[00:00:00] Dr Sanjaya Senanayake: Hi, this is Dr Sanjaya. Emergency departments are big, bright and buzzing parts of a hospital. It is an environment that my latest Behind the Curtain guest, Dr Alison Lally, knows very well, having worked in emergency medicine in the United States and now in Canberra. Alison is a strong advocate for neurodivergent patients, and she spoke about the strategies and tools she and her colleagues use to support these patients in the ED.

[00:00:33] Dr Sanjaya Senanayake: Let's jump into our chat.

[00:00:33] Dr Sanjaya Senanayake: Welcome to today's Behind the Curtain podcast. We have another very special guest from Canberra Health Services. Gracing us with her presence is Dr Alison Lally, who is an emergency physician and Deputy Director of the Emergency Department at Canberra Hospital. Welcome, Alison.

[00:01:03] Alison Lally: Thank you for having me. I'm very excited to be here.

[00:01:05] Dr Sanjaya Senanayake: Oh, look, no problem. Alison, we did talk about this. You can't be called Allie, and can you explain the reason why?

[00:01:12] Alison Lally: Cause there's another Allie in the department who took the name first. And it suits her really well. So she's Allie at work and I'm Allie at home.

[00:01:20] Dr Sanjaya Senanayake: Okay. Okay. So potential tension there, but sorted out.

[00:01:25] Alison Lally: No tension. No tension at all.

[00:01:26] Dr Sanjaya Senanayake: Oh really?

[00:01:27] Alison Lally: Yeah. No.

[00:01:28] Dr Sanjaya Senanayake: I want to make it exciting for the podcast.

[00:01:30] Alison Lally: No.

[00:01:31] Dr Sanjaya Senanayake: Okay.

[00:01:32] Alison Lally: We've got lots of Alisons and Allie’s in the department. So, it's an awesome name.

[00:01:35] Dr Sanjaya Senanayake: Okay. Wonderful. So, Alison, you're an emergency physician. You obviously decided to take that at some point in your medical career, where did you do medicine?

[00:01:46] Alison Lally: I actually did medicine here at ANU. I was one of the third year through so it was all very new and it's almost a bit of nostalgia now when you see all these new medical students starting at ANU. So that was many years ago and I finished my training here. I did intern and resident year here. Halfway through my SRMO, well third year out, I went to America and worked as an emergency physician there in a residency program.

[00:02:15] Alison Lally: And there was a turning point when I was over there where I just realised I want to come back to Australia. There were a few massacres that happened, not to turn all doom and gloom straight away. But it was a major trauma. So, lots of gunshot wounds, we were in Western Massachusetts.

[00:02:33] Alison Lally: And I just reached a stage where I was just like, no, I can't do this anymore. I can't think about having family or having my further life here. So, I did make that tough decision to leave a residency program early, which I know a lot of people kind of go, why? But it was more for a life purpose.

[00:02:50] Dr Sanjaya Senanayake: Yeah.

[00:02:51] Alison Lally: Life reason. I came back and worked in Brisbane for a number of years, continued my training there, and then life had it that I came back to Canberra. I reached out to the team here and said, ‘will you have me back?’ And they said, yes. So, I finished my training here and I've been a consultant now for four years.

[00:03:07] Dr Sanjaya Senanayake: Yeah, look, obviously you've mentioned the gunshot trauma in the US. Apart from that, was it very different working in the US?

[00:03:18] Alison Lally: It was very different. It was really different. Their residency is much shorter, but really long hours. You know, I think the Australian way is much better and not just because I'm Australian and I've done the Australian way.

[00:03:33] Alison Lally: There's no such thing as wasted clinical years in your training, and so for anyone who's in the middle of their training and they think they've done a year or two wasted as, for example, unaccredited registrar or moving somewhere else because they don't know what they want to do, I think every year you learn so much, and that's a great thing about emergency or just medicine in general.

