliwell R. Paech M.J. Short T.G. Walker S. Beta-blocker management in high-risk patients presenting for non-cardiac surgery: Before and after the POISE Trial. Anaesthesia and Intensive Care 2012; 40(2): 319-327. Events 4th Annual Strategic Research Workshop, Sea Temple, Palm Cove, Qld, August 10-12. Following a very successful workshop meeting in Palm Cove in 2011, the ANZCA Trials Group is returning to Palm Cove for its 4th annual consecutive meeting this year. The workshops bring together experienced researchers as well as new and emerging researchers from Australia, New Zealand and Hong Kong. These meetings aim to present, mentor and encourage new ideas for multicentre research in anaesthesia, perioperative and pain medicine. Participants receive updates about existing research and are encouraged to engage in multicentre trials. We also encourage anaesthesia research nurses and co-ordinators to attend. ANZCA Research Co-ordinators’ – Special Interest Group (ARC-SIG) has invited the Australian and New Zealand Intensive Care Society-Clinical Trials Group (ANZICS-CTG) Research Coordinators – Special Interest Group chair, Rachael Parke, from Auckland, to present at one of the breakout sessions. Associate Professor Steve Webb, the chair of the ANZICS-CTG, is a guest speaker along with biostatistician Dr Katherine Lee from the Clinical Epidemiology and Biostatistical Unit, Murdoch Children’s Research Institute Melbourne. There will also be a POISE-2 trial investigators’ meeting. Participants are encouraged to bring along their ideas for future multicentre research. Please contact [email protected] edu.au prior to the workshop with the title and a one-page summary of your proposal(s). More information can be found at: www.anzca.edu.au/fellows/Research/ anzca-trials-group-events.html Stephanie Poustie ANZCA Trials Group Research Fellow and Co-ordinator 8th ISHA 2013 ISHA 2013 ! s r e t t a M y r o t s Hi 8th International Symposium on the History of Anaesthesia, 22–25 January 2013, University of Sydney, Australia ‘The Anaesthetist’ by Harold Cazneaux 1933 Satellite meeting, Melbourne, January 29-30 Geoffrey Kaye Museum of Anaesthetic History, Australian & New Zealand College of Anaesthetists The University of Sydney www.isha2013.com [email protected] 47 Welcome to the Melbourne 2013 Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Taking place from May 4 to 8, 2013, the regional organising committee has planned a scientific program in a venue with an international green star rating that prides itself on high quality food and wine, complemented by an engaging social program. All in one of the best cities in the world – which combines refined culture with cutting edge cool! With its leafy boulevards, intimate laneways, cultural precincts and known for its dining-out scene, Melbourne is the perfect setting to reconnect with colleagues and to meet new ones. The theme ‘Superstition, dogma and science’ is an opportunity for each of us to critically examine our practice and reflect on these elements in all that we do. Are we creatures of habit? Are we as open to change as we think? Can we justify and explain the choices we make every day? We have embraced this theme by developing a diverse scientific program to be delivered by an exceptional group of world-renowned anaesthetists and pain specialists, in conjunction with many other outstanding medical specialists, scientists and non-medical professionals. We will showcase the strengths of our specialty through these highly respected champions and support their teaching with dynamic workshops and small group discussions. The flexibility and scheduling of the program will allow you to choose your own adventure and create the conference experience that you seek. We invite you to bring an open mind and look forward to welcoming you to Melbourne in 2013. Dr Debra Devonshire, Convenor Dr Mark Hurley, Deputy Convenor Dr David Bramley, Scientific Co-Convenor Dr Rowan Thomas, Scientific Co-convenor Dr Michael Vagg, FPM Scientific Convenor 48 ANZCA Bulletin June 2012 ConFIrmed keynote SPEAKERS Professor Kevin Tremper MD, PhD (ANZCA ASM Visitor, USA), University of Michigan and head of the Multicenter Perioperative Outcomes Group, whose plenary lecture will address the translation of large population outcome study results into decisions for individual patients under our care. Associate Professor Timothy Short MB, ChB, MD Otago, FANZCA, FHKCA (Australasian Visitor, New Zealand), current chair of the ANZCA Clinical Trials Group, an expert in pharmacological interactions as reflected in response surfaces, as well as the association between depth of anaesthesia and outcomes. Professor Edzard Ernst MD, PhD, F Med Sci, FRCP, FRCP(Ed) (FPM ASM Visitor, UK), the first full professor of complementary medicine in the UK, who has vast experience in bringing science and evidence to this often unscientific and largely unregulated field. Register your interest at www.anzca2013.com or via email at [email protected] Coming soon... The regional organising committee recommendations on the top FIVE coffee houses, bars, bike routes and kick back venues. Professor Paul White PhD, MD, FANZCA (ANZCA Victorian Visitor, USA) from Cedar Sinai Medical Centre, a widely published expert in anaesthesia for ambulatory surgery and section editor for Anaesthesia & Analgesia, who will focus particularly on some of the myths and science behind anaesthesia for our aging population. Professor Fabrizio Benedetti, MD (FPM Victorian Visitor, Italy), internationally recognised for his research in the neuroscience of placebo and for his book The patient’s brain: the neuroscience of the doctorpatient relationship. Professor Colin Royse, MBBS MD FANZCA (Organising Committee Visitor, Australia), known for his research in cardiac anaesthesia, ultrasound and echocardiography, who will address the outcomes that really matter to patients. KeY dates Call for Abstracts Open September 2012 Registration Opens November 2012 Call for Abstracts Close February 2013 Notification to Authors Early March 2013 Early Bird Registration Closes March 2013 ANZCA ASM 2013 May 4-8, 2013 49 Successful candidates Primary examination February/April 2012 One hundred and sixty four candidates successfully completed the Primary Fellowship Examination and are listed below: Nathan Mark Oates Ross Ingle Hanrahan Adam Mark Hill Adelene Su-Chen Ong Alison Beth Main Alyson Patricia McGrath Aman Bamra Deep Singh Amardeep Singh Ananth Kumar Andrew Mena Nikola Ashokkumar Murugesan Christopher Michael Mason Daniel Hernandez David Jack Zalcberg David Sai-Wo Cheng Jang Cheu Cham Jessie Ly Joseph Peter Wilbers Karen Ann Hungerford Karina Simone Berzins Lara Rybak Leonid Pinski Lucy Rebecca Kelly Mahsa Mirkazemi Marcin Felix Teisseyre Michael Patrick Reid Nathan Andrew Moore Nathan Roy Thompson Neil Lawrence Pillinger Penelope Gaye Taylor Peter Alexander Baird Phui Leng Chan Rebecca Jade McNamara Rebecca Scott Sheung Hei Anthony Wan Shirin Jamshidi Simon Christopher McLaughlin Sunshine Kaya Austin Trylon Matthew Tsang Abigail Ngar-Yee Wong Behruz Mohammad Jamshidi Catherine Ann Abi-Fares Christian Van Nieuwenhuysen Christopher John Gorton Claire Margaret Amy Manning Clinton John Patricks 50 ANZCA Bulletin June 2012 ACT ACT NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW Qld Qld Qld Qld Qld Qld Qld Craig Andrew McDonald Daniel James Robertson David Gutierrez-Bernays David Liu Desiree Vanguardia Perez Jacqueline Yung Joanne Lyn Cummins Jolyon Jay Bond Karl James Gadd Kellie Maree Bird Linh Tien Nguyen Michael John Saba Ohmar Aung Paul Robert Mills Peter Francis Correa Rajdev Toor Rebecca Helen Kamp Samuel Michael Bongers Sim-Wei How Sorcha Eibhlin Evans Stephen Chi-Wei Fung Thomas Michael Walsh Victor Khi Lee Wai-Mee Foong Yee-Jen Jane Chia Adam Richard Storey Alexandra Alison Bull Ann-MareeBarnes James Arthur London Laura Jane Willington Marni Calvert Richard Peter Champion Richard Samuel Lumb John James Carney Alireza Shangarffam Amandeep Singh Sarai Bishoy Moussa Bronwyn Calire Scarr Carolyn Sarah Varney Clara Anamaria Cotaru Damien Elsworth Daniel Knox Joyce Darragh Eoiw O’Brien Dorothy Wai-Lin Chan Fazian Zia Gordana Ukalovic Gregory Michael Bulman Harriet Clare Beevor James Austin McGuire Jenny Clare Hewlett Joshua Anthony Szental Julia Kuchinsky Julie Yin Mei Chan Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld SA SA SA SA SA SA SA SA Tas Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Kacey Nicole Williams Marissa Ferguson Melinda Neroli Miles Murthi Sangeetha Nathalie Mei Gomes Noam Benjamin Winter Peter Doukas Ryan Basil McMullan Sophia Cotton Bermingham Thomas Peter Sullivan Vanita Mohan Bodhankar Verity Rachel Sutton Vina Meliana Vincent Andrew Kun-Sai Yuen Ying Chen Andrew Jin-Meng Lee Anna Carter Christine Siang-Yin Ong Daniel Eric Anderson Ing-Kye Sim Jan David Janmaat Jen Aik Tan Mumtaz Anwar Khan Nathan Jon Curr Paul Anthony Cosentino Paul Matthew Ricciardo Renuka Alakeson Rohan David Mahendran William Henry Fellingham Ka-Hei Chong Maggie Wai Ying Tsui Sen Yin Stevienne Tam Wai-Naam Wales Chan Woon-Lai Lim Abhishek Jain Alison Jackson Beau Curby Klaibert Chen Seong Ong David Samuel Prior Emily Claire Rowbotham Erica Ting-Yi Hsu Gemma Anne Malpas Graham Clifford Wesley Heidi Joanna Mary Nelson Jeremy Stephen Young Joesph Raoul McKerras Julia Kate Taylor Katia Vanya Hayes Madison Rosanna Elaine Goulden Michael Richard Tan Rochelle Amanda Barron Ruth Elizabeth Brown Sallie Elizabeth Malpas Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic WA WA WA WA WA WA WA WA WA WA WA WA WA WA HK HK HK HK Mal NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ NZ Sathish Krishnan Scott Yu-Chun Wu Siew Ting Chin Sophie Caroline Van Oudenaaren Yiyi Zhang Desmond Yu Mun Ho Fung Chen Tsai Lik Han Tee Selene Yan Ling Tan Stella Lin Ang Xian’en Hope Ang Zhi-Xiang Tan NZ NZ NZ NZ NZ Sing Sing Sing Sing Sing Sing Sing Renton Prize The Court of Examiners recommended that the Renton Prize for the half year ended June 30, 2012, be awarded to: Ing-Kye Sim WA Merit Certificates Merit Certificates were awarded to: Jacqueline Yung Jen Aik Tan Julie Yin Mei Chan Andrew Mena Nikola Emily Claire Rowbotham Yiyi Zhang Jeremy Stephen Young Julia Kuchinsky Selene Yan Ling Tan Daniel Eric Anderson Gregory Michael Bulman Adam Richard Storey Thomas Peter Sullivan Jolyon Jay Bond Sangeetha Murthi Alexandra Alison Bull Qld WA Vic NSW NZ NZ NZ Vic Sing WA Vic SA Vic Qld Vic SA Final examination March/May 2012 One hundred and thirty five candidates successfully completed the Final Fellowship Examination and are listed below: Hon Earn Sim Adrian Boyn Alexander Duthie Andrew Alexander Lovett Angela Suen Arjun Nagendra Brendan Alexander Irvine Caroline Anne Jackson Caroline Liana Fung Christopher Charles Stone Dinesh Harkishin Thadani Elizabeth Mei-Ying Symons Emily Ching-Ying Yeoh Jia Jia Ye Jonathan Douglas Minton Marie Christiane Hadassin Paul Mark Healey Rachel Ruff Ragu Nathan Robert Patrick Heavener Stanley L. Yu Stephanie Wei Yin Fong Stephen Jonathan Smith Thananchayan Elalingam Timothy Suharto Wajdi Hadi Mohamad Ahmad Al-Salhi Yasmin Vivian Celeste Zarebski Alistair Grant Kan Bradley John Smith Brooke Jean Vickerman Colin Thomas Brodie Emma Lucinda Walters Francesca Lee Rawlins Jacqueline Annette Evans Jeremy Luke Brammer Joshua Surian Daly Kellie Anne Ovenden Lisa Deecke Lynda Glenys Veronica Allchurch Minka Grenier Mitchell Morse Nurul Shamsidar Mohamed Bakri Paul Francis Wigan Paul Joseph Bennett ACT NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Qld Paul Robert Nicholas Peter David Koudos Philip Lloyd Stagg Torben Neal Wentrup Wendy Julia Morris William Thomas Meade Yasmin Whately Andy Sisnata Siswojo Arvinder Grover Benjamin Philip Jones Chuan-Whei Lee Daniel Hsin-Kai Liu Gareth Iain Symons Gauri Sangeeta Resch Grace Mei Ling Seow Herman Lim Ian Thomas Chao Jamahal Maeng-Ho Luxford James Stuart Clark Joseph Isac Josephine Agnes Morrison Kirsten Alice Bakyew Lahiru Nipun Amaratunge Lakmini Kamithri De Silva Li Ann Teng Mark Joseph Heynes Martin N-H Hoai Nguyen Matthew Garry Richardson Melinda Kelly Same Michelle Sue-Lin Chia Nam Van Le Nerida Frances Telec Rachel Dilernia Sina Mahjoob Suet-Ling Goh Suzanne Claire Whittaker Timothy James Byrne Trung Thien Du Andrew Fah Andrew Norman Richard Wing Jeremy Thomas Sutton Kuan Lee Ng Michael Douglas Schurgott Nathan Trent Judd Vicki Anne Cohen Daniel John Aras Mark Michael Alcock Byrne Erik Redgrave Claire Louise Hinton David Andrew Kingsbury David Edward Bridgman David William Hoppe Qld Qld Qld Qld Qld Qld Qld Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic Vic SA SA SA SA SA SA SA Tas Tas WA WA WA WA WA (continued next page) 51 Successful candidates continued Hamish Stuart Mace WA Marlene Louise Johnson WA Miles Earl WA Natasha Kamala Epari WA Riyad Adul Aziz Dawood WA Vanessa Greta Percival WA Wong Yoke Mooi WA Alastair James Ineson NZ Andrew Lynn Hamiliton Childs NZ Benjamin Thomas Hayes Greenwood NZ Ching Wan Wu NZ Conrad Engelbrecht NZ David Heather Laurence NZ Geoffrey Paul Carden NZ Jaime Leigh O’Loughlin NZ James Edward Moore NZ Jeffrey Ian Reddy NZ Jennifer Anne Wright NZ Jeremy James Archer NZ Jin Hyuk Kang NZ Jonathan Colin Kersley Taylor NZ Joseph Charles Luke Taylor NZ Kathryn Frances Dawson NZ Lucy Rebekah Stone NZ Marsha Kim Heus NZ Nicolas William Rogers NZ Owen Callender NZ Phillip John Quinn NZ Po Che Yip NZ Rachel Clair Dempsey NZ Samuel Morrow Grummitt NZ Victoria Yien Freeman NZ Ku Ying Wai HK Ling Wai Yip HK Mak Wai Yin HK Or Yin Ling HK Tse King Yan Catherine HK Tsui Sin Yui Cindy HK Wong Tak Yee HK 52 ANZCA Bulletin June 2012 Fifteen candidates successfully completed the International Medical Graduate Specialist Exam and are listed below: Namita Rakheja Mahesh Ganji Caroline Collard Sibi Kurian Kajari Roy Nitin Nair Tharapriya Ramkumar Tilo Willy Klinger Arnold Beeton Adly Ariff Abas Andreas Rassamy Manopas Cristina Revenga Cilla Jesco Kompardt Raymond Sinnadurai NSW NT Qld Qld SA SA SA Tas Vic WA WA WA WA WA Cecil Gray Prize The Court of Examiners recommended that the Cecil Gray Prize for the half year ended June 30, 2012, be awarded to: Hon Earn Sim ACT Merit certificates Merit certificates were awarded to: Andrew Norman Richard Wing Chuan-Whei Lee Ian Thomas Chao Jamahal Maeng-Ho Luxford Lahiru Nipin Amaratunge Marlene Louise Johnson SA Vic Vic Vic Vic WA Combined Education, Management, Simulation and Welfare SIG Meeting “Workforce: future force” September 21-23, 2012 Hyatt Regency Sanctuary Cove, Qld For further information: Hannah Burnell, SIG Coordinator T: +61 3 8517 5392 E: [email protected] www.anzca.edu.au/events/sig-events The Perioperative Medicine Special Interest Group in conjunction with the Acute Pain Special Interest Group presents: “When worlds collide: Perioperative medicine – the new specialty on the block?” The Byron at Byron Resort, Byron Bay, NSW July 27-28, 2012 For further information, please contact the conference organiser: Kirsty O’Connor T: +61 3 8517 5318 E: [email protected] www.anzca.edu.au/events/sig-events 53 Anaesthetic history: Museum receives valuable historical gifts from South America Three items of historical significance, including a Takaoka ventilator and a Takaoka universal vaporiser, have been donated to the Geoffrey Kaye Museum of Anaesthetic History at a presentation in Buenos Aires, Argentina. At the recent World Congress of Anaesthesiologists, the honorary curators of the Geoffrey Kaye Museum, Rod Westhorpe and Christine Ball, were guests at a historians lunch, hosted by the Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires. The association, whose headquarters are in a suburb of the great city of 14 million inhabitants, proudly showed us their museum, with its own street frontage and display window. Two of the items donated to the museum were invented by Brazilian anaesthetist and engineer Dr Kentaro Takaoka in the 1950s. The Takaoka ventilator and the Takaoka universal vaporiser were enormously popular in Latin America, and elsewhere in the world. The ventilator is particularly interesting because of its compact size. The third gift was a copy – one of only two known to remain in existence – of the first edition of the journal Revista 54 ANZCA Bulletin June 2012 Argentina, Anestesia y Analgesia, April, 1939. This is one of the earliest anaesthesia journals ever published and, after being brought home very carefully, it is now in the proud possession of the Geoffrey Kaye Museum. The Geoffrey Kaye Museum of Anaesthetic History enjoys an international reputation as one of the major collections in the world and many international historians admire and envy the role the museum has played in furthering professional and public knowledge of the history and practice of anaesthesia. The visit to the World Congress of Anaesthesiologists gave us the opportunity to renew the many close relationships that the museum maintains with international anaesthesia historians. Christine Ball presented at one of the historical sessions. The Buenos Aires association presented a fascinating display throughout the congress, including what is believed to be the oldest film of an anaesthetic. Taken in 1899, the film shows the surgical removal of a hydatid lung cyst. The anaesthetic, believed to be chloroform, is administered by open drop by a medical student while the surgeon, without gloves, mask or headwear, removes the cyst. The Geoffrey Kaye Museum now has a copy of the film on DVD. The Geoffrey Kaye Museum of Anaesthetic History and ANZCA are proud supporters of the forthcoming International Symposium on the History of Anaesthesia, to be held in Sydney in January. A two-day satellite symposium in Melbourne will follow a few days later, when we expect to host many international guests at the College. Dr Rod Westhorpe, Honorary Curator, Geoffrey Kaye Museum of Anaesthetic History Dr Christine Ball, Honorary Assistant Curator, Geoffrey Kaye Museum of Anaesthetic History ANZCA history and heritage update ANZCA’s history is highly valued among many Fellows and trainees who identify history and heritage as a tangible reminder of the high standards and achievements of previous generations. Consequently, the ANZCA Council signed off on a history and heritage strategy in 2011 that aims to meet 10 key objectives in capturing and documenting the history of the College while enhancing the Geoffrey Kaye Museum of Anaesthetic History, an internationally significant collection. The 10 objectives are focused around preservation, engagement, accessibility and relevance to Fellows and trainees. In 2012, key activities to date have included the filming of three interviews with key College figures – Professor Emeritus Tess Cramond, Dr Duncan Campbell