Ambulance UK - Vol 30 No. 4 August 2015

Page 1

Volume 30 No. 4

August 2015

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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CONTENTS

CONTENTS 180

EDITOR’S COMMENT

183

FEATURES

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

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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INTERVIEW REPORT

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

they need.

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

183 Do you have anything you would like to add or include in Features? Please contact us and let us know.


INTERVIEW REPORT

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?

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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

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FEATURE

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 andy.thomas2@nhs.net

Abstract:

(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.

Key words:

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

Introduction

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.


27965

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 TCA’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 – 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

recovery.

186 For further recruitment vacancies visit: www.ambulanceukonline.com


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187


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.

Discussion

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

AMBULANCE UK - AUGUST

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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189


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 patient’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 “low flow state� (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

complications.

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

presented.

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.

Conclusion

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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Cardiac Tamponade

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07/04/2014 12:24:05


TVAA

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

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

operations.

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

Service:

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.”

Birmingham.

centres of population.

hospital emergency medicine.

ending up in police custody.

On each day lectures were

AMBULANCE UK - AUGUST

4:05

NEWSLINE

197 For all your equipment needs visit: www.ambulanceservicesuppliers.com


NEWSLINE SECAMB

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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199


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

their families.

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

community paramedicine.”

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

Visit www.durham.ca/

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

LAS

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

donate £5.

200 For further recruitment vacancies visit: www.ambulanceukonline.com


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201


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

of Sheffield.

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

have found.

England. It covered call-outs for

receiving appropriate advice,

999 call.

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

indicators.

Group, and the report will also

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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

Expectations.

areas, first aid, water rescue and

in hand,” he added.

event of emergencies including

Group.

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.

SCAS

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

earthquake.

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 volunteer2go@btinternet.com

203 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com


NEWSLINE SCAS

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

trips.”

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

this year.

a month!”

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

SCAS said:

clinical experience.

Council (HCPC) registration. Once

questions we have. The main

this is achieved, they become fully

difference we have found is that

operational paramedics.

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

Australia.”

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

medical emergency.

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

nhs.uk/get-involved/community-

Redcar, patients will be either

groups in Wells, in North Norfolk,

first-responders.htm

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,

routine rehabilitation.

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

their treatment.

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

enhance facilities.”

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.

Today Conferences.

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

www.lifeconnections.uk.com

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

between them.

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

ceremony.”

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

acceptable.

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

EMS

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.

EEAST

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 jamie@theairwaysite.com.

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

www.eastamb.nhs.uk/

across the East of England.

Performance/performance.htm

206 For more news visit: www.ambulanceukonline.com


NEWSLINE

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).

207


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.

KSSA

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

communications capability

agreed to the joint development

in remote and difficult areas.

of an in-flight Omni-Hub™ for the

The technologies aggregate

future.

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

Omni-Hub™ multi-mode

technology, surveyed key areas

pre-hospital environment is

technological advance, which will

communications system.

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.

solution.’

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

for patients’.

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.

out-of-hours care.

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


NEWSLINE YAA

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

aspects.

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.

members course.

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

patients.”

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

hospital.

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

the Trust.

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

conditions.”

four years, said: “I’m delighted that our already award-winning

The YAA is an independent

IHAG has been shortlisted in the

attachment.

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.

SECAMB

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

xxx

xxx

Programme

xxx xxx

Wednesday 21st October 2015

xxx

xxx xxx xxx

xxx

NEWSLINE

Kettering Conference Centre, Kettering, Northants NN15 6PB Time

Presentation

08.30 – 09.30

Registration

09.30 – 09.45

Introduction

Speaker

Position

Patrick Bourke SBLS-Ed

Director, Severe Burns Life Support Foundation

xxx 09.45 – 10.30

Burns to the Integumentary System – A Critical Overview?

xxx

10.30 – 11.15

Tea/Coffee, Exhibition

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

Consultant

14.30 – 15.15

Tea/Coffee, Exhibition

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

xxx

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

www.lifeconnections.uk.com

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


NEWSLINE SCAS

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,

(HIOWAA).

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

Hospital Southampton.

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

speed.

for the service, but it is believed many of them were successfully appealed against because speed

MEDITECH GLOBAL

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 !

PROGRAMME

speeding on his way to a call-out, as the exemption does not cover

Topic

Details

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.

WNAA

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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04/03/2015 09:00


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

supporters.

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

theairambulanceservice.org.uk/

emergency patients.”

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

access charge.

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

Details

08.30 – 09.30

Registration

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.

09:00


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

area.

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

coverage.

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

shifts.

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.

patient demand.

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.

patients.”

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). !

PROGRAMME

at all Major Trauma Centres and key A&E hospitals across

Time

Details

08.30 – 09.30

Registration

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

Self-Scope Video

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

Final Moulages

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


NEWSLINE WAS

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,

WAST

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.

performance measurements.”

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

PROGRAMME Time

Details

08.30 – 09.30

Registration

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

Nottinghamshire, Cambridgeshire

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

last winter.

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.

ambulance service.

“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.”

with us.”

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

each week.

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

Commissioning Group.

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

End.

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

Abbey, Essex

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

approximately £15,000.

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.

until 2011.

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.

ambulance service.

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

in 1992.

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

investiture.”

“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

Honours list.

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.

News

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

company.

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

Executive.

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

LAS News

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.

partnership working.”

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

outcome.”

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

cricket lesson.

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.

community.

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.

Hospital.

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

who participated.

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.”

DAA News

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.


PRODUCT SHOWCASE

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

transit.

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.

ambulance trusts.

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

communications/administrative equipment

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

working environment.

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

space?’

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

a destination.

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,

interchangeable.

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

Operational advances

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.

www.ferno.co.uk

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.

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10/2013 10:53 Page 254

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1 2

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