Ambulance UK - August 2016

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Volume 31 No. 4

August 2016


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142 An exploration of the views of paramedics regarding airway management

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151 Barriers in the implementation of the Resuscitation Guidelines


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EDITOR’S COMMENT Welcome to this issue of AUK So Brexit is now upon us, irrespective of the politics, the one thing that most people fear is change. The complexity of the NHS means that little changes quickly, and I suppose much will depend on the will of the politicians to determine exactly when (if ever..) leaving the European union will happen. Nevertheless, it is an unsettling time and I’m sure most of you are wondering what the future holds. In terms of the NHS the key issue of funding is bound to remain, not only because of the promises of the brexit campaigners but also because the fragility of both currency and market share is bound to affect the costs to the country of both the tangible and intangible assets of this precious resource.

“There will always be opportunities to work abroad and demand for UK skilled personnel around the world and the same is true for talented individuals to work here”

There are a great number of staff from European countries working in the UK service, some of whom may well be concerned about their continued right to work in the UK and it is conceivable that some of these may well look towards their future security and choose to leave before any change. That would be sure to cause additional pressure on recruiting and if you add to this foreign staff working in other areas of the health and social care network there would inevitably be issues. But its not all doom and gloom, its unlikely that individuals will see any major changes to their normal daily lives. There will always be opportunities to work abroad and demand for UK skilled personnel around the world and the same is true for talented individuals to work here, having lived and worked abroad I can say with a degree of certainty that this will remain the case. Whilst working conditions may change, it may be that removing levels of eurocracy will facilitate improvements, not necessarily worsening of these conditions. As I see it the biggest challenge is not around change but around how we respond and adapt to it, at the end of the day, the NHS is always changing and rarely if ever do we fail to move with the times. With that in mind can I urge all of you to read the NIHR Care at the Scene review, an interesting document which is particularly relevant to the Ambulance services. Don’t forget Life Connections this autumn, tickets are already going quickly, but in the meantime, take care and have a great summer...

Sam English, Co-Editor Ambulance UK


ADDENDUM The article headed ‘The Face of Major Trauma is Changing’ which appeared on page 98 of our June 2016 edition was written and submitted by Professor Sir Keith Porter, Consultant of Clinical Traumatology, University Hospitals, Birmingham NHS Foundation Trust. We, the publishers, apologise for this oversight.

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AN EXPLORATION OF THE VIEWS OF PARAMEDICS REGARDING AIRWAY MANAGEMENT Janet Brandling1, Megan Rhys2, Matthew Thomas3, Sarah Voss1, Sian Emma Davies5 and Jonathan Benger4 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:56




Airway management, Cardiac arrest, Paramedics

Paramedics are a skilled group of clinicians with expertise in airway


management. Our research group has completed a trial comparing supraglottic airway devices with tracheal intubation during out

Out of hospital cardiac arrest (OHCA) is a common medical emergency

of hospital cardiac arrest. This is a contentious topic amongst

with a very poor prognosis: there are 118 OHCAs per 100,000

paramedics in the United Kingdom (UK). We explored the customs

population per annum [1], and approximately 7 % survive to hospital

and beliefs of UK paramedics in relation to airway management, and

discharge [2].

whether tracheal intubation contributes to and sustains paramedic Our research group has recently completed a research study (REVIVE-

professional identity.

Airways) that assesses the feasibility of completing a definitive


randomised trial to compare a supraglottic airway device with tracheal intubation during OHCA [3].

The study took place within South Western Ambulance Service NHS Foundation Trust. We used a qualitative approach, conducting interviews and focus groups with paramedics. The themes arising from interviews were discussed in focus groups, developing a deeper understanding and providing insight and recommendations for future research and policy. Purposive sampling accounted for differing training and for participation in the main trial. There were 17interviews and five focus groups with a further 17 participants. Data saturation was achieved.

The skill of tracheal intubation is a contentious topic amongst paramedics [4]. Recommendations from the Airway Working Group of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) conclude that: “The weight of evidence suggests that prehospital intubation without the use of drugs can worsen patient outcome. Supraglottic airway devices (SADs) have been shown to be safe and effective devices in elective and emergency hospital procedures … Ambulance trusts should be encouraged to adopt and use these devices as an alternative to tracheal intubation [5]”. This recommendation led to a detailed response from the College of


paramedics, defending the practice of pre-hospital tracheal intubation,

Four domains were identified. Pride - The ability to use a life-saving skill in austere conditions. Utility - Different training routes and experience have led to different attitudes towards airway management. Inconsistent expectations - Paramedics felt that there were different perceptions AMBULANCE UK - AUGUST

of their abilities amongst hospital staff and the general public. Professionalization - Debate over airway management is not founded on good evidence.

which is viewed by many paramedics as an essential and valuable skill [6]. This skill, among others contributes to the individual, interpersonal and societal-institutional paramedic professional identity [7]. Paramedicine is a developing discipline [8, 9], and although it is assimilated into the allied health professions through the regulatory body of the HCPC it continues to differentiate itself. It’s professionalization project and subsequent status is dependent upon how it is viewed at street level and by managers and educators within the profession as well as other professions outside [10, 11].


Whilst it proved possible to engage the required number of paramedics We have demonstrated that UK paramedics have a wide range of views

in our feasibility study, the majority of eligible paramedics within South

regarding airway management, and that these are based on evidence

Western Ambulance Service NHS Foundation Trust chose not to

and experience rather than dogma. Airway management contributes to

participate, and the strength of feeling regarding airway management in

paramedics’ professional identity, but is not reliant on this.

pre-hospital cardiac arrest has been apparent.

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FEATURE We therefore undertook this companion qualitative study to explore

Thematic analysis was used and performed by an independent

paramedic views on resuscitation research and airway management

qualitative researcher. This was done in 2 stages:

and the reasons why paramedics did, or did not, take part in our feasibility study.

A. After interviews, for presentation and discussion at the focus groups;

Literature review identified only two previous studies of paramedics’ perceptions of airway management and tracheal intubation: these were

B. After focus groups, for final reporting.

from North America, and not specific to cardiac arrest [12, 13]. A well-established iterative process of thematic analysis was used by The aim of this study was to understand paramedic views and

the researcher to analyse each verbatim transcript [14]. This included:

behaviours in relation to pre-hospital airway management and resuscitation. Our objectives explored the following areas:

1. Familiarisation with the data: reading and re-reading transcripts

1. The existing customs and beliefs influencing pre-hospital intubation

2. Generating initial codes: noting codes of interesting and pertinent

and resuscitation by paramedics in the South West of England; 2. Whether intubation skills contribute to and sustain the professional identity of the paramedic, and how this might change and adapt in

ideas 3. Searching for themes: systematically organising these recurrent ideas with extracts of text

future. 4. Reviewing themes: checking themes are meaningful and relate to


the text

A two level qualitative approach was used, conducting interviews and focus groups with paramedics. The interviews identified issues arising for paramedics as individuals and as a professional group. Focus groups were used to discuss the themes arising from the interview data in depth, developing a deeper understanding but also providing insight and recommendations for future research and policy. The study followed our feasibility study, REVIVE-Airways [3]. Both took place within South Western Ambulance Service NHS Foundation Trust. This research was funded by the Resuscitation Council UK and sponsored by the University of the West of England, Bristol. The funder and sponsor took no part in the design, conduct or reporting of the study. Since participants were NHS staff, NHS ethics committee approval was not required. However the project was reviewed and governance provided by the research ethics committee of the University of the West of

5. Defining and naming themes: summarising the narrative with clear definitions 6. Producing the report: using extracts of data to exemplify the themes To supplement and triangulate the analysis, paramedics and prehospital clinicians from the study team reviewed and commented on the themes presented independently. Confidentiality, the right to refuse specific questions and withdraw were ensured via the consent process. A wide variety of paramedics felt able to participate, rather than just those with the strongest opinions or vested interests [15].

England, Bristol.


It is known that paramedics have been trained either through a

There were 34 study participants, with 17 paramedic interviews followed

vocational pathway accredited by the Institute of Health Care

by five focus groups involving a further 17 individuals. Data saturation

Development (IHCD), and more recently paramedics have been

was achieved, with no new themes were emerging from the data. The

educated to degree level by Higher Education Institutes (HEI). This

available population was also limited, and so recruitment was ceased

may impact on paramedic beliefs and customs. Furthermore, some


paramedics have expressed strong opinions on this topic in relation to REVIVE-Airways. Some were ineligible to take part in our feasibility study,

The characteristics of the 34 participants, in terms of their training and

whilst some declined to do so. Therefore a purposive sampling strategy,

participation in REVIVE-Airways, are summarised in Tables 1 and 2.

taking account of these factors, was used. Invitations were sent to Table 1

technique was used.

Interview participants

Interviews and focus groups were held either within the workplace or on a University campus, and were conducted by an independent

Interview participants

IHCD trained

qualitative researcher. This researcher was advised on technical issues by a physician and a paramedic, both of whom had been on the study management team of the original trial. The interviews lasted between


Excluded from or declined REVIVE


Excluded from or declined REVIVE





11 and 50 min, while focus groups lasted 60–90 min. All were audiorecorded and recordings transcribed verbatim. Participant contribution was acknowledged with a gift voucher to the value of £10.


HEI trained



paramedics who fitted the sampling categories; thereafter a snowballing


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FEATURE “… I work on my own and I am going to have to do ALS until the troops

Table 2

arrive… I found the i-gel brilliant actually … and that was much better

Focus group participants

than just sort of an OP airway bag and mask …But I still agree that there Focus group participants

is a place for intubation.” (FOCUS GROUP2) IHCD trained



HEI trained

Excluded from or declined REVIVE





Total Good resuscitation was in part due to the guidance issued in recent

Excluded from or declined REVIVE 2

years. Although intubation is considered a treatment of last resort, its loss would be to remove a core skill, disabling paramedic ability to respond in absolute necessity. The geographic distant from hospital, 17

having patients being trapped in awkward situations, with family members, pets and other observers involved and difficult retrieval circumstances were presented as contributory factors. Patients often

It is clear from the accounts given by paramedics in this study that there

had full stomachs, already soiled airways, injuries and co-morbidities;

are strong themes arising about paramedic identity, and how this relates

all indications to move immediately to intubation as an airway

to patient safety during the course of their work.

management technique.

Figure 1 illustrates the four domains into which paramedic identity was

“…because we are in an environment where the patients are not fasted,

divided to discuss their opinions of airway management in practice.

often have an airway full of detritus, whether it’s vomit or fluid or a piece of pork pie and it is one of the last ditch adjuncts that we can use to

PRIDE Life saving skills An evolving profession A step-wise approach Hierarchy of competence

PROFESSIONALISATION Where do we go from here? Education, research and policy Being involved in research

just you, so it is absolutely a key skill.” (FOCUS GROUP2) This clear narrative was a primary response to interview questions

Paramedic Identity and Airway Management UTILITY Tools to support airway management Training and confidence Training routes Skill fade and proof of competence

maintain that airway and there’s only us… no doctors, no anaesthetists,

INCONSISTENT EXPECTATIONS Health professional views Public views Paramedic views

and reflects protocols used in paramedicine but as interviews progressed it began to be contested. Some respondents suggested a move from universal skills to a hierarchy, where specialist skills are targeted when necessary, and are performed by individuals experienced in that technique.

Hierarchy of competence

Fig. 1 Paramedic Domains

A hierarchal view became apparent (Fig. 2), with a pyramid of

Domain 1: pride

specialism and with it the ability to use intubation skills. This was situated firmly in the top levels.

Life saving skills

Highly Competent Practitioner

The debate about retaining the skill of intubation was contentious for this group, and many of the paramedics immediately defended their practice of intubation, suggesting they would be extremely unhappy to

Competent Practitioner

relinquish it. This quote exemplifies this viewpoint. “I will defend that skill to my dying day, really, because I think it’s still something we should have in our arsenal” (FOCUS GROUP4)

Pre-competent Practitioner

This view appeared to be based on concern for patient safety; the possibility of not being able to respond adequately to life threatening aspiration and patient transport.

A step-wise approach

Fig. 2 Hierarchy of Competence At the bottom of this pyramid inexperienced practitioners who have yet to develop competence require easy to use airway management

The utility and necessity of resuscitation skills was discussed in depth.

techniques, while at the top the most highly specialist practitioners

The paramedics provided consistent narratives about the practice

retain the highly desirable skill of intubation. Between these levels fall

and step-wise manner of resuscitation and intubation. They expressed

competent practitioners, and many respondents saw themselves in this

value for supraglottic devices as a component of this approach, with

zone. However this is clearly a contested zone, with variable views of

progression to intubation when necessary.

competency and deservedness.


events. Intubation is a technique that the paramedic can trust in case of

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FEATURE Participants wondered if it would work in practice, with a competent

about airway management skills, finding the supraglottic airway

specialist in attendance:

devices sufficient in most instances. Nevertheless they rarely wanted to relinquish intubation altogether. It was referred to as the ‘gold standard’,

“I think if only certain paramedics had it then you’d end up with situations

as if the pinnacle of practice. After the initial discussion of intubation

where you needed it on scene but you couldn’t get somebody there to

paramedic views of their own competence, in relation to skill fade, were

do it… So I think it needs to be a skill for everybody otherwise when you


need it you won’t have it.” (FOCUS GROUP1) Overall there was a strong sense of pride in resuscitation skills during the paramedic interviews and focus groups. Although there were several participants who questioned this view, most of the respondents wished to keep the skill and strongly defended tracheal intubation as part of paramedic identity.

Skill fade, confidence and proof of competence Participants discussed statutory, mandatory and personally acquired training subsequent to basic training. Many talked of ‘skill fade’, and noted a lack of confidence in themselves or colleagues. Some admitted they didn’t always feel confident about intubation.

Domain 2: utility Tools to support airway management

“..if you are not well versed at doing it, faffing around trying to do this intubation, you know, I find it’s difficult at times…I’d just like to be more trained in it and keep the skills up so I’d be more efficient at it.” (FOCUS GROUP2)

This theme represents the practicalities of skilled airway management and the mechanisms that support good practice. The participants discussed recently acquired tools to support airway management, such as intubating bougies and capnography. These tools enhanced their ability to successfully maintain the airway and intubate. “I find that we’ve actually got more equipment now. They’ve got introducers and bougies and people are starting to use them and

Participants also discussed the increased need to develop skills such as assessment, diagnosis and drug administration, which relates to a greater proportion of their work, rather than focus so directly on resuscitation.

Domain 3: inconsistent expectations

intubations are becoming more successful because they’ve used the equipment correctly… It takes a lot of the guesswork out of it …” (FOCUS GROUP2)

Health professional views Expectations of paramedic skill were thought to be different

Training routes

according to observer. Some were cynical about other health professional’s view of their abilities, and felt that they were at risk

The participants reflected upon training and variable views resulted

of being criticised by other professions who lacked insight into the

from differences between the IHCD training pathway and the HEI route.

complexity of their work. Some had encountered frosty or critical

Intubation as a core skill seemed to depend upon this:

receptions by other health professionals in emergency departments because they had brought in people who did not need emergency

“…experientially older staff, is they often see it as a core skill of a


paramedic whereas perhaps newer people who have come through the university route where in the last few years intubation hasn’t been quite

“I don’t think they have the comprehension of trying to manage

pushed as much as it was when some of us older ones went through,

somebody’s airway when they’re trapped between the bath and a toilet,

it’s not as important.” (FOCUS GROUP5)

or they’re at the bottom of a ditch and it’s dark and it’s blowing a hooly and you can’t see. There isn’t the comprehension at all.” (FOCUS GROUP2)

During IHCD training paramedics were required to complete 25 intubations in a hospital environment under the tutelage of an anaesthetist. Once completed, they were certificated competent.

In some cases they felt that their skill and training counted for little and

The HEI route does not have a similar process, and was suggested to

they were viewed as little more than ‘ambulance drivers’. Specifically,

be an inferior training mechanism.

it was suggested that some health professionals think retention of


intubation skills is related to paramedic ego rather than necessity.

The repetitive rehearsal in IHCD training was seen as providing skill confidence. For some this was a motor skill; once learned, never

Public views

forgotten. The public, on the other hand, were considered to hold paramedics in “…intubation really is a piece of cake… you know. If you’ve got the

high regard, and have high expectations.

equipment and you keep it up together it is second nature.” (FOCUS GROUP4)

“I think we’re… generally we’re held in really high esteem by the public and normally most people think we are like doctors…”

HEI trained paramedics, on the other hand, were often more sanguine


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FEATURE Participants felt that members of the public did not distinguish between

environment, and is consistent with previous research from North

paramedics and emergency care assistants, and in an emergency

America looking at the skills most highly ranked by paramedics, where

situation would expect a paramedic response, with personnel able to

tracheal intubation was deemed the most important [12]. However

utilise extended skills regardless of training and capacity.

tracheal intubation may also be viewed as part of the “exclusive body of knowledge” that defines a profession, such that a threat to intubation

Paramedic views

is a threat to the profession itself [18]. Although the paramedics in our

Paramedics demonstrated conflicting views of their own profession,

adequate there was a lack of trust or belief in the utility of supraglottic

study recognised that other airway management methods are often

largely related to the training route they had taken. IHCD trained paramedics valued the ‘on-the-road’ practical experience compared to HEI trained practitioners, who prioritised theory. On the other hand HEI practitioners considered themselves autonomous, able to critique practice rather than slavishly following protocol and guidelines. This issue represented a considerable, although not acrimonious, divide between the two groups.

devices in difficult situations, when airways are soiled or patient extrication is difficult. It is apparent that in order to successfully manage the airway in the most difficult of circumstances, paramedics should be provided with the best possible training, equipment and support. These issues have been identified previously [13], but there were several suggestions that this is not always the current situation. If airway management can be supported

“And we used to take people to hospital because we were scared if we left them at home something might happen. But now we have the knowledge and we know why we’re leaving them at home.” (FOCUS GROUP2)

by the use of adjuncts such as supraglottic devices and capnography, and competency can be demonstrated regardless of the frequency of intubation, it remains valuable to encourage the use of a stepwise approach to airway management that includes intubation, since the removal of this skill may act to discourage and disempower UK paramedics.

Domain 4: professionalization

We have shown that UK paramedics have a wide range of views regarding airway management that are based on evidence and

Where do we go from here?

experience, and that although airway management contributes to paramedics’ professional identity, it is not reliant on this. It is apparent

Discussions of paramedic identity led to broader consideration of the

that frontline paramedics do not tend to occupy either of the divergent

profession’s future. Only some paramedics had considered this in

positions of the College of Paramedics or JRCALC [5, 6], but instead

detail. The recommendations made by the Airway Working Group of the

are able to use skills, experience and research evidence to form

Joint Royal Colleges Ambulance Liaison Committee [2], were viewed as

their own opinions. The themes illustrate a profession proud of its

unwarranted criticism and provoked discussion. Paramedics robustly

skills and contribution to health care and discussion elicited the

defended their profession and position.

professionalization agenda. This contemporary debate is emergent in the literature McCann et al., [10], Williams et al., [8], Burford et al., [7])

“Contrary to popular belief paramedics are an intelligent group of people

and illustrates the tensions from within the discipline and from related

who will listen to argument, who will consider research in the right light

and influential professions. It is clear that paramedics still have mixed

and will come to a reasonable conclusion, I think, but I think it’s when

views about their status and associated skills, such as intubation

it’s forced on you… that’s when you sort of get the kick back.” (FOCUS GROUP3)

and this is influenced by the educational route taken. If, as McCann et al. [10] discuss, para-medicine is moving towards increasingly

This appears to be specifically directed towards doctors, where the efficacy of intubation in the pre-hospital environment was raised. They noted that the debate had served to galvanize their professional group, stimulating a desire to lead the direction of education, research and practice.

professionalized and autonomous practice through its higher level education, professional body, professional journals, state registration and code of ethics, it may seek to hold on to skills, such as intubation, which differentiate it from other professions. Although this is a small study, attempts were made as far as possible


to sample a range of paramedics and therefore a wide range of views. Data saturation was reached and focus groups enabled some deep


Prehospital airway management, and tracheal intubation in particular,

interrogation of the themes. In light of this research it is suggested that,

has studies both supporting it and suggesting it can cause harm [4, 17].

until a decision is made regarding the effectiveness of alternative airway

Our study was the first UK research to qualitatively assess paramedic

management methods compared to intubation during OHCA, intubation

airway management.

competency is retained but reviewed to ensure it is supported and provided to a consistently high standard.

Participants were largely reluctant to relinquish intubation skills in favour of other devices, even if tracheal intubation remained available

Several of the authors of this paper(JBr,MT,SV, JB) are involved in the

to a smaller group of more highly-trained paramedics. This is similar

practice of and research into prehospital airway management. All

to the findings from a North American study of pre-hospital intubation,

will hold their own opinions. At the time of this research we used an

where it was believed strongly that paramedics should retain this skill

independent qualitative research, who has since become involved

[13]. In our study this view was justified by perceived clinical need,

further in prehospital research. We have used robust qualitative

and the challenges of delivering excellent care in the out-of-hospital

methods to ensure that personal opinions are not present.

