MEDICAL ELECTIVE REPORTS

Skiing doctor trains on the slopes

An exciting elective in the Scottish Highlands was made possible for medical student Charlie Gregory (S16) with the help of funding from the Dr Donald Dean Medical Award. He describes his experience learning from the Glenshee patrol team

At the end of February, a friend and I undertook the long drive from Cardiff up to the Isle of Skye for a few days hiking before heading over to the Glenshee Ski Resort, near Braemar in the Cairngorms, to start our elective shadowing the Ski Patrol team. Each day, the chief patroller and four or five other team members start early and take to the mountains to set up the resort and ensure it’s safe for customers to use. This involves checking the lifts and being first down every freshly groomed piste to keep a lookout for hazards, before marking them with poles or chevrons. When fully open, Glenshee has 40km of groomed piste to manage so the team must work quickly and effectively to get the resort open for first lifts at 8:30am. Throughout the day, the teams patrol their sectors of the mountain, communicating by radio and responding to injured customers. They are taken down the hill to the safety of the treatment room before decisions are made about if further transport is needed and whether by ambulance or helicopter. For the month we were with them, we would be paired with a patroller, shadowing their work, learning their techniques, and assisting to treat customers on and off the hill. Common injuries ranged from broken wrists, collar bones and arms, dislocated shoulders, head injuries, lacerations from skis and twisted knees. A call would begin with either the team spotting an injury or us being informed by lift staff or a member of the public. We would head via the quickest lift to the site of the incident, often taking a sled with us. Once with a patient, we would first make the scene safe, crossing our skis above the site before moving down to assess any injuries.

Adverse weather conditions mean it’s essential to keep the casualty warm, so this assessment is often quick with the main aim to stabilise. Depending on the injury, this could be done via leg splint, sling, or vacuum mattress for full spinal injuries. serious injuries for further help. Most ski resorts have an injury rate of 3-4/1,000 people, meaning that during the busy period we had a steady flow of patients most days. We had fantastic snow for the first three weeks of our stay with Glenshee Ski Patrol, something I was surprised by, having never skied there before. Conditions ranged from clear blue sky to torrential rain and winds so strong you were getting blown back up the piste - something that definitely made patrolling challenging at times! It was on these days that we would hear the phrase ‘If you can ski in Scotland, you can ski anywhere’ get passed around and this was definitely the case! While in Scotland, I also had the opportunity to visit the Mountain Rescue team in Braemar and spend a day with the Scottish Charity Air Ambulance in Perth. It was great to visit the air ambulance and shadow them after seeing them respond to calls with us at Glenshee. I was paired with an advanced paramedic and spent the day in one of the RRVs responding to calls around the

If patients were in severe pain, we were able to give gas and air on the mountainside to make the trip more comfortable. We would then package patients in a waterproof sleeping bag on the sled before taking them down the slopes. On steeper sections, we sometimes resorted to back roping – where another patroller would ski down attached to the back of the sled to provide extra support – or abseiling the sled down. Glenshee has a four-bed treatment room that was used to assess patients and provide any other basic first aid. Due to the remoteness of the resort, with the nearest hospitals approximately an hour and a half drive away, there is a helicopter landing site for the air ambulance to transport

Perth and Dundee area, mostly cardiac arrests. This was a hugely informative experience where I learnt a lot about the advanced care of critical patients and was able to put essential skills from university into practice. Towards the end of the month, the weather warmed, and the snow began to melt. Although the skiing was limited, this did give me the opportunity to explore the Cairngorms in all their glory and in just over a week, managed to scale 17 Munros, climbed 9514m and hike over 180km. I really enjoyed my elective in Scotland and would highly recommend this to anyone looking to get into pre-hospital or expedition medicine. The Dr Donald Dean Award enabled me to fund this trip as well as make sure I was well-equipped for any weather the wildness of Scotland could throw at me.

