Max Marsden
@MaxMarsden83
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General Surgeon | Trauma | Academic Dept of Military Surgery & Trauma / Centre for Trauma Sciences | Decision Making BNs Views my own, not those of my employer
London
Joined January 2013
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Pinned Tweet
Brilliant to work with Will Oakley on this project!
Our now-published systematic review highlights the potential of ML in predicting blood transfusion after injury.
🩸💡
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Arrival of the new baby has been welcomed by all, except this guy. This guy is furious.
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A note on kindness and medicine.
The best doctors I’ve met are exceptional for their kindness first. Competence second.
Today I witnessed the most awful arrogance of a doctor being rude to a member of staff.
Be kind to each other.
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After 22 years since stepping into medical school, I'm ecstatic to announce I've completed my surgical training!
So grateful for the inspiration and support along the way, especially from the late Mr. Prakash Sinha,
@nigeltai
and Richard Hargrove.
Now to do something with it!
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Now, I know I’m a bit biased but I just bumped into a group of Soldiers sent to support the NHS in the hospital corridor. Their attitude is superb. Keen, cheerful and happy to help. And dare I say it, needed.
@DMS_MilMed
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Very excited to be recognised at this level thank you so much. The researh was a huge team effort
@NaTRIC_Research
and
@tela_natric
with >100 collaborators. But I, personally could not have contributed in such a way without the time and funding from
@BritishArmy
thank you.
Major Max Marsden RAMC has won the American College of Surgeons’ Committee on Trauma’s 44th Annual Resident’s Research Prize for ‘best clinical research paper’ for his work Trauma Laparotomy in the UK. It is a wonderful achievement for a non-US based surgeon to scoop this prize.
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Pascal can barely contain his excitement that the first draft of the PhD is nearly finished.
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🧵 How do you decide which trauma patient needs a blood transfusion? Seems straight forward? That’s the question we put to 10 expert pre-hospital care doctors. The answers were fascinating. 1/7
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Fancy doing a PhD in trauma & combat care?
There are 2 *funded* PhDs
@CommsC4TS
, with
@nigeltai
and
@ZBPerkins
.
Working on the development and application of machine learning.
It's open to all doctors post FY2 + postgrad exam with interest in trauma.
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Just delighted for Professor Tai. He is so modest and fully deserving of every accolade. An awesome surgeon, educator and researcher. Brilliant news.
@DMS_MilMed
Many congratulations to my friend and colleague Colonel Nigel Tai on his appointment to Chair at Barts and the London School of Medicine & Dentistry, Queen Mary University of London. Congratulations Professor Tai!
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GoodSAM first-responder app associated with increased survival after out-of-hospital cardiac arrest
-turns notifications back on…
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This was an awesome experience. Great honour to fly the flag for
@NaTRIC_Research
and hugely grateful to the RCS and the
@tela_natric
collaborators for the opportunity.
Please come and join us for the next trauma studies being launched shortly... open to all
RCS England Member,
@MaxMarsden83
is the first UK winner of
@AmCollSurgeons
Residents Trauma Papers Competition. Max tells us about his research,
@NaTRIC_Research
, and the competition in our new blog:
Feeling inspired? Applications are open for 2022!
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We looked at everyone that got TXA after injury in London and Nottingham. The patients who got TXA before they arrived in hospital had half the interval from injury to drug than those that waited to hospital admission. Earlier means more beneficial. 1/2
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After all isn’t kindness and compassion what inspired us into healthcare?
You can make someone feel better about themselves with simple kindness and manners.
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Is it possible to accurately predict if a patient has trauma induced coagulopathy within their first 10 minutes in the Emergency Department?
No
172
Yes
231
Show me the evidence
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Great competition
@ACSTrauma
last night. The win was just so unexpected. I couldn’t be prouder of our team effort. So many colleagues and friends forming
@tela_natric
and
@NaTRIC_Research
made this happen 🙏
Impossible without brilliant mentorship
@CommsC4TS
More to come...
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In Sweden 🇸🇪 for the
#evtm
meeting with
@DrPaulRees
and
@EMDocJB
.
Great society motto “No Ego, just good science”
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1/2 Just recruited the 1st participant into "EmPHATTIC". This study compares a
#MachineLearning
algorithm with clinicians. The aim is to assess the potential to augment decisions in pre-hospital trauma. Very grateful for the support of
@LDNairamb
and
@airambulancekss
...
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Our paper on the need to study fibrinogen replacement in trauma patients, and the evidence base behind choosing cryoprecipitate for the Cryostat-2 trial is in print in the BJA this month. Here's a link to the full paper.
