Author Archive | David Hogg

Clinical courage: an evolving concept crucial to rural practice

I was introduced to the concept of clinical courage when attending an International Rural Research Symposium last year at Tromso University in Norway.  Dr Lucie Walters, of Flinders University in Australia, ran an enthralling workshop about some work that she and her team are doing to quantify and understand what we mean and can learn from clinical courage, particularly in the context of professional isolation and delivery of rural health services.

It’s a concept that seems to resonate easily with rural health practitioners, particularly rural GPs.  Despite this, there is relatively little that I have found to expand on the concept.  Two very helpful resources are a “President’s Message. Clinical Courage” by Dr John Wooton (found in Can J Rural Med 2011; 16(2)) and two comments from Peter Dunlop and Keith MacLellan in the followup issue (found in Can J Rural Med 2011; 16(3)).  The latter comment introduces another concept of ‘learned helplessness’, and I suspect that this will be of increasing importance as debate evolves regarding the fragmentation of undergraduate curriculums and the need to consider generalist undifferentiated training versus teaching in more specialist settings.

So, I was delighted to be asked to participate in an interview run by two of the Flinders University students Ella and Laura who are assisting with the project, whilst here in Cairns at the WONCA World Rural Health Conference.  They interviewed me, and they kindly agreed to me interviewing them!

You can hear about their experiences of medical teaching so far, and also more about the concept of clinical courage in the audio clip below:


Ella and Laura, 2nd year medical students at Flinders University

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Voices from #ruralwonca: Day 1

Yesterday I caught up with several delegates attending the WONCA World Rural Health conference being held in Cairns, Australia over the next few days.

Hear more about their backgrounds and why they have come to #ruralwonca by clicking on the interviews… and please don’t be shy if you are asked for a similar clip over the next few days.

Thanks to Dr Minh Le Cong of the Flying Doctors Service, who provided a much-needed-but-forgotten cable to make these interviews possible!

Dr Sophia Åman, Sweden


Dr Sergius Onwukwe, South Africa


Dr Karen Flegg, Australia









Dr Pratyush Kumar, India

Pratyush has an important job: he is organising next year’s WONCA World Rural Health conference in New Delhi, in April 2018.  Hear a bit more about how the planning for that is going.  You can visit the website for the conference here.








Dr David Hogg, Scotland

Karen decided I should be on the other end of the microphone too, so how could I possibly decline!




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#RuralGPframed – bringing rural healthcare into focus

Check the end of this article for tweets and images that have been posted online since the hashtag went live… and you can also now view most of the photos from the #ruralGPframed series at too

Image from W Eugene Smith’s “A Country Doctor”.  LIFE Magazine, 1948.

the best camera is the one you have with you

1948 saw the beginning of the National Health Service in the UK.  Many of its principles were based on the development of the Highlands & Islands (Scotland) Medical Service which was launched in 1913 following the publication of the Dewar Report into the challenges of rural healthcare in Scotland – and many consider the Dewar Report to be the blueprint of today’s NHS.

1948 was also a key moment in photojournalism, when LIFE Magazine featured the photography of W Eugene Smith. His photoessay of the work of Colorado country doctor Ernest Ceriani became a benchmark for photojournalism, and remains an iconic reference in the power of photography to provide perspective and insight. A YouTube presentation of the article is available too.

Since then, photography and photojournalism has evolved significantly.   Nearly everyone now has a quality camera-phone in their pocket.  The development of digital photography has resulted in the limits of photography being confined only to battery power, memory card space, and creativity.

Dr Greg Hamill (Arran GP) and Dr Stephen Hearns (Consultant, Emergency Medical Retrieval Service) work together using ultrasound-guided vascular access in an acutely unwell patient. (Patient consent obtained).  iPhone; 2017.

And yet, some would argue that this has had the effect of devaluing the art of good photography.  Paradoxically, because photography is within such easy reach, we sometimes fail to document episodes of experience – either as we assume someone else will be, or the immediacy of image capture devalues the art of composition, style and creative depiction.  And because so many images are produced (Facebook estimates that over 300 million photos are uploaded to its website every day), it is likely that great images fail to get the recognition and prominence that they deserve.

In just over a month’s time, I will be running a ‘Practical Tips’ session at the Rural WONCA conference in Cairns, Australia – on The Visible Rural GP: developing an image bank for modern rural practice.  The idea for this evolved through a personal interest in photography and its journalistic role, an interest in ‘how do we represent rural practice to potential rural GPs’ and awareness of projects such as  Document Scotland – just one inspirational project that aims to “photograph the important and diverse stories within Scotland at one of the most important times in our nation’s history”.

