Ambulance UK - Vol 30 No.5 October 2015

Volume 30 No. 5

October 2015

DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS

Yorkshire Ambulance Service Adopts the AutoPulse Resuscitation System

In this issue Creating a culture for decisions Theory and Evidence Clinical Assessment on the right path

A strong

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CONTENTS

CONTENTS 236

EDITOR’S COMMENT

238

FEATURES

238 Creating a culture for decisions

242 Theory and Evidence

Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street SWANLEY BR8 8BQ ADVERTISING & CIRCULATION: Media Publishing Company Media House, 48 High Street

248

Clinical Assessment on the right path

250

NEWSLINE

280

IN PERSON

282

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Yorkshire’s Ambulance Service Adopts the AutoPulse Resuscitation System

The views and opinions expressed in

PUBLISHERS STATEMENT: this issue are not necessarily those of the Publisher, the Editors or Media

In a move to make further improvements to the treatment of patients suffering an outof-hospital cardiac arrest, Yorkshire Ambulance Service NHS Trust has invested in 16 AutoPulse® Resuscitation Systems to assist with providing vital life-saving chest compressions.

The ZOLL AutoPulse equipment is an automated cardiopulmonary resuscitation (CPR) device that delivers customised, high-quality CPR wherever and whenever a patient needs it. The devices have been allocated to members of the Trust’s dedicated Red Arrest Teams which respond to patients in cardiac arrest, provide life-saving treatment and organise rapid transfer to a specialist facility such as a hospital cath lab.

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Dr Steven Dykes, Deputy Medical Director at Yorkshire Ambulance Service, and his colleagues selected the AutoPulse after an extensive evaluation because it is easy to use and enables the Red Arrest Teams to extricate and move patients with no interruption to life-saving chest compressions.

For Yorkshire Ambulance Service, the flat design of the AutoPulse is also beneficial as it makes it possible to store the units very easily aboard its rapid response vehicles and can be carried as a backpack by paramedics as they rush to the aid of patients.

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Commenting, Dr Steven Dykes said: “The AutoPulse is designed for resuscitation on the move and increases the number of treatment options for clinicians dealing with cardiac arrest patients. I’m confident that this innovative tool will help us to save more lives.”

Rest of the World:

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

EDITOR’S COMMENT

EDITOR’S COMMENT Welcome to this issue of AUK A busy couple of months in the NHS, the pressure is still firmly on but the Urgent and Emergency Care Review revealed recently puts the future firmly in perspective. The only way is not Essex but wherever the patient happens to live!

In other words, high quality, safer care closer to their home. Only by improving both hear and treat and see and treat will the system remain able to accommodate those genuinely in need of admission to hospital in the future.

“Only by improving both hear and treat and see and treat will the system remain able to accommodate those genuinely in need of admission to hospital in the future.”

Now for as long as I can remember I’ve been advocating the development of Paramedicine as a recognised profession with a key role in the future delivery of patient centred care. It would seem that somewhere along the way someone else had the same idea. The UECR mentions ‘a new clinical model’ for the ambulance service. No matter who you ask there is little information about what this may mean. The inference being that there is no clear plan for an ambulance service which continues to exist in its current format. I suspect, having looked at the briefings from Health Education England that the future model will see Paramedicine as a graduate profession with each Ambulance Trust tasked with the development of level 7 practitioners who will be able (or mandated) to work right across the health economy, not just in Out of Hours supporting GPs but at the frontline of A&E, Urgent care and even Mental Health practice.

This is surely evidence that to work, the system will have to rely on the generalist skills and knowledge inherent in Paramedic practice to ’feed’ the patient care needs of the future. It seemingly indicates that a decision might have already been made to fund accelerated development of ambulance staff to meet the demand for practitioners in the new urgent care agenda.

This may well be the most exciting thing to happen for years… The future for paramedic practitioners has probably got somewhat brighter since in a demand driven economy, the price of commodities usually goes up…

There is though a small fly in an otherwise shiny ointment. Research…but more specifically pre-hospital research particularly around the needs of the individual patient groups or the economic contribution of services we provide. We are mentioned in some guidelines but contribute little to their development, unintentionally leaving what actions are recommended for us to be fairly basic. There is only one way to remedy this and the solution sits squarely in our lap.

So there you have it, another packed edition, hot from the press in time for you all to peruse whilst visiting the world famous Life Connections later this month in Kettering. I’ll be there, please feel free to pop into the exhibition hall and chat in between the excellent conference program…

Sam English, Co-Editor Ambulance UK

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237

FEATURE

CREATING A CULTURE FOR DECISIONS DURING RESUSCITATION Philip Quirk – Director – HBP Training ltd – HF specialist Steven Shackleton – Clinical Tutor – South Western Ambulance NHS Trust Key words – Human Factors, Team development, Transactional Analysis Succinctly summarised, Human Factors is the study of the non-technical skills (NOTECHS) present in accidents. Perhaps more importantly than this though it also develops measures of prevention against such occurrences.

Human Factors concerns itself with how the central human operative interacts with several other components: such as environment, hardware, software and also other humans – colloquially known as the SHELL model1.

Human to human interface The human interface with other humans is understood as the most complicated relationship since both parts are continuously changing from moment-to-moment, and also perhaps occasionally unpredictable!

The care environment is a dynamic constantly shifting continuum whereby likely outcomes change from minute to minute and information is often slow to arrive or reliant on diagnostic testing, it is full of unseen potentials unfolding along the timeline. The most complicating factor perhaps is that healthcare teams are often not close nit units familiar with the ways each other operate but more likely An ad hoc group thrown together for a shift , or in the case of resuscitation team called together to perform and this can also including staff unfamiliar even in the surroundings such as agency staff. In the pre hospital world there is also the multi agency approach and the individual good Samaritan to deal with.

At the centre of these safety critical collaborations is the requirement for complimentary communication, which in itself is atypical of the humanto-human interface.

Lessons can, and should be learned between different industries. There is much for health professionals focussing on resuscitation or other

Environmental considerations within a resuscitation event are now being studied and our relationship and that of fellow clinicians relating to the placement of equipment is a fascinating area to research, design of resuscitation areas and space creation are coming to the fore in many of our hospitals.

critical events to gain from understanding how aviation has embraced and developed Human Factors. The aim of this is to identify where improvement has been made following incidents that aid future delivery and avoid negative outcomes There have certainly been challenges in Aviation’s Human Factors

In prehospital care, specific techniques are taught to crews to enable

journey - and some still remain. Notably pilots scepticism of the

the smooth running of a cardiac Arrest - such as the airway kit

psychological component of HF, sometimes known affectionately as

going on the patients Right hand side - (dictated by the fact that the

‘psychobabble’ within pilot online chat forums.

laryngoscopes is a left handed tool) which enables the ET tube to AMBULANCE UK - OCTOBER

238

passed into the intubators free hand (the right).

This is almost certainly similar In medicine and the field of resuscitation, clinicians tend to be rightly proud of their clinical ability and focus on

These basic techniques all assist with the smoothness of the lifesaving

technical aspects of their role to improve their performance. There

event.

remains some scope for developing human factors training that uses examples to tease out the failures not of technical competence but of

Throughout medicine there are other examples of how adaptation

the interactive process and identify methods for reducing likelihood of

following failure / critical incident that was attributable to Human factors

error. This is supported by the work Professor Pat Crosskerry and Dr Mark

has taken place. The development of checklists, processes for challenge

Graber who have both pushed the importance of de-biasing strategy

and response and development of new hardware such as the colour of

to avoid diagnostic error this work certainly overlaps, whether it is the

resus drug boxes all come from and understanding that Human Factors

success or failure of a group task such as resuscitation or an individual

and human fallibility play a significant part in the delivery of critical care.

diagnostic error there will often be a human factors element to it.

1

Ebermann HJ, Scheiderer J. Human Factors On The Flight Deck. Frankfurt, Germany: Springer, 2013.

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FEATURE

239

FEATURE There are however, without doubt, effective models that can be migrated

behaviour, to attempt culture change and accept that whilst hierarchical

from Psychology to better improve safety critical communication,

systems are useful for clinical seniority, expertise and accountability

notably Dr Eric Berne’s Transactional Analysis (TA)2.

there still needs to be a freedom for all involved to communicate and provide a human backstop to error when the potential is identified.

This shift in culture can only begin once an understanding of the human factors affecting outcomes is widespread. It involves the most senior and the most junior in equal measure.

Many of us have realised that the best person to be leading a cardiac arrest is often not the most senior clinician, or the greatest clinical brain, but may in fact be one of their juniors who specialises in ALS or Paediatric ALS. Their confidence to take charge, to speak out and dictate a course of action that over rules the established rules.

Perhaps the most devastating example of a Human Factors failure / communication failure can be found in Aviation. On Sunday 27th March

Within aviation there is an identified barrier to effective communication,

1977 two Boeing 747’s, one from Pan Am and one from KLM, collided

known as Cockpit Authority Gradient.

on the runway of Los Rodeos Airport, Tenerife.

Without doubt this authority gradient is required to ensure a needed

It is still regarded as the worst aviation disaster of all time with the loss

hierarchical structure remains in place to protect against a demographic

of life standing at 583. Although as always with a major accident there

assault on effective decision making processes. Rather the discussions

were many contributing factors, one of the most subtle, yet crucial was

and debates centre on the situational steepness of the gradient.

the steep Cockpit Gradient on the Dutch KLM flight.

This authority gradient can become counter productive in any industry where the established authority, by definition of itself, can compromise effective safety critical communication.

Many breakdowns in communication took place between both planes and Air Traffic Control (ATC), heightened by dense fog on the runway and the closure of Gran Canaria Airport after a bomb explosion.

The authority gradient was very steep in the KLM flight3. Captain Van

Parent

Parent

Zanten was the highest ranked pilot in KLM, his co-pilot did not feel empowered to communicate the mistake he had noticed about the permission to take off from ATC.

Adult

Adult

There is a psychological reason for the co-pilots lack of assertiveness, even in the presence of such catastrophic danger. The answers potentially lie in Dr Berne’s Transactional Analysis – a psychological pill for a psychological ill.

AMBULANCE UK - OCTOBER

240

Child

Child

Agent

Respondent

A similar cockpit authority gradient exists in medicine, with medical consultants and surgeons having hundreds of years of established hierarchies, but also within their own professional communities, overlaying the nursing hierarchy and other healthcare professionals.

There are 3 ego states in Transactional Analysis model the Parent, Adult and Child.

The Parent can further be divided into Critical Parent and Nurturing Parent, the Child ego state also can be further divided into Free Child, Little Professor & Adaptive Child.

The Adult ego state remains singular, this is because this ego state is rational, in the now conscious thought process without contamination.

This is also the most rational ego state for effective communication.

Many now acknowledge this and recent confidential enquiries have caused us to question the established norms. The aim of human factors

The barrier to communication on the KLM flight was the established

training and discussion is to provide awareness to those within the

Capt. who was operating from a Critical Parent ego state, the co-pilot

organisation to ensure an understanding of how this may affect their

had been forced into Adaptive Child, which is complimentary.

2 3

Hay J. Transactional Analysis For Trainers. Hertford, UK: Sherwood Publishing, 2009.

Grech M, Horberry T, Koester T. Human Factors in the Maritime Domain. Boca Raton, Florida: CRC Press, 2008.

FEATURE When in an Adaptive Child state the person can lack assertiveness and

Effective communication is central to the success of modern day

becomes passive in decision-making. The results from this can be as

businesses, especially those who work in the presence of high risk

disastrous as they are entirely avoidable.

and consequence. Any body of knowledge that improves safety critical communication should be researched, understood and if appropriate

A basic understanding of how authority gradient can produce passive

taught. It is often simply a matter of raising the subject and promoting

participants in important decisions could prevent many accidents from

discussion.

occurring. Human Factors training gives organisations the opportunity to engage directly with employees about how they may implement change

Resuscitation experts are now being taught the importance of

to avoid error such as checklists, a process of challenge and response

human factors, teams who work together are trained together, and

for critical skill intervention or simply an improved reporting process and

communication and critical incidents are simulated and practiced.

less punitive approach to serious incident review.

Team briefings, in situ simulation and recreating critical incidents and debriefing are all seen as essential components of the modern

The fallibility of humans can never be overlooked and unfortunately

resuscitation team. The real difficulty comes when, as mentioned earlier,

this fallibility does not recognise the seniority of qualifications and

the team are nothing more than a group with a vague knowledge of

experience, furthermore the most competent humans are capable of the

each other. It is probably here that an understanding of how Human

biggest accidents.

Factors can influence outcome would be paramount and also where some of the useful preventative measures such as checklists are useful

When we acknowledge this fallibility we immediately step closer

to set the standard and reduce the opportunity for error. This is perfectly

to a safety culture by recruiting the balanced views of supporting

illustrated in the Resuscitation Council UK ALS algorithm.

professionals, this is best achieved by Adult-Adult transactions. By offering Human factors training an organisation ensures staff are aware of this fallibility and mindful on the effect it may have on decision making and outcomes. It produces an environment open to change and a willingness to engage in system improvement.

There has been a cultural development within the Royal Air Force RAF in which the flying instructors first words to the trainee pilot is to actively encourage the questioning of any decision the trainee feels is unsafe.

This is because statistically it is the senior pilot who will cause the plane to crash through cockpit gradient.

Below is an example of a medical emergency in aviation in which the Professor visibly shallows the authority gradient to produce the right

In pre- hospital care many interactions involve hierarchical, human and environmental factors, decisions about when to move patients, how to move patients, looking after relatives and the safety of the scene, ourselves and other crews are all areas that can and will need to be considered and communicated.

As the clinical science of resuscitation grows so will the focus on the other aspects that impact on patient care. Human Factors training has the potential help organisations and teams accept and manage the unseen challenges of human interaction in the high risk dynamic environment of Resuscitation and Critical Care.

diagnosis.

About HBP-Training

Orthopaedic surgeon, Professor A.W Wallace, showed thorough and

Whether working with South Pole adventure teams, fast jet pilots or

creative option checking when he was travelling from Hong Kong to LHR

financial sector bankers, HBP-Training understands the importance

on an aeroplane.

of the central human component of the SHELL model and strives for excellence in all levels of performance across industries.

He was asked to care for a passenger who had developed chest pain (who had been involved in a motor cycle accident before boarding the

Their unique ability to design, deliver and measure bespoke

plane). The passenger rapidly became seriously unwell. A pneumothorax

developmental training interventions ensures they target specific areas

was suspected by the Professor (this happens when a damaged lung

in order to create the most positive and safe working environment

leaks air into the pleural space, between the chest wall and the lung;

possible.

when the air becomes trapped, the lung collapses and threatens life). cultures and national cultures that also impact upon patient care and

for a junior doctor. Dr T. Wong, who was also on the plane, agreed with

the hierarchies within the organisations we support.

the diagnosis. They then improvised a chest drain set using a urinary catheter, a coat hanger as a trocar, adhesive tape, oxygen tubing and a

We are keen to share our knowledge with teams of clinicians who seek

plastic bottle of mineral water as a water trap. They also used five-star

to develop safe ways of working.

brandy as a disinfectant. The patient made a full recovery.4 Phil Quirk – Co-Director of HBP-Training.

The professor felt comfortable to seek the advice of a junior and between

www.hbp-training.com

them a solution was developed.

phil.quirk@hbp-training.com

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We strive to ensure that we take time to understand the occupational With minimal aids to diagnose, the Professor asked for a second opinion

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

FEATURE

CRITICALLY EXAMINING THE THEORY AND EVIDENCE SURROUNDING PREHOSPITAL RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA (REBOA) IN TRAUMA PATIENTS Piers James Peberdy - Paramedic

Key words:

Discussion

Reboa, Trauma, Aortic Balloon, Combat Gauze

Caroline (2008) states that hypotension without obvious external bleeding is a common sign of pelvic injury and lists other signs of symptoms of trauma to the pelvis, to include pain in the groin and

Introduction

hips as well as haematomas or contusions in the pelvic region. To this

When it comes to trauma, shock is the leading cause of

binder as the first line management to stabilise the pelvis for trauma

end, Acharya and Forward (2014) recommend application of a pelvic

preventable deaths (Barash, Cullen and Stoelting et al, 2013).

Patients who fall victim to high energy mechanisms of injury, such as road traffic accidents (RTC’s) or falls from height, are particularly susceptible to pelvic trauma (Dolan and Holt, 2013).

Fractures to the pelvis can be complicated and of course lethal when taking into consideration surrounding vasculature. It is

patients who present with hypotension and a potential for pelvic injuries.

Salamone, Pons and Guy et al. (2007) provide rationale behind this way of thinking, explaining that because some pelvic injuries are associated with an increase in abdominal volume, eg: the ‘open-book’ fracture, there becomes less tissue surrounding the pelvis to ‘tamponade’ the bleeding. Salamone, Pons and Guy et al. (2007) continue to say “Before

well documented that a patient can quickly lose their entire

the development of pelvic binders, patients with these injuries and

blood volume into the pelvic cavity (Caroline, 2008), therefore

haemodynamic instability would almost always undergo external fixation

clinicians must carry a high index of suspicion when assessing

of the pelvis to decrease the pelvic volume and increase the likelihood

the poly-trauma patient.

of tamponading haemorrhage.”

In the civilian prehospital arena there have been several recent

This leads to another form of management for patients with pelvic

evidence-based advances in trauma care, including the use

trauma, which is fluid resuscitation. Previous thinking has led the

of tourniquets as well as the introduction of pelvic binders and

prehospital care provider to administer fluids aggressively however

tranexamic acid in order to increase chances of survival to

more recent evidence shows “permissive hypotension” as best practice

discharge for trauma patients. Research aimed at enhancing trauma

(Durusu, Eryilmaz and Özturk et al, 2010). Acharya and Forward (2014)

care has utilised the Afghan War as its ‘springboard’ due to the

explain this further, stating that this practice stems from the ideation

high number of casualties seen in the binational hospital at Camp

that the first clot is the best clot: “permissive hypotension theoretically

Bastion, Helmand Province (NHS, 2013), and includes the long

protects the initial clot and prevents clot dislodgement.” For this, initial

debated issue of fluid management with emphasis on ‘permissive

crystalloid fluids should be used sparingly such that systolic blood

hypotension’ having found that “the first clot is the best clot”

pressure is kept between 70-80mmHg, with the exception of patients

(Acharya and Forward, 2014). An emerging topic of conversation

with head injuries (NICE, 2004).

is the utilisation of prehospital Resuscitative Endovascular Balloon

AMBULANCE UK - OCTOBER

Occlusion of the Aorta (REBOA) a technology which, although

It is recognised however that crystalloid fluids possess no oxygen-

having existed for a number of years with a good theory base, has

carrying capability (Pante and Pollak, 2010) and therefore have

never been utilised in the acute trauma patient (Paetow, 2014).

limited benefits when it comes to the goal of replacing blood and its constituents. It could also be argued that not all pelvic ring injuries

This literature review will analyse and critique the underpinning

will benefit from compression by pelvic binders, in particular lateral

evidence surrounding prehospital REBOA. Current standards in

fractures. One could therefore question if pre-hospital management of

trauma care will be discussed and the subsequent effect on patients

pelvic trauma is substantial. Despite the opening of numerous Major

if a change in clinical practice were to occur. Protocols, guidelines

Trauma Centres (MTC’s) in April 2012, an analysis of ambulance service

other issues (eg: environmental) will be taken into consideration,

data by Morrison, Lendrum and Jansen (2013) showed that as much as

with a view to summarising the feasibility of REBOA as a ‘standard’

76.4% of patients with haemodynamic alterations suggestive of blood

in both military and civilian healthcare systems. Areas for

loss were taken to a hospital without full surgical capability, suggesting

development of research, as well as personal learning will also be

that crews fear they did not have enough time to transport that patient

highlighted.

to more definitive care at a trauma centre. With haemorrhage being the

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

FEATURE leading cause of preventable death from traumatic injury (Tien, Spencer

dressing, or no intervention at all. Morrison, Percival and Markov et

and Tremblay, 2007), the need for improved methods of haemorrhage

al. (2012) recorded rates of haemorrhage as well as mortality, which

control beyond the scope of standard paramedic practice has catalysed

showed that the group with no intervention has the fastest rate of

the start of a number of studies into the feasibility of using REBOA for

haemorrhage and suffered 100% mortality, which is to be expected.

shock as a result of trauma.