@rossdavenport
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How should we approach REBOA now?
Especially, in the UK after the UK-REBOA Trial?
We discuss this question and our opinion on the role of REBOA in resuscitation after injury in this publication 1/3
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I have so much admiration for the job
@TheParachuteReg
are doing in Kabul. A dreadful situation.
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Delighted to present some research on pre-hospital decision making today at the military PHEC conference / Webinar
#MPHECconf20
Some brilliant speakers lined up.
Amazing, 270 delegates logged in by 0845, number keeps going up and up!
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When I first saw this I thought it was very cool. But having just had this next bit pointed out by the incredibly inspirational
@NottFoundation
I now think it’s very very cool.
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Today I’m in Milan 🇮🇹 at Niguarda Hospital, talking about prehospital
#REBOA
on behalf of
@robbielendrum
,
@SamySadek8
and
@LDNairamb
. Delighted to be able to share their success, challenges and future research direction.
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"It appears that the best way to improve outcomes in bleeding trauma patients is to stop bleeding earlier, resuscitate them with blood products “while” moving rapidly to the hospital."
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Trauma Gurus - if you FAST - is the interpretation binary?
Or, if it’s positive do you estimate the volume of intra-peritoneal blood?
@ZBPerkins
@janjansenuk
@dbootland
@traumakhan
@docmartin22
@TopKniFe_B
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@TessaRDavis
1) be kind & courteous
2) when you’re important - be kind & courteous
3) when you’re stressed - be kind & be courteous
Never belittle others.
Remember there’s almost always a patient at the centre of what you’re doing.
From a trainee in his (late) 30s.
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Well done
@Paulvulliamy
for recruiting the first UK REBOA trial patient!! Huge amount of work to get to this point.
@CommsC4TS
@EmCareandTrauma
@robbielendrum
@janjansenuk
@karimbrohi
@SamySadek8
#UKREBOATRIAL
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At the future surgery conference
#fs21
listening to Ross Fisher discuss Kintsugi - the Japanese art of repairing broken pottery with Gold. How to rebuild after medical error. So many great ideas - errors are ubiquitous and not indicative. Bottom line - look after each other.
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I’m absolutely blown away by this review from
@stemlyns
As a long time fan of the site it’s unbelievable to see our work discussed so enthusiastically. Hugely grateful.
#DecisionMaking
Ever thought that decisons about blood transfusion are complicated? You're not alone! Great work here from
@MaxMarsden83
@airambulancekss
@LDNairamb
@JWohlgemut
@ZBPerkins
@nigeltai
@drrichardlyon
@GilliesKatie
@LeechCaroline
@gareth_grier
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@rossdavenport
@tela_natric
@NaTRIC_Research
@CommsC4TS
@NELANews
Here’s to collaborative trauma research in the UK 💪
There’s been ups and downs but this is brilliant.
Massive thanks to
@Paulvulliamy
@richcarden
@drnnajiuba
@karimbrohi
@rossdavenport
and
@nigeltai
and all the NaTRIC collaborators.
You made this.
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Really looking forward to discussing the foundations of decision support this morning at the UK’s Major Haemorrhage Meeting.
And thrilled to see, after a very long time of listening, our paper has been covered by the excellent resusroom podcast. Highly recommended!
March ‘24 Papers Podcast
•Manual vs mechanical ventilation in cardiac arrest, an RCT
•CSF drainage in aneurysmal SAH, an RCT
•Decision making in prehospital trauma & blood administration
#FOAMed
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My interview study of expert pre-hospital clinicians in the key decision points in blood transfusion and trauma induced coagulopathy is nearly done. Thanks to the kind experts at
@airambulancekss
&
@IofPHC
for answering all my questions.
@CommsC4TS
This is my favourite extract.
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Amazing opportunity. Another brilliant meeting. Fascinating studies presented with outrageous depth and breadth.
Twice in a week! Time to get
@MaxMarsden83
talking about something other than REBOA 😱
“5 years work in 7 minutes”
#RSMColt21
@karimbrohi
@LDNairamb
@airambulancekss
@nigeltai
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As a collaboration of computer scientists and trauma clinicians, we developed a model to see how accurately we could predict coagulopathy. The results have just been published in the
@AnnalsofSurgery
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I’ve had a great time at
#mhsrs
; huge amount to learn and think about after the conference. Really enjoyed presenting our
@LDNairamb
&
@robbielendrum
REBOA paper. Thanks to
@DMS_MilMed
for sending me and
@CommsC4TS
for the opportunity.
