Ambulance UK - April 2019

Page 1

Volume 34 No. 2

April 2019



The Ortus Group wins EEAST Asset Monitoring Contract

THURSDAY MAY 16 2019 Doubletree by Hilton, Edinburgh International Airport EH28 8LL For the benefit of Scottish medical staff, the following conference / individual workshops will be taking place on the above mentioned date which we hope will be of interest. First Responder Conference - start time 09.30, finish 12.45. Topics include: Community Defibrillation - The Loch Lomond Model, Airway Management, Epilepsy Awareness, etc. Thanks to the generosity of Future Awards & Qualifications, a delegate rate of £24 will be offered. Only 15 places remain available Ultrasound Workshop - start time 09.30, finish 16.00. Supported by NEMUS Education & Training, this full day workshop is covering: The Common Uses of Ultrasound in Pre-Hospital and Hospital Practice and is suitable for all non doctor clinicians who want to see how point of care ultrasound can actually enhance your practice. Delegate rate £90. Limited places available Plus Size Workshop - start time 14.00, finish 16.00. This half day afternoon workshop run by Outreach Rescue is focusing on dealing with plus size patients and the use of tripods, bipods and lifting systems that can be used for the extrication of plus size patients from a wide range of locations, including RTC’s. The workshop will include a 15 minute presentation being given by Hospital aids. Delegate rate: £60 Trauma Management Workshop - start time 10.00, finish 12.30. Run by MedSkills Academy. This two hour morning workshop will be covering basic to advanced trauma skills and include: Trauma Patient Assessment, Catastrophic Bleeding, etc. Delegate rate £60 Airway Management Workshop - start time 14.00, finish 16.00. This two hour afternoon workshop which is also being run by MedSkills Academy will be covering: Basic to Advanced Airway Skills including Positioning, BVM, Video Laryngoscopy, Emergency Surgical Airway, etc. Delegate rate £60 Pre Hospital Major Incident Workshop - start time 09.00, finish 17.00. Run by MedSkills Academy, this workshop will update and prepare those fulfilling healthcare and professional roles at the scene of a major incident including doctors and paramedics. Delegate rate £90 All of the above rates include: lunch, tea/coffee and, as workshop places are limited, early registration is recommended. To secure your place please visit: - combined discounted workshop rates are available, call The Organsiers on: 01322 660434. Media Publishing Co, Media House, 48 High Street, Swanley, Kent, BR8 8BQ. Tel: 01322 660434



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42 The Recruitment Drive

44 Impact of drug and equipment preparation on pre-hospital emergency Anaesthesia (PHEA) procedural time, error rate and cognitive load

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COVER STORY Ortus wins contract to supply Insight Telematics & Asset Monitoring solution to EEAST fleet


Media Publishing Company Media House 48 High Street SWANLEY, Kent, BR8 8BQ

The Ortus Group is extremely proud and excited to announce that following a comprehensive technical evaluation and detailed procurement process, the East Of England Ambulance Service NHS Trust has selected our Insight Telematics & Asset Monitoring solution to be rolled out across its operational fleet. Over the 5 year contract term, in addition to market-leading telematics functionality, EEAST will now benefit from access to detailed information relating to key assets carried within the vehicle – whether they be high value, high risk or operationally significant. This information will greatly assist the Trust in the areas of medical device servicing, make-ready processes, asset management, risk reduction and operational efficiency. The Ortus team have been working closely with EEAST since 2013, providing and supporting the current vehicle telematics solution as well as the Corpuls3 pre-hospital defibrillator monitor. This latest innovation bridges the gap between the telematics and medical devices technologies and provides a unique overview of the complete inventory and activity of the Trust’s frontline emergency response vehicles. Using the Insight solution EEAST will be at the leading edge of NHS Improvement initiatives, closely aligned with the recent Carter Report, designed to increase ambulance operational productivity, support frontline staff and improve patient outcomes.

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EDITOR’S COMMENT They say the only constant in the NHS is change. Anyone who has spent time with an ambulance service will agree with that. Policies, processes and procedures are constantly being reviewed and updated, as new evidence comes to light, or as we engage differently with the wider NHS. In my job, I get more opportunity than most to appreciate the background to some of these changes. Whether it’s due to national or trust strategy, or perhaps an individual’s attempt to improve a particular area of work, it is interesting to see how our role continues to develop, as priorities change over time.

One or two other things that are being emphasised at the moment also seem to have similarities with earlier practice. We are now encouraging more timely assessment of seriously ill patients, in order to reduce time on scene. This resonates with the days we would examine every delayed thrombolysis, in order to understand how we could have reduced call to needle times. Similarly, in the treatment of cardiac arrest, we are seeing a de-emphasis of the various advanced techniques that have developed over the years, and going back to basics. Sometimes old lessons are forgotten as we strive to move forward. There is nothing wrong with revisiting things we used to do, as long as we build on the lessons learned first time round.

Matt House, Co-Editor Ambulance UK


“Sometimes old lessons are forgotten as we strive to move forward. There is nothing wrong with revisiting things we used to do, as long as we build on the lessons learned first time round.”

What is also interesting, and is perhaps more apparent as you spend more time in the NHS, is that new ideas often have a familiar ring to them. There have been a few initiatives over recent months that have felt like this. There is a lot of talk at the moment of rotational working; the idea that we can develop our clinicians by allowing them to work in other clinical environments, and allow them to learn from other professions, with the aim of reducing hospital attendances. Those of you who remember the emergency care practitioner roles of the early two thousands will already have noticed the similarities here.

41 For all your equipment needs visit:


THE RECRUITMENT DRIVE WAS UK has unveiled the ground-breaking 3.5 tonne double crew ambulance (DCA). This is the first DCA in a generation that can be operated at full capacity and still be driven on a standard type ‘B’ driving licence. Director of Operational Services at South Western Ambulance Service NHS Foundation Trust, Neil Le Chevalier, tells us about some of the key issues affecting ambulance trusts in England and shows how the arrival of this new vehicle can address them head-on:

Tom Howlett explains: “As you would be expect from a lighter vehicle, the new 3.5 tonne ambulance provides environmental benefits: it reduces air pollution (CO2) by 20% compared to a current national specification van. This enables our customers to meet the target set by Simon Stevens well ahead of the 2024 target. Fuel consumption is also reduced in line with the emissions reduction, in the case of South Western Ambulance Trust this figure will be hundreds of thousands of pounds.”

Prior to the 1990s ambulances in the UK were based on a 3.5 tonne weight capacity, but with the introduction of more and more life-saving medical equipment the operating weight of ambulances has continued to increase. The WAS innovative lightweight aluminium ambulance body combined with a state-of-the art Fiat based chassis system has enabled this previously out of reach goal once again to be a reality, putting the UK at the very forefront of mobile medical technology.

All of the WAS UK test data has been independently validated by Millbrook testing ground. Emissions and fuel consumption were compared for normal driving, emergency driving and overall.

This launch will enable ambulance trusts all over the UK to address one of the key issues they encounter on a daily basis: that newly qualified paramedics, technicians and emergency care assistants must take a C1 driving licence prior to being able to drive a DCA, at a cost of around £1000. Neil Le Chevalier explains: “With the ambulance service recruiting more younger paramedics now, straight out of university, their driving licence no longer has a C1 category. Until they have their C1 driving licence they can’t drive any vehicle weighing over 3.5 tonne. This can be a limiting factor. There’s also the cost of taking the additional driving test, which new recruits usually have to pay themselves. If we moved to a 3.5 tonne vehicle on a replacement basis we’d solve the problem in the longer term as there is no requirement for any additional license at this weight. “Innovation in design is also critical. The ambulance is the working office of the paramedic and needs to be designed with them in mind. Issues such as infection control, ergonomics and patient and crew safety are all features that have been addressed in the new vehicle.”


Sales Engineering Manager at WAS UK, Tom Howlett, says: “Our new 3.5 tonne vehicle provides 20% more ergonomic working space than a van conversion. Our users tell us that this additional space is essential to the design of the ‘treatment triangle’, the area where the paramedic is seated. It enables medical equipment to be in arms’ reach while crews remain seated with a seat belt on. The increased ergonomic space also provides 360o patient access for enhanced clinical care - this has been a feature of ambulances operated on the continent for many years.” In February 2019, NHS England Chief Executive Simon Stevens challenged vehicle manufacturers to help “blue lights go green” and cut air pollution by developing more environmentally friendly ambulances. The NHS Long Term Plan also makes commitments to cutting mileage and air pollution by a fifth (20%) by 2024 and ensuring nine out of 10 vehicles are low emission within a decade. Neil Le Chevalier says: “In South Western Ambulance Trust we do 24 million miles a year – we’re a rural service – so we’re always interested in new ways to be greener. The 3.5 tonne vehicle is good for fuel economy as well as for the environment.”

Lord Carter’s report into unwarranted variation in the ambulance service identified the need to make efficiencies in the ambulance service, including development of a minimum standard ambulance specification. NHS Improvement’s recently launched national ambulance specification provided an opportunity to set a new standard for vehicle specification, with a focus on innovation, the environment and to address the practical challenges faced by the service up and down the country. Neil Le Chevalier comments: “Trusts would welcome a lighter vehicle – it’s something that’s been talked about for a number of years. The new specification is a minimum standard currently, it has been designed to be constantly renewed and updated. There are plans for an innovation group to be set up and I hope that they will also take into consideration the benefits of this newer, light-weight vehicle. “In the South Western Ambulance Trust we’d welcome the opportunity to pilot this innovative new 3.5 tonne vehicle. A light weight, 3.5 tonne vehicle helps to address the issues we’re facing in the service in the longer term: recruitment of paramedics and Emergency Care Assistants who are already licensed to drive, together with improved environmental and safety credentials.” Commercial Manager at WAS UK, John Rumsey, explains: “The 3.5 tonne DCA really is the ‘Holy Grail’ in terms of ambulance design. In the future all newly qualified paramedics, technicians and workshop staff will be automatically licensed to drive our vehicles and there will be no need for costly C1 license tests. We hope that this is a significant development in supporting the NHS recruitment of young paramedics into the Ambulance Service. “Our 3.5 tonne DCA was designed to address NHS England Chief Executive Simon Stevens’ challenge for vehicle manufacturers to help “blue lights go green” and our investment in lightweight aircraft grade aluminium extrusions has enabled us to deliver this. Our next step will be working with NHS improvement team to ensure that this design is added to the National Specification to enable Ambulance Trusts to procure this by the end of the summer 2019. Finally, our 3.5 tonne paves the way towards an all-electric version of this lighter-weight vehicle. Watch this space…” If you’d like to find out more information about the new WAS 3.5 tonne vehicle please contact, or contact Tom Howlett on 07496 982199 or 0845 459 2785.

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IMPACT OF DRUG AND EQUIPMENT PREPARATION ON PRE-HOSPITAL EMERGENCY ANAESTHESIA (PHEA) PROCEDURAL TIME, ERROR RATE AND COGNITIVE LOAD Paul Swinton1,2*, Alasdair R. Corfield3, Chris Moultrie3,4, David Percival1, Jeffrey Proctor1, Neil Sinclair5 and Zane B. Perkins6 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2018 26:82 © The Author(s). 2018, Published online 21 September 2018 Reproduced with permission from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Abstract Background We examined the effect of advanced preparation and organisation of equipment and drugs for Pre-hospital Emergency Anaesthesia (PHEA) and tracheal intubation on procedural time, error rates, and cognitive load. Methods This study was a randomised, controlled experiment with a crossover design. Clinical teams (physician and paramedic) from the Emergency Medical Retrieval Service and the Scottish Air Ambulance Division were randomised to perform a standardised pre-hospital clinical simulation using either unprepared (standard practice) or pre-prepared (experimental method) PHEA equipment and drugs. Following a two-week washout period, each team performed the corresponding simulation. The primary outcome was intervention time. Secondary outcomes were safety-related incidents and errors, and degree of cognitive load.

Results In total 23 experiments were completed, 12 using experimental method and 11 using standard practice. Time required to perform PHEA using the experimental method was significantly shorter than with standard practice (11,45 versus 20:59) minutes: seconds; p = < 0.001). The experimental method also significantly reduced procedural errors (0 versus 9, p = 0.007) and the cognitive load experienced by the intubator assistant (41.9 versus 68.7 mm, p = 0.006). Conclusions Pre-preparation of PHEA equipment and drugs resulted in safer performance of PHEA and has the potential to reduce on-scene time by up to a third. Keywords Airway, Intubation, Emergency, Patient safety / safety, Human error, Drug preparation, Risk management, Human factors.



The primary purpose of an ambulance service is to provide rapid access

A particular challenge in improving the overall benefit of PHEA is to

to emergency care. This involves prompt, effective pre-hospital care and

reduce the time penalty of the procedure while ensuring that the highest

rapid transport to hospital.

safety standards are achieved [2].

Pre-hospital interventions that delay transport to hospital may worsen

In the UK, thirty pre-hospital services provide PHEA, and perform

outcome [1]. For effective pre-hospital care, it is therefore important

approximately 1600 PHEA procedures a year [6]. There is some

that the likely benefit of any intervention is weighed up against potential

variability between services with regard to the amount of PHEA

risks, including delayed transport to hospital.

preparation that is done prior to tasking, and the amount done onscene. The busiest services pre-prepare equipment and drugs prior to

Pre-hospital Emergency Anaesthesia (PHEA) with oral tracheal intubation

tasking, while the majority of services perform this step on-scene.

is the technique of choice to manage critically ill or injured patients who cannot maintain their airway or achieve adequate ventilation [2]. While

The aim of this study was to evaluate the effect of pre-prepared

a potentially life-saving intervention in this group of patients, PHEA is

equipment and drugs, on PHEA procedure time and safety. In addition,

associated with significant risks and is a recognised cause of prolonged

we assessed the effect that pre-preparation had on the cognitive load

on-scene times [1–5]. Most PHEA complications are predictable, and risk

of clinicians. We hypothesised that the use of pre-prepared PHEA

can be significantly reduced with appropriate preparation [2]. However, it

equipment and drugs could reduce procedural time and risk, thus

is this preparation step that accounts for the majority of procedural time.

improving the overall benefit of the intervention.

