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Tag: pre hospital care
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Paediatric Trauma and Acute Care course: Frequently Asked Questions (FAQ's)
14th March 2019 WEM Marketing DeptTraumaNo CommentsEoin Walker, extreme medicine, Paediatric Trauma, Paediatric Trauma and Acute Care course, pre hospital care
We asked Eoin Walker, a London HEMS Paramedic, UKMED Team Member, WEM MSc in Extreme Medicine Faculty and our Paediatric Trauma course leader to run through the most frequently asked questions he gets asked regarding the course.
What content do you cover in the Paediatric Trauma course?
The course offers a fully immersive and highly practical hands-on approach to learning including various slow time simulations relevant to situations and scenarios you might find yourself, group workshops and faculty panel discussions. Attending the course will teach you the key skills needed to assess and stabilise a critically ill paediatric trauma patient in a pre-hospital environment including:
Paediatric trauma assessment and airway
IO (Intraosseous infusion) access and pain management
Paediatric traumatic and medical cardiac arrests
Breaking bad news in paediatric death, the 2nd patient
Integrated parent relationship management, non-technical skills and troubleshooting
Collapsed infant from Asthma, Anaphylaxis, Sepsis and Seizures
Medical assessment tools and FOI
Panel discussions with paediatric case scenarios
Kit familiarisation
Variations in approach to paediatric patients including the differences in Airway, Breathing and Circulation
Is cardiac arrest – medical and traumatic covered on the course?
Yes, both are covered across the two days within their own 45 minute integrated workshops, as well as enhanced fidelity simulations to increase learning and improve skills and WEM panel discussions with some of the country's leading paediatric specialists including specific paediatric case scenarios.
How do you adapt care for a pre-hospital environment?
Decision making in any medical situation can be a challenge, add to that a high stress situation and a paediatric trauma patient and you as the health professional needs to be confident in providing the gold standard of critical care we all aspire to. Within a pre-hospital environment we will teach you how to follow and adapt the ceiling of care principle, where the aim is to provide continuity of care and ensure good communication is prevalent throughout.
Do you cover pain management for children?
Yes, this topic is covered extensively on the first day of the course within a workshop and also as part of slow time simulation reflective of a paediatric fall from height scenario. It's important to understand the unique and challenging problems a paediatric trauma patient can present with and how best to assess and proficiently manage the patient, to achieve the optimum outcome.
How do you achieve paediatric splintage?
There are various adaptions taught within the course and all will be dependent on the patients' trauma, range of movement and environment. We will discuss in great detail and focus your skills through hands on practical experience.
Which airway techniques are preferable?
Airway control is a critical skill for any pre-hospital healthcare provider and as such we advocate various airway techniques which will depend on the environment your find yourself in. Techniques will be taught through a combination of taught lectures, workshops, simulation and plenary discussions and will include supplementary additions to both intubating through a supraglottic airway (SGA) and Endotracheal intubation (ETI).
Do you teach around assessment tools in Paediatrics?
Yes, these are essential to form a general impression of our patient and will be used to assess and determine the treatment given. We will teach and discuss the Paediatric Assessment Triangle (PAT) that consists of three areas of assessment: Appearance; Work of Breathing; and Circulation to Skin with adjunctive TICLS – pronounced 'tickles' – that looks at muscle tone, irritability, consolability, look (gaze) and speech.
If you want to feel more confident in treating sick children together with how to proficiently manage traumatic and medic paediatric cardiac arrests, then this is the course for you!
To find out more information about our Paediatric Trauma and Acute Care course or to book your place on what we promise will be an incredibly inspiring 2 days, please click here.
London HEMS join the Extreme Medicine Conference lineup
7th May 2014 Mark HannafordExtreme Medicine EXPO, Extreme Medicine EXPO Boston, International 'World Extreme Medicine Conference & Expo'anne weaver, extreme medicine, gareth grier, hems, LAA, london, mark hannaford, medical, pre hospital care, rsm
We are privileged and humbled by all the support that this years Extreme Medicine Conference is receiving.
We are so honoured that the London HEMS Team is joining us to offer a 2 pre conference Pre-Hospital Care Course – talk about learning from the best!!
You dont need to be coming to the conference to reserve a space BTW…
Spaces are strictly limited and cancellation fees apply please check our T&C's for details
http://www.extrememedicineexpo.com/index.php/workshops/workshop/205
About London's Air Ambulance (http://londonsairambulance.co.uk/) is the charity that delivers an advanced trauma team to critically injured people in London. The service provides pre-hospital medical care at the scene of the incident and serves the 10 million people who live, work and commute within the M25.
Based at The Royal London Hospital and founded in 1989, the service operates 24/7, with the helicopter running in daylight hours and rapid response cars taking over at night and in adverse weather conditions.
The team, which at all times includes an advanced trauma doctor and paramedic, perform advanced medical interventions, normally only found in the hospital Emergency Department, in time critical, life threatening situations. Missions commonly involve serious road traffic collisions, falls from height, industrial accidents, assaults and injuries on the rail network.
London's Air Ambulance has an international reputation for clinical excellence and delivers pioneering procedures that have been adopted across the world.
The Institute for Pre-Hospital Care. For twenty-five years, London's Air Ambulance has been a leader in the development and practice of pre-hospital care. Through its research, innovation and education activities, as well as the professional affiliations and publications of its clinical leadership, it has influenced clinical guidelines, governance standards and the practice of numerous air ambulances, in the U.K. and abroad.
The Institute of Pre-Hospital Care at London's Air Ambulance (www.IoPHC.co.uk) was founded in 2013 to build on and expand this influence. Its mission is to drive excellence in pre-hospital care standards and practice through research, innovation and education; and by fostering collaboration across medical disciplines and institutions dedicated to improving outcomes for people afflicted by critical injury and illness.
In 2014, The Institute created, and will deliver, the UK's first undergraduate degree in pre-hospital medicine, in partnership with Queen Mary University of London.
Join us at Extreme Medicine 2014 #extremeexpo #LDNairamb
London Air Ambulance and Extreme Medicine 2014
3rd March 2014 Mark HannafordExpedition & Wilderness Medicine, Extreme Medicine EXPO, Extreme Medicine EXPO Bostonemergency medicine, extreme medical, hems, LAA, london air ambulance, mark hannaford, pre hospital care, ram, Royal Society of Medicine, trauma
The world famous London Air Ambulance team will be joining the Extreme Medicine Conference in 2014 not only as highlighted speakers during the main conference but also partnering to deliver a pre conference trauma workshop.
As details of this training event are confirmed why not watch their life-saving work on the BBC…. click here to find out more.
London's Air Ambulance features in BBC Two – An Hour To Save Your Life (#AHTSYL) – 3-part series starting 4th March, 9pm
This new series looks at innovations in emergency medicine and the improvements in patient outcomes as a result of doctor-led pre-hospital care and fast-tracking heart attack/cardiac arrest, stroke and trauma patients to specialist centres.
It was filmed over the summer of 2013, spending two months with London's Air Ambulance including with our Physician Response Unit (PRU), a medical emergency fast response team who are tasked to out-of-hospital cardiac arrest patients, at The Royal London and London Chest Hospitals and with the London Ambulance Service. Filming also took place in Nottingham and Birmingham.
Across the three programmes, nine patient stories are featured, five of these are involving London's Air Ambulance in the pre-hospital phase. The key clinicians involved in each patient case conducted in-depth retrospective interviews so the style of the programmes is very much clinicians taking the audience through what happens.
Extreme Medicine 2014 Conference – London 8-11 November
World Extreme Medicine Expo – what it's all about… from Expedition & Wilderness Medicine on Vimeo.
NEEDED: Medical Professionals to support Fundraising Marathon (May 2014)
20th February 2014 Mark HannafordAfrica, CME, CME Training, cme travel, Extreme medicine, Jobs in Expedition Medicine, marathon, Wilderness MedicineAfrica, Expedition & Wilderness Medicine, health, job, jobs, marathon medical support, medic, medic job, medicine, pre hospital care, race director, remote medic jobs, sierra leone, wilderness medicine
STREET CHILD are looking for assorted medics and also a Medical Director* to provide cover for this fundraising event in the world's 10th poorest country and help improve the lives of vulnerable children in West Africa.
**** POSITION NOW FILLED *****
The Street Child of Sierra Leone Marathon 2014 is an ambitious project and we need medical help to stage it. It's more than just a run. We invite runners to join Street Child in Makeni, Sierra Leone to see and assist with the work we do in country, and to get involved with the local community. All of this takes place in a developing country with a basic medical infrastructure.
The race covers tough but beautiful terrain, invariably with high temperatures and humidity. The route is classed as a category "black" marathon – a marathon where serious consideration should be taken to safety provision. For this reason medical support is vital. Over the last 2 years, under the guidance of the Medical Director, groups of medical professionals from across the world have travelled to Sierra Leone to help out. When joined by local medics and nurses, mining corporation paramedics and medical students, this team have provided essential cover to the marathon. More importantly, previous teams can testify that they have have had an amazing adventure, providing a great talking point for grand rounds on their return!
Most of the action for the medical team takes place on race day, where teams set up makeshift medical stations around the course, providing first line medical care to the runners. This is co-ordinated from Medical HQ, the headquarters for ongoing treatment, and communication centre to each of the medical stations.
Sierra Leone is very much a developing country – supplies and equipment are limited and expertise is varied. This is a challenge, but one worth taking on. Outside of race day, the medical team will be involved in procuring equipment, medical briefings to international runners, and manning clinics offered to local runners on registration day. Another important job for the team is spending time chatting to the runners before the race, providing reassurance and advice, usually over a local beer!
We would like people who like the sound of this event to travel out to Sierra Leone for between 1 and 2 weeks to help us organise the 2014 Sierra Leone Marathon. We do ask that you fund your own trip (flights and accommodation only, all transport and meals will be free) but in return we will give you your own 'experience of a lifetime' seeing and assisting with Street Child projects in urban and rural Sierra Leone, taking part in a week of festivities in Makeni and you still get to finish on a high joining our West African beach party and 2 night beach hut retreat!
Dates are pretty flexible, the marathon is on Sunday 25th May so an 8 day trip could fly Wed 21st May and return Wed 28th May 2014. Direct 6 hour flights from London are available from Gambia Bird Airlines and BA.
For more information, photos and videos please look at www.sierraleonemarathon.com and www.facebook.com/sierraleonemarathon.
To enquire or apply please send your details to info@sierraleonemarathon.com.
*For applications to the role of Medical Director, the role will be to provide leadership and direction to the medical team. A return flight from London will also be provided. Minimum dates Mon 19th – Wed 28th May 14.
MBE for EWM Faculty Member
2nd January 2014 Mark HannafordExpedition & Wilderness MedicineDr theo Western, expedition medicine, keswick, MBE, pre hospital care, trauma
GP Dr Theo Weston has been appointed MBE for services to victims of trauma in Cumbria. Theo who has recently joined the Executive Council of BASICS also flies with the North West Air Ambulance. He set up the BEEP Fund (Birbeck Emergency Equipment for Patients) in 1994 that has raised more than £400,000 to buy equipment needed for doctors providing prehospital emergency care throughout the North East.Theo said said:
"It's a huge honour and a big surprise – I never dreamt I would be worthy of such a prestigious honour but I'm absolutely delighted. I also want to give credit to all the others who have supported me over the last 20 years, allowing me to do this kind of work. In particular my family have been so supportive, allowing me to drop things at the drop of a hat."
Theo was one of the original founding faculty for the gold-standard Expedition Medicine course based just outside of Keswick.
http://www.expeditionmedicine.co.uk/index.php/products/events/-/pt-0010.html
Disaster and Trauma Medicine workshop sign up closes midnight on Sunday 20th October
18th October 2013 Mark HannafordExpedition & Wilderness Medicine, Extreme Medicine EXPO, Extreme Medicine EXPO BostonExtreme Medicine Conference, mass casualty management, medicine in remote area, pre hospital care, trauma medicine, wilderness emt
Sign up for this remarkable disaster and humanitarian 2 day workshop in Boston CLOSES this Sunday 20th October – quick get your ticket!!!
http://boston.extrememedicineexpo.com/index.php/workshops/workshop/198
PRE-HOSPITAL TRAUMA AND DISASTER MEDICINE WORKSHOP
Pre Conference workshop for Extreme Medicine Conference, Harvard Medical School boston.extrememedicineexpo.com
This course is an intensive 2 day Pre-Hospital Trauma and Medical Emergency course for medical practitioners who may not have regular exposure to witnessing and managing acute medical emergencies and/or trauma injuries day to day, and who are interested in improving and refining their skill base whe…
Treating Yaws with MSF
19th September 2013 Mark HannafordExpedition & Wilderness Medicine, Extreme Medicine EXPO Bostondrc, endemic treponematosis, Médecins Sans Frontières, MSF, pre hospital care, relief medic, Remote medicine, surgeon
Curtesy of our friends at (c) Adventure Medic » Adventures » Treating Yaws with MSF
Working as an MSF Doctor
Matthew Coldiron / MSF Doctor
When Matthew Coldiron first found out that he would be working on a mass treatment campaign for yaws, he had to struggle to remember what the disease was. In his words – yaws puts the "neglected" into the phrase "neglected tropical disease". Most of us haven't even heard of it, let alone the serious conditions it can cause, so Matthew gives us a summary and then tells us about his mission with MSF to help eradicate it amongst the Aka pygmies. (Photos: Benoit Finck.)
Yaws is an endemic treponematosis – a close (non-venereal) cousin of syphilis. It thrives in humid tropical areas, and is transmitted by direct cutaneous contact. Like syphilis, it has primary, secondary, and tertiary forms, as well as long latent periods. The primary and secondary forms are mainly cutaneous lesions, though periosteitis is not uncommon. 10% of untreated cases will develop tertiary forms decades after the initial infection. The most common of these involve hyperkeratosis of the soles and palms, complete destruction of the nasal cartilage (called gangosa), and severe bowing of the tibia, which results in serious disability.
Massive treatment campaigns with injectable penicillin in the 1950s and 1960s nearly resulted in the eradication of the disease. But the hardest-to-reach areas didn't get treated, and the disease persisted in some of the most forgotten corners of the world – largely in central African forests, Indonesia, and the Pacific islands.
A single dose of oral azithromycin was recently shown to be non-inferior to penicillin for the treatment of yaws, which resulted in a new push for yaws eradication by 2020. An oral antibiotic can be administered to a whole population, which takes care of the problem of latency and reduces the logistical burden of administering injections in isolated areas. Médecins sans Frontières/Doctors Without Borders (MSF) decided to put this new eradication strategy into action for the first time in a remote region of Congo-Brazzaville, among the Aka pygmies, a nomadic group of hunter-gatherers greatly affected by yaws, during September and October 2012.
In some ways, I knew what to expect when I arrived in September. I had gone to the area well before the campaign to start our preparation, visiting the Aka camps (often only accessible after several hours' walk through the dense forest). I had crossed rivers in leaky dugout canoes, trudged through waist-deep mud, and arrived in the heart of the pygmy homeland. But my planning visits couldn't have prepared me for the reality of our campaign. The vast distances, the extreme living conditions, and the sweat, dirt, and mud posed major challenges for MSF's three teams.
As a result, my team's communal life together was intense. In total, we were eight: a doctor, two nurses, a logistician, a translator, an 'advance man' who preceded the teams in the villages to inform the population of our upcoming visit, and two drivers. We had wildly different professional and personal backgrounds – from an American doctor with lots of field experience, to a French nurse on her first mission, to a Congolese pastor working as the advance man. We worked up to 13 days in a row without a break, trekking for hours through the muddy jungle, sharing tents and meals, and bathing only occasionally. It was a true team effort, and we all brought different talents to the table – from the drivers who did double-duty registering patients, to the translator who unfailingly found bush meat to cook at dinner time, to the nurse who could pitch a three-person tent by herself in under two minutes.
By the end of the campaign, we had treated nearly 17,500 Aka with azithromycin, a great success by any standard. We also offered measles vaccinations and a very basic mobile clinic that cared for malaria, respiratory infections, diarrhoea, and other common easy-to-treat problems. On the other hand, I was always frustrated at my inability to treat many other conditions that affect the Aka. Leprosy is rampant, and I saw many patients whom I suspected to have tuberculosis. The saddest condition is infestation with chiques – a type of burrowing louse that lays its eggs under the skin of the feet. In many villages we visited, every child had them. Some had what looked like hundreds in each foot, and because of the pain, itching, and super-infections, were forced to walk on their heels.
MSF and the Aka
The Aka are a geographically isolated group, and like many of the pygmies of central Africa, very marginalized. Historically, they lived in conditions of forced labour at the hands of their Bantu neighbours. Things are slowly changing in that regard, but their isolation means that they have little to no access to health care and education. Functioning structures are few and far between, and even then, the distances are too long to be practical for them, to say nothing of the cultural factors that affect their willingness to seek allopathic medical care.
So in this campaign, we went to them, and it was an unforgettable experience. As a doctor, I'm used to seeing patients who come to see me in a clinic. At MSF, we do lots of out-of-hospital care, but usually in the form of mobile clinics. But during this campaign, we had the privilege to live among the people we were serving, sleeping in their villages every night, eating the food they had hunted that morning, sometimes even dancing with them around a fire late into the night. Spending so much time in the Aka villages was a great way to gain their confidence. I'll never forget eating caterpillars and smoked porcupine, the village chief who shared fresh honey – bees included – with us, and entering a village in the middle of a funeral rite whose centrepiece was a person covered in reeds twisting and twirling, representing the spirit of the deceased.
MSF first came to the area because of an influx of refugees from the neighbouring DRC which doubled the region's population almost overnight. It supports the District Hospital in Betou, and has fixed and mobile clinic sites in the surrounding areas. Our yaws campaign also included the much larger district of Enyellé. In the coming months, MSF plans to revisit the areas of high yaws prevalence that we saw during the first phases of our campaign to ensure that any new cases and their families are treated. On a broader level, MSF is working to raise awareness both of this disabling and deforming neglected disease, and also the immense challenges faced by the isolated and vulnerable Aka.
You don't have to trudge through the tropical rain forest to get involved, even though it is an amazing experience. You can learn about working with MSF, or make a donation to support our activities here. Medically speaking, yaws should be easy to eradicate, though obviously, the logistical side will be more complex. But as I've come to realise, solving the problem of this neglected disease will also involve concerted efforts at providing access to a basic level of care to the neglected people it affects.
Médecins sans Frontières/Doctors Without Borders (MSF)
Expedition Medicine Course (4 days)
An AMREF shift comes to an end….
15th August 2013 Mark HannafordExpedition & Wilderness MedicineAMREF, flying doctor, MD's Matt edwards, Medicine Africa, pre hospital care, Remote medicine, wilderness medic
EWM faculty member Dr Matt Edwards says and emotional farewell to workimg as a flying doctor in Africa on his way to 'sunny' Dartmoor to speak of his experience on the next Expedition Medicine Course
BA flight 060 has left Nairobi and I'm once again in the African skies. But this time I am not in my own private jet and I will not be retrieving some unfortunate soul from the depths of the continent. My time with AMREF Flying Doctors has come to an end and I will soon be back on home soil in Heathrow. The time has streamed by in steady flow of little adventures that, no sooner had I started to reflect on one, I was whisked off on another.
It was not all that long ago I was in a similar aircraft approaching Nairobi and, to be blunt, utterly bricking myself. Since then I relaxed into my role and was embraced into the AFD family. The variety and frequency of the strange situations flash through my mind like someone rapidly flicking through a comic book. It's so difficult to pick them out from each other. I'm now so glad I started writing the blog so I can revive the memories for years to
come. I've thoroughly enjoyed writing the stories and I'm really chuffed so many of you have enjoyed reading them. To date over 7000 people have read these posts and I find it hard to believe my mother was responsible for all of them! I would love to continue writing them but life as an emergency physician in St Mary's hospital is less conducive to attention grabbing headlines. 'Woman gets offended when told her sore throat is not an emergency' is just not as exciting as 'Buffalo attack wake up call'.
The guys were able to summarise the work which I have done over the last three months and it has surprised even me: –
Countries visited – Iraq, UAE, Sudan, South Sudan, Ethiopia, Djibouti, Somalia, DRCongo, Uganda, Rwanda, Burundi, Tanzania, Chad, Zanzibar, Madagascar, South Africa and all over Kenya.
73,000 miles flown, which is nearly three times around the world.
My work as a volunteer has provided over $33,000 USD which has been saved by the charity.
It has been an exceptional time, providing me with some of the most heartwarming, bizarre, frustrating, terrifying and challenging medical experiences of my life. I've learnt a huge amount as a clinician. I've learnt about teamwork and timework, suffering and salvation, injustice and incompetence, African cultures and corruption. I've been so privileged to be involved in some of these stories and would urge any of you, who have the appropriate skills, to seriously think about taking this job on. I would imagine this is my last post for AMREF Flying Doctors and thanks again for following the blog. It's been emotional.
Dartmoor Expedition Medicine Course
Remote Medicine Courses
EWM's intrepid Dr Edwards reports on Buffalo attacks and other goings on…
30th July 2013 Mark HannafordExpedition & Wilderness MedicineAMREF, Dr Matt Edwards, flying doctor, pre hospital care, remote medicine in AFRICA
Buffalo attack wake up call, Medicine with AMREF in East Africa Dr Matt Edwards reports
(warning – there is a gruesome picture)
"Daktari… …immediately… …Buffalo attack… …Magadi."
That's about as much information as filtered through into my brain as I answered the bleeting phone at 05:00 this morning. Before I was really aware I was not dreaming I had my trousers on inside out and was ineffectually attempting to fight my way out of my mosquito net in the darkness.
About 03:30 in the morning, a park ranger in a reserve close to Magadi, about 75km South West of Nairobi was on patrol when a buffalo attacked him. I am now reliably informed by my friends here that 'Don't worry about lions and snakes. Buffalo are one of the only beasts around here that will attack you for no reason.' And they can cause some nasty damage. They are not as invariably lethal as the elephants but they will charge and impale you with their horns. This poor chap in question was charged before any shots could be fired. Apparently it dragged and threw him before attacking him on the ground and ran off into the night.
He was rushed back to the camp where the nurse there tried her best to stem the bleeding from the huge wounds in his shoulder, his thigh and his head. She did a good job with little equipment and established IV access and gave him painkillers and a tetanus shot. Throughout the ordeal he never lost consciousness.
With the scanty information of 'buffalo attack, head injury, severe bleeding' we prepared for the worst (always a good bet for AMREF FD as I have said
before). As we took off into the dawn, Phyllis and I drew up basic drugs ready for a critically ill patient and very soon we were circling over the remote little airstrip in the Rift Valley. On ground we were greeted by a group of concerned looking rangers and staff from the park. Some of them obviously very shook up by the nights events. Others less so. I suppose, in general, there isn't much to be worried about when you are carrying an absurdly massive gun.
We were all driven with our equipment through the bush to their camp and we were relieved to find a young man, in pain and bleeding admittedly, but conscious and orientated. The buffalo had managed to leave him without critical head, spinal, chest, abdominal or pelvic injuries. He had a few minor head wounds and a large thigh wound without underlying fracture. It had stopped bleeding and exposing it showed how very close the buffalo's horn had come to tearing open his femoral artery. I doubt he would be alive if it had.
His biggest problems was a horrendous right shoulder injury. The animal's horn had punctured through one side of the shoulder, shattering the proximal humerus bone as it went and torn through to the other side. Unfortunately he is right hand dominant. His pulse at the elbow was pretty weak but, amazingly, he had preserved sensation to his fingers and upper arm. The wounds were still oozing profusely and the arm was at a horrible angle. It was time to introduce him to my good friend Ketamine.
Ketamine is a fantastic drug for the pre-hospital environment and I think it would be one of your 'must have' drugs for remote medicine. It is 'remarkably safe and is certainly the safest anaesthetic if you are inexperienced' as, one of my old bosses Dr Sinclair wrote in his book on basic bush anaesthesia for AMREF 'Ketamine is particularly useful in developing countries'. It's a potent sedative, analgesic, bronchodilator and best thing about it is that you can give it to patients who had lost a lot of blood without their blood pressure plummeting. Most of the other strong analgesics and anaesthetics will do that, so you run a tightrope of cardiovascular instability if you use them in trauma.
It has its side effects of course. Some of you may know it as Special K for its exciting hallucinatory effects that probably make clubbing vaguely interesting. Those waking from the sedative effects of high dose ketamine often have crazy 'emergence phenomenon' which effect different people very differently. Last chap I gave it to, to extricate him out the back of landrover, stared at me and asked 'Are you God? I am dead. You are angels'. Kids often have fun with their hallucinations but adults have a greater tendency to freak out. Children generally have an overactive imagination anyway, meaning that seeing a dragon at the end of your bed is quite cool, but as an adult you might start climbing the wall.
The other stumbling block for using ketamine in trauma is that the majority of the medical world thinks it will make patients' heads explode. If you have sustained a head injury, due to a couple of case series written up in the 70s, ketamine is strictly not allowed as it was thought to detrimentally increase the pressure in the head. Making them explode! I'm not sure how many more review papers, head-to-head comparisons (excuse the pun) or research papers into its potential neuroprotective qualities in head injury need to be performed to revise the dogma. Doctors across the world are still far happier using drugs which dangerously drop blood pressure, an effect shown definitely to worsen outcomes in head injury, than use evil ketamine. It is so engrained into medical culture that I still feel uneasy about giving it. Not because I think it's going to cause harm but more because of the stern criticism I can expect from other colleagues, utterly convinced I have made the patient's HEAD EXPLODE!
We popped in another IV line, attached him to monitoring and I gave a mild dose of sedative in the vain hope that we wouldn't get emergence issues. Then something a bit weird happened…
There is an old medical proverb that 'if you hear hoofs coming down the corridor, don't assume it is a zebra'. Which basically means, think of the common stuff first before rushing to weird and wonderful diagnoses. Real medicine is not like House MD, more's the pity. So imagine my surprise as, having just administered the ketamine, I heard hoofs, turned round and was face to face with a curious zebra. It was watching me work as I knelt beside the patient. I had a double take, making sure I hadn't inadvertently given the hallucinogenic drug to myself. 'Nope, that's a zebra alright.' Now none of my medical mentors ever told me what to do if there is actually a zebra in the corridor. I pondered this for a second as the zebra and I stared back at each other. The surreal but beautiful little moment was broken as he was shooed away by one the rangers and we carried on.
I gave traction to the horribly crunchy upper arm as Phyllis applied a battlefield style dressing, splintage and a sling. The patient didn't even flinch but I think his colleagues were slightly concerned by his fixed disembodied gaze at the sky. They do that. Soon we had control of the haemorrhage and the patient was packaged up and ready to move. We rang ahead to warn the receiving hospital that we had a limb threatening injury and to let their surgical teams know. With a 30 minute flight time we were in their emergency room in about an hour. The patient was taken for imaging and I understand he is now in theatre. Neither I nor the orthopaedic surgeon were particularly optimistic about the future function of that arm but, after all, stranger things have happened. Like zebras watching you at work for example.
AMREF website
Interested in working in remote medicine? Courses of interest
Expedition Medicine CME course (4 days)
Trauma Medicine (2 days)
Extreme Medicine Confernce (4 days) pre conference trauma workshop (2 days)
EWM's intrepid Dr Edwards reports on Buffalo attacks and other goings on…
Part 2 of medically challenging week in Kenya with Dr Matt Edwards
17th July 2013 Mark HannafordExpedition & Wilderness Medicine, Expedition Doctor, Jobs in Expedition MedicineDr Matt Edwards, emt, expedition medicine, kenya medicine, medicine in remote areas, pre hospital care, Remote medicine, wilderness medic
Adventures with AMREF Flying Doctors
The Calm Before the Storm – Part 2 Matt Edwards
Matt Edwards Blog working in remote medicine
About 1900 in a place called Kisii, close to Kisumu on Lake Victoria, an over laden bus full of about 70 teenagers attending a sporting event had crashed at high speed. There were about 8 dead at the scene including the teachers and 10 or so critically injured and the other 50 with an assortment of walking wounded. The local population had mobilised and were dragging the casualties to the local hospitals including to the larger nearby town of Kisumu. The pictures and footage at the scene depict what you would expect: people running about haphazardly carrying people in bedsheets, rushing off with them in the back of pick ups and taxis, a couple of local policemen completely overwhelmed and no sign of a fire service or any ambulances. Mass casualty disasters like that must be terrifying, especially if you know that no help is coming. When you know there will be no flashing lights, no big boys in uniform telling you what to do and no one to assess and triage the injured. As I slept peacefully, Kisii had turned to complete chaos.
