British Association for Immediate Care Scotland

Paramedicine is a fast-paced, ever-changing profession and those who practise as paramedics must be able to keep up to date with changes using the latest evidence and expert opinion where evidence does not exist. This chapter provides a diverse range of detailed case studies that realistically represent the conditions, scenarios, and challenges encountered in trauma cases. The trauma cases include burns, limb injury and hanging. Case-based learning and problem-based learning rely on high-quality, well-written case studies that paramedic educators, students and clinicians can use to aid their understanding of out-of-hospital care. The chapter also provides interactive learning activities, discussion questions, practical tips, and authoritative guidance aligned to national and international best-practice standards.

Green Beacons are used by many doctors across the UK when responding to emergencies, particularly in rural areas. These are used to alert other road users to the doctor's urgent need to reach a destination, with the hope that members of the public will make provisions for the doctor to make progress unhindered. While such warning lights have been used for many years, there is a paucity of research into the safety and efficacy of their use. This pilot study aimed to explore whether the use of Green Beacons does lead to reduced response times in rural areas of Scotland, and recorded any accidents occurring during such emergency response journeys. A repeated measures design was devised to investigate this question. The response times and distances travelled for 10 consecutive emergency journeys undertaken by a rural primary care and prehospital doctor during the winter of 2019 using Green Beacons were recorded. The same journeys were then repeated, at a later date by the same driver, under normal driving conditions, with no Green Beacon use. Travel times were compared for both journey types. Travel times were on average 4 minutes shorter when responding using Green Beacons (range 0-13 minutes), with statistically significantly faster average speeds during the emergency response journeys. There was a trend towards higher average speed with longer journeys. No accidents occurred during either type of journey. The use of Green Beacons when responding to emergencies in rural Scotland appears to reduce journey times and appears safe in this exploratory work. This is in keeping with other researchers' work into the use of blue and red emergency vehicle lighting, and does not dissuade from continuation of current practice among doctors in the UK. Further research in this area would benefit from a larger dataset, and quantitative time-motion data from the vehicles involved.

Following critical events many people experience a period of emotional and cognitive disturbance before re-establishing well-being without the need for formal psychological support. Those working in emergency care have frequent and repeated exposure to such incidents and are therefore at increased risk of psychological distress. This article discusses the psychological sequalae of the author's witnessing and involvement in the immediate on-scene care of those injured in the Shoreham, England air show crash in August 2015. Using narrative reflection, the author describes, with reference to the literature, his psychological journey drawing particularly on the conservation of resources theory. Within this is the recognition that unduly early and misinformed emphasis on psychological disorder and post-traumatic stress disorder are not only unhelpful but may deliver the person into greater distress and long-term mental health problems.

BackgroundRecent analysis shows a higher risk of death after Out of Hospital Cardiac Arrest (OHCA) for patients who lived in rural areas of UK in casemix adjusted comparison with urban areas. Sandpiper Wildcat is an action research project aiming to increase survival rates through the implementation of a novel network of trained responders in rural Grampian.MethodsAfter using historic data to identify 50 locations with poor response times but significant numbers of OHCA we established teams of trained volunteer responders equipped with automatic external defibrillators (AED 3, Zoll) and Vehicle Locator Systems. Responders were trained and made available for dispatch to OHCA by ambulance control. In addition to real time CPR quality feedback the AED 3 also records ECG, compression metrics and audio of the incident for analysis and debrief.ResultsAround 500 responders were successfully trained and deployed in 53 rural locations during the first 6 months. They were mobilised to 109 OHCA, arriving on scene an average of 7 min (−15 to 48 mins) before Scottish ambulance service resources. Analysis of metrics from defibrillator downloads showed high quality resuscitation. In addition there were many reports of significant ‘added value’ to patients, families and Scottish Ambulance Service staff as a result of Sandpiper Wildcat responders’ attendance. Responders replied overwhelmingly positively to debrief questions ‘did you feel of value at scene’ and ‘do you feel you made a difference’, all indicated that they would be willing to respond again.ConclusionsSandpiper Wildcat project has reduced the response time to OHCA in rural Grampian and increased the number of responders at each OHCA. Responders have delivered high quality BLS and provided assistance to SAS personnel. Further analysis will examine the spread and sustainability of this approach in rural UK and the longer term impact on clinical outcomes.

‘The pre-hospital management of chest injury: a consensus statement’ was originally published by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in 2007. To update the pre-existing guideline, a consensus meeting of stakeholders was held by the Faculty of Pre-hospital Care in Coventry in November 2013. This paper provides a guideline for the pre-hospital management of patients with the life-threatening chest injuries of tension pneumothorax, open pneumothorax, massive haemothorax, flail chest (including multiple rib fractures), and cardiac tamponade.

