Multi-agency Major Incident exercise Invergordon – 31st July 2017

Many thanks to our colleagues in SAS and FRS for the invitation and hosting of a fantastic joint training exercise today.

The level of professionalism and cohesive inter-agency working on display from both services made what could have been an overwhelming clinical scenario the manageable affair it turned out to be.

PICT supplied medical staff for both forward and field hospital site medical teams with an abundance of P1s and prolonged entrapments to cope with and the chance to road test the SORT team field hospital was invaluable.

Lessons learned – even in a closely packed scene, the flow of information is still incredibly difficult to control and utilise effectively. Changing staff roles and indeterminate review periods for patients with prolonged entrapments may compromise the quality of such information. The calm and systematic team approach to a major incident is the most powerful tool available to sort the chaos. Forward planning and early pre-alert through the chain of care-givers from site to hospital is crucial and must be kept up as the situation rapidly evolves.

Tasks acquired -revise triage packages for PICT responders and major incident kit bags. Revise documentation for casualty clearing station. Continue to train 6-12 monthly as a major incident team and do so with other agencies at every opportunity.

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PICT final report and Business Case presented to NHSH Senior Management Team

On the 23rd of March 2017 the 12 months of data from the Pre-hospital Immediate Care and Trauma pilot was presented to the health board’s Senior Managemnt Team with a Business Case outlining the potential for an ongoing investment in this approach to improving patient care in Highland.

The key recommendations of the Business Case were:

Commission PICT pilot as ongoing resource in NHSH

PICT team as default MI SMT response in NHSH.
Regular slots for PICT responders located centrally (ie Raigmore site) travelling with SAS paramedics/ASMs in joint tasking
Extend role of DST clinician for decision support of other local clinicians or SAS staff
Continue with full case review of every PRF by DST and 6 monthly data review.
Ongoing training, recruitment, administration and governance by Consultant 0.2 WTE, Nurse Practitioner 0.4 WTE and Band 2 admin assistant 0.6 WTE
Other loci to get central support for the training, recruitment, administration and governance of PICT style teams (eg Caithness, Skye, Argyll & Bute).
Increase analgesic capabilities and provision of pharmacy for PICT. Ketamine and diamorphine to be supplied to those with prescriber status and proficiency with the medications and SOP.
Increase effectiveness and frequency of tasking. Trial tasking by national trauma desk. Engage further with local ACC, dispatchers and supervisors
Develop prehospital RSI capability for PICT critical care clinicians if central resource provisioned.
Continue the re-imbursement financial instrument approved by NHSH finance at a rate of £60 net to the responder per pre-hospital attendance.

Whilst positively received by the Management Team, no immediate provision for ongoing funding was identified and so the project awaits such funding to be identified before it can continue to develop as outlined.
For anyone wishing to see the current version of the business case please contact Luke Regan on luke.regan1@nhs.net

Clinical Governance Day – Dingwall – 18th Feb 2017

Many thanks to Dr Iain Craighead, Dr James Hayward and their team for hosting a fantastic day of joint learning and training at Dingwall Health Centre today.

It was a real smorgasbord with reports back from the Major Trauma Interface project across all the northern health boards and the six month PICT audit allowed to congregate alongside far more hands on sessions with electronic CPR feedback, the new SAS frontline ambulances and trauma packs and deep dive discussions on the challenges of paediatric assessment and logistics co-ordination across the many disparate agencies serving patients in the north currently.

The over-riding take home was of a multi-disciplinary team in the truest sense of the word with much to learn of each other’s perspectives and skill sets…and a firm intention to do more of the same!​

Exercise Meteor – Multi-Agency Major Incident Exercise Dalcross Airport – 4th October 2016

“After a multiple bird strike a fixed wing passenger aircraft (SAAB 2000) crashes on landing in an area off the airfield between the security fence and the public highway (RW05 undershoot area) close to a deep drainage ditch. There are numerous casualties and there are a number of small fires in the vicinity of the wreckage. It is likely that a quantity of aviation fuel has been released during the incident.“

PICT fielded 15 staff who took on roles of Medical Commander, Casualty Clear Station Medical Officer, Forward Medical Officer and the Site Medical Team active in both triage, forward treatment and the management of the Casualty Clearing Station.

Many thanks to all in attendance. Invaluable exposure to large scale multi-agency working and road testing the PICT Site Medical Team in a large scale mass casualty scenario.

