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And thanks Tim. I'd like to introduce Kevin Sang, who's a consultant, neurosurgeon and Clinical Lead for spine trauma at Imperial College, London based at Charing Cross Hospital. And he's going to talk to us about his cranial facial work and his formula one adventure afternoon, everyone. Thank you very much for inviting me along. I spent 2.5 years in Bristol training as a registrar. Um And a lot of what I do is very much to the idea you heard earlier in the morning about being adventurous. A lot of our previous speakers have talked about how are Bristol consultants are always very adventurous, trying new things. And I think I've taken that on board maybe a little bit too much because everything I do is very much adventurous and not quite what I was actually trained for. Uh um So, you know, I do some charity work in Vietnam from a cranial facial point of view, mainly based on the training I received from Mr Mike Carter, but also Mr Edwards and Mr Popo on the pediatric side. Um And then on the trauma side, I think that was mainly because when I was here nobody wanted to do any trauma. So I ended up seeing every head injury and I think that's how I developed that kind of interest. Um Just a little bit about Vietnam. So when I go to Vietnam, um we go once a year for a whole week and it's very much the MDT situation that we've been talking about, you know, it's collaborating with everybody. And actually the main reason for going to Vietnam is they don't have MDT working. And a lot of that partly is because they don't feel the need to, they feel like they can do everything themselves. Um But actually bigger part is the government. Um They're only allowed to charge the patient the same amount of money regardless of how many surgeons involved. So if a neurosurgeon came along and fixed someone's orbital fracture, as well as the cranioplasty, they would earn all of the money together. But if they ask the max fact surgeon came along, then they have to divide the money between the two of them. So therefore, there was no incentive to go and get other specialties in to work as a result. You end up seeing pretty poor outcome because you have neurosurgeons trying to fix the face and max back surgeons trying to do things to the brain. Um So, so a lot of what we're trying to do is put everything together. So we would arrive uh you know, on a Saturday morning, we start our clinic, usually about 100 and 50 patient's every half a day. Um And actually we do this joint clinic where you have ent max fax, oculoplastics, plastics, anesthesia. Um myself, all seeing patient's together, which actually is really quite interesting. It's really interesting to hear what everyone else is doing and what they're saying as well. We also deliver talks to the local surgeons. You know, ultimately, you're not trying to go and do all the operating for them. You're trying to make them, give them the resources to make their own decisions and do their own work. So one day we never have to return again because they're self sufficient. Um So that's what we're trying to do to be there with everyone else. Um um doing a little bit of teaching. Um And as you can see, we do joint operating with the local teams, which is quite fun. Um And some of the learning that I've had when I was in Vietnam is um very efficient. The extremely efficient you can get through four or five complex craniofacial cases within the day. And I think I love that we probably can't reproducing the UK. Um So one of the things they do is they have all the preoperative patient's lying on the trolley outside your operating theater while you're operating on the previous case. So there is absolutely no downtime between, you know, cases because you're not waiting for a porter, the patient's already there. They're awake but they're there. And um so you're in the operating theater, operating um and just very quickly. Um This is the recovery area. So this is also another reason why it's really quick. They think extra bait patient's in the theater. Once you finish putting in the last ditch, your patient's disconnected from the ventilator and they get pushed into recur and the recovery nurses will wake the patient up and extra beat the patient while you're anesthetic team is putting that patient outside of your operating room to sleep. So they're ready for your next operation. So there is literally a five minute downtime just in time for you to get some water and then your next cases ready to go. Um So, so they're very, very efficient. Um Just a few interesting cases we've done, I'm not going to go into them in detail. Um uh This is clearly a case with hypertelorism. Um The surgery we did was to try and bring the orbits back closer to the midline to mainly help with the vision. Um This is a patient with a very severe April syndrome. We see April syndrome in the UK, but hopefully very rarely to the extent that you're actually seeing what we call copper beating skull and you can see the impression of the gyre eye on the, on the scalp, which is obviously quite severe and significant. Um and another slightly less severe case of April syndrome um in this child that we did operate on one of the interesting thing about the operating. And this is where I learned a lot from Mr Sanderman, even though he's not a cranial facial surgeon as such is that the hospital can only afford about two syringe worth of propofol for your patient. So that's 100 meals of propofol. So when they run out, your