London's Air Ambulance Charity Strategy Document

Save time – treating everyone who needs us, when and where they need us

SAVING MORE LIVES

London’s Air Ambulance Charity: Future direction and five year business plan 2018-2022

OUR VISION

OUR VALUES

Save time – treating everyone who needs us, when and where they need us

To end preventable deaths in London from severe injury.

OUR MISSION To save more lives in London through rapid response and cuttingedge care.

Compassionate We care about people and put them at the heart of everything we do.

We are kind, respectful and always keen to listen to feedback.

Courageous We are prepared to achieve our mission in challenging environments. We are authentic, honest and not afraid to challenge and take calculated risks.

Pioneering We embrace and lead change through our innovation and creativity. We are constantly learning, both from our successes and from our failures to make sure we are always striving to improve.

Save time – treating everyone who needs us, when and where they need us

OUR FIVE STRATEGIC GOALS Saving time – treating everyone who needs us, when and where they need us.

Outstanding care – to improve patient care and to end preventable deaths.

Connecting with the people of London – to increase the number of charity givers in London who support our service.

Double income – to ensure our financial security and sustainability over the next five years to fund our organisational objectives.

Our culture – continue to develop a supportive and enabling environment that gets the best out of our people.

(See pages 10 to 15)

THINGS WE WILL NOT CHANGE

also believe we have a responsibility to share Save time –EVERY treating everyone who needsWe us, when LIFE MATTERS our learnings beyond the boundaries of London.

Our innovations in the treatment of severe injuries and where Our they need usheart of everything we do. patients are at the at the roadside, as well as our medical systems and Our history and our future are defined by three questions:

1. Are we there for everyone who needs us, as quickly as they need us?

2. Is our care the best it can be?

3. Do we share our learnings for the benefit of patients in London and beyond?

We must be relentless in constantly reviewing the answers to these questions.

WORKING TOGETHER TO SAVE LIVES

training, have been shared across the UK and the world.

OUR PIONEERING HISTORY London’s Air Ambulance Charity was established because of a group of committed, determined and pioneering individuals who saw a way to save more lives, despite the medical establishment view at the time that patients with critical injuries could only be treated effectively in hospital.

London’s Air Ambulance could not provide its lifesaving service without its unique partnership with Barts Health NHS Trust, London Ambulance Service NHS Trust (LAS) and the people of London.

Today, treating patients before they get to hospital has been transformed into an established medical discipline and our service is a world leader of rapid response care. We have provided support to the Capital in its times of greatest need, such as advanced trauma response to a terrorist attack.

Barts Health NHS Trust provides doctors and LAS provides paramedics to deliver the charity’s advanced medical trauma team.

Our pioneering spirit continues to drive our constant self-evaluation and innovation, to understand what we can do to save more lives.

We have an integral role in the response to major incidents in the capital, working with others as part of a coordinated effort to provide life-saving treatment at the scene.

We are a charity and reliant on support from the people of London to continue our work. Without the money and time our supporters provide, we could not continue to save lives in London.

THE NEED IN LONDON

injury can happen to anyone, at any Save time –Serious treating everyone who needs us, when time. It does not discriminate. and where People theyofneed all ages us and backgrounds are dying in London; dying from injuries that they could survive if they receive the right treatment quickly enough.

In England, severe injury is the biggest killer of people under 40 years old. Road traffic accidents, falls from height, industrial accidents, assaults and injuries on the rail network, kill more people under 40 than heart disease and cancer combined.

!

Severe injury from road traffic accidents, falls from height, assaults and other accidents is the biggest killer of people under 40 years old in England.

Serious injury and death are also estimated to cause nearly ÂŁ4 billion in lost economic output every year.

Quick and effective treatment of patients before they get to hospital is a critical means of combating this issue.

HOW WE SAVE LIVES

Save time – treating everyone who needs us, when and where they need us

THE SERVICE WE PROVIDE

Save time –RAPID treating everyone who needsRESEARCH us, when RESPONSE AND INNOVATION and where Our they need ustrauma team treats on We continue to use our pioneering spirit to look advanced medical average five people a day in life threatening situations.

