Plymouth Medical Society

Founded 1794
Presentations to the PMS 2017-8 season


Minutes of  Plymouth Medical Society Meeting:

Friday 27th October 2017
Presidential Address, Mr Robert Jeffery
Lament for the Blue Cedar

We were delighted to give Robert a warm welcome for his President’s Address, in which he discussed the way in which the hospital environment has evolved over his years in Plymouth.  After some introductory comments about the changes in the constitution of the society, he introduced the programme for the year.

He introduced the talk with his poem, Lament for the Blue Cedar, based on Robert Burns’ Address to the Haggis, which refers to the magnificent tree which was in front of the hospital.  

Farewell you proud majestic Cedar
Great Chieftain of the parkland deer,
In recent years you pardoned Derriford’s austere and façade and comforted her.  
Well are ye worthy of a tear bitter as myrrh.

The tree provided many moments of comfort to Robert whilst working in the Hospital, and has also been a measure of the way the surroundings of the hospital has changed.  He showed paintings of Greenbank Hospital painted by Chris Robinson, and Freedom fields, painted by Robert Jones.  
We learnt much of the history of the site at Derriford.  The land was purchased  in 1946 for the purpose of the building a hospital.  He highlighted an arboretum that was on the land.  This has suffered a fate of removal in stages over the years.   
He showed historic pictures of the environment of the hospital through the last 4 decades, and how trees have been removed over this period.  He showed a picture of the hospital after the Terence Lewis building was constructed, with a substantial copse to the northwest, which was felled to make a new entrance, which never materialised.  
He then highlighted how the decision made in this instance made him feel like a powerless employee, rather than part of a shared community.  He was able to find many others who were upset by these changes and formed a group to promote a sustainable environment.  There is a need to involve more people to arrive at decisions made in a sensitive manner, and this became the Environment Group with formal Terms of Reference.  
The group would have responsibility to consult and advise, and report to the executive of the hospital.  The group consists of 8 members, 4 of which are staff, and 4 non staff public members.  The first meeting was in July 2015, with the terms of reference  approved by the group on 1in September, and then the terms of reference approved by the tTrust on 30in November.  Hot of the heels ofJust before this, the trust Group was informed of the details of plans for a bus interchange scheme, with huge implications for the site at Derriford, and with about 629 days to submit any comments to the planning authority.  The planning process is now difficult to negotiate to Despite over 100 people submittedplace objections, and in this application 56 trees were ear marked to fellingthe scheme measuring 0.98 hectares, it was not considered “large or controversial, and was passed under delegated powers, without referral to the council’s Planning Committee.  There was little opportunity to discuss the plans, and the 56 trees were felled with no effective discussion, including the iconic cedar and monkey puzzle trees.  
The group did not like what was done, and even less the way in which it was done.  The group now meets with the trust management to discuss proposals and at least this gives the opportunity to discuss  options available.  The group has had some success in preserving trees on the hospital site.  

He then talked about the Royal Oak trees outside the maternity block.  The expansive oaks that we see are not in their natural state, as the wild habitat would have many oak trees, competing to reach the canopy, and would not live to the age of the solitary oaks seen here.  

The current architecture of the buildings and current trees do provide constraints of the possibilities of flow of traffic.

The garden within the Terence Lewis building is now under threat due to the plans for the MIR scanner.  More diagnostic facilities are required to achieve the efficient flow of patients within the acute unit, and there is continuing on going pressure for space, which has to be balanced with the need to preserve the safe spaces for plants, trees, and garden space.  

Robert has worked with Anne James, the chief executive to achieve a dialogue on how these competing demands can be met.  Flow of traffic important in achieving realistic access to services, and for the safety of pedestrians within the grounds around the hospital.  

Robert conceded that the environmental group has lost most of their battles, but had gained some significant improvements to plans in progress.  

We are grateful to Robert for providing this interesting insight into the processes around the management of the site.

The meeting was attended by 31 members, 16 guests, 24 for dinner.


A British Hospital Ship at War by Nicci Pugh

This entertaining and lively presentation detailed the creation of the first hospital ship of its kind from a P&O Cruise Liner during the Falklands War.

The Falkland Islands are one of the most inhospitable of their kind lying many thousands of miles from any medical facilities, windswept and treeless in the South Atlantic Ocean.
The cruise ship conversion started with the addition of a steel helicopter landing pad in the port of Gibraltar and then, with its fitters still aboard busy creating wards, ambulance bays and an operating theatre amidst the luxurious interior, she set off to sea on her unique mission.

Aboard, was a full medical team, preparing to deal with any emergency of warfare efficiently and promptly, despite the hostile conditions of the surrounding seas, often so ferocious, that equipment had to be strapped down to stop it all sliding across the floor.
Liaison between the crew on the bridge and the theatre allowed the operating team to be forewarned when the weather was so severe, that operating had to be halted.
Patients were brought to the hospital ship by helicopter, carried in on their stretchers, which fitted onto the operating theatre table, thus avoiding any need for transfers.
There was an ITU ward, which cared for the most serious injuries, including extensive burns, gunshot injuries and trench foot. 40 nurses in all made up the team.
Ship ambulances were invaluable in the repatriation of patients.   

