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Contemplating life.

Generation Y

Earlier this week I¬†travelled to Hamburg, a great city in the far north of Germany, with a rich history of trade and some beautiful views (especially in the snow), even if the general attitude of the folk there can be rather cool and direct…consider yourself warned ūüôā

IMG_6323There was a lot to see and do, including some very early Porsche experimental vehicles in the Prototyp Museum, strolling along the Reeperbahn, and finding out that apparently the fifth member of The Beatles was a police van. Who knew?

Hamburg, being a hanseatic city, thrived and thrives on trade through its port, which it has been relying upon for centuries. Knowledge, experience and wisdom has continually been passed down from one generation to the next in a move to keep the city, and the trade, at the top of its game.

What has that got to do with Paramedic Services, I hear you ask? And for the more established adults amongst you, dear readers, do I detect a hint of frustrations at us Young ‘uns, with all their Facetagram, Twitspace, Blogtube, glued to their screens all day and night? And for fellow Young ‘uns, I can hear your sighs when you think about those old guys who just don’t get what the net is all about.

Well, earlier this week I attended the 1. Zukunftsforum Rettungsdienst, the 1. Future Forum for Paramedic Services in Hamburg, to talk about just that: Generation Y – our expectations and demands.

Keep your eyes peeled for next weeks post…

Collaboration & Specialisation

ambulance-157036_640

 

I recently attended the Blue Light Collaboration Conference in London representing the College of Paramedics. I was initially a little sceptical, as I don’t have much to do directly with collaboration between services apart from direct contact with them as an on road paramedic, but then I thought this may be a good opportunity to meet new people, see different perspectives and get some other thoughts.

And it delivered. There were many delegates¬†from various UK Fire & Rescue Services, plus a few paramedic, police and government representatives. Due to this, the main `topic was the collaboration between paramedic and fire services – co responding, emergency response, joint response…different names for basically the same thing: Fire & Rescue Services with their decreasing workload assisting Paramedic Services with their increasing workload.

There are a couple of different models how this works, but the most advanced and integrated (or overlapping?) model comes from Lincolnshire, in the East Midlands of England. There, East Midlands Ambulance Service (EMAS) and Lincolnshire Fire & Rescue Services (LFRS) have been working together in an official capacity since 1998, and their current setup is a natural progression of pure first responder type scheme: In a UK first, Fire & Rescue are actually manning three ambulances.

In my opinion, the pros outweigh the cons: The Fire & Rescue Service have capacity to spare. Their workload has gone down significantly over the past decades, but the public still deserve a good level of fire protection. In between fire and rescue calls, there is only so much training one can do Рwhy not utilise their time for medical transport? Ideally, fire cover should not suffer from this model, but have a thought and compare: the risk of morbidity and mortality of medical origin (mainly cardiac) outweighs the morbidity and mortality of a fiery origin by quite a high factor. Both Paramedic and Fire & Rescue Services have one single task when broken down to the bare essentials: to serve & protect the public. Why not collaborate in order to maximise our efforts and outcomes?

This direction also got me thinking one step further: What if Ambulance Services (you may have noticed I have been avoiding that term) focus on their core strength¬†of providing healthcare to the public, and “outsource” the transport side of operations to other services or suppliers?

A true Paramedic Service would take requests for help from the public, and point them in the right direction. If they can be helped at the point of their initial query and be referred on to more appropriate services (e.g. home care, GP, pharmacy), that works in favour of the public (accessing the appropriate care as timely as possible), and in favour of the service (only sending paramedic resources to the patient when appropriate). If a Paramedic is required at the scene of an incident, they can decide if transport is necessary. All this is already happening in some services around the world, but lets take it one step further: The Paramedic on scene then needs transport capacity, as they respond in mobile rapid response units (fancy speak for cars or minivans). Enter Fire & Rescue Service: they provide the transport capabilities, with basic life support dual trained fire fighters. Should the patient be stable and only need transport, they they can be transported. Should they need ongoing paramedic intervention and/or monitoring, the paramedic can hop in the back of the fire ambulance, and paramedic care can be given en route until handover at hospital.

Currently, there are only three Fire & Rescue (F&R) Ambulances in Lincolnshire supporting the Ambulance Service in a transport capacity. But if F&R took charge of the entire transport side of things, Ambulance Services could turn in to dedicated Paramedic Services, and focus on delivering high quality paramedic care to the community, without the overhead and distraction of not only fleet maintenance but number of other areas. F&R Service would be able to use their resources more effectively, and not have to close fire stations, thus keeping up fire cover for the public.

