Tell us a bit about yourself…
I’m from a small town in 'Norn Ireland' called Enniskillen, home of possibly the world’s best pub, Blakes the Hollow, followed closely by the finest chips, stuffing and gravy.
Having trained as a GP in the west of Ireland I left for 'a year’ to see how things were done in the antipodes.
Ten years later I am working as an emergency physician in Grafton and Coffs Hospitals and enjoying life with my wife and two little ones in a small village by the beach.
When/why did you get involved with POCUS?
A young Justin Bowra and I crossed paths in St Vincent’s ED in Sydney in 2009. Intimidated by his booming voice and inspired by his skills with a probe I started my journey into the world of Focused Ultrasound.
In 2012 I joined the original UTEC program in Liverpool hospital and did the workshop and online credentialing and found it a valuable way to learn more in the art of POCUS.
2015 was a game changer. In my first job as an ED Fellow I came across a case that changed the way I practiced emergency medicine.
A female patient in her early 30s was brought in by ambulance looking very unwell, pale, shut down with an unrecordable BP. All of the resus bays were full and the patient was parked on a trolley waiting for a bed, randomly, next to an ultrasound machine.
The team initiated resuscitation as I asked a focused history including LMP and lifted the probe and briefly scanned the abdomen. There was a large collection of intraperitoneal fluid.
I called the OG doc on call and explained the situation and that we needed to go to theatre immediately. He said he would come down and assess the patient in ED. I said, 'with respect, we will meet you in theatre, we do not have time. I have saved the images, we have a ruptured ectopic and she is heading south.'
The patient was in the ED for 9mins before leaving for theatre. There is no doubt that performing the 15 second ED ultrasound expedited definitive management dramatically and enabled the good outcome that was achieved.
The patient happened to be an emergency doctor herself... and she also acknowledged the significance of POCUS in her resuscitation. Full consent was given to discuss this case.
Why did you start EMUGs?
Seeing how pivotal this 'new' technology would be in delivering best care I realised I needed to up skill further.
After attending excellent training courses in advanced emergency ultrasound and echo I soon realised there was a large vacuum between doing a course and practicing on the floor.
I met with another new FACEM Chris Partyka and we decided to team up and start an Emergency Ultrasound network to bridge this gap, and EMUGs was born in early 2015.
We set the network up to include any staff looking after emergency patients, with a slant towards FACEMs, Trainees and other ED doctors. Our aim was to have sensible approach with the knowledge that clinical assessment came first, and ultrasound was purely an extension of this.
Our initial goals were to:
develop an online and in person network to bring other POCUS users together
run educational meetings to help expand the knowledge and practice of bedside ultrasound
re-launch the UTEC online training modules
We achieved our goals within 12 months of setting up and the momentum spread throughout NSW, and then to VIC, QLD, WA and NZ, and more recently SA.
What progress have you seen with regard to POCUS?
Since 2015 we have been fortunate to meet a wave of like-minded critical care staff and the regional teams have collaborated and put together over 50 meetings with approximately 2,000 attendees.
We have had over 25 Clinical Leaders Meetings and developed agreed documents on a number of POCUS areas.
3,000 UTEC modules have now been completed in over 50 locations.
We have engaged with college and all ANZ ultrasound organisations and in the last four years POCUS has become an integral part of the ACEM curriculum, exam questions, and accreditation which is phenomenal to see.
We have also witnessed a growing wave of Emergency Ultrasound training programs develop across towns and cities in New Zealand and Australia with EMUGs support and involvement.
There are a number of other projects which have been growing including the Developing Country program, the Sonography Educator (SEED) project and establishment of formalised regional networks of Clinical Leads and Supervisors in EM ultrasound.
Who was behind this wave of change?
EMUGs would not exist if it were not for the enthusiasm and support of our Grassroots Members, Regional Co-chairs and other POCUS users. You know who you are.
The ‘3 Wisemen’ who have mentored and guided us over the years have been rock solid: Adrian Goudie, John Mackenzie and Justin Bowra.
Also integral to EMUGs success are Scott Flannagan, Genevieve Carbonatto, Tina Cullen, Kylie Baker among many others.
The fantastic teams at ASUM, ACEM and all our superb sponsors have played a vital role and we are deeply grateful for their support.
Lastly, we are thankful to our world class Operations Team who have provided the backbone and glue that has brought the networks together in such a positive process.
Do you have anything to say to other doctors thinking of becoming involved with EMUGs?
There is a strong belief all critical care doctors will have their own hand-held ultrasound device by 2024, or sooner…
Focused Ultrasound is now an integral part of assessment of the undifferentiated sick patient.
EMUGs has played a vital role in POCUS training and education development. There has been recent expansion with enhanced governance and the foundation of the EMUGs Central Council with new vision and leadership.
Drop us a line and we will put you in touch with someone in your region to help you get up and going in your Focused Ultrasound journey…
Or better still come to one of our events, meet your local team in person and get involved.
Good luck! May the probe be with you.
('Aka' - BOC)