Volume 30 No. 5
October 2015
DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS
Yorkshire Ambulance Service Adopts the AutoPulse Resuscitation System
In this issue Creating a culture for decisions Theory and Evidence Clinical Assessment on the right path
A strong
head and
a good heart...
Think
outside a box
...are always a
formidable combination.
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CONTENTS
CONTENTS 236
EDITOR’S COMMENT
238
FEATURES
238 Creating a culture for decisions
242 Theory and Evidence
Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street SWANLEY BR8 8BQ ADVERTISING & CIRCULATION: Media Publishing Company Media House, 48 High Street
248
Clinical Assessment on the right path
250
NEWSLINE
280
IN PERSON
282
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COVER STORY
SWANLEY, Kent, BR8 8BQ
Yorkshire’s Ambulance Service Adopts the AutoPulse Resuscitation System
The views and opinions expressed in
PUBLISHERS STATEMENT: this issue are not necessarily those of the Publisher, the Editors or Media
In a move to make further improvements to the treatment of patients suffering an outof-hospital cardiac arrest, Yorkshire Ambulance Service NHS Trust has invested in 16 AutoPulse® Resuscitation Systems to assist with providing vital life-saving chest compressions. The ZOLL AutoPulse equipment is an automated cardiopulmonary resuscitation (CPR) device that delivers customised, high-quality CPR wherever and whenever a patient needs it. The devices have been allocated to members of the Trust’s dedicated Red Arrest Teams which respond to patients in cardiac arrest, provide life-saving treatment and organise rapid transfer to a specialist facility such as a hospital cath lab.
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Dr Steven Dykes, Deputy Medical Director at Yorkshire Ambulance Service, and his colleagues selected the AutoPulse after an extensive evaluation because it is easy to use and enables the Red Arrest Teams to extricate and move patients with no interruption to life-saving chest compressions.
For Yorkshire Ambulance Service, the flat design of the AutoPulse is also beneficial as it makes it possible to store the units very easily aboard its rapid response vehicles and can be carried as a backpack by paramedics as they rush to the aid of patients.
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Commenting, Dr Steven Dykes said: “The AutoPulse is designed for resuscitation on the move and increases the number of treatment options for clinicians dealing with cardiac arrest patients. I’m confident that this innovative tool will help us to save more lives.”
Rest of the World:
235 Do you have anything you would like to add or include? Please contact us and let us know.
EDITOR’S COMMENT
EDITOR’S COMMENT Welcome to this issue of AUK A busy couple of months in the NHS, the pressure is still firmly on but the Urgent and Emergency Care Review revealed recently puts the future firmly in perspective. The only way is not Essex but wherever the patient happens to live! In other words, high quality, safer care closer to their home. Only by improving both hear and treat and see and treat will the system remain able to accommodate those genuinely in need of admission to hospital in the future.
“Only by improving both hear and treat and see and treat will the system remain able to accommodate those genuinely in need of admission to hospital in the future.”
Now for as long as I can remember I’ve been advocating the development of Paramedicine as a recognised profession with a key role in the future delivery of patient centred care. It would seem that somewhere along the way someone else had the same idea. The UECR mentions ‘a new clinical model’ for the ambulance service. No matter who you ask there is little information about what this may mean. The inference being that there is no clear plan for an ambulance service which continues to exist in its current format. I suspect, having looked at the briefings from Health Education England that the future model will see Paramedicine as a graduate profession with each Ambulance Trust tasked with the development of level 7 practitioners who will be able (or mandated) to work right across the health economy, not just in Out of Hours supporting GPs but at the frontline of A&E, Urgent care and even Mental Health practice. This is surely evidence that to work, the system will have to rely on the generalist skills and knowledge inherent in Paramedic practice to ’feed’ the patient care needs of the future. It seemingly indicates that a decision might have already been made to fund accelerated development of ambulance staff to meet the demand for practitioners in the new urgent care agenda. This may well be the most exciting thing to happen for years… The future for paramedic practitioners has probably got somewhat brighter since in a demand driven economy, the price of commodities usually goes up… There is though a small fly in an otherwise shiny ointment. Research…but more specifically pre-hospital research particularly around the needs of the individual patient groups or the economic contribution of services we provide. We are mentioned in some guidelines but contribute little to their development, unintentionally leaving what actions are recommended for us to be fairly basic. There is only one way to remedy this and the solution sits squarely in our lap. So there you have it, another packed edition, hot from the press in time for you all to peruse whilst visiting the world famous Life Connections later this month in Kettering. I’ll be there, please feel free to pop into the exhibition hall and chat in between the excellent conference program…
Sam English, Co-Editor Ambulance UK
AMBULANCE UK - OCTOBER
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237
FEATURE
CREATING A CULTURE FOR DECISIONS DURING RESUSCITATION Philip Quirk – Director – HBP Training ltd – HF specialist Steven Shackleton – Clinical Tutor – South Western Ambulance NHS Trust Key words – Human Factors, Team development, Transactional Analysis Succinctly summarised, Human Factors is the study of the non-technical skills (NOTECHS) present in accidents. Perhaps more importantly than this though it also develops measures of prevention against such occurrences. Human Factors concerns itself with how the central human operative interacts with several other components: such as environment, hardware, software and also other humans – colloquially known as the SHELL model1.
Human to human interface The human interface with other humans is understood as the most complicated relationship since both parts are continuously changing from moment-to-moment, and also perhaps occasionally unpredictable! The care environment is a dynamic constantly shifting continuum whereby likely outcomes change from minute to minute and information is often slow to arrive or reliant on diagnostic testing, it is full of unseen potentials unfolding along the timeline. The most complicating factor perhaps is that healthcare teams are often not close nit units familiar with the ways each other operate but more likely An ad hoc group thrown together for a shift , or in the case of resuscitation team called together to perform and this can also including staff unfamiliar even in the surroundings such as agency staff. In the pre hospital world there is also the multi agency approach and the individual good Samaritan to deal with. At the centre of these safety critical collaborations is the requirement for complimentary communication, which in itself is atypical of the humanto-human interface. Lessons can, and should be learned between different industries. There is much for health professionals focussing on resuscitation or other
Environmental considerations within a resuscitation event are now being studied and our relationship and that of fellow clinicians relating to the placement of equipment is a fascinating area to research, design of resuscitation areas and space creation are coming to the fore in many of our hospitals.
critical events to gain from understanding how aviation has embraced and developed Human Factors. The aim of this is to identify where improvement has been made following incidents that aid future delivery and avoid negative outcomes There have certainly been challenges in Aviation’s Human Factors
In prehospital care, specific techniques are taught to crews to enable
journey - and some still remain. Notably pilots scepticism of the
the smooth running of a cardiac Arrest - such as the airway kit
psychological component of HF, sometimes known affectionately as
going on the patients Right hand side - (dictated by the fact that the
‘psychobabble’ within pilot online chat forums.
laryngoscopes is a left handed tool) which enables the ET tube to AMBULANCE UK - OCTOBER
238
passed into the intubators free hand (the right).
This is almost certainly similar In medicine and the field of resuscitation, clinicians tend to be rightly proud of their clinical ability and focus on
These basic techniques all assist with the smoothness of the lifesaving
technical aspects of their role to improve their performance. There
event.
remains some scope for developing human factors training that uses examples to tease out the failures not of technical competence but of
Throughout medicine there are other examples of how adaptation
the interactive process and identify methods for reducing likelihood of
following failure / critical incident that was attributable to Human factors
error. This is supported by the work Professor Pat Crosskerry and Dr Mark
has taken place. The development of checklists, processes for challenge
Graber who have both pushed the importance of de-biasing strategy
and response and development of new hardware such as the colour of
to avoid diagnostic error this work certainly overlaps, whether it is the
resus drug boxes all come from and understanding that Human Factors
success or failure of a group task such as resuscitation or an individual
and human fallibility play a significant part in the delivery of critical care.
diagnostic error there will often be a human factors element to it.
1
Ebermann HJ, Scheiderer J. Human Factors On The Flight Deck. Frankfurt, Germany: Springer, 2013.
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FEATURE
239
FEATURE There are however, without doubt, effective models that can be migrated
behaviour, to attempt culture change and accept that whilst hierarchical
from Psychology to better improve safety critical communication,
systems are useful for clinical seniority, expertise and accountability
notably Dr Eric Berne’s Transactional Analysis (TA)2.
there still needs to be a freedom for all involved to communicate and provide a human backstop to error when the potential is identified. This shift in culture can only begin once an understanding of the human factors affecting outcomes is widespread. It involves the most senior and the most junior in equal measure. Many of us have realised that the best person to be leading a cardiac arrest is often not the most senior clinician, or the greatest clinical brain, but may in fact be one of their juniors who specialises in ALS or Paediatric ALS. Their confidence to take charge, to speak out and dictate a course of action that over rules the established rules. Perhaps the most devastating example of a Human Factors failure / communication failure can be found in Aviation. On Sunday 27th March
Within aviation there is an identified barrier to effective communication,
1977 two Boeing 747’s, one from Pan Am and one from KLM, collided
known as Cockpit Authority Gradient.
on the runway of Los Rodeos Airport, Tenerife.
Without doubt this authority gradient is required to ensure a needed
It is still regarded as the worst aviation disaster of all time with the loss
hierarchical structure remains in place to protect against a demographic
of life standing at 583. Although as always with a major accident there
assault on effective decision making processes. Rather the discussions
were many contributing factors, one of the most subtle, yet crucial was
and debates centre on the situational steepness of the gradient.
the steep Cockpit Gradient on the Dutch KLM flight.
This authority gradient can become counter productive in any industry where the established authority, by definition of itself, can compromise effective safety critical communication.
Many breakdowns in communication took place between both planes and Air Traffic Control (ATC), heightened by dense fog on the runway and the closure of Gran Canaria Airport after a bomb explosion. The authority gradient was very steep in the KLM flight3. Captain Van
Parent
Parent
Zanten was the highest ranked pilot in KLM, his co-pilot did not feel empowered to communicate the mistake he had noticed about the permission to take off from ATC.
Adult
Adult
There is a psychological reason for the co-pilots lack of assertiveness, even in the presence of such catastrophic danger. The answers potentially lie in Dr Berne’s Transactional Analysis – a psychological pill for a psychological ill.
AMBULANCE UK - OCTOBER
240
Child
Child
Agent
Respondent
A similar cockpit authority gradient exists in medicine, with medical consultants and surgeons having hundreds of years of established hierarchies, but also within their own professional communities, overlaying the nursing hierarchy and other healthcare professionals.
There are 3 ego states in Transactional Analysis model the Parent, Adult and Child. The Parent can further be divided into Critical Parent and Nurturing Parent, the Child ego state also can be further divided into Free Child, Little Professor & Adaptive Child. The Adult ego state remains singular, this is because this ego state is rational, in the now conscious thought process without contamination. This is also the most rational ego state for effective communication.
Many now acknowledge this and recent confidential enquiries have caused us to question the established norms. The aim of human factors
The barrier to communication on the KLM flight was the established
training and discussion is to provide awareness to those within the
Capt. who was operating from a Critical Parent ego state, the co-pilot
organisation to ensure an understanding of how this may affect their
had been forced into Adaptive Child, which is complimentary.
2 3
Hay J. Transactional Analysis For Trainers. Hertford, UK: Sherwood Publishing, 2009. Grech M, Horberry T, Koester T. Human Factors in the Maritime Domain. Boca Raton, Florida: CRC Press, 2008.
FEATURE When in an Adaptive Child state the person can lack assertiveness and
Effective communication is central to the success of modern day
becomes passive in decision-making. The results from this can be as
businesses, especially those who work in the presence of high risk
disastrous as they are entirely avoidable.
and consequence. Any body of knowledge that improves safety critical communication should be researched, understood and if appropriate
A basic understanding of how authority gradient can produce passive
taught. It is often simply a matter of raising the subject and promoting
participants in important decisions could prevent many accidents from
discussion.
occurring. Human Factors training gives organisations the opportunity to engage directly with employees about how they may implement change
Resuscitation experts are now being taught the importance of
to avoid error such as checklists, a process of challenge and response
human factors, teams who work together are trained together, and
for critical skill intervention or simply an improved reporting process and
communication and critical incidents are simulated and practiced.
less punitive approach to serious incident review.
Team briefings, in situ simulation and recreating critical incidents and debriefing are all seen as essential components of the modern
The fallibility of humans can never be overlooked and unfortunately
resuscitation team. The real difficulty comes when, as mentioned earlier,
this fallibility does not recognise the seniority of qualifications and
the team are nothing more than a group with a vague knowledge of
experience, furthermore the most competent humans are capable of the
each other. It is probably here that an understanding of how Human
biggest accidents.
Factors can influence outcome would be paramount and also where some of the useful preventative measures such as checklists are useful
When we acknowledge this fallibility we immediately step closer
to set the standard and reduce the opportunity for error. This is perfectly
to a safety culture by recruiting the balanced views of supporting
illustrated in the Resuscitation Council UK ALS algorithm.
professionals, this is best achieved by Adult-Adult transactions. By offering Human factors training an organisation ensures staff are aware of this fallibility and mindful on the effect it may have on decision making and outcomes. It produces an environment open to change and a willingness to engage in system improvement. There has been a cultural development within the Royal Air Force RAF in which the flying instructors first words to the trainee pilot is to actively encourage the questioning of any decision the trainee feels is unsafe. This is because statistically it is the senior pilot who will cause the plane to crash through cockpit gradient. Below is an example of a medical emergency in aviation in which the Professor visibly shallows the authority gradient to produce the right
In pre- hospital care many interactions involve hierarchical, human and environmental factors, decisions about when to move patients, how to move patients, looking after relatives and the safety of the scene, ourselves and other crews are all areas that can and will need to be considered and communicated. As the clinical science of resuscitation grows so will the focus on the other aspects that impact on patient care. Human Factors training has the potential help organisations and teams accept and manage the unseen challenges of human interaction in the high risk dynamic environment of Resuscitation and Critical Care.
diagnosis.
About HBP-Training
Orthopaedic surgeon, Professor A.W Wallace, showed thorough and
Whether working with South Pole adventure teams, fast jet pilots or
creative option checking when he was travelling from Hong Kong to LHR
financial sector bankers, HBP-Training understands the importance
on an aeroplane.
of the central human component of the SHELL model and strives for excellence in all levels of performance across industries.
He was asked to care for a passenger who had developed chest pain (who had been involved in a motor cycle accident before boarding the
Their unique ability to design, deliver and measure bespoke
plane). The passenger rapidly became seriously unwell. A pneumothorax
developmental training interventions ensures they target specific areas
was suspected by the Professor (this happens when a damaged lung
in order to create the most positive and safe working environment
leaks air into the pleural space, between the chest wall and the lung;
possible.
when the air becomes trapped, the lung collapses and threatens life). cultures and national cultures that also impact upon patient care and
for a junior doctor. Dr T. Wong, who was also on the plane, agreed with
the hierarchies within the organisations we support.
the diagnosis. They then improvised a chest drain set using a urinary catheter, a coat hanger as a trocar, adhesive tape, oxygen tubing and a
We are keen to share our knowledge with teams of clinicians who seek
plastic bottle of mineral water as a water trap. They also used five-star
to develop safe ways of working.
brandy as a disinfectant. The patient made a full recovery.4 Phil Quirk – Co-Director of HBP-Training. The professor felt comfortable to seek the advice of a junior and between
www.hbp-training.com
them a solution was developed.
phil.quirk@hbp-training.com
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We strive to ensure that we take time to understand the occupational With minimal aids to diagnose, the Professor asked for a second opinion
241 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE
CRITICALLY EXAMINING THE THEORY AND EVIDENCE SURROUNDING PREHOSPITAL RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA (REBOA) IN TRAUMA PATIENTS Piers James Peberdy - Paramedic
Key words:
Discussion
Reboa, Trauma, Aortic Balloon, Combat Gauze
Caroline (2008) states that hypotension without obvious external bleeding is a common sign of pelvic injury and lists other signs of symptoms of trauma to the pelvis, to include pain in the groin and
Introduction
hips as well as haematomas or contusions in the pelvic region. To this
When it comes to trauma, shock is the leading cause of
binder as the first line management to stabilise the pelvis for trauma
end, Acharya and Forward (2014) recommend application of a pelvic
preventable deaths (Barash, Cullen and Stoelting et al, 2013). Patients who fall victim to high energy mechanisms of injury, such as road traffic accidents (RTC’s) or falls from height, are particularly susceptible to pelvic trauma (Dolan and Holt, 2013). Fractures to the pelvis can be complicated and of course lethal when taking into consideration surrounding vasculature. It is
patients who present with hypotension and a potential for pelvic injuries. Salamone, Pons and Guy et al. (2007) provide rationale behind this way of thinking, explaining that because some pelvic injuries are associated with an increase in abdominal volume, eg: the ‘open-book’ fracture, there becomes less tissue surrounding the pelvis to ‘tamponade’ the bleeding. Salamone, Pons and Guy et al. (2007) continue to say “Before
well documented that a patient can quickly lose their entire
the development of pelvic binders, patients with these injuries and
blood volume into the pelvic cavity (Caroline, 2008), therefore
haemodynamic instability would almost always undergo external fixation
clinicians must carry a high index of suspicion when assessing
of the pelvis to decrease the pelvic volume and increase the likelihood
the poly-trauma patient.
of tamponading haemorrhage.”
