Volume 30 No. 4
DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS
In this issue The Future of UK Ambulance Services Pre-Hospital Traumatic Cardiac Arrest Life Connections 2015 more special offers
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183 The Future of UK Ambulance Services
185 Pre-Hospital Traumatic Cardiac Arrest
Ambulance UK This issue edited by: Barry Johns c/o Media Publishing Company 48 High Street SWANLEY BR8 8BQ ADVERTISING & CIRCULATION: Media Publishing Company Media House, 48 High Street
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EDITOR’S COMMENT Welcome to the August edition of Ambulance UK, and since my last editorial in April, we have witnessed, amongst other events, a general election, a budget, further proposals for emergency and urgent care reform and the outcomes from the ‘dispatch on disposition’ pilot schemes undertaken in the London and South West Ambulance Services. All of these events will no doubt impact, to some degree, on the future role of the ambulance service in ensuring the provision of the highest quality of care to all its patients, and one which is safe, evidence based, clinically effective and cost efficient.
AMBULANCE UK - AUGUST
“The general election and budget, although maintaining a further period of austerity, put the NHS at the centre of ‘political thinking’ and confirmed that budgets will be protected, additional investment will be made and policy thinking will focus on a ‘true’ 24/7/365 health service.”
The general election and budget, although maintaining a further period of austerity, put the NHS at the centre of ‘political thinking’ and confirmed that budgets will be protected, additional investment will be made and policy thinking will focus on a ‘true’ 24/7/365 health service. Despite these positive ‘headlines’, year on year efficiencies will still be required, and pay rises for staff, will once again, be limited for the next 4 years, to the public sector threshold of 1%. This in practical terms translates into a realisation that there will be no apparent easing or respite from the current financial and resource pressures facing all services. Of course, ambulance services have always been at the forefront of a 24/7/365 emergency care service, and in many ways, has been the ‘default setting’ for the rest of the NHS, and therefore, it is important that any policy changes arising from Professor Willett’s proposals for reforming emergency and urgent care needs to ensure that there is a thorough transformation process that delivers a fully integrated solution involving emergency care, urgent and unplanned care, community healthcare and home care. The proposals, adopted by NHS England, are progressed through a number of ‘Vanguard sites’, which amongst other aspects, provides paramedics for mobile urgent treatment centres and announces the development of a new specified role for ambulance services, which could and should be delivered in the future. I sincerely hope that this ‘new specification’ recognises that ambulance services can play a pivotal role by expanding their range of services into the community healthcare footprint, based on strategic needs and opportunities to progress new models of ‘converged care’. The impact of developing an integrated and dynamic IT solutions in enabling the new models of converged care, is perhaps best evidenced by the centre fold feature article within this edition, which reports upon developments in the Southern Hemisphere, and demonstrates the challenges and opportunities facing all healthcare systems. The pilots on ‘dispatch by disposition’ are indicating a reduction of some 25% in the number of blue light responses with no added risks to patients. This approach is now being rolled out to other services, and therefore, it is important to ensure that it is ‘presented’ to the general public as an appropriate and considered approach to the increasing levels of emergency demand, and not seen as a ‘2 minute back door gain’ to ensure compliance with the 8 minute emergency response standard. I have often reflected within these editorials, that it feels as if the service is on a constant merry-go-round, and whilst we have witnessed considerable progress in the clinical practice of staff, as well as the adoption, application and implementation of new operational procedures and the use of advanced technology, it still remains to be seen as to whether future policy initiatives will enable the service to break out of the constant dilemma of demand v resources v input standards, and develops into an organisation that is central to a new model of converged care. It is encouraging to see that over 400 delegates have already registered for the Life Connections event in Kettering on the 21st/22nd October 2015, where no doubt there will be something for everybody, and therefore would certainly encourage attendance, as inevitably, some, if not all, of the above subjects, will be on the agenda.
Barry Johns, Co-Editor Ambulance UK
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LOOKING INTO THE CRYSTAL BALL: A VIEW OF THE FUTURE FOR UK AMBULANCE SERVICES FROM NHS PROVIDERS What will the Ambulance Service look like in five years? It’s the
time of call to the time that the patient receives the definitive intervention
question that we would all like the answer to, particularly in light of
the recent update of Sir Bruce Keogh’s Urgent and Emergency Care Review. Whilst most of us just speculate, there is one organisation
Ben suggests, “the whole picture, including 111 re-procurement put
with a far clearer understanding and ability to perhaps forecast the
on hold, and becoming a formal part of the UCE process represents
direction of travel.
‘the right way’ of dealing with people, right through the system…”. One cannot argue with this view that essentially we need a more integrated
NHS Providers is the membership body for NHS acute hospitals,
system of planning to support an increased role for out of hospital
community, mental health and ambulance services. It has more than
services, including the crucial role of the Ambulance Service. His
90% of all NHS foundation trusts and aspirant trusts in membership
colleague Siva Anandaciva adds that future performance metrics may
and a dedicated team of policy experts and analysts. NHS Providers
focus more on outcomes at a system level rather than only process
acts as the public voice for those NHS trusts, helping to deliver high
targets at an institution level. The work ambulance services have
quality care by promoting shared learning, providing support and
done around clinical quality indicators that measure outcomes across
development and shaping the strategic system in which their members
patient pathways is an example of this ‘whole systems’ approach
operate. Recent highlights include work on stabilising and protecting
and unified working, and this work will only develop further in the
the re-procurement for 111 services, working closely alongside the
future as commissioning, regulatory and payment models change to
Association of Ambulance Chief Executives (AACE) and NHS England,
accommodate new models of care.
and aiding the development of funding strategies to closely reflect the integration and tracking of payments throughout the patient pathway. In
At the top of NHS Providers’ agenda is a drive to develop consistency
this, the first of a two part discussion, their Director of Development and
and collaboration across the system, and to prioritise quality in the
Operations with a special interest in Ambulance Services, Ben Clacy
patient journey. Siva Anandaciva, their Head of Analysis points out,
and Head of Analysis, Siva Anandaciva agreed to share their insight into
”The long term journey for the NHS links into prevention, educating
those matters which most affect front line clinicians.
the public to self-care and bringing people into the system at the right point..”. I queried how this might come about and the ‘mobile treatment
There is of course one all important question that we all would like to
centres’ mentioned in the U&EC review, “ I suppose that the Ambulance
know the answer to, it surrounds the 8 minute response standard and
service of the future may not be as we understand it today, they will
the handcuffs it appears to put on the delivery of increasingly high
be doing different things, staffed differently, paid and incentivised
quality clinical care for patients.
differently. The U&EC review and development of patient pathways will mean we must move on from penalizing providers of individual
Recognizing that this one metric can drive the entire behaviour of an
components of the patient journey, and instead increase incentives for
organization, I asked Ben Clacy if there was any national movement
providers to ‘pull together” and support “system level thinking…”.
to review or remove this. He admits “it’s not an easy question and perhaps a more appropriate question would be to ask if it is in fact the
I asked why in all the plans, the role of Ambulance Service seemed
right target in light of the Urgent and Emergency care work”. One of
somewhat understated, Siva admitted that whilst a coherent strategy
the key aims of this review is the connection of urgent and emergency
was as yet unarticulated he did feel that a key feature of the Ambulance
care services together so that the overall health and social care system
Service, and something that he admired, was its ability to “just get on
becomes more than just the sum of its parts.
with it rather than waiting for the answer..” even in the face of adversity. Service. Having worked with both Peter Bradley and Mathew Cooke
that in the medium to long term the “totemic primacy” of this target may
at the Department of Health, Siva revealed how the Ambulance
well change. Ben reflects on the current standard “recent Government
Service had developed clinical quality indicators including ‘survival to
agreements to trial extended triage times perhaps reflect a genuine
discharge following cardiac arrest’ that would be significantly affected
and general agreement that whilst having a tangible feel to the public,
by factors outside their control such as the quality of hospital care, “
individual process based targets may not truly represent the best value
we talked candidly about the difficulty of system leadership and shared
for the entire patient journey”. They suggest that the future may still have
accountability, and the risks of people being penalised for performance
a time metric in a ‘basket’ of metrics, but that it may be more sensible
issues that were not ‘their fault’, but the ambulance service stepped up
to measure something that is more outcomes focused. A suggestion
and volunteered to measure survival to discharge because they said it’s
might be that we measure more clinically meaningful times such as the
the right thing to do for patients..”
AMBULANCE UK - AUGUST
He summed up this resilience and its uniqueness to the Ambulance Close scrutiny by the experts at NHS Providers would seem to suggest
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Evidence based airway management in emergency medicine and resuscitation
It is this ‘right thing to do’ culture perhaps that ensures that Ambulance Clinicians continue to be motivated and even with a lack of referral pathways will work towards small scale change and innovative projects, as Ben adds, “everyone is looking for the big savings but widespread smaller schemes add up…”. Siva concurred “changes that will benefit the patient in the longer term are now being recognised by the regulator..”, Ben continues, “different ways of working, breaking down barriers, trying things no-one else will” are the key qualities that ensure the future ambulance service is fit for purpose, he summed up “no-one else will drive this for us..” Somewhere in here there is a silent but clear message, if a strategy has not yet been considered, it surely then must be in the interest of the Ambulance Service to ensure that any future work in this area is driven forward from within, but what of the move to increase 111 triage and referral pathways, will there be a need for 999 services in the future?
Siva points out that for the U&EC model to work there has to be more emphasis on alternate referral pathways but emphasizes that there will be a need for caution in under-modelling future services by commissioners, given previous initiatives such as 111 and Walk in Centres have shown how hard it is to ‘shift’ activity away from 999 and A&E services - any increase in Hear and Treat and See and Treat commissioning and activity “ will not necessarily remove significant work from the bluelight Ambulance service and commissioners need to plan for this reality appropriately”. In terms of a crystal ball, there is then, some reassurance that Paramedics will still be an inherent part of any change and that more importantly there may well be light at the end of the tunnel for those of us that have argued against the tyranny of the 8 minute target for so long. What I did bring from this at times frank discussion, was the importance of recognising that each of us still have a part to play in ensuring that the role of the Ambulance Service of the future is designed by us and not for us…
AMBULANCE UK - AUGUST
Quality, innovation and choice lnteract with us
184 AMBULANCE_UK_07_15_igel_o2_half_page.indd 1
21/07/2015 09:56 For more news visit: www.ambulanceukonline.com
THE MANAGEMENT OF PRE-HOSPITAL TRAUMATIC CARDIAC ARREST Flight Sergeant Andrew Thomas Academic Research Fellow (Paramedic), Royal Air Force, Department of Academic Emergency Medicine (DAEM), James Cook University Hospital. Part of Academic Department of Military Emergency Medicine (ADMEM). Warrant Officer Anthony Kyle Academic Research Fellow (Nurse), Royal Air Force, Department of Academic Emergency Medicine (DAEM), James Cook University Hospital. Part of Academic Department of Military Emergency Medicine (ADMEM). Lieutenant Colonel Simon Le Clerc Emergency Medicine Consultant (Army). James Cook University Hospital. Military Lecturer in Pre-Hospital Emergency Medicine, (RCDM), 127 Sqn, 16 Med Regt, Deputy Medical Director The Great North Air Ambulance Service. Lieutenant Colonel Mike Davison Emergency Medicine Consultant (Army). Department of Academic Emergency Medicine (DAEM), James Cook University Hospital. Part of Academic Department of Military Emergency Medicine (ADMEM). Medical Officer on The Great North Air Ambulance Service. Andy Mawson Senior Aircrew Paramedic. The Great North Air Ambulance Service Contact Info: Flight Sergeant Andrew Thomas, Department of Academic Emergency Medicine (DAEM), Academic Centre, James Cook University Hospital, Martin Road, Middlesbrough, TS4 3BW. 01642 854299 email@example.com
(NCEPOD 2007). This article aims to explore the management of this
This article aims to examine current and developing practice in
series will challenge current protocols and provide evidence regarding a
smaller group of OHCA with trauma aetiology. The presented case
relation to the understanding and treatment of patients suffering Traumatic Cardiac Arrest (TCA). Current military and civilian practice is examined and consideration is given to a contemporary approach that would allow paramedics to focus on addressing the reversible causes whilst de-emphasising the need for External Chest Compressions in certain circumstances.
less traditional approach to the management of pre-hospital Traumatic Cardiac Arrest (TCA) involving mainly hypovolaemia as the primary cause for paramedics.
Background TCA is diagnosed when patients present unresponsive, apnoeic and
By examining the existing evidence and reviewing a selection of
have no palpable pulse. Evidence of a traumatic injury should also
case examples this article highlights that appropriate and focused
be present (Soar et al 2010). Current paramedic practice is to initiate
resuscitation of TCA patients can be successful. The attempted resuscitation of this group would have previously been deemed futile, however positive outcomes, enhanced by a new and yet simple contemporary approach. It further highlights the key role paramedics will face in future development of this area.
Advanced Life Support (ALS) including airway management, Cardio Pulmonary Resuscitation (CPR), Intravenous fluids (crystalloids) and rapid transport to definitive care in penetrating trauma, and a vague idea that you should attempt to address the reversible causes and cease resuscitation after 20 minutes in blunt force trauma (Fisher et al 2013). The UK military has been operating a physician-lead pre-hospital care system in Afghanistan utilising a 4 person multi-disciplinary team
Traumatic Cardiac Arrest (TCA) • Resuscitation • Medical Emergency
from 2006 to 2014. Employing Damage Control Resuscitation (DCR)
Response Team (MERT) • HEMS • Pre-Hospital • Paramedic
techniques, the team delivers ‘high end’ capability in an austere and difficult working environment (Kehoe et al 2011, Thomas 2014). A
similar approach has been employed for a number of years by London Helicopter Emergency Medical Service (HEMS) utilising combined skills of the HEMS crew and ground based ambulance staff already at the
of approximately 66 per 100,000 (Atwood et al 2005). Extensive work has
scene (Lockey et al 2006). Both the Medical Emergency Response
gone into improving outcomes, especially when the aetiology is medical
Team (MERT) and HEMS personnel have embraced a contemporary
in nature. In 2012 the North East Cardiac Arrest Network (NECAN)
approach to TCA. This highlights the benefits of simple techniques that
produced the first annual report outside of the London Ambulance Service
may contribute to increased survival in patients where hypovolaemic
(LAS) examining OHCA. The report noted that in 2011 the North East
trauma has resulted in cardiac arrest and where these patients have
Ambulance Service (NEAS) attended 3862 calls involving cardiac arrest
traditionally been regarded as unlikely to survive “Cardiac arrest as a
with 92%(n=3541) presumed to have a cardiac aetiology, and 9%(n-164)
result of hypovolaemia is virtually always fatal” (Lockey et al 2006).
due to trauma or other causes (Kendall et al 2012). Perception exists that TCA as a result of hypovolaemia from trauma Major trauma is the leading cause of death in people under the age
is universally futile. As lessons learnt on deployed operations begin
of 40 within the United Kingdom (UK), This equates to approximately
to filter back into clinical practice in the UK, it is hoped more survivors
5,400 deaths annually of which 2,400 occur prior to hospital admission
will ensue. The instigation of early and aggressive treatment of causes
AMBULANCE UK - AUGUST
In Europe, Out of Hospital Cardiac Arrest (OHCA) has an incidence rate
185 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE of TCA by paramedics could result in the type of successes seen
activity seen on a cardiac monitor; sustained end-tidal CO2 that is
by military medics on operations. The improvements in the services
present on invasive ventilation and confirming the presence of cardiac
provided by many UK HEMS units, and specifically the carriage of blood
movement on ultrasound examination if available. It further states if
in many areas may also contribute further to outcomes.
none of these are present, resuscitation is unlikely to be successful (DCA EM 2013).
Tarmey et al (2011) published a prospective observational study of all the TCAâ&#x20AC;&#x2122;s brought into the UK led Role 3 hospital at Camp Bastion in
The treatment priorities are focused around identifying and treating
Helmand Province. Of the 52 patients meeting the inclusion criteria
any reversible causes of TCA. This takes precedence over performing
27% (n-14) achieved a temporary or permanent Return Of Spontaneous
ECC and the administration of adrenaline. It further emphasises the
Circulation (ROSC), with 8% (n-4) surviving to hospital discharge, all of
following 4 steps to maximise success:
which were neurologically intact. This compares with a medical OHCA overall survival rates of 7.1% (n-112) in North East Ambulance Service (Kendal et al 2012) and 10.9% (n-326) in London Ambulance Service (Watson et al 2012), which shows the potential for equal success. Tarmey et al (2011) further noted whilst the majority of patients were injured from blast and penetrating trauma, most of the survivors came from the group whose primary cause for TCA was exsanguination (75%). Although the total numbers of this study are small, it demonstrates the potential for positive outcomes of those suffering a TCA from
1. Control of catastrophic haemorrhage and restoration of circulating volume. 2. Airway patency and appropriate ventilation (with limited tidal volume and respiratory rate to minimise intra-thoracic pressure). 3. Decompression of tension pneumothorax. 4. Resuscitative thoracotomy, where indicated.
hypovolaemia or other reversible causes (each patient who survived received a resuscitative thoracotomy shortly after arriving in the
3 case studies are presented at appendix 2, as a small number of
emergency department). One patient who presented with an agonal
the many examples where ROSC has been achieved in patients who
rhythm on the ECG was resuscitated with a positive outcome. This
would previously have been labelled as unsurvivable in both the
contradicts guidance to withhold resuscitation on futility grounds issued
military and civilian pre-hospital environment. These case studies
by the National Association of Emergency Medical Service Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACSCOT) (Hopson et al 2003). This example, together with other case studies described by (Powell et al 2004, Pickens et al 2005 and Lockey et al 2006) demonstrates survivors who may not have been resuscitated using above guidance. This suggests that for some people resuscitation may have a positive outcome when previously deemed futile, and consideration should be given to recent military experience and practice in contributing to this group of survivors. Especially as military advances in times of conflict often lead to innovation in civilian settings (Grathwohl et al 2008).
The Medical Emergency Response Team (MERT) approach to TCA
highlight the potential for successful pre-hospital resuscitation in TCA.
Case Example 1 â&#x20AC;&#x201C; Physician lead The MERT was called to an outlying Forward Operating Base (FOB) in Afghanistan to treat an Afghan soldier who had been shot in the left thigh. Despite appropriate battlefield pre-hospital interventions including; application of proximal tourniquets, compression bandages and the infusion of crystalloid, the soldier continued to deteriorate. Approximately ten minutes prior to the arrival of MERT the patient suffered a TCA. On arrival, CPR was being performed the patient was loaded and a rapid assessment confirmed a PEA arrest with an agonal rhythm on the cardiac monitor and a grossly distended abdomen. ETI without drugs was performed, ETCO2 of 1.2 was noted. Aggressive
The UK MERT applies damage control resuscitation (DCR),
resuscitation was then commenced involving the administration of
judiciously applied horizontally to the 360 of the patient. DCR is
tranexamic acid (TXA), calcium chloride, four units of packed red
conducted by a well-trained team lead by a Consultant physician with
blood cells (RBC) and four units of fresh frozen plasma (FFP) via two
an Emergency Nurse (EN) and 2 paramedics (Thomas 2014). It is
fluid warming devices. No ECC were performed and no cardiac arrest
this approach that provides the corner stone of the Clinical Standard
drugs were given. Within five minutes the casualty had a palpable
Operating Procedure (CSOP) for TCA management (DCA EM 2013).
femoral pulse on the right side with a narrow complex tachycardia.
Aggressive resuscitation of battlefield casualties continues as they are
His ETCO2 was 3.1.
