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ISSUE 3 MARCH 2013
The Newsletter of the Association of Air Ambulances
ALL SYSTEMS GO
Since the AAA officially became incorporated at the beginning of the year, there has been a surge of important activity. Starting as it means to go on, the Association has made great progress on several important projects in the first two months of the year. The board and three sub-committees (Operational, Communications, Clinical) have all worked to advance their agendas and would like the wider membership to know exactly what the latest developments are. They include:
Standard Operating Procedures Five Standard Operating Procedures (SOPs) have been published in the past month. The Operations sub-committee has produced the HEMS Tasking SOP, which can be used across the sector to aid improvements in efficiency. Its aim is to guide air ambulances in best practice and it includes a standardised lexicon of terms so commonality of data can be established. Currently certain phrases mean different things to different teams and it is this sort of confusion that should be challenged. As an aside, the Association has also supported Dr Carl McQueen in securing his PhD application; his invaluable work will further explore tasking and increasing effectiveness in the identification of trauma. The Clinical sub-committee has issued Guidance SOPs on Caldicott - Confidentiality and Post-ROSC Care and also Clinical Guidance on Management of Major Haemorrhage and on Traumatic Cardiac Arrest. Both Clinical Guidance documents contain high-level detail of key areas of care that HEMS practitioners should observe.
NAAW National Air Ambulance Week 2012 was a great success and the Communications sub-committee continues to study information about related activity and additional income provided by member air ambulance charities. With lessons from 2012 in mind, the Communications sub-committee will work together to ensure NAAW 2013 is even better at both awareness-raising and also raising additional funds. We’ll keep you informed in Airway of all the latest news on NAAW.
Website The Association has briefed a specialist website design agency to create a brand new website for the Association. The process is in its very early days but the agency has presented some exciting new ideas and hopes to have the site live in midsummer 2013. The new site will be an important resource for members, with key information and documents contained in a Members Area.
CRACKING THE CODE As C Ai OT rw L A it ir ay AN w Am w ou a D ld bu s go TA be lan in K Fu gin ce ( g to ES ll r op SC p ep e AA res TO or rat ) a s, t n ion n Sc TH ex s no otl E t on un an SK iss 8 ce d’ ue Ap d s C IE . ril tha ha S 20 t rity 13 .
The Association believes it is crucial to cement the ever-increasing professionalism of its full members through the creation of a Code of Conduct. The hope is that the rest of the sector will also take note of the high standards that the Code sets, and will be encouraged both to follow the same standards and to join the Association.
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AAA is grateful to those members who offered their feedback on the initial draft of the Code of Conduct. A significantly revised document has now been created with a single page at the beginning giving its high level objectives. This is backed up with a procedural document which the AAA Board will follow. Any new members will need to demonstrate their commitment to meeting the standards of the Code. The new documents will be sent to all members shortly for further consultation and dialogue. One important new development is that the Association has made an agreement with the Fundraising Standards Board that allows the AAA to include the FSB’s own Code of Conduct within our Code. This will ensure clarity and consistency, and give members’ fundraising arms even more authority and credibility. As part of the agreement with the FSB, AAA membership now also means automatic FSB membership at no additional cost.
