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Volume 34 No. 5

October 2019



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Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street

166 Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study

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EDITOR’S COMMENT Welcome to this issue of AUK. I hope you all had time out over the last few months with friends and family and got some well earned respite. It’ll probably be needed as we head into the annually ‘unexpected’ winter period pressures that necessitate hours of planning each year. If you’re involved in this, as I am, you’ll no doubt empathise and feel that the additional work is a necessary but thoroughly aggravating evil amidst the myriad of other pressing matters that need to be placed on the back burner for the next couple of months.

“Halloween has its issues for us but there are far more unknown and scary things surrounding Brexit”

In between all this, and just to really drive home the knife, it won’t be long before the supermarket shelves are full of goodies for Christmas. This one will be my 29th as a Paramedic and due to the vagaries of rotas and other things, I’ve worked most of them or at least it feels that way. There is a simple test to see if you’re becoming an ancient ambulanceman (or person these days), its when you find yourself describing what it was like for all the crews to sit down to a proper Christmas dinner made on station without getting disturbed by a 999 call. Today, you’re unlikely to see a station over Christmas let alone eat or celebrate, even in a small way, with colleagues such is the pressure and expectation placed on the modern service. So, even though its September at the moment may I wish you all a good one. It doesn’t seem two minutes since summer came and went, now looking forward to the next major event in the UK ambulance calendar, I can see October 31st fast approaching. Halloween has its issues for us but there are far more unknown and scary things surrounding Brexit, at any rate it will mirror the problems voiced many years ago by the Clash in their song ‘Should I stay or should I go’, with either continued uncertainty or the as yet unknown challenges of parting ways. As an apolitical individual in general terms, I have sympathies with both arguments, the reality though in either scenario for the ambulance service is, likely as not, to be just as challenging in terms of staff resource, patient concern and pressure on crews to enter all these anxieties surrounding the future into the already complex soup of patient assessment and management. I’m sure by now everyone is aware of preparations to support the inevitable or continuing problems and their impact on both staff and patients but spare a thought for those who perhaps have more invested in stability than others, those who have left family and friends to move to other parts of Europe and in turn those Europeans who have left their families to work as part of our health and other services. I cannot conceive of anything worse than uncertainty especially when so much has been committed to a new life. Or perhaps I can, the uncertainty of almost every patient under the care of the NHS about the future of their care in a new world or at best in a fundamentally changed old one.

Sam English, Co-Editor Ambulance UK


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NON-TECHNICAL SKILLS EVALUATION IN THE CRITICAL CARE AIR AMBULANCE ENVIRONMENT: INTRODUCTION OF AN ADAPTED RATING INSTRUMENT - AN OBSERVATIONAL STUDY Julia A. Myers1*, David M. C. Powell1, Alex Psirides2, Karyn Hathaway3, Sarah Aldington4 and Michael F. Haney5 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:24 © The Author(s). 2016, Published online 08 March 2016 Reproduced with permission from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine


Results The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase

Background In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. Methods In the first phase of the project the anaesthetists’ non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published

two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (rs = 0.4, p = 0.11) or observed non-technical skills performance (rs = 0.4, p = 0.1). Discussion This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance.

literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed


a simulated critical care air transport scenario, and their non-

The AeroNOTS framework could be used to facilitate education and

technical skills performance was independently rated by two blinded

training in non-technical skills for air ambulance clinicians, and further

assessors. Observed and self-rated general clinical performance

evaluation of this rating system is merited.

ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced


and inexperienced clinicians, and relationships between different

Non-technical skills, Air ambulance, Intensive care, Patient transport,

assessment approaches and assessors.

Clinical training



In health care, preventing errors and avoidable adverse events

with low tolerance for error (such as aviation and the nuclear power

for patients (patient safety) is paramount. High quality clinical

industry) were early to recognise the importance of non-technical

performance requires adequate knowledge and technical ability, but

skills for safety; these industries developed rating frameworks to

also relies on non-technical skills such as the ability to adapt to a

evaluate crew performance based on observable behaviours [4, 5].

rapidly changing clinical situation and to function as part of a team

This approach has also been implemented in high-risk health care

[1, 2]. Non-technical skills can be defined as “the cognitive, social

domains, where behavioural marker systems are increasingly utilised

and personal resource skills that complement technical skills and

as part of training or assessment of clinical competence [6, 7].

contribute to safe and efficient task performance” [3]. Even though a high degree of technical expertise in important, this alone is not

The air ambulance environment is a complex and dynamic health-care

enough to prevent clinician error or mishap. Non-technical skills are

setting, where clinicians work with limited resources to provide very

more likely, compared to technical skills, to be sensitive to individual

advanced levels of care [8-10]. Highly specialised care is centralised

human factors such as fatigue and stress [3]. High risk industries

in many modern health care systems and critically ill patients are

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FEATURE routinely transported large distances to tertiary hospitals to provide

teamwork [3], however specific skill elements and behavioural

timely access to intensive care [11, 12]. Air ambulance transport

descriptors vary according to the clinical requirements of the specific

teams tend to be small and comprise different professional categories

domain [20]. An existing behavioural rating framework can be

such as nurses, emergency medical technicians, and physicians.

adapted to another clinical setting using data gathered directly from

Challenges for maintaining patient safety in an aviation environment

the new setting [7]. In the aeromedical setting, the well-established

include managing sometimes acutely life-threatening and rapidly

Anaesthetists’ Non-Technical Skills (ANTS) framework [17] is suitable

evolving medical issues without the support and facilities available

for this purpose [21, 22]. The ANTS system provides a framework

in a hospital environment [13, 14]. High noise levels in the cabin

for describing the individual non-technical skills of clinicians as well

may preclude traditional options for clinical surveillance such as

as a tool to guide their assessment within the clinical workplace

auscultation or audible alarms, and make communication challenging.

for anaesthesia [23]. The overall goal of this study was to assess a

Clinicians cannot always access additional assistance, resources,

newly adapted non-technical skills rating system based on the ANTS

or expertise, should problems arise or clinical status change while

system but modified for the air ambulance clinical environment. Our

the patient is in transit. In this context, while good technical expertise

hypothesis was that a non-technical skills framework adapted to a

is certainly required, it may be non-technical factors such as how

critical care air ambulance environment could discriminate between

well clinicians have planned and anticipated, or how quickly they

stronger and weaker non-technical skills performances. We aimed

recognise, understand, and make decisions, that most strongly

to test this with a volunteer cohort of lesser and more experienced

influence eventual outcome. Well-designed training for air ambulance

intensive care physicians in a challenging air ambulance transfer

clinicians should aim to prepare them for the recognised risks

simulation, where non-technical skills assessors were blinded to

to patient care during all phases of transfer, and an assessment

clinician experience.

framework based on non-technical skills would clearly have a high degree of relevance for this purpose. However there are no published reports identifying or applying a non-technical skills framework specific


to an intensive care air ambulance setting. The project was undertaken in two phases. First, a non-technical skills A number of non-technical skills rating frameworks have been

framework was adapted to the critical care air ambulance setting

developed for health-care domains closely related to the air

using the ANTS system as the foundation. The adapted framework

ambulance setting, including emergency care [6, 15], critical

was referred to as an aeromedical non-technical skills framework, or

care [16], and anaesthesia [17-19]. Each of these frameworks is

AeroNOTS. In the second phase the adapted AeroNOTS framework

broadly similar, reflecting the generic nature of non-technical skills’

was utilised to evaluate the non-technical skills observed in clinicians

categories such as situational awareness, decision making, and

working in simulated inter-hospital transport scenarios.


Fig. 1 Literature search to identify tasks and non-technical skills associated with safe and effective clinical practice in the air ambulance clinical environment

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FEATURE Adaptation of a non-technical skills framework to the critical care air

university hospital-based air ambulance services as well as larger and

ambulance setting

smaller private air ambulance organisations in the United Kingdom,

Using the ANTS framework as the starting point, a selected and broadly

Australia and New Zealand. Any behaviour not rated by at least 75 % of

representative group of experienced critical care transport and aviation

respondents as either “very important” or “essential” was considered

medicine clinicians agreed definitions for each non-technical skills

to potentially lack content validity [24] and was therefore revised. All

category and element as they pertained to critical care air transfer.

free-text comments were reviewed to inform behavioural descriptor

They also provided suggestions for good and poor clinical behaviours.

modifications and confirm they could be coded to an existing skills

This work was initiated with a scoping review of the literature to

element. The prototype framework was also field tested in two critical

identify skill elements and observable behaviours essential for the air

care flight services in New Zealand and Sweden. Transport missions

ambulance environment, and to understand the range and nature of

were observed from start to finish noting essential tasks observed or

existing evidence. A search utilising online databases (Ovid Medline,

required but not covered by the framework, elements missing from or

Ovid Nursing, AMED, PsychInfo and Embase) was undertaken in two

superfluous to the four main categories, and behavioural descriptions

stages. The following search terms and all derivatives were used for

that may have needed modifying. A change was made from the ANTS

the initial search: aero, air medical, air ambulance, transportation of

scale to introduce a five-point scale for each element or category and

patients, patient safety, error, patient transfer, retrieval, non-technical,

a seven-point global rating (Fig. 2), following suggestions that the four

crew resource management skills, clinicians. In the second stage

point ANTS rating scale may lack sensitivity for measuring changes in

of the search the ANTS tool and other derivatives were used as the

performance [25] and that an overall non-technical skills scale may also

basis for describing specific non-technical skills categories, which

be a useful addition [18, 26].

were then added as the following search terms: behaviour, teamwork, decision making, situation awareness, communication, leadership.

Evaluation of non-technical skills using clinical simulation: study

There were no date restrictions and the search was conducted in March

setting and participants

2014 (Fig. 1) [Additional file 1]. Four focus group interviews were also

The observational study took place in the simulation suite of a New

undertaken, three with experienced New Zealand and Australian-based

Zealand tertiary hospital; it was timed to take place around a training

air ambulance clinicians (physicians, flight nurses, paramedics) and

placement changeover with the aim of recruiting a convenience

one with a group from an international post-graduate aeromedical

sample of minimally experienced intensive care transport physicians.

education programme. Open ended questions were used to facilitate

Experienced intensive care transport physicians were also recruited

discussion concerning the essential tasks undertaken from beginning

and assessed. Prior to the simulations, the intensive care unit (ICU)

to end of a patient transport, and examples of the relevant good or poor

flight service medical director categorised all the participants as either

‘observable’ behaviours associated with those tasks. Behaviours and

‘experienced’ or ‘inexperienced’ in ICU inter-hospital transport. All

tasks arising out of the focus group data and literature were integrated

participants provided informed consent and completed an enrolment

with the developing AeroNOTS prototype to complete and inform the

questionnaire which included details of training, transport and simulation

behaviour descriptions.


A content evaluation survey was undertaken using a purposive sampling

Simulation scenario

method and Qualtrics electronic survey software (version 9340538,

Following orientation to the simulator all clinicians completed a critical

Copyright © 2015 Qualtrics., Provo, UT, USA). Clinicians from a range of

care inter-hospital transport scenario with a highly experienced flight

critical care flight services rated the importance of positive behaviours

nurse serving as a ‘confederate’ and standardised team member.

from the prototype AeroNOTS framework and suggested key skills or

The scenario took approximately 20 minutes, with an initial phase set

behaviours they believed had been missed. The services were selected

in a high-fidelity regional emergency department where the transport

via contact with our Aviation Medicine teaching section including

physician and flight nurse took over care of a ventilated patient requiring

air ambulance organisations associated with previous students

air ambulance transfer to a tertiary hospital ICU in another city. The

and current teachers in our international programme. This included

second phase was set in a low fidelity helicopter fuselage with actual


Fig. 2 Rating scale descriptors for aeromedical non-technical skills performance

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FEATURE transport equipment (stretcher, ventilator, monitors) and comparable

Statistical analysis

space restrictions, but no aircraft noise or vibration. In the scenario the

The AeroNOTS scores from two assessors for each participant

patient’s condition deteriorated rapidly, and a life-saving intervention

were averaged for further analysis within participant groups. A priori

was required [Additional file 2]. Following the scenario an observing ICU

assumptions were that non-technical skills ratings for clinicians more

consultant facilitated a de-brief, which was not recorded.

experienced in air transports would be higher than for less experienced clinicians, and that general clinical performance levels would correlate

Assessment of non-technical skills

with non-technical skills performance levels. Statistical analysis was

Clinicians were informed that purpose of the study was to evaluate

undertaken using SPSS software (IBM SPSS Statistics for Windows,

methods for assessing clinical performance. They were not specifically

Version 22.0. Armonk, New York). Demographic variables were

told that the key focus for that assessment was on non-technical

compared using t-tests or Fisher exact tests. AeroNOTS ratings scores

skills. As recommended when undertaking formal assessment of

(summed total scores between 4 and 20, and individual category scores

non-technical skills performance, each skill element was initially rated

between 1 and 5) were treated as ordinal data and analysed using rank-

separately, then final ratings were made at the level of the four main skill

based methods. These included Mann–Whitney U to test for differences

categories of task management, team working, situation awareness and

in performance between groups, Spearman’s rank correlation to

decision making [27]. Since communication is required to demonstrate

examine relationships between different assessment approaches and

skill elements across all categories there was no specific category for

assessors, and Wilcoxon signed-rank to examine individual scoring

communication in the AeroNOTS system, as with the ANTS system

from the two assessors. Spearman’s rank correlation was also used

[17]. Possible scores for each skill category and element ranged

to test for association between the immediate general rating of clinical

between 1 and 5, where a rating of ‘5’ was “Excellent – extremely good

performance compared to non-technical skills rating. The level of

performance which could serve as a model example for others; patient

statistical significance was set at p < 0.05.

safety enhanced”, down to ‘1’ which was “Poor - absence of behaviour required by the situation; performance endangered or potentially

Ethical approval

endangered patient safety” (Fig. 2). Category scores were analysed

Ethical approval was provided by the University of Otago (Health)

separately giving a score for each category of between 1 and 5, and

Human Ethics Committee, New Zealand (HD12/233 and HD14/44).

then added to give a single summed score (providing an overall non-

All clinicians who participated in the clinical simulation study provided

technical skills score between 4 and 20) [25, 28]. Half marks on the

signed informed consent.

scale were not permitted; assessors were instructed to score at the lower level if they felt the performance fell between two levels on the scale [Additional file 3]. The assessments were carried out independently by two observers who viewed video recordings of the scenarios; assessors were blinded to the experience level of the participants. Assessment of general clinical performance Immediately after the simulation (prior to the debrief) one of the investigators, who was also playing the role of the confederate flight nurse, rated the general clinical performance of each participant on a five point scale ranging from a highest score of “5 = Excellent performed at the highest level; all issues well managed and patient safety enhanced”, down to “1 = Poor - performed well below the expected standard; significant lapses in skills or safety” (Fig. 3). Participants rated their own clinical performance on the same five point scale slightly re-worded to reflect self-rating, rather than observed rating of others.