[00:03:50] Alison Lally: So, I did take a lot longer to get through my training than others. But it was a really good experience. They're also, at that time, a lot more progressive than us here in Australia. So, it was pretty amazing where I fell in love with the ultrasound. They were really passionate about ultrasound back in 2012. And I feel like we're really lagging behind on that.

[00:04:09] Alison Lally: Electronic medical records over there were so well integrated and that was 12 years ago. We’ve introduced that about 18 months ago. So, some of it was amazing. Some of it is certainly a different relationship than what we're used to here in Australia. I found a lot of over investigating, a lot of admissions. And, at times, down the track, I think it might be at the risk of the patient probably getting over investigated. And the role of admitting everyone, not appropriate for all patients to be admitted to the hospital.

[00:04:44] Dr Sanjaya Senanayake: And I think part of that over investigation is related to the whole medical legal background there, isn't it?

[00:04:49] Alison Lally: Yes. Yes. And there is a lot of medical legal things. So, they really have no risk stratify. Here we do a lot more of our risk stratifying, not over investigating and CT scanning everyone because that down the track has really adverse outcomes to the patient. So very different.

[00:05:08] Alison Lally: We got very good at documenting over there. And it was a really great experience. Really wonderful doctors over there, wonderful patients. And I just thought it was such a diverse patient population there because there were a lot of poor people in the state of Massachusetts at that time.

[00:05:23] Alison Lally: It was the Romney Care, so everyone got cover. So, we saw everyone, no one was not treated based on their health insurance, which was really good. So, I didn't see that other side of America. But the medicine and the teaching, very structured programs, but very short. And I think that we've got a good balance here.

[00:05:42] Alison Lally: You get a bit of everything first.

[00:05:43] Dr Sanjaya Senanayake: Yeah, my understanding of the U.S. system is that you finish medical school and you sort of have to decide then and there I'm going to be a surgeon or an emergency physician or a dermatologist or whatever and you just enter a training program and after a relatively short training program, you're it.

[00:06:03] Dr Sanjaya Senanayake: And I do agree with you. I think having that more holistic approach experience doing some weeks in emergency, some months in emergency on a medical term, on a surgical term just helps.

[00:06:14] Alison Lally: I definitely think the first two years is really important. You become a more grounded doctor because you've got more experience.

[00:06:19] Alison Lally: You also know how other things work. So, it gives you that insight as to what it's like on the ward. You're not going straight into emergency, and it is only three years. And so, one of the other downsides about emergency over there is that the physicians or the attendings consultants, what we call here, do nights when they’re done.

[00:06:36] Alison Lally: And so, I don't really see much of the motivation to finish your training over there because there's always nights. So, they have a really tough roster there, but they've had a mass exodus from emergency medicine in America recently. And I think a lot of it's been the result of the impact of COVID.

[00:06:52] Alison Lally: They had it really tough over there. We were quite protected here when hearing stories about some of the people I worked with, what they went through. So, I hope that there are some people that can find their passion in emergency medicine over there again, because it is a great specialty.

[00:07:06] Dr Sanjaya Senanayake: Exactly. And now you mentioned you were one of the early cohorts to the ANU, and in fact, one of our infectious diseases physicians, she was in that first year. So, you know, the medical school is really thriving, which is wonderful to see. Did you come from another place to go to the ANU or were you based in Canberra?

[00:07:25] Alison Lally: So, I came from Sydney and because I come from a big family, there are five siblings, which I know is almost unheard of these days. I made the decision to move away because I just didn't want to live at home. I think you have a much better experience and immerse yourself into the culture.

[00:07:39] Alison Lally: And also, just focus with all these people who you go through this amazing journey with. So, I moved to Canberra. There are amazing cafes, there are heaps of breweries, there's a lot more here than what there was back in the day.

[00:07:52] Dr Sanjaya Senanayake: I can tell you hearing this from younger people that people at universities in Sydney say that Canberra or the ANU is the party university and maybe because of that college culture as well.

