Gerry Egan, interim executive director, College of Paramedics, outlines some of his key objectives for the College in ensuring it continues to grow and meet the expectations of its members.

Trauma systems have been shown to reduce death and disability from injury but must be appropriately configured. A systematic approach to trauma system design can help maximize geospatial effectiveness and reassure stakeholders that the best configuration has been chosen.This article describes the GEOS [Geospatial Evaluation of Systems of Trauma Care] methodology, a mathematical modeling of a population-based data set, which aims to derive geospatially optimized trauma system configurations for a geographically defined setting. GEOS considers a region's spatial injury profile and the available resources and uses a combination of travel time analysis and multiobjective optimization. The methodology is described in general and with regard to its application to our case study of Scotland.The primary outcome will be trauma system configuration.GEOS will contribute to the design of a trauma system for Scotland. The methodology is flexible and inherently transferable to other settings and could also be used to provide assurance that the configuration of existing trauma systems is fit for purpose.

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland.

BACKGROUND Trauma systems have been shown to reduce death and disability from injury but must be appropriately configured. A systematic approach to trauma system design can help maximize geospatial effectiveness and reassure stakeholders that the best configuration has been chosen. METHODS This article describes the GEOS [Geospatial Evaluation of Systems of Trauma Care] methodology, a mathematical modeling of a population-based data set, which aims to derive geospatially optimized trauma system configurations for a geographically defined setting. GEOS considers a region’s spatial injury profile and the available resources and uses a combination of travel time analysis and multiobjective optimization. The methodology is described in general and with regard to its application to our case study of Scotland. RESULTS The primary outcome will be trauma system configuration. CONCLUSION GEOS will contribute to the design of a trauma system for Scotland. The methodology is flexible and inherently transferable to other settings and could also be used to provide assurance that the configuration of existing trauma systems is fit for purpose.

AIMS:Haemorrhage is a leading cause of death from trauma. Management requires a combination of haemorrhage control and resuscitation which may incur significant surgical and transfusion utilisation. The aim of this study is to evaluate the resource provision of the destination hospital of Scottish trauma patients exhibiting evidence of pre-hospital shock. METHODS:Patients who sustained a traumatic injury between November 2008 and October 2010 were retrospectively identified from the Scottish Ambulance Service electronic patients record system. Patients with a systolic blood pressure less than 110 mmHg or if missing, a heart rate greater than 120 bpm, were considered in shock. The level of the destination healthcare facility was classified in terms of surgical and transfusion capability. Patients with and without shock were compared. RESULTS:There were 135,004 patients identified, 133,651 (99.0%) of whom had sustained blunt trauma, 68,411 (50.7%) were male and the median (IQR) age was 59 (46). There were 6721 (5.0%) patients with shock, with a similar age and gender distribution to non-shocked patients. Only 1332 (19.8%) of shocked patients were taken to facilities with full surgical capability, 5137 (76.4%) to hospitals with limited (general and orthopaedic surgery only) and 252 (3.7%) to hospitals with no surgical services. In terms of transfusion capability, 5556 (82.7%) shocked patients were admitted to facilities with full capability and 1165 (17.3%) to a hospital with minimal or no capability. CONCLUSIONS:The majority of Scottish trauma patients are transported to a hospital with full transfusion capability, although the majority lack surgical sub-specialty representation.

Background: Trauma systems reduce mortality and improve functional outcomes. The aim of this study was to analyse the demographic and geospatial characteristics of pediatric trauma patients in Scotland, and determine the level of destination healthcare facility which injured children are taken to, to determine the need for, and general feasibility, of developing a pediatric trauma system for Scotland.Methods: Retrospective analysis of incidents involving children aged 1-14 attended to by the Scottish Ambulance Service between 1 November 2008 and 31 October 2010. A subgroup with physiological derangement was defined. Incident location postcode was used to determine incident location by health board region, rurality and social deprivation. Destination healthcare facility was classified into one of six categories.Results: Of 10,759 incidents, 72.3% occurred in urban areas and 5.8% in remote areas. Incident location was associated with socioeconomic deprivation. Of the patients, 11.6% were taken to a pediatric hospital with pediatric intensive care facilities, 21.8% to a pediatric hospital without pediatric intensive care service, and 50.2% to an adult large general hospital without pediatric surgical service.Conclusions: The majority of incidents involving children with injuries occurred in urban areas. Half were taken to a hospital without pediatric surgical service. There was no difference between children with normal and deranged physiology. (C) 2013 Elsevier Inc. All rights reserved.

