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

2. 2 2

3. What’s The Issue? 3

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. Which Patients? 11

12. “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

13. Single point of contact;
Activation
Rural Dr
Retrieval Cons
Single point of contact;
RAH switchboard 13 13

14. Activation
Consultant in RGH
Rural Dr
Retrieval Cons 14 14

15. Activation
Rural Dr
Retrieval Cons
Retrieval
Definitive care 15 15

16. Activation Paramedic Rural Dr Retrieval Cons Retrieval Definitive care16 16

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

18. Activation
Rural Dr
Retrieval Cons
Advice only
Local care 18 18

19. “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

20. Response Time Issues 3 2 1 20

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

24. 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

25. Questions? 25 25