In the civilian prehospital arena there have been several recent
This leads to another form of management for patients with pelvic
evidence-based advances in trauma care, including the use
trauma, which is fluid resuscitation. Previous thinking has led the
of tourniquets as well as the introduction of pelvic binders and
prehospital care provider to administer fluids aggressively however
tranexamic acid in order to increase chances of survival to
more recent evidence shows “permissive hypotension” as best practice
discharge for trauma patients. Research aimed at enhancing trauma
(Durusu, Eryilmaz and Özturk et al, 2010). Acharya and Forward (2014)
care has utilised the Afghan War as its ‘springboard’ due to the
explain this further, stating that this practice stems from the ideation
high number of casualties seen in the binational hospital at Camp
that the first clot is the best clot: “permissive hypotension theoretically
Bastion, Helmand Province (NHS, 2013), and includes the long
protects the initial clot and prevents clot dislodgement.” For this, initial
debated issue of fluid management with emphasis on ‘permissive
crystalloid fluids should be used sparingly such that systolic blood
hypotension’ having found that “the first clot is the best clot”
pressure is kept between 70-80mmHg, with the exception of patients
(Acharya and Forward, 2014). An emerging topic of conversation
with head injuries (NICE, 2004).
is the utilisation of prehospital Resuscitative Endovascular Balloon
AMBULANCE UK - OCTOBER
Occlusion of the Aorta (REBOA) a technology which, although
It is recognised however that crystalloid fluids possess no oxygen-
having existed for a number of years with a good theory base, has
carrying capability (Pante and Pollak, 2010) and therefore have
never been utilised in the acute trauma patient (Paetow, 2014).
limited benefits when it comes to the goal of replacing blood and its constituents. It could also be argued that not all pelvic ring injuries
This literature review will analyse and critique the underpinning
will benefit from compression by pelvic binders, in particular lateral
evidence surrounding prehospital REBOA. Current standards in
fractures. One could therefore question if pre-hospital management of
trauma care will be discussed and the subsequent effect on patients
pelvic trauma is substantial. Despite the opening of numerous Major
if a change in clinical practice were to occur. Protocols, guidelines
Trauma Centres (MTC’s) in April 2012, an analysis of ambulance service
other issues (eg: environmental) will be taken into consideration,
data by Morrison, Lendrum and Jansen (2013) showed that as much as
with a view to summarising the feasibility of REBOA as a ‘standard’
76.4% of patients with haemodynamic alterations suggestive of blood
in both military and civilian healthcare systems. Areas for
loss were taken to a hospital without full surgical capability, suggesting
development of research, as well as personal learning will also be
that crews fear they did not have enough time to transport that patient
highlighted.
to more definitive care at a trauma centre. With haemorrhage being the
242 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE leading cause of preventable death from traumatic injury (Tien, Spencer
dressing, or no intervention at all. Morrison, Percival and Markov et
and Tremblay, 2007), the need for improved methods of haemorrhage
al. (2012) recorded rates of haemorrhage as well as mortality, which
control beyond the scope of standard paramedic practice has catalysed
showed that the group with no intervention has the fastest rate of
the start of a number of studies into the feasibility of using REBOA for
haemorrhage and suffered 100% mortality, which is to be expected.
shock as a result of trauma.
Groups that received REBOA or combat gauze dressing had drastically reduced rates of haemorrhage (822+/- 415ml/min versus 11+/-13ml/
According to Davenport (2013) REBOA is described as the insertion of
min and 0.2+/-0.4ml/min respectively) and had much improved
an end vascular balloon into the femoral artery, which is then advanced
mean arterial pressures (MAP), both 15 minutes and 180 minutes into
into the aorta and inflated in order to control haemorrhage and therefore
each procedure: 70+/-4mmHg for combat gauze, 70+/-11mmHg for
increase perfusion to the heart and brain. This is not a new technology,
REBOA versus 5 +/-13mmHg for the control group. Morrison, Percival
as Stannard, Eliason and Rasmussen (2011) explain that this procedure
and Markov et al. (2012) report no deaths in the intervention groups,
was described over 50 years ago whilst resuscitating injured Korean
although it was noted that pigs subjected to REBOA had greater fluids
soldiers, and despite a brief mention in an emergency medicine
requirements during the resuscitation phase, which one could argue is
journal in 1986, literature surrounding REBOA hasn’t been seen again
resolved easily. These results show REBOA in a promising light however
until 2011. According to Paetow (2014), the lack of traction regarding
based on this data, one might question the necessity for REBOA when
REBOA research may have been down to “sub-optimal endovascular
it has such similar results to combat gauze which is both cheaper and
technology, a poorly understood skill set or anticipated ineffectiveness.”
easier to use. This can be addressed by the simple explanation that not
Indications for REBOA include shock as a result of haemorrhage,
all haemorrhage is compressible or accessible (Salamone, Pons and
abdominal trauma (both penetrating and blunt mechanisms), pelvic
Guy et al, 2007) which renders combat gauze ineffective, or at least of
fractures causing abdominal bleeding, ruptured aortic aneurysms
limited use, should it not be placed correctly.
or “the crashing trauma patient with no obvious injury on cardiac ultrasound” (Paetow, 2014).
Morrison, Percival and Markov et al. (2012) repeated the study using pigs that had been subjected for dilutional coagulopathy. In this setting,
Stannard, Eliason and Rasmussen (2011) simplify the manoeuvre
it was found that REBOA was superior to combat gauze following a
into five steps: 1 - Femoral artery access, either by cut-down or
rate of bleeding of 20+/-7ml/min versus 229+/-295ml/min respectively.
percutaneously using ultrasound guidance, 2 - Balloon selection (those
MAP was also higher in the REBOA group, with five deaths occurring
which are soft and compliant) and positioning, either with or without
in the combat gauze group, compared to nil in the REBOA group. With
fluoroscopy 3 - Balloon inflation using a 30-60ml solution of sterile
this in mind it could be suggested that in theory, and despite greater
saline 4 - Balloon deflation, 5 - Sheath removal and closure of the artery
fluid resuscitation needs, the use of REBOA for non-compressible
once REBOA is no longer required.
haemorrhage is feasible.
For this critique, numerous databases were used to search for papers
This study is reflective of that by Martinelli, Thoni and Declety et al.
relating to the use of REBOA for trauma. These included CINHAL Plus,
(2010) who, using a constructed algorithm, selected 13 patients out of
Medline, Science Direct and Scopus. These databases were chosen
a possible 2064 that were being treated for uncontrolled haemorrhage
for their dedication to medical science and evidence based practice.
as a result of pelvic fractures. A range of mechanisms of injury were the
In order to ensure the quality and relevance of research retrieved,
cause of admission to the emergency department, including vertical
numerous parameters were employed including limiting the results to
falls and road traffic collisions (RTC’s), which one could suggest are
within the last five years. For ease, search results were limited to those
commonly seen by civilian medical services. Martinelli, Thoni and
written in English. Search terms ranged from simply “REBOA” to REBOA
Declety et al. (2010) report that all balloons were successfully placed
AND prehospital” and “REBOA AND Trauma”.
without the need for fluoroscopy, with a significant increase in systolic blood pressure being seen as a result (70mmHg). All but one of the
It was found that in comparison to other trauma related topics, there
patients became transferable to CT scan or to another department,
is significantly less research into the use of REBOA for the trauma
where angiography confirmed that 92% of the patients had arterial
patient, with research being particularly sparse on the use of REBOA
injuries, for which they received arterial embolisation (Martinelli, Thoni
in the prehospital arena. A suggested explanation for this could be
and Declety et al. 2010).
that although this is not a new procedure, changes to the settings we A similar trial by Brenner, Moore and DuBose et al. (2013) also selected
for new ideas, whilst utilising a limited arsenal of resources as we see
trauma victims as candidates to receive REBOA for end-stage shock
ever limiting budgets. A large bulk of the research complied so far has
in a civilian trauma centre. REBOA was performed in 6 patients (4
been undertaken by Morrison J. (2012-2014), who has led retrospective
having suffered blunt trauma, 2 with penetrating trauma) with access
studies as well as those porcine model-based trials.
being obtained by either percutaneously or by direct cut-down. Brenner, Moore and DuBose et al. (2013) report a mean increase in systolic
Initial trials were focused on evaluating how efficiently REBOA
blood pressure of 55mmHg with no REBOA-related complications or
works for acute traumatic vascular injury, rather than its traditional
haemorrhage-related deaths.
use in elective surgery. Morrison, Percival and Markov et al. (2012) took a number of pigs and subjected them to forty five seconds of
Examining the results of the study by Martinelli, Thoni and Declety et al.
haemorrhage. After a 500ml intravenous colloid infusion, the pigs then
(2010), it would appear that this study suffered some bias; Unfortunately
either received intervention in the form of REBOA or combat gauze
the survival rate following the procedure was only 46%, with the vast
AMBULANCE UK - OCTOBER
work in and the resulting types of injuries seen have meant a demand
243 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE majority of fatalities occurring in the early stages of the trial. With more
torso measurements in relation to arterial lengths could potentially differ
people surviving at the end of the trial one could argue that the study
based on gender. For this it could be recommended that a further study
was somewhat of a learning curve, rather than trialling a proven method.
would be required to include female patients.
This is further confirmed by admission by Martinelli, Thoni and Declety et al. (2010) that they found only after the event, that balloon deflation must
As previously stated, the study by Martinelli, Thoni and Declety et
be done slowly and delicately. However in the same breath the study
al. (2010) found that survival seemed to be inversely proportional
found survival was inversely related to the length of time the balloon was
to occlusion time. To probe this further, a study by Markov, Percival
inflated - something they reduced by as much as 85 minutes after the
and Morrison (2012) looked to examine the ‘physiological sequelae’
death of the 5th patient; a factor which was consistently low in the study
occurring when a REBOA system is introduced. 24 pigs were split
by Brenner, Moore and DuBose et al. (2013), whose average occlusion
equally into four groups consisting of 30 or 90 minutes of haemorrhagic
time was as low as 18 minutes. It would be unfair to suggest however
shock, and 30 or 90 minutes of REBOA. All animals prior to their
that this study was not without success, and based on REBOA being an
intervention stage underwent a haemorrhage stage which meant a
‘extreme’ measure, such a significant increase in survival rate can only
controlled haemorrhage of 35% of the blood volume of the course
be looked upon in a good light.
of twenty minutes. according to Markov, Percival and Morrison et al. (2012), the study looked to measure the changes in “mean central aortic
One might question if such low samples in both studies are reflective of
pressure (MCAP), lactate concentration and organ dysfunction”, the
the general population, in that from this data alone it is unclear if REBOA
latter of which was done by postmortem.
could be performed on all victims of pelvic trauma in a ‘one size fits all’ manner, or if the numbers of patients are vast enough to warrant the
The study found that both REBOA groups had a higher MCAP than
cost of training and equipment role-out. A study by Morrison, Ross and
that of the control groups, which we can expect given the data shown
Rasmussen et al. (2014) looked retrospectively at all trauma sustained
by the previous studies. However, the study also found that the groups
by UK military personnel as defined by the abbreviated injury scale
subjected to REBOA accumulated a high serum lactate level, which was
over the course of ten years. Morrison, Ross and Rasmussen et al.
positively correlated to the amount of time the animals were subjected
(2014) separated patients into three groups, including those who had
to REBOA (30 and 90 minutes). One could point out this could be
an indication for REBOA, those with contraindications and those with
responsible for the higher mortality rate seen in previous studies (this
no indication. 1317 patients were split into these groups with a ratio of
study saw only 2 deaths; on in the haemorrhage stage and another in
18.5%, 11.2% and 70.2% respectively.
the resuscitation phase), however Markov, Percival and Morrison et al. (2012) emphasise that the serum lactate levels were easily ameliorated
The study found nearly one fifth of all casualties in the battlefield had
during the resuscitation phase by use of blood, fluids and inotropic
potential benefit from REBOA, giving give good cause for further
support, although the amount of time required to achieve ‘controlled’
research into employing this procedure. This is further justified when
levels increased with the amount of time the pigs were subjected
Morrison, Ross and Rasmussen et al. (2014) report that of the 244 that
to REBOA (150 vs 320 minutes for the 30 and 90 minutes REBOA
had indication for REBOA, 66 died en route to hospital, with a further
respectively). Blood values combined with a postmortem examination
29 in hospital; these patients could have been saved. One might argue
also showed more renal dysfunction with some evidence of liver
that certain patients will have died at the point of injury and whilst this
necrosis in the group receiving 90 minutes REBOA compared to 90
is true, the study found that this was the case for only half of all deaths,
minutes of shock, further pressing the issue of prolonged REBOA.
with a median time to death being 75 minutes, giving ample time for REBOA to be introduced. It must be highlighted however that this data is military-based, and therefore may differ from that of civilian-based time projections. To further probe the issue of generalisability with regards to the population sample, Morrison, Stannard and Midwinter et al. (2013) acknowledge the problematic nature of fluoroscopy-free REBOA placement in relation to the length of the aorta, and hence conducted a prospective study in which a convenience sample of 177 male patients, aged between 18 and 50, underwent CT imaging to measure AMBULANCE UK - OCTOBER
the true length of the aorta, comparing it to the estimated length which was taken by tape measure, starting at the jugular notch down to the pubic symphysis. The study found a strong correlation between torso height and true arterial length. The relevance of this is that torso height can easily be measured in the pre-hospital setting and is therefore a reliable prediction tool for insertion length of the REBOA system. It would be erroneous however to ignore the obvious limitations of this study. Although a larger sample, 177 patients could still be put into question in terms of generalisability. Morrison, Stannard and Midwinter et al. (2013) also used only male patients in their study. Despite stating that the sample was one of convenience, it could be challenged that
244 For more news visit: www.ambulanceukonline.com
FEATURE To further add to the drawbacks of REBOA, a study by Long, Houston
whether REBOA prior to transport to the ED is feasible; an increase in
and Watson et al. (2014) gives some contradicting evidence to that
the amount of time spent on scene could have detrimental effects on
found in by the study by Markov, Percival and Morrison (2012) who
patient outcomes. However a study by Roberts, Blethyn and Foreman
stated that they did not find any evidence of cerebral or spinal cord
et al. (2009) which centred around the feasibility of paramedic rapid
necrosis. A further set of 22 pigs were divided into three groups; one of
sequence intubation (RSI), found that despite introducing a complex
which receiving occlusion of the proximal aorta (n=8), another group
procedure into the extensive list of treatments required for each trauma
receiving occlusion in the distal aorta (n=8), with the third being a
patient, the mean time spent on scene increased by only one minute.
control group (n=6). Following preparation in the same manner those
The study also found that as a result, fewer patients died “on arrival at
pigs used in the trial by Markov, Percival and Morrison (2012), Long,
hospital” (Roberts, Blethyn and Foreman et al. 2009).
Houston and Watson et al. (2014) subjected the pigs to 60 minutes of REBOA followed by resuscitation and multiple examinations for spinal
This topic sparked further research into timings surrounding REBOA,
cord injury, including that by ischaemia or reperfusion, as well gait and
for which Anderson, Rehn and Oropeza-Moe et al. (2014) developed
bladder function tests. Both groups receiving REBOA had a mortality
two training methods: a gelatin model and a live model in the form of
of three (37.5%), with one of these (12.5%) being spinal cord injury
yet more pigs. After continuous training on gelatin models, a doctor-
related. Long, Houston and Watson et al. (2014) report that spinal cord
paramedic crew performed REBOA three times in a “realistic prehospital
symptoms without mortality were present in a further 12.5%, although
environment” with arrival to balloon inflation times recorded, as well as
gait scores improved with time.
skin contact to balloon inflation times. Anderson, Rehn and OropezaMoe et al. (2014) report a mean arrival to inflation time of (a very quick)
With the exception of 37.5% of the group receiving distal REBOA
4 minutes and 19 seconds), with a mean time of 3 minutes and 12
placement returning to ‘normal baseline status’, compared to the
seconds for skin contact to balloon inflation. From this it could be
proximal group (12.5%), the results above are suggestive that there is
reasonable to suggest that the introduction of REBOA in the prehospital
little difference in outcomes seen when REBOA is placed in a different
setting is not entirely dismissible, provided that the right patients are
aortic site, be it higher or lower. That said one must question again the
seen by the right people at the right time.
sample size in this study, and hence its generalisability when it comes to the general population. Also noteworthy were the results tables which
From this, one might question why we would introduce REBOA when
showed little clinical significance (p=0.6897) when it came to spinal
aortic clamping exists and is available pre-hospitally. According to
cord related mortality, and therefore it could be advised that future study
Davenport (2013), clamping can be achieved via thoracotomy by a
of a similar nature would need a far greater sample size to be clinically
doctor-paramedic crew, for which survival rates are around 18% in
relevant. Further critique may enquire why 60 minutes of REBOA was
selected patient groups. A study by White, Cannon and Stannard et al.
chosen rather than a shorter (or longer) period time, for which there
(2011) investigated this further, taking 18 pigs and dividing them into
appears to be little explanation. More importantly the suggestion that
3 groups: REBOA, Clamping or no intervention. The study found that
REBOA may led to spinal cord damage is potentially devastating for the
the group receiving balloon occlusion were less acidotic compared to
development of the procedure into mainstream civilian trauma systems.
the group who’s aorta’s were clamped (pH 7.35 vs 7.24) with a much
According to Long, Houston and Watson et al. (2014), research into
lower serum lactate and pCO2 levels (4.27 vs 6.55 and 43.5 vs 49.9
preventative methods including that of therapeutic hypothermia and
respectively). White, Cannon and Stannard et al. (2011), the group
cerebrospinal fluid drainage have long been documented in literature
who underwent REBOA rather than aortic clamping also required less
surrounding aortic clamping during cardiothoracic surgery, however it
fluid during resuscitation (667ml vs 2166). This may be due to the
could be questioned however feasible these methods are in the acute
minimally-invasive nature of REBOA compared to the maximum invasion
trauma setting.
of a thoracotomy. As with other studies, bias seems to be apparent here as one might question how transferable the results from pigs are
The acute trauma setting could be described as somewhat arduous.
to humans. From here, further research is most definitely required to
It is an uncontrolled environment in which road, vehicle or machinery
explore the potential benefits (and downfalls) of REBOA.
noise and multiple conversations between endless personnel on scene As previously stated, research by Morrison, Ross and Rasmussen et al.
well lit and prepared environment such as the emergency department
(2014) found that nearly one fifth of all trauma patients in the battlefield
(ED). Specialist equipment and expertise are often in short supply
had the potential to benefit from REBOA, had it been available at the
prehospitally, which in turn puts pressure on the clinicians on scene to
time. Nonetheless one might query if traumatic injuries sustained by
make quick yet critical decisions, with which comes risk.
civilians are so similar to those sustained by military personnel, posing the question “Will this skill be used regularly?” Willis, Hurd and Jernigan
With this in mind, it would be questionable as to whether REBOA is
(2002) list several differences between civilian and military trauma
suitable for the prehospital environment. Dependant on the method
including lower bullet velocity, lower contamination of wounds and the
used to gain arterial access, prehospital ultrasound may be required,
prevalence of comorbidites. The introduction of an advanced skill has
which according to Davenport (2013) remains a topic of controversy,
major cost issues, not just with initial training and equipment role-out,
argueing that ultrasound may delay the transfer to more definitive
but also with skill maintenance (Bernard, Nguyen and Cameron et
care in hospital. Rogers and Rittenhouse (2014) remind us of the
al. 2010). A highly publicised literature review by Deakin, King and
importance of the “golden hour” in which a patient must reach hospital
Thompson (2009) surrounding skill erosion in a civilian healthcare
within 60 minutes of time of injury, and highlight the “platinum ten
setting (of advanced airway manoeuvres in particular) showed that
minutes” of EMS onscene time limitation, meaning that it is debatable
the 75.8% of all paramedics carried out one or less intubations in an
AMBULANCE UK - OCTOBER
mean the potential for mistakes is much higher than that in a controlled,
245 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE entire year, which in turn put patient safety in question and the sparked
and Acute care surgery (AORTA)” led by Joseph DuBose, Brenner
the debate about withdrawal of the skill altogether. As highlighted by
and Cannon et al. (2014) at a MTC in Baltimore, USA. This study looks
Braude (2009) low volume, yet high risk procedures require the clinician
to determine outcomes following the use of aortic occlusion devices,
to be adept in the skill, something that can only be achieved by regular
specifically mortality, neurological outcomes and complications. The
hands on training and experience, a solution which is supported Adnet,
study also hopes to determine how practice patterns alter outcomes
Lapostolle and Ricard-Hibon et al. (2001), who urge cultivation rather
and therefore identify predictors of successful outcomes (DuBose,
than removal of a potentially lifesaving technique.