BACKGROUND:Trauma systems reduce mortality and improve functional outcomes from injury. Regional trauma networks have been established in several European regions to address longstanding deficiencies in trauma care. A perception of the geography and population distribution as challenging has delayed the introduction of a trauma system in Scotland. The characteristics of trauma incidents attended by the Scottish Ambulance Service were analysed, to gain a better understanding of the geospatial characteristics of trauma in Scotland.METHODS:Data on trauma incidents collected by the Scottish Ambulance Service between November 2008 and October 2010 were obtained. Incident location was analysed by health board region, rurality and social deprivation. The results are presented as number of patients, average annual incidence rates and relative risks.RESULTS:Of the 141,668 incidents identified, 72·1 per cent occurred in urban regions. The risk of being involved in an incident was similar across the most populous regions, and decreased slightly with increasing rurality. Social deprivation was associated with greater numbers and risk. A total of 53·1 per cent of patients were taken to a large general hospital, and 38·6 per cent to a teaching hospital; the distribution was similar for the subset of incidents involving patients with physiological derangements.CONCLUSION:The majority of trauma incidents in Scotland occur in urban and deprived areas. A regionalized system of trauma care appears plausible, although the precise configuration of such a system requires further study.

Introduction: Call processing impacts survival after out-of-hospital cardiac arrest (OHCA). [1] Kuisma M. Boyd J. Väyrynen T. Repo J. Nousila-Wiik M. Holmström P. Emergency call processing and survival from out-of-hospital ventricular fibrillation. Resuscitation. 2005; 67: 89-93https://doi.org/10.1016/j.resuscitation.2005.04.008 Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar We sought to examine recordings of caller/call-handler interactions after OHCA to identify delays in progression to starting bystander-CPR.

BACKGROUND:Traumatic brain injury is common. Guidelines from the Brain Trauma Foundation and the Scottish Intercollegiate Guidelines Network recommend that patients with suspected severe traumatic brain injury should be treated in centres with neurosurgical expertise. Scotland does not have a framework for the delivery of trauma care. The aim of this study was to examine the demographic characteristics of incidents involving patients who have suffered a suspected traumatic brain injury, and to evaluate the level of the destination healthcare facility which patients are currently taken to.METHODS:Retrospective analysis of prospectively collected Scottish Ambulance Service data on incidents involving traumatic injury, between Nov 2008 and Oct 2010. Two groups of casualties were analysed: those who had a Glasgow coma scale of less than 14 (GCS<14), and those who had a Glasgow coma scale of less than 9 (GCS<9).RESULTS:126,934 incidents were identified and analysed. 3890 (3.1%) patients had a GCS of less than 14, and 657 (0.5% of total) had a GCS of less than 9. Almost one-third of incidents involving patients with either a GCS<14 or GCS<9 occurred in the greater Glasgow health board area. The Lothian health board region had the second-highest number of patients with either a GCS<14 or GCS<9. Only 13.8% of patients with a GCS<14, and 16.7% of those with a GCS<9, were taken to a hospital with a neurosurgical service.CONCLUSIONS:Many patients who may harbour a traumatic brain injury are taken to a facility which may not be equipped or staffed to deal with such injuries. This mismatch needs to be addressed. However, the care of patients with head injuries is only one aspect of trauma care. The UK has long lagged behind North America in terms of the quality of trauma care provided, although the provision of trauma care in England is currently undergoing major changes. Scotland should consider the development of a similar service delivery framework.