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FEATURE Methods Study design This was a randomised, controlled simulation experiment with a

consultant physician, and a retrieval practitioner. When deployed by air,

crossover design. The study design is presented in Fig. 1 with the full

the EMRS team delivers PHEA with a Helicopter Emergency Services

study protocol showing more detail [see Additional file 1].

(HEMS) Paramedic in the role of intubator assistant.

Experiments were conducted between 04 January and 01 March 2017.

The service has strict clinical governance procedures, which includes

The study was reviewed and approved by Queen Mary, University of

an intense training program prior to independent pre-hospital practice;

London Research Ethics Committee (QMREC1839a), Greater Glasgow

adherence to SOPs that govern all aspects of pre-hospital practice,

and Clyde Clinical Research & Development committee (GN16AE762),

including the delivery of PHEA; and regular simulation training in the

and the Scottish Ambulance Service. Written informed consent was

application of these procedures.

obtained from participants. Eligible participants are experts in pre-hospital care, and perform PHEA Participants and setting

as part of their normal working practice. Consultant retrieval physicians

The study was undertaken at Scotland’s national Specialist Transport

were recruited from the Emergency Medical Retrieval Service (EMRS),

and Retrieval service (ScotSTAR). The service exists to provide a

ScotSTAR’s adult retrieval service. As this study was conducted

safe and dedicated transport and retrieval service to the 5.5 million

within the Greater Glasgow and Clyde NHS board (NHS GG&C) only

population of Scotland [7, 8].

consultant physicians currently working for the Emergency Medical Retrieval Service and employed by NHS GG&C were permitted to

The Emergency Medical Retrieval Service (EMRS), ScotSTAR’s adult


retrieval service is a physician-led team delivering a primary pre-hospital response, working with the ambulance service to provide pre-hospital

Paramedics were recruited from the Scottish Ambulance Service pool of

critical care at the scene of incidents. The EMRS team comprises a

HEMS Paramedics.


Fig. 1 Study Scheme Diagram

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FEATURE Consultant retrieval physicians were eligible for enrolment if they were: 1) currently working with EMRS and employed by NHS GG&C, 2) had > 6 months’ experience as a retrieval physician, and 3) had been assessed by EMRS to be competent and current at PHEA. HEMS paramedics were eligible for enrolment if they 1) were currently working for the SAS air ambulance division alongside EMRS, 2) had > 6 months’ experience as a retrieval paramedic, 3) had > 8 years’ experience as a paramedic, 4) had completed a recognised PHEA course [9], and 5) were assessed by EMRS to be competent and current at assisting PHEA. All eligible participants were emailed an invitation to participate in the study. Willing participants were randomized using a computerised random number generator to identify which eligible participants would be enrolled into the study. Randomisation and allocation concealment A third party, not involved with enrolment and unaware of the study outcomes, used a computerised random number generator to block randomised participants into 12 two-person (physician /paramedic) teams. In addition, computer batch randomisation was used to establish the first simulation that would be undertaken by the team (standard practice or experimental method). Clinical teams were randomised to either the standard practice or experimental arm. Following a two-week wash-out period, the same clinical teams performed the corresponding simulation. Before each simulation, teams received a standardised briefing, including review of the services standard operating procedure (SOP) [10] and opportunity to prepare and ask questions. Teams were blind to outcomes being measured.

Fig. 2 The Adult SCRAM Bag. “The Adult SCRAM (Structured CRitical Airway Management) Bag is an Emergency Airway Bag which provides a structured reproduceable approach to airway management”[34]. Fig. 2 The Adult SCRAM Bag. “The Adult SCRAM (Structured CRitical Airway Management) Bag is an Emergency Airway Bag which provides a structured reproduceable approach to airway management”[34]. Methods of measurements and outcomes measures

Simulations were filmed, which allowed accurate measurement of outcomes and maintained blinding of participants to the outcomes being measured. Two reviewers independently analysed recordings and extracted study data from the video recording into a pre-prepared spreadsheet. Any discrepancy was resolved by consensus with a third independent reviewer who was blind to the study aims. A full pre-hospital clinical simulation was simulated to reduce moulage artefact and mask the aspects of pre-hospital care that were being measured. Participants were blind to the study outcomes measured during the simulation (intervention time and error rate). Primary outcome was PHEA intervention time (minutes: seconds). Intervention time was

Interventions In both arms of the experiment, the clinical team performed PHEA on a mannequin, presented within a realistic pre-hospital clinical simulation [Additional file 2]. This included the decision to perform PHEA, and the performance of the procedure according to the services SOP. The preparation for PHEA involves establishing an equipment “kit dump” as well as the preparation and administration of drugs (Alfentanil (1 mg intravenously (IV)), Ketamine (2 mg/kg IV) and Rocuronium (1–1.2 mg/ kg IV)). Correct placement of the tracheal tube (ETT) is confirmed by visualising it pass the vocal cords, by auscultation and by the measure of quantitative end-tidal capnography (EtCO2), before securing it in place.

defined as starting at the decision to perform PHEA and ending when correct ETT position was confirmed with the facilitator turning on the EtCO2 simulation software, in response to visualising chest inflation. Secondary outcomes included procedural errors, defined as an unintended/unexpected incident, which led, or could have led to harm. Errors were counted and classified according to Table 1. In addition, we assessed the degree of individual cognitive load (ICL), defined as the amount of cognitive work/energy required by the participant to complete the procedure, including the level of judgements/decisions needing to be made. ICL was measured using Visual analogue score (VAS). At the end of each simulation, participants were asked to indicate the

The fidelity of the simulation required it to be performed accurately in accordance with the ScotSTAR PHEA protocol [10], safely, in real time and with the retrieval consultant physician undertaking the role of intubator, and the HEMS paramedic the role of assistant. AMBULANCE UK - APRIL

The standard practice arm (unprepared), consisted of a drug bag containing all the required drug vials, syringes and labels to prepare for a PHEA, and a conventional airway bag holding all the required airway equipment. In this method, the “kit dump” and drugs are prepared according to the SOP after the decision to intubate has been made. The experimental method consisted of, equipment and drugs, optimally organised and prepared prior to the procedure being required (preprepared), having the kit dump pre-prepared within the airway bag, with individual items held securely in place (Fig. 2), and the drugs pre-

Fig. 3 Pre-prepared anaesthesia medications. Drugs are prepared in syringes that are clearly labelled with the agents name and concentration. Fig. 3 Pre-prepared anaesthesia medications. Drugs are prepared in syringes that are clearly labelled with the agents name and concentration.

prepared in labelled syringes (Fig. 3).

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FEATURE Table 1 Error Classifications Classification



Procedural error in the preparation or use of medications or equipment with the potential to result in harm.

Examples Medication:

○ Syringe anaesthesia medication labelled incorrectly Table 1 Errorcontaining Classifications

or not labelled Classification Definitions administered ○ Incorrect medication ○ Incorrect dose administered Error Procedural error in the preparation or use of medications or Equipment: equipment with the potential to result in harm. ○ Sharps injury ○ Procedure performed not in accordance with SOP (i.e. checklist not used, bougie not used) Lapse

A failure to execute an action due to lapse in memory and a routine behaviour being omitted.

Medication preparation: ○ Same needle used to draw up multiple medications ○ No syringe cap ○ Unsafe sharps management Equipment preparation: Lapse A failure to execute an action due to lapse in memory and a ○ Cuff of tracheal not checked routinetube behaviour being omitted. ○ Laryngoscope bulb operation not checked ○ No bougie

magnitude of their perceived cognitive load during PHEA by marking a

Primary outcome: Intervention time

standard 100-mm line appropriately (0-mm representing no cognitive

Overall, the average intervention time was 16:13 (SD 5:17) minutes:

load and 100-mm representing maximal cognitive load). Visual analogue

seconds. Teams were able to perform PHEA significantly faster using

scores have been shown to be effective tools for measuring cognitive

the experimental method compared to standard practice (11:45 (SD

load [11, 12].

1:45) versus 20:59 (SD 3:13); MD 9:14 (95% CI, 7:42 to 10:45) minutes:


Medic ○ Sy or n ○ In ○ In Equip ○ Sh ○ Pr not

Medic ○ Sa ○N ○U Equip ○C ○ La ○N

seconds; p = < 0.001) (Students t). Statistical analysis Statistical analysis was performed using SPSS 24.0 software (SPSS Inc., Chicago, IL, USA). Shapiro-Wilk test and normal-quartile plots were used to assess normality. Categorical data are reported as frequency (n) and percent (%), and numerical data are reported as mean with Standard Deviation (SD) or median with Interquartile Range (IQR). Sample size was calculated using data from observation of prior EMRS practice: in ten consecutive standard PHEA’s, the mean procedural time was 20:03 (3:26) minutes: seconds. A 20% reduction in procedural time was considered clinically significant. We determined that eleven simulations in each arm of the study were required for the paired t-test to have a 90% chance of detecting a difference in means of four minutes at a level of significance of 5% (two-sided). We adjusted the sample size to twelve each arm to allow for any exclusions. Tablesimulations 2 BaselineinCharacteristics of study participants Characteristics Consultant HEMS Physicians Paramedics Parametric data were compared using the paired t-test and non(n = 12) (n = 12) parametric data were compared using Wilcoxon matched-pair signedAge (years) 43 (34 to 53) 44 (35 to 49) rank test. An absolute (Mean Difference, MD, or Difference of Medians,

Group comparison demonstrated that slow working teams worked slowly in both methods, and faster working teams worked faster in both methods. Despite this, all teams were significantly quicker when using the experimental method. Pre-preparation of drugs resulted in the largest procedural time savings (Table 4). Secondary outcomes Procedural errors Overall, 99 errors occurred during the 23 PHEA simulations (Table 5). Significantly fewer errors occurred when teams used the experimental method compared to standard practice: (0 (IQR: 0 to 2) versus 9 (IQR: 0 to 17); DM 9 (95% CI, 4.5 to 12.8); p = 0.007) (Wilcoxon matched-pair signed-rank).

Table 2 Baseline Characteristics of study participants Characteristics

Consultant Physicians (n = 12)

Age (years)

43 (34 to 53)

44 (35 to 49)

Gender (male)

12 (100)

9 (75)

Emergency Medicine

10 (83)


Anaesthetists / Intensivist

2 (17)


HEMS Paramedic


12 (100)

Twenty-three simulations (11 in standard arm,9 12 in 14) experimental arm) PHEA Experience (years) (4 to 2.5 (0.5 to 7) were*Median completed and the data included in this analysis. Characteristics experience of HEMS paramedics as frontline ambulance paramedics

NHS Consultant Physician Experience (years)

9 (2 to 16)


of participating clinicians are described in Table 2. One simulation

Paramedic Experience (years)*


13.5 (8 to 28)

9 (4 to 14)

2.5 (0.5 to 7)

(male) (100) 9 (75) (CI) DM)Gender measure of intervention effect with 95% 12 Confidence Intervals Speciality was Background calculated for primary and secondary outcomes. A two-tailed

P-valueEmergency < 0.05 was considered significant. 10 (83) Medicine


2 (17)


HEMS Paramedic


12 (100)

9 (2 to 16)



13.5 (8 to 28)

Results NHS Consultant Physician Experience (years)

Characteristics study participants Paramedic of Experience (years)*

Background Speciality

(standard arm) could not be completed due to operational demands.

PHEA Experience (years)

The outcomes of PHEA simulation using the two methods of equipment

*Median experience of HEMS paramedics as frontline ambulance paramedics


Anaesthetists / Intensivist

HEMS Paramedics (n = 12)

and drug preparation are presented in Table 3.

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FEATURE Table 3 Outcomes - PHEA simulation using standard practice and an experimental method of equipment and drug preparation Outcome

Standard Experimental Method Mean Difference P-value Practice (12 simulations) (95% CI) Table 3 Outcomes - PHEA simulation using standard practice and an experimental method of equipment and drug preparation (11 simulations) Outcome Standard Experimental Method Mean Difference P-value Intervention Time (min:sec) 20:59 (3:13) 11:45 (1:45) 9:14 (7:42 to 10:45) < 0.001 Practice (12 simulations) (95% CI) Errors 9(11(0simulations) to 17) 0 (0 to 2) 8.6 (4.5 to 12.8) * 0.007 Intervention Time (min:sec) Cognitive Load Intubator (mm)

20:59(20.5) (3:13) 49.9

11:45(20.5) (1:45) 49.4

9:14(−16.7 (7:42 to 0.5 to 10:45) 17.8)

< 0.001 0.945

Errors Cognitive Load Assistant (mm)

9 (0 to 17) 68.7 (24.8)

0 (0 to 2) 41.9 (22.4)

8.6 (4.5 26.8 (9.8toto12.8) 43.1)*

0.007 0.006

Cognitive Intubator * DifferenceLoad of Medians with (mm) 95% CI

49.9 (20.5)

49.4 (20.5)

0.5 (−16.7 to 17.8)


Cognitive Load Assistant (mm)

68.7 (24.8)

41.9 (22.4)

26.8 (9.8 to 43.1)


* Difference of Medians with 95% CI

Cognitive load Cognitive load of the intubator was similar between groups (49.9 (SD 20.5) mm versus 49.4 (SD 20.5) mm; MD 0.5 (95% CI -16.7 to 17.8) mm; p = 0.945) (Students t). However, the cognitive load of the intubator assistant was significantly reduced when using the experimental method compared to standard practice: (41.9 (SD 22.4) mm versus 68.7 (SD 24.8) mm; MD 26.8 (95% CI 9.8 to 43.8) mm; p = 0.006) (Students t) (Fig. 4).

intubator assistant cut a finger while opening an ampoule, highlighting the risk of sustaining a sharps injury when working under pressure. In another, a Rocuronium syringe was not labelled, and then confused for another agent, highlighting the risk of a drug administration error. These errors and safety-related incidents were, however, eliminated by using pre-drawn-up drugs in labelled syringes, resulting in significantly safer operation. The variance in procedural time was less in the experimental arm,


which may suggest an improved workflow. By improving workflow, overall performance was enhanced, and cognitive load was reduced.