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PARTNERSHIP
IN ACTION Eurocopter can trace its involvement in air ambulances as far back as 25 years ago when the service first began. Today 21 of the 34 air ambulances are Eurocopter aircraft, mostly their EC135 but also the Bolkow 105 and the larger AS365. The company supplies the sector both as supplier to operators and also direct supplier to Trusts. It also prides itself on the full range of services it offers, such as servicing, technical support, repairs and training. Most important of all though, says National Resilience Sales Manager William Long, is Eurocopter’s commitment to partnership: “We have two ears and one mouth and should use them accordingly. This is my approach to working with our customers because we need to listen carefully to what their requirements are. Not only is this important to maintain customer satisfaction but it also helps us improve, innovate and seek the best solutions. Dayto-day customer contact constantly feeds into our research and development, while we also use our experience across sectors and nations to share best practice and new ideas.” One example of partnership in action is explained by Nigel Hare, Operations Manager for Devon Air Ambulance Trust: “One of our exciting developments in the future is being able to operate at night. Currently when the aircraft is shut down there is no power to operate the medical equipment or internal lights, meaning the
paramedics would be treating the patient in the dark. Working with Eurocopter has enabled us to specify a system whereby even when the aircraft is shut down, power is still provided to the medical installation. This enables our paramedics to treat patients without having to rely on torch light.” So, as a company in constant contact with its customers, what are the current big issues? William Long explains: “The first priority is safety, as it always is and always should be. Second is costeffectiveness. We are constantly looking at ways we can reduce costs for customers. At the moment we’re looking into extending service intervals for the EC135 from 400 to 500 flight hour intervals, for example, which would mean 25% more flying time before the next maintenance. And thirdly, noise is being talked about more and more. Our EC135 has one of the lowest noise signatures in its class and we’re working on improving it still further – but noise is a real challenge. We have some very clever people working on it but there’s only so much you can do.” Eurocopter would like to welcome members to visit its Oxford base to see for themselves how the Group operates, what its 1,500 employees across the UK do, what plans it has for the future and how it creates satisfied customers across the country. Left: The blades go on to DAAT’s new aircraft.
KEY ISSUES QUESTION The Association is asking members to review the Key Issues it has outlined and give their feedback. National Director Clive Dickin explained, “After extensive consultation, these are the issues we have identified for the Association to focus on, especially in our lobbying programme, in the months and years to come. I would like members to tell us if, in their view, we are focusing on the right things and if there is anything else they would add. I very much want members to understand this is a live document under continual review and all members’ views are very welcome.” At the latest board meeting, the board approved the Key Issues and also the way in which members can bring them forward. Members should present their Key Issues to the National Director in the first week of each quarter, ie the first week or January, April, July or October. The board will then consider which issues affect enough of the membership that they should be taken forward as Key Issues. The latest addition to the list is one recently raised by several air ambulance charities: it relates to the way supermarkets are dealing with lotteries. Many supermarkets have chosen to stop lotteries operating at their front doors and the AAA is now
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speaking to supermarkets and lotteries to seek a solution. More detail is available on the AAA website but the Key Issues in brief are: The removal of VAT in relation to the operation of air ambulances The maintenance of Ambulance Services as the primary coordinator of pre-hospital care The funding support of DoH for local air ambulances Improving helicopter landing facilities at trauma centres Clarifying inaccuracy and confusion regarding general HEMS, paediatric HEMS and transfer. Supermarkets’ treatment of lotteries.
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Email: info@aoaa.org.uk with your views.
www.associationofairambulances.co.uk
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TWO INSPIRING For two days in November, the air ambulance community came together to enjoy high quality discourse, take part in great learning opportunities, seize the chance to reunite with old friends and find new ones, and take part in important discussions on the future shape of the air ambulance sector. The 2012 Conference at Telford International Centre marked a step-change in the way the event was delivered, with more than double the number of delegates compared to the previous year and a real focus on providing top quality speakers to each strand within the sector. Delegates from the UK, Ireland and as far away as Hong Kong enjoyed invaluable opportunities to reflect on best practice, learn about innovations and keep themselves up to date with the latest thinking.
The conference The Conference delivered an ambitious programme of keynote speakers and experts from the NHS, emergency services, aviation and charities. Among the speakers were three senior emergency service chiefs: Anthony Marsh, Chair of the Association of Ambulance Chief Executives; Sir Hugh Orde, President of the Association of Chief Police Officers; and Vij Randeniya, President of the Chief Fire Officers Association. Following a welcome from the Association’s Chairman Anthony Marsh, the first keynote speaker set the tone for the event with a comprehensive overview of the health sector, the direction in which The three leading blue-light chairmen: Vij Randeniya, Anthony Marsh and Sir Hugh Orde.
