Мы используем файлы cookie.
Продолжая использовать сайт, вы даете свое согласие на работу с этими файлами.
Emergency service
Highland PICT Team
Другие языки:

    Highland PICT Team

    Подписчиков: 0, рейтинг: 0

    Highland PICT Team
    Headquarters Raigmore Hospital Emergency Department, Inverness
    Region served Highland and Moray
    NHS region NHS Highland
    Area size Highland and Moray

    The Prehospital Immediate Care and Trauma (PICT) Team is a prehospital care team which operates from Raigmore Hospital emergency department in Inverness, Scotland. It receives funding from NHS Highland, BASICS Scotland and the Scottish Trauma Network. They are a stand-alone enhanced care team responding to trauma and other critical care incidents in Inverness and the Northwest Highlands, utilising a rapid response car. PICT comprises either a senior doctor from Raigmore Hospital or a local GP, together with a Scottish Ambulance Service advanced rural practitioner. In light of the sparsely distributed ambulance resources in the Highlands and the challenges of distance and weather in the north west of Scotland, PICT has a considerable remit beyond trauma. PICT provides support to ambulance crews and community responders in medical emergencies, and also provides a "see and treat" service to patients in order to prevent transport and possible hospital admission for problems manageable at home. In this way PICT acts as a senior decision maker for prehospital clinicians across the North of Scotland.

    The team was also the winner of the 2022 Highland Heroes awards in the category of Emergency Services.

    Remit and workload

    PICT currently operates 12 hours per day, seven days a week across the Highlands and Moray. They respond to around 150 patients a month, attending a range of 999 calls, but being tasked to the most serious calls (major trauma, cardiac arrests etc). For comparison, MEDIC 1 in Edinburgh attended around 3 patients a month in the decade between 1980 and 1990, the Tayside Trauma Team (TTT) attends to 5.6 patients a month, each of the EMRS teams attend 12 primary retrievals a month, while an individual BASICS Scotland volunteer responder may attend 2-3 calls a month.

    Tabulated prehospital workload by resource
    Trauma Resource Prehospital patients seen each month Notes
    PICT † 150 Data from January 2022
    EMRS Team † 12 Data from 2015–2015
    TTT † 5.6 Data from 2009
    MEDIC 1 * 3 Data from 1980 to 1990
    BASICS Scotland Volunteer * 2-3 Responder on the Outer Hebrides
    Graphical Prehospital Workload by Resource
    Prehospital Resource Patient's Attended per Month
    PICT†
    150
    EMRS Team†
    12
    Tayside Trauma Team†
    5.6
    MEDIC1*
    3
    Individual BASICS Scotland Responder*
    3

    † NHS Funded * Charity Funded

    The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network) and critically unwell patients in the Highlands of Scotland. The doctor on the PICT Care will also assume the role of the medical incident officer when required at a major incident. They work to standard operating procedures, and national clinical guidelines for best practice. The team currently responds in a Scottish Ambulance Service vehicle. The PICT Team have attended a variety of incidents, including aircraft crashes, road traffic collisions, stabbings, shootings and critically unwell patients.

    When audited, it was found that the PICT Team were able to discharge on scene 22% of the cases they attended; 17% of their patients were paediatrics, and 39% were traumatic injuries. This is due to the PICT Team including a senior doctor who is able to facilitate alternative care pathways or provide interventions in someones home, such as access to prescription medications to allow them to avoid attending the hospital.

    Highland PICT response map

    Enhanced Medical Care

    In addition to providing senior decision making support, the PICT Team provide a number of clinical interventions which currently lie outwith the standard remit of a Scottish Ambulance Service paramedic, such as;

    The administration of:

    • ketamine, levobupivicaine (and intralipid if required), adenosine, magnesium sulfate, fentanyl or diamorphine.

    Undertaking:

    • Diagnostic and procedural ultrasound, wound closure, joint reduction, regional anaesthesia, sedation, pacing, cardioversion, thoracostomy (and drain insertion), mechanical CPR device deployment, amputation or surgical airway.

    Facilitating:

    • Onward referral
    • Provision of prescription medications or a prescription for the patient to collect at a pharmacy
    • Senior decision making
    Intervention Rationale EMRS PICT AP(CC)
    Amputation Extrication / Access Yes Yes No
    Anaesthesia Maintain ventilation Yes No No
    Blood administration Maintain circulation Yes No No
    Central line insertion Vascular access Yes No No
    Chest drain insertion Pneumothorax management Yes Yes No
    IV Antibiotics Reduce morbidity Yes Yes Yes
    IV Calcium Gluconate/Chloride Prevention of cardioplegia Yes Yes Yes
    IV Ketamine Sedation and Analgesia Yes Yes Yes
    Reduction of fractures Minimize pain and morbidity Yes Yes Yes
    Senior decision making Managing challenging circumstances Yes Yes Yes
    Surgical Airway Maintain Oxygenation Yes Yes Yes
    Thoracostomy Tension pneumothorax management Yes Yes Yes
    Thoracotomy Cardiac tamponade management Yes No No
    Ultrasound Detection of major injury Yes Yes Yes

    Personnel

    Doctors

    The PICT doctors include consultants in the critical care aligned specialties of emergency medicine, intensive care medicine, acute medicine and anaesthesia. In addition to this there are consultants in obstetrics and gynaecology and speciality doctors from anaesthesia and intensive care. There are also a number of General Practitioners with further training in prehospital emergency medicine who work as rural practitioners, emergency practitioners or rural GPs across the Highlands and Islands. The doctor on the PICT car will assume the role of the medical incident officer when required at a major incident. The clinical lead is Dr Luke Regan. Regan is a consultant in emergency medicine and holds the diploma in retrieval and transfer medicine.

    Response car used by PICT Team

    Advanced practitioners

    The advanced practitioners in pre-hospital care of the PICT Team are a cohort of clinicians from a paramedic or nursing parent specialty who are currently in training with PICT and in the emergency department at Raigmore Hospital.

    This is a new advanced practice role introduced with funding from the Scottish Trauma Network and represents a collaboration between PICT, NHS Highland and the Scottish Ambulance Service. The role of the advanced rural practitioner is designed to support PICT doctors in managing trauma and medical emergencies, including undertaking the blue light (emergency) driving to attend these calls. The advanced practitioners all undertake a master's degree to fulfil this role. Once fully trained, they utilise critical care clinical competencies, and a number of primary care competencies to allow safe management of patients in the community or en route to hospital. In 2022 one of the advanced practitioners was nominated for the Scottish Health awards for his role in the rescue of a 6 year old boy from a mountainside.

    2022 PICT funding crisis

    NHS Highland announced in early 2022 that they would defund the Inverness PICT Team, in steps which will leave the Highlands and Inverness without a seven-day physician-led enhanced care service. This led to the local MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding. Mountain stated that

    "This pioneering service is essential when responding to major trauma incidents across the Highlands – we simply cannot afford to lose it."

    In 2023 the PICT Team secured ongoing funding as was able to recruit a permanent cohort of physicians.

    Awards

    Medic of the Year 2021

    In early 2022, Dr Luke Regan, the PICT Team clinical lead, was awarded "Medic of the Year 2021" by the College of Remote and Offshore Medicine and invited to join their Council of Members for his work relating to the provision of trauma care across the Highlands of Scotland.

    Highland Heroes 2022

    In March 2022, the PICT Team was awarded Highland Hero Emergency Services Hero of the Year for their life-saving work across the Scottish highlands.

    See also

    External links


    Новое сообщение