[00:08:08] Alison Lally: There's a few of us who are still here and it's amazing how so many years down the track we just formed such great friendships there and now you run into each other and it's like no time has passed at all. I think the smaller classes here is amazing as well and it's really good for that ongoing support that you have.

[00:08:25] Dr Sanjaya Senanayake: And what do you think now if you're a young doctor? And thinking about a critical care pathway like emergency. Canberra a good place to train?

[00:08:35] Alison Lally: Well Canberra is an amazing place, and I guess the reason why I'm saying that is I did do part of my training up in Brisbane. And you've got to go to all different sites and travel lots of different places and there is traffic and stuff in the bigger cities.

[00:08:50] Dr Sanjaya Senanayake: Right, sorry, what's this traffic thing you talk about? What is it?

[00:08:55] Alison Lally: I know there are people that are actually okay driving like an hour to work and sit in traffic and they go five kms. It's bonkers. I guess you get to fit in some good podcasts but when you're trying to juggle work and home life, I think traffic's just something that you don't have time for.

[00:09:11] Dr Sanjaya Senanayake: I know and I think once you, if you haven't experienced a 10 minute unencumbered drive to work you probably will put up with the one hour, five kilometre traffic.

[00:09:22] Alison Lally: And just before we left Brisbane, it did start to get really bad where it was like, actually this is not doable with a growing family. So, with regards to Canberra, we've just opened up this new emergency department.

[00:09:34] Alison Lally: So that's been pretty busy for us over the past few months preparing for that. And we moved into it three weeks ago. And so for a new trainee coming to a brand new department is really exciting. We have expanded and we've got good capacity to grow into our department over the next 40 years. And it's massive.

[00:09:51] Alison Lally: You get to do your foot count during a shift. But we have major trauma. We see really unwell kids, unfortunately. We have a lot of subspecialty services here, both neurosurgical, vascular, we have a catchment area for all of Southeast New South Wales. So, from an emergency perspective, you're going to see everything that you need to see in your training.

[00:10:16] Alison Lally: You can actually do all your training here in Canberra Health Services, which includes the peripheral site of North Canberra Hospital. Not peripheral, but that's what's great. One of the peripheral site hospitals is, you know, 15, 20 minutes away. We have a really good critical care stream here. So, I'd recommend most people to do two years of general, intern, resident, and then really start to focus during your resident year going into a critical care year.

[00:10:40] Alison Lally: I know most want to just start their training straight away, but you actually get to work with other colleagues who you're going to work with. for the next 15, 20 years of your career where they go into ICU, anaesthetics. Some of our critical care streams do have critical care, sorry, cardiology as well.

[00:10:54] Alison Lally: So, it's really good to go and do that term. So, you experience that for a year and then go into your registrar training.

[00:11:03] Dr Sanjaya Senanayake: And we had another critical care pathway consultant, Sean Chan, from intensive care. He was speaking to us recently and Sean was telling us about why he went veered away from emergency towards intensive care.

[00:11:20] Dr Sanjaya Senanayake: Now what about you? I'm sure as you say, when you're introduced to those different pathways, ICU, anaesthetics, emergency, you have to choose one. What made you go down the emergency path?

[00:11:32] Alison Lally: Well, I wanted to do emergency when I got into medical school. So, I was one of those people who really wanted to do it.

I did get pulled in different ways. I really liked orthopaedics and O & G. And then I just came back to emergency cause it's a bit of everything. The things I love about emergency is that you're always working in a team. Having that ability to really have an impact on someone who's having usually their worst day.

[00:11:57] Alison Lally: You know, to be able to have that impact and help them. And it might only be something really simple to us, such as give them pain relief or to explain something that someone hasn't had the time to explain about, for example pneumonia. You're actually going to feel lousy for more than just a few days.

[00:12:13] Alison Lally: It's a few weeks to months recovery. Or you're going to have a cough for a while. You don't need antibiotics. And it's just sometimes just explaining things or an anxious first-time parent who's really worried about a fever, you know, and explaining that to them. So, there's also all the stuff from the TV show ER that totally inspired me to do medicine.