Results Non-technical skills framework adapted for the critical care air ambulance setting The final prototype of the AeroNOTS framework was produced from expert working group, literature review, focus group, clinician survey, and field testing data (Fig. 4a and b). The content evaluation survey was fully completed by 38 clinicians; 20 flight nurses, 12 specialist transport physicians and six paramedics, who had a median aeromedical transport experience of 8 (IQR 4 – 13) years. Based on responses there were no skills or behaviours added, though five existing behaviour descriptors were revised [Additional file 4]. Field testers expressed a preference for being able to distinguish between good and exemplary performance preferring a five-point performance rating scale over a four-point scale, and they confirmed that a “not applicable” category was required as some transport missions either do not require all skill elements or they just could not be observed. Evaluation of non-technical skills using clinical simulation intensive care, emergency medicine and anaesthesia took part in the clinical simulation study (Table 1). Eight of the participants practiced at a senior trainee level or higher and were categorised as ‘experienced’, having undertaken a median of 45 (IQR 25 – 51.5) previous inter-hospital patient transports. The other eight practiced at a senior trainee level or lower and were categorised as ‘inexperienced’ in patient inter-hospital transport (median 0.5, IQR 0 – 4.5). The mean age for the experienced group was 36.1 (SD

Fig. 3 Rating scale descriptors for general clinical performance

5.6) years and 50 % of them were male. The inexperienced group


A total of 16 physicians from speciality training programmes in

were younger (p = 0.009) with a mean age of 29.8 (SD 2.1) years,

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Fig. 4 a Aeromedical non-technical skill categories and elements; Definitions of skill categories and elements in the aeromedical non-technical skills framework b; Illustrative behaviours for aeromedical non-technical skills; Examples of positive and negative illustrative behaviours for non-technical skill elements in the aeromedical non-technical skills framework

and all were male. There was no difference in any other baseline

Assessment of non-technical skills

characteristics including previous experience of simulator training,

Performance ratings from the two assessors were similar, with a high

the number of hours they had worked or slept in the 24 hours prior to

degree of correlation (rs = 0.65, p = 0.006) and no significant difference in

the simulation, and their fatigue level at the time of simulation.

overall scores (AeroNOTS summed scores, Wilcoxon signed-ranks test,

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FEATURE p = 0.21). These results stayed consistent across the four individual skill

a high risk medical environment, and both improve with good training

categories (correlation coefficients ranging between rs = 0.54 and 0.76, all

[29-31]. Necessary elements for improving clinical performance include

significantly greater than 0 at p = 0.05). However for the category of ‘task

identifying specific skills directly relevant to performance quality,

management’ the scores from one assessor rated higher than the other

then measuring or assessing those skills in a standardised manner

(Wilcoxon signed-ranks test, p = 0.02). The averages of the 2 assessors’

[32]. The results of this study indicate that by characterising the non-

scores were used for the analyses.

technical skills requirements for clinicians, and distinguishing higher and lower levels of non-technical performance, the prototype AeroNOTS

Non-technical skills ratings for all participants (Table 2) showed that

framework could be used to facilitate good education and training in

clinicians with experience in patient transfer had higher non-technical

non-technical skills. Published standards (on which training curricula

skills (AeroNOTS) scores than less experienced clinicians (Mann Whitney

may be based) from Europe [33], New Zealand [34], and the US [35],

U, p = 0.001) (Fig. 5). The experienced clinicians also had higher general

all mandate crew resource management (CRM) training in areas such

performance ratings than inexperienced clinicians (Mann Whitney U,

as decision making, communications processes, team building and

p = 0.003) (Fig. 6). For all clinicians, ratings for non-technical skills were

maintenance, workload management, and situation awareness, but they

highly correlated with general performance ratings (rs = 0.9, p = 0.001).

include little specific detail to define these skills. The specific behaviours

Self-ratings of clinical performance did not discriminate in the same way

identified in the AeroNOTS instrument can facilitate identification of

as ‘observed’ performance measures, and the self-rated performance of

specific areas for individuals where further training might be beneficial.

experienced clinicians was no different to that of inexperienced clinicians (Mann Whitney U, p = 0.32) (Fig. 7). In addition, self-rated performance was

In this study, ‘self-ratings’ of performance were not useful in

not strongly associated with either observed general performance (rs = 0.4,

distinguishing different levels of performance, with inexperienced

p = 0.11) or observed non-technical skills performance (rs = 0.4, p = 0.1).

clinicians tending to over-estimate their performance level. Limitations in clinicians’ ability to self-assess performance have been reported previously [36], but it is possible that our findings were partly a


result of recruiting one group of inexperienced clinicians who lacked appropriate inter-hospital transport experience on which to base their

This study describes the development and evaluation of a framework

self-assessments. It is also possible that self-ratings are more accurate

to assess non-technical skills in aeromedical transport. The framework

at the extremes, such as when performance is significantly degraded

discriminated between more and less experienced clinicians, based

[36]. Further examination of ‘self-rating’ is warranted in light of the fact

on their non-technical skill performance during simulated transfer of

that critical care air ambulance clinicians are particularly vulnerable to

a critical patient. Both technical and non-technical skills are needed

factors like fatigue [37], and risk management systems generally rely on

in tandem for good medical team performance and patient safety in

clinicians ‘self-identifying’ if their performance is compromised [38].

Table 1 Clinical simulation study: baseline characteristics of participants Characteristic



P value

Age (mean ± SD)

36.1 ± 5.6

29.8 ± 2.1


Male gender, n (%)

4 (50 %)

8 (100 %)



2 (25 %)

0 (0 %)

Registrar (senior)

6 (75 %)

2 (25 %)

Registrar (junior)


5 (62.5 %)



1 (12.5 %)

ICU and Anaesthetics

1 (12.5 %)

2 (25 %)


0 (0 %)

3 (37.5 %)

Critical and Intensive Care Medicine

3 (37.5 %)

0 (0 %)

Emergency Medicine

3 (37.5 %)

2 (25 %)

General Medicine

Training level, n (%)

Specialty training programme, n (%)

1 (12.5 %)

45 (25 – 51.5)

0.5 (0 – 4.5)


Number of previous simulations, median (IQR)

15 (2.25 – 20)

5 (5 – 16)


Sleep in 24 hrs pre-scenario, median hours (IQR)

7.0 (6.6 – 7.9)

7.0 (7–8)


Work in 24 hrs pre-scenario, median hours (IQR)

8 (1 – 13.5)

6 (1.75 – 7.75)


Samn-Perelli Fatigue Scorea, median (IQR)

3 (1.25 – 4.75)

2.5 (1.25 – 3.75)


a Samn-Perelli Fatigue checklist - possible scores between 1 and 7 where 1 is “fully alert wide awake” through to 7 which is “completely exhausted, unable to function effectively” (Samn SW, Perelli LP. Estimating aircrew fatigue: a technique with implications to airlift operations. Brooks AFB,TX: USAF School of Aerospace Medicine; 1982. Technical Report No. SAM-TR- 82–21.)


1 (12.5 %)

Number of previous inter-hospital patient transports, median (IQR)

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

FEATURE Table 2 Assessment scores: Non-technical skills and general clinical performance Performance measure

Experienced group

Inexperienced group

Non-technical skills (AeroNOTS)a, median (IQR)

16 (15.125 – 17.125)

11.75 (8.75 – 14.25)


b Table 2 Assessment scores:(IQR) Non-technical skills and general performance Task Management , median 3.75 clinical (3.5 – 4.375)

2.5 (2.125 – 3)


Performance bmeasure

3Inexperienced (2.5 – 3.5) group 11.75 – 14.25) 3 (2.5 (8.75 – 3.375) 2.5 (2.125 – 2.75 (2.125 –3)3)

Teamwork , median (IQR) a b Non-technical skills (AeroNOTS) , median Situational Awareness , median (IQR) (IQR) b b, median (IQR) Task Management Decision Making , median (IQR)

4Experienced (3.625 – 4.5)group 16 (15.125 17.125) 3.75 (3.5 – –4.375) 3.75 (3.5 – 4.375) 4 (3.625 – 4.375)

b Teamwork (IQR) c, median (IQR) General clinical, median performance b c Situational Awareness , median (IQR) (IQR) Self-rated clinical performance , median

P value*

P 0.002 value* 0.001 0.03 0.001 0.02

(3.625 3 (2.5(2––3.5) 44 (4 – 4) – 4.5) 2.75 3) 3.75 (3.5 – 4.375) 3 (2.5 – 3.375) 4 (3 – 4) 3.5 (2.125 – 4) a Decision Makingb, median (IQR) 4 (3.625 4.375) 4 and 20, higher scores 2.75 (2.125 –a higher 3) Median Aeromedical Non-technical Skills rating (summed score, possible range–between represent level of performance)

0.002 0.003 0.03 0.32 0.02

Median non-technical skills category rating (possible range between 1 and 5, higher scores represent a higher level of performance) 4 (4 – 4) 2.75 (2 – 3) Overall clinical performance rating (self-rated or observed - possible range between 1 and 5, higher scores represent a higher level of performance) c *Mann-Whitey U, two-tailed test , median (IQR) Self-rated clinical performance 4 (3 – 4) 3.5 (2.125 – 4)



General clinical performancec, median (IQR)




Median Aeromedical Non-technical Skills rating (summed score, possible range between 4 and 20, higher scores represent a higher level of performance) b Median non-technical skills category rating (possible range between 1 and 5, higher scores represent a higher level of performance) c clinical performance rating (self-rated or observed - possible range betweenfrom 1 and higher scores transport represent domain a higher level of performance) the5,aeromedical (clinician experts and relevant ThereOverall is a paucity of literature and no published skills taxonomy, so *Mann-Whitey U, two-tailed test

collecting additional data from the critical care air ambulance domain to

literature). For example, based on literature an addition to the ‘using authority

adapt the well-established ANTS system was essential [7]. Anaesthesia

or assertiveness’ element of Teamwork was: “questions others regardless

is a medical speciality with a leading role in addressing patient safety and

of seniority when they are unsure the right decision has been made”; and

taking a human factors approach to training and safety [39], and while a

a negative behaviour for the ‘gathering information’ element of Situational

behavioural rating system cannot simply be applied to another specialty

Awareness: “does not alter layout of the workplace to improve data visibility

area [27] non-technical skills are broadly generic [3]. As previous authors

or audibility” (ability to hear in aircraft is limited so clinicians need to be able

report significant overlap in the non-technical skills requirements of

to see monitors to make up for this). From focus groups a recurrent theme

intensive care and anaesthesia [20], it was reasonable to expect similarity

emerged that experienced air ambulance clinicians “plan for things to go

between the skills required of intensive care air ambulance clinicians and

wrong” and “plan for every eventuality”. They also develop strategies for

anaesthesia specialists. Both function in teams of variable professional

potential vulnerable points in the transfer, such as communication strategies

makeup, and so require frameworks where the fundamental focus is on

for working with unknown team members, being assertive in acquiring

the non-technical skills of individual clinicians, but encompassing how

information when working in unfamiliar surroundings, and ensuring they

they function as part of a team.

are being listened to. Results from the clinical simulation study provided support for the construct validity of the AeroNOTS framework as a tool for

A measurement system suitable for evaluating the non-technical skills of air

assessing non-technical skills performance. In accordance with the a priori

ambulance clinicians should provide a true (valid) and consistent (reliable)

expectations we set, experienced clinicians received higher scores from

representation of those skills. Face and content validity for the AeroNOTS

blinded assessors than inexperienced clinicians, and AeroNOTS scores

system were addressed during development by collecting data directly

were strongly correlated with general performance scores.


Fig. 5 Non-technical skills ratings for experienced versus inexperienced intensive care transport clinicians

Fig. 5 Non-technical skills ratings for experienced versus inexperienced intensive care transport clinicians

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Fig. 6 General clinical performance ratings for experienced versus inexperienced intensive care transport clinicians

not the same in all countries [40]. We aimed to provide that international One limitation in the study design was that while data from all air Fig. 6 General clinical performance ratings for experienced versus inexperienced intensive care transport clinicians perspective through assessment of the literature, content evaluation ambulance clinician groups were informative concerning the phase one AeroNOTS adaptation process, only physicians participated in the second

survey and field testing, all of which provided support for validity. However

phase clinical simulation study. It was not possible to recruit comparative

more wide-spread evaluation may be required.

groups containing inexperienced flight nurses or air ambulance paramedics locally. Ongoing evaluation should therefore include all

This study was not designed to test the reliability of the AeroNOTS rating

clinician groups routinely involved in critical care transfer. Another potential

system. Based on results from studies of non-technical skills in other

limitation is that much of the initial adaptation work and evaluation for

domains, some variability between assessor ratings, such as in our

the AeroNOTS framework involved clinicians and services based in New

findings, was not unexpected [16, 41, 42]. The assessors were trained

Zealand or Australia and it is possible that roles and responsibilities of air

in non-technical skills concepts and use of the rating system [23], but

ambulance clinicians, and therefore the required non-technical skills, are

no attempt was made to calibrate their ratings before the study. This will

Fig. 7 Self-rated clinical performance of experienced and inexperienced intensive care transport clinicians


Fig. 7 Self-rated clinical performance of experienced and inexperienced intensive care transport clinicians

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

FEATURE require further examination if the AeroNOTS framework is to be used for formal assessment of clinical competence.

