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HKSEMS eNewsletter Issue 010
2019Jul

香港急症醫學會

Hong Kong Society
for Emergency Medicine & Surgery

HKSEMS continued to collaborate with HKCEM to sponsor the HK-Taiwan Young Fellows/Trainees Exchange Program. This was also the first year HKCEM sponsored two teams from Hong Kong to join the POCUS(Point-of-care ultrasound) Game in the Taiwan Society of Emergency Medicine annual conference. Please click here to read the visit reports by the participants.

The president of HKSEMS, Dr Ludwig Tsoi will talk about " Patient Confidentiality". Please click here for further reading.

The 11th Asian Conference on Emergency Mediicine (ACEM) will be held in Hong Kong from 17-19 December 2021! Please mark the dates on your calender !

Message from the President
From the Editors
Council News
Members Area
Medical Tips
Upcoming Events and Conferences

Message from the President Dr Ludwig Chun-Hing TSOI

Patient Confidentiality

Introduction
It has been an uneasy summer for Hong Kong. This year we witnessed some of the most unimaginable conflicts between the government and the citizens. The unrest has produced repercussions that affect not only

the commercial sector and government agencies, but also the operation of the hospital and emergency services. In particular, the issue of patient confidentiality has been brought to the news headlines after police making an arrest in a hospital. The topic is hot for a number of reasons: loss of trust between different agencies and the potential conflict between different parties.

Patient confidentiality
Healthcare workers have the obligation to protect the information our patients disclosed to us. However, will there be any circumstances that we may need to violate the principle of confidentiality? It is a serious question. To respect the confidentiality of patients is our professional call. The trust in the doctor-patient relationship will be weakened when the confidentiality of patient’s information is not adequately protected. Without trust, patients are less likely to share sensitive information to clinicians, and there is no guarantee the diagnosis and treatment thereafter will be accurate or meaningful.

If there is a request from the police to provide patients’ information, it may be confusing to many frontline workers. The essence is, it must be done according to the law. Medical and nursing staff must pay attention to the fact that the police do not have the right to patient’s information, nor do they have the right to obtain medical records by default. If it is necessary for the police need to obtain our patient’s record, a court order is needed.

Serious crime
The exception to the general principle of confidentiality is serious crime. Murder, manslaughter, rape, kidnapping and child abuse causing major harm will usually be regarded as serious crime. However, this is not a complete list. In situations where the doctor believes an ethical or legal exception to confidentiality exists, he would need to ask himself whether withholding the patient’s information will put another person at serious risk of major harm. If the answer is yes, then his decision to disclose the information to the law enforcement agent may be warranted. On the other hand, healthcare workers are not obliged to assist the police in finding or identifying people who are injured in a protest, and he should not assist in making an arrest unless there is a court order.

Lastly, I know that all the healthcare workers are upset during this chaotic period. As professionals, what we need to do is to abide by our professional principles. I would end my message with one sentence from Declaration of Geneva that is very relevant in this context, “I WILL RESPECT the secrets that are confided in me, even after the patient has died”.

Dr Ludwig TSOI

From the Editors Dr Chor-man Lo & Dr Sam Siu-ming Yang

Welcome to the new issue of our Newsletter.
The political atmosphere in Hong Kong has been tense in the past two months. This tense atmosphere had ubiquitous effects on all parts of our lives. It is understandable that variance in political stance exists, yet we need to maintain our

professionalism in treating every one of our patients. Impartiality, neutrality, patient privacy and confidentiality are duties we have to uphold when we are performing our job as a medical professional. Dr Tsoi, the President of our Society will elaborate this in his message.

In the past quarter of the year, we continued to support exchange activities between Mainland, Taiwan and Hong Kong. The 7^th Shenzhen Hong Kong EM Conference was held at Peking University Shenzhen Hospital recently this year. HK Taiwan Young Fellows/Trainees Exchange Trip was also successfully organized at end of June, under the support from both HKCEM and HKSEMS. It offered a valuable opportunity for our new generation of EM physicians to broaden their horizon.