Background In certain European countries pre-hospital doctors attend all out-of-hospital cardiac arrests. This is not routine practice in the United Kingdom. Pre-hospital doctors can provide support, education and certain additional clinical procedures during a resuscitation attempt. Little is known about the interaction between EMS crews and pre-hospital doctors in the field. Aims To establish the EMS crews9 views, impressions and attitudes towards pre-hospital doctors immediately after an OHCA resuscitation attempt. Methods Prospective, observational questionnaire survey. A pre-hospital doctor attends the scene of OHCA in the Lothians regions of Scotland as part of an on-going research project. After a resuscitation attempt at which the doctor was present, the attending EMS crew was invited by email to complete an anonymous, online survey on their experience with working with the doctor at the scene. Results 68 emails were sent to EMS personnel immediately after a resuscitation attempt at which a doctor was present. 48 (71%) responses were received. All respondents felt reassured by the presence of a doctor at the scene of OHCA and all felt the doctor gave useful, real-time feedback. 16 (24%) of EMS personnel felt their own performance improved after arrival of the doctor. 44 (92%) EMS personnel found the presence of a doctor at the OHCA useful. Of the 15 that responded in the free comments section, 11 (92%) felt that on-scene training and feedback were the most useful attributes of having a doctor at an OHCA. Overall, EMS crews felt pre-hospital doctors were most useful in cases of major trauma (94%), compared to major incident (75%), cardiac arrest (75%) and paediatric emergency (58%). The majority (70%) of surveyed EMS personnel prefer pre-hospital doctors to be tasked by ambulance control directly rather than wait for an on-scene crew request. Conclusions The presence of a pre-hospital doctor appears to be accepted by EMS personnel in this region. EMS crews value the experience of learning and gaining feedback and on-scene training from a pre-hospital doctor during OHCA resuscitation. Pre-hospital doctors can be beneficial for EMS crew training and relations as well as providing advanced medical care.

Purpose of study: Survival from out-of-hospital cardiac arrest (OHCA) depends on good quality cardiopulmonary resuscitation from ambulance personnel. Electrocardiograph impedance analysis allows retrospective quality control and feedback to ambulance crews after a resuscitation attempt. We aimed to establish the feasibility of using thoracic impedance for pre-hospital resuscitation quality control, gain baseline data on pre-hospital resuscitation practice in south-east Scotland and quantify the effect of a simple resuscitation education package.Methods: Prospective, observational 12-month pilot study. Broadband modems were placed on ambulance defibrillators and configured on the Lifenet (Physio Control) data network. After a resuscitation attempt the attending ambulance crew was asked to telemetry the resuscitation trace to a research computer. The impedance trace was then analysed using computer software (CODESTAT – Physio Control) and a report on the resuscitation attempt generated and sent to the ambulance crew. Resuscitation classes for ambulance crews were held once per month.Results: 101 OHCA were included in pilot. All ambulance crews agreed to use telemetry. Of the initial 12 OHCA cases, none met optimum resuscitation targets, with a mean compression ratio of 42% and a mean compression rate of 149/min. The mean time from cessation of chest compressions to delivery of defibrillatory shock was 46 s. During the study period pre-hospital resuscitation improved with a mean compression ratio of >80%, mean compression rate of 106/min and mean time for shock 14 s.Conclusion: Telemetry of ECG impedance analysis is a straightforward, accurate, accepted method of assessing quality of pre-hospital resuscitation by ambulance personnel. Baseline data from our region suggests that the quality of advanced life support could be improved by focussing on basic elements of resuscitation. Using software-generated resuscitation reports and educational classes for ambulance personnel has improved the quality of pre-hospital resuscitation in our region. Purpose of study: Survival from out-of-hospital cardiac arrest (OHCA) depends on good quality cardiopulmonary resuscitation from ambulance personnel. Electrocardiograph impedance analysis allows retrospective quality control and feedback to ambulance crews after a resuscitation attempt. We aimed to establish the feasibility of using thoracic impedance for pre-hospital resuscitation quality control, gain baseline data on pre-hospital resuscitation practice in south-east Scotland and quantify the effect of a simple resuscitation education package. Methods: Prospective, observational 12-month pilot study. Broadband modems were placed on ambulance defibrillators and configured on the Lifenet (Physio Control) data network. After a resuscitation attempt the attending ambulance crew was asked to telemetry the resuscitation trace to a research computer. The impedance trace was then analysed using computer software (CODESTAT – Physio Control) and a report on the resuscitation attempt generated and sent to the ambulance crew. Resuscitation classes for ambulance crews were held once per month. Results: 101 OHCA were included in pilot. All ambulance crews agreed to use telemetry. Of the initial 12 OHCA cases, none met optimum resuscitation targets, with a mean compression ratio of 42% and a mean compression rate of 149/min. The mean time from cessation of chest compressions to delivery of defibrillatory shock was 46 s. During the study period pre-hospital resuscitation improved with a mean compression ratio of >80%, mean compression rate of 106/min and mean time for shock 14 s. Conclusion: Telemetry of ECG impedance analysis is a straightforward, accurate, accepted method of assessing quality of pre-hospital resuscitation by ambulance personnel. Baseline data from our region suggests that the quality of advanced life support could be improved by focussing on basic elements of resuscitation. Using software-generated resuscitation reports and educational classes for ambulance personnel has improved the quality of pre-hospital resuscitation in our region.

