THE INTENSIVIST

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					 Advocate for intensive care throughout Australia and New Zealand
                                                                             THE INTENSIVIST                                                           June 2008




  Invited Editorial     Whilst providing complex intensive care to children            The medical and nursing staff on these missions
                        can provide challenges on a daily basis, attempting to         comprise a combination of local and international staff.
 Phil Sargent           provide a similar level of care in the developing world        It is not unusual to be on a mission in the Philippines
                        can be a daunting experience. For the last 10 years, a         with Pilipino anaesthetists, Venezuelan plastic surgeons,
                        few colleagues and I have travelled to a number of             American recovery nurses and Costa Rican dentists. All
                        developing countries around the world to assist                of this makes for a fascinating cultural experience as
                        numerous organisations in providing specialist medical         each nationality has a different take on the others
                        care to children and young adults. During this period I        behaviours and responses. It also makes for some
                        have visited Kenya, Vietnam, and the Philippines;              interesting social evenings at the end of the missions.
                        children also come through our PICU at Brisbane’s              The missions themselves are usually about 10–14 days
                        Mater Children’s Hospital for more complex                     long. This involves getting to the site, locating all the
                        procedures. Whilst my knowledge base has been tested           equipment that has been shipped, checking out the
                        during these visits (who would know the most common            local facilities, rechecking your gear, setting up for
                        cause for post op fever is malaria?) it’s more often the       screening and then the operating. When there is no
                        appreciation of the systems required to deliver health         laboratory back up, I find that my clinical assessments
                        care at anything above the very basic that is the feature      become much more focussed and decisions are made
                        of these trips. In most of these places, physical deformity    with fewer shades of grey. A decision not to do a
                        leads to rejection by the society, sanctioned or               procedure because of some concern about the
                        otherwise. A cleft lip which has minor health                  underlying health of a child has significant implications
                        implications means that schooling and gainful                  for the families who have on some occasions travelled
                        employment are beyond the expectation of an                    for days on foot to get to the mission site. Conversely
                        otherwise healthy child.                                       the impact if you get the decision wrong can lead to
                                                                                       quite threatening behaviours from the locals and
                                                                                       therefore compromise the safety of all those on the
                                                                                       mission. At the end of the time there is a need to put
                                                                                       some final follow up mechanisms in place and ensure
                                                                                       the handover of documentation. Usually this is the part
                                                                                       where you divest yourself of all expendable items that
                                                                                       you have brought along and give them to your local
                                                                                       assistants. One final check of the last patients, some
                                                                                       further explanations and move back to the local capital
                                                                                       to then make your way home.
                        To provide the health services required to repair such a
                        simple condition in a safe and timely manner is beyond         So why undertake such activities? As an intensivist
                        the capacity of the local systems. Operation Smile is an       I am not gullible enough to believe in altruism, (that is
                        organisation that facilitates the resources required to        just psychopathology that hasn’t been properly
                        perform a large number of these relatively simple              explored). It is a great way to hone your clinical skills, it
                        procedures in a short time-frame. In about a week a            is a good reality check for what I do on a day to day basis
                        mission team will arrive in a township assess 100–200          in my home unit, it is a really interesting way to visit a
                        children and then organise theatres, post op facilities        country and learn about its values and culture. A large
                        and operate on about 60–100 children in the week.              number of children get access to medical procedures
                        Whilst this relies upon having a base in the local             that would otherwise not be available to them, so that
                        hospital, it is essential to not be dependant on the           isn’t a bad thing.
                        services in that region. Most often the biochemistry,
                                                                                       I like the work that I do. I also realise that the ability to
                        haematology and blood bank services are no more than
                                                                                       provide such a level of specialist care is dependant on
                        random number generators. Radiology is simple but
                                                                                       an incredibly well resourced medical system. Getting
                        often reliable. Medical records don’t exist, and even in
                                                                                       out of my comfort zone helps me to understand a little
                        Colombia the only analgesia available is paracetamol.
                                                                                       more about my own practice and the system that is
                        Therefore it is necessary to bring as many of these
                                                                                       required to support it. In adult educational terms it is
                        processes in tow or learn to not depend on them. This
                                                                                       the most interesting way to undertake reflective
                        means bringing record systems, monitoring, anaesthetic
                                                                                       practice, and get overseas and see some intriguing
                        equipment, dressings and significantly reduced
                                                                                       places and people at the same time. It’s definitely not
                        expectations. Whilst a cleft lip would be repaired in the
                                                                                       for everyone and in fact I would most strongly advocate
                        first months of life in Australia in the countries we visit,
                                                                                       not going if you want to help and make a difference. But
                        the procedure is done on children over 10 months, over
                                                                                       if you are of an inquisitive mind and can accept that
                        10 kgs and over 10 gms/dl of haemoglobin. Why?
                                                                                       things get done differently in different places, maybe
                        Because these are all clinically observable
                                                                                       these sorts of trips should be on your schedule.
                        characteristics that provide a level of safety that is
                        commensurate with the local capacities even with               by Dr Phil Sargent
                        augmentation.                                                  Mater Children’s Hospital, Brisbane, Australia




                                                                    ANZICS BOARD
  P.Hicks (President), I.Jenkins (Immediate Past President), M.O’Leary (Hon Secretary), A.Turner (Hon Treasurer), G.Hart (CORE), J.Cooper (CTG),
Y.Shehabi (PricE), S.Erickson (Paediatric), R.Sistla (Tas), M.Ziegenfuss (Qld), C.MacIsaac (Vic), M.White (SA), N.Ramakrishnan (NSW), D.Blythe (WA).
    Australian and New Zealand Intensive Care Society, PO Box 164, Carlton South, Vic 3053 Australia. Tel. +61 (0)3 9340 3400 Fax +61 (0)3 9340 3499
                                    ABN 81 057 619 986 E-mail: anzics@anzics.com.au Website: www.anzics.com.au
                                                                                 regular budget and our collective plan is that this will be
      From the                                    Welcome to the first
                                                  edition of the Intensivist     the one medical professional group to represent organ
    President’s                                   this year and my first         donation. We have put $10K aside for the meeting costs
                                                  edition as President.          of the Paediatric Study Group, we want to redo the
        Desk…                                 I took up my position in
                                                                                 ANZICS website and I am very keen to explore using
                                                                                 Microsoft Sharepoint to build an Intranet (which will be
                                              October 2007 from Ian
                                                                                 externally accessible).
                                              Jenkins and wish to thank
                                              Ian for his hard work over         Membership: A question we often get asked is “What
                                              the previous two years.            does ANZICS do for me?” or alternately “Why should I
                  The past six months have seen a lot change and there is        join ANZICS?”. When we write out a list, there isn’t a lot
                  more to come.                                                  there that you can only get by joining. Many of the
                                                                                 benefits of our activities don’t require membership- unit
                  In November our CEO Kelli Cheales left us to take up a
                                                                                 reports from the CORE group, involvement with CTG
                  position with the Podiatry Association in Melbourne.
                                                                                 research, use of the BDOD guidelines, access to the
                  After some review we changed the position to a General
                                                                                 private practice fee schedules, attendance at conferences
                  Manager position and advertised. Ah, the wonders of the
                                                                                 and the like. However it is clear that without members
                  internet. We advertised on the Seek website and had 45
                                                                                 financial support we couldn’t provide the infrastructure
                  applicants over 10 days. Many thanks to Michael O’Leary
                                                                                 described above and couldn’t undertake the work we do.
                  and Mary White for helping to read them, and interview
                                                                                 So my answer becomes: by joining ANZICS you help to
                  the 5 short listed candidates.
                                                                                 support all the activities we do, that ultimately aim to
                  We were pleased to find that Kathy Muscat was the best         improve patient care and outcomes.
                  candidate. Kathy had decided she wanted to work in the
                                                                                 The email lists are one way we can provide direct benefits
                  not for profit sector and had been working in ANZICS as
                                                                                 to members, by circulating you with notices of
                  our administrative assistant for four months. She has been
                                                                                 conferences and activities. This can be overdone and we
                  in the new position now for two months.
                                                                                 will be seeking some feedback about the volume and
                  What is happening at ANZICS? As you will read from             nature of these.
                  the committee chairs there is plenty of activity, that at
                                                                                 The Future and the JFICM: At the recent JFICM AGM
                  times I find hard to keep up with. I will focus my report on
                                                                                 a motion was passed to separate from ANZCA and RACP
                  the corporate administrative matters and let the others
                                                                                 and to form an independent college (90% voted yes).
                  describe their progress.
                                                                                 ANZICS supports this plan and we have offered to assist
                  It is clear that ANZICS has moved from a small cottage         the JFICM Board. It is unclear how this will happen or
                  craft group to a small – medium sized business. We now         when it will happen. My personal view is that this will
                  employ 12 staff and this needs good management practice        bring the Joint Faculty and the Society much closer
                  and infrastructure. We are about to install new Network        together which will benefit everyone. The ANZICS board
                  hardware and software, have replaced old PCs and added         and committees are aware that there could be significant
                  a wireless network. We have reviewed HR policies,              changes for us as well, in the next three-four years. For the
                  Committee terms of references, and begun our                   moment we will offer our support to the JFICM board and
                  Occupational Health and Safety project.                        Fellows, and wait to see how we can help. ANZICS and
                  There is additional accounting software to manage our          the “College” will always be legally separate but visions of
                  budgets, a new Membership database program and we are          being co-located in “Intensive Care House” are a real
                  attempting internet based document sharing.                    possibility.