A tick that I removed from a patient who presented to our Arran War Memorial Hospital one summer weekend oncall. (Assumed consent from tick).  Canon 60D, with reversed 50mm; August 2016.

Perhaps we should be considering the need for presenting inspiring, accurate visual representations of rural practice today.

And so today, in the run-up to Rural WONCA 2017, I am committing to share (via Twitter, using the hashtag #RuralGPframed) at least one photo per day, from my own images, that depicts an aspect of rural practice.

I would be delighted for others to join me.  The more images that we can collect and share, to represent the stimulation, challenge and professional satisfaction of rural practice, the more insight that others – including potential rural GPs – will have into the opportunities that rural practice can offer.

Dr Kate Dawson (GP, Benbecula) and Dr Charlie Siderfin (GP, Orkney) during a valuable opportunity to get together and discuss research opportunities in rural practice.  Fujifilm XT1; January 2017.

What about video?

‘A picture is worth a thousand words’ but video often allows a narrative and mood to be more easily captured.  Video is important, and submissions of video are welcomed to this project.

Please remember, explicit consent is required for any footage featuring patients or anything related to them. Creativity  is welcomed!


(search Twitter)

4/4/17 Update

Within 24 hours of this post going live, we’ve had an amazing amount of coverage across the world, particularly our Australian confreres.  Keep them coming!  Here’s just a few of the tweets that we’ve picked up on the hashtag…

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Scotland’s Mobile Simulation Unit – our experience on Arran

In January 2017 the team at Arran Medical Group and Arran War Memorial Hospital hosted a visit from the NHS Education for Scotland Mobile Skills Unit (MSU) – or ‘Skills Bus’ as some folk refer to it. In case you haven’t seen it: the MSU is a lorry, which expands into a workshop area where patient simulation scenarios can be run from a separate control room (also on the lorry). This setup enables a modern simulation facility to be delivered anywhere in Scotland – particularly rural areas – as it only requires a flat piece of land and an electricity hook-up similar to most caravans.

The skills unit just needs a flat area of ground, and an electricity hook-up. We were grateful to Scottish Fire & Rescue for hosting the unit at Lamlash Community Fire Station.

The folks at the Managed Educational Network (MEN) at NHS Education for Scotland (NES) [don’t worry, the acronyms will stop soon!] are keen for awareness to be raised about the unit, particularly its benefits to rural teams. We hope this description of our experience will encourage others to consider arranging a visit with the associated teaching that can often be organised to coincide.

Stop Press 8/9/17 – we were delighted to learn yesterday that the Arran NHS team were awarded the Gordon Nixon Award for this emergency training week. For more details see this page or watch the video below…

Tell me more about the unit…

The MSU operates from its base in Tayside, and can be booked by contacting the MEN team. At the time of writing, Lynn Hardie is overseeing the unit’s bookings and couldn’t have been more helpful in organising for its delivery to Arran for a week.

Once the unit is set up and expanded by the driver, who usually returns the same day back to their base following delivery, there is a large teaching area which comfortably seats up to 12 people. The unit has heating and lighting, and offers a comfortable teaching space.

The unit can be set up – using the James-Bond style concealed TV – to deliver didactic teaching presentations. Whilst this is its most basic of functions, there are some areas in Scotland which will will find this to be a useful function as part of a more comprehensive course.

However, the main purpose of the Unit is by using its SimMan, SimJunior or SimBaby, along with various provided medical paraphernalia, to enable a wide range of patient assessment simulations to be carried out. The unit has been custom-built: its layout enables pragmatic connection points for the mannequins; there is a separate control room set up with appropriate control software; and an impressive ‘SMOTS’ video system records scenarios from three different angles. This is useful both for monitoring progress through a simulation, as well as for playback during scenario feedback.

This sounds a bit complex

The kit is certainly modern, technically impressive, and requires familiarisation. However the MEN runs excellent (and free) Faculty Development Courses (FDC) – usually at the Scottish Simulation Centre in Larbert – to introduce potential hosts to the simulation equipment and also the daily setup and operation of the unit.

We found the FDC to be fun, interesting and useful – not only for the operation of the unit but for generic skills in running simulations and delivering effective feedback.

The unit also comes with relatively idiot-proof set up instructions, as well as an A-Z guide of equipment and a very helpful troubleshooting guide. This is all covered in the FDC and the MSU team also make themselves available by phone to help sort out any urgent problems during a visit.

