Critical Care Practitioners
EMRS has seven full time critical care practitioners. The CCP team is led by Stu Daly. Our CCPs come from both nursing and paramedic backgrounds. The role is varied including pre-hospital care, secondary aeromedical retrieval, service development, audit, research and training. EMRS CCPs are examiners in the Diploma in Retrieval and Transfer Medicine and all are undertaking the retrieval medicine MSc at Glasgow Caledonian University. A number of the CCPs have recently achieved advanced critical care practitioner status and are embarking on a programme leading to autonomous ACCP critical care retrievals.
Stuart joined the Emergency Medical Retrieval Service in October 2010 and is the Lead Critical Care Practitioner for the service. Prior to joining the team, Stuart worked in the emergency department of the Royal Infirmary of Edinburgh and as part of this role was the lead nurse for the Medic One prehospital care team. Stuart holds a specialist practitioner qualification in critical care and is a faculty member and examiner for the Diploma in Retrieval and Transfer Medicine (DipRTM) run by the Royal College of Surgeons, Edinburgh. Stuart has completed courses in clinical decision making, cadaveric surgical skills, London's Air Ambulance Helicopter Crew Course, ATLS, ALS, TNCC and RSI and is an instructor with BASICS Scotland. He has had an elective placement with the London Air Ambulance (HEMS), has spent time with the MedSTAR team in Adelaide, Australia and has experience of working within a mountain rescue team. His main interests are prehospital care, critical care and trauma.
Personal interests include walking, cycling, music, technology and watching sport from the safe distance of his armchair at home.
BSc (Hons) DipRTM (RCSEd) PGCert
Lisa joined the Scottish Ambulance Service in 2000 and completed her paramedic training in 2002. Based in Glasgow for the past 15 years, she has completed various secondments including team leader and clinical advisor in the ambulance control centre and also graduated with a BSc (Hons) Advanced Paramedic Practitioner.
Being extremely interested in working in critical care and retrieval medicine, Lisa joined the Emergency Medical Retrieval Service in 2011 as a critical care practitioner and is currently part of a team driving the prehospital development. She is current in ALS, APLS, SCOTTIE and has completed the London's Air Ambulance Helicopter Crew Course (Medical Module). Out with clinical courses, she has completed a PRINCE2 project management course and an Introduction to Simulation, Medical Education course.
Lisa passed the first diet of the Diploma in Retrieval and Transfer Medicine held at the Royal College of Surgeons of Edinburgh and has been a member of the examination faculty since. She has completed a Post Graduate Certificate in Advanced Practice & Innovation (Critical Care) and will be continuing her MSc studies next year.
In her spare time, Lisa tries to stay upright on her road (& mountain) bike and enjoys live gigs.
BSc DipIMC RCS (Edin) DipRTM RCS (Edin)
Neil began his career with the Scottish Ambulance Service 10 years ago and has been a paramedic for 8 years. He gained most of his experience working in Edinburgh staffing traditional ambulances, response cars and cycle response units. He relocated to the west coast in 2010 to take a secondment with the SAS helicopter Helimed 5. The highlight and most challenging move of his career was joining the Emergency Medical Retrieval Service in the role of critical care practitioner in 2011. Neil has a Bachelor of Science degree in paramedical science from Stirling University and has gained the diploma in immediate medical care and the diploma in retrieval and transfer medicine from Edinburgh's Royal College of Surgeons. He is looking forward to the challenge of returning to the royal college of surgeons this year as a member of the faculty and examiner for the retrieval and transfer medicine diploma.
Neil's specialist clinical interests are prehospital cardiac arrest management after being one of the founder members of the successful TOPCAT resuscitation project in Edinburgh and the development of the retrieval practitioner role within EMRS. Currently Neil is the lead CCP for education and training and is utilising his experiences from the London air ambulance Helicopter Crew Course to increase the intensity and complexity of the daily simulation at the base. He will be continuing his post graduate studies this year and hopes to complete a MSc in Advanced Clinical Practice.
In his spare time, Neil tries to mountain bike and snowboard when the weather permits.
Jeff began his career with the London Ambulance Service and qualified as a paramedic in 2007 whilst completing his BSc Hons in Paramedic Science at Hertfordshire University. After relocating to the Scottish Ambulance Service he worked in Glasgow for 18 months before joining Helimed 5 in December 2010. Jeff has recently complimented his CPD portfolio with courses in AMLS, GEMS, major incident management ALS and ATLS.
In October 2011 he joined the Emergency Medical Retrieval Service and is the lead Critical care Practitioner for research and audit. Jeff completed a critical care module in September 2012 and has a growing experience of teaching with BASICS and the ED anaesthetics assistant course in Lanarkshire. Recently he has completed the Dip IMC, London's Air Ambulance crew member course and will be sitting the DRTM in October this year.
Away from work, Jeff enjoys the odd run, sailing and snowboarding.
Alistair joined the SAS in 1996 before moving to Manchester to train as a paramedic and returned to Scotland in 2004. He joined the Scottish Air Ambulance Service in 2006 working predominantly on Helimed 5 in Glasgow and took up a full time secondment with the EMRS as a critical care practitioner in June 2011.
Alistair gained the DipIMC in 2009 and has completed a number of external courses in adult, paediatric, neonatal and trauma life support. He recently completed a gereric instructors course and hopes toteach on ALS and Basics courses in the future. Alistair completed a critical care module in 2010 and is now commencing a BSc in critical care at the Glasgow Caledonian University. He is the lead CCP for the services pre hospital response development.
