The Prehospital Immediate Care and Trauma (PICT) Team is a prehospital care team which operates from Raigmore Hospital emergency department in Inverness, Scotland.^[1] It receives funding from NHS Highland, BASICS Scotland and the Scottish Trauma Network.^[2][3]

They are a stand-alone^{[clarification needed]} enhanced care team responding to trauma and other critical care incidents in Inverness and the Northwest Highlands, utilising a rapid response car. PICT comprises either a senior doctor from Raigmore Hospital or a rural GP, together with a Scottish Ambulance Service advanced practitioner in critical care.^[4]

In light of the sparsely distributed ambulance resources in the Highlands and the challenges of distance and weather in the north west of Scotland, PICT has a considerable remit beyond trauma, operating as a Community Emergency Medicine (CEM) service as well as a prehospital trauma team. PICT provides support to ambulance crews and community responders in medical emergencies, and also provides a "see and treat" service to patients in order to prevent transport and possible hospital admission for problems manageable at home. In this way PICT acts as a senior decision maker for prehospital clinicians across the North of Scotland.

The team was also the winner of the 2022 Highland Heroes awards in the category of Emergency Services.^[5]

PICT currently operates 12 hours per day, seven days a week across the Highlands and Moray.^[6][1][7] They respond to around 150 patients a month, attending a range of 999 calls, but being tasked to the most serious calls (major trauma, cardiac arrests etc).^[8] For comparison, MEDIC 1 in Edinburgh attended around 3 patients a month in the decade between 1980 and 1990,^[9] the Tayside Trauma Team (TTT) attends to 5.6 patients a month,^[10] Emergency Medical Retrieval Service teams attend 33 primary retrievals (prehopsital care patients) a month,^[11] while an individual BASICS Scotland volunteer responder may attend 2-3 calls a month.^[12]

† NHS Funded * Charity Funded

The PICT Team responds by land to major trauma (as an integrated part of the Scottish Trauma Network)^[13] and critically unwell patients in the Highlands of Scotland. The doctor on the PICT Care will also assume the role of the medical incident officer when required at a major incident. They work to standard operating procedures, and national clinical guidelines for best practice. The team currently responds in a Scottish Ambulance Service vehicle. The PICT Team have attended a variety of incidents, including aircraft crashes, road traffic collisions, stabbings, shootings and critically unwell patients.^[8][14]

When audited, it was found that the PICT Team were able to discharge on scene 22% of the cases they attended; 17% of their patients were paediatrics, and 39% were traumatic injuries.^{[citation needed]} This is due to the PICT Team including a senior doctor who is able to facilitate alternative care pathways or provide interventions in someone's home, such as access to prescription medications to allow them to avoid attending the hospital.^{[citation needed]}

In addition to providing senior decision making support, the PICT Team provide a number of clinical interventions which currently lie outwith the standard remit of a Scottish Ambulance Service paramedic,^[15][16] such as;

The administration of:

• ketamine, levobupivicaine (and intralipid if required), adenosine, magnesium sulfate, fentanyl or diamorphine.

Undertaking:

• Diagnostic and procedural ultrasound,^[17][18] wound closure, joint reduction, regional anaesthesia, sedation, pacing, cardioversion, thoracostomy (and drain insertion), mechanical CPR device deployment, amputation^[19] or surgical airway.^[20]

Facilitating:

• Onward referral
• Provision of prescription medications or a prescription for the patient to collect at a pharmacy
• Senior decision making

NHS Highland announced in early 2022 that they would defund the Inverness PICT Team, in steps which will leave the Highlands and Inverness without a seven-day physician-led enhanced care service.^[26][27] This led to the local MSP Sir Edward Mountain to campaign to save this prehospital resource from defunding.^[28]

Mountain stated that:

"This pioneering service is essential when responding to major trauma incidents across the Highlands – we simply cannot afford to lose it."^[28]

In 2023 the PICT Team secured ongoing funding as was able to recruit a permanent cohort of physicians.^{[citation needed]}

• Emergency Medical Retrieval Service
• Emergency medical services in the United Kingdom
• Air ambulances in the United Kingdom