Dr Colville Laird emphasises importance of collaboration at AAA National Conference

Alistair Quaile
Wednesday, December 2, 2015

Working together in pre-hospital careFollowing a brief welcome from AAA national director, Clive Dickin, Hannah Sebright, AAA vice chair, outlined the challenges facing the air ambulance sector. The keynote presentation was then given by Dr Colville Laird, chair of the Faculty of Pre-Hospital Care, who explained how he was tasked by the organisers of the conference to deliver a ‘controversial’ talk. Coming under the enigmatic title of ‘Air Ambulances, Budgerigars and Formula One’, Laird highlighted the importance of working together in pre-hospital care, as the result is better than the sum of its parts. He emphasised that air ambulances are only part of a very big system in pre-hospital care and that the Faculty of Pre-Hospital Care is encouraging interaction between all levels of care provider.Dr Nick Crombie, clinical lead for Midlands Air Ambulance, then discussed some of the possibilities of pre-hospital research. Crombie explained how the current evidence base in the pre-hospital environment is weak and that we need organisational systems to enable research. He noted that because a high proportion of current research is hospital driven, it is often extrapolated into the pre-hospital setting, or based on anecdote.After a short break for coffee, Dr Dindi Gill, consultant in emergency medicine, spoke on Wales Air Ambulance and the setting up of the Emergency Medical Retrieval and Transfer Service (EMRTS). Launched in April 2015, the service aims to stabilise and transfer the most critically-ill and injured patients to hospital by road and air, ensuring they receive the best life-saving care.Erica Ley and Ryan Jones of Essex and Herts Air Ambulance Trust then gave a talk on the use of positive end-expiratory pressure (PEEP) in patients with traumatic head injury, considering whether it improves survival. Presenting the results of a number of studies, they explained how intracranial pressure tends not to increase with PEEP and that there is contradictory evidence regarding appropriate levels of PEEP. A decrease in mean arterial pressure is a uniform finding and PaCO2 levels can increase if alveoli are hyper-inflated instead of recruited. However, they mentioned that they could not find any data on the use of PEEP for traumatic brain injury in the pre-hospital environment, and so pointed out that further studies are needed.The final talk before lunch was given by Fraser MacKay of FEC Heliports, outlining the good, the bad and the ugly of helipads. According to MacKay, elevated helipads represent the good of helipads, as they offer the greatest choice of obstacle-free helicopter airways. The bad refers to helipads that are built at ground level. These are less expensive than elevated helipads, but take up more space. The ugly was explained as non-conventional operating sites with little or no marking, limited visual clues and no lighting.

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