References 1. Gordon M, Darbyshire D, Baker P. Non-technical skills training to enhance patient safety: a systematic review. Med Educ. 2012;46(11):1042–54.


2. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143–51.

An air ambulance non-technical skills framework derived from the

3. Flin RH, O’Connor P, Crichton M. Safety at the sharp end: A guide to non-technical skills. Farnham, UK: Ashgate; 2008.

ANTS tool is capable of distinguishing good and poor performers in a simulated inter-hospital transport setting. Scores can be highly correlated with observed general performance, and also with the general experience of the clinician. Our findings confirm that selfratings are not useful for distinguishing between higher and lower levels of performance. This framework could be useful in identifying when specific non-technical factors are likely to break down in the air ambulance environment, and facilitating a more structured approach to training and assessment. The AeroNOTS rating system shows utility and applicability for a critical care air ambulance environment, and further evaluation of this framework is merited. Abbreviations AeroNOTS: Aeromedical non-technical skills; ANTS: Anaesthetists’ non-technical skills; ICU: Intensive Care Unit; CRM: Crew resource management

5. Helmreich RL. Managing human error in aviation. Sci Am. 1997;276(5):62–7. 6. Flowerdew L, Brown R, Vincent C, Woloshynowych M. Development and validation of a tool to assess emergency physicians’ nontechnical skills. Ann Emerg Med. 2012;59(5):376–85. 7. Kodate N, Ross A, Anderson JE, Flin R. Non-Technical Skills (NTS) for enhancing patient safety: achievements and future directions. Jap J Qual Saf Health Care. 2012;7(4):360–70. 8. Flabouris A, Runciman WB, Levings B. Incidents during outof-hospital patient transportation. Anaesth Intensive Care. 2006;34(2):228–36. 9. Freebairn R. Interhospital and emergency transfers in New Zealand. N Z Med J. 2012;125(1351):7–10. 10. MacDonald RD, Banks BA, Morrison M. Epidemiology of adverse events in air medical transport. Acad Emerg Med. 2008;15(10):923–31.

Competing interests There are no financial or non-financial competing interests to declare. Author contributions Each author contributed to the study. JM conceived of the study, participated in study design, data collection, data analysis and manuscript writing. DP participated in study design, data collection, data analysis and manuscript writing. AP participated in study design, data collection, data analysis and critical review of the manuscript. KH participated in study design, data collection, data analysis and critical review of the manuscript. SA participated in study design, data analysis and manuscript writing. MH conceived of the study, and participated in study design, data collection, data analysis and manuscript writing. All authors read and approved the final manuscript. Acknowledgements This project was supported by funding from the University of Otago, New Zealand and Umeå University, Sweden. The authors would also like to thank the staff of the Simulation & Skills Centre, Wellington Regional Hospital, for their help with data collection. Author details Correspondence: 1Occupational and Aviation



Medicine Unit, University of Otago Wellington, Newtown, Wellington 6021, New Zealand. 2Department of Intensive Care Medicine, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington 6021, New Zealand. 3Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington 6021, New Zealand. Department of Emergency Medicine, Wellington Regional Hospital,


Wellington, New Zealand. 5Anesthesia and Intensive Care Medicine, Umeå University Medical Faculty, Umeå Sweden; Occupational and Aviation Medicine Unit, University of Otago Wellington, Newtown, Wellington 6021, New Zealand.

4. Flin R, O’Connor P, Mearns K. Crew resource management: improving team work in high reliability industries. Team Perform Manag. 2002;8(3/4):68–78.

11. Warren J, Fromm RE, Orr RA, Rotello LC, Horst HM. Guidelines for the inter-and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256–62. 12. Brandstrom H, Winso O, Lindholm L, Haney M. Regional intensive care transports: a prospective analysis of distance, time and cost for road, helicopter and fixed-wing ambulances. Scand J Trauma Resusc Emerg Med. 2014;22(1):36. 13. Hearns S, Shirley PJ. Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems. Emerg Med J. 2006;23(12):943–7. 14. Abrahamsen HB, Sollid SJ, Öhlund LS, Røisli J, Bondevik GT. Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a crosssectional survey. Emerg Med J. 2015;32(8):647–53. 15. Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation. 2010;81(4):446–52. 16. Weller J, Frengley R, Torrie J, Shulruf B, Jolly B, Hopley L, et al. Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams. BMJ Qual Saf. 2011;20(3):216–22. 17. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth. 2003;90(5):580–8. 18. Lyk-Jensen H, Jepsen R, Spanager L, Dieckmann P, Østergaard D. Assessing Nurse Anaesthetists’ Non-Technical Skills in the operating room. Acta Anaesthesiol Scand. 2014;58(7):794–801. 19. Rutherford JS, Flin R, Irwin A, McFadyen AK. Evaluation of the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system: A behavioural rating system to assess the non-technical skills used by staff assisting the anaesthetist. Anaesthesia. 2015;70(8):907–14. 20. Reader T, Flin R, Lauche K, Cuthbertson BH. Non-technical skills in the intensive care unit. Br J Anaesth. 2006;96(5):551–9. 21. Wax R. The ABC’s of Air Medical Resource Management. In: Fredriksen K, editor. Principles and direction of Air Medical Transport. Salt Lake City: Air Medical Physician Association; 2006.

174 For further recruitment vacancies visit:

22. Martinsen J. Observation and rating HEMS Crew in Non-Technical Skills, CRM Medical Simulation in Norwegian Air Ambulance. Scand J Trauma Resusc Emerg Med. 2015;23 Suppl 2:A21. 23. Flin R, Patey R. Non-technical skills for anaesthetists: developing and applying ANTS. Best Pract Res Clin Anaesthesiol. 2011;25(2):215–27. 24. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459–67. 25. Riem N, Boet S, Bould MD, Tavares W, Naik VN. Do technical skills correlate with non-technical skills in crisis resource management: a simulation study. Br J Anaesth. 2012;109(5):723–8. 26. Jepsen RM, Spanager L, Lyk-Jensen HT, Dieckmann P, Østergaard D. Customisation of an instrument to assess anaesthesiologists’ non-technical skills. Int J Med Educ. 2015;6:17. 27. Flin R, Patey R, Glavin R, Maran N. Anaesthetists’ non-technical skills. Br J Anaesth. 2010;105(1):38–44. 28. Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre. Qual Saf Health Care. 2009;18(2):104–8. 29. Aggarwal R, Grantcharov TP, Darzi A. Framework for systematic training and assessment of technical skills. J Am Coll Surg. 2007;204(4):697–705. 30. Pena G, Altree M, Field J, Sainsbury D, Babidge W, Hewett P, et al. Nontechnical skills training for the operating room: A prospective study using simulation and didactic workshop. Surgery. 2015;158(1):300–9. 31. Yee B, Naik VN, Joo HS, Savoldelli GL, Chung DY, Houston PL, et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology. 2005;103(2):241–8. 32. Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth. 2012 Dec;109 Suppl 1:i3–i16. 33. European Aeromedical Institute EURAMI. Standards Version (2013) 4.0. Accessed July 22 2015.

Resuscitation and Emergency Care A full range of products for use in an emergency and resuscitation situation. • • • • •

Bag-Valve-Mask (BVM) Pocket Resuscitation Mask Airway Management Devices Video Laryngoscopy Oxygen Therapy Masks

34. Ambulance New Zealand. Air Ambulance/Air Search and Rescue Service Standard Version 2. standards/ (2013). Accessed July 22 2015. 35. Commission for Accreditation of Transport Services. 10th Edition Draft Standards. 2015. Accessed July 22 2015. 36. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102. 37. Myers JA, Haney MF, Griffiths RF, Pierse NF, Powell DM. Fatigue in air medical clinicians undertaking high-acuity patient transports. Prehosp Emerg Care. 2015;19(1):36–43. 38. Lerman SE, Eskin E, Flower DJ, George EC, Gerson B, Hartenbaum N, et al. Fatigue Risk Management in the Workplace. J Occup Environ Med. 2012;54(2):231–58. 39. Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ. 2000;320(7237):785. 40. Wisborg T, Manser T. Assessment of non-technical skills in the operating room–one assessment tool per specialty. Acta Anaesthesiol Scand. 2014;58(7):773–4. 41. Flowerdew L, Gaunt A, Spedding J, Bhargava A, Brown R, Vincent C, et al. A multicentre observational study to evaluate a new tool to assess emergency physicians’ non-technical skills. Emerg Med J. 2013;30(6):437–43. 42. Yule S, Rowley D, Flin R, Maran N, Youngson G, Duncan J, et al. Experience matters: comparing novice and expert ratings of non-technical skills using the NOTSS system. ANZ J Surg. 2009;79(3):154–60.

The complete solution from the respiratory care specialists To view the full range visit

Quality, innovation and choice lnteract with us

NEWSLINE HART in the country. The team

point of injury so that life-saving

and effective working relationships

Ambulance service’s specialist response team celebrates ten years

members are trained and

medical intervention can begin

and providing a streamlined and

equipped to safely work at

immediately. They can then

strategic response to complex

heights, in confined spaces, in

continually manage the patient’s


both swift and still water and use

condition to avoid further injury

breathing apparatus, refreshing

whilst partner agencies provide

Joe continues: “Over the last ten

these skills every seven weeks.

the rescue element.”

years, the team has gone from

Set up in 2009 in response to

Joe Barrett, Head of Special

In a large scale or major incident,

training the paramedics undergo,

the national terrorist threat,

Operations for NWAS, said: “Prior

the team is able to quickly

along with the equipment they

North West Ambulance Service’s

to HART, ambulance clinicians

identify the most seriously injured

use, is second to none and

(NWAS) Hazardous Area

would often have to stand back

patients, prioritising and treating

has proven to be life-saving on

Response Team (HART) this year

when faced with a hazardous

those patients in need of help the

numerous occasions.

celebrates its tenth birthday.

incident and wait for specialist

quickest. HART paramedics are


strength to strength. The constant

support from fire and rescue

then able to relay back information

“Using their unique problem

Trained up to a national standard,

services or police for them to

regarding the situation and

solving skills, teamwork and

the team of 84 experienced

bring the patient back to a place

size of the required ambulance

co-ordination, they are able to

paramedics, split between two

of safety.

response to control as well as set

keep calm under pressure and

up a casualty collection point and

apply their skills and training to

sites in Manchester and Liverpool, use specialist equipment and

“By providing specialist

provide life-saving clinical early

help patients in a wide-range

skills to safely access and treat

paramedics with the training


of unexpected and difficult

patients in difficult and hazardous

and equipment to be able to


risk assess and manoeuvre

By training and exercising with their


through difficult and hazardous

emergency services colleagues,

“I am extremely proud of the

NWAS was one of the first

environments, they are now

they are able to plan and prepare

whole team, they work together

ambulance services to implement

able to access patients at the

for major incidents, creating strong

amazingly, knowing each


176 For more news visit:


other’s individual strengths and

Outside of responding to

that the ‘Two Uniforms, One Job’

the skills and experience gained

supporting each other after

emergencies, the team members

initiative has had on patients and

within the NHS benefits their

difficult incidents, they’re like one

keep busy making sure that their

staff experiences within the health

military careers.

big family!”

equipment is fully compliant, their

sector. Director of Workforce and Military

clinical skills are refreshed and Introducing its second fleet

they are kept up to date on key

Over 3% of our workforce have

Champion at WMAS, Kim Nurse,

of high-specification vehicles

changes nationally and within the

previously served with the military,

added: “We are delighted to have

in December 2018, the team

trust. They also undertake regular

be that Navy, airforce or army and

been shortlisted as this recognises

has advanced equipment and

fitness tests and often attend

the Trust actively encourages staff

the collaborative efforts and

technology which allows the

community events promoting the

to continue their military career

dedication of our staff members over

paramedics to set up their own

work of the ambulance service.

as well as their work with the

the last 12 months implementing

ambulance service.

‘Two Uniforms One Job’.

HR Manager, Maria Watson, said:

HSJ editor Alistair Mclellan, said

“Candidates from the military and

“We would like to congratulate

reserve forces come with structure

WMAS on being nominated in

and purpose and a definite sense

the category of Reservist Support

communications network in remote locations, provide an ongoing response over days and months if necessary and travel over difficult terrain.



HART is primarily reserved for

The work West Midlands

of belonging. Many of their skills

Initiative Award recognising

complex, large scale or major

Ambulance Service undertakes

are extremely transferrable which

their outstanding contribution

incidents such as serious road

supporting former members

means many find it an easy

ahead of this year’s 2019 HSJ

traffic collisions or entrapments.

of the military and serving


awards. Each of the finalists in

The team will respond to

reservists has been recognised

incidents were the patient would

by making the shortlist of a

“We believe that WMAS offers

based on their outstanding

benefit from additional skills

prestigious award.

a long-term career option as

commitment to excellence in

they come back into civilian life.


assistance is required.

