Why did you first get into medicine?
First, I think it was the academic rigour of the undergraduate medical course. Secondly, it was just the huge variety of different jobs you could do once you have a medical degree.
What inspired you to pursue your specialty?
I enjoy working in high-pressure situations. My role as an aeromedical retrieval consultant involves travelling by helicopter to look after critically ill and injured patients in resource limited environments, such as the site of a car accident, on a remote island, mountain or on an expedition. That is the type of challenge that I generally enjoy because you are pretty much dependent on your own skills and those of your teammates.
I graduated from Glasgow Medical School in 1993 and then trained in emergency medicine. Along the way I worked for air ambulance services in London and in Queensland Australia. This inspired me to lead the establishment of Scotland’s Emergency Medical Retrieval Service, from a small voluntary service to a fully government funded aeromedical retrieval organisation.
Now the career path is more organised although still relatively new. Pre-hospital emergency medicine (PHEM) is a sub-specialty of anaesthetics, emergency medicine, intensive care medicine and acute internal medicine with a GMC-approved training pathway. Sub-specialty training is a 12-month programme starting at ST5 or above.
How does your chosen specialty differ from other medical settings?
The number one difference has to be the limited resources. You and the paramedic or nurse working with you have to be very self-reliant: you have only got what is in your rucksack; you can’t send to another ward for more drugs or equipment if power fails or you run out of oxygen; and you can’t call for a colleague to come down and help.
You are often the first responder, seeing patients shortly after they have become seriously unwell or injured in an uncontrolled environment and sometimes in the presence of their relatives and other bystanders. It’s a whole world of difference from seeing that patient on a trolley in the resuscitation room some time afterwards and that can be quite emotionally challenging.
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Another difference is working in what I call flash teams. Normally in a hospital critical care setting you will be aware of the skillset of the other nurses and doctors and you may actually know them personally. In pre-hospital retrieval medicine, I’ve been thrust into situations where there have been 60-70 people there that I have never met, all with different skillsets. To lead the team and achieve a shared mental model requires a lot of emotional intelligence and some really good communication skills.
As well as looking after the patient, there are the logistics of transporting them to hospital. I need to feel comfortable in a search and rescue helicopter at 3 o’clock in the morning, in a storm in Scotland!
What additional skills have you learned as a result?
I have definitely improved my communication in high-pressure situations and I have better skills with regard to debriefing and reflecting on cases because formal debriefing, case reviews and reflective practice is completely routine for us in the helicopter retrieval service. And I definitely think my ability to perform under pressure has improved as a result of my experiences and also the learning culture within the service.
It is important to be flexible. While you have to be decisive, you also need to pick up on subtle cues from other members of the team and maybe change your course of action in the light of an evolving situation. There is quite a hierarchical structure in hospitals where the consultant is in charge but it’s important to involve all members of the team in decision-making and trying to achieve a shared mental model.
My ability to perform under pressure has improved as a result of my experiences.
Finally, I am fortunate to regularly work alongside professionals with completely different backgrounds: ex-military pilots, people in the oil and gas industry, remote expeditions. That has given me a different perspective on things like safe systems which has helped my practice and informed my research into the effect of pressure on performance.
What advice would you give to a student who is considering this specialty?
I actually run a Helicopter Medical Careers Conference for doctors and medical students that are interested in a career in pre-hospital and retrieval medicine but that is the only event of its kind.
All the air ambulance services in England, Wales and Northern Ireland are run as charity organisations (Scotland’s Aeromedical Retrieval Service is actually part of NHS Scotland) but there are some that provide medical student electives so it would be good to go in and experience that.
However, my main message is to concentrate on trying to achieve all your competencies and experience during your training programme in emergency medicine, anaesthetics and intensive care. Once you’ve got that nailed, then think about sub-specialising in pre hospital and retrieval medicine.
Details of approved training programmes and other resources are available from the Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (IBTPHEM).