Outgoing chairman Anthony Marsh with incoming chairman Bill Sivewright. it is heading and the challenges it faces. Professor Ian Cumming is the CEO of Health Education England and began his address by outlining the enormous numbers involved in healthcare in the UK. He explained that £104 billion will be spent on healthcare this year, and 1.4 million staff are employed in the sector – comfortably the largest employer in the UK. Health has managed to escape budget cuts to date but must prepare for a tougher financial future – but must also respond decisively to other drivers for change including advances in treatment, the changing nature of disease and ageing, patients’ higher expectations and the effect of the information age. For the next three sessions, delegates were then able to attend seminars relevant to their sector: charity and communications, air ambulance operations or clinical excellence. The sessions got off to a flying start with the renowned trauma surgeon, Professor Sir Keith Porter addressing the clinicians while Captain Brian Baldwin from the CAA addressed a packed room waiting to hear about the latest developments in Night HEMS. This impressive start continued as all three strands enjoyed presentations of high quality across both days, while keynote speakers from the National Ambulance Commissioners Group and the CQC continued to engage, surprise and stir debate. The first day’s formalities were closed with a Question Time panel taking questions from the floor before National Director Clive Dickin spoke briefly
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NG DAYS Left: After-dinner speaker, Dr Phil Hammond.
Above: Anthony Marsh addresses delegates. Left: The RNLI’s Paul Savage speaks to clinical experts. Below: The busy exhibition area. Above: Question Time. Right: The conference.
Left: A discussion in full flow. about the Association, its current period of growth and change and some of the major developments to look forward to in 2013. The evening was devoted to entertainment, with the dinner, disco, presentations and after-dinner speech by comedian and GP Dr Phil Hammond. A room full of 180 people enjoyed the chance to relax, catch up with colleagues and share stories – and the odd glass of wine. It was back to business the following day, however. Sponsors once again enjoyed plenty of chance to talk to customers and prospects, and the high quality line-up of conference speakers continued to draw in the delegates.
New beginnings Although only a short meeting on the second morning, the wellattended AGM marked a significant milestone in the AAA’s development. A series of five resolutions were passed unanimously, which allowed the Association to become a company limited by guarantee from 4 January 2013. This will be the foundation on which the Association’s continued growth and development will be built. The meeting also saw Bill Sivewright formally appointed Chairman, while the Board of Directors for the new organisation was also voted for and announced. The Board members are: Bill Sivewright, Hanna Sebright, Jane Gurney, Peter Aldrick, Steve Wheaton, Paul Leaman and Nigel Hare.
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Bill Sivewright paid tribute to his predecessor, Anthony Marsh: “I would like to pay tribute to the excellent work undertaken by Anthony in moving the agenda forward in a number of key ways. His drive and determination will be seen as a turning point in the future of the Association.” Also looking to 2013, the Association officially launched at the conference its new Air Ambulance Awards of Excellence. These Awards, which will be presented for the first time at next year’s event, will recognise some of the outstanding individuals in the sector, rewarding their effort and dedication with a prestigious Award. The nine awards will celebrate achievements in fundraising, operations and clinical delivery of an air ambulance. Each award is sponsored by dedicated supporters of all local air ambulances and is open to any organisation across the UK and Europe that meet the entry criteria. Each award will be judged by an independent panel of experts drawn from charitable, operational and clinical backgrounds. Looking back on the Conference, Clive Dickin, National Director of the Association, said: “This was an ambitious conference but I was delighted to see it backed by so many people from across the industry. The interest delegates showed in updating their knowledge and sharing best practice just demonstrates the commitment and enthusiasm people in this sector have for their work. I hope to be able to bring more excellent opportunities like this to AAA members during 2013.”
www.associationofairambulances.co.uk
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PRIORITIES
FOR 2013
Much of AAA’s work is done through three important sub-committees. Here, each sub-committee reports on its work and plans for 2013.