and Dr Nerida Dilworth. Dr Dilworth is a well-known retired paediatric anaesthetist from Western Australia, Dr Campbell designed the Campbell ventilator and was awarded the Orton Medal at the Perth annual scientific meeting and Professor Cramond is a significant historic figure in Australasian anaesthesia. These engaging oral histories will be available to all Fellows via the ANZCA website during the second half of 2012, forming part of an ongoing series. Other activities have focused on the implementation of robust historical collection and archiving policies that will provide guidance on the collection and maintenance of items of historical importance. Work has also commenced on improving accessibility to the collection held by the College through the use of information technology. This is focused on providing a rich and interactive experience of material via the ANZCA website. Also under way are plans for a strong historic presence at next year’s ANZCA annual scientific meeting in Melbourne and the development of materials that highlight the history of the College. Opposite page clockwise from top left: Group photo outside the Anaesthesia Museum of the Buenos Aires Anesthesia Association. From left: Dr Enrico Buffa, Dr Hector Venturini (Curator), Dr Rod Westhorpe, Dr Christine Ball, Dr David Wilkinson (WFSA President), Dr Douglas Bacon (Wood Library Laureate), Dr Alberto Varela (Director), and Dr George Bause (Curator, Wood Library Museum); Dr Christine Ball being presented with the Takaoka ventilator by Dr Enrico Buffa, Dr Alberto Varela (Director), and Dr Hector Venturini (Curator); A copy of the first issue of the Argentinian journal Anestesia y Analgesia, 1939. This page from left: Filming oral histories are Dr Nerida Dilworth and Dr Wally Thompson; Dr Duncan Campbell and Dr Christine Ball. Mark Harrison General Manager, Fellowship Affairs 55 The early development of anaesthesia practice in Queensland This is the fifth article in a series about the foundation Fellows of the Faculty of Anaesthetists, Royal Australasian College of Surgeons. Professor Tess Cramond takes up the story as it unfolded in Queensland1. The first practitioner with a higher degree in anaesthetics to practice in Brisbane was Dr “Doggie” David Aubrey Davis, MB ChM (Syd) 1923, Diploma in Anaesthetics (DA), Royal Colleges of Physicians and Surgeons (RCP&S) 1939. There is a record of his having an appointment at the Brisbane Hospital as an Honorary Physician (1932-38). Dr Horace Johnson completed physician training in Edinburgh as well as special training in anaesthetics and is also recognised as one of the founder practitioners in Queensland. He worked as honorary anaesthetist to the Mater Children’s Hospital in Brisbane from 1935 until the wartime period. As his resident in 1952, my interest in anaesthetics was nurtured by him. When Dr Johnson volunteered for the Australian Imperial Force (AIF), his anaesthetic practice was taken over by Dr Vera Madden (married name Watson) MBBS (Melb) 1935, who provided yeoman service to an overworked surgical community. She was the first full-time appointment in anaesthetics at Brisbane Hospital (1938-41). She went into private practice when Dr Horace Johnson volunteered for 56 ANZCA Bulletin June 2012 the AIF, remaining in practice until her husband, Dr Donald Watson (orthopaedic surgeon), returned from active service in 1946. Dr Madden was followed (1941-45) by Dr Agnes Coates Earl, MBBS (Syd) 1939 and, when she resigned, from 1945-49 by Dr Ray Robinson, MBBS (Qld) 1943, who obtained the two-part DA (Syd) 1951. Dr Robinson was to play a pivotal role not only as one of the “Queensland Girls”, but also in the development of paediatric anaesthesia at the Hospital for Sick Children and in thoracic anaesthesia at the Brisbane Hospital and later at the Princess Alexandra Hospital. She anaesthetised the first neonate to have surgery for repair of a tracheo-oesophageal fistula by Dr Morgan Windsor, and it was a memorable experience for me to have been the anaesthetic registrar helping her that night in 1954. Dr Robinson was joined in 1947-49 by Dr Joan Dunn, MBBS (Qld) 1944. She completed her training in Oxford, obtaining the two-part DA,RCP&S (1951) – the first Queensland graduate to obtain a higher degree in anaesthetics. She was appointed the first anaesthetics supervisor (later called director), at the Brisbane Hospital (1951-53). A superb, quietly efficient administrator, she had the unenviable task of providing clinical care, supervising and training junior staff and organising a new department. There was limited finance, facilities were primitive and the administration less than supportive. For Dr Dunn, there “were no problems, only solutions”. There were 20 operating theatres in eight areas of the three hospitals – the Brisbane Hospital, the Women’s and the Hospital for Sick Children. Another woman whose re-entry to medicine after 21 years was to have a marked impact on the future of anaesthetics in Queensland was Dr Isabel McLelland, MB ChM (Syd) 1918. She was almost 50 before she retrained in medicine to give anaesthetics for her husband, gynaecologist Dr Hugh McLelland. Mrs McLelland, as she was always known, established the partnership which was later known as “The Queensland Girls”, interstate and overseas. She did much to foster the role of the specialist anaesthetist “She managed even the most irritable surgeons superbly telling them to get on with the surgery for which they were trained – and giving them a score on her ‘grizzle graph’!” providing excellent service for elective and emergency surgery. She was elected to membership of the faculty of anaesthetists but later declined election to fellowship on the grounds that fellowship was the accolade for those who did formal training and successfully fulfilled the examination requirements. It was my privilege to be invited to join the group – with Mrs McLelland, Dr Robinson, Dr Dunn and Judith Foote. Dr Ruth Molphy, MBBS (Qld) 1947, was appointed registrar 1948-1950 and then proceeded to the UK, obtaining the two-part DA in 1952 before returning to the Brisbane Hospital as director of anaesthetics 1953-1963, and later as foundation director at the Prince Charles Hospital 1963-1983. Dr Molphy was an innovator. She built on Dr Dunn’s firm foundation and introduced the recovery room and the respiratory unit, the forerunner of the modern intensive care unit. She managed even the most irritable surgeons superbly telling them to get on with the surgery for which they were trained – and giving them a score on her “grizzle graph”! The input of three remarkable women – Dr Dunn, Dr Robinson and Dr Molphy – moulded anaesthetic practice in Queensland. They were exceptionally competent clinicians, gentle and technically dextrous, ready to be innovative with new drugs and techniques. Importantly, they related well to patients, surgeons, nurses and other health professionals. So the precedent was set – women doctors make good anaesthetists! Appointment of women as anaesthetic registrars was accepted. On the other side of the river, the first anaesthetics registrar at the Mater was Dr Patricia O’Hara (Lady Brennan) MBBS (Qld) 1950, in 1952, followed by Dr Gavan Carroll MBBS (Qld) 1952, who served in the position from 1954 to 1955. He undertook all the teaching of medical students until the appointment of Dr Sheila Power MRCS LRCP (Sheffield) 1957, DA 1959 as the first director, from 1963 to 1973. The last two-part DA,RCP&S was held in 1953 and it was replaced by the two-part FFARCS. Both Dr Dunn and Dr Molphy were admitted to FARCS in 1954. The Faculty of Anaesthetists of the Royal Australasian College of Surgeons was established in 1952 and Dr Dunn and her colleagues, including Dr Averil Earnshaw MBBS (Qld) 1950, DA 1953, were disappointed to miss out on early offers of foundation membership of the new faculty although many did in fact become foundation members. It is apparent that many ex-servicemen had learnt anaesthetics under field conditions, working with surgical colleagues who were now in private practice and important in medical politics. It is not surprising that prominent ex-servicemen – Dr Arnold Robertson MBBS (Syd) 1936, Dr Hec Willson, MBBS (Syd) 1939, Dr Hugh Connolly MBBS (Qld) 1941, Dr Edward Muller MBBS (Qld) 1940, and Dr John Woodley MRCS LRCP 1940 – were sponsored for admission to the fledgling Faculty of Anaesthetists, RACS. Dr Robertson and Dr Willson were admitted as foundation Fellows and Dr Connolly, Dr Dunn, Dr Win Fowles MBBS (Syd) 1939, Dr Molphy, Dr Muller, Dr Robinson and Dr Woodley, who graduated from the University College Hospital London, as foundation members2. (continued next page) From left: Dr Arnold Robertson; Dr Joan Dunn; Professor Tess Cramond. 57 The early development of anaesthesia practice in Queensland continued Dr Robertson was the son of a distinguished ear, nose and throat surgeon and had a privileged education – the Armidale School, St Andrew’s College and the University of Sydney. He had blues for rowing and rugby. Initially a general practitioner in Queensland, he drifted into full-time anaesthetics practice because “he enjoyed it and was good at it”. He was appointed visiting specialist at the Mater and could be described as the founder of the specialty in Queensland. His war service was equally outstanding. He retired with the rank of Lieutenant Colonel, an OBE and several mentions in dispatches. He served on the Council of the British Medical Association and was its secretary in 1948. He became state representative to the federal executive of the Australian Society of Anaesethetists, and then its federal president in 1950-51, when he was convenor of the anaesthetics section of the Australian Medical Conference. In 1952 he decided to migrate to the United Kingdom, where he remained for 20 years. Dr John Hector “Hec” Willson enjoyed a long successful career as a clinical anaesthetist, which included a post as Special Lecturer in General Anaesthesia, Faculty of Medicine and Dentistry, University of Queensland, and senior roles at the Mater and Brisbane General hospitals as well as visiting and consultant roles at Greenslopes Repatriation Hospital and Yeronga Military Hospital. 58 ANZCA Bulletin June 2012 With the establishment of the regional committees of the faculty in 1956, Dr Willson, Dr Connolly and Dr Muller all accepted a role for a short period, but the driving forces were Dr Dunn, Dr Robinson and Dr Molphy, later supported by Dr Roger Bennett MBBS (Qld) 1945. References: 1. Professor Cramond served as Dean of the Faculty of Anaesthetists, RACS, from 1972 to 1974 and has published a number of previous articles in the ANZCA Bulletin about outstanding women anaesthetists, including: Obituary article - Dr Lillian Joan Dunn, published in the March 2002 edition, pp. 26-27 Obituary article – Dr Margaret Smith, March 2008 edition, pp. 16-17 Obituary article – Dr Agnes Mary Daly, March 2010 edition, pp. 98-99 Obituary article – Dr Ruth Molphy, June 2011 edition, pp. 106-107 2. Three doctors were added to the list of foundation members in June 1953: Dr William Ackland-Horman of South Australia, Dr Isabella McLelland of Queensland, and Dr Stewart Peddie of New Zealand. Please refer to the Register of Fellows and Members of the Faculty of Anaesthetists, Royal Australasian College of Surgeons, page 43 [held in ANZCA Archives]. “The input of three remarkable women – Dr Dunn, Dr Robinson and Dr Molphy – moulded anaesthetic practice in Queensland.” advertisement Postoperative pain relief * that’s fast, and lasts 1 *DYNASTAT is indicated as a single perioperative dose for the management of postoperative pain. Before prescribing, please review Product Information. (parecoxib sodium for injection) ™ PBS Information: This product is not listed on the PBS. BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE FROM PFIZER AUSTRALIA PTY LTD. MINIMUM PRODUCT INFORMATION DYNASTAT ™ Injection (parecoxib) 40 mg Powder and Diluent for Injection. Indications: single peri-operative dose for post-operative pain. 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Nine media releases were issued promoting the ASM, the Faculty of Pain Medicine Refresher Course Day and the Joint Trauma and Anaesthesia and Critical Care in Unusual and Transport Environments (ACCUTE) Special Interest Group meeting, which focused on mass casualties and burns. Topics that generated the largest amount of media interest included Dr Bob Large from the Auckland Regional 60 ANZCA Bulletin June 2012 Pain Service talking about the uses of hypnosis in analgesia and pain management; Professor Geoffrey Dobson from James Cook University explaining how he is developing a resuscitation fluid for injured soldiers inspired by hibernating hummingbirds; Associate Professor Andrew Davidson from Melbourne’s Royal Children’s Hospital talking about the increased risks of anaesthesia for newborns; Professor Jamie Sleigh from New Zealand’s Waikato Hospital explaining a possible genetic link to anaesthetic awareness; Dr Nolan McDonnell from Perth’s King Edward Memorial Hospital for Women outlining increased complications associated with extremely obese pregnant women; Professor Amy Tsai from the University of California, San Diego, explaining how worms are being used to develop artificial blood; and visiting US Professor Ruth Landau talking about the “love hormone” oxytocin. Seventeen speakers from the conference and associated meetings were interviewed and ANZCA greatly appreciates their contribution. Full coverage from the meeting can be found on the ANZCA website under “Events”. Apart from the ASM, ANZCA also contributed to a 4000-word feature on chronic pain in the Weekend Australian (circulation 300,000) quoting Associate Professor Milton Cohen and Professor Michael Cousins, and a pain medicine career special in the MJA Careers section featuring FPM spokesmen. Also in the pain area, former FPM Dean, Dr David Jones, was interviewed by a NZ wire service about the need for New Zealand to follow Australia’s lead on prescription opioid tracking. A media release promoting publication of the Safety of Anaesthesia: A review of anaesthesia-related mortality reporting in Australia and New Zealand 2006-08 received coverage, as did one about the Specialist Training Program funding secured by ANZCA, which was widely reported in regional and rural areas. Meaghan Shaw Media Manager, ANZCA Since March this year, ANZCA has generated… Media releases distributed by ANZCA since March this year $50,000 raised to save lives in developing countries (May 16) Perth anaesthetist and pain expert new ANZCA president (May 16) 67 print stories 85 online stories 170 radio reports 44 television reports Oxytocin: the love hormone’s new role in pain relief (May 14) Primordial species could be the key to artificial blood (May 13) Post-operative nausea and vomiting: is there a genetic link (May 12) Hypnosis in pain management (May 11) Revolutionary pain service leads the way on pain relief (May 10) Hibernating hummingbirds inspire new resuscitation fluid (May 10) More than 1300 anaesthetists to attend key meeting in Perth (May 8) Anaesthesia remains extremely safe (April 23) Boost for rural health with extra specialists trained (April 12) ANZCA Bulletin out now: ANZCA turns 20; NZ urged to adopt prescription opioid monitoring; Christchurch one year on – NZ release (March 30) ANZCA Bulletin out now: ANZCA turns 20; training Mongolian skeptics; NZ urged to adopt prescription opioid monitoring – Australian release (March 30) 14 - 17 November 2012 Auckland, New Zealand www.iccva2012.com Register now www.iccva2012.com New Zealand Anaesthesia Annual Scientific Meeting combined with the 13th International Congress of Cardiothoracic and Vascular Anesthesia Hosted by In association with 61 The Anaesthesia and Pain Medicine Foundation Dr Roderick Deane appointed Knight Companion Anaesthesia and Pain Medicine Foundation Board member Dr Roderick Deane, who joined the board in October 2011, has received the honour of appointment to the New Zealand Order of Merit as a Knight Companion. Sir Roderick was appointed by Her Majesty the Queen on the occasion of the celebration of the Queen’s Birthday and Diamond Jubilee this year. The significance of this honour is reflected in the fact it is one of just four Knight Companion appointments made to the New Zealand Order of Merit in this year’s Queens Birthday and Diamond Jubilee Honours List. Sir Roderick’s senior level contributions to New Zealand in corporate and business leadership, public sector reform and central banking, particularly through his leadership during the currency crisis of 1984, are widely recognised for having significantly improved economic opportunities for all New Zealanders. 62 ANZCA Bulletin June 2012 The appointment also reflects Sir Roderick’s long-term commitment to the arts and his provision of assistance and leadership to charitable causes and organisations. Along with his participation on ANZCA’s Anaesthesia and Pain Medicine Foundation Board, Sir Roderick’s contributions have been a strong example of personal community service that helps to improve the quality of life through expanding economic, cultural, creative, and health and wellbeing opportunities. Sir Roderick’s contribution to the board of the Anaesthesia and Pain Medicine Foundation comes at a time of renewed effort to increase the foundation’s fundraising, to increase support for scientific research, overseas aid and indigenous health. Improving support in these areas is vital for delivering better health outcomes to millions of New Zealanders, Australians and people in developing countries. Give to the foundation’s research funding appeal As part of its fundraising program, the foundation recently sent an appeal to Fellows and the public in Australia and, pending the response, is planning a similar appeal in New Zealand. If you haven’t responded already, please consider sending a contribution. Previous research by ANZCA Fellows has produced results and further grants far outweigh the small initial costs. Making a gift to the foundation is one of the best and most relevant philanthropic investments available! Thank you to all Fellows who have already given generously. Gifts can be made by mail or by calling Rob Packer at the foundation on +61 3 8517 5306. Robert Packer General Manager, Anaesthesia and Pain Medicine Foundation, ANZCA To donate, or for more information on supporting the foundation, please contact Robert Packer, General Manager, Anaesthesia and Pain Medicine Foundation on +61 3 8517 5306 or email [email protected] advertisement Heading Sample MetaVision® Proven Anaesthesia Information Management Systems Ease the burden of documentation Improve compliance with protocols & best practices Create accurate, complete anaesthesia records In today’s perioperative environment, clinicians need to plan and administer care while simultaneously documenting and responding to vast amounts of information. Anaesthesiologists must comply with numerous clinical protocols while capturing the administrative information necessary for maximum and speedy reimbursement. 