Introduction: The introduction of advanced practitioner roles has challenged the traditional boundaries of health care. While studies have been undertaken to understand the role of physicians in respect of mass-gathering medicine, the role of advanced nurse practitioners (ANPs) has not been investigated. Problem Does the presence of an ANP reduce the referral rates of patients presenting for medical care at mass-gathering events to external health care resources? A prospective observational study was undertaken to determine whether the presence of an ANP would reduce the patient referral rate to external health care services by first aiders and paramedics working within an event medical team. Patients identified as requiring referral were reviewed by an ANP as part of the on-site medical provision for four mass-gathering events in the south of England. Additionally, information was gathered identifying which patients would have been transported to hospital by ambulance compared to those actually transported following ANP review. Statistical analysis was undertaken for three key measures (referrals to all local health resources, referrals to hospital-based acute services, and transfers to hospital by ambulance). A rounded total of 842,000 people attended four mass-gathering events held over 14 days. Of these, 652 presented for medical care, many self-referring. Using a one-tailed Fisher's Exact Test and Phi analysis, this study demonstrated statistically significant reductions in the overall referral of patients to all external health care resources (P<.001; φ=0.44), to the emergency department (ED; P<.001; φ=0.43), and a reduction in ambulance transport (P<.001; φ=0.42). Effect size analysis demonstrated a medium-sized effect evident for all of the above, which was also demonstrated in economic terms. The event medical team would have referred 105 (16.3%) of the 652 patient presentations to external health care services; 47 (7.2%) would have been transported by ambulance. In comparison, the ANP referred 23 patients (3.5%) with 11 (1.7%) being transported by ambulance. It also was noted that the first aiders and paramedics could be more selective in their referral habits that were focused primarily on the ED. Appropriately trained and experienced ANPs working within event medical teams have a positive impact on referral rates from mass-gathering events.

Maternal mortality is a global burden, with more than 500,000 women dying each year due to pregnancy and childbirth-related complications. Birth-preparedness and complication readiness is a comprehensive strategy to improve the use of skilled providers at birth, the key intervention to decrease maternal mortality. Birth-preparedness and complication readiness include many elements, including: (a) knowledge of danger signs; (b) plan for where to give birth; (c) plan for a birth attendant; (d) plan for transportation; and (e) plan for saving money. The 2003 Burkina Faso Demographic and Health Survey indicated that only 38.5% of women gave birth with the assistance of a skilled provider. The Maternal and Neonatal Health Program of JHPIEGO implemented a district-based model service-delivery system in Koupéla, Burkina Faso, during 2001–2004, to increase the use of skilled providers during pregnancy and childbirth. In 2004, a cross-sectional survey with a random sample of respondents was conducted to measure the impact of birth-preparedness and complication readiness on the use of skilled providers at birth. Of the 180 women who had given birth within 12 months of the survey, 46.1% had a plan for transportation, and 83.3% had a plan to save money. Women with these plans were more likely to give birth with the assistance of a skilled provider (p=0.07 and p=0.03 respectively). Controlling for education, parity, average distance to health facility, and the number of antenatal care visits, planning to save money was associated with giving birth with the assistance of a skilled provider (p=0.05). Qualitative interviews with women who had given birth within 12 months of the survey (n=30) support these findings. Most women saved money for delivery, but had less concrete plans for transportation. These findings highlight how birth-preparedness and complication readiness may be useful in increasing the use of skilled providers at birth, especially for women with a plan for saving money during pregnancy.

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p 1411), recalling feelings of "too little, too late" at the King's Cross Station tragedy. This inadequacy is shared by many doctors when they are called to cope with incidents away from the bright lights and comfortable surroundings of the surgery or hospital. The British Association for Immediate Care (BASICS) was formed in an attempt to improve prehospital care for victims of road accidents and other disasters. It provides a forum and training for doctors interested in immediate care. In recognition of this need, par- ticularly for general practitioners, the Royal College of Surgeons of Edinburgh has agreed to establish a diploma in prehospital care. BASICS doctors trained in the use of breathing apparatus were present at King's Cross but because of the inevitable delay in appreciating the size of the incident they were called some time later. They provided on site care and a site medical officer and subsequently searched the station with fire crews and helped certify and identify the dead. They too shared the feeling of grief but perhaps less the inadequacy. New members are always wel- come. At present there are only 2000 doctors in 70 immediate care schemes covering about one third ofthe United Kingdom.