Before I get onto the PRIME course a few questions.
How would you prepare people for prehospital work? What skills would you need to respond to well anything at all and do the “Golden hour” things? How would you teach them?
Enough questions onto the course itself.
PRIME is a five day course designed to prepare both rural nurses and doctors for prehospital work. It accepts the people on the course have previous experience and teaching is based around preparation, with lots of skill stations and scenarios to teach from.
The course is run by St Johns New Zealand and tutors are Intensive care paramedics/Advanced paramedics. These guys are great, heaps of stories, an attention span that matches mine and see the lighter side of medicine. I really enjoyed chatting with them about cases. Asking what if? is a favourite trick. Take what seems simple in ED and twist it. Things are much more complicated on the side of the road, in a paddock or upside down.
Day 1 Airway day (bit of IV/IO Access.)
Introductions and straight into it. The course has a deemphasised intubation as the primary skill and pushes airway management. The vast majority of the PRIMEs are “occasional” or almost never intubators. Great of talk about LMA vs ETT and as I mentioned earlier emphasis on ventilation not intubation. Then run through the common airway compromise situations. Discussions about airway adjuncts. Into practical skills. Using few models including some difficult airway models.
Day 2 Arrest/ACLS using Lifepacks. Cardioversion and pacing.
Kicked off with whiteboard discussion around arrest in the community. Some gems “Firefighters are great they do awesome CRP and they come in a team of at least 4. thats 2 mins on 6 mins off.” Lots of scenarios so people get used to the protocols and just recognising the time pressures and being organised. (knowing your way around the PRIME bag)
Then moved onto Tachy/Brady rhythms and cardioversion/pacing. Again short discussion, ECG analysis and then onto using the machines.
Day 3 Medical +
Day spent on common medical emergencies. Again moving quickly over certain topics we see regularly and taking time on the more rare serious conditions. Big discussion around IV adrenaline when to and not to use. (Ill get onto this in part three promise!)
Got a few people hooked on LITFL (Its the number one gateway #FOAMed drug) after showing them the ECG library.
Day 4 Trauma
Discussion around the “trauma mindset” and triage scenarios.
Their approach to patients is to use a “critical action check” which is very similar to ATLS as you would expect. Then jumping into simulation. practice getting people out of cars with boards ect. Also putting splints on people and discussing practical things like the fact a Thomas femoral splint doesn’t fit in many of the rescue helicopters. They have stopped teaching surgical chest decompression on the course and are pushing needles for tension only. But again if you do it in your own practice the PRIME handbook is all for “Further procedures felt appropriate by the practitioner”
The trauma had an excellent simulation, you arrive at a car crash with trapped passengers. Assessment. when you asked for help eg: fire they were waiting around the corner. Turned up lights an sirens and helped you extricate your patients. Really nothing prepares you better for the reality than spending time around a crash scene. Loud, sometimes difficult patients (had great actress in the car). Makes you realise the need to take control of the scene.
Day 5 Paeds/O&G/ Mental health emergencies
Good discussion around pregnancy issues, we had an O+G trained GP and midwife who took these session. Another common theme on the course was the instructors passing the education to someone in the group who does this regularly. Covered difficult deliveries and flat babies/resus.
Had a fantastic talk about capacity and mental health that even @Eleytherius would have been proud of.
The assessments on the course were usually done in the morning. Scenarios/Sim just really showing that you could do the skills which you had practiced and felt comfortable with the protocols ect. They were happy with people doing slightly off protocol things. Provided you could justify you decision and management. There was supposed to be a written test but the papers were never written so they skipped that.
I felt the course was good. It covers what needs to be covered in a short period of time. Five days seems like ages but it flew past. Having done ATLS and APLS the major difference was the practical approach on PRIME and much less PowerPoint. Obviously with the time pressures some topics are brushed over, esp topics we see regularly or that perhaps don’t need such emphasis. Hand hygiene talk was short…
As a course I would recommend to those who dont do ED work day to day. Many of the things are straightforward to those who do them regularly. For me the biggest difference is getting into the prehospital mindset and “doing it”. Not alot I would change on the course, the protocols are due a work over and few bits of their kit are disappearing see below!
So that’s PRIME ill discuss some protocols in next few weeks. Happy to answer any questions you have.
The most important machine in the building