Personal insight into Pre-Hospital Emergency Medicine Crew Course
Multiflight is proud to manage, crew and maintain the helicopters for the Great North Air Ambulance Service, as well as to play an instrumental part in the delivery of the Pre-Hospital Emergency Medicine Crew Course (PHEMCC) provided by the Ambulance Service.
An article in AirMed&Rescue covers this course, giving a review from both a paramedic’s and doctor’s perspective. The article discusses a paramedic’s experience undertaking the course as well as the content, structure and delivery of each module. It concludes with a doctor’s and a paramedic’s overview.
The course consists of three one-week modules and is aimed at paramedics and doctors wishing to enhance their advanced pre-hospital care skills. The course was derived from the original Helicopter Crew Course (HCC) that GNAAS had provided to new operational staff since 2004. With the changes to training in pre-hospital emergency medicine, however, the course has evolved and adapted to provide opportunities for non-GNAAS applicants from across the UK. The course organisers intentionally aim for a 50:50 doctor/paramedic candidate ratio, meaning that the training and assessment scenarios ensure a similar skill mix to a normal operational crew.
The paramedic writing the main article comments: “Personally, I thought this approach proved invaluable, as course candidates were able to bounce ideas and experience off each other – often doctors bringing hospital-based knowledge (for instance, how to give a general anaesthetic), and the paramedics having a greater amount of experience with primary management of injury and working in the pre-hospital environment.”
They write: “Before arriving on the PHEMCC, I had very little knowledge of what the course entailed. My preconceived ideas of the course content differed quite significantly from the actual programme. I expected that the main focus would be on providing critical care interventions and studying the evidence base behind them. Although practical training was indeed a key part of the course (particularly performing pre-hospital anaesthesia, thoracostomies, thoracotomies etc.), it was the emphasis on the non-technical aspects like crew resource management (CRM), communication skills, working in close partnership with a senior doctor and developing the interface with other emergency services that surprised me most.
“A doctor/paramedic team working together in pre-hospital emergency medicine brings a unique skill mix to a critically injured patient at the scene. There is increasing evidence to suggest that advanced interventions including pre-hospital anaesthesia, blood component therapy and advanced procedural skills, such as thoracotomy, bring an increased survival benefit to the sickest of patients at the roadside (Chesters et al, 2013 & AAGBI, 2009).”
Co-ordinated by Multiflight
On Module 1 – airmanship and aviation module, they write: “The crew course commenced with a week of aviation teaching and assessments. Co-ordinated by Multiflight at Leeds Bradford Airport, the week began with two days of ground training. This covered the legal principles and framework for HEMS operations, crew competencies and familiarity with various aircraft types. This phase was followed by basic air navigation skills, meteorology and flight mechanics.
“Upon successful completion of an exam covering the theoretical knowledge, the course took to the sky for practical navigation training. Each candidate took the front left-hand seat on a 60 to 90-minute flight around Yorkshire. Elements of this flight included planning routes, coping with last-minute diversions, and gaining familiarity with using various paper and electronic navigation aids.
“After completing the flying phase of week 1, CRM, arguably one of the most important subjects, was taught in some detail. CRM is a relatively new concept in the pre-hospital world, but has been used in aviation for years. This approach identifies the importance of strong leadership while encouraging individual team members to speak up in order to share critical information (LeSage et al, 2010). This culture is deeply embedded in modern day flight safety, but prior to this course I was unaware of it. However, this concept is now starting to filter into the medical profession to improve patient care and safety (Crosskerry & Cosby, 2009). Candidates’ use of CRM then underpins the training and assessment serials for the remainder of the entire PHEMCC.
“This first module finished on a high note with aircrew underwater escape training. This involved being strapped into a simulated helicopter rig, being submerged in a cold swimming pool and flipped upside down. This was a pass or fail drill, and you had to be able to remain calm and follow the procedure to escape. This was done four times simulating various different scenarios, each one more difficult than the last. Following successful escape, the use of a life raft, life jackets and winching was practised, concluding the week.”
“All aspects of the course were excellent”
The Doctor comments: “As a Royal Navy doctor with over 10 years’ experience in various environments worldwide, this course really did add so much to my knowledge base. All aspects of the course were excellent from start to finish. With the credibility of the instructors so high, it really was possible to learn so much from all of them.
“It wasn’t just the knowledge and technical skills that you gain from this course, but I think the key aspects are the CRM and interagency awareness that run as the backbone to the course. The course enables candidates from both doctor and paramedic backgrounds to work closely together and learn a great deal from each other. The size of the course (maximum eight to 12 participants) means everyone can get to know each other and then hopefully work operationally together on various PHEM systems.
“I would recommend this course to anyone with even a passing interest in pre-hospital care, as the confidence you gain from having to push yourself cannot be underestimated.”
The paramedic says: “As a paramedic with 10 years’ experience, ranging from double manned ambulance crew and rapid response to a being member of the HART, I have completed a number of different training courses all of which have been invaluable in developing my practice. The PHEM Crew Course is both the most challenging and also the most rewarding one. It is important to have a good base knowledge, in particular with regards to PHA. Having already completed a PHA course, I found I could concentrate on the other aspects of this course.
“The lectures were all given by professionals with extensive knowledge in their area of expertise including GNAAS, police, fire and rescue and the NHS ambulance service; this all added to the credibility of the course. Their enthusiasm and commitment to each of their specialties in the lectures made it very easy to listen to and learn from. There were a number of lectures, but the majority of the course was practical, being continuously assessed over the course of the three weeks. Using the County Durham and Darlington fire training facility allowed the scenarios to take place in actual pre-hospital environments. This included night exercises and a number of RTC scenarios working with other emergency services – this in turn providing a realism that I had not encountered on a training course before.
“The opportunities to learn and improve as a paramedic were fantastic, and I would recommend this course to all pre-hospital practitioners whether planning to work on a HEMS unit or not. The knowledge, skills and confidence taken from completing such a well organised course is invaluable.”
Read the full article here: https://www.airmedandrescue.com/features/inside-PHEMCC-gnaas
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