The above lines are only a thought experiment taking the Lincolnshire model one step further, but it is an option to be considered. The people behind the pilot programme in Lincolnshire are due to publish some numbers based on their facts and figures over the past month (the preliminary data, I’ve been told, is promising). It will have to be properly evaluated and adapted to local needs, but ¬†I believe this could be quite an exciting game changer. I will be watching these developments¬†carefully and with a lot of interest.

Ormskirk

Yes, Ormskirk. A little town in the North West of England, 14 miles north of Liverpool. Bus driver, pub owner, town locals…all asking me the same question: “What are you doing here?!” It seems visitors, be it from London or from Mars, are a rarity. Ormskirk is not a place that prides itself on tourism.

Doesn’t matter to me, I didn’t get to see much of the place anyway. I was here for the Continuing Professional¬†Paramedic Development – a one day conference put on by the UK College of Paramedics.

The day started off with Dr John Freese, Chief Medical Director of New York City Emergency Medical Services. A rather good speaker with an interesting background (John started as a basic EMT in the rural US, worked his way up to Paramedic, then turned to medicine). His talk was based around trauma care in the US, its history and direction of the future. Some interesting points I picked up:

  • Skill decay is a big problem amongst NYC paramedics. Intubation success rate is approximately 30%, many paramedics don’t even get a chance of intubating, and their average training is far less than that of an average UK paramedic.
  • For severe trauma patients, definitive care is needed. Where this care is provided best (i.e. what is the most suitable hospital), NYC EMS has developed a simple reductive flow chart based on patient presentations, events and mechanism in order to determine if a patient should be taken to a trauma centre, and if so, what level. An important note was emphasised: the clinicians decision. The chart could not indicate any need for higher care, but the paramedic must still be allowed to take a patient to the highest care facility if judged so by their clinical experience.
  • Then the big one: “Spineboards: they need to go”. NYC EMS has realised that far too many patients are immobilised for no good reason. Research is proving that immobilisation is possibly doing more harm than good. Currently, new guidelines are being written in order to drastically lower numbers of spineboard usage in NYC. Personally, I applaud this. A big step in the right direction.
This talk was particularly interesting for me, as I had just visited New York last year (if you’ve been reading this blog recently, I am just putting up the stories now). Very nice having seen NYC EMS, then hearing all about it from the Chief MD.
Up next was Professor Kevin Mackway-Jones, Medical Director of the North West Ambulance Trust¬†(NWAS). The presentation was similar to the previous, but this time from the NWAS perspective – a much more diverse landscape with urban, regional and rural settings (something you wouldn’t find in NYC!).
  • To provide a similar level of care that urban area enjoy everywhere in the NWAS catchment area, another 14 full time helicopters and anaesthetist would need to be employed. Far too expensive and ridiculous, he explored the alternatives: Full time HEMS, vs on call residential doctors, vs volunteer doctors (e.g. BASICS), vs full time specialised (critical care) paramedics. The last option won – cost effective, good exposure means good quality, experienced, available and a good skill set.
  • Kevin agreed with John about spineboards, and repeated the overuse of the device, stating that many UK services are re-evaluating their use. Additionally, he stated he is not convinced by pelvic splints; there is not enough evidence to support them.
Next speaker was Professor Andy Newton, Chair of the College of Paramedics and Clinical Director of South East Coast Ambulance Service. After some information update from the College itself, Andy got us in the right mood with a clip from the Simpsons: Homer as an Ambulance Driver (could unfortunately only find it online in Italian). Some points Andy talked about:
  • The history of Paramedicine, especially with regards to the “founder” of out of hospital care, Dominique Jean Larrey.
  • The specialisation of the workforce. The police have a very specialised workforce: General duties, traffic, homicide, fraud…certain cops target certain crime. Paramedicine should (and is) heading int he same direction: Paramedic Practitioners for minor issues that can bypass the A&E department, Critical Care Paramedics for very serious cases.
  • Apparently providing Ambulance Services in the United Kingdom costs 2 billion Pounds annually (surprising actually, since London’s Metropolitan Police alone have an annual budget of 3.5 billion¬†Pounds. Compared to the 282 million Pound London Ambulance annual budget).
  • Then a great point: “Paramedics as a disruptive technology“. Adapted from the business world, the point was made how Paramedicine is influencing healthcare, changing the way care is delivered (e.g. via Paramedic Practitioners), together with potential ways Paramedicine may influence the provision of healthcare in the future.
  • Another video, this time from a cardiac arrest in London from the early 1980’s. Horrible grey uniforms, ghastly hairstyle, but the intubation was spot on (unfortunately nobody cared about chest compressions…). Nothing how an arrest is run in 2012, thirty years later.
After lunch, there were two more presentations; Sudden Arrhythmic Death, and Obstetric emergencies.

