In April 2022 the ScotSTAR Emergency Medical Retrieval Service (EMRS) North team marked 3 years of operations. EMRS North is part of the Scottish Ambulance Service (SAS) and is funded through the Scottish Trauma Network (STN). Operating from the Aberdeen Airport ScotSTAR North base the duty team comprises of a retrieval consultant and a retrieval practitioner / clinical fellow.

EMRS North consultants come from an anaesthetic, emergency medicine or intensive care medicine background. Consultants spend time working for EMRS and time working in their base hospitals. At present we have consultants from NHS Grampian, NHS Tayside and NHS Highland. The retrieval practitioners all come from a paramedic or nursing background and work full-time for EMRS. The clinical fellow posts have proved extremely popular and allow anaesthetic, emergency medicine or intensive care medicine specialty trainees to join the team for 6 months and develop skills in pre-hospital and retrieval medicine.

The EMRS North has 3 main roles-

• Primary Missions- The team will respond to incident scenes by response car or air and can provide “red” interventions such as pre-hospital anaesthesia, blood transfusion, ultrasound, advanced analgesia, procedural sedation and resuscitative surgical procedures
• Secondary Missions- The team will transfer critically ill patients from a remote/ rural hospital to a larger centre for specialist care. As an example, this could be the transfer of a trauma patient from an island Local Emergency Hospital to the Major Trauma Centre. These transfers can involve multiple SAS transport modalities including road ambulances, planes and helicopters. The team are also available to support rural clinicians through advice calls
• Major Incident Response- Along with the other pre-hospital teams EMRS North has a key role in major incident preparedness and as part of the national major incident response.

EMRS North predominantly cover the North of Scotland but all procedures, equipment and tasking are the same as EMRS West which has two duty teams available 24/7. Practically this means at any one time there are 3 EMRS teams providing national cover spilt between the bases in Glasgow and Aberdeen. This cross cover has seen EMRS North attend taskings across Scotland from Shetland to the Scottish Borders and provides resilience.

The workload is not exclusively trauma and is a good example of how the STN has wide reaching benefits especially in the care of critically ill patients.

In April 2020 Scotland’s Charity Air Ambulance launched their Aberdeen based aircraft Helimed 79. The Helimed 79 base is adjacent to the ScotSTAR North base and the teams work closely together. EMRS North and Helimed 79 brief and train together daily; when requested by the Trauma Desk EMRS North will accompany the Helimed 79 team allowing “red” interventions to be delivered faster and across a greater area.

The first 3 years of EMRS North operations have seen-

• 600 primary taskings
• 422 secondary transfers
• 312 advice calls.

Primary taskings typically take around 2.5 hours from a

ctivation to being back on base while secondary transfers take a bit longer with an average duration of 7.5 hours. EMRS North have responded to one major incident and assisted with cross-cover while other major incidents ongoing.

2021 saw the teamwork with Firecrest Films as part of the filming for the Channel 4 series “Rescue: Extreme Medics”. Episode 2 features the EMRS North duty team who attended a plane crash – check it out on All 4 (Channel 4 on demand).

Looking forward the team are expecting a busy summer with international tourists returning and rural populations increasing over the holiday periods. The team are also looking forward to getting out on more liaison visits to referring sites and local ambulance stations.

The Royal College of Physicians and Surgeons of Glasgow  are delighted to let you know that tickets are now available to purchase for our upcoming International Orthopaedic and Trauma Conference which will be delivered in hybrid format on Wednesday 11th and Thursday 12th May 2022. The conference has been approved for 12 CPD points.

This conference is a key event in our educational calendar for 2022. Covering a wide range of subjects, it is relevant for everyone involved in orthopaedics and trauma, including consultants, orthopaedic training and non-training grade doctors, medical students, physiotherapy colleagues and orthopaedic and trauma nurses.

The Glasgow International Orthopaedic and Trauma Meeting will be a two day event with the opportunity to participate in a cadaveric or practical course prior to the conference

The cadaveric masterclass and trainee instructional course taking place on 10 May are an essential and integral part of the Glasgow International Trauma and Orthopaedic Meeting. Our cadaveric and practical courses allow for unparalleled hands on experience which will allow participants to develop their operative skills. Delegates will leave the course with increased confidence in their intra-operative decision making and will have the opportunity to pick up tips and tricks from a truly world class faculty.

