Medical Students involved in Prehospital Care
IT’S 5.30am on a Sunday morning, and the staff of the London Ambulance Service (LAS) are ten hours into a nightshift when a call comes in. They are needed to help a patient who, as a result of a suspected drug overdose, has suffered a massive seizure. First to arrive at the scene is a LAS fast response car. The two people inside immediately take control of the situation, as an ambulance crew arrive. The patient could suffer a cardiac arrest at any time, and as such, the team is forced to work against the clock under extreme pressure if the patient is to stand any chance of survival. They eventually manage to sufficiently stabilise the patient so he can be transferred to the Royal London Hospital nearby. A casual observer would never know there was anything unusual about this team.
One of the team however, is still an undergraduate medical student, who, thanks to a pioneering new programme, which she herself is the driving force behind, has already accumulated considerably more experience in the prehospital care field than many qualified doctors. This type of incident is one she has already encountered many times. She has also witnessed medical emergencies including heart attacks and trauma such as stabbings, gun shot wounds and traffic accidents and, where appropriate, has been able to offer assistance. All this and she isn’t even due to graduate for another 18 months.
Now thanks to several years of hard work by the student and a team of dedicated mentors and tutors, this type of invaluable trauma experience is available to other undergraduate medical students. The student is Emma Lightbody, a fourth year undergraduate at Barts & The London School of Medicine, and instigator of the Prehospital Care Programme (PCP). Keen to develop her interest in prehospital care and trauma, Emma first approached the LAS in 2006 and started taking regular observer slots with paramedic Craig Cassidy. Around the same time she started to build links with the London Helicopter Emergency Medical Service (HEMS), based at the Royal London Hospital and made particular contact with HEMS Lead Clinician Dr Anne Weaver. After proving herself to be a competent and reliable member of the team, Emma’s role evolved organically, to the point where, under Craig’s guidance, she was able to take a role in assessing and treating patients. Realising there was a niche for a structured programme, in which other students would be able to experience prehospital care under the guidance of paramedics and doctors, as she herself was already doing; she, approached Dr Danë Goodsman from the medical school to see if it could be included in the part of the undergraduate curriculum. And thus from her initiative, this team Emma had created, collaborated and set about devising the Prehospital Care Student Selected Component pilot programme.
Craig explains: “I thought the Prehospital Care Programme was an excellent idea. [and] After we ran the pilot, it just took on a life of its own. Emma worked so hard doing all the background work, and it’s really taken off now. I trust Emma because I know if there was something she felt she couldn’t do, she would tell me.”
Dr Anne Weaver, also readily agreed to dedicate a significant amount of time to mentoring Emma and developing the programme. For Anne, the reasons why she chose to support the programme and the benefits she saw for both students and HEMS, were clear. Anne discussed: “It’s very easy to forget that your job is special and you are lucky to do it. I am very lucky to be doing a job I love, and being in that position, you have to give something back. At HEMS we are very lucky to have the best of the best doctors, on average the top five per cent in the country. It’s a great opportunity for the students to be able to work with them, and the doctors get a lot out of teaching. It’s nice to be able to act as a mentor.”
The pilot scheme involving five students was launched in early 2008. Its success attracted several more potential mentors, and numerous students who were interested in taking part. The team worked together to decide which students would become the first full intake. Anne adds: “When people are nineteen, they don’t have a great deal on their CVs to distinguish them. You go on gut instinct, and if they show drive and enthusiasm. It’s also good having someone like Emma on the team who sees it from a student’s perspective. Allowing people to go out in ambulances is a big deal; it isn’t something to be taken lightly.”
Once accepted, the undergraduates begin a structured four-year programme, during which they will be assigned a paramedic mentor from the LAS, and will spend on average one shift a month with an ambulance crew. After two years, they receive additional mentoring from a HEMS registrar or consultant. Shifts on the tasking desk at central ambulance control, attendance at HEMS clinical governance days and death and disability meetings are also key components of the programme. Students must keep records of every case they attend with the LAS, and must accomplish a series of learning objectives.
Craig can already see the significant benefits the PCP is having for the undergraduates who started the programme in September 2008. “A lot of the undergraduates have come straight out of school; they are very academic and are often coming into a world which is totally alien to them. To see them come out of themselves, after being quite introverted is very rewarding. The programme is structured so it’s progressive. You can see after just a few shifts that people really start to remember things. They are already leaps and bounds ahead of their peers and I really look forward to bumping into them all when they’ve qualified.”
Emma herself says she is delighted with the way in which the PCP has evolved, and is incredibly grateful to the rest of the development team for their involvement. Emma said: “You get out of this experience what you put in. I feel privileged to be able to be there when a patient is at the most vulnerable point in their hospital admission. Getting to work with the best of the best is more than I ever could have dreamed of, and I am incredibly proud to be mentored by Anne and Craig.” Emma continues to discuss the direct impact that this has had on her training: “I know my clinical acumen has improved. I have the confidence to trust what I am seeing and hearing, and to work things out under pressure. Having this much experience of trauma and prehospital care as a medical student is quite rare. It’s something a lot of doctors just don’t have the opportunity to do. I’m incredibly lucky to be doing something I love in totally supportive environment”
What began three years ago with an approach by a medical student to the London Ambulance Service about the possibility of spending a few shifts as an observer, has evolved into a groundbreaking student led, structured training programme, which offers undergraduates unrivalled and meticulously thorough hands-on training in an emerging, and increasingly needed speciality. It is the first of its kind in the country, but undoubtedly won’t be the last. Central to its success is the close bond the development team have formed, and their mutual desire and dedication to creating exceptional doctors, who are fully prepared for the demands of a career in prehospital care.