PATRICK A. NEE FRCS, FRCP, FRCEM, FFICM

Visiting Professor of Emergency Medicine, Liverpool John Moores University
Consultant in Emergency Medicine and Critical Care Medicine, Whiston Hospital, Merseyside

Correspondence Address:
76 Gartside Street
Manchester
M3 3EL

Tel: 0161 835 3692

Email: patricknee@btconnect.com

GMC Registration No 2616405
Full: 1st August 1983
(Revalidated:2013)

Practice Manager: Christine Bailey

Tel/Fax: 0161 835 3692 (mobile: 07891 949980)

Email: patricknee@btconnect.com

Consulting rooms at:

76 Gartside Street, Manchester, M3 3EL

75 Rodney Street, Liverpool L1 9EX

81 Harborne Road, Birmingham, B15 3HG

22 Harley Street, London, W1G 9PL.

 

  1. Visiting Professor of Emergency Medicine, Liverpool John Moores University.
  2. Consultant in Emergency Medicine and Critical Care Medicine at Whiston Hospital, Merseyside, since January 1994.
  3. Honorary Clinical Lecturer, University of Liverpool.
  4. Fellow of the Royal College of Surgeons in Edinburgh.
  5. Fellow of the Royal College of Physicians of the United Kingdom.
  6. Fellow of the Royal College of Emergency Medicine.
  7. Fellow of the Faculty of Intensive Care Medicine.
  8. Member, National Institute for Health and Clinical Excellence. Clinical Guideline Development Group. Reported as Acutely ill Patients in Hospital, 2007.
  9. Member; Review Advisory Group, Emergency Medicine Journal.
  10. Member; Clinical Advisory Group (Acute Care and Surgery), Trauma Care in England. Department of Health 2009-10.
  11. Founding Faculty Member; Intercollegiate Faculty of Intensive Care Medicine, 2010-.
  12. Author of numerous articles published in the peer reviewed medical journals.
  13. Member NICE Guideline Development Group on IV Fluid Therapy 2011-13.
  14. Qualified instructor in advanced life support, advanced paediatric life support and advanced trauma life support.
  15. Former Chair, North West Regional Board, College of Emergency Medicine
  16. Former Member of Council, College of Emergency Medicine.
  17. Former Programme Director for Higher Specialist Training in Emergency Medicine (Mersey Deanery).
  18. Former Examiner for the Membership Examination in Accident & Emergency Medicine at the Royal College of Surgeons in Edinburgh and for the Speciality Examination in Emergency Medicine.
  19. Former Examiner – UK and European Diplomas in Intensive Care Medicine and The Fellowship Examination in Emergency Medicine.
  20. Special interest in the pathophysiology of injury, injury mechanisms, injury control and the immediate care and clinical management of injured patients.
  21. Special interest in the resuscitation, immediate care and clinical management of critically ill adults and children.
  22. Comprehensive experience in the management of the full range of emergency presentations, including carbon monoxide poisoning, infections, sepsis, orthopaedic, neurological, cardio-respiratory, gastro-intestinal and uro-gynaecological emergencies.
  23. Special interest in the biomechanics of whiplash injury, energy transfer and the crash and human related factors that promote and protect against injury in vehicle occupants.
  24. Familiar with the published literature on personal injury and the LVI defence (see below).
  25. Equality and Diversity Training (NHS) 2012.
  26. Certified Seminar on Clinical Negligence, October 2013.
  27. First tier medical expert, APIL 2013.
  28. Bond Solon Expert Witness Training on Civil Procedure Rules (CertMR Part 1), June 2011 and Whiplash Associated Disorder Module (CertMR Part 2), June 2013.
  29. Registered A&E Consultant on Medco in respect of the MOJ's protocol for low value personal injury claims in road traffic accidents.

LVI CASES

  1. In my clinical practice in the NHS I see and treat hundreds of patients with whiplash injuries of all grades of severity each year. My department also runs a daily review clinic in which eligible patients are monitored to recovery, enabling an assessment of disease trajectory in soft tissue injuries.
  2. In medico-legal practice, approximately one third of my instructions are concerned with low velocity impact (LVI) cases. The majority originate from claimants’ representatives although I have also been instructed by defendants’ representatives and as agreed joint expert.
  3. I have conducted a comprehensive literature search on the issue of whiplash injury and the low speed defence. My literature review is appended to every report to the Court in which LVI is raised as an issue, and I have published on the topic.
  4. I am aware of the arguments on both sides in respect of the low speed defence and I am well used to assisting the Court with the interpretation of the range of professional opinion.
  5. I believe that I am the most widely instructed medical expert in the field and I assist other experts in the provision of reports. I have assisted the Court on numerous occasions where the defendant has sought to refute causation based upon engineering considerations, such as the extent of vehicle damage. My evidence in the Birmingham County Court was found to be “balanced and careful” in the judgment of Mr. Recorder Denniss.

