Archive | Emergency Care

What are green lights all about?

Flashing green lights are rarely seen in cities, but they are part of an important emergency response to rural areas.  In this article we highlight the use of green lights in the provision of prehospital and other health care in Scotland.

Please help us by sharing this article with others who may be visiting rural Scotland this summer.

You’re enjoying the amazing scenery to be found on the North Coast 500 route around northern Scotland.  Behind you, you notice a car with a flashing green light.  What does this mean?…

  1. it’s a funeral director attending a sudden death
  2. it’s a vet attending an emergency
  3. it’s a doctor attending a medical emergency
  4. it’s a fashion statement

The answer is 3.

We’ve written this article as a number of our members have highlighted increasing difficulties getting to emergency calls as other road users can seem unaware of the meaning of green lights.  As we head into another busy summer to welcome tourists and visitors to Scotland’s rural countryside and islands, we thought we might provide some information about the meaning of green lights.

The NC500 (North Coast 500) seems to have particular issues – perhaps as it has experienced a significant increase in the number of people travelling along its roads, who aren’t used to driving in rural/remote Scotland.  Here’s what one of our members recently described…

The NC500 is becoming a significant concern, in particular with groups of cars travelling nose to tail in convoy and not appreciating that they will not all fit into one passing place. This as I’m sure you can imagine causes complete gridlock. Thankfully we have very few emergency calls ourselves but both of us have experienced difficulty getting past slow traffic in recent weeks despite using green lights.

My particular one was a very urgent call to **** (young man, cardiac arrest, we were told, so you can imagine how keen I was to get there safely but as soon as possible). I found myself behind a group of 3 open top sports cars. On open road they were going fast enough for me not to need past but I could see that as soon as we reached a narrow section there would be a problem. Indeed at the first passing place they couldn’t all get in, and ended up with a prolonged negotiation with a large campervan not wanting to reverse.

I had green dashboard lights on and also tooted and flashed my lights, hoping they would stay where they were and let me pass once the campervan was away, but all I got was rude gestures in the air, and they moved off very slowly, continuing in very close convoy. I assume (hope?) that they did not notice the green lights or did not know what they meant but there are other similar tales which I’m afraid make me wonder.

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).

Across Scotland’s rural landscape, the Scottish Ambulance Service rely on over 500 volunteers (probably a lot more) to augment its emergency service.  As well as First Responders (local community members trained up to use a defib, oxygen, administer CPR and deliver vital emergency care to heart attack and other seriously ill patients), there are Sandpiper BASICS doctors, nurses and paramedics who make themselves available – including in their own time – to attend road accidents, cardiac arrests, seizures and lots of other medical emergencies.  Sometimes they will be requested to attend by the ambulance service directly, or they decide to attend a patient after a phone assessment or having been informed by another community member.  We work closely with our local ambulance crews, and national services such as Helimed, the Emergency Medical Retrieval Service and Coastguard helicopters.

Green flashing lights are permitted in law – The Road Vehicles Lighting Regulations 1989 s 11 (2)(m) – to be used as “a warning beacon fitted to a vehicle used by a medical practitioner registered by the General Medical Council (whether with full, provisional or limited registration)”.  They do not permit drivers to be exempt from any road traffic laws, but serve as an important means of making other drivers aware that a doctor is on their way to an emergency call.  In rural areas – where traffic lights, 30mph speed limits and other restrictions are less frequent – it can make a significant difference if a clear passage can be enabled for doctors to attend emergencies as soon as possible.

Lights are usually only used in life-or-limb threatening situations – when time is of the essence.  Rural areas normally experience longer ambulance response times.  This is partly due to longer distances being travelled due to geography.  However many islands in Scotland have only one or two ambulances (which are normally also used for patient transport too) – so if they are unavailable, or if there are multiple casualties at an incident, a local GP, nurse or off-duty paramedic is often asked to assist.

So what should I do?

As with assisting any emergency vehicle with their progress, there is no need for erratic action.  However, it makes a significant difference to pull over safely, and allow a car behind you to get through.  If you see a doctor’s car approaching, plan ahead where possible to ‘create space’ in the road for them to pass other users, and use passing places on single track roads.  Please don’t stop on corners however, as this is a dangerous place to overtake, unless there is a clear view of the road ahead.

If it’s not safe to allow the car to pass, then don’t worry – just wait until the next suitable opportunity to pull over and let the vehicle past.