Groups that received REBOA or combat gauze dressing had drastically reduced rates of haemorrhage (822+/- 415ml/min versus 11+/-13ml/

According to Davenport (2013) REBOA is described as the insertion of

min and 0.2+/-0.4ml/min respectively) and had much improved

an end vascular balloon into the femoral artery, which is then advanced

mean arterial pressures (MAP), both 15 minutes and 180 minutes into

into the aorta and inflated in order to control haemorrhage and therefore

each procedure: 70+/-4mmHg for combat gauze, 70+/-11mmHg for

increase perfusion to the heart and brain. This is not a new technology,

REBOA versus 5 +/-13mmHg for the control group. Morrison, Percival

as Stannard, Eliason and Rasmussen (2011) explain that this procedure

and Markov et al. (2012) report no deaths in the intervention groups,

was described over 50 years ago whilst resuscitating injured Korean

although it was noted that pigs subjected to REBOA had greater fluids

soldiers, and despite a brief mention in an emergency medicine

requirements during the resuscitation phase, which one could argue is

journal in 1986, literature surrounding REBOA hasn’t been seen again

resolved easily. These results show REBOA in a promising light however

until 2011. According to Paetow (2014), the lack of traction regarding

based on this data, one might question the necessity for REBOA when

REBOA research may have been down to “sub-optimal endovascular

it has such similar results to combat gauze which is both cheaper and

technology, a poorly understood skill set or anticipated ineffectiveness.”

easier to use. This can be addressed by the simple explanation that not

Indications for REBOA include shock as a result of haemorrhage,

all haemorrhage is compressible or accessible (Salamone, Pons and

abdominal trauma (both penetrating and blunt mechanisms), pelvic

Guy et al, 2007) which renders combat gauze ineffective, or at least of

fractures causing abdominal bleeding, ruptured aortic aneurysms

limited use, should it not be placed correctly.

or “the crashing trauma patient with no obvious injury on cardiac ultrasound” (Paetow, 2014).

Morrison, Percival and Markov et al. (2012) repeated the study using pigs that had been subjected for dilutional coagulopathy. In this setting,

Stannard, Eliason and Rasmussen (2011) simplify the manoeuvre

it was found that REBOA was superior to combat gauze following a

into five steps: 1 - Femoral artery access, either by cut-down or

rate of bleeding of 20+/-7ml/min versus 229+/-295ml/min respectively.

percutaneously using ultrasound guidance, 2 - Balloon selection (those

MAP was also higher in the REBOA group, with five deaths occurring

which are soft and compliant) and positioning, either with or without

in the combat gauze group, compared to nil in the REBOA group. With

fluoroscopy 3 - Balloon inflation using a 30-60ml solution of sterile

this in mind it could be suggested that in theory, and despite greater

saline 4 - Balloon deflation, 5 - Sheath removal and closure of the artery

fluid resuscitation needs, the use of REBOA for non-compressible

once REBOA is no longer required.

haemorrhage is feasible.

For this critique, numerous databases were used to search for papers

This study is reflective of that by Martinelli, Thoni and Declety et al.

relating to the use of REBOA for trauma. These included CINHAL Plus,

(2010) who, using a constructed algorithm, selected 13 patients out of

Medline, Science Direct and Scopus. These databases were chosen

a possible 2064 that were being treated for uncontrolled haemorrhage

for their dedication to medical science and evidence based practice.

as a result of pelvic fractures. A range of mechanisms of injury were the

In order to ensure the quality and relevance of research retrieved,

cause of admission to the emergency department, including vertical

numerous parameters were employed including limiting the results to

falls and road traffic collisions (RTC’s), which one could suggest are

within the last five years. For ease, search results were limited to those

commonly seen by civilian medical services. Martinelli, Thoni and

written in English. Search terms ranged from simply “REBOA” to REBOA

Declety et al. (2010) report that all balloons were successfully placed

AND prehospital” and “REBOA AND Trauma”.

without the need for fluoroscopy, with a significant increase in systolic blood pressure being seen as a result (70mmHg). All but one of the

It was found that in comparison to other trauma related topics, there

patients became transferable to CT scan or to another department,

is significantly less research into the use of REBOA for the trauma

where angiography confirmed that 92% of the patients had arterial

patient, with research being particularly sparse on the use of REBOA

injuries, for which they received arterial embolisation (Martinelli, Thoni

in the prehospital arena. A suggested explanation for this could be

and Declety et al. 2010).

that although this is not a new procedure, changes to the settings we A similar trial by Brenner, Moore and DuBose et al. (2013) also selected

for new ideas, whilst utilising a limited arsenal of resources as we see

trauma victims as candidates to receive REBOA for end-stage shock

ever limiting budgets. A large bulk of the research complied so far has

in a civilian trauma centre. REBOA was performed in 6 patients (4

been undertaken by Morrison J. (2012-2014), who has led retrospective

having suffered blunt trauma, 2 with penetrating trauma) with access

studies as well as those porcine model-based trials.

being obtained by either percutaneously or by direct cut-down. Brenner, Moore and DuBose et al. (2013) report a mean increase in systolic

Initial trials were focused on evaluating how efficiently REBOA

blood pressure of 55mmHg with no REBOA-related complications or

works for acute traumatic vascular injury, rather than its traditional

haemorrhage-related deaths.

use in elective surgery. Morrison, Percival and Markov et al. (2012) took a number of pigs and subjected them to forty five seconds of

Examining the results of the study by Martinelli, Thoni and Declety et al.

haemorrhage. After a 500ml intravenous colloid infusion, the pigs then

(2010), it would appear that this study suffered some bias; Unfortunately

either received intervention in the form of REBOA or combat gauze

the survival rate following the procedure was only 46%, with the vast

AMBULANCE UK - OCTOBER

work in and the resulting types of injuries seen have meant a demand

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

FEATURE majority of fatalities occurring in the early stages of the trial. With more

torso measurements in relation to arterial lengths could potentially differ

people surviving at the end of the trial one could argue that the study

based on gender. For this it could be recommended that a further study

was somewhat of a learning curve, rather than trialling a proven method.

would be required to include female patients.

This is further confirmed by admission by Martinelli, Thoni and Declety et al. (2010) that they found only after the event, that balloon deflation must

As previously stated, the study by Martinelli, Thoni and Declety et

be done slowly and delicately. However in the same breath the study

al. (2010) found that survival seemed to be inversely proportional

found survival was inversely related to the length of time the balloon was

to occlusion time. To probe this further, a study by Markov, Percival

inflated - something they reduced by as much as 85 minutes after the

and Morrison (2012) looked to examine the ‘physiological sequelae’

death of the 5th patient; a factor which was consistently low in the study

occurring when a REBOA system is introduced. 24 pigs were split

by Brenner, Moore and DuBose et al. (2013), whose average occlusion

equally into four groups consisting of 30 or 90 minutes of haemorrhagic

time was as low as 18 minutes. It would be unfair to suggest however

shock, and 30 or 90 minutes of REBOA. All animals prior to their

that this study was not without success, and based on REBOA being an

intervention stage underwent a haemorrhage stage which meant a

‘extreme’ measure, such a significant increase in survival rate can only

controlled haemorrhage of 35% of the blood volume of the course

be looked upon in a good light.

of twenty minutes. according to Markov, Percival and Morrison et al.

(2012), the study looked to measure the changes in “mean central aortic

One might question if such low samples in both studies are reflective of

pressure (MCAP), lactate concentration and organ dysfunction”, the

the general population, in that from this data alone it is unclear if REBOA

latter of which was done by postmortem.

could be performed on all victims of pelvic trauma in a ‘one size fits all’ manner, or if the numbers of patients are vast enough to warrant the

The study found that both REBOA groups had a higher MCAP than

cost of training and equipment role-out. A study by Morrison, Ross and

that of the control groups, which we can expect given the data shown

Rasmussen et al. (2014) looked retrospectively at all trauma sustained

by the previous studies. However, the study also found that the groups

by UK military personnel as defined by the abbreviated injury scale

subjected to REBOA accumulated a high serum lactate level, which was

over the course of ten years. Morrison, Ross and Rasmussen et al.

positively correlated to the amount of time the animals were subjected

(2014) separated patients into three groups, including those who had

to REBOA (30 and 90 minutes). One could point out this could be

an indication for REBOA, those with contraindications and those with

responsible for the higher mortality rate seen in previous studies (this

no indication. 1317 patients were split into these groups with a ratio of

study saw only 2 deaths; on in the haemorrhage stage and another in

18.5%, 11.2% and 70.2% respectively.

the resuscitation phase), however Markov, Percival and Morrison et al.

(2012) emphasise that the serum lactate levels were easily ameliorated

The study found nearly one fifth of all casualties in the battlefield had

during the resuscitation phase by use of blood, fluids and inotropic

potential benefit from REBOA, giving give good cause for further

support, although the amount of time required to achieve ‘controlled’

research into employing this procedure. This is further justified when

levels increased with the amount of time the pigs were subjected

Morrison, Ross and Rasmussen et al. (2014) report that of the 244 that

to REBOA (150 vs 320 minutes for the 30 and 90 minutes REBOA

had indication for REBOA, 66 died en route to hospital, with a further

respectively). Blood values combined with a postmortem examination

29 in hospital; these patients could have been saved. One might argue

also showed more renal dysfunction with some evidence of liver

that certain patients will have died at the point of injury and whilst this

necrosis in the group receiving 90 minutes REBOA compared to 90

is true, the study found that this was the case for only half of all deaths,

minutes of shock, further pressing the issue of prolonged REBOA.

with a median time to death being 75 minutes, giving ample time for REBOA to be introduced. It must be highlighted however that this data is military-based, and therefore may differ from that of civilian-based time projections.

To further probe the issue of generalisability with regards to the population sample, Morrison, Stannard and Midwinter et al. (2013) acknowledge the problematic nature of fluoroscopy-free REBOA placement in relation to the length of the aorta, and hence conducted a prospective study in which a convenience sample of 177 male patients, aged between 18 and 50, underwent CT imaging to measure AMBULANCE UK - OCTOBER

the true length of the aorta, comparing it to the estimated length which was taken by tape measure, starting at the jugular notch down to the pubic symphysis. The study found a strong correlation between torso height and true arterial length. The relevance of this is that torso height can easily be measured in the pre-hospital setting and is therefore a reliable prediction tool for insertion length of the REBOA system. It would be erroneous however to ignore the obvious limitations of this study. Although a larger sample, 177 patients could still be put into question in terms of generalisability. Morrison, Stannard and Midwinter et al. (2013) also used only male patients in their study. Despite stating that the sample was one of convenience, it could be challenged that

244 For more news visit: www.ambulanceukonline.com

FEATURE To further add to the drawbacks of REBOA, a study by Long, Houston

whether REBOA prior to transport to the ED is feasible; an increase in

and Watson et al. (2014) gives some contradicting evidence to that

the amount of time spent on scene could have detrimental effects on

found in by the study by Markov, Percival and Morrison (2012) who

patient outcomes. However a study by Roberts, Blethyn and Foreman

stated that they did not find any evidence of cerebral or spinal cord

et al. (2009) which centred around the feasibility of paramedic rapid

necrosis. A further set of 22 pigs were divided into three groups; one of

sequence intubation (RSI), found that despite introducing a complex

which receiving occlusion of the proximal aorta (n=8), another group

procedure into the extensive list of treatments required for each trauma

receiving occlusion in the distal aorta (n=8), with the third being a

patient, the mean time spent on scene increased by only one minute.

control group (n=6). Following preparation in the same manner those

The study also found that as a result, fewer patients died “on arrival at

pigs used in the trial by Markov, Percival and Morrison (2012), Long,

hospital” (Roberts, Blethyn and Foreman et al. 2009).

Houston and Watson et al. (2014) subjected the pigs to 60 minutes of REBOA followed by resuscitation and multiple examinations for spinal

This topic sparked further research into timings surrounding REBOA,

cord injury, including that by ischaemia or reperfusion, as well gait and

for which Anderson, Rehn and Oropeza-Moe et al. (2014) developed

bladder function tests. Both groups receiving REBOA had a mortality

two training methods: a gelatin model and a live model in the form of

of three (37.5%), with one of these (12.5%) being spinal cord injury

yet more pigs. After continuous training on gelatin models, a doctor-

related. Long, Houston and Watson et al. (2014) report that spinal cord

paramedic crew performed REBOA three times in a “realistic prehospital

symptoms without mortality were present in a further 12.5%, although

environment” with arrival to balloon inflation times recorded, as well as

gait scores improved with time.

skin contact to balloon inflation times. Anderson, Rehn and OropezaMoe et al. (2014) report a mean arrival to inflation time of (a very quick)

With the exception of 37.5% of the group receiving distal REBOA

4 minutes and 19 seconds), with a mean time of 3 minutes and 12

placement returning to ‘normal baseline status’, compared to the

seconds for skin contact to balloon inflation. From this it could be

proximal group (12.5%), the results above are suggestive that there is

reasonable to suggest that the introduction of REBOA in the prehospital

little difference in outcomes seen when REBOA is placed in a different

setting is not entirely dismissible, provided that the right patients are

aortic site, be it higher or lower. That said one must question again the

seen by the right people at the right time.

sample size in this study, and hence its generalisability when it comes to the general population. Also noteworthy were the results tables which

From this, one might question why we would introduce REBOA when

showed little clinical significance (p=0.6897) when it came to spinal

aortic clamping exists and is available pre-hospitally. According to

cord related mortality, and therefore it could be advised that future study

Davenport (2013), clamping can be achieved via thoracotomy by a

of a similar nature would need a far greater sample size to be clinically

doctor-paramedic crew, for which survival rates are around 18% in

relevant. Further critique may enquire why 60 minutes of REBOA was

selected patient groups. A study by White, Cannon and Stannard et al.

chosen rather than a shorter (or longer) period time, for which there

(2011) investigated this further, taking 18 pigs and dividing them into

appears to be little explanation. More importantly the suggestion that

3 groups: REBOA, Clamping or no intervention. The study found that

REBOA may led to spinal cord damage is potentially devastating for the

the group receiving balloon occlusion were less acidotic compared to

development of the procedure into mainstream civilian trauma systems.

the group who’s aorta’s were clamped (pH 7.35 vs 7.24) with a much

According to Long, Houston and Watson et al. (2014), research into

lower serum lactate and pCO2 levels (4.27 vs 6.55 and 43.5 vs 49.9

preventative methods including that of therapeutic hypothermia and

respectively). White, Cannon and Stannard et al. (2011), the group

cerebrospinal fluid drainage have long been documented in literature

who underwent REBOA rather than aortic clamping also required less

surrounding aortic clamping during cardiothoracic surgery, however it

fluid during resuscitation (667ml vs 2166). This may be due to the

could be questioned however feasible these methods are in the acute

minimally-invasive nature of REBOA compared to the maximum invasion

trauma setting.

of a thoracotomy. As with other studies, bias seems to be apparent here as one might question how transferable the results from pigs are

The acute trauma setting could be described as somewhat arduous.

to humans. From here, further research is most definitely required to

It is an uncontrolled environment in which road, vehicle or machinery

explore the potential benefits (and downfalls) of REBOA.

noise and multiple conversations between endless personnel on scene As previously stated, research by Morrison, Ross and Rasmussen et al.

well lit and prepared environment such as the emergency department

(2014) found that nearly one fifth of all trauma patients in the battlefield

(ED). Specialist equipment and expertise are often in short supply

had the potential to benefit from REBOA, had it been available at the

prehospitally, which in turn puts pressure on the clinicians on scene to

time. Nonetheless one might query if traumatic injuries sustained by

make quick yet critical decisions, with which comes risk.

civilians are so similar to those sustained by military personnel, posing the question “Will this skill be used regularly?” Willis, Hurd and Jernigan

With this in mind, it would be questionable as to whether REBOA is

(2002) list several differences between civilian and military trauma

suitable for the prehospital environment. Dependant on the method

including lower bullet velocity, lower contamination of wounds and the

used to gain arterial access, prehospital ultrasound may be required,

prevalence of comorbidites. The introduction of an advanced skill has

which according to Davenport (2013) remains a topic of controversy,

major cost issues, not just with initial training and equipment role-out,

argueing that ultrasound may delay the transfer to more definitive

but also with skill maintenance (Bernard, Nguyen and Cameron et

care in hospital. Rogers and Rittenhouse (2014) remind us of the

al. 2010). A highly publicised literature review by Deakin, King and

importance of the “golden hour” in which a patient must reach hospital

Thompson (2009) surrounding skill erosion in a civilian healthcare

within 60 minutes of time of injury, and highlight the “platinum ten

setting (of advanced airway manoeuvres in particular) showed that

minutes” of EMS onscene time limitation, meaning that it is debatable

the 75.8% of all paramedics carried out one or less intubations in an

AMBULANCE UK - OCTOBER

mean the potential for mistakes is much higher than that in a controlled,

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

FEATURE entire year, which in turn put patient safety in question and the sparked

and Acute care surgery (AORTA)” led by Joseph DuBose, Brenner

the debate about withdrawal of the skill altogether. As highlighted by

and Cannon et al. (2014) at a MTC in Baltimore, USA. This study looks

Braude (2009) low volume, yet high risk procedures require the clinician

to determine outcomes following the use of aortic occlusion devices,

to be adept in the skill, something that can only be achieved by regular

specifically mortality, neurological outcomes and complications. The

hands on training and experience, a solution which is supported Adnet,

study also hopes to determine how practice patterns alter outcomes

Lapostolle and Ricard-Hibon et al. (2001), who urge cultivation rather

and therefore identify predictors of successful outcomes (DuBose,

than removal of a potentially lifesaving technique.

Brenner and Cannon et al, 2014).