Brenner and Cannon et al, 2014). In June 2014, the London Air Ambulance, comprising of a doctor and
Conclusion
double paramedic team performed the worlds first prehospital REBOA,
Despite clinically proven and effective pre-hospital treatments available
Trust (LAA, 2014), is two years in the running. Further data is required
as part of a trial which, led by Professor Brohi of the London Barts NHS
for patients sustaining traumatic pelvic injuries, such as pelvic binders and fluid management in conjunction with permissive hypotension, a consistently high mortality rate has necessitated us to look for improved methods of treatment. With REBOA being a new and very current topic, this essay has sought to analyse and critique the current literature surrounding this procedure.
before conclusions can be made from this study, but this step has made the feasibility of mainstream introduction of REBOA much more likely. Ultimately, REBOA is a life saving tool who’s benefits outweigh the drawbacks. It buys us more time and hence would appear well suited to both congested urban areas, as well as more rural territories where transfer to hospital time may be elongated.
After an exhaustive online database search, it has been established that the amount of published literature is still low in volume compared to more established prehospital treatments, despite being first mentioned
References
more than 50 years ago. Analysis of the published literature showed REBOA in a mostly positive light; the general consensus reporting that implementing REBOA meant a significant rise in systolic and arterial blood pressure (and hence increased cerebral and cardiac perfusion), with a dramatic reduction in the rate of haemorrhage. Subsequent haematological derangement postREBOA meant that survivability was inversely proportional to the length of time that REBOA was in-situ. The need for fluoroscopy to guide insertion was overcome using torso measurement; a tool that can be easily used in the prehospital arena, with minimal time required for insertion.
Acharya, M. and Forward, D. (2014) The initial assessment and early management of patients with severe pelvic ring injuries. Orthopaedics and Trauma 28(3): pp151-158 Adnet, F., Lapostolle, F., Ricard-Hibon, A., Carli, P., Goldstein, P. (2001) Intubating trauma patients before reaching hospital – revisited. Critical Care 5(6): pp290-291 Andersen, N., Rehn, M., Oropeza-Moe, M. and Oveland, N. (2014) Pre-hospital resuscitative endovascular balloon occlusion of the aorta. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 22(1): pp:19
Despite a positive light however, certain factors put a negative slant on the topic. Although metabolic acidosis being rectifiable given time and aggressive treatment, paralysis was found to be a disastrous potential sideeffect of REBOA. The cost-benefit ratio of implementing REBOA was also called in to question, with skill erosion and subsequent skill maintenance being factors; despite high numbers of military personnel potentially benefitting from the treatment, the likeness of typical civilian injuries compared to those sustained by the military have weak correlation. Further critique of the literature queried the consistently low sample
Barash, P., Cullen, B., Stoelting, R., Cahalan, M., Stock, C. and Ortega, R. (2013) Clinical Anaesthesia. 7th ed., Lippincott Williams and Wilkins, UK. Bernard, S., Nguyen, V., Cameron, P., Masci, K., Fitzgerald, M., Cooper, D., Walker, T., Myles, P., Murray, L. and Taylor D. et al. (2010) Prehospital Rapid Sequence Intubation Improves Functional Outcome for Patients With Severe Traumatic Brain Injury. Annals of Surgery 252(6): pp959-965 Braude, D. (2009) Rapid Sequence Intubation, RSI. 2nd ed. USA, University of New Mexico.
sizes used in all the of the studies discussed. The use of pigs suggested prehospital REBOA is still in its infancy, and has a lot more research to go before it can be brought into mainstream emergency AMBULANCE UK - OCTOBER
medical systems (EMS). Topics to look at in particular would include assessing which patients would benefit most from this treatment, as well as outlining exactly how long REBOA can be left in situ before removal is required. As there are no studies examining the feasibility of paramedic-led REBOA, it is fair to suggest that this procedure, much like RSI, will be kept entirely doctor-led in the long-term, as arguably REBOA is beyond the current skill set of autonomous paramedics, but as demonstrated by Anderson, Rehn and Oropeza-Moe et al. (2014), paramedic involvement is entirely feasible. Current trials include the “Aortic Occlusion for Resuscitation in Trauma
Brenner, M., Moore, L., DuBose, J., Tyson, G., McNutt, M., Albarado, R., Holcomb, J., Scalea,. T and Rasmussen, T. (2013) A clinical series of Resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. Journal of Trauma and Acute care Surgery 75(3): pp506-511 Caroline, N. (2008) Nancy Caroline’s Emergency Care in the streets. UK, Jones and Bartlett. Davenport, R. (2013) Haemorrhage control of the pre-hospital trauma patient. London Trauma Conference, 10-13 December 2013, London, UK. Deakin, C., King, P., Thompson, F. (2009) Prehospital advanced airway management by ambulance technicians and Paramedics: Is clinical
246 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE practice sufficient to maintain skills? Emergency Medical Journal 26(12): pp888-891
Available at http://www.nhs.uk/Livewell/Militarymedicine/Pages/ Medicaladvances.aspx [Accessed 15 January 2015].
Dolan, B. and Holt, L. (2013) Accident and Emergency: Theory into Practice. UK, Bailliere Tindall.
National Institute of Clinical Excellence (NICE) (2004) Pre-hospital initiation of fluid replacement therapy in trauma. London: NICE.
DuBose, J., Brenner, M., Cannon, J., Rasmussen, T. and Holcomb, J. (2014) Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA): A prospective observational study of the Endovascular Skills in Trauma and Resuscitative Surgery (ESTARS) Working Group. Unpublished.
Paetow, G. (2014) Endovascular balloon occlusion of the aorta (REBOA) [online]. Available at http://hqmeded.com/resuscitative-endovascularballoon-occlusion-aorta-reboa/ [Accessed 15th January 2015].
Durusu, M., Eryilmaz, M., Ozturk, G., Mentes, O., Ozer, T and Deniz, T. (2010) Comparison of permissive hypotensive resuscitation, lowvolume fluid resuscitation, and aggressive fluid resuscitation therapy approaches in an experimental uncontrolled hemorrhagic shock model. Ulusal Travma ve Acil Cerrahi Dernegi 16(3): pp191-197 London Air Ambulance (LAA) (2014) World’s First Pre-hospital REBOA performed. [online] Available at http://londonsairambulance.co.uk/ our-service/news/2014/06/we-perform-worlds-first-pre-hospital-reboa [Accessed 15 January 2015]. Long, K., Houston, R., Watson, D., Morrison, J., Rasmussen, T., Propper, B. and Arthurs, Z. (2014) Functional outcomes following Resuscitative endovascular balloon occlusion of the aorta of the proximal and distal thoracic in a swine model of controlled haemorrhage. Annals of Vascular Surgery 29(1): pp114-121 Markov, N., Percival, T., Morrison, J., Ross, j., Scott, D., Spencer, J. and Rasmussen, T. (2012) Physiological tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Journal of Surgery 153(6): pp 848-856 Martinelli, T., Thony, F., Declety, P., Sengel, C., Broux, C., Tonetti, J., Payen, JF. and Ferretti, G. (2010) Intra-Aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. Journal of Trauma 68(4): pp942-948 Morrison, J,. Lendrum, R. and Jansen, J. (2013) Resuscitative endovascular balloon occlusion of the aorta (REBOA): A bridge to definitive haemorrhage control for trauma patients in scotland? The Surgeon 12(1): pp119-120
Pante, M. and Pollak, A. (Eds.) (2010) Advanced assessment of Treatment of Trauma. UK: Jones and Bartlett. Roberts, K., Blethyn, K., Foreman, M., Bleetman, A., (2009) Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice. Emergency Medical Journal 26(2): pp128-134 Rogers, F. and Rittenhouse, K. (2014) The Golden Hour in Trauma: Dogma or Medical Folklore? Journal of Lancaster General Hospital 9(1): pp11-13 Salomone, J., Pons, P., Guy, J. and Giebner, S. (Eds.) (2007) Prehospital Trauma Life Support. UK, Jones and Bartlett. Stannard, A., Eliason, J. and Rasmussen, T. (2011) Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Journal of Trauma 71(6): pp1869-1872. Tien. H., Spencer. F., Tremblay. L. (2007) Preventable deaths from haemorrhage at a level 1 Canadian Trauma Center. Journal of Trauma 62(1): p142-146 White, M., Cannon, J., Stanard, A., Markov, N., Spencer, J., and Rasmussen, T. (2011) Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Journal of Surgery 150(3): pp400-409 Willis, D., Hurd, W. and Jernigan, J. (2003) Aeromedical Evacuation: Management of Acute and Stabilized Patients. 2nd ed., Springer, UK
Morrison, J., Percival, T., Markov., N., Villamaria, C., Scott, D., Saches, K., Spencer, J. and Rasmussen, T. (2012) Aortic Balloon occlusion is effective in controlling pelvic hemorrhage. Journal of Surgical Research 177(1): pp341-347 Morrison, J., Ross, J., Markov, N., Scott, D., Spencer, J. and Rasmussen, T. (2013) The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock. Journal of Surgical Research 191(1): pp423-431
Morrison, J., Stannard, A., Midwinter, M., Sharon, D., Eliason, J. and Rasmussen, T. (2013) Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system. Journal of Surgery 155(6): pp1044-1051
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Morrison J., Ross, J., Rasmussen, T., Midwinter, M. and Jansen, J. (2014) Resuscitative endovascular balloon occlusion of the aorta: A gap analysis of severely injured UK combat casualties. Journal of Shock 41(5): pp388-393
National Health Service (NHS) (2013) War Medical Advances [online].
247 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE
CLINICAL ASSESSMENT ON THE RIGHT PATH Every day ambulance services receive thousands of calls
Since NHS Pathways was first used 10 years ago, it has been used
requesting emergency care.
to triage more than 50 million calls, currently at a rate of more than 14 million a year.
As everyone working across ambulance services will know, the demand for support is high. And the decisions about where and
Programme Head for NHS Pathways Jackie Shears explains how
when emergency care is needed must be made quickly, clearly and
she and her team of IT specialists, doctors and nurses developed
consistently.
the pilot system to be used not just by clinicians, but by trained lay personnel as well.
The most widely used tool used by ambulance services for making these clinical assessments is marking its tenth anniversary this
“There were teething troubles, of course. Creating an integrated
month.
system opens up learning about where and how services are, or in some cases aren’t integrated.
Led by the Health and Social Care Information Centre (HSCIC), NHS Pathways is a suite of clinical assessment content for triaging
“For instance, when we started testing NHS Pathways years ago
telephone calls from the public, based on the symptoms they report
with Hampshire Ambulance Service there was initially significant
at the time of contact.
noise from out of hours clinics about the number of home visits they felt were being booked. We quickly confirmed that NHS
For the last 10 years health policymakers have recognised that
Pathways does not identify where a patient should see a clinician;
common clinical assessment is vital to create an integrated urgent
this is a locally made decision. However, the numbers of home
and emergency care system. But looking back 10 years, patients
visits were higher than average and investigation identified that the
who needed urgent care were faced with several different places
out of hours clinic did not open on weekend afternoons, leaving
to call, with each using a different means of assessing their clinical
caller handlers with no choice but to book a home visit for patients
needs. If the caller was passed on – for instance from GP out-of-
who had urgent care needs at these times.
hours to 999, or from NHS Direct to GP out-of-hours - the whole assessment needed to be repeated.
“Once highlighted through conversations involving all parties, changes to the overall integrated service could be made. Even
Now callers can place a call to 999, or NHS 111 and in most cases
now, if a service is not commissioned, or correctly profiled on the
they will not need to repeat their history or be assessed more than
DoS, there is little the NHS Pathways assessment can do to match
once. And by the end of that call an ambulance will be on the way if
the patient to that service so partnership working is essential.
needed, or they may have a booked appointment with an out-ofhours GP or other appropriate service.
“A successful six months of safe, appropriate clinical assessments led to a further pilot, commissioned by the Department of Health,
NHS Pathways enables this more streamlined and consistent
to use the system in an ambulance service. By testing in 999 and
handling of patient calls. Once the clinical assessment has been
GP out of hours environments, the principle of whether a consistent
completed, NHS Pathways enables the call handler to identify
clinical assessment system was possible was being formally
the clinical skills needed, and the timeframe in which they are
tested.”
required. If an emergency ambulance is not required at the end AMBULANCE UK - OCTOBER
of an assessment, an automatic search is carried out using
NHS Pathways is now used by six of the 11 ambulance trusts
the integrated comprehensive Directory of Services (DoS). This
across England.
directory then finds a service that offers the appropriate clinical skills. Used together, NHS Pathways and DoS direct patients to the
In 2006, North East Ambulance Service (NEAS) became the first
right care provider that meets their needs.
ambulance service to pilot NHS Pathways. For the first time, contact centre staff were able to perform a detailed, consistent
NHS Pathways has been independently evaluated by three
triage using NHS Pathways, with the support of an on-site clinician
universities as a safe and appropriate clinical assessment tool and
to provide additional advice if required. By asking more questions,
is the only such tool to have the gained the support of the British
in a structured, standardised flow, those who did not require an
Medical Association (BMA) and Royal Colleges.
ambulance could be identified and directed to appropriate care.
248 For more news visit: www.ambulanceukonline.com
FEATURE NHS 111 Assistant Contact Centre Manager for NEAS Gerardine Hope said: “The numerous benefits of this more streamlined system working across both the ambulance service and NHS 111 were immediately apparent. Through integrated systems, NEAS can provide a complete end-to-end service from a single point of contact. Using NHS Pathways in NHS 111 centres has allowed a wider variety of care options to be provided for patients and has received very positive feedback.” South Western Ambulance Service NHS Foundation Trust (SWASFT) also uses NHS Pathways and has recently undertaken a pilot known as Dispatch on Disposition. Until now, ambulance services have dispatched a vehicle as soon as they have the location. In the Dispatch on Disposition pilot, ambulance services are given extra time (up to a maximum of 120 seconds) to make full use of the detailed clinical assessment by NHS Pathways. Director of Operations at SWASFT Neil Le Chevalier said “The pilot has been very successful. One of the main benefits is that call handlers now have more time to understand the patient’s needs. In situations where a patient is not breathing or unconscious, an ambulance is still dispatched immediately. Using NHS Pathways enables call handlers to thoroughly triage patients to ensure they receive the right care, in the right place, at the right time.” Clinical safety and governance is central to NHS Pathways activity. Over the years, NHS Pathways has been under constant review and direction by the clinical community via the independent National Clinical Governance Group. This group is chaired by the Royal College of General Practitioners and is made up of representatives from the College of Emergency Medicine (CEM), BMA and other organisations with an interest in and/or involved in the delivery of urgent and emergency care. Dr Anil Gill, NHS Pathways Medical Director said: “NHS Pathways not only saves the NHS money and frees up resources in emergency departments, it contributes significantly to improving patient outcomes. By triaging calls and consistently assessing patient symptoms, NHS Pathways means that fewer ambulances are sent when they are not required. This also means that patients can be referred to a care provider closer to home such as a GP or specialist team such as a falls team or mental health team. “Over the next six months, we will be developing NHS Pathways functionality even further. Early pilots are being developed to provide on line self-assessment using NHS Pathways, and trials in one hospital of a face to face version of NHS Pathways found that located primary care centre. “We have also developed a new symptom activity dashboard which enables users to monitor episodes by symptom group, which should help surge managers and Clinical Commissioning Groups (CCG) to spot rising pressures in local areas based on the level of NHS 111/999 call activity.” For more information about NHS Pathways visit:
AMBULANCE UK - OCTOBER
29 per cent of patients arriving at A&E could be referred to its co-
http://systems.hscic.gov.uk/pathways
249 Do you have anything you would like to add or include in Features? Please contact us and let us know.
NEWSLINE YAS
Air ambulance medics get new life saving kit New potentially life saving equipment has been fitted into both Yorkshire Air Ambulance aircraft. The rapid response emergency service now carries the portable Zoll Autopulse, an automated, battery-powered chest compressor. The equipment provides chest compressions to patients who are in cardiac arrest and will help
“It also frees them up to
be particularly beneficial when
Councillor Colin Dudley, Chief Fire
provide other treatments such
dealing with hypothermic and
Officer Andy Fry and members
as ventilations, administering
drowning cases. I’m sure it will be
of the Fire Authority to officially
medication or carrying out
a valuable asset for patient care.”
launch the co-responding scheme
compressions continue.
SCAS
New Co-Responder Partnership for Hungerford – The First Scheme of its Kind in Berkshire
Nic Morecroft, Lead Community
South Central Ambulance
and support in order to get it
Yorkshire Air Ambulance (YAA)
Service NHS Foundation Trust
up and running for the benefit
provides a service to five million
(SCAS) and Royal Berkshire
of the community. Having the
people across Yorkshire from its
Fire and Rescue Service
airbases at RAF Topcliffe, near
(RBFRS) are celebrating a new
Thirsk, and Nostell Priory, near
potentially lifesaving partnership
Wakefield.
which launched officially this
“The Autopulse also allows uninterrupted effective chest compressions to be carried out while a patient is being transferred to the aircraft and whilst in flight which is proven to improve patient outcomes and survival rates.”
trauma paramedics carrying out on-the-scene CPR.
and recognise its success to date.
defibrilation whilst chest
week in Hungerford which is the The independent charity has to
first of its kind in Berkshire.
raise £12,000 every day to keep In its first week the Autopulse
its two aircraft flying and has
Mark Ainsworth (Director of
was used three times by crews
so far flown over 6,200 people
Operations) Nic Morecroft (Lead
and Pete Vallance, Yorkshire Air
to major trauma centres across
Community Response Manager)
Ambulance Clinical Operations
the county.
