EMRS has eight full time retrieval practitioners. The RP team is led by Stu Daly. Our RPs 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 RPs 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 RPs have recently achieved Advanced Retrieval Practitioner status and are embarking on a programme leading to autonomous ARP critical care retrievals.
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 retrieval practitioner. First employed by the service in 2010 as critical care practitioners, when EMRS became a national service, the RP role has developed rapidly and continues to evolve at pace.
The retrieval 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 RPs perform all aspects of the practitioner role equally and interchangeably.
TRAINING AND EDUCATION
Training and education is a hugely important aspect of the RP 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 RP 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 RP 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 Specialist Retrieval Practitioner can then start the process of becoming an Advanced Retrieval Practitioner (ARP). 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 ARP 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 ARP 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 RP team have been award the DipRTM and are now examiners with the Royal College of Surgeons.
OTHER ASPECTS OF ROLE
The RP 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.