[00:12:30] Alison Lally: I loved it. Loved it. So real as well. Especially when I was working in the States in the old hospital. Then we moved to a new one while I was over there, but it was very much like, oh my god, it's so real and the scrubs. So yeah, there's all parts of emergency, but I also think we have this ability to really help people in a crisis.

[00:12:48] Alison Lally: And I think that's one part that a lot of us do really well even though it might not seem like we're doing a lot, but a lot of people go, well, just thank you. Thank you for taking the time. Thank you for explaining it to me.

[00:12:59] Dr Sanjaya Senanayake: Yeah, the other thing that I also tell junior doctors who are thinking about a career, I always say look at not just what interests you just look at the doctors working in that area and are they sort of similar to you and their outlook their personality and generally if that's, you've got the interest and the other people are a bit like you then it probably is a reasonable chance that's the right one for you.

[00:13:21] Alison Lally: Yeah, and I also tell juniors, no matter what you do, you gotta be happy doing relatively the same things for the next 20 years of your career, so to speak, you know.

[00:13:30] Dr Sanjaya Senanayake: 20 years? Look, these days are probably up 40 years or something, isn't it?

[00:13:34] Alison Lally: I dunno, some people might branch drop and do other things or do earlier retirement, I don't know.

[00:13:38] Alison Lally: But you know, by the time you finish with your training, usually training takes anywhere between five to 10 years, depending on what happens with life. But you just gotta be happy doing it. So, you're happy doing the same thing, you know, if you'd want to go into ICU, you're happy dealing with that sort of environment for the next 20 years. Are you happy dealing with orthopaedics, doing your hip replacements all the time, so no matter what career you go down, make sure you think you're going to be happy doing it.

[00:14:02] Alison Lally: And also how happy are the bosses? That's a really big thing is that if your bosses are happy and enjoying work, then that's a really good example of a supportive department, a really good place to work. And I think on the whole, most of us, on a day to day good are good. Sometimes we all have our bad moments where we're just exhausted, or the patients don't stop coming.

[00:14:25] Alison Lally: But on the whole, we're all really a good team and everyone's really happy in their jobs. And, you know, I think it's a good sign that emergency here is really good.

[00:14:35] Dr Sanjaya Senanayake: Alison, you've got an interest, as we all get interests as we go into a speciality, yours is in the area of neurodivergence.

[00:14:45] Alison Lally: Yep.

[00:14:46] Dr Sanjaya Senanayake: And I will tell you that I do not know much about this area. My first introduction to this area would have been Rain Man back in 1988.

[00:14:56] Alison Lally: Yeah, yeah, yeah.

[00:14:57] Dr Sanjaya Senanayake: So I was a school kid and Dustin Hoffman played, acted very well, the goofy brother, socially awkward, mathematically brilliant individual. That was my first exposure to someone with autism.

[00:15:13] Dr Sanjaya Senanayake: And since then, I've had the terms Asperger's syndrome, autism, neurodivergence. on the spectrum, all these different terms, being bandied around for what is probably the same thing. But just with those terms, for instance, do you mind breaking it down and telling us what's correct, what's not, and what's old and what's new?

[00:15:38] Alison Lally: Yeah, so, I guess a little bit about how I'm here. I was very similar to you. Although I'm a little bit younger than you, so I don't remember Rain Man coming out. But Rain Man is very commonly quoted regarding what it’s like to be autistic or dealing with someone who's autistic.

[00:16:03] Alison Lally: And certainly, there's the scene with him really wanting to go to Melbourne at the airport; that is our son all the time. So, I'll be honest, at medical school and life in general, I just thought autism or what we were taught was autism was a boy, who's usually non-verbal and just sits in a corner and doesn't do anything and we're told it's a developmental issue and that's about it.