Key findings This study demonstrates the effectiveness of a system of prepreparation of equipment and drugs, together with optimal ergonomic organisation of equipment, for PHEA. Our results show a significant and clinically meaningful reduction in 1) the time it takes to perform the procedure, 2) errors during procedure / or significantly safer performance, and 3) the cognitive load of operators.

However, realising where cognitive resilience within a team lies is an important consideration, especially when performing complex, highrisk interventions such as PHEA. In our study, the intubator assistant reported a significantly reduced CL in the experimental method, even lower than that of the intubator. This enables the team to utilise this resilience to their advantage, for example by maintaining the team’s situational awareness “through” the intubator assistant to deliver safe, timely, effective, high quality care as a team.

When aiming for short scene times (< 30 min) a reduction of 9:14 min is clinically meaningful. Two elements contributed to this: 1) the time to set up the equipment “kit dump” and 2) the time to prepare the required drugs, which accounted for most of the time saved.

Time reduction The initial resuscitation and evaluation of critically injured or ill patients begins in the pre-hospital environment, and the care that they receive can have a major influence on subsequent outcome [13, 14]. Providing

Most of the errors and safety-related incidents occurred during the preparation and labelling of drugs on scene. In one incident, the

individualised, tailored care based on injury patterns, means that some patients may require specialised care, such as PHEA to optimize their

Table 4 Component Times Component (min:sec)

Standard Practice (11 simulations)

Experimental Method (12 simulations)

Mean Difference (95% CI)


Equipment preparation Component (min:sec) Drug Preparation Equipment preparation

05:01 Standard Practice (03:42 to 06:19) (11 simulations) 08:23 05:01 (06:43 to to 06:19) 10:03) (03:42

03:57 Experimental Method (03:13 to 04:41) (12 simulations) 00:16 03:57 (00:07 to to 04:41) 00:24) (03:13

01:04 Mean Difference (− 00:18 to 02:26) (95% CI) 08:07 01:04 (06:26 (− 00:18toto09:49) 02:26)

0.114 P-value

Checklist Drug Preparation

03:50 08:23 (03:02 (06:43 to to 04:38) 10:03)

00:10 08:07 (−00:27 00:47) (06:26 toto09:49)

0.551 < 0.001

Drug Administration Including Onset Time Checklist

01:36 03:50 (01:16 (03:02 to to 01:57) 04:38)

03:40 00:16 (03:12 (00:07 to to 04:08) 00:24) 01:40 03:40 (01:31 (03:12 to to 01:49) 04:08)

−00:04 00:10 (− 00:24 to to 00:47) 00:17) (−00:27

0.702 0.551

Tracheal Intubation Including Onset Time Drug Administration

00:42 01:36 (00:32 to to 01:57) 00:51) (01:16 20:59 00:42 (18:49 (00:32 to to 23:09) 00:51)

00:37 01:40 (00:32 (01:31 to to 00:43) 01:49) 11:45 00:37 (10:34 (00:32 to to 12:56) 00:43)

00:04 −00:04 (−00:07 (− 00:24 to to 00:15) 00:17) 09:14 00:04 (07:42 (−00:07toto10:45) 00:15)

0.407 0.702

11:45 (10:34 to 12:56)

09:14 (07:42 to 10:45)

< 0.001

Table 4 Component Times


Total Intervention Tracheal Intubationtime

Data presented as mean (95% CI) 20:59 Definitions of Pre-hospital Anaesthesia components [see Additional file 3]

Total Intervention time

(18:49 to 23:09)

Data presented as mean (95% CI) Definitions of Pre-hospital Anaesthesia components [see Additional file 3]

48 For more news visit:

< 0.001 0.114

< 0.001 0.407

FEATURE clinical condition prior to transfer [15]. However, these interventions are known to increase time on scene, [2, 16] while the Association of

Table 5 Characteristics of procedural errors

Anaesthetists of Great Britain and Ireland stipulate that “every effort must


Standard Practice

Experimental Method


Laps in medication preparation




Error in medication preparation




Laps in equipment preparation




Error in equipment preparation




Total errors




be made to keep pre-hospital time to a minimum”[2]. As a service, we aim to spend time on scene and minimise Table 5 Characteristics ofwisely, procedural errors time from incident to definitive care. To spend a large proportion Experimental of this time preparing for Characteristics Standard p-value Practiceill or injured Method PHEA, while caring for a critically patient, is not effective use ofLaps medication preparation




Error the in medication 31 0 gains” [17] and 0.011 Using concept of “aggregation of marginal breaking preparation down the intervention (PHEA) into its core components, we identified Laps in equipment 23 0.0027 the preparation phase of a procedure to be2critical in determining both preparation the safety of the procedure and the time it takes to perform PHEA. We Error in equipment 2 0 0.317 were then able to demonstrate a significant time reduction in delivering preparation the intervention. It was also clear that most of the preparation for this Total errors 97 2 0.007 procedure could be done before the procedure became necessary, i.e.

our study shows that 40% of on-scene time was spent preparing drugs for PHEA, and most of the errors that occurred arose during the

in controlled undisturbed conditions at base rather than on-scene with

preparation of drugs on scene. These included (Table 5): drug labelling

all the attendant competing demands on our attention and potential

errors, omission of labels, poor sharps management and inadvertent

for distractions and interruptions. This time saved may be reflected in

“syringe swaps”, all of which can cause serious patient harm [20, 21,

reducing scene times and time to definitive care. However, performing

22]. For example, routine practice is to prepare Rocuronium (100 mg)

an intervention more quickly does not automatically mean that it is

in a 10 ml syringe, and Ketamine (200 mg) in a 20 ml syringe. In one

performed more safely.

observed error, Rocuronium (200 mg) was prepared in a 20 ml syringe, and subsequently incorrectly labelled as Ketamine. This could have

Error reduction

resulted in a neuromuscular drug being administered without prior

Human error is an important problem in health care, contributing to a

anaesthesia, exposing the patient to harm.

high instance of preventable medication errors [18–21]. Preparing drugs is a time-consuming process, requiring precision. Carrying out this

Such incidents are “almost invariably judged to represent sub-

critical task, while at the same time treating a critically injured patient

standard care and litigation is almost invariably successful” [22, 23].

in an uncontrolled pre-hospital environment, is far from desirable and

An anaesthetic practice review of 896 drug error reports that a large

inherently prone to error. Using standard practice of PHEA preparation,

number of errors involve drugs in similar sized syringes, along with


Fig. 4 Box-and-whisker plot presenting the individual cognitive load - Standard Practic

Fig. 4 Box-and-whisker plot presenting the individual cognitive load - Standard Practice Arm vs Experimental Arm

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

FEATURE drug preparation errors, which suggest that this is a frequently

We hope the findings of this study will support a change in practice from

occurring incident. [24] In a systematic review of drug administration

on-scene PHEA drug and equipment preparation to pre-preparation.

error prevention during anaesthesia, Jensen et al. recommends “drugs should be presented in prefilled syringes (where possible) rather than

We believe that the results of our study are generalisable to any pre-

ampoules (either for emergency drugs or in general)” [25]. This is also

hospital situation where PHEA is being delivered, as factors such as

supported by the Anaesthesia Patient Safety Foundation as part of

time, safety and cognitive load are the same regardless of the model of

a “new paradigm” to reduce the number of drug related errors, and

pre-hospital care (physician/paramedic, nurse/paramedic, critical care

improve patient safety [26].


Currently, there is wide variation in the way that pre-hospital services

The strengths of this study include the realistic simulation of a pre-

prepare drugs for PHEA, including using pharmacy-prepared drugs in

hospital scenario, allowing unbiased measurement of important aspects

pre-filled syringes, teams preparing the drugs at the start of the shift,

of PHEA, which would likely not be possible under real conditions.

drawing them up en route to an incident, and drawing them up on Our study has several limitations. This experiment was done in a


simulated setting, so the results may not replicate true clinical practice. Syringes can be pre-prepared by the service or pharmacy. Individual

However, the pre-hospital clinical simulation [Additional file 2] was

services would need to consider the associated costs, waste, and shelf

piloted by clinicians not involved in the study, before the trial recruitment

life of each method [Additional file 4]. A barrier to pre-prepared drugs

began, to ensure that the simulation was reproducible, straightforward,

maybe the additional cost of pre-prepared drugs or concerns over the risk of drug wastage. The additional cost may, however, be offset by the accompanying reduction in the frequency of errors in preparing intravenous drugs and, more importantly, the iatrogenic harm and human cost of such errors [22, 27]. Furthermore, the magnitude of the time reduction to administer the drugs for PHEA using pre-filled labelled

and that it recreated the clinical practice as closely as possible. It is likely that real pre-hospital cases would be even more complex than those simulated, and would result in even more errors. The same pre-hospital clinical simulation was used in both methods of the trial which may have introduced exposure bias or training bias. A

syringes cannot be ignored.

two-week washout period between the first and the second simulation

Reduction of cognitive load

outcomes being measured during the simulation. No difference in

was implemented to reduce this bias, and clinicians were blind to the

Cognitive load can affect human performance. The effect of human performance on the safe delivery of anaesthesia is widely recognised. Over 40% of adverse outcomes reported to the 4th National Audit Project (NAP4) [4] were attributed to human factors. “Cognitive resources, though limited, are under conscious control and can be directed from task to task as necessary” [28]. In the complex and unpredictable pre-hospital environment, the clinician is faced with additional load, beyond that of delivery of the PHEA. The cognitive demands of managing oneself, the team and the environment can exacerbate an escalating workload, risking plan continuation bias and cognitive overload [29]. This can compromise the delivery of safe, effective high quality care [30], as demonstrated in the seminal case of Elaine Bromley, an example of the considerable harm that can result from cognitive overload [31].

performance was seen either side of the washout period. The VAS is used in a wide variety of populations and situations due to its adaptability and ease of use [35]. However, VAS is subjective, and some evidence exists that suggests that it lacks sensitivity and that risks of error exist in some subject groups [36]. We acknowledge that visual analogue scales have not been validated to measure cognitive load in this setting. Nevertheless, we feel that these simple tools are able to provide an unbiased meaningful message, that signal how cognitive resilience could be enhanced during this intervention. A further limitation of this study is that only 23 of the 24 simulations were included into our analysis as one of the simulations (using standard practice) was incomplete and thus excluded. However, even if the quickest procedure time, across both groups, was input as the missing value, the

There are several ways of reducing cognitive load in critical situations,

procedural time using the experimental method remained significantly less.

including the development of strategies such as briefings, flows (workflow patterns), and checklists and limiting the number of critical decisions that need to be made. The cognitive burden can potentially


be further reduced by standardising the equipment and processes required for the intervention, for example by streamlining packaging or AMBULANCE UK - APRIL

numbering various components sequentially. Such improvements could enhance patient safety by contributing to greater reliability, resilience

Pre-preparation of PHEA drugs, and to a lesser extent the prepreparation and organisation of PHEA equipment, significantly reduced procedural time and has the potential to reduce on-scene

and situational awareness [22, 4, 32].

time substantially. In addition, pre-preparation of equipment and drugs

There is a recognised relationship between workflow and cognitive

of the PHEA assistant.

resulted in safer performance of PHEA and reduced the cognitive load

load [28] and this can be influenced by the storage and presentation of equipment [33]. If the method of storing and presenting equipment

Additional Files

for an intervention is designed to reflect more precisely the series and sequence of steps required for that intervention, the method itself

Additional file 1:

becomes a useful “tool” for reducing the cognitive burden (see Fig. 2).

Research Protocol (PDF 755 kb)

50 For further recruitment vacancies visit:

FEATURE Additional file 2:

have followed the regulations of our institutions concerning intellectual

Pre-hospital clinical simulation (PDF 358 kb)


Additional file 3: Definitions of Prehospital Anaesthesia components (DOCX 77 kb)

Authors’ information

Additional file 4:

1. PS. Dip IMC, MSc. HEMS Paramedic & Retrieval Practitioner.

Pharmacy-prepared prefilled syringes cost and shelf life [37, 38] (DOCX

2. AC. MPH. Consultant in Emergency & Retrieval Medicine.

14 kb)

3. CM. MBChB, MCEM. Clinical Research Fellow. 4. DP. BSc. Paramedic & Retrieval Practitioner.


5. JP. BSc, PgC. Paramedic & Advanced Retrieval Practitioner.

CL: Cognitive load; DM: Difference of Medians; EMRS: Emergency

6. NS. BSc, MSc. Consultant Paramedic.

Medical Retrieval Service; EtCO2: End-tidal capnography; ETT: Tracheal

7. ZP. MBBCh, PhD. Honorary Clinical Lecturer.

tube; HEMS: Helicopter Emergency Services; ICL: Individual cognitive load; IQR: Interquartile Range; IV: Intravenously; MD: Mean Difference;

Ethics approval and consent to participate

mm: Milimeters; mm:ss: minutes: seconds; n: Frequency; PHEA: Pre-

The study was reviewed and approved by Queen Mary, University of

hospital Emergency Anaesthesia; SAS: Scottish Ambulance Service;

London Research Ethics Committee (QMREC1839a), Greater Glasgow

ScotSTAR: Scotland’s national Specialist Transport and Retrieval

and Clyde Clinical Research & Development committee (GN16AE762),

service; SCRAM®: Structured CRitical Airway Management; SD:

and the Scottish Ambulance Service. Written informed consent was

Standard Deviation; SHIL: Scottish Health Innovations; SOP: Standard

obtained from participants prior to their participation.

operating procedure; VAS: Visual analogue score Consent for publication Acknowledgements

Written informed consent was obtained from all participants for the

The authors would like to thank the HEMS paramedics from the

composite data collected in this study to be used for publication.