                  We had hoped to have on-line membership renewal ready          These are exciting times and this is why I joined the
                  for this year but it is 1–2 months away.                       ANZICS executive.

                  We have a new Professional Conference Organiser, Peter         Peter Hicks
                  Gray and a second PCO, Anne Blucher working part               President
                  time, who just happens to be Peter’s partner. They are         Queensland
                  very busy organizing the Sydney 2008 Asia Pacific
                                                                                                                                                 Regional
                                                                                 Queensland is a flurry
                  ANZICS/ACCCN ASM, starting the Perth 2009 ASM
                                                                                 with activities of interest                                     Reports
                  and managing four other ANZICS meetings. This has
                                                                                 to the membership. Past
                  become a small business in itself which will provide great
                                                                                 events include the ever
                  continuity and consistency. One of Peter’s
                                                                                 successful       ANZICS-
                  recommendations has been to only offer on-line
                                                                                 Clinical Trials Group
                  conference registration which reduces time and errors,
                                                                                 meeting in Noosa, and the
                  improves money handling costs and means we no longer
                                                                                 highly            regarded
                  need to chop down forests to mail out many paged
                                                                                 Leadership course by the Australian Centre for Clinical
                  registration brochures.
                                                                                 Leadership (ACCL) held at the Gold Coast was well
                  This year we should break even financially having made         attended and highly praised. Dr. Shehabi returned to our
                  losses for the past three years. This is partly because we     shores for a presentation of the Practice and Economics
                  have contained costs but also because of a small rise in       Committee (PRICE) survey to a core group of members.
                  income and the ASM surplus. Finances are a worry for           The Centre for Outcome and Resource Evaluation
                  me. Because we are a small society with a relatively small     (CORE) group has also produced the Central Area
                  membership number (compared to some professional               Health Service ICU Outcomes Report.
                  societies) that successfully manages to do a very large
                                                                                 The near future will be interesting as we enter into
                  amount of work means we have to charge more per
                                                                                 negotiations with Queensland Health for the Enterprise
                  member. We do rely on conference surpluses but these can
                                                                                 Bargaining Agreement No. 7. You may recall the pivotal
                  be unreliable and places more pressure on the organizing
                                                                                 role ANZICS played during Enterprise Bargaining
                  committees than we wish. We are asset rich with the
                                                                                 Agreement 6 (EB6) by providing support to the
                  building but have limited cash reserves. So one of my aims
                                                                                 “Pineapple Group”. High on the agenda for EB7 are
                  this year is to find other income sources so we can build
                                                                                 issues related to alleviation and reimbursement for
                  these up and also fund more activity.
                                                                                 Fatigue. Watch this space.
                  What else: The Brain Death and Organ Donation
                                                                                 Marc Ziegenfuss
                  working party has become a regular committee with a
                                                                                 Chair
2
New South Wales                                               The Senior Medical Officers national employment
                                                              contract has been settled thus avoiding any industrial
The year thus far has been busy for all of us in New
                                                              action. The full time pay rates are still substantially lower
South Wales. We have had two successful educational
                                                              than Australia which is of concern as we try to retain
evening meetings organized in association with the
                                                              specialists. The Junior doctors had two strikes which was
JFICM (NSW) regional committee. These meetings
                                                              an interesting experience (again) and still haven’t settled
have been organized without any external industry
                                                              their contract.
support which has allowed intensivists to attend
without any perceived conflict of interest. It is             I have stepped down as chair of the NZ committee and
envisaged that as a group we would have more meetings         Janet Liang has taken up the reins along with Ben Barry
organized in this fashion. For this I would like to thank     as treasurer. We are aiming to coordinate our committee
Dr. Mark Lucy for organizing & hosting the meetings at        meetings with the NZ JFICM committee meetings and
Royal Prince Alfred Hospital. This venue is very central      include all the ANZICS committee.
and the feedback from the membership was very                 Peter Hicks
positive. It was encouraging to see a good turnout and        Chair
also to see a few local trainees attend. It is proposed, at
this stage, that the meeting be held at least every           South Australia
second month. In time the frequency may be increased          The South Australian
to monthly. It is proposed that an education program for      Region continues to
trainees will be presented through the existing tele-         maintain a very good
health bridges in NSW. It is planned that the                 working relationship with
curriculum will focus on core ICU topics and these will       the local Joint Faculty
also be held in association with the JFICM (NSW).             committee. The Dean of
The organizing committee is working hard to put               the Joint Faculty of
together the Asia Pacific Critical Care 2008 Congress to      Intensive Care Medicine
be held in Sydney in October 2008. The annual NSW             (JFICM), Dr Richard Lee, addressed a combined meeting
regional educational meeting will not be held this year       of the two organizations in December 2007. His vision for
as the national ANZICS/ACCCN Critical Care Annual             the future of both the JFICM and ANZICS provided for
Scientific Meeting (ASM) will be combined with the            a very interesting presentation which was well received
15th Congress of the Asia-Pacific Association of              by the group.
Critical Care Medicine and AuSPEN to present this             A meeting was held in conjunction with JFICM in late
meeting. I would like to encourage you all to support         2007 which was entitled ‘ANZICS – present and future’.
this meeting. At this meeting I propose to hold this          The SA representatives on all of the ANZICS
year’s AGM for ANZICS (NSW). The current                      committees gave an update on committee activities and
representative from NSW to the PRICE committee has            the then president Ian Jenkins also spoke of his vision of
stepped down and nominations are invited from the             ANZICS now and into the future. The ensuing
membership for this position. Please contact me if you        discussions were extremely robust, particularly in relation
are interested.                                               to the PricE committee and the proposal to change the
The changes proposed at the recent JFICM AGM will             ANZICS membership criteria. The general feeling was
affect us all. I think the way forward as a group is to       that this was a useful exercise in letting people know
recognize the challenging road ahead and take up the          what exactly is happening in our society. We plan to run
challenge collectively in a collegiate fashion. At the        similar sessions on a regular basis.
local meetings, I have had the opportunity to meet a fair     The current Enterprise Agreement (EA) for salaried
few new fellows of the faculty who I have invited to join     medical officers in SA expired in April 2008.
ANZICS. I would request members to encourage their            Negotiations regarding pay and conditions for the new
colleagues to join ANZICS. Please ask them to contact         Agreement have only recently commenced. There are
me if they have any questions. The future of Intensive        many and varied ‘special deals’ currently in existence,
Care training and representation on professional              most of which have been negotiated by individual craft
matters, as in past, rest on each and every one of us in      groups largely in response to ongoing problems of
the profession to contribute, to improve the science and      recruitment and retention. Intensive Care is just such a
make it a more rewarding area to work in. I call on you       group with better conditions having been negotiated for
to support ANZICS and participate in ANZICS                   all specialists following the recent problems regarding
activities.                                                   training at the Royal Adelaide Hospital.
Naresh Ramakrishnan                                           Concerns have been expressed that the current
Chair                                                         negotiations may have a negative impact on some of
                               New Zealand                    these arrangements with the fear that smaller groups may
                                                              in effect be sacrificed for the greater good. A meeting was
                              Our national scientific         arranged at short notice under the auspices of ANZICS
                              meeting was held in             to discuss these issues. It was one of the best attended
                              Auckland      in    April,      meetings in recent memory! A small Executive was
                              convened by the staff on        formed with a brief to examine the issues and liaise with
                              North Shore Hospital.           the South Australian Salaried Medical Officers
                              The theme was “ICU is           Association (SASMOA) such that the best outcome is
                              not an island” and the          secured for Intensive Care. There certainly appeared to
                              “overseas”         invited      be a renewed interest in ANZICS membership on the
speakers were Dr Maureen Coombs, Dr Charles                   night. The society would appear to have a very useful role
Gomersall, Dr Kwok Ming Ho and Dr Gillian Bishop.             in such matters.
Eighty doctors and nurses attended and the discussion
was lively. This was an excellent effort as the Rotorua       Mary White
ANZICS/ACCCN ASM was only six months earlier.                 Chair
Many thanks to the organisers. Next years meeting will
be convened by the Cardiovascular unit of Auckland
City Hospital.



