Gareth Grier
@gareth_grier
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Fingers crossed for 24 swim marathons in 2024 PHMBSc @PHMMSc @PHMBSc_alumni @The_PCP Prehospital medicine @QMULBartsTheLon @EHAAT_ 🏴
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A pleasure to spend a night shift at an unnamed, currently prestigious, generally fabulous central London Emergency dept with not a sign of any blood on any floor thanks to our more than tremendous team. London is littered with prestigious & shiny clean emergency departments. 🐔
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1K
Reflections on today. 1. The
#Nightingale
hospital has some of the most effective medical leaders I’ve ever encountered. 2. The pace of activity in the
@nhs
is immense 3. Staff on the front line are not just doing their jobs and are indeed heroes. 4. Staff who aren’t on the 1/2
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A lot of people are asking about
@NightingaleLDN
and the current response. Having spent a lot of time there during the last wave, we are proud of all the energy that went into the response. The NHS in London has adapted and changed since the first wave, with hospitals such as 1/
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468
While we wait to realise the impact of
#tier4
a shocking number of covid patients are coming through now. Entire
@NHS
team pulling together against what is a palpably bigger wave than before. Thank you to everyone
@NHSBartsHealth
@Ldn_Ambulance
- an immense effort from all.
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The NHS does gob-smacking, astounding things every day. I had a gob-smacking amazing thing done a couple of weeks ago. No one tweeted, no one put videos of me or them on social media. The air ambulance community needs to pause, and think. Stop the nonsense.
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Well done to
@themattmak
for signing off as a London HEMS doctor. Well deserved. Hope you get some rest.
@NHSBartsHealth
@RoyalLondonHosp
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I’ve seen the difference many times between a child hit by a car at 20mph vs a child hit by a car at 30mph. The difference is terrible. If they’re not dead, it changes their entire lives and the lives of all those around them. Sorry
@RishiSunak
but you’re wrong.
I’m slamming the brakes on the war on motorists - it's as simple as that.
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Proud to be at the final
@LDNairamb
@NHSBartsHealth
lecture by my friend and inspiration, Dr Gareth Davies, this afternoon. His impact on prehospital care across the world is truly immense. I’m sensing there’s more to come from this living legend, but what a story. Thanks GD.
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Two giants of paramedicine. Really sad, and pensive, that
@SteveJones1054
@lardyc7
are leaving
@LDNairamb
- so many years of outstanding service. Your impact on the lives of so many injured patients has been immense. Thanks for everything you’ve done (and will do) for
@IofPHC
😢
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For clarity, armed forces personnel ‘driving ambulances’ has the same level of parity as me standing in for Tom Daley at the Olympics.
Armed forces personnel could drive ambulances and stand in for frontline hospital roles under emergency plans to deal with a possible winter of strikes
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Crazy proud of my sister
@CeriThomas1510
who retires today after 36 years of nursing in intensive care. So many hands held, thousands of infusions, ventilators, filters, and the most complicated of decisions made to help the sickest of patients. All those family explanations, 1/2
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I wish fully trained doctors weren’t called ‘trainees’.
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London HEMS doctor job advert. Posts from Oct 2020. Come and join an amazing team doing great things for patients. Learn lots, train hard & encounter some exceptionally challenging cases. Criteria - You have to love seeing patients (and a few other bits)
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For
@metpoliceuk
@Ldn_Ambulance
teams this is played on repeat many times a week. Always police officers giving care when
@LDNairamb
gets to cases like this & it’s first class. Seen deaths prevented because of it. Police an integral part of
@London_Trauma
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Exciting new term invented this morning by
@misslyns27
for our PHCC lecture. ‘Checklist offal’. Stuff that appears on checklists that no one cares about and that doesn’t matter. It impacts on a healthy checklist culture, and dilutes those items that are crucial to the mission.
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Nod to the work of our HEMS paramedics in REBOA cases. Quite a few recent cases where they have shown some extraordinary multitasking. Scene assessment and reading wreckage to determine injury load, (and point out what the doctors haven’t spotted yet), team leadership while 1/n
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Really pleased that Mariana signed off as a nurse on the physician response unit (PRU) team yesterday. Joining an expanding team of first class people providing this service. Great job Bill Leaning for keeping the standards high with crafty questions!