The local hospitals did their best but the majority of the critically injured succumbed to their injuries overnight. With current advances in trauma care I can reasonably claim that most of the critical initial survivors would not had died if there was an early, coordinated Emergency Medical Service, Fire and Police response taking them to a well-resourced major trauma centre. In the same week there has been two similarly horrific events occur in the first world – a train crash in France and an oil tanker explosion in Canada. I have watched those stories unfold on the BBC World News, CNN and Al Jezeera. I bet you didn't even know about this tragic loss of life in Kenya though, despite it being officially declared a 'national disaster' by the Government or the fact that there was a worse crash back in February killing 35. The tragic thing is that Kenya has enthusiastic people with the skills and the resources to provide a better response. This is the kind of horror story that my new friends at KCEMT (the Kenyan Council of Emergency Medical Technicians), the CDC and John Hopkins University are working so hard to make a thing of the past.
This should be the part of the story in which I explain how we were mobilised and ready at first light with two planes fully equipped to go and stabilise and retrieve the most critical from the disaster. Unfortunately we had no idea of the scale of the tragedy that morning and I was sent off early to Kismayo to pick up a load of injured but stable soldiers. It was only as we were setting off back to Nairobi that we learned that the regional governor for Kisii had informed the Government's 'disaster control centre'. The reason for the delay is unclear. Then this plea for help was escalated to the President himself who officially declared it a disaster.
It still took a while for AMREF FD to be authorised to send a caravan plane out to Kisii, along with a few police helicopters and bring the patients back to Nairobi. Kenya's Red Cross ambulance service were also heavily involved but they could not cope with the situation on their own. They are a paramedic staffed ambulance provider and are simply not geared up for the safe transfer of severely injured patients. AMREF FD is the only certified air ambulance in East Africa that can do the kind of highly skilled rapid triage, treatment and evacuation of the most critical casualties. I hope that the Kenyan people are starting to recognise this. I do hope that the government can now understand that AMREF FD is a specialist resource that can be used to save lives if they are allowed to be involved early enough.
Personally I found all this out after we had handed over our soldiers in Nairobi and one of our caravans had already headed out for Kisii. Frustrated I had missed the action, I was put on standby in case they needed another team. Our guys had already made it the hospital to find that 'most of the local population seemed to have taken up residence in the hospital'. People from all over the region rushed there after the accident to look after their relatives or probably just to have a good look at the tragic story. The ambulance was unable to even get to the entrance of the hospital because the main road had become a car park with empty vehicles. Then inside the hospital there was barely room to assess and transfer the patients along the corridors, it was so packed with people. It was a perfect example of why the police are so vital to control the crowds and ensure access and egress from the scenes of major incidents. In the end they managed to get in and triage the 53 patients concluding that only 4 needed to be airlifted to Nairobi. The rest could be safely treated where they were.
As we waited at Wilson by our hanger it became busier and busier. Soon there was a massive crowd of news media, the Red Cross chaps, members of parliament and the Kenyan police. I thought it was a rather big turnout for just four patients. Then someone explained to me that nearly 20 injured patients were being airlifted because the President had declared a disaster. Therefore all the injured must come to the Government hospital in Nairobi.
As the cameras clicked away Charles and I took the first multi trauma case (head and chest injuries) to Kenyatta hospital. I had never been there before and we greeted by even more media. We were soon joined by more and more ambulances dropping off their patients and the already stretched A+E was suddenly swamped. Our staff and the Red Cross paramedics were impressed by how many staff had been diverted to come and take their patients. It's true, we did not need to hang around. The patients from the incident were all seen very quickly. But I saw how busy the A+E Department was before we arrived and I wonder how the other patients fared while this influx inundated the hospital.
As I returned to Wilson airport, we were asked to head straight out to Kisumu (not far from Kisii) where one of the young girls involved in the crash had been taken. Strangely, we were stood down at the last minute. Apparently new arrangements had been made. I was surprised and assumed that she must have passed away. I was even more surprised when, the next day, Kizito and I were instructed to retrieve the poor girl again. What had happened became clear when we arrived. We were told by the staff at Kisumu that a police helicopter had turned up instead of AMREF FD with just a mattress in the back and no medical personnel. Thankfully the medical staff at Kisumu stood their ground and refused to allow such a critically ill young girl to get airlifted like that. Again I have to emphasise that when there is a resource like AMREF FD, capable of stabilising and safely transporting such a patient, sitting on your doorstep, ready to go at a moment's notice, then it must be used. Unfortunately another 24 hours had been wasted.
By the time we were at her bedside, her conscious level had deteriorated further. She was now only responding to painful stimuli by inwardly twisting and extending her arms, which is a sign of quite considerable neurological impairment. She was certainly not protecting her own airway so, yet again, Kisito and I set to intubating, sedating and ventilating her and trying to protect her brain as best we could. I think we were reasonably successful as the high spikes in pulse, respiratory rate and blood pressure she was having on the ward, settled with us and she was nice and easy to manage on transfer.
Upon arrival we were met by the CEO of Kenyatta hospital who was extremely grateful for the safe transfer. I think that he clearly understands that now, when the police or Nairobi's ambulance services can't handle it, he knows who to call.
About; AMREF's vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty. We believe in the inherent power within African communities – that the power for lasting transformation of Africa's health lies within its communities.
Latest Dispatches from Kenya with EWM Medic Matt Edwards
16th July 2013 Mark HannafordAfrica, Expedition and Wilderness Medicine Facualty, Expedition DoctorAfrica, Dr Matt Edwards, emt, flying doctors, kenya, pre hospital care, wilderness medicine
The Calm Before the Storm – Part 1
The past week at AMREF has been one of strange contrasts. There were no flights at all for three days and it was making the staff twitchy. It just doesn't feel right to have nothing going on. In actual fact there was quite a bit going on at AMREF FD headquarters, just no flying. We had the official launch of the new Beechcraft King Air air ambulance on Monday. It was an impressive event with the dignitaries and guests sitting in the hanger alongside the beautiful new plane. Proudly I watched as my film was being shown on repeat in the background. Dr Bettina Vadera, a representative from AMREF and the visiting MP all made speeches with a compare from Nairobi radio. She did a fantastic job of helping market the Maisha cover plan which is new insurance policy which is affordable to a large proportion of Kenyans and they then can get rescued from wherever they are in East Africa. But after the banners and tables were cleared we sat around twiddling our thumbs for the rest of Monday and then Tuesday. Then suddenly on Wednesday morning, we had three medevac flights come in simultaneously. During the next two days AMREF FD would take on 9 flights, many of them extremely sick patients.
As I entered the office I was directed to the waiting caravan plane to do our checks as we had to fly out to Lewa where an 8 year old girl had fallen from her horse and was unconscious. There really is nothing like paediatric trauma to brush off the morning cobwebs. Far more effective than coffee. As I was busy agonising over whether I should be using the (A+4)x2 or the (Ax3)+7 calculation for her weight and the plane was about to start off, we were suddenly stood down. The girl was being brought straight to Wilson in a small plane with the parents and I was needed on another urgent flight into Tanzania. But we had to stay on site to receive the little girl from Lewa at Wilson to resuscitate as required and pop her in our ambulance to take her straight to hospital.
One of our locum doctors was on his way in to help out but was a little way off in the infamous Nairobi traffic. The tiny Cessna plane arrived from Lewa and taxied to us. The little girl had improved on the journey and was now wriggling away from stimulus. It was a good sign; lots of little kids respond like that after a significant head injury. I see mostly insignificant head injuries in children back home, and often I have to physically catch them from the play-area in the waiting room to assess them. We packaged her up while calming the parents and sent her off to the hospital for a scan of her head to exclude a neurosurgical issue. I am told she awoke fully on the way to the hospital and is doing fine.
So as we popped her in the ambulance the King Air was brought around and had been loaded ready for us to head into Tanzania. A young girl of 15 had been involved in a nasty car accident and was critically ill. She had been unrestrained in the back seat of her father's car as they hit a pot hole, breaking the axel and the car rolled several times. The father was fine but his daughter had been ejected though the front window and was lay unconscious on the road. Once they got to the local hospital, we were contacted. As far as they could tell she only had a head injury (always a dangerous assumption) and she was still unconscious. All they could do was wait for us and give her strong medication to suck fluid out of the cells in her brain and halt the swelling going on inside.
It took about an hour to get to this gold-mining town in Kahama, Tanzania and on the way, while being bumped around by the thermals coming off the baked ground, we did our standard checks and discussed our plan. Given that we were expecting to be escorted to the patients bedside, we thought we would have a little time to assess and plan in the relatively safe and sheltered environment of the hospital. As we taxied around at the dusty runway, I noticed an ambulance sitting just outside the gates on the other side of the airstrip. I wandered off in the baking heat to have a pee (I am always totally convinced I am going to get bitten by a snake when I do this) and Kisito the flight nurse explained to the airstrip's official that the ambulance needed clearance to enter. It seems no matter where you go in the world you will find irritating 'jobsworths'. It's just that in Africa they tend to back up their obstinate behaviour with an AK-47. Kisito gave up and beckoned the ambulance to bring some people to help us hump the equipment the 500m over to the gate. I lifted a few pieces of equipment out of the aircraft and then noticed he had started running towards them.
It took me a little while to work out what the problem was through the heat haze. Then I could make out a little group of people hurriedly carrying a small body on a stretcher. 'Oh bugg*r' I thought and quickly followed Kisito.
A rapid sequence induction on a critical patient in the pre-hospital environment can be one of the most stressful situations you can encounter as a doctor. But it needs to be calm, clear and systematic with good communication between the intubator and the assistant. So many things can go wrong; the powerful drugs you use to render the patient amnesic and unaware of the whole process, to reduce the stress response to having the breathing tube put down their throat and to paralyse their muscles, can easily put them into cardiac arrest. And if you can't get the tube down and can't breathe for them then they will asphyxiate. In a critically ill patient the time you have to get a breath into the patient can be only seconds before the oxygen in their blood is used up. The pre-hospital environment makes this procedure even more difficult especially in injured patients with potentially broken necks, damaged lungs and occult internal blood loss.
From one look at this girl, you did not need to be a doctor to see she was in a bad way. She was unresponsive with a partially obstructed airway, breathing extremely fast with a pulse rate of 170. Her blood pressure was actually slightly elevated, as young people often do before it starts dropping. Her head was bandaged and she had signs of a facial fracture. Kisito and I did not need to spend long deciding what we needed to do. In the shade under the wing of the aircraft we beavered about. Soon Kisito had established a large IV line and was getting one of the crowd (of course there was a crowd) to squeeze a bag of fluid into her, while I drew up the necessary drugs. Soon we had her assessed, oxygenated and her pulse rate was sensible. I was prepared for it all going horribly wrong but the tube passed simply and she did not respond adversely to the medication. We continued to optimise her chances of neurological recovery as best we could on our way back to Nairobi but I'm afraid the prognosis for such injuries is not very good.
Just as we were handing over in Nairobi we were instructed to return urgently as we were needed in Kisumu next to Lake Victoria. A normally sprightly elderly man had had a heart attack the day before and was not doing well. We had had a non-urgent enquiry about a transfer for him to have cardiac catheterisation earlier in the day. The clot busting and cardiac support drugs he had been given had seemed to be working. But then as his heart started to fail and the pressure started backing up, he had started to drown in his own fluid. This is not an uncommon occurrence for us in the emergency department and we deal with 'crashing pulmonary oedema' pretty regularly. Nitrates and 'non-invasive assisted ventilation' works pretty well. Obviously this was not available in Kisumu hospital. They also couldn't do an echocardiogram because the machine is owned by one of the other physicians and apparently it can only be used on his patients.
Our radio room informed us that the patient was deteriorating and we needed to get a move on.
Unfortunately the relatives could only afford a flight with our caravan. We could have been there in 20 minutes in a jet. Two hours and a bumpy road journey later we were at the patient's side to discover the doctors had intubated him despite the advice of the guys in the radio-room. They had intubated and sedated him but had no capacity to give him positive pressure ventilation. So he was basically in a worse state than if he had been left to his own devices. He was sedated, driving down his own appropriate urge to breathe rapidly and the tube was merely providing an extra long windpipe, like a rather thin snorkel, just making the work of breathing more difficult with the froth from his chest bubbling out the end periodically. I've never seen this done to a patient before. Without the benefit of assisted ventilation I simply don't understand what they were hoping to achieve.
For the second time in the day Kisito and I exchanged glances, sighed and got to work. Thirty minutes later we had this chap settled on the vent and his chest was already improving. We had to contend with his heart doing some weird things as we ascended but with a little tweaking and strong cardiac drugs we had them solved by the time we handed him over back in Nairobi to go have his angiogram.
As I settled down to a well-earned sleep that night, little did I know that, across the other side of the country, something terrible had just happened. The storm was about to get worse…
Stay tuned for the next signal….
Dr Matt Edwards philosophies from Africa
10th July 2013 Mark HannafordExpedition & Wilderness MedicineAMREF, Dr Matt Edwards, Expedition and Wilderness Medicine Courses & Conferences, flying doctors, pre hospital care, Remote medicine
Dr Matt Edwards, facualty member of Expedition & Wilderness Medicine writes about this time as flying doctor with AMREF in Africa
Source: Matt Edwards Blog | AMREF – http://www.flydoc.org/
The inverse Swiss cheese model of Success!
I have been shown the Swiss cheese model for error or disaster many times in my career. But I wonder if there is a Swiss cheese model for success? So instead of the multiple holes lining up to allow an environment for disaster, all the right holes line up allowing you to sail through against all the odds and come out the other side with a truly excellent result. If there is not such a model, I would like to propose it now and give you an example that happened just the other day.
I have written little about the staff and expertise that goes on behind the scenes allowing AMREF FD to do its job. They made those first layers of Swiss cheese line up, just in time.
Coming from a first world country and working at AMREF you become very acutely aware of the different medical capabilities in the third world and how incredibly remote (geographically and logistically) some of these places are. And that's coming from someone who has worked in Antarctica! If taken ill in one of these places you had better cross your fingers and hope your own body can sort it out. While out here I have often thought about one of my medical school colleagues, who tragically succumbed to a severe illness in the bush of Africa on her elective. I wonder if she would still be with us if AMREF FD had been there and able to pick her up in time
We received word of a young man travelling in a remote area of Ethiopia who had become extremely sick. They thought it was probably malaria but could not confirm. He had had a pretty classic malarial course with a few days of very high fevers, rigors and then started to develop dark urine and jaundiced skin. He seemed to improve on a dose of artemether (administered by another member of the group he was with) and then during the night became drowsy, confused and convulsed. He had not regained consciousness since. The doctors in the small clinic there had neither the supply of medication, nor the facilities to treat such a severe illness. Their experience of severe malaria like that in their local population is that it is invariably fatal. They just expect to watch people pass away.
When a distress emergency call like this comes into AMREF a number of things need to happen before we can get going. One of the first things is getting confirmation from the insurance that they will pay and the patient is covered for what we propose to do. Then we need to get the guys at Phoenix to work out how to get us there. That requires knowledge of the airspace, the airstrips in the region and, crucially in this case, their opening hours. Our operations team need to get immigration to agree to let the patient into the country and get clearance for our aircraft to enter the countries airspace and land.
In this particular case, the challenge was that the call came through about lunchtime and the airstrip we were flying to could not support night flights. Lalibela is a site of considerable beauty and cultural heritage in Ethiopia attracting a large amount of pilgrims and tourists alike, so the runway is tarmac and well maintained, allowing us to get there is a jet. But immigration dictates we cannot go straight there; we use first stop in the capital Addis Ababa to process the paperwork. Only in extremely rare circumstances is that wavered in any country, not just Ethiopia. (For example, because of a prior agreement, we can fly straight to any airstrip in Tanzania without going to Dar Es Salaam). So given that it's two hours from Nairobi to Addis Ababa, then about 30 mins until we can set off to Lalibela which takes 45minutes and shuts at 18:00, we were looking at a cut-off time of 14:30. If we missed it we would have to wait until morning. The medical report strongly suggested that the patient would not survive such a delay.
As our Operations staff battled with Ethiopian immigration and badgered to gain clearance for the flight, our radio room in desperation tried to charter a flight in Ethiopia to go get the patient and bring him to Addis (which is open 24 hrs) then we could pick him up there, but we couldn't get a doctor or nurse to do the escort. At 13:45 it was looking like this young man's life was slipping through our fingers. All we could do as the medical team was sit with our equipment, ready to go and hoping the operations team could pull it off in time. It just seemed crazy to me that this red tape can't be sorted out while we are on our way or even once we had picked him up, but that just isn't the way it works.
At 14:10 we got the call the clearance had been granted, the insurance had confirmed they were happy, the patient's travel documents had been found and we started up the jet. It was still going to be tight. It was entirely dependent on the immigration officials at Addis Ababa. Airport officials here seem to behave a little like 'Rheopectic liquids' i.e. they become 'slower and thicker over time when shaken, agitated, or otherwise stressed'. Utter deference to their lofty status and prostrated begging normally works better for the fluid dynamics of the situation.
In Addis we were able to speak to the doctor treating this chap. He was worried. Really worried. He said his respiratory pattern was changing indicating he was not long for this world. This news came as the pilot did his calculations and worked out we would have about 30 minutes on ground. We told the doctor to him to get him to the airstrip, we couldn't come to him. He was reluctant but it was the only way.
The flight into Lalibela was about 45 minutes. As Clement the flight nurse and I drew up drugs and set up the ventilator I caught glimpses out the window of an incredible landscape. If the only pictures of Ethiopia you have ever seen have been from Oxfam adverts, the country has been rather misrepresented. This particular region is breath-taking, with vast undulating valleys, deep canyons and lush green cultivated fields. From that elevation I missed any of the famous temples carved out of the ground and canyon walls but I could see the scattered village buildings resembling little mushroom plantations. Soon we were banking hard around a valley rim and on finals into Lalibela.
The patient had been brought to the airstrip and he looked worse than I imagined. His travelling companions were obviously incredibly worried and glad to see us. Like any of these situations a little crowd of locals had gathered to watch. It's annoying and intrusive but you get used to it. There simply is no point telling them it isn't a spectator sport. Because it is really. You just have to get on with it and they can be useful on occasions as another pair of hands to help lift things.
Clement and I set to our resuscitation (being given our absolute max time of 45 minutes) and the pilots were incredibly helpful and just became members of the medical team. When rushed in a situation like this where there is no one to bail you out like in hospital, it is even more critical you keep your head, calm down and go through your checklists. Communication is key and despite not having worked with Clement for long (he is one of our newest flight nurses) we gelled and did a bloody good job if I do say so myself. Within our allotted 45 minutes we had more IV lines in him with improving oxygenation, a blood pressure, and had established him on the ventilator without any complications. We settled him into the plane with all our pumps, drips and machines and were taking off from the beautiful Lalibela just as the light was fading.
With all our kit we were able to invasively monitor his progress as we treated and correct his various issues. As he improved he started to require more sedation to help him cope with the ventilator which is a promising sign that his brain was coming back on line. By the time we arrived in the hospital in Nairobi we performed a blood gas test which showed he had massively improved and was even breathing for himself. I am told he is now stable and improving in intensive care and the doctors are very positive about his prognosis. Discussing the case, we all agree that had it not been for the actions of our dedicated operations team busting through that red-tape and our pilots 'pushing the envelope', the story would have been very different. But for this lucky young man, all the holes in the Swiss cheese lined up just in time.
Of interest – relevant Expedition and Wilderness Medicine Courses & Conferences
Expedition Medicine (4 Days)
Extreme Medicine Conference, Harvard Medical School (4 days)
EWM Facualty Dr Matt Edwards report on his day hob with AMREF
4th July 2013 Mark Hannaford.members, Expedition DoctorAfrica, AMREF, Dr Matt Edwards, Expedition & Wilderness Medicine, flying doctors, kenya, medicine, part of the Expedition & Wilderness Medicine's faculty team has taken up a post with AMREF Flying Doctors based in Kenya, pre hospital care, Remote medicine
Dr Matt Edwards, part of the Expedition & Wilderness Medicine's faculty team has taken up a post with AMREF Flying Doctors based in Kenya see Matts Blog in full….
Having recovered from travelling the length and breadth of the the continent last week, I've been doing a few shorter retrievals into the wild expanses of Kenya's neighbor to the south – Tanzania. I've done a few medevacs from there in the last month but haven't written much about it. But as I seemed to be spending more and more time buzzing around it's vast landscapes in the co-pilot seat of a Cessna caravan, I thought I'd expand on my experiences there.
I was first called out to a young man stuck in the middle of the game reserve of Katavi, the other side of Tanzania and close to Lake Tanganyika, with resistant malaria. Now if I've learnt to respect one thing out here it's malaria. I suppose I am exposed to a pretty severe case-mix to be fair. If the local treatment isn't working or they are in a collapsed state we get involved. Some of these guys are impressively sick and I suppose, now I reflect on it, I think what is actually affecting me about this is the number of young people with critical illness I'm seeing on this placement. Working in the UK I'm so used to critically unwell elderly patients but I've just not been asked to manage many elderly patients here. Well apart from the minister in Musoma and the jogging octogenarian rose farmer who had broken his hip in Kampala but they don't count as really ill. They could both beat your average middle aged Brit in a race, even with a fractured neck of femur.
I was lucky enough to be allowed to sit in the co-pilot seat for the trip there. It was a long journey in the caravan but you simply couldn't get bored with that view. We flew past the famous Ngorongoro crater into the wide open plains of the Serengeti. I was told on the way that the crater is an incredible, almost 'locked-in' ecosystem of a huge variety of animals. Even though Sir Arthur Conan Doyle's Lost World was based in South America, it's tempting to believe the crater could have been an inspiration for the tale. It is truly vast and few animals, especially the lions, seem to see the need to cross the rim. As we made our way into the Serengeti plains I could not stop humming Toto's rock ballad 'Africa' – it drove me mad.
My second mission over the weekend was to attend to an unfortunate gentleman tourist who had collapsed and had had a 'cardiac arrest' with ROSC (Return Of Spontaneous Circulation) while at a remote retreat in Grumeti, just over the Kenyan border and within the Serengeti Park. Again you don't need to be a doctor to realise that having a cardiac arrest in a place like that is likely to have a poor outcome. I've heard of AMREF arriving to a situation in which the poor bystanders have been doing CPR for a few hours, only to tell them that any continuation would be futile. However if someone gets a pulse back after a short period of basic life support in the field then we could really do some good with post-arrest care (if we get there quickly enough).We had to fly fairly high over the Serengeti National Park and so any animals were tiny specks down on the ground but you could see the impressive migration trails made by the herds. From above you could get a scale of how many thousands of these beasts must march along these tracks every year. It must be incredible to see. I wonder if somehow I will get a chance. It can be put on my 'bucket list' for the future if not.
Soon we were landing in Tabora for a fuel stop and then continued south west towards Lake Tanganyika. The landscape became relatively featureless and it reminded me of flying in Antarctica. The huge marshlands of the Katavi National Park came into view – the home of a huge number of hippos and billions of bloody tsetse flies unfortunately. At least when you went to see Antarctic wildlife you didn't have to cope with their irritating, disease-spreading, insect entourage.
We managed to find the secluded airstrip and did a dummy run to clear it of about five impala. No wonder cheetahs struggle to catch those things – they move incredibly fast. At most of the Tanzanian airstrips we have to get rid of a number of large animals standing in the way. Not something most pilots normally need to worry about. There are certain interesting considerations to this animal clearing such as; if you are going to land between two herd animals, bail out and climb. If it is just one, it will run away so you can land. The instinct to herd is so strong when they are threatened, that they will run together. So if the plane is landing between them, the likelihood is that one of them will run into the path of the plane and that would be sub-optimal for a landing.
Our patient was not too bad so was quickly popped into the plane and connected up to some fluids etc. I am told he has been treated for recurrent malaria and is recovering well.
This was a shorter journey and the route was thronged with wildebeest (with a couple happily grazing on the airstrip). When we arrived on the beautifully secluded airstrip we found our patient, who was alive, cheerful and looked pretty chipper! We examined the circumstances surrounding this cardiac arrest and it was very short, while he was witnessed drifting off to sleep. It is possible that someone's heart can stop due to an abnormal heart rhythm briefly and then it reverts to normal when someone starts thumping on their chest. It's possible. If that was the case, then he is one lucky guy. For our years and years of research into the outcomes of out-of-hospital cardiac arrest, we know that the only people who have a reasonable chance of walking out of hospital with an intact brain are those who are witnessed to collapse and have good early bystander CPR. Just look at the survival outcomes they acheived in Las Vegas! (Valenzuela, NEJM 2000) The situation is slightly different in the middle of the Serengeti I'm afraid. There are many different explanations to what happened to this chap, including the fact he might have just been asleep, but the key fact was that someone was at his side and and started life saving actions immediately. I can only hope that, in the event of a sudden collapse for myself or my loved ones, someone close-by acts as promptly.
Who are AMREF?
In 1956, three doctors – Michael Wood, Archibald McIndoe and Tom Rees – drew up a groundbreaking plan to provide medical assistance to remote regions of East Africa, where they had all worked for many years as reconstructive surgeons.
Spurred by what they had seen of the combined effects of poverty, tropical disease and a lack of adequate health services in East Africa, their collective vision was born in the foothills Mt Kilimanjaro.
At that time, there was one doctor to every 30,000 people in East Africa – in Britain it was 1:1,000. Medical facilities were sparse, with rough terrain and often impassable roads making access to medical care difficult for people in rural and remote areas. As this was where the majority of the population lived, Archie, Tom and Michael saw an air-based service as the only way to get health care to remote communities.
AMREF Flying Doctors provides air evacuation services in medical emergencies across East Africa, as well as air ambulance transfers between medical facilities.
We are Africa's leading provider of air ambulance services and operate across many East African countries including Uganda, Kenya and Tanzania and, when clearance can be obtained, most neighbouring countries including the Democratic Republic of Congo, Eritrea, Somalia, Ethiopia, Rwanda and Burundi. Subject to flight clearances, AMREF Flying Doctors will carry out evacuations from anywhere on the African continent.
In addition, patients can be repatriated via an AMREF Flying Doctors aircraft to Europe, Asia and North America or a medical escort can be provided on commercial carriers. AMREF Flying Doctors operates 24 hours a day, 365 days a year. As a vital link between remote areas and AMREF's Control Centre at Wilson Airport in Nairobi, AMREF has established a radio network that comprises over 100 HF radio stations across East Africa, making it the largest two-way radio network in Africa.
As well as emergency evacuations, AMREF Flying Doctors provides a medial outreach programme, taking essential health care to some of the most impoverished and remote areas of Africa. AMREF Flying Doctors, part of the African Medical and Research Foundation, is based in Nairobi, Kenya and has been delivering health care to some of the most remote areas of east Africa since its formation in 1957 by Sir Michael Wood.
AMREF Flying Doctors is committed to providing world-class medical services to the people of Africa.
Remote Medicine Training Course for Medics
Trauma and Pre Hospital Care Course


