Interview with Surgeon Captain Jason Smith (ICEM Keynote Speaker)

Interview with Surgeon Captain Jason Smith (ICEM Keynote Speaker)

1200 1842 Craig Wylie


Craig Wylie from #badEM interviews Surgeon Captain Jason Smith regarding his up and coming Keynote Speech entitled Advances in military resuscitation – experience from a decade of conflict” at ICEM (International Conference in Emergency Medicine) being held in Cape Town.

Read more about Surgeon Captain Smith here:


Craig: The ‘crossover’ between civilian and military emergency medicine has been on the increase over the last couple of years. What do you think the future holds for mixed military/civilian EM?

Jason: I think we will continue to learn from each other. The patient population, and in particular the mechanism of injury, is different in the patients presenting to deployed medical treatment facilities – over half of the severely injured patients presenting during the recent conflict in Afghanistan were injured by blast – but many of the lessons learned are transferable to a civilian population. Much of the knowledge and many of the skills we acquire on deployed operations can be used to contribute to improving patient care back in our normal work environment.


Craig: What is the next “big thing” coming to the civilian sphere from Military EM?

Jason: I think there are a few things that have transferred really well from military to civilian practice. For example, the use of intraosseous access in adult patients; the use of ketamine as an induction agent for patients with major trauma; and the use of simple tourniquets to control exsanguinating haemorrhage. The principles of damage control resuscitation are well understood but difficult to implement in centres that are struggling to appropriately resource their emergency departments. I think that the management of massive haemorrhage, including proactive replacement of blood and blood products, is key to survival in major trauma.


Craig: What do you think Military EM can learn from Civilian EM?

Jason: A vast amount. My day to day clinical practice is in a national health service hospital in the UK, and my clinical credibility is underpinned by working in a busy emergency department seeing the same kind of patients as everyone else. Working in a busy ED is the best preparation for deploying on a military operation – it means you have the breadth of experience to fall back on when needed.


Craig: What do you feel strongly about in emergency medicine?

Jason: Pain control & communication.

We think we are good at managing pain in emergency patients but if you listen to feedback from those patients it is one of the things that we could do better. We need not only to treat their pain when they come through the door (and there is some evidence to suggest we’re not good at that either) but also control their pain over the subsequent few hours. I think we have a long way to go to achieve analgesic nirvana.

We also could do better when communicating with patients. When we speak in medicalised language to patients (‘I’m going to check your troponin level to see if you’ve got an acute coronary syndrome’) it’s gobbledegook to most of them. We need to speak to patients in a language they understand, which may be different for each individual. This is a core clinical skill, and one that should be valued, taught and developed.


Craig: You will be speaking to us about advances in military resuscitation at ICEM 2016, want to let anything out the bag?

Jason: I’ll be talking about some of the key areas of emergency medicine and resuscitation practice that have developed over the last decade of conflict in Iraq and Afghanistan, hopefully pointing to areas where these lessons can be translated and applied to civilian emergency medicine.