Learning on the job

Sarah Elliott (L17) describes her Dr Donald Dean aided elective in the Channel Islands where she gained essential practical experience

At the end of my final year at the University of Southampton, I chose to compete my eight-week elective in Jersey, splitting my time between the Emergency Department and Paediatrics with four weeks in each. I hoped it would give me a chance to experience a healthcare service outside the NHS, while also seeing some of the challenges faced by an island setting. The last few years of my degree were hugely affected by the COVID pandemic. This was due to being taken off placement for the initial lockdown and an ongoing lack of face-to-face contact, with more clinics taking place online and patients being in isolation within the hospital. Travel was also greatly impacted and was something I had to take into serious consideration when planning my elective, as it was impossible to predict what restrictions would be in place. Jersey provided an ideal solution, it gave me a chance to experience a healthcare setting similar to, but outside the NHS as well as the opportunity to get more face-toface experience with patients. Having flown in a few days after completing finals I was pleasantly surprised by how welcoming everyone was. I stayed in hospital accommodation along with several other elective students who were in constant rotation the whole time we were there. They were from different universities from across the UK and all brought their own experiences from the hospitals they had been on placement in. Their presence greatly enhanced not only the medical side of the elective but also made exploring the island far more enjoyable.

DR DONALD DEAN MEMORIAL MEDICAL AWARD

As part of the legacy of the late Dr Donald Dean, Canford is able to offer funding to support up to two OCs embarking on medical electives each year. Dr Dean’s career took him all over the world and he helped create hospitals and medical services in Aden, Nigeria, Trinidad, Abu Dhabi and Kuwait. He was awarded a Fellowship of the Faculty of Occupational Medicine to recognise his significant contribution to the practice of occupational medicine in tropical countries. OCs are invited to apply for the award of up to £1,500. For further information see: www.canford.com/school-community/old-canfordians/drdean-medics-award

From the moment I arrived in the hospital, all the members of staff were really welcoming and willing to teach. Starting in Emergency Department gave me an opportunity to get involved straight away, allowing me to go and assess patients immediately after triage and then discuss management plans with senior doctors. This approach gave me a chance to act far more like a doctor than a medical student when being challenged to suggest how to manage the patient, while still having a chance to observe how the consultants then approached the patients. I was also able to spend time with some of the nurse practitioners who were very happy to teach me more about musculoskeletal injuries and how these are managed, something that is very much skimmed over at medical school. As there is only one hospital on the island, all cases come via the Emergency Department from minor injuries to trauma calls. During my time in ED, there was a trauma call with two patients blue lighted to hospital. The ED consultant had to assess the information provided and put out a trauma call to ensure all relevant team members were in Resus for when the patients arrived, which was very soon after the call. Initial focus was on the most injured patient who was assessed as clinically stable and then rushed for a trauma CT to assess any unseen injuries which might have indicated the need for surgery. While waiting for the CT, the consultant was then able to assess the other patient who fortunately had escaped with only minor injuries. This was one of the first trauma cases I had seen and it was fascinating to see how effectively everyone communicated to assess the patient and ensure that they were treated in the best way. It was also interesting to be involved in the assessment of the CT as it came through, alongside the surgical team who were then able to work up the management plan. My four weeks in paediatrics was very different. I spent the morning in handovers and on ward rounds which included both the paediatric patients as well as the special care baby unit. The rest of the time was split between new admissions, clinics, baby checks and teaching from the doctors who were more than willing to cover any topics that I wasn’t sure on. Clinics were particularly useful as not only were there general paediatric clinics but also specialist respiratory and neurology ones, with the specialists travelling over from the UK mainland to run the clinics. Jersey has a large number of healthcare workers who have trained within the NHS system, and it refers many cases to the UK mainland for more advanced treatment. However, the nature of being outside the NHS and on an island makes the challenges it faces unique. On Jersey, hospital care is free while GP appointments are paid for by the patients. This means that, compared to the UK, milder aliments end up in the Emergency Department. There is also more reluctance to return to the GP for follow up and, therefore, over the time I was in the Emergency Department I saw a number of the same people. The wait for treatment appeared less than in the other EDs I have worked in but, due to the size of the department, it didn’t take much for them to become overwhelmed and with no option to divert to another hospital this brought its own unique challenges. Due to its size and island location, not all services are available, so patients regularly need to be transferred by air to hospitals on the UK mainland for treatment. My elective experience was easily the best thing I’ve done during my five years of medical school, it gave me a chance to consolidate the knowledge I have, get teaching from so many of the healthcare staff and also gain many more of the skills I’ll need when I start practicing as a doctor. Having never been to Jersey before, I honestly couldn’t recommend it enough as an elective location or failing that simply as a holiday. I am grateful to Dr Dean Medical Award for helping me to take up and make the most of this opportunity which, without a doubt, has helped my preparation for my future job.