The submission, ‘Two Uniforms,

Equally, the skills they gain as a

One Job’ has made it through to

Reservists has great benefit for

The full list of nominees for

Notable incidents in recent years

the final of the 2019 Health Service

the patients they treat and for their

the 2019 HSJ awards can be

include major flooding in Cumbria

Journal Awards in the Reservist

work with the Trust in general.

found at https://awards.hsj.

and Greater Manchester as

Support Initiative category.

well as gas explosions, rescues - winners will “We firmly believe that supporting

be presented at the HSJ awards

from cranes, the Manchester

The panel recognised the

our Reservists has a positive

ceremony, at the Battersea

Arena attack and the Bosley Mill

ambition, visionary spirit and

effect on their jobs in the

Evolution Centre, London on


demonstrably positive impact

ambulance service and equally

Wednesday 6th November.


and equipment or if additional

this category have been chosen

177 For the latest Ambulance Service News visit:

NEWSLINE counts, administering life-saving first aid while an ambulance is on its way. A patient who suffers a cardiac arrest stands a much better chance of survival if someone with a defibrillator can attend the patient in the first minutes of collapse.”


Improving the chances of surviving a cardiac arrest in the North East Improving the chances of survival for cardiac arrest patients is something close to North East Ambulance Service’s heart and their latest initiative is set to do just that. If you or someone you cared about was having a cardiac arrest and just a short walk away from where you were, there was someone trained in lifesaving skills, would you want them to come and help? Approximately 60,000 people suffer a cardiac arrest out of hospital in England every year and of these, 28,000 patients will have resuscitation started or continued by the ambulance service. Survival rates for these patients is 8.6%. This is significantly lower than for populations in other developed countries like Holland (21%), Seattle (20%) and Norway (25%). The current rate of initial bystander CPR in England is reported as being 43% compared to up to 73% in other countries. North East Ambulance Service has now switched on GoodSam, a mobile app that alerts community first responders to an incident, in an attempt to boost the numbers of people who survive cardiac arrest in the region.


GoodSAM connects with a community of first aid trained responders, willing to assist during a cardiac arrest. NEAS will be switching on the system in the North East and inviting its clinically trained staff, trained in basic first aid and qualified to perform lifesaving cardiopulmonary resuscitation, to register initially.

GoodSAM will automatically notify nearby GoodSAM responders of a medical emergency. The platform connects those in need with those who have the skills to provide critical help before the emergency services arrive. The app is free to download on all smartphones. GoodSAM is already working in partnership with ambulance services in London, North West, Wales and East Midlands as well as further afield in Australia, New Zealand, Ireland, USA, Canada and South Africa. Gareth Campbell, Emergency Care Operations Manager says, “This is excellent news for the North East population and means that those special skills our workforce uses every day to help save lives are even more accessible. By ensuring a patient has a clear airway and quality CPR is in place in those first few minutes, they are more likely to achieve a good outcome.” With the system now switched on, the NEAS emergency operations centre will alert the three nearest responders to life threatening incidents and simultaneously dispatch an ambulance, giving the patient the best possible chance of survival. The partnership will not impact on or substitute standard ambulance dispatch, with crews continuing to be sent to scene in the usual way. When a volunteer is alerted, they

will be able to accept the alert via the GoodSAM app and make their way to the location of the incident. If a volunteer responder is not in a position to accept the alert, it can be declined and diverted to the next nearest responder. Campbell continues, “Having seen how successfully this app works elsewhere, we wanted to bring GoodSAM to the North East for the benefit of our region’s patients. Thanks to funding from NESTA, we have been able to work in partnership with the GoodSAM team to bring this app to the North East.” NEAS already has a team of Community First Responders who are everyday members of the general public trained by NEAS in basic first aid and life support. They are provided with oxygen and a defibrillator and are deployed by NEAS to life threatening emergencies, such as chest pain, breathing difficulties, cardiac arrests, and unconsciousness, if they are the nearest resource, followed by the next nearest emergency care crew. This app provides an opportunity for those with first aid skills who volunteer and work for the service to join the robust community of first responders already working within the North East. Campbell adds, “Responders will be able to provide immediate care to a patient where every second

178 For further recruitment vacancies visit:

Professor Mark Wilson, GoodSAM’s Medical Director and Co-Founder, said: “If a patient has a cardiac arrest, it’s the first few minutes after the incident that determine the outcome – life, death, or long-term brain damage”. “There are first aid trained people all around us but usually the first they know of a neighbour having a cardiac arrest is an ambulance appearing in their street. Our work with Ambulance Services, allows us to harness the lifesaving skills in the minutes before ambulance arrival. GoodSAM has saved lives globally and we look forward to working with NEAS to bring the benefits to the North East.” Steve Dunn from Newton Aycliffe in County Durham has been a community first responder in the North East for eight years after he found himself coincidentally at the scene of two serious road traffic collisions in which he assisted patients whilst an ambulance was travelling. Having formerly been registered with GoodSam in London, he’s really pleased to be able to connect in his own region. He explains, “I was alerted by GoodSAM to an incident in St Pancras when I was in London recently on a business trip and I was really overwhelmed by the number of people nearby who also got the alert. I was first on scene and between those of us who attended, the patient had the best chance of a good outcome. On this occasion it wasn’t a cardiac arrest luckily. It was really surprising and reassuring that so many people were willing to stop what they were doing and help and it’s great that we can do the same here.”


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Ambulance service celebrates clinical excellence across Cheshire and Mersey Celebrating those who have demonstrated the highest levels of patient care and innovation across Cheshire and Merseyside, North West Ambulance Service (NWAS) has held its second ever Achieving Clinical Excellence (ACE) Awards. The ceremony, which took place on Tuesday 30 July at Formby Hall Golf Club, was hosted by Dave Kitchin, Head of Service. Chief Executive, Daren Mochrie and Chair, Peter White presented eleven awards to individuals, teams of staff and also external agencies. Winners were rewarded for their clinical excellence and achievements over the past year. Daren Mochrie, Chief Executive says: “The awards are an opportunity to reward our professional employees who are committed to delivering the highest quality of patient care as well as members of the public who have stepped in to make a real difference. As chief executive I am extremely proud to recognise such outstanding achievements.” The categories and award winners were:


• Consultant Paramedic Award – Leona Blayney, Craig Butterworth, Gary Fitzpatrick, Gareth Owen, Jade Parry, Danielle Shaw • Advanced Paramedic Award – Wayne Evans, Dylan Hughes, Jessica Heath • Clinical Leadership Award – Andy Baines • Supporting Clinical Excellence Award – Cheshire & Mersey Fleet Team • Mentor of the Year – Paul Campbell

• Student of the Year – Samuel Hebden • Communication Centre Award – EOC Orange Team • Innovation and Change Award – Darren Earley • Patient Choice Award – Sarah Camplin, Andrew Hazley, Michael Jackson, Diane McGann, Aaron Murray, Michael Quirk, Stephen Rickards • Everyday Hero Award – Total Fitness, Crewe • The John Harrison Award for Outstanding Achievement – Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney Winners were selected from peer nominations by a judging panel consisting of Head of Service, Dave Kitchin, Consultant Paramedics for Cheshire and Mersey, Nick Sutcliffe and John Collins alongside the trust’s Medical Director, Dr Chris Grant. Maxine Power, Director of Quality, Innovation and Improvement chose the winner of the Innovation and Change Award. This was presented to Senior Paramedic Team Leader, Darren Earley who has developed a tool to support NWAS clinicians when treating patients with mental health concerns. The John Harrison Award is in memory of Dr John Harrison, the trust’s former associate medical director who exemplified the highest clinical standards of care. The recipient of this award was emergency services team, Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney who were recognised for outstanding professionalism when faced with a colleague having a medical emergency. Their award was presented by John Harrison’s wife, Margaret, along with their colleague who thanked the team for their lifesaving actions.

Staff from Total Fitness in Crewe were given this year’s Everyday Hero Award. Thanks to their training, quick thinking and use of the defibrillator on site, the team were able to help save the lives of two people in separate incidents just three months apart. All winners were presented with a certificate and award to recognise their actions.


Trust welcomes much-improved CQC rating and exits special measures South East Coast Ambulance Service NHS Foundation Trust (SECAmb) has warmly welcomed the Care Quality Commission (CQC) report on its services, published on 15 August 2019, which sees the Trust rated as ‘Good’ overall and it’s Urgent & Emergency Care service rated as ‘Outstanding’ overall, including ‘Outstanding’ for Caring.

patients and pleased that the big improvements we have made as a Trust during the past couple of years have been acknowledged.” Across emergency and urgent care, several areas were highlighted as ‘Outstanding’ including work to reduce hospital handover times and improve services for mental health patients, with staff receiving particular praise. Inspectors also commended the introduction of Joint Response Units with police services and the Trust’s Wellbeing Hub, which provides a range of resources to assist staff with their physical and mental health. Throughout the report, the CQC spoke positively about a number of aspects of the Trust’s service including: • Staff treating patients with compassion and kindness, respecting their privacy and dignity and taking account of individual needs • A strong, visible person-centred culture and that staff were highly motivated

The report, which follows planned inspections of the Trust’s services in June and July, sees the Trust rated as ‘Good’ overall in each of the inspection areas – safe, effective, caring, responsive and well-led. The Trust is pleased that the NHS 111 service has retained its overall rating of ‘Good’.

• The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff

SECAmb also welcomes the announcement by NHS Improvement today that, following the CQC’s recommendation, the Trust should exit Special Measures.

• Staff were supported following traumatic experiences and events

Acting Chief Executive Dr Fionna Moore said: “This positive report is testament to the huge amount of work that has been ongoing at SECAmb for the past couple of years. I am delighted, but not surprised, that staff have been recognised for the fantastic care they provide to

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• There were clear systems and processes to safely prescribe, administer, record and store medicines. Inspectors observed outstanding practice in the management of controlled drugs.

• Trust leaders, new to the organisation at the last inspection, had now embedded into their roles. The changes had had a positive impact on the organisation. • Staff told inspectors they felt respected, supported and valued. They were focused on the needs of patients receiving care.

NEWSLINE Rigloo QP.qxp_Layout 1 31/07/2019 16:33 Page 1

• The service promoted equality and diversity in daily work and provided opportunities for career development. While the Trust is pleased that the CQC has evidenced such significant improvements, it is aware that there are areas where further work is required. The Trust is working hard to improve its response times to less seriously ill and injured patients. While SECAmb is performing well against the national average in responding to the most serious call categories (category one and two), at times of high demand patients in lower priority categories can sometimes wait longer than they should. Recent weeks have seen an improvement in the Trust’s response times to these patients and it is committed to further improvements. It is also committed to improving staffing levels across the Trust, including in its Emergency Operations Centres.

Acting Chief Executive Dr Fionna Moore added “I would like to thank everyone at SECAmb for the dedication and commitment they show, day-in, day-out and hope they take a moment to celebrate how much we have achieved.

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“I am very aware that there remains work to be done to ensure we meet the high standards rightly expected. I am, however, very confident that we are on the right path to deliver further progress.” Trust Chair, David Astley added: “I would like to thank everyone who has worked so hard to get SECAmb to where it is today. Every single member of staff and our volunteers contribute to the assessment made by the CQC and everyone should be very proud of what has been achieved. We are very aware that there remains a lot of hard work ahead and we will expect to deliver even higher standards in the years ahead.”

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Northern Ireland Paramedics get formal recognition as Allied Health Professionals (AHP) Paramedics have been formally recognised as members of the Allied Health Professional (AHP) group by the Department of Health (DoH).

colleagues and their peers in the

Ambulance Service, also

“I congratulate all paramedics on

rest of the UK, and recognise the

welcomed the recognition of

having attained this recognition,

contribution paramedics currently

paramedics as Allied Health

which brings them into line with

make as inter-professional

Professionals. He said:

colleagues across the UK, and

clinicians working across

“Paramedics are, day and daily,

would like to thank everyone

urgent, emergency, primary and

the first contact that many patients

involved in bringing about this

community care provision here.

have with the Health Service and

AHP recognition.”

often at times when they are most “This change is also in line with

anxious and vulnerable, including

the values within the new DoH

requiring the highest levels

Workforce Strategy. It is important

of clinical intervention due to

that paramedics feel supported

trauma or medical emergencies.

in their challenging roles and this

Paramedics are increasingly

move will assist in that.

bringing the initial treatment to the patient at the scene of the

The move follows recent discussions with the Department of Health Permanent Secretary Richard Pengelly, DoH officials and the NI Ambulance Service (NIAS). Richard Pengelly welcomed the change. “Formal recognition of paramedics in Northern Ireland is essential to professionalise the profession so paramedics know just how much they are valued as members of the Health Service. “This recognition will align paramedics with other AHP

“Over recent years paramedics


have taken responsibility for

The Allied Health Professions (AHP) currently consists of 12 distinct and unique disciplines. These professionals provide key services and add critical value across primary and secondary prevention, diagnostics, treatment and care.

greater clinical decision making

“This recognition is testament

and are providing an increasing

to the increasing role of

range of interventions as part of

paramedicine in the provision

the wider transformational agenda.

of health and social care within

This is being underpinned by the

Northern Ireland. Paramedic

move to Higher education for

Education has been evolving,

paramedic practice. By including

and will continue to evolve,

the health service and has the

paramedics as AHPs will enable

as part of the transformation

potential to influence patient

them to expand their networks

agenda ensuring that those who

pathways and make huge

within the wider group of other

have need of our service can be

differences to patients’ lives. It

AHP professions.”

confident that their clinical care

can help make use of skills to

is delivered by individuals and

develop a more flexible workforce

Michael Bloomfield, Chief

teams operating to the highest

and provide more responsive

Executive of Northern Ireland

professional standards.

services to service users.”