We attend only the most severely injured people who may not survive the journey to hospital without urgent treatment.

!

In our history we have made a hugely positive impact: treating thousands of the most severely injured patients.

We have treated over 40,000 patients since our life-saving service was established 30 years ago.

for new ways to save more lives. We research and develop new innovations in treating severely injured patients before they get to hospital.

We are proud to have a number of firsts to our name, which include:

We carry out critical care procedures at the scene of an incident that are normally only found in a hospital emergency department.

•

ground-breaking roadside surgery only previously carried out in hospital, including open heart surgery;

We provide:

•

pioneering a procedure at the roadside used to control catastrophic bleeding in trauma patients called REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta);

•

administering blood transfusions at the roadside;

•

leading on the provision of safe pre-hospital anaesthesia.

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a 24/7 advanced medical trauma team, ready to respond 365 days of the year;

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a helicopter between 8am and sunset;

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rapid response vehicles at all other times; and

•

an award-winning Physician Response Unit (PRU) – the service operates with two cars and its hours run from 8.30am to 11pm seven days a week.

The PRU responds to 999 calls, treating patients in their homes who would otherwise have often required an ambulance transfer to hospital.

We also form part of London’s emergency response to major incidents in the Capital, such as terror attacks, rail crashes and fires, including: the Paddington rail crash; 7/7, London Bridge and Westminster terror attacks; Grenfell fire.

More lives can be saved if we start more complex treatments sooner after injury occurs. With the complexity of treatments increasing, more expertise, research and innovation is needed in our team.

We are determined to search for ways to reduce the time taken to give patients the life-saving treatments they need, providing a knowledge platform for both civilian and military clinical innovations.

Save time –EXCELLENCE treatingINeveryone who needsOUR us,IMPACT when CARE BEYOND LONDON and where Making theysure need We believe we have a responsibility to share our we giveus the right treatment to patients and providing support to their families in their greatest time of need is at the heart of everything we do.

We founded the Institute of Pre-Hospital Care in 2013, to drive excellence in care standards for treating patients at the roadside. Through the Institute we train and educate the next generation of specialists.

We provide:

•

a Patient Liaison Nurse dedicated to assisting patients with their transition back to independent living and supporting bereaved families;

•

the first BSc course in pre-hospital medicine;

•

the first MSc in pre-hospital care, started in 2019;

•

providing an educational programme and courses for professionals in London and around the world.

The Institute developed a Performance Psychology in Medicine Symposium, sharing our expertise in human factors with the wider emergency medicine sector. We worked with UK Sport’s elite athletes and coaches to develop high performance training.

learnings beyond the boundaries of London.

In the UK and worldwide, we lead the way in treating serious injuries at the scene of incidents.

Our registrars join us on secondments from all over the world, taking the skills and operating procedures they learn to their own hospitals and pre-hospital care services.

Through research, innovation and education activities we have influenced clinical guidelines, governance standards, and the practice of air ambulances in the UK, Europe, the US and Australia.

Victoria was woken from the induced coma a week Save time – treating everyone who needs us, when later, but it was only two weeks later that she really started to fully understand what had happened. and where they need us

It was a normal December morning in 2014 and Victoria was cycling through London to work, when she was hit by a lorry, suffering severe pelvic injuries.

She was slowly bleeding to death.

Victoria still remembers what happened: “The police arrived first and cordoned off the area. Then the paramedics and London Ambulance Service arrived.

The next thing I remember is the London’s Air Ambulance team arriving. Simon, the air ambulance doctor, talked me through what would happen next.”

Victoria was deteriorating minute by minute. The team didn’t think she would survive the trip to hospital. They decided her best chance was to stop the bleeding by using a technique called REBOA: a balloon is used to block the main artery from the heart to stop the bleeding. This gave Victoria a chance of surviving the journey to hospital so she could receive the life-saving treatment she needed.

Victoria underwent major surgery over the next couple of days and unfortunately, despite continual efforts by surgeons, her left leg had to be amputated.