OK, but who can we get to help us?

Dr Mark Davidson, Consultant with the ScotSTAR paediatric team, was one of several skilled colleagues who provided excellent teaching during the week.

The unit can be used by confident local teams to deliver training, however we would highly recommend requesting input from the ScotSTAR transfer teams who are often able to provide outreach support for rural training visits. In our case, over the duration of a week, we allocated Monday & Tuesday for paediatric acute care, Wednesday for obstetric emergencies, and Thursday & Friday for adult acute care. For this we were able to enlist the excellent help of the ScotSTAR Paediatric Retrieval Team, the Scottish Multiprofessional Maternity Development Programme (SMMDP) and EMRS (Emergency Medical Retrieval Service) who each came to Arran and delivered excellent teaching – including simulation sessions – during their stay.

In addition we invited a number of clinicians at Crosshouse Hospital – to whom we usually refer our cases – and their involvement was crucial both in clarifying local protocols and also understanding some of the challenges that we face in the rural and community hospital setting when referring to them and their teams.

How did it go?

Our local fire station provided excellent additional presentation space to run workshops, lectures and ample catering facilities.

We found that smaller groups worked best for simulation sessions. We also benefitted from the free use of our Lamlash Community Fire Station (who also kindly provided electricity and additional training space) as well as a daily donation of snacks and food for our Faculty from the Co-op.

Over the week the programme progressed through paediatric, obstetric and adult sessions. We allocated 10-14 clinicians into each morning or afternoon session, usually splitting them up into two groups to alternate between simulation and workshop training. We also held lunchtime ‘drop-in’ update sessions on topics such as sepsis, DKA (diabetic ketoacidosis), drug overdose and ECG interpretation; and we invited our First Responders to an evening of simulation too.

We delivered over 540 training hours during the week to Arran’s GPs, nurses, nursing assistants and paramedics/technicians, and collated feedback using SurveyMonkey – which was generally very positive and indicated an enthusiasm for doing more simulation training in the future.

What went particularly well?

Multidisciplinary colleagues worked together in simulations, and this reflected the nature of work on Arran in our community hospital.

Our teams enjoyed working in the same multi-disciplinary setup that we usually work in. For example, at our community hospital, it is common for a GP, two nurses, a nursing assistant and paramedics to continue working on an emergency case on arrival at the hospital, and we emulated this in teaching scenarios. The quality and experience of our Faculty – comprising experienced consultants, nurses and paramedics – was clearly appreciated by participants, along with the relevance of the teaching.

Prior to the training week, we surveyed our colleagues to identify what they felt were priority areas for development. As expected, sepsis and acute coronary syndrome were low down the priorities – there has already been a focus on these areas in our hospital (and nationally) over the last few years. Higher up were – obstetric emergencies, unresponsive/hypoxic children, severe asthma, drug overdose and major trauma; and so these were the areas that we focussed our training on this year.

During the week we kept a ‘Great Ideas’ board updated using post-it notes, to capture great suggestions and points for further consideration following the course. Collating this at the end of the week provided not only a snapshot of over 40 learning outcomes, but a great range of action points for implementation, as a result of discussion during the week.

What would we have done differently?

Based on feedback, we might have built in more time for skills stations – for example airway management, NG tube placement, chest drain insertion and femoral line access. There is equipment to provide this training on the Unit, however we opted to focus on more simulation training for our week.

Any further efforts to keep groups small and reflective of typical team configurations would have had benefits too, although the feedback indicated that most of the time this was achieved.

We also found – as do organisers of similar training – that running a week can be tiring!  Inevitably, there is a bit of running around before and during the week, to sort out equipment, printing documents and keeping a track on the programme.  Two of us kept an eye on this, and our advice to anyone considering running a training week would include the importance of running the week as a team, with adequate time to oversee the logistics!

What about funding?

We used local training funding to free up time in order for two Arran clinicians to attend the Faculty Development Course, as well as some admin time required before, during and after the training week. Funding was also identified for GP locums – and this, combined with restricted leave during the week – meant that we were able to maintain normal service whilst maximising participation in the training scenarios.

The crucial advantage that we had by involving ScotSTAR teams is that they were able to fund their input via their own team outreach budgets – this is centrally funded with the aim of supporting rural clinicians, and so the conversion factor between local funding and the ‘worth’ of the week was 3-4 (i.e. we gained nearly four times as much value from the local funding required to organise the week).


