In the Shadow of the Ben Radiography in one of Europe's busiest mountain trauma centres Susan Stopforth Superintendent Radiographer Belford Hospital, Fort William Bezirkskrankenhaus Reutte Gilbert Bain Hospital, Shetland Belford Hospital, Fort William “RURAL GENERAL HOSPITAL” - Belford leader in promoting remote and rural medicine. - Concept of diagnosing and transferring patients efficiently and safely. - Combined Assessment Unit (CAU) - Day Case Surgery - Care in the Community LOCHABER Mountaineering Head Trauma -Avalanche Abdominal Trauma - Climbing 70,000-100,000 walkers per year Lochaber Mountain Rescue LMRT • Busiest mountain rescue team in UK. • Around 100 call-outs per year. • Approximately 40 members, with ages from early twenties to early sixties. • All members are unpaid volunteers. • Rely totally on voluntary donations. KAYAKING Posterior Shoulder Dislocation • Rare: 2 – 4% of all shoulder dislocations • Approximately half go undiagnosed on initial presentation. • In traumatic circumstances almost always caused by fall onto outstretched, internally rotated arm. Clinical Presentation • Patient usually presents with arm adducted and internally rotated. • Posterior bulge may be present and humeral head may be palpable below the acromion process. • Attempted abduction and external rotation are painful. Imaging Posterior Dislocation • AP Shoulder – Dislocation may be missed in 50% of cases as humeral head appears normally aligned with the glenoid. • Scapular “Y” view has been shown to be unreliable • Modified axial view preferable. Signs of Posterior Dislocation Posterior Dislocation Modified Axial Image Modified Axial Snowsports Mountain Biking IMAGING STATISTICS 4.5 Over 3 days 16 patients 4 were x-rayed. 3.5 3 2.5 Series1 Series2 12 examinations – 2 positive injury 1.5 1 0.5 6% of competitors had 0 shoulder wrist hand chest pelvis elbow lspine tspine CT head CT cspine CT abdo bony injury! scaphoid DR IMAGE - SCAPHOID # # 5th Metacarpal Shoulder clavicle Clavicle Humerus pelvis Chest Haematoma CHALLENGES • STAFFING • REPORTING A&E EXAMINATIONS • CONNECTION TO PACS • NETWORKING A&E REPORTING TIMES • NHS Highland up to 5 week wait for A&E plain film examinations to be reported! • Shortage of radiologists • Shortage of trained reporting radiographers • Reliance on batch reporting by Medica or recently remote agency reporting radiographers Why is this a problem now? • No orthopaedic/trauma specialists onsite • No radiologist onsite • Changes in consultant staff • Reliance on junior doctors, ANPs and radiographers The Solution??? • To have a reporting radiographer based on site:- • Report A&E examinations for Belford, Skye and beyond. • To be able to advise on best imaging practice as part of a multidisciplinary team. • To provide training opportunities. THANK YOU FOR LISTENING!.