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We've recently been looking at the provision of regional anaesthesia for rib fractures in our trauma unit.
How are you doing it? ... a🧵 (of questions)
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Well this made my day 🤓🥳
This might just be one of my most favourite lectures in the world…
@TraumaMasters
@MaxMarsden83
#tech
#trauma
#AI
#machinelearning
@RLHPED
@TraumaEMC
@London_Trauma
@WatfordED
The future is here…
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Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective. Just published: . TL,DR: No improvement with damage control laparotomy in military or civilian hypotensive trauma patients overtime.
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delighted with the progress this study is making. *Huge* effort from all over the country. Thank you to the Major trauma centres and Trauma Units in 🏴, 🏴, 🏴 and 🇮🇪 all smashing it.
@karimbrohi
@rossdavenport
@NavySurgeon
@douglas_bowley
@nigeltai
@traumakhan
@richcarden
47 patients entered in the first month of TELA. This is a fantastic start, especially considering January is traditionally a quieter month! If we continue at this rate we will have a really meaningful oversight of DCR in the UK. Thank you everyone involved!!!
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Busy and really rewarding week in the hospital capped off today by
@DocPads
flying in a patient and in doing so demonstrating what an awesome Dr he is. Absolutely first class pre-hospital care. Couldn’t help but snap the selfie.
#teamarmy
@DMS_MilMed
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We made a thing.
With a very patient Prof Jansen.
@janjansenuk
We discussed the UK REBOA Trial. 🎈
🎙️ 20 min podcast 🎙️
Would be great to get your thoughts 💭
Should we make more?
Happy 2024! 🎉 Let's make this year fantastic. Kicking off
#MondayUpdate
on a high note,
@Asgbi_ma
is thrilled to release our first
#Surgeon2Resus
podcast, featuring an insightful interview with
@janjansenuk
on the
#REBOA
trial.
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Massive thanks to all the trauma speakers today who gave up their time to prepare candidates for the FRCS exam. 4 brilliant talks.
@KateHancorn
@duncanbew
@phillpearce
Management of neck stabbing, essential trauma training at ASGBI MA
#EGSweekend
in Birmingham. Bet you want to come next year
@KateHancorn
@TheTraumaSurg
@MaxMarsden83
@ASGBI_MA
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@ZBPerkins
delivered an incredible analysis of >600 pre-hospital thoracotomies from London’s Air Ambulance
#LTC2022
Time is key and differentiate between cause of TCA. Exsanguination v poor outcomes. ECG and organised cardiac active key to prognostication
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Huge thanks to
@kssairambulance
yesterday for having me along as ‘Clinton’. Really looking forward to our AI prehospital care research
#EmPHATTIC_trial
. Shameless cheesy fots ensue.
@andrewalrais
@themattmak
@drrichardlyon
@CommsC4TS
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Here’s a link to our paper about
@LDNairamb
experience with prehospital REBOA. Written by the highly experienced
@robbielendrum
@ZBPerkins
@manikchana
@gareth_grier
and
@SamySadek8
TL;DR: associated with survival in the right patient
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A couple of big announcements in our house over the last few days. First of two - Sylvia (aged 4) made her first sculpture. Imagined out of snow - we present her rabbits Paxton and Pibberly
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Really excited for this. Thanks
@drjenross
for the invite. Some great thinkers gave me their time to put this together
@docdgn
@gareth_grier
@drrichardlyon
@dbootland
@AnnielondonAA
@robbielendrum
@GilliesKatie
@RBagga95
@DrJuliaWilliams
@101dnarg
@ZBPerkins
@nigeltai
@_thenoise
THIS WEEK!!!!
Excitingly, we have Max Marsden (
@MaxMarsden83
) talking about:-
'Decision Making in the Bleeding Patient - a Study of Pre-Hospital Experts'
Definitely one not to miss!
Thursday, 12.30pm.
Link below:-
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I’m in Newcastle at the Collaborative of Collaboratives meeting
@NRCM2019
presenting the early findings from
@tela_natric
and
@NaTRIC_Research
progress so far.
Amazing testament to the huge amount of work from *all* the collaborators.
@rossdavenport
@richcarden
@Paulvulliamy
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Tower bridge enforcing 5 minutes of reflection on impatient london commuters for nearly 150 years.
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Reflections at 1am.
Surgery is hard work but is there anything more rewarding when it goes well?
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Thank you
@ICSMSurgicalSoc
a real privilege to share the virtual stage with such an amazing group of trauma thought leaders.
Sad to miss the in person interactions this year. Looking forward to the next opportunity.