Elbow Trauma and Approaches (rcpsg.ac.uk)

Further information and links to register for the conference can be found on the flyer or by following the link below:

Orthopaedic and Trauma Conference 2022 (rcpsg.ac.uk)

If you require any further information, please feel free to contact myself at donna.johnston@rcpsg.ac.uk

The NoS have released their Spring 2022. This issue updates on staffing changes, educational course and an update on the latest Key Performance Indicators (KPIs).

An introduction from Anne-Marie, NoS Network Manager:

Welcome to our new-look newsletter, we hope you like the new format. There is snow on the ground as I write this but my calendar assures me it’s spring! Unlike other springs though, I appreciate that services are still under extreme pressure and trauma workload has not diminished. The good news is that we are fortunate to have new trauma staff coming on board into new posts (details further on) while we say goodbye and thanks to colleagues who have worked on the development and implementation of the Network, such as Dr Luke Regan and Dr Angus Cooper.

Because of these pressures we have had to make the hard decision to postpone the Network Annual Event from 11th May to 31st August – please see further down for more information. Network colleagues were keen to have a face to face rather than a virtual event so I hope you can still attend and participate.

New developments and ways of working have continued to be implemented and we will cover many of these in the Network Annual Report which will be published later this spring. In the mean time we hope you have some time off to rest and recuperate during the Easter holidays.

Please click here to view the newsletter

Issue 12 – Winter Edition

The North of Scotland (NoS) have released Issue 12 of their newsletter. The NoS newsletter features an update from network partners and network staff, upcoming educational dates, NoS network statistics over the past three years and an article on Paediatric Trauma Training that took place in Orkney.

Please click HERE to view the newsletter.

The NoS has just celebrated it’s 3rd anniversary as a network, they’ve created a video to showcase what they have achieved in the last three years.

Please click HERE to view the YouTube video 

Congratulations to the NoS Network!!

Issue 11 – Summer 2021

The North of Scotland have released Issue 11 of their newsletter. The newsletter features updates from the STN, MTC and the trauma documentary. There is a focus on Psychology services within the network and information on upcoming education sessions.

To download the newsletter, please click HERE

The eighth report by the Scottish Trauma Audit Group (STAG) since 2011 can be found on the Public Health Scotland website. Compliance with a subset of the Scottish Trauma Network Key Performance Indicators, case-mix adjusted mortality and Patient Reported Outcome Measures (PROMs) are within part one of the report. Part two and three provide a comprehensive summary of injuries and the patient journey for both adults and paediatrics respectively.

Introduction from National Clinical Lead

2020 – 21 has been variously difficult, challenging, interesting and rewarding across the many spheres of activity, development and progress for the Scottish Trauma Network (STN). This Annual Report sits alongside and complements the imminent publication of the Scottish Trauma Audit Group’s (STAG) Annual Report for the same period. They both reveal and explore much of the data, operational and patient-centred clinical stories around this past year’s extraordinary activity within the Network. Set against the pandemic backdrop, the strong message coming from these reports is one of resilience, maintained high-quality patient care and an above-and-beyond spirit of collaboration and pragmatism on a national scale. That key performance and outcome measures have been delivered, yet alone maintained and improved in several areas, is worthy of acknowledgment and appreciation. The reports further explore much of our presentation and discussion at the Scottish Parliament Health and Sport Select Committee in January 2021.

There are many examples to celebrate, but I take this opportunity to highlight and express admiration and gratitude to the Scottish Ambulance Service, the ScotSTAR and EMRS transport and retrieval arms, and the newer Advanced Paramedics in Critical Care red teams therein. Their relentless and complex work in supporting and enabling the pandemic response across trauma and all related critical care services has been inspiring. The STN and patients are thankful to them beyond words. These thanks are expressed in equal measure to all staff and services recruited in good faith and optimism to the STN, yet who found themselves redeployed and reallocated to support the response in other vital areas such as Emergency Departments, Trauma Wards which became Covid High Dependency Units and Critical Care areas, and Theatres.

More interesting still is what much of this tells us about the improved access we now have to data and patient-reported measures. These are the mainstays of why the STN does what it does. With STN Trauma and STAG coordinators now embedded in our hospitals, we are able to reach more broadly across and deeper into the care of trauma patients than ever before. The resulting information and its analysis will further “tell the story” as we move beyond delivery of Phase I later this year, with the opening of the Major Trauma Centres at the Queen Elizabeth University Hospital in Glasgow, and the Royal Infirmary of Edinburgh, and the operational delivery of the Regional Networks in the West and South East of Scotland. These final pieces of the jigsaw will complete the national picture alongside the MTCs at Aberdeen Royal Infirmary and Ninewells Hospital in Dundee opened in 2018, supporting all the component services within our Regional Networks.

