Coda Change

Sharon Desmond, Group Manager for Caring for People & Planet at Mercy Health, discusses Mercy Health's strategy for developing sustainable models of clinical care.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Ramsey Awad shares how the Hunter New England Health Service is moving towards net zero infrastructure to provide high quality healthcare today without harming future generations.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Nick Watts answers questions from the CODA22 audience to bust some common myths about implementing systems of sustainable healthcare. 

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Michelle Fox, Corporate Vice President at Teleflex shares an industry perspective on how medtech companies are working towards a model of sustainable healthcare

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Kate Charlesworth talks about the Climate Risk and Net Zero Unit at NSW Health and the macro actions we can take. 

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Eugenie Kayak talks about why we need a national sustainable healthcare unit.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion Clare Arnott talks about decarbonising health and medical research institutions.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this #Codapodcast, Ben McDonald Country President of AstraZeneca talks about decarbonising the pharmacy supply chain.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, Kate Charlesworth and Eugenie Kayak answer questions from the audience of the Sustainable Healthcare Workshop, which took place at Coda22 in Melbourne, September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, Nick Watts, Ramsey Awad, Sharon Desmond, Michelle Fox, & Ben McDonald answer questions from the audience of the Sustainable Healthcare Workshop, which took place at Coda22 in Melbourne, September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, Amy Freeman-Sanderson, Wade Stedman, & Simon Finfer answer questions from the audience of the Sepsis Leaving Nothing & No one behind Workshop, which took place at Coda22 in Melbourne, September 2022. This discussion also features a first person account from Cherie, a sepsis survivor.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, Simon Finfer & Michelle Patson answer questions from the audience of the Sepsis Leaving Nothing & No one behind Workshop, which took place at Coda22 in Melbourne, September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, David Anderson and Gladis Kabil answer questions from the audience of the Sepsis Leaving Nothing & No one behind Workshop, which took place at Coda22 in Melbourne, September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Matthew Humar presents 4 case studies which discuss unrecognised oesophagael intubation. 

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Tim Cook uses individual cases and analysis of the systems, processes and human factors involved in unrecognised oesophageal intubation to investigate why this tragic occurrence is still a problem around the world. He offers us some tools and advice to prevent unregognised oesophageal intubation from happening in our practice.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Nicholas Chrimes, Andy Higgs and Tim Cook - three of the authors of the recently published PUMA guidelines - outline their key recommendations for the prevention of unrecognised oesophagael intubation.

As a component of PUMA, these guidelines are intended for airway practitioners of all disciplines working in any context and have been endorsed by the world’s major airway societies.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

The mission of the Project for Universal Management of Airways (PUMA) is to create a single set of airway guidelines that provide consistent guidance for airway practitioners of any discipline, in any country, in any context. Following years of development these guidelines will be released in six separate papers over the rest of 2022. In this session, two of the authors, Nicholas Chrimes and Andy Higgs, will present highlights of the papers published so far.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

David Anderson describes the current state of play with airway management in the prehospital setting.

There are important differences between airway management in the prehospital environment and airway management in hospital. Prehospital intubation has been practiced for over 50 years and continues to evolve, with many techniques and procedures devised from prehospital use finding their way into ED and ICU practice. The main indications for prehospital intubation are cardiac arrest and severe TBI. 3 large studies show no evidence to support prehospital intubation in cardiac arrest and this practice should probably be reserved for specific cases. Prehospital RSI for TBI remains controversial as the evidence available to date is conflicting and isn’t high quality. While scene time if often commented on, there is no evidence available prehospital RSI increases time to CT or OR for patients with a severe TBI. There is no evidence that any one craft group is better at intubation than any other. In order to make prehospital airway management as safe as possible, innovations such as checklists, kit dumps and pre-drawn syringes are common. Many prehospital services invest much more heavily in the training and maintenance of airway skills than in-hospital specialties.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Adam Rehak and Gerri Khong walk through the good, the bad and the ugly of human factors in airway management. Using video footage of a highly realistic (tachycardia inducing) simulated airway emergency, the multi-stage case discussion canvases both audience responses and the input of a panel of human factors experts: David Brewster, Brooke Dench, Ben Meadley and Ian Summers, to illustrate that airway management is far more than just a technical skill. Instead, it will become clear that success is equally dependent on careful preparation, coordinated teamwork, precise communication and effective cognitive tools.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

David Brewster describes the current state of play with airway management in the critical care setting, including a summary of the INTUBE study and the Safe Airway Society guidelines for airway management in COVID-19 patients.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This discussion discusses the use of ketamine in fibre-optic intubation. 

