I’m currently in my third year of working in a rural district general hospital Accident and Emergency Department, and one of the things that has struck me most is the use of pre-hospital medicine. Being in an area where it can take an hour and a half to get to the us, as the nearest trauma unit, really puts into perspective the need to have people trained to a level where they can provide immediate aid to people within the Golden Hour. From local First Responders to BASICS trained doctors, pre-hospital medicine in Dumfries and Galloway is more prevalent than most people think.

I’ve always had a keen interest in pre-hospital medicine. From an early age, I always wanted to be the person on the scene helping those in need (my earliest memory was my mum teaching me first aid and CPR- a seed was planted me thinks!). Throughout my high school years, my study breaks were filled with watching reality shows like “Air Ambulance ER” and when I went to medical school at Edinburgh University, my first port of call at the Freshers Fair was the Emergency Medicine Society. A few years later, I took an active role in the EM Soc committee and helped to organise their annual conference – that year themed with a pre-hospital focus. Throughout university, I always sought out opportunities for experience in emergency and pre-hospital care. As part of an SSC group presenting a poster, I attended the Intensive Care Society’s State of the Art conference where I was starstruck to meet Gareth Davies (at that point London’s HEMS Medical Director) and told him I wanted his job! I also became a first aider for a local company providing first aid coverage for events which I felt tied in nicely with my other job as a lifeguard.

After qualifying I moved to Dumfries – the largest town in a rural, agricultural area in southwest Scotland. The local hospital, Dumfries and Galloway Royal Infirmary is a trauma unit (a stopgap, if you like, for stabilisation before onward travel to a trauma centre- see Scottish Trauma Network for more information on Scotland’s trauma system) which is utilised often for trauma calls due to its location near the M74 and A75 (a busy road linking the Ireland-Stranraer ferry to the M74) and its accident-prone farming community. When I initially moved, I was (as always) seeking opportunities to engage in pre-hospital experience. This, combined with my lifeguarding and competitive swimming experience, led me to seek out opportunities with the local lifeboat. Enter Nith Inshore Rescue! An independent lifeboat crew (not part of the RNLI but it does similar work) with search and rescue capabilities and an experienced crew who often had to provide first aid to casualties provided the perfect opportunity. Luckily I was welcomed onto the crew and have been training with them for the past three years.

As part of the crew, I’m often the one with the first aid bag, but have also gained qualifications allowing me to be the helm of the “big boat” (a RIB called St. John), hold a VHF radio license and participate in water rescues. The crew have the capability to insert airway adjuncts and provide drugs such as oxygen and Narcan with training to FREC 3 level. Providing first aid in an environment which is not clinically controlled is one of the major challenges of pre-hospital care, and attending to a casualty in the middle of a choppy estuary is about as hard as it gets! Our regular training exercises often utilise actors as casualties to simulate assessing patients on a stretcher on the back of the RIB, hurtling along the water in the pouring rain at 38 knots. Nith Inshore Rescue work closely with other emergency services, including the Scottish Ambulance Service, and have taken part in multi-agency training exercises to practice our handovers and inter-agency teamwork skills.

Enough about me and my experience…

What can you do within pre-hospital care as part of your career?

BASICS

BASICS (British Association for Immediate Care) is a charity providing training for doctors, nurses, and paramedics, with a keen interest in pre-hospital care. You can join as a member and attend their conferences and courses. In Scotland, after a certain level of training, members can become responders who liaise with the Scottish Ambulance Service to attend calls, particularly in rural areas.

Mountain Rescue

Being part of a mountain rescue team is tough but provides a great opportunity to provide immediate medical care in very challenging environments. My local mountain rescue team, for example, has members with a wide range of medical experience, from doctors to physiotherapists, who all have expertise in providing medical assistance whilst on call-outs and regularly attend training to enhance their skills.

Air Ambulance

Charities operate many air ambulances in the UK and have associated rapid response cars for when the weather doesn’t allow for flying. Within Scotland, we have EMRS (Emergency Medical Retrieval Service) which plays a wide role from rural retrieval to pre-hospital trauma and major incident care. It’s operated by the ambulance service, however, some other NHS boards have their own services which leave directly from the Emergency Department (for example, NHS Lothian’s Medic 1).

First aid at events

Providing medical care at major events is becoming more and more popular. From being a first aider to being an event doctor once you’ve been working for a while, this is a great opportunity to be involved in on-scene care and attend some really cool events! From my own experience, a vast array of medical care can be provided at events, from being able to suture at the scene, to commencing a full-blown resuscitation.

What can you do to gain experience I hear to ask? Lots!

Societies

As I’ve already mentioned, if you’re a student then joining a relevant university society can be very beneficial. It allows you to expand your network of other like-minded people and can allow you to attend talks and events involving people already working in the field.

Already graduated? Fear not! The Royal College of Emergency Medicine is a great college to be a member of for information and access to training to enhance your emergency medicine skills. The Royal College of Surgeons of Edinburgh has a Faculty of Pre-Hospital Care which provides further information and events for those interested in PHEM.

Attending conferences can be so much fun and allows you to learn about ground-breaking developments before most other people. You can gain contacts in pre-hospital medicine and learn more about the different careers available. And, by entering posters for presentation, you can add to your ever-growing CV and show that you are enthusiastic about pre-hospital medicine through your own research/audits/QI work.

Become a fellow

The Royal College of Surgeons of Edinburgh’s Faculty of Pre-Hospital Care allows you to become a fellow by sitting their Fellowship in Immediate Medical Care (FIMC) exam. As a student, I volunteered to be a mock patient during these exams, and this allowed me to gain experience in what the exam entails, and the curriculum assessed. Any healthcare professional with involvement in pre-hospital care can sit this exam.

Observership

Applying for an observership can allow you to gain insight into the work of pre-hospital teams. I spent a day with the EMRS in Paisley and was taken on calls in their rapid response vehicle. I was also able to take part in a training exercise and was talked through all the equipment carried in the car. This enabled me to see what life would be like working as a doctor with the service and let me ask questions regarding how the service operated.

Training

Professional development is elementary to furthering your knowledge in key skills required for pre-hospital medicine. Ensuring that key courses such as ALS, ATLS and PLS are up to date is essential (and you’ll often find that your local trust will provide funding for these). Going the extra mile and attending BASICS or RCEM courses is even better! See what conferences are also coming up and use these to network and update your knowledge on the latest developments in pre-hospital care. Overall, I think that pre-hospital medicine is an exciting, evolving subspecialty within the profession and there is so much to be gained by experiencing what PHEM has to offer!

Author: Dr Erin Cooper – Clinical Development Fellow in Emergency Medicine

Reviewer: Dr Joshua Grubb – Mind the Bleep Pre-Hospital Medicine Lead