What about other responders?

The law allows only registered medical practitioners (doctors) to use green lights.  However rural areas rely on lots of voluntary responders – including lifeboat crews, mountain rescue teams and coastguard teams.  Team vehicles are often permitted to use blue lights and sirens.  Some volunteers will make themselves more visible by wearing emergency clothing en route, or by using sun-visor signs that should be visible in your rear-view mirror.

Often, they will be the first responder on scene for some time, particularly if the nearby ambulance is already busy.  Please do what you can to allow these essential services to make good progress through traffic – it could be you or your family who need their assistance the next time!

Where can I learn more?

To learn more about the role of Sandpiper BASICS responders, and of Community First Responders, watch the videos below.  Here are some links to the organisations mentioned above:

Finally, here’s two stories about where a fast local voluntary response made a significant difference…

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BASICS Scotland Adult Tele-education Course Starts 28th August 2017

BASICS Scotland would like to announce the dates for the next Adult Tele-education Course, presented by Karyn Webster. This 10 week course will start on Monday the 28th August and run for 10 weeks with a 2-week break in October.

Tele-education by BASICS Scotland is an online learning resource ideal for remote and rural practitioners eager to reinforce and develop their skills in pre-hospital emergency care. The benefit of Tele-education is that participants can take part without having to leave their home or place of work. The course is delivered entirely over the web, with weekly 1-hour live sessions in a video conferencing format which participants can attend or view the recordings later at a time more convenient for them!

Topics on this course include:

  • Allergy & Anaphylaxis
  • Asthma
  • LVF – Adult Pneumonia
  • Stroke & TIA
  • Chest Pain & Thrombolysis
  • Head Injury
  • ENT Emergencies
  • Wounds
  • Burns & Tetanus
  • Pain Relief
  • Seizures

If you are interested in taking part in this course or would like more information head over to the BASICS Scotland website and complete an application form today!

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European Resuscitation Academy Day

BASICS Scotland are proud to be hosting this year’s ERA Day which will be held at the Carnoustie Golf Hotel on the 8th September 2017 (the day before our conference).

Places are limited for this event and registrations will be opened up to all at the beginning of March. We are offering BASICS Scotland members the opportunity to register first by accepting registrations from them now! We have also reserved accommodation at the hotel if you want to make a weekend of it by attending both the ERA day and our conference.

For more information and to register visit era.basics-scotland.org.uk

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BASICS Scotland Annual Conference & AGM

BASICS Scotland are pleased to announce their annual conference will take place at the Carnoustie Golf Hotel on Saturday the 9th September 2017.

This year’s theme is “It takes a system to save a life” and there are some fantastic speakers and workshops lined up including:

  • Deputy CMO for the Scottish Government and the Keynote Speaker, Dr Gregor Smith
  • National Clinical Advisor Dr David Caesar on Scotland’s Trauma System
  • The Sandpiper Wildcat Team and their “Story So Far”
  • Angela Lewis of Personal Support Aviation on Human Factors and Responder Welfare

…and many more!

To learn more about the speakers and sponsors at this year’s conference, or to book your place now, visit conference.basics-scotland.org.uk

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BASICS Scotland Paediatric Tele-Education Course

basics_logo_new_large_csNews just in from BASICS Scotland about their latest educational offerings…

We are pleased to announce the latest start date for our popular Paediatric Tele-Education Course

Book now for 24th April Start!

This popular course is specifically designed to refresh your knowledge of Paediatric Emergency Medicine

The course covers 9 topics over 9 weeks presented live over internet based video conferencing and recorded for you to watch at your own convenience.

Live sessions will take place on Tuesday evenings 7pm-8pm to allow those with busy schedules during the day to participate.

Topics covered include:

  • Fever and Meningitis
  • Head Injury
  • Seizures
  • Allergy & Anaphylaxis
  • Asthma
  • LRTI
  • Epiglottitis & Croup
  • Gastroenteritis & Dehydration
  • Pain Relief

Can’t make the live sessions?

Don’t worry, each live session is recorded and made available on our E-learning website for you to view in your own time – access to course materials ends 6 weeks after last live session.

Book Now as closing date for registration is Friday 7th April 2017.

What does it cost?

The cost for this course is:

  • £135 for BASICS Scotland members
  • £150 for non-members

To download the information flyers and application form, visit the BASICS Scotland Tele-education page.