I bought this book based solely on a recommendation made to me by a work acquaintance, and I'm so glad it worked out. Don't you feel awkward when someone recs you a book but you end up hating it? What do you do then? Pretend you like it, or be honest?
Anyway, I normally wouldn't have picked this up on my own, mostly because I tried reading The Astonishing Life of Octavian Nothing and hated it. I'm happy I did pick this up, though, because it was seriously good.
I thought Feed was really well-written. The world the characters live in is fascinating and scary, and I want to know more about it. We don't get much in the way of details except for what Titus knows (not much) and various bits of news inserted throughout. The whole thing was so mysterious I ended up not really caring about the characters– I wanted to know more about their surroundings and not them. Wtf the lesions were about! And when their skin started falling off? Holy crap! And wtf was the black stuff in South America?! Seriously creepy.
1. The way the Feed people were stupid and extremely consumeristic was scary and sad, but no, I don't think we'll get to that point in our own society. I don't think that was what the book was saying either, because a) people with feeds aren't all the same amount of stupid and consumeristic (Violet's dad, for instance, though he doesn't have the same kind of feed as Violet and Titus; Titus himself learns how to express himself clearly and meaningfully), b) only a small amount of the population actually have feeds (I think 73% don't? Something like that), c) things were on the verge of changing again, partly because of the lesions and partly because the rest of the world wasn't going to tolerate the Feed society any longer. Feed, I thought, was more a "what if we continue on this route we're on now" than "OMG WE'RE ALL GONNA DIE BECAUSE WE'RE DUMB." Though it could be both, I suppose.
2. Dead seas, fake clouds, not enough air? Filet mignon farms? Funny and SCARY. SCARY SCARY SCARY.
3. Actually most things in Feed was scary, except…it was funny, too. In a black humor kind of way.
And see, while a lot of things in Feed were scary, they were scary because they were happening in that world. Not because I thought they could ever really happen in our world. It was like a horror story, where the vampires and werewolves stay safely in their own pages and don't intrude onto mine. Maybe I'm just optimistic, but I don't think we'll get to the point where we're all walking around with half our skin missing because it fell off due to a brain implant. Y'know?
At least, I certainly hope we don't get to that point.