In June 2014, the London Air Ambulance, comprising of a doctor and

Conclusion

double paramedic team performed the worlds first prehospital REBOA,

Despite clinically proven and effective pre-hospital treatments available

Trust (LAA, 2014), is two years in the running. Further data is required

as part of a trial which, led by Professor Brohi of the London Barts NHS

for patients sustaining traumatic pelvic injuries, such as pelvic binders and fluid management in conjunction with permissive hypotension, a consistently high mortality rate has necessitated us to look for improved methods of treatment. With REBOA being a new and very current topic, this essay has sought to analyse and critique the current literature surrounding this procedure.

before conclusions can be made from this study, but this step has made the feasibility of mainstream introduction of REBOA much more likely.

Ultimately, REBOA is a life saving tool who’s benefits outweigh the drawbacks. It buys us more time and hence would appear well suited to both congested urban areas, as well as more rural territories where transfer to hospital time may be elongated.

After an exhaustive online database search, it has been established that the amount of published literature is still low in volume compared to more established prehospital treatments, despite being first mentioned

References

more than 50 years ago.

Analysis of the published literature showed REBOA in a mostly positive light; the general consensus reporting that implementing REBOA meant a significant rise in systolic and arterial blood pressure (and hence increased cerebral and cardiac perfusion), with a dramatic reduction in the rate of haemorrhage. Subsequent haematological derangement postREBOA meant that survivability was inversely proportional to the length of time that REBOA was in-situ. The need for fluoroscopy to guide insertion was overcome using torso measurement; a tool that can be easily used in the prehospital arena, with minimal time required for insertion.

Acharya, M. and Forward, D. (2014) The initial assessment and early management of patients with severe pelvic ring injuries. Orthopaedics and Trauma 28(3): pp151-158 Adnet, F., Lapostolle, F., Ricard-Hibon, A., Carli, P., Goldstein, P. (2001) Intubating trauma patients before reaching hospital – revisited. Critical Care 5(6): pp290-291 Andersen, N., Rehn, M., Oropeza-Moe, M. and Oveland, N. (2014) Pre-hospital resuscitative endovascular balloon occlusion of the aorta. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 22(1): pp:19

Despite a positive light however, certain factors put a negative slant on the topic. Although metabolic acidosis being rectifiable given time and aggressive treatment, paralysis was found to be a disastrous potential sideeffect of REBOA. The cost-benefit ratio of implementing REBOA was also called in to question, with skill erosion and subsequent skill maintenance being factors; despite high numbers of military personnel potentially benefitting from the treatment, the likeness of typical civilian injuries compared to those sustained by the military have weak correlation.

Further critique of the literature queried the consistently low sample

Barash, P., Cullen, B., Stoelting, R., Cahalan, M., Stock, C. and Ortega, R. (2013) Clinical Anaesthesia. 7th ed., Lippincott Williams and Wilkins, UK. Bernard, S., Nguyen, V., Cameron, P., Masci, K., Fitzgerald, M., Cooper, D., Walker, T., Myles, P., Murray, L. and Taylor D. et al. (2010) Prehospital Rapid Sequence Intubation Improves Functional Outcome for Patients With Severe Traumatic Brain Injury. Annals of Surgery 252(6): pp959-965 Braude, D. (2009) Rapid Sequence Intubation, RSI. 2nd ed. USA, University of New Mexico.

sizes used in all the of the studies discussed. The use of pigs suggested prehospital REBOA is still in its infancy, and has a lot more research to go before it can be brought into mainstream emergency AMBULANCE UK - OCTOBER

medical systems (EMS). Topics to look at in particular would include assessing which patients would benefit most from this treatment, as well as outlining exactly how long REBOA can be left in situ before removal is required. As there are no studies examining the feasibility of paramedic-led REBOA, it is fair to suggest that this procedure, much like RSI, will be kept entirely doctor-led in the long-term, as arguably REBOA is beyond the current skill set of autonomous paramedics, but as demonstrated by Anderson, Rehn and Oropeza-Moe et al. (2014), paramedic involvement is entirely feasible.

Current trials include the “Aortic Occlusion for Resuscitation in Trauma

Brenner, M., Moore, L., DuBose, J., Tyson, G., McNutt, M., Albarado, R., Holcomb, J., Scalea,. T and Rasmussen, T. (2013) A clinical series of Resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. Journal of Trauma and Acute care Surgery 75(3): pp506-511 Caroline, N. (2008) Nancy Caroline’s Emergency Care in the streets. UK, Jones and Bartlett.

Davenport, R. (2013) Haemorrhage control of the pre-hospital trauma patient. London Trauma Conference, 10-13 December 2013, London, UK. Deakin, C., King, P., Thompson, F. (2009) Prehospital advanced airway management by ambulance technicians and Paramedics: Is clinical

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FEATURE practice sufficient to maintain skills? Emergency Medical Journal 26(12): pp888-891

Available at http://www.nhs.uk/Livewell/Militarymedicine/Pages/ Medicaladvances.aspx [Accessed 15 January 2015].

Dolan, B. and Holt, L. (2013) Accident and Emergency: Theory into Practice. UK, Bailliere Tindall.

National Institute of Clinical Excellence (NICE) (2004) Pre-hospital initiation of fluid replacement therapy in trauma. London: NICE.

DuBose, J., Brenner, M., Cannon, J., Rasmussen, T. and Holcomb, J. (2014) Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA): A prospective observational study of the Endovascular Skills in Trauma and Resuscitative Surgery (ESTARS) Working Group. Unpublished.

Paetow, G. (2014) Endovascular balloon occlusion of the aorta (REBOA) [online]. Available at http://hqmeded.com/resuscitative-endovascularballoon-occlusion-aorta-reboa/ [Accessed 15th January 2015].

Durusu, M., Eryilmaz, M., Ozturk, G., Mentes, O., Ozer, T and Deniz, T. (2010) Comparison of permissive hypotensive resuscitation, lowvolume fluid resuscitation, and aggressive fluid resuscitation therapy approaches in an experimental uncontrolled hemorrhagic shock model.

Ulusal Travma ve Acil Cerrahi Dernegi 16(3): pp191-197 London Air Ambulance (LAA) (2014) World’s First Pre-hospital REBOA performed. [online] Available at http://londonsairambulance.co.uk/ our-service/news/2014/06/we-perform-worlds-first-pre-hospital-reboa [Accessed 15 January 2015].

Long, K., Houston, R., Watson, D., Morrison, J., Rasmussen, T., Propper, B. and Arthurs, Z. (2014) Functional outcomes following Resuscitative endovascular balloon occlusion of the aorta of the proximal and distal thoracic in a swine model of controlled haemorrhage. Annals of Vascular Surgery 29(1): pp114-121 Markov, N., Percival, T., Morrison, J., Ross, j., Scott, D., Spencer, J. and Rasmussen, T. (2012) Physiological tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Journal of Surgery 153(6): pp 848-856 Martinelli, T., Thony, F., Declety, P., Sengel, C., Broux, C., Tonetti, J., Payen, JF. and Ferretti, G. (2010) Intra-Aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. Journal of Trauma 68(4): pp942-948 Morrison, J,. Lendrum, R. and Jansen, J. (2013) Resuscitative endovascular balloon occlusion of the aorta (REBOA): A bridge to definitive haemorrhage control for trauma patients in scotland? The Surgeon 12(1): pp119-120

Pante, M. and Pollak, A. (Eds.) (2010) Advanced assessment of Treatment of Trauma. UK: Jones and Bartlett.

Roberts, K., Blethyn, K., Foreman, M., Bleetman, A., (2009) Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice. Emergency Medical Journal 26(2): pp128-134 Rogers, F. and Rittenhouse, K. (2014) The Golden Hour in Trauma: Dogma or Medical Folklore? Journal of Lancaster General Hospital 9(1): pp11-13 Salomone, J., Pons, P., Guy, J. and Giebner, S. (Eds.) (2007) Prehospital Trauma Life Support. UK, Jones and Bartlett.

Stannard, A., Eliason, J. and Rasmussen, T. (2011) Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Journal of Trauma 71(6): pp1869-1872.

Tien. H., Spencer. F., Tremblay. L. (2007) Preventable deaths from haemorrhage at a level 1 Canadian Trauma Center. Journal of Trauma 62(1): p142-146 White, M., Cannon, J., Stanard, A., Markov, N., Spencer, J., and Rasmussen, T. (2011) Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Journal of Surgery 150(3): pp400-409 Willis, D., Hurd, W. and Jernigan, J. (2003) Aeromedical Evacuation: Management of Acute and Stabilized Patients. 2nd ed., Springer, UK

Morrison, J., Percival, T., Markov., N., Villamaria, C., Scott, D., Saches, K., Spencer, J. and Rasmussen, T. (2012) Aortic Balloon occlusion is effective in controlling pelvic hemorrhage. Journal of Surgical Research 177(1): pp341-347 Morrison, J., Ross, J., Markov, N., Scott, D., Spencer, J. and Rasmussen, T. (2013) The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock. Journal of Surgical Research 191(1): pp423-431

Morrison, J., Stannard, A., Midwinter, M., Sharon, D., Eliason, J. and Rasmussen, T. (2013) Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system. Journal of Surgery 155(6): pp1044-1051

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Morrison J., Ross, J., Rasmussen, T., Midwinter, M. and Jansen, J. (2014) Resuscitative endovascular balloon occlusion of the aorta: A gap analysis of severely injured UK combat casualties. Journal of Shock 41(5): pp388-393

National Health Service (NHS) (2013) War Medical Advances [online].

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

FEATURE

CLINICAL ASSESSMENT ON THE RIGHT PATH Every day ambulance services receive thousands of calls

Since NHS Pathways was first used 10 years ago, it has been used

requesting emergency care.

to triage more than 50 million calls, currently at a rate of more than 14 million a year.

As everyone working across ambulance services will know, the demand for support is high. And the decisions about where and

Programme Head for NHS Pathways Jackie Shears explains how

when emergency care is needed must be made quickly, clearly and

she and her team of IT specialists, doctors and nurses developed

consistently.

the pilot system to be used not just by clinicians, but by trained lay personnel as well.

The most widely used tool used by ambulance services for making these clinical assessments is marking its tenth anniversary this

“There were teething troubles, of course. Creating an integrated

month.

system opens up learning about where and how services are, or in some cases aren’t integrated.

Led by the Health and Social Care Information Centre (HSCIC), NHS Pathways is a suite of clinical assessment content for triaging

“For instance, when we started testing NHS Pathways years ago

telephone calls from the public, based on the symptoms they report

with Hampshire Ambulance Service there was initially significant

at the time of contact.

noise from out of hours clinics about the number of home visits they felt were being booked. We quickly confirmed that NHS

For the last 10 years health policymakers have recognised that

Pathways does not identify where a patient should see a clinician;

common clinical assessment is vital to create an integrated urgent

this is a locally made decision. However, the numbers of home

and emergency care system. But looking back 10 years, patients

visits were higher than average and investigation identified that the

who needed urgent care were faced with several different places

out of hours clinic did not open on weekend afternoons, leaving

to call, with each using a different means of assessing their clinical

caller handlers with no choice but to book a home visit for patients

needs. If the caller was passed on – for instance from GP out-of-

who had urgent care needs at these times.

hours to 999, or from NHS Direct to GP out-of-hours - the whole assessment needed to be repeated.

“Once highlighted through conversations involving all parties, changes to the overall integrated service could be made. Even

Now callers can place a call to 999, or NHS 111 and in most cases

now, if a service is not commissioned, or correctly profiled on the

they will not need to repeat their history or be assessed more than

DoS, there is little the NHS Pathways assessment can do to match

once. And by the end of that call an ambulance will be on the way if

the patient to that service so partnership working is essential.

needed, or they may have a booked appointment with an out-ofhours GP or other appropriate service.

“A successful six months of safe, appropriate clinical assessments led to a further pilot, commissioned by the Department of Health,

NHS Pathways enables this more streamlined and consistent

to use the system in an ambulance service. By testing in 999 and

handling of patient calls. Once the clinical assessment has been

GP out of hours environments, the principle of whether a consistent

completed, NHS Pathways enables the call handler to identify

clinical assessment system was possible was being formally

the clinical skills needed, and the timeframe in which they are

tested.”

required. If an emergency ambulance is not required at the end AMBULANCE UK - OCTOBER

of an assessment, an automatic search is carried out using

NHS Pathways is now used by six of the 11 ambulance trusts

the integrated comprehensive Directory of Services (DoS). This

across England.

directory then finds a service that offers the appropriate clinical skills. Used together, NHS Pathways and DoS direct patients to the

In 2006, North East Ambulance Service (NEAS) became the first

right care provider that meets their needs.

ambulance service to pilot NHS Pathways. For the first time, contact centre staff were able to perform a detailed, consistent

NHS Pathways has been independently evaluated by three

triage using NHS Pathways, with the support of an on-site clinician

universities as a safe and appropriate clinical assessment tool and

to provide additional advice if required. By asking more questions,

is the only such tool to have the gained the support of the British

in a structured, standardised flow, those who did not require an

Medical Association (BMA) and Royal Colleges.

ambulance could be identified and directed to appropriate care.

248 For more news visit: www.ambulanceukonline.com

FEATURE NHS 111 Assistant Contact Centre Manager for NEAS Gerardine Hope said: “The numerous benefits of this more streamlined system working across both the ambulance service and NHS 111 were immediately apparent. Through integrated systems, NEAS can provide a complete end-to-end service from a single point of contact. Using NHS Pathways in NHS 111 centres has allowed a wider variety of care options to be provided for patients and has received very positive feedback.”

South Western Ambulance Service NHS Foundation Trust (SWASFT) also uses NHS Pathways and has recently undertaken a pilot known as Dispatch on Disposition. Until now, ambulance services have dispatched a vehicle as soon as they have the location. In the Dispatch on Disposition pilot, ambulance services are given extra time (up to a maximum of 120 seconds) to make full use of the detailed clinical assessment by NHS Pathways.

Director of Operations at SWASFT Neil Le Chevalier said “The pilot has been very successful. One of the main benefits is that call handlers now have more time to understand the patient’s needs.

In situations where a patient is not breathing or unconscious, an ambulance is still dispatched immediately. Using NHS Pathways enables call handlers to thoroughly triage patients to ensure they receive the right care, in the right place, at the right time.”

Clinical safety and governance is central to NHS Pathways activity.

Over the years, NHS Pathways has been under constant review and direction by the clinical community via the independent National Clinical Governance Group. This group is chaired by the Royal College of General Practitioners and is made up of representatives from the College of Emergency Medicine (CEM), BMA and other organisations with an interest in and/or involved in the delivery of urgent and emergency care.

Dr Anil Gill, NHS Pathways Medical Director said: “NHS Pathways not only saves the NHS money and frees up resources in emergency departments, it contributes significantly to improving patient outcomes. By triaging calls and consistently assessing patient symptoms, NHS Pathways means that fewer ambulances are sent when they are not required. This also means that patients can be referred to a care provider closer to home such as a GP or specialist team such as a falls team or mental health team.

“Over the next six months, we will be developing NHS Pathways functionality even further. Early pilots are being developed to provide on line self-assessment using NHS Pathways, and trials in one hospital of a face to face version of NHS Pathways found that located primary care centre.

“We have also developed a new symptom activity dashboard which enables users to monitor episodes by symptom group, which should help surge managers and Clinical Commissioning Groups (CCG) to spot rising pressures in local areas based on the level of NHS 111/999 call activity.”

For more information about NHS Pathways visit:

AMBULANCE UK - OCTOBER

29 per cent of patients arriving at A&E could be referred to its co-

http://systems.hscic.gov.uk/pathways

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

NEWSLINE YAS

Air ambulance medics get new life saving kit New potentially life saving equipment has been fitted into both Yorkshire Air Ambulance aircraft.

The rapid response emergency service now carries the portable Zoll Autopulse, an automated, battery-powered chest compressor.

The equipment provides chest compressions to patients who are in cardiac arrest and will help

“It also frees them up to

be particularly beneficial when

Councillor Colin Dudley, Chief Fire

provide other treatments such

dealing with hypothermic and

Officer Andy Fry and members

as ventilations, administering

drowning cases. I’m sure it will be

of the Fire Authority to officially

medication or carrying out

a valuable asset for patient care.”

launch the co-responding scheme

compressions continue.

SCAS

New Co-Responder Partnership for Hungerford – The First Scheme of its Kind in Berkshire

Nic Morecroft, Lead Community

South Central Ambulance

and support in order to get it

Yorkshire Air Ambulance (YAA)

Service NHS Foundation Trust

up and running for the benefit

provides a service to five million

(SCAS) and Royal Berkshire

of the community. Having the

people across Yorkshire from its

Fire and Rescue Service

airbases at RAF Topcliffe, near

(RBFRS) are celebrating a new

Thirsk, and Nostell Priory, near

potentially lifesaving partnership

Wakefield.

which launched officially this

“The Autopulse also allows uninterrupted effective chest compressions to be carried out while a patient is being transferred to the aircraft and whilst in flight which is proven to improve patient outcomes and survival rates.”

trauma paramedics carrying out on-the-scene CPR.

and recognise its success to date.

defibrilation whilst chest

week in Hungerford which is the The independent charity has to

first of its kind in Berkshire.

raise £12,000 every day to keep In its first week the Autopulse

its two aircraft flying and has

Mark Ainsworth (Director of

was used three times by crews

so far flown over 6,200 people

Operations) Nic Morecroft (Lead

and Pete Vallance, Yorkshire Air

to major trauma centres across

Community Response Manager)

Ambulance Clinical Operations

the county.

Dave Hamer (CFR Training and

Manager, said: “By using the

Liaison Officer) and Steve Gooch

Autopulse paramedics and

Pete added: “The Zoll Autopulse

(Co-Responder Officer) from

doctors can reduce the impact of

will be used by YAA crews in

SCAS joined the Chairman of

fatigue from doing CPR.

medical cardiac arrests and will

Royal Berkshire Fire Authority,

Response Manager from South Central Ambulance Service said: “We are pleased to have embarked on this new partnership with Royal Berkshire Fire and Rescue Service and are incredibly grateful for their commitment

Co-Responder scheme in Hungerford will complement our already Community Responder Scheme and Public Accessible Defibrillators which are also in the area helping to save more lives.”

Co-Responders are retained firefighters from Hungerford Fire Station trained by SCAS to provide a ‘first response’ to specific medical emergencies where there is an immediate threat to life prior to an emergency ambulance arriving on scene.

This new Co-Responder scheme started running as a pilot on 22 June and aims to ensure that an appropriately trained person is on scene as quickly as possible providing that first response prior to the arrival on an ambulance.

In cases of cardiac arrest the chances of a person’s survival decrease by 14% for every minute that without early defibrillation.

The introduction of the CoResponders means that we are able to attend and provide basic lifesaving skills and support to our

AMBULANCE UK - OCTOBER

patients quicker than ever before.

Group Manager Neil Carter, who manages the co-responding scheme for RBFRS, said: “One of our strategic commitments is to seek opportunities to contribute to a broader safety, health and Yorkshire Air Ambulance paramedic Andrew Armitage (l) and Clinical Operations Manager Pete Vallance practice using the Zoll Autopulse

250 For more news visit: www.ambulanceukonline.com

wellbeing agenda. Working in partnership with South Central Ambulance Service to provide

NEWSLINE a co-responding scheme in

Quickly on scene was SECAmb

Hungerford is just one of the ways

paramedic Andy Blick who

we are achieving this and, by

was so impressed with Jake’s

doing so, we hope that we can

calmness that he was determined

help to save more lives.

