Emergency Medical Retrieval ServiceEmergency Medical Retrieval Service

Dr Pete Davis Dr Pete Davis MRCGP FACEM Dip IMC Dip Mtn MedMRCGP FACEM Dip IMC Dip Mtn Med

Emergency Physician Emergency Physician Southern General Hospital GlasgowSouthern General Hospital Glasgow

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What’s The Issue?

• 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

Aeromedical Activity Audit In Argyll & Bute Prior To EMRS

• 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

A&B EMRS 12 Month Pilot 2004

Quality Quality pre-hospital & pre-hospital & intermediate intermediate

carecare

Direct triageDirect triageSafe transferSafe transfer

Stabilisation Stabilisation & critical care & critical care interventions interventions

ASAPASAP

What Do Patients Need?

Limited pre-transfer stabilisation

Limited patient assessment in transfer

Limited monitoring

Limited communication

Few if any interventions possible

Airway protection/ compromiseAirway protection/ compromise

Risks to medical personnel

Why Is Transfer Dangerous?

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• 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

Why Have A Retrieval Service?Why Have A Retrieval Service?

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• Patient assessment

• Point-of-care investigations– US, Bio, Haem

• Critical care intervention– RSI, ventilation, inotropes

• Optimised physiology

• Invasive monitoring

• Direct triage

• Safe transfer

EMRS = Consultant & ParamedicEMRS = Consultant & Paramedic

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

EMRS patients by diagnosis

Trauma33%

CVS15%

Neuro15%

Sepsis12%

Poisoning10%

Other15%

Which Patients?

“Adults with life threatening illness or injury where advanced

medical intervention is appropriate to facilitate safe

transfer”

“On-Line Senior Support!”

ActivationActivation

Retrieval Cons

Rural Dr

ActivationActivation

Single point of contact; RAH switchboard

0141 887 9111

Retrieval Cons

Rural Dr

ActivationActivation

Consultant in RGH

Retrieval Cons

Rural Dr

Definitive care

Retrieval

ActivationActivation

Retrieval Cons

Rural Dr

Paramedic

Definitive care

Retrieval

ActivationActivation

Retrieval Cons

Rural Dr

Paramedic

Definitive care

Retrieval

MissedRetrieval

ActivationActivation

Retrieval Cons

Rural Dr

Advice only

Local care

ActivationActivation

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““This will mean integrated working with This will mean integrated working with primary and secondary care in these areas.”primary and secondary care in these areas.”

““The Scottish Ambulance Service should….develop The Scottish Ambulance Service should….develop integrated solutions to particular healthcare integrated solutions to particular healthcare

challenges, for example in rural and remote areas” challenges, for example in rural and remote areas”

Comparison of "team ready" & "team airborne"

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0.05

0.1

0.15

0.2

0.25

1 6 11 16 21 26 31 36 41 46 51 56 61

Mission number

ho

urs

Time from call toairborne

Time from call toteam ready

Response Time IssuesResponse Time Issues

3

2

1

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EMRS PilotEMRS Pilot

•18 month SGHD funded pilot

•Independent evaluation

•Outcomes will influence evolution

•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

Rural Major IncidentsRural Major Incidents

Questions?

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