Managing uncertainty and being prepared

It's 6 o'clock in the evening; you are leaving the surgery, as the wind begins to pick up, when you get a frantic call. An islander has tripped and fallen backwards off a small cliff onto the beach. They have injured their head, they cannot move and the tide is coming in. These are your patients and also your friends. You will be the only medic responding to the call.

In General practice, uncertainty is the name of the game; we never quite know what will walk through the door. Managing our patients can often mean making decisions alone followed by time at home spent wondering if we did the right thing. Life as an island doctor can bring with it uncertainty in the extreme.

Any doctor on call will relay, with disdain, the annoyance of the pager or bleep, but I can only imagine the adrenaline rush that must, at least in the early days, accompany a call from the Balfour hospital asking you to attend a situation on Hoy. Many calls will not prove as challenging, many will be solved with a simple remedy or reassurance but how do you cope with those that aren't? How do you deal with the unexpected? The consensus seems to be by being prepared...

Now the bag of dreams, as featured in my earlier scribblings, had style and class. What it did not have was...kit.

Every workman loves his tools and what a vast array of tools we, as medics, have accumulated in recent years. Saving a life is no easy business and there is a multi-layered double rucksack complete with defibrillator out there to prove it.

These amazing bags are designed and distributed throughout rural Scotland by the Sandpiper trust; a charity set up in the memory of Sandy Dickin who, unable to be reached in time by emergency services, died at the age of 14 following a tragic accident.

Doctors working in rural areas of Scotland, such as the islands, have the opportunity to be trained in using the equipment the bag contains as part of the BASICS course in immediate care. Through these fantastic tools and expert instruction, GPs serving isolated communities are being enabled to provide more effective and safer emergency care to their patients.

The patient on the beach was reached by her GP within 7 minutes; a volunteer ambulance crew and coastguard within an hour. She was in the CT scanner within 3 hours in a hospital 250 miles away. Needless to say, they made it off the sand before the tide came in.

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