@NHSBartsHealth
@LDNairamb
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Every day
@NightingaleLDN
all the clinical leads and teams who are free, gather for a quality and learning session. What have we learned and how can we implement improvements and do it quickly? Everyone on the same mission, trying their utmost to attend to every detail 1/2
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Really pleased that as part of our vision for clinician career development
@EHAAT_
are funding a PhD opportunity for the EHAAT paramedic group, including significant funded study time. This will help us shape patient care into the future. Thank you! More to come soon!!
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Yesterday
@LDNairamb
had the honour of celebrating the care given to nearly 40000 patients by our HEMS paramedics. The collective experience of severe trauma care in 176 HEMS paramedics over 29 years is incredible. What an amazing contribution to London, and to prehospital care.
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Increasingly convinced that medical helicopter teams outside of London can deliver more and more for more patients. Increasingly convinced that London would be better served with three cars. Much cheaper, kit etc much closer to the patient and would be faster.
#savingtime
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Ok. A few bits. Will add a context of intravenous sedation for long bone fracture manipulation as an example. 1. Even when the pre-sedation environment is tense, noisy, loud, etc., speak gently with the patient before you start. Allocate someone to continue to speak smoothly and
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Defibrillators to be supplied to all state schools in England by next summer following campaign by Oliver King's family
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The more I think about urban ‘HEMS’ prehospital care, it becomes more and more clear that time is, as we always knew, the most important determinant of outcome. Bleeding control, thoracotomy, REBOA, & even head injury anaesthesia (dysventilation, airway failure) are hugely time
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Delighted that Dr Flora Bird will be our
@IofPHC
@LDNairamb
head injury research fellow. Working jointly with
@NHSBartsHealth
she will help us start to break the bubble in improving head injury outcomes. Prehospital interventions are key.
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Yesterday -
@LDNairamb
@NHSBartsHealth
#PHEM
doctor Neil doing his ‘sign off day’. A day where our doctors and paramedics are tested prior to working in the service. It follows ~6 weeks of daily 1:1 training, bespoke courses, (and of course, around 10 years after qualifying)....
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Got to love East London. Walk to work accompanied by an overture of a lady yelling at a man using the most expletives I’ve ever heard (and I’ve been here a while). She was cross that he’d been sniffing nitrous and there might be kids around. I want her for the next HEMS moulage.
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The hardest one hour sprint I’ve ever done. The team ‘forgot’ the 30 minute sign, teased me with 45 min, played ‘race the boat’, and this piece of land took SO long to get bigger. Arms don’t work any more.
@laainthechannel
over to Rob. Surrounded by stars.
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They wanted to do the arms folded thing. Tonight between missions we talked about coaching other people in HEMS systems. Coaching an individual on a shift is different to being someone’s coach, which is different to having a team of coaches. Systems need a team of coaches that 1/
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Intriguing HEMS D&D today. Trying to work out what on earth the physiology behind the clinical picture actually is makes me realise how much ‘we’ don’t know. In prehospital medicine we have mountains to climb - exciting mountains, but we’re not even at base camp yet.
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Thank you London
#NHS
#NHSNightingale
That is amazing. And from what I’ve seen today the
@nhs
is astonishingly good.
@SkyNews
@BBCNews
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3/3 8. Don’t send what’s app messages at 11pm about COVID. 9. We need to let people see their loved ones who are dying. 10. We need to find a way to do this while not spreading the virus. 11. Ethical decisions will weigh heavily on us all in years to come. 12.
@NHS
is fantastic
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Something powerful about the helicopter carrying the duty team, constantly coming in and out while our educational events go on. Reminds us that there is no need to ‘invent’ cases for simulation. All of our training scenarios are scripted from real cases. Sadly, there are many.
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11
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A respectful nod to all the families who were involved in discussions around the
#RECOVERYtrial
while their loved-ones were unwell. Some challenging conversations led by research teams, but ‘Hope’ was the theme that came through.
@MartinLandray
@PeterHorby
@mountfordjames
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Thanks to
@DrRosena
for all your selfless voluntary work during the pandemic and for the difference you made. Hold your head high.