Scottish Ambulance Service, and retrieval consultant physicians from the Emergency Medical Retrieval Service for their participation. As well

Competing interests

as the EMRS Advanced Retrieval Practitioners for their assistance and

We wish to draw the attention of the Editor to the following facts which

support running the pre-hospital simulations.

may be considered as potential conflicts of interest and financial contributions to this work. Authors, PS and NS are co-inventors of the


SCRAM® bag (Structured CRitical Airway Management) which is an

The cost of consumables used within this study was provided by

emergency airway bag used within this study. The SCRAM® bag is now

Scottish Health Innovations Ltd. (SHIL). SHIL is a publicly owned private

a commercially available product and as such PS and NS receive a

company limited by guarantee, wholly owned by Scottish Ministers

royalty. We confirm that the remaining authors have no known conflicts

and two health boards. Working in partnership with National Health

of interest associated with this publication.

Service (NHS) Scotland to support and develop innovative solutions which address a clearly identified healthcare need; with the proposed

Publisher’s Note

innovations being generated by NHS healthcare professionals.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Availability of data and materials The authors declare that the data supporting the findings of this study

Author details

are available within the article and its supplementary information files.


Emergency Medical Retrieval Service, ScotSTAR, Scottish Ambulance

Service, Glasgow, UK. 2Scottish Air Ambulance Division, Scottish Authors’ contributions

Ambulance Service, Glasgow, UK. 3Royal Alexandra Hospital, Paisley,

PS conceived the study and obtained research funding. PS, ZP,

UK. 4ScotSTAR, Scottish Ambulance Service, Glasgow, UK. 5Scottish

AC, CM and NS designed the protocol. ZP and PS supervised the

Ambulance Service, Clinical Directorate, Edinburgh, UK. 6Centre for

conduct of the study and data collection. PS, DP and JP undertook

Trauma Sciences, Queen Mary, University of London, London, UK.

recruitment of participating clinicians, filmed the simulations and



analysed the video recordings including quality control. CM, ZP, AC provided statistical advice on study design and analysed the data. PS, CM, ZP and AC were responsible for data analysis and interpretation. to its revision. PS takes responsibility for the paper as a whole. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are

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desaturation during emergency airway management. Ann Emerg

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Med. 2012;59:165–75.


PS drafted the manuscript, and all authors contributed substantially

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

FEATURE 4. Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 1: Anaesthesia. Br J Anaesth. 2011;106:617–31. 5. Cook T, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106:632–42. 6. Burgess M CK, Locky D.J, Perkins Z.B. Pre-hospital emergency Anaesthesia: an updated survey of UK practice with emphasis on the role of standardisation and checklists. Emerg Med J 2018 (in press). 2018. 7. National Records of Scotland. Scotland’s Population is Increasing, 2017. Accessed 20 Mar. 2018. 8. Emergency Medical Retrieval Service. Home, 2018. https://www. Accessed 20 Mar. 2018. 9. Great North Air Ambulance. Pre-hospital anaesthesia course, 2016. Accessed 20 Mar. 2018. 10. ScotSTAR. Standard operating procedure emergency Anaesthesia. Scottish ambulance service 2015. 11. Gentili R, Rietschel J, Jaquess K, Lo L-C, Prevost C, Miller M, et al. Brain biomarkers based assessment of cognitive workload in pilots under various task demands. Conf Proc IEEE Eng Med Biol Soc. 2014:5860–3. 12. DiDomenico AT. An investigation on subjective assessments of workload and postural stability under conditions of joint mental and physical demands: Virginia Tech; 2003. 13. Lockey DJ, Crewdson K, Lossius HM. Pre-hospital anaesthesia: the same but different. Br J Anaesth. 2014;113:211–9. 14. van der Velden MW, Ringburg AN, Bergs EA, Steyerberg EW, Patka P, Schipper IB. Pre-hospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care. Emerg Med J. 2008;25:444–9. 15. Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of pre-hospital time on trauma patients outcome: a systematic review. Injury. 2015;46:602–9. 16. Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA. 2000;283:783–90. 17. Durrand J, Batterham A, Danjoux G. Pre-habilitation (i): aggregation AMBULANCE UK - APRIL

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Work to upgrade the current

Suzanne Tracey, Chief Executive

we are delighted that we could

at the RD&E said: “We are

donate £1million to the Royal

Nigel Hare, Operations Director

extremely grateful to the HELP

Devon and Exeter hospital to

for Devon Air Ambulance said,

Appeal and all those who have

cover the entire cost for a brand

“Due to patient confidentiality

donated. The upgraded helipad

new helipad. It will be built in

we don’t know much about the

will make a huge difference to

the same great location as the

patients we help. For our 27,000th

patients at the RD&E.”

existing helipad just outside the

mission we were deployed at

ED but will be larger, allowing

1531 from a 999 call and were in

Gavin Lloyd, Emergency Medicine

bigger air ambulances to land and

the air at 1534 hours. The flight to

Consultant at the RD&E, said:

it will be fitted with lighting to allow

scene took just 11 minutes.”

“This is a hugely impressive

night landings, which will help to

The donation has covered the cost

financial contribution and,

save even more lives.”

of the redevelopment and will allow

on behalf of the Emergency

the introduction of night landings

Department at the RD&E, I’d like

at the hospital. At the moment,

to say a massive thank you to

the helipad does not have the

the HELP Appeal and all those

capacity to support night landings,

who support this really worthwhile

meaning that its day light operation

charity. Getting seriously ill

is limited, especially throughout

patients and those badly injured

the winter months. The upgraded

to us quickly saves lives, and this

Devon Air Ambulance has

to patient outcome. On this

helipad will also be extended to

money will enable us to continue

reached yet another landmark,

occasion, after assessing the

enable larger helicopters to land in

treating these patients as quickly

by attending it’s 27,000th

patient and assisting the land

the daytime.

as possible.”


ambulance crew with treatment,

Work is due to be completed and

Robert Bertram, Chief Executive

On 11 February the service was

suited to travel by road to the

fully functioning by November

of the HELP Appeal, said: “The

called to help a rural patient, in

RD&E Hospital in Exeter.”

helipad at the Royal Devon and Exeter NHS Foundation Trust will begin in April, thanks to a £1 million donation from the County Air Ambulance HELP Appeal.

He added “The advantage of travelling by air is that we don’t


Landmark 27000th mission flown by Devon Air Ambulance

get caught up in traffic jams or in narrow country lanes. This means we get our critical care specialist paramedics and doctor to the patient as quickly as possible, which can make a huge difference

the patient’s condition was best


58 For more news visit:

NEWSLINE Heléna Holt, CEO of Devon

Jodie said: “I thought I was going

Air Ambulance said “The last

to die. I had an awful feeling in

couple of weeks has seen us

my chest like a burning heat. I’ve

reach several landmarks; from

never felt anything like it before.

assisting our 100th patient in

But Ed arrived really quickly, and

the dark, opening the 100th

thanks to him and the other crew

Community Landing Site, to

I made it through.”

announcing that 2018 was our busiest year ever, helping 1,109

Now Jodie is encouraging other

patients. But we don’t have time

people to step in and take action

to rest on our laurels as we are

if they think somebody may be

constantly looking at the service

having a cardiac arrest or heart

and seeing what would make


our patient care even better.” Jodie said: “At first I struggled She added, “I would like to

with what had happened to me,

take the opportunity to say a

because there was no logical

huge thank you to our amazing

explanation. But since then I’ve

supporters, donors, staff, crews

realised how fortunate I was to

and volunteers across the


community. None of what we do would be possible without any

On the day of the incident Jodie’s

of them.”

mum Andria called 999 after her daughter had been in pain for


Jodie, 32, Thanks Ambulance Crew After Cardiac Arrest

around 30 minutes. Staff in the SWASFT Control Hub assessed Jodie’s condition over the phone, and organised for crews to respond.

A 32-year-old woman has been reunited with the South

Paramedic Ed Bowyer arrived

Western Ambulance Service

within five minutes to give her

NHS Foundation Trust

routine treatment. But then

(SWASFT) crew who saved her

Jodie’s heart stopped beating,

life when her heart stopped

and she needed urgent help to


stay alive.

Jodie Prudames, 32, had rapid

Ed led the effort to resuscitate

chest pains and began to

Jodie with the help of Janson.

sweat profusely at her home in

They pulled her onto floor, and

Midsomer Norton, North East

laid her flat on her back. By doing

Somerset in October.

CPR and shocking her with a defibrillator, they managed to get

Then she went into cardiac

her heart beating again.

arrest, lost consciousness and stopped breathing.

SWASFT Student Paramedic Nick Tolson and other SWASFT staff helped to provide post-

resuscitated Jodie, with the

resuscitation care for Jodie.

help of her partner Janson. She survived and has gone on to

Paramedic Ed Bowyer said: “This

make a fantastic recovery.

incident highlights that a cardiac

Video laryngoscopy wherever and whenever you intubate i-view is the new, single use, fully disposable video laryngoscope from Intersurgical, providing the option of video laryngoscopy wherever you might need to intubate.

arrest can happen to anyone, of Jodie went to Shepton Mallet

any age, and at any time.

ambulance station on Thursday 7 March to thank Ed and other

“Jodie is living proof that people

SWASFT staff for saving her.

can and do survive.”


SWASFT Paramedic Ed Bowyer

i-view™ video laryngoscope

Quality, innovation and choice


NEWSLINE Donation funds new helipad for Maidstone Hospital Maidstone and Tunbridge Wells NHS Trust is set to open a new 24 hour helipad at Maidstone Hospital thanks to the generous support of the HELP (Helicopter Emergency Landing Pads) Appeal. Robert Bertram, Chief Executive of the HELP Appeal, presented a cheque to the Trust on

our help. Seriously ill patients

workshops covering Haemorrhage

and Stoke-on-Trent

need hospital care in a matter

Control, Handling Bariatric

(November 28).

of minutes to increase their

Patients, Trauma Management,

chances of survival and recovery.

Airway Management, Pre-Hospital

The workshop will be looking at

Building a helipad with zero risk of

Major Incidents, Handling Minor

lifting systems that can be used

becoming waterlogged will ensure

Injuries and Seven Ways to Die

for the extrication of casualties

this happens, saving time and

in Cold Water. Delegate rates

or plus size patients from a wide

saving lives.’

start at just £36 which represents

range of locations including

tremendous value for money.

domestic situations and RTCs.

finished and ready for use by

For full details on all Conferences/

a 15 minute presentation on

Spring of 2020.

Workshops please visit:

handling plus size patients in the

£150,000 today and a further £150,000 will be donated later in

helipads. Currently helicopters are using a

If you have an interest in

temporary landing site at the rear of the oncology unit at Maidstone Hospital, but this site is frequently waterlogged. The new helipad will permanently replace this and will bring a 24 hour safe landing site

hospital environment, presented

Plus Size Workshop

Limited places are available at

by Hospital Aids.

each event at a delegate rate

the year.

Are you interested in Ultrasound?

dedicated to funding hospital The HELP Appeal has donated

Wednesday 13 March. The charity is the only one in the country

This workshop will also include

The helipad is expected to be

Half day plus size workshops,

of £60 to include VAT, lunch,

run by Outreach Rescue, will

refreshments etc. To secure

be taking place this year in

your delegate place visit www.

Edinburgh (May 16), Bristol or call

(June 20), Kettering (October 17)

the organisers on 01322 660434.

Ultrasound you may be interested to learn that NEMUS Education and Training are running 5 regional one day workshops this year in: Edinburgh (May 16), Bristol

back to Maidstone.

(June 20), Kettering (October

John Weeks, Head of Emergency

(November 28).

17) and Stoke-on-Trent

Planning & Response at Maidstone and Tunbridge Wells

Each workshop will be covering

NHS Trust, said: ‘We are extremely

the common uses of ultrasound

grateful to the HELP Appeal for

in pre-hospital and hospital

generously agreeing to fund the

practice and is suitable for all

landing site which will make a real

health care professionals as

difference to Maidstone Hospital.

they include FAST Scanning, Focused AAA, Echo and Life

Leigh Curtis, Executive Director of

Support, Vascular Access etc.

Service Delivery, Air Ambulance

plus lots of hands on scanning.

Kent Surrey Sussex said: ‘Having access to hospitals, like

Only 40 delegate places are

Maidstone, is vitally important

available on each workshop at

to Air Ambulance Kent Surrey

a rate of £90 to include lunch,

Sussex, as it gives us the ability to

refreshments etc.

MedSkills Academy Trauma Management Workshop Thursday May 16, DoubleTree by Hilton, Edinburgh International Airport EH28 8LL

This continuing education course that teaches the principles of PHTLS is ideal for first responders, EMS practitioners, etc. Topics being covered include: Airway/ Oxygenation & Ventilation, Circulation and Shock, Traumatic Brain Injury & Spinal Trauma.

reduce our patients’ journey time, AMBULANCE UK - APRIL

giving them access to critical care

To register please email:

quicker. This one is particularly

meaningful to us, as it allows us to

indicating your chosen location.

serve our founding community at

Visit: www.lifeconnections.

its very heart.’ to register online or call the Organisers on:

Robert Bertram, CEO of the

01322 660434.