In other words: Quite a good event. Interesting speakers, decent venue, and a good attendance. Can’t ask for much more! For those who would like an online summary, I did tweet most of the event under the #ParaUKCPD hashtag on twitter (should be visible on my timeline, dated 19th October).

Couldn’t make it? I will be visiting the Emergency Services Show¬†in Coventry on the 21st and 22nd of November, tweeting and blogging again. Hope to see you there!

Hobart – use the Hashtag! #PAConf2012

Next month, the 2012 Paramedics Australasia Conference will be held in Hobart, Tasmania. I was fortunate enough to be able to attend the 2010 and 2011 conferences (and even present at the last one), so it is a little sad that I’m missing out this time.

Two things I ask of you:

  1. Please attend the conference
  2. Please keep me up to date by live-tweeting the conference with the #PAConf2012 hashtag.

Pure selfish reasons, I know, but I do want to keep an eye on the mob Down Under, they are a good bunch!

2012 Student Paramedic Conference

Things are revving up for this years SPA (Student Paramedic Association) Conference. This will be the third year in a row that I am going РI’ve always had a great time, met some interesting people, learnt a little more, and explored a vibrant city. There are even free passes up for grabs!

From the website:

National SPA Conference 2012

When? Saturday, August 25 2012, 9:00am – 5:30pm

Where? Victoria University City Convention Centre (Level 12, 300 Flinders Street, Melbourne, VIC, 3000)

Cost? SPA members = $60, PA Members= $80, Non-Members = $95

Registration is NOW OPEN!

Welcome to the fifth SPA National Conference 2012. This year’s intensive conference program is designed to appeal to delegates looking to attend an affordable, clinically-focused Paramedic Conference. It is guaranteed to be educational, informative and entertaining with high calibre speakers providing delegates with a plethora of knowledge, skills and information that can be utilised to advance your professional development and clinical skills.

Topics for this years conference include Acute Myocardial Infarction, Trauma, Mental Health, Advanced Life Support and a case-study reviewing a sudden cardiac arrest survival story. Morning tea, lunch and afternoon tea will be provided at no additional charge and conference delegates are invited to attend the post conference social networking session only minutes from the venue. We are once again holding our very popular charity raffle in which 100% of the proceeds go directly to Youngcare.

Conference booklet with information on parking, accommodation, sponsors, speakers, program and more will be available soon!

I hope to see you there!

Paramedics Australasia conference #4

My first conference presentation was quickly approaching. There were a few hiccups regarding my time slot (tip: if a presenter drops out, don’t move the other presenters forward – people won’t know, even if an announcement is made), but I managed to start on time. The was even an audience, believe it or not!

Things ran quite well, some good questions were asked and I received positive feedback. I‚Äôd love to give you the presentation right here and now, but I am presenting it at my university’s e-culture conference next month, so I’ll wait until that’s done and then pop it up here.

Back to the highlight of the conference:

I was especially keen to meet with Gary Wingrove during the conference – as a founder and driver of International Paramedic, he was a main target on my conference radar. Plus, I had been told earlier that day that there was a conference call on to meet with other IParamedic supporters, and to build upon the inaugural meeting in April.

So after a quick dinner I headed down to the conference call room, and jumped on Gary as soon as I saw him. I think I may have startled him a little, but that quickly gave way to the history and potential direction of International Paramedic. Laid back yet determined, Gary and I discussed the parallels between the International Roundtable of Community Paramedicine and International Paramedic, his thought and my ideas of getting involved. Then it was time for the conference to start. 17 people, 4 of them on the phone – and I got to audio meet Scott Kier, which was a cool surprise!