AMBULANCE UK - AUGUST
transported from the point of wounding to a Deployed hospital. Five minutes from landing the patient required paralysis and sedation The TCA CSOP (Figure 1) addresses the current areas of controversy
as he was biting down on the ETT. His pupils had become reactive
to guide resuscitation and validates the approach to TCA described
and his colour improved. His NIBP was recorded as 85mmHg and
by London HEMS. All interventions are discussed including the
his HR had dropped from 160 bpm to 120bpm. The patient bypassed
use of adrenaline, vasopressors, intubation and ventilation. The
the emergency department and underwent damage control surgery.
effectiveness of external chest compressions (ECC) and the rationale
The bullet had entered the pelvic and abdominal cavities before
for using capnography as both a measure of cardiac output and
severing the left external iliac artery. After ligation of common iliac
confirmation of endotracheal tube placement is also discussed. The
artery, haemostasis was achieved. Postoperatively, the soldier made
indications for commencing resuscitation include; witnessed cardiac
swift progress, was found to be neurologically intact and made a full
arrest that occurs during transport to hospital; organised electrical
186 For further recruitment vacancies visit: www.ambulanceukonline.com
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FEATURE Case Example 2 – Paramedic lead The MERT was called to a desert location to attend two Afghan National Security Force (ANSF) patients who had been inured by a rocket propelled grenade with 1 patient suffering from an arm amputation. No other information was received from the scene. On landing at the location 29 minutes after the patient were loaded onto the aircraft. Patient 2 was managed by the double paramedic team as the doctor and nurse were dealing with the other critically wounded casualty. Initial assessment of the patient noted a proximal amputation of the left arm. In addition, multiple First Field Dressings (FFDs) applied to the patient’s pelvis and upper limbs. Primary survey noted a deformed and ‘boggy’ pelvis, with external catastrophic haemorrhage under control. The airway was clear and the patient was suffering a TCA. The airway was managed initially by oropharyngeal airway with artificial ventilation provided via a Bag Valve Mask (BVM). The second paramedic gained intraosseous (IO) access in the right humeral head, DCR was commenced and emergency transfusion of warmed blood products was initiated. ECC was not performed at this stage in view of the likely cause of profound hypovolaemia. ETI without drugs was performed using an Airtraq device. Initial ETCO2 was recorded as 0.8, with the ECG monitor showing an agonal PEA. The patient received 2 units of RBC,1 unit of FFP and TXA. ECC was commenced once other treatment priorities were completed, reversible causes addressed and 2 units of blood products had been administered. On hand over at hospital the patient showed signs of clinical improvement with an ETCO2 of 1.6 and a PEA rate of 80bpm. Within minutes of receiving further blood products in the ED the patient had a palpable carotid pulse. Primary x-ray revealed the patient had unsurvivable pelvic injuries and subsequently died.
Case example 3 – UK air ambulance physician lead The HEMS crew were called to a motorcyclist who had been involved in a head on collision with a car. The impact speed was estimated to be approximately 60mph but the bike was relatively undamaged in comparison to the car, which led the HEMS team to conclude the patient had taken the majority of the impact. HEMS arrived on scene 14
but drainage of 300-400mls of blood from both sides of the chest indicated bilateral haemothoraces. Circulatory access was secured by both intravenous (IV) and IO routes with continuous ECC performed. Blood was not available, therefore 2 litres of crystalloid was infused. Despite no signs of a significant head injury the motorcyclist was found to have fixed, unreactive pupils (3mm bilaterally). Following a rapid infusion of 1800mls of sodium chloride a rhythm check revealed profound bradycardia with single normal complex, followed by asystole. ECC was continued and a further 200mls saline was infused. The monitor then showed normal sinus rhythm with a rate of 100bpm, the patient had a strong carotid pulse and ROSC had been achieved after an 11 minutes. The patient was packaged and transferred to a Level 1 Major Trauma Centre (MTC), and a pre alert was given. The observations remained satisfactory with a BP of 80/40 and an ETCO2 of 2.8. TXA was administered. During the latter part of the flight the patient lost a femoral pulse and a further 500mls of saline was administered. The patient was handed over to the MTC with a HR of 130bpm, BP, 80/40, SPO2 99% ventilated and an ETCO2 of 3.4. 5 minutes after arriving at the MTC and whilst receiving blood products the patient re-arrested. A clamshell thoracotomy was performed which revealed T4 on T5 fracture dislocation which had ripped the azygous vein. The vein was clamped and the patient rapidly regained cardiac output. He was then transferred to the operating theatre for damage control surgery. Within 4 hours the patient’s serum lactate, Ph and biochemistry had normalised. A ‘pan CT’ scan revealed no additional injuries apart from known chest injury and femoral fracture. However over the next 4 hours, the patient’s condition deteriorated with signs of raised intracranial pressure. A further CT scan was performed, which identified massive diffuse axonal injury. The patient died 48 hours later following organ donation.
minutes after the initial 999. The case series showed 3 patients achieving ROSC, with 1 patient Scene assessment revealed a male in his early 20’s lying supine, slightly
surviving to hospital discharge neurologically intact. Positive
head down in a shallow ditch with obvious deformity of right femur. The
outcomes were achieved in patients who had received pre-hospital
patient was lying 3 metres away from the car with significant intrusion to
advanced airway management, volume replacement by either
engine block and a bulls-eye on the windscreen. The crash helmet had
blood products or saline as well as aggressive but appropriate
been removed and inspection noted abrasion but no crack.
use of interventions, with systematic assessment and treatment of
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reversible causes. It can also be seen that the priority for ECC was A rapid response paramedic was already on scene providing ventilation,
de-emphasised in this patient group.
a member of the public was assisting the paramedic with ECC. The patient’s cardiac rhythm was asystole. The HEMS physician noted no
Although the evidence presented is from previous level IV studies with
catastrophic external haemorrhage, with prioritisation given to airway
small sample sizes and a small case series, a valuable theme has
management and reversible cause correction.
emerged. Level I evidence is hard to ascertain especially as trauma Randomised Controlled Trials (RCT’s) often have small sample sizes,
Initially, the physician instructed the cessation of ECC to allow critical
are difficult to undertake and often suffer from baseline imbalances and
interventions to be undertaken. A SAM pelvic binder was applied
low power (Curry et al 2011). It is therefore vital that change is made in
with the airway secured by ETI without drugs, before bilateral
the absence of stronger evidence, when the limited evidence available
thoracostomies were performed. Both lungs were found to be inflated,
supports improved patient outcomes, compared to existing practice.
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FEATURE The examples presented show the potential benefit of a contemporary approach can have on patient outcome. This however has been achieved by advanced medical teams, and often results in a significant surgical intervention. Figure 2 may empower non specialised paramedics to focus on the clinical needs of the patient and address the reversible causes within individual skill sets. The concept of Sustain, Slice and Survive will allow non-specialised paramedics to address the reversible causes within their power and hopefully sustain the patient in a viable state until advanced help arrives and performs the necessary surgical (Slice) procedure to hopefully give patients a chance to survive.
ECC on a heart that is unable to fill due to external pressure, either as a result of pericardial tamponade, or from tamponade occurring as a result of increased intra-thoracic pressure due to tension pneumothorax is also likely to be ineffective. In these cases, recognition and treatment of the underlying cause of cardiac arrest is paramount. ECC will not improve the patient condition if the underlying cause of arrest is not addressed first. This critical decision making to address the reversible cause and in some cases reduce the need for ECC may be essential to improve patient survival.
Adrenaline The International Liaison Committee of Resuscitation (ILCOR) include adrenaline in their ALS guidelines and note for the past 40 years that adrenaline has been the primary sympathomimetic drug for the management of cardiac arrest (Deakin et al 2010b). Despite there being no randomised placebo controlled trials, adrenaline continues to be the drug of choice in patients with cardiac arrest. Its alphaadrenergic effects cause systemic vasoconstriction, which increase coronary and cerebral vasoconstriction. The perceived benefits may in fact be moderated by a concomitant increase in myocardial oxygen consumption, impaired microcirculation and increased post cardiac arrest myocardial dysfunction (Deakin et al 2010b). These additional effects are often unwelcome in TCA. Consideration towards increasing circulating volume rather than a drive to increase systemic vascular resistance is adopted in military pre hospital care for a hypovolaemic casualty. Furthermore, it is considered opinion that in trauma patientâ&#x20AC;&#x2122;s massive surge of endogenous catecholamine has already been released as a result of any life-threatening injury. To this end, early administration of supplementary adrenaline is unlikely to be of benefit in TCA. In the absence of robust evidence supporting the benefits of adrenaline use, the risk of harm is too great to justify continued use in this specific patient group. This is supported by current evidence, which shows potentially worse outcomes of cardiac arrests when adrenaline is used (Lin et al 2014), when comparing
External Chest Compressions (ECC)
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The importance of ECC has long been the focus of resuscitation attempts but may not always be effective in TCA. Indeed this is not a new concept as Luna et al (1989) noted that in patients suffering TCA from severe hypovolaemia, chest compressions are likely to be ineffective due to poor cardiac filling and compressing an empty heart. Recently with the use of ultrasound it has been noted that despite the lack of a palpable pulse the heart may still be contracting and producing organised electrical activity. This reduced volume and low carbon dioxide production is termed â&#x20AC;&#x153;low flow stateâ&#x20AC;? (Pepe et al 2005) and can be seen more commonly in the patient in a Pulseless Electrical Activity (PEA) arrest.
this to hospital discharge and neurological outcome. This systematic review reviewed extensive Randomised Controlled Trails (RCTs), using meta analysis and is therefore robust and strong data. Finally with the PARAMEDIC 2 trail now underway in the UK, this large multi centre, placebo, pre hospital care RCT should provide definitive evidence on patient outcomes when adrenaline is used compared to when it is not used.
Airway and ventilation Securing a definitive airway and providing adequate ventilation is standard procedure for TCA when the responder or team is proficient in its application. Paramedic-led advanced airway management using an ETT is not without controversy and is claimed to have adverse patient effects (Deakin et al 2010a, Lyon et al 2010). Discussion
Therefore the priority in hypovolaemic TCA is to replace the volume and not compress an empty heart. Furthermore ECC could cause harm in chest injuries and importantly detract resources away from addressing the reversible causes. It should be noted that if a medical cause of the cardiac arrest is suspected or unclear which has resulted in traumatic injuries ECC should be commenced whilst the origin of the arrest is established (Lockey et al 2013).
regarding the rationale, for or against paramedic intubation is beyond the scope of this paper; however, it is important to review how Intermittent Positive Pressure Ventilation (IPPV) is delivered. There is substantial evidence to show that assisted ventilation using excessive tidal volumes can be detrimental to any patient. Increases in intrathoracic pressure leads to a marked reduction in venous return to the heart as well as precipitating barotrauma to the alveoli (Ho et al 2009).
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FEATURE In trauma, a critically injured patient often requires insertion of an ETT
paramedics especially relating the pelvic binder as treatment to a
when their airway is at risk, their breathing is compromised or to mitigate
reversible cause and not just a packaging device.
the secondary effects of a primary brain insult. In all of these patients it is vital the pre hospital responder considers delivering a reduction in
Airway (A) Secure airway to the most advanced skill level where
tidal volume thus maximising venous return to the heart, protecting the
possible. The use of a Supraglottic Airway device (SGA) may be most
lungs from barotrauma and reducing the risk of Systemic Inflammatory
appropriate if ETI cannot be performed confidently. Surgical airway
Response Syndrome (DCA EM 2013). Typically, HEMS clinicians follow
devices could also be considered as a last resort.
anaesthetic guidelines and aim to deliver a tidal volume equating to 6-8ml/Kg of the patient’s body weight. To this end a 70Kg patient should
Breathing (B) Ensure adequate ventilation, making sure not to over
receive between 420ml and 560ml via BVM. If a clinician is struggling
ventilate the patient. Address any additional chest injuries within your
to oxygenate patients, consideration should be given to altering the
scope of practice. This may include the application of chest seals, needle
ventilation rate (minute volume), and applying a small amount of
thoracocentesis or open thoracostomies. By decompressing the chest
extrinsic Positive End-Expiratory Pressure (PEEP) (4 to 5 cmH2O), could
of a patient in TCA, you are effectively eliminating tension pneumothorax
prevent alveolar collapse and is used in most mechanically ventilated
as a problem. Needle thoracostomy may not treat the underlying tension
patients (Manzano et al 2008). By using a mechanical ventilator
and often gives the pre-hospital practitioner a false sense of security,
you are less likely to over ventilate and therefore reduce unwanted
needles can become dislodged or kink in situ. In 50% of cases the
standard 4.4cm cannula will not make it through the chest wall to reach the pleural space (Stevens et al 2009). This may therefore require an up
Utilising ETCO2 monitoring as a minimum standard in pre hospital care
skill of paramedic training and practice for certain paramedics especially
is essential to ensure adequate ventilation of the patient (Badjatia et al
with the specialist and advanced paramedic roles.
2008). ETCO2 also allows the pre-hospital clinician to confirm correct tube placement and monitor cardiac output (a gradually declining
Circulation (C) Gain IV/IO access and commence fluid resuscitation
ETCO2 could indicate a loss of Cardiac output). It can also be used as
without delay, noting the safe use of IO access has been well proven in
a diagnostic tool to inform of disconnection or leak in the circuit and
a large military case series from Afghanistan (Lewis and Wright 2014),
provide an indication of hyper or hypoventilation. The use of ETCO2
including the use of fluids, blood products and administration of drugs.
monitoring could be vital in the low flow state patient population as an
This is likely to be normal saline until the arrival of a blood product
improved ETCO2 reading may be the first sign of clinical improvement
carrying pre- hospital care service e.g. HEMS or MERIT. The aim should
following treatment as was the case with the patient examples
be to ‘fill’ a hypovolaemic patient, rather than ‘squeeze’ them at this
stage. Skill set dependant, consider the use of Tranexamic Acid (TXA) early in the resuscitative phase although not at the expense of other
Implications for paramedic practice
priority interventions. TXA could benefit the resuscitation as this synthetic
Paramedic practice varies and is an ever growing and more complex
decreases fibrinolysis, promoting coagulation (Harvey et al, 2013).
profession. Paramedics are employed in various roles including Air Ambulance Services, NHS solo responders, offshore oil and gas industry, in remote and expeditionary settings and more recently within the military environment. Within the paramedic profession, skill sets and training vary and the level of knowledge and confidence in the TCA situation will differ. The case examples discussed in this paper have highlighted various situations in which paramedics can have a positive
derivative of the amino acid lysine (Boling & Moore, 2012), is used to
Remember, with a patient who is hypovolaemic and in TCA ECC is not a priority and at no point should detract from haemorrhage control, preventing hypoxia, treatment of respiratory failure and the initiation of fluid resuscitation.
impact on the outcome of a patient when operating as part of a preThe traditional treatment of TCA, along with its perceived futility has
acting independently whilst waiting for additional support to arrive. It’s
been challenged in recent years by both military and civilian evidence
essential in this situation to recognise a patient suffering from TCA and
indicating that some of these patients can survive. Recent studies
prioritise time critical interventions and address the reversible cause.
now support that ROSC and hospital discharge of neurologically
Understanding the mechanism of injury and adopting the <C>ABCD
intact patients can be achieved in well-organised pre-hospital care
paradigm will maximise any potential benefit to patients. The
systems that focus on addressing the causes and aggressively
<C>ABCD paradigm was generated from military practice in the last
performing appropriate interventions where indicated. Similarly, case
decade to increase patient survival from trauma (Hodgetts 2006).
studies such as the ones discussed highlight the need for a more measured approach to resuscitation rather than a ubiquitous approach
Catastrophic Haemorrhage <C> Identify and address any external
consisting of CPR and medical ALS. The paper is designed to show that
bleeding that would result in death if no intervention was implemented.
patients can, on occasion survive and to establish debate both within
For this to be successful and to rule out occult injuries the practitioner
the paramedic profession and the growing pre-hospital care multi-
will need to undress the patient down to the skin. Treatment may
disciplinary community. The evidence presented is limited to a small
include the use of tourniquets, haemostatic dressings or compression
series of case studies and a relatively small study in Afghanistan. The
bandages and elevation. Apply a Pelvic binder at this stage if significant
need for a much larger, multicentre study examining ROSC, Hospital
pelvic injury is suspected to reduce any non-compressible pelvic
discharge and long-term outcomes is required to assess the true value
haemorrhage. This may require a mind set change amongst some
of this approach.
AMBULANCE UK - AUGUST
hospital team. Often however, many paramedics will be first on scene,
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FEATURE It is clear however that lives are being saved by this contemporary method and the paramedic profession is likely to be at the forefront of any further developments within the UK. By incorporating assessment skills, identifying treatment priorities, utilising limited resources appropriately and focusing on the treatment described in this paper, it is hoped that paramedic professionals can make a difference to this small but significant population.