                                                                                                                              3
                                  Tasmania                       and Steve is also involved at a national level with the
                                                                 CORE group. Ian continues his involvement with the
                                  Dr. Michael Anderson has
                                                                 PricE Committee and Geoff Dobb is Chair of the Brain
                                  relinquished his role as
                                                                 Death Organ Donation Working Party which is
                                  Regional Chair (Tas) in
                                                                 responsible for producing the ANZICS Statement on
                                  January 2008. Dr. Ram
                                                                 Death and Organ Donation, a truly impressive
                                  Sistla has replaced Dr.
                                                                 achievement.
                                  Anderson as Regional
                                  Chairman as of June 2008.      At a local level, ANZICS members continue to be
                                                                 involved in a wide range of bodies working on issues
    I have received excellent support from the Tasmanian
                                                                 related closely and not so closely to Intensive Care. One
    ANZICS community and am looking forward to
                                                                 of the major issues that will confront members in the
    participating in the activities of the Tasmanian Branch
                                                                 short to medium term is the proposed reform of the
    during 2008–2009.
                                                                 Health Services in WA and the development of the
    Issues such as the ANZICS membership, contributions to       Fiona Stanley Hospital. I am pleased to report that ICU
    CTG, Inter-hospital Educational meetings, the Adult          is well represented in these projects, and the issues
    patient Database, ANZICS Tasmania Annual General             relevant to ICU development are being examined by
    Meeting, and Tasmanian retrieval service remain the          practicing intensivists from the major teaching hospitals.
    focus of the Tasmanian Intensive Care community              The prospect of a 60-bed ICU in the new hospital is truly
                                                                 exciting, although it is still some way off. ICU also has
    Ram Sistla
                                                                 representation on the new Acute Care Network, which I
    Chair
                                                                 am involved in, although I personally have doubts about
                                  Victoria                       how effective this body can be. Remuneration issues are
                                 On Monday 21st April the        being addressed with the State Government by
                                 Victorian     region     of     representatives from all the tertiary hospitals.
                                 ANZICS held a highly            On an educational front, our last three ANZICS
                                 successful inter – hospital     meetings have been very well attended. We have
                                 education meeting and           attempted to attract outside speakers on issues a little
                                 AGM. Dr Yahya Shehabi           different to usual, and so far this has proved successful
                                 flew down from Sydney to        with about twenty attendees at each of the last three
                                 provide a wonderful mix         meetings. Sponsorship has proven easy to attract and
    of research, current clinical practice in relation to        feedback has been good. The Faculty Committee has
    sedation in the ICU and an update on activities of the       taken the opportunity to hold their meetings on the same
    ANZICS PRICE committee. There was a good                     evening as the ANZICS meetings and this has proven to
    attendance at the meeting and much lively discussion. It     be of benefit to both groups. Chair, David Morgan
    was pleasing to see a real enthusiasm for ANZICS             continues his sterling work with the Faculty, but will be
    matters.                                                     stepping down in the near future. Our most recent
    Seventeen dedicated Victorian ANZICS members stayed          meeting, on neonatal ventilation, attracted several
    on for the regional AGM where reports from various           consultants from King Edward Hospital; establishing
    representatives on a variety of ANZICS activities            links with our colleagues in the neonatal world is a good
    including ongoing education, The Intensive Care              initiative, which I hope will remain in place.
    Advisory Committee, CTG, Australian Resuscitation            The Clinical trials Group meetings also continue on a
    Council, Victorian Data Review Committee and the             quarterly basis and are as well attended as ever by the
    Consultative Council on Anaesthethetic Mortality and         members interested in research. As ever, all of our
    Morbidity were given.                                        meetings both educational and research are good
    There had only been one nomination for each position         opportunities for collaboration across sites and continued
    on the committee and thus I am continuing on as Chair,       good relations between members.
    Roberto Citroni as Vice-Chair and Stephen Warrillow as       David Blythe
    secretary. I wish to thank Rob and Steve for their           Chair
    assistance and congratulate them on their positions. I
                                                                 Since the last edition of this
    look forward to working with them this year.
                                                                 newsletter a number of
                                                                                                                              General
    The ANZCIS/ACCCN Annual Scientific Meeting
    (ASM) will be in held in Melbourne in October 2010 at
                                                                 changes have taken place.                                    Manager’s
                                                                 Membership criteria have
    the Melbourne Exhibition & Convention Centre.                changed to become more                                       Report
    Christopher MacIsaac                                         inclusive and representative
    Chair                                                        of those working in the field
                                                                 of intensive care medicine.
                                  Western Australia              Adult Patient Database
                                    ANZICS in Western            Committee (ADMC) has
                                    Australia continues to be    changed its name to the Centre for Outcome and
                                    a small but enthusiastic     Resource Evaluation (CORE), incorporating the former
                                    group, with involvement      ANZICS Research Centre for Critical Care Resources
                                    in a range of regional and   (ARCCCR).
                                    national activities. My      We’re grateful for the contributions of past ANZICS
                                    succession to the Regional   employees, and are pleased to welcome the following
                                    Chair is of note since the   team members – Peter Gray and Anne Blucher in
    last Intensivist newsletter and I would like to thank        Conferences & Events; Kelly Drennan, Jessica Andrews
    previous Chair, Brad Power, for his able management          and Kim Bingham in CORE; Shelley Tregea in
    before me. Joining the Board has been an instructive         ANZPICR and Katrina Fitzsimon in ANZICS Central
    experience and I look forward to a continued                 Administration. Congratulations go to Shaila Chavan
    contribution at that level. Ian Jenkins as Immediate Past    and her husband Yogesh on the birth of their son, Yash,
    President continues on the Board with me so WA has           in April; Shaila is currently on maternity leave. For
    strong representation in national ANZICS affairs. Steve      details on how to get in touch with ANZICS staff go to
    Webb and I also represent WA at the CTG Executive,           www.anzics.com.au and select the ‘About Us’ section.
4
                                                                             After a long and difficult
             After another very successful CTG meeting in Noosa in
             March this year, we’re gearing up for the 2nd                   gestation occurring in an
                                                                                                                                           Brain Death
             International Conference on Safety, Quality, Audit &            ever              changing                                    and Organ
             Outcomes Research in Intensive Care to be held in               environment, the 3rd
             Christchurch, New Zealand in late August. Registrations         Edition of the ANZICS                                         Donation
             are flooding in for the Asia Pacific Critical Care 2008         Statement on Death and
             Congress – we look forward to seeing you in magnificent         Organ       Donation      is
             Sydney in late October.                                         virtually complete. The
                                                                             process       has     been
             Finally, a brief reminder that member annual subscription
                                                                             exhaustive with a comprehensive review of relevant
             fees are now due. If you’ve not yet paid, please fax your
                                                                             literature, including comparable documents from other
             credit card details to +61 3 9340 3499.
                                                                             countries and a complete redraft of the content to
             Kathy Muscat                                                    enhance clarity and expand the detail around the more
             General Manager                                                 complex issues. After multiple drafts an exposure draft has
                                           As we go to press the             been made available for comment to ANZICS members,
Membership                                 Society has 398 Full, 69          medical colleges, state base organ donation agencies,
                                                                             other societies and associations, and the ACCCN. These
    Report                                 Associate, 30 Affiliate and
                                                                             comments have been collated and further changes made
                                           13 Trainee members.
                                           Following the passing of          to the Statement where appropriate after further review.
                                           the motion at Rotorua last        Wow! Well, the end of the process is now in sight and we
                                           year to expand the criteria       look forward to having this stage of our work complete.
                                           of eligibility for Full           We have been encouraged by the recommendation from
                                           membership the Regional           the Minister’s Taskforce on Organ and Tissue Donation
             Chairs have been asked to review their membership lists         for a key role for the Statement in providing guidance to
             to identify those who are now eligible to upgrade from          clinicians and others working in the organ and tissue
             Associate to Full membership. A number of you who are           donation sector. However, this implies a wider readership
             in this category will have received a letter from the           than originally envisaged. We therefore sought and have
             Society congratulating you on being promoted to Full            received some financial assistance from the Department
             Member status. Unfortunately it is possible that some           of Health and Aging to engage professional writers to
             members who are eligible will be missed, so please do not       help us with the formatting, style and language of the
             hesitate to get in contact if you think you have been           final document.
             overlooked.
                                                                             The Committee will now be considering its ongoing work
             As a reminder, the new criteria for Full membership are         plan once this major task is completed. This may include
             as follows:                                                     a web-based version of the Statement with links to the
             FULL MEMBERSHIP is available to:                                references and other resources. With the recent interest
             1) Certified Fellows of the Joint Faculty of Intensive          by the Australian Government in organ and tissue
                 Care, Australian and New Zealand College of                 donation, publication of the Report by the Minister’s
                 Anaesthetists and Royal Australasian College of             Taskforce, and the anticipated proclamation of a new Act
                 Physicians.                                                 to provide the legislative framework in New Zealand, it is
             Or                                                              likely new initiatives will become Committee priorities.
             2) Any medical practitioner who has a Specialist                As part of the wash up from the Taskforce’s report it is
                 Medical qualification acceptable to the Board, and          likely that educational programs related to organ and
                 who is working in intensive care.                           tissue donation, including ADAPT, will be reviewed and
             I accept that is has taken quite a long time to move            a review of the National Organ Donation Collaborative
             forward following the decision to expand Full                   is planned. The Committee maintain their strong support
             membership criteria and for this I apologise. We have,          for the medical ADAPT course.
             however, taken the opportunity to replace our                   The next Learning Session for the NODC is in Adelaide
             membership database and this should improve our ability         in early July in association with the South Australian
             to ensure membership categories are upgraded in a timely        Organ Donation Summit on Organ Donation.
             fashion in the future as well as provide members with the
             facility to renew on-line. By the end of the year we would      Despite completing work on the Statement, it looks like
             hope that many of the current Associate members will            being a busy time for this Committee.
             have been reclassified as either Full members or Trainee        Geoff Dobb
             members of the Society.                                         Chair
             The Society remains committed to its aim of being the           The Clinical Trials Group
             advocate for intensive care in Australia and New Zealand        continues to be a hive of
                                                                                                                                           CTG
             and therefore I believe we need to represent all                energetic activity on
             physicians that have a significant interest in the specialty.   many exciting fronts. We
             Members need to promote membership to their                     are all justifiably proud of
             colleagues and trainees in order that we can achieve this       the CTG achievements,
             aim For those of us in Australia, membership also allows        and of the potential that
             reduced rate membership of the Qantas Club as part of           has been set in place for
             our corporate membership package. Membership forms              the future. There are now
             can be downloaded from the website.                                                                           ,
                                                                             12 ongoing clinical studies: ARISE, ASAP DECRA,
             Michael O’Leary                                                 Early PN, ENTERIC, HiTBIC, NICE-SUGAR, NICE-
             Honorary Secretary and Membership Director                      TBI, PROTECT, RENAL, SAFE TBI II, and STATinS.
                                                                             Six ongoing randomised trials are funded by NHMRC
                                                                             project grants – an achievement we would never have
                                                                             dreamed possible only a few years ago. Later this year,
                                                                             two pivotal very large trials – RENAL and NICE-
                                                                             SUGAR – will complete recruitment, and we are all
                                                                             eagerly awaiting the results. Both studies are aiming for
                                                                             presentation at the 2009 Noosa CTG scientific meeting.