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Hazel Winning, the AHP lead in DoH who has worked with NIAS to deliver this recognition, said: “The professional recognition decision would bring opportunities across


Welsh Ambulance Service trains team of office-based volunteer Community First Responders The Welsh Ambulance Services NHS Trust has completed the training of eight new Community First Responders (CFR) who will carry out their duties while working from their office in central Cardiff. This initiative was launched by employees and strongly supported by management who see this as the way forward for individual organisations to train its staff with life-saving skills and support the wide NHS workforce. All eight volunteers are employed by the NHS Wales Informatics Service (NWIS) and were trained by the Welsh Ambulance Service CFR trainers directly at their central Cardiff office. The First Responders will always respond in pairs and be placed on a rota covering core working office hours (9 am until 5 pm). They can be called to incidents within 1,000 metres of their office and are trained to deal with 702 different

accident codes including cardiac arrests, strokes, allergic reactions or chest pains. This initiative came from NWIS employee Nicola Turner. Having trained as a CFR a few years prior in a previous organisation, she was keen to bring this initiative to NWIS. With a strong interest and support from her management, Nicola appealed for interest among colleagues and received a large number of positive responses.

counts. Central Cardiff is a busy and crowded area and having First Responders at the ready during working office hours can make a huge difference. They have been brilliant students and I look forward to hearing how they’ll apply their skills.” Given the success of this programme, NWIS would now like to expand the training to its other offices in the North and West of Wales. Employees have viewed this training as an opportunity to achieve personal goals.

Nicola Turner, Senior Product Specialist at NWIS said: “Because we work for the NHS, we want to help. When we started talking about this internally, I happened to be called to an incident and our director decided to tag along. He stayed with us outside in the cold, observing, until the incident was resolved. Shortly after, he gave the green light and we started our training. Now we have eight fully trained Community First Responders on call during working office hours.”

Hafsa Laksari Software Developer at NWIS said: “In the past, I’ve experienced what it was like to have to call an ambulance and I remember the way I felt, not knowing what to do. Thanks to this training, I now have a different mind-set. I now know exactly what I need to do and know that I can help my community. I’m looking forward to my first call. I know it will be daunting, but if I can help someone, this experience will make it a hundred times worth it.”

Jason Sadler, First Responder Trainer Paramedic at the Welsh Ambulance Service said: “In case of a medical emergency, and in particular in the case of a cardiac arrest, every second

Training to become a Community First Responder is a significant commitment. It is classroombased for five days and ‘students’ are also required to complete a total of 15 e-learning modules

“Thanks to this training, I now have a different mind-set. I now know exactly what I need to do and know that I can help my community. I’m looking forward to my first call. I know it will be daunting, but if I can help someone, this experience will make it a hundred times worth it.” which last around 20 hours. All CFRs go on a ride-out with an emergency ambulance crew before becoming operational and are required to attend a one-day assessment once a year. CFRs usually work in pairs – those who would like to operate solo need to go through a further assessment.

our organisation. The Welsh Ambulance Service trainers have been very accommodating and professional and I would recommend other organisations to consider training their staff as First Responders.”


Andrew Griffiths, Director at NHS Wales Informatics Service said: “Enabling our staff to receive the necessary training to provide medical assistance was an opportunity to allow our team to learn new skills and support

183 For the latest Ambulance Service News visit:

NEWSLINE Appeal to build on-site helipad at Sheffield Children’s Hospital receives £562,500 charity boost The fundraising campaign for a life-saving helipad at Sheffield Children’s Hospital took a major step forward today thanks to a £562,500 charity donation. The HELP Appeal’s Chief Executive Robert Bertram presented the second installment of their £2.25M pledge to David Vernon-Edwards, Director of The Children’s Hospital Charity. It takes the fundraising towards the Helipad to more than £1.3M. The HELP Appeal is the only charity in the country that funds lifesaving NHS hospital helipads. In 2016, it helped fund the helipad

at Sheffield’s Northern General Hospital. Its total donation of £2.25 million will cover half the cost of the helipad. The £6m The Children’s Hospital Charity’s appeal is raising includes a contingency fund should costs rise before its expected completion in 2023. Due to its status as a regional Major Trauma Centre, the Emergency Department at Sheffield Children’s Hospital helps up to 200 children a day. The helipad will ensure a smooth patient transfer for patients who need critical care directly into the hospital without having to cross the road. Currently, air ambulances land in Weston Park and patients are then transported across the busy A57 under a police escort before entering the Emergency Department at Sheffield Children’s Hospital.

One child who knows how important a Helipad would be for the Major Trauma Centre at Sheffield Children’s Hospital is 15-year-old Bradley Duke. In January 2017, Bradley from Middlewood was seriously injured in a car crash on his way to school. Everyone in the car was knocked unconscious and Bradley sustained multiple fractures to his skull, face, spine and wrist. The BMW automatically alerted the emergency services to give rescuers the car’s location. An air ambulance was called to the scene of the crash and Bradley was put into an induced coma before being taken to Sheffield Children’s Hospital. Bradley travelled on his own in the helicopter, landing in Weston Park where he was met by a team of emergency medicine professionals who rushed him across the busy road into the hospital’s resuscitation area.

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Bradley underwent a six-hour long operation and spent more than a month in Sheffield Children’s Hospital, including nine days in a coma, before his discharge. Bradley continues to struggle with his short-term memory, but he has now returned to school, where together with his classmates he is fundraising for the new Helipad. “Building the Helipad and expanding the Emergency Department would help ensure the staff have the facilities they need to save more lives like Bradley’s” Mum Claire said. The new Helipad would ensure air ambulances are able to land in the park after dark, significantly extending its operation throughout winter. It would also have electric trace heating incorporated into the deck to ensure that ice and snow do not disrupt the continued use of the facility during periods of inclement weather.

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NEWSLINE Key developments included:

David Vernon-Edwards, Director

a keynote speech, Mr Griffiths

London Ambulance Service,

of The Children’s Hospital Charity

called for the wider NHS to

agreed that all partners in the

said: “This new helipad has

follow LAS’s example and

NHS and other emergency

never been more needed, to

‘step up’ to prevent stabbing

services had to work together to

integrated urgent care 111

help patients who need critical

injuries in addition to treating the

prevent knife crime in London.

services in North East and South

care arrive at our Emergency

consequences of youth crime.

Department as quickly as possible.

• The launch of two new

East London to nearly 750,000 integrated urgent care calls

She said:

We’re so grateful to Robert and the

Martin Griffiths, a surgeon at Royal

HELP Appeal for their generous

London Hospital, revealed violence

“Our medics are world-leading

support today as we move one

was ‘endemic’ in London and at a

when it comes to helping save the

step closer to making this life-

level not seen for a decade. Last

lives of the victims of knife crime

saving project a reality.”

year, 1,400 wounds were deemed

but they would rather not have to

severe enough to warrant major

use these skills at all.

Robert Bertram, Chief Executive “Seriously ill children throughout

“Prevention is better than a cure. He said:

Sheffield and beyond deserve

than 850 new staff into the organisation, putting the Trust into a stronger staffing position than had been the case for a number of years

trauma care in London.

of the HELP Appeal added:

• The recruitment of more

I am determined the London Ambulance Service continues to

• Improvements in operational performance leading to an average response to the most ill patients of 6 minutes 28 seconds

the best medical care and a

“We have seen knife wounds

play a pioneering role in helping

helipad close to the emergency

happen in people getting younger

our emergency service partners

department, will be one of the

and younger. A quarter of what we

and the wider NHS stem the tide

main ways to achieve this. The

see happens to those 16 years

of these injuries.

HELP Appeal’s second instalment

or under. They don’t happen in

of over £562,000 will hopefully

the middle of the night fuelled

“We will offer our support to Martin

provide a huge boost to The

the 13 performance measures

by alcohol. They happen in the

and his team in the drive to make

Children’s Hospital Charity’s

relating to call handling, response

afternoon between three and

London a healthier place for the

campaign for a helipad.”

times and patient outcomes.

five: school time. This is a youth

capital’s young people.”

services in the country. • Ranking in the top three for all ambulance trusts nationwide in

violence problem.”

At the meeting, visitors could see During the course of the meeting,

a number of stalls showcasing the

Mr Griffiths said the scale of gun

the public heard from Chief

close work with partners that is

and knife injuries over the past ten

Executive Garrett Emmerson who

integrating urgent care across the

years meant trauma services here

outlined progress on the vision

capital to deliver better patient care.

were among the best in the world

set out in the five-year Strategy

with excellent care, innovation and

published in 2018.


Trauma surgeon hails London Ambulance Service’s pioneering role in curbing knife violence

- one of the fastest responding

Teams were on hand to explain

research. But he said there was

how they work with volunteers in

growing acceptance there has not

Mr Emmerson said significant

the community, how technology

been enough focus on preventing

progress had been made

was improving patient care and

injuries and the NHS had to ‘step

transforming the organisation

how the Service was reducing

One of the country’s leading

up’ to the challenge and listen to

from one seen as ‘the back door’

the environmental impact of its

trauma surgeons has hailed

communities to tackle knife crime.

of the emergency services to one

ambulances. Ambulance crews

acting as the ‘front door’ to the

and control room staff spoke

whole emergency care system.

about their different roles.

the pioneering role of the London Ambulance Service

He added:

(LAS) in helping to tackle knife violence which he describes as

“Prevention is the key… For

‘endemic’ in the capital.

the first time in my lifetime, all agencies – law enforcement, local government, large government,

the Violence Reduction network

education, social services – are

at NHS England and NHS

on the same page. It’s time to

Improvement (NHSE/I) praised

listen and support communities.


Martin Griffiths, Clinical Director for

the organisation for world-class trauma care and a ‘tremendous’

“I believe if we give young people

track record delivering prevention

better opportunity and the ability

messages through projects and

to deliver on their potential we

training in schools and communities.

can make London a healthier and happier place.”

The focus on knife crime came at the Service’s annual public

Speaking following the meeting,

meeting on Tuesday night. In

Heather Lawrence, Chair of

Martin Griffiths

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NEWSLINE First flight touches down on hospital’s new £500,000 helipad funded by HELP Appeal

signed off last week. And within

“Everyone is aware of the vital

children’s air ambulance have all

minutes of getting the ‘thumbs

roles that hospitals and air

completed at least one landing.

up’, the opportunity for the first

ambulances play in treating a

test landing arose as Lincs &

critically ill patient, but having a

Patients are currently flown to the

Notts Air Ambulance had just

helipad beside the Emergency

helipad on the other side of the

flown a patient in to the existing

Department (ED) can play a

hospital car park at Anlaby Road

helipad, on the opposite side of

significant part in saving vital

and have to be transferred to Hull

Argyle Street, and were awaiting a

minutes when transporting a

Royal in an ambulance. Once

call to their next job.

patient to the expert care they

all agencies have been able to

need to save their lives.

test land successfully, the new

The first helicopter to land on a new £500,000 helipad in

Intensive Care Consultant Dr Tom

Hull touched down on Friday 2

Cowlam, the trust’s clinical lead

“As the only charity in the country

regular use and the current one


for the MTC, said:

funding life-saving helipads we


helipad will be opened up for

are pleased to be able to cover A five person crew from Lincs &

“The new helipad looks very

the entire cost of the helipad.

Dr Cowlam continues: “The new

Notts Air Ambulance was the first

impressive. The fact that we

We know the difference having a

helipad will shorten the journey by

to fly in and step foot on the newly

were able to complete the first

ground level helipad right outside

a quarter of an hour and remove

completed helipad to the rear of

test landing so quickly after

ED would make.

the need for the patient to be

Hull Royal Infirmary.

construction was completed was

transferred in a second ambulance

down to pure chance, but now

“With the support of the air

Hull University Teaching Hospitals

that we’ve seen the first helicopter

ambulances and the excellent

NHS Trust has undertaken a major

land, we’re looking forward to

emergency care team at Hull

“It will make the transfer quicker

construction project so patients

being able to complete all of the

Royal Infirmary– this incredible

and more seamless for the trauma

seriously hurt in accidents across

tests with our partners and bring

mix of helicopters, helipad and


East and North Yorkshire and

the helipad into permanent use.”

hospital medical staff – will make

to the Emergency Department.

a huge difference to those people

“When you have a really poorly

into the hospital grounds, the

The helipad, situated behind

who may urgently need life-saving

person, this might be the difference

Major Trauma Centre (MTC) for

Hull Royal Infirmary’s £12m


between life and death because

the area.

Emergency Department, has

parts of Lincolnshire can be flown

this could be the time when they

been funded entirely by the HELP

Test flights will continue over

are having surgery or a massive

Following demolition of the old

Appeal, which is the only charity in

the next few weeks until all

blood transfusion to save them.”

Haughton Building to the rear of

the country dedicated to funding

15 agencies which regularly

the hospital and many months

hospital helipads.

fly patients in to Hull Royal

Trust Chief Executive Chris Long

Infirmary, including Yorkshire Air

said: “We are deeply grateful to

of planning, clearing work and development, the helipad

Robert Bertram, Chief Executive of

Ambulance, the Search & Rescue

the HELP Appeal for its £500,000

construction work was finally

the HELP Appeal said:

helicopter, and the Embrace

donation, which has allowed us to construct the helipad directly behind our Emergency Department. “There is no doubt that having a helipad so close to our highly skilled major trauma team means we will be able to save more lives in situations where every second counts.” Duncan Taylor, Director of Estates,


Facilities and Development, said the trust funded the demolition of the Haughton building among others and clearance of the site before main contractor Unico Construction could begin work on the helipad. Measuring 30 metres by 30 metres, 900 tonnes of concrete were brought onto the hospital site, over the course of one day in September.