HELP Appeal commented: ‘We go where we are needed most

Our one day regional Life

and Maidstone Hospital needed

Connections events also include

Only 12 places are available at a rate of £50.00 plus VAT (50% below normal Course costs). To register please visit:

60 For further recruitment vacancies visit:


Bereaved mum wins 999 control room award

“It’s just too much: it’s too much that

The team – which also runs

“He’s never going to get married,

parents are having to go through

sessions on road safety and

he’s never going to drive a car, he

what I went through by losing a child

careers advice – frequently work

will never have children. He died

– because of knife crime.

alongside the police, courts and

before his life started.

A mother whose teenage son

London Ambulance Service’s public

young offenders or those at risk of

“It’s just all been taken away from

education team is showing the


him; you bring a child into the

was stabbed to death has won an award for her bravery in taking a

prison service to engage with

stand against knife crime.

children not to carry knives.

Amanda Cassidy has made a film

In the film, Amanda makes a

for London Ambulance Service urging youngsters to stop carrying knives.

world and you’re there to look

film in schools to try to persuade Amanda has been presented with

after them all your life.

the APD Control Room Award 2019 for services to the public.

“You should never have to bury your own children, not

direct appeal to young people, saying, “Pick up your phone, pick

Margaret Luce, head of public

through something so stupid, so

up your keys, pick up your money

education, said: “Amanda was


but leave the knife at home.

very courageous in coming

Greg was 18 when he died.

forward to tell her story. It is very

The 54-year-old started working as a 999 call handler for the

“If you’ve got a knife in your hand

powerful to hear first-hand about

Almost exactly a year later she

service after her eldest son Greg

you’re going to use it and you’re

her experience and we hope that,

got a job with London Ambulance

was killed.

going to be taking someone’s life

by making the film, we will help to

Service. She started taking


make a difference.”

calls and is now responsible

something more from my life. I

“Or, you’re going to end up dead

Greg had just started training as a

emergencies across London.

needed to do something to make

yourself and your parents are

chef when he went to visit friends

She admits her colleagues in the

a difference; and the job we do -

going to have to go through what I

and family in the north. That night,

control room have helped her get

we save people’s lives.”

went through. It’s got to stop.”

Amanda got a phone call from a

through the dark times.

for dispatching ambulances to

She said: “After that I needed

nurse. She added: “I love my job. I love

When Amanda started in the

In 2018 paramedics from the

call centre 15 years ago, calls to

London Ambulance Service

She said: “We got a call saying

the people I work with. We’re a

stabbings were scarce. Now she

talked to around 8,500 young

he had been stabbed and was at

big team that look out for each

says they are a daily occurrence.

people at 68 events throughout

hospital. By the time we got there,

other. I enjoy what I do and I think

the capital, to tell them about the

he had died. It was a single stab

I make a difference, and we save

consequences of carrying knives.

wound to the chest.

people’s lives.”

Amanda, from west London, said:


61 For all your equipment needs visit:

NEWSLINE UK ambulance service stands firm with New Zealand counterparts

extremely proud of our colleagues in New Zealand and we wanted to do something highly visible to

show our solidarity, express our gratitude to those who responded to this horrific event and send

Delegates at the Association of Ambulance Chief Executives’ annual conference (#ALF2019) gathered together on 19th March 2019 to form a human ‘NZ’ to show their support for, and solidarity with, their New Zealand colleagues who responded to the deadly terrorist attack in Christchurch, as well as the families and friends of the victims. Anthony Marsh QAM, National Strategic Adviser of Ambulance Services, Chief Executive of West Midlands Ambulance Service and Chair of the Association of Ambulance Chief Executives said: “We are


62 For more news visit:

our love to them, as well as the families and friends of the victims.”

NEWSLINE St John Ambulance purchases state-ofthe-art defibrillators in the fight against sudden cardiac arrest St John Ambulance has announced that it has purchased 30 new ZOLL® X Series® Monitor-Defibrillators for its clinicians to use on ambulances and at events around England to assist in its life saving mission in communities. The ZOLL X Series is about half the size and half the weight (less than six kg) of competitive

From left to right: Alan Weir, Head of Clinical Operations, Adrian Waller, Zoll’s EMEA Strategic Account Manager and Jonathan Dexter clinical manager for East region

full-featured monitordefibrillators, but a lot more powerful thanks to its advanced capabilities. Key among the X Series’ assets

“Once a person is in cardiac

a cardiac arrest no matter where

faster and with accuracy because

arrest, it’s a matter of life and

they are and St John Ambulance

patient data is provided so

death,” said Alan Weir, Head of

is called to treat them.”

quickly. All data is provided in a simple real-time colour display,”

Clinical Operations at St John Ambulance. “The X Series lets

The X Series was designed

said Adrian Waller, ZOLL’s EMEA

us assess, monitor and treat

expressly for healthcare

Strategic Account Manager.

the patient’s needs without any

professionals to meet the specific

unnecessary delay.

demands and extreme conditions

“The X Series is capable of

that St John Ambulance’s

taking automated blood pressure

“The X Series not only helps us

clinicians face regularly. Based

readings, monitoring the heart

save lives, but makes the work of

on a platform for the military and

rhythm and other vital signs, and if

our clinicians a great deal easier

air medical operations, the X

required can defibrillate the heart

without pausing. ZOLL’s Real

by having so many life-saving

Series is ruggedised and highly

by providing a life saving electrical

CPR Help ® provides real-time

capabilities in one unit. With


shock -- all critical measures

CPR feedback, and with CPR

ZOLL’s technology, we believe

Stat-padz measure the depth,

we are better equipped to protect

“The X Series monitor helps St

rate and effectiveness of chest

the lives of members of the

John Ambulance’s team make


public who are taken ill or suffer

better patient care decisions

is the unequalled ability to assist and improve CPR quality to keep oxygen-rich blood flowing. ZOLL’s proprietary See-Thru CPR® lets rescuers reduce interruptions in chest compressions by allowing them to see underlying heart rhythms


life savers need to perform to determine a patient’s condition.” Photos courtesy of Stephan Kahn.


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


Ambulance team to take on Three Peaks for cancer ward A team of South East Coast Ambulance Service staff will be lacing up their walking boots to take on the Three Peaks Challenge this summer. The team, made up of staff from Polegate and Paddock Wood, as well as staff family from Gatwick Airport security, is raising money for the charity-

The team, who will begin their

ward. Any support or donations

I cannot express how grateful I

challenge on 11 June, chose to

would be gratefully received.”

am to them all.”

several colleagues and their

Anyone who wishes to make

She said: “I was a fit and

relatives were directly affected

a donation towards team’s

healthy 35-year-old who woke

by cancer and some received

efforts can visit https://www.

up in intensive care to find out

treatment on the ward.

my heart had stopped beating.

raise funds for the ward after

pevenseywardedgh/ Polegate Make Ready Centre Acting Operations Manager Matt Templeman said: “We’re looking forward to what will be a tough challenge. The team are currently training hard for this event, and will be walking under the guidance of Mountain Leader (And Operational Team Leader) Martyn Hall from our

funded Pevensey Ward at

Polegate Make Ready Centre.

Eastbourne District General

Over recent months, we have

Hospital. The challenge will see

sadly seen a number of our

them aim to scale Ben Nevis,

colleagues affected by cancer

Scafell Pike and Snowdon in 24

and we were keen to raise

hours, including driving time.

money for such a vital specialist

Cathy said the incident has SWASFT

Mum thanks lifesavers after her heart stopped A mum has been reunited with the South Western Ambulance Service NHS Foundation Trust (SWASFT) team and bystanders who saved her life when her heart stopped beating. Cathy Angell went into cardiac arrest at Ashdown Riding Centre near Wootton Bassett,

MedSkills Academy Essentials of Advanced Airway Management Thursday May 16, DoubleTree by Hilton, Edinburgh International Airport EH28 8LL

Swindon during her six-year-old son’s lesson in April 2018. The 35-year-old lost consciousness, stopped breathing, and her skin went blue. Fellow mum Stacey Buckland dialled 999, before riding centre owner Chloe Prim and bystander Wes Decker began

Learn the full range of Airway Management techniques, including: The Use of Extraglotic Devices, Video Assisted Intubation and Surgical Cricothyrotomy. AMBULANCE UK - APRIL

Only 10 places are available at a rate of £50.00 plus VAT (50% below normal Course costs). To register please visit:

trying to resuscitate her.

changed her perspective on life. She said: “I feel like I’ve been given a second shot at life. I’m not fully recovered, especially mentally. It’s been a slow and difficult journey, but I’m still here.” Cathy writes an online blog to share her experiences of living life after a cardiac arrest and to raise awareness of the condition. Paul Murphy, who was the first SWASFT Paramedic to treat Cathy, said: “Unfortunately a cardiac arrest can happen to anyone, of any age, and at any time. “Cathy is not the stereotypical person to suffer this condition. Many are elderly or suffer with known heart problems, but Cathy was young and healthy. “Cathy survived because people recognised that she wasn’t breathing effectively, and called 999. They followed instructions

SWASFT responders used

from the call handler to do CPR,

a defibrillator to administer

which they continued to do even

electronic shocks in an effort

after the volunteer responder

to restart her heart. Cathy was

and crews had arrived. Cathy

taken to hospital where she was

was given defibrillation at the

given emergency heart surgery.

earliest opportunity, and taken onto hospital where doctors

Cathy, who lives locally,

continued her care.

returned to riding centre on Thursday 21 March to thank

“Cathy is living proof that can

those who kept her alive. She

people and do survive cardiac

has no memory of the incident.

arrests, if they are given the right treatment and the right

Cathy said: “If it wasn’t for all

time. It is hugely humbling to be

these people, my husband

a part of a team that achieves

would no longer have a wife and

such an amazing outcome for a

my son wouldn’t have a mum.


64 For further recruitment vacancies visit:


We offer innovative EMS solutions, helping you provide a high level of care

More power to you


This document is intended solely for the use of healthcare professionals. A healthcare professional must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that healthcare professionals be trained in the use of any particular product. The information presented is intended to demonstrate the breadth of Stryker product offerings. A healthcare professional must always refer to the package insert, product label and/or instructions for use before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Power-PRO XT, Power-LOAD, Stryker. All other trademarks are trademarks of their respective owners or holders. The products depicted are CE marked in accordance with applicable EU Regulations and Directives. 08-2018, 2018-18327

65 For all your equipment needs visit:

NEWSLINE Charles Fowler, attended as the


Long service and achievements celebrated at annual awards ceremony South East Coast Ambulance Service NHS Foundation Trust (SECAmb) staff, volunteers and members of the public have gathered to celebrate long service and achievements. The awards evening, the second of three being held across the Trust’s region, took place on Thursday 07 March at Woodlands Park Hotel, Cobham, Surrey. Chief Executive Commendations were presented across a range of categories including Clinical Excellence and Exceeding Expectations while staff were recognised for 20, 30 and even 40 years’ service.

Queen’s representative to present Queen’s Long Service and Good Conduct medals to frontline A&E staff, while volunteer Community First Responders were thanked and recognised for 10 years’ service. Among those awarded Chief Executive Commendations was paramedic Jennifer HughesGolding who, while still a student paramedic, and working on a non-emergency patient transport vehicle, was flagged down by a police officer to assist a traumatic cardiac arrest in Crawley, West Sussex. Community First Responder, Marc Harrold, picked up a commendation for his voluntary efforts in leading Horsham Community First Responders as well as a 10 year service award

There was a public commendation for Surrey Police PC Mikko Ball and delivery driver Alin Nicola for their quick actions in providing CPR to save the life of Reigate man, Francis Fernandes in July 2018. The Employee of the Year award went to the Trust’s Assistant Company Secretary Isobel Allen while the Team of the Year trophy this year was awarded to SECAmb’s Wellbeing Hub Team – a team launched in January 2018 to bring together a range of previously separate staff support services under one umbrella. SECAmb Chief Executive Daren Mochrie said: “With a total of some 850 years’ service recognised alongside some amazing individual and team achievements, I was very proud to celebrate with staff, volunteers and members of the public.

the perfect example of how it takes a team to save a life. The work we celebrated was, of course, just a small number of examples of the fantastic care which is delivered day-in, day-out, across our region. Well done to everyone. “I would also like to thank the family, friends and loved ones of staff who dedicate their careers and lives to helping others. Working for the ambulance service is a rewarding but also often challenging career.” Details of every award winner can be found below – for further information on each award, please see the awards booklet. Please note that this is the second of three awards ceremonies so only those staff named below received their awards on 7 March. Chief Executive Commendations

alongside his partner Hilary Deputy Lieutenant of Surrey,


“Our public commendation was

Exceeding Expectations:

“...the moment they turned the camera on, the patient in front of them and their attitude immediately changed - so it is having that deterring effect. “ Mark Cotton, assistant director at NEAS




Edesix VideoBadge and VideoTag cameras offer protection from threats and abusive behaviour, and have proven to be a valuable asset for facilitating training and operational de-brief. Paired with Edesix’s VideoManager software, the cameras capture video and audio footage when required, and store the data securely for future training purposes, or as court-ready evidence.

