Highland PICT Team

The Prehospital Immediate Care and Trauma (PICT) Team is a prehospital care team which operates from Raigmore Hospital emergency department in Inverness, Scotland.[1] It receives funding from NHS Highland, BASICS Scotland and the Scottish Trauma Network.[2][3]

Highland PICT Team
HeadquartersRaigmore Hospital Emergency Department, Inverness
Region servedHighland and Moray
NHS regionNHS Highland
Area sizeHighland and Moray

They are a stand-alone enhanced care team responding to trauma and other critical care incidents in Inverness and the Northwest Highlands, utilising a rapid response car. PICT comprises either a senior doctor from Raigmore Hospital or a rural GP, together with a Scottish Ambulance Service advanced practitioner in critical care.[4]

In light of the sparsely distributed ambulance resources in the Highlands and the challenges of distance and weather in the north west of Scotland, PICT has a considerable remit beyond trauma, operating as a Community Emergency Medicine (CEM) service as well as a prehospital trauma team. PICT provides support to ambulance crews and community responders in medical emergencies, and also provides a "see and treat" service to patients in order to prevent transport and possible hospital admission for problems manageable at home. In this way PICT acts as a senior decision maker for prehospital clinicians across the North of Scotland.

The team was also the winner of the 2022 Highland Heroes awards in the category of Emergency Services.[5]

Remit and workload

PICT currently operates 12 hours per day, seven days a week across the Highlands and Moray.[6][1][7] They respond to around 150 patients a month, attending a range of 999 calls, but being tasked to the most serious calls (major trauma, cardiac arrests etc).[8] For comparison, MEDIC 1 in Edinburgh attended around 3 patients a month in the decade between 1980 and 1990,[9] the Tayside Trauma Team (TTT) attends to 5.6 patients a month,[10] Emergency Medical Retrieval Service teams attend 33 primary retrievals (prehopsital care patients) a month,[11] while an individual BASICS Scotland volunteer responder may attend 2-3 calls a month.[12]

Tabulated prehospital workload by resource
Trauma Resource Prehospital patients seen each month Notes
PICT † 150 Data from January 2022
EMRS Team † 33 Data from 2023
TTT † 5.6 Data from 2009
MEDIC 1 * 3 Data from 1980 to 1990
BASICS Scotland Volunteer * 2-3 Responder on the Outer Hebrides
Graphical Prehospital Workload by Resource per Month
Prehospital Resource Patient's Attended per Month
PICT†
150
EMRS Team†
33
Tayside Trauma Team†
5.6
MEDIC1*
3
Individual BASICS Scotland Responder*
3

† NHS Funded * Charity Funded

The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network)[13] and critically unwell patients in the Highlands of Scotland. The doctor on the PICT Care will also assume the role of the medical incident officer when required at a major incident. They work to standard operating procedures, and national clinical guidelines for best practice. The team currently responds in a Scottish Ambulance Service vehicle. The PICT Team have attended a variety of incidents, including aircraft crashes, road traffic collisions, stabbings, shootings and critically unwell patients.[8][14]

When audited, it was found that the PICT Team were able to discharge on scene 22% of the cases they attended; 17% of their patients were paediatrics, and 39% were traumatic injuries. This is due to the PICT Team including a senior doctor who is able to facilitate alternative care pathways or provide interventions in someone's home, such as access to prescription medications to allow them to avoid attending the hospital.

Highland PICT response map

Enhanced Medical Care

In addition to providing senior decision making support, the PICT Team provide a number of clinical interventions which currently lie outwith the standard remit of a Scottish Ambulance Service paramedic,[15][16] such as;

The administration of:

  • ketamine, levobupivicaine (and intralipid if required), adenosine, magnesium sulfate, fentanyl or diamorphine.

