Highland PICT Team explained

Highland PICT Team
Headquarters:Raigmore Hospital Emergency Department, Inverness
Region Served:Highland and Moray
Area:Highland and Moray
Nhs Region:NHS Highland

The Prehospital Immediate Care and Trauma (PICT) Team is a prehospital care team which operates from Raigmore Hospital emergency department in Inverness, Scotland.[1] It receives funding from NHS Highland, BASICS Scotland and the Scottish Trauma Network.[2] [3]

They are an 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 rural GP, together with a Scottish Ambulance Service advanced practitioner in critical care.[4]

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, operating as a Community Emergency Medicine (CEM) service as well as a prehospital trauma team. 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.[5]

Remit and workload

PICT currently operates 12 hours per day, seven days a week across the Highlands and Moray.[6] [7] 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).[8] For comparison, MEDIC 1 in Edinburgh attended around 3 patients a month in the decade between 1980 and 1990,[9] the Tayside Trauma Team (TTT) attends to 5.6 patients a month,[10] Emergency Medical Retrieval Service teams attend 33 primary retrievals (prehopsital care patients) a month,[11] while an individual BASICS Scotland volunteer responder may attend 2-3 calls a month.[12]

Tabulated prehospital workload by resource!Trauma Resource!Prehospital patients seen each month!Notes
PICT †150Data from January 2022
EMRS Team †33Data from 2023
TTT †5.6Data from 2009
MEDIC 1 *3Data from 1980 to 1990
BASICS Scotland Volunteer *2-3Responder on the Outer Hebrides

† NHS Funded * Charity Funded

The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network)[13] 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.[14]

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 someone's home, such as access to prescription medications to allow them to avoid attending the hospital.

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,[15] [16] such as;

The administration of:

Undertaking:

Facilitating:

Intervention Rationale EMRS PICT AP(CC)
AmputationExtrication / AccessYesYesNo
AnaesthesiaMaintain ventilationYesNoNo
Blood administrationMaintain circulationYesNoNo
Central line insertionVascular accessYesNoNo
Chest drain insertionPneumothorax managementYesYesNo
IV AntibioticsReduce morbidityYesYesYes
IV Calcium Gluconate/ChloridePrevention of cardioplegiaYesYesYes
IV KetamineSedation and AnalgesiaYesYesYes
Reduction of fracturesMinimize pain and morbidityYesYesYes
Senior decision makingManaging challenging circumstancesYesYesYes
Surgical AirwayMaintain OxygenationYesYesYes
ThoracostomyTension pneumothorax managementYesYesYes
ThoracotomyCardiac tamponade managementYesNoNo
UltrasoundDetection of major injuryYesYesYes

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 speciality doctors from anaesthesia and intensive care. There are also a number of rural 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.[21] The clinical lead is Dr Luke Regan. Regan is a consultant in emergency medicine and holds the diploma in retrieval and transfer medicine.[22]

Advanced practitioners

The advanced practitioners in critical care (APCC) 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.[23]

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,[24] 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.[25]

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.[26] [27] This led to the local MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding.[28]

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.[29]

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.[30] [31]

