Volume 31 No. 1
February 2016
DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS
In this issue A Revolution to Support Clinicians developing Future Practice Clinical Scores - How Good Are They? Newsline
Focus on creating and maintaining optimised crew rosters
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CONTENTS
CONTENTS 4
EDITOR’S COMMENT
6
FEATURES
6 A Revolution to Support Clinicians developing Future Practice
Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street SWANLEY BR8 8BQ ADVERTISING & CIRCULATION: Media Publishing Company
9 Clincial Scores for Predicting Recurrence after Transient Ischemic Attack or Stroke - How Good Are They?
16
Environment Shapes our Care
Media House, 48 High Street SWANLEY, Kent, BR8 8BQ Tel: 01322 660434 Fax: 01322 666539 E: info@mediapublishingcompany.com www.ambulanceukonline.com PUBLISHED BI-MONTHLY:
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IN PERSON
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Rostering insight and technology for ambulance services With many Ambulance Trusts facing staffing shortages, rationalising rosters and ensuring they are closely aligned to demand is essential. Working Time Solutions use accurate demand data, expert insight and powerful specialist software to create and manage optimised rosters.
The views and opinions expressed in this issue are not necessarily those of the Publisher, the Editors or Media Publishing Company. Next Issue April 2016 Subscription Information – February 2016
Through a combination of consultancy, technology and engagement, we help design, implement and maintain demand-led crewing patterns that reduce private ambulance costs, help tackle overworking and ensure high service standards are maintained.
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Our work with London Ambulance Service to rationalise its rosters was able to create significant cost savings by releasing thousands more hours from the same core workforce.
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The visual, interactive elements of our rota design software enabled crews to co-create their rosters, encouraging deep engagement and high levels of satisfaction with the change process.
The roster management and self-service elements of our software also make it easy to administer shift swaps and holidays, whilst providing a single view over working time that is essential to strategic planning and compliance monitoring. Crucially, Working Time Solutions’ experienced consultants will be with you every step of the way, from advising on project planning and roster design through to facilitating effective employee engagement and providing ongoing insight and support.
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This tool can also help improve the wellbeing and work-life balance needs of Paramedics, supporting a Trusts’ recruitment and retention efforts without adding complexity or compromising service-levels.
Rest of the World:
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EDITOR’S COMMENT
EDITOR’S COMMENT Welcome to this issue of AUK and best wishes for the coming year from all of the team. So, the wrapping paper is filling the bins and a million used Christmas trees are waiting for the re-cycling collection, the NHS had a busy winter and many of you would have spent much of the holiday queuing in A&E. Whilst a happy (and expensive!) time, it does seem that each year has its share of tragic stories, from the unexpected death of colleagues, the sad loss of life of those for whom Christmas is not so happy to the heart wrenching tales of child and family incidents which litter the papers. This year Cumbria and the North of England suffered perhaps the most and Christmas 2015 will not doubt hold sad memories for many. As we move into the new year our thoughts are with all those people but also with the attending ambulance staff who also share the burden of sadness despite their valuable and tireless efforts to assist.
AMBULANCE UK - FEBRUARY
“Despite some excellent effort from the CoP, HEE and others, the Commission on Human Medicines was unable to recommend IP for the Profession.”
I’m somewhat fatalistic in that whilst my wife insists on New Year resolutions (usually involving more exercise for me...), the fragility of our existence on this planet triggers more ‘enjoy life now’ feelings and less planning for rainy days that I might never see... at least that’s my excuse for not buying a 12 month gym pass! I suppose the burning issue on all our minds has got to be independent prescribing. Despite some excellent effort from the CoP, HEE and others, the Commission on Human Medicines was unable to recommend IP for the Profession. Sadly disappointing as a judgement when you consider all the work that brought the proposal to this point. Citing a ‘lack of clarity’ in the definition of an advanced practitioner and concerned about ‘the wide range of conditions’ requiring diagnosis the panel didn’t feel they could move forward. I’ve read the presentation and, I suppose, yes these are a wide variety of ‘advanced paramedic practitioners’, there are also a wide variety of clinical situations where independent nurse prescribers find themselves working! I do feel that rather than a blanket ‘no’, a much fairer solution might well have been to recommend in principle then add conditions to enable Trusts to ‘work toward’ meeting the Commissions’ concerns. The question I personally am left with is, does this point towards a national role? And if so what pressure is it possible to put on every Trust to ensure equal opportunities for development... So what does 2016 have in store... well firstly congratulations to colleagues receiving honours, but my favourite story surrounds one Brent Kenny at NWAS, who managed to resuscitate Father Christmas thus saving the day and the future. For the ambulance services the big talking point is around meal breaks, with the Government talking about paying for 12 hours work and losing the unpaid ‘protected’ meal break, I wonder if someone has costed out the additional hours that would be worked? I tried simple math and it came out around £10 million, in times of austerity, it may well be back to the drawing board! Looking forward, start saving for LC2016 which promises to be bigger and better than ever, and as ever enjoy what we do out there... the public would be lost without us. Enjoy this months content and my sincere best wishes to you all.
Sam English, Co-Editor Ambulance UK
4 For more news visit: www.ambulanceukonline.com
PEN
NEW
FEATURE
Advancing Acute Pain Management
At last, PENTHROX® is here...
Fast, effective pain management designed for fast, efficient patient management. PENTHROX is indicated for the emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain1
Now there’s a new PCA* in a lightweight, portable, handheld inhaler for emergency relief of moderate to severe pain in conscious adults with trauma. With minimal set-up and no need for cylinders, cannulas or mandatory opioid-related A&E attendances, PENTHROX offers you the potential to reduce dedicated treatment time and improve patient management. less than 3 months, may increase the potential for hepatic injury. Cautious clinical judgement should be exercised when PENTHROX is to be used more frequently than on one occasion every 3 months. Potential effects on blood pressure and heart rate are known class-effects of high-dose methoxyflurane used in anaesthesia and other anaesthetics. Caution required in elderly due to possible reduction in blood pressure. Potential CNS effects such as sedation, euphoria, amnesia, ability to concentrate, altered sensorimotor co-ordination and change in mood are known class-effects. The CNS effects can be a risk factor for potential abuse. To reduce occupational exposure to methoxyflurane, the PENTHROX Inhaler should always be used with the AC Chamber which adsorbs exhaled methoxyflurane. Multiple use of PENTHROX Inhaler without the AC Chamber creates additional risk. Elevation of liver enzymes, blood urea nitrogen and serum uric acid have been reported in exposed maternity ward staff when methoxyflurane was used in the past at the time of labour and delivery. PENTHROX is not appropriate for providing relief of break-through pain/ exacerbations in chronic pain conditions or for the relief of trauma related pain in closely repeated episodes for the same patient. Interactions: Methoxyflurane is metabolised by the CYP 450 enzymes, particularly CYP 2E1 and to some extent CYP 2A6. It is possible that enzyme inducers (such as alcohol or isoniazid for CYP 2E1 and phenobarbital or rifampicin for CYP 2A6) which increase the rate of methoxyflurane metabolism might increase its potential toxicity and they should be avoided concomitantly with methoxyflurane. Concomitant use of PENTHROX with CNS depressants, such as opioids, sedatives or hypnotics, general anaesthetics, phenothiazines, tranquillisers, skeletal muscle relaxants, sedating antihistamines and alcohol may produce additive depressant effects. If opioids are given concomitantly with PENTHROX, the patient should be observed closely. Concomitant use of methoxyflurane with medicines (eg contrast agents and some antibiotics) which are known to have a nephrotoxic effect should be avoided as there may be an additive effect on nephrotoxicity; tetracycline, gentamicin, colistin, polymyxin B and amphotericin B have known nephrotoxic potential. Sevoflurane anaesthesia should be avoided following methoxyflurane analgesia, as sevoflurane increases serum fluoride levels and methoxyflurane nephrotoxicity is associated with raised serum fluoride. When methoxyflurane was used for anaesthesia at the higher doses of 40–60mL, there were reports of drug interaction with hepatic enzyme inducers (eg barbiturates) increasing metabolism of methoxyflurane and resulting in a few reported cases of nephrotoxicity; reduction of renal blood flow and hence anticipated enhanced renal effect when used in combination with drugs (eg barbiturates) reducing cardiac output; and class effect on cardiac depression, which may be enhanced by other cardiac depressant drugs, eg intravenous practolol during cardiac surgery. Fertility, pregnancy and lactation: No clinical data on effects of methoxyflurane on fertility are available. As with all medicines care should be exercised when administered during pregnancy especially the first
trimester. There is insufficient information on the excretion of methoxyflurane in human milk. Caution should be exercised when methoxyflurane is administered to a nursing mother. Effects on ability to drive and use machines: Methoxyflurane may have a minor influence on the ability to drive and use machines. Patients should be advised not to drive or operate machinery if they are feeling drowsy or dizzy. Undesirable effects: The most common non-serious reactions are CNS type reactions such as dizziness and somnolence (≥1/100 to <1/10) and are generally easily reversible. Serious dose-related nephrotoxicity has only been associated with methoxyflurane when used in large doses over prolonged periods during general anaesthesia. Adverse drug reactions observed in PENTHROX clinical trials in analgesia: Common (≥1/100 to <1/10): Amnesia, anxiety, depression, dizziness, dysarthria, dysgeusia, euphoria, headache, sensory neuropathy, somnolence, hypotension, coughing, dry mouth, nausea, feeling drunk, sweating; uncommon (≥1/1,000 to <1/100): paraesthesia, diplopia, oral discomfort, fatigue, feeling abnormal, increased appetite and shivering. Post-marketing experience: rare (≥1/10,000 to <1/1,000) reports of hepatic failure/hepatitis have been observed with analgesic use of methoxyflurane. Other events linked to methoxyflurane use in analgesia include drowsiness, agitation, restlessness, dissociation, affect lability, disorientation, altered state of consciousness, choking, hypoxia, oxygen saturation decreased, blood pressure fluctuation, vomiting, hepatitis, increased liver enzymes, jaundice, liver injury, increased serum uric acid, urea nitrogen and creatinine, renal failure, blurred vision and nystagmus. Overdose: Refer to SPC. Legal Category: POM. NHS Price: £17.89. Marketing Authorisation Holder: Medical Developments UK Limited c/o Price Bailey LLP, Causeway House, 1 Dane Street, Bishop’s Stortford, Herts, CM23 3BT, United Kingdom. MA Number: PL 42467/0001. Full prescribing information available from: Galen Limited, Seagoe Industrial Estate, Craigavon, BT63 5UA, United Kingdom. Date of Preparation: November 2015.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Galen Limited on 028 3833 4974 and select the customer services option, or e-mail customer.services@galen-pharma.com. Medical information enquiries should also be directed to Galen Limited.
AMBULANCE UK - FEBRUARY
PENTHROX 3mL inhalation vapour, liquid: Please refer to the Summary of Product Characteristics (SPC) before prescribing. Abbreviated Prescribing Information. Presentation: Each vial of PENTHROX contains 3mL of methoxyflurane 99.9%, a clear, almost colourless, volatile liquid, with a characteristic fruity odour. Each PENTHROX combination pack consists of one 3mL bottle, one PENTHROX Inhaler and one Activated Carbon (AC) chamber. Indications: Emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain. Dosage and administration: PENTHROX should be selfadministered under supervision of a person trained in its administration, using the hand held PENTHROX Inhaler. Adults: One bottle of 3mL PENTHROX to be vaporised in a PENTHROX Inhaler. On finishing the 3mL dose, another 3mL may be used. The dose should not exceed 6mL in a single administration. Methoxyflurane may cause renal failure if the recommended dose is exceeded. The lowest effective dosage to provide analgesia should be used. Onset of pain relief is rapid and occurs after 6-10 inhalations. Patients are able to titrate the amount of PENTHROX inhaled and should be instructed to inhale intermittently to achieve adequate analgesia. Continuous inhalation provides analgesic relief for up to 25-30 minutes; intermittent inhalation may provide longer analgesic relief. Administration on consecutive days is not recommended and the total dose to a patient in a week should not exceed 15mL. Children: PENTHROX should not be used in children under 18 years. For detailed information on the method of administration refer to the SPC. Contraindications: Use as an anaesthetic agent. Hypersensitivity to PENTHROX or any fluorinated anaesthetic. Patients with known or genetically susceptible to malignant hyperthermia or a history of severe adverse reactions in either patient or relatives. Patients who have a history of showing signs of liver damage after previous methoxyflurane use or halogenated hydrocarbon anaesthesia. Clinically significant renal impairment. Altered level of consciousness due to any cause including head injury, drugs or alcohol. Clinically evident cardiovascular instability. Clinically evident respiratory depression. Warnings and Precautions: Methoxyflurane causes significant nephrotoxicity at high doses. Nephrotoxicity is also related to the rate of metabolism. Factors that increase the rate of metabolism such as drugs that induce hepatic enzymes can increase the risk of toxicity with methoxyflurane as well as sub-groups of people with genetic variations that may result in fast metaboliser status. The lowest effective dose should be administered, especially in the elderly or patients with other known risk factors of renal disease. Methoxyflurane should be cautiously used in patients with conditions that would pre-dispose to renal injury. Methoxyflurane is metabolised in the liver, therefore increased exposures in patients with hepatic impairment can cause toxicity. PENTHROX should be used with care in patients with underlying hepatic conditions or with risks for hepatic dysfunction. Previous exposure to halogenated hydrocarbon anaesthetics (including methoxyflurane when used as an anaesthetic agent), especially if the interval is
Reference: 1. Penthrox Summary of Product Characteristics. October 2015. Date of preparation: December 2015. PMR-JUL-2015-0239
Before administering PENTHROX, make sure you have read and fully understood the SmPC and educational materials, which provide important information about how to safely use the device to minimise risk of serious side effects. PENTHROX educational materials and training on its administration are available from Galen on request. *PENTHROX should be self-administered under supervision of a person trained in its administration, using the handheld PENTHROX Inhaler.1
5
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PEN-15-075 Penthrox RTA Ambulance UK 297x210.indd 1
22/01/2016 16:22
FEATURE
CLINICAL SKILLS LOG - A REVOLUTION TO SUPPORT CLINICIANS DEVELOPING FUTURE PRACTICE By Andy Thomas & Andrew Ormerod
Introduction The Clinical Skills Log supported by MedTree and CPDCloud was
The research and technology behind the app are designed to monitor and
launched on the 23 Dec 15 for IOS devices. This app based system
support the clinician and allow access to clinical case history and aid you in
allows clinicians to swiftly log their patient exposures, examinations
developing learning opportunities to encourage professional practice.
conducted and clinical skills performed. By creating a comprehensive log of skills performed it is envisaged this will support clinical staff in
It gives you the ability to log all clinical interventions from airway
developing future CPD and learning strategies.
management, to drugs administered and examinations complete (see figures 1). The app is designed to evolve from feedback and will be
By having the ability to record, learn and develop through analysing
updated regularly to ensure its fit for purpose for those who are using
your clinical activity the clinical skills log hopes to signpost individuals to
it. An example of this is on launch day we received feedback from
potential gaps in practice, record mandatory skills and provide a single
paramedics in Australia and within a few hours the drugs they requested
easy to use app to assist in your life long learning process.
for inclusion were available on the app including Box Jelly fish antivenom. The app allows you to build clinical reports at the touch of your fingers
History
and has a mixture of graphical and descriptive reporting functions, including a UK ambulance service compliant airway log.
