Dr Steven Hearns and


Yerkes-Dodson curve (below)


do I interpret this ECG or ultrasound? What’s actually wrong with the patient? What do I do next?’ So you are offloading the cognitive burden by planning what’s predictable and practising that.” One major innovation that has also


helped reduce cognitive overload and transformed the care provided by EMRS is the development of a mobile app with immediate access to all 148 SOPs along with a wealth of other essential tools and information, such as drug calculators and formularies, direct dial telephone numbers for hospitals, information on landing sites and what clinical facilities are available where. “A team can be in flight to the island of Barra”, says Dr Hearns, “and find out that the aerodrome is eight miles from the hospital and takes 18 minutes to reach. It has no X-rays, it has no blood and if we are taking someone from Barra we are going to the Queen Elizabeth in Glasgow.” Te team also employs multiple checklists


to ensure nothing essential is missed out in delivering emergency care. “We use a two-person check and response system with one person reading out the list and the other checking.” Te system is used at all stages of a mission from restocking emergency medical bags, checking equipment and supplies before departure, carrying out procedures on-site and also before leaving the scene. Restocked and checked medical bags are then sealed


WINTER 2016 High Optimal performance Alert Under-stimulated Low


Excess anxiety


Overwhelmed, distressed,


dysfunctional Stress level


with plastic tabs before the next mission. “Tat means if we are going out on a job


and the various pockets are sealed we know that everything we need is in that bag.”


Drill and drill some more In free time between missions the duty team makes use of an on-site simulation suite with medical manikins, or uses mobile manikins to practise procedures in more difficult circumstance such as in stairwells or in a cramped helicopter cabin. “Tere are certain procedures that might


have 20 or 30 stages. So if we drill everyday so that everyone is confident about how to perform a procedure – such as anaesthetising a patient or how to put on a splint or start a blood transfusion – it will


High


take up less of our cognitive bandwidth when we are with an actual patient.” Tese are only


a few of many innovations that have made the EMRS team recognised world leaders in the field of retrieval medicine. Te service has been instrumental in the development of a


diploma in retrieval and transfer medicine at the Royal College of Surgeons of Edinburgh, with candidates from all over the world. Each year EMRS also runs a conference in Glasgow on retrieval medicine. Dr Hearns believes the service provided by EMRS will become even more vital in future. “Te increased move towards centralised


specialist services is improving outcomes but you’ve got to get the patient safely to those specialist centres. Tat’s where prehospital care and retrieval medicine comes in. It provides equity of access to people wherever they are in the country.”


n Jim Killgore is managing editor of Summons


15


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