References Atwood C, Eisenberg M, Herlitz J and Rea T (2005) ‘Incidence of EMS treated out-of-hospital cardiac arrest in Europe’. Resuscitation. 67: 75-80. Badjatia N, Carney N, Crocco TJ et al (2006) ‘Guidelines for Pre-hospital Management of Traumatic Brain Injury’ 2nd Edition. Available at: http://informahealthcare.com/doi/ abs/10.1080/10903120701732052?journalCode=pec (Accessed 15 Mar 2015). Boling, B. & Moore, K. (2012). ‘Tranexamic acid (TXA) use in trauma’. Journal of Emergency Nursing, 38(5): 496-497. Curry, N. Hopewell, S. Doree, C. Brohi, K. and Stanworth, S (2011) ‘The acute management of trauma haemorrhage: a systematic review of randomized controlled trials’. Critical Care. 15(2): R92. Deakin, CD. Clarke, T. Nolan J et al (2010a) ‘A critical reassessment of ambulance service airway management in pre-hospital care: Joint Royal Colleges Ambulance Liasion Committee Airway Working Group’. Emergency Medicine Journal. 27:226-233. Deakin, CD. Morrison, LJ. Morley, PT et al (2010b) ‘Part 8: Advanced life support 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency cardiovascular care Science with Treatment Recommendations’. Resuscitation. 81S: e93-e174. Defence Consultant Advisor in Emergency Medicine (2013) ‘Defence Medical Services, Medical Emergency Response Team (MERT), Clinical Standard Operating Procedure: Traumatic Cardiorespiratory Arrest management’. (Internal MOD document). Fisher, JD. Brown, SN. and Cooke M et al (2013) Joint Royal Colleges Ambulance Liaison Committee: UK ambulance services clinical practice guidelines 2013. 3rd edn. UK. Class publishing Ltd. Grathwohl, KW. Venticinque, SG. Blackbourne, LH. and Jenkins, DH (2008) ‘The evolution of military trauma and critical care medicine: Applications for civilian medical care systems’. Critical Care Medicine. 36(7): S253-2254. Harvey, V. Perrone, J. & Kim, P. (2013) ‘Does the Use of Tranexamic Acid Improve Trauma Mortality?’ Annals of Emergency Medicine. 63(4): 460-2. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24095056 (Accessed 12 Apr 15). Ho, AMH Graham, CA. Ng CSH et al (2009) ‘Timing of tracheal intubation in traumatic cardiac tamponade: A word of caution’. Resuscitation, 80: 272-274. AMBULANCE UK - AUGUST
Hodgetts, TJ. Mahoney, PF. Russell, MQ. and Byers, M (2006) ‘ABC to <C>ABC: redefining the military trauma paradigm’. Emergency Medicine Journal. 23: 745-746 Hopson, LR. Hirsh, E. Delgardo, J. et al (2003) ‘Guidelines for withholding or termination of resuscitation in pre hospital traumatic cardiopulmonary arrest’. Journal of American College of Surgeons. 196: 475-481. Kehoe, A. Jones, A. Marcus, S. Nordmann, G. Pope, C. Reavley, P. and Smith, C. (2011) ‘Current Controversies in Military Pre-Hospital Critical Care’. Journal of the Royal Army Medical Corp, 157(3): S305-S309 Kendal ,S. Phillipson, A. and Wright, J (2012) ‘North East Cardiac Arrest Network (NECAN). Out of Hospital Cardiac Arrest Registry: First year of
data report 2011’. Available at: http://www.networks.nhs.uk/nhs-networks/ north-east-england-cardiac-arrest-network/documents/Out%20of%20 Hospital%20Cardiac%20arrest%20registry.pdf/view (Accessed 20 Feb 15). Lewis, P. Wright, C (2014) ‘Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access’. Emergency Medical Journal. Online. Available at: http://emj.bmj.com/content/ early/2014/06/30/emermed-2014-203588.full.pdf (Accessed on 24 Mar 15). Lin, S. Callaway, CW. Shah, PS. Wagner, JD. Beyene, J. Ziegler, CP. and Morrison, LJ (2014) ‘Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomised controlled trials’. Resuscitation. 85(6): 732-40. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24642404 (Accessed 13 Apr 15). Lockey, DJ. Crewdson, K. and Davies, GE (2006) ‘Traumatic Cardiac Arrest: Who are the survivors?’ Annals of Emergency Medicine. 48: 240-244. Lockey, DJ. Lyon, RM. and Davies, GE (2013) ‘Development of a simple algorithm to guide the effective management of traumatic cardiac arrest.’ Resuscitation. 84: 738-742. Luna, GK. Paulin, EG. Kirkman, J et al (1989) ‘Hemodynamic effects of external cardiac massage in traumatic shock’. J Trauma. 29:1430. Lyon, RM. Ferris, JD. Young, DM. McKeown, WD. Oglesby, AJ. and Robertson C (2010) ‘Field intubation of cardiac arrest patients: a dying art? ‘Emergency Medicine Journal. 27(4): 321-323. Manzano, F. Fernandez-Mondejar, E. Colmenero, M. et al (2008) ‘Positiveend expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients’. Critical Care Medicine. 36(8): 222531. Available online at : http://www.ncbi.nlm.nih.gov/pubmed/18664777 (Accessed 12 Apr 15). National Confidential Enquiry into Patient Outcome and Death (2007) Trauma: Who cares? Available at: http://www.ncepod.org.uk/2007report2/ Downloads/SIP_report.pdf (Accessed: 20 Mar 2015). Pepe, PE. Roppolo, LP. and Fowler, RL (2005) ‘The detrimental effects of ventilation during low-blood-flow states’. Current Opinion in Critical Care. 11(3): 212-218. Pickens, JJ. Copass, MK. and Bulger, EM (2005) ‘Trauma Patients receiving CPR: Predictors of survival’. Journal of Trauma. 58: 951-958. Powell, DW. Moore, EE. Cothren, CC. et al (2004) ‘Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring pre-hospital cardiopulmonary resuscitation?’ Journal of American College of Surgeons. 199: 211-215. Soar, J. Perkins, GD. Abbas, G. et al (2010) ‘European Council Guidelines for resuscitation 2010 section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution’. Resuscitation. 81: 1400-1433. Stevens, RL. Rochester, AA. Busko, J. et al (2009) ‘Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography’. Prehospital Emergency care. 13(1): 14-17. Tarmey, NT. Park, CL. Bartels, OJ. Konig, TC. Mahoney, PF. and Mellor, AJ (2011) ‘Outcomes following military traumatic cardiorespiratory arrest: A prospective observational study’. Resuscitation. 82(9). 1194-1197. Thomas, A (2014) ‘An overview of the Medical Emergency Response Team (MERT) in Afghanistan: a paramedic’s perspective’. Journal of Paramedic Practice. 6: 232-237. Watson, L. Vird, G. and Forthergill, R (2012) ‘Cardiac Arrest Annual Report:2011/12 London Ambulance Service’. Available at: http://www. londonambulance.nhs.uk/news/news_releases_and_statements/londons_ cardiac_arrest_suriva.aspx?lang=en-gb (Accessed 16 Mar 15).
192 For more news visit: www.ambulanceukonline.com
FEATURE FigureFigure 1 1 MANAGEMENT OF TRAUMATIC CARDIAC ARREST BY MERT Traumatic arrests are different to medical arrests. DO NOT just follow ALS algorithm. Assess casualty and direct treatment towards the most likely cause. See notes below for guidance on use of compressions and adrenaline. ASSESS CASUALTY FOR SPONTANEOUS VENTILATION AND CAROTID PULSE
CONFIRM TCRA (No respiratory effort and absence of carotid pulse)
LOOK FOR MOST LIKELY CAUSE
CORRECT ANY POSSIBLE REVERSIBLE CAUSES (See below) NB DO NOT ALLOW CHEST COMPRESSIONS TO PREVENT REVERSAL OF POSSIBLE CAUSES OF ARREST i.e. reverse causes and only then continue or start external cardiac compressions. Start with most likely cause, and tailor resuscitation towards correcting this. CAUSE Catastrophic haemorrhage Hypoxia
Tension Pneumothorax Hypovolaemia
High Spinal Cord Injury (neurogenic shock) Hyper or hypothermia
Prevent further blood loss if on-going bleeding: Apply or tighten CATs · · Celox gauze and pressure dressing Reverse airway obstruction: Secure definitive airway (ETT or surgical airway) · · Commence ventilation with BVM (minimising intra-thoracic pressure) Decompress chest with bilateral thoracostomies IV or IO access Give 1:1 Red Cells and FFP Clamshell Thoracotomy: Open pericardium, release tamponade and close · holes in heart. · Compress aorta, give internal compressions, and fill heart with warmed blood. · Lung twist if bleeding lung. ABC as per ALS guidelines. Adrenaline is given if this is the sole cause of arrest. Cool or warm as appropriate
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NEWSLINE Glittering Evening Raises Over £100,000 For Midlands Air Ambulance Charity Forty-two further life saving air ambulance missions are now possible as £105,011 was raised at Midlands Air Ambulance Charity’s recent Recognition Awards and Charity Ball.
to support the Midlands Air
for their incredible commitment to
Fundraiser of the Year – Winifred
Cumiskey, Wombourne Funeral
Among the famous faces who
“Not only did the night bring
attended were Rustie Lee, rugby
tears and laughter, but we also
Extreme Fundraiser of the Year
star Thinus Delport MBE, boxer Joe
raised our largest ever total,
– Hannah Palmer, Hereford
Egan, Olympic hockey player Jane
for which we are extremely
Sixsmith MBE, Paralympic athlete
grateful. As each air ambulance
Business Partnership of the Year
Mickey Bushell MBE, TV presenters
mission costs the charity
– The Phoenix Group, Wythall
Nina Hossain and Michael
£2,500, the £105,011 raised will
Collie, race horse trainer Michael
fund 42 additional life saving
Medic of the Year – Tom Waters,
Scudamore, plus Ed James who
missions flown by our aircrew –
kindly compered the event.
it doesn’t get much better than
that.” The glittering evening started
Bravery Award – Georgia Bennett, Worcestershire
with a drinks reception and the
During the evening, the
arrival of one of the charity’s red
Recognition Awards highlighted
Special Recognition Award –
helicopters, which landed on
some of the great work of the
Roger & Diane Cole, Droitwich
Edgbaston Stadium’s famous
charity’s supporters, staff and
pitch. Guests were then treated to
patients in raising awareness
In addition to Platinum Sponsor,
Stadium in Birmingham, the
a four course dinner, followed by a
and in giving so generously
Concept Resourcing, the evening’s
record breaking six figure
live auction, prestigious raffle, live
to the largest air ambulance
Gold Sponsors were TH Baker,
sum was raised thanks to the
entertainment, casino and after
charity in the country.
GMS Security, Silverstone
generosity of the 500 guests who
Sponsored by a number of corporate partners including Platinum Sponsor, Concept Resourcing, and held at the stunning setting of Edgbaston
attended the black tie event.
Auctions, Unity4, M6 Toll, Yogurt The 2015 winners* were:
Top Marketing and Rybrook Group.
Hanna Sebright, chief executive The night also celebrated and
of Midlands Air Ambulance
Volunteer of the Year – Gina
To find out more about the
recognised the hard work and
Charity, said: “Our Recognition
service, please contact Midlands
dedication of a number of
Awards and Charity Ball is always
individuals and businesses who
a truly inspiring evening as we
Sky Champ – Ben Lovegrove,
0800 8 40 20 40 or visit
have gone above and beyond
thank some very special people
Air Ambulance Charity on
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Thames Valley Air Ambulance trains the trauma team of the future Thames Valley Air Ambulance (TVAA) leads the training of new Helicopter Emergency Medical Services (HEMS) paramedics and pre-hospital emergency doctors across Berks, Oxon and Bucks. More pre-hospital emergency medicine trained paramedics and doctors will be available in the South Central region following a five-day Clinical HEMS Crew Course at TVAA’s training centre at RAF Benson, developed by Dr Syed Masud, clinical team leader for TVAA and Consultant in Emergency Medicine & Pre Hospital Care at the John Radcliffe Hospital. 25 – 29 May 2015 saw eight paramedics (from both Thames Valley Air Ambulance and Hampshire and Isle of White Air Ambulance), six emergency medical doctors and one consultant nurse from the John Radcliffe hospital prepare for helicopter emergency medical services, training together to build the ‘paramedic physician partnership’ that is essential for a truly gold standard delivery of pre-
Dr Masud said: “Trauma happens from the second an incident occurs and it is vital that our crews are at the cutting edge of pre-hospital emergency care in order to treat and stabilise patients at the scene. “The course pushes the boundaries of medical intervention and demonstrates that what people thought could only be done in hospital is now being done in minutes by the roadside.” Mark McGeown, CEO of Thames Valley Air Ambulance added: “This course shows that our Charity and the South Central Ambulance Service are committed to developing and enhancing the helicopter emergency service in our region to provide the highest level of care for patients who need us.” In the autumn TVAA will take delivery of a new helicopter, fully equipped with specialist equipment, such as night vision equipment and additional flood-lighting needed for night
WMAS staff scoop top Ambulance Awards West Midlands Ambulance Service (WMAS) scooped three top awards at a prestigious ceremony held on June 25th, at the House of Lords in London. The main focus of the Ambulance Service Institute (ASI) Awards is to award outstanding work in the out-of-hospital care arena and encourage and promote the highest quality of treatment and effectiveness of out-ofhospital care. Those recognised yesterday included ambulance staff, community first responders volunteers and the military. Presenting the awards, Baroness Browning, said: “What a privilege it is for all of us to hear these wonderful accounts of the bravery, professionalism and dedication of the people who will
receive their awards today and of
The move into Night Operations
they work for.”
will be a major step change for TVAA enabling the helicopter and crew to bring their life-saving care
course the people in the teams
The following citations were given for those award recipients
to the most seriously injured or
from West Midlands Ambulance
most seriously ill people by night
Neil Ashmore and Sarah Lawrence - Frontline Ambulance Persons of the Year. Neil and Sarah were first on scene at a serious fire in Tipton in the West Midlands in August 2014. They were faced with a second floor apartment well alight when they arrived. The two occupants managed to leap from the second floor and Neil and Sarah immediately went to their assistance and started to treat them where they fell. However, they were forced to carry the patients to safety after the intense heat of the fire blew the windows out of the building. Neil and Sarah were praised for their bravery at the scene and have both been awarded the ASI Frontline Ambulance Persons of the Year Award. Mental Health Intervention Unit - ASI Innovation Award The Unit started as a trial scheme and has led to close collaboration between West Midlands Ambulance Service, West Midlands Police and Birmingham and Solihull Mental Health Trust. The multi-agency scheme has resulted in a dramatic reduction
as well as by day, responding to more emergency calls and
Steve Harris WMAS Motorcycle
in the number of people suffering
saving more lives.
Unit – President’s Awards
a mental health episode and
followed with advanced ‘on-
Mark concluded: “We are
Motorcycle paramedic Steve
scene’ training scenarios.
extremely proud of our air
Harris from Smethwick was
Since January 2014, the
Subjects covered full general
ambulance and its crew. The new
presented with the ASI Presidents
‘Mental Health Intervention
anaesthesia and open surgery
recruits will provide a huge step
Award for his long serving
Unit’ has seen police officers
at the roadside, immediate pre-
up to a higher level of capability
contribution to WMAS. Steve has
crewed with mental health
hospital blood transfusion and
and this is a result of the very
served over 36 years with WMAS
nurses and paramedics in
advanced ultrasound techniques
close partnerships we have
and has worked an impressive 18
a responder vehicle, seven
to diagnose patients quickly,
with the NHS and South Central
years on the bikes. Affectionally
days a week in Birmingham
helping to shave off valuable
Ambulance Service. But it is also
known as a ‘Forest’ by his
the Black Country as well
seconds in the golden hour.
important to remember that our
colleagues as well as fans of
as Coventry and Solihull. So
ambition of delivering a gold
Channel 5’s Emergency Bikers TV
successful has the Unit become
The new recruits will directly
standard service is dependent
series, Steve was honoured for his
it is now plays an active part in
transfer these skills to the field
on the generosity of the people,
outstanding service to WMAS, the
supporting vulnerable patients
when they join Thames Valley Air
companies and organisations
motorcycle unit and the people of
in communities across the main
Ambulance’s air crew full time.
who support us.”
centres of population.
hospital emergency medicine.
ending up in police custody.
On each day lectures were
AMBULANCE UK - AUGUST
197 For all your equipment needs visit: www.ambulanceservicesuppliers.com
Folkestone teenager praised for quick thinking Quick thinking by a 13-year-old Folkestone boy almost certainly saved the life of his mother when she collapsed face down in her full bath. Zyel Abraham had suffered a seizure in March which led to her collapse and when son Josh Anslow heard her cry out he went to her aid. Finding the bathroom door locked, he ran and alerted a neighbour, Linda Clark and came back managing to use a knife to unlock the door. Folkestone Academy pupil Josh and Linda then pulled his mother from the bath. Fortunately she was still breathing when they pulled her out but had turned blue from the immersion and was coughing up water while struggling to breathe. They then laid her on her side. Quickly on scene was South East Coast Ambulance Service (SECAmb) paramedic Simon Wilks who was extremely impressed with Josh’s coolness and calmness
in what was obviously a very traumatic situation. Simon said: “When I arrived Josh gave me a calm, clear account of what had happened and his mother’s medical history. He then helped in calming his mother when she became agitated in the postictal stage. “His actions and behaviour were exemplary and he showed great maturity and bravery during the incident. I, and the crew who backed me up, agreed his actions undoubtedly prevented a far worse situation from developing and probably saved his mum’s life.” Zyel was then taken to the William Harvey Hospital in Ashford by SECAmb crew Nathan Jeffrey and Andrew Currie as a precaution in case she had ingested water in her lungs which could have caused later breathing problems. Zyel has suffered from epileptic fits for about five years but this was the most dangerous seizure she had suffered. Thankfully new medication has also meant it the last fit she has suffered since this experience. She said: “I get no warning of the fits and it has been difficult for Josh. He has learned to cope and
he did all the right things to get me help. I am also so grateful for what Simon, Nathan and Andrew did for me. Although I don’t remember much about the incident I know they were amazing.” Josh was presented with a certificate of commendation from South East Coast Ambulance Service for his actions and he and his mother were given a tour of Trust’s Ashford Make Ready Centre which houses the area’s Hazardous Area Response Team and is where all vehicles in the region are cleaned, stocked and maintained. Simon is a paramedic with the area HART team and was working as a single responder when Zyel suffered her fit.
O&H Vehicle Conversion’s PTS to be driven 10,000 miles to aid Mongolian charity Goole – This July an O&H Passenger Transport Service conversion joined the Mongolia Charity Rally on an epic 10,000 mile pan-continental road trip from London to the Mongolian capital city of Ulaanbaatar. The vehicle will then be donated to
Go Help’s flagship ambulance service in Mongolia! The 2006 Renault Master an ex-West Midlands Ambulance Service PTS vehicle was recently purchased and restored by Mr and Mrs Cornago, with a little help from O&H. The vehicle will shortly commence the long journey which negotiates some rough landscapes including mountain ranges, deserts and near inhospitable lands to eventually arrive at Ulaanbaatar. O&H Patient Transport Service Ambulance Conversions O&H Vehicle Conversions offer a large range of fully tested and certified PTS ambulances compliant to CEN: 1789 based on vehicles from Renault, Vauxhall, Fiat, Peugeot, Citroen and Mercedes. O&H PTS vehicles main features include a personalised seating and stretcher layout, tail lift, wedge or manual ramp, overhead lockers, upright cupboards, privacy glass, blinds, oxygen storage & pipe work, heating/ ventilation and external livery. Go Help Charity Go Help is a UK adventure charity that is committed to working with local communities in Central Asia and Central America to improve their access to education and healthcare services. It is run by volunteers and begun as an effort to launch and operate ambulance services in third world countries. The cause is now much broader and they endeavor to help local organisations. Go Help’s fundraising platform is called Charity Rallies, which runs the Mongolia Charity Rally, the Roof of the World Charity Rally, and the MesoAmerica Charity Rally.
AMBULANCE UK - AUGUST
For more information on O&H Vehicle Conversions products and services please visit: www.oh-vehicleconversions.co.uk or contact 01405 769867 or email sales@oh-vehicleconversions. co.uk For more information on the rally please visit http://mongolia. charityrallies.org
198 For more news visit: www.ambulanceukonline.com
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NEWSLINE New name for Durham ambulance service EMS being phased out; replaced by Paramedic Services It’s now known as the Region of Durham Paramedic Services and the change is being done to better reflect the services provided by
says charitable support is to
“Ambulance services staff are
London, Your Helicopter’
be developed to help under-
totally dedicated and sometimes
campaign by donating
pressure staff cope with the
need our support. They are often
advertising space on its taxi
increasing demands of the job.
the very last people to ask for help
topper LED screens.
themselves. TASC, The Ambulance Services
200 taxis are supporting London’s
Charity was established this
“We provide support not only to
Air Ambulance, the charity that
year as the leading UK charity to
ambulance personnel but also to
delivers an advanced trauma
provide vital advice and support
their families. Support can consist
team to critically injured people in
services to both serving and
of access to rehabilitation and
London, in its bid to raise money
retired ambulance personnel and
mental health services including
for a second emergency medical
counselling for those suffering
helicopter for London.
from Post-Traumatic Stress
paramedics, Durham officials say.
Six Ambulance Trusts have
Disorder, bereavement support
Christian McGuinness, Chief
spoken out to warn of major staff
and welfare and debt advice.
Operating Officer at BrightMove
“This change in name recognizes
shortages, growing numbers
the significant contribution paramedics provide to ensure the well-being of the residents of Durham Region. It is also consistent with what is occurring in other paramedic services throughout Ontario,” Regional
“The charity is here to provide
when I hear of the remarkable
Stress Disorder, high absenteeism
independent, confidential advice
work that the charity carries out
and low morale.
to those in the ambulance services
I think ‘that could be someone’s
Lorna Birse-Stewart, Chief
and advice. We are also planning
Executive of TASC, said ambulance services staff are
Chairman Roger Anderson said.
facing the same pressures as
Richard Armstrong, chief of the
National Health Service in the UK.
Region’s Paramedic Services
their colleagues working in the
stated, “This new name not only
“The charity was formed in Spring
more appropriately reflects the
2015 in response to the increased
scope of our services, but also
challenges that are facing around
encompasses future expansion
70,000 people working in the
of paramedic services into
UK ambulance services which
non-emergency care such as
includes paramedics and staff
working in call handling centres, patient transport and other areas.
The name change will be phased in over the next few years and will
“The charity is well-placed to
be reflected on both paramedics’
provide support and advice to
uniforms and the services’
all ambulance service personnel
vehicles. The phasing in of the
in the NHS and independent
new name will incur no additional
sectors through its independent
costs to the service.
and professional team of staff and via our free Support Line at
community who turn to us for help to make representations to government and decision makers to highlight this growing need for support for our under-pressure ambulance staff and TASC who supports them. “In order for us to deliver these vital services we need the backing and support of not only The Ambulance Services Community itself but also the general public, other funders and donors.” For more details and information about the role of the charity and its work please contact Lorna Birse-Stewart or TASC Chair Cliff Randall at www.theASC.org.uk, or by telephoning 02477 987 922. The Support Line number is 0800 1032 999.
