Emergency mecical retrieval and transfer service Cymru A talk by Mike Palmer at TBS23

1. Mike Palmer – Critical Care Practitioner (CCP)
Emergency Medical Retrieval and Transfer Service Cymru
(EMRTS)

4. • Population of 3 million people
• Snowdonia highest mountain 3,560 feet
• 746 miles of coastline
• 130 mile from north to south
• Two major cities.
The 24/7 EMRTS operates:
• Critical Care Hub (CCH) Operation – 24/7
• Cardiff Operation 24/7
• Caernarfon Operation – 8am to 8pm.
• Welshpool Operation – 8am to 8pm.
• Dafen Operation – 7am to 7pm.

6. • Government funded national service
• Wales Air Ambulance is a Charity
• Organisationally separate to Ambulance Service
• 24/7 – Car & aircraft response (Pan-Wales in 20 minutes, day time)
• Mixed pre-hospital / critical care retrieval & Transfer (all ages)
• Blended Doctor & Critical Care Practitioner delivery model
• Equity of care to the population, regardless of location
Emergency Medical Retrieval and Transfer Service (EMRTS)

10. Critical Care Hub (CCH)

11. • Healthcare professionals from a paramedic or nursing background
• Clinical shift consists of either doctor and CCP or double CCP led
• In house established training program
• Currently, there is no national standard established for CCP practice
The Critical Care Practitioner (CCP)

12. Training Programme
• 4-5 year training programme from appointment to Qualified CCP (Q-CCP).
• HEMS Technical Crew Course (TCM)
• RCUK Courses (ALS / EPALS / NLS / FEEL/ Operator 1 status RSI)
• Diploma in Immediate Medical Care (DIMC)
• Core placements in ICU / Emergency Medicine / Anaesthetics / NICU
• MSc (Approved ACCP MSc or Bespoke EMRTS MSc at University of Bangor)
• Specific courses (Level 1 ultrasound +/- accreditation / Surgical Skills etc)
• PGCert in Blood Component Transfusion (NABT)
• Independent Prescribing (IP)
• CCP portfolio

14. • Blood products (RBC, FDP, Fibrinogen)
• Procedural sedation & advanced analgesia
• Post-ROSC sedation, paralysis & mechanical ventilation (intubated patients)
• Limb manipulation
• Advanced haemodynamic management (inotropes / vasoconstrictors)
• Paralysis and sedation (Managing an already intubated patient (e.g Intubated during arrest)
• Emergency surgical procedures – surgical airway – procedural sedation,
• Insertion and management of arterial lines
• Ultrasound
• Point of care ABG / VBG / Coagulation
• Ventilator strategies
• Termination of resuscitation outside Paramedic practice
• Direct referral to specialist care (PPCI, paediatrics, burns, plastics and Major trauma)
• Diagnosis and correction of electrolyte and metabolic derangements
• Administration of medicines outside of normal UK paramedic guidelines
• Non-invasive ventilation (CPAP / BiPAP) – All ages (including neonates)
Interventional Skillset

15. 177 Core Competency Stems.
Must be captured through serial work
based assessments (WBA)
Consultant & educational supervisor
• DOPS
Direct observation of practice
• CEX
Clinical Evaluation Exercise
• CBD
Case Based Discussion
• SIM
Simulation

16. Expectation to obtain multiple work based
assessments for individual competencies
prior to completion of training QCCP signoff
Portfolio reviewed annually ahead of PADR
Airway log book and mission log book

17. CCP Case Study
• Motor cyclist v barrier in rural Wales.
• 2 x CCP aircraft
• Sent further 2 x CCP team aircraft
First on scene:
• Traumatic cardiac arrest
• HOT principles applied
• ROSC achieved.
Second on scene:
• POCUS – underfilled + RBC + Lyoplas + fibrinogen (10 units)
• ROSC maintained.
• Air transfer to the closest MTC (20 minute flight)
• Rocuronium, Calcium 10%, Co-amoxiclav given enroute by air, Hamilton T1 ventilator.

18. Now
• Ongoing transition to e-portfolio.
• Increasing investment into internal training and development / governance.
• CCP Clinical Fellowship for Paramedics & Nurses launched – CCP’s of the future!!!
The pipeline…?
• Accreditation with professional body for advance level practice in the UK
December 2022 – 34,640 HCPC registered paramedic in the UK. ?CCP
• Discussions around progress towards CCP led Pre-Hospital Emergency Anaesthesia
Starting with CCP led level 3 interhospital transfers?? (Top Cover vetted cases)
• Fellowship in Immediate Medical Care (FIMC)
The future for Practitioners in Wales?

19. @mikekeithpalmer
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