All refuelling had to take place at sea and took considerable skill.
Painted white all over with prominent red crosses, Uganda was the first British hospital ship in history to take casualties direct from the battlefield by helicopter.

This fascinating story is expertly told in the publication, White Ship + Red Crosses, A Nursing Memoir of The Falklands War by Nicci Pugh, now into its third edition.

Dr Susan Overal
1st December 2017


Minutes of Plymouth Medical Society Meeting:

Friday 10th November 2017

James Metcalfe, with the Tavistock team
Dartmoor Search and Rescue

We were delighted to welcome Mr James Metcalfe, who is part of the orthopaedic team at Derriford, with members of the Tavistock Dartmoor Search and Rescue Team, who gave a fascinating talk on the work of the team and their work.  

James arrived under cover of dimmed lights, and introduced the talk with a picture of Dartmoor, illustrating that the environment is stunning on a clear day, but under bad conditions or at night time is a hazardous place to be.  Other members who arrived with their head torches in action followed him.  His first header was to describe who in in the team, what they do, and how they do it.
The team is part of the Mountain Rescue Council, and the Tavistock team is in the PenMaCRA region, which is the Peninsula Mountain and Cave Rescue Association.  The team is 40 strong, with 3 search dogs, with an age range of 18 to 71.  The base is in Abbey Rise in Tavistock.  The duties of the team are to find lost persons, to get them to a place of safety after any required first aid, and to cover events on the moors, including the Ten Tors, and to talk to groups about mountain safety.  
Josephine then talked about the core skills required in the team members.  Navigation was first on her list.  The moor is 360 square miles, and in places does not have many features.  The training includes observation of micro features, which enable members to accurately to identify location.  The team uses GPS and phone signal, but these cannot be relied upon, and therefore accurate navigation skills are essential.  Often foot paths are not accurately represented on maps, so there is no substitute for local knowledge.  
James Grant then followed, giving a review of the IT aspects of the work of the team.  He is responsible for the command, control and communications briefings.  
The Police will be the first point of contact with the public should there be any concerns about a missing person.  They will take a view on the need to contact the search and rescue team.  The police will need to know how thoroughly the area has been searched.  The control of the search is conducted by a van that becomes the hub for the search.  The vehicle has a number of aerials on the van, and he showed a picture of the inside of the van, which has a number of workstations.  
The software used in the management of incidents is called SARCALL, which co-ordinates the search information.  SARLOC is software that can locate a missing person, provided that they have a mobile phone, are within a signal are, and wish to be found.  Despondent persons often initially do not wish to be found, but may feel differently once the exposure to the elements takes hold.  James illustrated the challenges by reviewing a search in the Lake District.  
He showed pictures of the VHF hand held radios used by the teams, which are vital for the communications of the teams.  One of the radios used automatically transmits the location every 2-3 minutes.  

James Metcalfe then talked about the First Aid and casualty care required in the field.  He showed the variety of splints used, and insulation blankets.  The teams carry oxygen and entonox.  He detailed the training required of volunteers, and the attachment begins with 6 weeks probation, and then onto to 6-12 months of weekly training.  

We then heard from Kathryn about the dog training.  Dogs are very valuable, as they can be equivalent to 10 people searching and area.  The majority are Collies, as these have the characteristics required.  The dogs are all part of the family who care for them.  The dogs can be trained by the use of a squeaky toy, and some will need food rewards.  The training starts with an essential obedience test, and safety with stock.  The dog is then trained to return to the handler when the casualty has been located.  The next step is to train the handler to search the area which has been identified.  The dog and handler are then taken through more complex tasks.  Kathryn showed a picture of an assessment in the Lake District, and in the Brecon Beacons.  The dogs need to be comfortable around and in helicopters.  Local training takes place on Sunday, and there are national training weekends, which allow meeting and sharing with the wider network.
Neil Richards then took the stand, and talked about his role in Off Road Driver Training.  The vehicles are an expensive asset for the teams, and need to be treated with respect and care.  
James Metcalfe then talked about swift water rescue, and showed a short clip of the Erme in full flow in Ivybridge.  Getting across a fast flowing river is demanding, and requires training for the teams.  There is training in river searching, and getting casualties across fast water.  
Fundraising is a vital part of the work, and is an opportunity for teamwork, and there are regular events in the calendar.  
James described the process when a call is received, and the organisation of the team.  He showed some slides of rescue training, and the use of the waterproof weather protection.  Sometimes helicopters are available, but 90% of the time carrying is the means of recovery.  
The team was involved in Haldon Hill when the snowfall brought the A38 to a standstill, and went to York to assist in the flooding last year.  
The flooding paralysed the communications in the city, and the radio communications that the team had were invaluable.  There were difficulties with elderly people who had become isolated as a result of the flooding.   
The members’ commitment is 12 months of training to become badged, a minimum of 18 training days per year, and 24/7 on call year round.  There about 30 call outs per year, and James gave a list of some of the calls that they have had.  
The meeting was attended by 28 members, 18 guests, and 19 stayed for dinner.
We are most grateful to James and his team for an interesting talk on the valuable work done by the Dartmoor Teams.