0800 103 2999.
information about Region of
“With over 10 million 999 calls
Durham Paramedic Services.
and a call every three seconds to our UK ambulance services, we
AMBULANCE UK - AUGUST
recognise the significant demand and pressures facing this incredible band of professionals and the charity is here to support them.
child, even my own’. Any initiative aimed at saving a life should be embraced. The doctors, pilots, paramedics and operational teams have my utmost respect.” London’s Air Ambulance is in its final fundraising drive to secure the £2.1 million still needed to acquire and sustain a second helicopter. Through the acquisition of a second helicopter and by extending its daylight flying hours in the summer months, the charity will be able to reach an estimated 400 more patients per year by aircraft. London’s Air Ambulance Director of Development, Mark Davies, said: “We are extremely grateful to Brightmove Media for this generous donation of advertising. We need people in London to know that we are a charity and that London needs a second
paramedicservices for more
Major UK ambulance charity to help underpressure ambulance staff cope with demands
Media said: “As a doting dad,
suffering from Post-Traumatic
London Black Cabs Fly Flag for a Second Emergency Medical Helicopter
emergency medical helicopter. If other organisations can help by donating money at yourhelicopter. london and advertising to their employees and customers, we should be able to get the second helicopter flying this year.”
Have you seen London’s black cabs displaying the London’s
The charity is urging the 10
“TASC has seen an increase in
Air Ambulance iconic red
million people who live, work and
requests for support and advice
livery on their roofs? This is
holiday in the capital to donate
and we have enhanced our
thanks to advertising company
at yourhelicopter.london or
The Chief Executive of the new
Support Line Service and the
BrightMove Media, which is
text HELICOPTER TO 70800 to
UK Ambulance Services Charity
range of services we plan to offer.
supporting the charity’s ‘Your
200 For further recruitment vacancies visit: www.ambulanceukonline.com
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NEWSLINE Reassurance can be as important as waiting times for ambulance patients
telephone or in person, being
Janette Turner from the University
“Our findings could be used
involved in the handover process
to inform the development of a standardised measure of patient
if they were taken to hospital, and a more informal style of
Fiona said: “There is an increasing
communication by clinicians.
need to assess the performance
experience for ambulance services.”
of emergency ambulance services
The study concluded there was
The study was carried out with
using measures other than the
an “increasing need” to consider
patients and relatives who had
time it takes for an ambulance
other factors in the performance
Ambulance services should be
received care from the East
to arrive on scene. Patients and
of ambulance trusts in addition to
assessed on how reassured
Midlands Ambulance Service
their families are often extremely
response times. The performance
patients and their families feel
NHS Trust (EMAS), which serves
anxious, and they value the
of ambulance services is currently
during an emergency as well as
a population of around 4.8 million
reassurance from ambulance
judged on how quickly they reach
on response times, researchers
people across five counties of
service staff that they were
emergency patients following a
England. It covered call-outs for
receiving appropriate advice,
conditions ranging from kidney
treatment and care.
The report from the University of
stones, high fevers, breathing
Lincoln and University of Sheffield
difficulties, and severe abdominal
“Our findings demonstrate that a
per cent of the most serious ‘Red
in the UK found that offering
pain, to anxiety attacks, medicinal
fast response and high standard
1 and Red 2’ cases within eight
reassurance to patients and their
side effects, injuries, and stroke.
of clinical care, although important,
minutes. For non-life threatening
may not be sufficient for a good
conditions, response time targets are set locally.
families alleviates anxiety, fear or
The national target is to reach 75
panic. These aspects of care can
Lead author, Fiona Togher
patient experience. The implication
be as important as other NHS
and colleague Viet-Hai Phung,
of this is that the proportion of users
performance measures such as
researchers who work with
reporting that they feel reassured
The findings have been presented
response times, the study said.
Professor Niro Siriwardena in the
by the ambulance service response
to the National Ambulance
Community & Health Research
should be measured alongside
Services Clinical Quality Group
The reassurance was gained
Unit at the University of Lincoln,
current measures such as response
and the National Ambulance
from the continuous presence
carried out the study with
times and clinical performance
Services Research Steering
of healthcare staff, whether by
Professor Alicia O’Cathain and
Group, and the report will also
XPS - expandable patient surface - is adjustable with 7 locking positions and a wider mattress, designed with patient comfort in mind.
AMBULANCE UK - AUGUST
The Power from Stryker
202 For more news visit: www.ambulanceukonline.com
NEWSLINE be sent to the Association of
the unfortunate event of another
through huge piles of rubble as
are volunteers are trained to respond
Ambulance Chief Executives
disaster taking place.
the search for survivors continued.
to medical emergencies while an
Steve will teach 20 students a
“Whilst it was a difficult
The research is part of a wider
variety of topics, including what
environment due to the trauma
They possess a wide range
five-year programme to improve
to do before international help
and upset people were going
of emergency skills, and use
pre-hospital care across the
arrives, emergency planning, how
through, my job as a paramedic
specialised equipment such as
NHS*. The study has now been
to search rubble piles, how to
helps with that type of situation as
defibrillators and oxygen therapy
published in the journal Health
lift concrete and support search
I have to be focussed on the task
to provide early intervention in the
areas, first aid, water rescue and
in hand,” he added.
event of emergencies including
ambulance is on its way.
health and wellbeing. WMAS
Paramedic set to return to Nepal A West Midlands Ambulance
heart or asthma attacks. “Ultimately, I was there for the
The idea then is for the students to
people and you could see how
Forfar currently has one
take the information away, translate
grateful they were, which is why
Community First Responder and
it into Nepalese and teach it to
it will be rewarding to return and
local area co-ordinator Bill Spence
approximately 700 youngsters of
help give something back.”
said a second is awaiting training.
He continued: “All the training
approximately sixth form age.
Service paramedic is set to return to Nepal to teach locals
Speaking about the trip, Steve
how to cope should they ever
said: “It will be my job to teach
suffer the trauma of another
them (the people of Nepal) every
bit of information and knowledge
Steve Watkins, based in Stoke,
prepared as possible should they
is a member of the Search and
ever be unfortunate enough to
Rescue Assistance in Disasters
suffer another disaster.
A fund-raising drive has been launched to help boost and enhance a vital frontline health service in Forfar
tasked to Kathmandu in April
“The first 48 hours in a rescue
The campaign, being run by the
when the first of two devastating
operation can be absolutely vital.
Scottish Ambulance Service,
“It’s critical to get someone to a
earthquakes struck the country.
So if the residents know what
is to provide a fully equipped
patient in the first eight minutes,
to do, and how to search for
Community First Responder to
and if they get defibrillation
He is now returning to the country
survivors effectively whilst waiting
help deal with emergency call-
within three minutes their survival
as the SARAID representative to
for help to arrive, the more chance
outs in the town.
prospects are very good.
pass on advice and knowledge on
there is of people surviving.”
I can, so they can be as well
(SARAID) charity and was
is carried out by the Scottish Ambulance Service to their own standards. If there has been a cardiac arrest, they will send a First Responder, someone local who can be there within three or four minutes. An ambulance is also sent, but they could be anywhere at the time.
a wide range of topics, all linked
Working with the ambulance service,
“It’s about buying time for the
to locals knowing what to do
On his first visit to Nepal, Steve
in partnership with the Order of St
paramedics and they will assist
whilst waiting for help to arrive, in
spent eight days searching
John, Community First Responders
when the paramedics arrive. We currently have one First Responder waiting for training and we hope to get more - the more we have the more we can cover round the clock.” Each basic defibrillator costs £1300 and Mr Spence said that fundraising is being carried out mainly using collection buckets and cans. He added: “When we’ve had they’ve been in local supermarkets and have been very effective.” Anyone interested in finding out more about the Community First Responders scheme can contact Mr Spence on 01382 350553
AMBULANCE UK - AUGUST
collections in Forfar in the past
or email email@example.com
203 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
SCAS turns to Poland as part of its paramedic recruitment drive Four skilled and experienced Poles have recently become the first cohort of qualified paramedics from Poland to begin working for South Central Ambulance Service (SCAS) NHS Foundation Trust. It has been well publicised that all UK ambulance services are currently experiencing a shortage of qualified paramedics within their workforce. Like all Trusts across the country, SCAS is working extremely hard using a number of different recruitment strategies to address this issue. These include advertising nationally for qualified paramedics as well as supporting staff who wish to develop their career as a paramedic through both traditional and fast-track degree programmes with local universities. Recently the Trust has also developed a new specialist
paramedics whose clinical
return on investment of such a
practice virtually mirrored that of a
trip more than outweighs the cost
UK paramedic. Having narrowed
of not having enough clinically
these countries down to a small
qualified staff. Recruiting such
handful we felt Poland would be
staff ensures that more frontline
the most suitable to visit first in
ambulances are covered by
terms of meeting our criteria.”
qualified paramedics rather than having those vehicles, or shifts,
Although also considered by other
sitting uncovered or the Trust
UK trusts, SCAS is the first such
having to utilise private providers
organisation to set up a formal
to meet demand.
recruitment process in Poland in partnership with an internationally
“To put the cost versus value
recognised recruitment company.
arguments in some sort of
Earlier this year, a small team from
context”, says Sharon, “if only
SCAS comprising experienced
one of the recruited paramedics
recruitment and education staff
remains working for SCAS for 12
and a number of experienced
months, this would more than
SCAS paramedics who originated
cover the cost of three recruitment
from Poland, visited Warsaw to
conduct an initial assessment centre with over 30 attendees that
The initial recruitment drive in
had been pre-selected by SCAS’
Poland identified 15 suitable
in-country recruitment partner.
paramedics and the initial cohort of four are currently in the UK
“The ‘Polish paramedics’ who
and undertaking a six-week
came on the trip were invaluable”,
familiarisation training programme
says Sharon. “They were able to
at the Trust’s Nursling Ambulance
provide us with guidance around
Station in Southampton. A further
qualifications, working practices
11 qualified paramedics from
and culture. It was also a bit of
Poland are due to arrive to start a
an eye-opener for our HR and
second familiarisation course.
education team to discover what it’s like to be an operational
The Trust is also approached by
frontline paramedic in Poland,
overseas candidates directly and
including having to hold a BSc
following careful assessment, an
and work in excess of 300 hours
Australian paramedic has joined
the four Poles currently training
A further strategic decision was
During the initial assessment,
international candidates will join
attendees had to undertake a
the second cohort.
paramedic programme, with the first cohort of 20 staff beginning last month and a second cohort scheduled to start in September
taken by the Trust this year to expand its recruitment horizon
at Nursling and a further six
driving test, a clinical scenario
“We were looking at a number of countries and our criteria included the fact that there needed to be access to BSc qualified paramedics whose clinical practice virtually mirrored that of a UK paramedic. Having narrowed these countries down to a small handful we felt Poland would be the most suitable to visit first in terms of meeting our criteria.” as paramedics, but with the HCPC working towards the role of a UK paramedic becoming an all graduate profession, this takes time. Which is why the international recruitment drive will remain important for the Trust for the next few years. And what do the candidates themselves think about coming to work for SCAS? “Our training is really important
AMBULANCE UK - AUGUST
and look beyond UK shores
and a full interview in addition to
The six-week course covers
to attract more qualified staff
the normal background checks
everything clinically required
to come and work in the UK.
held for any potential SCAS
according to both SCAS and
Following extensive research by
employee. The tests employed
Joint Royal Colleges Ambulance
the Trust, the decision was made
were identical to those carried
Liaison Committee (JRCALC)
to focus initially on Poland.
out in the UK and candidates
protocols thereby allowing the
whose English language was not
international staff to initially
going really well and we would
Sharon Walters, Director
of a high enough standard for
practice at student paramedic
like to thank staff for being so
of Human Resources and
work within the UK were rejected,
level until they have gained their
welcoming, supporting us in
Organisational Development at
irrespective of the quality of their
Health and Care Professions
our move and answering any
Council (HCPC) registration. Once
questions we have. The main
this is achieved, they become fully
difference we have found is that
the equipment that you have is a
for us and is going really well. We’re really enjoying it; it’s really appreciated and it’s a chance to see how you work. The third manning shifts have been
“We were looking at a number of
Whilst there is of course costs
countries and our criteria included
associated with recruitment from
the fact that there needed to
abroad in this way, the Trust
SCAS continues to support its
equipment we have in Poland or
be access to BSc qualified
believes that in the long-term, the
own staff to develop their careers
lot more advanced than that of the
204 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE NHS Clinical Commissioning Group simplifies emergency stroke care in the Whitby area
Following this, the more specialist
They are usually called on their
staff how close they are to a
rehabilitation required for these
mobile phones by East of England
patients now takes place initially
Ambulance Service NHS Trust
in Redcar, before, longer term,
(EEAST) emergency operations staff.
For more information becoming a CFR, visit: http://www.eastamb.
people are able to return to their home. Following discharge from
However, since last month three
Redcar, patients will be either
groups in Wells, in North Norfolk,
back to their normal place of
East Bergholt, in Suffolk, and
residence or to Whitby hospital
Steeple Bumpstead, in Essex,
Following hard work behind
for the remainder of their more
have been trialling the use of
the scenes, NHS Hambleton,
handheld digital radios.
Clinical Commissioning Group
Dr George Campbell, Whitby
Gary Morgan, Head of Emergency
new arrangements are now in
GP and HRW CCG Vice Chair,
Operations Centres at EEAST,
place for emergency stroke
said: “We are really pleased we
said: “We are always looking at
patients. As of 14 July 2015
have been able to find a simpler
ways to improve communications
patients are now taken directly
solution for emergency stroke care
with our volunteer life-savers.
to hospital in Middlesbrough for
in the Whitby area. Patients will
be taken directly to James Cook
“These are groups that have
University Hospital for all their
reported localised mobile phone
You may previously have heard
main treatment, rather than the two
signal issues and the trial will aim
about changes to the way
legged approach to Scarborough
to show if an improvement in both
emergency stroke patients are
then to York. Middlesbrough is also,
communication and activation
We are again running, in individual
cared for, with patients from
of course, much closer and more
time can be achieved through the
rooms, the following Conferences;
the Whitby area first going
accessible for visiting relatives.
use of the radio.”
Paramedic Practice, Community
assessment and then to York for
“The long-term plan is to provide
CFRs attend a range of 999 calls
First Aid and, for those looking for
their main treatment.
all stroke rehabilitation from April
such as cardiac arrests, patients
something different, this year’s
2016 onwards in Whitby, once
with breathing difficulties, chest
Workshops include: Paramedics in
This change came about because
work has been completed to
pain and diabetic emergencies.
Hazardous Environments, Difficult
of major problems at Scarborough
Richmondshire and Whitby
to Scarborough for initial
Life Connections 2015 - Something For Everyone Over 400 delegates have now registered for the various Conferences and Workshops taking place at Life Connections 2015 on Wednesday 21 and Thursday 22 October at The Kettering Conference Centre, Kettering, Northants.
First Responder, Resuscitation and
Airway Course, Motorsport Medicine
Hospital in recruiting replacements
Kevin Short, a CFR with the
CPD Workshop, Cardiac Based
for stroke consultants who are due
Wells group, said: “In the winter,
Study on ECG Interpretation, Minor
mobile phone signal is fine, but
Injuries Workshop, Paediatric
in the summer months and bank
Workshop, NAEMT Trauma First
holidays we do not get any signal
Responder Course and an ALSG
at all. For a CFR that can be
Facilitation Course. Delegates
demoralising because you are
booking on to these Workshops
tied to your phone, car and kit
are also being offered a free place
when you are logged on.
on our Paramedic or Resuscitation
to retire this summer. However, clinicians at HRW CCG felt the journey to Scarborough then to York was too far, and were keen that a one-journey solution
Pilot project to overcome mobile phone ‘not spot’ issues for community first responders
should be found for patients who A pilot project has been launched
need emergency care.
to improve the way volunteer
“With the radio, we don’t have
As a result HRW CCG colleagues
responders are dispatched to
those issues any more. It is really
Once again, delegates will also
have been working with Yorkshire
medical emergencies in the East.
good and you can mobilise so
have the opportunity to visit over
much quicker and slicker. The
50 trade stands during the break
Ambulance Service and South The region’s ambulance
other advantage is that the radio
out sessions and, with delegate
solution for local people.
service has begun trialling the
has GPS tracking and the control
rates starting from just £36.00 to
use of digital radios with three
room can guide you to an address
include lunch, tea/coffee, etc., we
Now, as of 14 July 2015, any
community first responder (CFR)
if you struggling to find it.”
believe Life Connections 2015
stroke emergencies from Whitby
groups in areas where there are
town, Robin Hood’s Bay and
phone signal issues.
offers tremendous value for money. Other CFR groups in Soham, Sudbury and St Albans and are
For full details, visit
patients taken by emergency
There are more than 290 CFR
also trialling the use of handheld
ambulance directly to the
groups in the East of England who
personal digital assistant (PDA)
specialist stroke unit at James
make themselves available in their
devices to assist them attending
We look forward to receiving
Cook University Hospital,
free time to attend emergencies
999 calls. The devices use GPS
your registration online via the
Middlesbrough, for the main acute
in their communities before the
mapping to help find addresses
above website or, by calling the
phase of care.
arrival of ambulance service staff.
and tells emergency operations
Organisers on: 01322 660434.
the surrounding villages will see
AMBULANCE UK - AUGUST
Tees Hospitals to find a better
205 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE Celebrating and commemorating ambulance work Remarkable careers and outstanding contributions to patient care have been the focus of a special ambulance awards service. At the long service and commendation awards ceremony on Wednesday 1st July, East of England Ambulance Service NHS Trust (EEAST) Chief Executive Anthony Marsh opened the
than 100 staff, volunteers, and
which was presented on behalf
Dozens of people who received
members of the police service
of Her Majesty the Queen by the
emergency medical help from
from across the region. They were
Deputy Lieutenant of Suffolk. The
the region’s ambulance service in
joined by special guests including
award winners have clocked up
April completed questionnaires.
the Deputy Lieutenant of Suffolk,
more than 1,000 years’ service
councillors, emergency service
and NHS colleagues. Anthony added: “Our staff and
Other awards recognised the long
volunteers work tirelessly to make
service of volunteers, those who
sure the thousands of patients
had gone above and beyond the
we treat every week get the
call of duty in trying to save lives,
best possible care, whenever
and outstanding achievement
they need it. Having worked in
for staff and volunteers. These
the ambulance service myself
included Gloria Bullen, a
for nearly 30 years, I know what
community first responder, who
a difficult and challenging job
was called to a patient in Thurrock
this can be for our staff and
who had gone into cardiac arrest
volunteers and I am proud
and started life saving CPR
of their achievements which
ceremony by telling guests it
and paramedic Ken Tovee who
we celebrated at our awards
was “an opportunity to recognise
attended an RTC in Colchester
and bravely extinguished the fire
and celebrate the motivation,
And 98.9% of respondents said they were very satisfied, satisfied or fairly satisfied with the service they received from the East of England Ambulance Service NHS Trust (EEAST). High scores were given for the attitude and professionalism of call handlers and front-line staff, according to the latest patient experience report. The results reveal that 97.5% said the handling of their 999 call was
in the car.
very acceptable or acceptable
ceremony were for 20, 25, and
Also to receive Chief Officer
waited for an ambulance to
35 years’ long service and the
Commendations were Alan Jones,
arrive was very acceptable or
Queen’s Medal for long service
Paul Rampley, Adam Wright and
The Trust ceremony, held at Trinity
and good conduct – a medal
Amanda Warby, who were praised
Park in Ipswich, honoured more
specially for ambulance staff
by Norfolk Police for disarming a
More than 95% of respondents
patient armed with a knife in Great
said the help they received
Yarmouth earlier this year.
exceeded or met their
dedication and commitment
Awards presented during the
of our wonderful staff and volunteers”.
and 93.4% said the time they
expectations and 96.8% said the
A Two-Day course specifically designed for ALS level Pre-Hospital Care providers. • Learn the full range of airway management techniques — including use of extraglottic devices, drug-assisted intubation and cricothyrotomy. • Face the most challenging patient scenarios in a no-risk environment. • Practice decision-making and airway techniques in Code Airway™ stations.