See also

External links

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Notes and References

  1. Web site: Highland . N. H. S. . 2023-03-23 . Prehospital immediate care and trauma . 2023-03-24 . NHS Highland . en-GB.
  2. Web site: 2018. North of Scotland Trauma.
  3. Web site: 2019 BASICS Scotland Annual Report.
  4. Web site: WordPress.com . 2023-08-16 . WordPress.com . en.
  5. Web site: Highland Heroes - Nominate now . 2 March 2022 . HN Media . en.
  6. Web site: Maclennan . Scott . 20 January 2022 . 'World-class' Highland trauma team must get health board support, says MSP . 25 January 2022 . RossShire Journal . en.
  7. Web site: Maclennan . Scott . 20 January 2022 . NHS Highland's refusal to fund a 'world class' lifesaving trauma team sparks questions . 25 January 2022 . Inverness Courier . en.
  8. Highland PICT . highlandpict . 1496125656215740417 . 152 prehospital taskings for the PICT team in January. 10% cases were to cardio-respiratory arrests. More common taskings were to trauma cases such as car accidents, falls, stabbings and industrial accidents. Furthest RTC 53miles. Longest journey 50mins. . 2 March 2022.
  9. Cusack . S . Steedman . D J . Robertson . C E . Little . K . 1992-06-01 . Flying squad response to out-of-hospital cardiac arrest--a decade of experience. . Emergency Medicine Journal . en . 9 . 2 . 203–207 . 10.1136/emj.9.2.203 . 1472-0205 . 1285861 . 1388497.
  10. Maddock . A. . Donald . M. . February 2014 . Caseload of a land-based trauma team . Scottish Medical Journal . 59 . 1 . 45–49 . 10.1177/0036933013518151 . 0036-9330 . 24413928. 206428497 .
  11. 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 .
  12. Mallinson . Tom . 2021-06-28 . A year as a prehospital physician in the Outer Hebrides, Scotland . 2022-04-16 . Rural and Remote Health . 21 . 2 . 6115 . 10.22605/RRH6115 . 34176277 . 235659724 . en. free .
  13. Web site: 2017. STN Minimum Requirements for Pre-Hospital Care.
  14. Web site: 2022-07-05 . Four people rushed to hospital following serious crash which closed A9 . 2022-08-11 . STV News . en-GB.
  15. Web site: Highlandpictpilot . 2022-04-01 . PICT Team Stakeholder Report 2022 . 2022-05-16 . Highland PICT . en.
  16. Web site: 2023-09-02 . Team Capabilities . 2023-09-02 . Highland PICT . en.
  17. Web site: Boyle . Janet . Medics hail mobile device that's saving lives in rural areas . 2023-06-14 . The Sunday Post . en-US.
  18. Web site: 2023-09-02 . Ultrasound . 2023-09-02 . Highland PICT . en.
  19. Web site: 2023-09-02 . Prehospital Amputation . 2023-09-02 . Highland PICT . en.
  20. Highland PICT . highlandpict . 1488972374640930822 . Highland PICT Response Team . 2022-11-10.
  21. Web site: Scottish Trauma Network / NHS Scotland . Scottish Trauma Network Report to Scottish Parliament Health and Sport Committee . live . https://web.archive.org/web/20210420204341/https://scottishtraumanetwork.com/wp-content/uploads/2021/02/2021-01-STN-Report-to-HS-Com-1.0.pdf . 20 April 2021.
  22. Web site: Dr Luke Regan . 27 March 2022.
  23. NoS Trauma Network . NoSTraumaNtwk . 1453302723240153089 . The Advanced Practitioners within the PICT response team come from both @Scotambservice paramedic and senior nursing backgrounds, with extensive hospital based training in managing critically ill and injured patients.
  24. Web site: 29 January 2020. TOWARDS 2020: TAKING CARE TO THE PATIENT AND QUALITY IMPROVEMENT. Scottish Ambulance Service.
  25. Highland PICT . HighlandPICT . 1549709297692676096 . A colleague so universally respected by everyone scientists question he may be the elusive 'fifth fundamental force of nature'....
  26. Web site: 20 January 2022. 'World-class' Highland trauma team must get health board support, says MSP. 23 January 2022. RossShire Journal. en.
  27. Web site: 21 January 2022. Supporters of a 'world class' lifesaving life-saving trauma team demand a rethink. 23 January 2022. Inverness Courier. en.
  28. News: Maclennan . Scott . 18 February 2022 . Highland MSP Edward Mountain calls for medical trauma response team to be saved . Inverness Courier .
  29. Web site: 2022-03-30 . Big award for Raigmore medic . 2022-03-30 . Inverness Courier . en.
  30. Web site: 24 March 2022 . Highland Heroes from across the region are crowned . 25 March 2022 . Inverness Courier .
  31. Web site: 25 March 2022 . Emergency response team delighted with 'wonderful' award . 25 March 2022 . Strathspey Herald .