As an eye care professional, you have a tremendous level of commitment to keeping your patients, yourself, and staff safe from infectious diseases by utilizing the best practices for pachymeter disinfection and other equipment. Let's take a quick look at a few best practices for pachymeter disinfection, cleaning, and sterilization.
Cleaning is a relatively general term that explains whenever you remove foreign materials with water, detergents, or enzymatic measures. Cleaning is a key protective measure against infectious organisms caused by tissue, mucus, dried tears, or cosmetics. When you're cleaning, you will scrub all surfaces to remove debris. It's important to only clean equipment with a cleaning agent compatible with the surface.
Disinfection is the process of inactivating all pathogenic microbes, but disinfection doesn't deactivate all microorganisms. For example, disinfection techniques typically do not work well for bacterial endospores, fungi, and protozoa. The majority of all medical clinics and eye care practices achieve disinfection by methods of water and heat or chemicals.
Sterilization is a process of removing all and every microorganism, including bacterial spores. In many instances, sterilization includes autoclaving, which exposes instruments to high temperature and high pressure.
To ensure your PachPen Handheld Pachymeter or AccuPach VI Pachymeter continues to perform as intended, make sure to keep the surfaces free of dirt and dust. When you're not using the device, make sure to store it in a cool and dry place to avoid adversely affecting any of its sensitive electronic parts. While no specific cleaning interval is recommended, you should clean as needed and follow with a disinfection.
Whenever your PachPen needs to be cleaned, do so by using only a soft, damp, lint-free cloth. Never spray liquids or cleaners onto your unit, and you should avoid pouring liquids onto your PachPen at anytime. If necessary, the lint-free, damp cloth may contain a mild soap.
When it comes to pachymeter disinfection and cleaning, you'll only disinfect parts that contact the patient's eye prior to each use on a patient. The proper pachymeter disinfection process is to gently wipe the tip of the probe with isopropyl alcohol.
You should not use any other substance to disinfect your pachymeter. Once you wipe the tip with alcohol, make sure you allow the alcohol time to evaporate before you attempt to apply a pachymeter probe to your patient's eye. However, you should never immerse your entire PachPen in any liquid.
The tip of your PachPen should be sterilized and/or disinfected prior to use on each patient. The recommended sterilization technique is to immerse the probe tip — and only the probe tip — into an approve antibacterial solution. Never immerse your complete device into any liquid and always let it dry completely prior to use.
An autoclave is a pressurized chamber used to eradicate biohazardous waste from the surface of instruments or tools. Autoclaves disinfect and sterilize through the process of using temperature, pressure, and steam. These devices are often referred to as steam sterilization machines. Never use an autoclave to sterilize your PachPen Pachymeter.
All facilities should have written and circulated protocols for pachymeter disinfection and sterilization. These policies and procedures should be primarily based on industry guidelines and standards with input from the medial staff in the office.
These cleaning, disinfection and sterilization measures should be regularly reviewed at least once a year and updated anytime new instruments are introduced into the facility. All procedures and policies should be approved by management, which should include a MD eye practitioner.
All personnel of your practice should be effectively trained in the best practices for pachymeter cleaning, handling, sterilizing, and disinfecting as well as for other exam and/or surgical ophthalmic instruments. Staff training and education should be documented and updated at a minimum of once a year or anytime you introduce new equipment into the practice. It's always a good practice to make a habit of cleaning any additional equipment and pachymeter accessories, such as keyboards and/or power cords.
For more than 100 years, Keeler has been the leader providing world-class optometric equipment. We offer a range of different types of pachymetry devices and other ophthalmic instruments designed to meet your needs and exceed your expectations.