186 For further recruitment vacancies visit:

NEWSLINE An access road for fire engines and service vehicles has been

a team from the North East Ambulance Service.

built alongside a second pedestrian route where patients will be carried out of the air ambulance and rushed into the emergency department. Special double fences have been erected around the helipad as

turfed with pinned grass covered

Tristram takes up the story of what happened on the day.

with mesh overlay to act as a “soakaway” to remove water from the helipad. Lights have been imported from Holland to be set into the concrete, now covered in specialist paint. Hull is one of the country’s 27 Major Trauma Centres (MTCs),

“We had cycled to North Shields and got the ferry. He said he felt uncomfortable, with pains in his shoulders, but I put that down to the fact that he hadn’t been on a bike for quite some time. We were going to get the Metro back. We were pushing our bikes up a road to Chichester station.

credited with saving an additional 1,600 people’s lives since they were established in 2012. Lincs & Notts Air Ambulance use the Hull helipad most often, with Yorkshire Air Ambulance and Derbyshire, Leicester and Rutland Air Ambulance also flying casualties to the city. The Search and Rescue helicopter, based at Humberside Airport, also lands in Hull with people winched

doing a really good job with CPR. They were very focussed

Bruce, a 61 year-old selfemployed plumber, suffered a cardiac arrest while out cycling around Tyneside with his brother Tristram. The brothers were reunited with the ambulance crew so Bruce could thank them.

“baffles” to reduce noise pollution and the majority of the site will be

clear he and the passer-by were

“I was slightly ahead of him but when I looked back he was down on the ground. I was expecting him to be dehydrated and suffering from heat exhaustion but when I got to him he was totally lifeless. I started CPR (cardiopulmonary resuscitation). A passer-by called Peter offered to help, so he took over while I rang for an ambulance.”

and it was crucial that CPR was administered so quickly.” The Monkton-based crew of paramedic Michael Hugo, student paramedic Paul Wales and emergency care assistant Emma Newton were only minutes away when they got the call to respond. Michael said: “Paul took over CPR and we realised he was in ventricular fibrillation which is a cardiac arrest and required a defibrillation shock so his heart could then be re-started. After the shock CPR continued and eventually his heart went into a normal rhythm. “We got him on to a stretcher and into the ambulance. By the time he woke up, he was understandably very confused and didn’t know where he was. “Effectively he had died for

Mr Carter was taken to South Tyneside Hospital, and then transferred to the Sunderland Royal Hospital where he had stents inserted. Bruce, from Thorntree Drive in Newcastle, said: “My brother is trained in first aid and used CPR – that’s probably what saved me – meaning my brain wasn’t starved of oxygen. “I’m very grateful to the crew. They were fantastic, helping to treat me and reassuring me. I just wanted to thank them personally for what they did. At first I was making light of what happened, but after a couple of days the seriousness of what happened struck home.”

20 minutes – he had stopped breathing and didn’t have a pulse. His brother and the passer-by helped to save Mr Carter’s life

Clinical advisor Lisa Ahmed took the call from Tristram. “It was

Paul said: “Tristram and the passer-by were doing excellent compressions when we arrived.” While for Emma, it was the most dramatic case after changing jobs a couple of months ago from being an office-based health advisor to working on an ambulance.

– he needed CPR with the initial cardiac arrest.”

Tristram, an RAF Squadron Leader who works in air safety, added: “The ambulance crew were wonderful, they were the ones who brought him round.”

off mountains or those injured on oil rigs or out at sea. The helipad will also be used by the Children’s Air Ambulance, which can fly specialist medical teams into Hull to treat seriously ill children as well as fly children from here to hospital with specialist paediatric services. AMBULANCE UK - OCTOBER


Brother and ambulance crew get Carter – just in time A Newcastle man was effectively dead for 20 minutes, but Bruce Carter is alive thanks to his brother, a passer-by and

187 For the latest Ambulance Service News visit:

NEWSLINE with the MOD’s Career Transition


Partnership and the Step Into

Partnership between Yorkshire NHS Trust and ambulance manufacturer delivers £1.7million boost to economy

Health programme to promote the recruitment of service leavers, as well as honouring the individual pledges of support. WMAS employs more than 100 veterans and were the first ambulance service to provide an access course in order to help

The vast majority of ambulances

complete the transition to the

on Yorkshire’s roads have been


manufactured by O&H Vehicle Technology. In 2018, Yorkshire Ambulance Service (YAS) placed a further order for over 300 new units, to modernise its fleet of vehicles. 13th August 2019 marked the handing over of the 250th unit, from O&H’s managing director, Oliver North, to YAS Chairman, Kathryn Lavery. During the milestone event, which took place at O&H’s manufacturing facility, Mr North was keen to champion one, key message – the importance of UK ambulances being built in Britain. He used the example of YAS choosing to partner with a UKbased manufacturer, opposed to an international supplier. The 18-month contract has contributed a total of £1.77million back into the UK economy, via employee contributions and

providing a further boost to the UK system.

secure local jobs, and has used a total of 118 local suppliers,

The service also boasts a network

on paramedic and patient safety.

of Military Champions who were instrumental in setting up

Commenting on the event, Oliver said: “Before I joined O&H as MD in January, the business was set to reduce its staff levels because of the impact of internationallybuilt ambulances. With Brexit impending, I knew the time was right to step in and help to grow this magnificent company. “We are so proud of the level of quality in these ambulances and we chose to host this event, as our way of thanking YAS in an official capacity. We’re now already on the path of an intense period of growth and have all of the essential elements in place for a successful Brexit, which is partly due to YAS’ commitment to working with a UK supplier, whilst in turn, recirculating valuable taxpayers’ contributions.”

business tax. It utilised 102,000 skilled labour hours, helping to

impact of a modern, efficient fleet

YAS receives an average of 2,500 emergency and routine calls per day, emphasising the emphatic

Finishing, Oliver said: “This is

the access course and act as

precisely what a positive and

advocates, ensuring all former

fruitful partnership between public

members of the military receive

and private sector looks like, all in

the support they need when

conjunction with the single most

joining and throughout their time

important aspect - improving first

with WMAS.

responder safety in conjunction with casualty care. And the pride

Director of Workforce and

every single one of us at O&H

Military Champion at WMAS,

feel when we see one of our ambulances responding on the streets of Yorkshire, couldn’t be higher.”


WMAS strikes gold in recognition of armed forces employer scheme

Kim Nurse, said: “We are thrilled to have been recognised with a Gold Award as it highlights the level of importance the Trust puts on supporting members of the military. “As a service we are able to offer a long-term career option for those coming back into civilian life and the skills they have gained during their military career and whilst serving as

West Midlands Ambulance

Reservists has great benefit

Service has been recognised

for the patients they treat and

for the support it shows to the

for their work with the Trust in

armed forces community by


being awarded an Employer Recognition Scheme Gold

Defence Secretary, Ben Wallace,


said: “These awards recognise the outstanding support for our


Issued by the Ministry of Defence

armed forces from employers

(MoD), the Gold Award represents

across Britain and I would like to

the highest badge of honour

thank and congratulate each and

available to those that employ

every one.

and support those who serve, veterans, and their families.

“Regardless of size, location or sector, employing ex-forces

As part of the process of

personnel is good for business

achieving the Gold Award, the

and this year we have doubled the

Trust has signed the Armed

number of awards in recognition

Forces Covenant and engaged

of the fantastic support they give.”

188 For more news visit:

NEWSLINE Saving Time Saving Lives appeal receives almost £2million boost to help London’s flying medics deliver their world class care London’s Air Ambulance Charity has announced it has received £250k from the HELP Appeal, the only charity in the country dedicated to funding hospital and air ambulance helipads, and £1.4million from the Department of Health and Social Care towards much needed redevelopment of its helipad base.

£1million to redevelop the team’s

respite, deliver peer-to-peer

help deal with the most critically

helipad base at The Royal London

support and debrief critical

injured patients in London. The

Hospital to enable the medics

missions. This space is

additional facilities and bespoke

to respond even faster, improve

essential to the wellbeing of our

space will allow us to do even

training and ensure crews have

teams helping them to recover

more for our patients. We are

the facilities they need for their

and recuperate after being

passionate about bringing the best

mental health and well-being.

exposed to exceptional levels

treatments available anywhere in

of trauma on a daily basis. This

the world to the people of London

Robert Bertram, Chief Executive of

would also be used for patient

when they suffer their biggest ever

the HELP Appeal said:

and family visits

challenge and this kind donation is

“After visiting London’s Air Ambulance’s helipad base, it was clear that improvements were urgently needed to provide far better and more suitable facilities for the Doctors, paramedics and pilots who are involved in highly stressful situations on a daily basis. We are proud that we are able to help them create a state-of-the-art

A fundraising appeal was launched at the start of 2019 as London’s Air Ambulance Charity marked its 30th anniversary with the campaign 30 Years Saving Lives, of which HRH The Duke of Cambridge is a Patron. The Saving Time Saving Lives appeal aimed to raise at least

facility that will also enable crews to reach critically ill patients even more quickly, helping to save more lives.” The money will go towards providing; • A ready crew room placed closer to the aircraft for faster dispatch • A space for crews to find

• Education and training facilities • Rest accommodation for frontline staff • New storage space to accommodate additional

extremely welcome. Thank you.” Louise Robertshaw, Director of Fundraising and Marketing at London’s Air Ambulance Charity said:

medical and major incident response equipment.

“We had an ambitious target to raise £1million during our 30th

Dr Gareth Grier, Consultant in

anniversary, and are delighted that

Emergency Medicine and Pre-

the generous support from the HELP

hospital care at Barts Health

Appeal and the DHSC has meant

NHS Trust and with London’s Air

we have almost doubled the amount

Ambulance, said:

we can use for redevelopment of our operational space. The money

“We are most grateful for the

will enable our teams to continue

generous support that will help

to provide world-class rapid

us improve our facilities, and

response care, every second of

equipment at London’s Air

every day, and help find the next

Ambulance. We spend a great

clinical developments to create

deal of time training to specifically

the next generation of survivors.”


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


Trust remains only outstanding ambulance service The results are in and the Care Quality Commission (CQC) has once again rated West Midlands Ambulance Service as ‘Outstanding’, the highest possible rating from health and social care

difference to people, and the

hugely pleased that the CQC

be delivered over the next few

trust and its staff should be very

saw a positive, patient centred

months. These vehicles are

proud of what they do.”

culture within the Trust with hard

replacing 30, 2011 registered

working staff proud to work here

non-emergency ambulances

WMAS Chief Executive,

and making a real difference to

as part of the trust’s vehicle

Anthony Marsh said: “This is

patients’ lives.

replacement programme and

fantastic news and is down to

they will be based across the

the hard work of staff and the

“Compassion is a large part of

volunteers who support us, for

our role and I am equally proud

providing the best possible care

that the report highlighted staff

The new vehicles are Fiat

to patients across the West

were outstanding in the way

Doblos which, following


they support people who are

adaption can accommodate a

distressed or overwhelmed in

standard wheelchair and four

stressful situations.

passengers or a specialised

whole NW region.


“I am so incredibly proud of

In their report, they say: “The

for helping us to maintain our

“Quality and safety are key

position as the best ambulance

priorities for us; they are

Some of the features include

very proud of what they do.”

service in the country. That’s

essential for running an

a handy USB port for the front

not me saying it, but the

effective ambulance service

seat passenger, a reversing

The CQC inspected the Service

organisation that looks at the

and I’m pleased that this was

camera, which is useful if the

safety and care of our patients.

highlighted by the CQC as

view of the rear windscreen

was our strong and stable

is obstructed, emergency

leadership team.

egress equipment and first aid

Trust and its staff should be

in April and June looking at our core services of urgent and emergency care and patient transport services along with the leadership of the

each and every one of you

“This rating reflects the hard

wheelchair and two passengers.

work and professionalism of our staff and provides the

equipment. “Congratulations to everyone.”


recognition they rightly deserve.

We have been rated as

“To have independent

‘Outstanding’ for our services

inspectors make such positive

being effective, caring,

comments about the Trust is

responsive and well-led, and

incredible; it is rare that any

Good for whether our services

Trust has received such high

are safe.

praise from the CQC.

The CQC’s Chief Inspector,

“I am particularly pleased

Professor Ted Baker, said:

that they have specifically

We are delighted to confirm

accommodate wheelchairs of all

“WMAS was the first ambulance

highlighted the work of the

that we have recently taken

types. By moving to a different

service in England to receive

Patient Transport Service, who

delivery of the first eight of 30

model, we have also realised

an Outstanding rating and I

were more challenged the last

brand new Patient Transport

a cost saving, not only on the

am pleased to announce that

time the CQC came. Today’s

Service vehicles which have

procurement of the vehicles

it continues to provide an

report specifically comments on

been specially adapted to

themselves, but also these

excellent service.

how responsive PTS staff are to

accommodate wheelchairs.

vehicles will reduce our need to

the changing needs of patients

The remaining 22 vehicles will

use third party providers.”

“There was a positive culture

and highlights the work of the

that supported and valued

ambulance liaison assistants

staff and a strong and

who support patients waiting for

embedded focus on continuous

transport to minimise distress.

The spacious vehicles have NEAS

Delivery of the first eight of 30 brand new Patient Transport Service vehicles


“We do accept that there is

effective systems for identifying

further work to be done and we

risks or plans to eliminate or

will continue to strive to improve

reduce them.

services and support staff even better than we already are.”

“Overwhelmingly this is an Outstanding trust and the hard

Trust Chairman, Sir Graham

work of staff across the trust

Meldrum, added: “Helping

continues to be exemplary.

others is at the heart of

WMAS are making a real

everything we do and I am

rear lifting back doors and fold down ramps, all for easy access. Head of PTS Ian Stringer said: “We are thrilled with the new style of vehicle being introduced, as they can easily

improvement to offer the best quality service for patients, and

sliding side passenger doors,

190 For further recruitment vacancies visit:

NEWSLINE tips on using the changes

“Continuously developing our

device provided with music in

in the ambulance to prompt

service to meet the specific needs

specific decades to allow staff

conversations, how to alter

of our patients is vital and enables

to choose tracks that patients

their communication style to

the response patients receive

are most likely to have positive

meet the needs of the patient

across the East Midlands to be of

reactions/memories to.

and things to keep in mind for

the highest possible standard.”