148 For more news visit:

FEATURE Qualitative studies are useful in helping to determine future research priorities, and this paper supports numerous others in calling for a randomised control trial in this area [19]. We have demonstrated that paramedics need to be at the centre of any trial investigating a key

(2) Research Paramedic, South Western Ambulance Service NHS Foundation Trust (3) Anaesthesia and Critical Care, University Hospitals Bristol NHS Foundation Trust

part of their practice, and that this in turn supports paramedics in the

(4) Emergency Care, University of the West of England

development and consolidation of their profession [7, 8, 9, 10, 11, 20].

(5) University Hospitals Bristol NHS Foundation Trust


From the Editor

We have demonstrated that UK paramedics have a wide range of views

Airway management and its place in Paramedicine has been, over the

regarding airway management, and that these are based on evidence

years, a source of both debate and controversy. I received this article

and experience rather than dogma. Airway management contributes to

for review following its publication and permission to reproduce it from

paramedics’ professional identity, but is not reliant on this.

the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.


For a time I considered how the contention and emotion surrounding


the subject would affect its reception were it to be included, but whilst its content does not represent the views of the publisher, editor or Ambulance UK, I decided, since it is a small scale study, that it should

We are grateful to the paramedics who took part in this study, and to

be presented as an opportunity for your review, in the hope that it would

South Western Ambulance Service NHS Foundation Trust for support

prompt comment from practitoners within the UK, that you would feel

and facilitation.

motivated to pass on your views, good bad or indifferent to AUK with a view to compiling them for inclusion in a follow up article.

This is qualitative research and none of the research checklists apply. In the search for knowledge, the right to analyse published material


and put forward your thoughts as a professional is extremely important. The address for your submissions can be found at the front of the

This research was funded by an unrestricted grant from the Resuscitation Council UK. The funding body did not influence the design, conduct, analysis or reporting of this study. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons. org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons. org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Competing interests The authors declare that they have no competing interests.

Authors’ contributions and analysed the data. Also drafted the report SV contributed to the study design, set up and management. MT and JB conceived the idea and applied for funding. MR/SV/ED organised and participated in the interviews. All were involved in the final manuscript.

Authors’ Affiliations (1) Department of Health and Applied Sciences, University of the West of England

References 1. Fothergill RT, Watson LR, Chamberlain D, Virdi GK, Moore FP, Whitbread M. Increases in survival from out-of-hospital cardiac arrest: a five year study. Resuscitation. 2013;84:1089–92.View ArticlePubMedGoogle Scholar 2. NHS England. Ambulance Quality Indicators Data 2012–13. Accessed 9 Nov 2014 at: statistical-work-areas/ambulance-quality-indicators/ambqi-2012-13/ ambulance-quality-indicators/ambqi-2012-13/. 3. Benger JR, Voss S, Coates D, et al. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol. BMJ Open 2013;3:e002467. 4. Lyon RM, Ferris JD, Young DM, McKeown DW, Oglesby AJ, Robertson C. Field intubation of cardiac arrest patients: a dying art? Emerg Med J. 2010;27:321–3.View ArticlePubMedGoogle Scholar 5. Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Airway Working Group. A critical reassessment of ambulance service airway management in pre-hospital care. London: JRCALC; 2008. Google Scholar 6. Woollard M, Furber R. The College of Paramedics (British Paramedic Association) position paper regarding the Joint Royal Colleges Ambulance Liaison Committee recommendations on paramedic intubation. Emerg Med J. 2010;27:167–70. doi:10.1136/ emj.2009.088443.View ArticlePubMedGoogle Scholar 7. Burford B, Morrow G, Rothwell C, Carter M, Illing J. Professional education should reflect reality: findings from three health professions. Med Ed. 2014;48:361–74.View ArticleGoogle Scholar


All authors read and approved the final manuscript. JBr collected


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

FEATURE ‘ETCO2 is safe, noninvasive, inexpensive, and rapidly performed at the bedside. It is an essential tool for evaluating patients in the emergency setting’.* *Capnography for the Nonintubated Patient in the Emergency Setting. Craig A. Manifold, CA, et al. J Emerg Med. 2013;45(4):626-632.

8. Williams B, Onsman A, Brown T. Professionalism. From stretcherbearer to paramedic: the Australian paramedics’ move towards professionalism. J Emerg Prim Health Care. 2009;7:4.Google Scholar 9. O’Meara P. Paramedics marching towards professionalism. J Emerg Prim Health Care. 2009;7(1):1–5.Google Scholar 10. McCann L, Granter E, Hyde P, Hassard J. Still blue-collar after all these years? An ethnography of the professionalization of emergency ambulance work. Manag Stud. 2013;50(5):750–76.View ArticleGoogle Scholar 11. Morrow G, Burford B, Rothwell C, Carter M, McLachlan J, Illing J. Professionalism in Healthcare Professionals. Report to the Health and Care Professions Council. London: HCPC; 2011.Google Scholar 12. Pollock MJ, Brown LH, Dunn KA. The perceived importance of paramedic skills and the emphasis they receive during EMS education programs. Prehosp Emerg Care. 1997;1(4):263–8.View ArticlePubMedGoogle Scholar 13. Boyce Thomas J, Abo BN, Wang HE. Paramedic perceptions of challenges in out-of-hospital tracheal intubation. Prehosp Emerg Care. 2007;11:219–23.View ArticleGoogle Scholar 14. Braun V, Clark V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.View ArticleGoogle Scholar

Are you monitoring ETCO2

15. Head E. The ethics and implications of paying participants in qualitative research. Int J Soc Res Methodol. 2009;12(4):335–44.View ArticleGoogle Scholar 16. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–81.View ArticleGoogle Scholar

in non-intubated patients? Intersurgical’s Sentri range permits the sampling of exhaled carbon dioxide in non-intubated patients during the administration of supplementary oxygen.

• •

Sentri ETCO2 medium concentration mask Sentri ETCO2 nasal cannula

17. Tanabe S, Ogawa T, Akahane M, Koike S, Horiguchi H, Yasunaga H, et al. Comparison ofneurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study. J Emerg Med. 2013;44:389–97.View ArticlePubMedGoogle Scholar 18. First S, Tomlins L, Swinburn A. From trade to profession-the professionalisation of the paramedic workforce. Journal of Paramedic Practice. 2012;4(7):378–81.View ArticleGoogle Scholar 19. Soar J, Nolan JP. Airway management in cardiopulmonary resuscitation. Curr Opin Crit Care. 2013;19(3):181–7.View ArticlePubMedGoogle Scholar 20. Woollard M. Professionalism in UK paramedic practice. AJP. 2009;7(4).


For further information please visit

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BARRIERS IN THE IMPLEMENTATION OF THE RESUSCITATION GUIDELINES: EUROPEAN SURVEY OF DEFIBRILLATION TECHNIQUES Paweł Krawczyk1, Andrzej A. Kononowicz2 and Janusz Andres1 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:28




There are limitations and barriers in the implementation of the defibrillation technique guidelines. There are still countries where the

The European Resuscitation Council (ERC) Guidelines recommend providing chest compressions during defibrillator charging and using adhesive pads for defibrillation to increase the effectiveness of resuscitation. However, the most common defibrillation technique in each European country is unknown, as are the potential barriers in implementation of the guidelines. The aim of this study was to assess the techniques of defibrillation procedures performed by professional European healthcare providers and to estimate how frequently adhesive pads are used.

use of adhesive pads is low due to economic and traditional reasons. There is a need for further efforts focused on guidelines implementation.

Keywords Defibrillation, Technique, Adhesive pads, Manual paddles, Cardiopulmonary resuscitation, Advanced life support, Monitoring, Coupling medium



Performing defibrillation when a shockable rhythm has been identified

We sent an online questionnaire to the ERC National Representatives that contained 12 questions regarding the techniques of defibrillation and monitoring heart rhythm during cardiac arrest. We also evaluated the frequency and indications of manual paddles use.

is one of the key interventions of cardiac arrest with clearly proven benefits influencing patient survival [1]. The likelihood of a successful defibrillation attempt is lower not only when the procedure is done too late [2, 3], but also when there is a delay between stopping chest compressions and shock delivery [4, 5, 6]. A pause longer than 5–10 s may influence defibrillation effectiveness [7]. The European Resuscitation


Council (ERC) Guidelines [1] recommend providing chest compressions during defibrillator charging to eliminate unnecessary breaks in chest

We collected questionnaires from 27 out of 33 invited ERC member

compressions and to decrease the time between the stopping of CPR

countries. The response rate was 82 %. Seventeen (17/27; 63 %)

and shock delivery. The guidelines also recommend the use of adhesive

declared the use of adhesive pads. The leading cause for not using

pads for defibrillation. This has the potential to make the procedure

adhesive pads was economic reason (9/17; 53 %). Some respondents

quicker, safer and more effective than with manual paddles [8, 9, 10]. The

declared resistance to using adhesive pads by healthcare providers

ERC Guidelines for Resuscitation 2015 recognize that defibrillator paddles

or tradition connected with manual paddles use. We found three

are used in some settings [1]. The use of paddles is still common in many

leading techniques of defibrillation with manual paddles: Charging

European countries [11, 12, 13], however, it is not known what the most

paddles keeping them on the defibrillator during chest compressions

common defibrillation technique is in each country or what the potential

being delivered (9/21; 43 %), Charging paddles keeping them on the

barriers in implementation of the guidelines are.

patient chest during chest compressions being delivered (6/21; 29 %), This paper provides information regarding the technique of defibrillation

(5/21; 24 %). Respondents from 11 countries declared the use of gel or

procedures carried out by professional European healthcare providers

electrode pastes during defibrillation with manual paddles.

in both pre- and in-hospital cardiac arrests. It also indicates the barriers in implementation of the guidelines regarding the use of adhesive pads.



This study collected preliminary data showing how defibrillation is performed in Europe. It revealed the recommeded techniques underuse

In January 2016, we sent an e-mail with invitation to participate in the online

and identyfied barriers in the Resuscitation Guidelines implementation.

survey [14] to all ERC National Representatives – one per each member

The survey should be open to a wider group of respondents. in each

country. The questionnaire contained 12 questions regarding the technique

country in future.

of defibrillation and how heart rhythm is monitored during cardiac arrest.


Charging paddles on the patient chest without chest compressions

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

FEATURE Additional questions were asked in regard to manual paddles

adhesive pads by healthcare providers or a tradition connected with

use (indications, coupling medium usage, technique of manual

using manual paddles. In cases of using manual paddles, 7/23 (30 %)

defibrillation). The study questionnaire was created based on results

respondents declared use of gel and 4/23 (17 %) electrode pastes as

and conclusions of the previous studies [11, 12, 13] and after consulting

a coupling medium and 48 % (11/23) used gel pads. In the free text

it with the then ERC Director of Science and Research. In case of no

comments, some respondents declared a problem with the availability

response within one week we sent up to 3 reminders. When still not

of gel pads in their country.

successful we sent the invitation to the missing national resuscitation councils’ secretariat or second contact person if available.

We found three leading techniques of manual defibrillation with paddles (21 responses):


A. Charging paddles keeping them on the defibrillator during chest

We collected questionnaires from 27 out of 33 ERC member countries: Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Italy, Luxembourg, Malta, Norway, the Netherlands, Poland, Romania, Russian Federation, Serbia,

compressions being delivered (9/21; 43 %) B. Charging paddles keeping them on the patient’s chest during chest compressions being delivered (6/21; 29 %)

Slovakia, Slovenia, Sweden, Switzerland, Turkey, Tunisia and the United Kingdom. The following countries did not respond: Bosnia and Herzegovina, Egypt, Portugal, Spain, Sudan and United Arabic Emirates

C. Charging paddles on the patient chest without chest compressions (5/21; 24 %)

(Fig. 1). The response rate was 82 %. The respondents were physicians (24/27; 89 %), two nurses and a paramedic. Most of the respondents

As a free text comment, one respondent stated that “there was no

worked in a hospital only (13/27; 48 %), both in- and out-of-hospital

uniform practice”.

worked 8/27 (30 %) and 6/27 (22 %) worked outside of the hospital only. The respondents judged the benefits of the chosen defibrillation Sixty-three percent of the respondents (17/27) declared using adhesive

technique with manual paddles selecting high chest compression

pads as the defibrillation technique. In the opinion of the respondents

quality during charging paddles in 7/17 (41 %), a short time from chest

adhesive pads are used more often in pre-hospital cardiac arrest than

compression cessation to shock delivery in 5/17 (29 %), and safety of

in-hospital (the frequency of use 76–100 % was estimated for pre-

the rescuer in 2/17 (12 %) of responses.

hospital 16/27 (59 %) vs. in-hospital 10/27 (37 %)). Figure 1 presents responses regarding the technique of defibrillation used pre-hospital

Cardiac arrest rhythm was initially assessed using adhesive pads by

and in-hospital. There were 10/27 (37 %) countries declaring use of

15/27 (56 %) of respondents, 6/27 (22 %) declared use of the quick-

adhesive pads in both pre- and in-hospital environment in a rate of

look technique for that purpose and 5/27 (19 %) preferred 3-lead ECG

76–100 %. The leading cause indicated by respondents for not using

for initial monitoring of cardiac arrest. As a free text comment, one

adhesive pads in their country was for economic reasons 9/14 (64 %).

respondent stated that “there was no standard practice, depending on

Three (3/14; 21 %) respondents declared a resistance to the use of

people involved and equipment available”.

AMBULANCE UK - AUGUST Fig. 1 Responses on technique of defibrillation used in pre-hospital and in-hospital areas

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


FEATURE The detailed resultsofofthe thisdefibrillation part of the survey are available in Table Table 1 Results techniques survey 2016.1.

Questions 1-9 Table 1 Results of the defibrillation techniques survey 2016. # Question Response n % Questions 1-9 1. How do you usually perform # defibrillation Question Response in your department/working place: 1. How do you usually perform defibrillation in your adhesive pads department/working place: manual paddles adhesive pads 2. What do you estimate is the percentagemanual of usingpaddles adhesive pads in your 2. What do you country: estimatePre-hospital is the percentage76–100 of using % adhesive pads in your country: Pre-hospital 51–75 % 76–100 % 26–50 % 51–75 % 6–25 % 26–50 % 0–5 % 6–25 % 3. What do you estimate is the percentage of 0–5 % using adhesive pads in your country: In-hospital 3. What do you estimate 76–100 % is the percentage of using adhesive pads in your country: In-hospital 51–75 % 76–100 % 26–50 % 51–75 % 6–25 % 26–50 % 0–5 % 6–25 % 4. If adhesive pads use in your country is % % please specify the lower than0–5 76–100 reasonpads for that 4. main If adhesive use in your country is lower thanEconomic 76–100 % reasons please specify the main reason for that Resistance to use adhesive Economic reasons providers pads by healthcare Resistance to use adhesive Other, please specify in box pads by healthcare next to the questionproviders Other, please do specify 5. What coupling medium you in box next to the question use in order to facilitate manual with paddles your country? 5. defibrillation What coupling medium doinyou use in orderElectrode to facilitate manual pastes defibrillation with paddles in your country? Gel Electrode pastes Gel pads Gel Other Gel pads 6. If you are using manual paddles Otherof defibrillation what technique is preferred in your country 6. If you are using manual paddles what technique of defibrillation Charging paddles keeping is preferredthem in your on country the defibrillator


N = 27 % N = 27

17 63 % 10 37 % 17 63 % N = 27 10 37 % N = 27 16 59 % 2 16 1 2 4 1 4 4 4

7% 59 % 4% 7% 15 % 4% 15 % 15 % N = 27 15 %

10 N 37=%27 4 10 2 4 5 2 6 5 6

15 % 37 % 7% 15 % 19 % 7% 22 % 19 % N = 14 22 % N = 14

Table 1 Results of the defibrillation techniques survey 2016. Questions 1-9 (Continued) Table 1 Results of the defibrillation techniques survey 2016. chest compressions quality 7 41 % Questions 1-9High (Continued) delivered during charging paddles High Safetychest - no compressions risk for rescuerquality delivered during charging paddles Short time from chest compressions Safety - notorisk for rescuer cessation shock delivery Short time from chest Other (please specify) compressions cessation to shock delivery 8. What major drawback of other defibrillation (please specify) techniquesOther with paddles make them useless for you 8. What majorDelay drawback of other defibrillation from chest compressions techniquescessation with paddles makedelivery them useless for you to shock


41 12 % %

5 2

29 % 12 %


29 18 % %


N = 20 18 %


N 40=%20


40 20 % %

Poor chest compressions quality Risk for rescuer delivered during charging paddles Other (please specify) Risk for rescuer 9. If healthcare providers in your country use Other (please specify) the quick-look with manual paddles technique the FIRST providers assessment cardiac arrest 9. for If healthcare in in your country usevictim, what would bewith the next steppaddles when confirming the quick-look manual technique shockable rhythm for the FIRST assessment in cardiac arrest victim, what wouldCharge be thethe next step whenwith confirming defibrillator paddles shockable rhythm ON the patient chest WITH ongoing


20 35 % %

1 7

5% 35 % N = 16 5%


13 %

chest Chargecompressions the defibrillator with paddles ON the patient chest WITH Charge the defibrillator withongoing paddles chest compressions ON the patient chest WITHOUT chest


13 %


31 %

compressions Charge the defibrillator with paddles ON the patient chest Remove paddleschest fromWITHOUT the patient chest compressions and resume/start chest compressions,


31 %


31 %


31 %


25 %


25 %

Delay from compressions chest compressions Poor chest quality cessation shockcharging deliverypaddles delivered to during


64 %

3 9

21 % 64 %


21 14 % %

than deliver shockfrom afterthe charging Remove paddles patient chest defibrillator and resume/start chest compressions, than shockplease after charging Otherdeliver technique, describe in defibrillator box on the right hand side


14 N =%23

Other technique, please describe in box on the right hand side


N = 16

When the quick-look technique was used and shockable rhythm was

N = 23

detected, the next suggested step from 2/16 (13 %) of respondents was


17 %

charging the defibrillator with the paddles on the patient’s chest with

7 4 11 7 1 11

30 % 17 % 48 % 30 % 4% 48 % N = 21 4%


N = 21

ongoing chest compressions, however 5/16 (31 %) of respondents declared charging the defibrillator with paddles on the patient’s chest without chest compressions. Five out of 16 (31 %) of respondents suggested removing the paddles from the patient’s chest and resuming/starting chest compressions, and then delivering a shock after charging the defibrillator. The technique for further monitoring of cardiac arrest rhythm and the modification of the monitoring in case of low ECG signal quality is shown in Table 2.



43 %

during chest compressions Charging paddles keeping being delivered them on the defibrillator during chest compressions Charging paddles keeping being delivered them on the patient chest


43 %

In free text comments regarding the technique of monitoring cardiac rhythm,


29 %

changing ECG leads may be a solution for poor ECG signal quality and that

during chest compressions Charging paddles keeping being delivered them on the patient chest during chest compressions Charging paddles on the patient being deliveredchest compressions chest without


29 %


24 %



24 5 %%

The Resuscitation Guidelines recommend minimizing unnecessary


N = 17 5%

Charging paddles(please on thedescribe): patient Other technique chest without chest compressions 7. What major benefit of chosen manual defibrillation Otherpaddles technique describe): technique with you(please find useful 7. What major benefit of chosen manual defibrillation technique with paddles you find useful

N = 17

there were suggestions that adhesive pads provide a good ECG signal, that more modern equipment will result in a better quality of ECG.

breaks in chest compression delivery [1]. When defibrillation is attempted, the time from cessation of chest compressions to shock delivery should not exceed 5–10 s, which is possible if chest compressions are performed while charging the defibrillator.

