S Houghton, L Pangbourne, J Bennett, J Nicholson: Medical Students, University of Leeds
Background: There is minimal formal training in Pre-Hospital Emergency Medicine (PHEM) within the undergraduate curricula1. Community First Responder (CFR) schemes expose student to prehospital environments2-4.
Methods: A cross-sectional study of student CFR schemes across at UK medical schools was undertaken. Scheme coordinators were invited to complete a voluntary questionnaire.
Results: Twelve schemes were identified across seven ambulance service regions. During 2019, 483 students volunteered as CFRs, including medical, nursing and non-healthcare students. Student CFRs volunteered 13,663 hours and attended 2828 calls. Reported benefits fell into three domains: clinical learning, non-clinical learning and personal development.
Discussion: Results demonstrate student engagement in CFR across the UK. Only a minority of students are likely to go on to careers in PHEM. However, many skills developed are transferable to all medical specialties.
Conclusion: Across the UK, nearly 500 medical students volunteer as CFRs, obtaining a shared experience, developing transferable skills for all medical specialties.
A Dony, L Rouhi-Parkouhi: Year 3 Medical Students, University of Leeds
This study aims to investigate systemic and management changes introduced by Yorkshire Ambulance Service (YAS) in response to the COVID pandemic. Three directors and educators of YAS were interviewed. YAS faced inadequacies in clinical guidance and information available on a national level, followed by COVID outbreaks in centres causing severe staffing pressures. Video triaging, a volunteer based workforce in call centres, and sharing of ambulances between trusts are positive changes introduced by YAS during 2020. Mental health support services to frontline staff affected by stress and trauma could be developed further in the future. This research focuses on a small number of staff, with the majority operating as managers within YAS. Further studies should aim to include a larger number of staff at all levels of the organisation, and some patients, in order to gain deeper understanding of the impact of the pandemic on the delivery of pre-hospital care
Dr H Reynolds, Dr P Onion, Dr A Pountney
Blood transfusion is associated with hypocalcaemia, in part due to citrate chelation of serum calcium. There is increasing evidence that major trauma also contributes to hypocalcaemia. A substantial proportion of major trauma patients will receive blood transfusion, either before arrival or once at hospital, and this combination could be detrimental to patient outcome.
This preliminary observational study was undertaken to assess the pre-transfusion calcium levels in major trauma patients, and to assess whether transfusion correlates with a further drop in calcium.
We identified major trauma patients in Leeds with an Injury Severity Score >15, and compared their arrival and post-transfusion calcium levels using an unpaired t-test. Our results showed that major trauma patients arriving at the ED did not have a depressed calcium level, but after transfusion, hypocalcaemia was evident (mean ionised calcium was 0.08mmol/L lower). This may be due in part to the transfusion, but also due to the progression of pathophysiology of major trauma.
Dr H Reynolds, Dr P Onion, Dr A Pountney
This poster describes the results of our secondary outcomes from: ‘Cross-sectional study comparing effects of blood transfusion and major trauma on calcium levels, H Reynolds et al’. We found a non-significant trend towards a lower calcium level following haemorrhagic major trauma (1.16mmol/L) compared with non-haemorrhagic trauma (1.18mmol/L), which could be as a result of haemorrhage causing a drop in calcium levels. We also found that those patients who received a blood transfusion had a more normal haemoglobin and potassium level, but a more abnormal calcium, lactate, pH, INR and APTT level, which leads to the question of whether pre-hospital calcium could be of any benefit in major trauma.
Flt Lt F Wood, Dr C Bosanko, Dr C Fleury
Patients with intracranial bleeds, including subarachnoid haemorrhage, may require interventions at a neurosurgical centre to minimise morbidity and mortality. Delays in accessing interventions, such as aneurysm coiling, may reduce the potential benefit. As such, the team wished to investigate if it would be possible to identify these patients in the pre-hospital environment and whether they would benefit from transport directly to a neurosurgical centre.
Patients attended by Devon Air Ambulance 2019-21 were identified and followed up to record what interventions had been carried out in hospital. Although this service evaluation does not present a compelling case to change practice, further work may help identify patients likely to benefit from being directly conveyed to a neurosurgical centre.
This poster presents work undertaken to study the effect of the first wave of the Covid 19 Pandemic on UK Search and Rescue Helicopter deployments. A retrospective database analysis of Search and Rescue data was carried out looking at the total number of taskings and the number of persons rescued for the months of April to September in 2020. A comparison was made to the same period in 2019, 2018 and 2017. The study highlights some of the reasons for the differences between the 2020 and the previous years data and shows the effect of the pandemic.
Dr D Pallot
Mountain Rescue volunteers are mostly not medical professionals but are first aid trained including bag-valve-mask ventilation. The iGel is important for in-hospital resuscitation and has possible benefits in Mountain Rescue.
Volunteers attended a 30-minute training session and were assessed by questionnaire. They were taught BVM and iGel on a mannequin then assessed on both. Competence was assessed by time to deliver 2 effective breaths.
No participants had experience of iGel use but most had experience with BVM ventilation. Confidence was varied in BVM use before training; but improved after. Confidence in iGel insertion was comparable to BVM after training. Speed to initiate ventilation was different with BVM being 0.8s faster on average.
Volunteers are confident and effective on a mannequin after brief training. BVM ventilation still has an important place, but the iGel has many advantages in the mountain rescue environment. Both techniques are easier on mannequins despite poor technique.