And sitting in that conference room, I realised that I am sitting in a room with 17 people, ¬† Paramedics from all over the world, and that this is possibly the forefront of the international movement forwards and together for paramedicine. A truly global initiative, with a truly global perspective. Something never done before, but badly needed. And started by √ľber-passionate paramedics, now involving students, academics, government officials, the lot. I‚Äôd recommend to keep an eye out for ip, and more importantly, feel free to contribute and take part yourself (for example, the google groups¬†have some great discussions going on)! This is EMS 2.0 taken from the textbook as it being written, and turned in to practice. This is something we can shape. Influence our own profession. How effing exciting is that?

The call came to an end, but not after everybody on the line was encouraged to pitch in ideas and get some direction for the future – getting international representation, putting out documents for international comparison of systems and services, internatoinal exchange and more.

This is the stuff that really gets me excited – the world of paramedicine is growing smaller!

 

Paramedics Australasia Conference #3

Day three in Sydney was another early morning start, with a slightly nervous yours truly, as  it was to be the day of his first conference presentation. But first, there were talks to attend:

 

  • “What can Australian paramedics learn from the modern battlefield” by Col Dr John Crozier. apparently, we can learn that if the enemy shoots at us, we should shoot back. The first half of the presentation was very military focussed, and I found myself tuning out a lot because, you know, this is a paramedic conference, and not a manual of “how I won the war”. Finally, though, we got in to the clinical side of things, and my parasympathetic responses began to be suppressed: wound clotting bandages in general have come in to a recession, now that they are not as good as they thought to have been. Tourniquets are a last measure for haemmorhage control, but when used are life saving. An interesting fact that was points out was in regards to tourniquets in surgery: patients can have tourniquets applied for hours in an operating theatre – surely we can too in an out of hospital environment? Thing is, in the operating theatre, the patient is a) in a controlled environment, and b) generally haemodynamically stable. So 60 – 90 minutes is the general consensus to leave a tourniquet on.¬†One last point of interest was the fact that 28% of tension pneumothoraces were missed in the battlefield, which was traced down that clinical signs don’t always tell you what is happening to the patient. Time for portable ultrasound, in my opinion!
  • “The history of paramedic education” by Dr Ric Bouvier: hop in your Delorean,¬†dial in 1950, and slowly drive towards the now, and admire the view of past education systems and general progression in our profession. Ric got the audience on his side early on with the witty but accurate comment: “I’m glad to see so many paramedics without balls here!”. He was referring to the nearly 50/50 gender split amongst paramedics in Australia – not bad seeing that (depending on the state) females were not allowed to work on the frontline 20 – 30 years ago.
  • Professor Hugh Grantham continued with the topic with a very clear and informative presentation style, highlighting the journey from Ambulance Driver with a first aid certificate, moving up the ranks via structured courses, diplomas and now to tertiary level educated clinicians, driving research via Masters degrees and PhDs.¬† “Paramedicine needs to be driven by paramedics. Paramedics need to be driven by patients needs.” His quote sums it up nicely – history has shown us that instead of taking the patient to care, care needs to be taken to the patient. And for care to be take to the patient, quality caregivers are needed – decently educated paramedics. And who better to look after our profession than our own?
  • “Community Paramedics – here, there and everywhere” by Gary Wingrove. Gary brought up some great issues, such as that paramedicine needs to adapt to the needs of the community, and to coordinate these changes and learn from each other there needs to be an international exchange – this is where the International Roundtable on Community Paramedicine (IRCP) comes in . Other things he mentioned were…oh…umm…I have to admit, I got a bit sidetracked during Gary’s speech. Not because it was boring or I was disinterested, not at all, but because Gary is also a founder and leader of International Paramedic – and his talk had very many parallels and good idea for International Paramedic. He would talk about something, and that would trigger my mind off in to a world of thought…so, sorry Gary! I’ll make it up with a dedicated post to International Paramedic.
  • “A model of paramedic decision making in cases involving pain” by Bill Lord. A very interesting subject, as I believe we generally under treat pain in patients. Also a very tricky topic, as pain is such a personal experience – who am I as an outsider to judge what is going on inside someone else’s body? Bill’s extensive research (which won him an award at the conference) has shown amongst others that vital signs have no correlation to pain and that females are less likely to receive pain relief. Personally I am still a little sceptical in regards to some of the findings – probably warranting a dedicated blogpost.
  • “Perceptions of clinical leadership in St John Ambulance Service WA: A research report” by Joseph Cuthbertson. A report on Paramedics preferences and reactions to clinical governance and leadership by Clinical Support Paramedics. Interesting from a leadership perspective because Western Australian does not have a tiered response system, every out of hospital emergency care provider is a paramedic (or student paramedic). Clinical Support Paramedics have a supportive role only, and do not have additional skills. Findings were that Paramedics wanted leadership and guidance from Clinical Support Paramedics who were confident, had experience, extensive background knowledge and patience.
  • By now my presentation was quickly approaching, so I clinked out of the buzz and retreated for a little last minute preparation. I‚Äôll give you a more detailed version of my presentation in a dedicated post (hey, I have to give myself the special treatment somewhere!). Meanwhile, I had some spies scattered around reporting some interesting findings:
  • “Can relief from chest pain with nitrates inform a clinical decision?” by Laura Roberts. Studies have shown that you may as well flip a coin. That right, a complete 50/50 chance that the chest pain is of cardiac origin if it is relieved nitrates. Good knowledge to have in the back of your mind next time you respond to a chest pain call.
  • “Paramedic Response to Suicide Bombings: Learning form the Israeli Experience” by Christopher Foerster. Do you know how long it takes for an Israeli bus service to take up normal service after a bomb attack? 90 minutes. Pretty clued in, unfortunately the have had a fair bit of experience in these things…
  • ‚ÄúOccupational risks on undergraduate paramedic students in clinical placements‚ÄĚ by Tegwyn Bath. The lecture prior to mine, but I still managed to soak up a little information as how to minimise risks for potential future students that may be riding with me.
  • “Recent Australasian Disasters – Fire, Cyclones, Earthquakes” by Paul Holman, Neil Noble and Major Brendan Wood. The closing talk of the day, showing the efforts and effects of the¬†bush fires in Victoria, cyclone Yasi in Queensland and the Christchurch earthquakes. A little more on that in the next post though!