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Adam Rehak addresses confusion and lack of awareness around these combined techniques that are making their way into the armament of airway operators. 

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

ENT surgeon Georgie Harris and anaesthetist Drew Heffernan describe how they use high flow nasal oxygen to achieve tubeless airway surgery.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This panel features Jo Simpson, Forbes McGain, Andy Shrimpton and Tim Cook and took place during the SAS Workshop at CODA22, which took place in Melbourne in September 2022. This is Part 2 of this discussion.

For more information about the CODA Project go to: https://codachange.org/ 

Panel Description

Are we safe when we intubate COVID-19 patients? Are CPAP, high-flow oxygen, and intubation AGPs? Two years into this pandemic, what should we be doing at work to keep ourselves safe? An international panel of experts presents their research, emerging evidence and review current practice. Andy Shrimpton presents the game-changing AERATOR studies, Forbes McGain presents his experience with the ventilation hood and Jo Simpson reviews the historical evidence regarding AGPs and her work on aerosol containment devices.

Finally, Tim Cook, who was awarded an OBE for services to anaesthesia during COVID-19, brings the session together with his take on the evidence surrounding healthcare worker safety during the pandemic.

This panel features Jo Simpson, Forbes McGain, Andy Shrimpton and Tim Cook and took place during the SAS Workshop at CODA22, which took place in Melbourne in September 2022. This is Part 1 of this discussion.

For more information about the CODA Project go to: https://codachange.org/ 

Panel Description

Are we safe when we intubate COVID-19 patients? Are CPAP, high-flow oxygen, and intubation AGPs? Two years into this pandemic, what should we be doing at work to keep ourselves safe? An international panel of experts presents their research, emerging evidence and review current practice. Andy Shrimpton presents the game-changing AERATOR studies, Forbes McGain presents his experience with the ventilation hood and Jo Simpson reviews the historical evidence regarding AGPs and her work on aerosol containment devices.

Finally, Tim Cook, who was awarded an OBE for services to anaesthesia during COVID-19, brings the session together with his take on the evidence surrounding healthcare worker safety during the pandemic.

This panel discussion features features Eve Purdy, Casey Parker, Sarah Yong, Jeremy Pallas, and Chris Hicks and took place during the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation features Ben Dunne and took place during the Earth stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation features Victoria Brazil and took place during the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This panel discussion features Dr Sarah Yong, Associate Professor Nada Hamad, Professor Zoe Wainer, Dr Jessica Stokes-Parish, Dr Ian Summers, and Chris Bowles and took place during the Ethics stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by David Anderson as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Tanya Selak as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Eric Levi as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Karen Price as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Alex Psirides as part of the Clinical Care stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Gemma Figtree, Mya Cubitt, and Greg Kelly answer questions from the audience during the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Greg Kelly as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Mya Cubitt and Jeremy Pallas answer questions from the audience at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Ben Medley and Luke McDonald answer questions from the audience at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Yolanda Coleman and Nilru Vitharana discuss a paediatric trauma case study. This Panel took part at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Virginia Newcombe as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Kate Jordinson & Loren Gallagher as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Nilru Vitharana as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A features Dr David McCreary, Dr Jennifer Jamieson, and Associate Professor Joseph Matthews. It took place as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

Oli Flower sits down to talk with Penny Stewart, an intensivist working in Alice Springs, to discuss the upcoming "Together Outback: Hearing the Outback Voices in Healthcare" conference.