The app has been predominately developed by the authors who are both practising paramedics within the UK. This app was developed
Figures 1:
from 2 main areas, firstly to support data collection for a masters degree level research into the continued exposure of RAF paramedics to certain clinical skills and the effect that has on confidence and understanding toward practice. In addition, during this research phase the Association of Ambulance Chief Executives (AACE) with in the UK mandated that UK paramedics must keep a log of airway skills. Following this research, the authors then proceeded to develop an app based system that would assist clinical staff in recording clinical skills exposure for mainly the pre-hospital and EMS market. This was clinically developed by the authors with CPDcloud and MedTree to ensure this could be brought to market free for the end user. Following extensive research and extensive internal development the clinical skills log was launched. AMBULANCE UK - FEBRUARY
The Clinical Skills Log App The clinical skills log app is available now on IOS devices and can be downloaded by visiting http://www.clinicalskillslog.co.uk . It will be available on android devices by Feb 15 and you can register at the bottom of the website to receive updates. The clinical skills log allows you to accurately record your skills and clinical interventions in a simple, customisable and intuitive mobile app.
6 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE
The app also allows for you to deselect whole sections of the log and
encourage all who are using it to give us your suggestions and those
therefore customise to your individual needs (See figure 2). By having
who are not yet using download it and start your journey.
this ability the app is relevant to all pre-hospital and EMS providers, regardless of skill level or clinical backgrounds.
We also have the potential to develop this from other health care professional outside of the pre-hospital and EMS environment.
Also if you have been keeping paper records, spreadsheets etc the app allows you to back date entries.
One of the unique features of the Clinical Skills Log is the support system. The team have also arranged a monthly free webinar that allows app users to feedback live comments and suggestions and discuss
Figure 2:
future development with both the medical team and also the IT team behind the app. Along side this, support tickets asked from within the app are all answered within 12 hours. On the next update to the app, we will also be featuring the opportunity to subscribe to ReelDx, Trauma Care Videos and Skill Guides to enable you to both use the app to take part in learning and development but also use this in the future to assist with clinical practice.
Summary The clinical skills app has been developed by clinicians for clinicians and we hope to continue the innovation by reviewing and development feedback both the clinical team, CPDcloud and MedTree aim to ensure this is the must have app for years to come. So donâ&#x20AC;&#x2122;t delay, download now and begin your clinical skills log.
The future
www.cpdme.com
The future of this app is endless and we have already been planning
www.medtree.co.uk
hard on working on new sections, adding to sections from feedback and progressing the early development of this unique app.
www.clinicalskillslog.co.uk
The sky is truly the limit and we welcome feedback through the app and
https://clinicalskillslog.zendesk.com/hc/en-us
AMBULANCE UK - FEBRUARY
Useful links relating to this article:
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FEATURE
£
AMBULANCE UK - FEBRUARY
8 For more news visit: www.ambulanceukonline.com
FEATURE
CLINICAL SCORES FOR PREDICTING RECURRENCE AFTER TRANSIENT ISCHEMIC ATTACK OR STROKE HOW GOOD ARE THEY? Robin Lemmens MD, PhD; Stephanie Smet MD; Vincent N. Thijs MD, PhD
Risk scores are commonly used in the prediction of disease outcome. In the context of cerebrovascular diseases, risk scores have been created to identify stroke risk after transient ischemic attack (TIA) and (minor) stroke, to identify subgroups of patients with high risk of stroke (for instance, correlated with grade of carotid stenosis), or to predict functional outcome after stroke.
Results We identified 17 risk scores that were derived from TIA or stroke cohorts (Table 1) to predict short-term or long-term recurrence and one that was derived from a prospective population-based study in the general population but was validated in a TIA/stroke cohort. The characteristics and quality criteria for the risk scores are shown in Tables II and III
Identifying high-risk patients after TIA is important because early assessment and management of these patients is pivotal. Confident detection of the low-risk patient, however, is of similar importance. Performing multiple acute diagnostic investigations for all suspected TIA and stroke patients might overwhelm the medical system and might not be feasible because of resource limitations. Simple and reliable risk estimation of recurrence might be beneficial to high-risk patients to be admitted and investigated
in the online-only Data Supplement. The studies were performed in heterogeneous study populations with various designs and inclusion/ exclusion criteria. Qualification of these reports was, therefore, not always possible according to the criteria presented in Table I in the online-only Data Supplement. Ten of the predictive models were derived in cohorts that used TIA as an index event, 5 models included both TIA and (minor) stroke, whereas 2 scales were developed in a population that only included stroke patients. In general, cardiovascular risk profiles were adequately collected in the majority of the study populations.
early. Additionally, the medical health system might benefit as well, because lowrisk patients can be seen in less expensive outpatient
The diagnostic work-up after the incident event varied largely between
clinics.
studies, which might have indirectly influenced recurrence rates; for instance, performing ECG or holter monitoring to identify atrial
We performed a systematic review of published risk scores that
fibrillation likely has an effect on the treatment of patients and the
predict recurrence risk after stroke or TIA. We checked the quality
frequency of recurrence. Primary end points were rarely adjudicated
of the risk scores based on the characteristics of the various
by 2 independent persons and were often not determined by a patient
derivation and replication studies.
visit, but by patient file review. Different studies used various clinical end points: recurrence of stroke, vascular disease, (vascular) death, or combined end points. The nature of the recurrent stroke (ischemic
Methods
vs hemorrhagic) was frequently not specified. Race characteristics were rarely provided, which is of relevance because recurrence rates
One investigator (S.S.) performed a PubMed search with the search terms prognostic models stroke and prognostic scores
could differ between races.4-6 The various risk scores and their clinical applicability will be discussed.
reference lists of the identified articles. We excluded specific risk scores for stroke risk in atrial fibrillation, for instance, CHADS2,1
Californian Risk Score
CHADS2VASC2, or global vascular estimates, such as the QRISK2 and SCORE.3 The other exclusion criteria, internal and external
A simple 5-point score using age, diabetes mellitus, symptom duration,
validity, statistical methodology, validation of the models, and
the presence of weakness, and speech impairment was found predictive
clinical applicability were evaluated (for details, see Methods and
of stroke within 90 days in a retrospective study of 1000 patients admitted
Table I in the online-only Data Supplement) by 3 independent
with TIA to an emergency department.7 This risk score was externally
researchers (R.L., S.S., and V.T.). All results were compared
validated in large cohorts and population-based studies, although
between researchers and inconsistencies were resolved by
c-statistics did not reach 0.8.8,9 Whether addition of brain imaging to the
reevaluation of the original article.
score might be of additive value has not been determined.10
AMBULANCE UK - FEBRUARY
stroke for the period 1992 to 2011, and additionally explored the
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FEATURE Table 1.
Study Design of Index Event, Follow-up in Derivation Cohorts, and Performance in Validation Cohorts of Predictive Models Risk Score
TIA
Minor Stroke
Stroke
Short-term Recurrence (≤90 d)
Long-term Recurrence (≥1 y)
Validated in Replication Study*
California risk score
X
X
3/3
ABCD
X
X
9/12
ABCD2
X
X
19/23
ABCDI
X
X
1/1
AB2CD(2) (3)
X
X
1/1
ABCD2I
X
X
0/0
ABCD2 and DWI (including CIP)
X
X
2/2
ABCD2+MRI
X
X
0/0
ABCD3
X
X
1/1
ABCD3I
X
X
1/1
ABCD +
X
Oxford TIA (Hankey score)
X
Stroke Prognostic Instrument (SPI)
X
X
SPI-II
X
X
Dutch TIA
X
X
LiLAC
X
X
X
Essen Stroke Risk Score
X
Recurrence risk estimator at 90 d
X
X
1/2
X
2/2
X
3/4
X
0/2
X
0/1
X
3/4
X
1/1
AB2CD(2)(3) indicates AB2CD/AB2CD2/AB2CD3CIP; clinical- and imaging-based predictive algorithm; DWI, diffusion-weighted imaging; LiLAC, Life long after cerebral ischemia trial; and TIA, transient ischemic attack. *Risk score model used for replication needed to be similar as initially reported by the authors of the original article, based on stratification of patients or c-statistics. Numbers are studies validating the score over total replication studies (original studies on derivation of the risk score, which included an external validation cohort, are also included).
ABCD, ABCD2, and Additional Variables
across scores has less direct implications; therefore, in most studies, a dichotomization was analyzed and proposed that could be used
The 7-day risk for stroke after TIA was estimated based on clinical characteristics within the OXVASC study. The following significant predictors were included in calculation of the score (with different weights, as indicated in parentheses): age >60 years (1); blood pressure ≥140/90 mm Hg (1); unilateral weakness (2); speech impairment without weakness (1); duration ≥60 minutes (2); or 10 to 59 minutes (1).11 Since publication, this ABCD score has been replicated in most studies, which included >200 patients, with some of these also extending the prediction horizon to 90 days after the incident TIA (or minor stroke).8,9,12–20 In none of the replication cohorts, c-statistics reached 0.8, with the exception of one validation cohort8 (Table III in the online-only Data Supplement).
for individual patients. Based on the data in the original article, which divided the values of the ABCD2 score into 3 categories (0–3, 4–5, and 6–7), a score ≥4 would urge medical doctors to initiate adequate medical attention (eg, admission). Two observational studies and 1 prospective study, all with large sample sizes, however, failed to convincingly validate the ABCD2 score, which was reflected in observed higher recurrence rates in the low-risk groups.25,33,34 In summary, the ABCD2 has rather low specificity and positive predictive value but good sensitivity and negative predictive value. C-statistics in none of the publication reached 0.8, with the exception of one
Pooling of the studies deriving the Californian and the ABCD scores led to the ABCD2 score, which includes the following 5 factors (with AMBULANCE UK - FEBRUARY
different weights, as indicated in parentheses): age ≥60 years (1); blood
validation cohort8 (Table III in the online-only Data Supplement). The score can be used to identify those patients at increased risk who need admission, but caution is warranted because several studies identified recurrence in patients with low scores25,33,34 and high-risk disease has
pressure ≥140/90 mm Hg (1); clinical features: unilateral weakness (2)
been shown to be present in patients in the low-risk group.39 This
and speech impairment without weakness (1); duration ≥60 minutes (2)
was underscored by additional data from the discovery cohort of the
or 10 to 59 minutes (1); and diabetes mellitus (1).8 The ABCD2 score
ABCD/ABCD2 score, which showed the ABCD2 score to be predictive
was validated in 2 independent cohorts8 and has been the subject of
for severity of recurrence rather than risk.27 Potentially adding other
replication and modification in various other populations.
9,16,19–38
In a
characteristics, such as hyperglycemia, history of hypertension (AB2CD/
reasonable percentage (9/23 or 39%) of study protocols, imaging data
AB2CD2/AB2CD3),19 or dual TIA (ABCD3),31 might increase the negative
were required for additional analysis. This inclusion criterion enabled
predictive value, but validation is lacking.
researchers to refine the score by including imaging (MRI or computed tomography) data. Risk stratification seemed to be independent of
Additionally, several groups have explored whether adding imaging
follow-up duration (7, 28, or 90 days). In clinical practice, a trend
findings to the ABCD/ABCD2 scores might improve their performance.
10 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE Computed tomography, diffusion-weighted imaging (DWI), and vessel occlusion status data were analyzed.
18,21â&#x20AC;&#x201C;24,28,31,35
Initially, imaging data
on any evidence of infarction and leukoaraiosis were joined to the ABCD
In 3 additional large cohort studies, the SPI-II was evaluated. 36,38,42,45 The results were disparate, with both confirming the risk score as well as showing poor predictive power.
score to create the ABCDI, which resulted in similar accuracy compared with ABCD.18,35 The ABCD2I score, which included the presence of brain infarction on computed tomography or DWI, has been extensively studied in a multicentric approach.28 Three studies included acute DWI lesions on MRI in the prediction of stroke model, which clearly improved the accuracy to c-statistics >0.8 in all cohorts.22â&#x20AC;&#x201C;24 Moreover, the ABCD3I, which includes carotid stenosis in addition to abnormal DWI, also showed a superior prediction and was validated in a separate sample set, although c-statistics were less convincing in the validation set.31 Adding data regarding intracranial vessel stenosis to DWI lesions led to similar higher accuracy (c-statistics of 0.88), although no validation population was included in this study. These findings clearly support a role for 21
imaging data, in particular DWI lesions, to increase the reliability.
