The Prehospital Immediate Care and Trauma (PICT) Team is a
prehospital care
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
team which operates from
Raigmore Hospital emergency department in
Inverness
Inverness (; from the gd, Inbhir Nis , meaning "Mouth of the River Ness"; sco, Innerness) is a city in the Scottish Highlands. It is the administrative centre for The Highland Council and is regarded as the capital of the Highlands. Histori ...
, Scotland. It receives funding from
NHS Highland
NHS Highland is one of the fourteen regions of NHS Scotland. Geographically, it is the largest Health Board, covering an area of from Kintyre in the south-west to Caithness in the north-east, serving a population of 320,000 people. In 2016–1 ...
,
BASICS Scotland and the Scottish Trauma Network. 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
The Scottish Ambulance Service ( gd, Seirbheis Ambaileans na h-Alba) is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health ...
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.
The team was also the winner of the 2022 Highland Heroes awards in the category of
Emergency Services
Emergency services and rescue services are organizations that ensure public safety and health by addressing and resolving different emergencies. Some of these agencies exist solely for addressing certain types of emergencies, while others deal wit ...
.
Remit and workload
![Highland PICT Map](https://upload.wikimedia.org/wikipedia/commons/e/e7/Highland_PICT_Map.jpg)
PICT currently operates 12 hours per day, seven days a week across the
Highlands and
Moray
Moray () gd, Moireibh or ') is one of the 32 local government council areas of Scotland. It lies in the north-east of the country, with a coastline on the Moray Firth, and borders the council areas of Aberdeenshire and Highland.
Between 1975 ...
. They respond to around 150 patients a month, attending a range of 999 calls, but being tasked to the most serious calls (
major trauma
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependin ...
,
cardiac arrests etc).
For comparison, MEDIC 1 in Edinburgh attended around 3 patients a month in the decade between 1980 and 1990, the Tayside Trauma Team (TTT) attends to 5.6 patients a month, each of the
EMRS teams attend 12 primary retrievals a month, while an individual
BASICS Scotland volunteer responder may attend 2-3 calls a month.
† NHS Funded
* Charity Funded
The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network) 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, shootings and critically unwell patients.
Enhanced Medical Care
In addition to providing senior decision making support, the PICT Team provide a number of clinical interventions which currently lie outwith the standard remit of a
Scottish Ambulance Service
The Scottish Ambulance Service ( gd, Seirbheis Ambaileans na h-Alba) is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health ...
paramedic, such as;
The administration of:
* ketamine, levobupivicaine (and
intralipid if required), adenosine, magnesium sulfate, fentanyl or diamorphine.
Undertaking:
* Diagnostic and procedural ultrasound, wound closure, joint reduction, regional anaesthesia, sedation, pacing, cardioversion, thoracostomy (and drain insertion), mechanical CPR device deployment, amputation or surgical airway.
Personnel
Doctors
The PICT doctors include
consultants
A consultant (from la, consultare "to deliberate") is a professional (also known as ''expert'', ''specialist'', see variations of meaning below) who provides advice and other purposeful activities in an area of specialization.
Consulting servic ...
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 doctor on the PICT Care will assume the role of the medical incident officer when required at a
major incident
Emergency management or disaster management is the managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters. Emergency management, despite its name, does not actuall ...
. The clinical lead is Dr Luke Regan. Regan is a consultant in emergency medicine and holds the diploma in retrieval and transfer medicine.
![Response Car used by the PICT team](https://upload.wikimedia.org/wikipedia/commons/4/42/Response_Car_used_by_the_PICT_team.jpg)
Advanced practitioners
The advanced practitioners in pre-hospital care of the PICT Team are a cohort of clinicians from a
paramedic
A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are p ...
or nursing parent specialty who are currently in training with PICT and in the emergency department at
Raigmore Hospital 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 all undertake a master's degree to fulfil this role. Once fully trained, they utilise critical care clinical competencies, and a number of primary care competencies to allow safe management of patients in the community or en route to hospital.
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. This led to the local
MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding.
Mountain stated that
"This pioneering service is essential when responding to major trauma incidents across the Highlands we simply cannot afford to lose it."
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 th
College of Remote and Offshore Medicineand invited to join their Council of Members for his work relating to the provision of trauma care across the Highlands of Scotland.
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.
See also
*
Emergency Medical Retrieval Service
The Emergency Medical Retrieval Service (EMRS) provides aeromedical
Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident ...
*
Emergency medical services in the United Kingdom
Emergency medical services in the United Kingdom provide emergency care to people with acute illness or injury and are predominantly provided free at the point of use by the four National Health Services (NHS) of England, Scotland, Wales, an ...
*
Air ambulances in the United Kingdom
Air ambulance services in the United Kingdom provide emergency medical functions, patient transport between specialist centres, or medical repatriation. Services are provided by a mixture of organisations, operating either helicopters or fixed ...
References
External links
*{{Official website, https://highlandpict.wordpress.com
__FORCETOC__
NHS Scotland
Scottish Government
Emergency services