Communications sub-committee Jane Gurney, chair of the sub-committee, writes: A major part of the Communications sub-committee’s efforts focused on the first ever nationally co-ordinated National Air Ambulance Week in September. It was a great success, with many local air ambulance charities telling us how it increased both income and awareness. This was in no small part due to the way AAA members embraced the idea and made it work. We’re now in the process of understanding what worked well and what didn’t, and we will feed this into the process for NAAW 2013 to make it even better. Looking ahead, our priorities revolve around consistency in our communications, key messages and our digital platforms. When dealing with national issues we need to speak consistently and with one voice – but without losing the local identity of each of the air ambulance charities. Consistency is important when we are speaking to the general public but it’s especially crucial when speaking to legislators and the media. I believe that as a sector we are more joined-up now than we’ve ever been but there is still some real work to do. We are working to ensure our key messages are current, up to date and consistent, and we will shortly introduce our priorities for the coming year. It will be important for individual air ambulances to constantly refer back to the key messages to ensure we continue to develop our single voice. We are well aware of the need to maximise our use of online communication channels, especially as we seek to increase the value of AAA membership. There is plenty to be done and we will report back on our progress, which will include the creation of much more useful information in the members-only pages of the website. We have achieved a great deal over the past year and now want to really build on the hard work that everyone has contributed and help us strengthen the AAA.
Clinical sub-committee Adrian South, chair of the sub-committee, writes: The Clinical sub-committee was refreshed during November 2012 to ensure that it was fully fit for purpose moving forward within the increasingly strengthened and clinically-focused AAA. The main purpose of the new sub-committee is to provide members with a clinical forum to discuss issues, develop guidelines and SOPs, agree national best practice and above all to promote the delivery of the very highest standards of prehospital care across UK HEMS. The major workstream during 2013-14 will be the development of a set of national clinical SOPs, which incorporate the latest evidence and are developed by members in partnership, for the benefit of all. The first SOP, covering
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Operations sub-committee Becky Tinsley, chair of the sub-committee, writes: Our key workstreams this year include the following: Aircraft call-out guidelines / dispatch criteria - Best practice guidelines are being developed, demonstrating areas of best practice nationally. Once complete, these will be available for air operations units to use to ensure uniformity when dispatching aircraft - depending on the geography of the area they cover - based on the clinical requirement of the patient. The AAA is also supporting an evidence-based study to demonstrate patient groups benefiting from the service. Major incident response/mutual aid agreements - Major incident guidelines to include mutual aid and multi air asset response are being reviewed and considered. Collaborative working relationships with other emergency air services are underway to ensure a unified approach for the final document. Standardise operational data - Data is being requested to ensure we can report nationally on how we are all integrating and performing in this specialist field. The information collected will help demonstrate what is happening nationally and enable us to demonstrate best practice. KPIs - There are no nationally agreed KPIs for aircraft responses. We will review this and agree key areas we should monitor as individual air ambulances to ensure compliance and best practice based on our performance. Risk management – We are developing a platform for sharing key information to ensure any areas of risk can be shared and disseminated in a timely manner. Equipment – We are developing a list of equipment used by all air ambulance units. Once populated, this can assist in cost-efficient national procurement. Night operations (HEMS) – Using information from operators and air ambulance operations, we are constantly reviewing and monitoring Night HEMS to ensure that the service can be used to its full potential safely. UKSAR/HEMS working group The operations sub-committee is also represented in a number of other key agency meetings including the Emergency Air Response Group, chaired by UKSAR and DOH. We are also members of other organisations such as UKSAR and NPAS.
on-scene photography, has already been published and a range of topics including post return of spontaneous circulation care and major haemorrhage are due to be approved at the February meeting. I have been appointed as the new Chair of the clinical subcommittee and as Deputy Clinical Director for the South Western Ambulance Service, I hope to bring a wealth of experience in the development of SOPs. I’ve recently been leading a project to harmonise the clinical practice of 3,000 clinicians across the Great Western and South Western Ambulance Services, which became one organisation on 1 February 2013. Through the review of every single clinical publication, we managed to achieve almost complete standardisation of practice by day one, something not previously achieved by an ambulance service. I’m looking forward to using this experience to support the work of the AAA.