patient is waking up, so you have to operate very, very, very quickly. And that's why I've learnt a lot from Mr Sanderman, so very useful. Um And um all sorts of other horrible cases coming that luckily we don't see too much of in the UK in the Sofia burns and things. And actually we're learn to love operating on the face and orbit as well. Um So that's in Vietnam and then at the other end of the spectrum uh formula one. So I also spend a week usually in November going to Abu Dhabi as a trauma surgeon for the FA A. Um And uh sometimes I get to see in the ambulance in the middle of the track. So I get to watch the race in front of me and praying that nobody crashes. So I can just sit in the air conditioned ambulance and not have to walk outside to a 45 degree trackside. Um uh But it is really good fun. Um You get to walk around the pit lane, you get to meet the drivers, the engineers, the natural engineers are really clever. They do some amazing simulation, which actually is something we should bring back from a training point of view. So after every race, the driver sits down with six or seven engineers, they all have a computer screen in front of them. It will be a video of their race but superimposed on it will be the computer simulation of what the perfect race should have been. So at every corner they can see where they've hit the brakes half a second too early, they started turning, you know, 0.1 of second, too early. And if they didn't do that, they could have, you know, had an extra half second, you know, lead time, etcetera. And you know, you could potentially apply the two surgical training, you know, you could have been more efficient with your movement or etcetera, etcetera if you did that if you did that. Um So lots of learning, of course, we don't have the same amount of uh resource as the FAA. So we don't have that money to apply. Um One of the things we do do a lot is a lot of simulation within the medical team in the FAA. So we have to learn about how to be how to extricate patient's from the car. If there's trapped in the car, we have to learn the trapped inside out. So we know where we're going. And obviously the central control team has a view of the whole race so they can tell us exactly where we need to go if there was a crash. Um, and this is a picture of me sitting in Lewis Hamilton's car as part of a simulation of how to extricate drivers. The reason I'm in the car is because no one else can fit into the car because the seat is moded to Lewis Hamilton's body shape. Um, although I have to say every year has been absolutely fine. Last November when they put me out, somebody said, Kevin, your bun is getting bigger. Uh uh At least I'm, I can still fit in there, so I'm quite happy with that. Um So lots of practice or you put the driver out how to handle the neck. One of the things I'm trying to work with the FAA on at the moment is about collars. They insist that we put a collar on the driver even in the upright position when we pull them out, just because there's a million people are more watching you and that people expect to see a collar on the neck is completely ridiculous. So we're trying to work on that to change that practice. Um And then obviously learning how to load patient's onto the helicopter once you've done your quick primary survey. Um You know, it all sounds very fancy and we have thoracotomy kit and everything on site, but there is no blood on site. So actually there is no point doing any kind of resuscitative surgery because you can't give blood. So, the best thing to do is just a quick A to e put, you have to Kanye Larry into the helicopter and off to go. You really don't want to be keeping any major injured drivers on the site. They really need to go to the nearest hospital ASAP. Um, this is one of the crash is that I did have to attend. Uh, this was actually the first time I went along in the, in the ambulance and I was told that, uh, crashes usually happen on the first lap when people are fighting for the position and then they tend to just follow each other for the next 20 odd lapse. Um, so I was responsible for turn 3 to 7 and as I can see the cost go past me and they've all gone. I thought I'm safe, I'd have to do any work today. And then from the radio, which was in Arabic, they suddenly became really excited and I couldn't understand a word and, but clearly something's happened and then from my own radio, my chief medical officer suddenly goes. Ambulance one go now, go now. And I thought, okay, that means they've crashed just before it turns seven. So it's our problem. So as we arrived, you could see this car that was upside down, but, you know, you've geared yourself up for it. You've got adrenaline running, you're already about to get off the ambulance think I'm doing some amazing job. And then the chief medical officer goes by the way. Caffeine, don't forget us about 50 million people watching you think, do anything stupid. And suddenly the adrenaline's disappeared. I don't want to leave this ambulance. Luckily it was all fine. All I did was help flip the car background checked over the driver and, and nothing happened. Um, so overall, you know, I think, um, it's really lovely doing all these things outside of the NHS because you get to meet lots of new people, you get to work together as a team and learn lots of things from various people. And ultimately, like it says, be adventurous, take on the opportunities in front of you and just enjoy your life. Really. That's the end of my talk.