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FEATURE Table 2 The way of monitoring cardiac arrest rhythm. Results of the defibrillation techniques survey 2016. Questions 10–12 #

Adhesive pads

“Quick look” with paddles

3-lead ECG


No change in monitoring technique

10. Cardiac arrest rhythm initial assessment

56 % (15/ 27)

22 % (6/27)

19 % (5/27)

4 % (1/27)


11. Best signal quality for monitoring during cardiac arrest

37 % (10/ 27)

4 % (1/27)

56 % (15/27)

4 % (1/27)


12. Change in monitoring in case of low ECG signal quality

26 % (7/27) 11 % (3/27)

37 % (10/27)

7 % (2/27)

19 % (5/27)

(N/A – not applicable)

Despite the fact that guidelines recommend using adhesive pads, the

of using manual paddles are still important barriers in guideline

survey results revealed that the use of manual paddles is still common

implementation. The Hungarian study also revealed that the major

in Europe. There were just 10/27 (37 %) countries declaring use of

obstacle for adhesive pads use which were the perceived cost-

adhesive pads in both pre- and in-hospital environment in a rate of

efficiency concerns declared in 60 % of responds, however, the

76–100 %. The use of adhesive pads was declared by 63 % of the

majority of clinicians (92 %) were aware of the benefits of adhesive

respondents. There are discrepancies in the use of adhesive pads

pads use [15].

between the countries and the location of the healthcare service (preand in-hospital areas). In countries with low adhesive pads usage, we

Many of the respondents (47 %) using the manual paddles still use

see signs of growing use of adhesive pads in the pre-hospital area,

gel or electrode pastes as a coupling medium, despite the fact it is

which may be associated with awareness of the guidelines in this group

not recommended since 2005 Guidelines release [18]. The reason for

of healthcare providers which changes the former defibrillation practice

that may be low availability of gel pads is some European countries

[11, 12, 13]. In the recently published study from Hungary only 6,5 %

indicated by the respondents.

of the interviewed senior consultants of the intensive care units and emergency departments from audited 56 hospitals declared the use of

The use of adhesive pads is the leading technique for initial cardiac

adhesive pads routinely at the time of the survey [15].

arrest rhythm assessment (56 % of respondents), however, the quick-

The 2015 Resuscitation Guidelines recognize a possibility of providing defibrillation with manual paddles in case of lack of adhesive pads [1], however, there is limited number of evidence how frequent it happens and what is the technique of defibrillation performed with manual paddles since the Guidelines do not provide any information regarding this topic. Based on previous reports on this topic we identified the most common techniques of performing defibrillation. The questionnaire contained a field for any other technique, however, no respondent suggested a different approach. In our study three different techniques of manual paddles use were reported. Two of them include charging the defibrillator during chest compression delivery. The difference between them is the location of the paddles – either on the patient’s chest (29 %) or on the defibrillator (43 %). Currently, there is no evidence to determine which technique is better in terms of chest compression quality, safety of the rescuer and pre- and post-shock pauses in chest compressions. Five of the respondents declared they did not perform chest compressions during charging the defibrillator, which, despite the short time it takes for charging of the modern defibrillator, still generates long pauses in chest compression delivery. The survey was performed technique was still reported as being used, which may reflect current practice in some European countries. There are also differences in performing defibrillation with adhesive pads (charging the defibrillator towards the end of every 2 min cycle of CPR). This is also recognized in the 2015 guidelines by the ALS writing group, however, the benefit from

of respondents declaring 3-lead ECG use for initial monitoring. The choice of the different approach to initial cardiac rhythm assessment may influence the outcome of resuscitation. One of the key changes in ERC ALS Guidelines since 2010 is keeping the focus on the use of adhesive pads and a defibrillation strategy to minimize the preshock pause [1]. The use of 3-lead ECG monitoring for initial rhythm assessment is definitely inferior to either adhesive pads or “quick look” with paddles [9], however, five of the respondents who declared adhesive pads use chose 3-lead ECG monitoring for that purpose. There are also different approaches to the technique of defibrillation attempts when shockable rhythm is present during the quick-look assessment technique. Further studies are needed to indicate the optimal approach. When a low quality signal was detected, 10/27 (37 %) of the survey respondents changed the method of monitoring to 3-lead ECG, 7/27 (26 %) looked for better signal quality with adhesive pads use and 5/27 (19 %) of respondents did not change the method of monitoring. The quality of the ECG signal is vital during cardiac arrest management and may influence therapeutic decisions. Currently, there are no human studies known to the authors of this paper assessing this issue in terms of cardiac arrest management.

Study limitations

this intervention is unknown [1, 16, 17]. The study is limited by the small number of respondents: only those Interestingly, an economic reason for not using adhesive pads,

ERC National Representatives who decided to respond to the on-

even though high 9/14 (64 %), was not the only reason indicated by

line questionnaire. We did not receive responses from all European

respondents. Resistance to using adhesive pads and the tradition

countries which may generate a bias.


3 months after delivery of the 2015 Guidelines, however, the 2005

look technique appears to be used at a similar level (22 %) with 19 %

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

FEATURE Some respondents, however, representing their country, have found difficulties in indicating the exact percentage of adhesive pads use in their countries which hinders drawing clear conclusions. On the other hand it was the only way to collect preliminary data showing how defibrillation is performed in Europe. There were suggestions from the survey participants that the study should be open to a wider group of respondents in each country.

Authors’ Affiliations (1) Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College (2) Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College


Conclusions Based on the observations as presented above, we conclude that there are limitations and barriers in implementation of the defibrillation technique guidelines. There are still countries where the use of adhesive pads is low due to economic and traditional reasons. There is a need for further efforts focused on guidelines implementation in terms of the use of adhesive pads and a defibrillation strategy to minimize the preshock pause.


1. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Guidelines for Resuscitation 2015. Section 3. Adult advanced life support. Resuscitation. 2015;95:100–47.View ArticlePubMedGoogle Scholar 2. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-ofhospital cardiac arrest: a graphic model. Ann Emerg Med. 1993;22(11):1652–8.View ArticlePubMedGoogle Scholar 3. Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation. 1997;96(10):3308– 13.View ArticlePubMedGoogle Scholar 4. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006;71(2):137–45.View ArticlePubMedGoogle Scholar

Acknowledgements The authors wish to acknowledge their gratitude to Ruud Koster for fruitful discussions and support as well as Bart Vissers from the ERC Office for his help in acquiring data. The study was supported by Leading National Research Center 2012–2017. Figure 1 is based on a map by Maix (Wikimedia Commons, https://commons.wikimedia. org/wiki/File:Blank_map_of_Europe.svg) used with permission under Creative Commons CC-BY-SA 2.5 license. We would like to thank all respondents to the survey. The alphabetical list of the survey contributors: Souhail Alouini, Janusz Andres, Pascal Cassan, Diane Cimpoesu, Carlo Clarens, Michael Baubin, Kubilay Demirag, Zlatko Fišer, Jan-Thorsten Gräsner, Michael Colquhoun, Silvija HunyadiAnticevic, Marios Georgou, Jonathan Joslin, Jozef Köppl, Kristian Lexow, Freddy Lipert, Romano Mauri, Victor Moroz, Nicolas Mpotos, Ferenc Nagy, Federico Semeraro, Anatolij Truhlár, Jukka Vaahersalo, Felix Valsson, Elmer van den Berghaage, Dušan Vlahovic, Henrik Wagner. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the

5. Eftestøl T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105(19):2270–3.View ArticlePubMedGoogle Scholar 6. Gundersen K, Kvaløy JT, Kramer-Johansen J, Steen PA, Eftestøl T. Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study. BMC Med. 2009;7:6.View ArticlePubMedPubMed CentralGoogle Scholar 7. Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation. 2010;81(10):1293–304.View ArticlePubMedGoogle Scholar 8. Perkins GD, Davies RP, Soar J, Thickett DR. The impact of manual defibrillation technique on no-flow time during simulated cardiopulmonary resuscitation. Resuscitation. 2007;73(1):109–14.View ArticlePubMedGoogle Scholar 9. Perkins GD, Roberts C, Gao F. Delays in defibrillation: influence of different monitoring techniques. Br J Anaesth. 2002;89(3):405–8.View ArticlePubMedGoogle Scholar 10. Stults KR, Brown DD, Cooley F, Kerber RE. Self-adhesive monitor/defibrillation pads improve prehospital defibrillation success. Ann Emerg Med. 1987;16(8):872–7.View ArticlePubMedGoogle Scholar 11. Krawczyk P, Kononowicz AA, Andres J. Manual defibrillation technique – A pilot survey of European performance – poster presentation abstract. Resuscitation. 2012;83:e24–e123. View ArticleGoogle Scholar 12. Cebula G, Koszowski P, Krawczyk P, Kononowicz AA, Odrzywołek R, Andres J. Manual defibrillation according to the 2010 European Resuscitation Council (ERC) Guidelines – is there a consensus? Report from 6th International Emergency Medicine Championship. Resuscitation. 2011;82S1:S1–S34.Google Scholar 13. Cebula G, Krawczyk P, Kononowicz AA, Koszowski M, Odrzywołek R, Andres J. Manual defibrillation using paddles - Which is the best technique? Resuscitation. 2012;83:e127–8. View ArticlePubMedGoogle Scholar


data made available in this article, unless otherwise stated.

14. The archived Defibrillation Technique Survey 2016 questionnaire: Accessed on 9th February 2016.

Competing interests

15. Dioszeghy C, Molnar N. Current practice and perspective of hands-free defibrillation in Hungary – Investigating the obstacles of implementation. Interv Med Appl Sci. 2014;6(2):69–74.View ArticlePubMedPubMed CentralGoogle Scholar

The authors declare that they have no competing interests.

Authors’ contributions PK conceived the idea for the study. PK, AK, JA contributed to the design of the research. PK, AK were involved in data collection. AK made descriptive statistical analysis. All authors interpreted the data, edited and approved the final version of the manuscript.

16. Edelson DP, Robertson-Dick BJ, Yuen TC, Eilevstjønn J, Walsh D, Bareis CJ, et al. Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Resuscitation. 2010;81:1521–6.View ArticlePubMedPubMed CentralGoogle Scholar 17. Hansen LK, Mohammed A, Pedersen M, Folkestad L, Brodersen J, Hey T et al. The StopOnly-While-Shocking algorithm reduces hands-off time by 17 % during cardiopulmonary resuscitation - a simulation study. Eur J Emerg Med 2015. [Epub ahead of print] 18. Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council Guidelines for Resuscitation 2005 Section 4. Adult advanced life support. Resuscitation. 2005;67 Suppl 1:S39–86.View ArticlePubMedGoogle Scholar

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LIFE CONNECTIONS 2016 GREAT CHOICE, GREAT VALUE Over 200 delegates have already registered for the five conferences

Video Assisted Intubation and Surgical Cricothyrotomy. Only 12 places

and three workshops taking place at this year's unique multi conference/

remain available on this course at a rate of £96 including VAT which

workshop event being held at The Kettering Conference Centre,

again includes lunch, tea/coffee, etc.

Kettering, NN15 6PB on Tuesday 18 and Wednesday 19 October and, with delegate rates starting at just £18 including lunch, tea/coffee, etc.,

On Wednesday 19 October, the same organisation are running a PHTLS

Life Connections 2016 again represents tremendous value for money.

First Responders Course which teaches the principles of PHTLS and

This year's conference programmes include presentations on: Airway Management in Cardiac Arrest, The Role of the Critical Care Paramedic, The Changing Face of Major Trauma, Intra-Arrest Thrombolysis, Damage Control Resuscitation - Fluids in Trauma, Public Access Defibrillators Governance vs.Vigilance and, Medical Command - The Future, being given by quality speakers who are well versed in their respective fields.

is ideal for first responders, EMS practitioners, etc. the topics on this course include: Airway/Oxygenation & Ventilation, Circulation & Shock, Traumatic Brain Surgery and Spinal Trauma. Only 14 places remain available on this course which is again priced at just £96 including VAT. Lunch etc Also on Wednesday 19, Meditech Global are running a Motorsport Medicine CPD Workshop for those with an interest in motorsport. Sessions include: Concussion in Motorsport, A Paramedic's Life in Motorsport, The Use of Heamostatic Dressings, etc. Only 11 place remain available at a cost of £60 per person including VAT. Lunch etc All delegates will also have the added benefit of seeing the latest equipment and supplies being showcased by over 40 exhibitors. To secure your place and view the full conference programmes please visit our website: or call the Organisers on: 01322 660434

Conference/Workshop details Tuesday 18 October Paramedic Practice - Early bird registration extended until August 31 secure your place now for just £36 In addition, on Tuesday 18 October, Pre-Hospital Care Consultancy Ltd are running a course on Essentials of Advanced Airway Management where delegates will be able to learn the full range of airway management techniques, including The Use of Extraglotic Devices,

Emergency First Responder Conference - 40 subsidised places remain available at just £18 Essentials of Advanced Airway Management - only 12 places remain available at a discounted rate of £96 Wednesday 19 October

Specialist Paramedic - Critical Care Conference - Early bird registration extended until August 31 - secure your place now for just £36 First Aid Conference (supported by AoFA) - Early bird registration extended until August 31 - secure your place now for just £60 PHTLS First Responder Course - only 14 places remain available at a discounted rate of £96


Resuscitation Today Conference - Early bird registration extended until August 31 - secure your place now for just £36

Motorsport Medicine CPD Workshop - only 11 places remain available at a rate of £60

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


World’s fastest woman thanks Yorkshire Air Ambulance The world’s fastest woman has made a special return to Yorkshire to thank air ambulance medics after surviving a terrifying motorcycle crash at more than 200mph. Becci Ellis was trying to beat her own land speed record of 264mph at Elvington Airfield, North Yorkshire, last August when the high-speed accident happened. After reaching an astonishing 254mph her powerful turbo-powered bike was hit by a gust of wind sending her veering off the track.

Yorkshire Air Ambulance was

and the paramedics were there

what they do at events they have

quickly on scene and airlifted

very quickly. I was in Leeds

definitely save lives. Accidents

Becci to hospital in Leeds within

hospital fifteen minutes after the

happen but it is so reassuring to

minutes. Thanks to armour-plating


know that we have this amazing service on hand to look after us.”

inside her racing suit, the 49-yearold IT analyst miraculously

Becci’s recovery has been painful

escaped with a broken ankle,

and slow, but with the help of a

Becci set her world record of

severe bruising and whiplash.

sports therapist and the support

264mph in October 2014 Elvington

of her family she is now ready

Airfield, beating the previous title-

to ride again – although on a

she was trackside at Elvington

completely rebuilt bike.

is considering returning in August

other competitors and to help

The mother-of-two from

her record again.

raise money for Yorkshire Air

Scunthorpe took the new bike to


Yorkshire Air Ambulance’s Nostell

again the following day to watch

Air Base, near Wakefield, to show Becci said: “I had just gone

air crew and paramedics and to

through the speed gate at

thank them.

254mph when the wind caught me and in less than a second the

Becci added: “Mick and I have

bike had gone onto the grass.

been collecting for the Air Ambulance for about 12 years

“I managed to keep the bike

and the day after my accident we

upright but I was still doing

raised £500.

around 90mph when the bike Spectators - including her

finally dug into the dirt and I was

“The paramedics and pilots are

husband and former racer Mick

catapulted off. I don’t remember

just fantastic and I taking the new

- watched in horror as Becci’s

coming off or hitting the ground,

bike up was my way of saying

Suzuki Hayabusa careered out

but I landed on my front sliding for

thank you for being there for me

of control for a quarter of a mile

about 70 yards and blacked out

that day.

before, still travelling at around


90mph, the mother-of-two was thrown off.

holder by more than 20mph. She

After an eight-hour hospital stay,

“The air ambulance was called

to make a further attempt to break

“I’m having another couple of test and tune days next month and if weather conditions are perfect we aim to get as close to 270mph as possible. But it is totally down to me, I’m not going to put my life at risk for this, it’s not worth it, and I have nothing to prove.” Yorkshire Air Ambulance serves 5million people across Yorkshire and has carried more than 6,600 people in its 15-year history. The charity has just placed an order for two, brand new stateof-the-art replacements for its current ageing aircraft – G-SASH

“I know, not just from what

and G-CEMS - that will take to the

happened to me, but having seen

skies over Yorkshire later this year and in Spring 2017. The latest generation Airbus H145 helicopters will give paramedics a much more modern medical fit-out to treat and transport often critically injured patients.



What an experience… Students learn about life in the ambulance service It was a week like no other for a group of students from throughout the region as they experienced what it is like to work for the ambulance service.

Becci Ellis (front) and husband Mick (behind left) meet Yorkshire Air Ambulance pilot Capt Garry Brasher (behind right) and paramedics Matt Syrat and Sammy Wills.

158 For further recruitment vacancies visit:

Ranging from school years ten to 12, youngsters from schools in Staffordshire, the Black Country

NEWSLINE and Birmingham have spent

been pleased to host another

Partridge, who attends

dad is already one, but now it

the week at Dudley Hub as part

group of very keen students.

Summerhill Secondary School in

is something I would be really

Kingswinford, said: “It has been

interested in.

of the Trust’s work experience “They have shown great

a really interesting week and I’ve

enthusiasm to learn and hopefully

gained lots of information about

“As well as learning lots about

The 12-strong group met a range

this has given them an appetite

what the ambulance service does.

the service and the wide variety

of operational staff, including

to apply for jobs with us in the

paramedics from the Trust’s



Hazardous Area Response Team (HART) and motorbike

One of the students, Tom

of calls that people make to 999, “Being a paramedic wasn’t

I’ve also made lots of friends this

something I had thought about

week, it has been a really good

doing before, even though my


paramedic Mark Hayes to find out more about their roles and responsibilities. This included how 999 calls are handled, basic life support, how to use a defibrillator, what causes a cardiac arrest and the work of community first responders amongst much more. They also got to explore the back of an ambulance and sample some of the various equipment staff use on a daily basis to treat patients. Diane Pittom, the Trust’s Organisational Development Officer, said: “It has been a really enjoyable week and we have

West Midlands Ambulance Service


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VCS FULL STEAM AHEAD Operating from its’ all new modern 45,000 sq ft purposely designed facility, running three dedicated vehicle assembly lines, with the ability to scale up to a fourth assembly line giving a total output capacity annually of circa 650 vehicles. VCS have created a new production plant to take into consideration new products and design, the assembly lines to suit the product make up, aligning materials allocation so as to have a smooth and effective production process. Sales and Operations Director Mr Mark Kerrigan commented “Our aim and vision at VCS is to produce vehicles using controlled and disciplined procedures which gives the customer a quality and well-engineered product but also provides an efficient manufacturing process. Each assembly line is treated as its’ own cost centre which has its’ own project leads, engineering and design technicians and budgets. We strive to use the most up-to-date techniques be it laser cutting, 3D printing or CNC machining. We also engage on a regular basis with current suppliers and new suppliers to investigate new ideas and innovations so we can look to incorporate into our product design element” Mark explains. “Blue light vehicles play an important role in saving lives and in our opinion here at VCS they need to be produced to a high level of quality but also manufactured with strict control. We don’t believe in the conventional methods of manufacturing and that is why VCS do things very differently from many of our competitors in relation to the assembly techniques and materials chosen. VCS has unique process’s which are patented under the VCS banner”, Mark adds. “We are fortunate that we have customers who embrace the VCS product, its’ quality and appeal. Customer satisfaction is at the centre of the VCS philosophy”. VCS have created an impressive and slick production line build with material expeditors moving parts from the sub systems manufacturing department to line technicians, who in turn immediately install the engineered components with efficiency and confidence. I watched how each vehicle is examined by the Quality inspectors before the vehicle is given sign off to move to the next production assembly stage. It is evidently apparent to me that the shareholders at VCS mean business and want to serve the market for many years to come. Talking with key management and also looking at the investment that has gone into the all new production facility at VCS Limited, it is very clear that this brand is here to stay and will have a long and impressive impact/growth in the market place in the years ahead. VCS Limited, Commondale Way, Euroway Trading Estate, Bradford, BD4 6SF. Telephone: 01274 685872 Web:


Bedfordshire coresponse scheme launched A life-saving partnership between ambulance staff and firefighters has begun in Bedfordshire with the launch of a new co-responding scheme. In recent months, the East of England Ambulance Service NHS Trust (EEAST) has been working with six fire and rescue services on a pilot that will involve firefighters attending cardiac arrests. The scheme has been launched on a trial basis in Leighton Buzzard and Biggleswade. It sees firefighters deployed in response cars in addition to ambulance clinicians and community first responders to calls where a patient is not breathing and their heart has stopped beating. Rob Ashford, Acting Director of Service Delivery for EEAST, said: "We already work closely with 999 colleagues and this is an extension of our partnership to help patients with an immediately life-threatening condition.

He added: "The ambulance service will continue to send clinicians to such patients as a top priority, but the best thing for the patient is to get someone

Firefighters are trained in basic life support and equipped with defibrillators and the Trust will be providing on-going basic life support to those taking part in the trial. Ian Evans, Head of Operations at Bedfordshire Fire and Rescue

Service (BFRS) said: “We have fire stations located around the county to ensure we can reach any fire or other incident as quickly as possible. However, over the past ten years our fire prevention campaigns have significantly reduced the numbers of fires and we have the capacity to use our firefighters to deal with other life-threatening incidents in our community.

“Firefighters have volunteered to take part in this pilot, which is an evolution of the work we do every day. We are not turning firefighters into paramedics - we are making the most of their existing lifesaving skills and our ability to mobilise to incidents quickly in support of EEAST. We are not replacing paramedic services and will not be transporting casualties.”

MEDITECH GLOBAL Motorsport Medicine Workshop Wednesday 19th October 2016 Motorsport pre-hospital support can be just as challenging as it can be exciting. Our CPD day is open to all those providing medical or rescue cover during motorsport events and will include relevant information sharing with industry experienced doctors and paramedics, discussing current best practise along with hands-on medical/rescue workshop sessions. Only 10 places remain available at £60 per person

PROGRAMME Rescue Team Leader – Entrapment and Extrication in Motorsport – an interactive session discussing current and future trends in motorsport extrication. Paramedic – Practical Session on Extrication – vacuum and ked from single seater, with discussion on splinting during trauma induced coagulopathy. Celox – Demonstration in the use of haemostatic dressings during catastrophic bleeding injuries. Doctor – Role of a Motorsport Medic – duties and expectations of a medic working within the motorsport industry. Paramedic – A Life as a Motorsport Medic – anecdotal account from a paramedic with a lifetime of motorsport experience. Meditech Global – Motorsport Emergency Response & Care Training. A review of what is included in this new course aimed at medical and rescue operatives. To Register call 01322 660434 or visit


"Building on the collaborative work already undertaken through community first response (CFR), public access defibrillation and RAF co-response schemes, we also believe co-response schemes can add significantly to our ability to respond to patients quickly and start basic life support. We know that the quicker someone starts cardiopulmonary resuscitation (CPR) and gets a defibrillator to a patient in cardiac arrest the better chance they have of surviving.

trained in basic life support to their side as quickly as possible.”