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She will now sit on the NZNC ex officio as a councillor so at the June meeting the NZNC will consider coopting a further member in her stead. Internal elections for officers will be held at the June meeting. Dr Vanessa Beavis has been appointed chair of the NZ Panel for Vocational Registration. The NZNC meets on June 22-23, with the 2011 ANZCA Media Award winner, health reporter for TVNZ Lorelei Mason, as the guest speaker. She will talk to the committee about how the media works and what they are looking for when putting together a story. This meeting is preceded on the Friday by the NZNC’s annual joint meeting with the New Zealand Society of Anaesthetists’ Executive. ANZCA CEO Linda Sorrell and ANZCA President Dr Lindy Roberts will attend both meetings. General news Non-specialists practising anaesthesia The Medical Council of New Zealand (MCNZ) has revised the recertification requirements for general registrant doctors who are not vocationally registered or in a specialty training program. The MCNZ has contracted with Bpac (Best Practice Advocacy Centre – a joint venture between some primary care organisations and the University of Otago) to offer the required recertification training program. About 20 of these general registrants are already registered in ANZCA’s CPD program and in March the NZNC raised with the MCNZ and Bpac the issue of how to avoid these doctors having to undertake two CPD programs. The MCNZ has since advised that those registered in the ANZCA CPD program as at March 14, 2012 will not also have to undertake the Bpac program, provided that within two years, the ANZCA program is meeting all the MCNZ’s administrative requirements for general registrant recertification. Registration for anaesthetic technicians The new registration regime for anaesthetic technicians, bringing them under the Health Practitioners Competence Assurance Act 2003 (HPCAA), came into full effect as at April 1. Now only those registered as an anaesthetic technician can hold themselves out to be anaesthetic technicians or practising anaesthetic technology. Their registration is 64 ANZCA Bulletin June 2012 administered by the Medical Sciences Council of New Zealand (MSCNZ), formerly the Medical Laboratory Sciences Board (MLSB). Under the new regime, health practitioners who undertake anaesthetic technology duties for a minimum of 384 hours in one year are expected to be registered in the scope of practice of an anaesthetic technician. While trainee technicians do not need to be registered, they are required to work under the supervision of a registered anaesthetic technician. As at May 31, 620 anaesthetic technicians had registered. Anaesthetic nurses without the anaesthetic technician qualification but relevant experience have the option of registering as an anaesthetic technician through a process that includes a workplace-based assessment. Several are going through this process. Alternatively, such nurses may choose to continue performing an anaesthetic nursing role but then may not use the title ‘anaesthetic technician’. The MSCNZ is considering allowing nurses until 2014 to register as an anaesthetic technician. 40th anniversary celebrations now next February Ongoing repairs to the University of Otago, Christchurch’s main building (damaged in the earthquakes) has seen a further postponement of the 40th anniversary celebrations of the Christchurch Medical School. The damage forced out researchers and students and repairs have prompted postponement of the celebrations twice – firstly from February 2012 and now from September 2012. However, the building is being repaired rapidly and on February 20-22, 2013 the University of Otago, Christchurch, will celebrate both a return to these premises and 40 years of research and teaching in Christchurch. Those who have worked or studied at the school are invited to participate. Celebrations include an anniversary dinner on February 22 and a day of scientific sessions as well as tours through refurbished laboratories. Register your interest by completing an online form accessible via a 40th anniversary button on http://www.otago.ac.nz/christchurch, or email [email protected] Council of Medical Colleges (CMC) At its March meeting, it was agreed that the Council of Medical Colleges (CMC) would continue with its enlarged secretariat, which will involve a 36 per cent increase in subscriptions phased in over two years. A CMC website is being developed to provide a conduit for information sharing and to progress matters between meetings. At the May meeting, Professor Alan Merry, as Chair of New Zealand’s Health Quality & Safety Commission, and Dr Leona Wilson, as Chair of the Perioperative Mortality Review Committee (POMRC), each gave updates on the work of the HQSC and POMRC, and outlined how colleges can help with this work, especially disseminating information arising from their reports. HWNZ Executive Chair Professor Des Gorman (pictured above) spoke to the group about health workforce issues, noting that a shortage of nurses is a larger and more pressing problem than the shortage of doctors. Professor Gorman said HWNZ was focusing on ways of improving what already exists, for example productivity improvements, addressing mal-distribution, and looking at the impact of models of care on the demand for doctors and other healthcare practitioners. The best mix of generalist and specialist skills remains on the HWNZ agenda, as does the development of a ‘flexible, redeployable workforce”. A document on prioritisation of funding for medical disciplines has been released to district health boards and Professor Gorman said it would be sent to colleges in the near future. Anaesthesia research ARGONZ (Anaesthetic Research Group of New Zealand) is an informal association for New Zealand anaesthetists and trainees interested in furthering scientific and clinical research in anaesthesia. The group would like to collect information about current and planned research so that it can be made available to the anaesthesia community in case others can usefully contribute to that research. ANZCA has agreed to assist with this. As a first step, anyone who has a current research project (or an idea for a future project) is asked to email ANZCA’s New Zealand office (anzca@ anzca.org.nz) with the title of their research and a few lines explaining where they are up to and any difficulties they face. NZ government news More operating theatres for Middlemore Hospital The Counties Manukau District Health Board, which administers Middlemore Hospital in South Auckland (pictured above), has received government approval for three new operating theatres and the replacement of 11 existing aged theatres. The new clinical services block will also include a 42-bed assessment and planning unit, an 18-bed high dependency unit, and replace the clinical sterile supply department. New trauma network The government has established a Major Trauma National Clinical Network to develop a national, strategic approach to the provision of major trauma services, from pre-hospital emergency care to rehabilitation and injury prevention services, and to co-ordinate major trauma service improvements. The network’s clinical leader is surgeon Mr Ian Civil, Director of Surgery at the Auckland District Health Board and the immediate past president of the Royal Australasian College of Surgeons (pictured above). Faster broadband for rural hospitals Under the second phase of rural broadband initiative contracts, 37 rural hospitals, including Thames and Taumarunui, as well as 10 health centres, will receive ultra-fast broadband. The faster links will allow rural staff to take part in training sessions being run in urban centres and enable clinicians to view immediately electronic information recorded across the country, rather than having to wait for reports or films to be sent. Tobacco plain packaging Cabinet has agreed in principle to introduce plain packaging for tobacco products in alignment with Australia. However, this is subject to the outcome of a public consultation process to be undertaken later this year. 65 The Australian Society of Anaesthetists invites you to join them at their 71st National Scientific Congress in Hobart from 29 September to 2 October 2012 For further further information information please please visit visit www.asa2012.com www.asa2012.com For Anaesthesia and Intensive Care Want to to access access the the latest latest research research and and Want developments in in Australasian Australasian anaesthesia? anaesthesia? developments Read original original papers, papers, reviews, reviews, case case reports, reports, Read correspondence and and more! more! correspondence For more more information information or or to to subscribe subscribe For please go go to to our our website. website. please Sign up up for for e-Table e-Table of of Contents Contents alerts alerts and and RSS RSS feeds feeds Sign 66 ANZCA Bulletin June 2012 www.aaic.net.au People and events Airway Management SIG Meeting The third Airway Management SIG Meeting was held at the Mantra Erskine Beach Resort in Lorne, Victoria from March 9-11. The theme of the meeting was “Everything airways: Airway problems outside the OT” and the international guest speakers were Dr Josef Holzki (Germany) and Dr Paul Phrampus (US). The convenor was Dr Chris Acott and the co-convenors were Dr Zoe Lagana and Dr Louisa Heard. More than 250 delegates attended lecture sessions and workshops with 20 companies from the healthcare industry supporting the meeting. The next Airway Management SIG meeting will be held in 2014. Trauma & ACCuTE Special Interest Group Conference The joint one day Trauma and Anaesthesia and Critical Care in Unusual and Transport Environments (ACCUTE) SIG Meeting was held at the Parmelia Hilton Perth on Friday May 11, 2012. The meeting was well attended and covered a wide variety of topics under the general theme of “Mass casualty- burns”. Guest speakers included Professor Fiona Wood, Mr John Kelleher, Professor Geoffrey Dobson and Lieutenant Colonel Michael Reade. The next meeting of the Trauma SIG will be held in conjunction with the Airway Management SIG in Melbourne, June 2013. Associate Professor John Moloney Dr Allan MacKillop Joint Convenors Obstetric Anaesthesia Special Interest Group meeting The 3rd Quadrennial Obstetric Anaesthesia Special Interest Group meeting was held at the Quay West Resort, Bunker Bay, following the 2012 ANZCA Annual Scientific Meeting. The location was on the edge of the renowned Margaret River Wine region and gave the delegates the opportunity to unwind after the ASM. The theme of the meeting was ‘high risk obstetric anaesthesia’ and speakers included well-known anaesthetists from around Australia and New Zealand. Invited speakers included Dr Luke Torre (intensivist), Dr Nicole Staples (haematologist), Dr Andrew Miller (lawyer and anaesthetist) and Professor Yee Leung (gynaeoncologist). The program included a number of interactive sessions, workshops and PBLDs, which included practical tips and tricks for delegates. There was a welcome reception at the resort and a wine tour, which visited well-known vineyards in the Margaret River. The social program also included a conference dinner at the Wise Vineyard. Meeting delegates raised more than $1000 for the Lifebox project through a series of raffles supported by the sponsors, adding to the success of this initiative from the ASM. The meeting attracted 120 delegates and six healthcare industry representatives, all of whom took away new ideas and new friends and colleagues. Thank you to all the delegates, speakers and workshop and PBLD facilitators for attending and contributing to the success of the meeting, a number of whom travelled a long way. A special thank you to Kirsty O’Connor from ANZCA, for her help with organising the meeting. Dr Nolan McDonnell Convener Above clockwise from top left: Dr Paul Phrampus (US) and Dr Josef Holzki (Germany); Dr Andrew Heard, Dr Pierre Bradley and Dr Richard Semenov; Delegates at the 3rd Quadrennial Obstetric Anaesthesia Special Interest Group meeting; Professor Fiona Wood and Dr Kylie Hall; Lieutenant Colonel Michael Reade and Co-Convenor Associate Professor John Moloney. 67 Australian news Queensland Queensland Regional Report Activity in Queensland continues at a high level and in the last three months has included: •Aweek-longfinalexampreparationcourse. •Primaryandfinalpracticevivasessions. •Writtenandclinicalexams. •Twoprimarylectures. •Twowebinarsandrecordingoffourpodcasts. •Athree-dayfoundationteachercourse. •Thedirectorsofanaestheticsmeeting. •The15thAnnualRegistrars’meeting. Once again, the Queensland Regional Committee would like to acknowledge the work of the dedicated and capable course convenors, lecturers and mock examiners who have offered trainees these valuable learning opportunities. Committees have been elected for 2012-14. Office bearers will be advised in the next edition of the ANZCA Bulletin. The selection and allocation process for 2013 hospital rotations has been reviewed and applications for placements closed June 4. Assessment is in full swing. Opposite page from left: Adjudicators Dr Helmut Schoengen and Dr Brian Lewer; Dr Peter Moran and the formal projects officer for Queensland, Dr Kerstin Wyssusek; Dr Yasmin Whately receiving the Tess Crammond Award from Professor Tess Crammond; Formal project presenters Dr Conrad Macrokanis and Dr Satnam Solanki; Adjudicators Dr Helmut Schoengen, Dr Sanjiv Sawhney and Dr Brain Lewer; Dr David Goldsmith receiving the lucky draw prize from Stefan Dooney of Pert & Associates; Brian Pert of Pert & Associates with Dr Michael Steyn; Dr Chris Turnbull, Dr Robert Miskeljin and Dr Andrew Wilke; Dr Conrad Macrokanis receiving the Axxon Health Award from Dr Patrick See. 68 ANZCA Bulletin June 2012 OPAL: Obstetrics, Paediatrics and Law Dr Ben van der Griend is the keynote speaker at the Queensland combined ANZCA/Australian Society of Anaesthetists annual conference being held on Saturday July 7. Dr van der Griend is a paediatric anaesthetist at the Christchurch Hospital. He has a strong interest in training and has set up a successful education program called PAT:CH – Paediatric Anaesthesia Teaching: Christchurch. Dr van der Griend’s presentation, “Is it safe to anaesthetise children?”, will address the likelihood of a child dying or being harmed by anaesthesia and whether anaesthesia damages the developing brain. The full conference program is available at on ANZCA’s Queensland regional office website: http://qld.anzca.edu.au. The 36th annual Queensland combined ANZCA/Australian Society of Anaesthetists conference focuses on obstetric and paediatric anaesthesia, as well as medico-legal principles relevant for anaesthetists. The day will comprise a series of lectures and a medico-legal panel discussion in the morning, followed by an ultrasound workshop, a paediatric resuscitation workshop and problem-based learning discussions in the afternoon. Workshop 1 is led by Dr Phil Cowlishaw and will focus on ultrasound for obstetric anaesthesia. Workshop 2 is led by Dr Amanda Harvey and offers an update in paediatric resuscitation. This workshop will focus on the current paediatric advanced life support guidelines. The workshop will cover changes to the Australian Resuscitation Council guidelines published in 2010, and paediatric anaesthetic emergencies including anaphylaxis and local anaesthetic toxicity. Problem-based learning discussions will include: ‘The headache of providing safe, effective labour analgesia’ and ‘Paediatrics: the sniffling snorer’. Program and registration details are available on the ANZCA website Queensland home page. We hope you join us at this significant Queensland event. We thank our conference sponsors for their support: Avant, MDA National, Sonosite, AstraZeneca, Abbott Australia, MSD, Pfizer, Medfin, Ferring Pharmaceuticals, Hospira, LMA PacMed, Ultimate Medical, B Braun. 15th Annual Queensland Registrars’ Meeting The registrars’ scientific meeting for the presentation of completed formal projects was held at the West End premises of ANZCA’s Queensland office on Saturday April 28. This is a key annual event in the training of anaesthetists and offers registrars the opportunity to present their original research for their Formal Project at a meeting of their peers. The standard of presentations was high and the winner, Dr Yasmin Whately, was commended by the adjudicators for the significant development to her skills, required to collect and analyse the pathology data needed to examine the contractile function of cardiac tissue. Other prize winners included Dr Conrad Macrokanis, who received the Axxon Health Award for work on irukandji syndrome and Dr Brett Segal, who received the Australian Society of Anaesthetists Chairman’s Choice Award for his analysis of single-shot anaesthesia. Professor Tess Crammond presented Dr Whately with first prize, the Tess Crammond Award, and provided some sage words of encouragement and advice for trainees. We thank our major sponsor, Pert & Associates, who made a strong case for the importance of sound financial management for consultants. 69 Australian news continued Queensland continued Foundation Teacher’s Course A Foundation Teacher’s Course was held at the West End premises of ANZCA on April 18-20. Maurice Hennessey facilitated the course, assisted by Dr Kersi Taraporewalla, our resident educator of international specialist graduates. A total of 16 supervisors attended and were put to the test through lively discussions and problem-based learning activities. The main focus of these discussions and activities was how to give relevant feedback that enhances the acquisition of knowledge and skills, particularly in relation to the soon to be implemented workplace-based assessments (WBAs). The course also provided participants with an opportunity to engage with colleagues who were able to offer different views and opinions on the practice of assessment. 