Dave Hamer (CFR Training and
Manager, said: “By using the
Liaison Officer) and Steve Gooch
Autopulse paramedics and
Pete added: “The Zoll Autopulse
(Co-Responder Officer) from
doctors can reduce the impact of
will be used by YAA crews in
SCAS joined the Chairman of
fatigue from doing CPR.
medical cardiac arrests and will
Royal Berkshire Fire Authority,
Response Manager from South Central Ambulance Service said: “We are pleased to have embarked on this new partnership with Royal Berkshire Fire and Rescue Service and are incredibly grateful for their commitment
Co-Responder scheme in Hungerford will complement our already Community Responder Scheme and Public Accessible Defibrillators which are also in the area helping to save more lives.” Co-Responders are retained firefighters from Hungerford Fire Station trained by SCAS to provide a ‘first response’ to specific medical emergencies where there is an immediate threat to life prior to an emergency ambulance arriving on scene. This new Co-Responder scheme started running as a pilot on 22 June and aims to ensure that an appropriately trained person is on scene as quickly as possible providing that first response prior to the arrival on an ambulance. In cases of cardiac arrest the chances of a person’s survival decrease by 14% for every minute that without early defibrillation. The introduction of the CoResponders means that we are able to attend and provide basic lifesaving skills and support to our
AMBULANCE UK - OCTOBER
patients quicker than ever before. Group Manager Neil Carter, who manages the co-responding scheme for RBFRS, said: “One of our strategic commitments is to seek opportunities to contribute to a broader safety, health and Yorkshire Air Ambulance paramedic Andrew Armitage (l) and Clinical Operations Manager Pete Vallance practice using the Zoll Autopulse
250 For more news visit: www.ambulanceukonline.com
wellbeing agenda. Working in partnership with South Central Ambulance Service to provide
NEWSLINE a co-responding scheme in
Quickly on scene was SECAmb
Hungerford is just one of the ways
paramedic Andy Blick who
we are achieving this and, by
was so impressed with Jake’s
doing so, we hope that we can
calmness that he was determined
help to save more lives.
Jake be praised for his bravery.
“As the firefighters only take part
Andy said: “Luckily Kris had
in Co-Responding when we have
come round somewhat when I
sufficient availability, it has no
arrived but he was still confused.
impact on our ability to provide
I said to him straight away that it
retained cover in Hungerford. Since the scheme started in June, we have been averaging one call per day. It has been working so well that we are potentially looking to roll it out in other parts of the county in the future.”
VISIT US Stands 7 & 8 Life Connections Kettering Conference Centre 21–22 October
could have been far more serious for him and Jake’s actions could have saved his life which sounds dramatic but is very true.” “When I arrived Jake was able to answer all my questions very well and he didn’t appear
SECAMB
Ambulance service recognition for Ashford youngster A six-year-old Kent boy has been praised by South East Coast Ambulance Service (SECAmb) for his brave actions when his dad suffered a hypoglycaemic collapse at their home in Kingsnorth, near Ashford, Kent. When John Wesley Primary School pupil, Jake Selfridge, did not get a response from his dad on the morning of 31 March this year, he remembered what he had been taught and immediately went to his aid by phoning 999 and asking for someone to help. Jake, his dad Kris Selfridge (34), mum Abbey and grandparents, Jim, Jane and Richard visited Ashford Make Ready Centre recently where Jake was
contrary, he was concerned that he needed to get to school! I know there are many adults out
Resuscitation and Emergency Care
there who would struggle to deal with the situation in such a calm manner.” Jake and his family were given a tour of the Trust’s Ashford Make Ready Centre and Hazardous
A full range of products for use in an emergency and resuscitation situation.
Area Response Team (HART) base where all vehicles in the region are cleaned, stocked and maintained. HART Team Leader Steve Dowdall was honoured to present Jake with his well-deserved commendation certificate.
• • • • •
Bag-Valve-Mask (BVM) Pocket Resuscitation Mask Oxygen and Nitrous Oxide Delivery Systems Airway Management Oxygen Therapy
Although dad Kris doesn’t remember much of the emergency, luckily on this occasion he was recovered well and didn’t require hospital treatment. Mum Abbey said: “Kris was diagnosed with diabetes 12 years ago so Jake knows about his condition and he
Commendation certificate to thank
is aware when to call for help. I’m
him for his quick thinking and
so pleased he did the right thing
brave actions.
and we are very proud of him.”
Jake said: “I know when dad
Jake’s grandfather Richard
doesn’t respond that something’s
added: “The visit and certificate
wrong with him and that he needs
presentation made a little boy
help. I rang 999 and answered
very happy. We want to say a big
all the questions and gave my
thank you for all the great work
address.”
the ambulance service does.”
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AMBULANCE UK - OCTOBER
presented with a Chief Executive
to be distressed at all. On the
251 AMBULANCE_UK_09_15_resus.indd 1 For all your equipment needs visit: www.ambulanceservicesuppliers.com
07/09/2015 16:45
NEWSLINE 400 additional frontline staff,
funding will enable to the Trust
year’s Health Service Journal
including more than 40 in the
to further increase its frontline
(HSJ) awards.
Trust’s call centres. All these
staffing. Derek concludes: “It’s
will be deployed throughout
all well and good purchasing
The Trust has been shortlisted
the region (full breakdown of
additional ambulances but
in the Enhancing Care by
Communities in the North West
station vehicle allocation below)
people need to operate them,
Sharing Data and Information
will see a substantial increase
and have been located in areas
people are needed to answer the
category for its Intelligence
in the numbers of ambulances
where demand requires the
999 calls and staff are required
Based Information System,
and frontline ambulance staff,
additional resource.
to then dispatch the vehicles.
(IBIS), project.
NWAS
Ambulance boost for north west region
“We’re absolutely delighted
the North West Ambulance Service (NWAS) announced,
Derek adds; “This is a fantastic
to be able to say that, despite
following significant work
boost for the Trust and I’m sure
the financial challenges faced
between CCG Ambulance
for the staff who have been
by NHS trusts today, we are
Commissioners and the Trust.
working extremely hard to cope
swelling our ranks rather than
The announcement comes
with the additional demand.
reducing them.”
following the most challenging
Most of all, it is extremely good
year in the Trust’s history when
news for the people of the North
Allan Jude, Director of
last year, 2014-15, NWAS saw
West. “It is hugely important for
Ambulance Commissioning
an unprecedented increase
us to plan ahead and ensure we
at Blackpool CCG and Lead
of 8.1 per cent in ‘999’ calls
have the appropriate number
Ambulance Commissioner
and 11 per cent for the most
ready for when we need them
for the North West said: The
serious and life threatening
as new ambulances and staff
ambulance service is an integral
‘Red’ calls.
can’t just appear overnight. We
and key player in the urgent
have started the process for
and emergency health system.
While the Trust predicts growth
phasing these resources in over
“While last year they responded
in activity and plans ahead for
the coming months and hope to
to unprecedented levels of
the required resources, the rise,
have the full complement of new
demand, they also managed
which was seen nationally as
vehicles and staff in operation by
to significantly increase the
well as in the North West, was
the end of the year”.
number of patients who were successfully treated at home
substantially above what was
IBIS matches 999 calls to individual patients who have given permission for SECAmb to access their care plans. Operators in the Trust’s Emergency Operations Centres notify attending 999 clinicians of the presence of a care plan. After arriving on scene, ambulance crews calling a clinician in the centre receive important information on a patient’s ongoing care. In 2014/15 the system helped SECAmb clinicians avoid 7,300 patient transports to hospital, which equates to around 2,400 avoided admissions.
expected and unfortunately,
“We know that sending an
or within the community. By
did leave some patients waiting
ambulance to all patients is not
not transporting such patients
longer than they should have
the most appropriate course of
to hospitals they have relieved
done for an ambulance. Director
action, and our commitment to
some of the significant
of Operations, Derek Cartwright
providing alternative pathways of
pressures faced by emergency
“I’m delighted that our already
comments: “Based on these
care, we believe, is still the way
hospital department.”
award-winning IBIS project has
figures and planned trajectories
forward, however, the statistics
for the coming months, very
SECAmb Head of Clinical Development and Consultant Paramedic Andy Collen said:
been shortlisted for another
have shown that the numbers
With the levelling of activity, the
prestigious award. We’re very
open and constructive talks
of patients with life-threatening
Trust is currently achieving all
proud of the impact IBIS has
were held with Commissioners
conditions is rising and these
national targets, reporting a year
had on helping patient across
who fully understood the
are people who definitely do
to date performance (as at 9
our region efficiently receive the
challenge we faced. Since our
need an ambulance response.
August 2015) of 77.5 per cent for
treatment they need.”
establishment as a Trust in 2006,
These additional vehicles will be
we have seen a growth of circa
of tremendous benefit to them
two per cent per annum and
and the Trust and I look forward
there is no reason to believe that
to welcoming on board the new
will change.”
Red 1 and 76.2 per cent - the
AMBULANCE UK - OCTOBER
national target for these is set
The awards, in partnership
at 75 per cent. The Trust is also
with Celesio, will be held on
achieving the national 95 per
18 November at the Grosvenor
staff who will work on them.”
cent target for Category A calls.
House Hotel, London.
Commissioners have approved
Recruitment of staff has been
SECAMB
This year, over 600 unique
the provision of funds to
an important objective of the
enable NWAS to purchase more than 60 new ambulances,
year saw the Trust employ an
rapid response vehicles
additional 156 urgent care and
Trust shortlisted for prestigious national award
organisations submitted over
Trust for some time and last
and emergency vehicles for
emergency medical technicians,
community based paramedics,
146 paramedics and 114
South East Coast Ambulance
interviews to a specific judging
extend the operating hours of
control centre staff. However,
Service NHS Foundation
panel made up of senior and
some of our existing vehicles
with vacancies still needed to
Trust (SECAmb) has been
influential figures from the
and to recruit more than
be filled, the Commissioners’
shortlisted as a finalist in this
health sector.
252 For further recruitment vacancies visit: www.ambulanceukonline.com
1600 entries to the awards. Alongside the other shortlisted organisations, SECAmb will now complete presentations and
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AMBULANCE UK - OCTOBER
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253
NEWSLINE YAS
New scheme introduced in rural areas of West Yorkshire People who dial 999 after having a heart attack could be treated by a firefighter under a new scheme introduced in rural areas of West Yorkshire. Yorkshire Ambulance Service has teamed up with West Yorkshire Fire and Rescue Service to pilot a project that would see on-call firefighters living in more remote communities being deployed as “first responders” in life-threatening medical emergencies like cardiac arrests. They will be expected to give first aid to patients until an ambulance arrives. Fire service area manager Nick Smith said: “When someone collapses from cardiac arrest their chance of survival drops 10% every minute until resuscitation is started. “It makes absolute sense for firefighters who live and work in these rural localities and who are already trained in resuscitation and the use of a defibrilator, to get to the scene as early as possible to start this vital care. “The emergency first responders will aim to arrive as quickly as possible which should improve
The fire service said it had
cardiac arrest at the bed and
a donation of £500 to the East
already been successful in other
breakfast he runs in Whiting
of England Ambulance Service
areas and was introduced by
Street, Bury St Edmunds.
NHS Trust Charitable Fund, which
Humberside Fire and Rescue Service in 2013.
will be used to support volunteer But thanks to the quick response
community first responder groups.
of ambulance staff, they managed Firefighters being deployed
to get the 74-year-old’s heart
as first responders will have a
beating again after performing
separate uniform and will travel
cardiopulmonary resuscitation
in a marked car with blue lights,
(CPR) and shocking him once
not a fire engine. They will not
with a defibrillator.
transport patients to hospital. Gordon was reunited with five of Dr David Macklin, executive
the East of England Ambulance
director of operations at the
Service NHS Trust (EEAST) staff
ambulance service, said: “We
that came to his aid after he
have a responsibility to ensure
collapsed.
we explore every available option to improve clinical outcomes for
Paramedic Dale Boustead arrived
our patients. The Emergency First
in under two minutes in a rapid
Responder scheme has already
response vehicle and ambulance
proven successful in Humberside
crew Neil Stead and Roger
and the East Riding.”
Stearne were on scene in under
He added: “We have a very clear
EEAST
100% of patients happy with ‘world class’ ambulance staff Frontline ambulance staff have been described as “faultless”, “exemplary” and “super kind” in the latest patient survey. One hundred percent of respondents said they were very satisfied or satisfied with the care they had received from the ambulance staff.
four minutes followed by Duty
The people who handle the
Locality Officer Paul Goodchild.
999 calls in the region’s control
ambition to improve the survival
centres were also praised with
rate for those people who suffer a
After getting his heart restarted,
cardiac arrest in the community.
100% of respondents saying
the crews had to work out a way
We want to have world class
their call was very acceptable,
of getting Gordon down the steep
levels of survival from cardiac
acceptable or fairly acceptable.
stairs of his home, which resulted
arrest and the development of this
in the call to Edward Watt, Thomas
initiative is one more important
Comments from 96 respondents
Jones and Stephen Cole from the
element in saving more lives.
to the East of England Ambulance
Trust’s Hazardous Area Response
Service NHS Trust’s (EEAST) patient
Team (HART), who are specially
report included: “Staff were very polite
trained at working at height.
and professional”; “I have nothing
“West Yorkshire is already served by our award-winning community first
but praise for them (staff)”; “Excellent,
responder teams who do a fantastic
Gordon was placed on a stretcher
job as volunteers in their local areas.
cannot fault the service received”; “I
before being carefully pushed
The addition of emergency first
know once your (the trust’s) get to
through an open first floor window
responders will further strengthen
me I am safe and in great hands”;
on to a Suffolk Fire Rescue
“Simply put, outstanding”.
our response in these communities and the two models will work sideby-side to save more lives.”
Service aerial platform to lower him to ground level.
All respondents praised the ambulance staff they were in
He was taken to West Suffolk
contact with as very professional,
EEAST
Hospital before being transferred
and the same number said they were treated with dignity and
had a pacemaker fitted. A week
respect by crews.
the same way as they do now.
Suffolk man’s heartfelt thanks to life-savers
to Papworth Hospital where he
“This scheme provides an
A grandfather has said a heartfelt
“The first I remember was when
additional service to patients in
thank you to the ambulance
I woke up at Papworth. I cannot
rural communities, and is aimed
staff who saved his life after he
thank the ambulance staff enough
New trust chief executive, Robert
at helping to save more lives.”
collapsed at his Suffolk home.
for what they did for me. I am
Morton, who began his role on
lucky to be here,” he said.
Monday 24th August, said: “I am
the outcomes for patients and ultimately save lives. “Ambulance crews will continue to AMBULANCE UK - OCTOBER
respond to these emergencies in
later, he returned home and has gone on to make a full recovery.
More than 98% said the service had exceeded or met their expectations.
The scheme will be piloted
Gordon Wagstaff cannot
in Featherstone, Ilkley and
remember anything of the drama
Gordon and his wife Wanda
results and see the excellent patient
Skelmanthorpe near Huddersfield.
that unfolded after he went into
were go grateful that they sent
care at the centre of the service.”
pleased to see these outstanding
254 For more news visit: www.ambulanceukonline.com
NEWSLINE xxx
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AMBULANCE UK - OCTOBER
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255
NEWSLINE SECAMB
SECAmb identifies response post sites
Many of the Trust’s ambulance stations were built a long time ago since which the populations surrounding them
South East Coast Ambulance Service NHS Foundation Trust (SECAmb) Ambulance has submitted two planning applications for Ambulance Community Response Posts in Kent and will also begin responding from a new post in Chichester, West Sussex this week. The Trust has identified the
have changed. SECAmb is
West Midlands Ambulance
its Make Ready programme,
Service paramedic Steve
which sees vehicles cleaned,
Watkins swapped patients for
maintained and stocked to
pupils on a return visit to Nepal
a standard specification at a
as he passed on expert advice
Make Ready Centre before
on how to cope in the early
crews respond from the
stages of an emergency.
network of response posts, better suited to meet patient
Steve, based in Stoke, originally
demand.
visited Nepal in April to help
SECAmb Clinical Services
patient demand and, subject
Manager Andy Burton said:
to planning permission, will
“We’ve worked hard to identify
lease accommodation at the
these two new possible
Transit Works in Power Station
locations for crews to respond
Road in Halfway and the Kent
from. The new response posts
Enterprise House in Eddington.
we develop provide modern facilities for our staff between
James Industrial Estate, Westhampnett Road. SECAmb’s Ambulance Community Response Posts
call outs and it’s vital the locations reflect the demand placed upon us.” Senior Operations Manager Lorna Stuart added: “I’m
of two devastating earthquakes struck the country but his mission on this occasion was very different. A member of Search and Rescue Assistance in Disasters (SARAID), Steve’s return was arranged when the charity Global Action Nepal (GAN) asked for help and assistance in being able to react better whilst waiting for international aid should another disaster ever strike.
pleased the new response
Approximately 400 graduates
post for Chichester is now
from all over Nepal applied to
ready to be fully operational.
take part in the week-long training
It’s important that crews not
course, which was eventually
placed to respond to patient
only have somewhere suitable
whittled down to about 50. The
demand. The response posts
to rest but also that that place
idea now is that having gained
reduce the need for ambulance
is in the right place for our
as much knowledge as possible
crews to park on standby at the
patients and for us to respond
from Steve and his colleagues,
roadside – when they have no
to the rising number of 999
they can pass on the information
facilities to use between calls.
calls each year.”
to as many Nepalese residents as
(ACRPs) are strategicallyplaced across its Kent, Surrey and Sussex region to ensure ambulance crews are best
“It was a really rewarding experience to see the group absorbing the information, they were fantastic”
search for survivors when the first
Bay as suitable to meet current
crews will respond from St
Paramedic turns teacher on return visit to Nepal
in the process of rolling out
sites in Sheppey and Herne
In Chichester, ambulance
WMAS
possible across the course of the next five months. Speaking about the trip, Steve AMBULANCE UK - OCTOBER
said: “It was a really rewarding experience to see the group absorbing the information, they
Some of the topics taught included medical advice, how to safely search rubble piles and disaster preparation. “Each day we would start by doing a test on the information taught the previous day and it was good to see they were listening to what we were saying,” Steve added. “I’d never done anything like this before so there was a bit of thinking on my feet at times but when I saw them working together in groups to try and answer questions or overcome problems they had been set, it was a great feeling. “I gave all of the group my contact details and will be happy to help them however I can should they have any questions. “We still have volunteers in the country so we’re getting feedback about how they are getting on and I hope to plan another visit before the end of the year so I can see for myself how they are progressing.
were fantastic. “They certainly knew more at the end of the week than the beginning and hopefully now they will be able to pass on their new found knowledge to many more people.”
256 For further recruitment vacancies visit: www.ambulanceukonline.com
“There are clear signs of recovery in the country which is great to see and I just hope for the sake of the people that they can get themselves back on their feet without any future disasters to overcome.”