Jake be praised for his bravery.

“As the firefighters only take part

Andy said: “Luckily Kris had

in Co-Responding when we have

come round somewhat when I

sufficient availability, it has no

arrived but he was still confused.

impact on our ability to provide

I said to him straight away that it

retained cover in Hungerford.

Since the scheme started in June, we have been averaging one call per day. It has been working so well that we are potentially looking to roll it out in other parts of the county in the future.”

VISIT US Stands 7 & 8 Life Connections Kettering Conference Centre 21–22 October

could have been far more serious for him and Jake’s actions could have saved his life which sounds dramatic but is very true.”

“When I arrived Jake was able to answer all my questions very well and he didn’t appear

SECAMB

Ambulance service recognition for Ashford youngster A six-year-old Kent boy has been praised by South East Coast Ambulance Service (SECAmb) for his brave actions when his dad suffered a hypoglycaemic collapse at their home in Kingsnorth, near Ashford, Kent.

When John Wesley Primary School pupil, Jake Selfridge, did not get a response from his dad on the morning of 31 March this year, he remembered what he had been taught and immediately went to his aid by phoning 999 and asking for someone to help.

Jake, his dad Kris Selfridge (34), mum Abbey and grandparents, Jim, Jane and Richard visited Ashford Make Ready Centre recently where Jake was

contrary, he was concerned that he needed to get to school! I know there are many adults out

Resuscitation and Emergency Care

there who would struggle to deal with the situation in such a calm manner.”

Jake and his family were given a tour of the Trust’s Ashford Make Ready Centre and Hazardous

A full range of products for use in an emergency and resuscitation situation.

Area Response Team (HART) base where all vehicles in the region are cleaned, stocked and maintained. HART Team Leader Steve Dowdall was honoured to present Jake with his well-deserved commendation certificate.

• • • • •

Bag-Valve-Mask (BVM) Pocket Resuscitation Mask Oxygen and Nitrous Oxide Delivery Systems Airway Management Oxygen Therapy

Although dad Kris doesn’t remember much of the emergency, luckily on this occasion he was recovered well and didn’t require hospital treatment. Mum Abbey said: “Kris was diagnosed with diabetes 12 years ago so Jake knows about his condition and he

Commendation certificate to thank

is aware when to call for help. I’m

him for his quick thinking and

so pleased he did the right thing

brave actions.

and we are very proud of him.”

Jake said: “I know when dad

Jake’s grandfather Richard

doesn’t respond that something’s

added: “The visit and certificate

wrong with him and that he needs

presentation made a little boy

help. I rang 999 and answered

very happy. We want to say a big

all the questions and gave my

thank you for all the great work

address.”

the ambulance service does.”

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AMBULANCE UK - OCTOBER

presented with a Chief Executive

to be distressed at all. On the

251 AMBULANCE_UK_09_15_resus.indd 1 For all your equipment needs visit: www.ambulanceservicesuppliers.com

07/09/2015 16:45

NEWSLINE 400 additional frontline staff,

funding will enable to the Trust

year’s Health Service Journal

including more than 40 in the

to further increase its frontline

(HSJ) awards.

Trust’s call centres. All these

staffing. Derek concludes: “It’s

will be deployed throughout

all well and good purchasing

The Trust has been shortlisted

the region (full breakdown of

additional ambulances but

in the Enhancing Care by

Communities in the North West

station vehicle allocation below)

people need to operate them,

Sharing Data and Information

will see a substantial increase

and have been located in areas

people are needed to answer the

category for its Intelligence

in the numbers of ambulances

where demand requires the

999 calls and staff are required

Based Information System,

and frontline ambulance staff,

additional resource.

to then dispatch the vehicles.

(IBIS), project.

NWAS

Ambulance boost for north west region

“We’re absolutely delighted

the North West Ambulance Service (NWAS) announced,

Derek adds; “This is a fantastic

to be able to say that, despite

following significant work

boost for the Trust and I’m sure

the financial challenges faced

between CCG Ambulance

for the staff who have been

by NHS trusts today, we are

Commissioners and the Trust.

working extremely hard to cope

swelling our ranks rather than

The announcement comes

with the additional demand.

reducing them.”

following the most challenging

Most of all, it is extremely good

year in the Trust’s history when

news for the people of the North

Allan Jude, Director of

last year, 2014-15, NWAS saw

West. “It is hugely important for

Ambulance Commissioning

an unprecedented increase

us to plan ahead and ensure we

at Blackpool CCG and Lead

of 8.1 per cent in ‘999’ calls

have the appropriate number

Ambulance Commissioner

and 11 per cent for the most

ready for when we need them

for the North West said: The

serious and life threatening

as new ambulances and staff

ambulance service is an integral

‘Red’ calls.

can’t just appear overnight. We

and key player in the urgent

have started the process for

and emergency health system.

While the Trust predicts growth

phasing these resources in over

“While last year they responded

in activity and plans ahead for

the coming months and hope to

to unprecedented levels of

the required resources, the rise,

have the full complement of new

demand, they also managed

which was seen nationally as

vehicles and staff in operation by

to significantly increase the

well as in the North West, was

the end of the year”.

number of patients who were successfully treated at home

substantially above what was

IBIS matches 999 calls to individual patients who have given permission for SECAmb to access their care plans.

Operators in the Trust’s Emergency Operations Centres notify attending 999 clinicians of the presence of a care plan.

After arriving on scene, ambulance crews calling a clinician in the centre receive important information on a patient’s ongoing care. In 2014/15 the system helped SECAmb clinicians avoid 7,300 patient transports to hospital, which equates to around 2,400 avoided admissions.

expected and unfortunately,

“We know that sending an

or within the community. By

did leave some patients waiting

ambulance to all patients is not

not transporting such patients

longer than they should have

the most appropriate course of

to hospitals they have relieved

done for an ambulance. Director

action, and our commitment to

some of the significant

of Operations, Derek Cartwright

providing alternative pathways of

pressures faced by emergency

“I’m delighted that our already

comments: “Based on these

care, we believe, is still the way

hospital department.”

award-winning IBIS project has

figures and planned trajectories

forward, however, the statistics

for the coming months, very

SECAmb Head of Clinical Development and Consultant Paramedic Andy Collen said:

been shortlisted for another

have shown that the numbers

With the levelling of activity, the

prestigious award. We’re very

open and constructive talks

of patients with life-threatening

Trust is currently achieving all

proud of the impact IBIS has

were held with Commissioners

conditions is rising and these

national targets, reporting a year

had on helping patient across

who fully understood the

are people who definitely do

to date performance (as at 9

our region efficiently receive the

challenge we faced. Since our

need an ambulance response.

August 2015) of 77.5 per cent for

treatment they need.”

establishment as a Trust in 2006,

These additional vehicles will be

we have seen a growth of circa

of tremendous benefit to them

two per cent per annum and

and the Trust and I look forward

there is no reason to believe that

to welcoming on board the new

will change.”

Red 1 and 76.2 per cent - the

AMBULANCE UK - OCTOBER

national target for these is set

The awards, in partnership

at 75 per cent. The Trust is also

with Celesio, will be held on

achieving the national 95 per

18 November at the Grosvenor

staff who will work on them.”

cent target for Category A calls.

House Hotel, London.

Commissioners have approved

Recruitment of staff has been

SECAMB

This year, over 600 unique

the provision of funds to

an important objective of the

enable NWAS to purchase more than 60 new ambulances,

year saw the Trust employ an

rapid response vehicles

additional 156 urgent care and

Trust shortlisted for prestigious national award

organisations submitted over

Trust for some time and last

and emergency vehicles for

emergency medical technicians,

community based paramedics,

146 paramedics and 114

South East Coast Ambulance

interviews to a specific judging

extend the operating hours of

control centre staff. However,

Service NHS Foundation

panel made up of senior and

some of our existing vehicles

with vacancies still needed to

Trust (SECAmb) has been

influential figures from the

and to recruit more than

be filled, the Commissioners’

shortlisted as a finalist in this

health sector.

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

1600 entries to the awards.

Alongside the other shortlisted organisations, SECAmb will now complete presentations and

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253

NEWSLINE YAS

New scheme introduced in rural areas of West Yorkshire People who dial 999 after having a heart attack could be treated by a firefighter under a new scheme introduced in rural areas of West Yorkshire.

Yorkshire Ambulance Service has teamed up with West Yorkshire Fire and Rescue Service to pilot a project that would see on-call firefighters living in more remote communities being deployed as “first responders” in life-threatening medical emergencies like cardiac arrests.

They will be expected to give first aid to patients until an ambulance arrives.

Fire service area manager Nick Smith said: “When someone collapses from cardiac arrest their chance of survival drops 10% every minute until resuscitation is started.

“It makes absolute sense for firefighters who live and work in these rural localities and who are already trained in resuscitation and the use of a defibrilator, to get to the scene as early as possible to start this vital care.

“The emergency first responders will aim to arrive as quickly as possible which should improve

The fire service said it had

cardiac arrest at the bed and

a donation of £500 to the East

already been successful in other

breakfast he runs in Whiting

of England Ambulance Service

areas and was introduced by

Street, Bury St Edmunds.

NHS Trust Charitable Fund, which

Humberside Fire and Rescue Service in 2013.

will be used to support volunteer But thanks to the quick response

community first responder groups.

of ambulance staff, they managed Firefighters being deployed

to get the 74-year-old’s heart

as first responders will have a

beating again after performing

separate uniform and will travel

cardiopulmonary resuscitation

in a marked car with blue lights,

(CPR) and shocking him once

not a fire engine. They will not

with a defibrillator.

transport patients to hospital.

Gordon was reunited with five of Dr David Macklin, executive

the East of England Ambulance

director of operations at the

Service NHS Trust (EEAST) staff

ambulance service, said: “We

that came to his aid after he

have a responsibility to ensure

collapsed.

we explore every available option to improve clinical outcomes for

Paramedic Dale Boustead arrived

our patients. The Emergency First

in under two minutes in a rapid

Responder scheme has already

response vehicle and ambulance

proven successful in Humberside

crew Neil Stead and Roger

and the East Riding.”

Stearne were on scene in under

He added: “We have a very clear

EEAST

100% of patients happy with ‘world class’ ambulance staff Frontline ambulance staff have been described as “faultless”, “exemplary” and “super kind” in the latest patient survey.

One hundred percent of respondents said they were very satisfied or satisfied with the care they had received from the ambulance staff.

four minutes followed by Duty

The people who handle the

Locality Officer Paul Goodchild.

999 calls in the region’s control

ambition to improve the survival

centres were also praised with

rate for those people who suffer a

After getting his heart restarted,

cardiac arrest in the community.

100% of respondents saying

the crews had to work out a way

We want to have world class

their call was very acceptable,

of getting Gordon down the steep

levels of survival from cardiac

acceptable or fairly acceptable.

stairs of his home, which resulted

arrest and the development of this

in the call to Edward Watt, Thomas

initiative is one more important

Comments from 96 respondents

Jones and Stephen Cole from the

element in saving more lives.

to the East of England Ambulance

Trust’s Hazardous Area Response

Service NHS Trust’s (EEAST) patient

Team (HART), who are specially

report included: “Staff were very polite

trained at working at height.

and professional”; “I have nothing

“West Yorkshire is already served by our award-winning community first

but praise for them (staff)”; “Excellent,

responder teams who do a fantastic

Gordon was placed on a stretcher

job as volunteers in their local areas.

cannot fault the service received”; “I

before being carefully pushed

The addition of emergency first

know once your (the trust’s) get to

through an open first floor window

responders will further strengthen

me I am safe and in great hands”;

on to a Suffolk Fire Rescue

“Simply put, outstanding”.

our response in these communities and the two models will work sideby-side to save more lives.”

Service aerial platform to lower him to ground level.

All respondents praised the ambulance staff they were in

He was taken to West Suffolk

contact with as very professional,

EEAST

Hospital before being transferred

and the same number said they were treated with dignity and

had a pacemaker fitted. A week

respect by crews.

the same way as they do now.

Suffolk man’s heartfelt thanks to life-savers

to Papworth Hospital where he

“This scheme provides an

A grandfather has said a heartfelt

“The first I remember was when

additional service to patients in

thank you to the ambulance

I woke up at Papworth. I cannot

rural communities, and is aimed

staff who saved his life after he

thank the ambulance staff enough

New trust chief executive, Robert

at helping to save more lives.”

collapsed at his Suffolk home.

for what they did for me. I am

Morton, who began his role on

lucky to be here,” he said.

Monday 24th August, said: “I am

the outcomes for patients and ultimately save lives.

“Ambulance crews will continue to AMBULANCE UK - OCTOBER

respond to these emergencies in

later, he returned home and has gone on to make a full recovery.

More than 98% said the service had exceeded or met their expectations.

The scheme will be piloted

Gordon Wagstaff cannot

in Featherstone, Ilkley and

remember anything of the drama

Gordon and his wife Wanda

results and see the excellent patient

Skelmanthorpe near Huddersfield.

that unfolded after he went into

were go grateful that they sent

care at the centre of the service.”

pleased to see these outstanding

254 For more news visit: www.ambulanceukonline.com

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255

NEWSLINE SECAMB

SECAmb identifies response post sites

Many of the Trust’s ambulance stations were built a long time ago since which the populations surrounding them

South East Coast Ambulance Service NHS Foundation Trust (SECAmb) Ambulance has submitted two planning applications for Ambulance Community Response Posts in Kent and will also begin responding from a new post in Chichester, West Sussex this week.

The Trust has identified the

have changed. SECAmb is

West Midlands Ambulance

its Make Ready programme,

Service paramedic Steve

which sees vehicles cleaned,

Watkins swapped patients for

maintained and stocked to

pupils on a return visit to Nepal

a standard specification at a

as he passed on expert advice

Make Ready Centre before

on how to cope in the early

crews respond from the

stages of an emergency.

network of response posts, better suited to meet patient

Steve, based in Stoke, originally

demand.

visited Nepal in April to help

SECAmb Clinical Services

patient demand and, subject

Manager Andy Burton said:

to planning permission, will

“We’ve worked hard to identify

lease accommodation at the

these two new possible

Transit Works in Power Station

locations for crews to respond

Road in Halfway and the Kent

from. The new response posts

Enterprise House in Eddington.

we develop provide modern facilities for our staff between

James Industrial Estate, Westhampnett Road.

SECAmb’s Ambulance Community Response Posts

call outs and it’s vital the locations reflect the demand placed upon us.”

Senior Operations Manager Lorna Stuart added: “I’m

of two devastating earthquakes struck the country but his mission on this occasion was very different.

A member of Search and Rescue Assistance in Disasters (SARAID), Steve’s return was arranged when the charity Global Action Nepal (GAN) asked for help and assistance in being able to react better whilst waiting for international aid should another disaster ever strike.

pleased the new response

Approximately 400 graduates

post for Chichester is now

from all over Nepal applied to

ready to be fully operational.

take part in the week-long training

It’s important that crews not

course, which was eventually

placed to respond to patient

only have somewhere suitable

whittled down to about 50. The

demand. The response posts

to rest but also that that place

idea now is that having gained

reduce the need for ambulance

is in the right place for our

as much knowledge as possible

crews to park on standby at the

patients and for us to respond

from Steve and his colleagues,

roadside – when they have no

to the rising number of 999

they can pass on the information

facilities to use between calls.

calls each year.”

to as many Nepalese residents as

(ACRPs) are strategicallyplaced across its Kent, Surrey and Sussex region to ensure ambulance crews are best

“It was a really rewarding experience to see the group absorbing the information, they were fantastic”

search for survivors when the first

Bay as suitable to meet current

crews will respond from St

Paramedic turns teacher on return visit to Nepal

in the process of rolling out

sites in Sheppey and Herne

In Chichester, ambulance

WMAS

possible across the course of the next five months.

Speaking about the trip, Steve AMBULANCE UK - OCTOBER

said: “It was a really rewarding experience to see the group absorbing the information, they

Some of the topics taught included medical advice, how to safely search rubble piles and disaster preparation.

“Each day we would start by doing a test on the information taught the previous day and it was good to see they were listening to what we were saying,” Steve added.

“I’d never done anything like this before so there was a bit of thinking on my feet at times but when I saw them working together in groups to try and answer questions or overcome problems they had been set, it was a great feeling.

“I gave all of the group my contact details and will be happy to help them however I can should they have any questions.

“We still have volunteers in the country so we’re getting feedback about how they are getting on and I hope to plan another visit before the end of the year so I can see for myself how they are progressing.

were fantastic.

“They certainly knew more at the end of the week than the beginning and hopefully now they will be able to pass on their new found knowledge to many more people.”

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

“There are clear signs of recovery in the country which is great to see and I just hope for the sake of the people that they can get themselves back on their feet without any future disasters to overcome.”

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257

NEWSLINE Jill’s husband Brian Maddison

such as a defibrillator and oxygen

There are currently eight

Everybody needs good neighbours

said: “She just looked delirious

cylinder, which were invaluable.”

CFRs located across the Over

A newly qualified volunteer

“I said to our daughter to run and

Hampson for help. Lynn assisted

Community First Responder

get Peter to come and help as we

Peter when he was using some

Alongside their day jobs and

had been talking only a few weeks

of the equipment and she also

everyday commitments CFRs

before that he had completed his

helped give information to the

provide local support for

CFR training. We had even joked

emergency call handler until the

with him at the time that we didn’t

paramedics arrived.

NWAS

(CFR) for the North West Ambulance Service (NWAS) has been hailed a hero after he helped save the life of his neighbour who was having a cardiac arrest.

Peter Blundell completed his CFR training with NWAS’ Over Wyre Team at the end May, but only a few weeks later he got his first major call out and it just so happened to be for Jill Maddison who lives across the road from him in Knott End. Jill recalls the incident: “Earlier in the day I had been to the doctors as I thought that I had a chest

Wyre area and a total of 1140

and when she went unconscious I immediately called 999.

want to be his first patients.”

Peter said: “There was a knock at the door at around 11.30 in the morning and it was the daughter of the family from across the road.

She was really upset and crying and said that her mum was dying.

So I just grabbed my gear and ran over the road.

Peter said: “When I got there Jill was having difficulty breathing and was unresponsive. It was nerve wracking as it was my first serious call and you don’t

infection and then got home and

expect it to be for someone that

took some medication. I felt a rise

you know but the adrenaline

of heat and sweat and felt dizzy

just kicked in and I went into

and said to my husband that I

Jill’s daughter had also called on

volunteers across the whole of

one of their other neighbours Lynn

the North West region.

Jill was taken to Blackpool Victoria hospital and is now making a full recovery: “I have been overwhelmed by the support from all our neighbours who have sent get well cards and flowers,” Jill said – “Yet, without Peter that day I wouldn’t be here. I would hate someone to go through what I did and not have received any help, so to us he is our absolute hero.”

Peter, a retired Police Officer, explains why he decided to volunteer as a CFR: “I wanted to try something different and

ambulance crews as they are sent to incidents at the same time as paramedics and often can get there first to start basic life support procedures such as CPR. This is vital, especially in rural areas, as for every minute someone does not receive treatment after suffering a cardiac arrest, their chances of survival decreases by 14 per cent.