70 ANZCA Bulletin June 2012 Clockwise from top left: Dr Rudolf van der Westhhuizen sharing his experience with newly appointed supervisor Dr Aled Hapgood; ANZCA’s Maurice Hennessey observes the activities during a session on delivering training at the Queensland Foundation Teacher’s Course; Dr Maree Burke, Dr Julie Sherwin and Dr David Law practice the art of giving feedback; Dr Helen Davies with Dr Tim Scholz at the Queensland Foundation Teacher’s Course. South Australia and Northern Territory Current medico legal anaesthetic controversies On April 3, the SA & NT Continuing Medical Education Committee held “Current medico legal anaesthetic controversies” presented by Dr Andrew Miller. Dr Miller was an excellent speaker and received very positive feedback from the 40 or so attendees. Hot topics included information on mandatory reporting, anaesthetic case studies, epidural disaster case and the proposed National Disability Scheme. This initiated much discussion among the attendees and many stayed after the presentation to network and discuss. Above clockwise from top left: Dr Douglas Fahlbusch, Helena Manis, Dr Andrew Miller and Megan Sheldon; Dr Lynne Rainey and Dr John Hughes; Speaker Dr Andrew Miller; WCH Queen Vic Theatre. South Australia and Northern Territory Combined ANZCA/ASA South Australian & Northern Territory ASM November 3 Theme: “Anaesthesia and the Failing Organ” Venue: The Sanctuary, Adelaide Zoo Contact: Kerri Thomas Ph: +61 8 8239 2822 Email: [email protected] 71 Australian news continued Western Australia News from Perth A medical careers expo was held on March 27 at the Burswood on Swan. The aim of the expo was to provide interns, residents, service registrars, international medical graduates and senior medical students with information regarding vocational training programs and career pathways. The evening was very busy and was attended by more than 200 junior doctors and senior medical students. Thank you to Dr Suzanne Myles, Dr Michael Veltman, Dr Joel Adams, Dr Jim Miller, Dr Bree Maciejewski and Dr Melissa Haque who helped out with inquiries regarding the anaesthetic training program in WA. A supervisors of training workshop was held on the evening of April 26 at the WA regional office. The workshop focused on the workplace-based assessments (WBAs), which form part of the revised curriculum, and was presented by the WA WBA champions Dr Paul Kwei and Dr Ange Lee. Dr Jodi Graham also assisted with the workshop. Supervisors of training will now return to their departments and start teaching and recruiting assessors. On May 11, the WA regional office hosted an ANZCA Teachers Course-Foundation level. The course was attended by 11 Fellows, some of whom were in Perth to attend the annual scientific meeting, which was held at the Perth Convention and Exhibition Centre from May 12 to 16. Maurice Hennessy from the ANZCA Education Development Unit convened the course and covered the following areas: planning effective teaching and learning, teaching in context and effective feedback. The feedback from the course was very positive. The ANZCA WA annual general meeting was held at the Perth Convention and Exhibition Centre on May 14. Thank you to those who attended. On the evening of May 14, Oliver Jones, ANZCA General Manager, Education Development, gave a presentation at the WA regional office about the transition of existing trainees to the new curriculum in 2013. About 25 WA trainees attended. WA’s regional education officer, Dr Jodi Graham, was also on hand to answer questions. Thank you Oliver and Jodi. 72 ANZCA Bulletin June 2012 Above clockwise from top left: ANZCA General Manager, Education Development Oliver Jones and WA Trainees; Attendees at the WA ANZCA Teachers Workshop; Maurice Hennessey and attendees at the workshop. Tasmania Tasmanian Joint ANZCA/ASA Meeting in 2013 The 2013 Tasmanian Joint ANZCA/ASA Meeting will be held from February 22-23 at The Tramsheds Function Centre, Launceston. For further enquiries, please contact: [email protected] Australian Capital Territory WBA workshop The ACT regional office held a workplace-based assessment workshop on June 9, which was attended by delegates from hospitals in the ACT, Dubbo and Wagga Wagga. As well as providing a valuable opportunity to learn about the assessment tools required as part of the new ANZCA curriculum, the workshop gave participants a welcome opportunity to meet with colleagues. Preparations are underway for a difficult airways workshop to be held at the Hyatt Hotel, Canberra, on August 4. Further information and registration forms will be available on the ACT website soon. New South Wales Part Zero: An Induction to Anaesthesia takes off The 2012 Part Zero: An Induction to Anaesthesia course on March 10 proved a popular way to spend a quiet Saturday afternoon. Despite clear sunny skies outside, more than 100 interns, residents and registrars flocked to the Royal Prince Alfred’s Education Centre to learn more about the exciting life of an anaesthetic registrar. After a welcome by the NSW Regional Trainee Committee, the day kicked off with doctors Katherine Jeffrey, Simon Martel and Anand Pudipeddi reminding us what being an anaesthetic trainee is all about, and the various prestigious organisations a budding anaesthetic trainee can join. This was followed by Dr Pat Farrell covering “What is the College?”, Dr Simon Martel highlighting the structure of training and the new ANZCA curriculum and Dr Michael Stone’s famous exam tricks and tips lecture. Afternoon tea was followed by a presentation by Dr Michael Bonning, of Beyondblue, who covered the topic of mental health and happiness. Dr Greg Downey discussed mentorship and Dr Ken Harrison, of Careflight, gave a guide to career choice (as well as his family photo album!) Dr Greg Knoblanche rounded off the afternoon with his presentation on the ins and outs of medicolegal defence. Despite squeezing a lifetime’s worth of information into five hours, morale remained high thanks to the entertaining and informative lectures. The day was rounded off with a question and answer session followed by drinks at the local. Thanks go to all the presenters, the 2011 Regional Trainee Committee, and to Tina Papadopoulos and Warren O’Harae from the NSW ANZCA office for all their work behind the scenes. 73 Australian news continued New South Wales NSW Regional Committee There is a significant and exciting “changing of guard” at the NSW Regional Committee this year. Six members are leaving the committee, including three former chairs, Jo Sutherland, Michael Amos and Richard Halliwell. I thank these three dedicated people, who have more than 30 years of experience at regional committee level. They have given their time and experience to the College in many roles on the committee. Also leaving is Tracey Tay, who has made a great contribution to the committee including as regional educational officer. Thanks also to Michael Rose and Kar Soon Lim, who have contributed particularly with formal projects and education over the past four years. I sincerely thank all these retiring members of the state committee for all the excellent work they have done. This year presents the exciting challenge of the revised ANZCA curriculum. The NSW region also has a large number of hospital accreditation inspections ahead. To help lighten the load, I welcome Andrew Armstrong, Michelle Moyle, Nicole Phillips, Michael Stone, Suyin Tan, Emily Wilcox to the committee. Please feel free to speak to any members of the committee about any issues or concerns. Simon Martel and Carl D’Souza will represent the new Fellows, while we welcome Michael Wirth as Chair of the NSW Trainee Committee. Thanks to Lewis Holford who has handed over to Gavin Patullo representing the Faculty of Pain Medicine on the committee. The NSW Regional Committee as always has the support of the NSW representatives at the ANZCA Council, Frank Moloney, Patrick Farrell and Michelle Mulligan, and this continues. The committee welcomes the continued input of Carmel McInerney (ACT) and Michael Farr (Australian Society of Anaesthetists). To conclude, ANZCA Curriculum Revision 2013 presents an exciting change to education within the College and this, combined with the usual workforce and accreditation requirements, will present some challenges to the new NSW Regional Committee. I look forward to the contributions of all members as I thank those who have contributed greatly in the past. Dr Greg O’Sullivan, Director Anaesthetic Department St Vincent’s Hospital 74 ANZCA Bulletin June 2012 Australian Medical Association Careers Day Members of the ANZCA NSW Regional Committee and NSW Trainee Committee attended the NSW Australian Medical Association Careers Day on May 5 at Sydney Olympic Park. The day was designed to introduce the various career options available to junior doctors. Approximately 300 junior doctors and medical students attended the event. The NSW ANZCA table was well attended and questions ranged from “How do I become an anaesthetist?” to “How do I pass the primary exam?” and “How do I get a trainee job?”. There were also many questions about the curriculum change and how it will affect training. A highlight of the day was a retrieval demonstration by Careflight, who flew in to extricate an injured child from a mockup playground accident. This generated great interest among attendees when it was revealed that anaesthetists are part of the retrieval team. Many thanks to NSW ANZCA staff and doctors who gave up their Saturday to talk about anaesthetics. Above clockwise from top left: Dr Richard Halliwell and Dr Greg O’Sullivan; Mock retrieval at the Australian Medical Association Careers Day; The ANZCA table. Anatomy for Anaesthetists NSW Part II Refresher Course Saturday 24 November 2012 The University of Sydney For more information please contact NSW ACE Ph: +61 2 9966 9085 Fax: +61 2 9966 9087 Email: [email protected] Web: www.nsw.anzca.edu.au/events The NSW Regional Committee again conducted a very successful Part II Refresher Course in Anaesthesia at Royal Prince Alfred Hospital from February 20 to March 2. The course enabled candidates sitting for the final fellowship examinations a greater understanding of anaesthesia. It included seminars, panel sessions, demonstrations, lecturers and informal tutorial. A highlight on the last day of the course was the anatomical workshop held at Department of Anatomy and Histology, University of Sydney, which enlists the help of seven lecturers in a hands-on workshop. A special thanks to all the speakers who devoted a huge amount of time and effort in assisting the candidates to prepare for their final examinations, and especially to Dr Tim McCulloch and Associate Professor Gregory Knoblanche. New South Wales NSW REGIONAL COMMITTEE NEW SOUTH WALES SECTION AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS THE AUSTRALIAN SOCIETY OF ANAESTHETISTS Primary refresher course in anaesthesia The course is a full-time revision course, run on a lecture/tutorial basis and is suitable for candidates presenting for their primary examination in the first part of 2013. The first week will cover mainly physiology topics and the second week pharmacology topics. Date: Monday October 15 – Friday October 19 (physiology) Monday October 22 – Friday October 26 (pharmacology) Venue: ANAESTHESIA CONTINUING EDUCATION COORDINATING COMMITTEE AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS NEW SOUTH WALES SECTION THE AUSTRALIAN SOCIETY OF ANAESTHETISTS Fee: CONTINUING EDUCATION Seminar No 78 See one, Do one, Teach one h ow to G aiN aNd Large Conference Room, Kerry Packer Education Centre Royal Prince Alfred Hospital, Missenden Road Camperdown NSW 2050 m aiNtaiN S killS 3 - 4 November 2012, Shoal bay www.nsw.anzca.edu.au/events1/2 A$880 (incl gst) (two weeks) A$440 (incl gst) (one week) A comprehensive set of supplementary notes, lectures notes and USB will be given to each participant at the start of the course. APPLICATIONS CLOSE on Friday September 28 (if not filled prior) The number of participants for the course will be limited and late applications will be considered only if vacancies exist. For information contact: Tina Papadopoulos ANZCA New South Wales Regional Committee 117 Alexander Street, Crows Nest NSW 2065 Email: [email protected] Phone: +61 2 9966 9085 Fax: +61 2 9966 9087 page ad 75 Australian news continued Victoria Victoria Annual Victorian Registrars’ Scientific Meeting 2012 Friday November 9, 2012 ANZCA House Melbourne 3004 Calling all trainees Enhance your presentation skills Draw attention to your research Submit an abstract and be part of this annual event Members of the ANZCA Trials Group will moderate the research presentations For information please contact: Daphne Erler Victorian Regional Coordinator Australian and New Zealand College of Anaesthetists 630 St Kilda Road Melbourne VIC 3004 Victoria Register and join us at the 33rd Annual Victorian ANZCA/ASA combined CME Meeting “The ultra Meeting” Saturday July 28, 2012 Sofitel Melbourne on Collins 25 Collins Street, Melbourne Registration Fellows Trainees Retirees Dinner $330 including GST $217 including GST $110 including GST $120 including GST Registration form and flyer at: www.vic.anzca.edu.au/events For information please contact: Daphne Erler Victorian Regional Coordinator Email: [email protected] Telephone: +61 3 8517 5313 Full-time Primary FANZCA Course Our Course Coordinator, Minh Lam, has efficiently organised and run the Victorian Full-time Primary FANZCA Course from May 28 to June 8 at which we had a record attendance of 60 candidates. As there was a change in some lecturers, the program was challenging but resulted in a very successful course. I thank our participating lecturers and the mock viva examiners, both new and established, whose assistance and cooperation we could not do without. Their efforts are greatly appreciated and we look forward to their continued input. As convenor, I thank the College for the use of their facilities and the staff for their cooperation and understanding in the event that the course caused any inconvenience or disturbance. Dr Adam Skinner Primary FANZCA Course Convenor From top: Statistics lecturer Dr Craig Noonan (second from left) with trainees; Course convenor Dr Adam Skinner (second from left) with trainees. 76 ANZCA Bulletin June 2012 advertisement Royal Melbourne Hospital Royal Melbourne Hospital Department of Anaesthesia Department of Anaesthesia and Pain Management and Pain Management Annual Annual Refresher Refresher Course Course Theme: Complex Patients, Theme: Complex Patients, Practical Solutions Practical Solutions This year’s program revolves around lectures and This year’s program revolves lectures and workshops showcasing Royalaround Melbourne’s expertise workshops showcasing Royal Melbourne’s expertise in a range of anaesthetic topics in a range of anaesthetic topics Venue : Royal Melbourne Hospital Venue Date :: Royal FridayMelbourne 2 Nov 2012Hospital Date : 1230 Friday Novhr 2012 –2 1830 1230 – 1830 hr Further information, please contact Further information, please contact [email protected] [email protected] Tel : (+61) 3 9342 7540 Tel : (+61) 3 9342 7540 On-line registration : www.anaesthesia.mh.org.au On-line registration : www.anaesthesia.mh.org.au advertisement th 6 6th International International Hokkaido Hokkaido Trauma Trauma Conference Conference Rusutsu Ski Resort Rusutsu Ski Resort Japan Japan th January 13th - 18 2013 January 13th - 18th 2013 Topics include : : •Topics Airwayinclude Management in Trauma Airway Management in Trauma • Maxillo-Facial Trauma • Maxillo-Facial Trauma Damage Control Surgery Damage Control Surgery • Paediatric Trauma • Paediatric Trauma in Trauma Pain Management Management in Trauma • Pain Ortho-Trauma Ortho-Trauma • Neuro-Trauma • Neuro-Trauma Early bird registration now open till Early bird registration now open till 17 August 2012 17 August 2012 Registration close 2 November 2012 Registration close7540 2 November 2012 Tel : (+61) 3 9342 Tel : (+61) 3 9342 7540 www.hokkaidotrauma.com www.hokkaidotrauma.com 77 ANZCA Council meeting report April 2012 Report following the Council meeting of the Australian and New Zealand College of Anaesthetists held on April 21, 2012 Death of Fellows Council noted with regret the death of the following Fellows: • Dr Harold John White (NSW) FANZCA 1992, FFARACS 1967 • Dr Maurice John Brookes (NSW) FANZCA 1992, FFARACS 1968 • Dr Ronald Ernest Thiel (Qld) FANZCA 1992, FFARACS 1966 College honours and awards • Dr Leona Wilson has been appointed chair of the New Zealand Perioperative Mortality Review Committee. • Dr Andrew Kenneth Bacon has been awarded the Ambulance Service Medal (ASM), Victorian Ambulance Service, in the 2012 Australia Day Honours List. Education and Training ANZCA curriculum project: Council approved in principle a preliminary draft of the ANZCA Handbook for Training and Accreditation, which will now be circulated for wider consultation. A further draft of Regulation 37 “Training in anaesthesia leading to FANZCA, and accreditation of facilities to deliver this curriculum” was also approved. Copies of both documents will be presented to June meetings of the Education and Training Committee and the council for approval. Training program in Hong Kong, Malaysia and Singapore: In light of the achievement of the original purpose for training in Hong Kong, Malaysia and Singapore being fulfilled with the development of internationally recognised training programs and qualifications in each country, the ANZCA Council decided not to implement the 2013 curriculum in Hong Kong, Malaysia and Singapore. Trainees registered on April 21, 2012, will be supported to complete the current training program within a reasonable timeframe, with provisions for these trainees to be developed in consultation with the regional training committees of Hong Kong, Singapore and Malaysia. Support for and privileges of existing Fellows will continue. The council will work with anaesthesia leaders in Hong 78 ANZCA Bulletin June 2012 Kong, Singapore and Malaysia to shape a new collaboration that builds on our shared history and supports our shared objectives over coming decades. More information is available as a link from the front page of the College website. EMAC Course Subcommittee: Council approved the formation of an EMAC Course Subcommittee, which will oversee the accreditation of simulation centres for EMAC and provide advice to the Education and Training Committee and the ANZCA Council on trainee access to EMAC courses. In line with this decision, terms of reference have been developed for the subcommittee and Regulation 2 will be amended to reflect the disbandment of the Courses Working Group. Training Accreditation Inspectors: Council supported the development of a formal process for the appointment of training accreditation inspectors who are not councillors or members of the Training Accreditation Committee. They will be appointed for three-year terms and eligible for re-appointment three times (a maximum of 12 years). The process for appointments is outlined in the terms of reference for ANZCA Training Accreditation Inspectors. Training Accreditation Committee (TAC) 2013 Working Group: Council approved the establishment of an advisory body to review the changes and the implications for accreditation and to make recommendations to the Training Accreditation Committee about necessary changes. Terms of reference have been developed to assist in this process. Time limits for recognition of outstanding AVT forms: A time limit of May 31, 2012 has been placed on receipt of outstanding approved vocational training forms for training completed in 2009 or before. Trainees who do not submit relevant documentation by this date will lose accredited time for the relevant training terms. This is being communicated to individual trainees and their supervisors of training. Dr Lisa Akelisi-Yockopua was supported to attend the 2012 ASM in Perth from the ANZCA scholarship fund. Papua New Guinea: ANZCA will provide the best medical student with a certificate and $100, the best diploma of anaesthesia with a certificate and $400, and the best MMed student with the Professor Garry Phillips Prize in the form of a medal and $500. Fellowship Affairs New Fellows Conference: Council approved the following resolutions: (a) That new Fellows who attend the New Fellows Conference are eligible within five years of fellowship. (b) New Fellows will receive financial support to present at one annual scientific meeting only. (c) That the above recommendations are implemented from 2013 onwards. (d) That new Fellow representatives will be required to report back to their respective regional/national committees, by writing a report on the New Fellows Conference and presenting it to the regional or national committee. Annual scientific meetings 2018 ASM: Canberra will host the 2018 Annual Scientific Meeting, to take place at the National Convention Centre from Friday May 4 to Wednesday May 9, 2018. 