News and Media News Dr. Edward Norris-Cervetto What made you decide to go into PHEMS? In the last 10 years, the NHS has come to accept that outcomes for patients with life changing diseases are better if they are seen and treated as quickly as possible by experienced, senior doctors. As a consequence, there has been a push to deliver Consultant lead care at the front door in hospitals and there has been a marked change in how quickly and aggressively certain diseases are treated: think of how differently we now treat strokes, severe infections or heart attacks (treated the moment patients arrive to hospital) or even a breast lump or suspicious skin mole (assessed by experts within two weeks, often less). I chose a career in Emergency Medicine because I want to deliver great care as early as possible when people are ill - so moving into Prehospital Emergency Medicine (PHEM) was the logical next step, as it allows me to deliver that care even sooner, by taking the skills and experience of the Emergency Department to the patient’s side, so that we can deliver life changing care before the patient even gets to hospital. We now have plasma on board our aircraft, how is that helping patients? The two most common causes of death soon after major trauma are a significant brain injury or catastrophic blood loss. When you see a patient on TV or in hospital receiving a ‘blood transfusion’, they are receiving only the ‘red cells’ found in blood (which carry oxygen, and cause anaemia if low). However, recent evidence and UK guidelines tell us that patients bleeding to death do better if they receive not only red cells but also plasma, as the latter contains vital clotting factors to help stop the bleeding. We are one of the very few air ambulances in the UK that carries both red cells and plasma to deliver to patients before they get to hospital. I can think of a couple of anecdotal cases I have been involved with recently where the patient has been bleeding to death and where being able to give both red cells and plasma has probably helped us keep the patient alive until they reached the Emergency Department and both patients are now alive and well. How do you ensure great team work between Doctors, Pilots & Paramedics? The key is to have small teams that work together on a regular basis, so that you get to know each other well enough that you can work seamlessly as a unit. One of the greatest challenges of working in A&E is that the team looking after patients varies from day-to-day (due to the size of the hospital), meaning you will often be dealing with a critical patient surrounded with colleagues who you have never met before. At TVAA, we have pilots, paramedics and doctors who work regularly (or even exclusively) with the same team, so you quickly get to know each other well. We start every day with a team meeting that is essential for making everyone feel part of the same unit; we undertake regular training together in both clinical scenarios and human factors, and we make sure we also socialise together several times a year, to instill a true sense of team identity and friendship. This all results in us being able to turn up to a scene of utter devastation and work quickly, with purpose and with minimal communication, because we all share a mental model of what needs to happen and how. What do you do in your time away from work to wind down from such an intense job? Different jobs are intense for different reasons. In A&E, the intensity comes from the sheer and exhausting volume of work - a typical night shift would involve seeing 20 - 30 patients, often without a break or sitting down for more than a few minutes at a time. In prehospital medicine, the intensity comes from the sudden drama of the situation: one moment, you are discussing a case with a cup of tea at base, the next you are landing on a motorway, staring at several unconscious people in the back of a car, having to perform some fairly risky and high pressure interventions in full view of dozens of people, and then spending the next hour desperately trying to stop the patient in front of you from dying. The dramatic images, noises and smells mixed with the rush of adrenaline makes for a powerful cocktail that has a high risk of causing post traumatic stress disorder. When I am not at work, I find that exercise (a good gym workout, a good sprint or a good swim), making my daughters laugh at my silly antics and mindfullness training are all essential for achieving a healthy mind that allows you to do it all again the next day. What is your biggest achievement since working on the helicopter? I think the biggest achievement of having regular doctors like myself at TVAA is that we can become involved in spotting and improving all the little things which, added up, lead to incremental but substantial change. People often focus on ‘big change’ when often, the greatest value comes from carrying out lots of ‘little changes’ and instigating a culture of ‘constant improvement’. If I had to pick one achievement I am proud of, it is working with colleagues to reduce the weight of our rucksacks by almost 12kg by removing redundant kit - every time I run across a field or hop over a fence, my back is grateful.