Music credits: Spinifex Gum - The Children Came Back. Listen to the full track.

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Together Outback: Hearing the Outback Voices in Healthcare

20-21 June, 2024 | Alice Springs Limited free tickets available. Book now to confirm your place!

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Together Outback: Hearing the Outback Voices in Healthcare is a unique conference looking at the challenges of critical care in the rural and remote setting. The need to adapt to the environment, the resources and our patients. How adaption drives the need for innovation and advocacy to build strong critical care in remote Australia.

Get ready to be inspired as renowned journalist and Indigenous affairs expert, Stan Grant, takes the stage to share his unique insights on healthcare disparities and   the importance of hearing marginalized voices. With his thought-provoking perspectives, Stan Grant will challenge the audience to think critically about the current state of healthcare and its impact on First Nation communities.

But that’s not all.  “Together Outback” goes beyond one speaker, providing a platform for numerous   respected doctors and healthcare professionals to share their experiences and expertise. These esteemed individuals will shed light on the challenges faced by  clinicians delivering critical care in regional and remote Australia, as well as the unique challenges faced by Indigenous communities, and discuss innovative  approaches to bridging the healthcare gaps.

This event is a must-attend for anyone in the healthcare industry who wants to gain a deeper understanding of the issues   faced by First Nation Peoples. The insights shared by the speakers will provide valuable knowledge and tools that can be applied to improve health care practices.

Through a professional and compelling tone, this event aims to raise awareness and spark meaningful discussions about  healthcare inequalities. Attendees will have the opportunity to engage with like-minded professionals, exchange ideas, and contribute to the ongoing dialogue on improving healthcare for all.

Prepare to be captivated by the stories, ideas, and solutions presented at “Together Outback: Hearing the Voices in Healthcare.” By attending, you’ll be part of a transformative event that will leave a lasting impact on your understanding of healthcare disparities and the importance of inclusivity in the field. Don’t miss out on this unique opportunity to be part of the conversation.

*This event is funded by the Commonwealth Department of Health’s Specialist Training Program (STP)

For more information, go to: https://intensivecarenetwork.com/together-outback-the-free-conference-you-must-attend/

This presentation was delivered by Yolanda Coleman as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Luke McDonald as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Ben Medley as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Mya Cubitt as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Dinesh Palipana as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Jeremy Pallas as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Karin Thursky as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Fiona Gray as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Simon Finfer as part of the Cure stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Madiha Hashmi as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. Features introduction from Naomi Hammond and Brett Abbenbroek.

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A is moderated by Greg Kelly and features Dinesh Palipana, Marnee Shay, Jess Stokes Parish, Clara Tuck Meng Soo, Maya Newell, and Eve Purdy. It took place as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Maya Newell as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Marnee Shay as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Clara Tuck Meng Soo as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Jess Stokes Parish as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Dinesh Palipana as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

This podcast features an introduction by Greg Kelly.

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A features Emily See, Carol Hodgson, and Caleb Fisher, and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A features Chaturi Dissanayake and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A features Panka Jain and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A occured between various speakers from the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Caleb Fisher as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Carol Hodgson as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Chaturi Dissanayake as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Toby Jeffcote as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Panka Jain as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Luke Torre as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Emily See as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Charlotte Harper as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Elliot Long as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Warwick Teague as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This Q&A was part of the the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022. It features Fran Lockie, Jackie Schultz, Alison Boast, and Tony Norris

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Tony Norris as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Alison Boast as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Jackie Schultz as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was presented by Fran Lockie as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

You may have noticed that the last couple of podcasts we've published were neuro-related talks that were recorded at the BRAIN Symposium which took place earlier this year.

If you want more neurocritical care podcasts make sure to head over to the NeuroResus channel. Over the coming months we’ll be publishing more talks from the BRAIN Symposium around neurocritical care,  neuro resuscitation, and neuro emergencies.

Subscribe to Neuroresus in your preferred podcast app, or sign up to the Neuroresus newsletter to receive updates directly in your inbox.

Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. 

This podcast was recorded at the Brain Symposium which took place in March 2023. For more talks and content like this, visit neuroresus.com. 

Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life. 

This podcast was recorded at the Brain Symposium which took place in March 2023. For more talks and content like this, visit neuroresus.com. 

Ambulance Victoria has committed to become a more sustainable ambulance service. This includes achieving net zero emissions five years prior to the Victorian State Government commitment of 2050 with additional emissions reduction targets for 2025 and 2030. By fulfilling these targets, the carbon footprint for each patient cared for by Ambulance Victoria will be halved by 2030. It is apparent that to meet these emission reduction targets, Ambulance Victoria's current model of care needs perpetual refinement. Reducing emissions from electricity and fleet start to look easy in comparison to reducing low value care. Delivering better care to a patients according to their particular healthcare needs suggests that our pre-hospital service needs to be reimagined to start prior to any patient picking up the phone to dial Triple 000. Ambulance Victoria are discovering new ways to offer best care for particular patient cohorts via new technologies such as telehealth and the Virtual ED and by partnering across our communities primary and secondary healthcare networks, to offer timely support to those for whom an ambulance doesn't offer the greatest benefit. In 2021, Ambulance Victoria undertook a study to map the carbon pollution associated with its Triage Services and measure changes in carbon pollution resulting from the use of alternate patient care pathways. The analysis revealed interesting results that have implications for pre-hospital service design in the future. We hope that this study offers insight into new ways of thinking for decision makers and enables a triple bottom line approach to assessing the benefit of programs and keeping an awareness of how to serve the community in more environmentally sustainable ways. Using a multipronged approach to improving healthcare sustainability at Ambulance Victoria can reduce the environmental impact of pre-hospital healthcare services and thereby minimise the health impacts from the sector that are associated with dangerous climate change.

CODA Change and Sustainable Healthcare. Climate change is a pernicious environmental and health threat to humanity. Yet, healthcare itself pollutes, contributing to approximately 5% of total global anthropogenic emissions. What can be done to avoid this harm? Forbes McGain has spent 15 years undertaking research with colleagues to discover healthcare’s environmental footprint, with a particular emphasis upon practical efforts to reduce this environmental and economic burden. In this discussion we will hear of a series of micro, meso, and macro actions that each can contribute to reducing our carbon and other environmental footprints at work. Mico: all clinicians have agency to avoid, reduce, reuse, and if none of these are possible, recycle. Further, efforts to provide excellent primary care such as preventing obesity, diabetes, and drug harms, and delivering vaccinations are integral to ameliorating healthcare’s environmental footprint. From titrating oxygen on the hospital wards to deliver enough, but no more for patients, to undertaking antibiotic stewardship (and switching from i.v. to oral preparations) there are actually many daily activities in healthcare that could reduce our environmental footprint whilst delivering ongoing safe patient care. Meso: Collaboration is the key here! There are many low carbon healthcare activities that cannot be ameliorated without teamwork, for example at the GP clinic, hospital ward, or operating theatre level. A good example within hospitals are efforts to convert single use to reusable equipment. Although evidence is presented of the economic and environmental benefits of reusable anaesthesia equipment such information (and publications) has not lead to widespread adoption of such approaches. The importance of champions in each hospital and collaborating with clinical and non-clinical colleagues in hospitals is emphasized. Forming hospital environmental sustainability committees, and alliances with hospital executives and the board is vital. Macro: Advocacy at the medical and nursing societal and colleges level to incorporate environmentally sustainable healthcare into routine clinical education, examinations, and research agendas is the work of concerted groups of clinicians. Influencing the various state, territory and national governments to develop/extend sustainable healthcare units will likewise form part of macro efforts. Joining the Doctors for the Environment, Australia (DEA), activating the ANMF and AMA to get involved in environmentally sustainable healthcare will augment such efforts. Full Sails on Our Journey!