Lessons learned = unnecessary high visibility PPE in a casualty clearing station leads to confusion of roles. Collapse of radio comms requires rapid transition to alternative arrangements. Control of information at every level remains crucial and near-impossible. Tracking the changing of patients’ triage categories and staff roles is as important, if not more so than the original headcounts and designations.

Tasks set = revision of PICT major incident paperwork and backup plans for comms failure at scene.

Clinical Governance day- 24.Sept.2016

Our First Ever Clinical Governance day:

A massive thanks to everyone at the HM Coastguard Bristows Search and Rescue Base, Inverness for hosting us.   Plus an extra special thank you for all of your help, and enthusiastic participation in the day- you really made it!

Photos of our Major incident practice session:

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Minutes:

13:00- Welcome to the Base- Josh Williams, SAR Paramedic

13: 05- Welcome to the CGD– Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder

13:20- Major Incidents– Peter McPhee, Emergency planning officer for NHS Highland

13:50- Activity Review- Morbidity and Mortality– Stuart Swanson, Advanced Nurse Practitioner, PICT Pilot Co-Lead, Decision Support Team member & PICT responder, with some case discussion from  Dr. Richard Brown, GP, Decision Support Team member & PICT responder & Dr. Brian Fitzsimons, Occupational health & GP, Decision Support Team member & PICT responder.

14:10- Case- Prehospital Thrombolysis, Dr. Duncan Scott, Acute Medicine Consultant, PICT Decision support team member & PICT responder.

14:25- Break

15:10- Case- First time out responding, Dr. James Tullie, GP EP, and PICT responder.

15:20:  Major incident- Medical care & Major incident exercise brief  – Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder

15:30: Major incident exercise.  Including all attendees of the Clinical Governance Day & some Search and Rescue staff.  With Thanks to Josh Shaw- 5th year Medical student who played a major role in the co-ordination of this excercise.

17:00 Round up, feedback forms and close-Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder & Dr. Alicia Garland – Highland PICT admin & Academic FY1 Doctor

Feedback:

Of the feedback forms returned, 75% rated the day Good or Fantastic, 25% Didn’t complete this element of the feedback form.  0% rated the day as Neutral/Below Par/Poor.screen-shot-2016-10-03-at-20-29-02

Good Points:

  • Major incident exercise, allowed practice with both MI type scenarios, kit
  • Good discussion/debate on a wide range of topics
  • Good feedback from group on cases
  • Morbidity and Mortality Talk

Points to be improved:

  • Unable to cover all topics
  • Clarity on local pre-alerting policy

 

Thanks to the team:

To all attendees: Dr. Luke Regan, Mr. Stephen McNally, Dr. Claire Vincent, Dr. Mike Ashcroft, Dr. Connor Bowbeer, Donna McGregor, Angus Stephen, SAR staff, Dr. Jenny Parsons, Dr. Charles Lee, Jo Findlay, Dr. Graham Bee, Dr. Richard Brown, James Haywards, Leslie Pirie, Eric Pirie, Dr. Ian Craighead, Dr. James Tullie, Dr. Duncan Scott, Peter McPhee, Stuart Swanson, Dr. Dan Baraclough, Josh Shaw, Dr. Brian Fitzsimons & Alicia Garland.

To all speakers: Dr. Luke Regan, Peter McPhee, Stuart Swanson, Dr. Duncan Scott, Dr. James Tullie, Dr. Richard Brown, Dr. Brian Fitzsimons & Alicia Garland

To all organisers: Dr. Luke Regan, All the staff at SAR Inverness, Stuart Swanson & Alicia Garland.

To all facilitators: Dr. Luke Regan, All the staff at SAR Inverness, Stuart Swanson, Josh Shaw & Alicia Garland

Thank you to everyone, for making the day a huge success.

Next CGD due Jan 2016

Date, Venue and Time to be confirmed.

PICT News; June.

This month in numbers:

Tasking to scenes:

Screen Shot 2016-07-06 at 22.28.43

Screen Shot 2016-07-06 at 21.45.49Screen Shot 2016-06-22 at 17.28.31

OHCA= out of hospital cardiac arrest. RTC= Road traffic collision.

At the scene:

Average time spent at scene= 46.5 mins
Screen Shot 2016-07-06 at 22.00.45Screen Shot 2016-07-06 at 21.52.14

 

Thank you to all our Scottish Ambulance Service (SAS) and Helimed colleagues who were with us at the scene.

