I make clinical decisions at emergency incidents – and as a nurse I bring so much more

Pre-hospital emergency medicine consultant nurse Andy Thurgood on his challenging role

For many, the unspecified can be unnerving, but not for pre-hospital emergency medicine consultant nurse Andy Thurgood. ‘The unpredictability of emergency care sits within my comfort zone,’ he says. ‘Going into the unknown isn’t something that scares me, I actually like it – and emergencies are its definition.’

Having spent more than three decades nursing in his chosen specialty, Mr Thurgood’s achievements were professionally recognised last year when he became the first non-doctor in the UK to be accredited as a level 8 consultant in pre-hospital emergency medicine by the Faculty of Pre-Hospital Care, part of the Royal College of Surgeons of Edinburgh.

‘Only 33 people are recognised at this level and I’m the only one who isn’t a doctor,’ he says.

Empowered to make clinical decisions

In practice, this means he has the same autonomy in clinical decision-making as a consultant working in this field. ‘It’s probably a culmination of the past 20 years of my nursing career and formally underlines what I can do,’ explains Mr Thurgood.

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Initially, he felt the accreditation would make little difference to his work. ‘But a colleague very wisely said, "Think about those behind you who see the door kicked in." That’s enough reason for me,’ he says.

A wealth of experience in emergency care

After joining the army and becoming a paratrooper, Mr Thurgood qualified as a nurse with the Royal Army Medical Corps in 1989. He worked in a British Army field surgical team in Central America before joining the emergency department at Royal London Hospital.

He went on to work in various emergency departments across the West Midlands, and in the mid-1990s was one of a small group of nurses selected from the region to pioneer the MSc in advanced nursing practice at the University of Birmingham. He completed this in 1997, specialising in pre-hospital emergency care.

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His growing interest in pre-hospital emergency medicine led to a volunteer role with the West Midlands Central Accident Resuscitation Emergency (CARE) Team, a charitable organisation that responds to serious medical incidents across the West Midlands in support of the West Midlands Ambulance Service.

The team, which includes volunteer doctors, nurses, paramedics and other healthcare professionals, delivers enhanced clinical care to seriously ill and injured patients across the region, including those involved in complex road traffic collisions.

Complex nature of the role

‘In pre-hospital emergency care, not only do you have the undifferentiated patient to deal with but also the unquantified environment you’re working within, which adds an extra layer of complexity. I rise to that challenge and enjoy it,’ says Mr Thurgood, who is now deputy clinical director of the West Midlands CARE Team.

Other roles in his diverse career portfolio include medical director for West Midlands Fire Service, advanced clinical practitioner in emergency medicine at Wolverhampton’s New Cross Hospital, and medical director of Resuscitation Services UK.

Educating the public on responding to emergency incidents

In 2016, Mr Thurgood was one of four founding members of a new charity, Citizen Aid. ‘It came about because we recognised there was a need to inform the public about what to do if they were involved in an incident that resulted in multiple casualties,’ he says.

Launched in 2017, the charity offers an app, pocket guide and a set of slides. Already adopted by some NHS trusts, the free app offers advice for the public on what to do if they encounter a knife attacker, active shooter, acid burns, an explosion or unattended or suspicious items.

‘Initially our website crashed because we had so many people visiting it – a million hits a day,’ says Mr Thurgood, the charity’s managing director.

The unique skills that nurses can bring

While his professional achievements equal those of leading medics, nursing remains at the core of his approach. ‘It’s the defining feature of what I do,’ he says. ‘There have been many battles along the way and some people still don’t believe there is a place for nurses in pre-hospital care. But as nurses there are so many things we bring to the party.’

Among them is understanding the continuum of care. ‘I know what the patient’s journey will be like, through the emergency department, theatre, intensive care and high-dependency units. Having that insight adds a dynamic to your patient care.’

Making patients feel safe

Empathy is also key. ‘I joined a caring profession, and while a bit of what I do pre-hospital is quite medical in terms of process and procedure, the empathetic side is always there,’ says Mr Thurgood.

‘My nursing background expresses itself in the way I carry out those procedures. There is a care package I deliver to a patient who’s in trouble that makes them feel safe.’

But his work can take a heavy emotional toll. ‘You see the extremes of life and it can be distressing. There have been situations where I’ve needed to step back and settle for a few days, leaning into my colleagues, family and friends,’ he says.

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‘There’s also something different about seeing someone pre-hospital, compared with those who come in on a trolley. If you go out to someone in their home, you see the distress of the wife or husband.

‘I’ve been to cases where someone has died and, as you’re leaving, you pass the picture of them as a wedding couple and think, oh my gosh.’

Lynne Pearce is a health journalist