Climate change is now our lived experience. With no vaccine to reduce its impact on health, the only preventative strategy we have is to reduce emissions, including healthcare delivery. The greatest portion of healthcare’s emissions profile comes from the stuff we use, so we have to change what we do. But how?

Decarbonisation on the clinical floor is a look at every day work activities. It is bridging the gap between abstract concept and service delivery. It comes with triple bottom line wins – people, planet, and profit.

The future isn’t written yet. The things we do now are what make it. We have choices to make that matter. We need visionaries to show us the direction. We need practical examples that bridge the gap between ambition and action. We need to tell the climate story in a way that draws people in, that empowers them to take action and enables us to be part of the solutions.

Nick Watts

In today’s podcast, Nick Watts - chief sustainability officer at the NHS speaks about why - when the NHS says there are three things they want to implement over the next decade - their response to climate change is number two.

Watts explains that they understand the health implications of a rise in temperatures, they understand that it means a doubling of the number of high risk health facilities in flood zones, and a tripling of the average duration of fatal heatwaves and notes that they saw what that looks like for our healthcare system.

He talks about how while the average across a summer the UK face 2200-2400 excess deaths from heatwaves; the recent six-day heatwave saw 12800 deaths – six times the usual amount. That’s why the NHS cares deeply about this.

If the climate crisis is a healthcare crisis, Watts says that it’s important to face it head on. Principally, he says, acute care is responsible for the NHS’s emissions, while primary care also comes in strong due to its prescriptions and medicines.

He discusses how in order to cultivate real change, you don’t just run at one small part – turning off the lights and turning the temperature down simply isn’t enough - you need look at every single emission you can possibly think of. For the NHS it means net zero by 2045.

NHS reports publicly to both their board and 1.4million NHS professionals every single year. Watts says that it hit first year emissions target; he promises they’re going to hit their second. It will, however, start getting hard to hit their targets from year 5 onwards.

Transparency is critical. Milestones and scope need to be clear.

Watts explains that from 2027 onwards the NHS will no longer purchase from anyone that does not meet or exceed their commitments to net zero.

He says that while the NHS will do absolutely everything in their power, they can’t run at this alone. The challenge is too big, medicine is too complex. Thankfully the NHS isn’t alone. 14 other countries followed suit in committing to reaching net zero.

To end, Watts insists that it’s when other people take note, start taking this seriously, and when other healthcare systems start to engage that net zero stops becoming possible, and starts to become inevitable.

Sepsis in other words ‘life-threatening organ dysfunction’ in response to infection is a leading cause of death worldwide and a global health priority recognised by the World Health Organisation. In Australia, for adults with sepsis admitted to the intensive care unit, the in-hospital mortality is estimated as 18–27%. Early recognition of sepsis, prompt administration of antibiotics and resuscitation with intravenous fluids for those with features of hypoperfusion or shock are the mainstays of initial treatment. Emergency departments often being the first point of contact for patients presenting with sepsis, are required to prioritise sepsis as a medical emergency. The “Sepsis Kills” program implemented across the nation aims to reduce unwarranted clinical practice variation in management of sepsis.

In a recent Australian based study conducted across four emergency departments in Western Sydney Local Health District, among 7533 patients with suspected infection, a reduction in risk of in-hospital mortality was observed for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU. However, despite evidence showing mortality benefits, not all aspects of sepsis care have been given the needed attention. In the same setting, out of 4146 patients with sepsis, 45% of them did not receive intravenous fluids in the emergency departments within the first 24 hours. Younger patients with greater severity of illness and presented to smaller hospitals were more likely to receive fluids. 

The unanswered questions regarding the facilitators and barriers influencing intravenous fluid administration in sepsis are being explored using qualitative methods. Several emergency physicians and nurses have provided insight into aspects that influence their ability to provide appropriate fluid resuscitation such as constantly overcrowded emergency departments with chronic staff shortages of skilled health professional, failure to recognise sepsis early, the complexity of the presentations and lack of resources. Awareness of these challenges among stakeholders is the need of the hour. Leaving no one behind and not disregarding the critical aspects of sepsis care are crucial. Recognition of these factors and sustainable interventions are necessary to improve clinical outcomes for patients.