161 For all your equipment needs visit:

Focus on Cloud-Based Resource Optimization Technology

EMS Operations transformed by Cloud-based platform WC EMS, the ambulance service of the Western Cape Department of Health, is one of the largest EMS services in South Africa. Covering a land area similar in size to England, it services a population of 6.20 million, 3.75 million of whom live in the Cape Town metropolitan area. Operating six emergency control centres and a fleet of 460 vehicles, WC EMS attends in excess of 500,000 incidents annually. As well as emergency medical response, WC EMS comprises HealthNET, which provides non-emergency patient transport services across the Western Cape Province. Following an intensive 30-month project, WC EMS has incrementally implemented all main system components of Valentia’s CareMonX EMS Suite: Emergency CAD, Patient Transport CAD, MDT and ePCR. Also implemented are Valentia’s ERP systems covering Roster Management, Fleet Management and Operational Analytics. Together the systems are seamlessly integrated in one end-to-end platform that addresses all of WC EMS’s clinical and operational requirements. Being cloud-based and modular, CareMonX EMS Suite is highly versatile, scalable and future proofed, all of which were key selection criteria of WC EMS. All CareMonX mobility elements are operating system



agnostic across Windows, iOS and Android systems. Android was selected by WC EMS as the preferred platform for all MDT and ePCR mobile devices. Implemented by Valentia in conjunction with its South African partner, Dimension Data, the solution replaced Emergency CAD and Patient Transport CAD systems used by WC EMS in all six control rooms and also introduced, for the first time, MDT, ePCR and ERP systems. The solution, which has been configured as a multi-node survivable system, is deployed in a secure private cloud environment managed by Dimension Data. Immediate benefits of CareMonX Emergency CAD included a 20% reduction in call registration times as well as a sizeable

reduction in abandoned calls rates and improvements in call classifications. Average time-to-dispatch recorded a more than 40% improvement from over 11 minutes to six minutes, assisted by Valentia’s location management application which provide enterprise-wide views of all vehicle locations. CareMonX Emergency CAD also incorporates international standards-based Disaster Management functionality, including rapid activation of mobile control room units that utilise multiple wireless communication technologies. CareMonX Patient Transport CAD underpins the complex daily operations of the provincial scheduled patient transport service, HealthNET, which encompasses a fleet of almost 100 vehicles plying 60 routes extended across 495 collection points. CareMonX PTS CAD enables 100+ treatment facilities that receive transported patients to directly enter patient transport bookings via an online portal. An SMS based e-Ticketing facility is available for use by patients, especially those living in remote or rural communities. Benefits of CareMonX MDT include improved mobilisation times resulting from electronic communication of incident data rather than via radio, shaving up to 90

To find out more about Valentia Technologies’ product range visit: or call them on: +353 1 299 5600

Focus on Cloud-Based Resource Optimization Technology

”It has been our privilege to have worked closely with Western Cape EMS management and staff to implement our full CareMonX EMS Suite which has transformed WC EMS into one of the most joined-up EMS services anywhere in the world today.” Peter Nelson President Business Development Valentia Technologies seconds off each initial communication. Use of real-time status updates and two-way messaging has created additional benefits in the form of resource optimisation and capacity management. Additionally, intuitive navigation (map data provided by TomTom) in the MDT application has improved onscene arrival performance.

EMS Suite

records from in-field ambulances to hospital Emergency Departments where they are immediately viewable, thereby optimising use of the all-important “golden hour” for enhanced treatment outcomes. CareMonX ePCR also produces valuable operational and clinical data that contribute to improving service planning and paramedic staff skilling.

Systems • Emergency CAD • Patient Transport CAD • Repatriation CAD • Major Incident CAD • Mobile Doctor/Nurse CAD • Dispatch Management • Mobilisation (MDT) • Location Management • Community Responder Apps • Electronic Patient Care Reporting (ePCR) • Roster Management • Fleet Management • Billing Management • Operational Analytics Features • Service Oriented Architecture • Cloud enabled • Survivable multi node • Multi OS enabled • 4G, 3G, Wi-Fi and TETRA enabled • Standards-based PBX integration • HL7 and health information exchange with wider health services

“Implementation of Valentia Technologies CareMonX EMS Suite has provided Western Cape EMS with one of the most comprehensive and technologically advanced EMS business solutions in the developed world today.” Dr Shaheem De Vries Director Western Cape EMS CareMonX ePCR has enabled WC EMS to switch from manual paper recording to realtime digital capture for care interventions associated with the 500,000+ incidents responded to annually. As well as freeing up valuable paramedic time, CareMonX ePCR facilitates real-time transmission of care WESTERN CAPE

As CareMonX EMS Suite includes extensive in-built healthcare data sharing capabilities that enable EMS services to integrate with wider healthcare services, the WC EMS solution has been further designed to directly support the Service’s strategy of playing an increasingly pivotal role in the continuum of community-based care across urban and rural Western Cape. About Valentia Technologies

6.20m 129,462km2 45.0 per km2

Valentia Technologies develops and implements innovative software solutions and services that transform the way healthcare is provided outside of hospital.

WC EMS Personnel Control Rooms Stations Operational Fleet Calls Received Incidents Attended Patients Transported PTS Transports Director Web

1,950 6 55 460 735,000 515,000 620,000 95,000 Dr. Shaheem de Vries

Valentia’s integrated suite of products, spanning EMS, urgent and unplanned care, community healthcare, and homecare, enables new models of joined-up converged care that address many of the mounting challenges facing healthcare today: rising demand, escalating costs, improved quality outcomes and accountability, and the need for greater efficiency.

To find out more about Valentia Technologies visit: Or email: Telephone: +353 1 299 5600

To find out more about Valentia Technologies’ product range visit: or call them on: +353 1 299 5600


Key Facts Population Size Population Density

Valentia’s solutions are implemented at scale in organisations that provide EMS services, patient transport services, urgent care services, primary care, community nursing, allied healthcare services and homecare services in countries in Europe, Australasia, the Middle East and Africa.


NEWSLINE potentially life-saving treatment.


CFR group scoop Queens Award for Voluntary Service A community first responder (CFR) group in the West Midlands has been given the most prestigious award a voluntary organisation can get. FastAid Solihull has been recognised with the Queen’s Award for Voluntary Service for 2016 The group work with West Midlands Ambulance Service to respond to life threatening 999 calls in their local communities. CFRs are equipped with a defibrillator, oxygen and a first aid pack, they are responded at the same time as ambulance resources, but due to their location will often get to a patient just before the ambulance and are therefore able to start

As well as providing care for people in their local area, the CFRs spend a considerable amount of time teaching other people the skills and knowledge such as CPR sessions onto other local community organisations. Samantha Jackson and Mark Lines from FastAid attended a garden party at Buckingham Palace on Tuesday 24th May where they met the Queen and other winners of this year’s award. Sam Jackson Trustee and CoOrdinator of FastAid said: “We are absolutely delighted to have been given this award. It is clearly a testament to the efforts of all those involved in FastAid, who give up their time voluntarily to help those in need of medical care. The fact that this award has been received in this, our 10th year of operation, means it is even more special.

groups like FASTAID come in. For every minute a patient is in cardiac arrest, their chance of survival decreases by 10 percent.”

“I’d like to thank the volunteers in our group for all of their efforts. To get this award is clearly special, but knowing that we’ve saved someone’s life is even more so, and that is why we do it.”

WMAS Chief Executive, Anthony Marsh said: “Getting this award is a fantastic achievement for FASTAID and shows the value that such groups play in the community they live and work in.

Andy Jeynes, Community Response Manager for Birmingham and Solihull, said: “There are many patients alive today because of the work of community first responders. Even though they might only get to a patient a matter of minutes before an ambulance, starting CPR (cardiopulmonary resuscitation) earlier can make a massive difference to the chances of the person surviving.

“As an organisation, WMAS is tremendously fortunate to have many CFR groups like FASTAID who freely give of their time to help the ambulance service, but more importantly our patients. My warmest congratulations to each and every one of you.”

“CFRs can be called upon to attend to medical emergencies such as cardiac arrest, strokes, falls and breathing problems amongst others. Approximately 850,000 adults suffer a cardiac arrest every year in the UK. About 90% could be helped by early defibrillation, which is where

FastAid will receive the award from the Lord Lieutenant later this summer. For more information about the group, to make a donation or find out more information about joining them, please go to:

GET OUT OF THE CLASSROOM! HART teams and first responders are loving our new full bodied Airway Management manikin! The medical torso includes all anatomical landmarks and accepts an igel® supraglottic airway device.



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New Training Concept opens in Midlands In September 2016 the doors of the Emergency Care Education Centre will open its doors for the first time. The Centre is the brainchild of Allan Withers, a former Ambulance Service Manager, who has spent the last fifteen years managing some of the UK’s largest mass gatherings and music events. The Centre aims to offer realistic training opportunities and chose the Ricoh Arena in Coventry as its first location. There are already plans for a second Centre in the North-West and a third by mid-2017 in the Middle East. Andy Howes, Director of Clinical Care and Training, said “We have worked over the past twelve months to ensure we have the correct suite of courses available to delegates and chose the Ricoh Arena due to its central location, but also excellent conference facilities. We have developed a clinical training space known as the Skills Lab that is second to known in the country.” The Centre will offer delegates a range of CPD events to ensure best practice is available to all Health Care Professionals. We Train by offering you hands on experiential clinical education. Scenario based to add realism using the best equipment available delivered by the best Clinical Care Instructors. Training takes place in our Skills Lab specially developed to offer the best possible learning environment. AMBULANCE UK - AUGUST

We Maintain by offering you access to our Virtual Learning Environment. Using a bespoke platform we can offer extended support to all of our students and allow them to go on a journey with students from other courses sharing information, populating Continuous Personal & Professional portfolios, accessing forums where the faculty can assist for up to 12 months post course. We Develop by working with you to provide the next step – its not about when your certificate expires its how you use it in between and working on the core competencies.

166 For further recruitment vacancies visit:


ellenor provides training to ambulance crews to reduce A&E admissions With an eye on improving end-oflife care for everyone in the local community, ellenor is running training sessions for ambulance crew members to help them identify when a patient is dying. ellenor is the only charity in Kent that provides hospice care for people of all ages – babies, children and adults - and their families. This includes pain and symptom relief, end of life care, respite, bereavement support and emotional and spiritual care.

People who are dying can sometimes, having reached a crisis point, find themselves being transferred to an A&E department – particularly if they are not currently under the care of a hospice. However, it would very often be more appropriate for them to receive specialist palliative care. “Access to specialist palliative care support has been shown to be effective at reducing A&E attendance,” says Linda Coffey, Head of Adult Community Services at ellenor. The primary responders to patients in such a crisis situation are the ambulance service – so ellenor has been working closely with teams from South East Coast Ambulance Service (SECAmb) to help them to identify when a patient is dying.

Linda Coffey, along with Dawn Dark, Triage Nurse at ellenor have run a number of evening training sessions for SECAmb staff. The sessions covered the services provided by ellenor, symptom control, palliative care emergencies and identification of dying. The ambulance crew were also encouraged to ‘pick up the phone’ for advice. Staff who attended stated they now felt more confident in dealing with end-of-life care and would now call ellenor for advice and support. Discussions around recognition of dying were felt to be very helpful, as was the knowledge that advice for patients not known to ellenor could still be sought. “We’ve noticed that, since the training courses have taken place,

“Access to specialist palliative care support has been shown to be effective at reducing A&E attendance” there’s been an increase in calls and admission requests from crews, all of which have been appropriate and have supported patient choice at the end of life,” says Linda.


Dawn Dark (left) and Linda Coffey from ellenor at a recent training session for SECAmb employees

167 Life Connections - The Affordable CPD Provider:


Quality care for patients: new priorities for ambulance service

In the past year, despite an

“All of the work we are focused

the public and our stakeholders

unprecedented increase in 999

on is about us becoming

to measure our clinical focus

use, the Trust exceeded targets

a more clinically-focused

and successes, and a great deal

for heart attack and stroke care, achieved above the national average for asthma, mental health and child seizure care

organisation, that's patient driven and responsive. I’d like to thank my colleagues for their hard work and support in

of work goes into it to ensure we’re identifying what it is our patients need from us in terms of

delivering excellent care during

care and good clinical practice.

The way the ambulance

clinical outcomes, and improved

an exceptionally challenging

I’d like to thank the clinical

service has evolved the high

recognition of sepsis, a life-

year where, for the first time

teams for pulling together all

quality of patient care has

threatening disease that claims

ever, we took more than a million

this work and look forward to

been set out in a new report.

the lives of 44,000 a year in the

emergency 999 calls.”

making more progress in the

UK. Sepsis, end-of-life care, and mental health are, amongst

Robert said: “We absolutely

others, the focus of the East of England Ambulance Trust NHS Trust (EEAST) Quality Account for 2015/16, the first under Chief Executive Robert Morton.

For 2016/17, the Trust is focusing on a number of areas

coming months for colleagues and patients.”

to raise quality standards,

recognise that we have further

including stroke and heart

The Trust is currently revising its

to go on our journey – but I’m

attack care, timely responses

operating model to ensure that

exceptionally proud of what

to patients, sepsis recognition,

patient needs are met with the

we’ve achieved clinically this

improving experience for

most appropriate clinical service.

year. Getting to a patient quickly

dementia patients, and ensuring there is learning from serious

In addition, it’s continuing its ambitious recruitment and career

Under NHS regulations, all

can be an important measure for

organisations publish quality

our service, but what we actually

accounts to set out clinical

do clinically to look after and

Tracy Nicholls, Head of Clinical

help improve performance, and

priorities for the coming year and

care for people when we’re with

Quality, added: “The Quality

extending its existing student

reflect on the past 12 months.

them is more so.

Account enables our patients,

paramedic programme.


work for patient-facing roles to

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NEWSLINE two-year-old Fox was running a high temperature and was “really floppy”.


Birmingham paramedic set to trek to the South Pole

Ten minutes later, ambulance crew Paramedic Amy Hammerton and Student Paramedic Michael Bucher were at the family home in Shadwell, near Thetford.

A paramedic from Birmingham is set to join a team of fellow army reservists on a gruelling charity expedition to the South Pole later this year.

The East of England Ambulance Service NHS Trust (EEAST) staff suspected sepsis and blue lighted him to hospital. He was discharged from hospital but two days later, Shauna took her son back after Fox started being sick and his lips turned blue.

At the age of 16, Chris Brooke joined the army and served with the Cheshire Regiment. In 2010, he started his career as a paramedic and has worked for West Midlands Ambulance Service since 2012 based in Birmingham.

A blood test confirmed that Fox had sepsis as a result of a throat infection. He spent eight days in hospital and required an operation to remove fluid from his elbow - but is now on the road to recovery after a six week course of antibiotics.

His love of the Army remains and, as a serving reservist, Chris has been successful in joining a six-man team from the British Army Reserves for an expedition like no other to the South Pole in a bid to raise £100,000 for the Army Benevolent Fund (ABF), the soldiers’ charity. In November, the team called SPEAR17' (South Pole Expedition Army Reserves), will be dropped by ski plane on the coastline of Antarctica. From there they will attempt to ski over 1,100 miles unsupported across the polar continent to the Geographic South Pole. Each man will be hauling an individual pulk (a type of sledge used to transport supplies) weighing approximately 160kg containing everything they need to survive for three months on the ice. The expedition will face many challenges along the way

have never attempted before. We’re hoping to raise this money to help those service personnel that require it most. ABF is a charity close to my heart and it’s a very exciting opportunity to be part of a fundraising event like this.”

Chris, 34 from Cofton Hackett, is an avid supporter of ABF and said: “I’m always striving for new challenges and adventures but this is nothing like I’ve ever experienced before and is a once in a life time opportunity. I’m looking forward to it but a part of me is naturally apprehensive too. Antarctica is the coldest (-93°C), windiest and most inhospitable place on the planet but I’m told it’s also one of the most beautiful and rewarding places to travel in. It will test my endurance and physical fitness to the limit and, as you’d expect there’s lots of training to be done beforehand.

To donate, please visit https:// The team are also on the lookout for corporate partners so if you’d like to provide sponsorship please visit

“Over 4,000 people have summited Everest, but only a handful have walked unsupported to the South Pole and it’s something that Army Reserves

supporters/support-us/. EEAST

"I am so grateful for your confidence and honesty" - mother's thanks to ambulance staff A Norfolk mother has thanked ambulance staff who rushed to her son’s aid when he suffered a serious blood infection. Shauna Tate called 111 because

She told them: “Before taking us to the hospital we agreed that Fox had suspected sepsis. Two days later and too scared to waste paramedics’ time again I drove myself at 4am shaking with fear. I trusted your initial instincts and you were right. “I am so grateful for your confidence and honesty. It could have been too late and it wasn’t. We will always be thankful.” Shauna is planning on giving something back by training to become a community first responder (CFR) to help patients with life-threatening conditions in the Thetford area. “I always wanted to do something like that, but was nervous. When I was in hospital with Fox I went into coping mode and now I know I could cope if someone was really unwell,” she said.


including the harsh polar weather, crevasses, whiteout conditions, a climb from sea level to 10,000ft, isolation from the outside world and the constant mental and physical battle of manhauling their pulks across the ice.

Shauna said the whole experience was “surreal and petrifying”. However, she was “extremely grateful” to the ambulance staff and Fox joined her to meet the crew at Thetford station on Monday (11th July).

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




outside a box with

172 For further recruitment vacancies visit:


on o m e d See a J43 & OS310 Stands ESS2016 @



outside a box with

173 Life Connections - The Affordable CPD Provider:


‘Brilliant, could not fault it’: ambulance service commended in latest patient survey

time to fill in the questionnaires.

Before the helipad was built, the

been able to land beside the

This feedback from our patients

hospital had to settle for a grassy

Emergency Department for the

is clear evidence that the care

set-down area for air ambulances

expert care they urgently need.”

we deliver to patients is excellent

beside A&E. But as it was not

and that our services continue to

suitable for larger search and

Andrew Davies, Facilities

improve. I’d like to thank our all

rescue helicopters, their patients

Operations Manager for Plymouth

of staff, both patient facing and

had to make a potentially life

Hospitals NHS Trust, said:

support services, and all of our

threatening secondary transfer by

volunteers for their hard work,

road from Plymouth Airport which

“The new helipad has made a

‘First class’, ‘brilliant’ and

their care and their compassion

was due to close.

huge difference to the way in which

‘faultless’ are the words used

as without our collective

to describe ambulance staff by

commitment, these improvements

With a purpose built helipad

patients in a new report.

would not be possible.”

beside the emergency department, Derriford hospital has been able to

“This fantastic facility has made it

More than 100 people who used

The report showed areas for

accommodate all air ambulances

easier for operators to land, has

the East of England Ambulance

improvement, with 2.8% of

and search and rescue helicopters

extended their ability to land at

Service NHS Trust (EEAST) in

patients describing the length

within its grounds, as well as

night if required and has meant

May completed the Trust’s latest

of time they waited for the

landings throughout the night for

that a far greater type of aircraft is

survey and rated the care they

ambulance service to arrive

the past 12 months.

able to use the helipad.


as unacceptable or very

the hospital is able to receive and treat time critical patients.

unacceptable and 2% of patients

The HELP Appeal contributed

“It is hard the believe that only a

Ninety nine per cent of patients

who found the handling of their

£850,000, which made the

year ago we were still reliant on a

said they were very satisfied,

call unacceptable.

helipad’s construction possible.

large piece of grass for operators

Robert Bertram, its Chief

to land, the new helipad looks as

Plymouth’s Derriford Hospital helipad co funded with the HELP Appeal receives over 280 landings in its first year

Executive said:

if it has always been there and its

staff had treated them with dignity

There have been over 280 air

and respect.

ambulance and search and

critical. Minutes stuck in traffic can

of the helicopter operations flying

rescue helicopter landings at

worsen conditions and in some

into and out of the region’s major

Some of the comments from

Derriford Hospital since the

cases, cost lives. Every minute

trauma centre. The addition of this

the report referred to staff as

helipad was opened in June

counts. With a fully functioning

important infrastructure at Derriford

‘exemplary, true professionals’,

2015. Many of the patients

Helipad, search and rescue

has strengthened the entire region’s

‘friendly’, ‘kind and helpful’, and

have been involved in vehicle

patients and seriously ill patients

capability to deliver time critical

‘could not fault’ the service.

incidents or sustained falls.

that need air lifted at night have

patients by helicopter to this hospital.”

satisfied or fairly satisfied with the care they received. Figures from the patient experience survey report published this week, revealed 98% of respondents rated the handling of their call as very acceptable, acceptable or fairly acceptable and 98% felt that our

design and construction is a great “The HELP Appeal’s donation

credit to all those involved in its

has made such a difference to

conception and delivery.”

a huge number of critically ill patients who were rescued from

Paula Martin, Chief Executive of

across the South West.