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London can be proud of its NHS. Locally
@LDNairamb
&
@NHSBartsHealth
teams were exceptional last night, but the level of violence and brutality of knife injuries in London shocks all of us more and more at all the
@London_Trauma
centres. 2018 has started very badly.
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A load of total nonsense. Thanks to all the ‘medics’ & others working their nuts and nutesses off every night without a break & for all the voluntary extras while studying for exams paid for with loans so that you can work even more!
#hailstonesnotsnowflakes
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Thank you. Thank you. Thank you.
@GreenhalghRob
and Dan Ballard for all you’ve done during your London HEMS secondments. Special people, who have done something very special for London.
@NHSBartsHealth
@LDNairamb
@IofPHC
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We like a classy teaching environment
@LDNairamb
@NHSBartsHealth
@HEMSRLH
Midnight teaching on major incidents and comms, paeds anaesthetics, and head injury. But of a mixture!!
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8
156
Ultra-proud of Jason Morris on his QAM
#QueensBirthdayHonours
This guy is first class and has made a huge impact on patient care in many different ways. He also makes sure that I don’t sit down for longer than 5 seconds on a shift!! 😎 Thanks Jason and well done!!
#HEMSParamedic
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10
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Pleased that
@SamySadek8
@robbielendrum
and I managed to catch the thief with the portable angle grinder attempting to steal this bike from outside
@RoyalLondonHosp
Security have it. Thief ran off, hopefully into the path of a giant bus, needing REBOA.
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Thank you
@74RWS
for all you’ve given to HEMS and for giving your all. Such a great HEMS paramedic, person and mentor to many. All the very best, as you remain firmly within the family.
@LDNairamb
@NHSBartsHealth
@Ldn_Ambulance
Thanks for all you’ve done for
@IofPHC
Take care.
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Caption competition 2 doctors trying to load the boot of a HEMS car..........
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Graham
@ChalkyLAA
we salute you for your 35 years of service to the
@NHSBartsHealth
@Ldn_Ambulance
@LDNairamb
. From the 100’s of doctors, paramedics and others who you have influenced and nurtured during an incredible career, and for the thousands of patients you’ve impacted.1/2
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We’re seeing patients who are truly ‘agonal’ from exsanguination on arrival, usually from stabbing. This often presents as a slowing PEA on the monitor with ST segment changes, and brady-agonal breathing. Ideally here, ultrasound probe on the groin immediately and go for 1/
@DrPeteLax
@ERC_resus
That’s correct, it changed. Personally, I would base the decision on the initial rhythm (indicating the vitality of the heart), rather than time - with blood going in. Would you agree?
@DrPeteLax
@gareth_grier
@karimbrohi
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Major ITU’s are managing through sheer grit. 2. You can’t measure capacity by numbers of beds. 3. Kidney rescue is next to ventilation in urgency of provisions. 4. You can’t just make loads of filters, coz they’re not vacuum cleaners. 5. No patient will be alone 6. We’ve never1/2
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So today we’re talking about what makes a first class HEMS team....... Twitter thoughts welcome.
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Truly delighted that Dane has been made a Professor of Prehospital Medical Education
@QMULBartsTheLon
An inspiration to us all
@LDNairamb
@NHSBartsHealth
@The_PCP
@PHMBSc
@PHMBSc_Alumni
and incredibly proud to work with her
@IofPHC
A great day for our specialty.
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It’s clear that at major incidents, emergency service personnel usually go to extraordinary lengths to do the right thing on the day. The limits of what individuals do are bound only by things that make us human and even then, people go the extra mile. The real opportunities 1/
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19
140
Good luck to all the
@Ldn_Ambulance
paramedics attending HEMS selection over the next couple of days. Biased but our paramedics are first class clinicians with awesome ambition, enthusiasm and drive. All the best everyone.