The SMMDP programme ran a fantastic, relevant- and fun – one day course on obstetric emergencies for us. Twenty staff from all disciplines attended.

David Hogg (GP) and Ailsa Weir (Senior Charge Nurse) oversaw the week of training. We can both be contacted via Arran War Memorial Hospital if you wish to find out more about our week. Lynn Hardie (Mobile Skills Unit Project Officer) was instrumental in organising the unit to be available, and our attendance at the Faculty Development Course. Lynn’s contact details are available on the MEN website.

In terms of team contacts, Sandra Stark (Nurse Consultant, ScotSTAR Paediatric Team) and Kate Silk (Programme Administrator at SMMDP) were our key links and very helpful in setting up the training. Every rural area in Scotland has an EMRS ‘link consultant’ and this should be the route that EMRS involvement is requested. In our case we were grateful to Dr Drew Inglis and Dr Doug Maxwell for their input.

If you are keen to consider a visit to your local area, contact the MSU team in the first instance, and they will be able to advise on availability, and advise on how to set up an appropriate programme of training.

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Review: BASICS Scotland Smartphone App

A few years ago I downloaded the BASICS Scotland App.  Offering the ability to record patient demographics, observations and interventions in real time on a smartphone seemed like a useful idea.

Initially, however, the app proved to be a bit buggy… and the only way of sending on the information was in a difficult-to-understand stream of text in an email.  It was a good first effort, but it wasn’t quite reliable enough for retaining vital information and the end result was a report that needed some time to decipher.  The app occasionally crashed, for example when entering a patient’s BM.

Things have changed, however, and I recently tried using the updated version on a number of calls.  I’m pleased to have discovered that the bugs have resolved, and the Patient Report Form (PRF) generated at the end is much easier to follow.  Patient data is now exported into a well-formatted Adobe PDF file.  This can be emailed directly from the app, to BASICS Scotland and to your NHSmail address.  In fact it can be sent to any email address, but the sensible advice is to use a secure system such as NHSmail.

Importantly, the app does not need connectivity at the time of use – using it in a typical rural area with limited or no connection will not pose any difficulty, and information can be easily stored until you get to an area that offers a connection with which to email the completed data.

Why are the PRFs important?

View a sample PRF PDF

It is vital for BASICS Scotland to get feedback from any BASICS calls, and unfortunately there is a relatively low completion rate.  Information about emergency calls helps to inform future training, contribute evidence of the value of BASICS Scotland care, and keeps the Sandpiper Trust informed and enthused about providing ongoing equipment support to responders.

Of course, you can still use the paper forms (just contact BASICS Scotland if you need any) and post them back to the office.  Some responders will prefer to continue (or start!) to use these… however with the latest app improvements, you might find it easier than ever to quickly submit a PRF at the end of a job: both for your own medicolegal and appraisal records, as well as providing this vital feedback to the BASICS Scotland office.

 What else does the app do?

As well as enabling PRF data collection, and collating this into an easy-to-read PDF document, the app contains a wide range of useful resources such as contact details, a ‘find my local hospital’ for any responders who are less familiar with their patch (or perhaps providing locum cover), clinical procedure guides, an equipment checklist and direct access to the BASICS Scotland training videos – which cover everything from cricothyroidotomy, ALS algorithms and use of a pelvic sling.

Opportunistic learning has never been more important, and as busy GPs, paramedics or nurses, having all this information and learning material to hand is a big step forward for responder support.

The app is free to member responders, and the initial download can be obtained from the BASICS Scotland website.  It is available for iOS and Android platforms, and updates are automatically pushed to your phone.  The office will help if you have any difficulties logging in or setting up the app.

What was that about low completion rate?

We know that responders are busy professionals.  However, BASICS Scotland really needs decent feedback to ensure it learns effectively from the calls that responders are attending: details help to inform future training content, clinical governance support and kit development.  PRFs should, ideally, be completed for calls – including emergency calls that might initially bypass Ambulance Control, which is a common scenario in more rural areas.  The PRF form allows accurate recording of pertinent call details for medicolegal purposes and personal audit, but also shapes what equipment is rolled out to responders by the Sandpiper Trust.

Pads of PRF forms are easily available by contacting the BASICS Scotland office – or as the article above highlights, can be quickly generated from data entered to the BASICS responder app.

Whilst we’re on this topic – did you know that BASICS Scotland can arrange helpful bag checks via phone or videoconferencing?  An experienced member of the BASICS team can remotely go through your kit check with you, and make immediate arrangements for replacement of expired or missing stock.  To arrange this, simply contact the office directly.

