Retrieval medicine: a review and guide for UK practitioners. Part 1: clinical guidelines and evidence base.

It has been proposed that formalisation of training to encompass prehospital and retrieval medicine should be considered in the UK, using those currently involved in immediate care as the core providers of these services.(1) Although there is an overlap in some aspects of "prehospital" and "retrieval" medicine, there are some distinct differences, both in terms of the skill base and service provision required. Retrieval medicine is the term used to indicate the use of an expert team to assess, stabilise and transport patients with severe injury or critical illness. Implicit in this process is the early provision of specialised advice to the health providers at the patient's side. In the UK, there is currently no national and often no regional strategy to coordinate the provision of secondary retrieval services for critically ill patients. International models do exist, which may be of help in this respect.

Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems.

Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training.

A rural emergency medical retrieval service: the first year.

INTRODUCTION: We describe the first year of operation of a rural emergency medical retrieval service (EMRS), staffed by emergency medicine and anaesthetic consultants and providing air based retrieval of critically ill and injured patients from general practitioner led community hospitals in rural west Scotland. METHODS: Data were collected on all patients referred to the service, both those subsequently transported and those where transport by the service was not indicated, for a period of 1 year from 1 October 2004 to 30 September 2005. Data collected included information on demographics, physiology, and medical interventions. Detailed data were collected regarding advanced airway care and any complications relating to transfer. RESULTS: Forty patients were attended and advice was given on a further 21 patients. Twenty one of the 40 patients (53%) required rapid sequence intubation prior to transfer. The median Injury Severity Score (ISS) for trauma patients was 26 (range 2-59). The median Acute Physiology and Chronic Health Evaluation (APACHE) II score for all patients was 11 (range 2-37). CONCLUSION: Our data show a high level of acuity among this patient group and a need for advanced medical intervention to ensure safe transfer.

Establishing a rural Emergency Medical Retrieval Service.

In 2004 the Argyll and Clyde health board established the Emergency Medical Retrieval Service to support its rural community hospitals. This article describes both why the service was established and its aims. This service covers a geographically extensive area, with approximately 85,000 people living in remote locations. Rural general practitioners in six community hospitals provide initial patient assessment and resuscitation. Providing emergency care and safe transfer of seriously ill and injured patients presenting to these community hospitals is a significant challenge. All parties involved felt that there was a need to provide a service to transport critically ill and injured patients from these remote locations to definitive care. The idea of the team is to bring the resuscitation room to the patient in the rural setting. With this aim and in order to implement the Intensive Care Society guidelines for the transport of critically ill patients, it was decided that consultants in Emergency Medicine and Anaesthetics with an interest in critical care would staff the service medically. This service is unique within the UK and the authors aim to report our findings from ongoing research and audit in future papers.

The Scottish mountain rescue casualty study.

AIM: To describe injuries and illnesses in casualties rescued by Scottish mountain rescue teams during 1998 and 1999, with particular emphasis on major trauma. METHODS: Retrospective study. Information from mountain rescue reports, Scottish Trauma Audit Group database, and hospital case notes. RESULTS: Teams undertook 622 emergency callouts in the two years. A total of 333 casualties with injuries and illnesses rescued. There were 57 fatal incidents, 261 (78.4%) rescued with traumatic injuries, 12 (3.6%) suffering from major trauma, and 12 (3.6%) had spinal injuries. Half had lower limb injuries. Twenty six (7.7%) were suffering from non-traumatic medical problems. Forty six (13.8%) were suffering from cold or exhaustion. Fifty three casualties were dead when the rescue team arrived. Four died during or after rescue, one from hypothermia and three from trauma. All major trauma casualties were evacuated by helicopter. DISCUSSION: No previous similar studies identified. Significant numbers of seriously injured and ill casualties are being cared for by mountain rescue team casualty carers, many of whom are not healthcare professionals. The need for improved training, research, and equipment is discussed. CONCLUSION: Scottish MRTs are called upon to provide an advanced level of care for a significant number of casualties. There is a need for formalised opportunities for in hospital training, management protocols, and continuing research and audit-none of which currently exists.

Major incidents: training for on site medical personnel.

OBJECTIVE: To assess the present levels of training for the medical incident officer (MIO) and the mobile medical team leader (MMTL) throughout the UK. METHOD: Postal questionnaire to consultants in charge of accident and emergency (A&E) departments seeing more than 30,000 patients a year. Information regarding MIO staffing and training and MMTL training and provision requested. RESULTS: A&E provides the majority of both MIOs and MMTLs in the event of a major incident. Virtually all MIOs are consultants or general practitioners. However, 63% of MMTLs are from hospital training grade staff. One third of hospitals required their designated MIO to have undertaken a Major Incident Medical Management and Support course and a quarter had no training requirement at all. Two thirds of MMTLs were expected to have completed an Advanced Trauma Life Support course, but in 21% there was no minimum training requirement. Training exercises are infrequent, and hence the exposure of any one individual to exercises will be minimal. CONCLUSION: There has been some improvement in major incident training and planning since 1992, but much remains to be done to improve the national situation to an acceptable standard.