Undertaking:

  • Diagnostic and procedural ultrasound,[17][18] wound closure, joint reduction, regional anaesthesia, sedation, pacing, cardioversion, thoracostomy (and drain insertion), mechanical CPR device deployment, amputation[19] or surgical airway.[20]

Facilitating:

  • Onward referral
  • Provision of prescription medications or a prescription for the patient to collect at a pharmacy
  • Senior decision making
InterventionRationaleEMRSPICTAP(CC)
Amputation Extrication / Access Yes Yes No
Anaesthesia Maintain ventilation Yes No No
Blood administration Maintain circulation Yes No No
Central line insertion Vascular access Yes No No
Chest drain insertion Pneumothorax management Yes Yes No
IV Antibiotics Reduce morbidity Yes Yes Yes
IV Calcium Gluconate/Chloride Prevention of cardioplegia Yes Yes Yes
IV Ketamine Sedation and Analgesia Yes Yes Yes
Reduction of fractures Minimize pain and morbidity Yes Yes Yes
Senior decision making Managing challenging circumstances Yes Yes Yes
Surgical Airway Maintain Oxygenation Yes Yes Yes
Thoracostomy Tension pneumothorax management Yes Yes Yes
Thoracotomy Cardiac tamponade management Yes No No
Ultrasound Detection of major injury Yes Yes Yes

Personnel

Doctors

The PICT doctors include consultants in the critical care aligned specialties of emergency medicine, intensive care medicine, acute medicine and anaesthesia. In addition to this there are speciality doctors from anaesthesia and intensive care. There are also a number of rural General Practitioners with further training in prehospital emergency medicine who work as rural practitioners, emergency practitioners or rural GPs across the Highlands and Islands. The doctor on the PICT car will assume the role of the medical incident officer when required at a major incident.[21] The clinical lead is Dr Luke Regan. Regan is a consultant in emergency medicine and holds the diploma in retrieval and transfer medicine.[22]

Scottish Ambulance Service Highland PICT response car

Advanced practitioners

The advanced practitioners in critical care (APCC) of the PICT Team are a cohort of clinicians from a paramedic or nursing parent specialty who are currently in training with PICT and in the emergency department at Raigmore Hospital.[23]

This is a new advanced practice role introduced with funding from the Scottish Trauma Network and represents a collaboration between PICT, NHS Highland and the Scottish Ambulance Service. The role of the advanced rural practitioner is designed to support PICT doctors in managing trauma and medical emergencies, including undertaking the blue light (emergency) driving to attend these calls. The advanced practitioners all undertake a master's degree to fulfil this role. Once fully trained, they utilise critical care clinical competencies,[24] and a number of primary care competencies to allow safe management of patients in the community or en route to hospital. In 2022 one of the advanced practitioners was nominated for the Scottish Health awards for his role in the rescue of a 6 year old boy from a mountainside.[25]

2022 PICT funding crisis

NHS Highland announced in early 2022 that they would defund the Inverness PICT Team, in steps which will leave the Highlands and Inverness without a seven-day physician-led enhanced care service.[26][27] This led to the local MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding.[28]

Mountain stated that:

"This pioneering service is essential when responding to major trauma incidents across the Highlands – we simply cannot afford to lose it."[28]

In 2023 the PICT Team secured ongoing funding as was able to recruit a permanent cohort of physicians.

Awards

Medic of the Year 2021

In early 2022, Dr Luke Regan, the PICT Team clinical lead, was awarded "Medic of the Year 2021" by the College of Remote and Offshore Medicine and invited to join their Council of Members for his work relating to the provision of trauma care across the Highlands of Scotland.[29]

Highland Heroes 2022

In March 2022, the PICT Team was awarded Highland Hero Emergency Services Hero of the Year for their life-saving work across the Scottish highlands.[30][31]

