Emergency Medical Retrieval Service Explained

Emergency Medical Retrieval Service
Start Date:2004
Headquarters:Glasgow airport
Nhs Region:Scotland
Budget:£2 million

The Emergency Medical Retrieval Service (EMRS) is part of ScotSTAR retrieval service. The EMRS provides aeromedical critical care retrieval and pre-hospital care to people in Scotland[1] [2] in the form of two retrieval teams (North and West). The service provides patients in remote and rural areas with rapid access to the skills of a consultant or senior doctor in emergency medicine, intensive care medicine or anaesthesia, and facilitates transfers to larger, better equipped urban hospitals.[3] The EMRS functions supplementary to the regular Scottish Ambulance Service Air Ambulance service. Unlike air ambulance services in other parts of the UK, EMRS has no dedicated aircraft but both EMRS North and West are funded by the Scottish Government. The EMRS has featured on the Channel 5 documentary series Highland Emergency, which charts the work of rescue services in the Scottish Highlands.[4]

EMRS North team (in Aberdeen) is on base between 0800 and 1800, and EMRS West team (in Glasgow) are on base between 0700 and 2300, for immediate deployment; outside these hours the teams are on-call and will take at least 30 minutes longer to deploy.[5]

Services are provided in partnership with the Scottish Ambulance Service utilising road transport, helicopters and fixed-wing aircraft. The EMRS operates as part of ScotSTAR, the Scottish national retrieval service, sharing a bespoke base at Glasgow Airport.[6]

History

2004: The EMRS was formed in 2004 when NHS Argyll and Clyde approved a 12-month trial which involved 11 consultants in emergency or intensive care medicine.[7] The EMRS was initially based at Glasgow City Heliport and operated only in the Argyll and Clyde area. During the first 12 months the EMRS attended 3 patients a month.[8]

2007: In 2007, the service was extended to cover three rural general hospitals and 13 community hospitals as part of an 18-month trial funded with £1.59million.[9] The success of the service saw its operating zone expanded throughout the west coast of Scotland and the EMRS now operates from Stranraer in the south to Stornoway in the north.[10] An independent service evaluation demonstrated value for money and lifesaving benefits of critical care retrieval.[11]

2010: In March 2010, the Scottish Government acknowledged that due to its continuing success, the service would be further enhanced by the addition of a second team, operational from October 2010.[12] [13] The second team increased the number of participating consultants and doctors from eight to fifteen.[14]

In 2010, around 90% of EMRS activity involved secondary retrieval.[15] Annual running costs were now in the region of £2M.[16] In 2011, annual activity was estimated to be 324 transfers each year with around 60% of these by rotary wing and 35% by fixed-wing aircraft.[17]

2014: In June 2014, EMRS teams began to routinely carry a stock of O negative blood to allow transfusion earlier when responding to emergencies.[18] During the period of the 2014 Commonwealth Games a third team of medics was available., the staff of the service had expanded to include 27 part-time consultants and had completed more than 3,000 retrievals.[19]

2015: In September 2015, the EMRS announced their move to a new purpose-built base, located at Glasgow Airport.[20]

2019: A second EMRS base opened in Aberdeen, predominantly covering the North of Scotland.[21]

Transport Resources

The EMRS is supported by land ambulances, aircraft from the Scottish Ambulance Service's Air Ambulance Division, the Scottish Charity Air Ambulance and the helicopters of the UK Coastguard.[22]

Personnel

EMRS Teams are composed of Retrieval Practitioners (Advanced or Specialist) and one or more doctors.[23] Retrieval Practitioners come from a nursing or paramedic background and receive additional training in retrieval medicine. There are 47 part-time consultants who work with EMRS[24] and a smaller number of registrar or clinical fellow grade doctors.[25]

During staffing pressures in the early COVID-19 pandemic, the service occasionally deployed a Registrar with a Retrieval Practitioner as an operational team.

Equipment

Collaboration with the Scottish National Blood Transfusion Service (SNBTS) allows the EMRS teams to have O-negative blood immediately available to take on all missions.[26] The EMRS have developed a bespoke app to make their standard operating procedures available to clinicians.[27] The team also carry equipment to facilitate the provision of anaesthesia and surgical interventions.

Clinical Interventions

Pre-hospital Critical Care

The team attend between 1 and 3[28] prehospital patient a day, delivering advanced medical management and other critical care interventions many of these patients. In one study, 59.7% of patients received one of the following interventions; pre-hospital Blood transfusion, Chest drain insertion neuroprotective measures or Emergency ultrasound. In the same study 52.5% of patients were mechanically ventilated. In another study critical care interventions (emergency anaesthesia, thoracostomies, sedation, thoracotomy, chest drain insertion or administration of blood products) were provided to 17% of patients and 21% received an advanced medical intervention (these include patients who died on scene, gaining intraosseous access and any patient the team escorted to hospital).

The EMRS team perform prehospital anaesthesia as required, with a complication rate of 4%, and a first pass success rate of 80%.[29] This is comparable to other UK prehospital services offering this intervention.[30] EMRS are able to undertake surgical procedures at the road side, such as resuscitative thoracotomy, however EMRS does not have "specialist obstetric skills".

Retrieval and Transport

EMRS provide a retrieval service for adult patients across Scotland (paediatric retrieval is performed by ScotSTAR). EMRS' average (median) on-scene time with a patient requiring inter-hospital transport before transporting is one hour.