A fantastic talk about early haemorrhage control and his experiences as a junior doctor with the British Army in Afghanistan by Major
@MaxMarsden83
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Very smart scheduling at
#evtm
first session on day 2 - playing all the big hits - permissive hypotension, big C before A, and pre-hospital strategy. (Oh and TXA!!) Definitely worth getting out of bed for!
@traumakhan
@ResusOne
@talherer
@CarlosYanezCiru
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@theblitzdefence
Halfpenny is beaten for the ball by the skill of the player in the air. He changes from trying to catch the ball to taking the player in the air. Penalty. No issue for me.
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If you wanted to see how this model works for yourself the model is available to use at . We believe that prediction coagulopathy risk quantification will support early, accurate, and efficient activation of haemostatic resuscitation protocols.
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@TopKniFe_B
Don’t stay and play if the surgeon is in the same building. Sure, I think that’s clear from the UK REBOA trial.
If you’re bleeding to death outside the hospital, >x time from the OR, I don’t think the trial says scoop and run. I think that’s a different trial.
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REBOA in the military.
Different context.
Different outcomes?
My view: It’s an option.
And with options you can make decisions.
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6 months ago NaTRIC didn’t exist. Now, due to an amazing Collaborative effort, we have all 23 MTCs in England signed up and lots more centre across England, Wales and Scotland. Nearly 100 collaborators. 💪💪
@karimbrohi
@rossdavenport
@richcarden
Thanks for the amazing response from RVI in Newcastle and James Cook in Middlesborough....we now have all MTCs in the UK signed up! Legends!
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Our model is a Bayesian Network which fuses knowledge about the causes of trauma induced coagulopathy with data from 600 trauma patients. These patients were all recruited into the
@CommsC4TS
#acit
study.
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At an in person surgical conference!
#augis2021
Belfast
Listening to a presentation on leadership from
@AdmTonyRadakin
Key point for me - leadership requires a human connection
Mission command is useful and taking a genuine interest in others is vital. Sense of humour helps!
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A good friend just got some shitty news. Reminded me of this. Push on and don’t sweat the small stuff. Ramblings on a Wednesday.
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Amazing role model. Hugely deserved. So so pleased.
We are incredibly proud to announce that Mary Seacole Trust Ambassador Martin Griffiths,consultant trauma & vascular surgeon at Barts Health NHS Trust & national clinical director for violence reduction for NHS England,has been awarded a CBE
#QueensBirthdayHonours
@martinpgriff
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With
@LDNairamb
@nigeltai
@richcarden
@BartsC4TS
@Tomkonig
@CommsC4TS
@AnnielondonAA
discussing TXA on the roof. Great morning.
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In situ training at
@RoyalLondonHosp
this afternoon. Working through getting the sickest patients, the right treatment, as effectively as possible. Huge thanks to the
@Ldn_Ambulance
guys that came to help out on their break.
1
6
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@rossdavenport
kicks off the
@NaTRIC_Research
meeting today. NaTRIC exists to push forward the boundaries of collaborative trauma research in the UK.
Really exciting day lined up.
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6
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Two survivors following prehospital Blunt thoracotomy in the UK (1 recent patient not included in this paper). So should we continue advocate its use? Difficult dilemmas? Is courageous restraint needed? Should everyone “get a chance”?
6
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Loved talking to the
@tscipp
crowd tonight at
@QMULBartsTheLon
. So impressed with the enthusiasm and questions. Thank you! Can’t wait to see you guys contributing to the program. Who’s going to run
#EmPHATTIC
-2?
@nigeltai
Next up we have
@MaxMarsden83
talking about Artificial Intelligence in Trauma Care
#TraumaLates
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Amazing news!! Brilliant appointment - unbelievably knowledgeable, personable and so so helpful to us newbies learning the ropes. Congratulations Prof Elaine 👏🥳
Our amazing Elaine Cole (
@TraumaEMC
) has just been promoted to full Professor at the Faculty of Medicine & Dentistry at Queen Mary University of London
@QMULBartsTheLon
@QMUL
.
All delighted here at the Centre for Trauma Sciences
@CommsC4TS
@TraumaMasters
. Congrats Professor!
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Siri, show me a successful military-civilian trainee led research collaborative publication.
Here’s the link again:
Thanks to
@MaxMarsden83
@tucker_harriet
@smitchinson1
@Matt_Wordsworth
@dbootland
@MilitaryH_BMJ
@Tomkonig
@RobearPierre
@phillpearce
@ArmyPHEMGP
and many others
Let’s work together again soon!