Victoria remained in intensive care in an induced coma for the following week and she underwent a series of operations where pins where use to stabilise her pelvis.

Her parents and sister, Marie, were constantly by her side. Marie remembers: The first few days after Victoria’s accident were so difficult, as she was still in such a critical condition and there was a huge amount of uncertainty regarding her recovery. But despite this difficulty, I had such an overwhelming feeling of relief that she had survived the accident.”

“I remember the hallucinations I had whilst in intensive care. They were really scary, but it wasn’t until I was on the trauma ward that I started to remember what had happened,” she said.

VICTORIA’S STORY

In February 2015, Vicky was well enough to return home and following three months of intensive physiotherapy she was able to walk with the use of two sticks. A few years on, Victoria is still recovering from the accident physically and has had over fourteen operations. She is now back at work and her outlook on life remains positive.

In September 2019, Victoria joined a team of pilots, doctors and paramedics (including PRU clinical manager Bill Leaning, who treated her on that day), to swim the English Channel in aid of our life-saving service.

The teams were up against undeniably tough conditions, with the attempt being postponed and almost cancelled due to adverse weather.

Nevertheless, they fought on against strong tides, heavy winds and even jellyfish to make it to the French coast.

After completing the challenge, Victoria said: “I cannot believe we did it! It means so much to me to have completed such a hard, physical challenge given all my injuries. My team were amazing, and I feel so privileged to have shared this with them.”

I cannot believe we did it! It means so much to me to have completed such a hard, physical challenge given all my injuries. My team were amazing, and I feel so privileged to have shared this with them.”

OUR FUTURE DIRECTION

Save time – treating Our everyone long-term whoobjective: needs us, when and where they need To us deliver the best possible service in London to everyone who needs it, when and where they need it.

HOW WE WILL SAVE MORE LIVES

We will deliver this objective via two strategic goals and three enabling goals over the next five years.

1

Save time – treating everyone who needs us, when and where they need us. us We will constantly look for ways to reduce the time it takes us to reach and treat patients, to ensure we can help everyone in London, whenever and wherever they need us. To save time we will: • embed the enhanced clinical model for delivering our service, and launch the new paramedic model, ensuring maximum expertise on every mission; • produce plans to redevelop our helipad, to make our response quicker; • provide a new rapid response car fleet;

• prepare for the provision of a new helicopter fleet; • working with LAS to roll out the Good Sam app - providing video links to the scene of an accident via public mobile phones to give advice and treatment before we arrive; • continue to influence policymakers and politicians to ensure we can continue to deliver our rapid response services; and • collate and use data to ensure we can optimise our response times, we have access to landing sites and can deliver equality of service across London.

2

Outstanding Save time – treating care – toeveryone improvewho patient needs careus, and when to and preventable end where they need deaths. us We will relentlessly seek ways of improving the care we provide to patients and their families in their greatest time of need. We will: • review and deliver our clinical strategy, working closely with our partners, to ensure we continuously innovate and improve the treatment we provide and keep patients at the heart of everything we do.

• carry out research/feasibility studies into:

alive while they are transported to hospital; » the use of Emergency Preservation and Resuscitation (EPR) to cool people into suspended animation at the roadside to provide a chance for resuscitative surgery in hospital; » providing whole blood transfusions at the roadside;

» investing in our research infrastructure and people, ensuring we have the resources and expertise to continue to improve the treatment we provide;

» building a knowledge bank, recording the chemistry of blood samples from people who have suffered serious injury;

» the next stage of REBOA to control catastrophic bleeding in trauma patients;

» introducing the use of fentanyl lozenges;

» head injuries and how best we treat head injury patients at the roadside;

» having more patient liaison nurses available in London to provide the best support we can to patients and their families; and

» the causes of death in trauma patients, so we have better knowledge to develop the best possible treatments for the future; » the use of pre-hospital Extra-Corporeal Life Support (ECLS) - a way to bypass the heart and lungs to keep a patient

» collecting and recording data to drive our innovations and improvements, providing a knowledge base that can also be used to drive wider innovation in both civilian and military settings.