To help evaluate the benefits and cost-savings of Tele-education and Remote Skills Training, BASICS Scotland have commissioned a report which can be viewed on the BASICS Scotland website.

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15th March: Next BASICS Scotland Clinical Governance Meeting

basics_logo_new_large_csBASICS Scotland Clinical Governance Meeting

Wednesday 15th March 2017, 7-8.30pm

The BASICS Scotland Clinical Governance Meetings are held quarterly and are provided over internet based video conferencing allowing you to have a face to face meeting with your peers from the comfort of your own home or work place to share and discuss clinical cases that you may have been involved in or are interested in.

Each meeting consists of a selection of cases which are presented by the person involved and is then opened up for discussion giving you the opportunity to learn from others.

The programme for our meeting on 15th March can be downloaded here, and includes a number of general updates about BASICS Scotland work including our new responder debriefing pilot, a national guideline development group for prehospital care, and 2 cases from Highland.

Join us at the next meeting

This is a free benefit to all BASICS Scotland members and counts towards your CPD!

If you haven’t been to one of our meetings before and would like to attend this or future meetings please email or call Craig Stewart at the BASICS Scotland office – cstewart@basics-scotland.org.uk or tel: 01764 663671.

Invites will automatically be sent out to everyone who has previously attended one of our Clinical Governance Meetings.

The programme for this meeting will be distributed in due course and invites will be sent out on the Tuesday before the meeting.

Not sure how it works?

Never attended one of our internet based video conference sessions using Adobe Connect and unsure of how it all works? Contact Craig at the BASICS Scotland office (cstewart@basics-scotland.org.uk or call 01764 663 671 ) and he will be more than happy to help you get set up.

You can also catch up on previous meetings which will give you a good idea of what is involved by logging into the members area of the BASICS Scotland website ( http://basics-scotland.org.uk/members/clinical-governance/recordings/ ).

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BASICS Courses update

News just in from BASICS Scotland about their CPD day and other forthcoming course information…

CPD Day

We are pleased to offer you the opportunity to attend this specially developed course for BASICS Scotland Responders.

The course is a one day event designed for and specific to doctors, nurses and paramedics who are already BASICS Scotland Responders.

Dates available: 17th and 18th May 2017

Venue: Mobile Skills Unit which will be located at Dr Gray’s Hospital, Elgin

This course is limited to 8 delegates per day so make sure to register your interest asap to guarantee a place.

The course content will include:

  • Simulation training with video augmented debriefs
  • Human factors training with an external expert

Cost to attend is now only £50

Full details and programme available by clicking on the download PDF button below.

If you would like to register for this course please do so by sending an email to courses@basics-scotland.org.uk and provide us with your preferred day of attendance.

As the numbers are restricted places will be given on a first come first served basis and a waiting list will be kept in the event of a cancellation.

Download PDF information from BASICS Website

Future Face-to-Face Courses

If you are looking to attend a PHEC Course of PHPLS Course this year please find below the list of courses available for 2017 below.

10th – 12th March ’17

PHPLS

Carnoustie Golf Hotel

24th – 26th March ’17

PHECC

Carnegie Conference Centre, Dunfermline

21st – 23rd April ’17

PHECC

Islesburgh Hotel, Shetland

12th – 14th May ’17

PHECC

Peebles Hydro, Borders

9th – 11th June ’17

PHECC

Skye

22nd – 24th August ’17

PHECC

Clinical Skills Centre, Western Isles

15th – 17th September ’17

PHECC

Newton Hotel, Nairn, Highland

6th – 8th October ’17

TBC

Orkney

20th – 22nd October ’17

2 x IMC Ref

DGRI, Dumfries

10th – 12th November ’17

PHECC

Craigellachie, Grampian

24th – 26th November ’17

PHECC

DoubleTree, Dundee

If you would like to register for any of the above courses please do so by sending an email to courses@basics-scotland.org.uk

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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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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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Retrieval 2017 Conference programme now available

Details are now available for the annual Retrieval conference, hosted by the Emergency Medical Retrieval Service of Scotland.

Once again, there is a broad range of topics covered, and another impressive line-up of local and international speakers.  As well as clinical topics, there are also presentations about working with the media in the prehospital setting, and ‘Looking After the Team’ – being aware of the stressors and pressures placed on responders in the emergency prehospital setting.

Registration is now available and abstracts can also be submitted via the Retrieval 2017 website.

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