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The '''Emergency Medical Retrieval Service''' ('''EMRS''') is part of [[ScotSTAR]] retrieval service. The EMRS provides [[aeromedical]] [[Critical care medicine|critical care]] retrieval and [[Pre-hospital emergency medicine|pre-hospital care]] to people in [[Scotland]]<ref name=":3">{{Cite journal |last1=McHenry |first1=Ryan D. |last2=Moultrie |first2=Christopher EJ |last3=Cadamy |first3=Andrew J. |last4=Corfield |first4=Alasdair R. |last5=Mackay |first5=Daniel F. |last6=Pell |first6=Jill P. |date=2023-08-22 |title=Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage |journal=Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |volume=31 |issue=1 |pages=39 |doi=10.1186/s13049-023-01109-6 |issn=1757-7241 |pmc=10463457 |pmid=37608349 |doi-access=free }}</ref><ref>{{Cite journal |last1=Moultrie |first1=C. E. J. |last2=Corfield |first2=A. R. |last3=Pell |first3=J. |last4=Mackay |first4=D. |date=2017-05-01 |title=46 Forecasting the demand profile for a physician-led pre-hospital care service using a mathematical model |url=https://bmjopen.bmj.com/content/7/Suppl_3/A18.2 |journal=BMJ Open |language=en |volume=7 |issue=Suppl 3 |doi=10.1136/bmjopen-2017-EMSabstracts.46 |issn=2044-6055 |doi-access=free}}</ref> in the form of two retrieval teams (North and West). The service provides patients in remote and rural areas with rapid access to the skills of a [[Consultant (medicine)|consultant]] or senior doctor in emergency medicine, intensive care medicine or anaesthesia, and facilitates transfers to larger, better equipped urban hospitals.<ref name="what we do">{{cite web |title=What we do |url=http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=18&Itemid=28 |url-status=dead |archive-url=https://web.archive.org/web/20090411060354/http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=18&Itemid=28 |archive-date=11 April 2009 |access-date=2009-11-18 |publisher=EMRS |location=Glasgow}}</ref> The EMRS functions supplementary to the regular Scottish Ambulance Service Air Ambulance service. Unlike air ambulance services in other parts of the UK, EMRS has no dedicated aircraft but both EMRS North and West are funded by the [[Scottish Government]]. The EMRS has featured on the [[Five (TV channel)|Channel 5]] documentary series ''[[Highland Emergency]]'', which charts the work of rescue services in the [[Scottish Highlands]].<ref name="spin doctor">{{cite web |date=January 2009 |title=''Spin Doctor'' (EMRS Newsletter) |url=http://www.emrs.scot.nhs.uk/images/stories/newsletters/january09.pdf |access-date=2009-11-18 |publisher=EMRS |location=Glasgow}}</ref>
EMRS North team (in [[Aberdeen]]) is on base between 0800 and 1800, and EMRS West team (in [[Glasgow]]) are on base between 0700 and 2300, for immediate deployment; outside these hours the teams are on-call and will take at least 30 minutes longer to deploy.<ref name=":0" /><ref name=":4">{{Cite book |last=Gallier |first=Jonny |url=https://static1.squarespace.com/static/54a40119e4b0fbd5ffb33811/t/60dedd449cc52157c56eb443/1625218372992/OG028.pdf |title=OG028 ScotSTAR Referral}}</ref>
Services are provided in partnership with the [[Scottish Ambulance Service]] utilising road transport, [[helicopter]]s and [[fixed-wing aircraft]]. The EMRS operates as part of [[ScotSTAR]], the Scottish national retrieval service, sharing a bespoke base at [[Glasgow Airport]].<ref>{{Cite web |date=2023-03-29 |title=Emergency Medical Retrieval Service |url=https://www.emrsscotland.org/ |access-date=2023-09-28 |website=Emergency Medical Retrieval Service |language=en-GB}}</ref>
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'''2007''': In 2007, the service was extended to cover three rural general hospitals and 13 community hospitals as part of an 18-month trial funded with £1.59{{nbsp}}million.<ref>{{cite news |url=http://news.bbc.co.uk/1/hi/scotland/6237694.stm |title=Medical airlift service extended |work=[[BBC News]] |date=25 June 2007}}</ref> The success of the service saw its operating zone expanded throughout the west coast of Scotland and the EMRS now operates from [[Stranraer]] in the south to [[Stornoway]] in the north.<ref name="history">{{cite web|url=http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=44&Itemid=29 |title=History |publisher=EMRS |access-date=2009-11-18 |location=Glasgow |url-status=dead |archive-url=https://web.archive.org/web/20090411060359/http://www.emrs.scot.nhs.uk/index.php?option=com_content&view=article&id=44&Itemid=29 |archive-date=11 April 2009 }}</ref> An independent service evaluation demonstrated value for money and lifesaving benefits of critical care retrieval.<ref>{{cite report|url=http://www.gov.scot/Resource/Doc/304168/0095438.pdf |title=Evaluation of the Emergency Medical Retrieval Service | vauthors = Boyle J, Whyte R, Dickson E, Godden D, Heaney D, Munro A |publisher=Scottish Government |year=2010}}</ref>
'''2010''': In March 2010, the [[Scottish Government]] acknowledged that due to its continuing success, the service would be further enhanced by the addition of a second team, operational from October 2010.<ref>{{cite news |url=http://news.bbc.co.uk/1/hi/scotland/8545508.stm |title='Flying doctor' scheme to expand |work=BBC News |date=2 March 2010}}</ref><ref>{{cite news |url=http://news.bbc.co.uk/local/highlandsandislands/hi/people_and_places/nature/newsid_8652000/8652140.stm |title=The flying doctors |work=BBC News |date=29 April 2010}}</ref> The second team increased the number of participating consultants and doctors from eight to fifteen.<ref name="BBC 25Oct2010">{{cite news |url=https://www.bbc.co.uk/news/uk-scotland-11617569 |title=Flying doctor service takes off across Scotland |work=BBC News |date=25 October 2010}}</ref>