After the Scene:

Avoiding admission– 22% of patients have been discharged at scene, and thus have avoided travel to and admission to hospital.

Average time for Decision support team feedback on submission of PRF = <27hrs

Other numbers:

Number of responders active = 26% of all live responders.

 

 

 

 

PICT NEWS, Apr & May.

The NHS Highland (NHSH) Prehospital Immediate Care & Trauma pilot (PICT) is a scheme to co-ordinate and support a group os BASICS responders, distributed around the Moray Firth basin.  Dornoch to Aviemore, Nairn to Beauly.  Members of this group currently include, Intensivists, GPs, Anaesthetists, Advanced Nurse Practitioners and Emergency Physicians.

The first wave of 15 responders went live on 23.04.2016.

First month cases:  Cases in the first month of operations have seen multiple road traffic collisions (RTCs),  including a seven casualty three car incident; and an out out of hospital cardiac arrest (OHCA) with the attending physician securing a definitive airway, gained intra-osseous (IO) access and guided peri-arrest thrombolysis, amongst others.

So far we have achieved:

  •   The Introduction of the Decision Support Team (DST), made up of senior and experienced clinicians.
  • Standardised kit, drugs bags, standard operating procedures, and currencies for all responders.
  • An increase in responders available to be tasked by the Scottish Ambulance Service (SAS).

The role of the DST:

  • Supporting PICT responders, in the capacity of providing decision support at scene, via a dedicated and robust phone system- available to responders 24’7.
  • With the information the DST receive from responders, they can pre-alert receiving hospitals, and relaying information to Ambulance Control.
  • De-brief and Feedback.  The DST have been providing rapid feedback on all submitted patient report forms, providing governance and follow up of patients seen by PICT responders.

Recruitment:

AIM: Recruitment of responders and promotion of the role across wide disciplinary and seniority range

PROGRESS:

Screen Shot 2016-08-03 at 19.15.03Screen Shot 2016-08-03 at 19.14.52Virtual learning:

AIM: Additional training to current responders

PROGRESS: e-induction available to all responders; modules include: who are we; kit walkthrough;  good jobs/bad jobs;  training currencies, ride alongs, ACC, dual tasking….and more.

Case based learning: Available to all responders- Currently 2 cases available.

Interagency working:

AIM: Promote inter-disciplinary and inter-agency training and operations &  provide up to date responder information to ambulance control

PROGRESS:  During the initiation of this project we have had several useful and productive meetings with Ambulance control.  Thank you very much to all that attended.  Ambulance control has up to date information on all live responders.

Forecast: Document 2.0 in progress, ambulance control should  receive this shortly.

  • Proportion of total recruits who have attended Ambulance control, and or ambulance ride alongs = 40%.
  • Input from Police, SAR/Coastguard, Fire and Rescue in e-induction material

Appeal for more ideas/opportunities for interagency working. Please e-mail Alicia with any suggestions.

Decision Support:

AIM: To implement Decision support, case review and adverse event reporting.
PROGRESS:  The current average response time for DST feedback after PRF submission is <24hrs.  Thank you to all DST members who have been providing feedback.

Adverse event reporting is to be done via the EMRS developed SPHERE  pre-hospital reporting system http://www.sphere.scot.nhs.uk

A massive thank you to Luke Regan who has been on call for the decision support team until the implementation of the dedicated line.

Standardising our Service:

AIM: More formalised standard operating procedures for management of serious conditions & alignment with best practice in other Scottish pre-hospital teams currently operational

PROGRESS: We currently have a list of 18 SOPs available at  https://highlandpict.wordpress.com/resources/s-o-p/   Many of which are standard BASICS Scotland SOPs or are adapted from the Emergency medical retrieval service (EMRS).

Out of hospital cardiac arrest -OHCA:

AIM: Review tasking criteria, particularly in light of recent Scottish Government initiatives in delivering care to Out of Hospital Cardiac Arrest (OHCA) patients.

PROGRESS: We are collating data on the types of cases we’re being sent to including, special groups such as:

  • OHCA, RTAs, Entrapped and Paediatric patients.

Forecast: With data from cases,  we hope to demonstrate current PICT utilisation in OHCA cases.

Highland PICT is now LIVE

Screen Shot 2016-05-29 at 01.12.04.png

As of the 23.04.16, the Highland PICT pilot has gone live.  The first wave of BASICS trained prehospital responders are live, with more being recruited and kitted to follow in their footsteps.  A massive thank you to all our partners who have supported us up to this point.