CLINICAL NEGLIGENCE

  1. I am frequently instructed by both claimant and defendant organisations to advise the Court in cases of alleged clinical negligence. My instructions relate, in the main, to treatment in (Accident and) Emergency Departments in all parts of the UK. I also have experience in general medical and surgical matters as well as 20 years as an accredited intensive care (ICU) consultant. I have addressed four national conferences on the subject of clinical negligence in the emergency care setting as an invited speaker.
  2. ORIGINAL RESEARCH

    GCP Training updated, 2014

    1. First UK-based Emergency Physician to publish original research in the world’s leading EM journal (Ann Emerg Med 1994; 24(5):944-46).
    2. Lead investigator on effect on oxygen transport of transfused RBC in critical illness (presented at WFSCICM, Florence 2009).
    3. Portfolio studies
      1. CRASH study; Steroids in Head Injury. Published 2004 (Contributor)
      2. 3CPO study. NIV in Cardiogenic Pulmonary Oedema. Published 2008 (Contributor)
      3. TRACMAN study. Early Versus Late Tracheostomy in ICU. Reported 2009 (Contributor).
      4. Intravenous Paracetamol in Femoral Neck Fractures 2008/9. (Co-investigator).
      5. ProMISe study. Validation Study of Early Goal-Directed Therapy in Emerging Septic Shock. July 2010-2014. (CLRN Lead investigator).
    4. Chair; INTERFACE Research Group, Mersey Deanery 2012-

    CURRICULUM DESIGN

    1. Author. Acute Care Module. MBChB University of Liverpool
    2. Redesigned the new Curriculum and training programme for higher trainees in EM (Mersey Deanery) 2004-
    3. Contributor. MCEM and FRCEM curricula. College of Emergency Medicine.
    4. Contributor, FFICM examination (OSCE group). Faculty of Intensive Care Medicine.

    TEACHING AND TRAINING

    1. Author: Acute Care Module (Final MB ChB Liverpool).
    2. Supervisor; MSc Advanced Healthcare Practice. LJMU 1996-8.
    3. Supervisor; MSc Transfusion Science. University of Manchester 2009.
    4. Liverpool University Undergraduate examinations, MBChB; OSCE, LOCAS.
    5. Former Programme Director and STC Chair, Mersey Deanery.
    6. Examiner, Royal College of Surgeons of Edinburgh (MRCS, FRCSEd [A&E]).
    7. Examiner, Specialty Examination in Emergency Medicine (FRCEM).
    8. ALS, ATLS, APLS, ALERT, CCrISP instructor.
    9. Founding Faculty, UK Emergency Airway Course.
    10. Faculty, North American Emergency Airway Course.
    11. Lectures and presentations: London 2005, Chicago 2006, London 2006 (Feb), Boston 2006 (May), Stockholm 2006 (Oct), Birmingham 2008, Florence 2009 (poster).
    12. Author of one book and contributed chapters to three others.
    13. Appraiser; BMJ Point of Care update Shock. 2012.
    14. Reviewer, Emergency Medicine Journal.
    15. Reviewer, European Journal of Emergency Medicine.

    PUBLICATIONS since 2000

    1. Cunningham K, Brown TD, Gradwell E, Nee PA. Airbag associated fatal head injury:
      Case report and review of the literature on airbag injuries. Journal of Accident & Emergency Medicine 2000:17:139-142.
    2. Nee P. A. Why do children vomit after head injury? Emerg Med J 2001; 18(3):234.
    3. Nee PA and Griffiths RD. Ethical considerations in accident and emergency research. Emerg Med J 2002;19(5):423-7.
    4. Nee P. A. Serving by standing. Emerg Med J 2005:(4):suppl 1-2.
    5. Nee PA, Andrews F, Rivers. Critical care in the Emergency Department: Introduction, Emerg Med J 2006 23 (7): 560.
    6. Al-Jubouri MA, Inkster GD, Nee PA and Andrews FJ. Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia. Ann Clin Biochem 2006;43(4):323-5.
    7. Nee P. A. Critical care in the emergency department: severe sepsis and septic shock. Emerg Med J; 2006. 23(9):713-7.
    8. Nee PA, Benger J, Walls RM. Airway Management: Emerg Med J 2008; 25(2):98-102
    9. Influence of a previous neck sprain on recovery after a whiplash injury. Nee PA. Injury, International Journal of the Care of the Injured, (2008), 39, 1442-1443
    10. Mittal R, Vermani E, Tweedie I and Nee PA.Critical care in the emergency department: traumatic brain injury. Emerg Med J 2009;26:513-17
    11. Nee PA, Al-Jubouri MA, Gray AJ, O’Donnell C and Strong D. Critical care in the emergency department: Acute respiratory failure. Emerg Med J 2010 (accepted for publication)
    12. Nee PA, Bonney SC, Madden P and Overfield J. Transfusion of stored red blood cells in critical illness: impact on tissue oxygenation. Journal of the Intensive Care Society 2010;11(4):240-44
    13. Nee PA and Rivers E. The end of the line for the Surviving Sepsis Campaign, but not for early goal-directed therapy. Emerg Med J 2011; 28(1):3-4
    14. Mahambrey T, Pendrey K, Nee A, Bonney S and Nee PA. Critical Care in the Emergency Department; Massive Haemorrhage in Trauma. EMJ 2012 (on line first 10.2.12)
    15. Lowsby R, Gomes C, Jarman I and Nee PA. Lymphopenia as a predictor of bacteraemia in the emergency department (Poster). 34th International Symposium on Intensive Care and Emergency Medicine, Brussels. 18-21 March 2014
    16. Lowsby R, Gomes C, Jarman I, Lisboa P, Nee PA et al Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department Emerg Med J doi:10.1136/emermed-2014-204071. Published 2nd September 2014
    17. Rehnberg JV, Nee, PA. Vasopressin, steroids and epinephrine and neurologically favourable survival after in-hospital cardiac arrest. Journal of the Intensive Care Society. 2015; 16:77-79
    18. Nee PA, Bailey DJ, Todd V, Wootten AE, Sim KJ and Lewington AJ. Critical Care in the Emergency Department: Acute Kidney Injury. Emerg Med J (2015). Accepted for publication.