EVERYTHING IN AN EMERGENCY
YOU NEEDNEWSLINE
ON CALL 24/7
sales@spservices.co.uk
www.spservices.co.uk
AMBULANCE UK - OCTOBER
Tel: (+44) 01952 288 999
257
NEWSLINE Jill’s husband Brian Maddison
such as a defibrillator and oxygen
There are currently eight
Everybody needs good neighbours
said: “She just looked delirious
cylinder, which were invaluable.”
CFRs located across the Over
A newly qualified volunteer
“I said to our daughter to run and
Hampson for help. Lynn assisted
Community First Responder
get Peter to come and help as we
Peter when he was using some
Alongside their day jobs and
had been talking only a few weeks
of the equipment and she also
everyday commitments CFRs
before that he had completed his
helped give information to the
provide local support for
CFR training. We had even joked
emergency call handler until the
with him at the time that we didn’t
paramedics arrived.
NWAS
(CFR) for the North West Ambulance Service (NWAS) has been hailed a hero after he helped save the life of his neighbour who was having a cardiac arrest. Peter Blundell completed his CFR training with NWAS’ Over Wyre Team at the end May, but only a few weeks later he got his first major call out and it just so happened to be for Jill Maddison who lives across the road from him in Knott End. Jill recalls the incident: “Earlier in the day I had been to the doctors as I thought that I had a chest
Wyre area and a total of 1140
and when she went unconscious I immediately called 999.
want to be his first patients.” Peter said: “There was a knock at the door at around 11.30 in the morning and it was the daughter of the family from across the road. She was really upset and crying and said that her mum was dying. So I just grabbed my gear and ran over the road. Peter said: “When I got there Jill was having difficulty breathing and was unresponsive. It was nerve wracking as it was my first serious call and you don’t
infection and then got home and
expect it to be for someone that
took some medication. I felt a rise
you know but the adrenaline
of heat and sweat and felt dizzy
just kicked in and I went into
and said to my husband that I
Jill’s daughter had also called on
volunteers across the whole of
one of their other neighbours Lynn
the North West region.
Jill was taken to Blackpool Victoria hospital and is now making a full recovery: “I have been overwhelmed by the support from all our neighbours who have sent get well cards and flowers,” Jill said – “Yet, without Peter that day I wouldn’t be here. I would hate someone to go through what I did and not have received any help, so to us he is our absolute hero.” Peter, a retired Police Officer, explains why he decided to volunteer as a CFR: “I wanted to try something different and
ambulance crews as they are sent to incidents at the same time as paramedics and often can get there first to start basic life support procedures such as CPR. This is vital, especially in rural areas, as for every minute someone does not receive treatment after suffering a cardiac arrest, their chances of survival decreases by 14 per cent. The Trust is always looking for more people to volunteer to become Community First Responders and those who are interested don’t need to have had any previous first aid experience as full training
worthwhile as I had gained a lot
will be given. To find out more
automatic mode.
of job satisfaction from helping
information go to
ambulance crews in the various
www.nwas-responders.info.
sofa and that was the last thing
“Thankfully when you become a
incidents that I attended whilst I
that I remember.”
CFR you get specialist equipment,
didn’t feel well. I laid down on the
was in the police. “Now that I am retired becoming a CFR has been a great thing to do to try and help make a difference to our community.” Edward Shields, Team Leader for the Over Wyre CFR Team has also praised Peter’s calm actions: “This was only Peter’s second call and the first time he had been to somebody in a critical condition. “The added pressure of the
AMBULANCE UK - OCTOBER
patient being somebody he knew must have been very stressful but
SECAMB
Heartfelt praise for ambulance staff from Sittingbourne resident A Sittingbourne man who suffered a heart attack and underwent a life-saving quadruple heart bypass operation thanked South East Coast Ambulance Service (SECamb) staff in person just three months after his emergency 999 call.
he did brilliantly to keep his cool
Clifford Earl, 59, was out
and put his training into action to
driving his car delivering
save the patient’s life. We’re all
leaflets when he began to feel
very pleased for them both.
unwell and stopped his car.
“Happy endings like this are rare
Clifford recalled: “I got to
but they are the reason we all do
the stage I was thinking if I
what we do.”
continue to drive I’d cause an
258 For more news visit: www.ambulanceukonline.com
NEWSLINE an ECG. As I had suspected,
Since the operation Clifford
well and to hear that he has an
by the side of the road and
it showed that Clifford had
has made an amazing recovery
excellent long-term prognosis
call 999 rather than try and get
suffered a heart attack which
and was given the go-ahead
is fantastic. It’s the first patient
home. When I spoke with the
I told him straight out and I
by his doctors to go on holiday
emergency call operator I could
to Singapore to celebrate his
I have met in my 11-year career
called for back-up to take him
tell from the way questions
to hospital.”
daughter’s engagement. He
accident and decided to stop
said: “Had I not co-operated
were being asked and the fact they kept me on the line that they were treating my call more seriously than I was expecting.” At that moment, Paramedic, Alison Waterman was stationed close-by in a single response vehicle and was on scene within minutes. Alison said: “My first reaction was that a call coming from a person sitting in his car is unusual and must be out of the ordinary and when I first saw Clifford he was
Ambulance Technicians Niki Fox and Michele Harvey soon arrived and with Alison monitoring Clifford’s condition in the ambulance, he was rushed to Medway Maritime Hospital. Investigations at the hospital revealed that two of Clifford’s arteries were blocked by as much as 97 per cent on one side and 92 per cent on the
with Alison, I would not be here today and I wouldn’t have seen my daughter getting engaged.
in the service and it has meant a lot to me to see first-hand how the job we do makes a difference. Niki, Michele and I were only too happy to be there
To be honest I didn’t feel the
for Clifford when he needed us.
excruciating pain I would have
That’s our job.”
expected from a heart attack but in the weeks before I had
Clifford added: “With hindsight
not been able to walk as fast
I should have listened to what
as normal and also thought
my body was telling me. I’m
that I had been suffering with
regularly exercising now in the
indigestion. I’m so grateful that
gym, I walk daily and watch
Alison insisted on checking me over thoroughly and in doing so she has saved my life.”
that I eat healthily. I’ve been discharged from St Thomas’s and I’m ready to continue my
very pale looking and sweaty. I
other. With his condition as
wanted to take an ECG straight
serious as this he was taken
Alison recently met with
away despite Clifford saying
from Medway Hospital to a
Clifford again in much better
that he ‘would be all right’. It
specialist unit in St Thomas’
circumstances at Sittingbourne
life. Thanks to Alison and her
took some strong persuading
Hospital in London where his
Ambulance Station. She said:
colleagues I got to hospital just
to get him to sit in the back
bypass operation was carried
“I can’t believe he’s been on
in time. I will be forever grateful
of my car so that I could take
out.
holiday already. He looks so
to them.”
work as a chimney sweep and enjoying my family and my
Simple to use, effective in performance and reliable in operation. The Eberspächer climate control system.
A world of CoMforT
Do you have anything you would like to add or include winwNewsline? w. e b ePlease r s p acontact c h e r.uscand o mlet –us 0know. 1425
480151
AMBULANCE UK - OCTOBER
A comfortable environment whatever the weather
259
NEWSLINE NWAS
NWAS & Lancashire Fire and Rescue Service introduce life-saving Community First Responder Scheme with fire crews
their communities to provide help
professionals with extensive
Derek Cartwright, North West
to patients while the ambulance is
experience of working in very
Ambulance Service Director of
en route. NWAS has a network of
difficult situations. All LFRS crews
Operations, said: “This is an
348 CFRs in Lancashire, including
carry defibrillators and oxygen,
extremely positive project and
28 CFRs from LFRS. The project
but those acting as CFRs will also
it’s great to work with LFRS on
was set to go live on 24 August.
be equipped with further pieces of
a scheme that will contribute to
equipment including suction units,
saving lives here in the North West.
The firefighters, fully trained as
pulse oximeters and bandages. “NWAS receives, on average,
CFRs by NWAS, will save many lives by attending time critical
The fire crews will be sent to
260 calls for patients in life-
emergencies such as heart
serious and life-threatening medical
threatening situations every day
attacks and cardiac arrests. All
emergencies in and around
across Lancashire. This is our
Lancashire Fire and Rescue
the firefighters are skilled in first
Morecambe and Ormskirk. They
opportunity to use the fantastic
Service (LFRS) crews are
aid at work and are all trauma
will respond to NWAS Red 1 and
expertise LFRS has in dealing
to operate as life-saving
trained. The crews involved in the
Red 2 cases and be mobilised
with emergencies and get help to
Community First Responders
CFR project have been given an
simultaneously with an ambulance
patients as quickly as possible.
(CFR) as part of a new joint
additional 20 hours training. All
crew. NWAS dispatchers will page
initiative with North West
NWAS CFRs are trained in how
on duty fire officers and send them
“Rural and semi-rural towns like
Ambulance Service (NWAS).
to recognise a cardiac arrest,
to Red calls if they are closer to a
Morecambe and Ormskirk are
dealing with patients who are
patient than an ambulance when
a particular challenge for the
The six month pilot project,
fitting, administering oxygen and
the 999 call comes through. CFRs
ambulance service. If a patient
operating from Morecambe
dealing with an obstructive airway.
rendered potentially life-saving
suffers from a cardiac arrest for
aid 3,992 times in 2014/15 across
example, their chance of survival
and Ormskirk Fire Stations, is an extension of NWAS’ highly
Unlike other CFRs, fire crews
Lancashire. Clinical evidence shows
reduces by around 10% for every
successful CFR scheme. CFRs
have the added advantage of
that patients in life-threatening
minute treatment is delayed – this
are volunteers who support the
being able to respond to patients
situations who receive rapid
scheme will provide additional
Trust by responding to serious
using blue lights, ensuring a
intervention have a significantly
protection for our patients in more
and life-threatening incidents in
speedy response, and are all
better chance of survival.
sparsely populated areas. I would
on et re el.n mo erj ad at Re w.w ww More information
AMBULANCE UK - OCTOBER
Professional burn care – around the world
260 For more news visit: www.ambulanceukonline.com
NEWSLINE like to thank the LFRS and the fire
South Molton home and resolving
was geared to anti-tank warfare
he has significant experience of
crews in both Morecambe and
that one day he would be a
so it was useful having someone
the night operations that DAA will
Ormskirk for their contribution in
helicopter pilot.
with experience of tanks on the
be undertaking in the Autumn of
ground, flying against them.
2016.”
getting the scheme underway and welcome them to our CFR
He achieved his ambition by
network here in Lancashire.”
learning to fly in a 23 year army
“Army flying is the perfect proving
Richie Tate added: “The job
career and has now landed his
ground for air ambulance
comes with many challenges.
Justin Johnston, Deputy Chief
dream job as a pilot with the
operations. In both scenarios
You don’t know what to expect but
Fire Officer Lancashire Fire and
Devon Air Ambulance flying the
you never really know what
have to respond. Every day is a
Rescue Service, said: “It makes
Charity’s EC135 helicopter out
terrain you might have to land
school day with something new
absolute sense for our firefighters
of its Exeter International Airport
on. Both require expert handling
to learn. The DAA aircrew are a
to become Community First
airbase.
often in tight situations and quick
fantastic team and I’m learning
decision-making.”
my part in it not just as the driver
Responders (CFRs) in Lancashire,
but as the paramedics’ eyes and
joining the ranks of other CFRs
The 43 year-old recounts how
in the county, supporting NWAS
he always knew he would be a
After army service, Richie flew as
ears on the ground. I also need
paramedics and saving lives.
pilot and mapped out his career
a police pilot at Middlemoor, the
to know what the equipment they
accordingly from a very young
airbase shared by the National
are using is and does in order to
“As CFRs they will bring a wealth
age. His ‘dream and aspiration’
Police Air Service and DAAT and
act as an additional pair of hands
of existing experience, such
to fly as an air ambulance pilot
“awaited on a vacancy next door”.
fetching and carrying at the scene
as getting to an emergency by
was intensified when his mother
The opportunity finally arose with
of a mission. Devon is where
fire engine under ‘blues and
was airlifted by DAA after a heart
the retirement of long-standing
I grew up and it’s an amazing
twos’ and working alongside
attack in late 2013.
DAAT pilot Rob Mackie and after a
place with every challenging
stringent interview, his dream had
scenario and difficult places to
come true.
land, from coastal and clifftop to
paramedics to deal with the trauma of casualties caught up
Richie joined the Household
in emergency incidents. As CFRs
Cavalry straight from school
at a medical emergency they will
before transferring to the Army
Ian Payne, Devon Air Ambulance
got a range of micro-climates to
bring skills and resources to the
Air Corps where he flew Lynx and
Trust’s (DAAT) Flight Operations
contend with.
incident additional to their existing
Dauphin helicopters and became
Director, said: “We are delighted
skills of CPR, use of defibrillators
involved in counter terrorism
to welcome Richie on board. His
“I have 17 years of active flying
and first aid.”
activities. He saw active service
flying experience in the Army
left before I retire and I intend to
on seven tours of Iraq and two to
and the Police is the perfect
spend every one of them with
Afghanistan.
background for a DAA pilot. The
DAAT.”
“Our pilot in Ormskirk and
moorland and farmland – it’s even
training is similar, he had already
Morecambe is an exciting development, introducing a
He said: “I went from horses to
flown EC135s and EC145s with
Richie Tate lives in Plymtree near
service that we are confident
tanks to helicopters. In those
the Police and has experience of
Cullompton with his wife Caroline
will save lives and giving us
days army helicopter training
attending casualties. Importantly,
and six year-old son, Arthur.
the opportunity to develop and refine our CFR capability before we consider extending our involvement in the NWAS network of CFRs in other areas.” To ensure LFRS resources are used first and foremost for fires, crews will be redirected should such an incident occur whilst they are en route to a medical call.
Air Ambulance role is a lifetime ambition As a child, Richie Tate recalls seeing helicopters delivering hay
AMBULANCE UK - OCTOBER
Pilot Richie lands his dream job
to snowbound cattle near his
261 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE SWAS
Innovation in Collaborative Educational Partnerships Over the past two years the Dept. of Allied Health Professions at the University of the West of England has been working closely with the South Western Ambulance Service NHS Foundation Trust (SWASfT) to develop education programmes for Paramedics. The national shortage of Paramedics, combined with a widening scope of practice in the role of a Paramedic, has led to a rapid growth in requirement for education and training opportunities. Dr Marc Griffiths, who was Head of Department for DAHP between 2011 and 2014, worked with Gary Smart (Paramedic Curriculum Lead), and Dr Fiona Lawrence (Faculty Director CPD & Partnerships) to ensure that the Department was in a strong position to develop education programmes to help address the increasing requirements. They worked with Emma Wood (Executive Director of HR & OD), Jim Petter (Head of Education & Professional Development) and Kerry Crawley (Clinical Training Manager) from SWASfT, to determine the areas of priority and, as a result, several innovative programmes and modules have been developed.
AMBULANCE UK - OCTOBER
Emma Wood said ‘Through partnership working we have been able to advance the careers and skills of our front line staff. We have explored new and exciting innovations in hear and treat practice and developed fast track programmes to upskill our staff in clinical practice. Over 150 staff have benefited from our partnership with UWE and I’m delighted to see the real benefits collaboration has to offer to patient care’.
In order to enhance the education experience for the students, a strong collaborative partnership has developed between DAHP and SWASfT. This has resulted in a number of beneficial initiatives for both parties, including development of pioneering new CPD modules related to clinical need, secondment of several members of clinical teaching staff from SWASfT to UWE; the provision of a frontline ambulance for simulation use; availability of teaching rooms for SWASfT usage. This relationship has led to flexible education solutions for the paramedic workforce. Having the largest NHS Ambulance Trust in England on-board as a strategic partner is vital for the Faculty and University, and promotes the evolving nature of how new income streams are being created and secured. The new Acting Head of Department, Dr Viv Gibbs, said ‘This collaborative partnership has resulted in a close working relationship between UWE and SWASfT, which has undoubtedly led to development of innovative new ways of delivering and enhancing Paramedic education. As a result we are seeing an improvement in the education experience for the students, and an ability to respond more quickly to changing workforce needs’.
North West Ambulance Service paramedic Paul Jones jumped out of his own carriage and ran along the platform to where the patient was to find another passenger trying CPR on the man. After quickly assessing the choking man’s condition, he used abdominal thrusts, back slaps, finger sweeps and manipulated the man’s throat until a large chunk of food came out; this allowed the passenger to breathe slightly. At this point an ambulance crew and rapid response vehicle arrived, three minutes after the 999 call. The three West Midlands Ambulance Service staff worked with Mr Jones to continue treating the man, clearing his throat completely and giving him oxygen. The man, who was in his 50s, was then taken off the train and driven by ambulance on blue lights the short distance to County Hospital, Stafford. Mr Jones, said: “It wasn’t an easy job working in the confines of the carriage, but working with the West Midlands staff, we were able to free all of the obstruction and the man had regained consciousness and was definitely looking better as he left on the ambulance. This was a job well done by everyone who helped.”
Off duty para helps save choking train passenger
A West Midlands Ambulance Service spokesman added: “There is no doubt that the early intervention of Mr Jones and the other people in the carriage has given this man the best possible chance of survival.
The quick actions of an off duty paramedic have helped save the life of a passenger who was choking whilst on board a train.
“Whilst it is early days, he was well enough to give ambulance staff a hug and thank them for their help before the crew left the hospital.”
An emergency call was put out on the tannoy of the Virgin Trains Liverpool to London service as it stopped at Stafford. The man, who was in a first class carriage, had stopped breathing and was becoming hypoxic from a lack of oxygen after eating a sandwich.
EEAST
Norfolk grandmother reunited with lifesavers Angela Page cannot remember much of Saturday 11th July.
262 For more news visit: www.ambulanceukonline.com
However, she is eternally grateful to the staff from the East of England Ambulance Service NHS Trust (EEAST) who rushed to her aid when she started experiencing chest pain. The 69-year-old was reunited on 11th September with the four staff that helped save her live after her heart stopped and she went into cardiac arrest. Her husband Terry phoned 999 just after 7.30am after Angela went pale and collapsed on the bed at their home in King’s Lynn. Seven minutes later, Paramedic Mick Spratt and Emergency Care Assistant Carole Taylor arrived – just before she went into cardiac arrest. Thankfully, they managed to quickly resuscitate Angela. And following the arrival of Emergency Medical Technician Alix Potter and Student Paramedic Luke Molyneux, she was rushed to the Norfolk and Norwich University Hospital where she was immediately taken into theatre to have a blood clot removed and stent fitted. Four days after the drama, she was well enough to be discharged from hospital. Angela said: “We had been to the allotment the day before and went to bed on the Friday night perfectly alright. The next morning I came out of the bathroom and I started sweating and I could not walk properly and fell on the bed. I still cannot believe what happened. “When I got home from the hospital, I was on top of the world but as the days went on I started bursting into tears and it has been hard to come to terms with. When you sit back you think I would not be here if it wasn’t for what they did for me. It is so nice to see them again.”