                                                                                                                                                     5
    The 10th Annual Scientific Meeting on Clinical Trials         sepsis and septic shock: 2008. Crit Care Resus.
    in Intensive Care was held in Noosa 14–16th March.            2008; 10: 8.
    The meeting was constructed by Steve Webb, organised
                                                               5. Dulhunty JM, Lipman J, Finfer S and the Sepsis
    with precision by Rhiannon Elliott, and as usual was a
                                                                  Study Investigators for the ANZICS Clinical Trials
    great success. This year there was an increased focus on
                                                                  Group. Does severe non-infectious SIRS differ from
    informed summary and commentary of key studies by
                                                                  severe sepsis? Results from a multi-centre
    more senior mentor figures, and increased time for the
                                                                  Australian and New Zealand intensive care unit
    debate and discussion which make these meetings so
                                                                  study. Intens Care Med 2008 [epub ahead of print
    unique and productive for trial planning and design.
                                                                  DOI 10.1007/s00134-008-1160-2].
    Professor John McNeil from Monash University was
    both the invited Guest speaker and the 2008 Randy          In the background, the CTG Executive continues a
    Chestnut medal winner. His contributions were terrific        busy program of reviewing new studies and future
    and enjoyed by everyone.                                      publications through the CTG Endorsement
                                                                  process. All members of the Executive contribute
    This year the Noosa ASM was preceded by a startup
                                                                  significantly to this busy and important process.
    meeting for the ARISE study investigators and also by
    our usual highly successful Research Coordinators          CTG Annual Report
    Workshop organised by Ms Belinda Howe. Ms Louise           The impressive 2007 CTG Annual Report was
    Lyons from the National Trauma Research Institute in       distributed nationally in March 2008. Once again
    Melbourne was the invited guest and had many useful        Rhiannon Elliott was the driving force and is mainly
    insights about the business of research and its funding.   responsible for its highly professional appearance and
    Two recent CTG initiatives are the Capacity Working        construction.
    Group - headed by Steve Webb, and the Point                Collaborations
    Prevalence Program (PPP) lead by Ian Seppelt. The
    Capacity Group is investigating strategies for the CTG     International collaborations with the CTG have
    to maximise and continue productivity within the           enhanced recruitment achievements in NICE-SUGAR,
    limitations of our population and our region. They have    and DECRA and have greatly facilitated PROTECT.
    already had some great ideas. The PPP team has linked      ARISE is being developed in close harmony with a
    with the George Institute in Sydney, and is aiming to      separate NIH funded US trial, PROCESS. International
    conduct point prevalence studies on two days each year     collaborations are likely to be one key part of resolving
    commencing in 2009. Grants have been submitted to          both our capacity constraints and the future logistic
    the Intensive Care Foundation to support the base          concerns of our many trials. Several different funding
    program and also the first planned studies.                models have been successful with different
                                                               investigators.
    In February 2008, two NHMRC grants were submitted
    through the ANZIC Research Centre at Monash                CTG Memberships
    University, with the aim of developing new randomised      The Clinical Trials Group is completely dependent on
    trials in traumatic brain injury for the ANZICS CTG in     member subscriptions, to fund the administrative
    Australia and New Zealand over the next 5 years. These     centre at ANZICS House in Melbourne. Could all
    studies are related to very early therapeutic              members please ensure that your 2008 memberships
    hypothermia and erythropoietin. Other grants have          have been completed and sent in.
    been submitted to the Victorian Neurotrauma
    Initiative, ANZCA and the Intensive Care Foundation.       Jamie Cooper
                                                               Chair
    2008 publications:
                                                               The former ANZICS
    1. Myburgh JA, Cooper DJ, Finfer SR, Venkatesh B,          Database Management
                                                                                                                           CORE
       Jones D, Higgins A, Bishop N, Higlett T and the         Committee has been
       ANZICS Clinical Trials Group ATBIS Investigators.       renamed the ANZICS
       Epidemiology and 12-month outcomes from                 Centre for Outcome and
       traumatic brain injury in Australia and New             Resource Evaluation or
       Zealand. J Trauma. 2008; 64: 854–862.                   ANZICS CORE. The
    2. Moran J, Bersten A, Solomon P Edibam C, Hunt T
                                     ,                         new name encompasses
       and the ANZICS Clinical Trials Group. Modelling         the ANZICS Adult
       survival in acute severe illness: Cox versus            Patient Database (APD), the ANZICS Research
       accelerated failure time models. J Eval Clin Pract.     Centre for Critical Care Resources (ARCCCR – now
       2008; 14: 83–93.                                        known as CCR), and the ANZICS Paediatric Registry
                                                               (ANZPIC).The new name reflects the closer
    3. Hicks P and Cooper DJ, Webb SAR, Myburgh JA,            relationship and overlap between the activities,
                                                  ,
       Seppelt IM, Peake SL, Joyce C, Stephens DP Turner       particularly in the areas of data management, software
       A, French C, Hart G, Jenkins IR, Burrell AR on          development and support, user support, research and
       behalf of the ANZICS Board and the ANZICS               publications.
       Clinical Trials Group Executive Committee. The
       Surviving Sepsis Campaign: International guidelines     Funding
       for management of severe sepsis and septic shock:       Negotiations for our next 3 years of funding have been
       2008 and the Australian and New Zealand Intensive       successfully completed with all Australian states,
       Care Society (ANZICS). Anaesth Intens Care.             territories and New Zealand agreeing to increase
       March 2008.                                             funding levels. The majority of jurisdictions have agreed
    4. Hicks P Cooper DJ, Webb SAR, Myburgh JA,
               ,                                               to the full funding request of $2.708 million over three
       Seppelt IM, Peake SL, Joyce C, Stephens DP Turner
                                                 ,             years. NSW has currently agreed to the additional
       A, French C, Hart G, Jenkins IR, Burrell AR on          funding (over CPI) for the first 12 months (subject to
       behalf of the ANZICS Board and the ANZICS               review after that). This increase in funding is however,
       Clinical Trials Group Executive Committee and the       conditional on enhanced governance and reporting
       Australian and New Zealand Intensive Care Society       within each jurisdiction.
       (ANZICS). The Surviving Sepsis Campaign:
       International guidelines for management of severe


