In 2013, Scott Weingart, MD, FACEP (@emcrit), declared SMACC (which stands for Social Media and Critical Care), a largely unknown conference held in Sydney, Australia, to be the “best critical care conference in the world.” At that time, Dr. Weingart was one of the attendings in my residency, but more to the point, he had become a major celebrity in the emergency medicine and critical care worlds through his wildly popular EMCrit podcast. For the first time, an emergency medicine podcast was being downloaded in droves and had tremendous influence. Dr. Weingart’s endorsement instantly put an entire conference on the educational map. The following year, SMACC (@smaccteam) was again hosted in Australia and swelled to more than 700 attendees, including many from the United States and around the world. By the time the conference moved to Chicago in 2015, SMACC had become the unofficial in-person reunion of the free open-access medical education (#FOAMed) community, and due to overwhelming demand, the organizers instituted a policy that specified a maximum of 2,000 attendees. They literally declined additional registrations in an effort to keep the conference from becoming too large and impersonal.

To the surprise of many, organizers Roger Harris, MBBS (@RogerRdHarris), and Oliver Flower, MBBS, BMedSci (@OliFlower), two of the Australian critical care physician founders of SMACC, announced that the sixth conference, again to be hosted in Sydney, would be the final one. Thousands of supporters were disappointed. In just a few short years, a medical conference had become an important part of many people’s lives. How did they do it? Here are some of the moments that highlight its influence, along with an indication of what may replace it.

In 2013, Dr. Flower opened the first-ever SMACC standing behind a lectern. He immediately started to drone on about data, accompanied by a busy PowerPoint slide. Within seconds, a wrestler appeared and literally knocked over the lectern and carried Dr. Flower off stage. He was obviously in on the joke. The gauntlet had been laid down. This would be no ordinary gathering. Just as important as the content, which promised to be cutting-edge critical care, was the style. SMACC talks would be as engaging as TED talks but with quality content that could rival an ACEP or Society of Critical Care Medicine conference.

At SMACC Gold in 2014, Liz Crowe (@LizCrowe2) delivered a talk titled “Swearing Your Way Out of a Crisis.” As a social worker who worked in intensive care environments, she wanted us to recognize our own humanity and that our desire to be “politically correct” or appear to be calm, level-headed providers was depriving us of permission to emote in ways that could be helpful both for us and our patients. This was a watershed moment; medical audiences were not accustomed to hearing such valuable insights from social workers at major conferences. This suddenly turned SMACC into a much larger tent gathering than a typical medical conference. From then on, SMACC was seen as a conference where major addresses were just as likely to be given by social workers, nurses, paramedics, and medical educators as they were by researchers and critical care physicians.

SMACC Chicago in 2015 was the pinnacle of “dogma-lysis,” the takedown of perceived wisdom in medicine and the zeitgeist of the #FOAMed community at that time. Whether it was how to treat pain (often with ketamine) or why many guidelines in sepsis were wrong, this was a conference that seemed to celebrate evidence-based iconoclasm. However, Simon Carley, MBChB, MPhil, MD, PhD (@EMManchester), gave a memorable talk about learning from your mistakes that heralded a new shift in SMACC toward an increased interest in the psychology of performing under pressure, as well as learning to deal with stressful situations clinically and interpersonally. Victoria Brazil, MBBS, MBA (@SocraticEM), sparked interest in this topic at earlier SMACCs, and it was taken to new heights by her and others, including Christopher Hicks, MD (@HumanFact0rz).

However, clinical and educational innovation was still at the core of SMACC. Highlights from SMACCDUB, held in Dublin in 2016, included Iain Beardsell, MBChB (@DocIB), giving a unique approach to the medical debate on thrombolysis for submassive pulmonary embolism. Rather than prattle on about the evidence, he performed an evidence-based rap to the music of Hamilton: “It must be nice, it must be nice, to have evidence on your side!” It was both entertaining and evidence-based, which was SMACC at its best. SMACCDUB was also remembered for a tragedy that occurred shortly after the conference. An ICU physician from Northern Ireland, John Hinds, MB BCh, BAO, died in a motorcycle accident just days after presenting at SMACC. Dr. Hinds had a talent for combining education and humor, and he had given classic SMACC lectures about the “evils” of cricoid pressure as well as the necessity to act fast and honorably in trauma scenarios. Dr. Hinds’ death was a true shock to what had truly become a community. He had made such a large impact both locally and globally that his death eventually was seen as the impetus for Northern Ireland to finally initiate an air-ambulance program in 2016, something that Dr. Hinds had advocated for vigorously during his all-too-short life.

Das SMACC, held in Berlin in 2017, took the conferences’ previous predilections even further. The opening session was a large-scale simulation of a car accident, imagining the resuscitation of the near-future. A drone delivering O-negative blood to the scene was an amazing touch. Additionally, SMACC had become increasingly interested in provider wellness and inspiration. Annet Alenyo Ngabirano, MD (@AAlenyo), an emergency physician from Cape Town, South Africa, introduced us to the southern African word “ubuntu” to describe why we do what we do, compassion and humanity toward others.

The final SMACC, back in Sydney where it all began, somehow solved a problem that had emerged. A victim of its own success, SMACC attendees from various fields and niches of medicine, from prehospital to emergency medicine to intensive care, comprised an unusually large tent. Somehow, the final conference found the balance between inspiration and education. The opening address, the John Hinds Plenary, was delivered by Gill Hicks, MBE, an amazing woman and gifted speaker who survived the July 7, 2007, London bombings. She reminded us why we do what we do. Later in the morning, clinical talks focused on topics such as managing maternal hemorrhage by Katya Evans, MBChB, MMed (@kat__evans), the South African emergency physician who founded BADem.co.za (Brave African Discussions in emergency medicine), as well as a reminder to think about zebras in medicine that may actually be more common than we realize, such as anti-NMDA encephalitis. This message was delivered by Canadian emergency physician David Carr, MD
(@DavidCarr333). Finding the balance between cutting-edge clinical medicine, medical education, and the psychology of critical and emergency care was no easy task, but the organizers accomplished it.

As the final SMACC unfolded, news of its replacement surfaced. Starting next year, SMACC will collaborate with The New England Journal of Medicine and the George Institute for Global Health to create a new meeting called Coda (@CodaChange). Coda promises to build on what SMACC began in order to “solve urgent health challenges around the world,” according to its Twitter page. How they intend to accomplish this tall order remains to be seen. However, with the strengths of the diverse and global community that SMACC has created already in place, anything seems possible.