The Lynne Storrie Award for a
attitude of staff that came to their
student in training who has proved
aid was “very professional”.
themselves to be exceptional was presented to Cambridgeshire-
“Absolutely brilliant”, “excellent”,
based student paramedic
“very impressed” and “first class
Samantha Cameron. The award is in memory of ambulance technician Lynne Storrie who Course Manual
died in a road traffic collision whilst driving home from Bedford training centre in February 2001.
To learn more or register for a course near you, visit theairwaysite.com today!
Awards were presented by the Deputy Lieutenant of Suffolk, Terry TM
AMBULANCE UK - AUGUST
A One-Day airway course specifically designed for ALS providers with non-RSI protocols. Learn: � Difficult and failed airway management Video laryngoscopy � Pediatric airway management � Cricothyrotomy � EGDs, Bougies, and More! �
Capnography � Ventilator management � Caring for intubated patients �
Practice decision-making & airway techniques in Code Airway™ stations.
Hunt, editor of the East Anglian Daily Times, and the Mayor of Ipswich.
Praise for ‘brilliant’ ambulance service
service” were just some of the comments of patients. Anthony Marsh, EEAST Chief Executive, said: “I’m delighted that patient satisfaction remains so high. This is testament to the dedication of our staff who work hard to provide the best possible care to patients every day. “I am proud to lead such committed staff and we will continue to strive to improve the service we deliver to patients in the East.”
If YOUR organization would like to be an Authorized Training Center, contact Jamie Todd at firstname.lastname@example.org.
Ambulance staff have been
To read the patient experience
Intensive, hands-on airway courses designed especially for pre-hospital providers
thanked for providing a
report in full, visit
“brilliant” service to patients
across the East of England.
206 For more news visit: www.ambulanceukonline.com
LIFE CONNECTIONS 2015
Diary Date: Wednesday 21st October & Thursday 22nd October 2015 Kettering Conference Centre, Kettering, Northants NN15 6PB
More Choice, More Value, More CPD Opportunities SPECIAL OFFERS AVAILABLE!!! Wednesday 21st October ATACC Conference
ATACC "Decoding the Future" - this ground breaking two day conference aims to explore the very latest medical advances in the fields of resuscitation, trauma, anaesthesia and critical care. A truly breathtaking list of international experts will present both advanced current practice and also remarkable evolving research that we are likely to see adopted over the next five to ten years. Two day delegate rate £250, one day delegate rate (Wednesday or Thursday) £150.
Paramedic Practice Conference
Presentations include "Burns to the Integumentary System", "Children's Distress and Clinical Holding",The Pre-hospital Management of Traumatic Cardiac Arrest", "The Importance of Non-Technical Skills in the Paramedic Community", "Intubation Without Traditional Laryngoscopy - Is this the future?", etc. that will capture delegate interest. Delegate rate £48. Student Rate £36. Special offer - book now at full delegate rate and receive a FREE 12 month subscription to Ambulance UK (value £24).
CFR Conference - Topics being covered
include 'Managing Children and Their Pain without Drugs' 'Fire Emergency First First Responders Working in Partnership with the Ambulance Service' 'The Future of CFR's'. Only 25 free places remain available *terms and conditions apply.
Pre-Hospital Care Consultancy Ltd NAEMT Trauma First Responders Course is a one day continuing education
Meditech Global are running a Motorsport Medicine Workshop aimed at medics and rescue personnel involved with motorsport events. Speakers will include: FIA Doctors and active motorsport paramedics. Only 14 places remain available at £72pp. Special offer book now to also secure a FREE delegate place on our Resuscitation Conference taking place the following day (value £48).
ALSG The Practical Approach - those interested in learning about or improving their role play and simulation facilitation skills are welcome to apply for a place on this once day course. Only 9 places are available at £140pp. Special offer - book now to also secure a FREE delegate place on our Resuscitation Conference taking place the following day (value £48)
Thursday 22nd October ATACC Conference
ATACC "Decoding the Future" - Day 2. One day delegate rate £150.
Resuscitation Today Conference -
up to the minute presentations on topics such as "Terminating Resuscitation", "Incorporating Non-Technical Skills in Life Support Teaching" etc - the new Resus Guidelines will also be announced and discussed. Delegate rate £48. Special offer - book now and receive a free 12 month subscription to Resuscitation Today (value £24).
Outreach Rescue Study Day -
Paramedics in Hazardous Environments The Pragmatic Approach - only 15 places remain available at a delegate rate of £72pp. Special offer - book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48).
Pre-Hospital Care Consultancy Ltd. The Difficult Airway Course: EMS - Learn the full range of
airway management techniques including use of extraglottic devices, video assisted intubation and surgical cricothyrotomy. Practice decision-making and airway techniques in Code Airway stations. Only 9 places remain available at a delegate rate of £108pp (50% below normal course costs). Special offer - book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48).
Meditech Global are repeating their
Motorsport Medicine CPD Workshop, aimed at medics and rescue personnel involved with motorsport events. Only 14 places are available at a rate of £72 pp. Special offer - book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48).
Thames Group are running a Cardiac Based Study Day on ECG Interpretation. Only 18 places remain available at £90pp. Alan R D Clarke MBE, Paramedic & PreHospital Care Consultant, will be running an interactive workshop on the subject of Long QT Syndrome and other Cardiac Arhythmias. Special offer - book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48). Medipro Training are running a one day Minor Injuries Workshop to include Musculoskeletal Assessment and Management of the Ankle, Knee, Shoulder, Wrist, and Urinalysis Pre-Hospital. Only 14 places remain available at a delegate rate of £60pp. Special offer - book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48). www.lifeconnections.uk.com
All prices quoted are inclusive of VAT. To secure your 2 for 1 delegate place or to register for any of the above conferences/study days, register online at www.lifeconnections.uk.com or call the organisers office on 01322 660434. Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
AMBULANCE UK - AUGUST
course, run by Jamie Todd, that teaches the principles of Prehospital Trauma Life Support (PHTLS) to non-EMS practitioners, including first responders, police officers, firefighters, rescue personnel and safety officers, it helps them prepare to care for trauma patients whilst serving as part of a transport team or awaiting a transport provider. Only 5 places remain available on this course offered at £108pp (50% below normal course costs). Delegates will also receive a free NAEMT TFR manual (worth £25) courtesy of Class Publishing. Special offer - book now to also secure a FREE delegate place on our Resuscitation Conference taking place the following day (value £48).
Medipro Training are running a Paediatric Workshop covering a general approach to Paediatrics to include Spotting a Sick Child, Red Flags Pre-Hospital and Pre-Hospital Pain Management. Only 24 places are available at £60pp. Special offer - book now to also secure a FREE delegate place on our Resuscitation Conference taking place the following day (value £48).
NEWSLINE The backpack-mounted Omni-
managing all 4 cellular networks
able to support our Enhanced
Kent Surrey and Sussex Air Ambulance Trust choose OmniHub™ to deliver critical connectivity for Enhanced Care Teams
Hub™ will provide paramedics
and the transmission content, live
Care Teams properly. Key to
with high quality video, audio and
video transmission was achieved
this is reliable and consistent
medical data links to and from
in areas where communications
connectivity to allow a resilient
KSSA’s control centre at Marden,
were otherwise impossible. These
and sustainable method of
Kent. The backpack Omni-Hub™
test sites were chosen based on
exchanging audio, video and
will operate for up to 8 hours
KSSA’s incident frequencies and
per day using on-board battery
its approved landing sites.
data swiftly and consistently
Omni-Hub™ integrates proven
and a GPS antenna, to provide
Peplink partner to develop
technologies: a world-leading
good cellular connectivity and a
multi-band router and an
long range WiFi hotspot.
innovative backpack version of Award winning universal sensor and communications hub for air ambulance crews Kent, Surrey and Sussex Air Ambulance Trust (KSSA) and Tactical Wireless Ltd (TWL) have reached an agreement
packs. Trials of the new system have started.
TWL’s unique MiMo antenna pod, combines up to 8 cellular, 4 WiFi
advanced video management system (VMS) to provide
The 2 organisations have also
agreed to the joint development
in remote and difficult areas.
of an in-flight Omni-Hub™ for the
The technologies aggregate
bandwidth and manage the transmission so that the available
Commenting on the
bandwidth is used efficiently.
development, KSSA’s CEO, Adrian Bell, said:
from anywhere across our region – the South East Coast. Omni-Hub™ is a very exciting advance and provides the level of technological capability that offers the potential to overcome the connectivity challenge; I am very much looking forward to the results of our forthcoming operational trials.” TWL’s Chairman and MD, Peter Morton, said: “This is an important
for the joint development of
As part of the programme,
a backpack-mounted version
TWL, using Omni-Hub™ and its
“Delivering life-saving advanced
Omni-Hub™ to provide KSSA
of TWL’s award winning
unique high-gain, MiMo antenna
critical interventions in the
with an important disruptive
technology, surveyed key areas
pre-hospital environment is
technological advance, which will
of KSSA’s area of operation. By
challenging and we need to be
enhance patient care.”
development and enables
AMBULANCE UK - AUGUST
208 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE But it is not yet known how many
999 operators get extra two minutes to dispatch an ambulance A controversial scheme that means ambulances will take longer to reach life-threatening cases is to be expanded across the country. It will see 999 operators given an extra two minutes to assess calls
patients suffered serious harm after only being offered advice over the phone when they really needed an ambulance. NHS guidelines state that ambulances should respond to all life-threatening ‘red’ calls within eight minutes. Under the scheme, any calls involving patients who are not breathing or whose hearts have
before dispatching paramedics.
stopped, as well as serious road
Senior doctors have warned such
get an ambulance in this time.
traffic accidents, should still
a move will ‘risk lives’.
But for all other cases including
The initiative has been piloted in
seizures, operators are given an
London and the South West since February and now NHS bosses plan to bring it in nationwide. However, at the time senior doctors and unions accused Health Secretary Jeremy Hunt of ‘moving the goalposts’ to meet targets.
strokes, breathing difficulties or extra two minutes for assessment. Neil Le Chevalier, of South West Ambulance, said: ‘It allows us to prioritise.’ He said the extra time allowed call handlers to gauge whether somebody reporting chest pain is suffering a heart attack or
The number of 999 calls are
indigestion. He added: ‘What
increasing by six per cent each
this trial allows us to do is ensure
year due to the demands from the
appropriate resources are sent,
rising and ageing population.
so we have available ambulances to send to those in most need.’
But figures from the South West Ambulance Service – which
Alan Lofthouse, of Unison, said:
covers 5.3million patients – show
‘I don’t think at this stage anything
that the scheme led to a dramatic
is going to solve ambulance
reduction in the number of times
delays. It needs a whole system
ambulances are sent out.
In the 23 weeks since the initiative
Tony Hughes, of the union GMB,
was launched, the organisation
which represents ambulance
received 398,423 calls, according
staff, warned when the pilot was
to figures obtained by Sky News.
launched that the scheme ‘only serves to bring worse outcomes
Of these, 56,049 were dealt with
many as the same period last
It comes as NHS England
year. Another 74,310 were sent an
announced plans to provide better
ambulance with a reduced priority.
In total, the service dispatched
Chief executive Simon Stevens
98,633 fewer blue light ambulances
said: ‘The NHS will begin joining
compared with last year and
up the often confusing array of
officials claimed paramedics were
A&E, GP out of hours, minor
being freed to deal with the most
injuries clinics, ambulance
critically ill patients.
services and 111.’
AMBULANCE UK - AUGUST
over the phone, nearly twice as
209 For all your equipment needs visit: www.ambulanceservicesuppliers.com
Yorkshire Air Ambulance launches top-flight paramedic training course Seven new Yorkshire Air Ambulance paramedics have become the first to complete the charity’s in-house training programme.
Ambulance (YAA) Clinical
spending a month with us and
Trust (SECAmb) has been
Operations Manager, said: “This
then going back on the road
shortlisted for two national
is the first year we have provided
for a month meant they were
equality and inclusion awards.
a full, in-house technical crew
constantly playing catch-up.
members course encompassing
The Trust has been shortlisted
both medical and aviation
“Now, even if they are not flying,
in the Employers Network for
the aircrew paramedics are
Equality & Inclusion (ENEI)
manning the air desk and it is
awards which took place in
“A lot of work has gone into this
a better experience for them,
London in July.
from both ourselves and Yorkshire
and a more effective way of
Ambulance Service to ensure
developing their skills during
SECAmb’s Inclusion Hub
we have provided training of the
their time with us.”
Advisory Group (IHAG) has been shortlisted in the Team of the
highest calibre.” The YAA is a rapid response
Year category while the Trust’s
The rapid response emergency
Ian Walton, Associate Director of
emergency service serving
Inclusion Manager, Angela
charity has worked closely with
Resilience and Special Services
5million people across Yorkshire.
Rayner, is shortlisted for the
Yorkshire Ambulance Service NHS
at Yorkshire Ambulance Service
It has transported over 6,000
Equality and Inclusion Champion
Trust to develop the intensive,
NHS Trust, said: “As partners we
critically ill or injured people to
of the Year award.
three-week technical crew
take every opportunity to work
hospital in its 14-year history.
together with colleagues at YAA.
The Trust’s IHAG, along with
Enhanced training packages and
Pete added: “The workload of
The intake, all experienced
secondment opportunities for our
land crews is much greater but
as the Trust’s ‘community of
paramedics with Yorkshire
paramedics will further enhance
the aircrew paramedics are
interest’. Members of the IHAG
Ambulance Service, was chosen
this vital service for the benefit of
primarily dealing with the really
were appointed through an
for the two-year secondment
critical end of the patient care
open and transparent process
cycle; the most life threatening
developed with stakeholders.
Previously new paramedics joined
injuries that need immediate
The group, which met for the
the YAA on a part-time basis over
attention and rapid transport to
first time in September 2012,
New recruit Paul Holmes said:
three years. But this latest cohort
is outcome focussed and its
“The first day’s training was
is also the first that has been
underwater escape from a
seconded full-time for two years.
following a rigorous selection process.
helicopter and it’s been an intense learning curve, but just fantastic.”
Pete Vallance explained: “Because of the advancements
The programme also includes
and requirements of aircrew
mountain and swift water rescue,
paramedics, we decided it would
navigation, air safety, advanced
be much better to have people
clinical skills and crew resource
with us for two years on a full-time
management. Pete Vallance, Yorkshire Air
SECAmb’s Governors, acts
activities are now extremely “As well as developing their
valued and respected across
clinical skills, the paramedics
learn a lot about working together as a team in often
Angela, who has led on Equality
highly pressurised working
and Inclusion at SECAmb for
four years, said: “I’m delighted that our already award-winning
The YAA is an independent
IHAG has been shortlisted in the
charity and needs to raise
ENEI awards. The group plays
£12,000 each day to keep its two helicopters in the air - equivalent
an extremely important role
“We found that paramedics
to £4.4 million a year. Without any direct government funding, the only help the charity receives is through the secondment of their 14 paramedics from Yorkshire
AMBULANCE UK - AUGUST
Ambulance Service NHS Trust.
at SECAmb and is successful because of the passion and enthusiasm of our members which enable us to make a real difference to patient care. She added: “It’s also an honour to be personally shortlisted and I’d like to thank my colleague Asmina for the nomination.
While I’m of course pleased to
SECAmb shortlisted for two equality and inclusion awards
be shortlisted, it really is a team effort and I will be representing SECAmb as a whole and the huge number of people who ensure that equality and
The seven new Yorkshire Air Ambulance paramedics
South East Coast Ambulance
inclusion are at the heart of
Service NHS Foundation
everything we do.”
210 For more news visit: www.ambulanceukonline.com
Paramedic Practice Conference
Wednesday 21st October 2015
xxx xxx xxx
Kettering Conference Centre, Kettering, Northants NN15 6PB Time
08.30 – 09.30
09.30 – 09.45
Patrick Bourke SBLS-Ed
Director, Severe Burns Life Support Foundation
xxx 09.45 – 10.30
Burns to the Integumentary System – A Critical Overview?
10.30 – 11.15
11.15 – 11.45
Intubation without Traditional Laryngoscopy – Is this the future?
Jamie Todd BSc (Hons) MCPara
Principal Consultant, Pre-Hospital Care Consultancy Ltd
11.45 – 12.15
Pre-Hospital – Where is the Evidence? Looking at truly evidence based material and whether true trials are possible.
Dr Nicholas Crombie
Clinicial Lead, Midlands Air Ambulance
12.15 – 13.30
Lunch and Exhibition
13.30 – 14.00
Surgical Airways – Can Evidence from the Battlefield Influence Paramedic Practice?
Flight Sergeant Andy Thomas MC Para
Academic Research Fellow
14.00 – 14.30
The Importance of Non-Technical Skills in the Paramedic Community
Mike Davis FAcadMEd
14.30 – 15.15
15.15 – 15.45
The Pre-Hospital Management of Traumatic Cardiac Arrest
Dr Simon Le Clerc
Military Consultant in Emergency Medicine
15.45 – 16.15
Children’s Distress and Clinical Holding
Christopher Preston MSc MCPara
Advanced Paramedic Practitioner
16.15 – Close
Gold Standard to Brown Standard – Developing Pragmatic Paramedics
Tim Roberts BSc Hons MCPara
Director & Senior Clinical Educator of ORMS
Topics & Speakers correct at the time of press but may be subject to change
Delegate Rates: £48 inc VAT (Student rate: £36 inc VAT) Special Offer – book now at full delegate rate to secure a free 12 month subscription to Ambulance UK (value £24).
To register call 01322 660434 or visit
AMBULANCE UK - AUGUST
Cost includes: delegate bag, refreshments and the opportunity to visit over 50 trade stands.
211 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
Andover mum reunited with SCAS staff who treated her in serious motorway accident Andover resident Danielle Bartley has been reunited with staff from South Central Ambulance Service NHS Foundation Trust (SCAS) who helped save her life following a serious motorway accident. Mother-of-one Danielle, 34, had been driving to a meeting when her car aquaplaned on the M3 on the morning of 14 November 2014. Her car overturned six times resulting in Danielle sustaining serious injuries to her spine and right arm.
Isle of Wight Air Ambulance
First paramedic on scene,
SCAS HART paramedic, Glyn Ethelston, explained:
Danielle was flown to University
“When we got there Danielle
Hospital Southampton for
was trapped in the car with
initial treatment before being
quite an obvious injury to her
taken on to Salisbury District
right arm and we knew that
Hospital where she remained
we needed to release her
in a coma for a total of 16 days.
from the car as safely and as
Unfortunately due to severe
quickly as we could.”
septicaemia (blood poisoning), Danielle’s right arm could not
Vicki Bodenham was one
be saved. To date, Danielle has
of the SCAS helicopter
had around 40 hours of surgery
paramedics on board the
to treat her injuries to her neck,
Hampshire and Isle of
back and arm.
Wight Air Ambulance who flew Danielle to University
On 10 June, Danielle visited
SCAS’s EOC in Otterbourne
She admitted: “Danielle’s a
to be reunited with the staff
hero in her own right as a
who all played a key part in
foster carer but to see her
helping to save her life.
up and about and survive
Danielle explained: “It was so good to meet everyone and get to piece together all the bits that were missing for
SCAS received the 999 call at its Emergency Operations Centre (EOC) in Otterbourne, Hampshire. EOC staff quickly despatched a range of frontline crews to the scene near to junction 6 including an ambulance crew, an ambulance officer, Hazardous Area Response Team (HART) and the Hampshire and
me. I really can’t thank you all enough, there are no words to explain how grateful we all are.” Emergency Call Taker Lisa Morris, said: “When the call
such serious injuries as well and the fact that she’s embracing it is really nice to see.”