6
Governance                                                    paediatric registry will be carried out by Brent McSharry
                                                              from the Royal Children’s Hospital in Brisbane.
Jurisdictions have agreed to provide membership and
representation at a twice annual National Intensive           A paediatric study day for data coordinators was held in
Care Registry Steering Committee (NICRSC). In                 Melbourne in December 2007 and focussed on
addition, each jurisdiction will establish and maintain       standardising coding, an explanation of the elements of
an ICU liaison committee similar to the existing              RACHS-1 and PIM2, and discussion on additional
Victorian Data Review Committee in function and               codes for the diagnosis list for 2008. While it was
terms of reference. The NICRSC will be responsible for        unfortunate that no New Zealand representatives could
establishing periodic external reviews of the CORE            attend, there was representation from almost all
infrastructure and activities to ensure compliance with       Australian states. It is envisioned that these study days
national Registry requirements. Further detail regarding      will be held annually. Many participants of the day also
the committee functions and terms and reference for           volunteered to be involved in the monitoring/auditing
the agreement can be accessed at sas.anzics.com.au            of all Australian & New Zealand paediatric ICUs during
                                                              2008, and this process is currently being finalised.
Information Portal
                                                              Graeme Hart
An upgrade of the SAS Information Portal is currently
                                                              Chair
underway. New servers have been installed (donated by
Intel) to improve performance. New SAS Strategic
Performance (SPM) software has been acquired to
                                                              The Intensive Care Echo-
                                                              cardiography Committee is
                                                                                                                          Echocardio-
provide a greater range of reports and easier user access.    a joint committee of                                        graphy
                                                              ANZICS and JFICM. The
Completion of the upgrade is expected to occur by the
                                                              terms of reference for this
31st August 2008.
                                                              committee were to make
Critical Care Resource Survey                                 recommendat-ions         to
                                                              ANZICS and JFICM on
Analysis of the 2006/2007 report is underway. The
                                                              matters     relating     to
response rate has again been strong with 93% of Adult
                                                              ultrasound including, but not limited to:
and Paediatric Intensive Care units completing the
survey. Unit reports providing basic comparative              • A system of training and accrediting Intensivists on
resource statistics will again be distributed to each           performing      ultrasound    examination       and
participating site. Publication of the final report is          interpretation. The main initial focus of training
expected to occur in August 2008. At this time, the             would be on echocardiography.
2007/2008 survey will also be distributed. Input from
                                                              • Minimal standards for an echocardiographic
interested members is welcomed.
                                                                examination.
Publications                                                  • Recommended indications for thoracic and
The ANZICS CORE publication rate has increased                  transoesophgeal echocardiography.
exponentially over the past two years.
                                                              The committee has achieved the later two points and
In 2008, ten publications have been accepted so far by        these have been published in the Intensivist. In regard
peer review journals. The work has principally been           to developing a system for training, examining and
undertaken by interested intensivists. Information            accrediting Intensivists the committee provided a
request forms and the ANZICS CORE publication                 report to the respective boards of ANZICS and JFICM
policy can be accessed at: sas.anzics.com.au                  in January of this year.
Particular thanks to Sean Bagshaw for his prolific            The recommendation was based on the draft document
output with three papers published so far this year,          that was circulated widely in 2007 on the recommended
utilising ANZICS CORE data. A full list of all                training program for Intensivists undertaking Level 2
publications can be accessed from the Portal Web site.        echocardiography. In general there was positive
                                                              feedback from many sections of the intensive care
Paediatric Registry
                                                              community with no major negative feedback received.
The 2006 annual report for admissions in 2006 to the          The outlined training program recommended 150
ANZICS Paediatric Registry has now been completed             TTE’s be performed, an additional 50 TOE’s (of which
and is available in pdf form from the ANZICS website.         25 were assisted or observed and 25 performed as the
The delay in the production of this report was due to a       trainee with the primary operator), with a total number
lack of continuity in registry managers, and it is            of interpreted studies of both TTE and TOE being 300.
anticipated that the analysis of data based on 2007           Training in level II is divided into 3 areas:
admissions data should be produced in a much shorter
                                                              • Theoretical
timeframe.
                                                              • Number of studies performed
There has been an increase in the number of general           • Number of studies interpreted
ICUs contributing their 2007 paediatric patient
                                                              An acquisition of theoretic knowledge could be
admission data to the paediatric registry, and this assists
                                                              achieved by a number of pathways. Studies performed
in ensuring the completeness of the data set for
                                                              would have to be logged and signed off by a supervisor.
Australian and New Zealand sites. Many general ICUs
                                                              Interpreted studies could be achieved either by
are using the paediatric screens in AORTIC to capture
                                                              dedicated days attached to a major national meeting, or
the fields needed, and their willingness to provide data
                                                              as an online module. The committee believes that some
is much appreciated by the Registry.
                                                              form of assessment would have to be undertaken so as
The diagnosis coding list for the paediatric registry was     to maintain standards of training. It was put to the
altered in 2007 to collect an expanded list of cardiac        ANZICS and JFICM Boards that either the current
surgery codes, particularly those relating to congenital      committee have its terms of reference adjusted to
heart surgery. The collection of these codes will enable      achieve this end, or a completely new committee be
the calculation of a RACHS-1 index to be calculated to        created for that purpose.
evaluate ICU care. Similar to PIM, this index is not
                                                              The increasing popularity of courses to achieve Level 1
intended to be used at the individual patient level, but
                                                              Critical Care Echocardiographic training has resulted in
rather at the ICU level as a performance indicator. The
                                                              the need for some formal structure. This is now being
programming work to integrate this index into the