text:
Business Manchester
Home Manchester The future is bright for Print
The future is bright for Print
Philip Ghayour
Victoria Hart
Famously described as the "brains and guts" of industrial Britain, Trafford Park remains home to pioneering, industrious & creative companies such as DCB Group which, in part, has operated there since 1973.
On 18th July the company, which is made up of print management company Print Search, creative and design agency Caspa and print on demand company Aspen, will celebrate its 10th anniversary located in what was the world's first industrial estate.
The DCB Group was founded in 2008 after an MBO by David Beale who had previously worked in print management since 1996 and had been a director at various print companies including Astron and Office Depot. David announced ambitions to take the business from £3m to £10m and invested over £750k to improve technology and efficiency within Print Search who organise the printing of menus, corporate literature, promotional posters, flyers and other materials plus overseeing the logistics of the likes of the Lowry Theatre, A-plant, NUS, plus a number of Premier League Football Clubs and most recently adding Explore Learning to their key client list.
The acquisition of the creative and design agency Caspa in 2012 enabled the group to go a step further and offer an all-round communications service to allow DCB to offer on-site creative and marketing services to existing clients whilst also having Caspa's own clients such as Carlsberg. DCB is referred to internally as a 'Family of Businesses' and this is how the sister companies relate to each other – the service offerings complement each of the businesses but equally are also capable of standing alone and servicing clients directly.
Managing Director, Victoria Hart, joined the business in 2000 after previously working at Co-operative Retail as a Supply Chain Project Manager and went on to look after in store digital marketing. Victoria rose steadily through the ranks at DCB Group from Account Manager to Account Director for pubs and restaurants to Client Services Director before being promoted to MD in 2015.
Victoria puts her success down to becoming an expert in her field, learning every day to understand her industry and its future enabling her to talk to clients and peers with facts and confidence. Being a woman in a male dominated sector did not hold Victoria back and she believes her tenacity and ambition was her recipe to success. Her advice to the next generation; "Ask questions – lots of questions. Respect those that have been in the industry for many years and try and learn as much from them as you can. I would also say to be authentic, believe in yourself and build a good support network around you."
The DCB Group will celebrate 10 years In July, which is not only a great achievement in itself but a chance to look back and reflect on the last decade and there is a lot to celebrate, including the acquisition of Caspa Marketing and Aspen Manufacturing. Various award wins followed including, most recently, the Best in Small Business Award in 2017. Awards complemented our Quality, Environment and Health & Safety accreditations as part of our long running commitment to be a safe and happy place to work, which was further confirmed with a major refurbishment of the premises.
As July marks 10 years, the DCB Group looks forward and contemplates what the next 5 years will look like. MD Victoria Hart said: "Print will remain a vital industry! In a digital world, printing is as necessary as ever. You only have to look at theatre programmes, football programmes, billboards by the road, labels, posters etc. Print is a fundamental part of daily life and helps lots of other industries to conduct business." Investments in systems such as the print on demand templating solution means more efficient processes and reduced transactional costs which ultimately leads to a future of happier clients.
Victoria adds "To be honest, I believe there will always be a demand and a place for printed media as people like to look, touch and feel it. Print brings a depth and permanence."
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Events, PR, and Marketing Manager at The Samuel James Group, Philip has a degree in Journalism from the University of Salford and holds an MSc in Marketing from Lancaster University, Philip has also worked at BBC Radio Lancashire, Clitheroe Football Club and Accrington Stanley Football Club.
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As they get older, it just becomes more & more fun. The excitement and joy kids bring at Christmastime is like nothing else. This little one had fun exploring Lakeside Park. Especially the bigger than life teddy bears!