For more head to our podcast page #CodaPodcast

Physiotherapists form a key part of the multi-disciplinary team in the Intensive Care, focusing on both respiratory care and optimisation of function. This talk will discuss the role of physiotherapy across the continuum specifically in the management of an acutely unwell septic patient. I will discuss the focus of a physiotherapy assessment, main treatment aims, some of the barriers for the implementation of physiotherapy in ICU, while identifying strategies to enable appropriate application of physiotherapy techniques.

For more head to our podcast page #CodaPodcast

Sepsis is a common presentation in the prehospital and retrieval environment, with most cases having a respiratory, urinary or soft tissue origin. However the best practice for identifying and management sepsis in the prehospital environment remains unclear.  Despite sepsis having been a priority for in hospital guidelines and protocols for decades now, relatively little attention has been paid to prehospital sepsis management. Traditional teaching is that early antibiotics in sepsis save lives, however trials examining this are observational and confounded by outdated ICU care. An appropriately sensitive and specific tool for the prehospital identification of sepsis remains elusive. NEWS2 is common and lactate-modified QSOFA emerging (although prehospital lactate measurement remains difficult). The role of prehospital antibiotics, and the most appropriate one are also unclear. Most ambulance services that carry antibiotics use ceftriaxone. The retrieval environment is similar, with sepsis probably being the single commonest reason to call a retrieval service.

For more head to our podcast page #CodaPodcast

As part of the Sepsis Workshop, this presentation will briefly touch on the challenges that patients and their families face on discharge from hospital after an admission for sepsis. 

For more head to our podcast page #CodaPodcast

As an ICU registrar you meet septic patients at different points in time: as the first responder, asking ‘could this be sepsis?’; as the second responder, admitting the patient to the ICU; or the third responder, having to consider adjuncts in the deteriorating patient. Each of these presents different challenges and learning experiences, making the reality of managing sepsis more complex than one might first expect.

For more head to our podcast page #CodaPodcast

As with everything else, ICU management of sepsis should ideally the evidence based. Evidence based practice combines the best scientific knowledge (evidence) with patient preferences and clinical assessment and judgement.

While the pursuit of specific pharmaceutical agents to treat Sepsis has resulted in the expenditure of billions of dollars without producing a single effective agent, much of what we do in the treatment of patience with Sepsis can be evidence based. Clinicians make literally hundreds of decisions day on the management of an individual patient in the ICU, often these decisions are made routinely without a great deal of thought about the reasoning behind them. Every decision made about the treatment of a critically ill patient should be based on evidence or the belief that the action resulting from that decision will improve a patient centred outcome for that particular patient. A patient centred outcome is an outcome that affects how the patient feels, functions or survives meaning we should question every decision we make to ask whether it is going to improve one of those outcomes.

The best evidence on which to base of such decisions comes from large robust randomised controlled trials conducted by unbiased investigators. The last 20 years has seen the emergence and maturing of regional and national clinical trials groups who conduct such studies and increasingly collaborate with each other. (2) Such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice. As someone who designs and contacts clinical trials I am well aware that they provide evidence on a population basis. Each trial result is the net of harm and benefit resulting from the treatment being studied and even when a treatment is proven to have a net benefit there may be some patients who are harmed by the use of that treatment. A graphic example of this is someone who suffers a massive intracranial haemorrhage when treated with thrombolysis. Causing visible harm to a patient may shake a clinician's faith in an effective treatment making it important that we accept such tragic events without changing our practice to deny that effective treatment to future patients.

Research, like clinical practice, has inherent imperfections. Researchers, like clinicians, need to recognise this and be prepared to put their hand up and admit when they have been wrong. Conducting robust studies of appropriate size in an effective collaborative research group is the best way to avoid being wrong too often!