3

Connecting Save time – with treating the everyone people ofwho London needs – tous, when and where increase thethey number need of uscharity givers in London who support our service.

We need to build our relationship with the people of London to successfully deliver our strategic goals. To do this we will: • build a better awareness of our charity, raising our profile to ensure people across the capital understand the work we do; • develop our schools programme across London to engage children and young people in our work;

• work with the people of London to influence key decision makers and politicians to ensure we can continue our life-saving service; • develop our speaker programme to ensure our story is being told to interested groups and organisations across the capital; and • increase the number of people who support us by volunteering/giving their time and enhancing the experience of our existing volunteers.

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4

Double Save time income – treating – to ensure everyone ourwho financial needs security us, when and sustainability where they need overusthe next five years to fund our organisational objectives.

We need to double our income over the next five years to fund the improvements to deliver our strategic goals. To double our income we will: • pilot and roll out a community fundraising model, to increase our fundraising activities at the heart of London’s diverse communities; • develop and deliver a legacy programme, encouraging more supporters to leave a gift to us in their will;

• continue to build and grow donations from individuals, through our lottery, raffle and regular giving products; • test fundraising across different channels; and • sustain and build our support from corporate partners, trusts and foundations.

5

Our culture Save time – –treating continue everyone to develop whoa needs supportive us, when and and where enabling environment they need us that gets the best out of our people.

People are our greatest asset in being able to deliver our lifesaving service. We will invest in the development of our people by: • leading, managing, recruiting and appraising according to our values; • supporting all our people to be leaders through learning and opportunity, including understanding and investing in the individual development or our talented team; • devising a learning and development programme to enhance skills and support good management;

• introducing quarterly temperature checks of the organisation, to replace the annual staff survey; • introducing cross functional work shadowing as part of the induction process; • form working groups to enable employee representation, social activities and wellbeing; and • implementing HR intranet and using it for management reporting and benchmarking.

Nigel was riding his scooter to Wembley in November Save time – treating everyone who needs us, when 2017 to watch a Tottenham v Real Madrid football match when and where they need us he was hit by a truck.

A policeman was first on the accident scene and realised that Nigel would need the expertise of London’s Air Ambulance advanced trauma team if he had any chance of survival.

NIGEL’S STORY

Nigel had serious internal injuries. His lungs were punctured and his windpipe twisted. The London’s Air Ambulance team operated on Nigel at the roadside, putting him in an induced coma and performing a tracheostomy to help him breathe.

Once stabilised, Nigel was taken by ambulance to St Mary’s Hospital. Thanks to the care he received he made a full recovery and after 12 days was able to return home and resume normal life.

Six months on, Nigel is now volunteering for the London’s Air Ambulance charity. He said: “I had hardly any memory of my accident. I wanted to find out what had happened and wished to thank those involved in saving me.

“I met with the doctor and paramedic from London’s Air Ambulance who had administered emergency treatment that kept me alive long enough to make it to hospital. It was at this meeting that I discovered the breadth and depth of the work done by the service.

“Most importantly, like most Londoners, I had no idea that London’s Air Ambulance was a Charity. So it was a no-brainer for me to volunteer to help raise funds.”

Most importantly, like most Londoners, I had no idea that London’s Air Ambulance was a charity. So it was a no-brainer for me to volunteer to help raise funds.”

OUR FIVE YEAR PLAN

Save time – treating everyone who needs us, when and where they need us

2018-2022

2018

2019

• • • • • •

Roll out recommendations of data review Embed enhanced clinical model Review access to landing sites Helipad expansion research GoodSAM app upgrade Expansion of PRU

• REBOA zone 1 training • Head injury fellow in post • Additional patient liaison nurse (delayed due to funding) • Whole blood trial agreed • Golden Hour Fellow in post

• • • • • • • •

REBOA zone 1 moved to study format Head injury research Additional patient liaison nurse (delayed due to funding) Whole blood trial PhD Fellow appointed Clinical strategy review ECLS trial commenced Adenosine trial approved Review research requirements