Southern University has reported 2,535 students on its New Orleans campus this fall, a 4.3 percent jump from fall 2016.
The enrollment includes 211 first-time freshmen, a 47 percent increase from the fall 2016 figure of 144. With 111 students in the joint program between SUNO and Southern University at Shreveport, there are more than 2,6000 students taking classes on SUNO's Park and Lake campuses, a news release said.
The university attributes the increase to more community outreach, engagement, marketing and recruitment efforts.


text:
Beano: 80 Years of Fun, The Box Set
by Benjamin Williams
3 minutes min read
The Beano is the first British comic to celebrate 80 years of continuous publication this month, with the actual anniversary being the 26th July (the original publication day of The Beano No.1) although the official birthday is 30th July (the cover date of the first issue). So how do you celebrate that? Through a brilliant box set.
D.C. Thomson have just published a limited box set full of Beano goodies that is packed, fun and rather interesting. And it's available now from selected shops or directly from the publisher. Beano: 80 Years of Fun, The Box Set includes the 100 page bookazine (which is available in shops on its own for £6.99) packaged with a whole lot more for £25. I personally feel that the bookazine is still the best part, and highly recommend that to anyone that is a fan of comics. The box set though? Yeah, that's worth the £25 you pay.
Within the slip-cased box you'll find reprints of eight significant issues of The Beano. The first shouldn't be a surprise, as there's the first issue. But there's so much more, which are listed here:
No.1 (1938): The first ever Beano.
No.272 (1945): The first Beano to sell over a million copies.
No.452 (1951): The first to feature Dennis the Menace.
No.954 (1960): One of the first 'new look' issues to modernise it for the Sixties.
No.1768 (1976): The first to announce the Dennis the Menace Fan Club.
No.2280 (1986): One of the 'Gnasher is missing' issues that had nationwide publicity.
No.3052 (2001): The issue with Jim Petrie's final Minnie the Minx artwork.
No.3800 (2015): Record breaking issue number.
The reproduction of the comics are quite simply fantastic. Some of them might look old, as you can see above, but they don't feel it! The ones that were originally on newsprint have been reprinted on matt paper with a 'yellowed' effect to look as authentic as possible. Thankfully the print is sharp and not how you'd expect them to look if you were lucky enough to keep one of the originals. The more recent ones are reprinted on a quality glossy stock. They're a brilliant selection of comics from the history of The Beano.
One thing of note with the reproductions, is that the racial stereotype character of 'Peanut' has been removed from the mastheads of Beano Nos.1 and 272. It's slightly disappointing because it's a part of the history of the comics and it makes them not true reproductions. But you can understand the reasoning behind it as it just wouldn't be acceptable today and it would have given some people a great excuse to jump down D.C. Thomson's neck about it - and it wouldn't be good press! So it's a good call to remove it in my opinion.
Along with the 8 comics, the box also contains some extra gifts. There's a perfect reproduction of a classic Gnasher Snapper free gift, and a replica Dennis the Menace Fan Club pack complete with the badges. There are also four postcards using artwork from memorable Beano Book covers, and a huge A1 sized poster featuring every Beano character from the past 80 years!
The 100 page bookazine gives some brilliant background information on each of the reprinted comics, and is an essential asset to the box set - my personal favourite being the very first chapter talking about how they created the first character, the interview processes and letters. Really interesting stuff.
This truly is a superb collection and is well worth the money. Check out your local WH Smith or bookshops to see if they have a copy in stock, or order one directly from D.C. Thomson at this link: https://www.dcthomsonshop.co.uk/limited-edition-80-years-of-fun-beano-box-set
It's worth every penny!
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We're very glad to invite you to a great MobileMonday Tel Aviv May event, that will look this time at the opportunities for Mobile Developers at the Emerging Markets.
While most of the Israeli mobile app developers are looking at the US and sometimes at Europe as their target markets, the big opportunities lies in connecting the next billions of mobile and smartphone users to Internet and apps. The mobile and smartphone penetration rate in areas like India, South-East Asia, Africa and Latin America, are growing very rapidly, and the device landscape and app needs are not necessarily the same as in the developed world.
19:00 - 19:15 - A developer's view on publishing apps at the emerging markets- by Shai Ifrach, Founder of FutureSoft.