Purpose of study: Pre-hospital doctors can provide support, education and additional clinical procedures during a resuscitation attempt. Little is known about the interaction between emergency medical services (EMS) crews and pre-hospital doctors in the field. We aimed to establish the EMS crews’ views, impressions and attitudes towards pre-hospital doctors immediately after an out-of-hospital cardiac arrest (OHCA) resuscitation attempt.Methods: Prospective, observational questionnaire survey. A pre-hospital doctor attends the scene of OHCA in the Lothians regions of Scotland as part of an on-going research project. After a resuscitation attempt at which the doctor was present, the attending EMS crew was invited by email to complete an anonymous, online survey on their experience.Results: 68 emails were sent to EMS personnel immediately after a resuscitation attempt at which a doctor was present. 48 (71%) responses were received. All respondents felt reassured by the presence of a doctor at the scene of OHCA and all felt the doctor gave useful, real-time feedback. 16 (24%) of EMS personnel felt their own performance improved after arrival of the doctor. 44 (92%) EMS personnel found the presence of a doctor at the OHCA useful. Of the 15 that responded in the free comments section, 11 (92%) felt that on-scene training and feedback were the most useful attributes of having a doctor at an OHCA. Overall, EMS crews felt pre-hospital doctors were most useful in cases of major trauma (94%), compared to major incident (75%), cardiac arrest (75%) and paediatric emergency (58%).Conclusions: The presence of a pre-hospital doctor appears to be accepted by EMS personnel in this region. EMS crews value the experience of learning and gaining feedback and on-scene training from a pre-hospital doctor during OHCA resuscitation. Pre-hospital doctors can be beneficial for EMS crew training and relations as well as providing advanced medical care. Purpose of study: Pre-hospital doctors can provide support, education and additional clinical procedures during a resuscitation attempt. Little is known about the interaction between emergency medical services (EMS) crews and pre-hospital doctors in the field. We aimed to establish the EMS crews’ views, impressions and attitudes towards pre-hospital doctors immediately after an out-of-hospital cardiac arrest (OHCA) resuscitation attempt. Methods: Prospective, observational questionnaire survey. A pre-hospital doctor attends the scene of OHCA in the Lothians regions of Scotland as part of an on-going research project. After a resuscitation attempt at which the doctor was present, the attending EMS crew was invited by email to complete an anonymous, online survey on their experience. Results: 68 emails were sent to EMS personnel immediately after a resuscitation attempt at which a doctor was present. 48 (71%) responses were received. All respondents felt reassured by the presence of a doctor at the scene of OHCA and all felt the doctor gave useful, real-time feedback. 16 (24%) of EMS personnel felt their own performance improved after arrival of the doctor. 44 (92%) EMS personnel found the presence of a doctor at the OHCA useful. Of the 15 that responded in the free comments section, 11 (92%) felt that on-scene training and feedback were the most useful attributes of having a doctor at an OHCA. Overall, EMS crews felt pre-hospital doctors were most useful in cases of major trauma (94%), compared to major incident (75%), cardiac arrest (75%) and paediatric emergency (58%). Conclusions: The presence of a pre-hospital doctor appears to be accepted by EMS personnel in this region. EMS crews value the experience of learning and gaining feedback and on-scene training from a pre-hospital doctor during OHCA resuscitation. Pre-hospital doctors can be beneficial for EMS crew training and relations as well as providing advanced medical care.

Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of pre-hospital mortality. Chest compressions performed during cardiopulmonary resuscitation aim to provide adequate perfusion to the vital organs during cardiac arrest. Poor resuscitation technique and the quality of pre-hospital CPR influences outcome from OHCA. Transthoracic impedance (TTI) measurement is a useful tool in the assessment of the quality of pre-hospital resuscitation by ambulance crews but TTI telemetry has not yet been performed in the United Kingdom. We describe a pilot study to implement a data network to collect defibrillator TTI data via telemetry from ambulances. Methods Prospective, observational pilot study over a 5-month period. Modems were fitted to 40 defibrillators on ambulances based in Edinburgh. TTI data was sent to a receiving computer after resuscitation attempts for OHCA. Results 58 TTI traces were transmitted during the pilot period. Compliance with the telemetry system was high. The mean ratio of chest compressions was 73% (95% CI 69–77%), the mean chest compression rate was 128 (95% CI 122–134). The mean time interval from chest compression interruption to shock delivery was 27 s (95% CI 22–32 s). Conclusion Trans-thoracic impedance analysis is an effective means of recording important measures of resuscitation quality including the hands-on-the-chest time, compression rate and defibrillation interval time. TTI data transmission via telemetry is straightforward, efficient and allows resuscitation data to be captured and analysed from a large geographical area. Further research is warranted on the impact of post-resuscitation reporting on the quality of resuscitation delivered by ambulance crews.

Outcome from OHCA is primarily determined by prehospital events and meaningful clinical OHCA research must include data recorded in this setting. There is little evidence on which to base the practice of prehospital resuscitation and research in this area presents huge challenges but is required if survival from OHCA is to improve. This short report aims to provide a practical guide to performing prehospital research on OHCA, based on lessons learned from the Temperature Post Cardiac Arrest (TOPCAT) research; an observational study into OHCA.

Objectives: To describe a prehospital thrombolysis (PHT) and expedited inhospital thrombolysis (IHT) programme in south-east Scotland using prehospital 12-lead ECG recordings transmitted by telemetry and autonomous paramedic-administered thrombolysis with decision support being provided by coronary care nurses.Design: Retrospective observational study.Setting: Three hospitals in south-east Scotland covering a population of 778 468 served by 54 ambulance vehicles.Patients: 11 840 patients who telephoned the ambulance service with "chest pain'' over 20 months, during which 812 patients were admitted with ST segment elevation myocardial infarction (STEMI).Main outcome measures: All calls and cardiac/potential cardiac calls to the ambulance service, type/time of patient presentation, symptoms/call/door-to-thrombolysis times.Results: Of the 11 840 calls to the ambulance service for chest pain over 20 months of the initiative, 60% were cardiac/potentially cardiac-related by Scottish Ambulance Service triage. ST segment elevation was present in 8% of the 5150 12-lead ECGs transmitted by paramedics to the ECG receiving station in the CCU. Over the 20 months, 812 patients were admitted to the three hospitals with STEMI and 71% received thrombolysis. Median symptom-tothrombolysis times were 91, 148 and 184 min, respectively, in the PHT, telemetry-facilitated IHT and self-presenting IHT groups. Median call-to-needle time for the PHT group was 40 min. In 2/146 cases the cardiologists judged that the patient should not have been administered PHT.Conclusions: Based on prehospital 12-lead ECG telemetry, it is possible for paramedics and CCU nurses to conduct live reperfusion decision-making in patients with STEMI, with resultant benefits in symptoms-to-thrombolysis time.