NEWSLINE continue to fundraise towards our
London Buys 2nd Helicopter for London’s Air Ambulance • London’s Air Ambulance has acquired a second emergency medical helicopter, a MD902 Explorer • It has been registered G-LNDN and is expected to
ultimate target and ask everyone to help in any way they can. Anyone can donate, either online at yourhelicopter.london, or by texting HELICOPTER to 70800 to donate £5.” Through the acquisition of a second helicopter and by
Photo taken by Jon Le Ray
extending its daylight flying hours in the summer months, the charity
by aircraft. This year, the charity
history and, as a result, it was
estimates it will be able to reach
flew longer hours in the summer
able to reach, and treat, a further
a further 400 patients per year
months for the first time in its
67 patients by air.
be operational early 2016 • The fundraising total to date of its ‘Your London, Your Helicopter’ campaign is just over £2 million • This is thanks to the generosity of the people and organisations in London • Donations from organisations, companies and the public are still needed to reach the £6 million target to keep it in the
The iPAD SP2
A new class of defibrillator
air for five years • People can donate online
A lightweight, compact defibrillator that delivers greater functionality than just an AED when it is needed most.
at yourhelicopter.london, or by texting HELICOPTER to 70800 to donate £5. • The largest pledge to date is from the London Freemasons, who have committed to donate £2 million Graham Hodgkin, Chief Executive Officer at London’s Air Ambulance, said: “We are absolutely thrilled to have now completed the acquisition of helicopter. While more money still needs to be raised and there is still more work to do to get the aircraft ready for UK HEMS operations, this is a truly exciting development for London and the biggest step-change in our
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service resilience in the charity’s history. Thank you to all those who have already contributed. We will
T: 03333 444789 E: info@ipad-aed.com W: ipad-aed.com/ipad-sp2
AMBULANCE UK - OCTOBER
our second MD902 Explorer
263 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE “The charity has been raising
our recent September trip,
Charity trip for trust staff
funds to build a new HIV
where we visited Melbourne
centre. HIV is very prevalent
and Sydney, we made 149
in Malawi and this new centre
job offers. Between now and
is essential to be able to
March next year, we will have
Two members of staff from
focus on providing specialist
another 170 joiners starting.
South Western Ambulance
care and treatment for the
We are offering Australians
Service NHS Foundation
thousands affected.
the chance to work for
SWASFT
one of the world’s busiest
Trust (SWASFT) will be heading to Africa to provide
“Joel and I will be getting
ambulance services which is
first aid and treatment for
involved with all the services
an incredible opportunity for
people living in a remote
the clinic offers, working on a
anyone in this field.”
part of Malawi.
full-time basis for six months from September.”
at Malmesbury) and Joel Brace (Lead Paramedic at Cirencester) are setting off for Cape Maclear in the south of Malawi where they will be working with the Billy Riordan Memorial Trust for six months. The pair will be working in a small, charity funded, rural clinic set up in remembrance of Billy Riordan. The clinic provides medical aid and facilities to over 15,000 people from Cape Maclear and the surrounding area. The clinic was set up in 2004 in memory of Billy who sadly lost his life at Lake Malawi in February 1999. The clinic includes a primary care facility that is open 24 hours a day seven days a
Australian High Commission Welcomes Australian Paramedic Recruits to London
Marathon and Notting Hill
The Australian High
a car, motorbike, bicycle
Commission hosted an event to formally welcome Australian paramedics who have been recruited to come and work for the
AMBULANCE UK - OCTOBER
Tel/Fax : 01268 833666
Carnival, which is a great opportunity for Australians, as well as paramedics in the UK. Coming to work with the London Ambulance Service opens up many opportunities for paramedics, in addition to frontline ambulance work. These include working on and helicopter, as well as specialist teams trained to work in hazardous or potentially dangerous environments.
London Ambulance Service. EEAST
The High Commissioner Alexander Downer and Director of Operations Jason Killens spoke at the event and welcomed the new recruits to the UK.
week. There is also a 12 bed
30 Brooklyn Drive Rayleigh, Essex SS6 9LW
London hosts world famous events such as the London
Harriet Illston (Paramedic
inpatient unit that can keep
More paramedics are needed
patients admitted for up to
in London due to year-on-
48 hours when they are either
year increases in demand
discharged or transferred to
and a national shortage of
the main hospital which is a
paramedics make it difficult to
two hour drive away.
recruit within the UK.
There are also various
Director of Operations Jason
outreach programmes
Killens said “We have had
offering maternity services,
great success in recruiting
feeding programmes and
Australians to work for us.
malaria prevention schemes.
We turned to Australia as the skills and training of
Speaking about the trip
their front line closely match
Harriet said: “They (the clinic)
ours. We have 190 Australian
have an ambulance, I say the
paramedics who are trained
word very loosely, which they
and already treating patients
use to transfer people.
on the streets of London. On
264 For further recruitment vacancies visit: www.ambulanceukonline.com
Cancer patient’s thanks to Peterborough paramedic When Tracey Goodacre first met paramedic Claire Squires, she was at her lowest ebb. After weeks of experiencing severe pain, weakness and confusion without a diagnosis, the 50-year-old was against being admitted to hospital. However, after listening to her concerns and gaining her trust, Claire was able to convince Tracey that she needed to be taken back to A&E, which led to doctors finding the source of her pain – bone cancer.
NEWSLINE The pair were reunited,where Tracey thanked the senior paramedic who gave her the faith to fight on. The mother-of-two from Eye, near Peterborough, had been suffering from headaches and back pain since March 2014, but doctors had been unable to find out what was wrong with her. When Claire rushed to her home in a rapid response vehicle on 15th May 2014, the patient was reluctant to go back to A&E after spending a week in hospital with no diagnosis. Tracey said: “I had a lot of paramedics coming out to me before this, but every time I got to A&E I was sent home. “Claire was the only one that listened and got me sorted out. It was such a relief when I got a diagnosis, even though it was so late finding it.” An MRI scan at Peterborough City Hospital revealed that Tracey had bone cancer and on 17th May, surgeons removed the tumour from her spine at Addenbrooke’s Hospital. Since her diagnosis, she has had chemotherapy, radiotherapy and stem cell therapy. Tracey added: “I probably would not be here now if I had not gone to hospital. The cancer is treatable, but not curable. If I get another three or five years it is better than not being here at all. I am so grateful for that. I’m here and that is the main thing and it is important to say thank you,” she said.
SECAMB
Sussex dad reunited with ambulance crews For a father of four, a night of celebration at his daughter’s college Leavers’ Ball became even more memorable for all the wrong reasons. During the evening Mike Champain, from Ardingly, West Sussex, suffered a cardiac arrest but decisive action by the South East Coast Ambulance NHS Foundation Trust crews, Mike was able to thank them personally at an emotional reunion at Crawley Ambulance Station recently. “So many people were in the right place at the right time that night and I am so grateful to them all for their support, care and expertise; college staff, ambulance staff and surgeons,” said Mike. Mike was with his wife Kate and his eldest daughter Caitlin at the Ardingly College Leavers’ Ball in July, when he started to feel unwell and an ambulance was called. Technician Alison Smith was first to arrive on scene, closely followed by ambulance crew Sam McCreesh (Paramedic) and Jade Paul (Technician).
It was while they were carrying out
“During the dinner I left the
an assessment that Mike suffered
marquee as I was not feeling well,
the first of four cardiac arrests.
I was looked after by college staff
He was shocked 11 times with a
who immediately called the college
defibrillator as the crew battled to get
doctor and then for an ambulance.
his heart back into a normal rhythm.
Both my arms were aching and I had pins and needles in both
With Mike’s condition unstable,
hands and chest pain. I think I
the team met up with critical care
knew very well what was going
paramedic team Stuart Plumbley
to happen and was absolutely
and Chris Roots while en route to
terrified of the outcome.
the Royal Sussex County Hospital. They provided further treatment as
“Fortunately the ambulance was
Mike arrested again.
called quickly and two physicians from Brighton Hospital, who were
“They are truly brilliant people and
attending the ball as guests,
there is no doubt their skill and
recognised what was happening
persistence ensured I got to the
and were able to help calm me
operating theatre in Brighton, where
and let the ambulance crews
the surgeons could complete the
know what to expect.
task of saving me,” said Mike. “I can’t thank them enough for The 51-year-old, who is managing
what they did for me that evening.
director of his own business,
It’s amazing to be given a second
had two stents put in his arteries
chance. I’m now feeling much
during a 45-minute procedure
better and have started back at
which restored a good flow of
work. The whole family is hugely
blood to the heart.
grateful.”
Mike added: “It had been an
Paramedic and Clinical Team
emotionally-charged day marking
Leader, Chris Roots said: “It is
the end of both Caitlin and son
great to be able to meet up again
Callum’s time at the college.
with Mike and Kate and to see
It was going to be a day to
him doing so well. It gives us a
remember for us all and that is
tremendous boost when we get
certainly how it turned out.
such a fantastic outcome.”
AMBULANCE UK - OCTOBER
Claire, who has worked for the East of England Ambulance Service NHS Trust for eight years and is based at Peterborough ambulance station, said it was lovely to meet Tracey again. “Tracey’s story reminds us paramedics to always keep an open mind with our treatment and working diagnosis as we need to remember that not everyone will present as a text book case. Most of all we must always listen to our patients and their families,” she said.
265 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE circumstances they were life
Robert Maxfield, The PGA’s
consultation event for local
critical helicopter emergency
joint chief operating officer,
residents and businesses to
medical air ambulance
commented: “While Midlands
find out about its proposed
missions, and taking in account
Air Ambulance Charity’s
new home to base the charity’s
the often remote location of
statistic is startling, it is sadly
helicopter, aircrew and office
golf courses, it is imperative
reflective of the situation across
staff.
we reach, treat and transfer
the country, which is why we
patients to hospital quickly,
launched a campaign prior to
The charity has been searching
as when someone suffers with
Ambulance Charity has
Christmas last year, whereby
for a site for its new home for over
a cardiac arrest for example,
a year and its preferred location
revealed a startling new
we want to see a defibrillator in
every minute counts.”
every golf club in the UK.
is on land at Outmarsh Farm,
all air ambulance missions
To help raise awareness of the
of Hampton Park West Industrial
undertaken by the service are
“We are also keen to support the
importance of the Midlands
Estate).
from golf courses.
life-saving work of the Midlands
Air Ambulance Charity among
Air Ambulance, which has
MAA
Midlands Air Ambulance Charity Goes A ‘Fairway’ For Golfers The team at Midlands Air
statistic – five per cent of
Semington, (immediately south
golfers, the charity has recently
undoubtedly saved countless lives
The 12.6 acre site is centrally
“We tended to 84 people on
partnered with The Professional
located which would enable the
golf courses in 2014, that’s
Golfers’ Association (PGA).
on golf courses in the region.”
helicopter to reach all parts of
one person every four days,” highlights Becky Tinsley, air
In recent years The PGA has
operations manager for the
taken an active role in health and
Midlands Air Ambulance
safety at golf clubs including
Charity.
playing a key role in supporting the Bernard Gallacher
WAA
Consultation event held for Wiltshire Air Ambulance’s proposed new base
Wiltshire within 11 minutes. As Melksham does not have an ambulance station, the charity believes that WAA would provide enhanced medical cover for
She adds: “A number of people
Defibrillator Campaign which
we airlift from golf courses
aims to install a life-saving AED
suffer with cardiac arrests, heart
(automated external defibrillator)
WILTSHIRE Air Ambulance
medical skills and as well as
attacks or strokes. In some
in every club in the country.
(WAA) held a public
responding in the helicopter,
the area. WAA’s Critical Care Paramedics have advanced
AMBULANCE UK - OCTOBER
266 For more news visit: www.ambulanceukonline.com
NEWSLINE they use a Rapid Response
Currently the helicopter and
Community First Responders,
Vehicle (car) to attend medical
aircrew are based at a hangar at
and the pub is now equipped
emergencies including road
Wiltshire Police Headquarters in
with a defibrillator.
traffic collisions, heart attacks
Devizes, while the charity team is
and strokes.
based at offices at Porte Marsh
Terry, who was a paramedic for
Industrial Estate, Calne. The
17 years, said: “Raising money
lease on the hangar runs out on
for the defibrillator all came about
December 31 2017 and the lease
after one of our regulars had a
on the offices runs out at the end
heart attack in the High Street
At a public consultation event, held at Trowbridge Rugby Club, people had the opportunity to talk with the project team and architects and give their feedback to the proposals. A total of 125 people attended.
of January 2018.
last year.”
The benefit of owning its own land would mean the charity has full control of its future and not
Mandy Clarke, Chairman of Wiltshire Air Ambulance, said: “We would like to thank everyone who attended our public consultation event to find out about our new home plans. The feedback we receive is really important to us as want to work
subject to the uncertainty that renting can bring.
Bideford pub raised thousands of pounds A Bideford pub with community at its heart has raised
in partnership with local people,
thousands of pounds for charity
be good neighbours and develop
over more than a decade.
plans that people of Wiltshire can be proud of.”
Terry England, whose boyhood dream was to run a pub, has
All the information from the
been landlord at the First In Last
public consultation event is
Out, in Clovelly Road, for 15
on the charity’s website www.
years.
The man’s heart stopped but because a defibrillator was onhand at a nearby dentist – his life was saved. “So we wanted to raise money for a defibrillator to be here in the pub and within two weeks our regulars had dug deep into their pockets and the money was raised,” he added. The couple are being put forward for an award for their fundraising efforts, and for what they have done to help the Bideford community. Terry, 58, said he has always wanted to run a pub, this pub in
wiltshireairambulance.co.uk/ Terry, along with his wife Carol,
particular as it was one of the first
and the pub’s cat, Melly, who
pubs he ever had a drink in, and
After the charity has assessed the
“rules the roost”, said charity was
had always been his local.
feedback it receives, it anticipates
at the heart of what they did.
who-we-are/about-us/new-home
submitting an outline planning application for the site in late Autumn 2015.
Carol, 58, said the pub was a “real The couple have raised
community pub” – a proper “local”,
thousands over the years,
family-friendly pub, where people
most recently raising money for
can feel safe and “have a laugh”.
“The charity’s new home would cost in the region of £3 million to build and equip. A private
WMAS
WMAS shortlisted in top awards West Midlands Ambulance Service (WMAS) has been shortlisted in not one but two categorises at this year’s prestigious Health Service Journal HSJ Awards. The shortlist has been announced and WMAS is the leading ambulance service participating in the award ceremony. For their combined work on the acclaimed mental health response unit in Birmingham, WMAS together with partners West Midlands Police and Birmingham and Solihull Mental Health Foundation Trust have been shortlisted in the ‘Enhancing Care by Sharing Data and Information’ category. The Trust’s Organisational Development team together with Coventry University will also be at the award ceremony hoping to be successful in the category of ‘Improving Outcomes through Learning and Development’. The programme, which was started in the Trust is now being rolled out across all NHS organisations in the Region in a programme with Health Education West Midlands. WMAS will face stern completion with ten other organisations shortlisted, including another ambulance trust and air ambulance provider.
benefactor, who wishes to remain 75% of this amount to pay for the building cost, which we are extremely grateful for. We will need to raise the remainder, amounting to some £750,000, to fit out and equip the building. In time, we will launch a Capital Appeal to raise this money as we want the people of Wiltshire to feel very much involved in our new home project,” said David Philpott WAA Chief Executive.
Terry, Carol and Melly
For more information about the HSJ Awards, please see: https://awards.hsj.co.uk/
AMBULANCE UK - OCTOBER
WMAS Chief Executive Anthony Marsh, said: “I am extremely proud that the Trust is to be a finalist in two categories at these national awards. I am delighted that we can share success with our partner organisations and further develop these initiatives to ultimately provide the very best healthcare to patients.”
anonymous, has agreed to fund
267 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE YAS
£1m boost for Yorkshire Air Ambulance new helicopter The Chancellor George Osborne has announced a £1 million cash injection towards a new state-of-the-art helicopter for Yorkshire Air Ambulance which will be taking to the skies next year.
helicopter, which should arrive by September 2016 and will fly out of Nostell. Yorkshire Air Ambulance Chairman Peter Sunderland, said: “We remain totally dependent on the generosity of the fantastic people of Yorkshire. “However, the phenomenal donation we have received today from The Chancellor of the Exchequer, will allow us to work towards fulfilling our mission to provide Yorkshire with the highest
Chancellor George Osbourne meets Yorkshire Air Ambulance paramedics James Stubley (l) and Paul Holmes during his visit to the charity’s air base at Nostell Priory
Mr Osbourne made the funding
quality rapid response emergency
pledge during a visit to Yorkshire
service – and I express my
Air Ambulance’s s air base at
sincere thanks for this exceptional
Nostell Priory, near Wakefield,
contribution.
operating and maintenance costs.
funding a new helicopter for the
with longstanding charity
“In planning for the future we have
The Airbus H145 is night capable
Yorkshire Air Ambulance.
supporter and cricketing legend
been building up our reserves
and is used by military, police and
Geoffrey Boycott who asked the
to ensure we can continue to
air rescue services around the
“It’s a brilliant charity that saves
Government for help.
develop and expand our life
world – including the Metropolitan
lives across Yorkshire, a county
saving service by having the most
Police.
very much at the heart of the
Following the completion of a
up-to-date aircraft.
detailed review of their evolving
Northern Powerhouse. It has a larger cabin and provides
needs for service delivery over
“G-SASH has been a familiar
paramedics with a much more
“This funding - and the £10 million
the next 25 years, Yorkshire Air
sight over the skies of Yorkshire
modern medical fit-out to treat
the government has donated
Ambulance has now placed
for the last 14 years. But in recent
and transport often critically
to Air Ambulances across the
an order for a latest generation
years, maintenance costs have
injured patients.
country in the past year - comes
Airbus H145 helicopter to replace
escalated and spare parts have
the older of its two aircraft,
become increasingly difficult
Mr Sunderland added: “Replacing
it’s only right that funds from
G-SASH.
to find. Now is the right time to
G-SASH will ensure the
those who have demonstrated the
replace her.”
continuation of a state-of-the-art
worst values should go to those,
air ambulance service for the
like the dedicated and skilled
The £1 million Government
from fines levied on banks, and
donation, from fines levied on
The new helicopter offers
people of Yorkshire for the next 25
air ambulance crews and their
banks, will contribute substantially
exceptional flight performance
years.”
supporters who demonstrate the
towards the new £5.7 million
and will have significantly lower
best of British values on a daily Yorkshire Air Ambulance is a rapid
basis.”
response emergency service that serves five million people across Yorkshire, operating from air bases at Nostell and RAF Topcliffe, near Thirsk. It attends more than 1,000 AMBULANCE UK - OCTOBER
incidents a year, on average, and
SCAS
Lady Cumberlege visits Labour Line at South Central Ambulance Service
the charity needs to raise £12,000 every single day to keep its two
On Tuesday 18 August 2015
existing helicopters maintained
as part of her visit to maternity
and flying.
services in the South, Lady Cumberlege visited the award
Chancellor George Osbourne meets Yorkshire Air Ambulance chairman Peter Sunderland and cricketing legend Geoff Boycott during his visit to the rapid response emergency service
George Osborne, Chancellor of
winning Labour Line at South
the Exchequer, said: “Geoffrey
Central Ambulance Service
Boycott asked the government
NHS Foundation Trust (SCAS)
for support, and I am delighted
which is run in partnership
to able to donate £1m towards
with Hampshire Hospitals
268 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE NHS Foundation Trust. Whilst
ambulance staff in emergency
visiting the centre she spent
situations and that offered in
time finding out about how
the community setting. When
the award winning service is
women or their partners call
delivered, had the chance to
the line they speak to an
speak to the midwives and
experienced midwife who is
see the Labour Line in action.
able to discuss birth plans, provide support and advice
The Labour Line is situated
and make all the necessary
at the ambulance Emergency
arrangements for their birth.
