NHS Emergency Fail Tale

Have you ever been to emergency because you can’t get off a fake nail? Taken your poorly pet to emergency instead of the vet? the next Emergency Musical Interlude comes form the NHS…

It might sound far-fetched but the star of this video, Dee, sings about some real-life examples of emergency department misuse. She is advised by our singing physician on the best times to use emergency and about the alternative services to utilise when things aren’t as emergent…


  • Concept and Creative: NHS Arden Commissioning Support
  • Lyrics by Aaron Ashmore, (NHS Arden Commissioning Support), James Cannock (One Nation Studios) and Edi Johnston
  • Design: Vashti Purvey (NHS Arden Commissioning Support)
  • Animation by Ignite Creative Ltd
  • Vocals: Edi Johnston
  • Music produced by: One Nation Studios

LITFL musings and meanderings

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Rational Approach to the Traumatic Arrest

Clinical EM Bottom Line:

  • Check pulses upon patient arrival. No pulses = Step 1.
  • Fundamental: Only perform actions that will affect patient survival

1. Airway - Control the airway.

  • Pre-hospital intubation = Move to Step 2.
  • No airway = Intubate or Supraglottic device > Move to Step 2.

2. Breathing – Bilateral Finger Thoracostomies

  • Tension Pneumothorax is one of the few reversible causes of traumatic arrest.
  • If no improvement = Move to Step 3.

3. Circulation – Bedside Echo

  • Cardiac Standstill = Futile Resuscitation
  • Cardiac Tamponade = ED Thoracotomy or Pericardiocentesis (less successful)
  • Cardiac Activity = Hemorrhagic Shock > Give blood products (ie. Massive Transfusion Protocol)

4. Identify Sources of Bleeding

  • Scalp Lacerations or Extremity Bleeding
  • Blood with Finger Thoracostomy = Bleeding in Chest
  • Positive FAST = Bleeding in Abdomen
  • Pelvic Instability = Bleeding in Retroperitoneum


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Patient safety in helicopter emergency medical services (HEMS): The safety management system

Originally posted on Auckland HEMS:

“Insanity: doing the same thing over and over and expecting different results”. Albert Einstein.

You could be right in thinking that “safety crusaders” are the glass half empty type, right? Those that believe “what can go wrong, will go wrong” (Murphys Law).

I’m not a pessimist, but I do believe in being prepared for the potential for error, or for when things do genuinely go wrong.  We need to avoid Einstein’s insanity; repeating that same thing and expecting different results the next time (as the next time might be a catastrophic outcome).  As HEMS clinicians we have a responsibility to get our patients from the pre-hospital to the hospital environment without harm, to the best of our abilities.  A culture of safety and forethought, identifying and mitigating for potential hazards (threat and error management) is a prominent facet of our work.

Both Aviation and medicine involve…

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Filed under: Aeromedical retrieval, FOAMEd, Prehospital medicine Tagged: HEMS, patient, safety

A Military Aviation model for Patient Safety?

Originally posted on Auckland HEMS:

In the September 2013 edition of the British Medical Journal, Robyn Clay-Williams has published a thought provoking article on the modelling of clinical risk management on civil aviation practices, and questions whether a military aviation model may be more prudent when assessing and managing risk in the healthcare environment.  The abstract can be found HERE.

The author questions the appropriateness of translating sometimes rigid civil aviation processes (and a zero tolerance for risk) into healthcare, as some healthcare systems (such as emergency departments and intensive care units) need more flexibility and autonomy in their workings and risk management. She suggests managing risk in high stakes clinical environments such as these would be more conducive to a military aviation model – the parallels being teams with limited resources who deal routinely with unpredictable situations, complex and time critical operations (as would happen frequently in the pre-hospital environment or the ED…

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Filed under: Aeromedical retrieval, FOAMEd, Prehospital medicine Tagged: aviation, military, patient, safety

Canadian Air Ambulance – a 2014 overview

HI folks

ON my twitter feed today I spotted a post by


She is a Canadian flight nurse in Halifax, Nova Scotia. She linked a good overview article of Canadian Air Ambulance and recent suspension issues related to patient safety concerns. Well worth a read so thanks to her!

Here is the news article

High risks, high rewards: why was STARS service suspended?

Filed under: Aeromedical retrieval, FOAMEd, Prehospital medicine Tagged: air, ambulance, Canadian