County’s ambulance service given 3,366 speeding tickets
first came in I was told that the accident was on the M3
MORE than 3,000 speeding
and that the car had flipped
tickets were issued to the
over several times so I had an
county’s ambulance service
idea it was quite serious.”
in just one year.
AMBULANCE UK - AUGUST
30 Brooklyn Drive Rayleigh, Essex SS6 9LW Tel/Fax : 01268 833666
212 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE Only two other ambulance
trust, another 58 were issued to
get a radio call sign and then
approved and robust system to
services in England – Yorkshire
paramedics working for SCAS
check this call sign against the
handle all notices of intended
Ambulance Service and East
between 2013 and 2015.
999 incident logging information.
prosecutions which means
were given more tickets than
The highest speed recorded by
If it turns out the incident log
notifications for activations
the 3,306 given to South
a SCAS emergency vehicle was
matches the time that the vehicle
where blue lights are visible.”
96mph in a 60mph zone.
got the ticket then the service
Midlands Ambulance Service–
Central Ambulance Service, which covers Oxfordshire, Berkshire, Buckinghamshire and Hampshire. The penalty charge notices added up to £330,600 in 2013
that we should not receive
must write an official letter to
Section 87 of the Road Traffic
In order for an ambulance service
police. SCAS spokeswoman
Regulation Act 1984 states that
to appeal against a speeding
Michelle Archer said: “SCAS has
police will assume a vehicle
ticket it must check the vehicle’s
worked closely with the police
with blue lights is allowed to
registration against records to
forces in our area to develop an
for the service, but it is believed many of them were successfully appealed against because speed
limits do not apply to emergency
Motorsport Medicine Workshop
vehicles responding to calls. Former volunteer SCAS ambulance driver Goff Smith, 66, said the tickets should not be issued. The Faringdon resident worked as a community first responder for the service for 15 years until 2013 before being sacked for
Wednesday 21st October & Thursday 22nd October 2015 Motorsport pre-hospital support can be just as challenging as it can be exciting. Our CPD day is open to all those providing medical or rescue cover during motorsport events and will include relevant information sharing with industry experienced doctors and paramedics, discussing current best practise along with hands-on medical/rescue workshop sessions. Only 14 places remain available on both days at £72 per person !
speeding on his way to a call-out, as the exemption does not cover
He was reinstated after an Oxford
Concussion in Motorsport & Return to Competition
FIA Affiliated doctor to present paper on appropriate recognition and return to competition following motorsport related head injury.
Casualty Extrication. A New Way Forward?
Workshop delivered by motorsport paramedic demonstrating the new Medirol Vacuum Vest and its potential benefits in casualty extrication. Also discussion on use of cervical collars.
A Life of Medical Support During Competitive Motorbike Racing
Light-hearted but frank discussion from paramedic with a lifetime of medical experience supporting world famous motorbike racing events.
Motorsport Medical Support – The Past/ Present/Future.
Discussion on lessons learnt from previous motorsport accidents / review of current guidelines / best practices / what the future holds.
Mail campaign but left SCAS again in December 2014 to retire. He said: “I think we need to look at the way these tickets are sent out to stop this happening. “I think if an ambulance goes through a speed trap but it clearly has its blue lights on a ticket should not automatically be issued. “It is an added pressure for paramedics and this has been going on for years but nobody has ever done anything to stop it happening. “The time spent appealing against these tickets would be much better spent saving lives.” As well as the 3,306 speeding
Special Offer – book now to also secure a FREE delegate place on our Paramedic Conference on 21st October or our Resuscitation Conference on 22nd October (value £48). To Register call 01322 660434 or visit www.lifeconnections.uk.com
AMBULANCE UK - AUGUST
volunteers in their own vehicles.
tickets issued to the ambulance
213 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE Larrey Society members’ cautious support for 999 texting Members of The Larrey Society, the cross sector ambulance “think tank” announced support for the proposal to adapt the 999 emergency number for smartphone technology but warned that safeguards are needed to be built in before any changes are made. In a poll, the members from the NHS ambulance trusts, independent companies and voluntary organisations, overwhelmingly endorsed the proposal from The Institute of Engineering and Technology to
make triaging difficult and also encourage an increase in hoax calls which are already putting substantial additional pressure on ambulance resources. A Larrey Society statement said: “The members’ poll recognised that the use of technology to improve all patient transport services was inevitable and extending the use of smartphones to include 999 texting would be an important step forward, provided there was also the possibility of two-way talking which would always be the best option. “Members also pointed out that beyond 999 texting, video technology which enabled doctors and paramedics to see in real time what was happening at the scene, offered even greater benefits for patients”
upgrade the present system which required callers to preregister, but expressed serious concerns that using texting to call 999 would
The Society is planning to assign a small task force of members to contribute to the government
debate on how emergency calls should be handled in the digital age. The membership task force will comprise qualified paramedics with operational/ front line ambulance experience, paramedical educators and experts from the International Academies of Emergency Dispatch, the recognised standard-setting organization for all aspects of emergency medical dispatch, fire and police dispatching. Recently the Academy certified membership surpassed the 54,000 mark.
New air ambulance scheme offers witness support after Corby man’s horrific accident leaves friends traumatised
The air ambulance service is launching a new tool to provide support for accident witnesses after a serious accident involving a Corby construction worker last year left his friends traumatised. Paramedics and doctors at Warwickshire & Northamptonshire Air Ambulance (WNAA) will now carry a business-card sized leaflet outlining emotional and mental health symptoms a bystander might experience following an accident or emergency. The scheme was inspired by Jamie Burnett, who was airlifted to hospital after being crushed by a dumper truck in a horrific accident that left him fighting for his life. The 26-year-old lost three quarters of his blood during the accident on the A14 last August, as well as suffering skin loss, a fractured pelvis and multiple broken bones. After four months spent in
at the See us NCY GE EMER S SHOW E C I SERV nd M22 Sta
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NEWSLINE different hopsitals, which involved
or provide them with details of
funding, it is run entirely on
some time in an induced coma,
support at a scene.
the generous donations of
extensive surgery and learning
to walk again, Jamie began
“This new tool in our arsenal
fundraising for the ambulance and
means we can make sure
To donate to Jamie’s Lifesaving
is now the face of their summer
witnesses have some support
Materials Appeal, visit www.
campaign to fund lifesaving
without a pause in tending to
gauze or call 08454 130999 for
materials. But although the work of expert doctors eventually put Jamie back on his feet, at the time of the accident itself it was his
more information. Each of WNAA’s missions costs an average of £1,700, and as the
Calls will cost 3ppm plus your
charity receives no government
colleagues Adam Davies and Jim Murphy who saved his
Outreach Rescue Study Day
life by reversing the truck off him, tourniqueting his wounds
Thursday 22nd October 2015
with their shirts and calling the emergency services. Without any experience in dealing with such traumatic events, the pair struggled to process and get over witnessing their friend’s injuries, which doctors described left Jamie looking as though he had been “blown up”. Mr Davies said: “Seeing and helping at an accident like Jamie’s
“Paramedics in Hazardous Environments – ! The Pragmatic Approach”! Only 15 places remain available at £72 per person PROGRAMME Time
08.30 – 09.30
09.30 – 10.30
Gold Standard versus Brown Standard Understanding the decision making process when providing care for patients in hazardous environments.
can really stick with you. “Witnessing anyone go through an emergency is hard, and sometimes it can be hard to know
10.30 – 11.15
Tea / Coffee / Exhibition
11.15 – 12.15
Principles in Packaging Why do we package patients and what are the key areas of consideration for this process
what to expect or who you can talk to.” The cards, similar to others provided by ambulance services
12.15 – 13.45
Lunch / Exhibition
13.45 – 15.00
Factors affecting Care Delivery From environments that are hazardous to the rescuer to circumstances affecting the patient. What can we do to mitigate or manage risk while providing care.
around the country, give advice on the possible effects of traumatic incidents, such as mood swings, loss of appetite, trouble sleeping, feeling anxious and tiredness.
15.00 – 15.30
Tea / Coffee / Exhibition
15.30 – 16.30
Special Circumstances Created by the Environment We take a deeper look at circumstances such as rescue from water “long carry outs” and confined spaces.
They also carry a list of organisations and phone to someone who might be struggling, including MIND, the Samaritans, and NHS 111. Philippa Gibbs, base manager and critical care paramedic for WNAA, said: “As pre-hospital care is urgent and fast-paced, it can
16.30 – 17.30
Special Circumstances – The Human Element We take a deeper look at circumstances such as single rescuer techniques and bariatric rescue.
Special Offer – book now to also secure a FREE delegate place on our Paramedic Practice Conference taking place the previous day (value £48).
To Register call 01322 660434 or visit www.lifeconnections.uk.com
AMBULANCE UK - AUGUST
numbers that can provide support
be hard to reassure witnesses
215 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE New central base sought for Sheppey ambulance service A more central location is being sought for ambulances on the Island. But a decision over the future of the Queenborough station has not been made. According to minutes from a Sheppey Local Engagement Forum, representatives from South East Coast Ambulance Service (SECAmb) said its vehicles were not getting to some places within eight minutes so they were being kept elsewhere while waiting to be called. They said this was not the most suitable scenario but it is the most effective solution until a more central point can be determined.
Sheppey has one ambulance and
MP Gordon Henderson met
“Sheppey Ambulance Station is
one response car.
operations manager Chris
not on its own in the best place
Stamp on June 19 to discuss the
to meet our current demand
future of services on the Island.
and we are looking into the
MP Gordon Henderson will hold
possibility of where else we can
a meeting to discuss the Island’s ambulance services.
A SECAmb NHS Foundation Trust spokesman said: “No
One sits in Minster so it can get
decisions have been taken
to life-threatening issues quickly
over any new configuration of
anywhere on the Island.
ambulance provision in the area.
If one vehicle is called out, it will
“As previously explained, we are
be replaced by one from another
in the process of introducing our
Make Ready system across our Kent, Surrey and Sussex region.
Sheppey also has community first responders who are trained
“Under this system, ambulance
first aiders, to provide broader
crews report to a central Make
Ready Centre and then respond from a network of strategically-
The representatives said the
placed ambulance community
pressure on hospital beds has
response posts during their
been helped by other paramedics
treating patients to prevent them
respond from to better serve the Island. “No decision has been taken on the future of the ambulance station and we are committed to providing the local community with the service they expect and deserve.”
County Air Ambulance HELP Appeal funds £1m lifesaving helipad planned for Stoke Mandeville Hospital Buckinghamshire Healthcare
from needing to go to hospital
“This ensures our crews are
NHS Trust has submitted
and the local referral unit at
better placed to respond to
a planning application to
Sheppey Community Hospital.
Aylesbury and Vale District
on et re el.n mo erj ad at Re w.w ww More information
AMBULANCE UK - AUGUST
Professional burn care – around the world
216 For more news visit: www.ambulanceukonline.com
NEWSLINE council for a helipad at Stoke
“A new, well-lit helipad that can
Mandeville Hospital treats
“Thames Valley Air Ambulance
Mandeville Hospital – home
cope with seriously injured
around 150 major spinal injury
has air lifted patients from
of the National Spinal Injuries
patients and those with other
patients from across the country.
across the region to Stoke
Centre - following a donation
life threatening conditions flying in from across the UK will be
Getting patients to us faster
Mandeville’s existing helipad
of £1million from the County Air Ambulance HELP Appeal.
of great benefit to patients
The grant will fund its entire
accessing our care. We are very
design and construction.
grateful to the HELP Appeal for
and without another ambulance involved will improve the care we can give to our most injured
over the past 15 years. Time from incident to hospital is a crucial factor in ensuring the best possible outcomes for
its generous donation.
approval, the new helipad is
“The National Spinal Injuries
Mark McGeown, Thames Valley
a shorter journey to the point of
planned to be opened in January
Centre, based at Stoke
Ambulance (TVAA) added:
definitive, life-saving care.”
Pending council and Trust Board
patients suffering major trauma and the new helipad will mean
2016 and be elevated over the main visitor car park - located beside the hospital’s emergency department. New LED lighting will also illuminate the entire
The Difficult Airway Course : EMS Thursday 22nd October 2015
helipad allowing for patients to land at night. The County Air Ambulance HELP Appeal is a charity which aims to deliver helicopter landing pads
Learn the full range of airway management techniques including use of extraglottic devices, video assisted intubation and surgical cricothyrotomy. Only 9 places are available at a delegate rate of £108 (50% below normal course costs). !
at all Major Trauma Centres and key A&E hospitals across
08.30 – 09.30
09.30 – 10.00
Introduction & Airway Algorithms
10.00 – 10.45
Prediction of the Difficult Airway
from a major trauma, including
10.45 – 11.30
Tea, Coffee, Exhibition
those with spinal injuries lands,
11.30 – 12.15
BVM & Laryngoscopy
12.15 – 12.30
12.30 – 14.00
Lunch / Exhibition
14.00 – 15.00
Skills Station I & II – BVM/ETI and EGD’s & Rescue Airways
four hours of the accident, their
15.00 – 15.30
Tea, Coffee, Exhibition
chances of walking out of the
15.30 – 16.30
Skills Station III & IV – Needle/Surgical Airway & Video Laryngoscopy
16.30 – 17.00
England and Scotland. Its Chief Executive Robert Bertram said: “Air ambulances currently have no other option but to land in a field close to Stoke Mandeville hospital. After a patient suffering
they need an additional transfer in an ambulance, which could seriously affect their chances of recovery. “If a patient with a broken back gets hospital treatment within
hospital increase dramatically. Building a helipad significantly closer to the hospital’s world help in this process, as the patient can then be admitted straight from the helicopter, rather than still being an ambulance ride away.” Stuart Blagg, Consultant Spinal
Special Offer – book now to also secure a FREE delegate place on our Paramedic Practice Conference taking place the previous day (value £48). To Register call 01322 660434 or visit www.lifeconnections.uk.com
AMBULANCE UK - AUGUST
class consultants could really
Surgeon at the National Spinal Injuries Centre added:
217 For all your equipment needs visit: www.ambulanceservicesuppliers.com
AACE welcomes new clinical model for Welsh ambulance service The Association of Ambulance Chief Executives (AACE) has welcomed the launch of the Welsh Ambulance Service’s New Clinical Model – a pilot programme that will enable the service to re-focus its efforts on improving patient outcomes rather than simply achieving time-based targets that may not necessarily be in the patient’s best interests.
AACE Managing Director Martin
“Across the UK, ambulance
Flaherty OBE says: “We welcome
services have changed
this new pilot which we consider
immeasurably in the past four
to be a sensible approach and
decades. Not only do they face
we will be monitoring the impacts with great interest. If successful, it could help inform the development and progress of other ambulance services elsewhere, while improving patient care and redistributing pressure more evenly across the broader health service.
the highest-ever level of demand for their services, they also provide a broader range of care,
New clinical model for the Welsh Ambulance Services NHS Trust
to more types of patients, in more
Following on from the
settings than ever before.
recommendations of the McClelland Review of Ambulance
“Today’s ambulance service is the backbone of the health service.
Services in Wales, the Welsh Ambulance Services NHS Trust (WAST) has announced that it
“For over forty years, the success
Initiatives that help individual
of ambulance services has been
ambulance services play an
measured purely on the time it
even greater role in enabling
takes to get to patients. However,
people to receive the best, most
while time can be a key factor
patient care and end the current
appropriate care from other parts
for patients with immediately
practice of sending multiple
of the health service too – such
ambulances to a 999 call just to
as the New Clinical Model pilot
chase the current 8 minute target.
will pilot a new clinical response model for 12 months from the 1st October 2015, which will prioritise
The one year pilot will help
lifethreatening conditions, it is
the Welsh Ambulance Service
not the only or best measure of
determine whether this new way
success for the majority of our
of working is better for the people
patients, and AACE has long
of Wales, and improves the
supported much greater emphasis
overall quality of care they receive
on the quality of care and overall
through the service being able to
outcome for patients as a more
and we continue to work closely
make more appropriate and timely
accurate barometer of an effective
with NHS England to explore
measures of clinical outcome,
use of the range of responses
service, particularly where less
new, more patient-focussed
and focus on the right care, at the
they can provide for patients.
urgent calls are concerned.
right time by the right clinician.
in Wales – should be welcomed. These changes are very similar to changes that we have proposed for ambulance trusts in England
AMBULANCE UK - AUGUST
218 For further recruitment vacancies visit: www.ambulanceukonline.com
The Service will move to a clinically led, evidenced-based system of performance measures that will shift the emphasis away from time-based measures to true
NEWSLINE As part of the new system, those people with an immediate life threatening condition – such as a cardiac arrest – will continue to receive an immediate response. All other patients will receive a ‘bespoke clinical response’ based on their health needs, rather than a generic response based solely on a 41 year old time target.
This new clinical model will give clinical contact centre call handlers extra time (120 seconds) to prioritise those calls which are not instantly identified as immediately life-threatening before an ambulance is dispatched – ‘dispatch on disposition’ as piloted by the London and South West Ambulance services.
This will allow WAST to focus on resources to deliver the highest quality of care, prioritising those patients most at need of emergency treatment. The new model will introduce three new categories of calls - red, amber and green – to replace the current system:
Call handlers will ask important questions about a patient’s
• Red calls are immediately life threatening calls – someone is in imminent danger of death with compelling clinical evidence to show an immediate emergency response will make a difference to a person’s outcome. The 8 minute standard will be retained for this group of call with an initial target of 65% receiving an 8 minute response. • Amber calls refer to those patients with conditions which may need treatment and care at the scene and fast transport to a healthcare facility, if needed. Patients will be prioritised on the basis of clinical need and patients will receive a fast blue light response. There will be no time-based target for amber calls, instead a range of clinical outcome indicators will be introduced to measure the quality, safety, and timeliness of care being delivered alongside patient experience information, which will be published every quarter.
The new system will help to remove what clinicians describe as ‘unnecessarily-high and unevenly-distributed clinical risk which leads to the way the ambulance service currently dispatches ambulances to chase the response time target. More information on the new clinical model can be viewed at:http://gov.wales/topics/health/ nhswales/service/?lang=en
NAEMT TRAUMA FIRST RESPONDER COURSE Wednesday 21st October 2015 Only 5 places remain available on this course offered at £108 (50% below normal course costs). Delegates will also receive a free NAEMT TFR manual (worth £25) courtesy of Class Publishing
08.30 – 09.30
09.30 – 10.00
Principles of Assessment & Management
10.00 – 10.45
Airway / Oxygenation & Ventilation
10.45 – 11.30
Tea, Coffee, Exhibition
11.30 – 12.00
Circulation & Shock
12.00 – 12.30
Traumatic Brain Injury & Spinal Trauma
12.30 – 14.00
Lunch / Exhibition
14.00 – 15.00
Interactive Skills Scenarios I
15.00 – 15.30
Tea, Coffee, Exhibition
15.30 – 17.00
Interactive Scenarios II / Golden Principles & Assessments
Special Offer – book now to also secure a FREE delegate place on our Resuscitation Conference taking place the following day (value £48). To Register call 01322 660434 or visit www.lifeconnections.uk.com
AMBULANCE UK - AUGUST
• Green calls are non-serious, which can be often be managed by other health services, including healthcare advice or through self-care. This category also includes calls from healthcare professionals which will be handled in a different, planned way in the future.
symptoms, identify the nature of their condition and the type of response needed – this may be an advanced paramedic who can provide treatment at the scene and prevent the need for further hospital treatment, or an ambulance crewed by paramedics to treat and stabalise a patient before taking them to hospital. Many people will be safely advised over the phone, helping to reserve ambulance resources for patients who need them.
219 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE NHS England announced eight
NHS England announces new plan to meet emergency care targets GP services in hospitals, mobile
“vanguard” areas to transform services. Among the measures are the acceleration of the development of GP services in hospitals, mobile treatment centres using ambulance staff, and
“This proves a modern NHS needs a very different approach”
A group of teenagers have
same-day crisis response teams including GPs and other acute
The new vanguards are in
treatment centres and mental
home-visiting professionals. More
south Devon and Torbay, south
health street triage among
mental health street triage services
measures rolled out to try to
will also be rolled out, along with
and Peterborough, north-east
meet A&E treatment targets
initiatives involving a broader role
England, Leicestershire and
for community pharmacists.
