Overview

This module will provide healthcare professionals working in the pre-hospital environment with the robust knowledge required for emergency anesthesia (pre-hospital and in-hospital) and the management of critically ill patients requiring level 3 inter-hospital transfer. The module is intended for experienced healthcare professionals who wish to formalise and develop their practice. The teaching of the module is a combination of distance learning, workshops and time in practice both in the pre-hospital environment and in operating theaters. It is devoted both to the acquisition of advanced clinical skills and to the acquisition of the under pinning knowledge to enable the HEMS practitioner to comfortably perform emergency anaesthesia in a pre-hospital environment. The student studying Advanced HEMS Practice at Bangor University is required to develop their clinical skills in operating theatres and in the pre-hospital environment. The time frame required for this module is a minimum of 7 hours per week for 7 weeks in the operating theatre and an appropriate number of hours in the pre-hospital environment which will be dictated by the student’s employment circumstances. If the student is not in a HEMS post they will have fulfilled their pre-hospital requirements as part of NHS 4435. The student is required to work with an appropriately qualified supervisor/mentor. A variety of interesting and innovative teaching and learning strategies will be used in the delivery of the module, to accommodate different learning styles, make use of your professional experience and expertise, and to enhance key leadership skills such as communication and discussion.

It should be note that to complete this module, practitioner are required to be able to spend time with an appropriate HEMS service.

General pathophysiology underlying multiorgan failure Anaesthesia: Detailed knowledge of indications Detailed knowledge of process Airway assessment Manual airway control Airway adjuncts: basic and advanced. Laryngoscopy: direct and video Use of suction

Manual ventilation: BVM and anaesthesia circuits Manual ventilation: neonatal equipment

Anaesthetic pharmacology: induction agents; neuromuscular blockade; maintenance

Use and interpretation of capnography Procedural sedation and analgesia Detailed knowledge of indications and process Use and interpretation of nasal capnography Pharmacology of sedatives and analgesics

Provision of multimodal anaesthesia including nerve blockade Neuroprotective strategies in the brain injured patient, including management of critical ICP.

Risk/benefit assessment Difficult airway management Variation in technique for special groups: critically ill or injured; children; the elderly Procedural sedation and analgesia Failed intubation management Failed oxygenation management Cricithyrotomy -needle and surgical Procedural sedation and analgesia Management of adverse events Management of local anaesthetic adverse event

Assessment Strategy

-threshold -Basic understanding of the facts and principles specific to the topics covered in this module. Students will be required to achieve a minimum of C- grade in the assignment to pass the theory component of the module.

-good -Very good understanding of the facts and principles specific to the topics covered in this module. Good understanding of professional accountability issues. This equates to a minimum mark of Grade B- in the Grading Criteria.

-excellent -Excellent understanding of the facts and principles specific to the topics covered in this module and evidence of additional evidence gained by the student. Very good understanding of professional accountability issues. This equates to a minimum mark of Grade A- in the Grading Criteria

Learning Outcomes

• Critically appraise possible approaches to procedural sedation and emergency anaesthesia.

• Critically appraise the modifications required for critical care delivery within hazardous areas and disaster management

• Critically discuss and apply the underpinning knowledge required to select appropriate anaesthetic techniques based on patient characteristics' and the local environment.

• Develop advanced airway assessment and management skills including, rapid sequence induction, difficult airway management, surgical airway and video laryngoscopy, identify and manage the complications of emergency anaesthesia.

• Draw upon a range of clinical decision making theory to make reasoned, safe and ethical clinical decisions in relation to when when emergency anaesthesia may be considered undesirable.

• Propose and critically justify advanced assessment and anaesthetic management plans for a wide variety of critically ill or injured patients, encountered within a pre-hospital environment.