text:
In Brief » Religion » Australia
Bishop says he suffered sexual abuse at hands of clergy
Vietnamese-Australian Bishop Vincent Long Van Nguyen of Parramatta tells inquiry he was an adult when abuse took place
A protester holds a placard outside the Royal Commission into Institutional Responses to Child Sexual Abuse in Sydney in this March 1, 2016 file photo. Bishop Vincent Long Van Nguyen of Parramatta told the commission on Feb. 21 that he too was sexually abused at the hands of clergy.
An Australian Catholic bishop has gone public for the first time about sexual abuse he suffered at the hands of clergy.
Bishop Vincent Long Van Nguyen of Parramatta talked about the abuse at a royal commission hearing in Sydney and called on the church to consider removing priests' honorifics and giving parishioners more power, The Guardian website reported.
"I was also a victim of sexual abuse by clergy when I first came to Australia, even though I was an adult," the former refugee told the Royal Commission into Institutional Responses to Child Sexual Abuse on Feb. 21.
"That had a powerful impact on me and how I want to … walk in the shoes of other victims and really endeavor to attain justice and dignity for them."
Bishop Long, the first Australian bishop of Vietnamese background, was applauded throughout his testimony. Child sexual abuse survivors and their loved ones approached him afterwards. Some cried as they spoke to him.
The bishop said titles, privileges and the church's institutional dynamics "breed clerical superiority and elitism."
He also said he had some degree of confidence that most of the survivors whose cases had been handled by Parramatta Diocese since his arrival were happy with how they had been treated.
"How can I look at these victims in the eyes and say I share your pain, I share your suffering without doing everything in my power to bring about justice, dignity and healing for them?" he said.


