No need for a doctor?
Thursday, 10 January 2019
Medico-Chirurgical Hall
Dr Alistair Glennie, Kemnay GP, Medical Officer Scottish Mountain Rescue and Aberdeen Mountain Rescue Team doctor.
Mountain Rescue Medicine - no need for a doctor?
Alistair will talk about the role of a team doctor, medical provision and equipment of MRTs, the national medical officer role and some stories of rescues.
Alastair is a dad to 2 young children and paid to be a full time GP in Aberdeenshire, but often spends more time in his voluntary roles as a BASICS doctor and Mountain Rescue Doctor. He is one of the Aberdeen Mountain Rescue Team doctors and for the past 3 years has been the national medical officer for Scottish Mountain Rescue, the umbrella organisation that supports and represents the teams in Scotland.
Notes
Note of MedChi meeting and lecture Thursday 10/1/19
The President wished everyone a Happy New Year and welcomed everyone to a very well attended meeting. Apologies were noted (see separate sheet) and new members mentioned and welcomed.
The President encouraged members and friends to attend the forthcoming Burns Supper and highlighted the recent calls which have been made to nominate both new Council members and a new President Elect for the 2019/2020 session. He also noted that Mr Pragnesh Bhatt became a new Council member as of 1/1/19.
He then introduced the speaker for the evening, Dr Alastair Glennie. Dr Glennie began his medical career as an ophthalmologist, but is now practising as a GP in Kemnay. He is a member of Aberdeen Mountain Rescue team and a medical officer for Scottish Mountain Rescue.
Dr Glennie began by saying that he wished to give an overview of what the local mountain rescue team does and that, although it may seem surprising, the team does not really need a doctor to function well. He also showed a picture of Bennachie and noted that, statistically, this is the Scottish hill where injury is most likely to occur, given that is easily accessible and visited by large numbers of people.
He went on to relate two stories from the Braemar Mountain Rescue Team book “Mostly Happy Returns”, to demonstrate how rescue from mountainous areas has changed significantly over the years, with the use of helicopters and technological advances contributing to this:
In January 2014, one climber from a small group fell through a cornice on Ben Macdui. GPS provided the exact location of the climber and Braemar Mountain Rescue Team responded quickly. Aberdeen Mountain Rescue Team was also relatively nearby, training in Glenshee. Despite poor conditions, a Sea King helicopter was able to lift Mountain Rescue team members to within 2km of the casualty. The climber was found with significant injuries, stabilised, placed on a vacuum mattress and stretcher and loaded in to a helicopter. Within four hours of his fall, he was being treated in A&E at ARI. It is of note that the main casualty carer, who accompanied the patient to hospital in the helicopter, was a forestry worker, not a doctor.
On 6th May 1934, Norman MacLeod, an experienced and famous climber of his time, fell on Ben Macdui. His walking companion sought help in Coylumbridge and parties of searchers from Aviemore and Braemar, under local police guidance, set off to look for him. His body was found four days later.
Scottish Mountain Rescue covers the whole of Scotland, divided in to coverage areas. It comprises:
- 27 volunteer teams
- 3 police teams
- 1 RAF team
- Search and Rescue Dog Association (SARDA)
- Search and Rescue Drone Association (since 2017)
- Coastguard Helicopter
There has been some recent controversy reported in the local press that use of the Coastguard helicopter, controlled from Southampton, rather than military helicopters based in Kinloss, may increase risk to Mountain Rescue Teams. There are feelings amongst some that awareness of extreme conditions and the need for helicopter support may not be appreciated fully by a control room in Southampton, in particular support with searches for, and recovery of, bodies. This was raised as a question and discussed.
Scottish Mountain Rescue respond to requests from the police to assist with incidents in mountainous environments, search for missing people, particularly vulnerable persons e.g. suicide risk, to search for injured people, assist in terrain where a 4x4 ambulance is required and in adverse weather conditions. They are available 24 hours per day, 365 days per year, whatever the weather.