If you’d like to take a look and download the app for yourself, visit this section of the BASICS Scotland website.

Enter patient observations here (can be done multiple times under different time stamps)

Some of the different sections of the electronic PRF.

Sample PRF generation within the app

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Are you a Rural Health Hero?

The forthcoming WONCA World Rural Health conference reminded me to publish the following ‘script’ on the RuralGP blog.  Dr Jo Scott-Jones, New Zealand GP, introduced delegates at the last World Rural Health conference in Dubrovnik to his modified version of the ‘Are you Human’ version from Ze Frank – and it went down brilliantly.

Jo kindly forwarded me the script to publish here, and we used it at the RGPAS conference in 2016 before the conference dinner. It seemed to resonate with rural GPs both in Dubrovnik and Inverness, and there have been requests to make it available here…

Rural Health Hero Test (after Ze Frank)

(Everyone in the room should stand up).

It is safe here.

Imagine…  We are surrounded by a soundproof glass bubble that protects us from all outside, only you and I are here and you and I can be honest with each other without fear. 

This test is designed to show if you are a rural health hero or not. Your only task is to answer honestly, by sitting down if the answer to the question is “yes”.

Have you ever trodden in cow pats on your way to a home visit? 

It’s OK. You are with friends.

Have you ever been chased down a gravel path by a goat, goose, dog, cow or chicken? 

Have you ever fallen over a wire fence at the scene of an accident and heard police, ambulance and fireman laugh  ?

It is OK, you are with friends here, you are a rural health hero.

Have you ever been on a home visit and had to have your car rescued by a tractor because it fell off the side of the road because the road was narrow and your reversing skills too poor?

Have you ever fought with a manager or government official over the future of a service to your community?

Yes. You are a rural health hero. 

Have you ever tried to match up skin edges ragged by a chainsaw?

Have you ever fallen asleep in front of a patient on a warm afternoon after a busy weekend on call?  

Have you ever spent an afternoon persuading a patient the trip to town to get healthcare is worth it?

Have you ever seen a man, a barn, a gun, his blood and brains?

Have you comforted a spouse in a kitchen left behind to deal with the debts?

Be calm, you are safe here, you are a rural health hero. 

Has your spouse ever been asked by a stranger in the street if you have the results of their Chest X-ray ?

Have you ever sat at a family dinner party with your best friend and his wife who you have just treated for an STI that she caught from someone who is not at the party?

Have you seen someone’s inner thigh in the cereal aisle of the local shop?

You are safe here. It is OK. You are with friends.

Do you live in a most beautiful house ? Is the view from your window amazing? Do you breathe clean air and walk in forests, fields, beaches, or mountains after work ?

Have you ever thought yours was the best job in the world ?

Have you ever wondered what will happen next and smiled?

It’s Ok, I see you have all passed the test, well done, you are all rural health heroes. 

More about Jo Scott-Jones  (video interview from 2013 | Jo’s blog)

Images: DHogg/view towards Torridon Hills, Scotland | Pixabay Free License.
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WONCA World Rural Health conference all set for April

This year will see the WONCA World Rural Health Conference take place in Cairns, Australia from 29th April.  It will be preceded by the National Rural Health Conference of Australia, which will promise to bring even more research, innovation and collaboration to the wider event.

Registration is now available from the conference website.  The organisers have also put together this film to whet the appetite of potential delegates.  It looks set to be a fantastic event. will be there, and we hope to run a similar range of interviews and podcasts like we did from Dubrovnik in 2015.  This reflective commentary from the 2015 conference demonstrates that the conference offers a unique chance to get together with like-minded confreres and share great practice from across the world.

We hope to see you there!

Early bird registration fees available until the end of January.

… and if that’s not enough (!), here’s Ian Couper of South Africa, being interviewed in Dubrovnik in 2015 giving some encouragement for others – particularly students and new doctors – to attend WONCA in Cairns…

ianIan Couper, South Africa

Ian is a rural family doctor, and a stalwart of Rural WONCA.  You can read more about his background here.

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#RGPAS16 a major success

Last week, over eighty students, trainees, new and more experienced GPs from across Scotland and beyond, met at the annual conference of RGPAS.  An action-packed programme provided a wide variety of clinical and non-clinical topics, and there were plenty of opportunities to meet and discuss rural practice.  Rural GP-ing in Scotland is a simulating place to be!


Scroll to the bottom of the page for more conference photos…


But we had some GPs from further afield too!