Awards

See also

Notes and References

  1. McHenry . Ryan D. . Moultrie . Christopher EJ . Cadamy . Andrew J. . Corfield . Alasdair R. . Mackay . Daniel F. . Pell . Jill P. . 2023-08-22 . Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage . Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine . 31 . 1 . 39 . 10.1186/s13049-023-01109-6 . 1757-7241 . 10463457 . 37608349 . free .
  2. Moultrie . C. E. J. . Corfield . A. R. . Pell . J. . Mackay . D. . 2017-05-01 . 46 Forecasting the demand profile for a physician-led pre-hospital care service using a mathematical model . BMJ Open . en . 7 . Suppl 3 . 10.1136/bmjopen-2017-EMSabstracts.46 . 2044-6055 . free.
  3. Web site: What we do . dead . https://web.archive.org/web/20090411060354/http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=18&Itemid=28 . 11 April 2009 . 2009-11-18 . EMRS . Glasgow.
  4. Web site: January 2009 . Spin Doctor (EMRS Newsletter) . 2009-11-18 . EMRS . Glasgow.
  5. Book: Gallier, Jonny . OG028 ScotSTAR Referral.
  6. Web site: 2023-03-29 . Emergency Medical Retrieval Service . 2023-09-28 . Emergency Medical Retrieval Service . en-GB.
  7. Whitelaw AS, Hsu R, Corfield AR, Hearns S . Establishing a rural Emergency Medical Retrieval Service . Emergency Medicine Journal . 23 . 1 . 76–78 . January 2006 . 16373814 . 2564140 . 10.1136/emj.2005.025528 .
  8. Corfield AR, Thomas L, Inglis A, Hearns S . A rural emergency medical retrieval service: the first year . Emergency Medicine Journal . 23 . 9 . 679–683 . September 2006 . 16921078 . 2564207 . 10.1136/emj.2006.034355 .
  9. News: Medical airlift service extended . . 25 June 2007.
  10. Web site: History . EMRS . 2009-11-18 . Glasgow . dead . https://web.archive.org/web/20090411060359/http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=44&Itemid=29 . 11 April 2009 .
  11. Evaluation of the Emergency Medical Retrieval Service . Boyle J, Whyte R, Dickson E, Godden D, Heaney D, Munro A . Scottish Government . 2010.
  12. News: 'Flying doctor' scheme to expand . BBC News . 2 March 2010.
  13. News: The flying doctors . BBC News . 29 April 2010.
  14. News: Flying doctor service takes off across Scotland . BBC News . 25 October 2010.
  15. Corfield AR, Adams J, Nicholls R, Hearns S . On-scene times and critical care interventions for an aeromedical retrieval service . Emergency Medicine Journal . 28 . 7 . 623–625 . July 2011 . 20724465 . 10.1136/emj.2010.091421 . 206939562 .
  16. Flying doctors flying high . . 2 March 2010 . 20 November 2015.
  17. Web site: Towards a Single National Specialist Transport Service for Scotland - ScotSTAR: Strategic vision . . 6 . 18 November 2011 . 22 November 2015.
  18. News: Flying doctors add new team to cover Games emergencies . Weldon V . The Herald . 12 June 2014 . 23 November 2015.
  19. News: Rural fast-response medics to be celebrated . The Scotsman . 3 December 2014 . 22 November 2015.
  20. New Glasgow Airport base for patient retrieval team . . 22 September 2015 . 22 November 2015 . https://web.archive.org/web/20151123043124/http://www.glasgowairport.com/corporate/media-centre/posts/2015/september/22/new-glasgow-airport-base-for-patient-retrieval-team/ . 23 November 2015 . dead .
  21. Web site: Scottish Trauma Network EMRS North . 2023-09-24 . www.scottishtraumanetwork.com . en.
  22. Web site: Scottish Ambulance Service . FOI Request .
  23. Web site: Retrieval Practitioners . 2023-09-27 . Emergency Medical Retrieval Service . en-GB.
  24. Web site: Consultants . 2023-09-27 . Emergency Medical Retrieval Service . en-GB.
  25. Web site: Registrars and Fellows . 2023-09-27 . Emergency Medical Retrieval Service . en-GB.
  26. Blood on board . Scottish National Blood Transfusion Service (SNBTS) . 27 March 2015 . 12 December 2015.
  27. News: Smartphone app to help rural healthcare wins two awards . Walker N . The Scotsman . 22 October 2012 . 12 December 2015.
  28. Neagle . Gregg . Curatolo . Lisa . Ferris . John . Donald . Mike . Hearns . Stephen . Corfield . Alasdair R. . 2019-04-01 . Epidemiology and location of primary retrieval missions in a Scottish aeromedical service . European Journal of Emergency Medicine . 26 . 2 . 123–127 . 10.1097/MEJ.0000000000000483 . 28746084 . 23053968.
  29. Ross . Mark . Corfield . Alasdair . McCormack . Jon . Loughrey . John Paul . 2015-11-01 . Tracheal intubation in primary and secondary retrieval patients: A study of tracheal intubation practice and complications in ICU and aeromedical retrieval . Resuscitation . English . 96 . 49–50 . 10.1016/j.resuscitation.2015.09.114 . 0300-9572.
  30. Lockey . D. . Crewdson . K. . Weaver . A. . Davies . G. . August 2014 . Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians . British Journal of Anaesthesia . 113 . 2 . 220–225 . 10.1093/bja/aeu227 . 25038154 . 0007-0912. free .
  31. Web site: Q&A: Dr Stephen Hearns of EMRS . Medical and Dental Defence Union of Scotland (MDDUS) . 30 June 2010 . 22 November 2015.
  32. Web site: Secondary Care Team of the Year 2010 . . https://web.archive.org/web/20120522015804/http://groupawards.bmj.com/secondary-care-team-of-the-year-2010 . 22 May 2012.
  33. Web site: plc . Reach . Scotland's Champions 2023 - Finalists . 2023-09-24 . scotlandschampions.co.uk . en.

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