Introduction
Kings College London (KCL) Emergency Medicine and Surgical Societies presented the 2013 National Undergraduate Trauma Conference at KCL on the 23rd / 24th February to more than 120 delegates. The conference was opened by the keynote speaker Professor Karim Brohi, Professor of Trauma Sciences at Bart’s and the London School of Medicine, followed by Dr Malcolm Tunnicliff and Mr Duncan Bew speaking about trauma and resuscitation. The remainder of the two days was a combination of talks from many renowned speakers and practical workshops on tasks such as suturing, haemorrhage control and trauma team management. Twelve delegates were selected to present their research in a poster competition, judged by the invited speakers and the presidents of the two KCL societies. The three winning abstracts are presented below. The overall winner was Miss Jennifer Anderson from St George’s Medical School, London.
The perceived need for Helicopter Emergency Medical Service at night – a prospective study
J Anderson, A Hudson, R Lyon and R De Coverly
St George’s Medical School, University of London
Introduction: Established in 1989, Kent, Surrey and Sussex (KSS) Air Ambulance Trust provide Helicopter Emergency Medical Service (HEMS) to the South East England area. KSS HEMS currently operate from two bases, during daylight hours only; between 0730-1900 hours. For the first time, this project aims to evaluate and quantify the need for a night HEMS service in KSS. Major traumas, especially road traffic collisions, often occur at night and therefore the requirement for night HEMS provision needs to be established. Currently, of the 18 air ambulance charities operating in England and Wales, only one provides a night time service with a single paramedic.
Methods: The study was a prospective case series over a 2-month period (2/7/2012-2/9/2012). During night hours (1900-0730) HEMS paramedics were asked to identify potentially suitable HEMS missions and perform a simulated dispatch by allocating a dummy call sign “HEMSAUDIT’. All HEMSAUDIT cases were reviewed.
Results: There were a total of 73 HEMSAUDIT incidents, involving 89 patients. The call origin timings were distributed throughout the night hours and the incident call categories were varied. Of 89 patients, 32 were transported to a Major Trauma Centre (MTC).
Discussion: 73 incidents in two months represents an average of just over 1 activation a night and the incident timings show a requirement of HEMS throughout the night. The results also illustrate a significant amount of serious incident call categories which would warrant HEMS activation. The high number of patients transported to a MTC suggests that HEMS involvement would enhance care of the most critically injured. Two limitations were: the study period was restricted to two months; and the decision for assignment of HEMSAUDIT and incident call category was subject to personal judgement.
Conclusion: This study suggests a potential saving of lives and further research is required to evaluate the impact of night HEMS on patient outcome.
Major incident awareness among junior doctors at Epsom and St Helier’s Hospitals
C Velho and S Kumar
St George’s, University of London and Emergency Medicine Department, St Helier’s Hospital.
Introduction: A major incident is any widespread, overwhelming event that causes multiple casualties and involves numerous emergency services, the NHS and a local authority. Each NHS Trust has to show evidence of emergency preparedness under the Civil Contingencies Act 2004 and have a Major Incident Contingency Plan. Junior doctors have specific “action cards” that must be adhered to during a declared incident in order to respond in an adequate and prompt manner. Inadequate protocol adherence by staff can lead to mediocre quality of care and poor prognosis. As it is important for health protection an investigation was carried out to explore the knowledge and understanding of Junior Doctors regarding their roles and responsibilities during a declared Major Incident.
Methods: An online and paper research questionnaire analysed awareness of 75 Foundation Year One and Two doctors at Epsom and St Helier’s Hospitals. The data was collated and presented as pie charts to analyse preparedness and awareness.
Results: Over 2/3 of junior doctors did not know where to report, with 94.5% unaware of the location of the Major Incident Control Centre and 70.9% unaware of how to prioritise major incident casualties. Only 29.1% of junior doctors believed that their hospital was adequately prepared for a major event, with only 30.9% having prior training. 72.7% of doctors identified a need for mandatory training and teaching sessions to improve their knowledge.
Conclusions: Overall, the results depicted that the majority of junior doctors were underprepared, with poor Major Incident Awareness.
Evaluation of an eye emergency referral pathway in a London trauma centre
R Annoh, G Fleming and E J Hollick
Kings College Medical School
Introduction: There is no national guidance on establishing an appropriate eye emergency patient pathway from accident and emergency (A&E) to the emergency ophthalmology department. We reviewed the eye referral pathway from A&E to ophthalmology at a London trauma centre, to identify any negative patient experiences and/or problems with the service. Changes to the pathway were then introduced and the service was re-assessed for evidence of reduced negative patient outcomes and improvement in quality of the service.
Methods: We analysed 470 eye emergency admissions into A&E during a 3 week-study period before and after revision of the pathway. Data was collected in A&E using EDM online and Symphony software, looking at patient presentation to A&E, the consultation outcome, any follow-up given and negative patient outcomes documented. Subsequently, A&E and ophthalmology clinicians modified the existing pathway using clinical expertise and local guidelines.
Results: A total of 185 cases were evaluated before changes to the pathway and 165 cases after. The total number of patients successfully referred for specialist ophthalmic review rose from 23.7 to 52.7% (p = 0.06). 5.5% of patients were still reviewed by A&E clinicians despite having ophthalmology referral letters (p = 0.49). Poor patient outcomes were still evident with difficulties contacting ophthalmology doctors rising from (3/20 vs. 5/15). Use of the referral decision guidance tool is sub-optimal with only 33% of chemical injury and 42.9% of retinal detachment emergencies being referred for urgent review.
Conclusion: We found an overall improvement in the eye emergency referral service. Yet communication between A&E and on-call ophthalmologists is still an on-going problem. Use of the referral decision guidance tool is also sub-optimal. New measures taken to improve communication between both clinical teams and an assessment of the quality of referrals will aid a more developed and efficient service to provide optimum patient care.
