Emergency Medical Retrieval Service Dr Pete Davis MRCGP FACEM Dip IMC Dip Mtn Med Emergency Physician Southern General Hospital Glasgow 1

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What’s The Issue? 3

Aeromedical Activity Audit In Argyll & Bute Prior To EMRS Snapshot of 3 months in 2004 All A&B air transfers 161 patients 9% critically ill or injured 5% deteriorated in flight 3 cardiac arrests in flight Extrapolates to 12 avoidable deaths / year in A&C alone Unacceptable standards of care Breach every set of professional guidelines regarding transfer of critically ill and injured patients 4 4

A&B EMRS 12 Month Pilot 2004 40 patients 34 transferred to definitive care 45% trauma 60% required critical care 40% other procedure chest drain, cardioversion or cardiac pacing 40% required drugs not available to paramedics > 90% of patients required medical intervention No critical morbidity or mortality during transfer Two patients died < 24 hours following transfer 5

What Do Patients Need? Quality pre-hospital & intermediate care Stabilisation & critical care interventions ASAP Direct triage Safe transfer 6 6

Why Is Transfer Dangerous? Limited pre-transfer stabilisation Limited patient assessment in transfer Limited monitoring Limited communication Few if any interventions possible Airway protection/ compromise Risks to medical personnel 7 7

Why Have A Retrieval Service? Rural practitioners have suggested it Paramedic-delivered service suboptimal Ad-hoc retrievals are hazardous Take “ER” to the patient Maintain level of care throughout transfer Optimal triage to definitive care 8 8

EMRS = Consultant & Paramedic Patient assessment Point-of-care investigations US, Bio, Haem Critical care intervention RSI, ventilation, inotropes Optimised physiology Invasive monitoring Direct triage Safe transfer 9 9

Which Patients? Ventilated patients High dependency patients Patients with deranged physiology Patients with identified major injury Patients with possible occult major injury If in doubt - please phone and discuss To date 2/3 medical : 1/3 trauma 10

Which Patients? 11

“On-Line Senior Support!” Activation “Adults with life threatening illness or injury where advanced medical intervention is appropriate to facilitate safe transfer” “On-Line Senior Support!” 12 12

Single point of contact; Activation Rural Dr Retrieval Cons Single point of contact; RAH switchboard 0141 887 9111 13 13

Activation Consultant in RGH Rural Dr Retrieval Cons 14 14

Activation Rural Dr Retrieval Cons Retrieval Definitive care 15 15

Activation Paramedic Rural Dr Retrieval Cons Retrieval Definitive care 16 16

Activation Paramedic Rural Dr Retrieval Cons Missed Retrieval Definitive care 17 17

Activation Rural Dr Retrieval Cons Advice only Local care 18 18

“The Scottish Ambulance Service should… “The Scottish Ambulance Service should….develop integrated solutions to particular healthcare challenges, for example in rural and remote areas” “This will mean integrated working with primary and secondary care in these areas.” 19 19

Response Time Issues 3 2 1 20

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EMRS Pilot 18 month SGHD funded pilot Independent evaluation Outcomes will influence evolution 23

Rural Major Incidents Clear role for EMRS Rural MI is different from Urban MI Early activation is crucial Specific areas of expertise: Liaison with aeromedical assets (MOD / SAS) Provide site medical teams (MERIT teams) Assist with triage and disposition 24

Questions? 25 25