• • • • • •

Plan for 30th Anniversary New branding developed Schools outreach programme developed Marketing strategy developed Develop political influencing and campaigning Increase volunteer and speaker network

• 30th Anniversary delivered – HRH Duke of Cambridge as Patron • New branding rolled out • Schools outreach programme increased • Fundraising strategy developed • Parliamentary reception held • Increase volunteer and speaker network

• • • • • •

Community fundraiser pilot undertaken Number of regular givers increased Number of lottery players increased Develop legacy marketing programme Build pipeline for funding capital and clinical projects Develop major donors’ programme

• • • • • • • •

• • • • •

REBOA zone 1 training Head injury fellow in post Additional patient liaison nurse (delayed due to funding) Whole blood trial agreed Golden Hour Fellow in post

Save time – treating everyone who needs us, when and where they need us

• Leadership framework in development • HR intranet project scoped

Community fundraising rolled out in SW London Increase number of regular givers increased Number of lottery players increased DRTV first test Develop legacy marketing programme Develop mid level giving programme Successful 30th anniversary gala event held Cultivate pipeline for capital and clinical projects

• Management training in place for first time managers • Staff surveys / health checks introduced • HR intranet delivered • Identify skills gaps and develop L&D programm

2020

2021

Roll out Helipad Digital Strategy Helipad expansion project complete Helicopter replacement – selection model Expansion of PRU – confirm funding New car fleet required Night time operations – pilot Extra team – recruiting and trialling

2022

• Roll out Helipad Digital Strategy • Helicopter replacement – tender and selection • Embed after dark use of helicopters • Extra team available 14:00–24:00

• • • • • • • •

Helipad Digital Strategy Embed enhanced clinical model Helipad expansion delivery GoodSAM app as part of Helipad Digital Strategy Expansion of PRU Helicopter replacement – define requirements Night time operations – feasibility Extra team – develop case

• • • • • • •

• • • • • • • •

REBOA zone 1 study approved Head injury strategy development Additional patient liaison nurses to be funded Whole blood trial study outcome Deliver new clinical strategy ECLS trial paused due to COVID-19 Adenosine study outcome Ultrasound programme launched

• REBOA zone 1 study • Head injury lead consultant identified • Patient liaison nurse cover expanded and follow-up rates defined • Whole blood roll out • Clinical strategy – partner alignment • ECLS next phase study • Adenosine as part of REWIRE trial

• • • • • • • •

REBOA zone 1 Head injury strategy roll out Patient liaison nurse cover meeting follow-up rates Whole blood roll out Clinical strategy roll out ECLS next phase study REWIRE study outcome Emergency Preservation Resuscitation (EPR) – define study criteria

• • • • •

Community fundraising collateral produced Schools outreach paused because of COVID-19 MP engagement in light of COVID-19 Volunteer and speaker network development paused HRH the Duke of Cambridge as Patron

• • • •

• • • •

Increase our presence in London’s communities Develop influencer programme (MPs, celebs, social) HRH The Duke of Cambridge as Patron Develop integrated campaigns

Community fundraising model adapted for London Recruitment of regular givers paused due to COVID-19 Recruitment of lottery players paused Development of digital lottery / gaming DRTV second test during lockdown Legacy marketing programme launched Mid level giving programme launched Develop plan for Capital Appeal to fund helicopter replacement • Scope new CRM project

• • • • • • •

Deliver CRM Project Increase number of regular givers Increase number of lottery players Develop strategy for cash supporters Develop improved supporter experience Continue legacy marketing programme Launch private phase of capital appeal for replacement helicopters • Expand supporter acquisition channels • Develop new products based on supporter insight

• • • • • • •

• • • •

• Map out key skill requirements and career development pathways • Introduce internship/apprenticeship programme • Introduce cohesive wellness programme across all teams • Recruitment process review and training • Digitise employee handbook and induction handbook

• Cross-team leadership training • Establish in-house training programme • Introduce job shadowing