Cornwall Air Ambulance said:

“Time between incident and

“The new helipad facility has

treatment in some injuries is

improved the safety and efficiency

Robert Morton, Chief Executive of EEAST, said: “Over the last four months, we have seen a 13% improvement in RED 1 performance since March and an 11% improvement in AMBULANCE UK - AUGUST

RED 2 performance. While an improvement in response times is welcomed, patient experience is critically important to us and is more reflective of the care and compassion that our staff deliver every day. “With that in mind, my thanks go to everyone who has taken the

174 For more news visit:


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NEWSLINE New £40,000 helipad for Western Isles Hospital thanks to surprise charity donation

It has been giving out grants for

The hospital stretchers also

“They had a no-nonsense,

helipad projects since 2009. The

risked getting stuck in the soft

straightforward approach. They

Stornoway one is its third project

grass when patients were being

were very quick to make decisions,

in Scotland, after a £700,000

transferred. This compelled me

very prompt in their responses and

donation towards the helipad

to get in touch straight away with

very positive. All round, I found

at the new Queen Elizabeth

Western Isles Hospital’s CEO.”

it a very positive and somewhat

University Hospital in Glasgow.

humbling experience and one for

A similar one is in the pipeline

He said the HELP Appeal was

for Edinburgh Royal Infirmary

“always on the lookout” for

Upgrade will save vital seconds

in 2017, and last year the HELP

hospitals which needed help with

Looking back at the challenge

on emergency transfers

Appeal funded a new helipad for

their helipads. They also help

with the helipad surface, he said:

Scotland's Charity Air Ambulance

with feasibility studies, as well as

“The stretcher wheels would

base at Perth.

the grants.

not traverse grass so this was a

Hospital in Stornoway has had

Robert Bertram, Chief Executive of

And they do all this without any

patient on and off the helicopter

a state-of-the-art upgrade thanks

the HELP Appeal, said: “We had

funding from the Government or the

and to the edge of the pad. Now

to a £40,000 donation from the

no hesitation in donating £40,000

National Lottery, being instead reliant

the helicopter can land, open the

HELP (Helicopter Emergency

to cover the entire cost of Western

solely on donations from the public.

door and out comes the stretcher.

Landing Pads) Appeal – the

Isles Hospital's helipad upgrade.

The emergency helicopter landing pad at Western Isles

which I will always remain grateful.”

problem in terms of getting any

only charity in the UK dedicated

It may sound dramatic but every NHS Western Isles Chief

second counts, it really does, when a patient needs evacuated.

to funding the construction of

“Following our pledges of

Executive Gordon Jamieson

hospital helipads.

£700,000 to both Glasgow and

recalled: “The charity made

Edinburgh's hospital helipads, the

contact with us to make us aware

“The quicker the transition to and

NHS Western Isles received the

Western Isles are the furthest north

of their work. They stepped

from the helicopter can be, it can

surprise cash injection from the

we've ever been and we hope

forward and were very positive

give us vital minutes which are

HELP Appeal after the charity’s

the upgrade will make a huge

from the word go that they could

extremely important to patients in

chief executive Robert Bertram

difference for seriously ill patients

at least contribute to the upgrade.

terms of eventual outcome.”

read about the current state of

and trauma patients needing

the hospital’s helipad in a local

treatment at Stornoway Hospital.

“What actually happened was that

Anyone wishing to make a

the charity funded the complete

donation to the HELP Appeal can

“Faced with extreme weather

works associated with bringing the

call the donation helpline on

The need for an upgrade

conditions on a regular basis,

helipad up to the right standard.

0800 389 8999, visit the website

became obvious in July during

never was a hospital helipad so

a test landing of the new Bond

deserving of an upgrade. Our

“I can only thank them most

by text: just type HPAD22 plus the

helicopters which were being

donation has helped to ensure

sincerely for their kindness, for

amount into the message box and

brought into service by the

a secure and solid landing area

making themselves known to us and

send it to 70070. The donation will

Scottish Ambulance Service.

for all air ambulances and the

then funding the work in its entirety.

be charged to your mobile bill.

The stretchers on board these

Coastguard search and rescue

helicopters have automatic

helicopter that will withstand any

drop-down wheels which were

future storms all the way through

incompatible with the surface,

to Wendy and beyond.”

newspaper article. or donate

potentially causing vital time to be lost during emergency transfers.

He added: “I read an article in the local newspaper saying how


At the time, NHS Western Isles

Western Isles Hospital urgently

Chief Executive Gordon Jamieson

needed to upgrade its helipad.

said the health board would

We have people supporting us

be speaking to the Ambulance

all over the country, including

Service about options for

Scotland, so it's important to help

upgrading the helipad – only to

save lives wherever there is a

then get an approach, out of the


blue, from the HELP Appeal. “Western Isles Hospital helipad They had soon pledged £40,000

needed an upgrade urgently. The

for a complete upgrade. Now, the

poor state of the Air Ambulance

grass surface has been replaced

landing area meant that vital time

with reinforced concrete paving

was being lost in rushing critically

and the lighting upgraded too.

ill patients to mainland hospitals.

From left to right are: Tony Dicks, Bristow winchman, David Smith, Senior Coastal Operations Officer, and Gordon Jamieson, NHS Western Isles Chief Executive.

176 For further recruitment vacancies visit:




GREAT CHOICE-GREAT VALUE-GREAT CPD OPPORTUNITIES! Diary Date: Tuesday 18 & Wednesday 19 October 2016 Kettering Conference Centre, Kettering, Northants, NN15 6PB



Paramedic Practice Conference - Professor Sir

xxx Keith Porter, David Halliwell, Dan Cody and Amy Chan-Dominy are among this year's speakers who xxx will be giving thought provoking presentations on a wide xxx range of topics including: The Changing Face of Major Trauma, How Resuscitation Works, The Role of xxx Critical Care Paramedics and Airway Management. Extended Early Bird Offer - Book by August 31st to secure a delegate rate of £36.00 xxx (saving £12) or pay £60.00 to also attend the xxx Resuscitation Conference or Critical Care Conference taking place the following day (saving xxx £36.00).


generosity of WEL Medical we are able to offer subsidised places at only £18pp on a 'first come first served' basis, to include lunch, etc. Topics include: Enhancing the Scope of Practice for EFR's, Indirect Resources - Easing the Pressure on the NHS - Who Pays?, The Rise of the Machines. Speakers again include Professor Sir Keith Porter, David Haliwell, Steve Pratten, etc.

Pre-Hospital Care Consultancy Ltd Essentials of Advanced Airway Management Learn the full range of Airway Management techniques, including: The Use of Extraglotic Devices, Video Assisted Intubation and Surgical Cricothyrotomy. Only 12 places remain available at a rate of £96.00 (50% below normal course costs)

WEDNESDAY 19 OCTOBER Resuscitation Today Conference

Specialist Paramedic: Critical Care Conference This conference programme includes excellent presentations being given by Professor Richard Lyon - Damage Control Resuscitation: Fluids in Trauma, Dr. Felicity Clark - Management of LifeThreatening Asthma & Anaphylaxis and Dr. Neil Thompson, Sedation in Acute Behavioural Disorder to name but a few. Extended Early Bird Offer - Book by August 31st to secure a delegate rate of £36.00 (saving £12) ) or pay £60.00 to also attend the Paramedic Practice Conference taking place the previous day(saving £36.00).

First Aid Conference supported by AoFA

This year's programme is again made up of presentations that will be of great interest to first aiders and first aid trainers, including: Sepsis Guidelines - Early Recognition is the Key, Minor Injury Management, How Safe is Your Home?, and Practical Management of Paediatric Emergencies. Extended Early Bird Offer - Book by August 31st to secure a delegate rate of £60.00

Pre-Hospital Care Consultancy Ltd "PHTLS for First Responders" Course

This continuing education course that teaches the principles of PHTLS is ideal for first responders, EMS practitioners, etc. Topics being covered include: Airway/Oxygenation & Ventilation, Circulation and Shock, Traumatic Brain Injury & Spinal Trauma. Only 16 places are available at a delegate rate of £96.00.

Meditech Global are running a Motorsport Medicine CPD Workshop, aimed at medics and rescue personnel involved or interested in motor sport events. The day will include: Concussion in Motorsport, Casualty Extrication - A New Way Forward, A Paramedics Life in Motorsport, The Use of Haemostatatic Dressings, etc. Speakers will include; FIA Doctors and active motor sport paramedics. Only 10 places remain available at a rate £60 per person.

All prices quoted are inclusive of VAT. To secure your delegate place or to register for any of the above conferences/workshops visit or call the organisers office on 01322 660434 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.


We are delighted once again to be hosting a resuscitation conference which this year will contain a number of topical presentations including: Human Factors in End of Life Care - Implications for Education & Training, Medical Command...The Future and Paediatric Retrieval/Resuscitation, presented by Ken Spearpoint, Stuart Blatston and Amy Chan-Dominy. Extended Early Bird Offer Book by August 31st to secure a delegate rate of

£36.00 or pay £60.00 to also attend the Paramedic Practice Conference taking place the previous day.


NEWSLINE With Air Ambulances being a

NHS Foundation Trust (UHB), the

level of speakers for this year’s

critical part of the acute care

University of Birmingham and

conference. The event has grown

agenda, clinical speakers of

the Royal Centre for Defence

year on year and has become the

the utmost quality and experts

Medicine in 2005. He remains

pinnacle event to attend within

within their fields have now been

the UK’s only Professor of Clinical

the sector. With further speaker


Traumatology and has been at the

announcements to be made

forefront of development wold-

over the coming months, a newly

Professor Jonathan Benger,

class treatment for injured military

streamlined agenda and such a

National Clinical Director for

servicemen and women who

high quality of experts already

Further to the recent

Urgent Care, NHS England will

return to the UK from both Iraq

taking to stage in November, I

announcement that Sir Stuart

speak on the subject of Quality

and Afghanistan since 2000.

believe this is set to be our best

Etherington, Chief Executive

and ask the important question:

of the National Council of

“How do we know if we are any

Sir Keith has played an integral

Voluntary Organisations (NCVO)

good at what we do?” Jonathan

part of the development of Pre

Last year’s National Conference

will be the Key Note Speaker

is the Director of the Academic

Hospital Emergency Medicine in

saw 90% of the UK Air Ambulance

at this year’s National Air

Department of Emergency Care

the UK and has been a member

operations attend with a sell-out

Ambulance Conference taking

at the University of the West of

of the Defence Scientific Advisory

275 delegates. The event has

England, Bristol and a Consultant

Committee and the Surgeon

grown year on year and has

14th November; the Association

in Emergency Medicine at

General Research Strategy Group.

become the pinnacle event to

of Air Ambulances is delighted

University Hospitals Bristol NHS

to confirm that an exceptional

Foundation Trust. He also has

Dr. Gareth Davies is Chair

line-up of Clinical Speakers will

extensive experience of pre-

of the Associations Clinical

The conference is followed by

also be taking to the stage.

hospital care, having previously

Subcommittee and is speaking

the prestigious Air Ambulance

contributed to the establishment

on the Horizon of pre-hospital

Awards of Excellence and Gala

A new streamlined structure to the

of a pre-hospital critical care team

medicine. As a Trustee and

Dinner held during the evening.

event’s agenda will focus on the

for Great Western Ambulance.

Medical Director at London’s

Nominations for this year’s awards

Air Ambulance he has a wealth

will close on 1st September 2016.

Pre-hospital Clinical Heavy Weight Speakers at Leading Air Ambulance Conference

place in London on Monday

key subjects: Quality, Innovation, Resilience and Horizon with

Professor Sir Keith Porter,

experts within the key colleges of

Lead in Clinical Traumatology

Clinical, Air Operations and Charity

and Clinical Service Lead for

sector delivering presentations on

Trauma at Queen Elizabeth

the respective topics, followed by

Hospital Birmingham was

an opportunity for questions and

awarded a professorship by


University Hospital Birmingham

Conference yet.”

attend within the sector.

of knowledge and experience which continues in his role as a Consultant in Emergency Medicine, Pre-hospital Care and Emergency Preparedness with Barts Health NHS Trust. With over 20 years’ experience in the air ambulance industry and a

For more information on the programme of events and to register online (early bird discount) visit: www.associationofairambulances.

well-recognised face on British television, his presentation is set to be “visionary”. Organised by the AAA; the leading pre-hospital air ambulance conference has become a firm fixture on event calendars across the world wide air ambulance community and is open to all members and non-members. It aims to inspire, inform and incite debate, AMBULANCE UK - AUGUST

providing a platform for the air ambulance industry to come together, share ideas and build partnerships. Clive Dickin, AAA National Director said: Professor Jonathan Benger

“We are extremely excited to have secured such an exceptional

178 For more news visit:

“We are extremely excited to have secured such an exceptional level of speakers for this year’s conference. The event has grown year on year and has become the pinnacle event to attend within the sector.”


Paramedic Practice Conference




xxx xxx

Tuesday 18th October 2016


xxx xxx xxx



Kettering Conference Centre, Kettering, Northants NN15 6PB. Extended Early Bird Delegate Rate…£36 including VAT. Book by 31st August 2016. Normal Delegate Rate £48 including VAT. Special Offer… Book Now to also secure a delegate place on our Resuscitation or Critical Care Conference taking place the following day for a combined rate of £60 including VAT

xxx xxx





Professor Julia Williams

Professor of Paramedic Science

Stuart Blatston



09.30 – 09.45


09.45 – 10.30

Medical Command…The Future

10.30 – 11.15

Tea/Coffee, Exhibition

11.15 – 11.45

Something Old, Something New…Novel Psychoactives in the Pre-Hospital Setting

John Talbot

Professional Lead Paramedic Science

11.45 – 12.15

Airway Management in Cardiac Arrest

Tim Edwards

Advanced Paramedic Practitioner

12.15 – 13.30

Lunch and Exhibition

13.30 – 14.00

How Resuscitation Works

David Halliwell

MSc Paramedic FIfL

14.00 – 14.30

The Changing Face of Major Trauma

Prof Sir Keith Porter

Professor in Clinical Traumatology, University Hospital, Birmingham

14.30 – 15.15

Tea/Coffee, Exhibition

15.15 – 15.45

The Role of Critical Care Paramedics

15.45 – 16.15

Is Education Making a Difference

16.15 – Close

Airway Management

Dan Cody

Associate Clinical Director Magpas Helimedix

John Donaghy

Senior Lecturer

Amy Chan-Dominy


Topics & Speakers correct at the time of press but may be subject to change For all your equipment needs visit:


08.30 – 09.30



New Era For North West Patient Transport Service A modernised and improved patient centred service is

every area of the service from

transport services begin on 1 July

gym for the first time when he

streamlining our online booking

2016 and NWAS’ performance

collapsed in cardiac arrest in the

service and consistent use of

will be closely monitored

changing rooms. Medics Keith

eligibility criteria, to using the

by Commissioners, NWAS

Hayes, Heather Cole and Carl

latest technology on our vehicles

managers and, the Trust hopes,

Wolfenden, were immediately

and providing opportunities

by the people who use the

dispatched, saving his life.

for regular engagement with

service – the patients themselves.


Having made a full recovery, Allan Jude, Director of

57 year old Iain praised the

“We are also delighted to be

Ambulance Commissioning,

ambulance crew:

able to provide an enhanced

Blackpool CCG commented:

service to regular service users

“The new contracts provide

“This has completely changed

with specialist needs; our cancer

numerous quality improvements

my outlook on life. I can’t thank

and renal dialysis patients, by

and ensure patients who need

the ambulance crew and the


increased service operating

assistance and transport can

staff at the gym enough for

hours, a more flexible service with

receive a service that is both

everything they did to save me –

Following a successful tender

dedicated Freephone telephone

timely and of high quality.”

they were completely first class.

available to patients requiring non-emergency transport in four counties across the North West as part of new contracts provided by the North West Ambulance Service NHS Trust

process, the Trust submitted bids for the contracts to provide non-emergency patient

numbers and a better escalation process if things go wrong.”

I’m trying to take life a bit easier Says Ian: “Feedback from our


patients is very important to Winning the Greater Manchester

us and to make this easier, we

Better’s Gurnell Leisure Centre

contract means welcoming back

have further developed the

staff Thomas Arnold, Mark

staff who left the Trust in 2013

user friendly website and will

Cameron and Adolpho Ventero

when the contract was taken over

be providing leaflets which will

de la Pena performed CPR and

by Arriva Transport Solutions Ltd.

clearly explain how patients can

used an accredited defibrillator

relay their experience of the

to deliver a shock to Iain, who

Working in partnership with Staff

service to us – whether that be a

initially responded before

Since then, NWAS has taken

Side, NWAS has completed

positive or negative one.

another cardiac arrest moments

the opportunity to re-examine

a restructure of managerial

the service and introduced

and support staff, improved

“This is a very exciting time for

new measures to ensure full

training and introduced more

the Trust. We were disappointed

London Ambulance Service

compliance with the contract

flexible operational rosters. A

to not win the contract in

Paramedic Heather Cole said:

and to listen to the views of

number of initiatives have been

Cheshire but we have worked

patients and other stakeholders,

implemented to ensure a more

closely with the new provider,

“We’re delighted to see Iain

resulting in a new and improved

responsive and accessible

West Midlands Ambulance

fit and well last week. There

experience for patients.

service which in turn benefits all

Service, to ensure a smooth

is no question that the staff at

our patients.

transition for both staff and

Gurnell Leisure Centre helped


to save his life, thanks to their

transport in Greater Manchester, Merseyside, Lancashire and Cumbria. It previously ran the service in Merseyside, Lancashire, Cheshire and Cumbria.

The improvements are



underpinned by an improved

Ian adds: “With the new contracts

and updated Patient Charter

come fresh expectations of us

which outlines the Trust’s

as a service provider and it was

commitment to the care and

clear that in order to meet those,

safe transportation of patients

we had to instigate change

– providing the right care, at

throughout the Trust. As with

the right time and in the right

our emergency colleagues,

place. The Charter explains

there are clear targets that we


“Around 32 per cent of people

what patients can expect of the

must meet and we have taken

Trust, how to access services and how to feedback their

service. We have also heavily

experiences as well as what the

invested in technology and

Ealing man praises ambulance crew who saved his life

survive a cardiac arrest in a

this opportunity to redesign the

service requires from them.

telecommunications to provide

knowledge of CPR and their “As we begin to deliver this new contract, we are very excited about the future and are looking forward to embracing the challenges ahead of us.”

quick use of their defibrillator.” Malcolm Ritchie, London Ambulance Service First Responder Manager, said:

public place but, where there is a defibrillator and someone trained to use it, the chance of survival can increase to 80 per

information on all aspects of

A London bus driver who was

Ian Stringer, Head of Patient

the patient journey and ensure

brought back to life after his

Transport Services (PTS)

effective dialogue between

heart stopped beating has

“Stories like these are why we

explains: “This is a major time

mobile staff and Control.”

thanked paramedics who

believe every shop, gym, hotel

saved him.

and office in London should

of change for NWAS’ patient transport service with work

The five year contracts to

being done to improve almost

provide non-emergency patient


have a defibrillator, so they’re Iain Wyllie was using an Ealing

180 For further recruitment vacancies visit:

ready to save a London life.”


Specialist Paramedic Critical Care Conference Programme Wednesday 19th October 2016

Kettering Conference Centre, Kettering, Northants NN15 6PB Extended Early Bird Delegate Rate…£36 including VAT. Book by 31 August 2016. Normal Delegate Rate £48 including VAT. Special Offer… Book Now to also secure a delegate place on our Paramedic Conference taking place the previous day for a combined rate of £60 Time




Mark Hodkinson

Specialist Paramedic Critical Care

Ian Wilmer

Advanced Paramedic Practitioner

08.30 – 09.30


09.30 – 09.45

Welcome and Introduction

09.45 – 10.15

Fit for Purpose? Advanced Seizure Management

10.15 – 10.45

Intra-Arrest Thrombolysis

10.45 – 11.30

Tea, Coffee, Exhibition

11.30 – 12.00

Management of Life-Threatening Asthma and Anaphylaxis

Dr Felicity Clark

Consultant in Anaesthetics and Intensive Care

12.00 – 12.30

Sedation in Acute Behavioural Disorder

Dr Neil Thompson

Assistant Medical Director

12.30 – 13.00

Cutting Up Rough…Surgical Skills for Specialist Paramedics

Tim Edwards

Advanced Paramedic Practitioner

13.00 – 14.30

Lunch and Exhibition

14.30 – 15.00

Retrieval Medicine…Developing the Welsh System

Dr Mike Greenway


15.00 – 15.30

Developing Paramedic Specialist Practice

Dan Cody

Associate Clinical Director Magpas Helimedix

15.30 – 16.00

Damage Control Resuscitation…Fluids in Trauma

Prof Richard Lyons

Consultant in Emergency Medicine

16.00 – Close

Closing Address

Prof Julia Williams

Professor of Paramedic Science

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


Topics & Speakers correct at the time of press but may be subject to change



Paramedics’ mighty hike for charity

“I was a full-time paramedic before being diagnosed at the age of 27 with breast cancer and the combination of surgery, chemotherapy, radiotherapy

A team of eight members of

and hormone treatment left

staff from the South Western

me unable to continue to work

Ambulance Service NHS

as part of an ambulance crew.