Operations Centre (EOC) in Hampshire and is staffed by
Tony Peters, Head of EOC
qualified midwives who are
said “We were very privileged
available 24 hours a day on the
to receive a visit from Lady
phone to provide support and
Cumberlege on Tuesday and
guidance to expectant mothers
it was a great opportunity
reassurance for the caller that
and their families.
to showcase the proactive
they are speaking to an expert
partnership which has had
who knows exactly the right
The service, the first of its kind
a very positive impact on
in the country, was launched
expectant mothers and their
21 months ago in partnership
care. Should we receive
with Hampshire Hospitals
calls relating to pregnancy or
NHS Foundation Trust. The
women in labour that come in
Labour Line provides additional
via our own NHS111 or 999
support, advice and guidance
services, we can pass these
to have more time to respond
to people over and above
if appropriate directly to the
to other non-pregnancy related
the clinical care and skills
experienced midwives on the
emergency and non-emergency
already being delivered by
Labour Line. This provides
calls that come in.”
questions to ask and can offer on the most appropriate and safe response. It allows our emergency operations centre staff, and frontline paramedics,
“We were very privileged to receive a visit from Lady Cumberlege and it was a great opportunity to showcase the proactive partnership which has had a very positive impact on expectant mothers and their care.”
XPS - expandable patient surface - is adjustable with 7 locking positions and a wider mattress, designed with patient comfort in mind.
AMBULANCE UK - OCTOBER
The Power from Stryker
269 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE WMAS
Formation of new national charity for the ambulance services A leading figure in the UK Emergency Services has heralded the formation of a new national charity for the ambulance services as “meeting a very definite need” in the industry. Sir Graham Meldrum, Chair of the West Midlands Ambulance Service NHS Foundation (WMAS) Trust for almost ten years, met staff of TASC, The Ambulance Services Charity, on a visit to its
ambulance service families in times
from small beginnings into
“I think TASC is meeting a very
of severe difficulty or bereavement.
a large organisation which
definite need because ambulance
provides support and grants
service personnel are facing
Before joining WMAS, Sir Graham
for firefighters and their families
increasing challenges and
was involved in the fire service
which is a similar mission to
significant demands and this
for over 50 years which included
TASC except their focus is on
impacts in the same way as in
being HM Chief Inspector of Fire
the ambulance service.
other emergency services.
and Chief Fire Officer of the West
“There are a lot of small
“Ambulance staff may suffer as
Midlands Fire Service as well as
regional benevolent funds and
a result of dealing with critical
being appointed Chair of the Fire
associations which carry out their
situations and exceptional
Services National Benevolent
own fundraising.
challenges in the line of duty and
Services for England and Wales
Fund, which is now known as the Fire Fighters Charity.
are sometimes injured themselves “TASC provides the opportunity
trying to give medical assistance in
for the whole ambulance services
difficult situations so they may need
Sir Graham discussed ideas for
community to come together and
help with support and grants to look
TASC’s future development with
get behind their own national
after themselves and their families.
Chief Executive Lorna Birse-Stewart,
charity which is dedicated to
and how the two organisations
helping and support them.
can work together to promote and develop the UK charity.
new Midlands Head Office.
“It will be good for TASC and the WMAS to work together because
“It also gives the general
this is an ideal way for the public to
public, who want to show their
show their thanks and appreciation to people in the service.”
He said: “I contacted TASC
appreciation and thanks to
He was on a fact-finding mission
because I thought this was a great
paramedics and other ambulance
to the Coventry-based charity
opportunity for me to give them any
staff who have helped them, the
Lorna Birse-Stewart, Chief
which was formed in March to
benefit I can from my experiences.
opportunity to make a donation
Executive of TASC, said Sir
for the benefit of the ambulance
Graham had also met Chairman
help provide vital support services and advice to serving and retired
“We grew the Fire Services
personnel and ambulance service
Cliff Randall and Trustee Gordon
ambulance personnel and
National Benevolent Fund
families it supports.
Enstone during his visit.
AMBULANCE UK - OCTOBER
270 For more news visit: www.ambulanceukonline.com
NEWSLINE never see my daughter or my granddaughter. “For the people here and the defibrillator – saved my life.” On Saturday 13th August 2011, Ian Hough, 59, a rower with Stourport Boat Club, suffered a cardiac arrest during a race at his home regatta. At the time, Stourport Boat Club didn’t have a defibrillator (a device which can restart the heart of someone who suffers a cardiac arrest) of its own. Fortunately for Ian, medical cover was being provided for the event meaning there was a defibrillator on site that day.
Sir Graham Meldrum, Chair of the West Midlands Ambulance Service NHS Foundation Trust (third, left) with, from the left, Cliff Randall, Lorna Birse-Stewart and Gordon Enstone from TASC, The Ambulance Services Charity “It was a productive and informative meeting and gave us the opportunity to explain the services we aim to provide to help support men and women throughout the ambulance service at times of crisis or severe difficulty,” she said. “There is a real need for a national ambulance services charity and TASC will play a vital role in focusing on the issues that are facing our ambulance staff and help address the significant impact that the daily stresses and challenges have.
The TASC Freephone Support Line telephone number is 0800 1032 999. For further information or if you would like to support the work of the charity, please visit www.theASC.org.uk
WMAS helps reshape apprenticeship scheme Ambulance Trusts across the country, including West Midlands Ambulance Service (WMAS), are the latest healthcare employers to gain government approval for developing new apprenticeship standards. The Trailblazers apprenticeship programme plays a key role in replacing complex apprenticeship frameworks with short, simple and accessible standards written and developed by employers. Prime Minister David Cameron recently announced the latest Trailblazer groups of leading employers within the healthcare sector. Ambulance Trusts have been working together to develop new apprenticeship standards with the aim of ensuring that every apprentice on a scheme can look forward to learning the necessary skills to pursue a career with the emergency services.
WMAS Chief Executive Anthony Marsh, said: “I’m delighted that the ambulance service is playing a leading part in the government’s programme to reform apprenticeships. This programme will ensure apprentices get a thorough introduction to the ambulance service and it should prove an influential starting point for those with aspirations of a career in emergency medicine.”
‘Pull through’ “I was dead for seven minutes.” “The people who were here; the nurse, the doctor, rowers – if it hadn’t been for their help I would
Ian’s story has been turned into a powerfully emotional short film called ‘Pull Through’, produced by his employer drpvideo, to encourage as many clubs, groups, businesses, societies and communities as possible to consider getting a defibrillator. Ian said: “Had this happened to me on a normal day at Stourport Boat Club, I know I would probably be dead. A cardiac arrest could happen to anyone at any time, in any place. I was lucky that it happened to me during the regatta when there was a defibrillator there. It saved my life.” Cliff Medlicott, West Midlands Ambulance Service Community Response Manager who also appears in the film said: “I want as many people as possible to see this film and think about getting a defibrillator. ‘Pull Through’ is a compelling reconstruction of what happened to Ian and why he is still alive today. Defibrillators are easy to use, they even tell you what to do. You can get them for as little as £800 and sometimes for free. What price a life?”
AMBULANCE UK - OCTOBER
“TASC can offer help and advice with access to rehabilitation services, mental health services and counselling including Post Traumatic Stress Disorder; bereavement support; and welfare and debt advice through our confidential support telephone line.”
WMAS
Julian Rhodes, WMAS Head of Education and Training and one of the architects of the new standards, said: “We’re pleased to be supporting the Trailblazer programme. It commits ambulance trusts to a comprehensive training scheme for aspiring apprentices who may wish to consider a future career in emergency and urgent care.”
Ian has made a full recovery. He continues to row and has a won a number of races and Stourport Boat Club has installed its own defibrillator with the help of West Midlands Ambulance Service who trained its members in its use.
271 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE counselling available and we
First member of the ambulance service to receive treatment under pilot scheme
hope that our grant will help support her recovery,” she said. “On the last day at the centre, Kat will be given
A paramedic who had major
recommendations about what
shoulder surgery after being
she needs to do next and we
seriously injured whilst
hope that she will be in a better
on frontline duties is to
position to be fit to return to
become the first member of
work.
the ambulance service to receive treatment under a
“TASC understands that
pilot scheme for the physical
ambulance services frontline
rehabilitation of ambulance
staff face significant challenges
staff launched by a new UK
and pressures in the line of
charity.
duty which can affect their own health and TASC is here
Kat, who lives in Somerset,
to help.
has received a grant from TASC, The Ambulance
“This pilot scheme will, we
Services Charity, to undergo
hope, make a significant
rehabilitation at the Police
difference to Kat and other
Treatment Centre in Harrogate
members of the service who
between Monday, September 7
we are able to help through the
and Friday, September 18 under
TASC rehabilitation pilot.
a new scheme commissioned by the charity. Kat was working as a paramedic for South Western
Kat Chignell who is the first paramedic to benefit from a pilot scheme run by TASC, The Ambulance Services Charity
“We would like to develop a much larger TASC ambulance service rehabilitation
After numerous months having
compete in triathlons; however
programme. To do this we
physiotherapy and diagnostic
I have missed my whole
really do need the whole
scans, Kat had to undergo
season this year, along with my
ambulance services sector
surgery in April 2015 to repair
motorsports trackside season
and the general public to get
October 2014.
her labrum and to have her
and I am looking forward to
behind us, join up and support
long head bicep released and
getting back to them both next
the work of the charity.”
She said: “I’m really grateful to
fixed. Recovery has included
year.”
Ambulance Service NHS Foundation Trust (SWASFT) when she was dispatched to a patient while on night shift on
TASC for organising this and
Ken Wenman, the Chief
four and a half weeks in a sling, Lorna Birse-Stewart, Chief
Executive of South Western
Executive of TASC, said the
Ambulance Service NHS
Harrogate. It shows how much
Kat said: “I need intensive
pilot scheme aims to support
Foundation Trust, is fully
this charity is needed by the
rehabilitation as after four-and-
the early intervention and
supportive of the initiative and
ambulance service community
a-half months, I still haven’t
rehabilitation of ambulance
said: “I am fully behind the
and we need to get behind
got a full range of movement
staff and that they are making
principles of TASC and would
them to give other ambulance
and I still have not regained
grants of up to £1,500 available
encourage others to show
staff these opportunities.
my muscle tone or power in
to enable up to 15 ambulance
their support. I wish Kat all the
my shoulder. I have been
personnel to go to this and
best with her treatment and
“When the incident happened,
seeing my NHS physio every
other centres where TASC
look forward to charting the
having released myself from the
two or three weeks and in
has agreed commissioning
progression of the charity.”
patient, I had instant pain in my
addition I have paid for a weekly
arrangements.
shoulder. Having taken my own
appointment with a private
pain relief to no effect, I had
physio.
for making a grant available for
physiotherapy and exercises.
my rehabilitation treatment in
AMBULANCE UK - OCTOBER
to attend A&E, who gave me
For more details about the “Kat’s need for treatment
TASC rehabilitation pilot
is really important and at
scheme or to find out more
stronger pain relief and referred
“I am looking forward to getting
the Police Treatment Centre
about joining and supporting
me to physiotherapy, which I
back to frontline duties as a
there are a variety of services
the work of the charity please
started ten days later.”
paramedic. When not at work, I
including physio, therapies and
visit www.theasc.org.uk
272 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE Dr Ben Clark added: “When
Assistant Chief Ambulance
you are faced with a situation
Officer, Steve Wheaton, said:
like that, making sure you get a
“I am so proud of my staff and
good outcome for the patients
fantastic job they did on the
is your primary focus. Although
day. It cannot be stressed what
for the whole team”, exactly
the rescue was incredibly
a tremendous job everyone did
sums up the feelings of the
complex we were all driven by
on the day – Tom, Dave and
two doctors and a critical care
the need to do everything we
Ben couldn’t have done what
paramedic who were given
could to save Leah, Joe, Vicky
they did without the help of all
a Pride of Britain Award last
and Daniel.”
of the other people involved.”
This award is for the whole team It’s an oft used phrase, but in this case, “This award is
“The patients are the real heroes. They have shown exceptional courage. We just did what we needed to do.”
night for their work rescuing the four people trapped in the front row of the Smiler Ride at Alton Towers on 2nd June. Army doctor Major David Cooper and aircrew paramedic Tom Waters were on the Midlands Air Ambulance at Cosford when they were called to the theme park following
ILLUMINATING CPR
the incident in June. Dr Ben Clark, who is a volunteer with North Staffordshire BASICS emergency doctors was also mobilised to the scene. Working with about 50 other
The First Manikin that helps you Visualise the effects of CPR
ambulance staff, the local Alton Community First Responders, staff at the Alton Towers Park and firefighters, the three climbed onto the Smiler Ride to free the trapped victims. Speaking at the awards last night, West Midlands Ambulance Service Paramedic Tom Waters, said: “We need to remember that it wasn’t just us up there. This was a massive team effort by everyone there. “Receiving the award does heroes are Vicky, Daniel, Joe and Leah who were trapped; they were so brave on the day and still are. Major David Cooper said: “The patients are the real heroes. They have shown exceptional courage. We just did what we
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AMBULANCE UK - OCTOBER
mean a lot, but for us, the real
needed to do.”
273 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE Innovative sepsis screening tool wins award University of Bolton Advanced Practitioner MSc student, Daniel Butterworth, has used his final year project to develop an innovative screening tool for the ambulance service. With its potential to have national and international impact, Daniel’s award has been selected for an award from the University, recognising its significance for patient care.
Advance Paramedic, Daniel, has formulated a pre-hospital screening tool to identify sepsis, a potentially fatal condition in which the body’s reaction to infection is to send the immune system into overdrive. This reaction can lead to a sudden drop in blood pressure, impacting on blood clotting and the blood supply to vital organs, such as the brain and heart. More than 37,000 UK deaths each year are attributed to sepsis, more than heart attacks and strokes, and yet the ambulance service has no nationally agreed guidelines for identifying the condition where an early diagnosis can be critical.
Said course senior lecturer, Dr Chris Mulryan: ‘Daniel is breaking new ground with his project that will undoubtedly have far reaching implications both nationally and internationally.’ North West Ambulance Service
As part of his Masters final year project Daniel has worked in collaboration with Salford and Central Manchester Foundation Trusts to look at the case history of 999 calls, tracking the patient journey for each case.
Said Daniel: ‘I looked at whether the patient was treated for sepsis, and whether we identified it or whether it was identified at hospital. ‘I then formulated a pre-hospital screening tool from models existing in hospitals and research reviews and applied that model to 300 cases. The screening tool I developed would have picked up sepsis in 90% of cases.’ Daniel’s diagnosis tool has been used in Manchester and Salford as part of a pilot project where 100 ambulance staff have been trained in its use. This pilot project has allowed Daniel to develop a best practice care bundle for severe sepsis with Daniel and his colleagues being better able to identify the condition, give best care possible on the way to hospital and be able to brief hospital ahead of arrival so staff there are ready to act.
AMBULANCE UK - OCTOBER
274 For further recruitment vacancies visit: www.ambulanceukonline.com
Daniel presented a paper on his research findings to the UK Sepsis Trust Conference in May. There are now funding bids being written to train more staff so Daniel’s project recommendations can be rolled out across the North West. Said Daniel: ‘I have found the Advanced Practice course at Bolton to be really good; I’ve loved it. The clinical skills aspect and the confidence it has given me in that area have really made a difference for me.’ Senior Lecturer on the Advanced Practitioners’ Masters, Dr Chris Mulryan, explained that the traditional dissertation format had been replaced to give meaningful, practical relevance to the students’ workplaces. ‘Our Advanced Practitioners are required to deliver a project which enhances the quality of patient care in their final year of study,’
NEWSLINE said Chris. ‘We changed this from a traditional academic dissertation a few years ago as we wanted our course and our students to effect real change in practice which improves the lives of patients. ‘Daniel’s award recognises that his project will likely have the most significant impact both in terms of saving lives and improving the quality of lives out of all the projects completed this year. We are really very proud of our students for all of the projects delivered this year.’
YAAS
Deloitte charity challenge takes off Yorkshire Air Ambulance is flying high after becoming the local charity choice of business advisory firm Deloitte. The rapid response emergency service was selected as Deloitte in
Yorkshire’s charity partner for the next two years after a vote by nearly 500 staff in the firm’s Leeds office. The firm is planning a range of fund raising events during the year including the Yorkshire Three Peaks Challenge and a charity auction. It is also offering Yorkshire Air Ambulance a range of volunteering and pro-bono professional support. Helen Kaye, Partner and corporate social responsibility lead at Deloitte in Yorkshire, said: “I am delighted that Yorkshire Air Ambulance will be our local office charity for the next two years. “With 490 people based in our Leeds office we already have some exciting plans in the pipeline for fundraising and volunteering activities over the next year to help Yorkshire Air Ambulance in their mission to save lives across the county. “Through our corporate social
responsibility programme at Deloitte, our aim is to play a proactive role in helping our local charity deal with key organisational challenges, not just raising funds but also providing time and expertise through volunteering and pro-bono support.” Yorkshire Air Ambulance serves five million people across the county and attends more than 1,000 incidents a year. The charity has so far airlifted more than 6,200 people. Paul Gowland, Yorkshire Air Ambulance Head of Fundraising, said: “We are delighted to have been chosen by Deloitte in Yorkshire as their charity partner and look forward to working closely with them. “We need to raise £12,000 every day to keep our two helicopters flying and it is support like this from fantastic companies like Deloitte that is so vital to helping us achieve that target.”
