Pre-Hospital Emergency Medicine (PHEM): Is it for Me?
About This Post
I was at the University of Leicester Medical School careers fair recently with @jmesillett and @RebeccaPrest79, and there were a lot of questions about a career in Pre-Hospital Emergency Medicine (PHEM).
Now, the first thing to say is sorry it has taken a little while to get this post up (although I have been rather busy recently).
Secondly, I’m not involved in the recruitment process, so whilst I’ve successfully been appointed to a PHEM training post, I can’t guarantee what the recruitment panels are looking for.
In this post, I thought I’d give you an overview of what PHEM is, and a few words of advice about applying for a PHEM post.
What is PHEM?
Pre-hospital services in the UK take many different forms, and there is a considerable degree of local variation. Therefore, one of the first things you need to ask yourself is what do you want to do, and then have a look at what is offered locally. PHEM is essentially anything that occurs outside a hospital, and includes:
Event Medicine
Ranging from small village fetes and local rugby tournaments typically covered by Private Companies and the Voluntary Aid Societies (St John Ambulance, British Red Cross, St Andrew’s Ambulance Association), through to concerts, festivals, and international motorsport events which typically have a team of medical staff alongside the aforementioned private/voluntary providers. Provision of services at these events can vary from a basic first aid post, to fully equipped operating theatres depending on the size of the event, risk assessment etc…
[COI, I volunteer with St John Ambulance, and attend local motorsport circuits as a Track Doctor]
BASICS/Responder schemes
This service involves individuals responding from home with equipment commensurate to their level of training/skill in support of the local ambulance service, often in their own time or on a voluntary or ad-hoc basis.
Car/Helicopter-based response schemes
These provide a physician/paramedic team within defined hours (although some services are 24/7), again supporting the local ambulance service.
Clearly there is potential for large variation within the latter two groups, depending on the skill set of the individuals providing the service, and what the service commits to provide. The key thing is that the service will provide something in addition to the statutory ambulance service provision. This can include:
Alternative analgesics
Sedation capabilities
RSI capabilities
Alternative transport mediums.
Skills for Health careers framework
These levels all fit into the Skills for Health careers framework (pictured) and this all returns to my earlier question, what do you want to do? If you’re interested in formal PHEM training (which aims to produce a level 8 practitioner), then read on…
PHEM Training
The formal training programme in PHEM is (in medical terms) relatively new, and all the information you could want to know can be found on the IBTPHEM website. In a nutshell, the training lasts 1 year working time equivalent, and is split into 3 phases:
1a, initial training with 100% Consultant supervision (1 month).
1b, development phase, with 20% Consultant supervision (5 months).
2, consolidation phase, with 20% Consultant supervision (6 months).
At the end of Phase 1, there is a summative exam – the Diploma in Immediate Medical Care (DipIMC), and at the end of Phase 2 there is another exam – the Fellowship in Immediate Medical Care (FIMC).
Assuming everything goes OK, at the end of all this you could expect to receive a recommendation to your parent speciality for sub-speciality accreditation in PHEM with the GMC.
It's worth knowing that the training starts with a lot of simulation. Somewhere in this mess are five patients...
Applications
As with the majority of postgraduate training, applications are done online via a national recruitment system. This has, for the last few years been run via Health Education, East of England, and further details can be found on the dedicated PHEM recruitment page.
Job descriptions / Person specifications are available on the website, but a few key points to bear in mind are that you need to be a Higher Specialist Trainee (HST) in Emergency Medicine, Anaesthetics, Intensive Care Medicine or Acute Medicine and have completed at least ST4 before appointment. Alongside this you need at least 6 months experience in anaesthetics, which makes ACCS (to me) an ideal route to take. You also need to have a reasonable level of fitness, and some prior experience of pre-hospital medicine & to be able to demonstrate a commitment to the speciality.
The fitness test isn’t as bad as it sounds, and the best way to gain some experience would be through electives and/or observer shifts (if you contact your local service, they will probably have a policy). Additionally, talk to people that work in your local area to get a better feel for what the job actually entails.
Above all I’d encourage you to get some experience travelling in a moving ambulance/car at speed. You don’t want to realise you get travel sick when you’re transporting your first intubated patient…
The rest of the specification should seem relatively straightforward and there shouldn’t be any ‘surprises’ as it were. I’ve always found PHEM people to be quite pragmatic (but I would say that), and I think the specification reflects this.
Final Word
I hope this has been useful, if you have more questions, take a look at the IBTPHEM site or you can contact me on Twitter.
I would also like to take the time to promote Magpas, who are providing my pre-hospital training. They are a charity and if you would like more information take a look at their website or follow them on Twitter.