The Trust is always looking for more people to volunteer to become Community First Responders and those who are interested don’t need to have had any previous first aid experience as full training

worthwhile as I had gained a lot

will be given. To find out more

automatic mode.

of job satisfaction from helping

information go to

ambulance crews in the various

www.nwas-responders.info.

sofa and that was the last thing

“Thankfully when you become a

incidents that I attended whilst I

that I remember.”

CFR you get specialist equipment,

didn’t feel well. I laid down on the

was in the police.

“Now that I am retired becoming a CFR has been a great thing to do to try and help make a difference to our community.”

Edward Shields, Team Leader for the Over Wyre CFR Team has also praised Peter’s calm actions: “This was only Peter’s second call and the first time he had been to somebody in a critical condition.

“The added pressure of the

AMBULANCE UK - OCTOBER

patient being somebody he knew must have been very stressful but

SECAMB

Heartfelt praise for ambulance staff from Sittingbourne resident A Sittingbourne man who suffered a heart attack and underwent a life-saving quadruple heart bypass operation thanked South East Coast Ambulance Service (SECamb) staff in person just three months after his emergency 999 call.

he did brilliantly to keep his cool

Clifford Earl, 59, was out

and put his training into action to

driving his car delivering

save the patient’s life. We’re all

leaflets when he began to feel

very pleased for them both.

unwell and stopped his car.

“Happy endings like this are rare

Clifford recalled: “I got to

but they are the reason we all do

the stage I was thinking if I

what we do.”

continue to drive I’d cause an

258 For more news visit: www.ambulanceukonline.com

NEWSLINE an ECG. As I had suspected,

Since the operation Clifford

well and to hear that he has an

by the side of the road and

it showed that Clifford had

has made an amazing recovery

excellent long-term prognosis

call 999 rather than try and get

suffered a heart attack which

and was given the go-ahead

is fantastic. It’s the first patient

home. When I spoke with the

I told him straight out and I

by his doctors to go on holiday

emergency call operator I could

to Singapore to celebrate his

I have met in my 11-year career

called for back-up to take him

tell from the way questions

to hospital.”

daughter’s engagement. He

accident and decided to stop

said: “Had I not co-operated

were being asked and the fact they kept me on the line that they were treating my call more seriously than I was expecting.”

At that moment, Paramedic, Alison Waterman was stationed close-by in a single response vehicle and was on scene within minutes. Alison said: “My first reaction was that a call coming from a person sitting in his car is unusual and must be out of the ordinary and when I first saw Clifford he was

Ambulance Technicians Niki Fox and Michele Harvey soon arrived and with Alison monitoring Clifford’s condition in the ambulance, he was rushed to Medway Maritime Hospital.

Investigations at the hospital revealed that two of Clifford’s arteries were blocked by as much as 97 per cent on one side and 92 per cent on the

with Alison, I would not be here today and I wouldn’t have seen my daughter getting engaged.

in the service and it has meant a lot to me to see first-hand how the job we do makes a difference. Niki, Michele and I were only too happy to be there

To be honest I didn’t feel the

for Clifford when he needed us.

excruciating pain I would have

That’s our job.”

expected from a heart attack but in the weeks before I had

Clifford added: “With hindsight

not been able to walk as fast

I should have listened to what

as normal and also thought

my body was telling me. I’m

that I had been suffering with

regularly exercising now in the

indigestion. I’m so grateful that

gym, I walk daily and watch

Alison insisted on checking me over thoroughly and in doing so she has saved my life.”

that I eat healthily. I’ve been discharged from St Thomas’s and I’m ready to continue my

very pale looking and sweaty. I

other. With his condition as

wanted to take an ECG straight

serious as this he was taken

Alison recently met with

away despite Clifford saying

from Medway Hospital to a

Clifford again in much better

that he ‘would be all right’. It

specialist unit in St Thomas’

circumstances at Sittingbourne

life. Thanks to Alison and her

took some strong persuading

Hospital in London where his

Ambulance Station. She said:

colleagues I got to hospital just

to get him to sit in the back

bypass operation was carried

“I can’t believe he’s been on

in time. I will be forever grateful

of my car so that I could take

out.

holiday already. He looks so

to them.”

work as a chimney sweep and enjoying my family and my

Simple to use, effective in performance and reliable in operation. The Eberspächer climate control system.

A world of CoMforT

Do you have anything you would like to add or include winwNewsline? w. e b ePlease r s p acontact c h e r.uscand o mlet –us 0know.

1425

480151

AMBULANCE UK - OCTOBER

A comfortable environment whatever the weather

259

NEWSLINE NWAS

NWAS & Lancashire Fire and Rescue Service introduce life-saving Community First Responder Scheme with fire crews

their communities to provide help

professionals with extensive

Derek Cartwright, North West

to patients while the ambulance is

experience of working in very

Ambulance Service Director of

en route. NWAS has a network of

difficult situations. All LFRS crews

Operations, said: “This is an

348 CFRs in Lancashire, including

carry defibrillators and oxygen,

extremely positive project and

28 CFRs from LFRS. The project

but those acting as CFRs will also

it’s great to work with LFRS on

was set to go live on 24 August.

be equipped with further pieces of

a scheme that will contribute to

equipment including suction units,

saving lives here in the North West.

The firefighters, fully trained as

pulse oximeters and bandages.

“NWAS receives, on average,

CFRs by NWAS, will save many lives by attending time critical

The fire crews will be sent to

260 calls for patients in life-

emergencies such as heart

serious and life-threatening medical

threatening situations every day

attacks and cardiac arrests. All

emergencies in and around

across Lancashire. This is our

Lancashire Fire and Rescue

the firefighters are skilled in first

Morecambe and Ormskirk. They

opportunity to use the fantastic

Service (LFRS) crews are

aid at work and are all trauma

will respond to NWAS Red 1 and

expertise LFRS has in dealing

to operate as life-saving

trained. The crews involved in the

Red 2 cases and be mobilised

with emergencies and get help to

Community First Responders

CFR project have been given an

simultaneously with an ambulance

patients as quickly as possible.

(CFR) as part of a new joint

additional 20 hours training. All

crew. NWAS dispatchers will page

initiative with North West

NWAS CFRs are trained in how

on duty fire officers and send them

“Rural and semi-rural towns like

Ambulance Service (NWAS).

to recognise a cardiac arrest,

to Red calls if they are closer to a

Morecambe and Ormskirk are

dealing with patients who are

patient than an ambulance when

a particular challenge for the

The six month pilot project,

fitting, administering oxygen and

the 999 call comes through. CFRs

ambulance service. If a patient

operating from Morecambe

dealing with an obstructive airway.

rendered potentially life-saving

suffers from a cardiac arrest for

aid 3,992 times in 2014/15 across

example, their chance of survival

and Ormskirk Fire Stations, is an extension of NWAS’ highly

Unlike other CFRs, fire crews

Lancashire. Clinical evidence shows

reduces by around 10% for every

successful CFR scheme. CFRs

have the added advantage of

that patients in life-threatening

minute treatment is delayed – this

are volunteers who support the

being able to respond to patients

situations who receive rapid

scheme will provide additional

Trust by responding to serious

using blue lights, ensuring a

intervention have a significantly

protection for our patients in more

and life-threatening incidents in

speedy response, and are all

better chance of survival.

sparsely populated areas. I would

on et re el.n mo erj ad at Re w.w ww More information

AMBULANCE UK - OCTOBER

Professional burn care – around the world

260 For more news visit: www.ambulanceukonline.com

NEWSLINE like to thank the LFRS and the fire

South Molton home and resolving

was geared to anti-tank warfare

he has significant experience of

crews in both Morecambe and

that one day he would be a

so it was useful having someone

the night operations that DAA will

Ormskirk for their contribution in

helicopter pilot.

with experience of tanks on the

be undertaking in the Autumn of

ground, flying against them.

2016.”

getting the scheme underway and welcome them to our CFR

He achieved his ambition by

network here in Lancashire.”

learning to fly in a 23 year army

“Army flying is the perfect proving

Richie Tate added: “The job

career and has now landed his

ground for air ambulance

comes with many challenges.

Justin Johnston, Deputy Chief

dream job as a pilot with the

operations. In both scenarios

You don’t know what to expect but

Fire Officer Lancashire Fire and

Devon Air Ambulance flying the

you never really know what

have to respond. Every day is a

Rescue Service, said: “It makes

Charity’s EC135 helicopter out

terrain you might have to land

school day with something new

absolute sense for our firefighters

of its Exeter International Airport

on. Both require expert handling

to learn. The DAA aircrew are a

to become Community First

airbase.

often in tight situations and quick

fantastic team and I’m learning

decision-making.”

my part in it not just as the driver

Responders (CFRs) in Lancashire,

but as the paramedics’ eyes and

joining the ranks of other CFRs

The 43 year-old recounts how

in the county, supporting NWAS

he always knew he would be a

After army service, Richie flew as

ears on the ground. I also need

paramedics and saving lives.

pilot and mapped out his career

a police pilot at Middlemoor, the

to know what the equipment they

accordingly from a very young

airbase shared by the National

are using is and does in order to

“As CFRs they will bring a wealth

age. His ‘dream and aspiration’

Police Air Service and DAAT and

act as an additional pair of hands

of existing experience, such

to fly as an air ambulance pilot

“awaited on a vacancy next door”.

fetching and carrying at the scene

as getting to an emergency by

was intensified when his mother

The opportunity finally arose with

of a mission. Devon is where

fire engine under ‘blues and

was airlifted by DAA after a heart

the retirement of long-standing

I grew up and it’s an amazing

twos’ and working alongside

attack in late 2013.

DAAT pilot Rob Mackie and after a

place with every challenging

stringent interview, his dream had

scenario and difficult places to

come true.

land, from coastal and clifftop to

paramedics to deal with the trauma of casualties caught up

Richie joined the Household

in emergency incidents. As CFRs

Cavalry straight from school

at a medical emergency they will

before transferring to the Army

Ian Payne, Devon Air Ambulance

got a range of micro-climates to

bring skills and resources to the

Air Corps where he flew Lynx and

Trust’s (DAAT) Flight Operations

contend with.

incident additional to their existing

Dauphin helicopters and became

Director, said: “We are delighted

skills of CPR, use of defibrillators

involved in counter terrorism

to welcome Richie on board. His

“I have 17 years of active flying

and first aid.”

activities. He saw active service

flying experience in the Army

left before I retire and I intend to

on seven tours of Iraq and two to

and the Police is the perfect

spend every one of them with

Afghanistan.

background for a DAA pilot. The

DAAT.”

“Our pilot in Ormskirk and

moorland and farmland – it’s even

training is similar, he had already

Morecambe is an exciting development, introducing a

He said: “I went from horses to

flown EC135s and EC145s with

Richie Tate lives in Plymtree near

service that we are confident

tanks to helicopters. In those

the Police and has experience of

Cullompton with his wife Caroline

will save lives and giving us

days army helicopter training

attending casualties. Importantly,

and six year-old son, Arthur.

the opportunity to develop and refine our CFR capability before we consider extending our involvement in the NWAS network of CFRs in other areas.”

To ensure LFRS resources are used first and foremost for fires, crews will be redirected should such an incident occur whilst they are en route to a medical call.

Air Ambulance role is a lifetime ambition As a child, Richie Tate recalls seeing helicopters delivering hay

AMBULANCE UK - OCTOBER

Pilot Richie lands his dream job

to snowbound cattle near his

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

NEWSLINE SWAS

Innovation in Collaborative Educational Partnerships Over the past two years the Dept. of Allied Health Professions at the University of the West of England has been working closely with the South Western Ambulance Service NHS Foundation Trust (SWASfT) to develop education programmes for Paramedics.

The national shortage of Paramedics, combined with a widening scope of practice in the role of a Paramedic, has led to a rapid growth in requirement for education and training opportunities.

Dr Marc Griffiths, who was Head of Department for DAHP between 2011 and 2014, worked with Gary Smart (Paramedic Curriculum Lead), and Dr Fiona Lawrence (Faculty Director CPD & Partnerships) to ensure that the Department was in a strong position to develop education programmes to help address the increasing requirements.

They worked with Emma Wood (Executive Director of HR & OD), Jim Petter (Head of Education & Professional Development) and Kerry Crawley (Clinical Training Manager) from SWASfT, to determine the areas of priority and, as a result, several innovative programmes and modules have been developed.

AMBULANCE UK - OCTOBER

Emma Wood said ‘Through partnership working we have been able to advance the careers and skills of our front line staff. We have explored new and exciting innovations in hear and treat practice and developed fast track programmes to upskill our staff in clinical practice. Over 150 staff have benefited from our partnership with UWE and I’m delighted to see the real benefits collaboration has to offer to patient care’.

In order to enhance the education experience for the students, a strong collaborative partnership has developed between DAHP and SWASfT. This has resulted in a number of beneficial initiatives for both parties, including development of pioneering new CPD modules related to clinical need, secondment of several members of clinical teaching staff from SWASfT to UWE; the provision of a frontline ambulance for simulation use; availability of teaching rooms for SWASfT usage.

This relationship has led to flexible education solutions for the paramedic workforce. Having the largest NHS Ambulance Trust in England on-board as a strategic partner is vital for the Faculty and University, and promotes the evolving nature of how new income streams are being created and secured.

The new Acting Head of Department, Dr Viv Gibbs, said ‘This collaborative partnership has resulted in a close working relationship between UWE and SWASfT, which has undoubtedly led to development of innovative new ways of delivering and enhancing Paramedic education.

As a result we are seeing an improvement in the education experience for the students, and an ability to respond more quickly to changing workforce needs’.

North West Ambulance Service paramedic Paul Jones jumped out of his own carriage and ran along the platform to where the patient was to find another passenger trying CPR on the man.

After quickly assessing the choking man’s condition, he used abdominal thrusts, back slaps, finger sweeps and manipulated the man’s throat until a large chunk of food came out; this allowed the passenger to breathe slightly.

At this point an ambulance crew and rapid response vehicle arrived, three minutes after the 999 call. The three West Midlands Ambulance Service staff worked with Mr Jones to continue treating the man, clearing his throat completely and giving him oxygen.

The man, who was in his 50s, was then taken off the train and driven by ambulance on blue lights the short distance to County Hospital, Stafford.

Mr Jones, said: “It wasn’t an easy job working in the confines of the carriage, but working with the West Midlands staff, we were able to free all of the obstruction and the man had regained consciousness and was definitely looking better as he left on the ambulance. This was a job well done by everyone who helped.”

Off duty para helps save choking train passenger

A West Midlands Ambulance Service spokesman added: “There is no doubt that the early intervention of Mr Jones and the other people in the carriage has given this man the best possible chance of survival.

The quick actions of an off duty paramedic have helped save the life of a passenger who was choking whilst on board a train.

“Whilst it is early days, he was well enough to give ambulance staff a hug and thank them for their help before the crew left the hospital.”

An emergency call was put out on the tannoy of the Virgin Trains Liverpool to London service as it stopped at Stafford.

The man, who was in a first class carriage, had stopped breathing and was becoming hypoxic from a lack of oxygen after eating a sandwich.

EEAST

Norfolk grandmother reunited with lifesavers Angela Page cannot remember much of Saturday 11th July.

262 For more news visit: www.ambulanceukonline.com

However, she is eternally grateful to the staff from the East of England Ambulance Service NHS Trust (EEAST) who rushed to her aid when she started experiencing chest pain.

The 69-year-old was reunited on 11th September with the four staff that helped save her live after her heart stopped and she went into cardiac arrest.

Her husband Terry phoned 999 just after 7.30am after Angela went pale and collapsed on the bed at their home in King’s Lynn.

Seven minutes later, Paramedic Mick Spratt and Emergency Care Assistant Carole Taylor arrived – just before she went into cardiac arrest.

Thankfully, they managed to quickly resuscitate Angela. And following the arrival of Emergency Medical Technician Alix Potter and Student Paramedic Luke Molyneux, she was rushed to the Norfolk and Norwich University Hospital where she was immediately taken into theatre to have a blood clot removed and stent fitted.

Four days after the drama, she was well enough to be discharged from hospital.

Angela said: “We had been to the allotment the day before and went to bed on the Friday night perfectly alright. The next morning I came out of the bathroom and I started sweating and I could not walk properly and fell on the bed. I still cannot believe what happened.

“When I got home from the hospital, I was on top of the world but as the days went on I started bursting into tears and it has been hard to come to terms with. When you sit back you think I would not be here if it wasn’t for what they did for me. It is so nice to see them again.”

NEWSLINE continue to fundraise towards our

London Buys 2nd Helicopter for London’s Air Ambulance • London’s Air Ambulance has acquired a second emergency medical helicopter, a MD902 Explorer • It has been registered G-LNDN and is expected to

ultimate target and ask everyone to help in any way they can.

Anyone can donate, either online at yourhelicopter.london, or by texting HELICOPTER to 70800 to donate £5.”

Through the acquisition of a second helicopter and by

Photo taken by Jon Le Ray

extending its daylight flying hours in the summer months, the charity

by aircraft. This year, the charity

history and, as a result, it was

estimates it will be able to reach

flew longer hours in the summer

able to reach, and treat, a further

a further 400 patients per year

months for the first time in its

67 patients by air.

be operational early 2016 • The fundraising total to date of its ‘Your London, Your Helicopter’ campaign is just over £2 million • This is thanks to the generosity of the people and organisations in London • Donations from organisations, companies and the public are still needed to reach the £6 million target to keep it in the

The iPAD SP2

A new class of defibrillator

air for five years • People can donate online

A lightweight, compact defibrillator that delivers greater functionality than just an AED when it is needed most.

at yourhelicopter.london, or by texting HELICOPTER to 70800 to donate £5.

• The largest pledge to date is from the London Freemasons, who have committed to donate £2 million Graham Hodgkin, Chief Executive Officer at London’s Air Ambulance, said: “We are absolutely thrilled to have now completed the acquisition of helicopter. While more money still needs to be raised and there is still more work to do to get the aircraft ready for UK HEMS operations, this is a truly exciting development for London and the biggest step-change in our

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service resilience in the charity’s history. Thank you to all those who have already contributed. We will

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AMBULANCE UK - OCTOBER

our second MD902 Explorer

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

NEWSLINE “The charity has been raising

our recent September trip,

Charity trip for trust staff

funds to build a new HIV

where we visited Melbourne

centre. HIV is very prevalent

and Sydney, we made 149

in Malawi and this new centre

job offers. Between now and

is essential to be able to

March next year, we will have

Two members of staff from

focus on providing specialist

another 170 joiners starting.

South Western Ambulance

care and treatment for the

We are offering Australians

Service NHS Foundation

thousands affected.

the chance to work for

SWASFT

one of the world’s busiest

Trust (SWASFT) will be heading to Africa to provide

“Joel and I will be getting

ambulance services which is

first aid and treatment for

involved with all the services

an incredible opportunity for

people living in a remote

the clinic offers, working on a

anyone in this field.”

part of Malawi.

full-time basis for six months from September.”

at Malmesbury) and Joel Brace (Lead Paramedic at Cirencester) are setting off for Cape Maclear in the south of Malawi where they will be working with the Billy Riordan Memorial Trust for six months. The pair will be working in a small, charity funded, rural clinic set up in remembrance of Billy Riordan. The clinic provides medical aid and facilities to over 15,000 people from Cape Maclear and the surrounding area.