Rutland, Solihull, west Midlands, the east London area covering
NHS England has announced eight vanguard areas to speed up times
The moves, designed to break
Barking and Dagenham, Havering
for dealing with A&E patients.
down barriers between primary
and Redbridge and west Yorkshire.
care and hospitals, are among A drive to make more one-stop
£200m worth of experiments.
Keith Willett, NHS England director
shops for urgent and emergency
The NHS hopes these will be as
of acute care, said: “This proves
care will be announced on Friday
successful as the setting up of
a modern NHS needs a very
as the NHS in England seeks
regional major trauma units three
different approach and shows,
to remedy its failure to meet its
years ago, which are said to have
even in times of austerity, we can
target for dealing with 95% of
brought about a 50% increase in
transform patient care. We cannot
A&E patients within four hours
the odds of survival for patients
delay in now securing that same
and saved hundreds of lives.
advantage for the thousands of other patients – such as those suffering a heart attack, stroke,
THAMES GROUP Cardiac-based Study Day on ECG Interpretation Thursday 22nd October 2015
or aneurysm, as well as helping critically-ill children. “Equally important is that these networks support and improve all our local urgent and emergency care services, such as A&E departments, urgent care centres, GPs, NHS 111 and community,
AMBULANCE UK - AUGUST
Alan R D Clarke MBE, Paramedic & PreHospital Care Consultant will be running an interactive workshop on the subject of Long QT Syndrome and other Cardiac Arhythmias.! ! Only 18 places remain available at a cost of £90 per person including VAT.!
social care and ambulance services,
Special Offer – book now to also secure a FREE delegate place on our Paramedic Conference taking place the previous day (value £48).
Life Connections 2015 Kettering Conference Centre, Kettering, Northants NN15 6PB. To Register call 01322 660434 or visit www.lifeconnections.uk.com
Students go ‘behind the nines’ for work experience week
so no one is working isolated from expert advice 24 hours a day. Our
been learning about life behind the nines with West Midlands Ambulance Service. Health service savvy students from schools in Birmingham, the Black Country, Coventry, Warwickshire, Worcestershire and Shropshire spent a week at Erdington Hub in Birmingham as part of the Trust’s work experience programme. The 12-strong group of teenagers aged between 14 and 18 met a range of operational staff, including paramedics from the Trust’s Hazardous Area Response Team (HART), to find out more about their roles and responsibilities. The students discovered how 999 calls are handled, the work of community first responders (CFRs), the management of trauma patients and how the Midlands Air Ambulance help patients. Diane Pittom, the Trust’s Organisational Development Officer, said: “We’ve been really pleased to, once again, host students for a work experience placement. Engaging with
vanguard sites will spearhead these
young people is an important
new ways of working together.”
investment for us and helps to further enhance the quality of our
He added: “The solution does
future workforce. This opportunity
not lie in simply providing more
has allowed the students to
and more money to emergency
see beyond the blue lights and
departments. It’s clear that we
explore the service ‘behind the
need to deliver a step change in
scenes’ to discover to broad
the way that health services in this
range of roles that make up the
country are used and delivered.
“All over the country there are
“Their enthusiasm to learn,
pockets of best-practice models
confidence to ask questions and
yielding enormous benefits; but to
unique personalities made the
ensure our urgent care services
week incredibly successful and
are sustainable for the future
I hope it’s given them food for
every region must begin delivering
thought to apply for future jobs
faster, better and safer care.”
220 For more news visit: www.ambulanceukonline.com
IN PERSON SECAMB News
SECAmb appoints new Medical Director
welcoming Rory, said: “I’m delighted that
on the last day, but this time we used A-roads
we have appointed Rory. He brings a huge
as opposed to B-roads last time, so there was
amount of experience to SECAmb and will
a lot more traffic to overcome.
contribute greatly to the development of the Trust as we continue to innovate in the care
“Gary’s back wheel also buckled very early
South East Coast Ambulance Service NHS
provided to our patients. I’d like to thank David
on so we had to get that replaced before he
Foundation Trust (SECAmb) has appointed
for all his effort in the recent months and wish
unfortunately fell ill with the end in sight, which
a new Medical Director.
him the very best for the future.”
sadly meant he wasn’t able to ride the last stretch with us.”
Dr Rory McCrea replaces Interim Medical Director Dr David Fluck. His role will be part
The trio cycled about 110-miles per day, often
time with him working at the Trust two days
leaving at 5.30am in the morning and not
reaching their next hotel until 9pm at night.
Having trained as a GP in the early 1990s, Dr
“It was tough, there was no doubt about it, but we had some great support from the Blood
McCrea has developed a wealth of experience
Bikers who travelled with us, and the welcome
having held leadership positions in both the
we received when reaching Stafford was
public and private sectors.
great,” Steve added.
He served as Medical Director of NHS West
“The highlight for me, aside from the valuable
Essex (Epping Forest Primary Care Trust)
money raised, would be the support we had
for more than a decade and then, in 2011,
throughout and seeing my two colleagues
went on to become Director of Clinical
work incredibly hard and become extremely
Transformation at West Essex Clinical
good cyclists when it isn’t something they have
had a massive amount of experience in.
In 2001 he established ChilversMcCrea Healthcare, the UK’s first corporate NHS
Dr Rory McCrea
General Practice provider with walk-in and
and under-served areas. Having developed the UK’s first Acute Medical
those who have donated.” News
Pedal power provides funding boost for CFRs
Care in the Home Scheme in West Essex, in 2014 he became a part-time Executive Director
A Staffordshire Community First Responder
of Amie Healthcare, an innovative start-up
has completed a gruelling fund-raising
acute and community healthcare provider,
mission by cycling more than 850 miles as
focusing on providing acute medical care
he travelled from John O’Groats to Land’s
in the home as well as step down facilities
for those who require more support, as an Steve Cartlidge, of Gnosall and District
alternative to hospital.
Community First Responders, set off with friends Nigel Maddox and Gary Fear and
on a part-time basis with his team in Waltham
completed the journey eight days later having
ridden 876 miles.
Dr McCrea was attracted to joining SECAmb
A keen fund-raiser for Gnosall CFRs, Steve
because of its innovative approach to pre-
raised about £2,500 throughout his trip,
hospital care. He said: “I am delighted to
taking his personal total across the years to
have the opportunity to be Medical Director
of SECAmb. I have a passion for patient safety and excellent clinical outcomes and the
Despite having done the journey on his own
opportunity to play my part in supporting the
before, in the opposite direction, Steve said it
highly innovative developments at SECAmb is
was not all plain sailing this time around.
very exciting.” “We were lucky that we had fairly good
“The highlight for me, aside from the valuable money raised, would be the support we had throughout and seeing my two colleagues work incredibly hard and become extremely good cyclists when it isn’t something they have had a massive amount of experience in.”
AMBULANCE UK - AUGUST
Dr Rory McCrea still practises as an NHS GP
SECAmb Chief Executive Paul Sutton,
to the CFR group and help contribute towards new equipment. I’m extremely grateful to all of
GP services stretching from Southampton to Leeds, taking on services in highly challenging
“Hopefully the money raised will be a big help
weather, apart from a drenching we received
221 Do you have anything you would like to add or include? Please contact us and let us know.
IN PERSON News
Stalwart Ambulance Service leader recognised in Birthday Honours List A Welsh Ambulance Service boss has been recognised in the Queen’s Birthday Honours list.
It was Gordon’s Executive Team colleagues who
seconded to Regional Director for the South
nominated him for the award, and gathered the
East Wales region in 2009, where he remained
evidence required of a judging panel.
Gordon added: “It’s a fantastic honour and a
For a period he was Regional Director for
privilege to have been nominated by the Trust.
the North Wales region until a management re-structure in 2012 meant the role became
“To actually receive the award is recognition
the Head of Service, and eventually Head of
not just for me, but for all the people I’ve
Operations for Betsi Cadwaladr University
worked alongside throughout my career in the
Health Board area.
Gordon Roberts, the Trust’s Interim Assistant Director of Operations, has been awarded the Queen’s Ambulance Service Medal (QAM) for his devotion to the service. Gordon, who has dedicated more than 37 years to the service, says it was a bolt out of the blue.
He is currently the Trust’s Interim Assistant “The amount of goodwill messages from
Director of Operations, and is based
colleagues has been enormous, and is very
temporarily in Cwmbran, Newport.
humbling.” Gordon has been instrumental in a number of Gordon joined the Gwynedd Ambulance
large-scale projects, including the original Trust-
Service in 1978 as an Ambulance Technician
wide roster review in 2007 and the introduction
in Bala after he undertook training at Wrenbury
of a performance management framework.
Hall in Cheshire. He said: “Usually people get a letter a
Tracy Myhill, Chief Executive of the Welsh
couple of weeks beforehand telling them
Two years later he transferred to Conwy and
Ambulance Service, said: “We’re over the
they’ve had the award, but I had nothing.
embarked on his paramedic training, qualifying
moon that Gordon has been recognised for his
dedication to our ambulance service in Wales.
congratulating me and I just thought it
In 2001, he was appointed Locality Manager
“Gordon is such worthy recipient for this award,
was a wind up, then more and more text
for Conwy, and four years later as Locality
and I’m delighted that his commitment has
messages came through.
Manager for Conwy and Denbighshire.
been recognised in such a distinguished way.
“I went onto the Internet and read my name
In 2007, he was promoted to Production
“We look forward to hearing all about his
on the official list, and couldn’t believe it.”
Manager for North Wales before he was
“I had a text message from a friend
AMBULANCE UK - AUGUST
222 For further recruitment vacancies visit: www.ambulanceukonline.com
IN PERSON The Queen’s Ambulance Service Medal was
SP Services has been producing and
Fionna has been the interim Chief Executive
introduced in 2012, when now retired Director
supplying medical consumables and
for the last six months, and previously
of Ambulance Services, Dafydd Jones-Morris,
equipment since 1989. Its customers include
medical director for 17 years. Chairman
was commended in the Queen’s Birthday
many of the UK’s ambulance services,
Richard Hunt said: “The final panel was in
NHS Trusts, Police Forces, Fire Brigades,
complete agreement about the decision
Premiership football clubs and large scale
to offer Fionna the role. She is a highly
In 2013, Mike Collins, then Head of Service for
events such as the London 2012 Games and
experienced leader and is always passionate
Abertawe Bro Morgannwg, also collected the
Baku International Games, SP work closely
about patient care.
medal for dedicating his 32-year career to the
with a number of large charities, NGO’s and
ambulance service in Wales.
government organisations. A number of
“Having worked for the Service for 17
products SP supply even have their own Nato
years, Fionna knows the organisation well,
Stock Number (NSN).
recognises the challenges we face and is
There was double delight last year when not one but two members of the workforce
already taking steps to improve patient care
were recognised in the New Year’s Honours
Paul said of his new role ‘I will be focusing on
list; Andrew Jenkins, Consultant Paramedic
the development of our new and expanding
and Deputy Director of Medical and Clinical
product ranges, for example the Parabag
Fionna has nearly 30 years’ experience as a
Services, and Advanced Paramedic
range has had a total redesign utilising the
consultant in emergency medicine and was
Practitioner Richard Hook.
latest B3P fabrics to ensure they are infection
recognised in the Queen’s Birthday Honours
control friendly and easy to clean. The range
in 2013 when she was awarded an MBE for
has been around for many years, trusted by
services to the NHS and emergency services.
Experienced Head of Business Development joins the SP Services Team
professionals and medics the world over, so to
SP Services, the Telford based international
and the working lives of our staff.”
be part of the team launching the new design
Fionna said: “It is a huge privilege to lead
features is very exciting.’
London Ambulance Service.
In addition to the new Parabag range the
“The last 18 months have been challenging
Donway range of emergency immobilisation
for all our staff, particularly for those working
supplier of medical consumables and
and transportation equipment is also evolving,
on the front line and in our control room.
equipment has appointed Paul Watts as
with new products including the Donway
We’ve started to see improvements and
the Head of Business Development for the
Vacuum Mattress, Vacuum Splints and the
one of my priorities is to continue to reduce
Donway Carbon Fibre 2-piece Stretcher. Paul
pressure on staff so we can improve our
said ‘this is an exciting time to be rejoining
response to all our patients.”
Paul, who has previously worked at London
SP, with a strong focus on new product
Ambulance Service, Laerdal, Johnson & Johnson,
innovations and assisting companies in their
As well as an experienced leader and NHS
DS Medical and SP Services (as Regional Sales
major incident preparedness plans.’
manager, Fionna does regular clinical shifts on ambulances, in cars and with London’s
Manager) and more recently for Medical Services, brings with him almost 12 years of medical and
The devastating effects of a major incident or
Air Ambulance. This decision will be well
healthcare industry experience to the SP Services
natural disaster have been thrust to the forefront
received by ambulance staff, many of
team and will be responsible for new clients and
of many individuals and organisations minds in
whom campaigned for her to be the Chief
managing a number of high profile partners.
recent times, with the Ebola pandemic in 2014
and the recent earthquakes in Nepal. By having Steve Bray, Managing Director at SP Services,
a disaster preparedness plan in place on a
Eric Roberts, Unison Branch Secretary, said:
said, “We are delighted that a person with Paul’s
business and personal level you can be better
“We welcome Fionna Moore as CEO and
experience and enthusiasm has re-joined the
equipped and ready for the short, mid and long
look forward to working with her to improve
company in a new capacity. We have taken
term effects of a major incident.
our Service and the working conditions of our members. We have a difficult few years
our time to recruit a high quality business To discuss SP being part of your Major Incident
ahead of us. It is vital that the CEO and
track record, but also has the niche experience,
plan or to arrange an appointment with Paul
Unison keep focused on what is important for
product knowledge, desire and determination to
now that he has rejoined the SP Services team,
our staff and Londoners.”
succeed. He will be a great asset.”
contact us now. Mick Butler, GMB Branch Secretary, said: “I
Paul said “I am very excited about this appointment as I have come up against SP Services many times over the past couple of years and I know how strong they are within
London Ambulance Service Chief Executive confirmed
was pleased to be part of the process and feel the right candidate has been selected. “Staff have confidence in Fionna as the leader of London Ambulance Service and
the industry. I am delighted to re-join the team – or as I like to call them, family - I look forward
London Ambulance Service is pleased to
I welcome her commitment to work closely
to my new challenges. In fact I am buzzing and
confirm that Dr Fionna Moore MBE has
with the trade unions in the true spirit of
I cannot wait to get started”.
been appointed as Chief Executive.
AMBULANCE UK - AUGUST
development manager who not only has a proven
223 Do you have anything you would like to add or include? Please contact us and let us know.
IN PERSON YAS News
Teenage Cardiac Arrest Survivor Thanks Life-savers An inspirational 15-year-old who suffered
Alex, who lives in Escrick, near York, said: “I
to the scene and I was privileged to see
had no idea how to do CPR before Restart
the stunning moment Alex came back to
a Heart Day last year but now this has
life. It was a really emotional process and
happened to me, I know how important it is
we are all just thankful that it was a good
and everyone should be made aware of the
benefits. Cardiologists believe Alex may suffer from
a cardiac arrest at school has finished his GCSEs - just weeks after school staff
“I am so thankful to the staff at the school
hypertrophic cardiomyopathy. Further tests
saved his life.
for acting as quickly as they did; what they
are now being carried out to determine
did saved my life - they were brilliant!”
whether it is genetic.
PE lesson at Fulford School in York, staff
The incident happened on 30 April 2015
Alex was reunited with the life-saving
recognised the seriousness of his condition
while Alex was taking part in an indoor
school staff and ambulance crew during an
and immediately started cardiopulmonary
emotional event on 25 June 2015 when they
When Alex Cowes collapsed during a
resuscitation (CPR) and used an on-site defibrillator to bring him back to life.
were presented with Yorkshire Ambulance “I felt totally normal during PE; we were
Service Certificates of Commendation for
doing short bursts of running,” recalled
their incredible efforts.
Thanks to their actions, Alex has since
Alex. “When I stopped I felt really dizzy and
returned to school and completed 14 GCSE
collapsed and that’s all I remember.”
exams, the first of which he sat just four
Alex’s parents Nick and Sue Cowes, who also have two other children, Harrison, 11,
days after having a cardioverter defibrillator
His PE teacher Kat Fairbairn immediately
and Simmone, 18, are now determined
implanted in his chest to continuously
raised the alarm and Shona Jagger,
to raise the profile of the importance of
monitor his heartbeat.
Head of Girls’ PE, and Erica Melsom, the
learning CPR and having defibrillators in the
school’s Medical Officer, started CPR.
Alex, a keen footballer and athlete with
Sue Igoe, First Aider and member of the
no previous health problems, was one
Administration Team, used the defibrillator
Nick said: “When we look back at what has
of almost 11,000 schoolchildren across
to shock his heart into a regular rhythm.
happened over the last few weeks, we feel
Yorkshire who learned CPR as part of a
Remarkably, Alex was sitting up and
total shock but also total gratitude. How do
record-breaking training event organised by
talking when York-based Paramedic Terry
you thank someone for saving your son’s
Yorkshire Ambulance Service in conjunction
Rawcliffe and Emergency Care Assistant
life? It goes way beyond any gifts or words;
with the British Heart Foundation (BHF) on
George Benjamin arrived to take him to York
they acted so professionally that day, we
Restart a Heart Day in October 2014.
can’t thank them enough.
Little did he realise that he would reap the
Dan Bodey, Deputy Headteacher at Fulford
“We feel so blessed that Fulford School
ultimate benefit of people taking the time to
School, said: “It was a real team effort -
has been so proactive in terms of having
learn this vital life-saving skill.
the staff were incredible. I was also called
an on-site defibrillator, with plans for two more, as well as enabling 1,050 pupils to have CPR training as part of Restart a Heart Day last year. Everyone should know CPR and if it could be put on the national school curriculum, together with defibrillator awareness, that would be a massive step in the right direction.” Simon Gillespie, Chief Executive at the British Heart Foundation, said: “Fulford School’s commitment to providing life-saving CPR training for its staff is the reason Alex is
AMBULANCE UK - AUGUST
here today. Having been a part of the mass training event last year, I was bowled over by the energy and enthusiasm of everyone involved and I’m delighted that the school can now truly appreciate the importance of what they achieved. “Had the teachers and staff not known what to do, the outcome would have been devastating - it really is a matter of life or death.
224 For more news visit: www.ambulanceukonline.com
IN PERSON “Through our Nation of Lifesavers campaign
in military situations are very suited to the
we’re calling for all secondary schools to
daily challenges faced by Air Ambulance
follow Fulford’s example by equipping their
crews where very different incidents on
pupils with life-saving CPR skills. What
unknown terrains make instant decision-
happened to Alex is proof that heart disease
making an integral part of the job.
can strike without warning. Alongside teaching CPR, we need to continue to
Ian Payne, Flight Operations Director
fund life-saving research to improve
of DAATCL said “Rob is a complete
diagnosis and treatments for conditions like
professional in the true sense of the
hypertrophic cardiomyopathy that could
word who has devoted a very significant
keep many more families together.”
proportion of his working life to the activities of the Devon Air Ambulance. From the
“Over many years Rob’s quiet, unassuming attitude has made him an ever popular member of both the operational crews and Devon Air Ambulance Trust”
Yorkshire Ambulance Service will be
embryonic days of the service, to the more
repeating the success of Restart a Heart Day
sophisticated practices and aircraft of
on Friday 16 October 2015 when 97 schools
the current operation, Rob has immersed
and over 20,000 pupils will be taught CPR,
himself in every aspect of the service and
Heléna Holt, CEO of DAAT added “Thankfully
including 250 Year 7 pupils at Fulford
has had a clear and lasting impact upon
we will not be saying goodbye to Rob. When
School. This year’s event is set to be the
the way in which air ambulance helicopters
we were awarded our own Air Operating
world’s biggest mass CPR training day.
operate within the county.