Dutch TIA Trial and Life Long After Cerebral Ischemia Trial Data from >3000 patients enrolled in the Dutch TIA trial were analyzed for their prognostic value for a 2-year risk analysis.46,47 Based on the hazard ratios in the initial publication, the predictive value of 13 parameters (Table IV in the online-only Data Supplement) was calculated in the same population but showed no strong discriminative value.47 This was confirmed in another cohort comparing 7 models in which this score was found to overestimate risk.36 The original Dutch TIA cohort was followed-up during a mean period of 10 years, and the data were reanalyzed (Life long after cerebral ischemia trial [LiLAC]). Three
Oxford TIA (Hankey Score) In a population-based cohort from Oxford, several vascular risk rates were calculated, and prognostic factors were determined for stroke, myocardial infarction, and combined end points, and they were translated into a 5-year risk percentage. The model for stroke was established by using the following 8 clinical factors: age, sex, affected region (amaurosis fugax as well as carotid and
different models were designed based on subcategories of variables: demographics (sex and age) and medical history (myocardial infarction, intermittent claudication, diabetes mellitus, peripheral vascular surgery, and hypertension) in model 1; addition of event characteristics (TIA vs stroke, Rankin grade, and vertigo) in model 2; and addition of brain imaging (white matter lesions and any infarct) and ECG data (Q wave on ECG and negative T wave) in model 3. Areas under the curve were clearly improved and reached values >0.8 for all 3 models48; however, this could not be confirmed in a validation cohort.42
vertebrobasilar), frequency of TIA, residual neurological deficits, peripheral vascular disease, and left ventricular hypertrophy.40 Although the risk score was able to discriminate high-risk patients from low-risk patients
Framingham: Stroke-Specific
(depending on the cut-off), a clear cut-off that was able to divide patients in high-risk vs low-risk groups could not be confidently recommended.41
A stroke risk score was derived based on 472 stroke events occurring
In 2 other studies, the Hankey score was found to overestimate the
within the initially stroke-free subjects from the Framingham study.
risk; although the model could be used for prediction of recurrence, the
A sex-specific risk model was developed that included age, systolic blood
accuracy seemed relatively weak
36,42
(Table III in the online-only Data
pressure, use of antihypertensive therapy, diabetes mellitus, smoking,
Supplement). Additionally, the risk prediction did not simply involve the
previous cardiovascular disease, atrial fibrillation, and left ventricular
collection of several clinical data set, but also a calculation of these
hypertrophy (on ECG). There is only 1 publication that evaluated the
variables in a formula probably reducing its clinical applicability.
Framingham stroke risk score in a cohort of patients with previous TIA and stroke. The score was not validated and had poor c-statistics.36
Stroke Prognosis Instrument
Essen Stroke Risk Score
The Stroke Prognosis Instrument (SPI-I) was developed in patients The Essen Stroke Risk Score (ESRS) was derived from the stroke
sample of 142 patients, 5 predictors (age, diabetes mellitus,
subgroup of the CAPRIE (clopidogrel vs aspirin in patients at risk of
hypertension, coronary heart disease, and distinction between TIA
ischemic events) trial, which compared the effect of clopidogrel over
and stroke) were included to define 3 risk groups for recurrence
aspirin in patients with vascular disease during a mean follow-up of 1.9
in a 2-year follow-up.43 Ten years later, this score was externally
years. This model used 8 clinical parameters: age, hypertension, diabetes
validated in 4 cohorts, and although the risk score was validated,
mellitus, myocardial infarction, other cardiovascular disease, peripheral
even in the lowrisk group, the recurrence rate was 10%.44
artery disease, smoking status, and history of TIA or stroke.49 Patients
A modified SPI-II was created that included the additional variables
with indications for oral anticoagulants were not enrolled in CAPRIE.
previous stroke and congestive heart failure. The patients were
In a validation cohort, this score was unable to significantly distinguish
more evenly distributed, and the c-statistics improved moderately,
between high-risk and low-risk patients.50 Thereafter, the ESRS was
although they remained <0.8. Still, the recurrence rate remained
calculated in various study populations in which the dichotomization
10% in the lowest-risk group. Furthermore, application of this score
cut-off between high risk and low risk was either confirmed42,51 or
was restricted to patients with carotid territory TIA or minor stroke
refuted.38 However, even in the replication cohorts, which confirmed the
based on clinical characteristics, impeding the clinical utility for
predictability, the positive predictive values were low, questioning the
primary care physicians.
usefulness of these risk scores in daily clinical practice.
AMBULANCE UK - FEBRUARY
with suspected carotid TIA or minor stroke. In a small patient
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FEATURE Recurrence Risk Estimator at 90 Days
Studies replicating only 1 risk score occasionally evaluated risk in patients with a dissimilar preceding event compared with the derivation
A Web-based prognostic 6-point score (the recurrence risk estimator at 90 days) was derived from a sample of 1500 stroke patients to estimate the 90-day risk of recurrence. Recurrent stroke was confirmed by MRI. 45
Two models, either with or without baseline imaging data, were validated in derivation and validation cohorts. The area under the curve for the 90-day risk of recurrence was 0.80 for the derivation cohort, which was
population or used longer or shorter duration of follow-up to determine recurrence. Additionally, patient characteristics varied between studies because patients with atrial fibrillation were sometimes excluded or imaging was used as an inclusion criteria. Many studies lacked a clear clinical confirmation of a recurrent event by a physician because patient files were used to obtain end points. This was illustrated by the
reasonably well-replicated in the validation cohort (0.76).
fact that a difference between hemorrhagic and ischemic stroke was
The models include the following factors: presence of multiple infarcts
added in the study design to validate recurrent stroke.
rarely reported. Furthermore, it is only recently that imaging has been
of different ages, simultaneous infarcts in different circulations, multiple acute infarcts, isolated cortical infarcts, history of stroke or TIA, and stroke subtype based on the Causative Classification of Stroke System. Stroke attributable to other causes, as typed by Classification of
When designing a predictive model, high event rates are desirable, with occurrence of at least 10 events per studied prediction variable; in several derivations and in half of the validation cohorts, this criterion
Stroke System, was identified as the highest-risk subtype. Interestingly,
was not met. Almost all models suffer from low c-statistics (<0.8) and,
conventional risk factors identified by scores estimating the risk after
therefore, cannot be confidently used in the clinic, because this implies
TIA (such as hypertension and diabetes mellitus) were not identified as
that cutoffs cannot be reliably introduced to make decisions regarding
short-term (90 days) risk factors for recurrence after ischemic stroke.
individual patients. This is reflected by the relatively high event rates in low-risk patients in some studies. Individual treatment decisions based on the current prognostic models cannot be justified.
Discussion
In efforts to improve the precision of the predictive models, researchers have increased the number of variables into risk models.
Several prediction models have been developed to evaluate the stroke
Although adding more factors to a model can increase accuracy and
recurrence risk after TIA and (minor) stroke (Table IV in the online-only Data Supplement). Ideally, one would like to know which is the best score. However, comparison of risk scores is hampered by the different study paradigms, particularly inclusion criteria of the index event (TIA vs stroke) and duration of follow-up to determine recurrence (Table 1). Therefore,
reliability, this often compromises its utility in daily clinical practice. Including imaging findings, such as diffusion lesions and the presence of vessel stenoses, increases accuracy. However, the initial purpose of risk stratification scores was to support emergency doctors and primary care doctors to identify patients at high risk for recurrence
studies that directly compare various scores need to be interpreted
with limited resources. Therefore, the addition of costly imaging will
with some caution. In an independent Dutch cohort, the 2-year risk was
face resistance by emergency doctors and primary care physicians.
obtained in patients after TIA or minor stroke, and the SPI-II, Hankey,
One can wonder whether the addition of MRI data interferes with the
Dutch TIA, and ABCD2 scores were validated. However, the ABCD2 36
was not developed to estimate the long-term risk of recurrence, and both the ABCD2 and Hankey derivation cohorts only included TIA patients. Another prospective study assessed the prognostic value of the ABCD2, ESRS, and SPI-II in patients presenting with minor stroke. The accuracy of all 3 models was poor in predicting recurrence rate at 7 and 90 days.
38
However, the ESRS and SPI-II were developed in stroke, not TIA, patients to predict long-term recurrence. It can be assumed that risk factors of a second cerebrovascular event differ between early and late recurrence,
purpose of these models. Therefore, adjusted models with increased accuracy might be more useful in epidemiological studies or clinical trials rather than in aiding clinicians in therapeutic decision-making. Additionally, requirement of neuroimaging may result in selection bias. For instance, one of the first studies to report on imaging data and ABCD score in TIA patients identified a substantial age difference between patient with and without MRI.12 Furthermore, in the assessment of recurrence risks of TIA, the yield of diffusion in addition
as well as between TIA and stroke as the index event. This is underscored
to the ABCD2 versus the yield of commonly recommended diagnostic
by the recurrence risk estimator at 90 days, a model predicting recurrence
tests, such as ECG and carotid ultrasound, has not been specifically
after stroke in a period of 90 days, which includes other prognostic
assessed.
factors compared with the ABCD2 score (which evaluates recurrence
AMBULANCE UK - FEBRUARY
at 90 days after TIA). Only a large prospective study in German stroke
Direct comparison studies evaluating various predictive models can
centers evaluated the risk in patients after TIA or minor stroke (with a
be criticized for the reasons mentioned above; however, the existence
median follow-up of 1 year) with scores that were derived to estimate the
of multiple models, including different index events for the evaluation
recurrence rate after follow-up of at least 1 year in patients with TIA or
of short-term as well as long-term recurrence, does reflect the real-life
minor stroke: the ESRS, SPI-II, Oxford TIA, and LiLAC scores.42
clinical experience. It is not likely that 1 model will be developed to evaluate short-term and long-term risk after stroke or TIA. Moreover,
None of these models could convincingly reproduce the prediction
given the various causes of stroke, a one-size-fits-all prediction
models. The finding that risk factors might differ in patients, based on
risk model is unlikely to be perfect under all circumstances. The
either TIA or stroke as index event, might explain the difficulty in replicating
heterogeneity of predictive models can be helpful to evaluate diverse
the accuracy of a scale, especially in the 5 models that were derived from
patients in various scenarios. Therefore, it may be less relevant to
cohorts that included both TIA and stroke patients. Potentially, variations
directly compare the models, but more important to validate each
in proportions of TIA and stroke patients could have resulted in different
model in the population cohort for which it was designed and for the
findings in the replication cohorts compared with the derivation sample.
end point that was chosen in the derivation study.
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FEATURE Table 2.
Key Points
Predictive models for recurrent stroke ultimately should be able to guide physicians in early decision-making after TIA and stroke A variety of models have been developed in various populations with different index events and methodology, complicating direct comparison, but probably mimicking the real-life experience Risk factors for recurrence differ between TIA and stroke as initial event The majority of predictive scales have been derived from cohorts that include patients with TIA as the index event Adding neuroimaging to predictive models increases accuracy but reduces simplicity High event rates have been reported in predicted low-risk categories The ABCD2 with diffusion imaging data seems most reliable to estimate the early risk of recurrence after TIA; RRE-90 might be an interesting tool to establish the early risk of recurrence after stroke by stroke specialists Validation in large sample sizes with adequate and similar inclusion criteria of the index event and end points as in the derivation study is of importance to confidently use these tools in daily clinical practice Stratification of the best therapeutic and diagnostic pathway for an individual patient based on simple predictive scales might be difficult to achieve When evaluating risk models, changes in diagnostic and therapeutic avenues need to be investigated to identify a correlation with improved patient care; thus far, this has not been clearly determined RRE-90 indicates recurrence risk estimator at 90 days; and TIA, transient ischemic attack.
At present, the early risk of stroke after TIA, the issue that has been
3. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer
most extensively studied, seems to be predicted best by the ABCD2
G, et al; SCORE project group. Estimation of ten-year risk of fatal
combined with DWI data. For early recurrence risk after stroke in
cardiovascular disease in Europe: the SCORE project. Eur Heart J.
the 2 models developed, the recurrence risk estimator at 90 days
2003;24:987–1003.
is optimally suited, but it requires both very accurate subtyping and neuroradiological assessment (Table 2). Long-term risk after TIA and
4. Kono Y, Yamada S, Kamisaka K, Araki A, Fujioka Y, Yasui K, et al.
stroke cannot be reliably assessed based on the current knowledge.
Recurrence risk after noncardioembolic mild ischemic stroke in a
Whether these models can be used for decision-making on an
Japanese population. Cerebrovasc Dis. 2011;31:365–372.
individualpatient level remains speculative. Further large prospective studies involving TIA and stroke patients using various models are still necessary to strongly validate the predictive models and, even more importantly, to evaluate the added value regarding improving care.
5. Levine DA, Neidecker MV, Kiefe CI, Karve S, Williams LS, Allison JJ. Racial/ethnic disparities in access to physician care and medications among US stroke survivors. Neurology. 2011;76:53–61. 6. Waddy SP, Cotsonis G, Lynn MJ, Frankel MR, Chaturvedi S, Williams
Sources of funding Drs Lemmens and Thijs are Senior Clinical Investigators for FWO Flanders.
JE, et al. Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. Stroke. 2009;40:719–725. 7. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA.
Disclosures
2000;284:2901–2906.
Dr Thijs has declared to have received modest support from Boehringer Ingelheim (Speakers’ Bureau) and from Boehringer Ingelheim, Sygnis, Bayer, and Pfizer (Consultant/Advisory Board). The other authors have no conflicts to report.
8. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369:283–292. 9. Nguyen H, Kerr D, Kelly AM. Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. Eur J Emerg Med. 2010;17:346–348.
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MJ. Validation of clinical classification schemes for predicting
et al. The California, ABCD, and unified ABCD2 risk scores and the
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presence of acute ischemic lesions on diffusion-weighted imaging
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2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M,
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Brindle P. Derivation and validation of QRISK, a new cardiovascular
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disease risk score for the United Kingdom: prospective open cohort
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13 Do you have anything you would like to add or include in Features? Please contact us and let us know.
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AMBULANCE UK - FEBRUARY
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14 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE 39. Amarenco P, Labreuche J, Lavallée PC, Meseguer E, Cabrejo L, Slaoui T, et al. Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack? Stroke. 2009;40:3091–3095.
VISIT US College of Paramedics National Conference
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8-9 March Royal York Hotel
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Resuscitation and Emergency Care
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Bag-Valve-Mask (BVM) Pocket Resuscitation Mask Oxygen and Nitrous Oxide Delivery Systems Airway Management Oxygen Therapy
48. van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, et al; LiLAC study group. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005;365:2098–2104. 49. Diener HC, Ringleb PA, Savi P. Clopidogrel for the secondary prevention of stroke. Expert Opin Pharmacother. 2005;6:755–764.
51. Weimar C, Diener HC, Alberts MJ, Steg PG, Bhatt DL, Wilson PW, et al; REduction of Atherothrombosis for Continued Health Registry Investigators. The Essen stroke risk score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for Continued Health (REACH) registry. Stroke. 2009;40:350–354.