• Music provision – a USB


First dementia friendly ambulance to launch in the UK EMAS has been working

• ‘Twiddlemuffs’ – a knitted hand

closely with the University

muff, decorated with internal

of Northampton’s dementia

and external items, such as

centre, UnityDEM to update people with dementia feel less frightened or confused when

include information such as

travelling in them.

what people like to be called, where they grew up, how they

The additions to vehicles

take their medication, things


they don’t like and can be completed at home by patients and their carers for paramedic

ambulance stretcher – is now

crews to refer to during future

covered with a scene that

emergency call outs.

contains key points to talk and

University’s NDRIC lead, said: “Sometimes, it’s not just the big

service on Monday 9 September

• This is Me documents – these

• The window nearest the

Professor Jacqui Parkes, the

able to communicate verbally. The ambulances will start

buttons and ribbons.

four current vehicles to make

any patients who may not be

things that make a difference in

in Northamptonshire and

people’s lives, but more subtle

Leicestershire and there are

adjustments and tweaks can

plans for all 104 ambulances

cumulatively, make a big impact.

across the two counties to be dementia friendly by the end of

“For people with dementia, going


into an ambulance can be a sudden, strange and potentially

We respond to emergency calls

frightening experience, but EMAS

from 43,000 patients a year who

have shown with their dementia

are living with a diagnosis of

friendly ambulance – the first of

dementia. Over 5,000 of these

its kind in the UK – that with little

patients live in Northamptonshire.

adjustments, this can be reduced

reminisce about, including

• Communication guide for staff

children playing to remind

– dementia friendly training

people of their youth and

for all front-line EMAS staff

Charlotte Walker, Ambulance

experience. We look forward to

animals for patients to guess

was rolled out from April this

Operations Manager and project

seeing the full fleet in action very

what they are.

year; this guide contains top

lead said:


and lead to a much more positive








191 Life Connections - The Affordable CPD Provider:

NEWSLINE Keith, 46, joined Wiltshire

by Puma, is mirage grey for

care paramedic when he is out

Swindon Town FC kick off 2019/20 sponsorship with Wiltshire Air Ambulance

Air Ambulance in 2015 after

the 2019/20 season and will

saving lives is very powerful.

spending two seasons working

now include the Wiltshire Air

as a paramedic at Swindon’s

Ambulance logo on the neckline

“It gives us great pleasure to

home matches.

above each player’s name and

gift the charity the back of our

squad number.

away shirt sponsorship too.

Wiltshire Air Ambulance’s logo will sit proudly on the back of Swindon Town’s away shirt for the 2019/20 season. The Sky Bet League Two club has chosen Wiltshire Air Ambulance as its Charity of the Year partner for another season and has kindly donated the prominent sponsorship area to the lifesaving service, which is based in Semington, near Melksham.

Wiltshire Air Ambulance chief Last season the Wiltshire club

“Swindon Town have been long-

raised £12,000, along with

term supporters of our charity

primary sponsors Imagine

and we’re very grateful to the

Cruising, to help fit out the

football club and their sponsors

charity’s RRV (Rapid Response

Imagine Cruising for all the


money they’ve helped to raise to date.

Adam Wainwright, the club’s commercial manager, said:

“We were delighted to welcome

“Last season Imagine Cruising,

Richie Wellens, his staff and

our mainline sponsors,

playing squad to the airbase,

supported us brilliantly with our

where they were able to meet

£12,000 target and are once

Keith, the trainee critical

again fully engaged with us

care paramedic they will be

and Wiltshire Air Ambulance to

sponsoring throughout the

deliver on the new fundraising


total as a three-pronged

campaign justice, their logo needs to be high in terms of profile and we can raise their profile considerably. “A great deal of planning has gone into the unique location for this season’s team photo. It was magnificent to be hosted at the airbase; being pictured by the helicopter and RRV emphasises the strength of the partnership. We have a part to play and genuinely care about the community and are passionate about achieving


results off the field of play too.

pride of place on the back

“We are immensely proud as

“We very much look forward to

of the away shirt in what we

a Football Club to be right at

all the partnership activation

all hope will be a memorable

the heart of the community with

planned and to the day when

campaign ahead.”

this partnership and to have

we can announce that we have

our crest embroidered on the

hit the target and as a club we

flight suit of the trainee critical

have funded a trainee critical

In addition, the Robins have

“We’re also very proud to take

pledged to sponsor trainee critical care paramedic Keith Mills, aiming to raise £8,500 throughout the season to fund his training, medical equipment and uniform.

We feel ultimately to do the

executive David Philpott said:

Swindon’s away kit, produced

care paramedic.” Imagine Cruising’s Martin Palmer commented: “As Swindon Town Football Club’s main sponsor for the past five years, we are delighted to help assist them in their fundraising goals to fund a trainee critical care paramedic. “We never know when any of us, our friends or family might need the life-saving services that the Wiltshire Air Ambulance AMBULANCE UK - OCTOBER

provides and look forward to working together to help save more lives in Wiltshire.” Swindon Town fans can contribute towards the sponsorship of paramedic Keith by making a donation Wiltshire Air Ambulance chief executive David Philpott and Swindon Town chief executive Steve Anderson unveil the away shirt with the charity’s logo in front of a team photograph at the airbase. Photo credit – Rob Noyes.

192 For more news visit:

through a special link – simply visit donate?campaign=SwindonTown


Paramedics Begin Hazardous Environments Degree Paramedics at South Western Ambulance Service NHS Foundation Trust (SWASFT) are beginning a brand new university course to help them to manage patients in hazardous environments. SWASFT has been working with Plymouth University to create the Masters degree in Hazardous Area Response Paramedicine. Last month, 16 paramedics were the first to take up their places on the postgraduate course. The Hazardous Area Response Team (HART) is a specialist unit that provides paramedic care in hazardous environments where previously clinicians would not be able to enter.

for a HART Paramedic has

spending long periods of time

In the weeks and months after

expanded hugely since the role

in hospital. However, ever since

this initial meeting, and as a direct

was created in response to the

the incident, Mr Gibbs always

result of Mr Gibbs speaking with

London bombings in 2005, with

wanted to be reunited with the

other organisations, the PECI team

additional disciplines and clinical

crew that came to his aid.

and in particular Isobel Jones,

skills growing over time. Since In November 2018, Mr Gibbs

Involvement Co-ordinator, received

additional clinical skills and began

approached our Welsh Ambulance

several invitations to community,

delivering enhanced care skills. This

Service’s information stand at a

mental health and carers groups

includes ketamine administration,

carers’ rights event in Maes Manor

to give talks about our services.

finger thoracostomies and surgical

Hotel, Blackwood, and shared his

Through these links, the PECI team

airways. Furthermore, HART also

story of survival from sepsis. He

was also contacted by Geraldine

provide cardiac arrest support for

praised our staff for the quality of the

Powel, Carer Coordinator for

frontline paramedics across the

care he had received which began

Caerphilly Council, who invited her

South West, offering extra staff,

with our call handler and carried

to visit four carers groups in the

equipment and skills for managing

through to the crew who arrived on

Caerphilly, Risca and Blackwood

a cardiac arrest.

his doorstep. He mentioned that he

areas, and was invited to take part in

would like to meet all involved, and

Carers Week events in Newbridge.

This will be the first level 7 bespoke further education course for HART in the country, which will provide the academic foundations for the skills and knowledge that HART paramedics possess, thus aligning HART with other specialist paramedics within the Trust. Staff undertaking this course will also provide the HART teams with

The types of situations that a HART Paramedic can be expected to operate in include: firearms, chemical, water, confined spaces, at height, mud and unstable structures such as collapsed buildings. Bianca Thomas-Mourne, HART Paramedic, said: “This is a really exciting opportunity for the HART speciality to acquire the academic accreditation that it deserves and to align with it’s urgent and

research opportunities through their university work. This will enable South Western Ambulance Service to begin a programme of research in relation to the work of the HART teams – something that has not yet been embarked upon. For more information on the course, go to: about-us/university-structure/ faculties/health-human-sciences/ patient-management-in-hazardousenvironments

critical care counterparts in the ambulance service.”

Patient Experience and Community

2016, SWAST HART has acquired

thank them in person. This was the beginning of a much longer series of

Most recently, a year-long

positive outcomes.

Carers Engagement Programme throughout 2019-2020 has been

Mr Gibbs and his wife Sharn

developed and covers the whole

were reunited with the crew in

of Wales. Work has been done in

December 2018, two years after

partnership with Geraldine Powell

the incident. Mr Gibbs finally had

and the first event was held in

the opportunity to say ‘thank you’.

Merthyr Tydfil on 18 July, which Mr and Mrs Gibbs attended. The

During the get-together, Mr Gibbs

latter, who are carers for each

got to explore and understand

other, are now taking part in our

the work that we do, and

patient experience improvement

especially how involved we are


with raising awareness around certain illnesses across Wales.

No one could have ever imagined

He particularly engaged with our

how many positive steps could

Patient Experience and Community

have come from the initial meet-

Involvement (PECI) team who

up back in December 2018.

organise events and educate

However, this story helps us

the public about how the Welsh

highlight how incredibly useful

Ambulance Service responds and

it is for us to receive feedback

prioritises calls, and also explore

from our patients. Our services

symptoms of certain conditions

are, and always will be, patient-

which can be life-threatening such

focused. We wish all the best to

as meningitis and sepsis.

Mr Gibbs and his wife.


Each HART paramedic is already their basic HART training, which can take up to six months of intense training. They are then

Back in 2016, Mr Gibbs

equipped with personal protective

suffered from sepsis. Struck by

equipment relevant to the

this life-threatening disease,

disciplines which can include items

he received the help of our

such as a drysuits, respirators,

services from ambulance

ballistic vests and ground kit.

crew Robert Morgan, Ross French and Dewi Jones. His

The role and scope of practice


highly trained, having completed

A chance meet sparked a series of positive outcomes

recovery was a journey in itself,

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


WMAS to work with commissioners to take 111 service to next level Plans that would see the integration of the 999 and 111 services in the West Midlands will lead to significant improvements for patient care. An agreement has been reached that will see West Midlands Ambulance Service take over the running of NHS 111 service in the majority of the West Midlands in November. The plan will see the 111 and 999 services integrated into a single service and will lead to further developments in integration with local services for the benefit of patients. The first step of this change will be for the service, across

dental nurses, paramedics and midwives. “We would also expect to see


Good Samaritan’ App Saving Lives

more calls diverted to GPs

arrive on scene, our crews

treatment centres and rapid

thanks to a new mobile app

work alongside the GoodSAM

response services operated in the

being used by South Western

volunteer to provide lifesaving


Ambulance Service NHS


Foundation Trust (SWASFT). WMAS Chief Executive, Anthony

“We continue to strive to

Marsh, said: “We have an

The GoodSAM app alerts

improve the care we provide,

outstanding track record in

trained responders to cardiac

running complex clinical call

and as GoodSAM responders

arrest incidents in their local

handling operations. This

community, so that they can

continue to rush to the aid of

expertise will allow us to bring

provide lifesaving support

real improvements to the 111

before ambulance crews arrive.

service for both patients and our staff.

For every minute that a cardiac arrest patient doesn’t receive

“We will initially deliver the current

CPR or defibrillation, their

service over the winter period but

chance of survival falls by 10%.

will then look to properly integrate the two in 2020. Staff currently

The GoodSAM app is intended

employed by Care UK will

to increase the number of

TUPE (Transfer of Undertakings

people who survive an out-of-

Protection of Employment) to

hospital arrest.

WMAS. Rhys Hancock, SWASFT Clinical GoodSAM app is a fantastic

of staff so that there is more

innovation, which means our

November 2019.

resilience over the winter period.

community of volunteers can

Rachael Ellis, Chief Officer for

“I firmly believe that this will be

patients sooner and help to

positive for both sets of staff

save lives.

Integrated Urgent & Emergency Care, Sandwell and West Birmingham CCG, said: “This is truly a first for the country and will lead to real benefits for patients

enhance the chance of survival for these patients. Once they

significantly increase the number

from Care UK to WMAS in early

is an additional response to

More lives are being saved

Lead (pictured), said: “The

Staffordshire), to be transferred

our ambulance response, but

(in and out of hours), urgent

“We will also be looking to

the West Midlands (except

“The app does not replace

reach the most seriously-ill

for example, providing new opportunities to develop and

“Every second counts when it

progress their careers.

comes to cardiac arrest. That is why it is vital for these patients

their fellow citizens, more and more people will survive cardiac arrest.” The system automatically alerts off-duty frontline staff and community first responders to a cardiac arrest within 500m of their location. If they accept an alert, the responder is given directions to the scene of the emergency, as well as information about the location of the nearest defibrillator. Following its launch by SWASFT earlier this year, GoodSAM has contributed towards various patients surviving cardiac arrest. These include: • A man surviving a cardiac arrest at home in Exmouth, Devon in July after a volunteer Community First

and staff.

“People who need help in an

to receive intervention as early

urgent or emergency situation are

as possible.

“The new service in development

often anxious and may be unsure

will see fewer patients being sent

how to access NHS services. By

ambulances and a reduction in

integrating 111 and 999, patients

the number of patients asked

can be better directed to the most

central Bristol in July with the

to attend A&E. The new model

appropriate care for their needs.

help of a GoodSAM responder.


will support more patients being

Responder (CFR) received an alert through the app. • A man being resuscitated in

• A man being kept alive

cared for in the most appropriate

“It won’t matter which number you

place for their needs.

use, it will be handled by a call

by a team of ambulance

handler who will be able to deal

responders, including a

“This will also include more

with either type. Call 999 only

GoodSAM responder, in

patients being provided with

for life threatening conditions.

August when he stopped

care over the phone by a team

Call 111 if it isn’t an immediate

breathing at home in

including GPs; other healthcare

emergency or a life-threatening

Cheltenham. Following

staff including advanced nurse

condition; whatever number you

treatment at the scene, he

practitioners; community mental

ring the ambulance service will

was taken by land ambulance

health teams; pharmacists,

manage your call.”

to hospital for further care.