The clinic was set up in 2004 in memory of Billy who sadly lost his life at Lake Malawi in February 1999.

The clinic includes a primary care facility that is open 24 hours a day seven days a

Australian High Commission Welcomes Australian Paramedic Recruits to London

Marathon and Notting Hill

The Australian High

a car, motorbike, bicycle

Commission hosted an event to formally welcome Australian paramedics who have been recruited to come and work for the

AMBULANCE UK - OCTOBER

Tel/Fax : 01268 833666

Carnival, which is a great opportunity for Australians, as well as paramedics in the UK. Coming to work with the London Ambulance Service opens up many opportunities for paramedics, in addition to frontline ambulance work.

These include working on and helicopter, as well as specialist teams trained to work in hazardous or potentially dangerous environments.

London Ambulance Service.

EEAST

The High Commissioner Alexander Downer and Director of Operations Jason Killens spoke at the event and welcomed the new recruits to the UK.

week. There is also a 12 bed

30 Brooklyn Drive Rayleigh, Essex SS6 9LW

London hosts world famous events such as the London

Harriet Illston (Paramedic

inpatient unit that can keep

More paramedics are needed

patients admitted for up to

in London due to year-on-

48 hours when they are either

year increases in demand

discharged or transferred to

and a national shortage of

the main hospital which is a

paramedics make it difficult to

two hour drive away.

recruit within the UK.

There are also various

Director of Operations Jason

outreach programmes

Killens said “We have had

offering maternity services,

great success in recruiting

feeding programmes and

Australians to work for us.

malaria prevention schemes.

We turned to Australia as the skills and training of

Speaking about the trip

their front line closely match

Harriet said: “They (the clinic)

ours. We have 190 Australian

have an ambulance, I say the

paramedics who are trained

word very loosely, which they

and already treating patients

use to transfer people.

on the streets of London. On

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

Cancer patient’s thanks to Peterborough paramedic When Tracey Goodacre first met paramedic Claire Squires, she was at her lowest ebb.

After weeks of experiencing severe pain, weakness and confusion without a diagnosis, the 50-year-old was against being admitted to hospital.

However, after listening to her concerns and gaining her trust, Claire was able to convince Tracey that she needed to be taken back to A&E, which led to doctors finding the source of her pain – bone cancer.

NEWSLINE The pair were reunited,where Tracey thanked the senior paramedic who gave her the faith to fight on.

The mother-of-two from Eye, near Peterborough, had been suffering from headaches and back pain since March 2014, but doctors had been unable to find out what was wrong with her.

When Claire rushed to her home in a rapid response vehicle on 15th May 2014, the patient was reluctant to go back to A&E after spending a week in hospital with no diagnosis.

Tracey said: “I had a lot of paramedics coming out to me before this, but every time I got to A&E I was sent home.

“Claire was the only one that listened and got me sorted out.

It was such a relief when I got a diagnosis, even though it was so late finding it.”

An MRI scan at Peterborough City Hospital revealed that Tracey had bone cancer and on 17th May, surgeons removed the tumour from her spine at Addenbrooke’s Hospital. Since her diagnosis, she has had chemotherapy, radiotherapy and stem cell therapy.

Tracey added: “I probably would not be here now if I had not gone to hospital. The cancer is treatable, but not curable. If I get another three or five years it is better than not being here at all. I am so grateful for that. I’m here and that is the main thing and it is important to say thank you,” she said.

SECAMB

Sussex dad reunited with ambulance crews For a father of four, a night of celebration at his daughter’s college Leavers’ Ball became even more memorable for all the wrong reasons.

During the evening Mike Champain, from Ardingly, West Sussex, suffered a cardiac arrest but decisive action by the South East Coast Ambulance NHS Foundation Trust crews, Mike was able to thank them personally at an emotional reunion at Crawley Ambulance Station recently.

“So many people were in the right place at the right time that night and I am so grateful to them all for their support, care and expertise; college staff, ambulance staff and surgeons,” said Mike.

Mike was with his wife Kate and his eldest daughter Caitlin at the Ardingly College Leavers’ Ball in July, when he started to feel unwell and an ambulance was called.

Technician Alison Smith was first to arrive on scene, closely followed by ambulance crew Sam McCreesh (Paramedic) and Jade Paul (Technician).

It was while they were carrying out

“During the dinner I left the

an assessment that Mike suffered

marquee as I was not feeling well,

the first of four cardiac arrests.

I was looked after by college staff

He was shocked 11 times with a

who immediately called the college

defibrillator as the crew battled to get

doctor and then for an ambulance.

his heart back into a normal rhythm.

Both my arms were aching and I had pins and needles in both

With Mike’s condition unstable,

hands and chest pain. I think I

the team met up with critical care

knew very well what was going

paramedic team Stuart Plumbley

to happen and was absolutely

and Chris Roots while en route to

terrified of the outcome.

the Royal Sussex County Hospital.

They provided further treatment as

“Fortunately the ambulance was

Mike arrested again.

called quickly and two physicians from Brighton Hospital, who were

“They are truly brilliant people and

attending the ball as guests,

there is no doubt their skill and

recognised what was happening

persistence ensured I got to the

and were able to help calm me

operating theatre in Brighton, where

and let the ambulance crews

the surgeons could complete the

know what to expect.

task of saving me,” said Mike.

“I can’t thank them enough for The 51-year-old, who is managing

what they did for me that evening.

director of his own business,

It’s amazing to be given a second

had two stents put in his arteries

chance. I’m now feeling much

during a 45-minute procedure

better and have started back at

which restored a good flow of

work. The whole family is hugely

blood to the heart.

grateful.”

Mike added: “It had been an

Paramedic and Clinical Team

emotionally-charged day marking

Leader, Chris Roots said: “It is

the end of both Caitlin and son

great to be able to meet up again

Callum’s time at the college.

with Mike and Kate and to see

It was going to be a day to

him doing so well. It gives us a

remember for us all and that is

tremendous boost when we get

certainly how it turned out.

such a fantastic outcome.”

AMBULANCE UK - OCTOBER

Claire, who has worked for the East of England Ambulance Service NHS Trust for eight years and is based at Peterborough ambulance station, said it was lovely to meet Tracey again.

“Tracey’s story reminds us paramedics to always keep an open mind with our treatment and working diagnosis as we need to remember that not everyone will present as a text book case. Most of all we must always listen to our patients and their families,” she said.

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

NEWSLINE circumstances they were life

Robert Maxfield, The PGA’s

consultation event for local

critical helicopter emergency

joint chief operating officer,

residents and businesses to

medical air ambulance

commented: “While Midlands

find out about its proposed

missions, and taking in account

Air Ambulance Charity’s

new home to base the charity’s

the often remote location of

statistic is startling, it is sadly

helicopter, aircrew and office

golf courses, it is imperative

reflective of the situation across

staff.

we reach, treat and transfer

the country, which is why we

patients to hospital quickly,

launched a campaign prior to

The charity has been searching

as when someone suffers with

Ambulance Charity has

Christmas last year, whereby

for a site for its new home for over

a cardiac arrest for example,

a year and its preferred location

revealed a startling new

we want to see a defibrillator in

every minute counts.”

every golf club in the UK.

is on land at Outmarsh Farm,

all air ambulance missions

To help raise awareness of the

of Hampton Park West Industrial

undertaken by the service are

“We are also keen to support the

importance of the Midlands

Estate).

from golf courses.

life-saving work of the Midlands

Air Ambulance Charity among

Air Ambulance, which has

MAA

Midlands Air Ambulance Charity Goes A ‘Fairway’ For Golfers The team at Midlands Air

statistic – five per cent of

Semington, (immediately south

golfers, the charity has recently

undoubtedly saved countless lives

The 12.6 acre site is centrally

“We tended to 84 people on

partnered with The Professional

located which would enable the

golf courses in 2014, that’s

Golfers’ Association (PGA).

on golf courses in the region.”

helicopter to reach all parts of

one person every four days,” highlights Becky Tinsley, air

In recent years The PGA has

operations manager for the

taken an active role in health and

Midlands Air Ambulance

safety at golf clubs including

Charity.

playing a key role in supporting the Bernard Gallacher

WAA

Consultation event held for Wiltshire Air Ambulance’s proposed new base

Wiltshire within 11 minutes.

As Melksham does not have an ambulance station, the charity believes that WAA would provide enhanced medical cover for

She adds: “A number of people

Defibrillator Campaign which

we airlift from golf courses

aims to install a life-saving AED

suffer with cardiac arrests, heart

(automated external defibrillator)

WILTSHIRE Air Ambulance

medical skills and as well as

attacks or strokes. In some

in every club in the country.

(WAA) held a public

responding in the helicopter,

the area. WAA’s Critical Care Paramedics have advanced

AMBULANCE UK - OCTOBER

266 For more news visit: www.ambulanceukonline.com

NEWSLINE they use a Rapid Response

Currently the helicopter and

Community First Responders,

Vehicle (car) to attend medical

aircrew are based at a hangar at

and the pub is now equipped

emergencies including road

Wiltshire Police Headquarters in

with a defibrillator.

traffic collisions, heart attacks

Devizes, while the charity team is

and strokes.

based at offices at Porte Marsh

Terry, who was a paramedic for

Industrial Estate, Calne. The

17 years, said: “Raising money

lease on the hangar runs out on

for the defibrillator all came about

December 31 2017 and the lease

after one of our regulars had a

on the offices runs out at the end

heart attack in the High Street

At a public consultation event, held at Trowbridge Rugby Club, people had the opportunity to talk with the project team and architects and give their feedback to the proposals. A total of 125 people attended.

of January 2018.

last year.”

The benefit of owning its own land would mean the charity has full control of its future and not

Mandy Clarke, Chairman of Wiltshire Air Ambulance, said: “We would like to thank everyone who attended our public consultation event to find out about our new home plans.

The feedback we receive is really important to us as want to work

subject to the uncertainty that renting can bring.

Bideford pub raised thousands of pounds A Bideford pub with community at its heart has raised

in partnership with local people,

thousands of pounds for charity

be good neighbours and develop

over more than a decade.

plans that people of Wiltshire can be proud of.”

Terry England, whose boyhood dream was to run a pub, has

All the information from the

been landlord at the First In Last

public consultation event is

Out, in Clovelly Road, for 15

on the charity’s website www.

years.

The man’s heart stopped but because a defibrillator was onhand at a nearby dentist – his life was saved.

“So we wanted to raise money for a defibrillator to be here in the pub and within two weeks our regulars had dug deep into their pockets and the money was raised,” he added.

The couple are being put forward for an award for their fundraising efforts, and for what they have done to help the Bideford community.

Terry, 58, said he has always wanted to run a pub, this pub in

wiltshireairambulance.co.uk/ Terry, along with his wife Carol,

particular as it was one of the first

and the pub’s cat, Melly, who

pubs he ever had a drink in, and

After the charity has assessed the

“rules the roost”, said charity was

had always been his local.

feedback it receives, it anticipates

at the heart of what they did.

who-we-are/about-us/new-home

submitting an outline planning application for the site in late Autumn 2015.

Carol, 58, said the pub was a “real The couple have raised

community pub” – a proper “local”,

thousands over the years,

family-friendly pub, where people

most recently raising money for

can feel safe and “have a laugh”.

“The charity’s new home would cost in the region of £3 million to build and equip. A private

WMAS

WMAS shortlisted in top awards West Midlands Ambulance Service (WMAS) has been shortlisted in not one but two categorises at this year’s prestigious Health Service Journal HSJ Awards.

The shortlist has been announced and WMAS is the leading ambulance service participating in the award ceremony.

For their combined work on the acclaimed mental health response unit in Birmingham, WMAS together with partners West Midlands Police and Birmingham and Solihull Mental Health Foundation Trust have been shortlisted in the ‘Enhancing Care by Sharing Data and Information’ category.

The Trust’s Organisational Development team together with Coventry University will also be at the award ceremony hoping to be successful in the category of ‘Improving Outcomes through Learning and Development’. The programme, which was started in the Trust is now being rolled out across all NHS organisations in the Region in a programme with Health Education West Midlands.

WMAS will face stern completion with ten other organisations shortlisted, including another ambulance trust and air ambulance provider.

benefactor, who wishes to remain 75% of this amount to pay for the building cost, which we are extremely grateful for. We will need to raise the remainder, amounting to some £750,000, to fit out and equip the building.

In time, we will launch a Capital Appeal to raise this money as we want the people of Wiltshire to feel very much involved in our new home project,” said David Philpott WAA Chief Executive.

Terry, Carol and Melly

For more information about the HSJ Awards, please see: https://awards.hsj.co.uk/

AMBULANCE UK - OCTOBER

WMAS Chief Executive Anthony Marsh, said: “I am extremely proud that the Trust is to be a finalist in two categories at these national awards. I am delighted that we can share success with our partner organisations and further develop these initiatives to ultimately provide the very best healthcare to patients.”

anonymous, has agreed to fund

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

NEWSLINE YAS

£1m boost for Yorkshire Air Ambulance new helicopter The Chancellor George Osborne has announced a £1 million cash injection towards a new state-of-the-art helicopter for Yorkshire Air Ambulance which will be taking to the skies next year.

helicopter, which should arrive by September 2016 and will fly out of Nostell.

Yorkshire Air Ambulance Chairman Peter Sunderland, said: “We remain totally dependent on the generosity of the fantastic people of Yorkshire.

“However, the phenomenal donation we have received today from The Chancellor of the Exchequer, will allow us to work towards fulfilling our mission to provide Yorkshire with the highest

Chancellor George Osbourne meets Yorkshire Air Ambulance paramedics James Stubley (l) and Paul Holmes during his visit to the charity’s air base at Nostell Priory

Mr Osbourne made the funding

quality rapid response emergency

pledge during a visit to Yorkshire

service – and I express my

Air Ambulance’s s air base at

sincere thanks for this exceptional

Nostell Priory, near Wakefield,

contribution.

operating and maintenance costs.

funding a new helicopter for the

with longstanding charity

“In planning for the future we have

The Airbus H145 is night capable

Yorkshire Air Ambulance.

supporter and cricketing legend

been building up our reserves

and is used by military, police and

Geoffrey Boycott who asked the

to ensure we can continue to

air rescue services around the

“It’s a brilliant charity that saves

Government for help.

develop and expand our life

world – including the Metropolitan

lives across Yorkshire, a county

saving service by having the most

Police.

very much at the heart of the

Following the completion of a

up-to-date aircraft.

detailed review of their evolving

Northern Powerhouse.

It has a larger cabin and provides

needs for service delivery over

“G-SASH has been a familiar

paramedics with a much more

“This funding - and the £10 million

the next 25 years, Yorkshire Air

sight over the skies of Yorkshire

modern medical fit-out to treat

the government has donated

Ambulance has now placed

for the last 14 years. But in recent

and transport often critically

to Air Ambulances across the

an order for a latest generation

years, maintenance costs have

injured patients.

country in the past year - comes

Airbus H145 helicopter to replace

escalated and spare parts have

the older of its two aircraft,

become increasingly difficult

Mr Sunderland added: “Replacing

it’s only right that funds from

G-SASH.

to find. Now is the right time to

G-SASH will ensure the

those who have demonstrated the

replace her.”

continuation of a state-of-the-art

worst values should go to those,

air ambulance service for the

like the dedicated and skilled

The £1 million Government

from fines levied on banks, and

donation, from fines levied on

The new helicopter offers

people of Yorkshire for the next 25

air ambulance crews and their

banks, will contribute substantially

exceptional flight performance

years.”

supporters who demonstrate the

towards the new £5.7 million

and will have significantly lower

best of British values on a daily Yorkshire Air Ambulance is a rapid

basis.”

response emergency service that serves five million people across Yorkshire, operating from air bases at Nostell and RAF Topcliffe, near Thirsk.

It attends more than 1,000 AMBULANCE UK - OCTOBER

incidents a year, on average, and

SCAS

Lady Cumberlege visits Labour Line at South Central Ambulance Service

the charity needs to raise £12,000 every single day to keep its two

On Tuesday 18 August 2015

existing helicopters maintained

as part of her visit to maternity

and flying.

services in the South, Lady Cumberlege visited the award

Chancellor George Osbourne meets Yorkshire Air Ambulance chairman Peter Sunderland and cricketing legend Geoff Boycott during his visit to the rapid response emergency service

George Osborne, Chancellor of

winning Labour Line at South

the Exchequer, said: “Geoffrey

Central Ambulance Service

Boycott asked the government

NHS Foundation Trust (SCAS)

for support, and I am delighted

which is run in partnership

to able to donate £1m towards

with Hampshire Hospitals

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

NEWSLINE NHS Foundation Trust. Whilst

ambulance staff in emergency

visiting the centre she spent

situations and that offered in

time finding out about how

the community setting. When

the award winning service is

women or their partners call

delivered, had the chance to

the line they speak to an

speak to the midwives and

experienced midwife who is

see the Labour Line in action.

able to discuss birth plans, provide support and advice

The Labour Line is situated

and make all the necessary

at the ambulance Emergency

arrangements for their birth.

Operations Centre (EOC) in Hampshire and is staffed by

Tony Peters, Head of EOC

qualified midwives who are

said “We were very privileged

available 24 hours a day on the

to receive a visit from Lady

phone to provide support and

Cumberlege on Tuesday and

guidance to expectant mothers

it was a great opportunity

reassurance for the caller that

and their families.

to showcase the proactive

they are speaking to an expert

partnership which has had

who knows exactly the right

The service, the first of its kind

a very positive impact on

in the country, was launched

expectant mothers and their

21 months ago in partnership

care. Should we receive

with Hampshire Hospitals

calls relating to pregnancy or

NHS Foundation Trust. The

women in labour that come in

Labour Line provides additional

via our own NHS111 or 999

support, advice and guidance

services, we can pass these

to have more time to respond

to people over and above

if appropriate directly to the

to other non-pregnancy related

the clinical care and skills

experienced midwives on the

emergency and non-emergency

already being delivered by

Labour Line. This provides

calls that come in.”

questions to ask and can offer on the most appropriate and safe response. It allows our emergency operations centre staff, and frontline paramedics,

“We were very privileged to receive a visit from Lady Cumberlege and it was a great opportunity to showcase the proactive partnership which has had a very positive impact on expectant mothers and their care.”

XPS - expandable patient surface - is adjustable with 7 locking positions and a wider mattress, designed with patient comfort in mind.

AMBULANCE UK - OCTOBER

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

NEWSLINE WMAS

Formation of new national charity for the ambulance services A leading figure in the UK Emergency Services has heralded the formation of a new national charity for the ambulance services as “meeting a very definite need” in the industry.

