The Pre-Hospital Underground and Novel Concepts Course (PUNCC)

This course was first designed by the team in 2017. Our team encounters a significant number of patients who have been struck by trains, usually on the underground system. There are many specific aspects of safety, procedure and clinical technical skill that are required if our clinicians are to work effectively and safety to help these very badly injured patients.Patients hit by trains (so called ‘one-unders’) are unfortunately often very badly injured. They have injuries to multiple body regions including major limb amputations, significant torso injury, and major head injury. They pose an enormous challenge for the emergency services and our teams usually climb, and crawl under the train itself to help retrieve the patient. In addition to this, many patients will receive interventions such as blood transfusion, REBOA, and thoracotomy, all within the challenging conditions of the train platform.

We couple the learning about ‘one-unders’ with the introduction into practice of novel concepts that our senior team have developed. The Novel Concepts part of the course (day two) therefore allows our team to practice new skills, rehearse new ideas, and simulate new activities as a team.

We recognise that many of those who are injured by trains are at a devastating time in their lives, and unfortunately decide to take their own lives. Organisations such as The Samaritans can help people during these very difficult times. 


                                                      Crucial teaching and learning on the 2019 PUNCC


Attending a 'one under' on the 2020 PUNCC