Rural GPs from across Scotland came for the conference…

Kicking off the programme, we heard from Dr Helen Brandstorp of the National Centre for Rural Medicine in Tromso, Norway.  Helen provided a good backdrop to the fact that “we’re all in this together” – the challenges and delights of rural practice are prevalent in Norway in similar levels to Scotland.  The ground is fertile for further collaboration with international confreres and we hope to see ongoing links with our Norwegian counterparts in rural medicine.

The rest of the conference featured a rich variety of clinical and non-clinical topics of relevance to rural practice.  We were lucky to have an excellent range of engaging and entertaining speakers.  From updates in emergency medicine, to humanitarian and MSF work, to developing rural LGBT-friendly health services, to IT Reprovisioning, to research tips, to rural surgery, to featured student presentations… there was plenty going on, and the conference dinner provided plenty of opportunity to make further connections and allow the conversations to flow, along with a bit of traditional music too.

We were delighted to host a good number of students, trainees and new doctors… in particular there were nineteen heavily-subsidised student places – and they didn’t disappoint in their contributions of innovative ideas throughout the conference.

Instead of listing all the speakers here, the programme remains available – and we were delighted that over 200 #rgpas16 tweets were exchanged in the course of the conference.  We’ve collated these with Storify, and you can view the Storify timeline here.

Here’s a few of the twitter highlights:

The conference rounded off on the Saturday with a visit to the Bristow Coastguard helicopter base at Inverness Airport, where Winchman Paramedic Duncan Tripp and his colleagues treated student and experienced GPs to a tour round the facilities, including one of their £26 million Sikorsky search and rescue helicopters.

Thanks to all those who presented, and to all others who contributed to the conference planning.  The event proved to be fun, engaging and relevant to rural practice.  We hope to do the same next year – provisionally booked at the Craigmonie Hotel again on 2nd-4th November 2017.  Meantime, at RGPAS we are keen to stimulate and encourage further work in Scottish rural practice.  A new committee was formed, and I am delighted to take the helm of an able and enthusiastic team.  It’s going to be an exciting year!

Here’s some photos of the event…


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#RGPAS16 brimming with student ideas for #ruralGP

newlogosquaretextToday over 80 students, trainees and rural GPs will meet up in Inverness, for the annual conference of the Rural GP Association of Scotland.

This year’s event has attracted record numbers of attendees, and a stimulating programme of events is in store, along with lots of opportunities to chat, network and seek new ideas for rural practice.

As part of the RGPAS student scholarship programme, we have encouraged student delegates to submit video or audio clips of around 60 seconds, outlining their visions of the future of rural practice.

Not all clips are available as yet, and we will develop this page over the next week to include more clips, as well as add the photos of RGPAS students on this page too.  In the meantime, take a listen to the diverse and innovative ideas being put forward by the students below, all of whom will be joining us in Inverness.  Great to hear such an inspired group of students!

The conference will run from 2pm today – Thursday 3rd November – to Friday 4th November.  You can follow events on twitter using the hashtag #RGPAS16 – we hope to share reports and presentations from the conference on soon after the conference too.


Innovation ideas

Sally Andrews (Aberdeen University): On the role of telemedicine to improve patient care and good housing availability to improve recruitment to rural areas…

Joe Daley (Glasgow University): Improving the interface between rural primary care and secondary care input…

Rhys Hall (Glasgow University):  The use of drones to overcome geographical barriers of rural practice…

Catherine Lawrence (Hull & York Medical School): Reflects on her experience of a Scottish rural GP elective…

Scott MacDonald (Glasgow University): Using technology to allow patients to take more responsibility for monitoring their health…

Lean-Lik Ng (Dundee University): How to engage with medical students of today to pave the way for future rural general practice…

Iona Robertson (Dundee University): Describes the increasing role of telemedicine in reducing the need to travel longer distances to secondary care…

Keenan Smith (Glasgow University): Reflecting on infrastructural revolution to provide better access to rural healthcare…

Blair Wallace (Dundee University): On the role of point-of-care investigations in improving efficiencies and quality of care offered to rural patients…


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Is there a Sandpiper Responder near you?

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. (Staged simulation - pic by Chris Hogge).

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. There are actually two in this photo.  (Staged simulation – pic by Chris Hogge).

Have you heard of the Sandpiper Trust?  If you are a rural GP or nurse in Scotland, you are very likely sitting there thinking ‘yeah, of course’!  You probably don’t have to look far in your home/car/work to find a familiar blue Sandpiper Bag – over £2000 worth of emergency life-saving kit brought together into a neat, organised package, ready to go at a moment’s notice.