2014 ASM: Due to the redevelopment of the Sydney Convention Centre, the 2014 ASM will be relocated to Singapore and will be a co-located meeting with the Royal Australasian College of Surgeons Annual Scientific Congress from Monday May 5 to Friday May 9, 2014. Dr Nicole Phillips will be the convenor of the 2014 Annual Scientific Meeting and Dr Timothy McCulloch the scientific convenor. Internal Affairs Appointment of external representatives: Council approved the following appointments: • Dr Rowan Thomas – ANZCA representative to the Standards Australia IT-014-13 Clinical Decision Support Sub-Committee. • Dr Phoebe Mainland – ANZCA representative to the Standards Australia mirror committee for ISO TC 210 (Quality Management and corresponding general aspects for medical devices). • Professor Kate Leslie – Health Workforce Australia – Expert reference group for the expanding workforce scope initiative: advanced practitioners in endoscopy nursing Indigenous Health Committee: In seeking to determine and monitor the numbers of indigenous trainees and Fellows in Australia and New Zealand and in line with a request from the Committee of Presidents of Medical Colleges Indigenous Subcommittee, questions derived from the census of both Australia and New Zealand will be included in the training application and subscription notices. Terms of reference: Council approved the following terms of reference for Fellows and trainees occupying leadership roles within ANZCA: President; vice-president; honorary treasurer; councillors; committee, subcommittee and working group chairs; committee, subcommittee and working group members; chair of examinations; final and primary examiners; Training Accreditation Committee inspectors; international medical graduate specialist panel members; international medical graduate specialist workplace-based assessment assessors; and the annual scientific meeting officer. Copies of these documents will be made available on the ANZCA website shortly. Australian federal not-for-profit sector reform: The CEO provided the ANZCA Council information about the establishment of an independent regulator, the Australian Charities and Not-for-profits Commission (ACNC), a new definition of ‘charity’ and other changes. The college will ensure it is prepared for these changes. Regulations: Amendments have been made as follows with copies to be made available on the ANZCA website shortly: • Regulation 2 – ‘Committees of the Council’ to include the EMAC Course Subcommittee and the Anaesthesia and Pain Medicine Foundation (regulation 34 was withdrawn). • Regulation 4 – ‘Examination Subcommittees and Courts’ (this regulation will be withdrawn from the start of the 2013 Hospital Employment Year, with content to be distributed to regulations 2 and 37 and the terms of reference). • Regulation 6.4 – ‘Admission to Fellowship by Assessment’. • Regulation 30 – ‘Reconsideration and Review’ to include a time limit of 3 months from the date of the decision to applications for reconsideration and review. Quality and Safety Recategorisation of ‘T’ documents to ‘PS’ documents During the work of the TE-Document Development Group, it became evident that the College’s professional documents could be rationalised by reclassifying all documents in the “technical (“T”)” category as “professional standards (“PS”)”. The proposed change in categorisation would apply to: • T01 Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and Other Anaesthetising Locations. • T03 Minimum Safety Requirements for Anaesthetic Machines for Clinical Practice. • T04 Guidelines on Equipment to Manage a Difficult Airway During Anaesthesia. PS42 Recommendations for Staffing of Departments of Anaesthesia A document development group will be established to review the document and develop an accompanying background paper. The following individuals have been appointed to the group: Dr Mark Reeves (lead; Tas), Dr Vanessa Beavis (NZ), Dr Kerry Brandis (Qld), Dr Peter Roessler (Vic) and Associate Professor Daryl Williams (Vic). individuals have been appointed to the document development group: Dr Rod Mitchell (lead; SA), Dr Justin Burke (Vic), Dr Alison Corbett (WA Regional Committee Vice-Chair), Dr Vaughan Laurenson (NZ) and Dr Peter Roessler (Director of Professional Affairs). Retiring Councillors This was the last council meeting for Councillor Dr Leona Wilson, the Faculty of Pain Medicine Dean Dr David Jones, and New Fellow Councillor Dr Justin Burke. The president thanked them for their contributions and wished them well for their future endeavours. Dr Roberts acknowledged the many significant contributions made by Professor Leslie as the ANZCA president and wished her well for the future. Professor Leslie will remain on the ANZCA Council for the next two years as a councillor. Dr Lindy Roberts will take office as the ANZCA President from the annual general meeting to be held at the Perth ASM in May 2012. Professor Kate Leslie President Dr Lindy Roberts Vice-President TE09 Guidelines on Quality Assurance in Anaesthesia A document development group will be established to review the TE09 and, develop it into a professional standard and accompanied by a background paper. The Quality and Safety Committee will put forward to council the document development group’s composition for approval. PS16 Statement on the Standards of Practice of a Specialist Anaesthetist and TE06 Guidelines on the Duties of an Anaesthetist A document development group will be established to amalgamate both documents into one professional standard and prepare an accompanying background paper. The following 79 Faculty of Pain Medicine Dean’s message It is a time of major change at Faculty of Pain Medicine Board, with the retirements of five board members, three of whom have served the maximum 12 years of board service allowable under the Faculty regulations. Dr Carolyn Arnold (2006-12) and Dr Guy Bashford (2009-2012) are retiring board members not standing for re-election. They have both been significant contributors as chairs of Training Unit Accreditation Committee and Continuous Professional Development Committee respectively, as well as being major contributors to several Faculty committees and initiatives. The demands on board members can at times be onerous and the significant contributions of Drs Arnold and Bashford are very much appreciated. In 1994, discussions began between leading thinkers of five participating medical colleges. These discussions ultimately resulted in the formation of the Faculty of Pain Medicine in 1998. An interim board was formed and later, in the year 2000, the first annual general meeting of the Faculty was held and the first board elected. Three members of that initial visionary group have continued to serve on the Faculty’s board until May this year. Associate Professor Leigh Atkinson (dean 2002-04), Dr Penny Briscoe (dean 2008-10) and Dr David Jones (dean 2010-12) have been instrumental in the foundation and refinement of not only the Regulations and processes of the Faculty, but the spirit and culture that has delivered our identity and success. They have nurtured their “baby” through to its teenage years and now, like all good parents, must stand aside, watch and worry as the Faculty forges its own ongoing, destiny. On behalf of the Faculty, I thank all five retiring board members for their invaluable contributions and wish them all the best the future. 80 ANZCA Bulletin June 2012 The imminent challenge to the incoming board this year is to ensure a smooth changing of the guard. The foundations we have inherited are solid and the future looks bright. Associate Professor Milton Cohen (Faculty dean 2004-06), another foundation board member, continues in his role as Director of Professional Affairs and provides an ongoing valuable source of corporate knowledge of Faculty affairs at this important time of transition. We welcome onto the board, Dr Melissa Viney and Dr Michael Vagg from Geelong and Dr Andrew Zacest, Dr Dilip Kapur and Dr Meredith Craigie from Adelaide. Professor Stephan Schug and Dr Kieran Davis will continue as co-opted members on the board from Western Australia and North Island of New Zealand respectively. The new members of the board bring new energy and vision and a feeling of optimism for the consolidation of achievements to date and to ensure growth and leadership in the Faculty. Over the first four months of this year, the Faculty has engaged in a wide-ranging review and strategic planning initiative. Input was sought from external stakeholder groups as well as regional committees of the Faculty and from within ANZCA and the Faculty board. Two facilitated sessions were held in conjunction with the February and May board meetings, to review feedback and agree our goals for the future, to understand the challenges we face and plan the actions and activities required to achieve our goals. The second session was attended by all retiring and new board members and was useful to ensure a seamless transition of ideas and aspirations for the future. I am pleased to report that the Faculty of Pain Medicine in Australia and New Zealand is strong and growing. Our relationship with ANZCA is strong and ANZCA’s support remains invaluable. Our own professional, courteous and effective Faculty staff are led with distinction by Ms Helen Morris. My sincere thanks, personally and on behalf of the board for your ongoing support. The focus for the Faculty continues to be on building a strong and effective support network for our Fellows and to maintain the highest standards of training and examination towards the award of our fellowship. We have an ongoing responsibility to promote the specialty of pain medicine to increase our fellowship numbers to enable us to better meet community needs. The important work towards recognition as a medical specialty in New Zealand remains a top priority. Progress remains steady and positive. We are working with the Royal Australian College of General Practitioners to produce and deliver an innovative online education program to be launched later this year, jointly at the Faculty’s spring meeting in Coolum and the GP12 (RACGP) meeting on the Gold Coast. Sixteen Faculty Fellows and invited experts have contributed to the content of this educational initiative. These efforts to promote knowledge and understanding of pain medicine and management can be extended to wider audiences in the coming years. We aim to build our knowledge and curriculum for the future. We have a vision to produce strong and reliable research. Cooperation across our fellowship to produce collaborative, or pooled data, presents an opportunity to contribute meaningfully as a Faculty to global scientific research. We are working steadily towards the establishment of national outcome data collaborations and registries. Pooling, accurately recording and analysing the effect and effectiveness of different treatment approaches will give us real and useful clinical direction to genuinely raise the level of treatment and care available to our patients in the community. An understanding of the future challenges for the Faculty begins and ends in the community. The problem of persistent pain continues to be misunderstood and access to information and treatment is alarmingly inadequate. The resultant suffering of people in persistent pain remains unacceptable. We must continue to advocate strongly and co-operatively with our partner organisations, ANZCA, Painaustralia, the Australian Pain Society, New Zealand Pain Society and consumer and industry groups, to keep the management of pain, in all its forms, on the political agenda. In my first address as Dean of the Faculty, I admit to feeling humbled and slightly overwhelmed. I am honoured to follow as dean, in the footsteps of people whose counsel I have cherished and whose work and achievements I respect and admire. I can only aspire to continue the quality of leadership to which this Faculty has become accustomed. Associate Professor Brendan Moore Dean, Faculty of Pain Medicine Dr David Jones’ farewell As ANZCA celebrates its 20th birthday, the Faculty of Pain Medicine reached its teens. I have been privileged to be there since its conception and gestation via an ANZCA Joint Advisory Committee on Pain Management (JACPM, 1994-1998) then continue to serve on the Faculty Board as inaugural censor (subsequently assessor) since the Faculty’s birth late in 1999 and through to being the sixth Dean. Now it is necessary for me to step aside. I would like to acknowledge many fine people who have also been dedicated to seeing the Faculty grow from a good idea, then evolve and thrive into the peak training and assessment organisation that it is today. In particular I pay tribute to Associate Professor Leigh Atkinson and Dr Penny Briscoe, both former deans who also now leave the board having completed maximum 12-year terms, and former dean Associate Professor Milton Cohen, who continues his valuable input as the Faculty’s first director of professional affairs. From the founding dean, Professor Michael Cousins, together with all other board members, these people have made a major contribution to this early genesis of the Faculty. In addition I acknowledge the strengthening relationship with ANZCA as the host College, which has made the venture possible. I would not like to belittle in any way all the other contributing specialists, but at the same time note that anaesthetists are present during the genesis of many long-term pain conditions, and have a very significant contributory role in working towards reduction of chronicity. A new board with five new members has been empanelled led by Associate Professor Brendan Moore. This happens at an exciting time – especially to continue developing a realigned curriculum flowing from the blueprinting project, and also the time of settling the strategy directions for the next five years. The priority directions include maturing of the project for outcome data collection and its evaluation, and development of future leaders and increased advocacy. Since pain traverses most areas of health practice, it is important to have all health professionals better educated, as well as the public in general. To that end, the Faculty is continuing to build new relationships. Primary care and gynaecology are two major fields where much persistent pain is encountered, and through the efforts of a former dean of Faculty, a new section on pain within Royal Australasian College of Surgeons connects to another large source of clinical cases. It is significant that the Faculty’s Visiting Speaker, Professor Henrik Kehlet, a world authority on persistent post-surgical pain, delivered his plenary on the transition from acute to chronic pain at the recent ANZCA ASM. The Faculty is multidisciplinary, and these examples illustrate the cross-specialty collaboration that is necessary to get all on the same page regarding persistent pain. In partnership with the pain societies and Painaustralia, the task of improving access to services looms larger than most. Growing a skilled workforce is inextricably linked to this in that increased places for training are also needed. There is growing unrest in Australia and New Zealand over what is appropriate regarding opioid prescribing, with much of what reaches the headlines lacking balance by only highlighting what is bad. Rarely, if ever, is there a mention of positive outcomes, which I can assert from experience do exist. Having the wisdom to know the difference comes to mind. Much of what has been presented at scientific meetings recently (for example, fMRI studies, graded motor imagery, placebo and nocebo research) tell me that the organ of pain is … the brain! If I had to select a single theme about helping pain sufferers to cope and improve their lot, I would choose the relationship we must form with them as being paramount. We do not cure long-term pain, we frequently control some of it, but always we need to strive to provide comfort. That comfort requires a huge range of tools, including active listening, believing and acknowledging the person has a problem – although not an unsurmountable one – reducing the perceived threat from a pain condition, reassurance, and providing realistic expectations from health interactions for pain. Stressors, such as the effects of not being believed, or uncertainty about the meaning of a particular pain regarding the patient’s future and even life expectancy, are consistent with recent research on creating nocebo effects. Dealing with these factors usually takes more than one interaction (that is, a relationship), and I ask whether we as specialists should be treating doctors (who do it) or consultant doctors (who tell other people what to do)? There may be some important style differences that alter outcomes – something for Faculty members to consider when it comes to evaluating outcomes data. None of those arts of medicine methods exonerate us from having top-notch knowledge about all the scientific aspects of our specialty. But the art of communicating that meaningfully to the patient needs much thought and practice. It should be no surprise then that experienced practitioners are questioning within Faculty circles the duration we allocate for training. How much is enough? Briefly I would like to mention something about the environment in which we operate. It is increasingly more politically correct, and a normal expectation, to provide information and gain informed consent. It certainly feels right to inform patients well – and is even expected by the law. But each month I encounter an example of another health professional undermining some aspect of what I thought was a job well done, usually an act by someone thinking they are doing their job well. For example, in a dispensing location reading to a patient each the side and adverse effects of a medication from the drug catalogue, or printing it from the computer and giving it to the patient. On the surface it may seem like the right thing to do, notwithstanding we (patient plus prescriber) might have discussed the most likely side and adverse effects before they departed the consultation. Patients return with reports like “it freaked me out”. It may increase their fear of taking anything. Research proves that active medications include placebo responses (a real response) 1 contributing to their beneficial effects . Similarly pairing of dire/negative messages with effective agents undermines their efficacy (nocebo effect). And that happens for even the safest of medicines we use. What can you as readers contribute on how we can remain ethical, comply with legal requirements but also not undermine the efficacy of our tools? The science is there already. I have learned innumerable lessons from those around me – practitioners of all types, patients and even a few politicians. I thank all those who have shared their wisdom, guidance, stories, secrets and tricks of practice, and those who entrusted me with stewardship of the Faculty and its board over my time as dean. To conclude, as I wish the Faculty and its Fellows an even brighter future, I would like to leave you with a modified version of the plea (from Niebuhr): “Give us Grace to accept with serenity what we cannot change, Courage to change what must be changed, and the Wisdom to distinguish between them”. Dr David Jones Immediate past Dean, FPM Reference: Tracey I. Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans. Nature Medicine (2010): 16;1277-1283. 81 Faculty of Pain Medicine News 2012 Examination Examination dates November 23-25, 2012 (Friday to Sunday) The Auckland Regional Pain Service, Auckland NZ Closing Date for Registration: Friday October 5, 2012 Pre-Examination Short Course The 2012 Pre-Examamination Short Course will be held from September 14-16, 2012 at ANZCA/FPM Brisbane Regional Office, West End Corporate Park, River Tower, 20 Pidgeon Close, West End, Queensland. Closing date for registration: Friday September 9, 2012. Admission to Fellowship of the Faculty of Pain Medicine By examination: Dr Simon Aaron Cohen, FRACP (New South Wales) Dr Cornelis Abraham De Neef, FACRRM (Victoria) Dr Louise Kathleen Brennan, FANZCA (Victoria) Dr Brett Chandler, FANZCA (Victoria) FPM Board meeting report Training Unit Accreditation Following successful reviews, Concord Repatriation General Hospital, The Royal Children’s Hospital and Flinders Medical Centre has been re-accredited for training. After its initial review, Gold Coast Interdisciplinary Persistent Pain Centre has become an accredited training unit, bringing the number of accredited pain units to 28. Dr Timothy Brake has been confirmed as the Supervisor of Training at the Kowloon East Cluster Pain Management Centre. May 2012 Report following the Faculty of Pain Medicine Board meetings held on May 10 and May 13. The Faculty of Pain Medicine Board met on May 10 in Perth and the new board met on May 13 to appoint office bearers and committee chairs. The chairs will confirm committee membership within the coming weeks. At the new board meeting, Professor Ted Shipton (NZ) was elected FPM ViceDean, Professor Stephan Schug and Dr Kieran Davis were co-opted for a second term representing Western Australia and the North Island New Zealand respectively. Associate Professor David A Scott, FANZCA, FFPMANZCA (Vic) was confirmed as the co-opted ANZCA Council representative to the board. The board now comprises: Associate Professor Brendan Moore Dean Professor Edward Shipton Vice-Dean, Chair, Education Committee Dr Meredith Craigie Chair, Examination Committee Dr Kieran Davis Co-opted member North Island of New Zealand Dr Ray Garrick Royal Australasian College of Physicians representative Dr Roderick Kenneth Grant, FANZCA (Queensland) Dr Chris Hayes Chair, Research Committee Dr Jason Suk Hyun Kwon, FANZCA (Queensland) Dr Dilip Kapur Treasurer Dr James Chor Hoaw Yu, FANZCA (New South Wales) Dr Frank New Assessor Dr Mohammed Saleem Khan, FAFRM(RACP) (Victoria) Dr Gopinathan Raju, MA (Malaysia) Honorary Fellowship: Professor Henrik Kehlet, PhD (Denmark) Professor Stephan Schug Co-opted member, Western Australia Dr Michael Vagg Chair, Continuing Professional Development Committee Dr Melissa Viney Chair, Training Unit Accreditation Committee Dr Andrew Zacest Royal Australasian College of Surgeons representative Associate Professor David A Scott Co-opted member of ANZCA Council 82 ANZCA Bulletin June 2012 The board congratulated Dr Frank Moloney (NSW) and Dr Michelle Mulligan on their re-election to ANZCA Council, and to Dr Vanessa Beavis (NZ) and Dr Gabriel Snyder (New Fellow councillor) on their election to ANZCA Council. Dr David Jones, Professor Leigh Atkinson, Dr Penny Briscoe, Dr Carolyn Arnold and Dr Guy Bashford were farewelled at the FPM Annual Dinner on Friday May 11. The Faculty Board will next meet in Melbourne on August 13. FPM strategic planning 2013-17 The board, including new board members, held a second strategicplanning workshop in conjunction with the May 10 board meeting to continue developing a five-year strategy. A summary of responses from consultation with key stakeholders helped identify strategic goals for FPM to 2017. Arising from the workshop, the Faculty’s driving aim for 2013-17 is “Building strength”. Key pillars of the strategy will be: • Build the fellowship and the Faculty. • Build curriculum and knowledge. • Build advocacy and access. Fellowship Two new Fellows were admitted in March, six in April and two in May, including the award of honorary fellowship to Professor Henrik Kehlet at the College Ceremony in Perth. This takes the total number of admissions to 328. Associate fellowship The board resolved to rescind FPM Regulation 3.5: Admission to Associate Fellowship by Training and Examination. The board agreed that a single registerable qualification, FFPMANZCA, will be awarded to persons who meet all Faculty training and assessment criteria. A prior specialist qualification “acceptable to the board” is one of the criteria. International medical graduate specialists applying for FPM training will be assessed on a case-by-case basis to determine the quantum of recognition of prior learning to be credited towards the Faculty’s training time requirements. Regulation 126.96.36.199 will be amended to remove reference to a requirement for an Australian or New Zealand specialist qualification acceptable to the board. International medical graduate specialists (IMGS) The board approved the formation of an FPM IMGS Working Group to review ANZCA Regulation 23 with a view to adopting this regulation and to follow closely ANZCA’s IMGS assessment processes adapted to pain medicine as the subject matter. The FPM working group will include representation from the ANZCA IMGS Committee and ANZCA’s manager IMGS and accreditation. The board resolved that FPM IMGS assessment fees will align with ANZCA’s. Relationships ANZCA The following Fellows were nominated to represent the Faculty on ANZCA committees: Dr Meredith Craigie Examinations Committee/Chair, Examinations Primary Examination Sub-Committee/ Chair, Examinations Final Examination Sub-Committee/Chair, Examinations Professor Ted Shipton Education and Training Committee/Chair, Education Committee Dr Chris Hayes Research Committee/Chair, Research Dr Penny Briscoe Fellowship Affairs Committee/ ASM officer Dr Frank New IMGS Committee/Assessor Dr Jane Trinca Quality and Safety Committee Associate Professor Roger Goucke Overseas Aid Committee Dr Melissa Viney Training Accreditation Committee Professor Stephan Schug ANZCA Trials Group Executive Dr Penny Briscoe/ Professor Ted Shipton ANZCA Terms of Reference Working Group Representation on ANZCA regional committees is to be confirmed following consultation with regional chairs. Royal Australian College of General Practitioners (RACGP) A steering group meeting for the joint FPM/RACGP GP online-learning project was held on April 27 in Sydney. Following development of the online content involving a number of Fellows, the project has now entered the review process and remains on track for a launch of a module at the FPM Spring Meeting in Coolum on September 29. The full active-learning module will be launched at the GP12 meeting on October 26. Australian Pain Society/New Zealand Pain Society/FPM/ANZCA boards breakfast meeting Faculty representatives attended an informal combined boards breakfast meeting during the Australian Pain Society Annual Scientific Meeting, which brought together key representatives of the Australian Pain Society, New Zealand Pain Society, Painaustralia, FPM and ANZCA. Another meeting of the group will be convened later in the year to discuss opportunities for closer collaboration to achieve the next steps to implement the National Pain Strategy. Education FPM curriculum revision During April and May, research was done into educational approaches used by fields relevant to pain medicine. The findings of the research and a second version of the proposed curriculum framework were presented to members of the Curriculum Revision Sub-committee in a workshop in Perth on May 14. Two current trainees have joined the subcommittee and were present at the workshop. The latest version of the proposed framework includes two streams of learning and assessment: Stream A – Understanding of theory and Stream B – Clinical skills development. Additional workshops are planned throughout the year. Implementation of the new curriculum is planned for 2015. (continued next page) 83 Faculty of Pain Medicine FPM Board meeting report continued Retrospective credit of prior training The board approved the establishment of a working party to develop criteria upon which to base decisions regarding the awarding of retrospective credit for prior training and experience in a manner that is reliable, available to relevant stakeholders, and based on the current understanding of the requirements of a specialist pain medicine physician. There will be collaboration with the planned IMGS Working Group. Training unit accreditation The Gold Coast Interdisciplinary Persistent Pain Centre has been accredited for pain medicine training. Concord Repatriation General Hospital, Royal Children’s Hospital and Flinders Medical Centre have been re-accredited. The board approved the revised Faculty professional document PM2 (2012) Guidelines for Units Offering Training in Multidisciplinary Pain Medicine. The revised document includes criteria for Tier 2 accreditation for units deemed by the Faculty Training Unit Accreditation Committee to have significant strengths in some areas of pain medicine practice, but not the breadth of practice required to satisfactorily meet the requirements of a comprehensive (Tier 1) training facility (as stipulated in PM2). Continuing professional development 2012 ASM and Refresher Course Day – Perth The Faculty’s Refresher Course Day and ASM programs were a great success. The refresher course attracted more than 130 delegates and strong support from healthcare industry sponsors and exhibitors. The program provided insights into the importance of outcome measurement in pain management. The day was completed with a dinner at the Old Brewery overlooking the magnificent Swan River. The meetings attracted widespread media coverage and the ASM E-newsletter was well received. Thanks go to all who contributed in bringing this event to fruition. 84 ANZCA Bulletin June 2012 The Best Free Paper Award was awarded to Dr Sarika Kumar for her paper titled “Total and free ropivacaine drug levels during continuous Transversus Abdominis Plane (TAP) block for postoperative analgesia after abdominal surgery: A pilot study”. The Dean’s Prize was not awarded. 2014 ASM and Refresher Course Day – Singapore Following the change of venue from Sydney to Singapore, the Faculty has appointed a Co-FPM Scientific Convenor, Dr Kian Hian Tan (Singapore), to work with Dr Lewis Holford. The Faculty is investigating potential venues for the Refresher Course Day in Singapore and opportunities for collaboration with the Royal Australasian College of Surgeons pain medicine section. Professional Electronic Persistent Pain Outcomes Centre (ePPOC) The project to develop a national benchmarking system for chronic pain has now been provisionally titled ‘Electronic Persistent Pain Outcome Centre’ (ePPOC). Development is planned in three stages; a funded planning stage; an initial pilot; larger roll out. Stage one is aimed at developing a sustainable business model for ePPOC. Once an approved business plan is developed and a funding module is secured, a pilot roll out involving six to eight centres is anticipated. This will enable initial implementation and system development. Once the benchmarking system is refined, a larger roll out will be launched. Submissions The Faculty’s submission to the Australian Medical Council for ongoing accreditation was submitted March 2012 and can be viewed on the FPM website at www.fpm.anzca.edu.au/communications/ accreditation-submissions. The Faculty has recently contributed to the following submissions, which can be viewed at www.anzca.edu. au/communications/submissions/ government-submissions-2012 • Health Workforce Principal Committee – Development of national criteria under the National Registration and Accreditation Scheme (NRAS) – April 2012 • Medical Board of Australia – Consultation on the board funding external doctors’ health programs – April 2012 • Department of Health and Ageing – Evidence requirements for assessment of applications for the prostheses list: A discussion paper – February 2012 • Deputy Director General, Governance, Workforce and Corporate – Request for information to support NSW medical specialist modelling – March 2012 Finance At the end of April, the Faculty remained in a positive position against budget. 2012 calendar Dates for future board meetings: August 13 (Melbourne) October 29 (Melbourne) SpRiNg meetiNg 2012 RiSiNg tideS FACultY oF pAiN mediCiNe AuStRAliAN ANd New ZeAlANd College oF ANAeSthetiStS FRom A Ripple to A wAve – the RiSiNg tideS iN pAiN mediCiNe SeptembeR 28-30, 2012 pAlmeR Coolum ReSoRt, SuNShiNe CoASt, QueeNSlANd On behalf of the Faculty of Pain Medicine and the organising committee of the 2012 Spring Meeting, we would like to invite you to this exciting three day event at the beautiful Palmer Coolum Resort in the Noosa Shire of the Queensland Sunshine Coast. The meeting will focus on new and interesting developments in medications, education and initiatives of our own Faculty. We will take a closer look at these “rising tides” of Pain Medicine as these new ideas develop from ripples to waves in our area of medicine. Please join as at this beautiful beach location with an international standard golf course and exquisite resort facilities. Associate professor leigh Atkinson, Convenor Associate professor brendan moore, Convenor and Dean, Faculty of Pain Medicine For further information, please contact: Conference Secretariat Kirsty O’Connor, Faculty of Pain Medicine 630 St Kilda Rd, Melbourne VIC 3004 T: +61 3 8517 5318 F: +61 3 9510 6786 E: [email protected] 85 Library update New titles Books can be requested via the ANZCA Library catalogue www.anzca.edu.au/resources/ library/book-catalogue.html AAGBI core topics in anaesthesia 2012 / Johnston, Ian [ed]; Harrop-Griffiths, William [ed]; Gemmell, Leslie [ed]. / Association of Anaesthetists of Great Britain and Ireland. -- Oxford, UK: WileyBlackwell, 2012. More e-books available to Fellows and trainees The ANZCA Library now provides access to over 25 online textbooks through Cambridge University Press, as detailed below: • Anaesthetic and Perioperative Complications. • Evidence-based Anaesthesia and Intensive Care. • Basic Science for Anaesthetists, 2nd Edition. • The Anaesthesia Science Viva Book, 2nd Edition. • Anesthesia in Cosmetic Surgery. • Core Topics in Airway Management, 2nd Edition. • The Clinical Anaesthesia Viva Book, 2nd Edition. • MCQs for the Primary FRCA. • Core Topics in Neuroanaesthesia and Neurointensive Care. 86 ANZCA Bulletin June 2012 Alfred Hospital faces and places. Volume IV / Alfred Hospital; Alfred Healthcare Group Heritage Committee. -- Prahran, Victoria: The Alfred, 2010. Kindly donated by the Alfred Hospital Heritage Committee Australasian anaesthesia 2011: Invited papers and selected continuing education lectures / Riley, Richard [ed]. -Melbourne: Australian and New Zealand College of Anaesthetists, 2012. Also available online through the ANZCA website • Anesthetic Pharmacology: Basic Principles and Clinical Practice, 2nd Edition. • Core Topics in Endocrinology in Anaesthesia and Critical Care. • Controversies in Obstetric Anesthesia and Analgesia. • Physics, Pharmacology and Physiology for Anaesthetists: Key Concepts for the FRCA. • Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters. • SBAs for the Final FRCA. • Anesthesia Oral Board Review: Knocking Out the Boards. • Anesthetic Management of the Obese Surgical Patient. • Case Studies in Neuroanesthesia and Neurocritical Care. • Clinical Ethics in Anesthesiology: A Case-Based Textbook. • Positioning Patients for Surgery. Basic and clinical pharmacology / Katzung, Bertram G [ed]; Masters, Susan B. [ed]; Trevor, Anthony J. [ed]. -- 12th ed -- New York: McGraw-Hill, 2012. Essentials of pain medicine / Benzon, Honorio T [ed]; Raja, Srinivasa N. [ed]; Fishman, Scott M. [ed]; Liu, Spencer [ed]; Cohen, Steven P. [ed]. -- 3rd ed -- New York: Elsevier Saunders, 2011. • Pharmacology for Anaesthesia and Intensive Care, 3rd Edition. • Core Clinical Competencies in Anesthesiology: A Case-based Approach. • SAQs for the Final FRCA. • Morbid Obesity: Peri-operative Management, 2nd Edition. • Anesthesia for the High-Risk Patient, 2nd Edition. These e-books and many more can be accessed through the ANZCA Library online textbooks list or library catalogue: www.anzca.edu.au/resources/library/ online-textbooks New ECRI publications Health Devices, Vol. 40, No. 9, September 2011 • Best vital signs monitors. Health Devices, Vol. 40, No. 12, December 2011 • Evaluation of 10 intensive care ventilators. Hadzic’s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia / Hadzic, Admir [ed]. -- 2nd ed -- New York: McGraw-Hill, 2012. Also available online through ANZCA Library online textbooks list Monitoring the nervous system for anesthesiologists and other health care professionals / Koht, Antoun [ed]; Sloan, Tod B. [ed]; Toleikis, J. Richard [ed]. -- New York: Springer, 2012. History of anaesthesia VII: proceedings (7th : 2009 Oct. 1-3 : Crete): proceedings of the 7th International symposium on the history of anaesthesia / Askitopoulou, Helen [ed]. -- Herakleion: Crete University Press, 2012. Neuroscientific foundations of anesthesiology / Mashour, George A. [ed]; Lydic, Ralph [ed]. -- 1st ed -- Oxford: Oxford University Press, 2011. • Ventilator alarms and safety alerts. Health Devices, Vol. 41, No. 4, April 2012. • Making connections: integrating medical devices with electronic medical records Health Devices, Vol. 41, No. 5, May 2012. • Interfacing monitoring systems with ventilators. • Advanced ventilation features. Operating Room Risk Management updates. • Basic Patient Monitoring during Anesthesia. • Pre-Use Checklist for Anesthesia Units. • Social Media in Healthcare. Liakopoulos OJ, Kuhn EW, Slottosch I, Wassmer G, Wahlers T. Preoperative statin therapy for patients undergoing cardiac surgery. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008493. Evidence-based practice corner Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD007598. Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD004233. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009234. Ophthalmic anaesthesia / Kumar, Chandra M [ed]; Dodds, Chris [ed]; Gayer, Steven [ed]. -- Oxford: Oxford University Press, 2012. Stoelting’s anesthesia and co-existing disease / Hines, Robert L. [ed]; Marschall, Katherine E. [ed]. -- 6th ed -- Philadelphia, PA: Churchill Livingstone, 2012. Available online through ANZCA Library Online Textbooks list Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD007293. Rutherford JS, Flin R, Mitchell, L. Nontechnical skills of anaesthetic assistants in the perioperative period: a literature review. British Journal of Anaesthesia, first published online May 11, 2012 doi:10.1093/bja/aes125 Calvache JA, Delgado-Noguera MF, Lesaffre E, Stolker RJ. Anaesthesia for evacuation of incomplete miscarriage. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008681. Contact the ANZCA Library www.anzca.edu.au/resources/library Phone: +61 3 8517 5305 Fax: +61 3 8517 5381 Email: [email protected] 87 Obituary Dr Ronald E Thiel 1934 – 2012 Ron Thiel was born and raised in Toowoomba, Queensland. He attended Toowoomba Grammar School from 194252 where he excelled both academically and on the sporting field. In his senior year, he was school captain, captain of school cadets, captain of the athletic team, president of school dramatic society and runner-up dux. He commenced medical studies at the Queensland University School of Medicine in 1953. He was offered one of five state scholarships during his first year, but declined, perhaps because a scholarship required a seven-year commitment to the state health department after graduation. He later took up an army scholarship to assist with his education expenses. After graduation he was posted to Singleton and other bases for his requisite two years. 88 ANZCA Bulletin June 2012 On returning to Brisbane, Ron worked as an anaesthetic registrar at Greenslopes Repatriation Hospital and the Royal Brisbane Hospital. He obtained his anaesthetic fellowship in 1966. (He was Fellow no. 303, which amused him considering his army background). He was awarded the prestigious Australian Society of Anaesthetists Gilbert Troup prize for his paper “The Myotonic Response to Suxamethonium”, which was published in the British Journal of Anaesthesia in October 1967. Ron and his family moved to Cairns where he was the sole specialist anaesthetist for six years. Ron was the mainstay of anaesthetic practice, both public and private, during this period, with some GP anaesthetists to support him. Because of his enthusiasm and teaching ability, he was instrumental in encouraging many residents to undertake post-graduate anaesthetic training. Ron was a perfectionist and this inevitably led to professional altercations (especially with surgeons), and accounts of these confrontations are now folklore. He developed a large dental surgery anaesthetic practice and was one of foremost practitioners in this field. In the early 1970s, Ron developed what was probably the first day-surgery unit in Queensland approved for Medicare rebates. For many years this facility at Solander Medical Centre provided a low-cost alternative to inpatient stays, prior to the establishment of hospital day surgery units. As the Cairns Anaesthetic Group expanded, Ron moderated his workload and in 1987 undertook a “tree change” to Malanda on the Atherton Tablelands. He commuted to Cairns several times a week and worked sessions at Atherton Base Hospital, again undertaking teaching duties with nursing and medical staff. Ron retired from anaesthetic practice in 1998 and relocated to Brisbane, then to Kooralbyn Valley and finally to the Sunshine Coast. His retirement was marred by the onset of Alzheimer’s disease that, with his usual tenacity and stubbornness, he fought for 12 years, far outlasting his initial prognosis. Ron had a very active life outside anaesthetics, with the emphasis on sailing and water sports. He will be remembered for his wicked sense of humour, a ready grin and sometimesquestionable jokes! Ron is survived by his devoted wife Gaye, his children William, Carey and Gillian and their families. Dr Robert J Shield Future meetings Australia and New Zealand July 7 Brisbane, Qld 36th Annual Queensland ANZCA/ASA Combined Continuing Medical Education Conference Theme: “Medic-legal issues, paediatrics and obstetrics” Venue: Brisbane Convention and Exhibition Centre, Brisbane, Queensland Website: www.qld.anzca.edu.au/events July 27-28 Byron Bay, NSW Perioperative Medicine and Acute Pain Special Interest Group Meeting Theme: “When worlds collide: Perioperative medicine – The new specialty on the block?” Venue: Byron at Byron, Byron Bay Website: www.anzca.edu.au/events/ sig-events July 28 Melbourne, Vic 33rd Annual ANZCA/ASA Combined CME Meeting Theme: “The ultra meeting” Venue: Sofitel Melbourne on Collins, Melbourne, Victoria Website: www.vic.anzca.edu.au/events August 10-12 Palm Cove, Qld November 3 Adelaide, SA ANZCA Trials Group Annual Strategic Research Workshop Combined ANZCA/ASA South Australian & Northern Territory ASM Venue: Sea Temple Resort, Palm Cove, Queensland Website: www.anzca.edu.au/fellows/ Research/anzca-trials-group-events.html Theme: “Anaesthesia and the failing organ” Venue: The Sanctuary, Adelaide Zoo Email: [email protected] September 21-23 November 3-4 Sanctuary Cove, Qld The Combined Education, Management, Simulation and Welfare Special Interest Group Conference Shoal Bay, NSW NSW Spring CME Venue: Shoal Bay Resort Website: www.nsw.anzca.edu.au/events Theme: “Workforce: Future force” Hyatt Regency Sanctuary Cove, Queensland Website: www.anzca.edu.au/events/ sig-events September 28-30 Coolum, Qld 2012 Faculty of Pain Medicine Spring Meeting Theme: “From a ripple to a wave – the rising tides in pain medicine” Venue: Palmer Resort Coolum, Sunshine Coast, Queensland Website: www.fpm.anzca.edu.au/ events/2012-spring-meeting The meetings in this listing are ANZCA or ANZCA-affiliated meetings. Non-ANZCA meetings are listed in the events calendar on the ANZCA website: www.anzca.edu.au/events Please check with conference organisers to confirm dates before arranging travel. 89 Future meetings Australia and New Zealand continued November 14-17 Auckland, NZ 13th ICCVA/NZ Anaesthesia ASM 2012 Theme: “What becomes of the broken-hearted? Outcomes and how to change them” Venue: Skycity Convention Centre, Auckland New Zealand Website: www.iccva2012.com January 29-30 Sydney, NSW Anatomy for Anaesthetists Venue: University of Sydney, Sydney, New South Wales Website: www.nsw.anzca.edu.au/events July 19-21 Queenstown, NZ Geoffrey Kaye Symposium Neuroanaesthesia SIG Conference Venue: ANZCA and University of Melbourne Website: www.anzca.edu.au/ resources/geoffrey-kaye-museum/ geoffrey-kaye-symposium.html Venue: Millennium Hotel Queenstown, New Zealand Email: [email protected] May 4-8 November 24 Melbourne, Vic Melbourne, Vic ANZCA ASM 2013 Theme: “Superstition, dogma & science” Venue: Melbourne Convention and Exhibition Centre, Melbourne, Victoria Website: www.anzca2013.com 2013 June 30 – July 5 Port Douglas, Qld Cardiothoracic, Vascular and Perfusion SIG Meeting January 22-25 Sydney, NSW ISHA 2013 Theme: “History matters” Venue: University of Sydney, Sydney, New South Wales Website: www.isha2013.com Venue: Sea Temple Resort & Spa, Port Douglas, Queensland Email: [email protected] The meetings in this listing are ANZCA or ANZCA-affiliated meetings. Non-ANZCA meetings are listed in the events calendar on the ANZCA website: www.anzca.edu.au/events Please check with conference organisers to confirm dates before arranging travel. 90 ANZCA Bulletin June 2012 $200.00 + $28.46 + $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + Savvy professionals $45.68 + $798.15 + can reap tax rewards $239.00 + Nobody likes paying tax. But how tax savvy you are has an effect on how $145.78 + much money is in your pocket at the end of the year. Leon Getler reports. $895.00 + $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + $239.00 + $145.78 + $895.00 + $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + $45.68 + $798.15 + Savvy professionals can reap tax rewards Crossing the South Island the hard way Rug up and explore with a wintry European adventure +$ x% Australian tax laws allow you to deduct costs of doing business from your gross income. What you are left with is your net business profit. This is the amount that gets taxed. Knowing how to maximise your deductible business expenses lowers your taxable profit. At the same time, there might be side benefits from your expenditure: a good car to drive, a combination business trip-vacation and superannuation. Anaesthetists have a range of deductions to lower their taxable profit. Medical practitioners earn high incomes so a tax strategy is critical. A tax deduction is any expense incurred in producing assessable income. In other words, if the cost was paid in the practice of your profession you can claim a tax deduction. In New Zealand, anaesthetists in private practice will now enjoy a lower tax rate than their Australian counterparts. New Zealand’s company tax rate dropped to 28 per cent last year, putting it below the Australian company tax rate. The deductions are the same for Australia but they need to be careful. The Supreme Court last year found two Christchurch surgeons used family trusts to pay themselves “artificially low salaries” and deliberately avoid tax. The deductions are what attract the most interest. Anaesthetists running a practice can claim medical supplies, medicines, equipment and material. They can also claim professional indemnity insurance. Another source for deductions comes with professional subscriptions, accreditations, literature, education and memberships. Anaesthetists also can claim travel, not including travel to and from work. Travel deductions can cover conferences and study trips, even if they include a holiday. Tony Greco, a senior tax advisor with Australia’s Institute of Public Accountants says: “Some people are able to claims trips abroad further research, as long as they don’t do too much of the other stuff.” This means the trip would need to be documented. There needs to be paperwork for every activity around research. If, for example, 60 per cent of the trip was spent on further research and the rest of the time on vacation, there would be a 60 per cent deduction. The airfare might be fully deductible but accommodation and other expenses would be apportioned. “It takes some co-ordinating and apportioning but that’s not to say you can’t go on a holiday,’’ Greco says. “That’s not to say you can’t mix a bit of pleasure with business.” (continued next page) 91 In Australia, superannuation presents a big tax opportunity. If you are self-employed and earn less than 10 per cent of your total income as an employee, you can claim your after-tax super contributions as a tax deduction. This not only boosts your super, but also your tax position. If you are under age 50, you can claim a deduction of this type of up to $A25,000 per financial year. A contribution of up to $A25,000 would be taxed at 15 per cent. Until now, if you were aged 50 or over, you could claim up to $A50,000 and have that taxed at 15 per cent. However, Australia’s recent Federal Budget changed that. Under the budget, people aged 50 years and older will be allowed a maximum $A25,000 contribution for their super fund. That will be taxed at 15 per cent. The government has halved the previous caps for people aged over 50. So what happens if the contribution is above $A25,000? It will be taxed at 46.5 per cent. For example, you might make a contribution of $A30,000. That means $A25,000 of that will be taxed at 15 per cent but the extra $A5000 will be taxed at 46.5 per cent. The move will disproportionately affect people who are now entering their 50s. These changes kick in from July 1. In other words, 2011-12 is the last financial year before the standard cap for concession contributions by members over 50 is halved from $A50,000 to the indexed $A25,000 that applies to other fund members. They need to act now – it could give them a lot of money. A $A50,000 deduction for a concessional contribution could be worth as much $A15,750. At the same time, it’s increasing the amount the person has set aside for their retirement. Tony Greco says anaesthetists seeking to minimise their tax with a $A50,000 contribution into their superannuation should act well before the end of June. “They only have until the end of June to get that in order,’’ he says. “Bear in mind that June 30 is a Saturday and a lot of people think that electronic transfers work on a Saturday, but you can’t do it,’’ Greco says. “It has to physically hit the super fund accounts on a business day before June 30. I wouldn’t leave it too late. I wouldn’t leave it until the Friday.” One of the big changes for small business that came in with the new Australian Minerals Resource Rent Tax is how much someone can claim for small assets. 92 ANZCA Bulletin June 2012 $200.00 + $28.46 + $45.68 + $798.15 + $239.00 + “It is best to keep record of every expense no matter how trivial it might $145.78 + seem. With an orderly record keeping system, you are more$895.00 likely to find + tax savings you never knew existed.” $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + $239.00 + $145.78 + $895.00 + $45.68 + $798.15 + $239.00 + $145.78 + $895.00 + $45.68 + Until now, small business entities with a turnover of less than $A2 million were eligible for a range of tax benefits, including simplified depreciation, capital gains tax concessions and exemptions and simplified depreciation rules allowing an immediate tax deduction for assets costing less than $A1000. But under changes that come in this July, cash flow will be enhanced with more tax write offs. From 2012-13, the value of assets that small businesses can instantly write off will rise from $A1000 to $A6500. Small businesses also will be able to claim an accelerated initial deduction of $A5000 for motor vehicles acquired from July 2012. Greco says this means it would be worthwhile deferring the purchase of assets until July. “If you’re in small business you could only spend $1000 and get an immediate write off,’’ he says. “Now that’s in place for the current year, but on July 1, it bumps up to $6500. “So if it costs less than $1000, you go to Officeworks and buy that printer for under $1000. “But if it costs more than $1000, you should wait until July 1 because the write-off goes from $1000 to $6500 if you are a small business. If you buy it before June 30, you would depreciate that and write it off over its useful life. But come July 1, you can get a 100 per cent tax deduction straight away. “With a car, you will get a $5000 deduction up front. With cars, you depreciate 15 per cent in the first year and 30 per cent thereafter. But come July 1, you knock five grand straight off and then get 15 per cent on the balance, which means faster cash flow.” It is best to keep record of every expense no matter how trivial it might seem. With an orderly record keeping system, you are more likely to find tax savings you never knew existed. Leon Gettler is a former Fairfax senior business journalist. He is now a freelance business writer. +$ Crossing the south island the hard way One of ANZCA’s Fellows, Invercargill anaesthetist Dr Joe Sherriff, holds a very special place in the history of New Zealand’s famous annual Speight’s Coast to Coast race. He won the first event in 1983 – and in this year’s 30th running of the race, he won the over-60 age group class and was the oldest finisher in the oneday event. Dr Sherriff spoke to ANZCA’s New Zealand Communications Manager, Susan Ewart, about his involvement in the race. The Speight’s Coast to Coast multi-sport event traverses New Zealand’s South Island from Kumara Beach on the Tasman Sea near Greymouth, through the Southern Alps to Sumner Beach on the Pacific Ocean in Christchurch – a total distance of around 243 kilometres. Now, the race may be undertaken as either a one- or two-day event. The course comprises about 140 kilometres of road cycling, 30 kilometres of very rugged off-road running and 70 kilometres of kayaking down the Waimakariri River. When Dr Sherriff won the two-day 1983 event, he had just completed the last year of his anaesthesia training in Dunedin. He then headed off to a consultant anaesthetist post in the UK before returning to Invercargill in 1991. Pressure of work, family and other interests (search and rescue dog training and being in the New Zealand orienteering team) prevented further participation in multisport races for a