Dr John Ferris HCA Fellowship Award – Report

Attachment: London’s Air Ambulance Dates: August 2013 – August 2014

I am a specialist in Emergency Medicine who completed my training on the East Coast of Scotland at Ninewells Hospital in Dundee. I have always had a strong belief that critically sick and injured patients require very early resuscitation and specialist management to improve outcome. During my training in Dundee I recognised that a large population within Scotland live in remote and isolated areas where being transported to specialist hospital care may significantly delay their care and that critical care must be taken out of the hospital and delivered at the scene of serious injury in order to provide such patients with the greatest opportunity to survive and recover. I therefore applied for a HCA foundation award to support my 12-month attachment to London’s Air Ambulance (otherwise known as HEMS) to develop my prehospital critical care skills with a view to examining ways in which this level of care may be replicated in certain areas of Scotland on my return from London.

London HEMS is a world-leading organisation providing amongst the highest levels of trauma care internationally. It provides a 24/7/365 service to the entire Greater London population of around 8 Million people. The services treats on average up to 8 seriously injured patients in each 24-hour period. The case mix consists of approximately one quarter road traffic collisions, one quarter falls from height, one quarter penetrating trauma (stabbings and shootings), one quarter being other jobs such as people trapped under trains, hangings and drownings. No other service in the UK offers the acuity and turnover of such patients for a Doctor to rapidly gain experience in prehospital critical care.

During my time at HEMS I undertook a 1-month sign-off period where I worked exclusively with Consultants on the Air Ambulance who undertook one-on-one training with me in order to provide the highest quality of handson experience and feedback for me on every single mission.

During my time in London I treated over 250 patients all of whom had sustained suspected major trauma injuries. I learnt up to date techniques of assessment and became exceptionally experienced in working within a Major Trauma Network, which involves triaging patients to the most appropriate centre for their injuries and providing their out of hospital care until reaching an Emergency Department.

A primary motivation for undertaking the HEMS job was to gain competency in on-scene emergency procedures. I have now accumulated vast experience of emergency anaesthesia for critically sick patients outside the hospital setting and performed this procedure in excess of 50 times during my year in London – probably more than most doctors would undertake it their entire career. I also trained to provide open-heart surgery at the roadside and undertook this procedure five times and managed to resuscitate two patients who were clinically dead at the scene to arrive at hospital alive and stable again usually a once in a career treatment for most doctors.

During my time at HEMS I was privileged to be trained in a very new procedure called REBOA (resuscitative endovascular balloon occlusion of the aorta), which involves inflating a balloon in a major blood vessel in the abdomen to control massive bleeding from pelvic fractures. Training for this world first treatment is only available at HEMS in London.

My year in London was a quite unbelievable experience offering unrivalled exposure to the most seriously injured patients a doctor would see in their career and training from world-renowned experts such as Dr Gareth Davies.

I am currently in the process of applying for a substantive consultant post at Aberdeen Royal Infirmary where it is my intention to instigate a pre-hospital care system providing patients of Highland and Aberdeenshire with the level of care afforded to the population of London.

I would like to take this opportunity to thank HCA foundation for choosing to support my application and would add that without your financial support this position for me would not have been financially feasible. The skills and experience I have accumulated over the last 12 months has left me in a unique position to markedly improve the care to patients within my own region in Scotland.