It is to be hoped that by the time of next year’s report we will be able to reflect upon a time of challenge and change with a more secure feel for what the immediate and medium-term future holds for our service. This learning allows us to reenergise and reconvene with strength, determination and the confidence that comes from surmounting such a significant hurdle.

Every person and every collaborative and linked service involved, described and embraced within the following pages is deserving of the greatest of gratitude and recognition. We are indebted to you all.

The full report can be seen here.

Martin McKechnie

National Clinical Lead

Scottish Trauma Network

Rehabilitation Learning Event – Wednesday 16th June 2021

The Rehabilitation Learning Event will feature presentations from the regional network on patient stories showcasing movement across the network and the benefits of the rehabilitation plan.

Themes of the event include:

• Movement across regions/networks
• Establishing services through a pandemic
• Innovative MDT working
• Involving community, 3rd sector or voluntary sectors

This is an opportunity to network with other colleagues working within the STN to share learning from other regions.

There will be an opportunity during the event to give your feedback and suggest the focus or topics for future meetings.

If you’d like to join the event, please email nss.scottrauma@nhs.scot

To view the event flyer, please click Rehabiliation Learning Event

This week is Child Safety Week hosted annually by the Child Accident Prevention Trust (CAPT) to raise awareness of preventable serious injury and death.

In our Paediatric working groups digestion of Button Batteries and Magnets are frequent topics with some parents unaware of the potential dangers. In the United Kingdom, clinicians have seen an increase of nearly double patients attending the Emergency Department with this injury.

Whys is swallowing button batteries and magnets so harmful?

Button Batteries 

Surprisingly, the harm is not usually caused by the chemicals leaking from the battery but due to the battery itself reacting with bodily fluids, such as mucus or salvia. This creates a circuit to release a substance like caustic soda, which is a strong alkali that can burn through tissue. Alkaline substances are on the opposite end of the pH scale to an acid but is still very dangerous. ‘Dead’ or ‘Flat’ batteries also have the potential to release the alkali so should be treated with the same caution.

BBC have released a video to highlight the risk of button batteries if they are digested:

Magnets 

If magnets are digested, they effectively burn holes in the intestines or bowels. The magnets stick together internally and through organs and tissues, and can cut off blood supply causing the tissue to die. Magnets are much more complex than button batteries to extract. The patient would need emergency surgery, then, depending on the severity of injuries, they may need numerous operations, bowel resection and time in intensive care.

The below picture from CAPT shows an x-ray from the case of a three-year-old swallowing small, round coloured magnets from a magnetic toy.

How to keep your children safe!

The British Association of Paediatric Surgeons have produced a set of questions to consider:

• Where are they used in your home or childcare setting? Do you have any in your car? Knowing where and what they are in means you can use items with caution and remove if needed.
• Are they installed securely? Are covers screwed tightly and even taped over? Avoiding Button Batteries all together is difficult but ensuring that when they are used they are installed correctly and covered up.
• Where are they stored? Are they out of sight? Are they out of reach? Don’t leave them loose in a draw!
• Dispose of them safely and immediately – even ‘dead’ or ‘flat’ batteries can cause significant injuries.

what are the symptoms after swallowing?

Button Batteries:

• Excess Dribbling
• Trouble Swallowing
• Vomiting
• Coughing
• Choking
• Unexplained chest infections

Magnets:

• Abdominal pain
• Fever
• Nausea
• Vomiting

IF YOU EXPECT YOUR CHILD HAS SWALLOWED A BUTTON BATTERY OR MAGNET, GO TO YOUR CLOSEST EMERGENCY DEPARTMENT AS SOON AS POSSIBLE. 

Many trusts, organisations have campaigned for the trading standards for magnets and button batteries to be changed, recently the standards had changed for button batteries.

Helpful Resources: 

The Royal College of Emergency Medicine: website

British Association of Paediatric Surgeons: website

Child Accident Prevention Trust – website

Healthcare Safety Investigation Branch – Final report – Healthcare Safety Investigation Branch (hsib.org.uk)

Building Safer Communities – Building Safer Communities (harmandinjuryhub.scot)

Issue 10 – Spring 2021

The North of Scotland Trauma Network have started to gain momentum over the last few months as staff, who were redeployed for COVID-19 purposes, return to their trauma posts and the numbers of COVID-19 patients begin to drop. This issue focuses on the launch of the networks e-rehabilitation plan, new staff introductions and an interview with a Trauma Unit Rehabilitation Coordinator.

To download the newsletter, please click HERE