while. However, in 2002, organiser Mr Robin Judkins coerced him to take part in the 20th Coast to Coast event. Dr Sherriff says that somewhat to his surprise, he finished the one-day event. He was disappointed by his time, however, so started training seriously and a couple of years later beat his original 1983 time by half an hour. This year, Dr Sherriff again came under pressure from Mr Judkins to participate in the 30th running of the race. He says that once again there was a serious training deficiency, but that he was encouraged by a great pre-race write up in the Christchurch Press, complete with photos of the bike he rode in 1983, which Dr Sherriff still uses to commute to work. This saw him lining up with other competitors on the beach at Kumara on Friday February 10 for a 6am start and a mad three-kilometre dash up the road to the waiting bikes. Dr Sherriff says he can’t run very fast these days so did the road bike ride in a slow bunch toward the back of the field. The run that followed was full of interest with multiple river crossings and car-sized boulders to circumvent. It goes over the alpine Goat Pass, well above the bush line and down into the Mingha River valley. Dr Sherriff says conditions for the kayaking section on the Waimakariri River were slow with a strong head wind and a very low slow flow – his excuse for a slow time, he says. Back on the bike for the last 70 kilometres, things weren’t much better, and it was a very tired Dr Sherriff who rolled into Sumner some 16½ hours after starting – but winner of his class and the oldest finisher in the one-day race. Dr Sherriff says none of it was possible without the dedicated assistance of his support crew, partner Ms Jo Wilson and friend Mr Andy Clayton, who have helped Dr Sherriff in all the eight Coast to Coasts he has done in the past 11 years. That support involves a 4.30am start followed by a day of getting the right gear to the right place with lots of kit to carry from van to transition point and back again. The bike and kayak have to be checked to see they are in perfect working order and at the end of each stage Ms Wilson and Mr Clayton ensure Dr Sherriff is in the right shoes, clothes, etc, and is fed, watered and ready for the next few hours. This year they found that an added challenge was negotiating the thousands of road cones and unfamiliar landscape in postearthquake Christchurch – which saw Ms Wilson and Mr Clayton get to the finish only a few seconds before Dr Sherriff himself. Hard though the event was, Dr Sherriff reckons it beats a 16-hour day in theatre and he hasn’t ruled out trying to get fitter and giving it another go. “This of course depends on the support crew,” he says, “especially Jo allowing me to do so.” A specialist anaesthetist at Southland Hospital in Invercargill, Dr Sherriff is a member of ANZCA’s New Zealand National Committee and is its national Quality and Safety Officer. The photos show Dr Sherriff kayaking and at the transition point from kayak to bike. Photos courtesy of Paul’s Camera Shop, Christchurch. 93 RUG up UP and AND Rug EXPLORE WiTh WITH a A ExploRE WINTRY EuRopEan EUROPEAN WinTRy ADVENTURE advEnTuRE There’s much much to to enjoy enjoy about about aa northern northern hemisphere hemisphere winter winter There’s provided you you know know where where to to go, go, writes writes Kendall Kendall hill. Hill. provided Winter in in Europe Europe offers offers far far more more than than jetset jetset ski ski resorts resorts Winter and aa white white Christmas. Christmas. Take Take advantage advantage of of affordable affordable and airfares and and hotels hotels and and barely barely there there crowds crowds to to discover discover airfares the treasures treasures of of aa cold cold continent continent –– but but whatever whatever you you do, do, the don’t pack pack light. light. don’t 1. Ice Ice dreams dreams 1. The Arctic’s Arctic’s greatest greatest architectural architectural folly folly was was The first carved carved from from frozen frozen water water in in the the Lapland Lapland first village of of Jukkasjärvi Jukkasjärvi 20 20 years years ago. ago. Since Since then, then, every every village November and and December December the the Ice Ice Hotel Hotel isis built built afresh afresh November and decorated decorated by by invited invited artists artists armed armed with with aa grand grand design, design, and chisel and and aa hardy hardy constitution. constitution. Their Their ephemeral ephemeral creations creations aa chisel simply melt melt back back into into the the earth earth each each spring. spring. Winters Winters can can be be simply bleakly bitter bitter and and perennially perennially dark dark in in northern northern Scandinavia Scandinavia but but bleakly there are are consolations consolations to to bedding bedding down down in in aa minus-five-degree minus-five-degree there art installation installation –– chief chief among among them them the the strong strong probability probability of of art witnessing the the Northern Northern Lights. Lights. There There are are also also the the uncommon uncommon witnessing pleasures of of sleeping sleeping on on reindeer reindeer furs, furs, steaming steaming cups cups of of hot hot pleasures lingonberry juice juice and and morning morning saunas. saunas. lingonberry The hotel hotel opens opens for for business business in in mid-December mid-December and and closes closes The by the the end end of of April; April; guests guests normally normally combine combine aa night night in in by the Ice Ice Hotel Hotel with with aa heated heated stay stay in in nearby nearby Kiruna. Kiruna. the Ice Hotel; Hotel; from from 1600 1600 SEK SEK aa person person aa night night Ice (about $230); $230); icehotel.com. icehotel.com. (about 2. AA more more serene serene 2. Serenissima Serenissima In spring, spring, summer summer and and autumn autumn it’s it’s hard hard to to appreciate appreciate the the In dazzling, cinematic cinematic beauty beauty of of Venice Venice through through the the constant constant dazzling, throng of of fellow fellow tourists. tourists. So So go go in in winter winter instead, instead, when when mists mists throng roll in in from from the the Adriatic Adriatic to to shroud shroud the the Gothic Gothic canalscapes canalscapes with with roll yet another another layer layer of of wonder wonder and and timelessness. timelessness. (It’s (It’s even even more more yet sublime with with aa light light icing icing of of snow.) snow.) Rain Rain isis relatively relatively scarce scarce in in sublime December and and January January and and the the mercury mercury ebbs ebbs to to single single figures figures December perfect for for ice ice skating skating in in the the Campo Campo San San Polo Polo or or exploring exploring the the –– perfect Palazzo Ducale, Ducale, the the Campanile Campanile and and the the wealth wealth of of heavenly heavenly Palazzo landmarks that that are are hell hell to to visit visit in in peak peak season. season. For For those those landmarks not averse averse to to hordes hordes and and exorbitant exorbitant hotel hotel rates, rates, the the famed famed not Carnevale will will run run from from January January 26 26 to to February February 13 13 in in Carnevale 2013 with with aa host host of of masked masked balls, balls, cultural cultural events events and and 2013 free guided guided tours tours of of such such cultural cultural institutions institutions as as free the Peggy Peggy Guggenheim Guggenheim Collection. Collection. the See carnevale.venezia.it carnevale.venezia.it for for full full See details. en.turismovenezia.it en.turismovenezia.it details. 94 ANZCA ANZCA Bulletin BulletinJune June2012 2012 94 3. AA classic classic white white 3. Christmas Christmas Christmas markets markets (Christkindlmarkts) (Christkindlmarkts) are are found found across across Christmas German-speaking Europe Europe but but for for the the complete complete fairytale fairytale German-speaking experience, head head to to Vienna. Vienna. The The Austrian Austrian capital capital blazes blazes experience, with bud bud lights lights and and monumental monumental public public spaces, spaces, such such as as the the with Rathausplatz and and Schonbrunn Schonbrunn Palace, Palace, transform transform into into festive festive Rathausplatz markets fragrant fragrant with with spiced spiced apple apple punch punch and and pine pine trees, trees, markets gluhwein and and gingerbread, gingerbread, and and laden laden with with Christmas Christmas decorations decorations gluhwein and gifts. gifts. Most Most markets markets hang hang out out their their shingles shingles from from and mid-November and and continue continue trading trading until until December December 23, 23, mid-November ahead of of the the traditional traditional Christmas Christmas Eve Eve or or Heiliger Heiliger ahead Abend celebration celebration of of tree-trimming, tree-trimming, carol-singing carol-singing Abend and present-giving. present-giving. Wien.info Wien.info and 4. Snow Snow time time 4. Avid skiers skiers will will already already have have their their favourite favourite Avid alpine escapes escapes earmarked, earmarked, and and be be aware aware that that the the alpine minimum booking booking period period at at many many European European resorts resorts can can minimum be up up to to 10 10 days days (compared (compared with with one one week week in in the the US). US). be The cheapest cheapest time time to to visit visit isis pre-Christmas, pre-Christmas, when when crowds crowds The are thin thin on on the the ground ground but but the the powder powder can can be be too. too. One One sure sure are way to to take take the the hassle hassle out out of of alpine alpine highs highs ifif you’re you’re travelling travelling via via way London: every every weekend weekend during during the the ski ski season, season, Eurostar Eurostar operates operates London: special Ski Ski Train Train direct direct from from London London St St Pancras Pancras to to French French ski ski aa special resorts such such as as Courchevel, Courchevel, Méribel Méribel and and Val Val d’Isère. d’Isère. The The Friday Friday resorts night service service will will have have you you on on the the slopes slopes by by Saturday, Saturday, and and night there’s also also aa Saturday Saturday morning morning departure departure that that arrives arrives in in time time there’s for the the evening’s evening’s après-ski. après-ski. Raileurope.com.au Raileurope.com.au for 5. Xocolate Xocolate 5. The Spanish Spanish antidote antidote to to winter winter isis simple simple and and The delicious –– mugs mugs of of steaming steaming hot hot chocolate chocolate that that delicious have been been enjoyed enjoyed by by the the elite elite since since Cortes Cortes first first have brought this this Aztec Aztec delicacy delicacy from from the the New New World World in in the the brought 16th century. century. There’s There’s no no more more atmospheric atmospheric place place to to indulge indulge 16th than in in Barcelona’s Barcelona’s Carrer Carrer de de Petritxol, Petritxol, aka aka Chocolate Chocolate Street Street than Gothic laneway laneway lined lined with with restored restored mosaics mosaics and and art art galleries galleries –– aa Gothic where the the aromas aromas of of churros churros and and xocolate xocolate perfume perfume winter winter days. days. where Catalans are are so so mad mad about about the the stuff stuff they they even even make make aa chocolate chocolate Catalans sausage –– the the best best isis from from the the superb superb smallgoods smallgoods store store La La sausage Botifarreria de de Santa Santa Maria Maria (labotifarreria.com). (labotifarreria.com). Botifarreria In Madrid, Madrid, join join the the huddled, huddled, happy happy masses masses at at Chocolateria Chocolateria San San In Ginés, open open till till 7am 7am daily daily (Pasadizo (Pasadizo de de San San Ginés, Ginés, in in the the city city Ginés, centre near near Puerta Puerta del del Sol). Sol). Spain.info Spain.info centre 95 95 6. Auction stations Forget Louis Vuitton and Isabel Marant – for a Parisian purchase to really cherish, head to the city’s most famous auction house, Drouot. Furniture designer Nicolas Blandin knows the labyrinthine salons and idiosyncracies of this 9th arondissement landmark better than most and can advise visitors on the smartest buys, whether it is Second Empire objets d’art, Mapplethorpe photography or Congolese fetish art. Major sales – the contents of a chateau, for example – tend to be major social events and Blandin is an engaging interlocutor between outsiders and the inner circle. Serious buyers should set aside at least two days, one to preview the sales (there are 21 salons to sift through) and another for the live auction. Blandin knows the city’s flea markets intimately too. His promise to prospective buyers is to explain the art market and flea markets to them and ensure they buy “at the right price and feel comfortable”. Contact him at nicolas. [email protected]; nicolasblandindesign.blogspot.com. 7. In with a show Even in the winter doldrums, London’s cultural calendar never wanes. The English capital offers something for almost everyone in its winter exhibitions, which range from an exhibition of British ballgowns at the V&A Museum (until January 6, vam.ac.uk) to the Science Museum’s centenary show honouring Alan Turing, the computer pioneer and Enigma codebreaker (until June 20, 2013, sciencemuseum.co.uk). Tate Britain is exhibiting more than 150 works by the ever popular Pre-Raphaelites (until January 13) while Tate Modern looks at the brief, bizarre reign of the Vienna Actionists (until April 13, tate.org.uk). Over at the National Gallery, Seduced by Art: Photography Past and Present, explores the influence of Old Masters’ painting on photography (until January 20, nationalgallery.org.uk). 96 ANZCA Bulletin June 2012 The Alfred Intensive Care Upcoming Events Program The profits from courses are 100% allocated to research, education, projects and equipment for The Alfred ICU. Major Events in 2012 Inaugural Renal Support in the Critically Ill Conference Our international guest speaker John Kellum will be joined by rinaldo Bellomo, Carlos scheinkestel and Ian Baldwin for a full day of presentations for all medical and nursing practitioners in intensive care with an interest in critical care nephrology and renal replacement therapy (rrT). A satellite hands-on practical session for nursing and interested medical staff will run concurrent to the afternoon session. This session will focus on the equipment, skills, troubleshooting and practical issues required for setting up and running rrT within the ICU. 17 July 2012 registration $330 – 700 Basic Assessment & Support in Intensive Care Two day introduction course for medical staff new to intensive care and care of the critically ill. 6 & 7 August, 7 & 8 november 2012 registration $650 Bronchoscopy for Critical Care All you need to know about fibre optic intubation, massive pulmonary haemorrhage, bronchial lavage, foreign body removal and safe bronchoscopy in critically ill patients. Interactive and simulation based course. 7 september 2012 the Friday prior to Echocardiography registration $800 - $990 Early bird $700 - $850 by 29 June 2012 4th Alfred International Symposium on ECMO & VAD Support in Critical Care The 2 day symposium will examine the latest device developments in the field of ECLs support and include contributions from leading International speakers marco ranieri (Italy) daniel Brodie, John Kellum & steven Conrad (UsA) and speakers from across Australia. This meeting is being held in conjunction with the Extracorporeal Life support Organisation (ELsO). An optional hands on session with live models is available for physicians wanting to develop competency in percutaneous ECmO cannulation. nurses workshop day will be held at The Alfred on Friday 20 July & is free for all nurses attending this symposium. Two day symposium 18 & 19 July 2012 registration $850 – $1600 symposium plus Cannulation 18 & 19 plus 20 July 2012 registration $3100 The Alfred Critical Care Echocardiography Course Two day course covering problem orientated approach to echocardiography in critically ill patients. Emphasis on echo guided management of the critically ill. Content tailored to suit participant’s echo experience with a favourable faculty : participant ratio providing ample hands on experience. 10 & 11 september 2012 registration $1750 ICU & Perfusion Adult ECMO Course Two day course for doctors, nurses & perfusionists seeking to provide ECmO support to patients with severe forms of cardiac and respiratory failure. Optional third day for cannulation training. 3rd Alfred ICU Nutrition in the Critically Ill Symposium 2 day Course 17 &18 October 2012 registration $800 Course and 1 day Cannulation 16 or19 October 2012 registration $2300 Two days of keynote lectures, up-to-date reviews, recent research and case presentations. For doctors, nurses and dietitians who deal with the sickest patients in our hospitals. International guest speaker: Pierre singer - Israel 9 & 10 november 2012. registration $600 - $750 Early bird $500 - $650 by 14 september 2012 Advanced Life Support (ALS) Provider Course Two day Australian resuscitation Council accredited adult life support provider training in advanced cardiac arrest and medical emergency management for doctors, nurses and paramedics. 27 & 28 August, 11 & 12 October, 3 & 4 december 2012 registration $770 - $1550 The HEaRT Course – Haemodynamic Evaluation and Related Therapies This two day course is designed for doctors and nurses working in all critical care areas including intensive care, theatres, coronary care & emergency & aims to improve understanding of the physiology, measurement, monitoring & support of the cardiovascular system. With practical sessions in small groups, there are only limited places available. 23 & 24 August 2012 registration $670 - $1100 Early bird $600 – 990 by 21 June 2012 For further information or to register online www.alfredicu.org.au/courses Contact: Cathy Oswald Ph: +61 3 9076 5397 E: [email protected] ALS or BASIC Contact: Kate Pearce Ph: +61 3 9076 5404 E: [email protected] Prices are subject to change AdvErTIsEmEnT advertisement CYKLOKAPRON solution for injection reduces peri- and postoperative blood loss and the need for blood transfusion in adult patients undergoing cardiac surgery, or total hip or total knee arthroplasty.1,2 So your good work won’t go down the drain. BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE FROM PFIZER AUSTRALIA PTY LTD. 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