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It discusses what to look at when noticeable trends arise, e. The chapter also recommends the use of particular growth media, e. However, it does not give details on how it comes to such decisions. It suggests certain conditions may require microaerophilic monitoring, e. It also runs against past work in the industry on using settle plates for quantifying contamination deposition. It provides a snapshot in time and can be useful and informative, but it is not a sterility check — a point reiterated by other speakers.

USP reminds microbiologists that all monitoring methods are flawed and that one method cannot detect all types of contamination, said Sandle. For example, it says that air samples are particularly weak, surface methods have poor recovery rates, and all methods are poor at recovering damaged or stressed micro-organisms. Therefore, numerical targets in cfu should not be used as limits, but rather as targets — and low or zero counts are not, by themselves, guarantees of microbial control. Due to the inaccuracies of current EM methods, rather than simply counting cfu it is more important to count the incidence rates and investigate when data is out of trend.

Equally, excursions beyond numerical limits do not necessarily indicate loss of control. It suggests that due to the inaccuracies of current EM methods, rather than simply counting cfu it is more important to count the incidence rates and investigate when data is out of trend. Due to the limits of quantification technology, the chapter says the lowest number of cfu that can be reported accurately is five. Therefore, it suggests that if the count is below 15cfu and the trending is OK, then it is not a concern; however, if the count is above 15cfu investigation is necessary.

This is in relative conflict with current EU regulatory expectations where action would be expected for results over 4—10cfu, Sandle said. Sampling frequencies are also less rigorous than in the EU GMP, and the document says sampling locations should be based on careful observation of the cleanroom, with the most likely route for contamination being airborne. USP is strongly supportive of the use of rapid microbiological methods in EM but it does not elaborate on how these could be used. All references to validation, meanwhile, have been dropped from the chapter. In summary, Sandle said the chapter has some good points but it does clash with EU GMP in places and lacks schematic guidance, leaving much open to interpretation by the microbiologist.

Finally, the contamination rate concept is a significant departure from the alert and action level system used since the s. David Keen, Microbiology Manager at GlaxoSmithKline and Pharmig Chair, looked at a risk-based approach to EM and highlighted some of the traps that microbiologists and cleanroom operators can fall into. An EM programme is not a static thing; every time something changes in the production area — i. Keen reminded delegates that an EM programme is not a static thing; every time something changes in the production area — i. Each change carries a different risk.

The biggest risk to the process is humans, followed by water, differential pressures, production equipment and process flow. Keen looked at the rationale for choosing sampling locations. Incorrect techniques he has observed include:. Keen also looked at situations that can affect results, such as inconsistent depths of medium in settle plates that will dry out at different rates. His other tips included:. When looking at samples and trending, it helps to understand how big or small and therefore relevant each sample is, said Keen.

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Funktionen durchaus […]. Sharing delicate data can be quite a daunting job. Build on your emergency medicine knowledge by making the most of online resources. A great way to do this is to base your learning around cases you have seen. Much of what you learn will be useful in day to day practice. Consider volunteering on a local first aid or life support course — this is a great way to get experience in resuscitation skills and the care of the seriously ill or injured patient. As you prepare for Foundation Training, make sure you apply for a rotation that includes four months spent in an Emergency Department in your F2 year, and use your taster week in F1 if you can.

Let your supervisor know early on that you are considering Emergency Medicine as a career and they can help to make sure you make the most of your time. Emergency Departments provide plenty of opportunity for short audit or quality improvement projects for those who are enthusiastic, another great way to get involved and begin to build your portfolio. Full details for EMTA Your local Emergency Department could be a good place to start — let them know you are interested and see if there are any other opportunities to be involved.

Training in Emergency Medicine puts you at the frontline of medical care and enables you to develop the knowledge and skills you need to manage the breadth of acute presentations. During your training you will gain valuable experience working with a number of multidisciplinary teams in Emergency Medicine and other acute specialties. You will develop a wide range of clinical skills and competencies that you can put into action when needed. As you progress further through training you will be supported to develop leadership and managerial skills, such as coordinating patient care across the department and supervising more junior colleagues.

You will be encouraged to develop sub-specialty interests such as Paediatric Emergency Medicine, and given the opportunity to take time out of program to gain additional experience that will complement your training. This could involve anything from academic research, developing your skills as a clinical educator, or practising Humanitarian Medicine abroad. This provides a good opportunity to get a feel for working in an Emergency Department, and start learning how to assess patients and make decisions with close supervision.

This can easily be extended by out of programme time, sub-specialty training, or if you wish to work part time. This is designed for doctors who have already gained additional experience in Emergency Medicine or other specialties, with entry at ST3 level. These training pathways are described in more detail below. Of course, a career in Emergency Medicine is flexible, and many doctors follow a career path that includes time spent out of training or one that follows a different route altogether. A pdf download available here.

Most trainees will start with the ACCS core training programme. This broad experience in acute specialties equips you with the confidence and skills to manage the full spectrum of acutely ill and injured patients. The third year is focused on gaining further experience in Emergency Medicine, and spending six months training in Paediatric Emergency Medicine, in preparation for Higher Specialist Training. As you progress through training you will build an e-portfolio of your learning and achievements, supported by your educational and clinical supervisors.

Your e-portfolio enables you to demonstrate increasing levels of competency and will be reviewed regularly to ensure you are on track with your training. As a senior trainee, you will spend your time working in the Emergency Department, consolidating and finely tuning your clinical skills. You will put them to good use, delivering care to the most seriously unwell or injured patients as resuscitation or trauma team leader.

You will feel confident to approach any clinical scenario. You will learn how to safely supervise more junior members of the team, and work with the consultant to coordinate care on the shop-floor and provide senior review. At other times you will be the most senior doctor in the department with on-call consultant support. You will learn more about leading and managing the emergency care system, with dedicated leadership training and a management portfolio that you will build up through supported experience. You will work towards completing your final FRCEM exams, which bring together all of the knowledge, skills, competencies and expertise you have learnt during training, and are used to putting into action in your daily practice.

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