Certificate (AOC) last year, Rob took on the role
Jason Carlyon, Clinical Development Manager
“Over many years Rob’s quiet, unassuming
in setting up our safety management systems.
with Yorkshire Ambulance Service and event
attitude has made him an ever popular
It was a challenging time for all the team as
organiser, said: “Alex’s case highlights why it
member of both the operational crews and
Devon Air Ambulance Trading Company Limited
is so important that we organise mass CPR
Devon Air Ambulance Trust.
(DAATCL) were the first Air Ambulance to have
of Safety Manager and played an integral part
training events like Restart a Heart Day. When
developed and awarded an AOC fully compliant
we held the first event last year, we always said
Rob regularly and freely contributes to
with the new EASA regulations. I am delighted
if it saved one life, it would be worthwhile but
the highly important fundraising and
that Rob has agreed to continue in this role
we never expected it to be one of the pupils
promotional activities of the Charity where
and will be overseeing the surveying of all the
his immense knowledge, approachable
community helipads needed to introduce night
manner and fervent loyalty to the Devon
flying next winter.”
“The incident highlights the importance of the
Air Ambulance make him a popular host
Chain of Survival, including early recognition,
to visitors and wonderful ambassador for
Rob, 59 and a Falklands veteran lives
calling 999, bystander CPR and early
both the Trust, his vocation as a helicopter
in Torquay. He is married to Helen, a
defibrillation. The speedy response of the
pilot and the emergency service flying
paramedic who has also worked aboard
school staff played a vital role in his survival
community as a whole.”
DAA, and their 12 year-old son, Thomas.
before the arrival of our staff and we are delighted that Alex has made a good recovery and was able to complete his GCSEs.”
End of an era for Devon’s Air Ambulances, with the final operational flight flown by Captain Rob Mackie One constant at Devon Air Ambulance Rob, who has flown with the service since April 1993. He is thought to be the longest serving Air Ambulance pilot working at one single service in the UK. In fact during his time with DAA he has flown in excess of 7,000 missions! Paignton born Rob started his flying career
AMBULANCE UK - AUGUST
(DAA) over its 23 years of operation is
as an Army pilot and the skills he picked up flying Scout and Gazelle helicopters
225 Do you have anything you would like to add or include? Please contact us and let us know.
IDENTIFYING INNOVATIONS IN AMBULANCE DESIGN AND PATIENT TRANSPORTATION What is the future of patient transportation? How will ambulances evolve to improve patient comfort, protect and empower paramedics, enhance clinical care and boost the efficiency and performance of ambulance fleet management? Words: Richard Smith, IPTS Programme Manager, FERNO UK.
The overriding aim of innovations in
costs, lower carbon emissions and lower
movement and enable them to adjust/cease
ambulance design and performance is
insurance premiums to name a few.
any patient care, which may be affected by the
improved patient experiences and positive patient outcomes. New ambulances will
temporary movement. 4. Patient experience – prevent delays with
seek to offer safer, faster patient-centred
shorter ambulance-loading times, increase
service and have the versatility to offer more
comfort prior to and during transit, quicker
in-transit clinical care.
access to enhanced standards of clinical care, higher levels of medical care during
Ambulances work at the frontline of the NHS
service and the reputation of the service is of paramount importance. The general public,
The first three areas offer a huge range of
the other emergency service partners and
opportunities for practical improvements. The
hospital-based medical practitioners and
fourth area, the patient experience, which
administrators must all have total confidence in
directly influences the broader healthcare
the ambulance service. This is why rethinking
objective of patient outcome, is largely
the design and role of ambulances is a key
determined by the aggregate of benefits
concern for everyone working within the UK’s
derived from the first three areas.
1. Paramedic welfare
Four areas of focus
Powered trolleys A new generation of touch button operated trolleys will minimise injury risks, meaning less bending and stretching for paramedics. Currently, every-day patient loading and unloading operations pose the risk of personal injury to emergency medical staff. This can and does result in injuries, which lead to lost workdays and, in the worst cases, careerending, long-term injuries. Both the personal costs and the economic costs of replacing and training these individuals present an overwhelming case for eradicating the risk of injury caused by
Improvements in the in-transit seated
avoidable manual handling and lifting.
The scope for improving ambulance
positions of paramedics and doctors can be
performance can be broadly split into four key
expected with the introduction of more flexible
The Department of Integrated Systems
areas. These are:
and ergonomic seating positions. Being
Engineering at Ohio State University in
able to comfortably reach both clinical and
Columbus in 2013 completed extensive
trolley ergonomics research. It measured
enhanced seating, better access to clinical
will minimise injuries from stretching and
and quantified the dramatic reduction in
apparatus, improved staff satisfaction,
stumbling and enable more productive
paramedics’ average and peak muscle
more protection from injuries caused by
activities during transit.
activity when using an advanced powered
1. Paramedic welfare – lighter equipment,
lifting, bending, stretching and sliding/ falling (during transit). 2. Interior layout – a move towards modular
auto-loading system. The new loading system The aim is for paramedics to be safely seated
removes the need for considerable manual
while in-transit 100 percent of the time. Flexible
handling and lifting.
seating and secure seatbelts will be designed
AMBULANCE UK - AUGUST
design will mean ambulance interiors can
to allow close attendance to the patient, as
Devices that mechanically lift and load patients
be reconfigured and replenished quickly,
and when necessary. An adjustable, fold-away
into ambulances are likely to mark the end of
creating a more ergonomic and efficient
laptop/tablet bar on an extending arm that is
A&E ambulance tail lifts and ramps. Currently it
secured to the side wall of the ambulance will
is common-place for paramedics to transport
allow paramedics to send e-mails and update
a patient on the carry chair and then to transfer
hospitals from the ambulance.
them to the stretcher in the back of the vehicle,
3. Vehicle data and informatics – a new generation of vehicle intelligence will
as it is easier to do this than use the stretcher
record and analyse data and provide both
Further innovations include incorporating
and loading system, however, ergonomically,
real time and cumulative information for
vibrating pads into the paramedic’s seat,
moving a patient from a carry chair to the
paramedics, hospital staff, fleet operational
which are activated when the driver turns on
trolley in the back of the vehicle creates its own
managers and drivers. Benefits will include
the indicator before taking a left or right turn.
risks. In comparison to self-loading powered
increased logistics efficiency, reduced fuel
This will forewarn the paramedic of the lateral
trolleys, tail lifts are very slow, take up valuable
226 For further recruitment vacancies visit: www.ambulanceukonline.com
PRODUCT SHOWCASE Although a number of standard configurations will be recommended, the ability to change the modular layout at short notice will greatly enhance the flexibility of ambulance crews to respond to a given situation and build in the equipment they need. For example, if a patient is known to need specialist equipment and intensive onboard care, the ambulance can be rapidly configured to meet these requirements before it leaves the base. In a very different scenario, the number of stretchers secured to the wall mounts can be increased to five if an ambulance’s designated role is simply to transport mass casualties over a relatively short distance. A new generation of touch button operated trolleys will minimise injury risks, meaning, less bending and stretching for paramedics. internal space and present a safety risk to
sponsored by the US Government into trauma
paramedics (push and pull injuries, trapped
response prompted design teams to look for
fingers etc). Tail lifts and ramps also add
new industry standards.
excessive weight to each vehicle, increase its carbon emissions and require expensive
One area of investigation was military
annual preventative service and maintenance.
ambulances. We asked the question, ‘How
Therefore, the case for incorporating the use
does the military fill an ambulance vehicle
of a faster, safer and lighter integrated patient
transportation and loading system is clear. Ambulances of the future will certainly be A new generation of ‘self-loading’ system will
influenced by advances in mobile care in
rapidly speed up the loading and unloading
the military sector. In particular, a modular
process. This versatile and stable system
approach to ambulance interiors will become
should also quickly convert into a seat if the
the norm. A series of wall-mounted brackets
patient would benefit from this configuration.
will allow interchangeable and modular
A built-in LED light system will automatically
equipment to be locked-in and removed as
illuminate the area around the trolley system
needed prior to the ambulance setting off to
offering increased safety when attending
patients while providing a visual warning
of the trolley during night-time loading. A further innovation is the automatic opening of ambulance rear doors as a patient transport device approaches. This will be activated by an intelligent signal sent between the trolley measure designed to significantly reduce loading times and save lives by speeding up patient care.
2. Interior layout The terrorist strikes in New York (11 September 2001) and London (7 July 2005) provoked a re-think in ambulance design. Research
ergonomics, intelligent, interoperable, reconfigurable, interchangeable, integration of equipment and data. iNTraxx and brackets sited within soft interior walls will allow cabinets and clinical apparatus to be securely installed and relocated quickly. Almost everything will be movable. Small storage boxes for consumables can be held onto the side of stretchers by the lock system in transit to ensure no movement or spillage from boxes or containers during transit. All large and small containers and equipment, including oxygen systems will be easily secured and
“Ambulances of the future will certainly be influenced by advances in mobile care in the military sector.”
All on board clinical apparatus, medical supplies, communications and administration devices need to be ergonomically optimised to allow the medic to respond to every situation that arises during patient transit. Even lighting within the ambulance cabin must respond to the needs of the paramedic and allow degrees of flexibility to enable the patient to receive the best care. As well as improving the quality and efficiency of patient care and team communications, a strategically designed modular interior will result in fewer injuries
AMBULANCE UK - AUGUST
and ambulance vehicle. This is just one more
Interior design focuses on safety,
to others nearby. This is also particularly important when lighting up the ground in front
Focus on ergonomics
and strains for paramedics caused by bending and stretching.
227 For all your equipment needs visit: www.ambulanceservicesuppliers.com
PRODUCT SHOWCASE Extending on board clinical care
The addition of vehicle informatics is inevitable and essential. It is to be welcomed because its primary objective is to optimise the use of assets and improve the efficiency of patient
The Keogh Review, Transforming urgent
care delivery. It will yield clear information
and emergency care services in England,
on all aspects of an ambulance’s clinical
published in November 2013 proposed the
and mechanical performance; highlighting
need to, ‘Develop 999 ambulances so they
maintenance issues early and identifying areas
become mobile urgent treatment services,
where changes in processes and behaviours
not just urgent transport services. We know
would benefit service delivery.
that paramedics can now deliver treatments that would only have been done by doctors
One of the outcomes will be an increase
10 years ago, whilst with the support of
in the amount of accurate data relating to
improved community services they can safely
driver performance. This should be seen as a
manage many more people at scene. This
method of educating all drivers in best practice
gives us both more options to treat people at
and elevating their subsequent performance,
home, and to travel further to reach specialist
rather than placing excessive pressure
care. There are opportunities for extending
on individuals. The data could lead to the
paramedic training to better assess, prescribe
identification and rewarding of elite drivers who
for and manage patients with exacerbations of
consistently ensure their vehicle achieves the
chronic illnesses and work more closely with
best possible performance.
GPs and community teams.’ Ambulances are a significant, long-term
Richard Smith, IPTS Programme Manager, FERNO UK.
investment by NHS trusts that have varied and complex specifications. During an ambulance life (typically seven years), advances in medical equipment technology, can give rise to the need for costly modifications to ensure that the new equipment is secured safely in transit or, alternatively, where the cost of these modifications are inhibitive, delays in the provision of the enhanced technology, creating a two tiered provision of patient care within ambulance trusts. An increase in the variety and versatility of modular equipment in ambulances means that it is possible to be more responsive to these changes providing more immediate access to
performance – including fuel consumption, satellite tracking, daily mileage and service records. This data will enable detailed analysis of vehicle performance, and the efficiency of fleet logistics, inter-team communication, partner coordination and driver performance. With many ambulance authorities facing an annual fuel bill of in excess of £6m, the use of vehicle informatics will play a substantial role in reducing costs as well as addressing important environmental issues by lowering carbon emissions.
patient care. Extensive research and trialling must be undertaken to measure the impact and advantages of more doctors travelling in A&E ambulances on selected call outs. This process will be data driven and the recorded efficiencies must also be evaluated in the AMBULANCE UK - AUGUST
context of alleviating the huge pressure on the overextended A&E departments in UK hospitals.
3. Vehicle data and informatics Vehicle informatics will include real-time information on stock levels of consumables
Ambulance fleet management can be expected to achieve new levels of sophistication and find new ways to measure and assess operational performance. Meaningful comparisons can be made between ambulances, similar fleets and regions. Best practice can be benchmarked and quickly disseminated to team leaders to ensure overall standards are continually rising and incremental efficiencies and savings can be introduced. The use of on board clinical equipment, communications devices and case document management systems will also be expected to improve when better data is available to
these essential, enhanced medical equipment or treatment pathways and advances in
all parties and the working environment for
“A pre-stocked and well-configured ambulance will ensure the patient receives the best possible treatment and care during transit.”
and accurate records of vehicle
paramedics is enhanced. Studies carried out by the Helen Hamlyn Design Centre on behalf of the NHS and the Keogh Review have shown that typically 40 percent of Emergency Admissions are patients who do not need to be admitted to hospital. More sophisticated data and new industry benchmarks will enable more at scene (treat and discharge) or in-transit diagnosis and decision-making. Technologies which coordinate ambulance crews with hospitals and other emergency service partners continue to evolve at great speed. We can rely on our partners in this fast-moving sector to integrate increasingly
228 For more news visit: www.ambulanceukonline.com
PRODUCT SHOWCASE efficient data and communication platforms
For example, an improved seating position
into ambulances in the near future. Extensive
for the paramedic within the ambulance
research and trialling must be undertaken
will raise the standard of patient care
to measure the impact and advantages of
administered. A faster transfer on a trolley
the availability of advanced level diagnostic
that can cope with stairs and obstacles will
equipment and providing ‘at-scene’ access
mean a shorter hospital admission time
to doctors or consultants advice through
for a critical patient – which could be life-
technology. This process will be data driven
saving. A pre-stocked and well-configured
and the recorded efficiencies must be
ambulance will ensure the patient receives
evaluated in the context of alleviating the
the best possible treatment and care during
huge pressure on the over-extended A&E departments in UK hospitals.
transit. And finally, optimised logistics A new generation of ‘self-loading’ system should also quickly convert into a seat if the patient would benefit from this configuration.
Capturing data Data captured will include journey logs, speed, duration, fuel consumption, reversing, blue light use, engine on and off, temperature control, tyre condition, broadband and radio
4. Patient experience Improving all aspects of the ‘patient journey’
dialogue and video recordings.
from the emergency scene to hospital is at
Secure ‘real time’ information will be stored
in this article. We take a holistic view of the
the heart of the new developments discussed
planning will also shorten transit times.
The future is closer than you think Many of the innovations discussed in this article are in the advanced stages of development and we believe most will be integrated into UK ambulances in some form in the next two to five years.
on cloud-based platforms and this allows
‘journey’ and this goes beyond ambulance
customised and flexible reporting systems
design to cover all equipment, activities,
to be set up. Extensive research is going
procedures and communications that combine
What is certain is that advances in both
into seamlessly integrating data capture and
to safely treat and transfer the patient.
materials and technology will continue to make ambulances and their equipment
communication devices within the fabric of the ambulance. The new technology will also
Specific measures to increase speed,
lighter, smarter, safer, more efficient and,
be designed to integrate with and enhance
efficiency, quality and safety in these areas
where appropriate, faster.
UK current control systems.
will contribute both directly and indirectly to improved patient outcomes.
The ambulance dashboard will continue to house a range of familiar LED warning lights driven by the vehicle’s ECU. The vehicle diagnostics will include battery, tyre pressures, oil levels etc. In addition, a GPS system will record the real time location, provide remote vehicle diagnostics and theft protection of equipment. The theft protection monitoring equipment will alert the driver if the ambulance is about to leave the scene without vital equipment, including stretchers, chairs and defibrillators. Engines which turn off when idling will and contribute to a considerable overall improvement in the ECO performance of the ambulance. Many of these changes will be data driven and best practice carbon reducing benchmarks will be introduced and refined based on real usage. In its broadest sense, more data allows better
AMBULANCE UK - AUGUST
cut fuel consumption by 20 percent
decisions, better operational performance and better patient experience.
229 For all your equipment needs visit: www.ambulanceservicesuppliers.com
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230 For further recruitment vacancies visit: www.ambulanceukonline.com
10/2013 10:53 Page 254
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Ambulance Fleet Support Manager Flexible location - UK / £26,000 - £30,000 pa depending on experience plus ILW if applicable / 35 hours per week
Terry or Rachel
Refusing to ignore people in crisis We have an opportunity for an experienced ambulance fleet manager to join our event first aid and ambulance support department and play a key role in developing Red Cross ambulance support services.
Tel: 01322 660434 Fax: 01322 666539
As our ambulance fleet support manager, you will provide specialist support in the form of guidance on fleet operations, technical issues, policies, procedures, legal and environmental issues, as well as preparing business cases and approval requests for new vehicles. Additionally, you will be working to ensure that the fleet is quality assured and cost effective.
If you have a clear understanding of the requirements and constraints of managing a widely dispersed ambulance fleet and are prepared and able to travel in the UK, we would be delighted to hear from you. For further details and to apply please visit www.redcross.org.uk/jobs and search by entering the job title “Ambulance Fleet Support Manager”.
or by post to: Media House, 48 High Street Swanley Kent BR8 BQ
Closing date: 31 August 2015. First interviews: 22 September 2015 at our UK office in London. The British Red Cross is proud to have a diverse and neutral workforce. We are bound by seven fundamental principles including impartiality, neutrality and independence and we are committed to welcoming people from the widest possible diversity of background, culture and experience. The British Red Cross Society, incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949), Scotland (SC037738) and Isle of Man (0752).
Life Connections 2014
Paramedic. Exmed Study Day ifficult Airway Course EMS™ – An introduction Clinical Leader. Thursday 15 May 2014 ering Conference Centre, Kettering NN15 6PB Consultant. TH
Great people PRESENTATION
go further.TIME: P.M
Qualified Paramedics - Senior Paramedics -
12.00 - 12.30
Registration Assistant Operation Manager
Rotation 2 - 13.30
13.30 - 14.00
ediction of the Difficult Airway
14.00 - 14.30
ills Stations (4 rotations/30 min. each)
D’s & Rescue Airways
Lunch, Exhibition Skill Stations Rotation 3
M and Laryngoscopy
AMBULANCE UK - AUGUST
At the North West Ambulance Service, we prepare you for career progression. We’re talking more oduction & History of the Course experiences and more training. This means you rise fast. Our paramedics have gone on to become senior managers, even CEO – and you can12.30 too. e Airway Algorithms For further information visit www.greatpeoplegofurther.co.uk/
Rotation 4 14.30 - 14.45
Airway Self Scope Video
For all your equipment needs visit: www.ambulanceservicesuppliers.com
14.45 - 15.00
Hands Down Nobody Beats ZOLL When it Comes to CPR
CPR quality is crucial. In systems that have focused on improving CPR quality, both in and out of the hospital, survival rates from sudden cardiac arrest have doubled, or even tripled.1,2 When it comes to assisting rescuers in providing the best CPR possible, no one is more experienced or can offer you as much as ZOLL®.
Real CPR Help® — Guides rescuers to proper depth and rate of compressions with real-time audio and visual feedback See-Thru CPR® — Reduces the duration of pauses during CPR by filtering CPR artifact so rescuers can see the underlying rhythm CPR Dashboard™ — Displays depth and rate of compressions and assists rescuers in achieving full compression release
Learn how ZOLL technology can help you improve CPR quality at www.zoll.com/uk/handsdown.
Bobrow BJ, et al. Ann Emerg Med. 2013 Mar 7. doi: 10.1016/j.annemergmed.2012.12.020. [Epub ahead of print]. Sell RE, et al. Circulation. 2009;120 (18 Supplement): S1441.
MCN EP 1410 0063