Sandpiper Bag - in this case there's a BASICS Scotland teaching exercise being carried out in the background.

Sandpiper Bag – in this photo there’s a BASICS Scotland teaching exercise being delivered in the background.

There are over 1000 such bags in Scotland, mainly in rural and remote areas.  They enable rural clinicians to support the Scottish Ambulance Service in providing emergency care when there isn’t an ambulance easily available, or sometimes as there is more than one casualty, or the skills of a doctor are required to augment those of an ambulance paramedic.

One thousand bags.  That’s over £2,000,000 (2 million) worth of kit – funded purely from public donations over the last fifteen years.  And that’s before considering that responders who are on islands or make themselves trackable by the ambulance service, are provided with even more resource, from EZIO needles and pelvic slings, to defibrillators and technology to plug themselves into the national responder system.

Bags are provided to rural clinicians who have successfully completed the excellent BASICS Scotland courses in emergency care.  From advanced paediatric life support, to trauma care, to ongoing teleconference sessions to share best practice… the system works because of this integrated approach between BASICS Scotland – who provide the training and support – and the Sandpiper Trust – who provide the kit and training resources.

What started the Sandpiper Trust?

The Sandpiper Trust Logo - inspired by 'a light hearted, cheeky bird who plays by streams and on the seashore' - just like Sandy Dickson, whose tragic death inspired the charity to be founded.

The Sandpiper Trust Logo – inspired by ‘a light hearted, cheeky bird who plays by streams and on the seashore’ – just like Sandy Dickson, whose tragic death inspired the charity to be founded.

The Trust was formed shortly after the tragic death of Sandy Dickson in 2000 – at the age of 14 years as a result of a swimming accident in rural Canada.  His parents, Penny and Aly asked the question ‘What would have happened if this had occurred in Scotland?’.  Penny’s sister Claire and brother-in-law Robin Maitland supported them on a journey that would soon provide rural Scotland with an integrated system of emergency care and resource that has become the envy of many other countries.

Their work has inspired others to provide advice and expertise – such as when Chris Tiso of the outdoor sports company Tisos came across the Mark 1 Sandpiper Bag by chance, and provided his support to enable the Mark 2 Bag to incorporate much improved fabrics, layout and carrying harness.

More background to the Trust can be found here.

Who funds the Sandpiper Trust?

Sandpiper Bags are designed to keep equipment laid out in a logical and helpful way (Pic from simulation training at recent BASICS Scotland course).

Sandpiper Bags are designed to keep equipment laid out in a logical and helpful way (Pic from simulation training at recent BASICS Scotland course).

The Sandpiper Trust exists entirely on personal donations.  If you visit the Sandpiper Trust facebook page, you’ll see a range of budding cyclists, iron men, stall holders, bakers, auctioneers and other inspired volunteers who give their time to fund the Trust’s activities.

Unfortunately the nature of the work that the Sandpiper Trust supports, means that there are often sensitivities in reporting this at the time.  Patient confidentiality remains a paramount aspect of healthcare, and so responders have to be careful when highlighting the work that they have carried out at the time.  Inevitably, responding to emergencies can result in contact with adversity, tragedy, and changed or lost lives.  However, where possible, work is publicised to give Sandpiper supporters an idea of how donations are used.

The Sandpiper Trust is keen to hear from Sandpiper Responders about where their kit has helped.  It helps to keep the energy going behind the colossal fundraising efforts behind the scenes.

How does the system work?

Bags and jackets like this are provided to responders across rural Scotland - here's mine (Pic: Chris Hogge).

Bags and jackets like this are provided to responders across rural Scotland – here’s mine (Pic: Chris Hogge).

I am one of many Sandpiper Responders across Scotland.  I offer my situation as a typical example of why the Sandpiper Trust works so well to support us rural GPs in Scotland.  On Arran we have one ambulance available at any one time, and it is used for emergency and non-emergency patient transport.  It takes two hours to drive round Arran, and our population rises from 5,000 to 25,000 over seasonal periods such as Easter, Summer and Christmas.  We see lots of outdoor activity enthusiasts on Arran – cyclists, hillwalkers, paragliders – and like many parts of Scotland, we are seeing our population become more elderly and medically complex.