Sir Graham Meldrum, Chair of the West Midlands Ambulance Service NHS Foundation (WMAS) Trust for almost ten years, met staff of TASC, The Ambulance Services Charity, on a visit to its

ambulance service families in times

from small beginnings into

“I think TASC is meeting a very

of severe difficulty or bereavement.

a large organisation which

definite need because ambulance

provides support and grants

service personnel are facing

Before joining WMAS, Sir Graham

for firefighters and their families

increasing challenges and

was involved in the fire service

which is a similar mission to

significant demands and this

for over 50 years which included

TASC except their focus is on

impacts in the same way as in

being HM Chief Inspector of Fire

the ambulance service.

other emergency services.

and Chief Fire Officer of the West

“There are a lot of small

“Ambulance staff may suffer as

Midlands Fire Service as well as

regional benevolent funds and

a result of dealing with critical

being appointed Chair of the Fire

associations which carry out their

situations and exceptional

Services National Benevolent

own fundraising.

challenges in the line of duty and

Services for England and Wales

Fund, which is now known as the Fire Fighters Charity.

are sometimes injured themselves “TASC provides the opportunity

trying to give medical assistance in

for the whole ambulance services

difficult situations so they may need

Sir Graham discussed ideas for

community to come together and

help with support and grants to look

TASC’s future development with

get behind their own national

after themselves and their families.

Chief Executive Lorna Birse-Stewart,

charity which is dedicated to

and how the two organisations

helping and support them.

can work together to promote and develop the UK charity.

new Midlands Head Office.

“It will be good for TASC and the WMAS to work together because

“It also gives the general

this is an ideal way for the public to

public, who want to show their

show their thanks and appreciation to people in the service.”

He said: “I contacted TASC

appreciation and thanks to

He was on a fact-finding mission

because I thought this was a great

paramedics and other ambulance

to the Coventry-based charity

opportunity for me to give them any

staff who have helped them, the

Lorna Birse-Stewart, Chief

which was formed in March to

benefit I can from my experiences.

opportunity to make a donation

Executive of TASC, said Sir

for the benefit of the ambulance

Graham had also met Chairman

help provide vital support services and advice to serving and retired

“We grew the Fire Services

personnel and ambulance service

Cliff Randall and Trustee Gordon

ambulance personnel and

National Benevolent Fund

families it supports.

Enstone during his visit.

AMBULANCE UK - OCTOBER

270 For more news visit: www.ambulanceukonline.com

NEWSLINE never see my daughter or my granddaughter.

“For the people here and the defibrillator – saved my life.”

On Saturday 13th August 2011, Ian Hough, 59, a rower with Stourport Boat Club, suffered a cardiac arrest during a race at his home regatta.

At the time, Stourport Boat Club didn’t have a defibrillator (a device which can restart the heart of someone who suffers a cardiac arrest) of its own. Fortunately for Ian, medical cover was being provided for the event meaning there was a defibrillator on site that day.

Sir Graham Meldrum, Chair of the West Midlands Ambulance Service NHS Foundation Trust (third, left) with, from the left, Cliff Randall, Lorna Birse-Stewart and Gordon Enstone from TASC, The Ambulance Services Charity “It was a productive and informative meeting and gave us the opportunity to explain the services we aim to provide to help support men and women throughout the ambulance service at times of crisis or severe difficulty,” she said.

“There is a real need for a national ambulance services charity and TASC will play a vital role in focusing on the issues that are facing our ambulance staff and help address the significant impact that the daily stresses and challenges have.

The TASC Freephone Support Line telephone number is 0800 1032 999. For further information or if you would like to support the work of the charity, please visit www.theASC.org.uk

WMAS helps reshape apprenticeship scheme Ambulance Trusts across the country, including West Midlands Ambulance Service (WMAS), are the latest healthcare employers to gain government approval for developing new apprenticeship standards.

The Trailblazers apprenticeship programme plays a key role in replacing complex apprenticeship frameworks with short, simple and accessible standards written and developed by employers.

Prime Minister David Cameron recently announced the latest Trailblazer groups of leading employers within the healthcare sector. Ambulance Trusts have been working together to develop new apprenticeship standards with the aim of ensuring that every apprentice on a scheme can look forward to learning the necessary skills to pursue a career with the emergency services.

WMAS Chief Executive Anthony Marsh, said: “I’m delighted that the ambulance service is playing a leading part in the government’s programme to reform apprenticeships. This programme will ensure apprentices get a thorough introduction to the ambulance service and it should prove an influential starting point for those with aspirations of a career in emergency medicine.”

‘Pull through’ “I was dead for seven minutes.”

“The people who were here; the nurse, the doctor, rowers – if it hadn’t been for their help I would

Ian’s story has been turned into a powerfully emotional short film called ‘Pull Through’, produced by his employer drpvideo, to encourage as many clubs, groups, businesses, societies and communities as possible to consider getting a defibrillator.

Ian said: “Had this happened to me on a normal day at Stourport Boat Club, I know I would probably be dead. A cardiac arrest could happen to anyone at any time, in any place. I was lucky that it happened to me during the regatta when there was a defibrillator there. It saved my life.”

Cliff Medlicott, West Midlands Ambulance Service Community Response Manager who also appears in the film said: “I want as many people as possible to see this film and think about getting a defibrillator. ‘Pull Through’ is a compelling reconstruction of what happened to Ian and why he is still alive today. Defibrillators are easy to use, they even tell you what to do. You can get them for as little as £800 and sometimes for free. What price a life?”

AMBULANCE UK - OCTOBER

“TASC can offer help and advice with access to rehabilitation services, mental health services and counselling including Post Traumatic Stress Disorder; bereavement support; and welfare and debt advice through our confidential support telephone line.”

WMAS

Julian Rhodes, WMAS Head of Education and Training and one of the architects of the new standards, said: “We’re pleased to be supporting the Trailblazer programme. It commits ambulance trusts to a comprehensive training scheme for aspiring apprentices who may wish to consider a future career in emergency and urgent care.”

Ian has made a full recovery. He continues to row and has a won a number of races and Stourport Boat Club has installed its own defibrillator with the help of West Midlands Ambulance Service who trained its members in its use.

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

NEWSLINE counselling available and we

First member of the ambulance service to receive treatment under pilot scheme

hope that our grant will help support her recovery,” she said.

“On the last day at the centre, Kat will be given

A paramedic who had major

recommendations about what

shoulder surgery after being

she needs to do next and we

seriously injured whilst

hope that she will be in a better

on frontline duties is to

position to be fit to return to

become the first member of

work.

the ambulance service to receive treatment under a

“TASC understands that

pilot scheme for the physical

ambulance services frontline

rehabilitation of ambulance

staff face significant challenges

staff launched by a new UK

and pressures in the line of

charity.

duty which can affect their own health and TASC is here

Kat, who lives in Somerset,

to help.

has received a grant from TASC, The Ambulance

“This pilot scheme will, we

Services Charity, to undergo

hope, make a significant

rehabilitation at the Police

difference to Kat and other

Treatment Centre in Harrogate

members of the service who

between Monday, September 7

we are able to help through the

and Friday, September 18 under

TASC rehabilitation pilot.

a new scheme commissioned by the charity.

Kat was working as a paramedic for South Western

Kat Chignell who is the first paramedic to benefit from a pilot scheme run by TASC, The Ambulance Services Charity

“We would like to develop a much larger TASC ambulance service rehabilitation

After numerous months having

compete in triathlons; however

programme. To do this we

physiotherapy and diagnostic

I have missed my whole

really do need the whole

scans, Kat had to undergo

season this year, along with my

ambulance services sector

surgery in April 2015 to repair

motorsports trackside season

and the general public to get

October 2014.

her labrum and to have her

and I am looking forward to

behind us, join up and support

long head bicep released and

getting back to them both next

the work of the charity.”

She said: “I’m really grateful to

fixed. Recovery has included

year.”

Ambulance Service NHS Foundation Trust (SWASFT) when she was dispatched to a patient while on night shift on

TASC for organising this and

Ken Wenman, the Chief

four and a half weeks in a sling, Lorna Birse-Stewart, Chief

Executive of South Western

Executive of TASC, said the

Ambulance Service NHS

Harrogate. It shows how much

Kat said: “I need intensive

pilot scheme aims to support

Foundation Trust, is fully

this charity is needed by the

rehabilitation as after four-and-

the early intervention and

supportive of the initiative and

ambulance service community

a-half months, I still haven’t

rehabilitation of ambulance

said: “I am fully behind the

and we need to get behind

got a full range of movement

staff and that they are making

principles of TASC and would

them to give other ambulance

and I still have not regained

grants of up to £1,500 available

encourage others to show

staff these opportunities.

my muscle tone or power in

to enable up to 15 ambulance

their support. I wish Kat all the

my shoulder. I have been

personnel to go to this and

best with her treatment and

“When the incident happened,

seeing my NHS physio every

other centres where TASC

look forward to charting the

having released myself from the

two or three weeks and in

has agreed commissioning

progression of the charity.”

patient, I had instant pain in my

addition I have paid for a weekly

arrangements.

shoulder. Having taken my own

appointment with a private

pain relief to no effect, I had

physio.

for making a grant available for

physiotherapy and exercises.

my rehabilitation treatment in

AMBULANCE UK - OCTOBER

to attend A&E, who gave me

For more details about the “Kat’s need for treatment

TASC rehabilitation pilot

is really important and at

scheme or to find out more

stronger pain relief and referred

“I am looking forward to getting

the Police Treatment Centre

about joining and supporting

me to physiotherapy, which I

back to frontline duties as a

there are a variety of services

the work of the charity please

started ten days later.”

paramedic. When not at work, I

including physio, therapies and

visit www.theasc.org.uk

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

NEWSLINE Dr Ben Clark added: “When

Assistant Chief Ambulance

you are faced with a situation

Officer, Steve Wheaton, said:

like that, making sure you get a

“I am so proud of my staff and

good outcome for the patients

fantastic job they did on the

is your primary focus. Although

day. It cannot be stressed what

for the whole team”, exactly

the rescue was incredibly

a tremendous job everyone did

sums up the feelings of the

complex we were all driven by

on the day – Tom, Dave and

two doctors and a critical care

the need to do everything we

Ben couldn’t have done what

paramedic who were given

could to save Leah, Joe, Vicky

they did without the help of all

a Pride of Britain Award last

and Daniel.”

of the other people involved.”

This award is for the whole team It’s an oft used phrase, but in this case, “This award is

“The patients are the real heroes.

They have shown exceptional courage.

We just did what we needed to do.”

night for their work rescuing the four people trapped in the front row of the Smiler Ride at Alton Towers on 2nd June.

Army doctor Major David Cooper and aircrew paramedic Tom Waters were on the Midlands Air Ambulance at Cosford when they were called to the theme park following

ILLUMINATING CPR

the incident in June. Dr Ben Clark, who is a volunteer with North Staffordshire BASICS emergency doctors was also mobilised to the scene.

Working with about 50 other

The First Manikin that helps you Visualise the effects of CPR

ambulance staff, the local Alton Community First Responders, staff at the Alton Towers Park and firefighters, the three climbed onto the Smiler Ride to free the trapped victims.

Speaking at the awards last night, West Midlands Ambulance Service Paramedic Tom Waters, said: “We need to remember that it wasn’t just us up there. This was a massive team effort by everyone there.

“Receiving the award does heroes are Vicky, Daniel, Joe and Leah who were trapped; they were so brave on the day and still are.

Major David Cooper said: “The patients are the real heroes.

They have shown exceptional courage. We just did what we

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AMBULANCE UK - OCTOBER

mean a lot, but for us, the real

needed to do.”

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

NEWSLINE Innovative sepsis screening tool wins award University of Bolton Advanced Practitioner MSc student, Daniel Butterworth, has used his final year project to develop an innovative screening tool for the ambulance service.

With its potential to have national and international impact, Daniel’s award has been selected for an award from the University, recognising its significance for patient care.

Advance Paramedic, Daniel, has formulated a pre-hospital screening tool to identify sepsis, a potentially fatal condition in which the body’s reaction to infection is to send the immune system into overdrive. This reaction can lead to a sudden drop in blood pressure, impacting on blood clotting and the blood supply to vital organs, such as the brain and heart.

More than 37,000 UK deaths each year are attributed to sepsis, more than heart attacks and strokes, and yet the ambulance service has no nationally agreed guidelines for identifying the condition where an early diagnosis can be critical.

Said course senior lecturer, Dr Chris Mulryan: ‘Daniel is breaking new ground with his project that will undoubtedly have far reaching implications both nationally and internationally.’

North West Ambulance Service

As part of his Masters final year project Daniel has worked in collaboration with Salford and Central Manchester Foundation Trusts to look at the case history of 999 calls, tracking the patient journey for each case.

Said Daniel: ‘I looked at whether the patient was treated for sepsis, and whether we identified it or whether it was identified at hospital.

‘I then formulated a pre-hospital screening tool from models existing in hospitals and research reviews and applied that model to 300 cases. The screening tool I developed would have picked up sepsis in 90% of cases.’

Daniel’s diagnosis tool has been used in Manchester and Salford as part of a pilot project where 100 ambulance staff have been trained in its use.

This pilot project has allowed Daniel to develop a best practice care bundle for severe sepsis with Daniel and his colleagues being better able to identify the condition, give best care possible on the way to hospital and be able to brief hospital ahead of arrival so staff there are ready to act.

AMBULANCE UK - OCTOBER

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

Daniel presented a paper on his research findings to the UK Sepsis Trust Conference in May. There are now funding bids being written to train more staff so Daniel’s project recommendations can be rolled out across the North West.

Said Daniel: ‘I have found the Advanced Practice course at Bolton to be really good; I’ve loved it. The clinical skills aspect and the confidence it has given me in that area have really made a difference for me.’

Senior Lecturer on the Advanced Practitioners’ Masters, Dr Chris Mulryan, explained that the traditional dissertation format had been replaced to give meaningful, practical relevance to the students’ workplaces.

‘Our Advanced Practitioners are required to deliver a project which enhances the quality of patient care in their final year of study,’

NEWSLINE said Chris. ‘We changed this from a traditional academic dissertation a few years ago as we wanted our course and our students to effect real change in practice which improves the lives of patients.

‘Daniel’s award recognises that his project will likely have the most significant impact both in terms of saving lives and improving the quality of lives out of all the projects completed this year.

We are really very proud of our students for all of the projects delivered this year.’

YAAS

Deloitte charity challenge takes off Yorkshire Air Ambulance is flying high after becoming the local charity choice of business advisory firm Deloitte.

The rapid response emergency service was selected as Deloitte in

Yorkshire’s charity partner for the next two years after a vote by nearly 500 staff in the firm’s Leeds office.

The firm is planning a range of fund raising events during the year including the Yorkshire Three Peaks Challenge and a charity auction. It is also offering Yorkshire Air Ambulance a range of volunteering and pro-bono professional support.

Helen Kaye, Partner and corporate social responsibility lead at Deloitte in Yorkshire, said: “I am delighted that Yorkshire Air Ambulance will be our local office charity for the next two years.

“With 490 people based in our Leeds office we already have some exciting plans in the pipeline for fundraising and volunteering activities over the next year to help Yorkshire Air Ambulance in their mission to save lives across the county.

“Through our corporate social

responsibility programme at Deloitte, our aim is to play a proactive role in helping our local charity deal with key organisational challenges, not just raising funds but also providing time and expertise through volunteering and pro-bono support.”

Yorkshire Air Ambulance serves five million people across the county and attends more than 1,000 incidents a year. The charity has so far airlifted more than 6,200 people.

Paul Gowland, Yorkshire Air Ambulance Head of Fundraising, said: “We are delighted to have been chosen by Deloitte in Yorkshire as their charity partner and look forward to working closely with them.

“We need to raise £12,000 every day to keep our two helicopters flying and it is support like this from fantastic companies like Deloitte that is so vital to helping us achieve that target.”

“With 490 people based in our Leeds office we already have some exciting plans in the pipeline for fundraising and volunteering activities over the next year to help Yorkshire Air Ambulance in their mission to save lives across the county”

AMBULANCE UK - OCTOBER

Helen Kaye, Partner and corporate social responsibility lead at Deloitte in Yorkshire (l) with Kerry Garner, Yorkshire Air Ambulance Regional Fundraising Manager West and South Yorkshire

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

NEWSLINE Daniel for a reunion at Warrington

Jon and Daniel added, “It’s

The charity has teamed up with

Ambulance Station to talk about

overwhelming to get so much

Great Western Air Ambulance

her experience. Diane was given

praise. We’re part of a huge team

Charity (GWAAC), based in Bristol,

a tour of the ambulance station

here at NWAS and just doing our

to fund the initiative. From August

and had the opportunity to thank

job. We’re so happy to see Diane

17 2015 GWAAC began carrying

Daniel and Jon for saving her life.

fully recovered and in such good

blood on its helicopter. This means

spirits. This job is a real privilege

that the two air ambulances are the

Diane said: “I woke up feeling

to do – we get the chance to

first in the south west of England to

sick with burning in my chest and

make a difference and it’s nice to

carry blood.

A North West Ambulance

my chest was getting tighter, so

get recognition for our work.”

Service (NWAS) Crew has been

I phoned for an ambulance as I

praised by a Warrington patient,

knew something wasn’t right.

NWAS

‘I wouldn’t be here if it wasn’t for you’ – Warrington patient tells NWAS ambulance crew

who said she ‘wouldn’t be here’ if it wasn’t for them, after

“Within minutes Jon and Daniel

suffering a heart attack.

came along to check me over.

They gave me morphine after

WAA Critical Care Paramedic WAA

Life saving blood on Wiltshire Air Ambulance

Diane Wilson, from Orford in

discovering I was having a heart

Warrington, suffered a heart attack

attack. The lads took me to

Pre-hospital blood transfusions

on 22 May. That evening Diane

Liverpool Heart and Chest Hospital

can now be given to patients

went to bed not feeling very well.

where their team gave me keyhole

treated by Wiltshire Air

After phoning for an ambulance,

surgery – I felt like I could run a

Ambulance’s Critical Care

NWAS Ambulance Crew Jon

marathon after I had it done!

Paramedics.

swiftly on the scene to give Diane

“A big thank you to the North

On August 17 2015 Wiltshire Air

treatment and took her directly

West Ambulance Service, I was

Ambulance (WAA) began carrying

to Liverpool Heart and Chest

looked after so well. I would like

blood on the helicopter and rapid

Hospital for specialist surgery.

to thank Jon and Daniel for their

response vehicle, which will

professionalism because I don’t

benefit seriously ill and injured

Now fully recovered from her

think I would be here without

patients in need of emergency

operation Diane joined Jon and

them.”

blood transfusion.

Almond and Daniel Ogdon arrived

Richard Miller said: “Without doubt having blood on the helicopter will save lives. At the very least, by giving blood to patients it will increase their blood volume and enable oxygen to get to their brain, heart and kidneys giving them a better chance of survival to enable us to get them to hospital for treatment.

“Over the last four years Wiltshire Air Ambulance has moved rapidly into pre-hospital care by diagnosing, stabilising and treating critically injured patients on the roadside before they are taken to hospital. Having blood on the aircraft is another enhancement we can make in taking the emergency department to the patient.”

Emergency blood transfusions are likely to be given to patients who suffer life-threatening bleeding caused by trauma and some acute medical conditions.

