Robin Mitchell Fellowship, Ross Archibald

In 2021, I spent the final few weeks of my EM training immersed in the emergency and pre-hospital care systems in Iceland, thanks to the Robin Mitchell Fellowship.

Iceland and Scotland share challenges to achieving equality of access to emergency care, including isolated rural populations, weather and terrain. We also face similar issues in our EDs, with increasing elderly presentations, overcrowding and exit block, as well as balancing training and service provision.

My attachment began with ED shifts at Landspítali, Iceland’s National University Teaching Hospital. I also had ambulance shifts in the capital and in Selfoss, a small rural town east of Reykjavík. I visited several bases, met the teams and gained insight into their facilities, equipment and work-life balance. Notable was the shared use of high quality bases by various emergency services, which had advantages in efficiency and co-operative working.

I then spent a few days with the Icelandic Coast Guard helicopter team, whose multiple roles include HEMS operations. One mission involved participating in a multi-stage simulation being filmed for a documentary about stroke patient care, later aired on national TV! In addition to medical activations, we flew off the east coast for winch rescue exercises with a coast guard vessel, with high level crew resource management on display.

After visiting the emergency call handling facility in Reykjavik, I headed north to Akureyri, the country’s second largest town and where its fixed wing air ambulance service is based. Landing in small remote communities with limited medical facilities, it was clear how vital the service was in connecting patients with the health service. Between call outs, I spent time in the ED in Akureyri Hospital, the main centre for specialised services in the north and east.

I learned a huge amount from being immersed in the Icelandic emergency care system and gained a detailed perspective of how Iceland meets the challenges of providing access to emergency care. Undoubtedly a highlight of my career, it is an experience I will continue to draw upon for many years.