RCEM as an organisation has a challenging job making sure that we keep up with the breadth of activity within our speciality, so that our function as a College can be fulfilled. We have some 52 committees, all of which undertake valuable work. This service is undertaken by professional and lay members, unpaid and often unrecognised, supported by our College staff. The College works hard to ensure that we get our committee structure right, that funds used to support their work are spent wisely, and that the outputs are useful to our members or to our charitable objectives.
This year RCEM has established the PHEM (Pre-hospital Emergency Medicine) Professional Advisory Group situated within the Service Delivery Cluster of the RCEM Committee structure. The committee is co-chaired by Ian Higginson (VP RCEM) and Caroline Leech (a PHEM and EM consultant). Along with the Paediatric Emergency Medicine Professional Advisory Group this committee is one of two new groups set up to recognise important sub-specialities within Emergency Medicine (EM).
So why was PHEM-PAG formed? And how do committees like this contribute to our work as a College?
Pre-hospital Emergency Medicine became a sub-specialty of Emergency Medicine in 2011 (along with the base specialties of Anaesthetics, Intensive Care Medicine and Acute Medicine in 2013). Emergency Medicine trainees continue to be the predominant base specialty making up 58% of all current PHEM trainees (IBPTHEM 2020). PHEM runs in a similar way to sub-specialty training in Paediatric Emergency Medicine with a year of extra out of programme training. To be awarded a sub-specialty CCT, PHEM trainees also have to successfully complete the Fellowship in Immediate Medical Care Examination.
Pre-Hospital Emergency Medicine (PHEM) has brought many positives to Emergency Departments. This includes training doctors in the critical care skills on the EM curriculum; creating sustainable Consultant job plans with PHEM time; and improving communication and collaborative working with the local ambulance service and air ambulance charities. Many interventions started life in the pre-hospital environment before widespread adoption into the Emergency Department. Resuscitation expertise can be gained or maintained from the pre-hospital experience of managing critically ill and injured patients, and departments with PHEM Consultants may be more likely to offer in-house RSI and procedural sedation.
Perhaps one of the major contributions of PHEM is as a recruiting sergeant for EM, and also in its many forms providing EM clinicians with fascinating options to do something a bit different. PHEM is a broad church, and is definitely not just about air ambulances and providing critical care skills. The specialty as a whole is striving to get away from the chest-cracking, “boshing”, jumping-out-of-helicopters stereotype and to showcase the breadth of opportunity available to our EM colleagues. PHEM includes crowd or teams sports cover, event medicine, expedition and wilderness medicine, motorsport, military medicine, and telemedicine providing support to remote areas. Community Emergency Medicine is also developing across the UK, in the form of Physician Response Units. These services can provide senior EM clinical input with advanced diagnostics at the patients home, reduce the number of patients who need to be conveyed to ED, and improve the accuracy of triage to the correct service. Many Emergency Physicians also choose to use their skills to contribute to their communities by volunteering as community responders, usually as part of BASICS, but also supporting mountain rescue and water rescue organisations. Emergency Physicians are perfectly placed to be involved in all of the above activities, undertake further learning or qualifications, and develop complementary sustainable interests to their EM career.
PHEM has relevance to every Emergency Medicine doctor. A third of our patients arrive to the Emergency Department by the ambulance service. To better understand the guidelines, capabilities and limitations of paramedic care, and to perhaps improve our teamworking at handover, it could be argued that every RCEM trainee should spend one day on a double-manned ambulance and one day in ambulance control (observing call-taking, dispatch and the trauma desk). In the current Covid situation we are working closely with our local ambulance services to overcome the difficulties offloading patients from ambulances into our crowded EDs whilst understanding the community’s need for 999 calls to be answered.
PHEM-PAG has been formed to ensure that pre-hospital activity is represented within the College structure and business, that the PHEM sub-specialty continues to be recognized and developed within EM, and to provide advice and support to the College and members on matters relating to pre-hospital care. Members of the PHEM-PAG committee represent a highly experienced group of EM doctors and paramedics with heterogenous interests, who are practicing across the UK. They were recruited following an open call for interest.
More specifically the objectives of the PHEM-PAG are to:
- Provide advice and support for external guidelines and projects pertaining to EM and PHEM. For example, the group have recently provided input into a UK NHS Ambulance services national document defining which ambulance patients should be alerted to the ED.
- Provide EM trainees with PHEM career advice and support to undertake sub-specialty training, and to ensure that gender and ethnic diversity in applications is supported.
- Ensure PHEM is represented within the RCEM curriculum, training, examinations, college conferences and study days, and RCEM learning modules.
- Provide written guidance for Emergency Departments who want to facilitate better collaborative working with the local ambulance service in quality improvement projects e.g. improving handovers for alerted patients, setting up a paramedic feedback scheme, injury prevention, or improving ambulance turnaround times.
- Promoting a culture of shared educational events and debriefing for EM and pre-hospital staff.
There are many pre-hospital focused organisations already established to advance pre-hospital care but the priority for this group is to concentrate on the interface between PHEM and EM. You can expect to see some outputs from the group in RCEM Learning and on the website in due course. If you have any questions or areas of interest that you think the group should be focusing on, you can get in contact with Dr Ian Higginson (email@example.com) or Co-chair Dr Caroline Leech (firstname.lastname@example.org).
We hope that this article has shone a light on the valuable committee work undertaken in College, and also on the value of PHEM within our speciality. At RCEM we are always happy to hear your ideas as to how we can improve the range and value of our activity, and are keen for our members to become involved.
By Dr Ian Higginson, Consultant in Emergency Medicine and Dr Caroline Leech, Consultant in Emergency Medicine