Qualifying as a doctor in the mid-1990s in Glasgow, Dr Stephen Hearns focused straight away on the field of emergency medicine. Keen to gain experience in different locations, he spent a year in Queensland, Australia, where he was a keen observer of the helicopter emergency medical service (HEMS) and the way in which emergency care was delivered to rural and remote communities. The parallels between the outback, and the more remote parts of Scotland (climate aside), were clear, and the benefits of urgent pre-hospital care and fast retrieval of patients to higher levels of care were obvious. Scotland, he decided, needed more of this.

Furthering his experience in HEMS, following his return to the UK, Dr Hearns spent six months with London’s Air Ambulance which was then – and is still – one of the foremost HEMS operations in the world. “The clinical exposure I gained while working there, the people I worked with, their clinical governance systems and the safety of the medical operations, were second to none,” he told AirMed&Rescue. 

Setting up the pilot project

Back to Scotland in the early 2000s, and the need for pre-hospital critical care and enhanced medical retrieval services was clear among the rural population. In the Highlands, there is an average population density of just nine people per square kilometer. “Local hospitals tend to be staffed by a nurse and general practitioner, so having the ability to take consultant-led teams to the side of the patient is invaluable,” explained Dr Hearns. 

It is this consultant-approach that led to the creation of the Emergency Medical Retrieval Service (EMRS). While the Scottish Ambulance Service at that time operated helicopters and planes, these were crewed by technicians and paramedics.

So, Dr Hearns and a group of nine other consultants started EMRS to augment the work of the Ambulance Service, where around 80 per cent of flights are still staffed by paramedics. “It took almost 10 years to get the service fully funded and established,” he told AirMed&Rescue. “This meant persuading the government, the Ambulance Service, and existing healthcare providers of the health economic benefits that a critical care team can deliver.” In 2008, the Scottish Government funded an 18-month extended pilot of the service covering the West of Scotland. An independent service evaluation was resoundingly positive, demonstrating value for money and lifesaving benefits of critical care retrieval. EMRS was awarded permanent funding and expanded to the full country in 2010.

Moving with the times

A few years ago, Dr Hearns and another member of his team were given approval to film each other performing emergency anesthesia, the footage of which was then used during debriefs. “It was illuminating,” said Dr Hearns. “What I noticed was that while in stressful situations that were going well, my communication was fine, if the patient started to go downhill, so did my communication skills. It’s all about psychology of performance and pressure.” It took him three years to write a book about professionals’ behavior during pressurized situations – Peak Performance Under Pressure was published in October 2019. “The vital lesson that the book aims to educate people on is how to ‘own the pressure’ and perform highly even when the situation isn’t going well,” said Dr Hearns. “A certain amount of pressure has a positive impact on performance, and the book is about calibrating the pressure to maintain that high performance level.”

On the back of the book being published, Dr Hearns started his Core Cognition face-to-face learning courses. They aren’t just for search and rescue (SAR) or HEMS personnel; the lessons they provide, and tools they offer, are applicable to any high-stress role.

With Covid putting paid to face-to-face teaching, Dr Hearns currently offers the course online as a series of 12 videos, with each one tackling a discrete aspect of how to deal with high-pressure situations and make that pressure work for each individual and their role. With attendees from Australia, Canada and Europe, it’s safe to say that the uptake of the course has been a success.

The role technology plays in emergency medicine

if the patient started to go downhill, so did my communication skills

Looking at current challenges faced by the EMRS, AirMed&Rescue asked about how technology has improved patient care for the consultants leading the team. “Our role is to get to the patient as quickly as possible, and once we are there, we might spend two or three hours with them, stabilizing and treating them. Point of care testing is, in this situation, invaluable,” said Dr Hearns. When it comes to more ‘traditional’ telemedicine, where doctors on scene can share patient data with a hospital to prepare them for a patient’s arrival, Dr Hearns said this wasn’t used by the team – a proper doctor-to-doctor handover is more effective at that point. And as the team is led by a consultant and a retrieval practitioner, there is very little they can’t do in terms of diagnosis and treatment that another remote physician, tuning in via telemedicine, would be able to assist with.

Mountain rescue team culture

Dr Hearns is also a volunteer with a mountain rescue team – has been for 23 years, in fact. And there is no doubt that what he has learnt from those teams over the years has shaped how he works today. “Mountain rescue teams are volunteers, experts in their various fields, who are committed to respond, for free, in the middle of the night, to undertake complex and occasionally risky missions. The culture in the team, the leadership, the can-do attitude of team members, and the fact that it is, and always will be, a learning organisation, has certainly influenced my philosophy and my leadership style,” he told AirMed&Rescue. 

This trust in the expertise of the different team members exemplifies the work ethic of the team

One particular rescue stands out in his mind as an example of where the bravery and expertise of the different members of the team resulted in a safe retrieval of a victim. “Cycling with my wife one day, the call came in, and I raced back to my car, leapt in and went to the SAR helicopter base, soon embarking the aircraft (still in my cycling shorts!),” he tells the story. “I’m not brilliant with heights, and I have to trust the crew onboard the helicopter during the flight and winch down to the side of the mountain. Once on the mountain, I was strapped into my harness to be lowered down to the patient – another moment of trust in the expert mountaineer who attached my harness. We spent two hours on the side of the mountain treating the patient – who by the way, was a friend from the mountain rescue team – before a winch rescue was effected.” This trust in the expertise of the different team members, he says, exemplifies the work ethic of the team.

Moving on

Two years ago, Dr Hearns stood down from his position of leader of EMRS. “We had achieved what we set out to do,” he explained. “We had brought together a great group of the right people, and we had managed to find funding, introduce systems that worked, performed research, gained an international reputation, introduced a retrieval conference, and a Diploma in retrieval and transfer medicine.” Quite a list of achievements, for sure – and in terms of positive outcomes for patients, there is no doubt that the EMRS in Scotland is an incredibly valuable asset.

Core Cognition’s online Performance course is available online: www.corecognition.co.uk/hp2-course