Home and away: The 2012 international pre-hopsital care conference

The joint BASICS (British Association of Immediate Care Schemes) and Faculty of Pre-Hospital Care conference was held on the 12-13th October 2012 at the Holiday Inn, Walsall. The title of the conference, although sounding like a television programme, referred to the conference theme of the ‘medics’ practicing both in the UK and abroad.

This article summarises the main presentations from a wide-range of topics covered in the two-day programme, most of which will be of interest to paramedics.

Consensus statements from the Faculty of pre-hospital Care: Sir Keith Porter

Following a welcome to the conference, the first session was an update by Professor Sir Keith Porter on the current status of the consensus statements on spinal immobilisation and pharmacologically assisted laryngeal mask insertion (PALM) from the Faculty of Pre-Hospital Care.

Although not yet finalised, the consensus from the Faculty and the delegates was for the use of ‘scoop’ stretchers to immobilise patients as opposed to long boards due to the reduced need to move or roll patients.

Time to bypass the resus room? Mr Tom Konig

The next session at the conference was delivered by Mr Tom Konig from the Royal Army Medical Corp. Entitled, Time to bypass the resus room, this presentation referred to the need of trauma patients to be in operating theatre rather than in the resuscitation room.

This was supported by the speaker's experiences from Afghanistan, where severely injured trauma patients were often taken to the adjoining operating theatre and not to the resuscitation room first.

Commander? Officer? Advisor? The EMAS approach to medical leadership in a major incident: Dr James Gray

The Medical Director of East Midlands Ambulance Service (EMAS), Dr James Gray, discussed the development of the medical incident advisor rota for the EMAS and how the Ambulance Trust views this, not as a commander role as prescribed by MIMMS, but as a ‘medical advisor’ to the Ambulance Incident Commander.

Vehicle safety. Alistair Crooks

The Motor Industry Research Association (MIRA), the independent test consultancy that crash test motor vehicles for manufacturers gave a presentation on how cars and other motor vehicles are tested. The presentation included several videos of the outcomes of crash tests conducted at their Nuneaton facility. MIRA also conducts research on road furniture such as signs and lampposts and, as illustrated in the presentation, the audience learnt how these objects were being made safer for road users, particularly through the development of break-off designs.

Big sick/little sick: good medicine in bad places. The latest RNLI Casualty Care programme:Paul Savage

Paul Savage is the clinical lead from the Royal National Lifeboat Institute (RNLI). His presentation discussed the challenges of teaching volunteers to deliver medical aid in hostile environments, such as a sinking ship, or delivering aid at the bottom of a precarious cliff face. To enable their volunteers to do this the RNLI has developed a symptoms based approach to teaching and employing cards carried by the lifeboat personnel.

‘To V or not to V, that is the question’—experiences of festival medicine: Dr Adrian Noon

Dr Adrian Noon discussed the medical coverage at the V festival including how with the support of the local police the medical staff was able to analyse samples from patients for traces of drugs, allowing for more accurate differential diagnoses of patients presenting with reduced levels of consciousness. The logistical challenges of providing medical coverage at a large music festival was highlighted with solutions such as the use of bicycles, quad bikes, and tracked vehicle in order to reach areas of the site not accessible to ordinary ambulances.

New diploma examination: Dr Juergen Klein.

The afternoon of the first day of the conference comprised breakout sessions one of which was led by Dr Juergen Klein, the convener for the Diploma in immediate medical care exam of the Royal College of Surgeons Edinburgh DipIMC RCS(Ed). Dr Klein discussed several year's worth of data highlighting that paramedics and doctors tended to fail this examination due to poor preparation but that the two professions fail in different areas of the exam. Doctors tend to fail in the core skill sections while paramedics are more likely fail in the major incident scenarios. From 2013, the exam will also be by Objective Structured Practical Examinations (OSPE).

To assist candidates in preparing for the DipIMC.RCS(Ed), the Faculty of pre-hospital care has set up regional groups (interestingly, this is similar to the way the College of Paramedics restructured in 2010), which it envisages will help candidates to prepare for exams and that a regional group member will be required to sign off the candidates application to sit the DipIMC.RCS(Ed) exam.

End Tidal CO ² Monitoring in pre-hospital care:Mr Andrew Thurgood

Andrew Thurgood, a consultant nurse and member of the Mercia Accident Rescue Service (MARS) BASICS scheme, gave a highly informative session on the use of end tidal CO ² in the pre-hospital environment showing not only its use in intubated patients, but also those who are self-ventilating.