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50. Weimar C, Goertler M, Röther J, Ringelstein EB, Darius H, Nabavi DG, et al; SCALA Study Group. Predictive value of the Essen Stroke Risk Score and Ankle Brachial Index in acute ischaemic stroke patients from 85 German stroke units. J Neurol Neurosurg Psychiatr. 2008;79:1339–1343.
Key Words: clinical score • predictive model • recurrence risk • review
15 AMBULANCE_UK_01.16_resus.indd 1
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14/01/2016 11:16
FEATURE
One of the UK’s newest simulation companies MDT Global Solutions have been developing new solutions for Ambulance Education and are busy developing new clinical technologies • Smart and easy to use scenario builder Working closely with a number of NHS trusts and the Private Sector • Over 50 ECG waveforms - Mdt global solutions are a UK based company focused on the • Over 20 support of Ambulance projects but also involved withadditional developing parameter settings infrastructures worldwide - including UK, UAE, Qatar, Lebanon, • Ability to useequipment 12-lead is Australia and USA - MDT focus is to ensure that where ECG, import video and supplied the staff are suitably equipped with the education x-ray images to use it.
“Environment Shapes our Care.” “Immersive Interactive technology produces far more engagement for students” - and seems to reduce the false feeds often associated with simulation. The feedback from learners has been incredible…because the students are able to practice in situations that look and sound dangerous. The team at St Georges have added smoke generators to their classroom, whilst smells can also be added with the addition of an atomising ‘smell machine”.
• Realistic trending of vitals over time • Sophisticated and realistic vital signs monitor • Instant CPR and PEA simulation • Safe to use on a simulated live casualty
Our immersive strategy transformed this boring classroom below
on,
rm nced ion ent nd and
We have saved many UK NHS ambulance Trusts approximately £1,700,000 in 2014-15 by transitioning education teams away from expensive manikin and defibrillator strategies towards iPad based trainingeducation solutions. Our clients equipment include East of England,enterprise SECAMb, and Yorkshire Ambulance and more than 20 UK Universities and Helicopter teams. Into this amazing learning space Resuscitation Training equipment is expensive and fragile and MDT have developed robust solutions that are now used AMBULANCE UK - FEBRUARY
to educate paramedics worldwide. Our other Ambulance education projects include supporting Yorkshire Ambulance with its immersive classroom solution used by their HART team - also used in St Georges (Kingston) University London, and other universities worldwide to teach paramedics the hazards associated with the pre hospital environment. Immersive Education as a strategy is a great way to get student involvement and create real debate about the needs to modify our approach to clinical care based on the Environment.
16 For more news visit: www.ambulanceukonline.com
FEATURE RFID technology
With 9 fully equipped classrooms the Director team have invested in an EMS academy that is the envy of many an ambulance Trust - MDT have invested in 3 immersive classrooms and have the ability to train 108 paramedics a day
MDT are transforming the vehicle checking and maintenance strategy for its Ambulance and Education clients worldwide - with projects underway in the Gulf region for Radio frequency tagging of ambulance equipment. Rob Clark an MDT director explained “We use RFID tagging and scanning linked to the ECRI database and can complete a vehicle check in 11 seconds!” “Having the confidence that vehicles are equipped and the equipment is all serviced with no manufacturer recalls or missing equipment is an incredible challenge that the MDT Team have now overcome!”
The Academy has an amazing array of courses available and seek NHS partners wishing to use the academy for their training. MDT have Hotel accommodation nearby and their clients from overseas are only 20 minutes drive from Heathrow.
The MDT solution is robust due to its links with ECRI and the updated
Education now EMS Academy
MDT are constantly Innovating to provide solutions for the Emergency Care Sector, and work with colleagues from around the world - TRIBALCO, (Military Medicine USA), Deployed Logix (Disaster Relief USA), PEKE (Biological transportation USA) and TSG (UK)
MDT’s latest investment is the development of the education now academy near High Wycombe.
Please contact - sales@mdtglobalsolutions.com Internet - www.isimulate.com/uk Blogsite - www.rebelmouse.com/mdt
scanning technologies.
Welcome to the next generation in simulation technology. The iSimulate ALSi Simulation platform provides an economical, highly advanced and realistic patient condition simulation package that enables advanced patient simulations that can be run quickly and easily without the need for expensive and complex manikins or monitors.
• Smart and easy to use scenario builder • Over 50 ECG waveforms • Over 20 additional parameter settings
It is so easy to use you can be up and running in less than 2 minutes allowing you to train anywhere and at anytime with a fully featured, multi-parameter monitor, AED and defibrillator without the cost and complexity of traditional simulators.
• Ability to use 12-lead ECG, import video and x-ray images • Realistic trending of vitals over time
Run off only two iPad’s, students view a realistic patient monitor while the instructor uses a handheld control ipad to control everything from parameters to time.
Monitor Mode
• Instant CPR and PEA simulation • Safe to use on a simulated live casualty
Defibrillator Mode
Facilitator Screen
AMBULANCE UK - FEBRUARY
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17 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE
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For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE Ambulance Service headquarters in
NWAS
Abbey Foregate. He later qualified
Senior Paramedic Saved Christmas!
as an ambulanceman and was based at the former Tweedale ambulance station in Telford.
Christmas could have been cut short when Santa was struck
In the 1990s, Steve became the
down with heart failure just a
first appointed media officer
few months ago. Thanks to a
for the 999 service and was
brave paramedic from the North
instrumental in winning national
West Ambulance Service Brent
recognition for Shropshire’s
Kenny Christmas was saved!
fledgling volunteer community first responder scheme with a coveted NHS Health and Social
Last August, David Hollowell was
Care award. When Shropshire
struggling to breathe at his home in Blackpool when Brent arrived
One of our Centres, Thames
their skills and training to offer
Ambulance Service merged with
on the scene to commence
Valley Ambulance & Paramedic
more than just basic first aid.”
its larger neighbour in the West
treatment. An ambulance crew
Service, who delivered this
followed and took him to hospital.
course for the first time received
On completion of the qualification
Santa’s life was saved and he’s
feedback from their learners on
the learner will be eligible to apply
now back in full flow giving out
how up to date and relevant the
to the Faculty of Pre-hospital Care
In 2006, Steve became
presents to children in Blackpool.
topics were stating, whilst reading
for Level 3 membership.
Head of Press for County Air
Midlands, he became its Head of Press and Communications.
Ambulance and was responsible
the syllabus it became apparent David makes a guest appearance
just how in-depth the course is
This qualification is aimed at:
for rebranding the popular
as Santa every year for Blackpool
compared with FAW and similar
Community first responders,
helicopter service to Midlands Air
Ambulance Station’s Christmas
courses. This is a reflection on the
Co responder e.g. police, fire
Ambulance Charity.
party. After last year’s scare he
nature of a level 3 qualification.
and other emergency services, Military, Security, Close protection,
In recent years he has been
costume for the celebrations and
The aim of the qualification is
Event medical cover, Cabin Crew,
credited with organising the highly
reunion with his lifesaver Brent.
to provide learners with the
Stewards as well as Voluntary sector.
rated WMAS award ceremonies
was raring to put on his Santa
and the National Air Ambulance
knowledge and skills required to After the reunion Brent said:
operate within a scope of practice
Any new centres wishing to offer
“It was great to see David fully
to stabilise and treat a patient in
this qualification please contact
recovered and back in his Santa
need of care for up to forty minutes
the number below.
costume. It was hard work at the
until an ambulance or other pre-
time, but I wasn’t letting him go – we needed him fit for Christmas!”
AOFAQ Centre delivers first courses in Level 3 Award in First Person on Scene
Awards of Excellence in London. Contemplating his retirement, Steve said: “When the office
For information on AoFAQ Level
apprentice tells you that she was
3 Award in First Person on Scene
far from a twinkle in her parent’s
Subjects covered include airway
please contact AoFAQualifications
eye, and they themselves had just
management and the recognition
on 01908 610093 or go to:
started primary school when I first
features of sepsis. The learners
http://aofaqualifications.org/
joined the Service, then it’s time to
hospital care provider arrives.
call it a day and retire gracefully to
undertook assessments and exam questions. They all agreed on the benefits of learning extra skills
WMAS
enjoy the finer things in life.”
patient care.
Long serving spokesman set to retire
of early intervention in terms
Clinically endorsed by the Royal
After providing thousands of
when dealing with often tragic and
of survival and recovery rates,
College of Surgeons Edinburgh,
quotes, interviews and stories
complex incidents as well helping to
so improving skills at this point
Faculty of Pre-hospital (FPHC)
to the media, one of the longest
highlight the excellent work carried
is crucial. This is where the
Care and meets the Level 3
serving press officers in the
out by our staff.
AOFAQ Level 3 Award in First
FPHC Pre-hospital Emergency
NHS is set to retire from West
Person on Scene is positioned.
Medical Skills Framework,
Midlands Ambulance Service
“He has been such an important
The Level 3 represents the more
the Director of Thames Valley
(WMAS) on Friday after a career
part of the team using his
‘Autonomous’ nature of the
Ambulance & Paramedic Service
spanning 39 years.
experience to provide help and
responder, this new regulated
said, “Both as an operational
qualification consists of 16
Paramedic and course trainer,
Steve Parry, 58 from Shrewsbury,
over the years. I know everyone
major learning outcomes which
this qualification is excellent for
started his career as a control
in the team will miss him, but we
is trained over 30 hrs.
anyone who wants to enhance
assistant at the former Shropshire
wish him well in his retirement.”
with underpinning knowledge to
We are all aware of the impact
WMAS Communications Director, Murray MacGregor, said: “Steve has always shown great compassion
AMBULANCE UK - FEBRUARY
advice to newer members of staff
19 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE Philanthropist Supports the Future of Pre-Hospital Medicine Beaverbrook pledges £60K to support The Institute of PreHospital Care at London’s Air Ambulance Lord Beaverbrook visited London’s Air Ambulance, the charity that delivers an advanced trauma team to critically injured people in London at its helipad atop The Royal London Hospital in recognition of his support for the charity through the Beaverbrook Foundation. The Foundation, which supports charitable causes both in the UK and overseas, has generously committed to donate £20,000 per year for the next three years to the Institute of Pre-Hospital Care at London’s Air Ambulance (“The Institute”). The money donated will support two students with £10,000 each per annum, as part of the scholarship programme for its Intercalated BSc (“The iBSc”) in
is open for application to all
students with a passion for
and this is a fantastic charity
students studying Medicine in
prehospital care too.”
that does an amazing job
the UK. The course is dedicated The Institute was founded
every day but relies totally on
serious injury and illness in the
in 2013 to build on and
public donations.
pre-hospital environment. An
expand the charity’s research,
innovative and growing field, it
innovation and education
“We have a fantastic
is recognised as a sub-specialty
activities, with a mission to
partnership with Yorkshire Air
by the General Medical Council
drive excellence in pre-hospital
Ambulance and are genuinely
and provides students with a
care standards. It supports
humbled by the work they do
strong foundation in the science
and fosters collaboration
every day. I’m delighted to
and practical skills required
across medical disciplines
say we will be raising as much
for success in pre-hospital
and institutions dedicated to
money as possible for them
medicine.
improving outcomes for people
again next year.”
afflicted by critical injury and Lord Beaverbrook and the
illness.
Foundation’s Chief Executive
Yorkshire Air Ambulance (YAA) has carried more than 6,400
Officer Jane Ford met with
The scholarship programmes
people in its 15-year history.
The Institute’s Clinical
will cover the full cost of The iBSc tuition fees for the
The rapid response emergency
Director, Dr Gareth Grier, and London’s Air Ambulance Chief Executive Officer, Graham Hodgkin. They also met The Institute’s two scholars for this current academic year, Oliver Malpass and Robert Willmore, who are benefiting from the
duration of the programme from the start of the academic year to its finish for each scholar. It will also provide additional financial support for successful applicants to attend international or national
Foundation’s generous support.
conferences related to their
Oliver Malpass said: “I feel
about The Institute visit
delighted and very grateful
studies. For more information iophc.co.uk/about-us/the-institute.
to have been selected for the YAA
without it, it wouldn’t have been
Asda fundraising tops £200,000 for Yorkshire Air Ambulance
financially possible for me to study in London. I am most
Pre-Hospital Medicine. Dr Gareth Grier said: “The
recommend that future students
experts in this field, and would apply for this opportunity too.”
service relies on the generosity of individuals and organisations to help save lives across Yorkshire. To keep both its helicopters in the air the charity needs to raise £12,000 every day - equivalent to £4.4 million a year. The charity has just placed an order for a state-of-the-art replacement aircraft that will take to the skies over Yorkshire
Beaverbrook scholarship, as
excited about learning from the
Intercalated BSc in Pre-Hospital
saving lives across Yorkshire
to educating on the treatment of
Yorkshire Air Ambulance
next year. The latest generation Airbus H145 helicopter will replace the older of the charity’s two aircraft, G-SASH, and providing paramedics with a much more modern medical fit-out to treat
is flying high after another
and transport often critically
Robert Willmore said: “I feel
fantastic fundraising feat
injured patients.
studying the scientific basis
hugely privileged to have been
by Asda staff and shoppers
of this ever-expanding and
awarded the scholarship, not
across the region.
innovative field of medicine,
only due to its prestigious
offering an exciting insight into
nature, but also due to the
During 2015, the supermarket
and South Yorkshire, said: “To
this fascinating specialty for
undoubtedly high standard of
chain’s stores in the region
have raised £200,000 over the
doctors of the future. On behalf
the other applicants.
– from Harrogate to Hull and
last three years is a remarkable
York to Sheffield – have raised
achievement. We continue to be
Medicine provides medical students with a formal way of
AMBULANCE UK - FEBRUARY
of all of us at the charity I would
Kerry Garner, YAA Regional Fundraising Manager for West
like to thank the Beaverbrook
“Aside from the initial
over £52,000 for the life saving
blown away by the generosity of
Foundation for its support with
excitement of being awarded
charity. That brings the total
Asda, their store staff and amazing
this.”
the scholarship, on reflection it
raised by Asda over the last
customers across Yorkshire.
will hopefully open many doors
three years to a staggering
Offered in partnership with
of opportunity in meeting some
£200,000.
Queen Mary University of
truly inspirational clinicians
London, The BSc is the
working in the pre-hospital
Asda Yorkshire Charity
support of Asda is great news.
equivalent of a full degree
arena. It is also an honour to
Champion Barkat Ali, said: “We
We really cannot thank them
condensed into one year, and
work alongside like-minded
are a Yorkshire-based business
enough.”