                                                                                                                                    7
                  achieved through the CCPU (Certificate in Clinician           Two randomised, controlled trials are being conducted.
                  Performed Ultrasound) pathway provided by ASUM.
                                                                                Hypothermia in Traumatic Brain Injury in Children
                  Development is also underway to provide a training
                                                                                (HITBIC), funded by the ANZICS Foundation and the
                  structure for Level II Critical Care Echocardiography by
                                                                                Victorian Neurotrauma Initiative, began recruitment in
                  ASUM. I feel strongly that ANZICS/JFICM should
                                                                                November 2006 in its two-year pilot stage. It compares
                  have ownership of level II training and credentialing,
                                                                                72 hours of early hypothermia to standard treatment in
                  ideally in partnership with ASUM.
                                                                                severe traumatic brain injury, with a dichotomous
                  Therefore, I believe the best way forward is for ANZICS       outcome (good versus poor). We are negotiating with
                  (subject to board approval) to proceed with                   overseas centres to accelerate recruitment.
                  development of a system of training and accrediting
                                                                                Aminophylline in bronchiolitis. This study, funded by
                  Intensivists on performing ultrasound examination and
                                                                                ANZICS Foundation, is comparing aminophylline to
                  interpretation with the main initial focus of training
                                                                                placebo in children in PICU with bronchiolitis for its
                  being echocardiography.
                                                                                effect on duration of ventilation. The Royal Children’s
                  Anthony McLean                                                Hospital, Melbourne, has done a 30 patient pilot study
                  Chair                                                         enabling modification of the protocol (altered inclusion
                                                                                criteria) and assessment of feasibililty. We plan to
    Paediatrics                                  The ANZICS paediatric
                                                 study group (PSG) is
                                                                                conduct the study over two seasons.
                                                 currently in its fifth year    Other studies:
                                                 of operation. It represents
                                                                                (i) The CARDS (Calfactant in Acute Respiratory
                                                 all     the       specialist
                                                                                    Distress Syndrome) study is currently recruiting
                                                 paediatric intensive care
                                                                                    sites across the US, Australia and New Zealand. The
                                                 units in Australia and
                                                                                    study is a randomised controlled trial of exogenous
                                                 New Zealand. Since
                                                                                    calfactant in adults and children with acute
                                                 paediatric intensive care
                                                                                    respiratory distress syndrome. The primary outcome
                  is a small specialty compared to adult intensive care, the
                                                                                    will be mortality at 90 days following admission. The
                  PSG is important in providing a platform for clinical
                                                                                    investigators are recruiting combined adult and
                  research in our area, by pooling expertise and patient
                                                                                    paediatric ICU's. Currently several units in
                  numbers. Each year, we conduct two face-to-face
                                                                                    Australia and New Zealand have expressed interest
                  meetings, at Noosa in March in conjunction with the
                                                                                    and are currently applying for ethics approval.
                  CTG meeting, and at the ANZICS annual scientific
                                                                                    There are a limited number of places available for
                  meeting in October. Between those meetings we have
                                                                                    Australia and New Zealand. Confirmed centres are
                  two teleconferences.
                                                                                    Perth (Fremantle and Princess Margaret Hospital),
                  At the 2007 5th World Congress on Paediatric Critical             Adelaide (Women’s and Children’s and Royal
                  Care in Geneva, we participated in a one-day meeting              Adelaide Hospitals), Melbourne (Royal Children's
                  with other, similar national bodies from Europe, the              Hospital) and Darwin (Royal Darwin Hospital) and
                  UK, USA, Canada, India and South America,                         Auckland (Auckland City Hospital and Starship
                  organised by my predecessor, Barry Wilkins. There was             Hospital). Site visits by investigators are planned for
                  a shared intention to collaborate internationally and we          the next few months with an aim to commence the
                  plan to create a register of studies and contacts to              study later this year. Simon Erikson is the paediatric
                  facilitate this in the future.                                    contact in Australia & New Zealand for this study.
                  The following studies have been completed:                    (ii) Launching in July is the CVC BSI and Thrombosis
                                                                                     surveillance study which endeavours to determine
                  Acute Lung Injury in Paediatric Intensive Care
                                                                                     the rate of CR-BSIs and clinically significant
                  (ALIPICU). This was a 12-month long prospective to
                                                                                     Catheter-Related Thrombosis in Australian and
                  determine the incidence and describe the condition and
                                                                                     New Zealand PICUs.
                  its treatment in our population. We found that ALI was
                  less common than in adults, and that early respiratory           While central venous catheters (CVCs) play an
                  severity predicted increased mortality but higher tidal          important role in the management of critically ill
                  volume ventilation was associated with decreased                 patients, their use can lead to complications that
                  mortality. The study was published the July 2007 issue           result in considerable morbidity. Two important
                  of Pediatric Critical Care Medicine.                             complications are catheter-related blood stream
                                                                                   infections and thromboses. It is aimed to study 1750
                  Glucose control, organ failure and mortality in
                                                                                   PICU patients with central venous catheters. Data
                  paediatric intensive care. This study was a two month
                                                                                   will be collected from all patients in Australian and
                  observational study of glycaemia, organ failure scores
                                                                                   New Zealand PICUs who have a central venous
                  and glycaemia management, conducted as a prelude to
                                                                                   catheter: a) insitu on PICU admission and/or b)
                  a possible randomised, controlled trial. It showed that
                                                                                   inserted during their PICU admission to estimate
                  hyperglycaemia was independently associated with
                                                                                   the incidence and risk factors for these
                  severity of organ dysfunction and mortality, but both
                                                                                   complications. The provisional timeframe for this
                  organ dysfunction and hyperglycaemia peaked early,
                                                                                   project is eleven months, from July 2008 to June
                  making organ dysfunction an unsuitable outcome
                                                                                   2009. Amanda Ullman, Debbie Long, Tony Slater
                  measure for a clinical trial. It was published in the
                                                                                   and Michael Yung are coordinating this study.
                  January 2008 issue of Pediatric Critical Care Medicine.
                                                                                (iii)Generation of the PIM3 mortality prediction index.
                  The application of risk adjusted control charts using
                                                                                     Mortality remains an important indicator of quality
                  PIM2 for monitoring paediatric intensive care
                                                                                     in the ICU, and the PIM2 model has been a useful
                  performance in Australia and New Zealand. This study
                                                                                     and widely-used clinical indicator tool in paediatric
                  was done to develop more sophisticated and timely
                                                                                     ICUs over the past five years, being both reliable
                  reports on PICU performance than annual standardised
                                                                                     and valid. However, it has been shown that the
                  mortality ratios. It has been accepted for publication by
                                                                                     degree to which such risk adjusted models
                  Intensive Care Medicine.
                                                                                     accurately predict their intended outcome in
                  We have collected the data fur the Children in ICU                 patients over time depends on the consistency of
                  study. This study was done to examine the risk-adjusted            case-mix and practice of care. Thus, in order to
                  outcomes of children treated in adult and paediatric               ensure continued applicability of the model,
                  ICUs. It is still being analysed.                                  recalibration and reassessment of the model using
8
           new data should be performed regularly.                    The Board of ANZICS and the PricE Committee are
                                                                      concerned with the burnout risk amongst intensivists
           The work to be done to develop PIM3 will involve
                                                                      and will be coming back to all intensivists for a
           both recalibration and remodelling and will make
                                                                      correlational survey to look into the root cause of this
           use of international data to increase the
                                                                      problem.
           generalisability of the model and to permit cross-
           country comparisons. Lahn Straney and Tony Slater          We encourage every intensivist to actively participate in
           are coordinating this work.                                the coming survey in the later part of 2008, such survey
                                                                      is critical in guiding us on the right path to tackle this
        Michael Yung
                                                                      insidious and dangerous disease.
        Chair, Paediatric Study Group
                                                                      The Australian Centre for Leadership (ACCL) and
PricE                                  Membership of PricE
                                                                      the April 2008 Program
                                       I would like to formally
                                                                      The second annual Leadership Conference held in April
                                       welcome Nick Edwards
                                                                      2008 at the Sheraton Mirage was an outstanding success
                                       from SA who joined the
                                                                      with more than 75 delegates, 14 presenters and 4 major
                                       committee and already
                                                                      sponsors.
                                       making a very positive
                                       impact on the committee’s      The delegates came from all back grounds including
                                       deliberation.                  intensive care, anaesthesia, emergency, medicine and
                                                                      surgery and ANZICS was highly praised for its leadership
        The Committee as always welcome members with a
                                                                      role in this area. The feedback was overwhelmingly
        proactive dynamic personality to join the committee, we
                                                                      positive with more than 90% of delegates saying they
        are currently short on NSW representation and I
                                                                      would highly recommend the conference and would
        appreciate hands up those in the know how to join us.
                                                                      attend again.
        With the committee’s ToRef approved by the Board, the
                                                                      The rating for all sessions were greater than 3.5/5 with
        PricE committee at its last meeting elected Geoff Dobb
                                                                      session like investing into your future, successful
        from WA to the position of deputy chair, I would like you
                                                                      negotiation and conflict resolution scoring greater than
        to join me in congratulating Geoff on his appointment
                                                                      4.5/5.
        and I may take this opportunity to thank Geoff for his on
        going contribution to the committee.                          The highlights of the meeting was a Healthcare reform
                                                                      session where Prof. Tom Stewart from Canada and Prof
        Lastly, on behalf of the committee and ANZICS, I would
                                                                      John Dwyer from NSW presented and engaged in a panel
        like to thank Eddie Stachowski for his time and
                                                                      discussion attended by a consumer representative.
        contribution on the committee, Eddie resigned from the
        committee to fulfill his expanding workload.                  The dinner on Saturday night was a fantastic event with
                                                                      Prof. Khadra the official guest speaker who didn’t
        The PricE of Intensivists (Results of 2007 Survey)
                                                                      disappoint at all with a highly entertaining informative
        The PricE Committee conducted an intensivists’ survey         speech.
        in Oct. 2007. The results of the survey have been
                                                                      I believe the ACCL has now established itself with
        presented in presentations around the main capitals of
                                                                      marketable product, the time ahead is very exciting for
        Australia. Despite a relatively poor response, 116
                                                                      both ANZICS and the new college of intensive care
        intensivists responded, the survey confirmed many
                                                                      medicine to build bridges with other craft groups,
        practice patterns as expected:
                                                                      government agencies and business schools and the larger
        1. Most intensivists use known gap or no gap schemes          community. I strongly encourage you to attend the next
           with less than 5% using AMA rates for intensive care       Leadership Program and to support our endeavors to
           services.                                                  work for the welfare of all intensivists.
        2. Most intensivists use individual billing rather than a     I would like to take the opportunity to specifically thank
           group or a partnership centralised billing.                Peter Gray (new ANZICS PCO) and Kathy Muscat for
        3. Most intensivists spend nearly 50% of their time in        logistic and organisational role in making this a very
           clinical ICU/HDU, 11% doing locum outside their            successful event. Welcome on board Peter and
           primary units, 10% on research and 10% on                  congratulation Kathy on your new appointment.
           administrative duties.                                     The Australian Health Insurance Association (AHIA):
        4. The average load of patients in main stream ICU is         Negotiation continues with the AHIA. The birth of a
           about 10 to 12 patients per intensivist with 2 new         new college of intensive care medicine independent to
           admissions on average per day.                             ANZCA and RACP place our position with government
        5. Most intensivists spend at least 2 hours per day in        agencies and funding agencies in a peculiar position.
           family conferences.                                        Members of the PricE committee (Nick Edwards, Ian
                                                                      Jenkins, Geoff Dobb and I) in addition to David Ernest
        6. Most intensivists think ANZICS should do more for          met with the AHIA recently and there is a good
           the welfare of intensivists, in particular on industrial   understanding of the mutual needs of each party.
           issues, mediation and conflict resolution, central
           locum and medico-legal agency.                             It is imperative that ANZICS remain the body that talks
                                                                      on behalf of all intensivists and therefore we are moving
        7. Most responders agreed that Leadership training is an      to solidify our position with the AHIA with a submission
           important part of ANZICS role.                             that will define the relationship with the health funds in
        8. Not surprisingly, overwhelmingly responders agreed         general and address the need to have intensive care unit
           that current MBS doesn’t reflect true value of             registered and accredited by an independent body like
           intensivists and their pivotal role in healthcare.         ANZICS. This is an exercise that has been already done
                                                                      successfully in Victoria and South Australia.
        9. The most disturbing part of the survey is that relating
           to risk of burnout syndrome amongst intensivists.          Significant developments are expected within the next
           More than 35% of those who were surveyed exhibited         few weeks, so watch this space.
           clear signs of burnout despite the fact that 90% of
           those surveyed were satisfied with intensive care
           as a job.