www.associationofairambulances.co.uk
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FINGER ON THE PULSE ZOLL Medical Corporation develops medical devices and software solutions that help advance emergency care and save lives, while increasing clinical and operational efficiencies. The company has recently joined AAA and is looking forward to working with members, says Senior Marketing Manager, Jill Garratt: “Having proved the value of our products in the field of resuscitation, we can’t wait to show air ambulance operators how we could help them advance patient care and improve outcomes. We are already working closely with four air ambulance charities and would like to work even more broadly on developing pathways that get patients to the most appropriate centre, for the right intervention, as quickly as possible.” Among the trailblazing air ambulance charities to be using ZOLL equipment is London’s Air Ambulance which has set up the first pavement to PCI pathway in the UK. This pathway takes specific patients in cardiac arrest direct to the cathlab for PCI with the use of ZOLL’s AutoPulse Non-invasive Cardiac Support Pump. Great North Air Ambulance Service (GNAAS) has also equipped its aircrafts with the ZOLL AutoPulse. This automated, portable chest compression device will be used on all cardiac arrest
Dates For Your Diary The Association has released a set of proposed dates for the coming year’s major events: 16 May 2013 – Members Forum and EGM. Presentations, workshops and networking. Open to all members. At Life Connections, Kettering Conference Centre. 11 June 2013 - Air Ambulance All Party Parliamentary Group, Palace of Westminster 22 November 2013 (Date to be confirmed) AAA Conference and Air Ambulance Awards of Excellence. For more information on any of these, please contact the Association.
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Contact Details Association of Air Ambulances Ltd. 50 High Street, Henley in Arden, Warwickshire, B95 5AN. Email: info@aoaa.org.uk Website:
Above: The ZOLL AutoPulse machine.
Above: Jane Peacock, Lead Paramedic at GNAAS. patients. It delivers consistent, uninterrupted, high-quality chest compressions via a load-distributing LifeBand, which squeezes the entire chest, improving blood flow to the heart and brain during sudden cardiac arrest. The AutoPulse is especially useful when patients are being transferred from the ground to the stretcher, from the stretcher into the helicopter, and during flight to hospital. Blood flow can be continued throughout the rescue and rescuers freed up to focus on critical interventions. “I don’t normally get excited about medical equipment but this device is amazing,” said Jane Peacock, Lead Paramedic at GNAAS. “The AutoPulse will save lives. We have used this device a couple of times now and we are seeing great results. We have even witnessed return of spontaneous circulation on patients whose hearts had completely stopped.” ZOLL also provides products for pacing, defibrillation, circulation, ventilation and fluid resuscitation - a comprehensive set of technologies to help clinicians resuscitate sudden cardiac arrest or trauma victims. Another recent introduction is the X Series monitor/defibrillator. The X Series is about half the size and half the weight of other fullfeatured monitor/defibrillators but a lot more powerful. ZOLL says it is compact without any compromise in display size, capability, or performance. Jill Garratt concludes, “We’ve already seen great results from our early adopters and we firmly believe our equipment can help all air ambulance charities save lives. I’d be really pleased to speak to anyone interested in the products or who would like a demonstration.”
SECTOR EDGES TOWARD
NIGHT FLYING
Bond Helicopters Europe has announced that the European Aviation Safety Agency (EASA) has approved one of its EC135 aircraft for night vision goggles (NVG) operations to ground level, a significant step towards the UK’s first night air ambulance operations.
The pace of the move towards Night HEMS has slowed in recent months but several manufacturers, operators and charities have continued to work hard behind the scenes and there are hopes that the Spring could bring the first night flights. Now that Bond, which is working on Night HEMS with East Anglia Air Ambulance, has received the EASA Supplemental Type Certificate (STC) approval for a night vision imaging system (NVIS) modification to a Eurocopter EC135 helicopter, the next step will be to secure operational approval from the UK Civil Aviation Authority (CAA), a process that is ongoing. Meanwhile, Kent, Surrey and Sussex Air Ambulance Trust (KSSAAT) has signed a contract with operator Medical Aviation Services (MAS) in a deal that will see the introduction of a new Night Vision equipped MD 902 Explorer helicopter, which will be flown by a two-pilot crew and operated from the Trust’s new base at Redhill in Surrey. This follows the recent successful evaluation by EASA of night vision trials conducted by MAS using the Explorer.
www.associationofairambulances.co.uk
Telephone: +44 (0)1564 339959
www.associationofairambulances.co.uk