Searches are often conducted in very poor visibility, frequently at night. The teams carry large, heavy kits. Incidents are often falls of walkers/climbers and occasionally avalanches. Experienced as well as inexperienced climbers may need assistance. In some instances, thousands of hours may be spent searching; if a climber is lost in winter, it may be several weeks before a body is found, often when snow melts. One of the few instances when it is helpful to have a doctor in the team is to certify death. There is also a desire to limit exposure of non-professional team members to death and horrific injury. Dr Glennie gave several examples of searches, including some on-going searches e.g. the search for a local schoolboy missing in Aberdeenshire for several weeks.
Attendance at mountain biking accidents is increasing, especially locally in Pitfichie Forest. In many instances, the Mountain Rescue Team is simply required to carry the casualty off the hill.
In the Ballater floods, resulting from Storm Frank, a local resident with a boat and the Mountain Rescue Team, were instrumental in rescuing stranded locals.
Aberdeen Mountain Rescue Team members must be over 18 years of age, are from all backgrounds (e.g. engineers, foresters, German teacher), are hillwalkers/mountaineers, have a two-year probationary period, must be physically fit, and work and family must be very understanding of the commitment. It is very difficult to use doctors for Mountain Rescue work because of the difficulty leaving their “day job” at a moment’s notice.
Mario Di Maio MBE has 48 years’ service with Aberdeen Mountain Rescue Team and continues to serve with the team. He is very experienced in knowing where people are likely to be and how to access these areas from either land or air.
All Mountain Rescue Team members train regularly. Training includes navigation skills (map, compass, GPS), searching, rope work, first aid (First Aid at Work minimum plus in-house training) and driving (on-road, off-road, trailer training).
A few members, who must be at least two years post probation, undertake further specific and intensive training in casualty care. This includes advanced first aid (and more!). The exam comprises a written paper, practical scenarios and log book. Casualty carers are able to give drugs from a fairly extensive formulary: oxygen, Entonox, morphine, fentanyl, salbutamol, diclofenac, codeine, cefuroxime, prochlorperazine, adrenaline, naloxone and midazolam.
Aberdeen Mountain rescue team was founded in 1964 and is based in Westhill, within premises gifted by the Order of St John. The team is well equipped, including five Land Rovers. The other local team at Braemar has additional equipment, including all-terrain vehicles. Other equipment includes stretchers (mainly McInnes), casualty bags, vacuum mattress, splints, first aid kits, ropes (including a 400m long rope, which requires four people to carry it!), an avalanche rescue kit and a swift water rescue kit (especially Southern and Borders’ teams). Teams are usually made up of eight people. It is essential to have another team of eight who can take over, as rescues are physically demanding e.g. carrying an 80kg casualty on a 30kg stretcher, along with other heavy kit, in difficult terrain and adverse weather.
Dr Glennie’s role as Aberdeen Mountain Rescue Team Doctor
- Treat/advise on injured and/or unwell casualties. It is uncommon for people to become unwell whilst walking/climbing in the local area, because hills/mountains are not very accessible to those with limited physical fitness. In contrast, teams in the much more accessible Lake District are frequently dealing with people who have become unwell
- Deal with medical incidents e.g. high risk individuals such as someone with acute psychosis
- Deal with fatalities
- Training (main part of role)
- Team support e.g. mental health welfare. Mountain Rescue Teams can now link to the Police Scotland health service
Dr Glennie’s role as Scottish Mountain Rescue Medical Officer
- Guidance/advice on medical issues
- Team support
- Home Office opiate licence
- Drug ordering/prescribing
- Casualty Care training
- Casualty Care assessment
- Oxygen supplies
- Liaise with Scottish Ambulance Service
- Liaise with Police Scotland
- Liaise with UK Search and Rescue Medical Group (advises Government on search and rescue issues)
- Liaise with International Commission for Alpine rescue (ICAR)
- Liaise with Faculty of Pre-hospital Emergency medicine
- Liaise with Maritime Coastguard Agency
Scottish Mountain Rescue receives a small government grant, but is mainly financed through charitable donations.
The evening concluded with Dr Glennie answering questions and receiving thanks from the President.