@LDNairamb
@HEMSRLH
@IofPHC
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6
138
Capture the moment. What is a world class HEMS handover? Focus on a case of a spinal injury, how would the patient want us to hand them over to the trauma team on the worst day of their lives? So many questions and loads of brilliant suggestions from the team 1/2
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7
137
When you’ve known the recipe you need to bake the cake for a long time, but then you are allowed to have the ingredients, and to finally turn the oven on. (Or something like that 😎). Thank you
@EHAAT_
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0
136
Shift over. Time to tell him. Never cruel enough to drag it out for long but couldn’t resist ‘how did it go today then?’. He said he enjoyed it!!! Anyway, an honour to sign off such a bright, keen, diligent & dedicated doctor who is a credit to everyone who has helped him.
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8
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Contemplating going back in. 😳😳😳 Amazing how bad circulating adrenaline can make you feel!
@laainthechannel
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4
137
Is there any way
@TowerHamletsNow
@MayorJohnBiggs
can help one of our nurses who spent a day (and extra time) looking after the most critically ill covid patients
@RoyalLondonHosp
get a refund of the £260 fee she paid when her car was impounded after she parked for her work?
7
36
135
Delighted to see David has started in his London HEMS role. It‘s been a long journey since he supported the courses
@IofPHC
ran years ago, and in securing two masters degrees!!
@PHMMSc
@TraumaMasters
A first class paramedic.
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1
134
Goodbye Dr Ryan, who played a vital role in recent tragic events.
@NHSBartsHealth
@LDNairamb
& London are proud of you. Safe trip back to Oz
1
17
135
Big week for
@LDNairamb
@NHSBartsHealth
- a trebling of consultant numbers for Prehospital Care will herald a new generation of innovation
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129
@SteveBarclay
@WeMakeAI
@MKHospital
@NHSEngland
Steve. This happens every time I need to move to a new computer. Never mind mobile penguins, let’s get the basics fit for the 20th century first.
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Listening to GD giving a talk I haven’t heard him give before. Reminded of the sheer depth of understanding that he has of prehospital care. Looking after, and exploiting the knowledge of people like this for the benefit of the next generation is an essential part of leadership.
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2/2 front line aren’t just doing their jobs and are indeed heroes. 5. If you’ve got a workstream focus on that and trust others to do theirs well. This is a mammoth task. 6. Respect the heavy pressure on colleagues 7. Don’t send what’s app messages at 5am about COVID. 2/3
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7
123
Thank you
@DocTomEvens
for everything you have done as a HEMS consultant
@RoyalLondonHosp
Special memories I’m sure of the patients you looked after and of the team. Warm wishes for your exciting new chapter.
@LDNairamb
@NHSBartsHealth
@HEMSRLH
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3
123
Proud to see the Physician Response Unit
@SkyNews
this morning. The jewel in the
@LDNairamb
crown during
#COVID
@NHSBartsHealth
@Ldn_Ambulance
@tonyjoy81
Great piece.
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18
123
I don’t understand how the 800 new ambulances will help. Is it because they’ll give an illusion to the voter that something is improving, or to free up cash so that trusts can recruit, retain, inspire, educate, and so on? (Can’t be?) I don’t think we’re actually short of trucks?
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5
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Restructuring / resignation at the top has pros and cons. Hopefully
@Ldn_Ambulance
can tap the massive reservoir of opportunity for advancing prehospital medical care, especially for critical care & major incidents. Huge medical / paramedic talent waiting for the tap to turn!
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5
121
Strange, and guiltily pleased not to be working NYE for the first time in around 30 yrs, if you count the
@stjohnambulance
treks to London pre / during med school! Happy New Year to everyone who is / isn’t working,
@nhs
and all the crucial services beyond!!
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0
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Chuffed to bits that my sister, (sister)
@CeriThomas1510
has been awarded a Cavell Star for her contribution to nursing. A superstar in many respects. Thanks to everyone at
@CwmTafMorgannwg
@CavellTrust
for making this happen, and for such lovely submissions.
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2
118
Wendy Chalk contributed so much over a long time. Her impact on paramedics & prehospital care is infinitely bigger than she’d accept credit for. Gutted for Graham. I hope he’ll feel the love & support of a very big HEMS/ air ambulance community. Rest proudly Wendy, and in peace.
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2 more assault deaths tonight breaking
@BBCNews
No words. Writing a talk about this for tomorrow and have had to change the numbers four times in two days. So sad.