[00:16:28] Alison Lally: And really, I learned about this, when I was sitting my fellowship exam. So, when we finish our exams, we have that really stressful year where everyone around us walks on eggshells because we're trying to balance everything. We just moved from Brisbane and my son just started, what we'll say regressing.

[00:16:47] Alison Lally: He just stopped really talking, not engaging and just acting a bit different. Yeah. And we had a one-week-old at the same time of moving down. So that was all happening with the transition and change. Then I went back to work, started focusing on my exam, and it was when he went to preschool that they just said, look, something's not right.

[00:17:09] Alison Lally: My husband and I thought something, but I remember looking up something going, does he flap his hands? You know, does he just stare in the distance? I remember we did a little checklist, like maybe he's autistic, but he doesn't meet any of this. Like sure, he's a little quiet at times. He sometimes looks in our eyes and sometimes doesn't.

[00:17:23] Alison Lally: Maybe it's just an adjustment issue. We'll just keep going. And then I remember the school sat me down after doing a day of study and said, look, we just think there might be something wrong with your son, you probably need to go see someone. At this stage, I reached out to one of the local paediatricians and just said, is there any way we could just start having a catch up?

[00:17:47] Alison Lally: And she approached it really well, we just had regular check ins every four or five months. Just to progress and see. And she, I've got to say, she did it in a really good way. I think she could see that I was probably feeling a bit stressed. We then started getting an OT and started getting a speech path and then I had my follow up appointment with the paediatrician.

[00:18:05] Alison Lally: The day I found out I passed my exam, so I was like so elated and then went to this appointment and she sat me down and she goes, I think Alex is autistic and we need to get him assessed by a psychologist. And I remember just breaking down, I was just so excited and then I felt really bad that I put all this stuff on hold.

[00:18:23] Alison Lally: Did it change anything? It really didn't change anything to where we are now, but my learning curve was massive, and I probably had bandwidth to start learning about it. Because I'd finished all my exams. Does that make sense? I think she just was really good and got that parental stress and that parental life of what's going on, like, when is she ready to deal with this?

[00:18:45] Alison Lally: So, I learned a lot. So, I started reading everything as I'm sure most parents do. So, this then started kind of a journey where I started to advocate for my son, because there were a few things that probably didn't fit. He didn't fit very well into the school system he was in. And so not only have I started to learn more about how we can do more in the medical area, but also how parents can advocate for their kids in that schooling education, which is really important.

[00:19:15] Alison Lally: I then realised once I had probably time to exhale, compound everything that I learned from all these different podcasts and books and webinars. I then was like, actually, we need to do better in the ED. This is the most chaotic, unpredictable environment ever. And we need to do more because even though autism is rising or the diagnosis of ASD, autism spectrum disorder is rising, we don't actually see that many kids in the ED. And the latest stats was one in 70 kids. We would see, you know, many kids a day.

[00:19:49] Alison Lally: In the course of a month, sometimes it's two and a half thousand kids. We don't see that many…

[00:19:55] Dr Sanjaya Senanayake: And when you say one in 70, do you mean one in 70 kids visiting an emergency department or one in 70 kids having autism?

[00:20:01] Alison Lally: Oh, having autism. So it's increased and part of that is for a few reasons, which I'll get to in a minute. But I was like, we're not seeing them in the ED. And the reason why is 'cause when I've had to bring my child to the ED, when I had to bring Alex, it was really traumatic and I work here and I was like, imagine those who don't work because a lot of autistic kids like to know what's happening.

[00:20:23] Alison Lally: They want to know so they can expect anything thrown onto them, causes a lot of stress and anxiety and they act out or they just don't want to go. And so, I had that experience and then that triggered me to actually, I need to start educating, I need to start looking at how we can improve a space for them and also how we can get some tools.

[00:20:43] Alison Lally: And so I guess I'll just park that for a second and just talk a bit about autism spectrum disorder. Because there was a lot of questions there. Neurodivergent is really something that's come out just recently. When I was doing all my reading five years ago, it was more talking about typical and atypical, and there was a really good, or neurotypical, neuroatypical.