Wish you enjoy this issue of Newsletter.

Council News

Dear Members,
Here comes the 2^nd issue of HKSEMS Newsletter in 2019
Let’s walk through the activities that have been conducted in the last 3 months!

The 7^th SZHK EM Conference

The 7^th SZHK EM Conference was held in the Peking University Shenzhen Hospital from 25/5/19 to 26/5/19. 21 speakers from Hong Kong speak and actively participate in the conference. This conference is a biennial event which has been organized for more than 10 years, in which HKSEMS and Shenzhen Medical Association take up the role as organizer alternatively. The next diet will be in 2021 and is planned to merge with our big event- ACEM 2021. Here are some exciting photos!

Exchange of souvenirs between 2 parties.

Opening Ceremony

Key Speakers for Day One

Key Speakers for Day Two

TSEM 2019

This is the second time that HKSEMS and HKCEM Young Fellow Chapter cooperate and support this exchange program. A group of 19 attended the exchange trip. The program included attending Annual Conference of Taiwan Society of Emergency Medicine and hospital visits.
On 29/6, which is the second day of the conference, we held the HK-Taiwan Young Fellows/Trainees Sharing Forum. Dr. Abraham Wai (HKU) and Dr. Jason Cheung (QEH) shared with Taiwan counterpart the sub-specialization of EM in HK and some views on the wellbeing and career planning of Emergency Physicians in Hong Kong.
Visits to the National Taiwan University Hospital and the Far Eastern Memorial Hospital were also fruitful which offered us eye-opening experience on the current development of EM in Taiwan. The whole program was both educational and exciting, please join us in 2021!!

Official program of 2019 Annual conference of TSEM.

TSEM conference

Conference Dinner.

HK-Taiwan sharing Forum

Impressive opening ceremony at the POCUS game

The team with the Best Costume in the competition.

The POCUS game team 1 from Hong Kong

The POCUS game team 2 from Hong Kong

Welcome new members ( and renewal to life members )

Membership	Name	Hopsital	Post
LF	So Lok Tsun Jerome	TKOH	Associate Consultant
OF	Chan Ching Yee	KWH	Resident
OF	Chan Ming Yin	PYNEH	Associate Consultant
OF	Chan Yuet Yan Fiona	TMH	Resident
OF	Chen Fuk Hoi	UCH	Resident
OF	Cheung Jason	QEH	Resident
OF	Hung Cheuk Lam Carolyn	PYNEH	Resident
OF	Lai Kwok Hung	TKOH	Medical officer
OF	Lam Ka Fung	PMH	Resident
OF	Lau Man Ting	UCH	Resident
OF	Leung Man Chee Ada	PMH	Resident
OF	Leung Tsz Hang	QEH	Medical officer
OF	Li Chun Kit	NLTH	Medical officer
OF	Lo Ka Kit	UCH	Resident
OF	Mak Hiu Yan Hilda	PYNEH	Resident
OF	So Chung Wai	TMH	Resident
OF	Tang Yuet Nog	TMH	Resident
OF	Wong Ion Wa	UCH	Resident
OF	Wong Lok Yu	QEH	Resident
OF	Wong Yu Chun	AHNH	Resident

Members Area

Taiwan Exchange trip 28-29 Jul 2019

Dr Cheung Koon Ho, Ralph
Consultant, PWH AED

We had chance to attend Annual Conference of Taiwan Society of Emergency Medicine, Health Information and Artificial Intelligence. The conference was held on 28-29 Jul 2019 in Taipei. In the conference, various aspects of emergency medicine with highlights on Artificial Intelligence (AI) were discussed by experts from different fields.

On second day of conference there came the POCUS game. POCUS refers to Point-of-care ultrasound. It is a summit of the conference. The POCUS game is a contest of emergency ultrasound knowledge and skills among residents of different hospitals. There are more than 40 teams from Taiwan A&E, two teams from Hong Kong A&E, and one from Macau A&E. First round of the game involved written exam of multiple-choice question. Second round involved testing of ultrasound psychomotor skills in different stations. Last round involved question and answer among finalist teams. Both the participants and spectators enjoyed the event very much. The spirit was high with impressive ultrasound educational value.