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..and even messaging while racing from meeting to meeting is tricky. 10. We’ll be remembered by how we treated families, how we were kind, and how we helped the bereaved. This ⬇️ is from
@drbenswift
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112
Thanks to much Sharon, our
@LDNairamb
@NHSBartsHealth
lead HEMS paramedic for all your counsel, stamina, authenticity & leadership over the past 2.5 years. Like all the best architects you will watch while your hard work glistens. Hope you get some rest and come back shiny soon!
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Terrorism is hideous and heartbreaking, superlatives are inadequate. The same is true for the effects of knife crime. Energy and profile must be focussed on both. Because the effects on individuals and families is awful. Truly awful.
1
25
112
Thanks to
@mackenney
for everything done for London HEMS during secondment. What a star. The great news is that he’s part of
@PHMMSc
faculty, so the leash is quite short! We’re lucky to have fantastic doctors and paramedics, but secondment time goes quickly!
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0
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As ever the
@stjohnambulance
volunteers at
#LondonMarathon2019
impressive today. Such an essential organisation. Runners treated in the thousands. Volunteers who give millions of hours to help every year.
5
8
114
Really pleased that
@dr_michaelkim
has joined
@LDNairamb
Institute of Prehospital Care as our ‘Golden Hour Fellow’, helping us 1/
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8
111
Congrats to Chris and Stu, HEMS firecrew
@RoyalLondonHosp
for reaching their 22nd and 20th anniversaries of service. What a great service is has been. Thanks both!! And thanks for all your support with
@PHMBSc
@The_PCP
5
4
110
Listening to
@SkyNews
@BBCNews
reporting the injury load in London this weekend. A nod to the work that
@metpoliceuk
@Ldn_Ambulance
and others do at these awful scenes to battle to save the victims. A very busy weekend for
@LDNairamb
@NHSBartsHealth
prehospital teams alongside.
1
13
109
Full COVID PPE has such a big impact on team performance. ‘Aerosol generating procedures’ such as drug assisted intubation in very low risk patients in outdoor settings need a careful revisiting of PPE, the use of which can cause harm to the patient and the team- my view.
3
12
104
Congratulations to this one,
@BryonyDunne
on her promotion
@IofPHC
- head of institute delivery. Such a fab person and well deserved.
18
1
105
Hmm. At some point some months ago it seemed like a superb idea to enter the 15k version of
@Dock2DockSwim
It’s now tomorrow. The spa pool at the gym clearly doesn’t class as training. Size 8 tube, any laryngoscope, and one run at ECMO, for anyone who’s involved in the mop up.
11
0
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Thanks to Jan for his brill contribution to
@NHSBartsHealth
@LDNairamb
and for finishing off his 6months with us, by doing a fab time
#LondonMaratho2019
2
8
103
Thinking of the awfulness in
#Beirut
,those supporting the injured and the tragic loss of life. For those helping with the response, EMS and HEMS / trauma teams across the U.K. will be sending our most sincere thoughts.
0
9
103
The number of people on London trains with no masks is now crazy.
13
13
101
Good luck to all the
@Ldn_Ambulance
paramedics taking part in the
@LDNairamb
assessment day today. And thanks to our fabulous group of emeritus HEMS paramedics for all the help.
1
10
100
Thanks to the tenacity and hard work of our HEMS registrars we now have followup info on ~90% of
@LDNairamb
@NHSBartsHealth
patients at the time of the case review, vs ~ 5% before October. Making a major impact to our understanding. Thanks folks!
4
18
101
To everyone who every got ‘rained on’ by the hosepipe on one of our
@IofPHC
courses, today was the day when Mother Nature got her own back.
#soaked
#londonfloods
#londonrain
#properprehospitalcare
#performanceunderpressureandallthatjazz
#Lightning
#Thunderstorms
#soggyfacemasks
10
1
103
Thank you to all who work
@RoyalLondonHosp
Queen Elizabeth Family Support and Liaison team. Since January over 3000 calls to families of those who are critically ill with covid on the intensive care. Some of the most compassionate people I’ve ever worked with in the
@NHS
. It 1/2
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