[00:21:03] Alison Lally: And at that stage there was a really good show on Netflix called Atypical, and it was about a teenage boy who was autistic and loves penguins, and my boy loves penguins. And it was, it's so good. Like they've done it in such a good way. And it's kind of sad that it stopped, but they did actually have, although the main character wasn't autistic, they did actually have a lot of autistic characters in the show.

[00:21:19] Alison Lally: And that was just kind of good as an introduction to tell people, why don't you watch this show? It just gives a bit of idea about what it's like to be autistic. When we talk about, I'm gonna say I'm not an expert, but there's things about, we don't say someone is autism or has autism, we say they are autistic.

[00:21:36] Alison Lally: It's a way of them being. I'm still learning. Person first or, you know, their identity first. All those sorts of things are still really, I'm still learning. So, I'm not an expert regarding the terminology, but neurodivergence, I like to think of it as all those people who are differently wired.

[00:21:56] Alison Lally: And I took that term from, as I said, I've done a lot of reading and listening to audio books where it's those kids that are just wired differently. And that includes people who've got ADHD, which is also another really common diagnosis now. People who've got ODD or oppositional defiant disorder, people who've got twice exceptional.

[00:22:12] Alison Lally: So there's all these things where people are just really, they just function in a different way. And the way I like to think it is, we are expecting people like Dustin Hoffman and Rain Man to live in our world, which at times is really overwhelming, yet we don't go live in their world. And if we want to go live in their world, they're seen as odd or different.

[00:22:35] Alison Lally: And because they're not fitting our social norms, that's why it's so obvious that someone is neurodivergent. They did get rid of DSMV classifications changed and that removed Asperger’s, and it started to bring in levels. So, ASD level one two and three, and usually the levels are based on the amount of need that is required or additional support or assistance or how well, you know, their challenges in functioning in our world.

[00:23:04] Alison Lally: And so my son is ASD level two. So he has a lot of social issues, language issues. And as a result of that, he has a lot of regulation issues as well.

[00:23:13] Dr Sanjaya Senanayake: So that progression, I guess, with all these subcategories in the DSM does suggest that hopefully we're better at understanding it than we were before.

[00:23:25] Alison Lally: Totally, I mean, I think Gen Z are just so accepting of different people, they are so accepting. When we think about all these different, the way life has turned, we've got so much more acceptance of things like being gender fluid, things like being neurodivergent, understanding that people learn different ways.

[00:23:51] Alison Lally: I think this generation is absolutely amazing. I'm considered a millennial, I didn't know anything about it, I get some girls to help help me with my kids. They're all like, oh yeah, I know heaps of autistic people. And it's just so different, and they're just so open, and accepting, and nothing phases them.

[00:24:09] Alison Lally: And I think this generation, we can learn a lot from them with regards to that, because it's just like, nothing phases them, and it's great. So, there is a lot more neurodivergent diagnoses out there, and I think part of it was when the diagnosis changed in 2012, the criteria changed, which meant there were more people getting diagnosed because there was changes and increased awareness, you know, there's so much more awareness of it now.

[00:24:35] Dr Sanjaya Senanayake: So, a sort of surveillance artifact almost.

[00:24:38] Alison Lally: Yeah, because there was always that odd person, what we would say odd or the socially awkward person or someone who really struggled. But when there was maths, you know, think of A Brilliant Mind where he's able to communicate all in his equations, they've always been around, but it's just more the awareness.

[00:24:55] Dr Sanjaya Senanayake: And now, coming back to the emergency department and the toolkit.

[00:25:01] Alison Lally: Yep. So, regarding how we can improve things in the emergency department, it did start with education. So, educating the staff, what is it to be neurodivergent? What's with all these new terms? How do we approach people who are, I've probably got more experience with autistic patients or autistic individuals because of all the reading I've done, but a lot of the strategies are much the same.

