New national training programme takes enhanced A&E skills out to patients


People who suffer life-threatening injuries will benefit by being treated by a new type of doctor specialising in critical care in the out-of-hospital environment, thanks to a partnership between Cambridge University Hospitals (CUH) and medical charity Magpas Helimedix.

Pre-hospital emergency medicine (PHEM) develops and enhances the skills of A&E doctors based at Addenbrooke’s and across the country, and those of paramedics experienced in working in challenging environmental and hazardous conditions.

Despite a long history of physician-based pre-hospital care in the UK, especially in the East of England, doctors have been providing PHEM mostly on a voluntary and ad hoc basis, with a variable level of care.

CUH, in partnership with Magpas and the Edinburgh-based Faculty of Pre-hospital Care, has now piloted specialist training programmes.

The PHEM training model focuses on caring for seriously ill or injured patients in urban, rural, or remote settings before they reach hospital, and during emergency transfer to hospital or between hospitals, and in support of the NHS ambulance services and air ambulance charities.

Just like a doctor can become a consultant in gastroenterology or orthopaedic surgery, doctors who are consultants in a specialty that focuses on very unwell patients will also be able to specialise in pre-hospital emergency medicine and provide out-of-hospital support for seriously sick patients.

Pre-hospital emergency medicine is the first new medical sub-specialty to be approved by the General Medical Council in several years.

The charity funded training is provided by Magpas, supported by CUH emergency department (ED) consultants. Nick Foster, one of the CUH ED doctors, was the first national trainee and started in post in the East of England in August 2012. He will finish his training in July this year.  There is a now a national recruitment into this sub speciality with 14 places available from August 2014.
The PHEM training course is the brainchild of Dr Roderick Mackenzie, consultant in emergency medicine, CUH Major Trauma Centre director, and Dr Simon Lewis, CUH ED consultant and East of England Regional Training Programme Director. Dr Robert Major, CUH ED consultant, is chair of the department of pre-hospital and retrieval medicine. All three are also Magpas doctors.

Dr Roderick Mackenzie said:

“I don’t define my specialty by bricks and mortar, by the boundaries of the emergency department. Emergency care is a process, not a place. It’s really important to me to understand and be able to influence what happens to people before they get to the emergency department. I can’t necessarily do everything I could do for them if they arrive in a poor condition or they arrive without having had optimal care in the pre hospital phase.

“Pre-hospital emergency medicine is a natural extension of emergency medicine. Instead of waiting for people to come we reach out and we either go to them to help them get to us or we support the services that go to them.

“Addenbrooke’s has really grasped that principle and understood that if we can optimise the care of patients before they get to us then actually they do better here and they spend less time in hospital. There is a powerful clinical and economic argument for providing optimal care from the moment someone is injured, rather just waiting until they arrive at a particular hospital.

“CUH has a long historical association with pre-hospital services around the region, and, with Magpas, has developed the new department of pre-hospital emergency medicine. And we have formed really close working relationships with the charity sector to provide the training, the training infrastructure, the consultant level supervision and practice to support the service.”

CUH continues to work closely with Magpas and other pre-hospital charities to further develop specialist training programmes and innovative ways of providing high quality pre-hospital care.


•       CUH has been at the forefront of PHEM service development and training for many years. The Trust have, in partnership with the Faculty of Pre-hospital Care and the emergency medical charity Magpas Helimedix, piloted specialist training programmes and supported the creation of a new Intercollegiate Board for Training in Pre-hospital Emergency Medicine (

•       The General Medical Council formally recognised PHEM as a new medical sub-specialty of Emergency Medicine and Anaesthetics in July 2011 and of Acute Medicine and Intensive Care Medicine in October 2013. This is the first new medical sub-specialty to be approved by the GMC in several years.

•       CUH was the first region in the UK to commence a formal GMC approved sub-specialty training programme in PHEM in August 2012. There are now five similar programmes across the UK with 14 trainees in post (more programmes are planned). The future aim is that each Ambulance Service area of the UK can access specialist PHEM consultants 24/7 to support the care of the sickest and most seriously injured patients and to facilitate emergency transfers.

•       Ten CUH Consultants currently have a sub-specialist interest in PHEM and the Trust has supported the development of a new Department of Pre-hospital and Retrieval Medicine (formed in 2012) to provide a focal point for the future development of PHEM services.

•       BBC Inside Out East has filmed in CUH ED and with Magpas

•       Collaboration between the Trust and Magpas Helimedix has, for example, allowed CUH to pilot a very successful Major Trauma Outreach Service (where a medical team from the Trust deploy to other hospitals in the region to support the transfer of patients to Addenbrooke’s).


For further information, please contact Adrian Ient, Media Relations Manager,
Communications Department, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ
Tel: 01223 274433 Email:


Cambridge University Hospitals is one of the largest and best known trusts in the country. As the local hospital for our community we deliver care through Addenbrooke’s and the Rosie hospitals.

Cambridge University Hospitals NHS Foundation Trust