On 28 Jul, we visited two Accident and Emergency Departments in Taipei, namely National Taiwan University Hospital (NTUH), and Far Eastern Memorial Hospital. National Taiwan University Hospital is a most academically prestigious hospital in Taipei. Lots of patients attend NTUH A&E from different areas of Taiwan to seek medical care. The department is well equipped with imaging equipment, like ultrasound, computed tomography, and magnetic resonance imaging scans. A big challenge of NTUH remains admission access block. In average, patients may wait for 4-10 days before arriving at in-patient ward. Admission decision of A&E patients to different specialties needs to be confirmed by different specialties.

In Far Eastern Memorial Hospital, we were welcomed by the local A&E team with warm hospitality. Different practices, training and career pathway between Taiwan and Hong Kong emergency medicine were interchanged.
To conclude, this Taiwan exchange trip broadened our horizons and expanded our emergency medicine networking.

HK-Taiwan Young Fellows/Trainees Exchange Trip 2019

Dr Fiona YY Chan
Resident, TMH AED

This is my second time to attend the Annual Conference of Taiwan Society of Emergency Medicine (TSEM). Our exchange trip mainly consists of three parts: hospital visit, conference and POCUS competition.

This time, we visited the National Taiwan University Hospital (NTUH) and the Far Eastern Memorial Hospital.

73% of patients in NTUH Accident and Emergency (A&E) Department are cat 3 patients. The admission block situation at NTUH is still severe compared to last year. Patients have to wait for up to 6 days before they could be admitted as in-patient, and patients in wheelchairs have to wait up to 12 hours before they have a bed to lie on. On our day of visit, there were more than 130 patients who were supposed to be admitted to Medical but were stuck in the Observation Unit in A&E. We also visited the resuscitation room. They have a large electronic counter showing the current time and duration of treatment in the resuscitation room. They also have a large screen displaying the extension number of on-call specialists for convenience when one has to consult them urgently.

The Far Eastern Memorial Hospital has an average attendance of around 300 per day. They have currently 33 resident specialists and 12 resident trainees. 61% of the patients are cat 3 patients. Due to the relatively low attendance and adequate doctor manpower compared to Hong Kong, they are most likely able to see even cat 4 and 5 patients within 30 minutes.

Hospitals in Taipei are highly computerized and paperless. All the medical records and medication orders are all within computer systems. In Far Eastern Memorial Hospital, they even have an electronic booth for the public to search for patients attending the emergency department or who were already admitted to the hospital. The Chinese name (with the middle character hidden and bed number could be searched for using the system. If you do not wish your information to be disclosed during your stay, you can also request that the hospital hide your data from the public.

The TSEM conference lasted for two days.

On the first day, we enjoyed watching the public speaking performance. A lot can be learnt from other people’s clinical experience, including knowledge, and how to face challenges both during work and outside as an emergency physician. We have learnt that we should always review the patient when the patient is seen by another doctor. Apart from that, how to deal with patient’s complaints, and how to handle our own emotions is equally important as a doctor. From being a doctor, to being a patient or a patient’s relative, we can understand more and be a more empathetic doctor.

On the second day, we held the Third HK-Taiwan Young Fellows/Trainees Sharing Forum. We compared subspecialty development in Hong Kong and Taiwan. We also discussed emergency physician’s well-being and life-planning. We deeply understand that it is important to strike a balance between work and play. To conclude the sharing forum, a retired emergency physician gave us a take-home message: see your parents and family more often when they are still around and spend some time to do regular exercise to keep ourselves healthy.