“2016 will be a big year for us and to have the continued
20 For further recruitment vacancies visit: www.ambulanceukonline.com
ADVERTORIAL FRED’s a life saver on the slopes The world’s smallest defibrillator keeps alpinist alive It happened on the Cho Oyu Mountain in Tibet. An alpinist was struck by lightning in a remote camp, lying motionless in her tent and needing immediate medical assistance. Apart from regressive paralysis symptoms and small burns, an initial ECG showed no abnormalities. However as a result
to save the young woman’s life. Once back at Basecamp, her heart rate was monitored continuously, thanks to the ECG monitoring function available with the Fred easyport AED. FRED easyport® is the world’s smallest defibrillator, The size and weight (only 490gms) makes it the ideal companion for mountain rescue and expeditions alike.
she experienced several episodes of paroxysmal tachycardia. In the following days, FRED easyport® fulfilled its role, helping
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AMBULANCE UK - FEBRUARY
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21 For all your equipment needs visit: www.ambulanceservicesuppliers.com
www.emer
NEWSLINE DAAT
Ground-breaking clinical development degree for air paramedics New qualification will create Devon as a centre of excellence for pre-hospital critical care
be encouraged to contribute to
while benefiting from the very real
wider profession with paramedics
advancing the body of knowledge
experiences of paramedics in
from several other air ambulance
underpinning pre-hospital critical
action.
services joining the course.
“This programme will not only help
“We are in no doubt that we have
practitioners with their decision-
developed a model of Paramedic
Devon Air Ambulance’s Clinical
making and enhance the quality
Support Officer and paramedic,
of critical care, it will help Devon
education that will lead the way
Darren Goodwin said: “The
Air Ambulance paramedics to
world of pre-hospital emergency
become genuine leaders in their
medicine is moving very
field and to make real and positive
quickly with numerous clinical
changes to best practice.”
care through continued research and further study.
A ground-breaking collaboration
papers published each month,
between Devon Air Ambulance
suggesting new and innovative
Amanda Denton, Post-graduate
Trust (DAAT) and Plymouth
procedures and practices. The
Lead at Plymouth University’s
University has resulted in a new
aim of this programme is to
Faculty of Health & Human
Master’s Degree course for
equip already highly experienced
Sciences, said: “The idea for
Paramedic air crew aimed at
paramedics with the knowledge
this degree was only formulated
making them amongst the highest
to appraise, and where necessary
in January last year and it is a
qualified in the profession.
challenge, current thinking and
testament to the commitment
bring their own experience to bear
of everyone involved in the
in advancing clinical practice.
collaboration, that the course is
The first module on the MSc Pre-hospital Critical Care/
up and running within a year.
in clinical development for air ambulance services and create a nationally recognised centre of excellence in pre-hospital critical care. “I must congratulate DAAT for the vision in identifying the need for this degree and the courage to fund it. It will help future proof the clinical work of air ambulance services everywhere.” The three year MSc PreHospital Critical Care – Retrieval and Transfer degree is being
Transport and Retrieval degree
“There are existing ‘off-the-
started in early September and
shelf’ courses but we wanted to
“We have created a platform
delivered by the School of Health
over a three year period studying
design a course that addressed
for personal, academic and
Professions at Plymouth University
for a minimum of 10 hours a
the specific needs identified by
practical advancement in this
and led by Amanda Denton and
week, 20 paramedics will gain
DAAT and one that addresses the
highly specialised area and it has
Peter Allum, with the course
this new qualification and will
application of theory in practice
already caught the attention of the
funded by DAAT.
AMBULANCE UK - FEBRUARY
22 For more news visit: www.ambulanceukonline.com
www.emergencyuk.com | Hall 5 | NEC | Birmingham | 21-22 September 2016 | www.emergencyuk.com | Hall 5 | NEC | Birmingham | 21-22 September 2016 | www.emergencyuk.com | Hall 5 |
NEWSLINE
Want to sell to the emergency services? Take a stand at The Emergency Services Show the only UK event you need to be at! The Show continues to grow year on year, and is a firm date in the calendar for all buyers and operational staff across all the emergency services.
www.emergencyuk.com
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Call the sales team today on 01737 824010 to discuss the right package for you.
ESS - the only show for the entire spectrum of the Emergency Services 23 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE the next stage of treatment.
further improve the outcomes
World first: London’s Air Ambulance trialling brain scanner prehospital
It also means medical teams
for our critically injured
know when not to carry out
patients.”
For the first time in the
The device has a 90%
are commonly associated
accuracy rate in hospital
with causing head injury.
world, a brain scanner is being trialled by the London’s Air Ambulance charity in the pre-hospital environment, to detect on scene for potentially lifethreatening head injuries. The Infrascanner works
certain treatments too, and it can also be used while the
Last year London’s Air
patient is being transferred
Ambulance treated 1806
to hospital, saving further
patients, 60% of which
potentially life-critical time for
were involved in road traffic
the patient.
collisions and falls from heights – mechanisms that
for finding clinically relevant blood clots on the brain.
Having treated over
With this trial, London’s Air
33,000 people, London’s
Ambulance is aiming to
Air Ambulance has an
match these figures in the
international reputation
pre-hospital environment.
for pioneering medical procedures which have been
The National Institute for
adopted across the world.
Health Research (NIHR) Brain
It pioneered thoracotomy
Injury Healthcare Technology
(open heart surgery) at the
Co-operative (HTC) has
roadside and was the first air
provided the seed funding
ambulance to carry blood on
through its ‘Innovation
board. Last year it performed
Small Funding Competition
the world’s first pre-hospital
2014-5’ to initiate this ‘Pre
Resuscitative Endovascular
may need once they arrive
Hospital Brain Imaging’ pilot
Balloon Occlusion of the
at hospital.
study. Through extensive
Aorta (REBOA), a pioneering
stakeholder engagement that
technique to prevent patients
Mark Wilson, London’s Air
included patients and carer
from bleeding to death
Ambulance Doctor and
representatives, the Brain
from severe pelvic injury.
Consultant Neurosurgeon
Injury HTC’s had identified
The charity has performed
at Imperial College London,
pre-hospital scanning as
REBOA three times and has
said: “It is really important
a major unmet need. The
had two survivors of the
to be able to find out
pilot Infrascanner trial by
procedure.
what is going on inside a
London’s Air Ambulance
patient’s head, and get
started in Spring 2015 and
London’s Air Ambulance
a clearer picture of any
will complete in Spring 2016
treats on average five
injuries sustained. By doing
– it has been used on over 60
critically injured people in
this during the transfer to
of London’s Air Ambulance
London each day, performing
hospital, we hope to be able
patients to date.
medical interventions at the
by detecting blood clots on the brain, allowing for earlier and more accurate diagnosis of potentially lifethreatening injuries. Early diagnosis will speed up the patient’s access to any further treatment that they
roadside which are normally
to expedite treatments, such
AMBULANCE UK - FEBRUARY
30 Brooklyn Drive Rayleigh, Essex SS6 9LW Tel/Fax : 01268 833666
as surgery, by knowing in
Professor John D Pickard,
only found in a hospital
advance what type of brain
Honorary Director of the
emergency department.
injury the patient has.”
NIHR Brain Injury Healthcare
Barts Health NHS Trust
Technology Co-operative,
provide the doctors and
The Infrascanner is a small
said: “The HTC is delighted
some financial support and
hand held device that takes
to be supporting Dr Wilson’s
the London Ambulance
less than two minutes to
vision of pre-hospital imaging
Service provides the
operate. By using it pre-
of head injured patients
paramedics and expertise
hospital, it is possible to
through this pilot study.
to dispatch the service.
better inform emergency
London’s Air Ambulance
The charity relies heavily on
departments of potentially life-
and other pre-hospital
voluntary donations and has
threatening bleeding on the
emergency providers are to
a world class reputation for
brain. Doing so can enable
be congratulated upon their
delivering clinical innovation
operating theatres to be set
enthusiasm for research to
and excellence at the
up accordingly and ready for
identify affordable ways to
roadside.
24 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE WAS
Welsh Ambulance Service awarded prestigious environmental management standard
and work continually to improve
procedures – and improving our
accreditation is due to the support
environmental performance.
performance doesn’t just benefit
and hard work by all staff.”
us, it benefits our patients too.” The Welsh Ambulance Service
Andrew Launn, Service Delivery
is currently the only ambulance
The Trust introduced a catalogue
Director at BSI, added: “The
service in the UK to hold this
of new initiatives in its bid to
Welsh Ambulance Service should
standard.
secure ISO 14001, which include
be proud of their certification to
improving waste management
ISO 14001 which demonstrates
Patsy Roseblade, the Trust’s
and recycling facilities in its
their commitment to being a more
The Welsh Ambulance Service
Executive Director of Finance,
premises and encouraging staff
sustainable organisation.
has been recognised for its
ICT and Estates, said: “This is a
to conserve energy and reduce
commitment to reduce its
significant achievement for the
waste through car sharing and the
“Implementing a management
impact on the environment and
Trust and I’d like to extend a huge
use of video conferencing which
system will now enable them to
become a more sustainable
thanks to everyone who made it
reduces travel time, emissions
control their environmental impact
organisation.
happen.
and costs.
and continually improve their
The Trust has been awarded
“Every organisation should be
The Trust also appointed and
the prestigious ISO 14001
mindful of its impact on the
trained ‘environmental co-
The Trust was accredited following
Environmental Management
environment – but it’s particularly
ordinators’ and ‘environmental
an audit which took place at a
Systems Standard by BSI (British
important for a busy emergency
auditors’ at each of its ambulance
sample of stations and office
Standards Institution) after a
service to do this, especially one
station buildings in North Wales
buildings across North Wales
rigorous eight-day inspection of its
with more than 3,000 staff, 700
to champion environmental
during June, July and August.
environmental governance system.
vehicles and 100 buildings up and
awareness amongst staff and
down Wales.
encourage good practice.
recognised standard which allows
“Working towards ISO 14001 has
Leading the work has been
December and the roll out of the
organisations to identify and control
allowed us to make continuous
Estates Officer Nicola Stephens,
Trust’s environmental governance
their impact on the environment
improvements to our systems and
who said: “Achieving ISO 14001
system in South Wales.
performance.”
ISO 14001 is an internationally
Preparations are now underway for further inspections by BSI in
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25 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE ‘Shoctober’ success set to save lives A social media campaign by North West Ambulance Service NHS Trust (NWAS) helped to identify 290 pieces of life-saving equipment across the region that now be used to help cardiac arrest patients in the future. NWAS’ shoctober campaign, which unsurprisingly ran throughout October, saw the public, schools, organisations and celebrities including Paddy McGuiness using the hashtag #findthedefib to locate defibrillators that could potentially be used to save a life in the event of a cardiac arrest. NWAS asked its followers to ‘send a selfie and save a life’ whenever they came across a defibrillator,
and tweet its location so that it could be checked against the list of defibrillators that 999 call handlers use to direct callers to when trying to save the life of a person in cardiac arrest. Automated external defibrillators (AEDs) are small machines which can ‘shock’ a person’s heart into restarting. They are easy to use as they talk through the process and they won’t deliver a shock unless it is required. There is no clinical training required to be able to use the machine. Tweeted 5,864 times, #findthedefib led the ambulance service to 686 defibrillator locations, some as far as Hong Kong and Australia. Of those identified in the North West of England, 290 were unknown to the Trust and will be added to NWAS’ database to help save the lives of patients in the future.
MPs, schools, gyms, youth groups, fire services, police officers, sports teams, councils, supermarkets, media organisations, business owners and NWAS staff all rose to the challenge to ‘find the defib’ and their efforts will contribute to more lives being saved in the region. NWAS Community Engagement Manager, Andy Redgrave said: “The response from the public and local organisations was absolutely fantastic. We hoped they would get behind us to make this campaign a success as we had zero budget for this, but never imagined it would go global! “During the campaign we took the opportunity to involve our Twitter followers in quizzes and fact or fiction posts to help dispel many of the myths that exists about defibrillators, for example that only trained people can use them and
AMBULANCE UK - FEBRUARY
26 For more news visit: www.ambulanceukonline.com
that you can be prosecuted for using one incorrectly which simply isn’t possible. “It’s heartening to learn that all these people know the importance of having defibrillators in public places. Our ultimate aim is for defibrillators to be installed in areas of high footfall across the UK, including schools and colleges, and for them to be positioned alongside fire extinguishers and first aid kits. “A cardiac arrest can happen to anyone – young or old, at any time and the use of a defibrillator within the first few minutes, while professional help is on the way, can improve the chances of survival by up to 70 per cent.” Last year, the Trust attended 13,636 suspected cardiac arrest incidents in the region and this number increases year on year.
NEWSLINE Finding the right address: a matter of life or death An Ordnance Survey software pilot has helped save lives, so say the Community First Responders (CFRs ) who used it. The prototype mobile web app was used by a sample of CFRs from across the country over an eight week period. During this time the sample group were called out to 440 emergency situations, of which the prototype was used on 270 occasions. Of those 270 cases three involved patients suffering cardiac arrest whose lives were saved following CPR. CFRs are volunteers that respond to emergencies, particularly in rural areas, providing Basic Life Support to patients before the arrival of an ambulance. A major difficulty they encounter is finding patients’ homes, especially when it is dark or if the home is remote or has neither a number nor a name board.
There are approximately 20,000 CFRs supporting communities
Jonathan Benger, National Clinical Director for Urgent Care, NHS England, says: “This initiative has the potential to positively influence the outcome of a patient attended by a Community First Responder. It is often simple pilots like these that have big impacts, and it would be useful if they were explored further. Development of this type of software could be vital to people across the country who find themselves in need of urgent and emergency care.” The prototype features OS’s accurate and up-to-date mapping data that responders can access at no cost under the Public Sector Mapping Agreement (PSMA). This data is accessible to the CFRs on any connected device using two of OS’s new APIs, OS Routes API and OS Places, which is the most comprehensive and up-to-date address database in Great Britain, with over 39 million unique address entries. The CFRs are able to copy and paste or type the patients’ address into the OS pilot app’s search bar which then presents a map with the property’s precise whereabouts, which can also be routed to from the CFRs current position. John Kimmance, Ordnance Survey Director of Public Sector, says: “The trial has ended and we are now seeking the funds to take this forward. Feedback from CFRs have identified a number of ways we can improve on what we have done. Projects like this demonstrate in a very clear way to the public the value of the agreement we have
with Government. Also, because our data is playing a part in saving lives, it clearly demonstrates the value of having the latest and most accurate data picture to work from.”