Paramedics Australasia Conference #2

An evening with a view:

Source: http://en.wikipedia.org/wiki/Darling_Harbour,_New_South_Wales

 

 

And an apparent poor choice of drinks which tempted my companions to register me for some gender realignment…ladybeer and cocktails.

They didn’t serve Bananenweizen (wheat beer with banana juice) like that when I lived in Germany…honest!

 

– ~ –

 

Day two in Sydney started off early, heading in to the city for the pre conference workshops “EMS Writing for Publication” and “EMS Reaearch Workshop. These two half day courses booked out quickly; I got in early and secured myself a place. Discussed were

  • “Writing Papers”. A introduction and general approach to how, what and why questions of research publication.
  • “Developing a research question and searching the literature”. Self explanatory really.
  • “Research Protocol and Ethics Submission”. Basically the frameworks, rules and regulations behind any research, giving it some structure and making sure that reasearch does not head down the path it took during the second world war under Josef Mengele.
  • ¬†“What should we Research in Prehospital Care”. Well‚Ķwhat should we research then? Good question, with a rather simple and straightforward answer: Everything! Out of hospital care has only just woken up to the calls of evidence based practice – so much of our daily practice is based upon ancient dogma with no scientific basis. The take home message was: pick a page from your guidelines or protocols, and research their evidence base – more likely than not there will be insufficient evidence for a majority of them (have a read of RogueMedics blog for an idea what I mean). From there on it’s easy: pick a topic of interest, and come up with some research which will then support or refute current practice.
  • “Study Design”. Explanations of different evidence levels and study designs (cohort study, meta analysis etc).
  • “Statistics made easy”. Phew – 40 minutes of statistics at the end of the day were tough, but it actually made sense. Some good advice was given how to present your data in a positive light, for example using the median for response times – using the mean or mode would likely reflect bad on the times. Good to know these things when reading research/reports. ‘Don’t trust any statistic you haven’t skewed yourself’, as they say!

As complicated, academic and offputting the above paragraphs may be – once you sit down and let people in the know explain these things to you, it all makes perfect sense, and I would highly recommend considering the research pathway for anyone even remotely interested. The profession needs it, and your career and practice will only benefit. It has helped me to get on track for heading in the direction of research path. But more on research later, let’s stick with the chronological order.