For more information, please contact / 0131 510 0232

NHS-Advert-March2019.indd 1

08/04/2019 17:32

For more news visit:

NEWSLINE Tangmere-based Jennifer

Team of the Year: The Trust’s

Simon Ramm, Woking

cycle rather than a one off might

Hughes-Golding, who, while still a

Crawley HQ-based Wellbeing

Andrew Latham, Crawley

affect an individual’s mental

student paramedic, and working

Hub Team – The Wellbeing Hub

Catherine Sigournay, Steyning


on a non-emergency patient

has had recorded approximately

transport vehicle, was flagged

2,500 interactions with staff since

“It highlighted things that you

its launch in January 2018. The


down by a police officer to assist a traumatic cardiac arrest in

hub brings together a range of

Crawley, West Sussex.

previously separate staff support

Paramedics sleep rough for charity

services under one umbrella. Big-hearted Paramedics and

Community/Voluntary: Marc Harrold, Horsham CFR team

Queen’s Ambulance Service

Emergency Care Assistants

leader, for the dedication shown to

medals for Long Service &

from South Western Ambulance

his team of volunteers alongside

Good conduct (20 years) were

Service NHS Foundation

presented to:

Trust (SWASFT) Swindon

classes for public to learn CPR.

Brian McArthur, Worthing

Station slept out rough for 24

David Craddock, Chichester

hours to highlight the issue of

Clinical Excellence and

David Deville, Epsom


the setting up of Heart Start

Quality Improvement: Worthing paramedic, Jamie Webb, for his efforts as part of a team who responded to an imminent birth emergency.

Denise Downham, Staines James Hacker, Worthing

On Thursday 28 February 2019,

Jamie Webb, Worthing

Paramedic Chris Kirby was

John Vivian, Farnborough

joined by colleagues in support

Katherine Crabb, Chichester

of local charity ‘The Swindon

Kevin Cover, Redhill

Clinical Excellence and Quality Improvement: Crawley Paramedic Practitioner, Dan Creton, whose dedication and commitment to a new Paramedic Practitioner pilot in West Sussex has led to positive outcomes for both patients and staff. Clinical Excellence and Quality Improvement: A large group of Chertsey-based staff who responded so well to a major incident in Woking November last year when a number of children were injured falling from an inflatable slide at a fair being held at Working Park.

Paul Biddlecombe, Guildford Paul Stewart, Redhill Robert Margaillan, Godlaming Sarah Jones, Staines

Night Shelter’ which provides emergency accommodation, food and clothing for homeless people. The SWASFT team did the 24-

Warwick Avery, Banstead

hour sleep-out on the steps of

20 years NHS Long Service

the second year running. They

medals Matthew England, Worthing 30 years NHS Long Service Award: Darin Ringshall, Tangmere Nicholas Baird, Brighton Mark Bailey, Crawley Sally Laven, Chertsey Thomas Whiteside, Redhill

Swindon Ambulance Station for

would never even consider such as road noise when you are trying to sleep, foxes coming for a sniff, how cold a pavement gets after a few hours, and the absolute boredom of staying in one place for fear of losing your spot if you move. “The passing public were very supportive and kindly gave us several rounds of free coffee and food. This year, inspired by our new neighbours, the Swindon Night shelter, we shall be raising money for this local charity with a target of £3,000. We have built good relationships with the shelter, and hope to create a referral pathway to them within the coming months. We would actively encourage people to run similar events - it definitely creates an understanding for those who

hope to beat last year’s total

have no option but to sleep

of £2,000 which they raised for


Shelter. The SWASFT team sleeping Paramedic Chris Kirby said:

out this year will be: Chris Kirby,

“Sleeping out last year opened all

Ollie Dalton, Charlie Goldsmith,

of our eyes as to what it must be

Adrian Sawyer, and two new

like for those homeless patients

faces: Lee Stagg and the Wiltshire

we treat, and how the thought of

Deputy County Commander Jane

being homeless as a continuous


Tina Shambrook, Tongham Tony Davies, Crawley

Public Commendation: Surrey Police PC Mikko Ball and Mr Alin

40 years NHS Long Service Award:

Nicola for their quick actions in

Anthony Bridges, Worthing

providing CPR to help save the

James Eaton, Redhill

life of Francis Fernandes, who

Phil Hamerton, Crawley

Reigate town centre in July last

Volunteer’s 10 years Long


Service Award Andrew Clark, Horsham

Employee of the Year: Assistant

Pauline Flores-Moore, Southwater

Company Secretary, Isobel

Marc Harrold, Horsham

Allen, who was nominated for

Hilary Humphrey, Horsham

personifying the Trust’s values

Suzanne Martindale, West

and regularly demonstrating them


in her day-to-day work.

Angela Small, Southwater


collapsed in cardiac arrest in

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

NEWSLINE outside their home in 2017.

has been totally dedicated

there to support me through it

Like mother, like daughter: Medic Mum’s pride as daughter follows in her life-saving footsteps

She quickly alerted her parents

throughout. I am so proud of

when I get home.”

Graeme and Tina – who were

everything she has achieved

off-duty – and sprang into action

to this point and much of this

Graeme and Tina met while both

to help the injured teenager.

is due to the wonderful training

working at London Ambulance

officers at Bromley.

Service in 1989.

two, said: “When I joined the

“It is surreal to think that in a few

Tina remains at the Service as

London Ambulance Service, I

weeks’ time Amelia and I may be

a paramedic and teaches life-

remember the training being

crewed together for a shift. I’m

saving skills including cardio

A Coulsdon mum has spoken

tough. However, back then our

sure that as long as she makes

pulmonary resuscitation (CPR)

equipment was quite basic and it

the tea, we’ll get along just fine!”

and using defibrillators.


of her pride this Mother’s

Tina, 48, and a mother of

Graeme, who worked for the

Day that her daughter is set

was all about getting the patient

to become a lifesaver in the

to the hospital as quickly as we

Amelia, who worked as an

Service for 38 years – including

ambulance service.

could. The role of the ambulance

office administrator and a police

a secondment on London’s Air

clinician has evolved so much

cadet, said: “Growing up with

Ambulance – is now retired,

Amelia Wilkie, 19, completed

and this is clear watching Amelia

my parents working for London

however, works part time in the

her training to be a medic with

go through the rigorous training

Ambulance Service has been

Service’s south east London

London Ambulance Service on

of not only learning the basics

quite normal for me. However,

NHS 111 control room.

29 March, exactly 30 years after

of emergency aid but also

watching them treat a critically ill

her mother, Tina, joined the

how to obtain and read ECGs,

teenager made me realise what

Graeme added: “I’m excited


administer drugs, and knowing

an important and responsible

for Amelia, although I can’t

how to use and understand the

job they have. Having now

help having parental concern

Amelia, who will be based at

extensive monitoring machines

completed the academic part of

about the situations she will be

Croydon ambulance station,

and equipment that is now a part

my training, I am looking forward

exposed to. However, she has

was inspired to follow her

of every ambulance clinician’s

to working operationally and

a calm and mature manner so

parents into the profession after

working day.

putting my skills into practice.

this job is perfect for her and

I also know that when I get a

I feel she will be an amazing

tough day, my parents will be


watching them help a victim of a serious road traffic collision

“Amelia has worked hard and


68 For further recruitment vacancies visit:


Ambulance service praised by minister for apprenticeships Apprentices at North West Ambulance Service (NWAS) met with Rt Hon Anne Milton MP, Minister of State for Apprenticeships and Skills and Chris Green MP for Bolton West and Atherton on Monday as the trust is named one of the top performing apprenticeship employers in the country. Currently employing 272 apprentices in a wide range of roles including frontline emergency medical technicians as well as ICT, finance, communications and fleet mechanics, the trust was thanked for its commitments, enthusiasm and drive for apprenticeships. The ambulance service changed the way it provides training to apprentices in May 2017 when it became an employer provider meaning it was able to deliver its first regulated qualification in-house.

Associate Ambulance Practitioner (AAP) apprenticeship, to become emergency medical technicians with 31 fully completed the course since May 2017.

proud of our apprentices who are really proving to us the value that they can bring to the organisation through their skills and drive for learning.

Apprentices are given 18 weeks of classroom and driver training before heading out on the road to gain hands-on experience working on an emergency ambulance whilst completing the remainder of the 12 to 18 month apprenticeship.

“By embracing government changes, we have been able to invest further into learning opportunities for our workforce widening the depth of skills they have and ultimately improving the level of care we give to our patients.

Successful AAP apprentices are employed by the trust as emergency medical technician 1s.

“Not just on the frontline, we have been able to offer apprenticeships within our corporate services too by linking in with relevant learning providers. This allows us to target a younger workforce and take advantage of junior positions with the hope that apprentices will go on to build a career within the organisation.”

Government reforms have meant that the trust has been able to benefit from using the apprenticeship levy to invest in training apprentices. Celebrating National Apprenticeship Week, NWAS will be showcasing ‘a week in the life of’ a number of apprentices and featuring them on their social media pages across the week. Carol Offer, Assistant Director of Workforce and Development at NWAS said: “We are extremely

Apprentices in other areas of the trust include fleet, learning and development and HR. Apprenticeships and Skills Minister, Anne Milton said: “I was thrilled to kick off National Apprenticeship Week 2019 with a visit to the North West Ambulance

Service, to meet apprentices who help deliver urgent and emergency health care across their region. “The apprentices I met are trained to deliver the right care, at the right time, in the right place – giving them an excellent foundation to progress in their careers, whilst making a huge difference to the lives of others. “Apprenticeships in the North West Ambulance Service are available in a number of different roles including paramedics, call handlers and urgent care assistants – all of which can lead to rewarding and fulfilling careers “Well done to all at North West Ambulance Service!” NWAS is now looking to expand its in-house apprenticeships and is working with ambulance services across the country to develop further apprenticeship opportunities for the ambulance workforce. All NWAS vacancies are advertised on NHS Jobs,

In her first visit to celebrate National Apprenticeship Week, Anne Milton MP met with apprentices from different areas of the trust and expressed the benefits of offering these learning opportunities to further grow a skilled workforce. Damian Hutton, Emergency Medical Technician 1 in Manchester said: “I have now completed my apprenticeship and it’s given me opportunities that I never would have had otherwise.

Currently, 251 apprentices are enrolled onto the Level 4

Apprenticeships and Skills Minister, Anne Milton (pictured in red) meets with apprentices and trainers from North West Ambulance Service along with Interim Chief Executive, Michael Forrest, Chris Green, MP for Bolton and Chairman, Peter White. (Central L-R)


“I was never interested in learning when I was younger but now have a nationally recognised qualification and have used this to progress onto further training to become a paramedic.”

69 Life Connections - The Affordable CPD Provider:


New research could provide early reassurance to patients with chest pain and reduce stress on ambulance crews and A&E departments

routinely taken to A&E for tests,

Service, we are delighted to be at

portable devices and could

although ultimately most do not

the forefront of this clinical study

become standard procedure

have a health problem that needs

to evaluate a new innovative way

in ambulances, avoiding many

treatment in a hospital.

of working to benefit patients

unnecessary transfers to hospital.

experiencing chest pain.

The PRESTO study will help researchers understand whether

The study aims to see if the NHS can safely avoid many

“This new technique allows us

T-MACS remains accurate inside

of these unnecessary hospital

to undertake more in depth tests

the portable ambulance setting.

attendances, thereby reducing

for patients at home, meaning

stress for patients and easing

clinicians can make more

Rick Body, Professor of

pressure on A&E departments

informed decisions about the best

Emergency Medicine at

and ambulances services, which

care for the patient.

Manchester Royal Infirmary, part of Manchester University

usually come under the greatest North West Ambulance NHS

stress during the winter months.

Trust paramedics in Greater

“This could mean that future

NHS Foundation Trust, and

patients who don’t require

Chief Investigator of the study,

Manchester are part of a major

All participants in the study will

immediate hospital treatment

said: “Every year the pressure

new research study to assess

see no difference to their standard

can be safely cared for in the

on Emergency Departments

whether future patients who

care or diagnosis.

community, reducing unnecessary

increases, and that leads to

A&E admissions and saving vital

patients having to wait longer

emergency resources.

in what are often very stressful

call 999 with chest pain can be safely assessed and managed

Angela Foulkes from South

by paramedics, without having

Manchester suffered a heart

to go to hospital.

attack 26 years ago after

“We are conducting the trial with

already helped to reduce the time

months of experiencing strange

paramedics and emergency

that patients with chest pain must

sensations around her neck.

medical technicians across

stay in hospital for tests.

Paramedics from North West

situations. Our research has

Greater Manchester, with patients

Ambulance Service NHS Trust are aiming to get more than 230

Late one evening, and with no

matching the criteria being given

“Paramedics are highly skilled

Greater Manchester patients to

diagnosis of cardiac problems,

the opportunity to be a part of this

professionals but, until now, they

take part in the trial. Consenting

Mrs Foulkes and her husband

significant project.”

simply haven’t had the equipment

patients are to be drawn from

called the out-of-hours GP, who

across central and north

examined her, then called for an

Manchester, Salford and Bolton.

ambulance to take her to hospital.

they need to be sure if patients How does it work?

have serious heart problems. That means that patients with chest

Researchers have already

pain are routinely taken to hospital

The study is being led by the

It was established that Mrs

developed a system called

for tests, which is inconvenient for

University of Manchester and

Foulkes had suffered a heart

the ‘Troponin-only Manchester

patients and inefficient for the NHS.

Manchester University NHS

attack and she was later

Acute Coronary Syndromes

Foundation Trust and funded by

diagnosed with angina, but she

(T-MACS) decision aid’ to avoid

“If we can now use portable

the National Institute for Health

has since lived comfortably with

unnecessary hospital admissions

blood testing devices to run those

Research. Three other ambulance

her condition.

from A&E. The PRESTO study

important tests without patients

is now assessing whether this

having to come to the hospital,

services nationally will also be involved, with a total of 700

She was invited to be a patient

decision aid is suitable for use

the impact would be huge.

patients expected to participate

representative on the PRESTO

before patients are taken to

Patients who don’t have serious

across three regions.

steering group having been


heart problems could receive almost immediate reassurance

involved with HeartHelp Support The study, titled PRESTO (the

Group in Withington since her

T-MACS calculates how likely it

with minimal impact on their lives.