EMAS
Patients put pen to paper to say thank you The number of people getting in touch with East Midlands Ambulance Service to say thank you for the care they’ve received has risen significantly. The patient experience team says that while it is common to receive more compliments than complaints, they’re dealing with more compliments this financial year than ever before (from April 2015). Between April and June 2015 (the first quarter), EMAS received 268 compliments compared to 13 complaints. This equates to a ratio of 20 compliments for every complaint (20:1), something never before seen at the Trust. In the second quarter of the year (July, August September), the number of compliments rose again to 302 compared to 34 complaints. Clare Wade, Patient Safety & Experience Manager, says: “To receive so many compliments is a real credit to the hard work of crews who are at the frontline of
patient care. However, we do take every complaint very seriously and aim to learn everything we can in order to improve our services. “When people feel that they’ve received excellent care that has gone above and beyond what they expected, they write in to say thank you and we really appreciate this. People are often most appreciative of our staff being courteous, supportive and showing empathy.” Compliments were for all of the EMAS services; 999 emergency calls, patient transport and call handlers. Words frequently used to praise staff included professional, excellent, caring, kind, grateful and kind. Patients and members of the public are actively encouraged to give feedback about the care they received from the ambulance service. They can do that via the Patient Advice and Liaison Service (PALS) – email: emas.pals@nhs.net or call at local rate on 0333 012 4216 Dominic Ford, Team Leader for North Derbyshire, said: “It’s great that we receive the thank you letters and compliments from the patients that we treat. It’s a credit to all the hard working frontline staff. The thank you letters and compliments make the crews feel appreciated by the many patients that we treat, and sometimes in difficult circumstances.”
Dominic Ford, Paramedic and Team Leader for North Derbyshire, in front of the thank you letter noticeboard at Chesterfield Ambulance Station.
AMBULANCE UK - FEBRUARY
Mark Norbury, National Ambulance Resilience Unit Coordinator, says: “There are three people alive today who might well not have been but for the prototype OS created. In two thirds of cases where the pilot software was used it speeded up the CFRs response to the patient’s side. Whilst it is difficult to identify exactly whether the earlier arrival of a CFR improved a patient’s outcome, it was clear in two thirds of the cases reviewed that the CFR got to patient quicker with less stress because of the ease of finding their patient’s house. CFRs appear to be getting more and more calls in wider areas than historically and the pilot scheme enabled them to respond with confidence in finding their patient. Finding named houses, especially in the dark, is an absolute life saver.”
in Great Britain today, and they respond to around 50,000 emergency calls a year. Each CFR covers an eight mile radius and receives details of the emergency via an SMS. With this information they then search the Internet on their mobile device to try and identify where the address is. The problem CFRs find with Internet mapping is that it only gives an approximation of an address and not an exact location, which, when a life hangs in the balance, loses vital time.
27 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE Exceptional’ new volunteers join lifesaving network in Hertfordshire The team of lifesaving
an 18-hour course, the last of
arrests in their communities.
car to attend 999 calls in. CCR
the year, by staff at the East of
Their aim is to reach a potential
is a Community First Responder
England Ambulance Service NHS
life threatening emergency in
scheme whose volunteers
Trust (EEAST) over last weekend,
the first vital minutes before the
are trained by West Midlands
which included learning vital
ambulance crew arrives on scene.
Ambulance Service to a
lifesaving skills such as cardio
If you’re interested in becoming
nationally recognised standard.
pulmonary resuscitation (CPR)
a CFR please visit: http://www.
They can be called upon to
and using a defibrillator.
eastamb.nhs.uk/get-involved/
attend medical emergencies
community-first-responders.htm
in their area while a blue-light
volunteers in Hertfordshire
Community Partnership Training
received one final boost before
Officer for Bedfordshire and
the new year.
Hertfordshire Simon Marshall said: “The group were of an
vehicle is en-route.
New car for lifesavers after big donation from local building society
The keys to the fully equipped Skoda Yeti was handed over
A group of nine new ‘exceptional’
exceptionally high standard
community first responders
in both written and practical
(CFRs) completed their training
assessments; I’m certain these
at Letchworth ambulance station
new volunteers will go on to be
and they will be based throughout
great ambassadors for the Trust
A group of life saving
the county.
and make a real difference within
volunteers were given an early
their communities.”
Christmas present thanks to
Coventry Community Responder
the generosity of a Coventry
Chairman, Mark Tolan, said; “We
based company.
would like to thank Coventry
The nine new recruits are: Victoria
to the group Chairman, Mark Tolan, by the Mayor of Coventry, Michael Hammon, and Anna Cuskin, from Coventry Building Society.
Wadley, Tracy Nicholls, Emily
In total, more than 60 new recruits
Sapsford, Julie Hood, Sally
completed these courses in
Tugulu, Sheryl Kelleher, Daryl
Bedfordshire and Hertfordshire
The Coventry Building Society
for their kind donation; the
Jooste, Andrew Harley, Emma
alone last year. Having been
made a huge £20,000 donation
largest they have ever made
Fulford, and Janine O’Neil.
trained in basic life support, it
to the Coventry Community
to any charity. It will enable our
allows the CFRs to attend medical
Responder group that has
volunteers to attend numerous
emergencies such as cardiac
enabled them to buy a second
999 calls and could help save
The responders were put through
Building Society immensely
AMBULANCE UK - FEBRUARY
28 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE numerous lives. We estimate that the car will enable us to attend to about 1,000 more patients every year. The earlier a
EMAS
EMAS sign the Blue Light Pledge
patient in cardiac arrest receives a shock, the much more likely they are to survive. All of our responders are volunteers who give up their spare time in addition to their own jobs. It is very satisfying being a CFR and knowing that you have made a difference to someone’s life.” About the donation, Corporate Responsibility Manager from The Coventry, Anna Cuskin, said: “So many of our members live in Coventry so when we heard about the fantastic work the
East Midlands Ambulance Service (EMAS) signed a ‘Blue Light Pledge’ showing their commitment to fighting mental health stigma and discrimination in the workplace. The pledge is run by Mind, the mental health charity, who are encouraging emergency services and organisations to join the programme to promote a better understanding of mental health problems and improve the support and wellbeing they provide to their staff and volunteers.
community first responders do, we were delighted to be able to support them. They really can make the difference between life and death.” If you would like to volunteer as a community first responder for West Midlands Ambulance Service, you can find out more details at: www.wmas.nhs. uk/Pages/Community-FirstResponders.aspx All vacancies are advertised via the NHS Jobs website www.jobs.nhs.uk
Kevin Charles, EMAS Chaplain and Staff Support Lead said: “Our staff respond to a high volume of emergency calls, often in very challenging circumstances, which can impact their mental and physical health. We want to fight the stigma around mental health whilst supporting our staff to get the help and support they need. We have a number of initiatives across the trust to support staff one of which is our peer to peer scheme which provides
colleagues with training in support techniques and how to signpost colleagues to other services. “We are very proud to be part of the Blue Light Programme and are looking forward to working with Mind.” EMAS joins a long list of emergency services but are the first ambulance service to sign the pledge. Others include Derbyshire Fire and Rescue and Leicestershire Police.
Amazing ambulance staff praised in new report The region’s “amazing” ambulance staff have been praised in a new report. More than 100 people who received emergency medical help in September responded to questionnaires with 97.1% saying they were very satisfied or satisfied with the service they received. Patients described ambulance staff as “very professional”, “amazing”, “faultless”, “very reassuring”, and “wonderful” in the latest patient experience report.
More than 95% of respondents rated the handling of the 999 call by the East of England Ambulance Service NHS Trust (EEAST) as very acceptable or acceptable. And almost 90% said the length of time they had to wait for the service to arrive as very acceptable or acceptable with almost 100% very satisfied or satisfied with the care they received from staff. Nine out of ten respondents described the comfort of their journey in an ambulance as very comfortable or comfortable and 96.2% said the service exceeded or met their expectations. Robert Morton, EEAST Chief Executive, said: “I’m delighted that these results reflect the organisation’s ethos of being innovative, responsive and excellent. I’d like to pay tribute to all the hard working patient facing staff across the East of England and to our support staff without whose excellent work we would not be able to deliver our services as effectively as we clearly do. “We really value the feedback from our patients.”
AMBULANCE UK - FEBRUARY
29 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE TVAA
Thames Valley Air Ambulance pioneers night simulation training course • Air Ambulance crews
in the South Central Region
Ambulance and Hampshire and
Mark McGeown, CEO of Thames
took place at Thames Valley Air
Isle of Wight Air Ambulance crews
Valley Air Ambulance added:
Ambulance’s state-of-the art
undertake three advanced trauma
“This course shows that our
training and simulation centre in
scenarios, working together to
Charity and the South Central
December 2015.
build the ‘paramedic physician
Ambulance Service are committed
partnership’ that is essential for a
to developing and enhancing the
Developed by Dr Syed Masud
truly gold standard delivery of pre-
helicopter emergency service in
(Clinical Governance Lead
hospital emergency medicine.
our region to provide the highest
for TVAA and Consultant in
level of care for patients who need
undertake advanced ‘on
Emergency Medicine & Pre
scene’ and ‘in flight’ training
Using state-of-the-art simulation
Hospital Care at the John
scenarios at night in
mannequins and live recording
Radcliffe Hospital) and Kevin
preparation for night flying
ability, where breathing, vital signs
TVAA’s aviation partner Bond
Letchford (Lead Paramedic for
launch early this year
and reactivity based on medical
Air Services Ltd and their highly
Training and Simulation for TVAA),
decisions can be controlled by
skilled helimed pilots are also
the course prepares medical
IPad software, the crews were
central to the service, ensuring
teams for night-time Helicopter
at the cutting-edge of pre-
tested on full general anaesthesia,
the most effective coverage for
Emergency Medical Services
hospital emergency medicine
immediate pre-hospital blood
the entire region, as well as the
(HEMS) to ensure the highest
transfusion and advanced
training in order to treat
speed, safety and precision of the
level of care is delivered to
ultrasound techniques under the
operation.
and stabilise patients at the
seriously ill and injured patients
conditions and challenges faced
scene.
in the challenging night-time pre-
by night-time operations. The
“We are extremely proud of our
hospital environment.
crews will directly transfer these
air ambulance and its crew.
skills to the field when both air
Night operations will provide a
• Thames Valley Air Ambulance
Specialist night operations
us at any time of the day or night.”
training for pre-hospital
The advanced training model
ambulance services launch night
huge step up to a higher level of
emergency medical doctors
saw doctors and paramedics
HEMS in early 2016.
capability and this is a result of
and critical care paramedics
from both the Thames Valley Air
the very close partnerships we Dr Masud said: “Undertaking
have with the NHS and South
emergency pre-hospital care at
Central Ambulance Service. But it
night brings new challenges to
is also important to remember that
air ambulance operations, most
our ambition of delivering a gold
obviously working with no, or
standard service is dependent
little light. This course paves the
on the generosity of the people,
way for advanced critical trauma
companies and organisations
care that ensures that no matter
who support us.”
what time of the day or night, our crews are equipped with the
roadside.”
Allianz UK announces association of air ambulances as forthcoming charity partner
Kevin Letchford commented
Allianz UK is proud to
“Simulation within the medical
announce that its new charity
world has come on massively over
partner is the Association
the last decade. Many felt it was
of Air Ambulances (AAAC).
confined to in-hospital scenarios
Launching in February 2016,
however technology has allowed
the partnership will initially
us to take it to the next stage
last three years and Allianz
in reference to pre-hospital
employees have set themselves
emergency medicine. On this
the target of raising £1million.
expertise and knowledge to treat and stabilise patients at the scene or in flight. What people thought could only be done in hospital is now being done in minutes by the
AMBULANCE UK - FEBRUARY
course we have simulated night time in flight emergencies as well
As the world’s largest motor
night time roadside scenarios. We
insurer, road safety is a major
have mirrored reality as closely as
issue for Allianz as road traffic
possible specially in reference to
accidents can have a devastating
night operations.”
effect on people’s lives.
30 For more news visit: www.ambulanceukonline.com
NEWSLINE The partnership between Allianz
vital work that the air ambulances
and improve air ambulance
chances of a person’s survival
and the AAAC will have a
do. The charity was voted for
services throughout the UK. We
decrease by 14% for every
positive impact on the ability of
by our employees and through
look forward to working with their
minute that passes without early
air ambulance services to reach
fundraising activities across
many colleagues and having fun
defibrillation. The introduction
critically ill and injured people
our branch network we can
raising vital funds to help our
of the Co-Responders means
across the country giving them
make a real impact in the local
patients.”
that we are able to attend and
the best chance of recovery and
communities that we serve.”
rehabilitation. The fundraising will help expand the service of the
The AAAC is a legally
AAAC by enabling them to update
independent body which is
equipment (for example allowing
designed to funnel national
for the carriage of blood),
donations into individual air
undertake further night flights and
ambulance charities. It allows
enhance clinical training.
air ambulance charities to approach national or large
Allianz UK will make central
regional organisations who may
donations and support its
want to make donations to the air
5000 employees in their local
ambulance sector as a whole.
fundraising activities, engaging with regional air ambulances.
Liz Campbell, Chairman of the
Allianz UK will also work to help
AAAC said: “We are delighted
raise awareness.
to have been chosen by Allianz to be their charity partner. We
Jon Dye, CEO, Allianz UK
share their value of excellence
commented: “We are very
and focus on customers. The
pleased to be supporting the
money that they raise will support
provide basic lifesaving skills
New co-responder partnership launches trial
and support to our patients
New Co-Responder
Central Ambulance Service
partnership launches trial across the Thames Valley between South Central Ambulance Service NHS Foundation Trust Royal Berkshire Fire and Rescue Service Oxfordshire Fire
quicker than ever before. Nic Morecroft, Lead Community Response Manager from South said: “We are pleased to have embarked on this trial with our partner organisations and are incredibly grateful for their commitment and support in order to get it up and running for the benefit of the local
and Rescue Service
communities. Having the
Buckinghamshire and Milton
extra response in Wokingham,
Keynes Fire and Rescue
Buckingham, Abingdon and
Service
Didcot will complement our already existing Community
South Central Ambulance
Responder Schemes and Public
Service NHS Foundation
Accessible Defibrillators which
Trust (SCAS) and fire services
are also in the area helping to
across the Thames Valley
save more lives.”