Foundation Trust (SWASFT)

The recovery has been long

have raised more than

and it was only this year that

£2,750 for Macmillan Cancer

I have well enough to take on

Support after taking part in

a challenge like this. The hike

the charity’s Jurassic Coast

was very tough, but I’m very

Mighty Hike. The team of eight

proud to have completed it and

crossed the finishing line at

to have helped raise money for

Corfe Castle with arms linked

Macmillan, who do so much

after setting out to cover the

to support people affected by

22 miles some 9 hours earlier

cancer. It’s my way of giving

from Weymouth.

something back. I now work giving clinical advice to crews

For one member of the team,

from the Trust’s clinical hub

the achievement heralded a

(control room).”

particular milestone. Caroline

The team at mile 21, nearly there!

along the coast. It was a great

ambulance crews and other staff

experience and achievement and

to equip them to treat cancer

we stuck together as a team the

patients they attend with the

whole way.”

most appropriate care. Macmillan and SWASFT recognise that

Shipway, from Weymouth, was

Louise Pennington, Macmillan

diagnosed 8 years ago with

cancer care development facilitator

Macmillan Cancer Support

breast cancer and the side effects

at the Trust organised the team

and South Western Ambulance

of the disease and treatment left

and said, “The mighty hike was

Service are working together to

her struggling with energy levels.

just that – up and down hills

develop training and support for

cancer patients can benefit from specialist cancer care services when paramedics respond to emergency calls. This can result in cancer patients avoiding the need to go to hospital at that time, by giving them treatment and support in the home. This project supports the Trust’s right care, right place, right time initiative. Macmillan is investing £736,000 in the project, funding specialist posts to create and deliver the training and support for Trust staff.


The paramedics at the end of their hike, left to right: (back row): Louise Pennington (Macmillan cancer care development facilitator), Pete Weeks (learning and development officer), Caroline Shipway (clinical supervisor), Bryan Steele (driving training officer). (front row): David Sale (learning and development officer, commercial training), Joanna Hernandez (learning and development officer), Martin Robinson (learning and development officer) and Katie Richards (clinical development officer/paramedic).

182 For more news visit:

“The mighty hike was just that – up and down hills along the coast. It was a great experience and achievement and we stuck together as a team the whole way.”


EFR Conference Programme


Tuesday 18th October 2016

xxx xxx

Kettering Conference Centre, Kettering, Northants NN15 6PB



xxx xxx

Thanks to the generosity of Wel Medical we still have 40 subsidised places available on this conference. The subsidised rate is £18pp to include lunch, tea, coffee etc.



xxx xxx



08.30 – 09.30


09.30 – 09.45


09.45 – 10.15

How Resuscitation Works

10.15 – 10.45

Public Access Defibrillators – Governance versus Vigilance

10.45 – 11.30

Tea/Coffee, Exhibition

11.30 – 12.00

Enhancing the Scope of Practice for CFRs

12.00 – 12.45

Rise of the Machines

12.45 – 14.00

Lunch and Exhibition

14.00 – 14.30

Medical Command – The Future

14.30 – 15.00

Observing and Observations of Children in the Pre-Hospital Phase

15.00 – 15.45

Tea/Coffee and Exhibition

15.45 – 16.15 16.15 – Close



Derek Middlehurst

Community Responder Team Leader

David Halliwell

MSc Paramedic Flfl



Steve Pratten

Community Response Manager

Amy Chan-Dominy


Stuart Blatston


Christopher Preston

Advanced Paramedic Practitioner

The Changing Face of Major Trauma

Prof Sir Keith Porter

Professor in Traumatology

Can Real Time Feedback & Competition During Training Improve CPR Quality?

Dr Jonathan Smart



Topics & Speakers correct at the time of press but may be subject to change

183 Life Connections - The Affordable CPD Provider:

NEWSLINE Host of New Features at The Emergency Services Show 2016 The Emergency Services Show has a host of new features for 2016 as it moves to the larger Hall 5 at the NEC, Birmingham on 21-22 September. New seminar programmes will cover Lessons Learnt, ICT Innovation and PPE. Home Safety 2016 runs as a new show within the show, the Drone Zone brings together everything UAV, while popular features like the Collaboration Zone and College of Paramedics CPD workshops have also been

delegates. The programme includes

Airport as well as being directly

The team began work on a trial

a presentation on risk management

accessible by motorway. Visitor

basis in April last year. A report

for Remotely Piloted Aircraft Systems

entry, seminar theatres and parking

published by GNAAS this week

(RPAS) and the factors affecting

at the Emergency Services Show

shows that the MERIT service

RPAS operational safety in both civil

are all free.

responded to 420 calls and

airspace and commercial space.

treated 233 patients in that time.

Other sessions will cover privacy,

To register for free entry visit

security implications and legislation.

The team has attended incidents all across the North-East. Most

The ever-popular College of Paramedics’ free 30 minute CPD workshops will be delivered from the expanded College of Paramedics’


An all night response car

CPD area. No pre-booking is

cases have been in urban areas such as Newcastle, Durham, Darlington and Middlesbrough, with shootings, stabbings and serious trauma road traffic

required and all those attending

An all-night rapid response car

accidents some of the types of

the workshops will be given a CPD

staffed by air ambulance medics

incident attended so far.

certificate. The new CPD-accredited

is saving lives across the North-

Trauma Care Training & Education

East, according to those behind

The crew has also performed the

Zone will feature CPD skills stations

the service.

first thoracotomy to take place

and a fully immersive training suite

outside of a hospital in the region.

where teams can perform a primary

The Great North Air Ambulance

This is an extremely advanced

entry at:

survey under pressure.

Service (GNAAS) and North East

operation where the doctor opens

Ambulance Service (NEAS) have

the patient’s chest to gain access

Lessons Learnt from past incidents

The Emergency Services Show

teamed up to provide a doctor-led

to their heart or lungs. This is a

is expected to feature over

trauma team to cover the hours of

procedure reserved for critical

450 exhibiting companies and

darkness – when the charity’s air

cases such as stabbings and

organisations. The impressive indoor

ambulances do not fly.


enlarged. Register now for free

and training together to prepare for the future will be key themes at this year’s event. A free two-day seminar programme focusing on lessons

and outdoor exhibition is a one-stop

learnt, curated and inspired by

shop for sourcing all the latest

The region’s first Medical

Grahame Pickering MBE, chief

JESIP and the National Operational

services and equipment required for

Emergency Response Incident

executive at GNAAS, said: “Before

Guidance Programme for the Fire

emergency response and keeping

Team (MERIT) responds to

we started this service there was

& Rescue Service, will review the

the public safe from threats such as

incidents in a specially equipped

no trauma team available after the

multi-agency responses to recent

floods, road traffic accidents and

car, staffed by GNAAS doctors and

aircraft finished work for the day.

incidents, identify the operational

terrorist attacks.

paramedics and funded by NEAS.

learning. It will include new rescue

Exhibiting companies include

Under Department of Health

blood and plasma transfusions,

techniques and communication

leading names in firefighting

guidance, ambulance services

administer anaesthetic and

models for improved outcomes in

equipment, search and rescue,

throughout the country are now

perform surgery on scene. It’s

the future. Further seminars will also

extrication, first response,

required to provide a MERIT

making a real difference and

cover the areas of ICT Innovation

communications, IT, protective

service to ensure a doctor-led

giving patients a chance where

and PPE.

clothing and uniforms, vehicles

response is available around-the-

previously they wouldn’t have

and fleet, vehicle equipment,

clock for the most seriously injured

had one.”

Home Safety 2016 is an exciting

outsourcing, training, community

or ill patients.

new show running alongside The

safety, station facilities, water

Emergency Services Show 2016,

rescue and medical supplies.

In daylight hours, this service is

NEAS, Paul Liversidge, said,

where emergency services will share

Several exhibitors are planning live

provided by the air ambulance

“Working closely with partners

collaborative approaches to helping

demonstrations of equipment and

and crew. When night falls, a fresh

GNAAS we have been able

people live safely at home and

rescue techniques.

GNAAS crew transfers to a rapid

to make a real difference to

response vehicle which carries all

critically ill patients using this

the latest specialist equipment for

The event also presents the ideal

the same life-saving equipment as

scheme when there may not have

the safe home.

opportunity to meet, network

its airborne counterpart.

otherwise been the same access

“Now, we are able to perform

challenges and capture positive


equipment suppliers will showcase

Chief Operating Officer from

and collaborate with colleagues

to such enhanced care.”

As well as showcasing drone

within the emergency services,

The team works on Friday and

suppliers, the new Drone Zone will

government departments, voluntary

Saturday nights from locations

Andy Mawson, deputy director of

bring together industry specialists

sector partners and NGOs.

across the region, with an on-call

operations at GNAAS, said the

service operational in the event

service was reliant on a strong

and end-users who will be making presentations on UAV technology

The NEC is next to Birmingham

of a major incident on Sundays

working relationship between the

and sharing their experiences with

International station and Birmingham

through Thursdays.

charity and NEAS.

184 For further recruitment vacancies visit:

NEWSLINE “The key to this is the call-handlers in ambulance control,” he said. “Without their knowledge and experience of when and where to dispatch, we wouldn’t be able to get out there and make a difference. They’ve handled it brilliantly so far, so credit must go to them.” Mr Pickering said the MERIT service is separately funded and is run independently of the charity’s air ambulances, which continue to rely on donations to survive.

Pool cardiac arrest patient meets lifesavers The parents of a boy whose heart stopped for 25 minutes during a swimming lesson in Bedfordshire have thanked his lifesavers exactly a month to the day the drama unfolded. Cade Ewington, 11, was at a school

swimming lesson on the 6th June at Lewsey Swimming Pool when he was found face down in the water. Life guards swiftly pulled him from the water and began cardio pulmonary resuscitation (CPR) as it was clear he wasn’t breathing. Minutes later Paramedic Michael Harnell and Student Paramedic Sarah Wright from the East of England Ambulance Service NHS Trust (EEAST) were on scene. Michael said: “Enroute to the job it was confirmed as a cardiac arrest and at that moment adrenaline shot through my body. However we devised a fluid plan of action which looking back now was key in improving Cade’s chances of survival.” They were shortly followed by colleagues Julia Hoswell, Cath Fry, Emily Wallis, and Critical Care Paramedic Chris Martin, who all assisted with CPR and care of Cade. After 25 minutes of CPR and two shocks with a defibrillator Cade’s heart restarted. He was taken to

Luton and Dunstable Hospital and then on to Great Ormond Street Hospital (GOSH) where started to make a remarkable recovery, returning home on 20th June. Speaking of that day, Mark said: “Not for one moment before I got to hospital did I think it was as bad as it was; he is my absolute everything and I can hand on heart say that I thought it was the end, you never want to see your son life that.” This week (Wednesday, 6th July), Cade and his family were reunited with the ambulance crews under much happier circumstances. Mark said: “We will forever be indebted to these guys who saved Cade’s life, including the lifeguards; it shows how important basic CPR is.” Albeit a scary incident to be involved in, Michael and his colleagues felt a positive outcome was likely: “Cade started to show really strong signs of improvement on the way to hospital. Once we handed over and wedebriefed, it felt very much like a job

well done. Despite the seriousness of the job everyone showed an assertive calmness.” Chris added: “It was a fantastic team effort from involved. I’m delighted to see Cade doing so well despite being in cardiac arrest for so long.” Amazingly, Cade is unfazed by his incident and after being fitted with an internal defibrillator, has tasked himself with writing to all the schools across Beds, Bucks, and Herts to help raise awareness of the importance of CPR. When asked if he remembers much of that day he said: “The last thing I remember was getting changed to go swimming, from then on nothing.” Mark added: “It was the unluckiest day of our lives but also the luckiest, the chain of survival from the actions of the life guards through to the ambulance to GOSH was done with the utmost care and professionalism.”

O&H at The Emergency Services Show...

Find our PPV inside on stand G31, and the PTS / A&E vehicles outside at OS70.


O&H will be at The Emergency Services Show, NEC Birmingham, 21-22nd September 2016.

185 For all your equipment needs visit:

Work Time to Change the Way We ’s It NEWSLINE

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* Figures shown are based on a typical fleet of 275 vehicles, 40,000 miles per annum each @ £1.01 per litre – if you require any further information please contact us on +44 (0) 1274 851 999 or speak to the WINNER of FLEET NEWS Fleet Manager of the Year Award 2016 – Justin Wand @ SECAmb

FERNO.CO.UK +44(0) 1274 851 999

For further recruitment vacancies visit:

NEWSLINE Arrival of new AW169 Ambucopter moves closer after official handover in Italy

and major trauma centres more

Lincs & Notts Air Ambulance

EMS2016 congress in Denmark,

quickly. It can also fly further

is non-government funded

which is held these days in

before it needs to be refuelled,

so we rely on the support of

Copenhagen. Over 1,000 experts

which will allow us to deploy from

our local communities and

and health professionals are

one mission to the next without

businesses to raise in excess of

gathered to find new ways to

returning to base to refuel.”

£2.3million every year to keep

improve the emergency medical

our Ambucopter flying, saving

systems around the world.

Jack O’Hern said: “When the

lives and improving outcomes for

Board of Trustees were first

patients 365 days a year.

New state-of-the-art

presented with the information

AgustaWestland 169

on the new top-of-the-range

Ambucopter has been

AW169, it was clear to see that

formally accepted at an official

this helicopter would be at the

handover in Italy on 5th July.

forefront of Helicopter Emergency

The championship challenges team work, skills, experience


EMS Championship winners

Medical Service (HEMS) Chief Executive Karen Jobling and

operations and would enable

Paramedics from Fulham

joint Chairman of the Board of

the Lincs & Notts Air Ambulance

ambulance station have

Trustees Jack O’Hern travelled to

to provide the best possible

been named the winners

Vergiate in Italy to formally accept

critical care to its patients. This

of the European EMS

the AW169, from AgustaWestland.

advancement in the service to

(Emergency Medical Services)

patients means that the Charity


and the ability to find a solution in chaotic situations. 12 teams participated from 11 countries.

IAA announces GSM Finance as a new business partner The IAA is pleased to announce GSM Finance as a new

“It has been really amazing to

now needs to raise in excess of

finally see our new Ambucopter

£2.3million each year to support

Facing teams from Turkey and

and to come out to the factory

our lifesaving work.”

Denmark in the final round, Clinical

GSM Finance are an independent

Team Leader Tim Weekes and

asset finance and leasing broker

in Italy where it has been built.

business partner.

Our pilots have recently been

Our fantastic new Ambucopter

Paramedics Ryan Parry and Sam

established in 1997, based in

here training and converting onto

will fly back to the UK very soon,

Cooper showcased their skills

South West London. They have

the AW169, and now seeing it

but it will be a little while longer

in a scenario involving a canoe

long standing relationships with

come off the production line

before the people of Lincolnshire

accident with four seriously injured

over 30 banks, asset finance

we’re looking forward to it flying

and Nottinghamshire will see it

patients, with judges commenting

houses and leasing companies to

back to the UK and becoming

taking to the skies. First stop for

that they “solved the very complex

enable to finance a wide range of

operational,” said Karen Jobling.

the Ambucopter is for a custom

case nearly to perfection.”

assets used within the ambulance sector, providing flexible and

built medical fit to ensure that all “The new helicopter will be in

of the state-of-the-art medical

Team Leader Tim Weekes, said

competitive solutions to meet

the same emergency yellow as

equipment is laid out properly,

“It’s a privilege to represent the

each customers' requirements.

our current helicopter, which

before it is finally delivered to

Service at such an important event.

the people of Lincolnshire and

mission headquarters at RAF

Scenarios like the ones we’ve

“GSM have been funding new

Nottinghamshire recognise as

Waddington later this summer.

dealt with show just how skilled the

start and established ambulance

paramedic profession is. I’m proud

companies since 2009. We

to have been part of a great team

have underwritten a wide variety

and to have demonstrated what

of assets including front-line,

we are capable of.”

bariatric, HDU, PTS and first

their air ambulance. Beyond the The AW169 will replace our

quite different. The AW169 has

current MD 902 Explorer

a significantly larger cabin area

helicopter. The registration

which will give our Critical Care

number of our AW169 is G-LNAC

Team 360° access to the patient,

(Lincs & Notts Air Ambulance

to provide time-critical medical

Charity), and we will continue

treatment during flight if needed.

to use the call sign Helimed 29

The AW169 is faster, meaning

Alpha when we’re flying to a

we can reach patients, hospitals

medical emergency.

responder vehicles, together with Anne Lippert, main instructor of

associated specialist equipment

the European EMS Championship

such as defibrillators, stretchers

said “Of course nobody wants to

and hydraulic ramps.” said Roger

be part of a major accident, but I

Wood, who negotiated the deal on

can honestly say after today’s LAS

behalf of GSM Finance.

performance that if I could choose a place to be traumatised, I

Alan Howson from the IAA

definitely wouldn’t mind being in a

commented “This is an exciting

place where I would be treated by

step for the Association and our

the London Ambulance Service.

member organisations. GSM

They did a remarkable job all

Finance clearly understand and

through the competition.”

are familiar with the sector and this arrangement opens the

The European EMS

door to new conversations for all

Championship is part of the



colour however, the aircraft is

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


Rescroft Ltd

‘Leading Suppliers to the NHS and Private Ambulance Operators’


Paramedic features in latest Historic England exhibition A paramedic from Homerton is one of 59 Londoners to


feature in the latest Historic


London's unique and complex


England exhibition celebrating identity.

Folding Tip-up Seating Easy-action 360° swivelling. 90° locking positions Multi-adjustable backrest recliner. Simple lever-action actuator

Easy-action 360° swivelling. 90° locking positions Multi-adjustable backrest recliner. Simple lever-action actuator 450mm single unit only Compliant to ECE Reg.14 (as amended) for category M1, M2 and M3 applications; Reg.17 For M1 applications with moulded or trimmed headrests Compliant on Embus, SmartFloor and Innotrax floor systems Available on 230, 250, 280 and 320mm flat bases. Variable centres available Standard lap/diagonal belt. Optional dual belts Optional moulded headrest and armrest

Other products include: Winga swivel Plica tip up Defender Titan

Craig Cassidy has his portrait on display at the Historic England’s ‘I am London’ exhibition'. Each person featured in the exhibition has been photographed at a historic building or place special to them. Craig was photographed outside Aldgate Underground Station, a significant London location for him, as it is the scene which he and other colleagues from the Service

like I’m frozen in time while life goes on behind me and I think that’s the best description of the photo.” Ellen Harrison, Head of Campaigns at Historic England: “We were very keen to have the London Ambulance Service involved. As with all the emergency services, they are the vital people that make the city work. “When we were putting together the exhibition, 7/7 stood out as an moment in the city’s history and we felt it was important to have a paramedic that was there involved. “Craig is one of the unsung Londoners and his photograph is one of the most moving ones in the exhibition. The emergency services, in particular the London Ambulance Service, do such great work in the city every day that often goes unnoticed.”

All compliant to ECE Reg 14 for M1, M2 and M3 applications; Reg 17 for M1

attended to treat the victims of

Single lap/diagonal belts with “Duo” option

now, but whenever I go to a job

Options for moulded or trimmed headrests and armrests

out great; it’s wasn’t a sunny

The first ever Cardiac

day when it was taken which

Arrest Conference, Resus

captures the sombre mood.

2016, has been hailed an

the London bombings on 7 July 2005. Craig said: “7/7 is 11 years ago around Aldgate it comes straight


Cardiac Smart hosts successful #Resus2016 Conference

back to me. The picture came

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188 1. Caution: It is not possible to test every permutation of seat width, accessory combination, leg height, position and type, or seat belt requirement. For this reason, it must be emphasised that compliance cannot be assumed where there is any deviation from

“My wife says it almost looks

For more news visit: Rescroft Limited 20 Oxleasow Road REDDITCH, B98 0RE, UK

NEWSLINE astounding success after a

cardiac arrest but only less than

them worse, but you can make

used the school’s recently

packed audience of delegates

one in ten people survive, but

them better”.

purchased defibrillator.

attended to learn how to

survival rates can be greatly

increase survival rates for

improved if effective treatment

Mike Helbock, a Senior

campaigned to get all schools

those who suffer a cardiac

is given as quickly as possible.

Paramedic and Clinical

and public places to install a

Educator from King County in

defibrillator so that others can

Clinicians, student paramedics,

Seattle, USA, spoke about the

also live to tell the tale.

The conference, held on

community first responder

importance of focus on good

25 June at Park Hall Hotel

volunteers and charities

quality CPR and that those

North West Ambulance Service

near Chorley in Lancashire

heard inspirational talks from

performing it shouldn’t stop for

Consultant Paramedic, Dan

and hosted by North West

international experts and

anything but to give breaths and

Smith said: “The whole day

Ambulance Service’s Cardiac

professionals from here in

shocks from a defibrillator. The

was extremely successful in

Smart Team, shared knowledge

the UK, as they spoke of their

knowledge that Mike passed on

learning from world renowned

and raised awareness to help

work in the field of emergency

explained exactly why Seattle

experts in cardiac arrest,

enable effective treatment is


has the world’s highest survival

medical professionals and our

rates of 62 per cent.

emergency service partners.

arrest out of hospital.

received as quickly as possible

Since his recovery Sam has

As a Trust we look to embrace

so that more lives can be

Freddy Lippert, CEO of


Emergency Medical Services

Towards the end of the day

the passion and motivation we

from Denmark, spoke of the

there was an emotional

came away with and move that

A cardiac arrest occurs when

need for everyone to learn how

presentation that reminded

forward to benefit our future

the heart stops beating in

to perform Cardio Pulmonary

the audience exactly why this

patients so more people can

a normal way and prevents

Resuscitation (CPR) and that it

subject was so important.

survive a cardiac arrest.

blood from circulating around

is vital that children are taught

Eighteen year old Sam Mangoro

the body, which can happen

this lifesaving skill in school.

spoke of when he suffered

“I would like to credit the

to anyone regardless of age

Freddy stated that people

a cardiac arrest during a PE

organisers for putting on a truly

or fitness. Currently in the UK

shouldn’t be afraid to help: “If a

lesson at school. He was

insightful day and the sponsors

around 60,000 people every

person has a cardiac arrest they

resuscitated by members of

who made the day possible as

year have an out-of-hospital

are dead, so you can’t make

staff who performed CPR and

we look forward to Resus 2017.”