Pre-hospital Evaluation of


is that a patient has a serious

Ambulances could respond faster

heart problem by considering

to people who most need their

Sensitive Troponin), is part of the


NHS’ ambition to find new ways

Mrs Foulkes, who worked with

their symptoms and the results

help. Emergency Departments will

of delivering healthcare more

children with hearing impairments

of basic tests. Research has

be less crowded, which will help

efficiently without the need for

before retirement, said: “Patients

shown that T-MACS can safely

to reduce waiting times.

hospital treatment.

value rapid, accurate information

reduce unnecessary hospital

about their condition. PRESTO

admissions, enabling immediate

“Patients who agree to take part in

Chest pain is the second most

promises good for patients and

reassurance for almost half of all

the study will see no difference to

common reason why people call

good for the NHS.”

patients having tests. It has been

their standard care or diagnosis,

successfully used in practice in

but will just have a few additional

Manchester since June 2016.

tests and observations to help

999 for an ambulance. However, the symptoms associated

Steve Bell, Consultant Paramedic

with a heart attack and those

and Principal Investigator at the

of non-cardiac conditions are

North West Ambulance Service,

The blood tests used in T-MACS

T-MACS and its suitability for use

often similar. These patients are

said: “At North West Ambulance

can now be carried out using

in ambulances.”

us to calculate the accuracy of

70 For more news visit:

NEWSLINE Researchers are looking to

with basic first aid and splinting

Steve said: “There were some

Tony, 55, recalled: “After it

recruit patients who call 999

skills. It was also quite a physical

businessmen having a meeting

clamped onto my trouser leg I

with a complaint of chest pain

job, with a lot of lifting involved

who got showered with glass

was leaping around like a river

and are subsequently attended

and no motorised tail lifts on the

after the explosion and there was

dancer, trying to get it off. I

by the ambulance service. After


a security guard who was injured.

eventually managed to shake

the necessary treatment for the

Over the years they have seen

“We took them to Barts Hospital

garden. We’ve done quite a few

patient, paramedics will draw a

the introduction of state of the

but the press were already aware

jobs with animals that have gone

blood sample in the ambulance,

art healthcare equipment, the

we were coming. As soon as we

for us in one way or another.”

comprehensively assess a heart

development of new lifesaving

opened the back doors of the

tracing, and record patients’

skills, driven several generations

ambulance the flashes started

Tony, who is an Emergency

symptoms including details

of ambulances and worn four

going off, we were like rabbits in

Ambulance Technician, said

relating to the T-MACS.

different uniforms.

the headlights.”

building up an intuition with

Both men are fathers, with Tony

They said their most memorable

advantage with working with the

having two girls and Steve two

job was being chased and


attacked by a “Labrador-sized”

obtaining consent and providing

Investigators will review the patients’ medical records after 30 days to find out the final diagnosis. The actual care given to patients will not differ from today’s standard care. But the data generated throughout the course of the study will allow researchers to calculate the accuracy of T-MACS and its suitability for standardised use in by ambulance paramedics. The study is supported by the NIHR Clinical Research Network: Greater Manchester and receiving in kind support from Abbott Point of Care, LumiraDx and Roche Diagnostics International Ltd.


Crewmates reach 28 year milestone

it off and outpace it across the

iguana that was in a patient’s “Tony’s second child and my


first were born within weeks of each other,” said Steve, who is a

Steve said: “We were called to a


house that was surrounded by a bit of land and a big wall. As we

“On the morning of our first shift

were going in we heard a rustling

back after being off on paternity

in the bushes but didn’t think

leave we had to deliver a baby in

anything of it. As I came back out

the footwell of a car!”

to take kit to the vehicle I was met by this iguana which was three

They have spent most of their

and a half foot long, nose to tail.

careers at Battersea Ambulance

It was obviously a pet that had

Station and have attended

been left out in the summer to

several major incidents including

sunbathe. It chased me across

the Baltic Exchange Bombing in

the grass but I managed to

April 1992, which resulted in them

escape. When Tony opened the

appearing on the front page of

door it lunged at him and got hold


of his trouser leg!”

his crewmate was the main same person for so long. “Steve will do his bit and I will do mine and depending on what’s happening one person can get the relevant bits of kit without the other person asking,” he explained. “The job just runs that much easier, and when the patient is in the ambulance you are well choreographed what you say and do.” Clinical Team Leader James Bradley said Steve and Tony are not only the longest serving crew in Wimbledon group but probably in the London Ambulance Service. “Twenty eight years together as a crew definitely makes their

During 28 years as crewmates

working relationship special and

two ambulance staff have saved

definitely the exception these

dozens of lives, delivered more

days,” he said.

than 40 babies and survived several animal attacks.

“I have known them both for nearly 25 years and I can honestly say their consistently professional

Tony West from Croydon joined

approach to their work has never

London Ambulance Service

wavered. They are both top guys

in 1986 and 1987 respectively

who have seen many changes

before becoming crewmates in

at Battersea over the last quarter


century and as senior members of the station they make all our

“When we joined we didn’t have

new staff feel welcome. Possibly

defibrillators and we couldn’t give

the highest compliment I can

out aspirins,” said Steve, 54.

pay them both is to say if any of my family were unwell, Steve

“Getting blood pressures is

and Tony are the crew I’d want

about all we could do, along

attending to them.”


Steve Redburn from Sidcup and

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

NEWSLINE Meet a woman at the cutting edge of critical care This International Women’s Day, Magpas Air Ambulance Doctor Charlotte Haldane, 32, from Cambridge explains why she became a doctor, what drove her to Pre-Hospital Emergency Medicine and what it’s like to work for a lifesaving air ambulance charity. Charlotte says, “I’ve always wanted to be a doctor, ever since I was a child. I got a plastic stethoscope set for my 4th birthday and never looked back! “I first heard of Pre-Hospital Emergency Medicine (PHEM) when I was a medical student. I’ve always been a very active, adventurous person and when I realised there was a specialty

where I could be right at the cutting edge of critical care, and working in unusual environments outside the hospital, I had to get involved.” Charlotte worked extremely hard to get into this field. After over 10 years of training, placements, exams and experience, her hard work paid off and she became Magpas Air Ambulance’s first full-time doctor and now brings hospital level care to seriously ill and injured patients at the scene of their incidents, when time is of the essence.

done to support women during this process. However, being female has never been a barrier to anything for me. I was brought up in a family where gender did not matter and I was told from a very young age that I could do anything I wanted to do, providing I was willing to put the effort in to achieve those goals. I still believe this to be true.” Charlotte continues, “The work Magpas Air Ambulance do is very special. We’re called to people in their very worst moments, when they are at their sickest and really need our help.

Discussing women in PHEM, Charlotte explains “There are

“We know that if we’re there, with

plenty of female doctors in medicine although far fewer in the Acute Specialties such as Pre-Hospital Care and I think it’s important to ask why. Often for women who are trying to juggle young families and complete their Acute training, this is a hurdle too far and more needs to be

the opportunity and the privilege to provide a patient with advanced care, then we are giving them the best possible chance they could have. We use all of our specialist knowledge and skills to try to make a difference and to help them – and when we do, it is truly amazing.


72 For further recruitment vacancies visit:

“Doing this job changes your perspective quite a lot. I am reminded regularly how exceptionally fragile life can be. The beauty of a normal day, where everything is just fine, is not something to be underestimated. In general I think we should focus more time and energy on being happy, laughing and being kind. It’s a cliché, but life really is too short.”

Life Connections Harrogate Over 140 delegates attended the various Conferences and Workshops that took place at this very unique event on Thursday 28 March and enjoyed listening to presentations given on topics such as: Mental Health in the Workplace, Heamorrhage Control, Injury and the Elderly, Epilepsy Awareness, etc., the Ultrasound Workshop

NEWSLINE provided delegates with an

A major achievement is the

Yourself microsite, which has

A quarter (26%) of UK adults

insight into: The Common

increased number of Blue Light

been created for staff to share

think they will be affected by a major emergency, but more than

Uses of Ultrasound in

Champions in post. Champions

their own stories, get tips and

Contemporary Pre-Hospital

are existing members of staff

ideas to help them be happy,

two thirds (70%) admit nobody in

and Hospital Practice,

who offer one to one support

healthy and fit, plus much more.

their household has taken steps

those attending the Trauma

for any mental health concerns

and Airway Management

staff may have, whether that be

Chairman, Peter White, who

to new research from the British

Workshops benefited from

due to attending a particularly

signed the pledge on behalf the

Red Cross.[2]

learning more about: Trauma

traumatic incident, or an issue

trust board said: “I am delighted

Patient Assessment, Essential

which may be happening at

that we’re playing a part in not

The British Red Cross is calling

Airway Skills, etc.

home. In 2016 there were just

only trying to reduce the stigma

on the sector, emergency

four champions, today there

associated with mental health,

services, local authorities and

The next of our one day

are almost 100 across the

but ensuring there is vital

the Government to work better

Life Connections regional


support available to all our staff.

together to meet four key needs

The board have a responsibility

identified in the report:

events will be taking place in Edinburgh on Thursday May 16 and will again include First Responder and First Aid Conferences plus Workshops covering: The Common Uses of Ultrasound, Trauma Management and Airway Management. To view all programmes and to register, please visit: or, call the Organisers on: 01322 660434.


NWAS increase mental health support for staff

to prepare[1] That’s according

The trust is also very proactive

to ensure this support continues

in raising awareness on

and I would like to thank all the

mental health and reducing

staff involved for their hard work

the stigma of talking about

and dedication.”

and accountability for their staff’s mental health and overall wellbeing by having

practical needs • communicating essential

it. Local managers are being equipped to take responsibility

• addressing immediate

Most UK adults are totally unprepared for an emergency

information • providing mental health and psychosocial support • helping people rebuild lives

conversations, encouraging take up of health and wellbeing

New British Red Cross report

with access to advocacy,

initiatives, providing information

‘Ready for Anything’ says needs

advice and ongoing support

about mental health support

of individuals and communities

and signposting to other

must be at heart of response

Drawing on a survey of 5,000 UK

support available. The trust

to flooding, terror attacks, and

adults, and insights from those

also has an in-house Invest in

other emergencies

with direct experience of major

The North West Ambulance Service has further extended its commitment to supporting the mental wellbeing of its staff by resigning the ‘Blue Light - Time to Change’ pledge. The trust initially supported the national ‘Blue Light Programme’ led by the mental health charity MIND, and a pledge committing to supporting staff was signed AMBULANCE UK - APRIL

in January 2016. However, a lot has happened since then and to reflect the progress made, and the future aspirations to continue to improve mental health support for staff, a revised action plan has been completed entitled ‘Blue Light - Time to Change’ in order to allow the trust to re-pledge its commitment three years on.

Pictured L-R: Amanda Ferguson - Blue Light Champion Co-ordinator, Peter White – Chairman, Laura Smoult – HR Project Manager, Michael Forrest, Interim Chief Executive

73 Life Connections - The Affordable CPD Provider:

NEWSLINE incidents and emergencies,

house fire, flooding or a terrorist

respond and support people’s

using the report launch to

Ready for anything: Putting

attack is different and those

recovery best. One size doesn’t

highlight some simple steps

people at the heart of

affected will have differing

fit all, and planning together

organisations and individuals

emergency response, looks in

needs which are best addressed

and listening to people’s needs

can take to help prepare for any

depth at what people expect

through a joined up approach

locally can both reassure and


and need when crisis hits.

involving the emergency

empower communities to

services and their partners,

withstand incidents in future.”

It finds that individuals and

response app: receive alerts

including the voluntary sector.

communities can respond very

Download its free emergency

Naomi Phillips, Director of Policy

about incidents like flooding in

differently, so the support they

“The police work closely across

and Advocacy, at the British Red

your area; available in the Apple

are given to plan, cope and

these sectors to ensure multi-

Cross said:

App Store and Google Play.

recover from an emergency

agency response plans involve

should reflect that diversity.

all the right stakeholders and

“When an emergency hits a

Download its free first aid app;

For example, 42% of UK

we welcome this research from

community, it can tear at its very

get first aid advice at your

adults would want support

the British Red Cross which

fabric. If people are prepared,

fingertips; available for Apple via

finding family members they

underlines the value of greater

they can withstand the impact of

iTunes or Google Play.

had become separated from

co-operation to deliver support

shocks and recover over time.

following a bomb threat

to the public when it is needed

And, while a community takes

A person who experienced a

or terror attack. And more

the most.”

time to heal, people should feel

flood speaks in the report about

empowered, supported and

how significant it was for them

younger people say they’d want emotional support than older

Roy Wilsher, chair of the

confident in their own and their

to help their infant daughter.

people, 26% of those aged 18-

National Fire Chiefs Council,

institutions’ ability to respond.