New high speed emergency driving legislation: Mr Andrew Reid

With upcoming changes to the legislation regarding high speed emergency driving, the head of driver training at the East of England Ambulance Service, Andrew Reid, gave an overview of the anticipated changes, and how those not employed by NHS ambulance trusts could continue to claim the exemption for the use of high speed.

During the BASICS annual dinner at the end of the first day awards were made to BASICS members for their services to pre-hospital care and education.

M5 Crash: Dr James Hickman

The first speaker on day two was Dr James Hickman—the first doctor on scene at the M5 crash in 2011. This crash involved 34 cars and heavy goods vehicles that led to seven deaths. Dr Hickman discussed his involvement in the management of the scene, and commented on how he saw his role to be a combination of advisor and manager, making reference to a previous presentation by the EMAS.

Maritime medicine—worse things happen at sea: Dr Joe Peoples

Having worked for several years as a cruise ship doctor, Dr Joe Peoples gave an entertaining presentation that illustrated the challenges of providing pre-hospital care for thousands of passengers and crew while far off land. With facilities and equipment on board, often more advanced than the destination visited, a dilemma presented that transferring a patient to the nearest land is not always the best option. Occasionally, help at sea could come from the most unexpected place, as Dr Peoples recalled, in one instance, such as a nuclear powered aircraft carrier.

EMS in Malta: Ms Vicky Rausi

The improvements in the emergency medical coverage in Malta were presented by a nurse from the main hospital on the island, Vicky Rausi.

The development of pre-hospital care was described for a country that has no paramedics and where emergency department nurses act as lead clinicians on ambulances supported by a driver and porter. Problems encountered included drink drivers, people making homemade fireworks, and the new problem of terrorist letter bombs detonated by mobile phones.

The Polar Bear Incident Dr Chris Press

In August 2011 there was the terrible case of a British teenager killed by a polar bear while on a UK– lead expedition on Svalbard. The expedition doctor and deputy leader was Dr Chris Press who recounted his involvement in what was the stand-out session of the conference. His description of trying to save the injured teenager and his friends was engaging and touching for the audience, yet must have been an extremely raw experience for the speaker.

A Year of Snow: Dr Sean Hudson

Dr Sean Hudson a GP spent a year working on the snow in both at Mount Hutt, a New Zealand Ski resort, and in Antarctica. He discussed the types of cases seen by medics working in the snow and ice and how video camera's used by extreme sport enthusiasts were often used for working out the mechanisms of injury.

‘Xtreme Everest—Lessons from Life at the Extremes’: Dr Sundeep Dhillon

The Xtreme Everest expedition was no ordinary expedition. It had an unusual focus, which was to take healthy volunteers up the mountain to study the effects of hypoxia and altitude on the human body.

At the summit of Everest, oxygen levels are a third of that at sea level and are comparable with patients in intensive care. The expedition also set up the highest laboratory on record in which they conducted tests on each other including muscle biopsies.

Treatment for Afghan civilians: Mr Jeff Evans

Jeff Evans is a nurse who volunteered to work in an Italian non-governmental organisation in Kabul, Afghanistan. His presentation, based on his experiences, showed healthcare in Afghanistan in a way not usually portrayed by western media and where the medics and nurses provide healthcare with very little in the way of equipment or drugs. He gave an example in which the antibiotics sent to the hospital were left on the runway in blistering heats and ruined due to bureaucracy.

The population would travel for tens of miles on very poor roads to access the hospital. The decades of war in Afghanistan has left a legacy of land mines which often take their victims from children who come into contact with them in rural areas often leading to severe injury, disfigurement and loss of limbs.

Blood on Board: Dr Anne Weaver

Dr Anne Weaver is the lead clinician for London helicopter emergency medical service (HEMS). She discussed the challenges of carrying blood on board UK air ambulances, a practice that has been used abroad in Afghanistan and Iraq for some time, and, how by working with those departments responsible for blood storage in the hospital, they were able to agree a policy that met UK law and governance arrangements.

The ‘code red’ call was described, and it is used by London HEMS to pre-alert hospitals to the needs to have blood, and blood products ready for patients on arrival at the emergency department.

Experts in the Dock: Mr Douglas Cooper

Douglas Cooper is a Barrister from the St Johns Buildings, Barrister Chambers. He specialises in defending clients in negligence cases. In this final session of the conference he discussed how expert witnesses give evidence and are cross–examined.