This is the first year our trainees joined the POCUS competition. It consisted of 2 parts: 20 multiple-choice questions and 5 practical stations. The multiple-choice photo questions covered a wide range of topics including
echocardiogram, musculoskeletal and lung ultrasound. The practical stations were creative and interesting. They required high ultrasound skills and teamwork as well. One of the stations required participants to scan the lumbar region of a mannikin in order to obtain the question envelope from the mannikin and perform some tasks. Another required scanning and counting number of foreign bodies within a piece of raw pork. Although our teams did not get into the finals, we all enjoyed ourselves and gained ample experience.

The HK-Taiwan Exchange Trip

Dr Siu Wing Chun
Resident, KWH AED

The Hong Kong – Taiwan emergency medicine exchange trip is a special experience. This trip included visit to the two emergency departments in Taiwan. I was surprised by the challenges faced by Taiwan colleagues. The waiting time for admission is so long that emergency physicians in Taiwan are required to tackle different medical problems on their own. This situation is quite different from what we are experiencing in Hong Kong. Hopefully, healthcare system can improve through experience sharing.

Work life balance is also a very important topic for all physicians nowadays. As the workload and expectation from patients are increasing, every physician is facing increasing amount of stress. The exchange forum on the second day allows me to understand how the Taiwan colleagues relax themselves during leisure time. It is common to feel exhausted after everyday work and I think talking to others is a good way to express one’s feeling. This will certainly avoid accumulation of negative feelings.

Finally, joining the point of care ultrasound competition is a unique experience. This event gives an interesting way to learn more about the knowledge of ultrasound. Ultrasound is a useful tool in daily practice and this competition really broaden my horizon on the application of ultrasound to different clinical scenarios.

Taiwan Exchange trip Review

Dr So Kit Ying
Resident, QEH AED

This was my first overseas conference experience and the whole exchange trip was enjoyable and eye-opening. By participating in the symposium and seminars, we have learnt some new knowledge and technology in the field of Emergency Medicine. Taiwan physicians were doing their presentation in an energetic and animated way.

The visit to two local hospitals was very valuable, especially one was public and the other was private hospital and therefore we could get known to Taiwan Emergency Service in a more

comprehensive way. It provided a good chance for us to share and learn the difference regarding the health care system and resident training in the two places. Residents from the two local hospitals are very nice and friendly; we were able to appreciate the pros and cons of their system via asking them numerous questions. In my opinion, I quite appreciate the scope of training and system in Taiwan Emergency Medicine. Residents are allocated to many different subspecialties for clerkship during their training i.e. Paediatric, Radiology, Toxicology, ENT, etc, which I think it is very ideal and comprehensive, and can be very useful for our daily practice in AED, as we indeed commonly encounter cases other than Medical or Surgical. Residents in Taiwan usually work in pairs with Specialist rather than independently; I believe this is an effective way to learn if manpower allows. The training duration in Taiwan is shorter like 3.5 years, yet we can see they are all very competent.

Another main activity during the exchange trip was the POCUS (point of care ultrasound) game. It was interesting and challenging. Although we lost in the first round, the MCQs already used up our knowledge as the questions were quite difficult. The trainees in Taiwan were very capable and confident in doing ultrasound, and they were very passionate in joining the competition. Afterall, I was more motivated in learning and practising ultrasound.

It was a short trip with tight schedule, nevertheless we enjoyed a lot due to the enthusiasm of Taiwan people and good food. I would recommend fellow trainees to join in the future.

HK-Taiwan EM Young Fellows/Trainees Exchange Trip

Dr Wong Ching Yee
Resident, TMH AED

Taiwan is a popular travel location for many of Hong Kong people and it is famous for its inexpensive medical service. Yet, we seldom have chance to look into their medical system. This trip gave me an opportunity to look at that. Same as Hong Kong and other parts of the world, it is facing aging population and has a heavy medical burden. Patients may need to wait for days before admitted to ward and healthcare workers are having long working hours. However, what impressed me more is about workflow in their emergency department, for example they have a better utilization of the outpatient service that helps to reduce the workload in emergency department, and therefore it is very

impressing that their waiting time to see a doctor in emergency department is much shorter than that in Hong Kong.