My colleague went to the other workshop, the two day simulation workshop.  He reported back as it being a great part of the conference, both from a networking and a learning point of view. Topics covered included:

  • The state of clinical simulations: Simulations are becoming increasingly important in clinical teaching, one major factor being the limited quality practical placements available for students today. As many of you I’m sure have experienced, placement time is never long enough, and once you get there, you often stand around until your feet hurt.
  • The research and evidence base behind it.
  • How to structure clinical simulations.
  • How to run clinical simulations.
  • How to give feedback: Another point worth highlighting – the simulation must be seen in its entirety for maximum learning efficiency; from thinking about what may face the student, to doing the simulation, debriefing after the simulation and finally reflecting about the simulation – all crucial steps to assure the highest learning experience is taken from the simulation.

 

The evening was occupied with the pre conference drinks: networking, recognising old faces, meeting new faces, and finally turning some virtual twitter and email virtual acquaintances in to real in the flesh meetings.

Paramedics Australasia Conference #1

I recently returned from the Paramedics Australasia Conference in Sydney. Six days of travel, breaking away from the daily routine, plunging myself in to a large metropolis. But, most importantly, being amongst the brightest and most enthusiastic bunch of paramedics and paramedic-associated people nationally with some great international guests.

Day one in Sydney was a gentle awakening on a beautiful morning – ideal for a run around the harbour.

After catching up with some friends for lunch (good burritos, but nothing compared to the San Francisco one I had with @setla!), I caught up with an long-time paramedic friend, who has always been very supportive of me, and actually brought me to the world of international paramedical travels – he has worked in six services in four countries himself, not to mention the many more he has visited along the way.

One interesting topic we came on to was that of the paramedic profession, the perception of the public, and media. As anybody who has worked out on the road for more than a couple of weeks quickly comes to realise, the public’s opinion of our role, and the actual role we have in healthcare differs vastly. Two things of interest we discussed:

1. Communication between the people and the service:

  • Some people expect and demand an instant response. Like any other service, how about giving estimated arrival times, not only “the paramedics have been dispatched, and are en route to you” for urgent jobs, but also “We currently have a high workload, and due to the nature of the call, you have been assigned a low priority call. It could take up to [x] minutes until a paramedic can attend”.
  • People often call us for an emergency because they overreacted in the initial situation. Recent trials in different services have ‘introduced’ the question of “did you regret calling an ambulance?”, both for calltakers and on road paramedics. Additionally, the calltakers let the callers know that they can be called back if they want to cancel the paramedic response.

2. Communication between the people and the media:

  • Where does the public get a vast majority of their education from? The media. We should use this vehicle much more extensively to get our cause across to the public. Keep the TV shows, but have paramedic consultants and continuous paramedic input – the underlying message is important. Tell Joe Blow on the street what we can do, but also what we [i]can’t[i].¬† Inject some more realism.

I’m sure there is already a beginning of this out there, but it needs¬†significant ramping up.

We need people with contacts within the media, who are willing to push our cause.

Know anyone?

Status update

I wrote this on the flight to Melbourne – unfortunately I didn’t get access to a WiFi hotspot to upload the post in time – the SPA conference has now been and gone. Great seeing you all there!

 

Busy times, I think to myself as the plane crosses rural Victoria. I’m on my way to this years Student Paramedics Australasia (SPA) Conference in Melbourne, and looking forward to catching up with many interstate colleagues and friends that I have made along the way – and of course, you, dear reader!

This time last year, I reflect, I was slogging away at work; bogged down in university studies, shafted from a roster point of view, and not happy with my whole situation. I needed a break. I needed to get out of my environment, have a breather, and mix with some enthusiastic people who love the job as much as I do. By pure chance, last years conference fell exactly during that time. What relief! The socialising, the networking, the professional and social exchange was just what the doctor ordered. I had refuelled myself with enthusiasm, and regained faith in my profession and peers. It’s amazing what positive effects a short holiday surrounded by some like minded people can have on your mental well being. It was my first conference attendance, and I knew I wanted more. The 2010 ACAP conference followed, a short while later the WA trauma symposium. From zero to three conference attendances in less than six months.

This year I am becoming an active participant in the conferences; presenting a poster at the SPA conference and speaking at the PA conference. This has gnawed away at my time a little, which has impacted on my blogging – but don’t despair, myEMStrip2011 posts are in the pipeline, and will be released shortly.

Hope to see you at one of the conferences this year!