[00:25:21] Alison Lally: So, I spoke about what are things that don't really cost anything, and that's simple things like dimming lights, turning off monitors that aren't needed, as minimal staff that's clinically safe. So, if you have like 10 people walking around, coming in and out, that's not really needed, and only one is fine, then that's going to actually help reduce the stress and anxiety.

[00:25:38] Alison Lally: Also explaining what's happening, which we do really, we could do a lot better in this space. A lot of the times we just go, we're going to a cannula and just pop it in without actually explaining, you know, it's going be cold, it's going to feel tight, you know, all those steps. It actually doesn't take a lot for us to explain.

[00:25:53] Alison Lally: So, trying to explain those things and where possible, giving the patient some choice, you know, would you like this sticker or this sticker? We know they need a sticker, for example, but in which way? So, a lot of it was education. Then there was a few tools and strategies. So, it started with a few of us getting some things and donating it to the department.

[00:26:12] Alison Lally: Really simple things. One is if we just dim the lights and use a light projector where you put like blue light and the stars. You dim a light, put that on and do some nitrous, for example, which is like a laughing gas, that just really calms a child getting a cannula.

[00:26:26] Alison Lally: You know? Or even just dimming the lights and blowing some bubbles.

[00:26:29] Alison Lally: It's really simple stuff, you know, but with the chaos and the busyness of ED, sometimes we don't stop to do this. A few other things we have are things that reduce stimuli. And so, we are sitting here now, and for some people the bright lights might really impact them, and they might hear a noise that you and I can't.

[00:26:50] Dr Sanjaya Senanayake: Yeah.

[00:26:51] Alison Lally: So in order to reduce that really overwhelming stimulus, we have headphones, not fancy Bluetooth ones just very simple ear muffs.

[00:26:56] Dr Sanjaya Senanayake: Sure, sure.

[00:26:57] Alison Lally: And, and sunglasses if they need that reduction of that over stimulus. Okay. So, they can just focus on other things. So, something simple like that, which unless you've done some reading into this and some understanding, you wouldn't think much about it. And so, it's trying to relay a message that's really easy to understand and we can pass on to staff quite frequently. We got some money from the foundation, which I'm very thankful for and they gave us funding.

[00:27:26] Dr Sanjaya Senanayake: Which foundation?

[00:27:27] Alison Lally: Oh, the Canberra Hospital Foundation.

[00:27:28] Dr Sanjaya Senanayake: Okay.

[00:27:29] Alison Lally: Which we're so thankful for.

[00:27:30] Dr Sanjaya Senanayake: Yes.

[00:27:31] Alison Lally: And we got smiley scopes, which are virtual reality goggles. And that actually, because I was really trying to see how we could help these neurodivergent patients, they did do a study on how it actually helps autistic people getting vaccinations and it showed that it actually improved their experience with getting vaccinations. So use that as part of our, you know, building a case.

[00:27:50] Dr Sanjaya Senanayake: What are these?

[00:27:51] Alison Lally: They're virtual reality goggles. So, you put them on and you pick, you know, one thing might be just a distraction technique regarding getting a cannula. The other one might be a relaxation. So doing some meditation with them, talking them through that.

[00:28:05] Alison Lally: Another one, which I really quite like is called relax and you can put it on. And it's a video of all the puppies, the guide puppies, and you can walk, look around and see all the puppies. So, it's really cool. And it's been game changer. We also use that for kids who have needle phobia, but also just kids in general to reduce the distress that comes from doing procedures.

[00:28:34] Alison Lally: And with our sensory trolley, we've got a few other things that help with particular senses, that help neurodivergent kids or patients relax. So, some people, without realising it, all of us do things without realising it when we're stressed. So, if you think about people who bite their nails, people who click a pen, people who constantly put stuff in their mouth, people who tap their feet, we are all doing things, and this is a way of regulation.

[00:28:47] Alison Lally: And there's been a lot of work done into this to see that some people have what we call sensory profile. And some of this stuff I don't even quite understand, I had to get my head around it.

[00:28:55] Dr Sanjaya Senanayake: Sure.