(Royal Berkshire Fire and Rescue Service, Oxfordshire
South Central Ambulance
Fire and Rescue Service and
Service NHS Foundation
Buckinghamshire and Milton
Trust (SCAS) provides
Keynes Fire and Rescue
emergency care for Berkshire,
Service) are celebrating a new
Buckinghamshire, Hampshire
potentially lifesaving trial which
and Oxfordshire. Our area
sees full time fire stations
covers approximately 3,554
responding as Co-Responders.
square miles and has a resident population of over four million
Co-Responders are firefighters
people.
from full time fire stations at Wokingham, Buckingham,
Produced by the South
Abingdon and Didcot trained
Central Ambulance Service
by SCAS to provide a ‘first
NHS Foundation Trust
response’ to specific medical
Communications Department
emergencies where there is an immediate threat to life prior
Visit us at www.scas.nhs.uk
arriving on scene. These
Nigel Wilson, Area Manager for
new Co-Responder schemes
Operations and Resilience for
started running as a trial from
Oxfordshire County Council’s
mid November and aims to
Fire and Rescue Service,
ensure that an appropriately
said: “This pilot scheme is an
trained person is on scene as
excellent example of effective
quickly as possible providing
partnership working, that will
that first response prior to the
see skills and resources shared
arrival of an ambulance. In
to enhance the service being
cases of cardiac arrest the
offered to the local community”.
AMBULANCE UK - FEBRUARY
to an emergency ambulance
31 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE NWAS
Double Queen’s honours this new year for North West Ambulance Service North West Ambulance Service’s (NWAS) longest
Steve joined the City of Liverpool Ambulance Service as an Ambulance Cadet in 1971. He became a Paramedic in 1989. He is author of a book now in its third edition, helping people to read heart rhythms and used by student paramedics, student nurses and medical students.
serving Paramedic, Steve Evans, is to receive an MBE in the Queen’s New Year’s honours list for his services to First Response and voluntary service to Young People. In 2001, he set up the ‘Don’t
He has demonstrated consistent drive and enthusiasm, locally, nationally and internationally to raise awareness and reduce risks of harm, particularly for young people.
Walk Away’ campaign to raise awareness amongst young people of the dangers of underage drinking and choking or hypothermia. He started with one poster and since then his enthusiasm and drive have ensured that the campaign has achieved
Steve said: “I’ve been bursting to tell people but of course I couldn’t otherwise it’d be straight down the Tower of London. It’s a great honour, the fact people think I’m worthy of it is beyond words for me.”
extremely high profile through being featured on TV and radio.
A further honour has been
awarded to Burnley Paramedic, Collette Kallee who is to be presented with an OBE for her services to the Ebola response in Sierra Leone. Collette worked in Sierra Leone during early 2015 and has since taken a 12 month career break from April 2015, returning to volunteer in Sierra Leone. Director of Operations, Derek Cartwright, said: “The Trust is extremely proud of our exceptional staff who are real assets to the whole ambulance profession and have proven they have true care and compassion as they are willing to go to extreme lengths for their patients.
SCAS
Review of the year 2015 As another year has come to an end, Will Hancock, Chief Executive of South Central Ambulance Service NHS Foundation Trust (SCAS) takes a look back at some of the achievements and challenges that SCAS has faced over the last 12 months. “I would like to start by thanking all our staff, volunteers, governors and members for their hard work and commitment over the last year. “Like many other areas of the
“These honours are truly deserved and show that working for the ambulance service is so much more than a job, it is a calling.”
AMBULANCE UK - FEBRUARY
32 For further recruitment vacancies visit: www.ambulanceukonline.com
NHS, 2015 has been challenging for SCAS but I’m pleased to see that since the summer, our focused efforts in turning around our performance against national
NEWSLINE response time targets has started
that a patient who we attended
“The New Year Bank Holiday
to see improvements and we
around 200 times a year for a
Weekend is traditionally a busy
are finishing the year with our
number of years has not called us
period for us and I saw this in
performance level on an upward
in the last 12 months. The patient
the New Year in our Clinical
trajectory that I am confident we
is happier, healthier and making
Co-ordination Centre in Bicester
can continue to sustain in 2016.
great changes to their personal
where demand for our non-
and professional life.
emergency NHS 111 service
“Trying to summarise everything
was particularly high. Whilst
“I’d just like to take this opportunity to thank the ambulance crew that saved my life and help keep me here”
that a 24-7 organisation such as
“Such change has been
there, our staff kept up a very
ours has achieved in the last year
described by the patient’s GP
high call answer performance
is a challenge in itself, but here
as “a miracle” – a rather apt
and as the weekend progressed
are just a few of the successes
description at this festive time of
the NHS 111 service got even
that continue to make me so
year. By ensuring our demand
busier with, at times, demand
very proud to be working with
practitioners understand the
reaching over 850 calls an hour.
the amazing staff we have right
root cause of why such frequent
The lack of a cold spell slightly
across all areas of SCAS.
callers use our service, and
reduced demand on our 999
solving that root cause with our
service this New Year compared
“Last year we have rolled out an
partners, we not only improve the
to 2014/15 but over the four-
Electronic Patient Record system
patient’s health and wellbeing but
day period we still attended
with our local hospital partners
also free up more of our frontline
over 2,500 Red 1 and Red 2
that has improved the speed and
staff and vehicles to attend other
“It was getting worse and I was
incidents and exceeded the
emergencies.
very clammy and sweaty- then it
efficiency of our handovers to
national response time target
became more difficult to breathe.”
A&E teams.
of reaching 75% of those calls “Being able to keep more of our
within eight minutes.
The ambulance crew arrived at
“I’m delighted that we are seeing
people and vehicles available
the efforts of our HR teams
to respond to life-threatening
“I would like to wish all our
assessed that he needed urgent
rewarded and since April 2015
emergencies saves more lives.
staff, volunteers, members and
hospital treatment.
we have increased our frontline
The impact of the speed, skill
everyone we serve in our local
workforce by over 5%. This
and professionalism of our
communities, a happy and
“On the way to the hospital, Kevin
comes at a time when we – like all
frontline teams and air ambulance
healthy New Year.”
suffered a cardiac arrest in the
ambulance trusts – are facing the
colleagues is evident day in, day
challenges of a national shortage
out, and was confirmed earlier this
of paramedics.
year following publication of data
Kevin’s home and immediately
back of the ambulance,” said EMAS
EMAS paramedic Russell NelsonTempest.
“The challenges of matching
Network that showed patients
our resources with forecast
who have a major trauma are now
demand on our service has been
63 per cent more likely to survive
significantly helped by a number
than they were in 2009.
Derby resident to thank ambulance crew for restarting his heart five times
introduced. One such initiative
“Away from the traditional view of
A young Derbyshire resident
“But thankfully, by the time we
has targeted our “frequent callers”
an ambulance service, the other
is set to meet the ambulance
reached the hospital, Kevin had
– who we classify as a patient
areas of our business continue
crew that saved his life after
regained a pretty good level of
who we have attended as an
to thrive. As a result of a number
restarting his heart 5 times
consciousness.”
emergency incident 12 times or
of tender wins, we now provide a
during a sudden heart attack.
more in the past 12 months. We
non-emergency patient transport
have introduced a new role in
service across the whole four
Paramedics from East Midlands
recuperation and rehabilitation,
SCAS of ‘demand practitioners’.
counties we serve. In November,
Ambulance Service (EMAS)
Kevin is now well on his way to
These demand practitioners work
inspectors from the Care Quality
where called by Kevin Payne,
making an amazing recovery.
with frequent callers and a range
Commission conducted a focused
36, after an onset of central
of local health and social care
inspection on our NHS111
chest pain during the evening of
“I’d just like to take this
partners to reduce emergency
service. I am confident that when
Wednesday 12 August.
opportunity to thank the
demand from the individuals and
the inspectors’ report is published
ensure that is sufficient planned
it will show we continue to deliver
“At first I thought it was heart
life and help keep me here,” said
care and support in place.
a high quality, responsive and
burn or indigestion, as I’d been
Kevin.
safe non-emergency telephone
to the gym earlier in the day
“One example of the success
service 24 hours a day, seven
but the pain started radiating to
“They do an incredible job
such innovation has delivered is
days a week which now takes
both of my arms,” said Alvaston
and definitely deserve to be
that we have managed to ensure
over one million calls a year.
resident Kevin.
recognised for it.
by the Trauma Audit Research
“We actually had to use our defibrillator 5 times to shock and restart his heart during the journey.
of innovations the Trust has
After nearly 4 months of
AMBULANCE UK - FEBRUARY
ambulance crew that saved my
33 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE Ambulance Service (NWAS)
EMAS
resources arrived on scene
Teaching to save lives in Kenya
within four minutes to commence treatment on Michael before taking him to Chorley District Hospital.
A leading consultant in critical care and major trauma has visited Kenya to teach the country’s
Now fitted with a pacemaker and
people vital lifesaving skills
‘fully recovered’ Michael joined
following major trauma incidents.
three members of the crew who saved his life for the emotional
Medical Director at East Midlands
reunion at Chorley Ambulance
Ambulance Service, Dr Bob
Station. NWAS crew Ronnie
Winter, is a member of the Advanced Trauma Life Support (ATLS) steering group which aims to create a uniformed way to treat trauma patients around the world. “I do it because I can probably save more people through education than I ever will individually,” said Bob.
Barnes-Brown, Liz Perry and means we can make the biggest
around the world including South
potential impact and save even
Africa, Italy, Norway, Denmark and
more lives,” continued Bob.
America.
“They now have most of the
The project is funded by the
essential equipment, so we just
Kenyan Red Cross and Innovative
need to equip them with the skills
Canadians for Change.
to use it.”
include lifesaving techniques during the first hour of a patient suffering major trauma, which means an injury that has the potential to cause prolonged disability or death.” Alongside John Garnham Davis, Clinical Skills Centre Manager for Nottingham University Hospital, Bob visited the Kenyan Red Cross training school in Nairobi during the first stage of establishing the ATLS program in the country. “Bringing this course to a developing country like Kenya
Skinner were part of the group of professionals that helped save Michael’s life. Michael presented each member of the crew with a bottle of champagne on his tour of the
NWAS
“The skills we focus on teaching
Community First Responder Tony
A mix of surgeons, medical officers and anaesthetists are taught during the course, who will then go on to teach more medical professionals throughout the country. “This is the fifth country where our group has done this type of work and Kenya is now half way through the process,” said Bob. “We will fully complete the teaching and training process next summer when we come back and run a course together rather than just presenting it to them. “It’s pleasing to think we’re making a difference in other countries but
‘I can see my kids grow up thanks to you’, says Chorley business owner
station. Ronnie Barnes-Brown, NWAS Paramedic, said: “When we arrived on scene Michael had gone purple. We treated him for about 40 minutes giving
A Chorley businessman
him adrenalin and even drilling
has said he ‘can’t thank the
into the bone on his left arm to
ambulance crew enough’ for
administer treatment – it’s great
their quick response when he
to see Michael has made such an
collapsed.
amazing recovery.”
46 year old Michael Bromley,
An emotional Michael Bromley,
who owns a business in Chorley,
who is a father of two young
collapsed at his premises on
children, said: “I am so very
Leigh Street suffering a cardiac
grateful to each member of the
arrest. After a member of his
crew for everything they did for
staff phoned 999, North West
me.
it also makes me really appreciate the advanced standard of emergency medical and trauma care we have here at home.
AMBULANCE UK - FEBRUARY
“Between the highly skilled ambulance paramedics who treat patients at an incident and the expert clinicians who take over at hospital, we can be reassured that we will always receive the best possible care.” The team that worked with Bob to provide the training was made up of medical professionals from
34 For more news visit: www.ambulanceukonline.com
NEWSLINE My business was moving
He said: “Our staff deal with
“We have nominated a local
“We are fully aware of the
premises that day and I was
stressful and sometimes violent
representative to communicate
challenges staff face and we can
loading a truck at the time I
situations on a day-to-day basis
regularly with the charity and we
provide a range of help including
collapsed. Since the incident I’ve
and the role which they carry
grants to attend rehabilitation
started at the gym and had all my
out is physically and mentally
have promoted their services to
demanding.
our staff so that they are aware
centres, funding for programmes to
staff trained in CPR – I hope one
of the kind of help and support
help with stress and post-traumatic
day they can save a life like this amazing group of people.”
“That can take a toll on their health and wellbeing and they
Emergency Medical Technician,
sometimes need support to help
Liz Perry said: “To find Michael
them deal with the consequences.
in such a bad way and after we
available.” Cliff Randall, who has been Chair of TASC since it was launched in March, said people
stress disorder, welfare support and advice, and bereavement support. “Ambulance staff provide a vital service in our emergency services sector, often in difficult
left him at hospital I thought it
“Until I joined the Welsh
working in caring professions
would be difficult for him to pull
Ambulance Service Trust, I
often didn’t ask for help even
through. Michael left a letter at the
assumed that police, fire and
when they needed it.
ambulance station and we were so
ambulance staff had similar,
happy to hear he was fit and well.
independent welfare support
He said: “TASC is here to
For Michael to see his kids after the
systems to fall back on in times of
The TASC Freephone Support
support past and present
incident and continue to live his life
difficulty.
Line telephone number is
members of the ambulance
0800 1032 999.
normally it’s absolutely incredible.” “However, I now know that until Senior Paramedic Chris Rowan
recently, ambulance service
and Phil King, who was a Student
staff have not enjoyed the same
Paramedic at the time, also
breadth and depth of services
attended the scene to help save
that their emergency services
Michael’s life.
colleagues have.”
Closer ties with a new national charity
Mick was keen to emphasise that
circumstances, and it is great to have the backing of the Welsh Ambulance Services NHS Trust.”
service in times of a crisis or severe difficulty need following
For further information or to
injury, illness, stress or
support the work of the charity,
bereavement.
please visit www.theASC.org.uk
the Welsh Ambulance Service had made significant investment in its occupational health and
A leading figure in the Welsh
wellbeing services in recent years
Ambulance Services NHS Trust
but recognised that the link with
has welcomed closer ties with a
TASC brings a new and different
new national charity dedicated
dimension which is very much
to supporting ambulance staff in
welcomed.
times of need. “We’re keen to support TASC because not everyone wants
chairman of the Trust for the
to talk to someone at work, or
last two years, is a former Chief
someone arranged through
Constable who served in the
work, about how they are
police force for 31 years.
feeling,” he said.