                                                                                                                                   9
                                                                               APCC 2008 Congress
                                 IMPORTANT NOTICE                                                                                          Conferences
                                                                               The Asia Pacific Critical
                              from the PricE Committee                         Care       Congress      is                                 and Events
                   We would like to remind Australian members that             progressing well. The
                   consultations and procedures performed in the               Conference Overview
                   Intensive Care and Hospital must be recorded by             and Registration Guide
                   the Procedural Medical Officer involved, including          has now been published
                   clear identification of the Supervising Intensivist.        and distribution is in
                   It is expected that chart reviews are conducted             progress. A pdf version is
                   as required to ensure compliance with the above.            also available from the web site and is being sent out to
                                                                               all ANZICS members.
                  The Latest in HDU Item submissions                           The conference program is now all but complete with
                  With the new government and changing priorities and          only some minor adjustments to be made. The
                  policy direction, we are yet to have a direct engagement     exhibition has now sold out.
                  with the new Federal MoH. However, dialogue with the         Registration is via a secure on-line registration form
                  DoHA regarding the HDU item submission has now               which can be accessed from the ASM web site
                  been suspended. ANZICS has submitted a revised               www.intensivecareasm.com.au). Payment can be made
                  submission that doesn’t include HDU items, the               by credit card or registrants can request an invoice if
                  Committee and the Board are of the opinion that unless       their hospital, company or organisation requires one
                  the HDU items define appropriately the model of care         prior to making payment. For those that cannot
                  expected to deliver quality safe care to patients            complete the on-line form a pdf version is available
                  (Intensive Care Model) ANZICS would not support the          from the Conference & Events Group.
                  introduction of these items. We are yet to hear back from
                                                                               We are now in the process of allocating rooms for
                  the DoHA and we are working through a mediator to get
                                                                               Sponsor events and for pre-conference or ancillary
                  a face to face meeting with the Federal MoH soon.
                                                                               meetings. The deadline for notification of requirements
                  I don’t expect a major breakthrough with the current         for ancillary meetings is 30th June 2008.
                  economic environment for the government but we will
                                                                               The social committee has confirmed details for the
                  give our best shot and hope to achieve the promised 8%
                                                                               Welcome Reception, the VIP Dinner and the Gala
                  rise to the intensive care schedule of fee.
                                                                               Dinner. A full partner program has been arranged and
                  Yahya Shehabi                                                bookings can be made via the web site.
                  Chair, PricE
                                                                               The 2nd International Conference on Safety,
                  Director, ACCL
                                                                               Quality, Audit & Outcomes Research in Intensive
                                                The S&Q Committee is
     Safety and                                 currently engaged in a
                                                                               Care will take place at the Millennium Hotel,
                                                                               Christchurch on Thursday and Friday, 28th and 29th
        Quality                                 number of activities.          August 2008. Details, including a registration form can
                                                 Plans are well underway       be found on the ANZICS web site. Speakers include
                                                 for the 2nd Annual            Claire Rickard, Steven Webb, Kathleen Ryan, Charles
                                                 Conference on Safety,         Vincent, David Pilcher and John McNeil. There are
                                                 Quality,      Audit    &      also post-conference ski and non-ski options for those
                                                 Outcomes – 28/29 August       who wish to stay on for the weekend.
                                                 2008 in Christchurch.         The Intensive Care Medicine Course 2008 will be
                  There are a number of well-known international and           held at the Box Hill Hospital, Victoria from 18th – 20th
                  national speakers, and the program is evolving into an       July. This course focuses on the ICU management of the
                  interesting mix of presentations on process and outcomes     critically ill. Course convenors, Ramesh Nagappan and
                  in IC. Details are now on the ANZICS website:                David Ernest have, as anticipated, already exceeded the
                  http://www.anzics.com.au/conference.asp?Section=sqo08.       previous record for attendees; registration will remain
                  Following the scepticism expressed by some ANZICS            open until 17th July. Full details of the course and an
                  members about the concept and utility of ‘bundles’, the      on-line registration form can be found on the ANZICS
                  Committee is to conduct a survey of members in order         web site.
                  to determine what factors are considered important in        The 2009 Annual Scientific Meeting will now be
                                             .
                  the prevention of VAP Factors could include:                 held at the Perth Conference and Exhibition Centre
                  assessment of readiness to extubate, sedation                from 27th October until 1st November 2009. This is a
                  management, DVT prophylaxis, stress ulcer prophylaxis        date change. Further details will be available on the
                  and so on. Hopefully this will facilitate further research   ASM web site in due course.
                  into this area.
                                                                               The 3rd International Conference on Safety,
                  Members of the Committee have been working with the          Quality, Audit & Outcomes Research in Intensive
                  CTG and ICCMU to develop a proposal for a study (as          Care will be held at the Millennium Hotel,
                  part of the CTG point prevalence program) into               Queenstown from 5th to 7th August 2009. The
                  compliance with various processes of care in the ICU.        committee is currently seeking a convenor for this
                  The Committee is also collaborating with ACCCN               event.
                  Quality Advisory Panel (QAP) to develop a research
                                                                               The 2010 and 2011 Annual Scientific Meetings
                  proposal Understanding the Safety Culture in
                                                                               have been confirmed for Melbourne and Brisbane
                  Australian Intensive Care Units; Establishing a Baseline
                                                                               respectively.
                  for Quality Improvements.
                                                                               Peter Gray
                  Lastly, we will be looking for ANZICS members to have
                                                                               Conference and Events Manager
                  input into the Tracheostomy Statement over the next
                  few months.
                  Tony Burrell
                  Chair



