Article: Anaesthesia and pre-hospital emergency medicine DOI: 10.1111/anae.12064
So what's it all about then?
Trauma is relatively infrequent in the UK and tends to affect younger age groups. Even with the dense population, patients may still be relatively far from a suitably equipped hospital. There have been calls for some time for dedicated pre-hospital teams, but these have taken a long time to develop. Although paramedics + BASICS Dr make a good combination, coverage, availability and training may be variable. The idea is to start care at the highest level on-scene and continue throughout the patient's stay and rehabilitation. The current system commonly involves Enhanced Care Teams (ECTs, doctor + paramedic) which are generally funded by charities (with the exception of the EMRS in Scotland). This system has been formalised over the past few years. [The paper doesn't comment that there is still a lot of work & training done by groups such as BASICS]
It is estimated that about 250 whole-time equivalent (WTE) Consultants are required. Now, people aren't expect to work full time in PHEM so that translates to about 600-700 in total. The rest of the time would be spent in the parent speciality. This is quite a lot of jobs!
Sounds great! What do I need to get in?
Applicants must be >=ST4 in either Anaesthetics or Emergency Medicine [since this was published they can now come from Intensive Care too].
What does training involve?
I thought this was rapidsequence.com?
"recent evidence suggests that secondary brain injury is lessened, not only by the avoidance of systemic hypotension commonly seen with other induction agents, but also because ketamine attenuates the haemodynamic response to intubation and appears to also have neuroprotective properties"
Interestingly suxamethonium is commonly used and even those using rocuronium don't routinely carry sugammadex (reversal is not really an option). Sedation is maintained with bolus midazolam & morphine or propafol infusions.
The airway algorithm followed bears a lot of similarity to those used in hospital, following the order of DL/VL/LMA/FM/Surg. (Direct laryngoscopy, video laryngoscopy, laryngeal mask airway, face mask, surgical airway). They point out that the best results in PHEA are likely to occur in the context of a bundle of good care (lung protective ventilation, damage control resus etc etc) which seems sensible (although isn't referenced).
Sum it up
Thanks for reading.