Our full team of GPs – along with one of our Practice Nurses with expertise in emergency care – are equipped with Sandpiper Kit.  Being island responders, we are given extra resources which means typical kit will cost more than £3000 per responder.  Three of us are mapped onto the Scottish Ambulance Service (SAS) system.  I carry an airwave radio and a smartphone that allows me to be tracked wherever my car goes – and to book on and off depending on other commitments.

If SAS require support – if Arran’s only ambulance is busy with another call, if there are multiple casualties, or if the crew have requested medical support – they will contact us by phone or radio, often using the map to see if anyone is closest and available.  Failing that, SAS will tend to call our community hospital to see if a response can be co-ordinated from there.  BASICS Scotland training includes not only advanced emergency medical care, but considerations about driving safely, providing a ‘sitrep’ back to ambulance control and keeping the initial scene as safe as possible.  Our personal protective equipment includes very high quality hi-vis jackets, which are extremely useful for road accidents and incidents in the open.

Sandpiper Responders can provide vital information back to ambulance control to help identify patients who need urgent evacuation for specialist medical care.

Sandpiper Responders can provide vital information back to ambulance control to help identify patients who need urgent evacuation for specialist medical care.

The job of a SAS call handler is very difficult, and sometimes it’s tricky to decide how urgently someone needs medical attention.  There are occasions when we are asked to assist with someone suspected of being very ill or injured, but being the first ‘eyes on scene’ we can further triage the call.  Being volunteers – and that emergency calls can take us away from a busy surgery, family life or time off – SAS tend to be careful and respectful on when we are asked to attend emergencies.  However, there’s no doubt that there are occasions when our early attendance can help to stand down limited resources – or indeed scale up a response for patients requiring emergency evacuation by helicopter.

Each year, across Scotland, Sandpiper responders attend thousands of calls.  These all depend on voluntary time, along with replacement of items which are used or which expire.  We continue to receive fantastic support from the Sandpiper Trust, who remain committed to providing us with great quality and often cutting-edge equipment.  Sometimes our ambulance colleagues are envious about the quality of the kit we are provided with!

What sort of calls do you attend?

Technology, funded by the Sandpiper Trust, enables some responders to link directly into the Ambulance Service responder system.

Technology, funded by the Sandpiper Trust, enables some responders to link directly into the Ambulance Service responder system.

I recently attended my 117th call in the last six years on Arran.  Without providing dates or specifics, here’s a look back at my last ten calls:

  • sudden heart failure, helicopter evacuation after stabilisation – SAS crew request for assistance
  • motorbike crash, thankfully only minor injuries – SAS crew busy with another call
  • fall off a ladder, serious injuries, helicopter evacuation from scene – SAS crew request for assistance
  • cardiac arrest, unfortunately fatal – ‘dual response’ requested
  • cardiac arrest, unfortunately fatal – ‘dual response’ requested
  • haematemesis (vomiting blood) – SAS crew busy with another call
  • mountain bike crash, teenager with chest and head injuries – SAS crew busy with another call
  • unresponsive 2 week old baby – ‘dual response’ requested
  • chest pain, suspected heart attack – SAS crew busy with another call
  • 35 week old baby with breathing problems – SAS crew delayed response due to location

What about WildCat?

wildcatWildCat is an impressive programme to trial a co -ordinated system of response to cardiac arrests in rural Aberdeenshire.  Building on the lessons of TOPCAT – a project in Edinburgh which has revolutionised how medics respond to cardiac arrests – WildCat aims to translate those lessons into a useful system for rural areas.  It builds on the response already provided by Sandpiper responders, and aims to train folk from much wider backgrounds to get early defibrillation and quality CPR to patients in cardiac arrest.  You can read more about WildCat here.

Sounds amazing.  Can I help?

Donations are particularly necessary to enable the Sandpiper Trust’s work to continue.  You can find out more about how to donate here.  If you live in a rural area of Scotland, ask your GP or practice nurse if they have a Sandpiper Bag next time you’re in.  If you feel able and inspired to help with local fundraising, your local responders and the Sandpiper Trust will be keen to support you with that.

Over the next few months, we hope to raise awareness about the amount of Sandpiper Kit in rural Scotland.  You can post messages to the Sandpiper Trust Facebook Page – and also there will be some twitter activity including the hashtag #spkit.

You can also use the comments section below to chip in your experience of using or benefitting from Sandpiper-funded equipment.

Her Majesty The Queen recently presented the 1000th Sandpiper Bag to a responder.

Her Majesty The Queen recently presented the 1000th Sandpiper Bag on behalf of the Sandpiper Trust to another responder in Scotland.




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