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NEWSLINE “This helicopter belongs to the people of Yorkshire and will do for the next 20 to 25 years. I am very proud to say we now have a level of service which is probably the best of any air ambulance charity in the UK.”


Yorkshire Air Ambulance unveils its new helicopter Geoffrey Boycott has officially unveiled Yorkshire Air Ambulance’s landmark new, state-of-the-art helicopter that will take to the county’s skies later this Summer. The rapid response emergency service is replacing both its current ageing aircraft – G-SASH and G-SEMS – with the latest generation Airbus H145 helicopter. Geoffrey, who is a Yorkshire Air Ambulance (YAA) Patron, joined charity staff, supporters and volunteers to get first sight of the first of the new aircraft which flew into the charity’s Nostell Air Support Unit near Wakefield. It will become fully operational in a couple of months following a full

medical fit-out and crew training.

planning the replacement of its

A second H145 has been ordered

existing aircraft for several years. The

from Airbus and will be in service by

purchase and fitting out costs have

Spring 2017.

been met through planned savings, grants, careful budgeting and the

The new aircraft – each costing

amazing generosity of the people of

£6m – offer exceptional flight


performance and will have significantly lower operational and

YAA Chairman Peter Sunderland

maintenance costs. The H145 is

said: “This really is a landmark day

night capable, enabling longer flying

for the charity and for Yorkshire. This

hours, and is used by military, police

amazing new helicopter is the result

and air rescue services throughout

of the hard work and dedication of

the world.

the tremendous team we have at the

Yorkshire Air Ambulance has been

Air ambulance doctors and paramedics have been involved from the start in the medical fit out of the H145s which provide a much larger cabin area to treat patients in flight, and will carry the latest medical equipment. YAA Clinical Operations Manager Pete Vallance said: “The open cabin allows clinicians to have full access to the patient inflight and we have future-proofed the specialized medical equipment that is being fitted.

charity and the wonderful generosity

“We believe we have now got the best aircraft and the best equipment available to enable us to provide toplevel clinical care across Yorkshire

of the people of Yorkshire.

for many years to come.”

PTS by Alfred Bekker


190 For further recruitment vacancies visit:

Driffield, East Yorkshire 01377 241 700

NEWSLINE Otley nursing student comes to rescue of her own gran A nursing student from Otley is urging more people to volunteer for St John Ambulance. Katie Quinn, of Riverside Park, has been a volunteers Community First Responder (CFR) for the first aid charity's Otley unit for two years. The role involves providing immediate, life-saving care to residents during medical emergencies – such as a heart attack, collapse or breathing difficulties – in the vital minutes before an ambulance arrives. To assist them, Community First Responders carry oxygen and an automatic external defibrillator that uses electrical charges to restart the heart in the event of a cardiac arrest. Katie, 20, is hoping more people will sign up to be trained during National Volunteers' Week, which runs until Sunday. She said: "St John Ambulance gives you really good first aid training and you learn the skills I think everyone should have. "Some people may have seen CPR done on the television, but wouldn’t have the confidence to do it because they haven’t practised it. "With this job, you give something back to the community and are there for people that need help in the worst situations.

"In addition to my CFR work, I have had two off-duty incidents already and being able to help gives you a great feeling." The first year Leeds University student was recently involved in a dramatic rescue involving her own grandmother, after she had fallen and broken a shoulder. The door to the 86-year-old's home was locked, so Katie and her father had to use bolt cutters to get in where they found her gran, who has dementia, in great pain. Katie's training kicked in while the family waited for the ambulance. She said: “Suspecting she had broken her shoulder, I didn’t move her but gently supported the shoulder. "I calmed her and knew not to give her anything to eat or drink, and gathered her medication and noted down her medical history to save time for the ambulance crew. "Her blood pressure was extremely high and had I not managed to calm her, she could have had a heart attack. "My parents were very relieved I was able to help." As well as first responders, St John Ambulance is also looking for volunteer first aiders, doctors, nurses and cycle responders. Once trained, volunteers provide first aid support at a wide range of public events, from village fairs to football matches, marathons and pop concerts.


Nursing student Katie Quinn, from Otley (second from left) with fellow St John Ambulance Community First Responders

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

NEWSLINE National Air Ambulance Awards: nominations now open The Association of Air Ambulances is today calling on all of the air ambulance community to nominate an individual or team for this year’s Air Ambulance Awards of Excellence. These prestigious, independent awards honour the exceptional contributions of staff and volunteers in the UK air ambulance community. The organisers are particularly calling on those organisations who may not have entered before to put in an entry this year. Chloe Smith MP, Chair of Judges, said: "The number of entries into the Awards is increasing year on year but we'd like to hear even more great stories from across the pre-hospital care community and especially those areas that may not have been well represented in the past. This might include ambulance service staff or HEMS desk staff who, among others, play vital roles in air ambulance operations.

"We have deliberately made the

everyday heroes were recognised,

Awards both straightforward and

and these awards will once again

free to enter in order to encourage

reflect the incredible dedication to

all organisations to nominate their

duty of all those involved in the air

star individuals or teams."

ambulance sector.”

The Air Ambulance Awards

Nominations are now sought in

of Excellence are now in their

the following categories:

fourth year and have quickly become a prestigious event for the pre-hospital care sector. Last year saw over 275 people watch BBC News's Sophie Long and Helicopter Heroes presenter Rav Wilding hand over 11 Awards to some outstanding individuals and teams.

• Outstanding Young Person Award • Charity Staff Member of the Year • Air Ambulance Paramedic of the Year • Air Ambulance Doctor of the Year • Air Ambulance Pilot of the Year

Nominations are now open so the entire sector’s most inspirational

• Air Ambulance Campaign of the Year

people get the recognition

• Charity Volunteer of the Year

they deserve. The Awards are

• Special Incident Award

judged by an independent panel

• Lifetime Achievement Award

of experts and presented at a

• Innovation Award

gala dinner in London on 14 November. Recipients last year

The closing date for nominations

included pilots, paramedics,

is 1 September 2016. The winners

doctors, fundraisers and

will be announced at the Air


Ambulance Awards of Excellence gala dinner to be held on 14

National Director of the


Association of Air Ambulances, Clive Dickin, said:

Further details of award categories, together with a

“Last year’s ceremony was

nomination form can be found at:

a wonderful occasion where


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192 For further recruitment vacancies visit:

NEWSLINE critical care skills. They will also work alongside physicians with the West Yorkshire Medic Response Team and British Association for Immediate Care (BASICS) who respond by road to serious incidents.


Doctors join new Yorkshire Air Ambulance Critical Care Team

Dr Pountney added: “This is about complementing the excellent service already provided by Yorkshire Air Ambulance paramedics and other frontline response teams.

Specialist emergency doctors have joined the crew of the Yorkshire Air Ambulance in a move that could save even more lives across the country. Yorkshire Ambulance Service NHS Trust (YAS) has worked with the Yorkshire Air Ambulance (YAA) and commissioners to launch a new Yorkshire Critical Care Team. This will see 11 consultants in emergency medicine and anaesthesia working on the lifesaving helicopter 12 hours a day, every day of the year. The team will carry additional drugs as well as being able to perform emergency anaesthesia and life-saving surgical procedures at the scene of an incident.

It includes three South Yorkshire Consultant Anaesthetists. Steve Rowe and Neil Sambridge are based at Sheffield Teaching Hospitals NHS Trust and Anil Hormis works at Rotherham General Hospital. Dr Andrew Pountney, Emergency Medicine Consultant at Pinderfields Hospital, Wakefield, is clinical lead for the Yorkshire Critical Care Team. He said: “We have had doctors flying with Yorkshire Air Ambulance

on an ad hoc basis for over 10 years now. “But thanks to this initiative we now have a dedicated and funded system to ensure that a consultant with appropriate training and experience in pre-hospital emergency medicine can respond every day of the year.” The doctors, who have been seconded to YAS by their host trusts, will support the work of YAA paramedics who have extended

“For the vast majority of the time the doctors will have a vital role providing support for the paramedics when they are using their extended skills. “The doctors will also be able to make advanced clinical decisions and deliver critical care interventions very quickly, including pre-hospital emergency anaesthesia. There will be occasions when having an experienced doctor on board will mean that certain life-saving procedures can be done on scene.”

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NEWSLINE After receiving a letter to tell him he had been nominated back in

Double delight for Welsh Ambulance Service in Queen’s Birthday Honours List

April, he said he faced a tense wait to find out if had been named. Chris, of Cardiff, said: “I got the letter in April from the

There has been double delight for the Welsh Ambulance Service as two of its colleagues are recognised in the Queen’s Birthday Honours List. Both the Trust’s Director of Operations (Interim), Richard Lee, and Head of Operations – Resilience, Chris Sims, have been awarded the Queen’s Ambulance Service Medal. Richard, who is based in Cwmbran, near Newport, first joined the ambulance service in 1993 after serving with the Royal Air Force.

government to say I had been nominated for the medal and to let them know whether I would accept. It then said that I wouldn’t hear anything else until Richard Lee

Chris Sims

the announcement in June. “The letter also said that on no

He said: “I received a letter from

After qualifying as a paramedic

the Department of Health in

in 1995 Richard worked

London in late April advising me

for ambulance services in

that I had been recommended to

Oxfordshire, London, Avon and

the Queen to receive the Queen’s


Ambulance Service Medal. In 2004, he moved into “I was really surprised and lost

management roles, firstly at

A former pupil at the Alun School in Mold, Flintshire, Richard admitted that receiving the award

for words. To think that the Welsh

London Ambulance Service and

Ambulance Service and my peers

then at Great Western Hospitals

had recommended me to receive

Foundation Trust, where he was

had come as a surprise.

this honour is an amazing feeling.”

manager for unscheduled care services.

account was I to tell anyone about the nomination, so I only told my wife and children and didn’t tell anyone else. “So we kept checking on the evening it was announced and that was when I found out. It’s a privilege to have been both nominated and awarded with the medal.” Chris started his career with the then South Glamorgan Ambulance Service as part of

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Richard joined the Welsh

the Patient Care Service before

Ambulance Service as Regional

joining the Emergency Medical

Director in 2009 and was


appointed Head of Clinical Services in 2012, before

After becoming a paramedic, he

undertaking his current role at the

rose through the ranks to work in

start of this year.

the control room and has since undertaken a large number of

He added: “I’ve been really lucky since I joined the ambulance service to work with some fantastic mentors and meet some brilliant patients and colleagues from other healthcare sectors and emergency services.


“I hope that everybody who knows me and has worked with me over the years will accept their part in this honour.”

roles including Regional Staff Officer and Regional Director. He was also operational lead for the creation of the Trust’s new South East regional headquarters at Vantage Point House in Cwmbran. More recently, Chris has been responsible for the rollout and management of the service’s Hazardous Area Response Teams (HART), before taking on

Meanwhile Chris has been

his current role in 2014.

a stalwart with the Welsh Ambulance Service for 31 years

He said had been inundated

and has held no less than 18

with messages from well-wishers

different roles in that time.

since he received the award.

194 For more news visit:

NEWSLINE Chris said: “The first one came

their colleagues and deserve all

Advanced Paramedic Practitioner

in the Queen’s Birthday Honours

through in the early hours of the

the credit that they get.

Richard Hook.

List, while Rob Jeffery, the Trust’s

morning and they haven’t stopped since via text, e-mail and on

“We look forward to hearing how


they get on at the Investiture.”

“It’s surprising how many people

The Queen’s Ambulance Service

you get to know over the years

Medal was introduced in 2012,

and the award is down to the

when now retired Director of

people I’ve worked with, who are

Ambulance Services, Dafydd

just as worthy.

Jones-Morris, was commended in

Head of Operations responsible for In June last year, the Trust’s Interim

the Hywel Dda and Powys areas,

Assistant Director of Operations,

collected the medal in the New

Gordon Roberts, was recognised

Year’s Honours list in December.

the Queen’s Birthday Honours list. “I’d like to thank my family too because I couldn’t have done it

In 2013, Mike Collins, then the

without them. It’s not always easy

Trust’s Head of Service in the

when you’re working shifts and

Abertawe Bro Morgannwg area,

missing your children’s parties

also collected the medal for

and other events.”

dedicating his 32-year career to the ambulance service in Wales.

Chief Executive Tracy Myhill said: “We are delighted that both

There was a double celebration

Richard and Chris have received

in 2014 when not one but two

recognition for their years of hard

members of staff were recognised

work and commitment to the

in the New Year’s Honours list;

Welsh Ambulance Service.

Andrew Jenkins, Consultant Paramedic and Deputy Director of

“They are both well respected by

Medical and Clinical Services, and

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


Trust awarded ENEI gold standard for third year running South East Coast Ambulance Service NHS Foundation Trust (SECAmb) has been awarded the ‘Gold Standard’ for the third year running at the Employers Network for Equality & Inclusion (ENEI) awards The only NHS organisation to be awarded the standard, SECAmb was recognised alongside the Home Office, Santander and Zurich Insurance at the awards which were held at the Law Society in London on 7 July. SECAmb received the gold standard after participating in ENEI’s ‘e-quality’ benchmarking diversity process. The awards recognise and celebrate the achievements of organisations that have taken a lead in challenging discrimination and are working inclusively to tap into their talented workforce. SECAmb’s Inclusion Manager Angela Rayner represented the Trust at the event along with Acting Director of Strategy and Business Development, Jon Amos. Angela said: “I’m delighted that we’ve now been given this standard for the third year in a row. It not only highlights our ongoing work around equality, diversity and inclusion, but it also sends an important message

to our patients, our staff and the public that we value and respect everyone for who they are.”

Service backs lifesaving campaign A rallying call has been issued to schools in the East to sign up to a life-saving initiative. The region’s ambulance service is backing the ‘Kids Save Lives’ campaign to teach hundreds of schoolchildren cardiopulmonary resuscitation (CPR) on European Restart a Heart Day. A CPR world record attempt will be attempted on Tuesday 18th October, led by The Resuscitation Council with support from The British Heart Foundation, British Red Cross, St John Ambulance and ambulance services across the country. The East of England Ambulance Service NHS Trust (EEAST) is now calling on schools in Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk to get involved. Wendy Risdale-Barrs, a community collaboration manager for EEAST, said: “A cardiac arrest - when someone is unconscious and not breathing - is the highest priority call for the ambulance service and the target is to reach a patient within eight minutes. However, every second counts and the chances of survival are greatly improved if someone can do effective CPR before the arrival of community first responders and ambulance staff.

“This is why it is so important that everyone knows what to do if they find someone in cardiac arrest. We are looking forward to training schoolchildren on 18th October and we hope this is a life-saving skill they remember for life and go on to spread the word with their families.” The aim is to train more than 100,000 young people across the country on how to perform CPR on Restart a Heart Day. Currently in the UK, fewer than one in 10 people survive a cardiac arrest. However, the survival rates in parts of Norway are 25% because CPR is taught in schools. To find out more about getting involved in Restart a Heart Day, visit events/rsah2016/ To get involved and register your interest by emailing wendy-jean. SCAS


South Central Ambulance Service celebrates 10 years of saving lives across Bucks Ten years ago South Central Ambulance Service was formed, providing 999 services as well as non-emergency patient transport and additional NHS 111 help.

196 For further recruitment vacancies visit:

Paramedics from across the service celebrated reaching the landmark on Saturday, cutting an ambulance cake to mark the occasion. On July 1, 2006, the Royal Berkshire Ambulance Service, Hampshire Ambulance Service, Oxfordshire Ambulance Service and part of Two Shires Ambulance Service merged together to form what is known as the South Central Ambulance Service (SCAS). Will Hancock was appointed chief executive of SCAS at the very beginning of the company's formation and still holds that position today. He said: “It was a real challenge as merging four organisations together meant we had four of everything when we only needed, in many cases, just one. “Some staff have, like me, been here from day one – and in many cases longer with their service in the other organisations that merged into SCAS – and others have joined more recently. “But thanks to the efforts of everyone, we have achieved a great deal over the last 10 years.” Joining in the celebrations, Mr Hancock was joined by Oxfordshire pupil Toby Valevou – who will also be celebrating his tenth birthday this month – to cut the official SCAS birthday cake.


Welsh Ambulance Service boss steps back in time as he collects Queen’s Ambulance Service Medal

“Princess Anne was really chatty and talkative

Those are the words of West Midlands

so it made it a really good day to remember.

Ambulance Service’s Motorcycle Paramedic

A Welsh Ambulance Service boss took a

After leaving the Welsh Guard in 1980, Rob

step back in time when he collected his

Steve joined the service in 1978 and has

later joined the Pembrokeshire Ambulance

Queen’s Ambulance Service Medal.

worked as a biker paramedic for 20 years.

Service in 1985 as a relief technician based in

During that time, Steve has provided patient

Pembroke Dock.

care to thousands of people in Birmingham

Steve Harris who has been made an MBE in “She said she’d heard good things about

the Queen’s Official Birthday Honour’s List.

the Welsh Ambulance Service and wanted to know about telemedicine.”

Affectionately known as Forrest by colleagues and fans of Channel 5’s Emergency Bikers,

Rob Jeffery, the Trust’s Head of Operations

City Centre and beyond.

responsible for the Hywel Dda and Powys

He qualified as a paramedic in 1991 and

areas, was presented with the medal by

has subsequently held a string of posts and

The award of the MBE comes just a year after

Princess Anne on Tuesday at Windsor Castle.

roles including control manager, regional

Steve, from Smethwick, received a President’s

staff officer, regional personnel manager,

Commendation at the Ambulance Service

The award, which was made as part of the

production manager and national staff side

Institute Awards at the House of Lords.

Queen’s New Year’s Honours List, was handed


to him almost 42 years to the day since he

Speaking about being made an MBE, Steve

performed his first ceremonial guard at the

He is now the Trust’s Head of Operations

said: “I am a mixture of totally thrilled and

castle as a member of the Welsh Guards.

in the Hywel Dda and Powys health board


areas. Pembroke-born Rob attended the ceremony

“I don’t understand why I am being singled out for

with his wife Paula Jeffery, an Advanced Nurse

Dedicating the award to his colleagues, Rob

this award, it feels like I am being recognised for

Paramedic based in Tenby and his 21-year-

said: “It was quite a humbling experience

turning up to work, but I am incredibly grateful.

old son Alex, who has not long joined the

and I was very conscious that I was actually

Trust’s Urgent Care Service and his youngest

receiving the award on behalf of all the

“It is very humbling that someone thinks I am

daughter Claire.

ambulance staff past and present.

worthy of being nominated and even more so

He said: “It was strange going back, but

that it has been accepted.

they went to great lengths to make you feel

“I was also conscious that this award

welcome and they were very friendly.

reflected how highly ambulance services, not

“I thoroughly enjoy my job and being able to

just in Wales but across the UK, were held.

provide care to patients in their hour of need, just as I know all of my colleagues at West

“I know people will find this hard to be believe, but I joined the army when I was 15 and I’m now 61.

“The award recognises the teamwork and

Midlands Ambulance Service do too.”

commitment that everyone puts in basically.” Chief Executive Tracy Myhill said: “We are extremely proud that Rob has been recognised for his years of hard work and dedication in this way. “We’re also glad that he and his family enjoyed themselves on what must have been a very memorable day. “Rob has dedicated more than 30 years to the service and is highly respected among his


‘Emergency biker’ is made an MBE “I’m very humbled, but I’m only doing the



same job as all of the other paramedics who turn up for work every day.”

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

IN PERSON It's a privilege to be asked to play a small part

appointed Head of Clinical Services in 2012,

in helping the charity in the next chapter of its

before taking up the role as Interim Director of

incredible journey."

Operations at the start of this year.

Graham Hodgkin, Chief Executive Officer

Richard, who was recently awarded the

Senior Communications professional and

at London’s Air Ambulance said: “The

Queen’s Ambulance Service Medal said he

former broadcast journalist, Will Walden,

charity is extremely fortunate to be guided

was delighted to have been offered the job on

has been appointed as Trustee for London’s

by a group of excellent Trustees, whose

a permanent basis.

Air Ambulance, the charity that delivers an

passion, enthusiasm, solid governance and

advanced trauma team to critically injured

expert advice are hugely beneficial to the

He said: “I am delighted to have been offered

people in London.

organisation. I am delighted that Will has

the post of Director of Operations for the Trust.