text:
Ernest Arthur Greswell (8 June 1885 in Cuddalore, Madras, India – 15 January 1962 in Minehead, Somerset, England), played first-class cricket for Somerset in 12 matches between 1903 and 1910.

A right-handed opening or middle order batsman and a right-arm slow bowler, Ernest Greswell was educated at Repton School and made his debut for Somerset in a single match in 1903, aged 18, when he opened the innings with Lionel Palairet.

In 1908, his younger brother Bill Greswell started playing for Somerset, becoming a regular member of the side in 1909, and in that season Ernest reappeared in six matches, with a further five in 1910. His highest score was only 44, made in the 1909 match against Middlesex in which brother Bill scored his only first-class century. While Bill went on to a successful, if intermittent, cricket career, Ernest did not play first-class cricket after 1910.

References

1885 births
1962 deaths
English cricketers
Somerset cricketers
British people in colonial India

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Explore Griesbach Edmonton homes for sale here! Griesbach is arguably one of Edmonton's best communities with a fantastic selection of homes and neighborhoods amenities. It's a perfect area for a young family seeing that's its peaceful and quiet with the area being part of the former CFB Edmonton military base. Griesbach is located east of 97 St., with 137 Ave bordering to the south and Castle Downs Rd. on the west. The community has 153 Ave bordering on the north. Homes and townhouses are newer, so you don't have to worry about renovating.
Learn more about Griesbach Edmonton homes for sale below the listings!
Griesbach Edmonton homes are situated very close to Anthony Henday Dr., and the Yellowhead Hwy, so residents can easily get to anywhere in the city in a matter of minutes. There is an abundance of shopping that's just a minute away from the community in North Town and Northgate Centres, where you can shop at places like London Drugs, Safeway, and Walmart. Not mention all kinds of professional services like banks, dry cleaners and hairdressers are all very close as well. And there are a couple of coffee shops in the area as well!
The nearby Brewsters is a popular gathering place for residents in Griesbach, who can go there and enjoy some craft beer and awesome pub fare. Laziza, on Castle Downs Rd., is another fantastic place to dine out if you enjoy Italian cuisine. In addition, there are several family favourite chains close by as well like Boston Pizza, Pizza Hut and Smitty's.
Major General Griesbach School (K-9) is within the community, while Dickinsfield Junior High is pretty close as well and offers students a French Immersion program. and M.E. LaZerta High School in nearby Kilkenny.
You'll find a number of townhouses in Griesbach as well, including some luxury units. Overall the area offers some fantastic recreational opportunities including a tobogganing hill during the winter months, along with sports fields and a lovely community gardens. There are also several playgrounds within the community where little kids can have all kinds of fun.
Golf is nearby with the Twin Willows Golf course, which is a fairly forgiving 18 holes that first opened as a 9-hole track back in 1965. It's a links style course with some 45 bunkers and 8 water hazards.
If you're interested in viewing any Griesbach homes for sale in Edmonton, please contact MaxWell Challenge Realty today. Reach the team by phone at 780-990-7777. We'd love to help you find your dream home in Edmonton.


Delighted to have Tabra join us to expand our digital marketing capability both for our clients and our White Marble learning & measurement propositions.
We've reached to the far ends of the earth, well Australia, to find the newest member of our team and Tabra joins us following her most recent experience leading digital initiatives with T Rowe Price in London.
Tabra has a range of experience across big firms and teams, and small start up firms.


We are a private dental practice that has played a central role in Maidenhead since 2006, providing specialist dental service to individual patients and families. Our mission at Portman Dental & Implant Clinic is to change the way dentistry is delivered to patients, ensuring that we offer you the very best personal care as an individual. To achieve this we commit ourselves to putting you, our patient, first.
Visit Portman Dental & Implant Clinic in Maidenhead, meet our highly trained team and then experience for yourself the warm welcome and quality treatment that our patients praise us for.
Here at Portman Dental & Implant Clinic we have a range of treatments available.
Teeth straightening, Dental implants, Teeth whitening, Hygienist services, Emergency appointments, Check ups, Stain removal, Fillings, Root canal, Inlays and onlays, Crowns, Bridges, Dentures, Dental veneers.


text:
Q: Problem installing apt-get on CentOS 5.5 Background: I'm wanting to move away from Apache and came across this article which walks through an install of nginx, PHP-FPM and APC. On trying to follow these instructions on my user account of my host I ran into a problem: lack of apt-get and broken yum. So, I tried to build apt-get from source:
wget http://apt-rpm.org/releases/apt-0.5.15lorg3.tar.bz2
tar -vxf apt-0.5.15lorg3.tar.bz2
cd apt-0.5.15lorg3
./configure --prefix=$HOME

This is where I run into an issue:
...
checking db1/db.h usability... no
checking db1/db.h presence... no
checking for db1/db.h... no
checking rpm/rpmlib.h usability... no
checking rpm/rpmlib.h presence... no
checking for rpm/rpmlib.h... no
configure: error: Can't find rpmlib.h

Any ideas on how to solve this or get around the issue?

A: What do you mean by "broken yum"? Is it not finding the package, or is it throwing you Python errors?
You can always try cleaning the yum cache, it fixes a lot of issues:
#yum clean all
If the main package manager on your OS is broken, the last thing you want to do is install another package manager, especially from source. Dependency hell is the last thing you need. I'd recommend trying to fix yum first and foremost.

A: *

*Download and install the rpm forge release, which will enable YUM to access:
      *
    wget http://packages.sw.be/rpmforge-release/rpmforge-release-0.3.6-1.el5.rf.i386.rpm
    rpm -i rpmforge-release-0.3.6-1.el5.rf.i386.rpm

*After this is installed (it takes a long time), you can install APT.

*You should now be able to use apt-get and install the apt repositories. You will have to add your sources at /etc/apt/sources.list.d

This link might be helpful.

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