Archive | Rural-Proofing

RRH Guide to Getting your work Published

One of the sessions at #ruralwonca was delivered by some of the team at the Journal for Remote & Rural Health.  I was really sorry to miss it, due to presenting in another session, but my tweeted request to make the advice available online was answered quickly and the presentation is now available – see below.

The journal team are keen to encourage and motivate rural healthcare professionals to share their research, and seem genuinely interested in helping budding writers to put pen-to-paper or finger-to-keyboard.

There is a lot of great innovation and problem-solving going on in rural practice.  Rural healthcare professionals tend to know their communities well, are used to dealing with limited resources, and some of the best examples of teamwork are to be found in rural settings.  However ‘being academic does not come easy to everyone, and the process of writing up evaluation and research can sometimes feel tedious and time-consuming.

However, it is now easier than ever to find interested journals, and there seems to be a drive to make the steps to getting work published more accessible.

Watch the presentation below for the RRH team’s top tips on getting your research out to a wider audience.  You can find the guidelines for authors available here.

Also, on the theme of research, here’s a great project that aims to enable rural doctors to develop their research activity through pragmatic and direct support.  Delivered by the Faculty of Medicine at Memorial University in Newfoundland, it’s called the ‘6 for 6’ programme.  Click here for more details or watch the video below.

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What happens when Deep End goes Rural?!

Many readers will be familiar with the Deep End project, originating in Glasgow but which has spread far and wide in describing the work of GPs working in areas of urban deprivation.  The original project brought together 100 general practices serving the most socio-economically deprived populations in Scotland.  The project team has carried out a fantastic amount of work to highlight the impact of inequalities on prevalence of medical conditions and access to healthcare.

So what happens when a Deep End GP (or a GP and GP trainee, to be precise!) travel out for some time in a remote island practice?  Dr Maria Duffy and Dr Elizabeth Dryden did exactly that, when they travelled to Benbecula to spend a week with rural GP Dr Kate Dawson… and produced this short video of their experience…

 

You can follow the Deep End project on Twitter – see below.

We look forward to the sequel!

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Setting the right path for Canadian rural practice

Thanks to Dr Douglas Deans for highlighting this recently-published report from a collaborative taskforce in Canada, which has been set up to identify positive actions that are likely to result in a more robust, sustainable and supported rural health service in Canada.  The collaboration comprises the Society of Rural Physicians of Canada (SRPC) and the College of Family Physicians of Canada (CFPC).

The report is refreshingly succinct, relevant and pragmatic, and likely to be of interest to anyone who is trying to work out how to articulate the balance between effective action and strategic direction to influence national policies, in the context of conflicting and difficult policy decision-making.  Many rural GPs and educators will be familiar with the challenge of identifying realistic interventions which can translate into more sustainable recruitment and retention to rural communities, so this road map from Canada is likely to be a welcome read.

Recruiting and retaining family physicians in rural areas through financial incentives alone is not enough.  We need a coordinated and thoughtful alignment of education, practice policies, community involvement, and government support.  Family medicine residents who are educated in rural training sites, who immerse themselves in the communities and who see themselves supported by peers, specialists, health care providers, and evolving distance technologies, are more likely to choose rural and stay rural.

Dr Trina Larsen Soles – SRPC Co-Chair of Taskforce

News Release   Download the Report

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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 gallery.ruralGP.com 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!

#RuralGPframed

(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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New Report: Health & Wellbeing in Rural England

Thanks to David Syme for highlighting this report which was published on 11th March 2017.

It offers a comprehensive view of the challenges and positive aspects of accessing and providing rural healthcare in England.

The report mentions eight key ‘health risks’ of rural areas:

  • Changing population patterns
  • Infrastructure
  • Digital access and exclusion
  • Air quality
  • Access to health and related services
  • Community support, isolation and social exclusion
  • Housing and fuel poverty
  • Employment and under-employment

There will of course be similarities between the issues raised in this report, and communities elsewhere in the UK and beyond.

You can download the report from this link.

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@RuralGPScot launches #ruralLGBTQ resources for #ruralGP

Last week, the Rural GP Association of Scotland (RGPAS) launched a range of guidance designed to make rural practice in Scotland more accessible to lesbian, gay, bisexual, transgender (LGBTQ+) patients.

At the annual RGPAS Conference last year, held in Inverness, we were delighted to welcome Dr Thom O’Neill to talk about LGBTQ+ inequalities in rural areas, and some of the practical ways that as GPs we can reduce barriers to healthcare.  Here he is talking about what doctors can do to better support LGBTQ+ patients.

Thom’s presentation stimulated a lot of discussion, and led to a project whereby he worked with RGPAS to develop factsheets, posters and other materials to help rural GP practices ensure that their services are welcoming to LGBTQ+ patients – especially younger patients.

You can find out more about these resources at: www.ruralgp.scot/lgbtq-plus.

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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).

Interested?

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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Rural GPs Scotland (RGPAS) Conference 2016 – registration open

newlogosquaretextTwitter hashtag: #RGPAS16

The annual RGPAS (Rural GP’s Association of Scotland) conference will be held on Thursday 3rd and Friday 4th November 2016, at the Craigmonie Hotel in Inverness.

Once again, we hope to welcome both new and experienced rural health professionals, and we have a stimulating programme lined up to cover a wide spectrum of topics which are relevant to rural general practice in Scotland.


