Notes From a Most Unusual Critical Care Conference

Christopher M. Tedeschi, MD, MA


July 28, 2017

Emergency medicine physician Christopher M. Tedeschi, MD, MA, recently attended an unconventional medical conference: SMACC (Social Media and Critical Care). According to the conference website, SMACC is run by C4, "an independent, not-for-profit organization that is dedicated to creating the most inspiring and educational conference experience possible." The site lists SMACC's cofounders as Australian emergency medicine and critical care physicians Roger Harris, Chris Nickson, and Oliver Flower.

Social media has an enormous impact on medical education, especially on students and residents. Since 2013, the creators behind the most influential blogs, podcasts, and online communities in emergency medicine and critical care have convened at the SMACC conference to celebrate the leading edge of the field. Last month I traveled to Berlin to check it out.

Since its first incarnation in Sydney, SMACC has embodied the FOAMed ("free and open-access medical education") movement. FOAMed has its roots in a loosely organized but influential community of bloggers and podcasters. EmCrit, arguably the most popular EM–critical care-focused site, boasts more than 34,000 Twitter followers. The Academic Life in Emergency Medicine blog, founded in 2009 by University of California, San Francisco, emergency physician Michelle Lin, reports more than 1 million page views annually.

FOAMed leaders organized the first SMACC conference 4 years ago, a relatively small gathering in Sydney, Australia. According to the conference website, in its second year the conference, which was held in Queensland, Australia, brought 1400 attendees. This was followed by a 2015 conference in Chicago that was attended by over 2000 clinicians. This year's Berlin conference reportedly attracted more than 2500 attendees, who scrambled for online tickets months before the event. After a hiatus in 2018, the event will return to its roots and resurface in Sydney in 2019.

SMACC doesn't feel like a typical medical conference. On the opening day, Metallica's "Seek and Destroy" blared from speakers outside the concert venue hosting the event. A team on stage dismantled the front compartment of an automobile with the jaws of life, and then extricated a simulated crash victim just before a drone delivering blood products for the patient descended from the auditorium's heights. Some participants I talked to felt that all of this showmanship sometimes amounted to "more sizzle than steak," although most presenters offered adequate amounts of solid medical content.

The lineup included fewer reports of new or unpublished data than traditional conferences, but it featured more anecdotes, inspirational TED Talk–like presentations, and allusions to tools and techniques like resuscitative endovascular balloon occlusion of the aorta (REBOA) and extracorporeal membrane oxygenation (ECMO), well known to the FOAMed community.

SMACC can be clubby; I sometimes felt like I had gone to a Harry Potter movie without reading the books first. There were a few near-misses, including the on-stage, one-on-one interviews, which often leaned on fluffy banter rather than content. A liberal dose of off-color humor offended at least some attendees. Nonetheless, I walked away from SMACC with some practice-changing lessons:

The Future Is Here

SMACC is often about speculation and aspiration rather than evidence. In his futuristic simulation of prehospital resuscitation, Australian emergency physician Brian Burns created a scenario in which rescuers monitored wireless vital sign data from a victim's wristwatch, performed point-of-care thromboelastometry, and received drone-delivered blood from a nearby trauma center. Speculative for sure, but I can imagine this scenario playing out somewhere soon in a tactical or remote setting. All of these techniques are outside of my everyday practice, but they represent basic principles (like early blood products delivered to trauma patients, guided by coagulation testing) that should be applied in my ED one day. Stay tuned.


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