[00:28:56] Alison Lally: But it's that I'm an oral seeking person to help reduce my stress. So, if you think about all the times we're stressed and we have chocolate, for example, where it's sensory seeking, oral sensory seeking.

[00:29:05] Alison Lally: So, I've got a few devices that help with that. So, one is very simple, like pinwheels, a lollipop, blowing up a balloon, all these things that help with your oral. The other thing is visual. So, a lot of people get fixated on things. So, we've got some things that help with the visual. So, you know, there's little games where you have a ball going around and you try and get it into the hole.

[00:29:24] Alison Lally: Another one is the water game where you press a button and the balloon, the ball goes to try and get into the hoop. We have stress balls. So just that being able to stretch it, squish it all the time. And another really easy one, which doesn't even cost a lot, is just Play Doh, for them to be able to play with Play Doh, roll it, you know, whichever way they want.

[00:29:45] Alison Lally: So yeah, we put this together based on what the sensory needs are of the child. We do have some of these things in place with our staff. Just those simple things like turn off monitors, as I said, reduce the lights. Those things really simple things we can really implement for all our patients when it's clinically safe to do so.

[00:30:05] Alison Lally: And so that's what we really want to do, but these other strategies will help. In particular the kids that don't quite know how to regulate themselves.

[00:30:12] Dr Sanjaya Senanayake: And Alison, is this something you would find in other major emergency departments in Australia? Or is this very much something that we've come up with in Canberra.

[00:30:20] Alison Lally: So, I want to say, the one thing we have come up with in Canberra is our sensory room in our children's emergency department.

[00:30:27] Dr Sanjaya Senanayake: Oh yeah, tell me about that.

[00:30:28] Alison Lally: Which is really exciting. I think it's so exciting. So it's a space in our children's emergency department that is a space for kids to essentially regulate and to prevent them from reaching a stage of a meltdown.

[00:30:44] Alison Lally: So autistic kids or neurodivergent kids who are starting to feel really anxious and stressed out, if we can start to see it by their pacing or starting to become a bit, no, no, no. We can put them into this space and it's essentially devoid of a lot of stimulus. So, it's dimmable lights. You can't really hear much in the way of sound.

[00:31:05] Alison Lally: It's quite bare when you first walk in there because the point is that it's a bare place that we then add things to. So, there's a beanbag and benches, we do have the funding approved for an interactive software so that kids can think they're underwater and press the fish, which is really exciting.

[00:31:22] Alison Lally: But we do have these other tools. So if someone really needs to just, you know, essentially just use their smiley scope with nothing else around, we can put that there or an iPad with.

[00:31:37] Alison Lally: So, it's a place that we're building that rapport with the patient and the parent, we help advocating for a child to have an experience that's not so overwhelming because otherwise they're less likely to seek health care later on in their life. We're hoping they have a positive experience now, so down the track it's not so overwhelming for them.

[00:31:56] Dr Sanjaya Senanayake: Alison, that's a wonderful innovation and it's been an absolute pleasure talking to you, hearing about your journey from Massachusetts, Brisbane, back to Canberra and all the great things you're doing, particularly with regard to the autistic spectrum disorder in emergency.

[00:32:13] Alison Lally: Thank you.

[00:32:14] Dr Sanjaya Senanayake: My pleasure and hopefully we can have you back one day.

[00:32:17] Alison Lally: Hopefully, anytime, anytime.

[00:32:25] Dr Sanjaya Senanayake: Thank you for listening. I hope you'll join us behind the curtain for our next episode where we'll delve into the story of another of our fantastic health professionals here at Canberra Health Services. If you're interested in starting an exciting career with us, head to our website to join Team CHS. And that website is www.canberrahealthservices.act.gov.au/careers

[00:33:16] Dr Sanjaya Senanayake: I acknowledge the Ngunnawal People as traditional custodians of the ACT, the land I’m recording on, and recognise any other people or families with connection to the lands of the ACT and region.