    BOOK:

    The Primary Care of the Injured Hand.
    Wilson G.R., Nee P.A., Watson J.S,
    Oxford University Press 1997

    CHAPTERS:

    Manual of Emergency Airway Management (third edition)
    The Geriatric Patient. Nee PA and Birnbaumer DM
    Lippincott, Williams & Wilkins 2008

    International Textbook of Emergency Medicine (First edition)
    Airway Management. Nee PA and Benger J
    Lippincott, Williams & Wilkins 2012

    ON-LINE PUBLICATIONS

    1. The duties of the medical expert and limitations of the medical evidence. Nee PA. Personal Injury Brief Update Law Journal.
      http://www.pibriefupdate.com/mags/20060717/article10.php
    2. Update on low speed impact medical literature. Nee PA. Personal Injury Brief Update Law Journal
      http://www.pibriefupdate.com/mags/20060605/article12.php
    3. Bunketorp et al. Proceedings of the International IRCOBI Conference, Gratz (Austria), Sept 2004: 245 –256. Review. Nee PA. Personal Injury Brief Update Law Journal
      http://www.pibriefupdate.com/mags/20060822/article10.php
    4. Critical Appraisal. Nee PA. Personal Injury Brief Update Law Journal
      http://www.pibriefupdate.com/mags/20061019/contents.php
    5. The influence of a previous neck sprain on recovery from whiplash injury. Injury, Int. J. Care Injured (2008) 39, 1442-1443 http://www.sciencedirect.com/science/article/pii/S0020138308001381

    MULTI-DISCIPLINARY LECTURES AND PRESENTATIONS since 2000

    1. Evaluation of guidelines for the empiric treatment of community acquired pneumonia. International Federation of Emergency Medicine hosted by American College of Emergency Physicians Boston, USA 4-7 May 2000.
    2. Care of the Unconscious Patient. Royal Society of Medicine, London 27 June 2003.
    3. The first four hours; early goal-directed therapy in the ED, London 11 April 2004.
    4. Delivering acute medical care-problems and solutions. York 5 November 2004.
    5. The Airway Course: Surgical airway. Chicago, USA 21 October 2005, Boston, USA, May 2006, Atlanta, USA. 15 November 2007. Rescue devices: Atlanta 2009, Boston 2010. Chicago 2011, Las Vegas 2011
    6. Chair of session; Sepsis. Annual Scientific Conference of the College of Emergency Medicine. Royal College of Surgeons, Edinburgh,
      25 November 2005.
    7. Implementation of the Surviving Sepsis Campaign. Cheshire and Merseyside Critical Care Network, Daresbury Park 29 March 2006.
    8. Sepsis. Royal College of Physicians (UK) teach-in. Liverpool Medical Institute 4 September 2006.
    9. Surviving Sepsis Campaign. Karolinska Institute, Stockholm, Sweden 28 October 2006.
    10. ICU admission: when is it futile? EMTA Annual Scientific meeting 8 Nov 2008 Birmingham, UK.
    11. The effect of transfused red cells on tissue oxygenation in critically ill patients (poster). World Federation of Societies of Intensive and Critical Care Medicine. Florence, Italy 31.8.2009
    12. Evidence-based treatment of severe sepsis. Second National Congress on Emergency Medicine. London, 15 January 2010
    13. Which patients benefit from ICU admission? Mersey Regional Advanced ICU Seminar. Liverpool. 5 March 2010
    14. Patient Selection for ICU admission. CEM CPD event, Kings Fund, London 22 April 2010
    15. Respiratory Failure in the Resuscitation Room. College of Emergency Medicine, London. 5 May 2010
    16. What’s new in volume resuscitation and replacement? British Trauma Society. Manchester. 5 May 2011
    17. Being Wrong: The Impossibility of Perfection. International Federation of Emergency Medicine. Symposium on quality and Safety in Emergency care. British Museum, London. 16 November 2012
    18. The Medical Expert. Expert Witness Conference. The Law Society, London. 30 November 2012.
    19. Complex Casualties. The Leeds Conference 23 May 2013. 7 Solicitors LLP.
    20. Medico-Legal Issues in Accident and Emergency Care: Current standards for stroke care in Accident and Emergency. London. 22nd January, 2015

Consultant in Emergency & Critical Care Medicine




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