The blood is collected daily from the North Bristol Trust Transfusion Laboratory at Southmead Hospital and delivered daily to WAA’s Operations Centre in Devizes and GWAAC’s airbase in Filton by the charity Freewheelers EVS, which

AMBULANCE UK - OCTOBER

covers the south west. Additional deliveries can be made if required by the air crews.

If the blood is not used, it will be returned to Southmead Hospital by the volunteer blood bikers after 24 hours. The blood storage Daniel Ogdan, NWAS Student Paramedic, Diane Wilson and Jon Almond, NWAS Paramedic at Warrington Ambulance Station

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

boxes maintain the temperature of the blood within very narrow limits for well over 24 hours. Any unused

NEWSLINE blood units are therefore able to be put back into the Southmead Hospital blood bank, preventing waste.

Melanie Rowbottom, a trustee of Freewheelers EVS, said: “Delivering blood supplies to air ambulances is a new venture for us and we are delighted to be working in partnership with Wiltshire Air Ambulance and Great Western Air Ambulance.

“We are excited to play our part in delivering a component of a service that could save many more lives, fully supported by the commitment of our members to make deliveries to the Air Ambulance bases 365 days a year.”

South Western Ambulance Service NHS Foundation Trust’s deputy clinical director, Adrian South, said: “SWASfT’s critical care specialist paramedics who work on the air ambulances

In the centre, Chris Nourse of Freewheelers EVS and Richard Miller, Wiltshire Air Ambulance Critical Care Paramedic, holding the Credo blood box watched by (l-r) Dan Tucker, WAA paramedic, Joanne Munday WAA Critical Care Paramedic, George Lawrence, WAA Chief Pilot, Simon Whitelock, Freewheelers EVS, Fred Thompson, WAA paramedic, and Dr Ed Valentine, WAA base doctor. receive additional training so they can bring even more clinical skills to the most seriously ill and injured patients. Along with critical care doctors, they are able to administer the blood.

This new initiative to carry blood for transfusions on the two air ambulances will be of real benefit for patients in the south west.”

The blood, two units of O negative, is stored in a Credo blood box, an insulated box that maintains the blood within a narrow temperature range preventing damage and spoilage.

When blood is to be given to a patient it will be warmed from its cool storage temperature towards

body temperature using a small portable device called a Belmont buddy lite Fluid Warmer.

The Credo blood box containing the units of blood can be switched from the helicopters to the Rapid Response Vehicles (RRV) used

by WAA and GWAAC Critical Care Paramedics, if needed.

AMBULANCE UK - OCTOBER

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

NEWSLINE She was accompanied by

So, which obstacles were the

“A couple of times I was thinking

TASC - New Tough Mudder

colleague Tim Falchi from Welsh

worst?

‘what am I doing?’ but I got

course where you got a 10,000

“Would I do it again? No, although

An ambulance paramedic

Johanne, who is married to TASC

volt shock from wires dangling

I feel really chuffed that I did it.”

has completed the ‘torturous’

Chairman Cliff Randall, had

down from a frame that you had

Tough Mudder challenge and

previously taken part in a couple

to go through,” she said.

raised hundreds of pounds for

of half marathons but clearly

TASC, The Ambulance Services

nothing like Tough Mudder.

Ambulance Services throughout the mud-filled challenge.

through it.

“There was one at the end of the

“Some of the wires didn’t seem to be charged, but one of them

Charity.

She said: “The weather was

caught my left arm and by the

Johanne Evans-Randall overcame

horrendous, in fact you couldn’t have

time I recovered from that another

a series of obstacles throughout

had a worse day. It was very wet and

caught my left leg. Some people

the gruelling 11.1 mile course,

cold and you never got warm at all.

were trying to walk through without

which included ducking your head

I imagined it to be muddy but there

touching any wires, but that would

under ice-cold water and being

was mud everywhere.

have been worse if you caught one as the pain would last longer.

jolted with 10,000 volts.

“Now that I’ve finished I can say I And, after completing the course in

enjoyed the experience, but it was

“The other main obstacle I didn’t

just under three-and-a-half hours,

awful while I was doing it.

like was a water chute where

Johanne has already raised more than the £500 target which she set for herself, and is hoping to get a few more pounds in to boost the total.

Anyone interested in supporting Johanne can still donate to TASC via her fundraising page at www.justgiving.com/JohanneEvans-Randall/ If you are interested in taking

they put ice cubes in to make the

part in a fundraising event or

“I ran with my colleague Tim

temperature minus one. You got

challenge on behalf of TASC

Johanne, who is a paramedic with

but everyone helped each other

a shock when you hit the water

please contact Fundraising

the Welsh Ambulance Services

round. We felt as though there

because it was so cold, but just

and Development Manager

NHS Trust, took part in the Tough

was one whole team helping

when you got used to it you had

Paul Kinsella on

Mudder South West event at

everyone else, particularly when it

to duck your head under the water

02477 987922 or email

Cirencester Park in Gloucestershire.

came to the obstacles.”

to go under some tyres.

paulkinsella@theasc.org.uk

Johanne vowed “never again!”.

AMBULANCE UK - OCTOBER Johanne Evans-Randall and Tim Falchi from the Welsh Ambulance Services NHS Trust

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

NEWSLINE Newly qualified paramedics graduate from Swansea University

designed to support EMTs in their

and Care Professions Council),

agreeing to fund this programme

progression.

and thus operate throughout the

and Swansea University in

Trust in a Paramedic role.

working with us to develop the content.

The 19-strong cohort collected their awards at a ceremony in

Judith Hardisty, the Trust’s

the city’s Brangwyn Hall from the

Director of Workforce and

“Thanks should also go to

University’s Pro Vice-Chancellor

Organisational Development,

the Trust’s Learning and

Professor Hilary Lappin-Scott.

added: “Studying is difficult at

Development Team and all

A GROUP of Welsh Ambulance

the best of times, let alone when

managers and colleagues who

Service EMTs (Emergency

Professor Lappin-Scott said:

you’re working on the frontline

have supported the students.”

Medical Technicians) who

“To graduate through this route

of the ambulance service at the

enrolled on a Diploma in

is a fantastic achievement,

same time.

Paramedic Sciences to qualify

particularly as the students are

as Paramedics have officially

working full time as an integral

“These awards are testament

Leeson Emery, Sian Lloyd,

graduated from Swansea

part of the Emergency Medical

to the group’s hard work and

Alexander Burnham, Steve

University.

Services.

effort, and I’d like to extend my

Rogerson, Adrian Evans, Zoe

congratulations and well wishes

Lambert, Marc Thomas, Sian

to them all.

Edmunds, David Jenkins, Mark

Among those recognised were: Darren Bright, Huw Jackson,

The diploma is the culmination

“Through commitment to hard

of 18 months of study, which the

work and application to study

students undertook while they

this cohort typifies the ethos of

“They have set a high standard

Ford, Catrin Morris, Adrian

continued with their day job as

the paramedic profession; that

for their colleagues who are in

Pagano, Christopher Ellis, Mark

EMTs.

of professionalism, compassion

the current programme and those

Scrivens and Keith O’Connor.

and clinical competence for the

due to start in September this

benefit of patients in their care.”

year.

the Welsh Ambulance Service

Successful completion of the

“We also want to thank the

Ambulance Service, please visit

in 2013 in conjunction with

programme enables the cohort

Workforce, Education and

the Working for Us section of

Swansea University, and is

to register with the HCPC (Health

Development Services for

the website.

The EMT-Paramedic conversion

Williams, Mark Howells, Laurence

To find out more about career opportunities at the Welsh

programme was established by

AMBULANCE UK - OCTOBER

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

IN PERSON NWAS News

New Non-Executive Director appointed for NWAS

with the National Ambulance Service in

Eve has spent much time on the Island both

Ireland where he eventually became Chief

for pleasure and for work. She was born

Executive for three years. He then went

in Southampton from a sea-faring family

on to be Chief Executive of the South

and joined the NHS as a National Graduate

Australian Ambulance Service.

Trainee. One of her very early assignments included supporting the new build project of

The NHS Trust Development Authority (NHS TDA) has confirmed the appointment of

Robert said: “I am thrilled to be the new

St Mary’s Hospital. She has been a successful

Richard Groome as Non-Executive Director

chief executive and very much look forward

leader in the NHS and in the voluntary sector.

of North West Ambulance Service NHS Trust.

to working with my new EEAST colleagues.

She has also run an international health

The service has been through some very

and care consultancy supporting a range of

Richard Groome is a Chartered Engineer and

difficult and challenging times over the last

services and Boards in the UK and abroad to

member of the Royal Society of Public Health.

few years, but I am confident we can build

improve their services and actively engage

Living in Shropshire, Richard has extensive

on the good work that Anthony Marsh has

with their communities.

business and family connections in our area

put in place to further improve our services

and has been heavily involved with major public

for patients and at the same time make this

Eve enjoyed a successful career as Chief

infrastructure projects like Alder Hey and North

a even better place to work.”

Executive at Homewood NHS Trust where working with a creative Board and partners in

Staffs Hospitals, Manchester Waste, GMPA, Robert added: “Having worked in the

Surrey they set up new models of integrated

ambulance service for many, many years I

care and support, working closely with local

Previously a Non-Executive director with

understand the challenges and issues and

communities. She has also held a range of

the Shropshire Heath Authority, he has also

how we can resolve them together. Whilst it

Non Executive roles at Board level on Housing

worked with West Midlands Ambulance

is not going to be easy, I know first-hand the

Associations and she served for two terms

Services (WMAS).

commitment and dedication of those working

as a Non-Executive Director of The Ridgeway

in the ambulance service and that together

Partnership NHS Trust, in Oxfordshire until

we can make a real difference for patients.”

2008 and was its Champion for Older People.

welcome Richard Groome to the Service and

Trust Chair Sarah Boulton said: “I am

Eve, her husband and three cats moved

are confident that he will be a positive addition

delighted Robert is going to lead our trust

permanently to St. Lawrence, Isle of Wight

to the Trust Board.

as we look to make further improvements to

in 2014 after retiring as Chief Executive of

the service we give to patients. Robert is an

the National Council for Palliative Care, the

“Richard has a wealth of experience within the

experienced ambulance chief executive who

umbrella charity set up by Government to

healthcare and public sectors, and this will be

will be able to connect immediately with

improve end of life care services across all

invaluable to the Trust, particularly his previous

frontline staff and volunteers thanks to his

sectors. She took it through three key phases

work with our ambulance colleagues in West

paramedic and volunteering background.”

of growth over 15 years working closely with

Oldham Housing and Manchester street lighting.

Chairman for North West Ambulance Service, Wyn Dignan comments: “We’re delighted to

the NHS, social care and leading national

Midlands.”

Sarah continued: “I would like to pay

and local charities, including services on

Non-executive appointments to NHS Trusts

special thanks to Anthony who has worked

the Island. She was asked to set up and

made by the NHS TDA are subject to the Code

tirelessly to rebuild the service since last

lead a new national coalition as part of the

of Practice of the Commissioner for Public

January. Thanks to this work, we are now

First National End of Life Care Strategy in

Appointments.

in a position to take the next steps on

2008 to raise public awareness about the

our journey, building a better service for

importance of talking about end of life wishes

patients and staff.”

and recording in care plans so they can be

Richard Groome has been appointed from

met. Eve was also asked to join the Prime

6 August 2015 until 5 August 2017. He has declared no political activity in the last five years.

IOW News

Minister’s Dementia Challenge Health and

New Chair for Isle of Wight NHS Trust announced

Care Champion Group in 2013 and became

The NHS Trust Development Authority (NHS

Speaking about her appointment Ms

TDA) has confirmed the appointment of Eve

Richardson said: “I am looking forward

The East of England Ambulance Service

Richardson as Chair of Isle of Wight NHS

to being the Trust Chair and working with

NHS Trust (EEAST) has announced that

Trust. Isle of Wight NHS Trust is the Island’s

everyone at the Isle of Wight NHS Trust

Robert Morton has been appointed as its

unique provider of ambulance, community,

and also with the Island’s commissioners,

new Chief Executive.

hospital and mental health and learning

partners and leaders within the wider health

disability services and serves a population

and social care and housing communities

Robert, a paramedic and a community first

of 140,000 with 2.5m visitors per annum on

to improve our services and make the most

responder, has worked in the ambulance

an offshore Island which is only accessible

of the ‘Island Pound’, given that we all have

service for nearly 25 years, predominantly

by sea and air.

scarce resources. I am sure that my range of

EEAST News

AMBULANCE UK - OCTOBER

Ambulance service appoints new Chief Executive

280 For more news visit: www.ambulanceukonline.com

an active member. She was awarded an OBE in 2015.

IN PERSON experience will be helpful to the Island. With

Ronnie Coutts MBE added, “I believe that

missions during his service but, as he

the recent announcement of the development

I can add a lot to Yorkshire Ambulance

approached his 60th birthday, regulations

of new models of care for the Island under

Service at this important time. The

demand he gives up single pilot flying.

the ‘My Life a Full Life‘ programme and the

ambulance service has the ability to be

Island’s status as a Vanguard site in the

a strong provider of excellent care in a

national New Models of Care initiative, we have

number of areas and I am pleased to have

a lot to do together and to also actively engage

been appointed to be part of that journey.

with our communities and the range of people

Heléna Holt, CEO of DAAT added “Thankfully we will not be saying goodbye to Rob. When we were awarded our own Air Operating Certificate (AOC) last year,

who use our services. I want everyone in the

“Engaging staff in a service which is

Trust to play a full part in this new programme.”

disparate is critical to any change but it is

Rob took on the role of Safety Manager

one that I am experienced at delivering and

and played an integral part in setting up

I hope to be able to impart this knowledge

our safety management systems. It was a

to good effect.”

challenging time for all the team as Devon

Welcoming Eve’s appointment Karen Baker, Chief Executive Officer at Isle of Wight NHS Trust, said: “Eve has extensive experience of working with health and social care organisations both as a Chief Executive and as a Non- Executive in partnership NHS Trusts.

Eve returns to us with a breadth of experience which I know she will use to help us in our endeavours to reshape health and social care

Air Ambulance Trading Company Limited Ronnie attended his first Board meeting on 28th July 2015 in Leyburn, North Yorkshire.

Ronnie has been appointed from 1st July 2015 until 30th June 2017. He has declared no political activity in the last five years.

on the Island.”

DAAT News

New role for record-breaking Yorkshire Ambulance Service air ambulance pilot appoints new Non-Executive The helicopter pilot who has the longest Director Designate service record and the most mission YAS News

flights with a single Air Ambulance Yorkshire Ambulance Service NHS Trust

charity is to use his vast accumulation

(YAS) has announced the appointment

of knowledge and experience to become

of Ronnie Coutts MBE as its new Non-

the Safety Manager at Devon Air

Executive Director (Designate).

Ambulance Trust (DAAT).

(DAATCL) were the first Air Ambulance to have developed and been awarded an AOC fully compliant with the new EASA regulations.

“I am delighted that Rob has agreed to continue in this role and will be overseeing the surveying of all the community helipads needed to introduce night flying next winter.”

Devon born, former Army pilot and Falklands veteran Rob, added: “It will take some adjusting to give up flying after a lifetime in the pilot’s seat but what better way to do so than continue with DAAT in a highly significant role. I am greatly looking forward to the challenges my new role

Ronnie is currently a Capability Director at

Captain Rob Mackie has flown with DAAT

will generate especially as it allows me to

Serco Defence leading their resilience, fire

for 23 years recording an amazing 7890

continue working with a great team.”

and defence training portfolio. A former Chief Executive of the UK Emergency Planning College Ronnie brings wide experience of the UK emergency services.

Ronnie is an apprenticeship ambassador developing opportunities for apprentices in all organisations. Before joining Serco, Ronnie had a varied Army career serving in Iraq, Afghanistan and the Balkans. His non-operational roles included human resources, training and recruitment.

2006 for his services in Iraq.

Chairman of the Board Ms Della M Cannings QPM said, “I am delighted that Ronnie has joined us. He has a very varied experience which will be extremely relevant as we move forward and his strategic focus and clear focus on results is critical to us at

AMBULANCE UK - OCTOBER

Ronnie was awarded an MBE in October

this time.

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

AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254 AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254

THE CLASSIFIED SITE For For further further information information or or to to make make aa reservation reservation please please contact contact

Terry Terry or Rachel

Tel: Tel: 01322 660434 Fax: Fax: 01322 666539 email:

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Life Connections Connections 2014 Life Exmed Study Study Day Day Exmed

Theme:Difficult DifficultAirway AirwayCourse Course EMS™ EMS™ –– An An introduction introduction Theme: TH Thursday15 15TH May 2014 2014 Thursday May KetteringConference ConferenceCentre, Centre,Kettering Kettering NN15 NN15 6PB 6PB Kettering

AMBULANCE UK - OCTOBER

282

TIME: A.M TIME: A.M

PRESENTATION PRESENTATION

TIME:P.M P.M TIME:

08.30 - 09.00 08.30 - 09.00

Registration Registration

12.00 - 12.30 12.00 - 12.30

09.00 - 09.15 Introduction & History of the Course 09.00 - 09.15 Introduction & History of the Course 12.30 - 13.30 09.15 - 09.45 The Airway Algorithms 12.30 - 13.30 09.15 - 09.45 The Airway Algorithms 13.30 - 14.00 09-45 - 10.30 Prediction of the Difficult Airway 13.30 - 14.00 09-45 - 10.30 Prediction of the Difficult Airway 10.30 - 11.15 BVM and Laryngoscopy 10.30 - 11.15 BVM and Laryngoscopy 11.15 - 11.30 Tea/Coffee, Exhibition 14.00 - 14.30 11.15 - 11.30 Tea/Coffee, Exhibition 14.00 - 14.30 11.30 - 12.00 Skills Stations (4 rotations/30 min. each) 11.30 - 12.00 Skills Stations (4 rotations/30 min. each) 14.30 - 14.45 Group 1 BVM, ETI 14.30 - 14.45 Group 1 BVM, ETI Group 2 EGD’s & Rescue Airways 14.45 - 15.00 Group 2 EGD’s & Rescue Airways 14.45 - 15.00 Group 3 Needle & Surgical Airway 15.00 - 17.00 Group 3 Needle & Surgical Airway 15.00 - 17.00 Group 4 Video Laryngoscopy 17.00 Group 4 Video Laryngoscopy 17.00 Topics and Speakers correct at the time of press but may be subject to change Topics and Speakers correct at the time of press but may be subject to change

PRESENTATION PRESENTATION Skill Stations Skill Stations Rotation 2 Rotation 2 Lunch, Exhibition Lunch, Exhibition Skill Stations Skill Stations Rotation 3 Rotation 3 Skill Stations Skill Stations Rotation 4 Rotation 4 Airway Self Scope Video Airway Self Scope Video Tea/Coffee, Exhibition Tea/Coffee, Exhibition Practical Moulages Practical Moulages Wrap up Wrap up CPD certificate provider CPD certificate provider

Delegate Rate: £72.00 (inc VAT) Delegate Rate: £72.00 (inc VAT)to visit over 60 trade stands. includes: delegate bag, refreshments and the opportunity includes: delegate bag, refreshments and the opportunity to visit over 60 trade stands.

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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