They said: “I realised the extent

24 compared with 14% of those

said: “In the event of an

over 65.

emergency incident occurring,

“Closer collaboration between

my daughter was going to be

the fire service will respond

central and local government,

wearing not her own clothes,

The report also shows providing

along with other blue light

emergency services and

clothes that didn’t fit her,

cash for people to buy what

services, using nationally

voluntary sector organisations

nappies that didn’t fit her, and

they need in an emergency,

agreed principles and guidance

could help ensure people are

that’s when I think it hit home

rather than assuming what they


as far as possible ‘ready for

with me that our lives had been

anything’ and that their needs

turned upside down. It was silly

need, was often more culturally

of what was happening, that

appropriate and desired. It gives

“The National Fire Chiefs

are met if the worst does

things, I remember the first day I

people dignity and allows them

Council actively works on closer


got a pink blanket to give her …

to make decisions about their

collaborative working between

own recovery.

all responders to emergency

“Our report offers powerful

incidents. We welcome the work

insights into what people require

A Red Cross volunteer spoke

The British Red Cross responds

undertaken by the British Red

after an emergency, whether

about the importance of talking

to an emergency in the UK

Cross in this report highlighting

a major event or the need to

about traumatic experiences

approximately every four hours.

how people can be supported

evacuate their home for a fire

after an emergency, they said:

The charity and its volunteers

following an emergency

or flood, something that could

“We as humans have a built-in

carry out first aid, run rest


happen to anyone. We’re inviting

need after a stressful situation

that was a big thing for me.”

emergency responders across

to go and talk about it. It’s part

where they offer emotional and

“I am also supportive of the

all sectors to work together and

of our survival mechanism.”

practical support. Every year,

British Red Cross’s new project

share our learnings.”

it helps around half a million

which aims to prepare local

people in the UK to prepare

communities to support each

The report also looks at the

for, respond to and recover

other and those responding to

needs of those who respond

in this survey as events that

from a crisis. It believes greater


to emergencies, whether as a

caused significant damage

job or through volunteering. It

and/or required evacuation

centres and provide safe spaces

collaboration between different

References 1 Major emergency defined


agencies and charities, as well

British Red Cross’ Head of

corrects some misconceptions,

and/or significantly disrupted

as sharing local knowledge and

Crisis Response, Simon Lewis,

e.g. a quarter of people wrongly

daily life such as a flood,

insights, will help meet the wide

said: “Major emergencies in the

believe that firefighters and the

terror attack, house fire or

range of individual needs in a

UK are thankfully rare and it’s

police routinely monitor social

severe storm.


important to stress the majority

media for people needing

of people won’t be caught up

help, or that posting on social

National Police Chief Council

in one. But, whether it’s a flood,

media is a good way to alert

online survey of 5,008 adults

Lead for Civil Contingencies,

fire, power or water outage or

emergency services.

(18+) carried out by Opinium

DCC Paul Netherton said:

other alert, this report builds

“Every emergency, whether a

on our knowledge of how to

2 A nationally representative

between November 2nd and The British Red Cross is also

74 For more news visit:

12th, 2018.


Providing lifesaving care thanks to our fundraisers

specialist critical care paramedics after demonstrating competency in administering drugs for pain relief and sedation,

LAS News

Chair Heather Lawrence OBE reappointed

carrying out surgical techniques as well as Two newly qualified specialist paramedics

completing postgraduate certificates. Fred

Heather Lawrence OBE has been

in critical care at Wiltshire Air Ambulance

has also achieved a postgraduate diploma.

reappointed as Chair of the London Ambulance Service for another term.

have praised people who fundraise for the Their training, which also includes aviation


skills, has been funded by the charity. Dan Tucker and Fred Thompson say it’s thanks to people who donate and fundraise that they

Before joining Wiltshire Air Ambulance

and their colleagues are able to save lives.

Fred, who is married with two daughters, worked as an ambulance operations officer

Dan, 42, who lives in Melksham, said:

in Bristol and before that was a paramedic

“Wiltshire Air Ambulance is a really important

based at Swindon Ambulance Station.

part of our community that gives the chance of life to many people who would otherwise

He said: “Working at Wiltshire Air

not make it due to the rural nature of Wiltshire.

Ambulance is great. I feel privileged to be

The people who donate and fundraise for us

able to come to work knowing what a great

are literally making the difference between life

team we have and our ability to make a

and death, because without their donations we

difference really counts.”

wouldn’t be able to provide the service we do.” Dan, who is married with three daughters, Fred, 45, who lives in Bristol, has fundraised

joined Wiltshire Air Ambulance after working

for the charity by running the Bath Half

as a paramedic based at Bath Ambulance

Marathon in 2017.

Station for ten years, including as a mentor to other paramedics.

He said: “Every pound counts and the charity makes sure that it supports all its employees,

He said: “Working at Wiltshire Air

volunteers and patients. It’s great to see how

Ambulance is an exhilarating job and

such a small county, in terms of population,

I love working in an environment that

supports their air ambulance.”

challenges me every day. The new airbase, at Semington, is a great place to work and

Both Fred and Dan joined Wiltshire Air

having the whole team together makes day

Ambulance in June 2015 and became

to day operations far more effective.”

The appointment was confirmed by NHS Improvement who are responsible for appointing and supporting NHS trust chairs using powers delegated by the Secretary of State. Chief Executive Garrett Emmerson said: “Heather has played a key role in transforming the Trust since she joined as Chair in 2016, leading its efforts to improve services as well as developing a pioneering strategy to ensure that by 2023 we are the primary integrator of healthcare services in London. “The significant contribution Heather has made to the Trust is reflected in the high esteem she is held by our colleagues across the Service and the wider NHS.” Her significant contribution and leadership steered London Ambulance Service out of special measures last year, leading to a ‘good’ overall rating from CQC. Chair Heather Lawrence OBE said: “I am delighted to be reappointed as Chair of the Trust Board. The Trust has made huge strides forward over the last few years and it’s want to do. “We must sustain what we’ve done and build on it and to that end, I intend to champion a change in our organisational culture to one that is even more collaborative and inclusive, making London Ambulance Service the

Fred Thompson and Dan Tucker, critical care paramedics at Wiltshire Air Ambulance.


a privilege to be a part of, but there’s more I

employer of choice for the best healthcare professionals in the capital.”

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


Twin paramedics retire after almost three decades caring for Londoners ‘Miracle worker’ twin paramedics are retiring after a combined 56 years of saving lives. London Ambulance Service’s Mark and Chris

Brian’s heart stopped beating and the twins

shame they’re retiring. I am really appreciative

performed cardiopulmonary resuscitation

to all ambulance workers – they do an

(CPR) before taking him to Barnet Hospital.

incredible job.”

Brian added: “They are miracle workers. I

The brothers plan to keep up their paramedic

would not be here today if it wasn’t for them

skills by working a few shifts a month, but will

and I can’t thank them enough for what

spend more time with their families as well as

they did. They were incredibly calm, and

doing hobbies they enjoy – including boxing at

professional and so experienced - it’s such a

Finchley Boxing Club.

McCarthy, 57, have worked their last shift from Friern Barnet station, after treating thousands of patients during their 28-year careers. Chris said: “Retiring was a very difficult decision to make but we do everything together so it seemed natural to retire together. We’ve had incredible careers, met amazing patients and worked with some great people. My wife said I was too squeamish to do this job and I’d only last three days, so I proved her wrong!” The brothers, who were both black cab drivers before joining the ambulance service, say it has changed considerably since they joined in 1991. Mark said: “The training and skills are unrecognisable – paramedics now all have degrees and it’s a true profession. “Years ago, we would literally pick up patients and get them straight to hospital, whereas now we stabilise and treat them on the scene before taking them to a specialist centre – it’s so much better for patients now. “There have been difficult times over the years, and in this job you do see some horrible things, however, we’ve always had each other for support. I’d definitely recommend it as a career – it’s been a real privilege to treat so many patients over the years.” Brian Wilson is one of the patients who owes his life to the twins. AMBULANCE UK - APRIL

The 68-year-old father and grandfather collapsed at his home in North Finchley five years ago and Chris and Mark were there in minutes. Brian said: “I collapsed earlier that day and was taken to hospital but tests didn’t find anything wrong so I went home. I remember thinking I must be sick as I was seeing double – not realising they were twins at the time!”

76 For further recruitment vacancies visit:


Paramedic awarded fellowship to support mental health in emergency services staff Consultant Paramedic for North West Ambulance Service (NWAS), Vinny Romano

which helps to support colleagues who have

knowledge and experiences to continue to

attended traumatic incidents.

make improvements to staff welfare.”

During his trip, Vinny will meet up with his

Vinny’s role as a consultant paramedic specialises

overseas counterparts to explore research

in education, he works alongside NWAS’

they have done around support for emergency

Education Team to provide important clinical

services staff. He intends to bring back his

input into all aspects of training, including newly

knowledge and learning to NWAS so that it can

qualified paramedics and frontline ambulance

be used to make positive changes in the trust.

crews as well as within the trust’s patient transport

has been awarded a prestigious Winston Churchill Fellowship.

service and emergency operations centres. Vinny says: “In life you only get a handful of amazing and unique opportunities, and

Chris Grant, Deputy Medical Director, said:

The Winston Churchill Memorial Trust runs the

I believe this is one of them. The chance

“This is a really exciting opportunity for Vinny

Churchill Fellowships, a unique programme

to travel to parts of the world and explore

to gain from the knowledge and experience of

of overseas research grants. These support

how goals can be achieved and barriers

our colleagues overseas.

UK citizens from all parts of society to travel

overcome will allow me to, not only share

the world in search of innovative solutions for

these ideas, but expand and improve on

“On his return, we will embed his learning into

today’s most pressing problems.


our own system to the benefit of our patients

Vinny, 43, from Penrith has been awarded the

“Colleagues of mine who have previously been

our senior clinical leaders and this award is a

fellowship for 2019 to visit USA and Canada

awarded a Churchill Fellowship were able to

demonstration of how colleagues like Vinny will

to research staff support systems within the

gain a huge amount of valuable knowledge

continue to drive the profession forwards.”

emergency services.

by travelling to other countries and building

and staff. NWAS is committed to developing

After witnessing first-hand the difficulties that

relationships and I’m looking forward to doing

Vinny will start his journey in July when he plans

the same.

to travel to California before heading over to

emergency services staff face as a result of

Canada and New Orleans in September.

the work that they do, Vinny has a passion for

“I am keen to make contacts across

supporting staff and leads the trust’s Trauma

the countries I visit and maintain these

Follow Vinny’s journey on Twitter, @NWAmb_

Risk Management (TRiM) programme

relationships for years to come, sharing



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

IN PERSON appointment and I look forward to working

protocols, identified the seriousness of the

Trust announces new Chief Executive

closely with Philip to continue to help drive the

man’s condition.

“I know that his experience at South Central

intervention and the patient was sent to A&E.

South East Coast Ambulance Service NHS

Ambulance Service and his variety of public

Three weeks later the man called Liam to thank

Foundation Trust (SECAmb) is pleased to

and private sector experience will be of real

him for saving his life.


announce the appointment of a new Chief Executive.

organisation forward. Liam recognised the need for medical

benefit to the Trust. The judges said: “Liam’s passion for his role “I would like to thank Fionna for stepping up to

really shines through and he is a thoroughly

offer her expertise ahead of Philip’s arrival.

worthy winner.

“Philip said: “I am greatly honoured to have

“We were impressed with all Liam has

been appointed to this role and look forward

achieved in such a short time and by how he

to working with the excellent team in place at

used his skills to ensure a caller, who didn’t


realise he was having a heart attack, received urgent medical intervention. That man believes

I would like to thank both Daren and Fiona for

Liam saved his life – a great example of the

their leadership and I know that we will build

amazing work of control room staff.”

on their successes.” Chris Powell, Area Manager for NHS Direct WAS News

Young Call Handler wins prestigious Control Room Award Philip Astle, will take up the role on 1 September, replacing Dr Fionna Moore, who

Liam Masurier joined the Welsh Ambulance

has acted up as CEO on an interim basis since

Service as a Call Handler for NHS Direct

the departure of Daren Mochrie.

Wales at Thanet House, Swansea, in September 2017, aged just 21.

Philip joins SECAmb from South Central Ambulance Service where he is currently Chief

Having joined from the retail

Operating Officer.

sector, Liam, from Swansea, has been praised for using a host

Dr Moore will remain at SECAmb in her substantive position as Medical Director. Prior to joining South Central Ambulance Service in 2016, Philip enjoyed a successful career in the British Army including a lead role as a strategist and planner for operations in Afghanistan. His final role was as Chief Operating Officer of the Army Training and Recruiting Agency. Since retiring from the Army, Philip held a AMBULANCE UK - APRIL

number of senior operational and leadership roles in both the public and private sectors. These have included director roles in Border Force, on the London 2012 Olympics, as Chief

of transferrable skills, including excellent communication, customer care and team working, to support patients across the country. His drive and passion have seen him excel in many areas, including as the top performing call handler in his team. He has consistently demonstrated his ability to identify emergency situations rapidly and obtain appropriate and timely help for patients.

Operating Officer of Her Majesty’s Passport

One such example was a patient

Office and, most recently, Vice President of

who rang reporting dental pain

Menzies Aviation plc.

when, in fact, he was having a heart attack. Liam used his

Welcoming Philip, SECAmb Chair, David Astley

questioning and listening skills

said: “I am delighted that we have made this

and, following training and

78 For more news visit:

Wales at the Welsh Ambulance Services NHS Trust, said: “This is a fantastic achievement for Liam. The ‘Young Achiever of the Year Award’ recognises his contribution to our service and he is a deserved recipient. “Liam is not only dedicated and passionate about his profession as a call handler but is a kind and caring person too. I know the award will mean a lot to him and his family and he should enjoy and treasure it.”

You could be the most important person they never meet. 999 Clinical Supervisors Salary ÂŁ28,050 - ÂŁ36,644 pa + Unsocial Hours Payment.* Job ref: 202-324-18

As an experienced registered nurse or paramedic, your face-to-face assessment and diagnostic expertise would rival any health care professional. However, delivering these skills over the telephone to a worried patient is arguably the biggest challenge in healthcare. Success relies on the ability of the Clinician to communicate clearly and effectively, working in close collaboration with the wider health and social care network to deliver clinical excellence. Our team expertly deliver this service every day and we are looking for passionate and ambitious clinicians to join us.


In return, we offer flexible working opportunities, fixed-hour contracts and a competitive professional development programme, within a supportive working environment, which both challenges and rewards in equal measure. If you are an experienced nurse or paramedic looking to put your skills to the test, we would love to hear from you.

For more information about this unique opportunity, please visit *Paid under Section 2 of NHS Terms and Conditions.




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