Robin Mitchell Medic 1 Fellowship 2014

Edinburgh EM and the Medic One Trust are delighted to announce that the 2014 Robin Mitchell Medic One Fellowship has been awarded to 2 excellent applicants.

Dr Stephanie Mackie and Dr Zoe Smeed both produced outstanding proposals and were able to convince the panel that they were both sufficiently "pushing the boundaries", as our dear friend and colleague Robin would have done, to be awarded support for their planned trips.

Below are excerpts from their applications:

Steph Mackie


One of the major challenges facing Scotland's Health Service in the 21st century is
providing cost-effective high-quality emergency care for a population which, outside
the major cities, is largely rural and often separated from the Central Belt by long
journeys across sea, mountains and isolated areas.

Since starting my Emergency Medicine training at Glasgow's Southern General
Hospital, I have seen at close hand the value to rural populations of support from
specialists in high-volume, high acuity care in urban areas, such as that offered by
the Emergency Medical Retrieval Service. I am keen to learn more about how
Emergency Physicians in urban centres can provide both remote and direct handson
support to isolated practitioners and patients to improve patient outcomes and
maintain high clinical standards in emergency care within the constraints of difficult

Although within the UK these obstacles to high quality emergency care are confined
to Scotland, innovative approaches to emergency care for remote populations have
been pioneered elsewhere. Iceland is a nation of around 320,000 people in over
100,000km2. Outside the capital, Reykjavik, it has lower population density, more
and higher mountains, more exposed coastline, and colder and wetter weather than

To meet these challenges, clinicians at Reykjavik's Landspitali University Hospital
Emergency Department have taken the lead in establishing Emergency Medicine as
a specialty and ensuring access to it for as many patients as possible. As well as
paramedic- and EMT-crewed land ambulances, Iceland has a very extensive
voluntary Search and Rescue Service which provides both general and specialist
crews for rescue and retrieval of casualties on land and at sea. Additionally, the
attending physicians in the department provide 24/7 telephone support to isolated
clinicians and fishing vessels up to 250 miles offshore. Transfers of critically injured
or ill patients to Landspitali can be undertaken by fixed wing or Coastguard rotary
wing aircraft.

The department's attending clinicians have been trained in the US, UK, Sweden,
Australia and New Zealand and aim to bring together the best elements of practice in
each of these countries.

I hope to spend 4 weeks in Reykjavik in June to July 2014 developing my knowledge
and skills in delivering first-class emergency care to patients who cannot easily reach
hospital. I would be honoured to have the chance to do this with the assistance of
the Robin Mitchell Medic 1 Fellowship. I believe that this period of time in Iceland
would offer an excellent opportunity for me to improve the direct clinical care I offer
patients here in Scotland, as well as forging closer relationships with Emergency
Physicians in an area which faces similar challenges to ours, in order to foster
continuing improvement in both countries.

Projected destination
Landspitali University Hospital, Reykjavik, Iceland
Clinical activity
• 4 weeks of direct experience seeing, assessing and managing patients on the
shop floor of a busy city centre Emergency Department
• Supervision and hands-on training in point of care ultrasound, particularly for
• Assisting and listening in on telephone support by attending Emergency
Physicians to remote practitioners and fishing vessels
• Shadowing local paramedic land ambulance and SAR helicopter teams
Named clinical supervisor
Dr Hjalti Mar Bjornsson, Training Programmed Director for Emergency Medicine
Plan of professional development
• Improve skills in coordinating care of critically ill patients from afar
• Familiarise myself with different approaches to care of geographically isolated
• Build on ability to support other clinicians with decision making outside their
usual role
• Develop competence in point of care ultrasound
Specific experiential targets
• At least 15 shifts seeing unselected adult patients in the ED (with 24/7
attending supervision)
• At least 4 shifts with paramedic ambulance crews and/or SAR helicopter crew
• Lead an audit of support provided for isolated practitioners and fishing
• At least 10 supervised diagnostic US scans plus procedural US as available


Zoe Smeed

There are many similarities between Norway and Scotland in terms of health care provision, patient populations, disease epidemiology and geographical challenges, thus making it an excellent place to compare Pre-hospital and Emergency Medicine systems.

If I am successful in achieving the Robin Mitchell Medic 1 Travel Fellowship, I propose to compare the Norwegian and Scottish Pre-Hospital and Emergency Medicine services, to identify future potential areas of practice development both within the Emergency Departments in NHS Lothian and remit of Medic 1, and additionally increase my knowledge and experiences of Pre-Hospital Emergency Medicine.

1. Location                                                                                                                  

My fellowship time will be based in Norway's capital Oslo. Oslo has a population of approximately 613.000 people over an area of approximately 450 square kilometres.