194 For further recruitment vacancies visit:


North East Ambulance Service NHS Foundation Trust (NEAS) has appointed Helen Ray as its new Chief Executive. Helen joins the organisation from

crucial part of our senior leadership team in

operational service delivery and create greater

the future.”

bandwidth at the top of the organisation.

Helen said: “I am absolutely delighted to be

Khadir has more than 10 years’ experience

appointed to a high performing ambulance

working at the regional level of the NHS in

trust. I am keen to further support the staff

London. As Director of Performance and

in the great care that they provide. I am also

Improvement and previously the Chief

keen to explore how we can continue to further

Operating Officer for NHS England (London),

improve and develop services together with

Khadir has provided visible and engaging

patients and other stakeholders.”

leadership during a period of significant

Northumbria Healthcare, where she has

change, including during a number of major

been the Chief Operating Officer since that

Helen has previously been joint managing

post was formed in July 2018, overseeing

executive director (operations) for North

urgent and emergency care, medicine, child

Cumbria acute and community services;

Khadir will oversee all aspects of LAS’s

health and community services with Board

deputy chief executive for North Cumbria

operating business, including:

level responsibility and emergency planning

University Hospitals and Chief Operating

and preparedness.

Officer for South Tyneside NHS Foundation Trust. She trained as a nurse and has held a

Helen, who brings a wealth of knowledge

professional registration for 30 years.

and skill from across the NHS with 36 years’ experience, replaces Yvonne Ormston MBE, who left in May to become Chief Executive at Gateshead Health NHS Foundation Trust. NEAS Chairman Peter Strachan said: “I believe Helen’s experience makes her ideally placed to lead our service and work with our partners

LAS News

We appoint Khadir Meer to coordinate all operational delivery in new Chief Operating Officer role


• Integrated patient care (including both 111 and 999 call answering and clinical triage) • Emergency ambulance services • Projects and programme delivery • Technical services • Asset and property management Khadir joins LAS in September. A member of the Service’s Board, Khadir will report to CEO Garrett Emmerson who said: “I’m delighted to

across the region to deliver high quality care to local people. I know she brings a passion

London Ambulance Service has announced

welcome Khadir on behalf of the Board and

for patient care and staff wellbeing, which are

that Khadir Meer, currently Director of

executive leadership team. He will bring a

integral to our Trust values.

Performance and Improvement at NHS

wealth of experience and skills to the Service.

England and Improvement (London), is to

“In the new role of Chief Operating Officer,

“I would also like to acknowledge the

join the Trust as its new Chief Operating

overseeing our operational service delivery,

tremendous efforts of our interim Chief


Khadir will lead teams at the forefront of our pioneering work in delivering outstanding

Executive Paul Liversidge, who stepped up from Chief Operating Officer following

The role of Chief Operating Officer is a new

patient care on scene, on the phone and

Yvonne’s departure and has given our service

post at LAS. It has been introduced to ensure

online – and providing patients with the best

a steady transition and will continue to be a

greater focus and more joined up and efficient

care for their needs.”


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


Chairman for North West Ambulance Service,

New Non-Executive Director appointed to NWAS

Peter White said: “I’m really pleased to welcome

NHS England and NHS Improvement,

“Alison’s vast knowledge and expertise in

North West has confirmed the appointment

the healthcare sector along with her passion

of Professor Alison Chambers as

for education will make a really valuable

Non-Executive Director of North West Ambulance Service NHS Trust. Currently Pro Vice Chancellor for Health and Social Care at Manchester Metropolitan University, Alison qualified as a Chartered Physiotherapist in 1985 and worked in clinical practice for 10 years specialising in neurological rehabilitation and older person care. She has over 20 years’ experience of

Alison to the trust and am confident that she will be a really positive addition to our board.

contribution to the organisation.” Alison Chambers has been appointed from 1 August 2019 until 31 July 2021 Alison comments: “It is a privilege and honour to be joining such a well-respected organisation and I am really looking forward to meeting as many new colleagues as possible over the next few months.” “It was upon Wilf’s advice that I applied to join

working in higher education. EMAS News

In 1995, Alison took up her first academic

Wilf Prince pictured (right) outside the City Hospital ambulance admissions entrance in the 1980s

86 years of service at EMAS

post at the University of Salford, as a lecturer in physiotherapy. In 2002, she moved to The

Two paramedics who completed their last

University of Central Lancashire to set up

shift on Saturday 31 August managed to

a department of Allied Health Professions

clock up an impressive 86 years of service

and was Dean of Academic Development

at EMAS.

the ambulance service after I saw an advert for the role of driver attendant in the newspaper in October 1977. “On 27 February 1978 I became an official member of the team.”

and Employability until 2014 when she was appointed Pro Vice Chancellor for Health at

Mark and Wilf, who happen to be brothers-in-

Buckinghamshire New University.

law, both had their last shifts working together at the Nottingham Forest Football Club.

Alison is passionate about higher education and places students at the centre. She believes in providing educational opportunity for everyone who can benefit with a strong emphasis on student outcomes and graduate employability.

Wilf Prince started his career at EMAS first on 12th August 1974 when the service was know as Nottinghamshire Ambulance Service. He said: “I had my job interview at Arnold Ambulance Station on Gedling Road and the interviewer took me on a driving test in one of the ambulances around the block.” “After a few minutes he said he was happy with my driving skills and offered me the job.” The recruitment criteria may be a little bit more stringent these days, but that is not the only thing that the legendary pair remember as

Mark Edwards pictured in front of an ambulance in March 1988 Mark and Wilf have seen a lot change during their times at EMAS, including the introduction of lifesaving equipment such as defibrillators in 1983. Mark said: “I was one of the first members of staff who was trained on how to use the defibs during a ten day course at the coronary care unit at Queen’s Medical Centre.

being different from today. AMBULANCE UK - OCTOBER

“We were then able to give cardiac arrest patients Mark Edwards applied to join the ambulance

more of a fighting chance as we could start

service while he was working in a Newsagents.

shocking the heart to try and regain a rhythm.”

Wilf happened to be dating Mark’s sister at the

Wilf shared one of the call-outs that has stood

time, which introduced Mark to what sounded

out for him against all others - The Kegworth

like a very interesting job.

Air Disaster that happened in January 1989.

Mark said: “I used to overhear Wilf talking to

He said: “It was harder to gain the most accurate

my sister about what he had been doing in the

information in those times and we were told that

job and I was really interested.

it was a light plane that had crashed.

196 For more news visit:

IN PERSON “You can imagine how taken aback I was when

Pads) Appeal, which is the only charity

I arrived and saw that it was a 737 aircraft with

in the country dedicated to funding NHS

people strewn everywhere.

hospital helipads.

“I’ll never forget it.”

Arthur Vestey’s appointment comes at an important time for the charity, which has already funded 36 hospital helipads and seen over 12,250 landings on helipads it has funded. There are now over 40 more helipads planned for hospitals around the country; and it is also funding the construction and upgrade of air ambulance base helipads and new critical care cars. All helipad projects built and planned, will cost £71million in total, and aim to save time in getting a critically ill patient to

Arthur Vestey

the lifesaving treatment they urgently need.

Wilf Prince’s identification badge from the 1970s Their last shift was obviously an emotional one. Mark had been an Events Team Leader for the last 17 years of his career with Wilf working alongside him since 2012. EMAS are recruiting 150 new members of staff between July and September this year. Wilf had some advice to give to the fresh new starters.

Vestey, who was an investment manager for six

“As our charity and the number of projects

years, before joining his family’s business, The

grow, Arthur’s extensive experience in the

Vestey Group in 2012, said:

finance sector will be invaluable. His passion for our mission will also ensure that many more

“I am delighted to have become a Trustee of

people across the country will become aware

such a wonderful charity as the HELP Appeal.

of the importance of the HELP Appeal’s work,

Each new helipad is able to save precious

which helps to save time and save lives.”

minutes for many thousands of patients. I look forward to working with the HELP Appeal

The HELP Appeal relies solely on charitable

as they continue with their vital mission

donations and does not receive any

throughout the country.”

government funding or money from the National Lottery. For more information on the

Michael Henriques, Chairman of the County Air

charity visit or call

Ambulance HELP Appeal added:

0800 3898 999.

He said: “Keep plodding on, do the job with all your best efforts and always take note of what your elders tell you. “If you ask for advice, take it.” We wish Mark and Wilf and long and happy retirement.


Arthur Vestey, son of Samuel Vestey, the 3rd Baron Vestey GCVO, has accepted his first Trustee role at the County Air Ambulance Trust – a charity founded in 1994, that supports the Helicopter Emergency Medical Services by funding air ambulances’ operational costs and infrastructure projects. Ten years ago, the charity created


The Hon. Arthur Vestey appointed Trustee of hospital helipad charity the HELP Appeal

the HELP (Helicopter Emergency Landing

197 Life Connections - The Affordable CPD Provider:

COMPANY NEWS Mangar hits record sales lifted by the Camel Inflatable Cushion Powys based Mangar Health has announced record annual sales to the period ending July 2019, after winning additional business for their safe patient lifting range of inflatable cushions. “Growth has come off the back of enhanced focus by the UK Ambulance Sector on improved post fall management procedures in care homes,”

service and care homes with

are to people who have fallen.

Mangar Health was acquired by

an early project evaluation

The Camel lifting cushion is

French medical device company

showing an 80% reduction in

a slightly bigger version of

Winncare Group last December

decisions by care homes to

the ELK and has become the

and has seen revenue growth in

call an ambulance within the

equipment of choice for care

both the UK and export markets.

first month of receiving the

homes because it is so easy


to use. This year we saw a

For more information email

phenomenal 40% uplift in sales

of this product line alone.”

or call 0800 2800 485

Mangar Health also launched interactive help for carers earlier this year in the shape of an App called ISTUMBLE™. ISTUMBLE™ is an algorithm used by paramedics to perform a health assessment on patients they treat, and the App takes healthcare workers through a check list of steps to ensure it is safe to lift their fallen resident.

said chief executive Simon

Simon adds, “Our ELK lifting

Claridge. “That’s where our

cushion is a product that has

innovative lifting equipment

been used by Ambulance

is used to enable carers to

Services for more than 15 years

deliver a safe, dignified lift for

because it protects paramedics

residents, without the need to

from back injuries when lifting

call an ambulance for support.

patients. There is an ELK in

We have been delighted to

every emergency ambulance

see some excellent outcomes

in the UK because between

for both the ambulance

10% and 20% of all their calls

WHY NOT WRITE FOR US? Resuscitation Today welcomes the submission of clinical papers, case reports and articles that you feel will be of interest to your colleagues. AMBULANCE UK - OCTOBER

The publication is mailed to all resuscitation, A&E and anaesthetic departments plus all intensive care, critical care, coronary care and cardiology units. All submissions should be forwarded to

If you have any queries please contact the publisher Terry Gardner via:

198 For further recruitment vacancies visit:

COMPANY NEWS Firescape launches UK’s smallest aerosol extinguisher ideal for ambulance crews

use, cost-effective and packs the

friendly extinguisher around as

punch of much bigger products.

we recognised there is a need in the market, particularly for

It is also ideal for those who work

organisations like the ambulance

in ambulance fleet maintenance

service, for this product.”

or for crews on the road to keep in their cab as Spray-Safe can

Spray-Safe is a lightweight aerosol

put out engine fires in seconds

extinguisher containing 200ml of

and is a cost-effective solution for

fluid, has no mechanical parts.

Backed by the London Fire Brigade, Firescape is launching a new range of state-of-the-art fire safety equipment, including the UK’s smallest aerosol extinguisher ideal for ambulance crews to stow in their cabs without taking up precious space.

budget-strapped authorities. The Fire Service advice is to Firescape Managing Director

tackle vehicle fires only if it’s

Paul Jameson said: “Every year

safe to do so. If the fire is in the

in the UK there are over 100,000

engine compartment, they advise

vehicles, which is nearly 300 a

people not to open the bonnet but

day, that go up in flames and

aim the extinguisher through the

sadly more than a hundred

radiator grille or under the edge of

people a year die as a result.

the bonnet.

The British-based company has

“Over a third of these (35%) are

Added Paul: “We designed Spray-

spent years developing their

accidental fires so it’s crucial fleet

Safe to be easy to use. Just hold

revolutionary products, which

managers do whatever they can

the bottle firmly and keep your

include the new Spray-Safe

to minimise potential fire risks,

arm out of range of the fire then

aerosol, ideal for all types of

from maintaining their vehicles to

douse the area. SpraySafe is one

vehicles to combat engine or

ensuring they equip their drivers

of the only fire safety products

interior blazes.

with the latest technology.

to work at all angles giving you

Perfect for the ambulance service,

“That’s why Firescape is so

with no loss of pressure. It’s as

Spray-Safe doesn’t require

proud to launch Spray-Safe as

simple as that which is why we

ongoing maintenance, is easy to

the most advanced and user-

are getting so much interest from

a 360-degree spray capability

those businesses and services with vehicles constantly on the road. It also suits companies where there is often imminent danger of further fires such as an accident. That’s why spreading the word to the ambulance service is so important to us.” To find out more visit, call 0207 870 4890 or email.

“Every year in the UK there are over 100,000 vehicles, which is nearly 300 a day, that go up in flames and sadly more than a hundred people a year die as a result.

WHY NOT WRITE FOR US? Ambulance UK welcomes the submission of clinical papers and case reports or news that you feel will be of interest to your colleagues.

All submissions should be forwarded to

If you have any queries please contact the publisher Terry Gardner via:


Material submitted will be seen by those working within the public and private sector of the Ambulance Service, Air Ambulance Operators, BASICS Doctors etc.

199 For the latest Ambulance Service News visit:

Profile for Media Publishing Company

Ambulance UK October 2019  

Ambulance UK October 2019