He has met with Cliff Randall,
“Sometimes, it is helpful for staff
Chair of The Ambulances Services
to have completely separate
Charity (TASC), to find out more
confidential support, independent
about the UK-wide charity which
of their employer and TASC can
can provide vital advice, counselling
play that vital role.”
and support services to both serving and retired ambulance staff,
He added: “Staff and their families
their families and dependents.
may also need help over an extended period of time.
Mick said that ambulance service staff, both past and present,
“TASC can help to provide that
deserved their own national
longer term support, particularly
charity which is dedicated to their
when dealing with bereavement or
wellbeing and welfare.
post-traumatic stress disorder.
Mick Giannasi, who has welcomed closer ties with The Ambulances Services Charity (TASC)
AMBULANCE UK - FEBRUARY
Mick Giannasi, who has been
35 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE Special pilot scheme The ambulance and fire services in Monmouthshire have begun working closely together in a special pilot scheme. The trial, launched on 21st December sees the two emergency services form a new Fire Medical Response (FMR) in an attempt to address consistently poor ambulance response times across the rural county. Fire Medical Response teams will be mobilised by fire control, as
between the emergency services
“The exact nature of the pilot
WMAS will now work with BCCG
to ensure a better operational
will vary in each Welsh Fire and
and Cheshire commissioners as
response, increase operational
Rescue Service region but the
part of a mobilisation process to
services and improve resilience –
overall aim of working together
ensure a smooth transition takes
adding real value for money whilst
to save lives will be a common
place with the current provider.
working more effectively and
approach in the three regions.” The pilot follows similar schemes
Director, Mark Gough, said:
Greg Lloyd, Head of Clinical
being launched by a total of 43
“We are delighted to have won
Operations at the Welsh
participating fire and rescue
this contract. We have a very
Ambulance Service, said: “Every
services across the UK. At the
strong team with vast experience
second counts in an emergency.
end of the pilot period, detailed
in running PTS operations.
If our fire service colleagues can
evaluation will take place to
Currently we complete around
get to a scene before one of our
determine its success.
700,000 PTS journeys per year.
deliver life-saving treatment –
Long-standing campaigner
“We will be implementing a tried
that’s only going to improve that
for better response times in
and tested service delivery model
patient’s chance of surviving.
Monmouth, Mathew Davies,
that is used elsewhere including
commented: “I am happy to
neighbouring Staffordshire where
hear that the ambulance service
we operate a Patient Transport
is merging with the fire service
Service, Courier Transport
in order to cut waiting times.
Service and Commercial
Paramedics deserve all the help
Services.
ambulances they can begin to
directed by the Welsh Ambulance Service Trust. South Wales Fire and Rescue Service will mobilise fire appliances as part of the FMR pilot, as well as 4x4 vehicles, both of which will proceed under blue light conditions. The vehicles will be equipped with specialised equipment enabling fully trained staff to respond to a set of clinical conditions where their arrival could be achieved the soonest, and where they would be adding the most value with their training and equipment.
“Thankfully, I know that local paramedics and members of the fire service care deeply about the community. I have no doubt that they will do everything they can to make this initiative work for the people of Monmouth”
This includes being mobilised to cardiac arrests, casualties who are reported unconscious or choking, and catastrophic bleeding. The pilot is being rolled out over the three Fire and Rescue Services in Wales and the Welsh
WMAS Commercial Services
efficiently.”
they can get in order to do what they do best. Saving lives!
“We are particularly pleased that we have been able to keep this
“Thankfully, I know that local
important contract within the
paramedics and members of the
NHS family and will be working
fire service care deeply about the
with staff to ensure that we have
community. I have no doubt that
a very strong presence in the
they will do everything they can
county.
to make this initiative work for the people of Monmouth”
“We know that this will be an unsettling time for staff so will
WMAS
Trust scoops new PTS contract
be doing everything we can to ensure that we work as closely as possible with them to reassure them that jobs are safe and that we want to work with them to take
North Wales Fire and Rescue
West Midlands Ambulance
Service’s Assistant Chief Fire
Service has scooped its first out
Officer Richard Fairhead said,
of area non-emergency patient
The new contract incorporates a
“We would like to reassure
transport service contract in a
number of quality improvements
residents across Wales that there
deal worth almost £25 million
following engagement with
will be absolutely no reduction in
over five years.
hospitals, patients and
emergency response and service
the service to the next level.”
commissioners. These include:
delivery, either from the fire and
The Trust has been chosen
and is expected to continue until
rescue services across Wales
by NHS Blackpool Clinical
June 2016.
or from the Welsh Ambulance
Commissioning Group (BCCG),
patients when their transport
Services Trust, during the pilot
Lead ambulance commissioners
will arrive
period.
for the North West, to run the
Ambulance Services NHS Trust AMBULANCE UK - FEBRUARY
Speaking on behalf of the three
service for Cheshire, Warrington
Welsh fire services, South Wales
• Text ahead service, to inform
• Streamlined quality standards,
Assistant Chief Fire Officer,
“The pilot will involve mobilising
Andrew Thomas said: “This pilot
responders who are suitably
is an opportunity for us to work
trained individuals who will work
The decision comes after a
more closely together to the
to preserve life until the arrival
rigorous competitive tendering
benefit of the public in Wales,
of either an ambulance or rapid
process and evaluation of
the eligibility criteria to ensure
improving collaborative working
response vehicle.
potential providers.
equitable access to the service
and the Wirral starting in July 2016.
particularly around the journey arrival and collection times
36 For further recruitment vacancies visit: www.ambulanceukonline.com
• Revised process for applying
IN PERSON but one thing has remained constant; Milly’s
SCAS News
SCAS says ‘thank you!’ to Milly after 47 years
dedication, enthusiasm and commitment to her patients. She has been an inspiration to many for her fantastic service and we will be very sad to see her go.”
On Thursday, 3 December, friends and colleagues from South Central
And whilst Milly may have ‘hung up her
Ambulance Service NHS Foundation
keys’ for the last time, she has no plans to
Trust’s (SCAS) Patient Transport Service,
put her feet up completely.
came together at Southern House in Otterbourne to say thank you to
“I’ll still keep up my volunteering – I won’t
Hampshire Volunteer Car Driver, Milly
be sitting around on my bottom! I’m already
Stokes, who retired after 47 years and
thinking about volunteering at my local
nine months’ service.
hospital, and maybe I’ll help out at a charity shop too.”
Milly began driving as a volunteer back in 1968 for the ambulance car service in Hampshire and has received six long as well as one from University Hospital Southampton NHS Foundation Trust.
the Trust Board.
Milly said: “In my first 10 years, I used to take three chaps from Netley village to
“He has a wealth of experience within the healthcare and finance sector, and as a NonExecutive Director, and this will be invaluable to the Trust.
Knowle Hospital. Getting them there at 9.30am and transporting them back to Netley for 3.30pm meant I could do my driving and still be there to collect my children from school.”
Non-executive appointments to NHS Trusts made by the NHS TDA are subject to the Code of Practice of the Commissioner for Public Appointments.
Over the years, Milly has driven patients to and from places as far from Hampshire as Liverpool, Plymouth, Norfolk and Birmingham as well as got to know lots
Mark Tattersall has been appointed from 10 December 2015 until December 2017. He has declared no political activity in the last five years.
of ‘regulars’ – patients who she has transported frequently as they attend hospital or treatment centres for dialysis, chemotherapy and radiotherapy.
about her role as a volunteer car driver, Milly said: “I’ll miss meeting all the patients and having so many different and interesting people to talk to. Also, I’ve loved seeing new towns, villages and countryside when I’m out driving so I’ll miss that too.”
James Underhay, Director of Strategy, Business Development, Communications and Engagement, said:
NWAS News
New Non-Executive Director appointed to NWAS The NHS Trust Development Authority (NHS TDA) has confirmed the appointment of Mark Tattersall Non-Executive Director of North West Ambulance Service NHS Trust. Mark is a qualified accountant who worked as a senior executive from 1991 until the end of 2007 in a range of businesses which included
“It’s hard to believe that in the year Milly started volunteering, Harold Wilson was Prime Minister, Dad’s Army first appeared on TV and British Rail’s last steam train service between Liverpool and Carlisle made its final journey. A lot may have changed since then
the Co-operative Bank, Leeds Building Society, the BBC and London Scottish Bank. In the last eight years he has held a number of Non-Executive Director roles within both
AMBULANCE UK - FEBRUARY
At the event to mark Milly’s retirement,
Mark is currently the Deputy Chair of the Your Housing Group where he chairs the Audit and Risk Committee and is a NonExecutive Director of Leasowe Community Homes one of the Group’s subsidiaries. Mark also currently operates as a self-employed consultant delivering financial and general management services to a number of businesses. Chairman for North West Ambulance Service, Wyn Dignan comments: “We’re delighted to welcome Mark to the Service and are confident that he will be a positive addition to
service awards including one from SCAS
When asked about what she’ll miss most
end of September 2015 he was a NonExecutive Director at Manchester Mental Health and Social Care Trust and during his seven years of service, chaired the Audit Committee, the Finance Committee, the Quality Board and acted as Interim Chair for a period of six months.
the public and private sectors. Up until the
37 Do you have anything you would like to add or include? Please contact us and let us know.
IN PERSON WAS News
Welsh Ambulance Service leader recognised in New Year’s Honours List A Welsh Ambulance Service boss has been recognised in the New Year’s Honours list. Rob Jeffery, the Trust’s Head of Operations responsible for the Hywel Dda and Powys areas, has been awarded the Queen’s Ambulance Service Medal, it was announced. Pembroke-born Rob, who has dedicated more than 30 years to the service, admits it still hasn’t sunk in.
Chief Executive Tracy Myhill said: “We’re thrilled that Rob has been recognised for his dedication to our ambulance service in Wales. “Rob is a stalwart and such determination, commitment and dedication results in the enormous respect he enjoys from his colleagues. “I’m delighted that his contribution has been recognised in such a distinguished way.” The Queen’s Ambulance Service Medal was introduced in 2012, when now retired Director of Ambulance Services, Dafydd Jones-Morris, was commended in the Queen’s Birthday Honours list.
He said: “I had a letter in November from the Department of Health to say I’d been recommended to receive the Queen’s Ambulance Service Medal. “It was a pleasant surprise and I replied to say that I’d love to receive it, but then kind of forgot about the whole thing. “At about 11.30pm last night I started getting text messages of congratulations and that’s when I realised I’d got the medal. “I have no idea who nominated me. I still don’t to this day!” Rob joined the Pembrokeshire Ambulance Service in 1985 as a relief technician based in Pembroke Dock.
In 2013, Mike Collins, then the Trust’s Head of Service in the Abertawe Bro Morgannwg area, also collected the medal for dedicating his 32year career to the ambulance service in Wales.
He qualified as a paramedic in 1991 and has subsequently held a string of posts and roles including control manager, regional staff officer, regional personnel manager, production manager and national staff side secretary.
There was double delight last year when not one but two members of staff were recognised in the New Year’s Honours list; Andrew Jenkins, Consultant Paramedic and Deputy Director of Medical and Clinical Services, and Advanced Paramedic Practitioner Richard Hook.
He is now the Trust’s Head of Operations in the Hywel Dda and Powys health board areas.
And in June of this year, the Trust’s Interim Assistant Director of Operations, Gordon Roberts, was recognised in the Queen’s Birthday Honours list for dedicating more than
Rob said: “There are others who I feel make a greater contribution than I do, so it’s really quite humbling to have been recognised.
37 years to the service.
AMBULANCE UK - FEBRUARY
“I’m obviously delighted but I’d like to think this medal is recognition of all the staff in the Welsh Ambulance Service; not just those who provide direct services to patients, but those who support our frontline staff too.”
SWASFT News
Rob will celebrate by spending a low-key New Year’s Eve with his family, including wife Paula Jeffery, an Advanced Nurse Paramedic based in Tenby and his 20-year-old son Alex, who has just joined the Trust’s Urgent Care Service.
South Western Ambulance Service NHS Foundation Trust (SWASFT) is delighted to announce that its Chairman, Heather Strawbridge OBE, has been awarded a New Year honour for services to health and care.
New Year honour for Chairman of South Western Ambulance Trust
38 For more news visit: www.ambulanceukonline.com
Heather has worked tirelessly to support and promote the work of ambulance services for 11 years, undertaking both national and regional roles where she is respected for her effectiveness and influence with regard to national policy. Appointed as Chairman of South Western Ambulance Service in 2006, Heather has supported significant management change to deliver ambulance operations from Gloucester to the Isles of Scilly, covering a one fifth of mainland England (10,000 square miles) and serving a population of 5.3 million with some additional 17 million visiting holidaymakers. Most notably, Heather led one of the geographically largest and most complex ambulance services in the UK to achieve Foundation Trust status. This was one of the first such awards for an ambulance trust. She then led the Trust through the acquisition of Great Western Ambulance Service. Under her Chairmanship, SWASFT has been acclaimed for its delivery of performance, as well as managing excessive demand and efficiency requirements over the past 10 years. In that time, £40m of efficiency savings have been achieved. She has also supported the development of new urgent care services, enabling SWASFT to pioneer many urgent care initiatives, ahead of other ambulance services. Chief executive, Ken Wenman said: “Heather has been an exemplary Chairman, steering ambulance services for over a decade through a range of roles in the sector. Under her governance, this Trust has demonstrated consistent innovation in patient care that has produced considerable benefits for the local and national community.” Speaking about the announcement, Heather Strawbridge OBE, said: “Working for the ambulance service is a real privilege, so to receive an OBE is such an honour. I am grateful to everyone in the ambulance service for the way they deliver excellent patient care across the region.” Baroness Watkins of Tavistock, a NonExecutive Director at South Western Ambulance Service, added: “I am delighted that Heather has been recognised with a New Year honour. Heather is well regarded in the ambulance community and her hard work and influence has improved partnerships and relationships across the health and social services, raising awareness of local needs and improving ambulance responses, particularly in more rural and challenging areas.”
AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254 AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254
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