10
Welcome to the following new members:
Jorge           Brieva           NSW    John Hunter Hospital
Kieran          Lennon           NZ     Dunedin Public Hospital
Violet          Ford             WA     Princess Hospital for Children
James           Walsham          QLD    Princess Alexandra Hospital/Qld Health
Subhasis        Talapatra        QLD    Queensland Health/Princess Alexandra Hospital
Casey           Nottage          SA     The Queen Elizabeth Hospital
Daniel          Magee            NSW    Liverpool Hospital
Mairead         Heaney           WA     Princess Margaret Hospital
Vishwanath      Biradar          SA     Royal Adelaide Hospital
Khaschayar      Saadat-Gilani    SA     Royal Adelaide Hospital
Simon           Iles             VIC    Royal Melbourne Hospital
Alan            Rashid           NSW    John Hunter Hospital
Gordon          Speed            NZ
Marc            Ziegenfuss       QLD    The Prince Charles Hospital – ICU
Gopal           Taori            VIC    Austin Hospital
James           Austin           NSW    Wagga Wagga Base Hospital
David           Rigg             TAS    Royal Hobart Hospital
Balaji          Bikshandi        NSW    The Tweed Hospital
Amanda          Connors          VIC    RMIT University
Raymond         Asimus           NSW    John Hunter Hospital
Carsten         Hermes           NZ     Dunedin Hospital
Andrew          Casamento        VIC    The Northern Hospital
Enda            O’Connor         QLD    The Prince Charles Hospital
Andreas         Faltlhauser      QLD    Robina Campus
Jayshree        Lavana           QLD    Queensland Health
Giri            Shankar          QLD    The Prince Charles Hospital
Nandan          Bhende           QLD    Royal Brisbane & Women’s Hospital
Cornelia        Mueller          QLD    Rockhampton Bas Hospital
Owen            Roodenburg       SA     Royal Adelaide Hospital
Liz             Steel            NSW    Royal North Shore Hospital
Ram             Sistla           TAS    Royal Hobart Hospital
Justin          Black            QLD    John Flynn Private Hospital
Lawrence        Caruana          QLD    The Prince Charles Hospital
Suzanne         Snookes          VIC
Manimozhi       Vellaichamy      QLD    Toowoomba Base Hospital
Godfrey         Lo               WA     Royal Perth Hospital
Joanne          Ritchie          NZ     Middlemore Hospital
Leo             Nunnink          QLD    Princess Alexandra Hospital
Carol           Hodgson          VIC    Alfred Hospital




                                                                                        11
ICM 2008 – ANZICS Intensive
   Care Medicine Course
          Care Medicine Course Focusing on the ICU Management of the Critically Ill
        Targeting Registrars & Fellows in ICU. A good update for practicing Intensivists
            and Beneficial for Emergency Medicine & Anaesthesiology Registrars.
                                    Australian & New Zealand
                                      Intensive Care Society
                                Practice & Economics Committee
                          Date: 18, 19 & 20 July 2008
            Venue: Box Hill Hospital, Melbourne, Australia
   Faculty: Prof. Bala Venkatesh, Prof. Rinaldo Bellomo, Prof John Myburgh, Prof Michael
   Grigg, A/Prof David Tuxen, Dr Andrew Davies, Dr Hayden Prime, Dr Angas Hamer;
   Dr Vin Pellegrino, A/Prof Stephen Bernard, A/Prof Paul Coughlin, Mr Malcolm Steel;
   Dr Charlie Corke; A/Prof John Botha; A/Prof Anthony Schwarer, A/Prof David Ernest
   and A/Prof Ramesh Nagappan. Course Conveners: Assoc. Prof. Ramesh Nagappan and
   Assoc. Prof. David Ernest.



Topics include: Inotropes; Head Injury Management Update, Strong Ion Difference, Pulmonary
Embolism, Aortic Aneurysm Management, Pace Makers – a Primer, Adrenal Function in Sepsis,
ECMO Basics, Therapeutic Hypothermia, Current Clinical Trials, Acute Renal Failure & Renal
Replacement Therapy; Asthma & COPD, Recruitment in ARDS, Bone Marrow Transplantation,
Colo-Rectal Surgical Issues in ICU, Sedation in ICU; Dysnatremia, JFICM Exam Preparation,
Critical Care Quiz, and more – (Attractive Prizes to be won at the Quiz).
                                                +
                      Acute Critical Event Simulation (Skill Stations)
Faculty: Dr Graeme Duke, Dr Helen Opdam, Dr Ann Whitfield, Dr Neil Orford, Dr Peter Cranswick,
     Dr Anthony Cross, Dr Vin Pellegrino, A/Prof Ramesh Nagappan, Prof. Bala Venkatesh.




               COST: Registrars & Fellows – AUD $ 660;
       Others: ANZICS Members – $ 700; Non-Members – $ 750


        Cost includes: All Sessions, Course Manual, Lunches and Coffee & Conference Dinner
                    *All prices include GST. A Receipt will be issued by ANZICS
           Registration & Payment: on-line via the ANZICS web site (www.anzics.com.au)
                Enquiries: Peter Gray, Conference & Events Manager at ANZICS on
                Tel (03) 9340 3493 & Fax (03) 9340 3499; peter.gray@anzics.com.au;
                           10, Ievers Terrace, Carlton, VIC 3053, Australia
                  Any further Information: Contact: A/Prof. Ramesh Nagappan
                Pager (03) 9387 1000 (RN or DE); Fax: (03) 98954909 or 98011754
        ramesh.nagappan@easternhealth.org.au ICM 2008 – Intensive Care Medicine Course
SCCM ad:1   8/5/08   1:54 PM   Page 1




       Asia Pacific Critical Care 2008 Congress

       PAST, PRESENT, FUTURE
       Celebration of Intensive Care
                                                                                 > 15th Congress Asian Pacific
                                                                                   Association of Critical Care Medicine
                                                                                 > 33rd Australian & New Zealand Annual
                                                                                   Scientific Meeting on Intensive Care
                                                                                 > 14th Australian & New Zealand
                                                                                   Paediatric & Neonatal Intensive Care
                                                                                   Conference
                                                                                 > 34th Australasian Society of Parenteral
                                                                                   and Enteral Nutrition (AuSPEN) ASM


       30 October - 2 November 2008
                                  Sydney Convention & Exhibition Centre,
                                  Darling Harbour, Australia
                                  Held in beautiful Darling Harbour, Sydney, there will be a range of international
                                  medical and nursing experts presenting: Adult Intensive Care, Paediatric
                                  Intensive Care, Neonatal Intensive Care, Parenteral/Enteral Nutrition.
                                  International speakers include:
                                  • Ken Boffard                                        For information contact:
                                  • Zavier Leverve                                     The Conference Team
                                  • Jean Louis Vincent                                 PO Box 164
                                  • Phil Dellinger                                     Carlton South VIC 3053
                                                                                       Email: info@intensivecareasm.com.au
                                                                                       Phone: (03) 9340 3435
                                  www.intensivecareasm.com.au


                                        ANZICS/ACCCN
                                        Intensive Care ASM
                                        Celebration of Intensive Care
                                        SYDNEY 2008
                       FREE!
        introductory     Australian & New Zealand
                            Intensive Care Society

     ANZICS membershipPractice & Economics Committee



            for all
       JFICM Trainees

 Enjoy one year’s complimentary
   membership with ANZICS.


                        Apply today!
The Australian & New Zealand Intensive Care Society (ANZICS) seeks
to promote the interests of our patients, the professional development
and interests of doctors who work in Intensive Care, and clinical
research in Intensive Care. Join today and reap the benefits!




                             www.anzics.com.au
                 PO Box 164, Carlton South VIC 3053 Australia
              Telephone: +61 3 9340 3400 Fax: +61 3 9340 3499

				
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