Save time – treating everyone who needs us, when and where they need us

• • • • • • • •

Identify diversity gaps and address Establish a programme of learning lunches Cross function work shadowing introduced Wellbeing working group established and mental health training rolled out

Increase our presence in London’s communities Develop influencer programme (MPs, celebs, social) HRH The Duke of Cambridge as Patron Develop integrated campaigns

Deliver CRM Project Increase number of regular givers Increase number of lotter players Delivery strategy for cash supporters Develop improved supporter experience Continue legacy marketing programme Launch public phase of capital appeal for replacement helicopters • Expand supporter acquisition channels • Develop new products based on supporter insight

FINANCIAL OVERVIEW

entered the period of this five-year plan in our Save time –We treating everyone who needsEXPENDITURE us, when strongest ever financial position but we still have go to achieve and where further theyto need usour ambition. We had The nature of the work we carry out incurs £5million in unrestricted reserves – equivalent to approximately six months operating costs – should the worst happen. This put us in a good position ahead of the COVID-19 pandemic.

However, our long-term aims require significant cash expenditure, particularly around maintaining and eventually replacing our helicopters over the next five years, as well as funding improvements to patient care and treatments.

The impact of the COVID-19 in 2020 has made this funding challenge much greater. We will not know the full extent of its impact for some time, but we currently estimate the income we have lost due to the pandemic will be around £5million over the next two years. Therefore, we have decided to continue invest in fundraising to diversify our income streams and to enable us to meet our target to double income over the next five years.

INCOME The lottery continues to be our largest income stream for the immediate future but concentrated investment in other regular giving activities will see our income from regular giving increasing over the coming five years, overtaking lottery income. This will be achieved by investing in our face-to-face fundraising teams.

Legacy income is expected to grow over time, as we start to develop our programme of activity from 2018 onwards.

substantial running costs in maintaining and updating our helicopter and car fleets.

We are also at the forefront of researching and developing new innovations for treating patients at the roadside to save more lives in the future.

The need to invest in fundraising campaigns to not only raise funds to continue and improve our operations but also to boost the charity’s profile over the coming five years will require a significant increase in fundraising costs in the short-term.

We are committed to reducing our charitable spend ratio, to ensure we are as efficient and sustainable as we can be and every penny possible is being spent on saving more lives.

ASSETS The charity owns its two helicopters and it is anticipated that these will be replaced in 2025.

Acquisition options will be considered including buying again or leasing the new helicopter fleet but either option will incur significant additional spend.

Our rapid response and PRU cars are leased and grant funded.

The cash reserves are currently held in cash accounts and over the coming year, the trustees will consider moving some of this cash to longer term, low risk investments to maximise the value of our assets.

OUR LIFESAVING HISTORY

2007

2006

2001

1999 1993 Save time1989 – treating everyone who needs us, whenPreHelicopter Physician Hospital First Emergency and whereLaunched, they need Response First us Care following research that 1,000 killed by trauma that could be mitigated by pre-hospital care

successful roadside thoracotomy

2012 Blood carried on board First training course launched for Advanced Paramedics

response cars added, 4 nights per week

2014 New, faster, response car fleet Patient Liaison Nurse appointed UK First PreHospital Care BSc launched via Institute 1st pre-hospital REBOA

Unit launched Provided advanced critical care to medical cardiac arrest

2015 New dispatch app to reduce time to patient side Extended summer flying hours First training course launched for pre-hospital REBOA 1st paramedic education/lead appointed

SAVING TIME OUSTANDING CARE

Medical Service (HEMS) crew course launched

2010 24x7x365 operations

programme

2016

2017

Second helicopter operational

PRU relaunched, 12hrs, 7 days New clinical model introduced; patient liaison nurse core funded 1st London Trauma Nurse Conference

2011 Pre-Hospital Care recognised by the General Medical Council

2018/19

Replaced response car fleet, to provide mix of vehicles to support future trials Whole Blood trial commences Launch of MSc in Pre-Hospital Care 1st PRU Conference

Save time – treating everyone who needs us, when and where they need us

londonsairambulance.org.uk @LDNairamb