Emergency Medical Retrieval Service

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Emergency Medical Retrieval Service
Established2004
Headquarters Glasgow airport
NHS regionScotland
Budget£2 million
Website www.emrsscotland.org OOjs UI icon edit-ltr-progressive.svg

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]

Contents

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] [6]

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. [7]

History

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EMRS locations

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. [8] 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. [9]

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 £1.59 million. [10] 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. [11] An independent service evaluation demonstrated value for money and lifesaving benefits of critical care retrieval. [12]

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. [13] [14] The second team increased the number of participating consultants and doctors from eight to fifteen. [15]

In 2010, around 90% of EMRS activity involved secondary retrieval. [16] Annual running costs were now in the region of £2M. [17] 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. [18]

2014: In June 2014, EMRS teams began to routinely carry a stock of O negative blood to allow transfusion earlier when responding to emergencies. [19] During the period of the 2014 Commonwealth Games a third team of medics was available. [19] As of December 2014, the staff of the service had expanded to include 27 part-time consultants and had completed more than 3,000 retrievals. [20]

2015: In September 2015, the EMRS announced their move to a new purpose-built base, located at Glasgow Airport. [21]

2019: A second EMRS base opened in Aberdeen, predominantly covering the North of Scotland. [22]

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. [5]

The EMRS team (red) with Paramedics (green) in 2009, loading a patient into a helicopter EMRS2.jpg
The EMRS team (red) with Paramedics (green) in 2009, loading a patient into a helicopter

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. [5]

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] [ clarification needed ] 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.[ citation needed ]

Clinical Interventions

Pre-hospital Critical Care

The team attend between 1 [1] and 3 [28] prehospital patient a day, delivering advanced medical management and other critical care interventions many of these patients. [29] 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. [1] In the same study 52.5% of patients were mechanically ventilated. [1] 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). [28]

The EMRS team perform prehospital anaesthesia as required, with a complication rate of 4%, [9] 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". [6]

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. [16]

