Dr Beth Barton - The PHEM Experience

I’m Beth and I have been a doctor for almost 10 years. I am training as a specialist in intensive care medicine but have also worked in anaesthetics and emergency medicine. I have been interested in pre-hospital emergency medicine (PHEM) for many years and when it was approved as a sub-specialty in 2011, I decided to train as a PHEM specialist. PHEM trainees can apply for the training programme once they are a senior trainee in a range of specialities. Selection is a national process so you compete for places with doctors from all over the UK, and the training jobs are also spread around the UK. The selection included a challenging interview as well as a clinical simulated scenario.

My experience so far…

I am a year into my training and it is one of the best experiences I have ever had – in or out of my medical career. Sure, flying around in a helicopter is incredible but it is far more than that. It sounds like a cliché, but every day is different. You have no idea what you are going to be doing, or where you will end up, when you turn up to work each day. PHEM is one of a few specialities where you are a true generalist. This year I have delivered a baby and been to patients in their 90’s, and every age in between. I have treated patients who have had a cardiac arrest, been seriously injured in vehicle collisions and accidents, needed emergency transfers between hospitals, or become unwell due an emergency medical condition. Whilst that has often been as part of a critical care team where we have given patients an anaesthetic on the side of the road, performed surgical procedures in a field and given massive blood transfusions in the back of a helicopter, there have also been opportunities to work shifts with the ambulance service, specialist medical rescue teams and a physician response unit aimed at hospital avoidance. That is still pre-hospital and, although very different, it can be just as challenging (and rewarding) to assess a child with a minor injury or close a minor head wound in an elderly patient with dementia; checking them over, making them a cup of tea and being able to leave them safely at home. I have worked in teams with doctors, nurses, critical care practitioners, paramedics, and ambulance staff on the road and in control rooms. I have also worked alongside the police, fire service, coastguard and other services both in training and in emergencies.

That may sound intimidating, and it would be if it wasn’t for the fantastic training you get and the colleagues you work with. Every day is a school day. Initially, it is an incredibly steep learning curve on essential skills, from how to get in and out of the aircraft without getting hurt to using the radio communications and all the specialist ambulance equipment. When the basics are established, you can focus more on the clinical challenges and how you can respond to those outside of a cosy, dry, well-lit and equipped hospital room. Teams spend a lot of time training together and doing simulated scenarios, with a real focus on team working and CRM skills. In addition, there is a strong focus on clinical governance and improvement, with lots of opportunities to get involved in projects and improvements in the services.

At the moment, PHEM is a male-dominated speciality. As a small, short female doctor who spends half her life in hospital being asked “are you sure you are old enough to be a doctor?” (I know, I should be grateful really), people have asked if it has been difficult slotting in and working in that environment. To be honest, no it hasn’t. It was incredibly intimidating at my interview and initially I did find myself getting a bit “lost” at busy scenes. However, it is a good opportunity to develop your assertiveness and leadership skills.

My advice for future PHEM trainees…

So, what would I say to someone thinking of applying to work in pre-hospital medicine? If I was making the decision whether to apply again, I would do it in a heartbeat. It is tiring, demanding, emotional and rewarding. The training is fantastic; you work with incredible people and have the privilege of being able to help people when they really need it. You have the opportunity to make a difference to their care. Yes, you need to be fairly fit and definitely willing to muck in and get the dirty work done, but it is completely achievable regardless of gender. You will get tired, cold and wet; and at times get overwhelmed with the amount of learning and exams crammed into a year. You will develop your leadership, decision-making and teamwork skills beyond recognition, as well as being able to navigate at 100mph. It is one of the hardest yet rewarding experiences ever, and you have an office with an incredible view.

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