Highland PICT Team

The Prehospital Immediate Care and Trauma (PICT) Team is a prehospital care team which operates from Raigmore Hospital emergency department in Inverness, Scotland. It receives funding from NHS Highland, BASICS Scotland and the Scottish Trauma Network.[1][2] They are a stand-alone enhanced care team responding to trauma and other critical care incidents in Inverness and the Northwest Highlands, utilising a rapid response car. PICT comprises either a senior doctor from Raigmore Hospital or a local GP, together with a Scottish Ambulance Service advanced rural practitioner. In light of the sparsely distributed ambulance resources in the Highlands and the challenges of distance and weather in the north west of Scotland, PICT has a considerable remit beyond trauma. PICT provides support to ambulance crews and community responders in medical emergencies, and also provides a “see and treat” service to patients in order to prevent transport and possible hospital admission for problems manageable at home. In this way PICT acts as a senior decision maker for prehospital clinicians across the North of Scotland.

Highland PICT Team
HeadquartersRaigmore Hospital Emergency Department, Inverness
Region servedHighland and Moray

The team was also the winner of the 2022 Highland Heroes awards in the category of Emergency Services.[3]

Remit and workload
Response car used by PICT Team

PICT currently operates 12 hours per day, seven days a week.[4][5] They respond to around 150 patients a month, attending a range of 999 calls.[6] For comparison, the Tayside Trauma Team attends to 9 patients a month,[7] each of the EMRS teams attend 12 primary retrievals a month,[8] while an individual BASICS Scotland volunteer responder may attend 2-3 calls a month.[9]

Tabulated prehospital workload by resource
Trauma Resource Prehospital patients seen each month Notes
PICT 150 Data from January 2022
EMRS Team 12 Data from 2015–2015
TTT 9 Data from January 2014
BASICS Scotland Volunteer 2-3 Responder covering two islands in the Outer Hebrides

The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network)[10] and critically unwell patients in the Highlands of Scotland. The doctor on the PICT Care will also assume the role of the medical incident officer when required at a major incident. They work to standard operating procedures, and national clinical guidelines for best practice. The team currently responds in a Scottish Ambulance Service vehicle. When audited, it was found that the PICT Team were able to discharge on scene 22% of the cases they attended; 17% of their patients were paediatrics, and 39% were traumatic injuries. The PICT Team have attended a variety of incidents, including aircraft crashes, road traffic collisions, stabbings and critically unwell patients.[6]

Personnel

Doctors

The PICT doctors include consultants in the critical care aligned specialties of emergency medicine, intensive care medicine, acute medicine and anaesthesia. In addition to this there are consultants in obstetrics and gynaecology and speciality doctors from anaesthesia and intensive care. There are also a number of GPs with further training in prehospital emergency medicine who work as rural practitioners, emergency practitioners or rural GPs across the Highlands and Islands.

The current clinical lead is Luke Regan, who is a consultant in emergency medicine and holds the diploma in retrieval and transfer medicine.[11] The doctor on the PICT Care will also assume the role of the medical incident officer when required at a major incident.[12]

Advanced practitioners

The advanced practitioners in pre-hospital care of the PICT Team are a cohort of clinicians from a paramedic or nursing parent specialty who are currently in training with PICT and in the emergency department at Raigmore Hospital[13] This is a new advanced practice role introduced with funding from the Scottish Trauma Network and represents a collaboration between PICT, NHS Highland and the Scottish Ambulance Service. The role of the advanced rural practitioner is designed to support PICT doctors in managing trauma and medical emergencies, including undertaking the blue light (emergency) driving to attend these calls. The advanced practitioners are all completing a master's degree to fulfil this role. Once fully trained, they will utilise critical care clinical competencies,[14] and a number of primary care competencies to allow safe management of patients in the community.

PICT funding crisis

NHS Highland announced in early 2022 that they would defund the Inverness PICT Team, in steps which will leave the Highlands and Inverness without a seven-day physician-led enhanced care service.[15][16] This led to the local MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding.[17]

Mountain stated that "This pioneering service is essential when responding to major trauma incidents across the Highlands – we simply cannot afford to lose it."[17]

Awards

Medic of the Year 2021

In early 2022, Dr Luke Regan, the PICT Team clinical lead was awarded "Medic of the Year 2021" by the College of Remote and Offshore Medicine and invited to join their Council of Members for his work relating to the provision of trauma care across the Highlands of Scotland.[18]

Highland Heroes 2022

In March 2022, the PICT Team was awarded Highland Hero Emergency Services Hero of the Year for their life-saving work across the Scottish highlands.[19][20]

See also

References
  1. "North of Scotland Trauma" (PDF). 2018.
  2. "2019 BASICS Scotland Annual Report" (PDF).
  3. "Highland Heroes - Nominate now". HN Media. Retrieved 2 March 2022.
  4. Maclennan, Scott (20 January 2022). "'World-class' Highland trauma team must get health board support, says MSP". RossShire Journal. Retrieved 25 January 2022.
  5. Maclennan, Scott (20 January 2022). "NHS Highland's refusal to fund a 'world class' lifesaving trauma team sparks questions". Inverness Courier. Retrieved 25 January 2022.
  6. "Highland PICT". Twitter. 22 February 2022. Retrieved 2 March 2022.
  7. Maddock, A.; Donald, M. (February 2014). "Caseload of a land-based trauma team". Scottish Medical Journal. 59 (1): 45–49. doi:10.1177/0036933013518151. ISSN 0036-9330. PMID 24413928.
  8. Scottish Specialist Transport And Retrieval Annual Report 2015-16 (PDF). Scottish ambulance service.
  9. Mallinson, Tom (28 June 2021). "A year as a prehospital physician in the Outer Hebrides, Scotland". www.rrh.org.au. Retrieved 16 April 2022.
  10. "STN Minimum Requirements for Pre-Hospital Care" (PDF). 2017.
  11. "Dr Luke Regan". Retrieved 27 March 2022.
  12. Scottish Trauma Network / NHS Scotland. "Scottish Trauma Network Report to Scottish Parliament Health and Sport Committee" (PDF). Archived (PDF) from the original on 20 April 2021.
  13. NoS, Trauma Network (27 October 2021). "PICT Team Tweet".
  14. "TOWARDS 2020: TAKING CARE TO THE PATIENT AND QUALITY IMPROVEMENT" (PDF). Scottish Ambulance Service. 29 January 2020.
  15. "'World-class' Highland trauma team must get health board support, says MSP". RossShire Journal. 20 January 2022. Retrieved 23 January 2022.
  16. "Supporters of a 'world class' lifesaving life-saving trauma team demand a rethink". Inverness Courier. 21 January 2022. Retrieved 23 January 2022.
  17. Maclennan, Scott (18 February 2022). "Highland MSP Edward Mountain calls for medical trauma response team to be saved". Inverness Courier.
  18. "Big award for Raigmore medic". Inverness Courier. 30 March 2022. Retrieved 30 March 2022.
  19. "Highland Heroes from across the region are crowned". Inverness Courier. 24 March 2022. Retrieved 25 March 2022.
  20. "Emergency response team delighted with 'wonderful' award". Strathspey Herald. 25 March 2022. Retrieved 25 March 2022.
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