Tuesday 21 November 2017
A rare but successful life-saving medical procedure performed at the scene of a challenging incident has seen EMRTS Cymru medics, who work on board the Wales Air Ambulance Charity helicopters, received a national award.
The team were presented with the Special Incident Award at the national Air Ambulance Awards of Excellence in London. They were Dr Tim Rogerson, Dr Mark Knights, Dr Matt O’Meara, Critical Care Practitioners (CCPs) Rhyan Curtin, Kate Owen and Chris Connor, along with pilots Andy Iceton and Ray Weatherall and Air Support Desk dispatcher Lynda Sage.
The prestigious awards, which are organised by the Air Ambulance Association, are independently judged and recognise outstanding work carried out by air ambulance crews.
Details of the case will remain undisclosed at this stage, however, below is an overview of the medical interventions carried out.
The patient had suffered a significant blunt trauma in rural Wales. Using ultrasound, Dr Tim Rogerson and CCP Ryan Curtin were able to identify an evolving cardiac tamponade. This required a resuscitative thoracotomy. They made a wide incision extending across the chest and opened completely the thoracic cavity. The pericardium was opened and the blood and clots were removed. The heart started to beat but blood continued to leak from the back of the heart. On lifting the heart the team found a small bleeding point to which they were able to apply a small clamp – this stopped the bleeding.
This is a rare, if not first ever, successful pre-hospital thoracotomy for blunt traumatic cardiac arrest due to left atrial appendage rupture.
The treatment also included the administering of anaesthesia and a rapid sequence induction (RSI). In addition, the medics carried out a blood transfusion using warmed blood and clotting products.
During the treatment, a second EMRTS Cymru team arrived, including Dr Mark Knights, CCP Kate Owen. They had been tasked by the Air Support Desk to provide additional blood products.
The patient was airlifted in a Wales Air Ambulance Charity helicopter to the appropriate cardiothoracic centre, a flight that that took 23 minutes. The road journey would have been at least 90 minutes.
On arrival, the patient was quickly transferred to theatre and the cardiothoracic surgeons were able to repair a small laceration to the left atrial appendage. The patient was transferred to critical care and despite a stormy course, is now alert and making a good recovery at home.
The successful outcome was the result of a multi-agency effort. Also involved in the case were:
Jodie Wakelin (Welsh Ambulance Service)
Ken Williams (Welsh Ambulance Service)
Nick Richards-Ozzati (Welsh Ambulance Service)
Danny Hollinger (Welsh Ambulance Service)
Andy Duffield (Welsh Ambulance Service)
Professor Ulrich Von Oppell (Consultant Cardiac Surgeon)
Theodore Efstratiades and the cardiothoracic team at the receiving hospital.
Dr Tim Rogerson said: “This incident showed the full benefit of what our service can offer patients across Wales. We offered leading-edge care with blood products, ultrasound, complex surgical procedures and the ability to deliver a second team and then transfer the patient directly to the cardiothoracic centre. The scene was hugely challenging and stretched our skills and knowledge, we relied heavily on our intense training, regular simulation and tight clinical governance to help us deliver this level of care. It was a fantastic team response that I am very proud to have played a part in.
“The team and I couldn’t be happier that that patient continues to make a great recovery. Despite our varied interventions, the expertise of the Welsh Ambulance Service call handler and crews, and the skill of colleagues at the receiving hospital, I still feel it airs on the miraculous as far as the final outcome.
“It was a real honour to be nominated and shortlisted for this award against stiff competition from excellent HEMS services across the UK. As a team, we were delighted and humbled to win the award.”
EMRTS Cymru is a unique partnership between the Wales Air Ambulance Charity, NHS Wales and Welsh Government. Through the generosity of the Welsh public, the Charity is able to raise the 6.5 million needed to run the helicopter operation. The NHS Wales medics who work with the Charity are funded by Welsh Government.