LAA News

Will Walden joins London’s Air Ambulance as Trustee

joined our already talented and dedicated In a 19 year broadcasting career as a TV and

Board, and myself and the team very much

“I know how hard everybody is working to

radio reporter, producer and editor, Will has

look forward to working with him.”

deliver care to patients. I am determined to get out and about to all parts of Wales to visit

worked for the BBC, ITN, GMTV & Granada Television. In that time he covered three UK general elections, nine budgets, a U.S presidential election, 9/11, the Afghanistan and Iraq wars, Hurricane Katrina, and the death of Diana Princess of Wales. Will worked with Boris Johnson as his Director of Communications and official spokesman for the majority of his tenure as London Mayor and continues to

London's Air Ambulance treats on average five

local teams and ensure we provide services

critically injured people in London each day,

equitably across Wales.

performing medical interventions at the roadside which are normally only found in a hospital

“The Welsh Ambulance Service is a fantastic

emergency department. Barts Health NHS Trust

organisation to be part of and we all know the

provide the doctors and some financial support

opportunities to deliver even better services to

and the London Ambulance Service provides

our patients in the future.”

the paramedics and expertise to dispatch the service. The charity relies heavily on voluntary

Chief Executive Tracy Myhill said: “We are very

donations and has a world class reputation for

pleased that Richard has accepted the post

delivering clinical innovation and excellence at

as he has made an outstanding contribution to

the roadside. Find out more about the charity

the Executive Team during his tenure as Interim

and its people at


of medics, and for the last few years I've had


“Throughout the recruitment process his

privileged access through City Hall to the

Welsh Ambulance Service appoints new Director of Operations

work for Mr Johnson in his capacity as MP for Uxbridge and South Ruislip. He’s also a father of three, a Tottenham Hotspur FC supporter, a cycling enthusiast and a golfer. Will Walden said: "I grew up among a family

work of London's emergency services, so as a long standing supporter of London’s Air Ambulance, accepting an invitation to help to shape the future direction of the organisation wasn't a difficult decision.”

experience in the Welsh Ambulance Service, as Assistant Ambulance Commissioner for Wales, at the London Ambulance Service and his reputation more widely in the worldwide ambulance community set him apart from a strong field.

The Welsh Ambulance Service has appointed a new Director of Operations.

“We would like to congratulate Richard and wish him well as he takes up the role on a

He added: “The doctors, paramedics, pilots and staff of the charity are at the cutting

Richard Lee, who previously held the post on

edge of medical intervention – saving lives,

an interim basis, has been awarded the role

transforming patient outcomes across the city

following a global recruitment search.

and setting new standards in critical care. Richard, who is based in Cwmbran, near Newport, first joined the ambulance service in

formal basis.”


New chair for Yorkshire Ambulance Service

1993 after serving with the Royal Air Force. NHS Improvement has appointed Kathryn


A former pupil at the Alun School in Mold,

Lavery as the new chairman of Yorkshire

Flintshire, he qualified as a paramedic in 1995

Ambulance Service NHS Trust.

before working for ambulance services in Oxfordshire, London, Avon and here in Wales.

Kathryn has 35 years experience, including chair of NHS Hull and chair of Healthwatch

In 2004, he moved into management roles, firstly

Kingston upon Hull. She is also director of

at London Ambulance Service and then at Great

Kath Lavery Associates, specialising in board

Western Hospitals Foundation Trust, where he

governance. Her role is to ensure the service

was manager for unscheduled care services.

performs effectively, delivering high quality community ambulance services and making

Richard joined the Welsh Ambulance Service

the best use of financial resources to maximise

as Regional Director in 2009 and was

benefits for patients.

198 For more news visit:



Prior to his appointment he was the National

collaborations and secure mutual benefits

Implementation Lead at the Department

for both organisations.”

of Health on the development and implementation of ambulance performance

Professor Ceri Phillips, who heads up the

standards. He is also a former Chief Executive

College of Human and Health Sciences,

of Kent Ambulance Service.

added: “The College is heavily reliant on the co-operation and contribution of the Welsh

Hayden says on his appointment “l am

Ambulance Service in ensuring that student

delighted to be joining the IAA at such an

experience is relevant for the future paramedic

exciting time and look forward to working for


the members of the Association”. “To enable the Trust’s Chair to have an Colin Vanlint joins the Board as part of the re-

affiliation with the College and University is

shaping of the Association, bringing significant

evidence that both organisations are serious in

experience of managing ambulance provision,

investing in future professionals, whose roles

both in the London Ambulance Service, where he worked for some 10 years, and 20 years

will become ever more significant.”

with the independent sector. Colin is the Chief Executive Officer for UK Specialist Ambulance Services and has a passion for providing patients with the best care experience and his Hayden Newton QAM is appointed nonExecutive Director

attention to detail is second to none!


Directors of the Independent Ambulance Association (IAA) are pleased to announce the appointment of Hayden Newton QAM as their new non-Executive Director, and Colin

Mick Giannasi appointed Honorary Professor at Swansea University

Vanlint (UK Specialist Ambulance Services)

The Chairman of the Welsh Ambulance

as a Director.

Service has been appointed Honorary Professor at Swansea University.

Hayden was the Chief Executive Officer of the East of England Ambulance Service for

Mick Giannasi was appointed by the

6 years until early 2013. Whilst at EEAST he

College of Human and Health Sciences,

was the National Lead for Operations and has undertaken national assurance projects on winter planning, Pandemic Flu, and most recently the London 2012 Olympic and ParaOlympic Games.

which has been educating paramedics since 1998 and is the sole provider of preregistration paramedic education in Wales. The number of paramedic students studying in Swansea has increased in recent years and the demand for places is on an upward

Mick Giannasi

Mick joined the Welsh Ambulance Service after a distinguished career with the police force


spanning 31 years.

In his role as Honorary Professor, Mick

During that time, he served in three police

will work with the University to develop

forces and ultimately attained the rank of Chief

programmes that meet the needs of the

Constable in Gwent. He was appointed Chairman of the Welsh

Of his appointment, Mick said: “I’m

Ambulance Service in September 2013.

delighted and honoured to have been

Colin Vanlint (UK Specialist Ambulance Services) appointed as a Director

given this opportunity to strengthen

Tracy Myhill, Chief Executive of the Welsh

our association with the University, with

Ambulance Service, said: “We’re beyond

whom we already enjoy a close working

thrilled for Mick and have every faith that he will


build on the fantastic partnership working that has already been achieved to date and inspire

“I look forward to working with colleagues

the next generation of paramedics to take up

in Swansea to develop our existing

opportunities in our ambulance service.”


ever-expanding cohort of students.

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

IN PERSON Lisa says she wants to go one better than


Staff awards keep it in the family A father and daughter have received long service awards for having worked 60 years - combined - for their

her Dad and complete 50 years in the ambulance service! Michael Forrest, Director of Organisational Development, at North West Ambulance Service (NWAS), added: “These awards

commitment to North West Ambulance

are designed to formally recognise the


commitment and dedication of our staff. We are fortunate to have a loyal team at

Lisa Stanway celebrated 20 years while her

NWAS and I would like to thank Lisa and

father Clive Heather notched up 40 years.

Clive along with 60 or so other staff for

Lisa, who started in the mid-1990s and qualified a couple of years later as a Paramedic, is now responsible for ensuring

their continued hard work.” In total, more than 60 staff received long

life -saving equipment is out in the

service awards for their hard work and


dedication to the ambulance service

“I love working for the ambulance service and knew from a very early age that it was the career for me.”

totalling 1,555 years combined. From an early age Lisa would listen to her father’s stories about the ambulance service and ask questions about his work she was hooked. Lisa, who works as a Community Resuscitation Development Officer, in Manchester, said: “I love working for the ambulance service and knew from a very early age that it was the career for me. A lot of my work focusses on ensuring there are defibrillators are in public places and working with community first responders and a team of about 50 volunteers. I am really proud of my Dad and what he has achieved during his career to date.” Clive now works as an Emergency Operations Centre Manager and has a strong background training Paramedics. His other three daughters also work in healthcare and nursing professions. Lisa added: “I think there must be a caring gene in the family as all my sisters went into a caring profession too. It might come to a halt as my two sons both want to AMBULANCE UK - AUGUST

become footballers! “Although Dad was never my boss, I worked briefly with him back in 2013 when he was Control Manager in Parkway, Manchester. I was working on the road as a Paramedic and he always stepped back and allowed me off the reins - I learnt a lot because of this and am really grateful to him for this.”

Clive Heather receives long service award for 40 years’ service along with his daughter Lisa Stanway who notched up 20 years

200 For further recruitment vacancies visit:

COMPANY NEWS continues to grow. Their lightweight,

Bluelight UK Bluelight UK Ltd is one of the UK’s longest serving providers of pre-owned ambulance, patient transport service and rapid response vehicles. Their wealth of experience in this field is unrivalled with clients using their services from all over the world. Over the years, their customer base has grown significantly with NHS Trusts, major industries, private ambulance services, voluntary ambulance services as well as TV and film companies all opting to use their vehicles. Bluelight UK has a stock of preowned and brand new vehicles, prepared and ready for work at their depot in Atherton, near Manchester. Current stock includes A&E box and van, PTS units and both commercial and

functional, under complicated design has won many UK supply contracts. The “VOR” reports have been very encouraging with limited downtime generated due to conversion faults. MD Simon Forster commented, “We have been in this industry long enough to know what works best with the private sector. All our customers demand minimal downtime, simple (easy-to-fix) technology and good value for money. Problematic ramp and lift systems coupled together with digi tal keypad systems can generate their own problems. The costs can be excruciating. For example, a new keypad can cost £300 when it breaks. A rocker switch and relay costs pennies in comparison and downtime is minimised.”

stretcher seat, Winga and Plica tip

Rescroft Ltd Rescroft is a well known name in the emergency services sector. Based in Redditch, Worcestershire, they are a key seating supplier to the majority of blue light vehicle builders and convertors throughout the UK as well as producing specialist seats for customers in both Europe and Asia.

and turn seats and the Defender Titan, an M1 standard passenger seat. All products are fully compliant to current legislation. Rescroft also have their own in house test facility and this helps them to continually monitor and improve seats as well as helping customers with in vehicle seat belt anchorage testing. Vehicle weight has recently become a major issue in some vehicles and in an effort to assist in this area, Rescroft have

Founded in 1976, they currently

developed a lightweight product

employ over a hundred people

from their minibus seat range to

who are involved in the design,

introduce a CT Lite version of a

manufacture and supply of a

twin belted rear facing attendants

varied range of products which


are fitted into the various blue light and emergency services

Further details of all the Rescroft

vehicles. Their current range

products can be found on their

includes the Levl, a swivelling

website at

“Renault Master has been one of the easiest vehicles to work with for us. It’s light enough, durable

car derived RRV units.

enough, and inexpensive to repair

Their rental fleet offers short and

for less than £2700 with warranty

long term rental solutions for

when things go awry.”

We can buy a brand new engine

companies and organisations who require quicker access to vehicles

Their social media page is quite

for event, breakdown cover and

interesting and their website is

contract work.

smartphone friendly. If you are in the market, it would be well-worth

Their new vehicle department

giving them a call on

opened 2 years ago and has

01942 888800 or email

produced many incremental sales

as their partnership with Baus AT


201 For all your equipment needs visit:

COMPANY NEWS O&H AT EMERGENCY SERVICES SHOW STANDS OS70 AND G31 O&H Vehicle Conversions launches ‘Flex PTS’ Multi-use Patient Transport Vehicle at Emergency Services Show • O&H claims a market first for its modular, ‘four layout options in one’ PTS vehicle • Common platform converts to seated, stretcher, wheelchair and bariatric layouts • Flexes in line with changing fleet demands • Quick version-to-version change-out • Avoids the need for shortterm ‘spot’ hire O&H Vehicle Conversions (‘O&H’) is launching ‘Flex PTS’, a modular, ‘four layout options in one’ patient transport vehicle that is the first of its kind according to O&H. Flex PTS can be converted for seated, stretcher, wheelchair and bariatric use. Its single platform design conforms to Care Quality Commission standards,

enables quick version-to-version change-out, keeps operator and maintenance training to a minimum and reduces the need for short-term or ‘spot’ hire say O&H. Flex PTS has been designed to maximise fleet use. “Our Flex PTS vehicles can be configured to flex with changing demand from NHS Trusts, private PTS providers and hire companies” says O&H marketing director Lee Bott. “Flex PTS will also reduce our levels of manufacturing change control – a saving that we would expect to pass onto the customer. For example the Flex PTS cab and saloon is common to all versions, as with the aerospace industry’s Airbus series.” Flex PTS is in line with O&H’s policy of continuous engineering improvement. The company uses lighter, stronger aerospace-type build materials that increase vehicle durability and lower weight, reducing fuel consumption and cutting CO2 emissions. Specific Flex PTS versions or ‘scenarios’ to be supplied by O&H include seated; seated with wheelchair; stretcher-capable; stretcher-wheelchair capable; bariatric/seated; and bariatric/ wheelchair.

Exciting innovations from Ruth Lee! Our working at height manikin will thrill FRS Technical rescue teams and working at height specialists. We use closed cell foam technology in the trunk area to provide extra rigidity, and reduce ‘slumping’ when using a rescue harness. Tough polypropylene strips extend from the shoulders to the knees to prevent excessive flexing when used aloft. “It’s so much more realistic!” is the enthusiastic response of customers across the UK. HART teams and first responders are loving our new full bodied Airway Management manikin! The medical torso includes all anatomical landmarks and accepts an igel® supraglottic airway device. This manikin is tough enough to be trapped under a heavy object and can easily be positioned in RTCs, confined spaces or other real life scenarios that professionals deal with every day.


Our new Ligature Training manikin has been developed as a solution to help the many professionals who deal with suicides on a regular basis. Training to demonstrate safe and sensitive release techniques is essential and highly valued by participants. Our fire simulation range is also on display, including PPV trainers and highly impressive

202 For more news visit:

smoke machines. Call us to attend our road show events! Stand G74 Hall 5

Aireshelta has been at the forefront of Inflatable Shelter design and manufacture for over twenty six years now. Aireshelta is very proud of the claim that every Ambulance, Police and Fire organisation in the UK has had and still owns an Aireshelta product. In 2004 Aireshelta proudly won the prestigious Queens Award for Innovation with the still highly commended Aireshower Decontamination System, a unit which is still favoured by many leading lights and operators in the Ambulance Service today. For a no obligation demonstration or to discuss servicing details please contact Kevin Bradley, Managing Director, Airshelta International Ltd 00 44 1773 768352


PARAMEDICS Locations across the North West but particularly the following areas: Cumbria (stations at Distington, Flimby and Carlisle) Greater Manchester Band 5 - £21,909 – 28,442 plus up to 25% unsocial hours payments Permanent and Bank Are you HCPC registered or recently/about to graduate as a paramedic? Are you ambitious, motivated and calm under pressure?

A Great Place to work

A Great Place to Live

– and you can too.

from urban to remote rural areas. To apply, go to #1:$PEXODQFH QZDVRI¿FLDO For all your equipment needs visit:


Working in the North West, you will apply your clinical skills in a variety of environments, ranging

At NWAS we have an unrivaled clinical development pathway. Meaning you’ll have access to fantastic training and development opportunities; including funding for formal DFDGHPLF TXDOL¿FDWLRQV DQG NHS leadership Training. Members of our team have gone on to become senior managers, clinical leaders, consultant paramedics and even CEO

203 | Hall 5 | NEC | Birmingham | 21-22 September 2016 | | Hall 5 | NEC | Birmingham | 21-22 September 2016 | | Hall 5


Bringing the Emergency Services together to improve public safety A unique event for everyone who works in the emergency services • Network with like-minded emergency staff • Source new kit and save money • Meet the market leaders in emergency services products • Get updated on collaboration and multi-agency plans • See the newest products on the market • Gain CPD points from our free College of Paramedics workshops • Learn from past emergency situations at the free seminars • Get up to speed on UAV technology in the Drone Zone • Watch live water rescue demo's FREE visitor entry and parking at AMBULANCE UK - AUGUST


ESS - the only show for the entire spectrum of the Emergency Services

Show supporters and sponsors include COLLEGE OF

paramedics For further recruitment vacancies visit: leading the development of the paramedic profession

COMPANY NEWS vehicles, control vehicles,

Cartwright to showcase latest products at Emergency Fleet Services Show

FERNO IPTS Journey The Research and Development Team at FERNO have been very busy throughout the Globe in order to achieve our goal of bringing exciting new innovations to market. Today we are ready to launch the most innovative solutions to be introduced within the EMS World for over 60 years!

New Modular Frontline Rear Door Concept Ambulance Unveiled for First Time

With IPTS we can save the Whole Health Economy a fortune in terms of time and efficiency’s. There may be an initial increase in capital cost, bringing this kind of innovation to market doesn’t come cheap, protecting our Intellectual Property with Patents, designing new innovations, tooling investment, then testing them to the most stringent Global crash standards at 26G forces has been a global endeavor. The Features, Benefits and Innovations are extensive and the results and feedback so far are beyond our expectations and getting the Gross vehicle weight under 3.5 Tons is definitely achievable which means crews have no need to pass their Category C1 Driving Tests.

mountain rescue vehicles It is a unique combination of innovative design and functionality with aerodynamic features resulting in improved fuel economy and a reduction in carbon footprint. Also on display will be the company’ NETS (non-emergency transport

IPTS Integrated Patient Transport System

special incident vehicles and

Two of the latest products

service) Fiat Ducato vehicle which

from leading body and trailer

has been converted by Cartwright.

manufacturer Cartwright, will We are ready to give you the Ambulance of the Future today, here are just a few key features; • A CONNECTED SMART AMBULANCE Integrated Patient Transport System • NO TAIL-LIFT eliminates weight on the Ambulance and high maintenance costs • ENHANCED PATIENT & CLINICIAN EXPERIENCE improves patient outcomes and reduces the risk of MSK • REDUCED GVW removed 250kg, saves fuel costs, servicing and maintenance reductions • TASK TIME saves at least 2 minutes using iN∫X to load and unload • UNIT HOURS phenomenal savings with less downtime and breakdowns • SYSTEM WASTE a smarter approach that removes excess stock • AMBULANCE AVAILABILITY vehicles on the road longer and quicker

be on display at this year’s

Fully equipped the vehicle,

Emergency Fleet Services Show.

which has been built for London Ambulance, includes a stretcher,

Making its debut at the show

wheelchairs and facilities for

will be Cartwright’s new Modular

attendants. The rear of the

Frontline Rear Door Concept*

vehicle can accommodate three

ambulance featuring an innovative

passengers and two staff in the

gliding offside rear door which

front cab.

is sequenced with the tail lift operation.

Cartwright has worked closely with customers to develop a

A first for the industry and based

solution which meets both the

on proven bus and coach

clinical and aesthetic needs while

technology, the offside rear door

meeting the strict CEN 1789

is electrically operated and glides

European safety standard for the

outwards to provide a decency

construction of ambulances.

screen to the offside of the tail lift when in operation. This feature

The Cartwright Group has over 40

saves time in the operational use

years manufacturing of specialist

of the rear doors.

vehicles. The company had built an enviable reputation in its field

The Cartwright Modular Frontline

and has enjoyed repeat business

ambulance forms part of our

with many of its customers.

wide range which also includes conversions, rapid response

* Patent Applied For


205 For all your equipment needs visit:

AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254

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

Terry Terry or or Brenda Rachel Tel: Tel: 01322 01322 660434 660434 Fax: Fax: 01322 666539 email: email:

info@mediapublishing info@mediapublishing or by post to: Media House, Media 48 High Street 48 Swanley KentBR8 BR88BQ BQ Kent

Life Connections 2014 Exmed Study Day

Theme: Difficult Airway Course EMS™ – An introduction Thursday 15TH May 2014 Kettering Conference Centre, Kettering NN15 6PB






08.30 - 09.00


12.00 - 12.30

09.00 - 09.15

Introduction & History of the Course

09.15 - 09.45

The Airway Algorithms

12.30 - 13.30

09-45 - 10.30

Prediction of the Difficult Airway

13.30 - 14.00

10.30 - 11.15

BVM and Laryngoscopy

11.15 - 11.30

Tea/Coffee, Exhibition

11.30 - 12.00

Skills Stations (4 rotations/30 min. each)

PRESENTATION Skill Stations Rotation 2 Lunch, Exhibition Skill Stations Rotation 3

14.00 - 14.30

Skill Stations Rotation 4

Group 1


14.30 - 14.45

Group 2

EGD’s & Rescue Airways

14.45 - 15.00

Group 3

Needle & Surgical Airway

15.00 - 17.00

Group 4

Video Laryngoscopy


Airway Self Scope Video Tea/Coffee, Exhibition Practical Moulages Wrap up

Topics and Speakers correct at the time of press but may be subject to change

CPD certificate provider

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

Only 7 places remain available!!

To register call 01322 660434 or visit: For further recruitment vacancies visit:

PARAMEDICS - SOUTH WEST £27,115 TO £35,225 (INCLUSIVE OF ENHANCEMENTS)* Join us and you’ll find an Ambulance Service that understands the better we look after you, the better equipped you’ll be to look after our patients. We are passionate about providing care closer to home and equip all of our staff with the training, support and skills they need to deliver a higher level of care, enabling more of our patients to be treated without conveyance to hospital. And we want a better future for you too. Our career framework supports our paramedics to develop specialist or managerial careers, with the progression of many of our current staff testament to our commitment to internal progression and career development Whether you crave a coastal location, the best of the British countryside or the historic cities of Cheltenham, Bath and Bristol (to name but a few), you really will find a better lifestyle outside of work here in the beautiful South West. • • • •

The most clinically advanced Trust within the UK Permanent and bank opportunities available One of the most beautiful parts of the country Lowest conveyance rate in the UK

Let us look after you better. For your next career move visit

• A better work-life balance • Dedicated staff support service • Structured career pathways

/swasFT *Subject to qualifying criteria.



Better you, Better everybody.


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