In 2010, around 90% of EMRS activity involved secondary retrieval.<ref name="EMJ 2011">{{cite journal | vauthors = Corfield AR, Adams J, Nicholls R, Hearns S | title = On-scene times and critical care interventions for an aeromedical retrieval service | journal = Emergency Medicine Journal | volume = 28 | issue = 7 | pages = 623–625 | date = July 2011 | pmid = 20724465 | doi = 10.1136/emj.2010.091421 | s2cid = 206939562 }}</ref> Annual running costs were now in the region of £2M.<ref name="SG 2Mar2010">{{cite press release |url=http://www.gov.scot/News/Releases/2010/03/02094826|title=Flying doctors flying high |publisher=[[Scottish Government]] |date=2 March 2010 |access-date=20 November 2015}}</ref> In 2011, annual activity was estimated to be 324 transfers each year with around 60% of these by [[rotary wing]] and 35% by fixed-wing aircraft.<ref>{{cite web |url=http://www.gov.scot/Resource/Doc/362956/0122968.pdf |title=Towards a Single National Specialist Transport Service for Scotland - ScotSTAR: Strategic vision |publisher=[[Scottish Government]] |page=6 |date=18 November 2011 |access-date=22 November 2015}}</ref>
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EMRS Teams are composed of Retrieval Practitioners (Advanced or Specialist) and one or more doctors.<ref>{{Cite web |title=Retrieval Practitioners |url=https://www.emrsscotland.org/retrieval-practitioners |access-date=2023-09-27 |website=Emergency Medical Retrieval Service |language=en-GB}}</ref> Retrieval Practitioners come from a nursing or paramedic background and receive additional training in retrieval medicine. There are 47 part-time consultants who work with EMRS<ref>{{Cite web |title=Consultants |url=https://www.emrsscotland.org/consultants |access-date=2023-09-27 |website=Emergency Medical Retrieval Service |language=en-GB}}</ref> and a smaller number of registrar or clinical fellow grade doctors.<ref>{{Cite web |title=Registrars and Fellows |url=https://www.emrsscotland.org/registrars |access-date=2023-09-27 |website=Emergency Medical Retrieval Service |language=en-GB}}</ref>
During staffing pressures in the early [[COVID-19]] pandemic, the service occasionally deployed a Registrar with a Retrieval Practitioner as an operational team.<ref name=":0" />
==Equipment==
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'''Pre-hospital Critical Care'''
The team attend between 1<ref name=":3" /> and 3<ref name=":1">{{Cite journal |last1=Neagle |first1=Gregg |last2=Curatolo |first2=Lisa |last3=Ferris |first3=John |last4=Donald |first4=Mike |last5=Hearns |first5=Stephen |last6=Corfield |first6=Alasdair R. |date=2019-04-01 |title=Epidemiology and location of primary retrieval missions in a Scottish aeromedical service |url=https://www.ingentaconnect.com/content/wk/ejeme/2019/00000026/00000002/art00009 |journal=European Journal of Emergency Medicine |volume=26 |issue=2 |pages=123–127 |doi=10.1097/MEJ.0000000000000483 |pmid=28746084 |s2cid=23053968}}</ref> prehospital patient a day, delivering advanced medical management and other critical care interventions many of these patients.<ref name=":2" /> In one study, 59.7% of patients received one of the following interventions; pre-hospital [[Blood transfusion]], [[Chest tube|Chest drain insertion]] neuroprotective measures or [[Emergency ultrasound]].<ref name=":3" /> In the same study 52.5% of patients were mechanically ventilated.<ref name=":3" /> In another study critical care interventions (''emergency anaesthesia, thoracostomies, sedation, thoracotomy, chest drain insertion or administration of blood products'') were provided to 17% of patients and 21% received an advanced medical intervention (these include patients who died on scene, gaining [[Intraosseous infusion|intraosseous]] access and any patient the team escorted to hospital).<ref name=":1" />
The EMRS team perform prehospital anaesthesia as required, with a complication rate of 4%,<ref name="A rural emergency medical retrieval" /> and a first pass success rate of 80%.<ref name=":2">{{Cite journal |last1=Ross |first1=Mark |last2=Corfield |first2=Alasdair |last3=McCormack |first3=Jon |last4=Loughrey |first4=John Paul |date=2015-11-01 |title=Tracheal intubation in primary and secondary retrieval patients: A study of tracheal intubation practice and complications in ICU and aeromedical retrieval |url=https://www.resuscitationjournal.com/article/S0300-9572(15)00509-2/abstract |journal=Resuscitation |language=English |volume=96 |pages=49–50 |doi=10.1016/j.resuscitation.2015.09.114 |issn=0300-9572}}</ref> This is comparable to other UK prehospital services offering this intervention.<ref>{{Cite journal |last1=Lockey |first1=D. |last2=Crewdson |first2=K. |last3=Weaver |first3=A. |last4=Davies |first4=G. |date=August 2014 |title=Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians |journal=British Journal of Anaesthesia |volume=113 |issue=2 |pages=220–225 |doi=10.1093/bja/aeu227 |pmid=25038154 |issn=0007-0912|doi-access=free }}</ref> EMRS are able to undertake surgical procedures at the road side, such as resuscitative [[thoracotomy]], however EMRS does not have "specialist obstetric skills".<ref name=":4" />
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