Graham completed his general nurse training in 1984 and following specialist training he began his career long involvement in critical care. He secured his first Charge Nurse post in the Neurotrauma ICU at Middlesbrough General Hospital in 1992. In 1994 he was appointed Clinical Specialist in ICU at Furness General Hospital and a year later was appointed to the same role in the ICU at the Western General Hospital, Edinburgh. In 2004, after a number of years with the RAF Reserves, Graham left the NHS and joined the RAF as a Regular Nursing Officer. Working in a variety of locations his clinical role was as a Team Leader in the Critical Care Air Support Team, transporting critically ill patients to the UK from around the world. He joined EMRS on a temporary contract in September 2013 and continues to work as a Reserve Nursing Officer with 612 Sqn at RAF Leuchars.
He holds a Further Education Teaching Certificate and has instructed on ALS and BATLS courses.
Graham has been involved with mountain rescue for many years and has an interest in delivering prehospital care in remote environments and also the training of mountain rescue search dogs.
His hobbies include all year round mountaineering, sea kayaking, mountain photography and DIY.
James qualified as a Psychiatric Nurse in 2000. He helped establish an Early Onset Psychosis Unit at Lambeth Hospital, London. In 2002 with gentle persuasion from his wife he moved to Scotland where he completed his conversion course to be dual qualified. The vast majority of his post-registration experience has been in emergency nursing. Prior to joining the Emergency Medical Retrieval Service on a temporary contract, he was a Charge Nurse and Emergency Nurse Practitioner in the Emergency Department of the Royal Infirmary of Glasgow.
He enjoys providing critical care and believes strongly that this should be delivered in a compassionate manner.
Away from work James strives to stay in peak physical condition to meet the challenges of the job and the demands of his young family.
Critical Care Practitioners
The Emergency Medical Retrieval Service clinical teams routinely comprise of a consultant with a background in emergency medicine, anaesthetics or intensive care and either a registrar from one of these specialties or a critical care practitioner. First employed by the service in 2010, when EMRS became a national service, the CCP role has developed rapidly and continues to evolve at pace.
The critical care practitioners are a multi-disciplinary team from a senior nursing or paramedic background. Due to the broad spectrum of clinical work involved in primary and secondary retrieval the decision was made to develop the practitioner team as a hybrid model utilising the skills and experience from paramedic pre-hospital care, emergency and critical care. The result is a strong team who are equally able to provide a high level of critical care in a full range of settings from pre-hospital major trauma such as road traffic collisions, multiple casualties / major incidents to intensive care patients being moved from remote and rural care facilities. Irrespective of their professional background the all the CCPs perform all aspects of the practitioner role equally and interchangeably.
TRAINING AND EDUCATION
Training and education is a hugely important aspect of the CCP role. Each team member is given a bespoke induction programme depending on the individual’s background and experience. This can include working within the aeromedical environment, emergency response driving, retrieval and pre-hospital equipment and considerations for critical care and pre-hospital care.
For at least the first year that a CCP is in post they will always be working alongside a consultant in any clinical situation and we view this as an initial apprenticeship for the CCP role. This one to one teamwork offers excellent senior supervision and excellent learning opportunities. Also whilst on clinical shifts, the duty teams aim to carry out two sessions of training or education every day. This can take the form of scenario training, skills and drills, topic teaching, journal article review, case based discussions or equipment revision.
After this initial year is completed the CCP can then start the process of becoming an Advanced Critical Care Practitioner (ACCP). This involves undertaking a Post Graduate Certificate (PgCert) in Advance Skills and Innovative Practices which forms part of the MSc framework and is delivered in conjunction with the Glasgow Caledonian University. This is assessed through clinical experience logs, practical procedure logs, directly observed practical procedures, case based discussions, submission of several pieces of written work and an Objective Structured Clinical Examination (OSCE). Following the successful completion of the PgCert and sign off by the service lead and clinical lead then the CCP will be recognised as ACCPs within the service. The ACCPs will also be recorded in the Scottish Workforce Information Standard System (SWISS). Five of the team have completed the ACCP pathway.
The ACCP project is continuing to develop and we are currently indentifying how best to utilise the advance and autonomous practice skills developed by the team including ACCP led retrieval missions.
The practitioner team have also benefitted from attending many internal and external courses and study days including: resuscitation council life support courses, pre-hospital care course run by London Air Ambulance’s Institute of Pre-Hospital Care, winch training/search and rescue, cadaveric surgical skills, extrication training, paediatric emergency care, major incident management, team resource management, simulation skills and mountain rescue training. Several team members also instruct and teach on various courses.
EMRS were instrumental in the conception of the Diploma in Retrieval and Transfer Medicine (DipRTM) at the Royal College of Surgeons in Edinburgh. Several of the CCP team have been award the DipRTM and are now examiners with the Royal College of Surgeons.
OTHER ASPECTS OF ROLE
The CCP team have a vital role in service maintenance, continuity and development. Each practitioner has a non-clinical role on which they lead. These currently include: equipment management, audit and research, trauma desk, major incident and training and education. These roles provide the practitioners experience in all aspects of project planning and delivery.
The team contributes to the rota of the Scottish Ambulance Service’s Trauma Desk which is based West Ambulance Control Centre. The aim of this desk is to identify any cases of major trauma from every 999 call made in Scotland and to mobilise the most appropriate pre-hospital care critical care team by the most appropriate transport mode. This can be a challenging task which utilises clinical knowledge and experience and logistical knowledge.
EMRS aims to carry out an outreach teaching and training visit every year to each of the remote and rural centres from which patients are referred. The practitioner team play an active role in these visits, delivering presentations and training to our remote and rural colleagues. Presentation skills are also utilised in broad spectrum of other situations such as case presentations as part of the service’s clinical governance meetings, lectures at local colleges and universities, presentations at local ambulance service teaching sessions and presenting at national and international pre-hospital and retrieval medicine conferences.
The team have also had several papers and letters published in a wide range of nursing, paramedic and medical journals.