Pre-hospital care

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Abstract
Many doctors are attracted to pre-hospital emergency medicine (PHEM) because of the variety of challenges that it presents. With limited time and resources, the doctor is expected to assess and treat a range of medical and traumatic pathologies in patients of any age, without delaying transport to the most appropriate location for definitive care. This must be done in spite of what is usually a suboptimal environment, e.g. in a ditch at the roadside, on a rainy building site, or in a crowded town centre. Recognizing the limitations of what can be achieved on scene is a key skill that must be balanced against the increasing range of lifesaving interventions at the disposal of pre-hospital teams. While PHEM has been practised by a variety of doctors for many years, it has only recently gained General Medical Council (GMC) subspecialty recognition. A formal training programme may now be undertaken by trainees with base specialties of acute medicine, anaesthetics, emergency medicine, and intensive care medicine, leading to a dual certificate of completion of training. The challenging nature of the pre-hospital environment, the high-risk nature of the interventions that can be undertaken, and the lack of availability of immediate assistance on scene mean that PHEM is a service delivered by consultants and senior trainees. Medical students and foundation doctors who may be interested in PHEM training should seek to spend time in the above mentioned acute specialties, as well as looking for opportunities to observe alongside some of the services that operate nationally. The following questions represent a small selection of the range of scenarios that may be faced by a PHEM practitioner on a day-to-day basis.

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