Furthermore, I am happy that I had joined POCUS game, which is a very interesting yet challenging competition. They are so creative in holding the competition and make everyone enjoy the competition. It also helps me to learn more about the ultrasound, and hope in my future practice, although in busy working environment, I can still make good use of the ultrasound to help patients.

However, as limited time for our trip, we can only able to see a very small part of their system; I hope we can have further medical exchange to deepen the understanding of their system.

Reflection of TSEM & POCUS Game

Dr Kam Wai Kuen, Ricky
Resident, TSWH AED

Travelling and gaming with my colleagues enriched additional values into this overseas conference among my numerous Taiwan trips before. It is an once-in-a-lifetime experience for us to work as a team representing Hong Kong for this ultrasound event. Growing in increasing

importance, ultrasound has been a necessary point-of-care ‘gadget’ for an A&E Doctor. We are so sophisticated that how advanced Taiwanese medicine has become. We exchanged a lot of our practice, characteristics and difficulties among us. We enjoyed good tours and meals with Taiwanese Doctors.

I am so overwhelmed with how Taiwanese use A&E services wisely and reasonably that there was minimal proportion of categories 4&5 patients whereas there is >80% in my new hospital in Hong Kong. Our patients spent most of the time in the hall awaiting doctor’s consultation. On the contrary, Taiwanese patients lie on the bed for 6 days in the corridor with the other 150 patients before going to the ward. Perhaps this makes a Taiwanese A&E Doctor so efficient with fast and accurate assessment and managements.

Taiwanese Doctors are intrigued by our flying services in Hong Kong that they admire us being a doctor out of the walls. In fact, I look forwards to the opportunities being out of the walls, not only joining the rescue with the Hong Kong Government Flying Service, but also being a medical control office in different kinds of disasters, say, earthquakes and typhoon in Taiwan. Those make a doctor more like a frontline healer, instead of a passive patient-receiver.

Last two feelings were tiring and thankful. We attended 2 full days activities and learned as much as we could. Tired like a diligent student, we spent our rest of the days like travellers. Tiredness is that, we woke up on time, cherishing every single opportunity to enjoy this trip as much as a usual Taiwan travel with my dearest colleagues. I am really thankful to my colleagues asking me to share this memorable event with them.

Medical Tips

ECG lead placement

12-lead ECG

A 12-lead ECG requires the placement of 10 electrodes

( Four electrodes on all four limbs (RA, LL, LA, RL) and six electrodes on precordium (V1–V6) )

The leads can be grouped to allow interpretation of specific areas of the heart
- Inferior (II, III, aVF)
- Lateral (I, aVL, V5, V6)
- Anterior (V1–4)

Right sided ECG electrode placement

A right sided chest lead is used to diagnose right ventricular infarct when inferior myocardial infarction is present
It can be performed by placing leads V1-6 in a mirror-image position on the right side of the chest.
Alternatively, it can be simpler to leave V1 and V2 in their usual positions and just transfer leads V3-6 to the right side of the chest (i.e. V3R to V6R).
ST elevation in V4R has a sensitivity of 88%, specificity of 78% and diagnostic accuracy of 83% in the diagnosis of right ventricular myocardial infarction.

Posterior leads

Posterior leads are used to diagnose posterior myocardial infarction when there are suspected changes in V1-3
Leads V7-9 are placed on the posterior chest wall along the posterior horizontal plane as V6 in the following positions:

V7 – Left posterior axillary line
V8 – Tip of the left scapula
V9 – Left paraspinal region

Upcoming Events and Conferences

The HKSEMS offers sponsorship for the following programs, please contact us if you are interested.

Training program in Trail Running 2019

Scientific Symposium on Emergency Medicine 2019

Emirates Society of Emergency Medicine Conference

Asian Conference on Emergency Medicine (ACEM) 2021

The 11^th ACEM organized by HKSEMS will be held on 17^th to 19^th December 2021. Please save the date, and see you on this big day!!

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