Awards

See also

Related Research Articles

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References

  1. 1 2 3 4 McHenry, Ryan D.; Moultrie, Christopher EJ; Cadamy, Andrew J.; Corfield, Alasdair R.; Mackay, Daniel F.; Pell, Jill P. (22 August 2023). "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. doi: 10.1186/s13049-023-01109-6 . ISSN   1757-7241. PMC   10463457 . PMID   37608349.
  2. ↑ Moultrie, C. E. J.; Corfield, A. R.; Pell, J.; Mackay, D. (1 May 2017). "46 Forecasting the demand profile for a physician-led pre-hospital care service using a mathematical model". BMJ Open. 7 (Suppl 3). doi: 10.1136/bmjopen-2017-EMSabstracts.46 . ISSN   2044-6055.
  3. ↑ "What we do". Glasgow: EMRS. Archived from the original on 11 April 2009. Retrieved 18 November 2009.
  4. ↑ "Spin Doctor (EMRS Newsletter)" (PDF). Glasgow: EMRS. January 2009. Retrieved 18 November 2009.
  5. 1 2 3 Scottish Ambulance Service. "FOI Request" (PDF).
  6. 1 2 Gallier, Jonny. OG028 ScotSTAR Referral (PDF).
  7. ↑ "Emergency Medical Retrieval Service". Emergency Medical Retrieval Service. 29 March 2023. Retrieved 28 September 2023.
  8. ↑ Whitelaw AS, Hsu R, Corfield AR, Hearns S (January 2006). "Establishing a rural Emergency Medical Retrieval Service". Emergency Medicine Journal. 23 (1): 76–78. doi:10.1136/emj.2005.025528. PMC   2564140 . PMID   16373814.
  9. 1 2 Corfield AR, Thomas L, Inglis A, Hearns S (September 2006). "A rural emergency medical retrieval service: the first year". Emergency Medicine Journal. 23 (9): 679–683. doi:10.1136/emj.2006.034355. PMC   2564207 . PMID   16921078.
  10. ↑ "Medical airlift service extended". BBC News . 25 June 2007.
  11. ↑ "History". Glasgow: EMRS. Archived from the original on 11 April 2009. Retrieved 18 November 2009.
  12. ↑ Boyle J, Whyte R, Dickson E, Godden D, Heaney D, Munro A (2010). Evaluation of the Emergency Medical Retrieval Service (PDF) (Report). Scottish Government.
  13. ↑ "'Flying doctor' scheme to expand". BBC News. 2 March 2010.
  14. ↑ "The flying doctors". BBC News. 29 April 2010.
  15. ↑ "Flying doctor service takes off across Scotland". BBC News. 25 October 2010.
  16. 1 2 Corfield AR, Adams J, Nicholls R, Hearns S (July 2011). "On-scene times and critical care interventions for an aeromedical retrieval service". Emergency Medicine Journal. 28 (7): 623–625. doi:10.1136/emj.2010.091421. PMID   20724465. S2CID   206939562.
  17. ↑ "Flying doctors flying high" (Press release). Scottish Government. 2 March 2010. Retrieved 20 November 2015.
  18. ↑ "Towards a Single National Specialist Transport Service for Scotland - ScotSTAR: Strategic vision" (PDF). Scottish Government. 18 November 2011. p. 6. Retrieved 22 November 2015.
  19. 1 2 Weldon V (12 June 2014). "Flying doctors add new team to cover Games emergencies". The Herald. Retrieved 23 November 2015.
  20. ↑ "Rural fast-response medics to be celebrated". The Scotsman. 3 December 2014. Retrieved 22 November 2015.
  21. ↑ "New Glasgow Airport base for patient retrieval team" (Press release). Glasgow Airport. 22 September 2015. Archived from the original on 23 November 2015. Retrieved 22 November 2015.
  22. ↑ "Scottish Trauma Network | EMRS North". www.scottishtraumanetwork.com. Retrieved 24 September 2023.
  23. ↑ "Retrieval Practitioners". Emergency Medical Retrieval Service. Retrieved 27 September 2023.
  24. ↑ "Consultants". Emergency Medical Retrieval Service. Retrieved 27 September 2023.
  25. ↑ "Registrars and Fellows". Emergency Medical Retrieval Service. Retrieved 27 September 2023.
  26. ↑ "Blood on board" (Press release). Scottish National Blood Transfusion Service (SNBTS). 27 March 2015. Retrieved 12 December 2015.
  27. 1 2 Walker N (22 October 2012). "Smartphone app to help rural healthcare wins two awards". The Scotsman. Retrieved 12 December 2015.
  28. 1 2 Neagle, Gregg; Curatolo, Lisa; Ferris, John; Donald, Mike; Hearns, Stephen; Corfield, Alasdair R. (1 April 2019). "Epidemiology and location of primary retrieval missions in a Scottish aeromedical service". European Journal of Emergency Medicine. 26 (2): 123–127. doi:10.1097/MEJ.0000000000000483. PMID   28746084. S2CID   23053968.
  29. 1 2 Ross, Mark; Corfield, Alasdair; McCormack, Jon; Loughrey, John Paul (1 November 2015). "Tracheal intubation in primary and secondary retrieval patients: A study of tracheal intubation practice and complications in ICU and aeromedical retrieval". Resuscitation. 96: 49–50. doi:10.1016/j.resuscitation.2015.09.114. ISSN   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. doi: 10.1093/bja/aeu227 . ISSN   0007-0912. PMID   25038154.
  31. ↑ "Q&A: Dr Stephen Hearns of EMRS". Medical and Dental Defence Union of Scotland (MDDUS). 30 June 2010. Retrieved 22 November 2015.
  32. ↑ "Secondary Care Team of the Year 2010". BMJ Group. Archived from the original on 22 May 2012.
  33. ↑ plc, Reach. "Scotland's Champions 2023 - Finalists". scotlandschampions.co.uk. Retrieved 24 September 2023.
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