See also

References
  1. Highland, N. H. S. (23 March 2023). "Prehospital immediate care and trauma". NHS Highland. Retrieved 24 March 2023.
  2. "North of Scotland Trauma" (PDF). 2018.
  3. "2019 BASICS Scotland Annual Report" (PDF).
  4. "WordPress.com". WordPress.com. Retrieved 16 August 2023.
  5. "Highland Heroes - Nominate now". HN Media. Retrieved 2 March 2022.
  6. Maclennan, Scott (20 January 2022). "'World-class' Highland trauma team must get health board support, says MSP". RossShire Journal. Retrieved 25 January 2022.
  7. Maclennan, Scott (20 January 2022). "NHS Highland's refusal to fund a 'world class' lifesaving trauma team sparks questions". Inverness Courier. Retrieved 25 January 2022.
  8. Highland PICT [@highlandpict] (22 February 2022). "152 prehospital taskings for the PICT team in January. 10% cases were to cardio-respiratory arrests. More common taskings were to trauma cases such as car accidents, falls, stabbings and industrial accidents. Furthest RTC 53miles. Longest journey 50mins" (Tweet). Retrieved 2 March 2022 – via Twitter.
  9. Cusack, S; Steedman, D J; Robertson, C E; Little, K (1 June 1992). "Flying squad response to out-of-hospital cardiac arrest--a decade of experience". Emergency Medicine Journal. 9 (2): 203–207. doi:10.1136/emj.9.2.203. ISSN 1472-0205. PMC 1285861. PMID 1388497.
  10. Maddock, A.; Donald, M. (February 2014). "Caseload of a land-based trauma team". Scottish Medical Journal. 59 (1): 45–49. doi:10.1177/0036933013518151. ISSN 0036-9330. PMID 24413928. S2CID 206428497.
  11. McHenry, Ryan D.; Moultrie, Christopher EJ; Cadamy, Andrew J.; Corfield, Alasdair R.; Mackay, Daniel F.; Pell, Jill P. (22 August 2023). "Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31 (1): 39. doi:10.1186/s13049-023-01109-6. ISSN 1757-7241. PMC 10463457. PMID 37608349.
  12. Mallinson, Tom (28 June 2021). "A year as a prehospital physician in the Outer Hebrides, Scotland". Rural and Remote Health. 21 (2): 6115. doi:10.22605/RRH6115. PMID 34176277. S2CID 235659724. Retrieved 16 April 2022.
  13. "STN Minimum Requirements for Pre-Hospital Care" (PDF). 2017.
  14. "Four people rushed to hospital following serious crash which closed A9". STV News. 5 July 2022. Retrieved 11 August 2022.
  15. Highlandpictpilot (1 April 2022). "PICT Team Stakeholder Report 2022". Highland PICT. Retrieved 16 May 2022.
  16. "Team Capabilities". Highland PICT. 2 September 2023. Retrieved 2 September 2023.
  17. Boyle, Janet. "Medics hail mobile device that's saving lives in rural areas". The Sunday Post. Retrieved 14 June 2023.
  18. "Ultrasound". Highland PICT. 2 September 2023. Retrieved 2 September 2023.
  19. "Prehospital Amputation". Highland PICT. 2 September 2023. Retrieved 2 September 2023.
  20. Highland PICT [@highlandpict] (2 February 2022). "Highland PICT Response Team" (Tweet). Retrieved 10 November 2022 – via Twitter.
  21. Scottish Trauma Network / NHS Scotland. "Scottish Trauma Network Report to Scottish Parliament Health and Sport Committee" (PDF). Archived (PDF) from the original on 20 April 2021.
  22. "Dr Luke Regan". Retrieved 27 March 2022.
  23. NoS Trauma Network [@NoSTraumaNtwk] (27 October 2021). "The Advanced Practitioners within the PICT response team come from both @Scotambservice paramedic and senior nursing backgrounds, with extensive hospital based training in managing critically ill and injured patients" (Tweet) – via Twitter.
  24. "TOWARDS 2020: TAKING CARE TO THE PATIENT AND QUALITY IMPROVEMENT" (PDF). Scottish Ambulance Service. 29 January 2020.
  25. Highland PICT [@HighlandPICT] (20 July 2022). "A colleague so universally respected by everyone scientists question he may be the elusive 'fifth fundamental force of nature'..." (Tweet) – via Twitter.
  26. "'World-class' Highland trauma team must get health board support, says MSP". RossShire Journal. 20 January 2022. Retrieved 23 January 2022.
  27. "Supporters of a 'world class' lifesaving life-saving trauma team demand a rethink". Inverness Courier. 21 January 2022. Retrieved 23 January 2022.
  28. Maclennan, Scott (18 February 2022). "Highland MSP Edward Mountain calls for medical trauma response team to be saved". Inverness Courier.
  29. "Big award for Raigmore medic". Inverness Courier. 30 March 2022. Retrieved 30 March 2022.
  30. "Highland Heroes from across the region are crowned". Inverness Courier. 24 March 2022. Retrieved 25 March 2022.
  31. "Emergency response team delighted with 'wonderful' award". Strathspey Herald. 25 March 2022. Retrieved 25 March 2022.
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