For more head to our podcast page #CodaPodcast

Sepsis causes organ and tissue dysfunction in response to severe infection, resulting in significant physical and cognitive morbidities. For patients diagnosed with severe sepsis, admission to an intensive care unit and use of an artificial airway are often required. The sequalae of severe sepsis necessitating critical care can result in significant changes to a patient’s swallowing and communication function. These negative changes and impacts to function can occur during and after a diagnosis of sepsis, and ultimately impact a patient’s health and functional status. The nature and long-term recovery of swallowing and communication function is still to be completely understood; however evidence affirms recovery continues well beyond hospital discharge.

This presentation will focus on tasks we do daily – eating, drinking and speaking. Specifically, the nature of swallow impairments will be described, and the impact of this new disability will be explored from the perspective of the patient’s body structure, function and activities. Core components of swallowing safety and efficiency will be described, alongside the role of assessment and management within and beyond the ICU. Changes to communication including altered voice, speech and language function will be described. Outcomes of altered communication function over the continuum of care during, and after hospital will be explored. The evidence base and the lived experience of sepsis and patient stories will underpin the content delivered in this presentation.

The final aim of the presentation will be to describe and highlight the role of speech pathology, an allied health profession, in the management of swallowing and communication function. Following the workshop attendees will be able to (1) describe the characteristics of swallowing and communication disorders; (2) have knowledge of the impact of these new disabilities; and (3) will be able to describe the role of speech pathology in the healthcare team for the patient with sepsis.

For more head to our podcast page #CodaPodcast

Dr Greg Kelly – a paediatric intensivist at Westmead Children’s Hospital – is today’s guest, on the #Coda22 podcast, during which he discusses a little girl called Abbie, who has lived in ICU for almost two years, and how she represents a very important group of patients – who are a tiny fraction of admissions, but a huge proportion of the workload at Westmead Children’s Hospital. Such patients are complex in such a way that no-one knows exactly what to do with them; nor how to respond to them. He goes on to discuss the problems they see every day at Westmead Children’s Hospital, and what the practitioners can do about them.

This session presents a series of medical cases with important clinical caveats. Additionally, a contextual discussion follows, focussing on the social determinants of health and their integral importance in delivering high quality care. The practice of acute medicine requires many skills to ensure the delivery of the highest quality care. Clinical knowledge and skill are essential, but equally communication, empathy, social/cultural awareness and advocacy are also vital. Knowing our patients and understanding their circumstances provides a foundation on which clinical practice can then be contextually applied. Without context raw facts can be misleading and even result in misdirected treatment plans.

In this week’s episode of the #CodaPodcast, Gemma Figtree – a Cardiologist and Professor discusses the profound inequality of gender issues.

In this week’s episode of the #CodaPodcast, Dr Daniel Nour – who founded Street Side Medics a not-for-profit, GP-led mobile medical service for people experiencing homelessness - in August 2020 talks about his grave concern for the homeless who have gone untreated for years. He talks about how it was seeing the inequality in healthcare among the homeless that made him want to do something about it and how we often think about their need for shelter and food, but not for suitable healthcare.

He also discusses the barriers that face homeless people and what it was that led him to launch Street Side Medics.

There is a moment that regularly occurs in the life of a clinician working at a major trauma service - where a rotating registrar, a keen sponge - appears, and a discussion about learning goals for the rotation is had. Its always about trauma, I'm here to learn procedures, intercostal catheter insertion, thoracotomies etc etc and if there is a trauma call, I'd love to be involved. But when I point to an older woman in the corner who has fallen from standing height, suggesting that perhaps we start our trauma education there, there are looks of confusion, annoyance even. This patient doesn't fit their expectation of what trauma physician needs to learn. But a trauma physician's paradigm, must evolve.

Healthcare Saves!

Healthcare Pollutes!

Healthcare is responsible for 7% of Australia's carbon emissions, consumes 10% of Australia's GDP, and has numerous other adverse environmental effects.

In this talk, Forbes McGain, an anaesthetist and intensive care physician, introduces healthcare's polluting ways, and how clinicians can mitigate their own carbon footprint. Action is the Antidote to Anxiety!

For more head to our podcast page #CodaPodcast