Programme

The latest programme will be kept updated here: http://scotland.ruralgp.com/conferences/

Thursday 3rd November 2016

(Lunch can be organised with the Craigmonie Hotel by prior arrangement – please contact them directly).

1330 Registration & Tea/Coffee

1400 Introduction :: Dr David Hogg (Rural GP, Isle of Arran)

1415 Rural Medicine – a Norwegian Perspective :: Dr Helen Brandstorp (National Centre of Rural Medicine, Tromso, Norway)

1445 Transfers Workshop :: Dr Iain Cromarty (Rural GP, Isle of Hoy) 

1450 Initial response and getting people away to hospital :: Dr Iain Cromarty

1505 Stabilisation & Treatment in the Rural Hospital :: Dr Kate Dawson (Rural GP, Benbecula)

1520 Transfer & the role of ScotSTAR Retrieval Teams :: Dr Sarah Maclean (Senior Clinical Fellow in Aeromedical Retrieval, EMRS/ScotSTAR)

1535 Discussion & Comments

1600 Refreshments

1620 Legal Highs  – should we be worried? … and other A&E Hot Topics :: Dr Luke Regan (Emergency Physician, Raigmore Hospital)

1700 Rural GP & Humanitarian Work: A Journey to Congo, Pakistan and beyond :: Dr Catherine Sutherland (Rural GP Fellow, Isle of Arran & MSF Volunteer)

1930 Conference Dinner :: Venue TBC

2200 Music Session at The Craigmonie Bar :: Open to all musicians, hummers, spoon-players…


Friday 4th November

0815 Breakfast Mentoring Session 

0900 LGBT Youth in Rural Communities :: Dr Thom O’Neill (Paediatric Clinical Research Fellow, NHS Lothian)

0945 BASICS Scotland Update :: Dr Ben Price (Assistant Clinical Director, BASICS Scotland & GP, Auchterarder)

1000 Sandpiper Trust: We Want to Support You :: Aly Dickson (Founding Trustee, The Sandpiper Trust)

1015 Rural Prehospital Care: Discussion

1025 Remote Island Medicine in Tanzania :: Dr Isla Hislop (Sessional Rural GP)

1045 Refreshments

Parallel Session A:

1100 Finding your Inner Teaching Mojo (Undergraduate Teaching Workshop) :: Dr Jim Finlayson

1145 GP IT Reprovisioning for Rural Practice in Scotland :: Speaker TBC

Parallel Session B: For Students & New Doctors :: Led by Dr Gemma Munro and GP Rural Fellows 2016-17

1100 Workshop: So You Want to Be a Rural GP?  Tips & experiences on what makes it fab

1215 Lunch

1300 The Challenges of Rural Medicine: New Models of Delivery :: Dr Charlie Siderfin (Rural GP, Orkney)

1330 Getting into rural research :: Prof Phil Wilson (Centre for Rural Health, Inverness)

1400 Pecha Kucha Presentations (back by popular demand) – presentations where a maximum of 20 slides auto-advance every 20 seconds, thus being able to keep lots of presentations to time!

Consortium of Longitudinal Integrated Clerkships, Toronto :: Dr Chris Williams (University of Dundee)

Invitational Symposium on Rural Health, Tromso (Norway) :: Dr David Hogg (Rural GP, Isle of Arran)

A Medical Elective on the Isle of Arran :: James McHugh (Glasgow University)

A Medical Elective on South Uist :: Michael Durbar (FY1, Complex Care Medicine, Royal Bolton Hospital, Lancashire)

Selected Medical Student Innovations (TBC)

1445 Refreshments

1500 AGM – all welcome

Including reports and standing items

Update from the Scottish Rural Medicine Collaborative Update (Dr Chris Williams)

University GP Societies – what can we do to support them?

Hot topics & representations

1700 Conference Closing Comments


For details about our student scholarships, please see this page.  Please also note our heavily discounted fees for students and trainees.

To register, please email hello@ruralgp.scot .

Registration Form
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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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New research: rural recruitment & retention

rural-4In January this year, I was contacted by Pauline von Zabeltitz, a final year student at the University of Aberdeen, who was studying for an MA (Hons) in Economics and International Relations.

For her dissertation, she was keen to explore the various projects and initiatives being used to improve recruitment and retention to rural GP practice in Scotland.

Pauline has very kindly agreed to having her dissertation published on RuralGP.com in order to share the analysis that she has undertaken over the last six months.  Her report provides yet more substance behind some of the core issues that we know affects rural recruitment & retention, whilst providing another perspective and some new ideas to add to the present work on this area.

Coming from a family with a strong medical background, healthcare related issues have always been of great interest to me and throughout my degree, I got the chance to explore this topic further through a Health Economics course. Discussing Health Economic issues and policies led me eventually to my final Dissertation topic, writing about the recruitment and retention issues in rural Scotland regarding healthcare providers such as GPs.

Specific issues highlighted include rural connectivity, access to undergraduate placements and the GP Rural Fellowship scheme.  She manages to cover a wide spectrum of other considerations, and some evaluation of present approaches to this problem.

You can download her report by clicking on the button below.

An analysis of current initiatives targeting the recruitment and retention of GPs to remote and rural Scotland [1.4 MB]

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