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We are very grateful for the support and funding from the Military-
@DMS_MilMed
@DMS_DG
@DMSResearch
. The authors
@ZBPerkins
,
@RIM_QMUL
,
@nigeltai
,
@rossdavenport
,
@karimbrohi
and I would welcome any observations as we go on developing this work in the future.
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Demonstrating potential of REBOA tonight to my military seniors. My understanding of
#REBOA
- conceived w US military
@usairforce
and developed w
@prytimemedical
. Implemented prehospital w
@LDNairamb
. Where I’ve learnt the huge potential of it. 1/2
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Today’s medical verb - “Safety Net”. Usage - yeah he was safety netted to come back in.
Joins NEWS-ing as horrible uses of the English language?
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This is important: The peak time to death after severe truncal injury is within 30 minutes of injury. However ... it currently takes 2.1 hours to achieve definitive truncal hemorrhage control.
@RLHTraumaTREATS
@EMDocJB
@DavidNNaumann
@richcarden
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Sometimes you have to get a different view to fully appreciate what’s in front of you.
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Great session on decision making from
@CommsC4TS
PhD researchers
@JWohlgemut
and
@BeccaSarahS
and Senior ED sister
@NikkiDavies22
on the
#PEER
course.
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Further analysis from PAMPer suggests pre-hospital transfusion of PRBCs and Plasma improves mortality from trauma. *Crystalloid only* increases risk of death.
Demonstration of the potential benefits of prehospital whole blood
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London’s Air Ambulance takes a step forward in prehospital blood transfusion from today. Towards whole blood...
Our charity is launching a pioneering new trial that will enable our service to save more lives. From today, we will carry both red cells and plasma in a single bag to give transfusions to patients at risk of bleeding to death before they reach hospital:
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01/01/2019
Let’s do this. For more information or to register to become a contributor email telastudy
@outlook
.com.
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Received this today. Thank you. Especially poignant before Remembrance Sunday.
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I’d go further and ban all pie charts with more than 2 groups.
A few notes on data presentation later, but for now, NO 3D PIE CHARTS WHAT IS WRONG WITH YOU?
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With experts like
@SamySadek8
@robbielendrum
@ClairePark01
and
@janjansenuk
. Now coming full circle to be trialed with
@DMS_MilMed
by
@JHubMED_Defence
driven by
@DrPaulRees
and
@nigeltai
. So many driven people. Amazing to play a v small part. Hoping for real patient benefit 2/2
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Great to get the message out there. Lots and lots of people made this study happen. Thank you all. Just some -
@Paulvulliamy
,
@ZBPerkins
@davidnnaumann
@traumakhan
@doctorwibble
@traumakhan
@NavySurgeon
@SomayyehM
@bengriffiths73
@duncanbew
@Anthony_Thav
@MarkWinstanley4
@rossdavenport
successfully dispelling the myths surrounding trauma laparotomy and presenting the work of
@tela_natric
@NaTRIC_Research
trainee led collaborative
#strongwork
@LDN_TC
@MaxMarsden83
@richcarden
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@karimbrohi
@nigeltai
@CommsC4TS
Well this is an amazing set of messages to come out of work to! Thank you 🙏
... and phew...
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Interesting day in theatre today. First time for me using
#ICG
through
@Medtronic
EleVision system with
@ThahaMo
. A system to assess blood flow. Beautiful laparoscopic images.
Does it change decision making though…?
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Very excited to announce our next meeting. Please do come and join us. Open to all.
Excited to announce this FREE multi-disciplinary in-person springboard event on 15th March 2022 to launch the next national collaborations in trauma research, and pitch new ideas!
@CommsC4TS
#trauma
#research
#collaboration
Register here:
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Thanks Matt. We agree.
@staceyjwebster
working on the data some more. With the surgical team too. There’s so much to this.
@edbarn
@DefProfEM
@docwrightyuk
@davidnnaumann
@douglas_bowley
@MaxMarsden83
& colleagues' UK
@MilitaryH_BMJ
study, echoing the results of
@beastridge22
et al
BLUF - most deaths are prehospital, so this is the critical location to intervene.
@TacTrauma
@UKTacMed
@ATMA_Tactical
@SpecOpsMedics
@MCGOpMed
#FOAMed
#FOAMems
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Three things to avoid on the phone when you need help:
1) generalisations (I’ve always done it this way…)
2) orders (you need to do this now…)
3) exaggerations (they’re dying…)
Sure fire ways to get the conversation off to a bad start.
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Personnel Could Have Life-Saving Blood Loss Prevention Technology By 2021
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