The majority of my fellowship time will take place working at the following

a) Oslo University Hospital, Ullevål, Oslo

Oslo University Hospital is Scandinavia's largest hospital, treating 1.2 million patients per year, and additionally accounts for 50% of medical and healthcare research.  Patients admitted to the hospital emergency department arrive either by ambulance or GP referral, there is no walk in service.  The Dispatch Centre and Physician Response Ambulance are based at this site.  Whilst working at Oslo University Hospital I will spend the majority of my time in the Emergency Department but will additionally visit the Dispatch Centre, Intensive Care Unit and Angiography suite.

I will additionally spend one day at the Oslo Emergency Ward (Oslo Legevakten) at Storgata in Oslo, which is a walk in centre for emergencies.  This will allow me to compare the facilities at the Emergency Ward in comparison to the multicentre Oslo University Hospital.

b) Norwegian Air Ambulance Service

The Norwegian Air Ambulance Service, initially began in 1979, funded as a charity.  It is now government funded.  Within Norway the National Air Ambulance Service comprises of 11 helicopter bases, 6 fixed wing bases and five search and rescue helicopter bases.  Medical staff include one Consultant Anaesthetist and one Rescue-man.  These are highly trained paramedics with 5 years experience and can additionally fly the aircraft if required!  The crew at the Oslo base have approximately 1,800 primary and 600 secondary missions/year. 

c) Physicians Response Ambulance

The Physician Response Ambulance is based in Ullevål, and is dispatched from Oslo University  hospital.  It is staffed by a Consultant Anaesthetist (who has to do an EMT exam to become a Paramedic on the ambulance), and additional Ambulance Service Paramedics and  Technicians. 

Both the Physician Response Ambulance and the Air Ambulance help fulfil the government's target that 90% of the Norwegian population can be attended to by a physician manned ambulance within 45 minutes. 

2.  Clinical Activity and Specific Experiential Targets

 A)  Pre-hospital Physician based services

Working with the Oslo Physician Ambulance and Norwegian Air Ambulance services.

Working with both the Norwegian Air Ambulance and the Physician Response ambulance will give me an overview of the availability and response criteria of different pre-hospital services in Norway, and gain further experience in the management of pre-hospital patients.  Additionally, comparing the Physician Response Ambulance to Medic 1 may enable possible future developments of the Medic 1 service, particularly around tasking to critical trauma and medical emergencies.  

 B)  Pre-hospital to Emergency Medicine care

Exploring links between pre-hospital care and emergency medicine

In Oslo the majority of doctors work shifts both in the Emergency Department and on the Physician Ambulance, allowing crossover of training and knowledge.  Pre-hospital services (for example call centres) are also based within the hospital, which may additionally improve  communication between pre-hospital and hospital based services. 

 Management of cardiac arrests 

In Oslo approximately 80% of Out of Hospital Cardiac Arrests are transported directly to PPCI facilities.  Working with the Pre-Hospital Physician Ambulance, reviewing the post ROSC protocol and spending some time working in the Angiography Suite and Intensive Care Unit at Oslo University Hospital will enable me to review the management of these patients in Norway and compare it to our current practice in Edinburgh.  Currently NHS Lothian is developing the "Edinburgh Pavement to PPCI Pathway", aiming to get patients directly to the PCI lab from the pre-hospital environment.  Drawing on experiences in Oslo could be helpful in developing the service in Edinburgh.

 Major incident planning

Reviewing the major incident plan and actual response for the Oslo shootings by consulting with those involved, will further my insight into managing major incidents and may be beneficial in developing Major Incident Planning in NHS Lothian.   I additionally aim to visit the fire, police and ambulance special operations sites to gain more insight into the services they provide during a major incident.  There may also be additional opportunities for me to attend major incident training sessions (date dependant).

 C)  Training

Training programme

I aim to review the training programme of those involved in working on the Physician Ambulance and Norwegian Air Ambulance Service.   As yet, there is no specific training for doctors to become Emergency Medicine specialists.  The Emergency Department is currently staffed by physicians from all specialities, primarily internal medicine and general surgery.  "First line" Emergency Department Physicians are typically interns or residents, with "back up" registrars or senior residents on call either in the hospital or at home.  It will be interesting to compare the training for these doctors and compare it to the training programme within the UK.

 Attend training sessions

I plan to attend pre-hospital and simulation training sessions  with the Air Ambulance and Physician Ambulance, in addition to possibly attending major incident training (date dependant). 

D)  Centralisation of services

Reviewing centralisation of services

Identifying centralisation of trauma centres, paediatric services and PPCI facilities within Norway will allow comparison to how services are managed in Scotland.


Congratulations to Steph and Zoe.