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Pre Hospital Emergency Medicine Training


24-October-2018

In 2018 the first trainee completed the new Pre Hospital Emergency Medicine (PHEM) subspecialty training programme in Scotland, a unique collaboration between the Scotland Deanery, Emergency Medical Retrieval Service (EMRS), Scottish Ambulance Service, London Air Ambulance and London Deanery. Trainees from Anaesthesia, ICU , Emergency Medicine and Acute Medicine from ST4 and above compete nationally for the programme which spends six months in Scotland at the ScotSTAR base at Glasgow Airport and six months with the London Air Ambulance, based at the Royal London in Whitechapel.

Origins of the Training Programme

The pre-hospital phase of a patient’s journey can be critical to their survival and morbidity. These environments are often resource limited and physically and mentally challenging. PHEM doctors are trained to provide critical care both on scene and in transit for the most seriously ill or injured. 

Recognising that there was no system, training scheme or workforce, the Faculty of Pre-Hospital care under the umbrella of the Royal College of Surgeons of Edinburgh supported the development of the PHEM subspecialty, approved by the GMC in 2011.

There are now 10 schemes in the UK, producing around 16 new subspecialists per year, enhancing the vital role already performed by the local ambulance services.

The Training Scheme

The curriculum is divided into six domains with three phases. Phase 1A is the gaining of core knowledge and familiarisation with local operations, a knowledge test must be passed at six weeks.

The Diploma in Immediate Medical Care must be passed at six months at the end of Phase 1B.

Phase 2 works towards independent practitioner competence and is completed on submission of the 110 WPBA to the training board and passing of the Fellowship in Immediate Medical Care exam.

The Training Environment

EMRS has 33 part-time Consultants from anaesthesia, emergency medicine and ICU. They respond by road, fixed wing or helicopter with either a registrar or retrieval practitioner providing remote and rural DGHs, GP surgeries and community hospitals in Scotland with critical care expertise on a 24/7 basis. A second team is available to respond to serious incidents requiring a time critical response before patients arrive at hospital – providing extrication analgesia, multi-casualty scene management and performing life saving interventions such as giving blood, RSI and chest decompression. Training has been fundamental since its inception and there have always been clinical fellows. Human factors education takes a high priority and is integrated into all ways of working and training within the service.

London’s Air Ambulance

This service is recognized as one of the best in the world and has been in operation for 25 years.

Trainees are exposed to the high volume, short transfer trauma that has become this services specialty in the city of London. From a training point of view, it means that the trainee not only gets experience of a different service but also high volume intervention exposure, essential for their logbook. 

Scotland’s first PHEM trainee, Dr Neil Studd says, “A fantastic scheme with incredible training opportunities, in my opinion the best in the UK.”

For more information contact nicola.littlewood@ggc.scot.nhs.uk