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Support for 'world class' Pre-hospital Immediate Care and Trauma (PICT) service in frame as MSP Edward Mountain calls for NHS Highland backing

By Scott Maclennan

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Members of the PICT team at a training exercise.
Members of the PICT team at a training exercise.

A “WORLD-CLASS” trauma service providing often life-saving care is facing a significant reduction in the support it can provide after NHS Highland refused to grant it extra funding.

Since 2016 the Pre-hospital Immediate Care and Trauma (PICT) service has provided specialised care through small teams (pictured) usually including a doctor, nurse practitioner and specialist paramedic.

Initially operating four days a week this increased to seven days around 18 months ago, funded largely by the Scottish Trauma Network (STN), a government-sponsored initiative to deliver the best possible care for casualties at risk of losing their life or who need urgent and advanced care.

It is understood the Scottish Ambulance Service and NHS Highland currently provide smaller shares of funding to the service, but a business case put to the health board for it to provide full funding in August last year was turned down.

An agreement for STN to continue funding a seven-days-a-week response is due to run out in March, after which the service could revert to just four days.

Supporters of the scheme say they are baffled by NHS Highland’s decision as the figures, they believe, speak for themselves. The service is estimated to save the health board 2496 bed days annually by avoiding 312 admissions to hospital over a 12-month period.

It also takes pressure off the ambulance service and is able to place patients directly into wards, avoiding the need for initial A&E assessment, a service currently missing waiting-time targets.

Taken together, the service is estimated to save the health board up to £1.3 million a year.

One PICT team member said: “We have dealt with everything from sick kids, life-threatening bleeding pregnancies, post-delivery bleeds, medical cases – severe asthma, heart attacks, cardiac arrests, strokes, seizures; surgical cases including ruptured aneurysms, severe abdominal pain, falls with fractures; major trauma in the form of falls, car crashes, and crush injuries.

“Lives have been saved; effects of the problems have been treated and severity minimised thus shortening recovery times and saving in-patient days; ill people needing help but not requiring admission have been treated, safety-netted and left at home, or diverted to other services; colleagues have been supported and given the benefit of years of medical training to help in their own professional development.

“We had one case not so long ago when a workman was crushed in a tunnel – his chest was basically separated from the rest of his body right down his spine and he was struggling to breathe.

“We put him in the helicopter to Raigmore, they got him stabilised and eventually he was operated on in Edinburgh, but he would certainly have died on scene if it hadn’t been for the care we were able to give him.”

Phil Wilson, Professor of primary care and rural health at Aberdeen University, and a GP for more than 34 years described it as “world-class” having seen it in action.

Speaking about a woman he knows who was in extreme pain due to a hip dislocation, Prof Wilson said: “I can’t imagine how anyone could possibly have got better treatment than she did.

“They were amazing. The pain was described as worse than childbirth, clearly she was in absolute agony but the whole thing was over and done with within two hours – and that is world-class treatment.”

Regional Conservative MSP Edward Mountain also gave the team his backing.

“The PICT team has saved lives and provided emergency care time after time,” he said.

“I therefore question why NHS Highland appear to have taken this funding decision and I have written to the chief executive setting out my concerns and requesting that the health board reconsiders its position.

“This is a service that should be available for the full week, not just weekends.”

A spokesman for NHS Highland said: “The PICT team is a valued part of NHS Highland’s acute care provision.

“Plans for the delivery of acute care across NHS Highland are under continual review, and pre-hospital care is an important aspect of this. In line with the rest of Scotland, NHS Highland is conducting a review of urgent care delivery, including the funding for the PICT team and all other urgent care services.

“We are committed to developing emergency medicine services in collaboration with our colleagues in the Scottish Ambulance Service and other regional and national emergency services, to ensure we continue to provide the best possible care for the people of the Highlands.”

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