“With 490 people based in our Leeds office we already have some exciting plans in the pipeline for fundraising and volunteering activities over the next year to help Yorkshire Air Ambulance in their mission to save lives across the county”
AMBULANCE UK - OCTOBER
Helen Kaye, Partner and corporate social responsibility lead at Deloitte in Yorkshire (l) with Kerry Garner, Yorkshire Air Ambulance Regional Fundraising Manager West and South Yorkshire
275 For all your equipment needs visit: www.ambulanceservicesuppliers.com
NEWSLINE Daniel for a reunion at Warrington
Jon and Daniel added, “It’s
The charity has teamed up with
Ambulance Station to talk about
overwhelming to get so much
Great Western Air Ambulance
her experience. Diane was given
praise. We’re part of a huge team
Charity (GWAAC), based in Bristol,
a tour of the ambulance station
here at NWAS and just doing our
to fund the initiative. From August
and had the opportunity to thank
job. We’re so happy to see Diane
17 2015 GWAAC began carrying
Daniel and Jon for saving her life.
fully recovered and in such good
blood on its helicopter. This means
spirits. This job is a real privilege
that the two air ambulances are the
Diane said: “I woke up feeling
to do – we get the chance to
first in the south west of England to
sick with burning in my chest and
make a difference and it’s nice to
carry blood.
A North West Ambulance
my chest was getting tighter, so
get recognition for our work.”
Service (NWAS) Crew has been
I phoned for an ambulance as I
praised by a Warrington patient,
knew something wasn’t right.
NWAS
‘I wouldn’t be here if it wasn’t for you’ – Warrington patient tells NWAS ambulance crew
who said she ‘wouldn’t be here’ if it wasn’t for them, after
“Within minutes Jon and Daniel
suffering a heart attack.
came along to check me over. They gave me morphine after
WAA Critical Care Paramedic WAA
Life saving blood on Wiltshire Air Ambulance
Diane Wilson, from Orford in
discovering I was having a heart
Warrington, suffered a heart attack
attack. The lads took me to
Pre-hospital blood transfusions
on 22 May. That evening Diane
Liverpool Heart and Chest Hospital
can now be given to patients
went to bed not feeling very well.
where their team gave me keyhole
treated by Wiltshire Air
After phoning for an ambulance,
surgery – I felt like I could run a
Ambulance’s Critical Care
NWAS Ambulance Crew Jon
marathon after I had it done!
Paramedics.
swiftly on the scene to give Diane
“A big thank you to the North
On August 17 2015 Wiltshire Air
treatment and took her directly
West Ambulance Service, I was
Ambulance (WAA) began carrying
to Liverpool Heart and Chest
looked after so well. I would like
blood on the helicopter and rapid
Hospital for specialist surgery.
to thank Jon and Daniel for their
response vehicle, which will
professionalism because I don’t
benefit seriously ill and injured
Now fully recovered from her
think I would be here without
patients in need of emergency
operation Diane joined Jon and
them.”
blood transfusion.
Almond and Daniel Ogdon arrived
Richard Miller said: “Without doubt having blood on the helicopter will save lives. At the very least, by giving blood to patients it will increase their blood volume and enable oxygen to get to their brain, heart and kidneys giving them a better chance of survival to enable us to get them to hospital for treatment. “Over the last four years Wiltshire Air Ambulance has moved rapidly into pre-hospital care by diagnosing, stabilising and treating critically injured patients on the roadside before they are taken to hospital. Having blood on the aircraft is another enhancement we can make in taking the emergency department to the patient.” Emergency blood transfusions are likely to be given to patients who suffer life-threatening bleeding caused by trauma and some acute medical conditions. The blood is collected daily from the North Bristol Trust Transfusion Laboratory at Southmead Hospital and delivered daily to WAA’s Operations Centre in Devizes and GWAAC’s airbase in Filton by the charity Freewheelers EVS, which
AMBULANCE UK - OCTOBER
covers the south west. Additional deliveries can be made if required by the air crews. If the blood is not used, it will be returned to Southmead Hospital by the volunteer blood bikers after 24 hours. The blood storage Daniel Ogdan, NWAS Student Paramedic, Diane Wilson and Jon Almond, NWAS Paramedic at Warrington Ambulance Station
276 For further recruitment vacancies visit: www.ambulanceukonline.com
boxes maintain the temperature of the blood within very narrow limits for well over 24 hours. Any unused
NEWSLINE blood units are therefore able to be put back into the Southmead Hospital blood bank, preventing waste. Melanie Rowbottom, a trustee of Freewheelers EVS, said: “Delivering blood supplies to air ambulances is a new venture for us and we are delighted to be working in partnership with Wiltshire Air Ambulance and Great Western Air Ambulance. “We are excited to play our part in delivering a component of a service that could save many more lives, fully supported by the commitment of our members to make deliveries to the Air Ambulance bases 365 days a year.” South Western Ambulance Service NHS Foundation Trust’s deputy clinical director, Adrian South, said: “SWASfT’s critical care specialist paramedics who work on the air ambulances
In the centre, Chris Nourse of Freewheelers EVS and Richard Miller, Wiltshire Air Ambulance Critical Care Paramedic, holding the Credo blood box watched by (l-r) Dan Tucker, WAA paramedic, Joanne Munday WAA Critical Care Paramedic, George Lawrence, WAA Chief Pilot, Simon Whitelock, Freewheelers EVS, Fred Thompson, WAA paramedic, and Dr Ed Valentine, WAA base doctor. receive additional training so they can bring even more clinical skills to the most seriously ill and injured patients. Along with critical care doctors, they are able to administer the blood. This new initiative to carry blood for transfusions on the two air ambulances will be of real benefit for patients in the south west.”
The blood, two units of O negative, is stored in a Credo blood box, an insulated box that maintains the blood within a narrow temperature range preventing damage and spoilage. When blood is to be given to a patient it will be warmed from its cool storage temperature towards
body temperature using a small portable device called a Belmont buddy lite Fluid Warmer. The Credo blood box containing the units of blood can be switched from the helicopters to the Rapid Response Vehicles (RRV) used by WAA and GWAAC Critical Care Paramedics, if needed.
AMBULANCE UK - OCTOBER
277 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE She was accompanied by
So, which obstacles were the
“A couple of times I was thinking
TASC - New Tough Mudder
colleague Tim Falchi from Welsh
worst?
‘what am I doing?’ but I got
course where you got a 10,000
“Would I do it again? No, although
An ambulance paramedic
Johanne, who is married to TASC
volt shock from wires dangling
I feel really chuffed that I did it.”
has completed the ‘torturous’
Chairman Cliff Randall, had
down from a frame that you had
Tough Mudder challenge and
previously taken part in a couple
to go through,” she said.
raised hundreds of pounds for
of half marathons but clearly
TASC, The Ambulance Services
nothing like Tough Mudder.
Ambulance Services throughout the mud-filled challenge.
through it. “There was one at the end of the
“Some of the wires didn’t seem to be charged, but one of them
Charity. She said: “The weather was
caught my left arm and by the
Johanne Evans-Randall overcame
horrendous, in fact you couldn’t have
time I recovered from that another
a series of obstacles throughout
had a worse day. It was very wet and
caught my left leg. Some people
the gruelling 11.1 mile course,
cold and you never got warm at all.
were trying to walk through without
which included ducking your head
I imagined it to be muddy but there
touching any wires, but that would
under ice-cold water and being
was mud everywhere.
have been worse if you caught one as the pain would last longer.
jolted with 10,000 volts. “Now that I’ve finished I can say I And, after completing the course in
enjoyed the experience, but it was
“The other main obstacle I didn’t
just under three-and-a-half hours,
awful while I was doing it.
like was a water chute where
Johanne has already raised more than the £500 target which she set for herself, and is hoping to get a few more pounds in to boost the total. Anyone interested in supporting Johanne can still donate to TASC via her fundraising page at www.justgiving.com/JohanneEvans-Randall/ If you are interested in taking
they put ice cubes in to make the
part in a fundraising event or
“I ran with my colleague Tim
temperature minus one. You got
challenge on behalf of TASC
Johanne, who is a paramedic with
but everyone helped each other
a shock when you hit the water
please contact Fundraising
the Welsh Ambulance Services
round. We felt as though there
because it was so cold, but just
and Development Manager
NHS Trust, took part in the Tough
was one whole team helping
when you got used to it you had
Paul Kinsella on
Mudder South West event at
everyone else, particularly when it
to duck your head under the water
02477 987922 or email
Cirencester Park in Gloucestershire.
came to the obstacles.”
to go under some tyres.
paulkinsella@theasc.org.uk
Johanne vowed “never again!”.
AMBULANCE UK - OCTOBER Johanne Evans-Randall and Tim Falchi from the Welsh Ambulance Services NHS Trust
278 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE Newly qualified paramedics graduate from Swansea University
designed to support EMTs in their
and Care Professions Council),
agreeing to fund this programme
progression.
and thus operate throughout the
and Swansea University in
Trust in a Paramedic role.
working with us to develop the content.
The 19-strong cohort collected their awards at a ceremony in
Judith Hardisty, the Trust’s
the city’s Brangwyn Hall from the
Director of Workforce and
“Thanks should also go to
University’s Pro Vice-Chancellor
Organisational Development,
the Trust’s Learning and
Professor Hilary Lappin-Scott.
added: “Studying is difficult at
Development Team and all
A GROUP of Welsh Ambulance
the best of times, let alone when
managers and colleagues who
Service EMTs (Emergency
Professor Lappin-Scott said:
you’re working on the frontline
have supported the students.”
Medical Technicians) who
“To graduate through this route
of the ambulance service at the
enrolled on a Diploma in
is a fantastic achievement,
same time.
Paramedic Sciences to qualify
particularly as the students are
as Paramedics have officially
working full time as an integral
“These awards are testament
Leeson Emery, Sian Lloyd,
graduated from Swansea
part of the Emergency Medical
to the group’s hard work and
Alexander Burnham, Steve
University.
Services.
effort, and I’d like to extend my
Rogerson, Adrian Evans, Zoe
congratulations and well wishes
Lambert, Marc Thomas, Sian
to them all.
Edmunds, David Jenkins, Mark
Among those recognised were: Darren Bright, Huw Jackson,
The diploma is the culmination
“Through commitment to hard
of 18 months of study, which the
work and application to study
students undertook while they
this cohort typifies the ethos of
“They have set a high standard
Ford, Catrin Morris, Adrian
continued with their day job as
the paramedic profession; that
for their colleagues who are in
Pagano, Christopher Ellis, Mark
EMTs.
of professionalism, compassion
the current programme and those
Scrivens and Keith O’Connor.
and clinical competence for the
due to start in September this
benefit of patients in their care.”
year.
the Welsh Ambulance Service
Successful completion of the
“We also want to thank the
Ambulance Service, please visit
in 2013 in conjunction with
programme enables the cohort
Workforce, Education and
the Working for Us section of
Swansea University, and is
to register with the HCPC (Health
Development Services for
the website.
The EMT-Paramedic conversion
Williams, Mark Howells, Laurence
To find out more about career opportunities at the Welsh
programme was established by
AMBULANCE UK - OCTOBER
279 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
IN PERSON NWAS News
New Non-Executive Director appointed for NWAS
with the National Ambulance Service in
Eve has spent much time on the Island both
Ireland where he eventually became Chief
for pleasure and for work. She was born
Executive for three years. He then went
in Southampton from a sea-faring family
on to be Chief Executive of the South
and joined the NHS as a National Graduate
Australian Ambulance Service.
Trainee. One of her very early assignments included supporting the new build project of
The NHS Trust Development Authority (NHS TDA) has confirmed the appointment of
Robert said: “I am thrilled to be the new
St Mary’s Hospital. She has been a successful
Richard Groome as Non-Executive Director
chief executive and very much look forward
leader in the NHS and in the voluntary sector.
of North West Ambulance Service NHS Trust.
to working with my new EEAST colleagues.
She has also run an international health
The service has been through some very
and care consultancy supporting a range of
Richard Groome is a Chartered Engineer and
difficult and challenging times over the last
services and Boards in the UK and abroad to
member of the Royal Society of Public Health.
few years, but I am confident we can build
improve their services and actively engage
Living in Shropshire, Richard has extensive
on the good work that Anthony Marsh has
with their communities.
business and family connections in our area
put in place to further improve our services
and has been heavily involved with major public
for patients and at the same time make this
Eve enjoyed a successful career as Chief
infrastructure projects like Alder Hey and North
a even better place to work.”
Executive at Homewood NHS Trust where working with a creative Board and partners in
Staffs Hospitals, Manchester Waste, GMPA, Robert added: “Having worked in the
Surrey they set up new models of integrated
ambulance service for many, many years I
care and support, working closely with local
Previously a Non-Executive director with
understand the challenges and issues and
communities. She has also held a range of
the Shropshire Heath Authority, he has also
how we can resolve them together. Whilst it
Non Executive roles at Board level on Housing
worked with West Midlands Ambulance
is not going to be easy, I know first-hand the
Associations and she served for two terms
Services (WMAS).
commitment and dedication of those working
as a Non-Executive Director of The Ridgeway
in the ambulance service and that together
Partnership NHS Trust, in Oxfordshire until
we can make a real difference for patients.”
2008 and was its Champion for Older People.
welcome Richard Groome to the Service and
Trust Chair Sarah Boulton said: “I am
Eve, her husband and three cats moved
are confident that he will be a positive addition
delighted Robert is going to lead our trust
permanently to St. Lawrence, Isle of Wight
to the Trust Board.
as we look to make further improvements to
in 2014 after retiring as Chief Executive of
the service we give to patients. Robert is an
the National Council for Palliative Care, the
“Richard has a wealth of experience within the
experienced ambulance chief executive who
umbrella charity set up by Government to
healthcare and public sectors, and this will be
will be able to connect immediately with
improve end of life care services across all
invaluable to the Trust, particularly his previous
frontline staff and volunteers thanks to his
sectors. She took it through three key phases
work with our ambulance colleagues in West
paramedic and volunteering background.”
of growth over 15 years working closely with
Oldham Housing and Manchester street lighting.
Chairman for North West Ambulance Service, Wyn Dignan comments: “We’re delighted to
the NHS, social care and leading national
Midlands.” Sarah continued: “I would like to pay
and local charities, including services on
Non-executive appointments to NHS Trusts
special thanks to Anthony who has worked
the Island. She was asked to set up and
made by the NHS TDA are subject to the Code
tirelessly to rebuild the service since last
lead a new national coalition as part of the
of Practice of the Commissioner for Public
January. Thanks to this work, we are now
First National End of Life Care Strategy in
Appointments.
in a position to take the next steps on
2008 to raise public awareness about the
our journey, building a better service for
importance of talking about end of life wishes
patients and staff.”
and recording in care plans so they can be
Richard Groome has been appointed from
met. Eve was also asked to join the Prime
6 August 2015 until 5 August 2017. He has declared no political activity in the last five years.
IOW News
Minister’s Dementia Challenge Health and
New Chair for Isle of Wight NHS Trust announced
Care Champion Group in 2013 and became
The NHS Trust Development Authority (NHS
Speaking about her appointment Ms
TDA) has confirmed the appointment of Eve
Richardson said: “I am looking forward
The East of England Ambulance Service
Richardson as Chair of Isle of Wight NHS
to being the Trust Chair and working with
NHS Trust (EEAST) has announced that
Trust. Isle of Wight NHS Trust is the Island’s
everyone at the Isle of Wight NHS Trust
Robert Morton has been appointed as its
unique provider of ambulance, community,
and also with the Island’s commissioners,
new Chief Executive.
hospital and mental health and learning
partners and leaders within the wider health
disability services and serves a population
and social care and housing communities
Robert, a paramedic and a community first
of 140,000 with 2.5m visitors per annum on
to improve our services and make the most
responder, has worked in the ambulance
an offshore Island which is only accessible
of the ‘Island Pound’, given that we all have
service for nearly 25 years, predominantly
by sea and air.
scarce resources. I am sure that my range of
EEAST News
AMBULANCE UK - OCTOBER
Ambulance service appoints new Chief Executive
280 For more news visit: www.ambulanceukonline.com
an active member. She was awarded an OBE in 2015.
IN PERSON experience will be helpful to the Island. With
Ronnie Coutts MBE added, “I believe that
missions during his service but, as he
the recent announcement of the development
I can add a lot to Yorkshire Ambulance
approached his 60th birthday, regulations
of new models of care for the Island under
Service at this important time. The
demand he gives up single pilot flying.
the ‘My Life a Full Life‘ programme and the
ambulance service has the ability to be
Island’s status as a Vanguard site in the
a strong provider of excellent care in a
national New Models of Care initiative, we have
number of areas and I am pleased to have
a lot to do together and to also actively engage
been appointed to be part of that journey.
with our communities and the range of people
Heléna Holt, CEO of DAAT added “Thankfully we will not be saying goodbye to Rob. When we were awarded our own Air Operating Certificate (AOC) last year,
who use our services. I want everyone in the
“Engaging staff in a service which is
Trust to play a full part in this new programme.”
disparate is critical to any change but it is
Rob took on the role of Safety Manager
one that I am experienced at delivering and
and played an integral part in setting up
I hope to be able to impart this knowledge
our safety management systems. It was a
to good effect.”
challenging time for all the team as Devon
Welcoming Eve’s appointment Karen Baker, Chief Executive Officer at Isle of Wight NHS Trust, said: “Eve has extensive experience of working with health and social care organisations both as a Chief Executive and as a Non- Executive in partnership NHS Trusts. Eve returns to us with a breadth of experience which I know she will use to help us in our endeavours to reshape health and social care
Air Ambulance Trading Company Limited Ronnie attended his first Board meeting on 28th July 2015 in Leyburn, North Yorkshire. Ronnie has been appointed from 1st July 2015 until 30th June 2017. He has declared no political activity in the last five years.
on the Island.” DAAT News
New role for record-breaking Yorkshire Ambulance Service air ambulance pilot appoints new Non-Executive The helicopter pilot who has the longest Director Designate service record and the most mission YAS News
flights with a single Air Ambulance Yorkshire Ambulance Service NHS Trust
charity is to use his vast accumulation
(YAS) has announced the appointment
of knowledge and experience to become
of Ronnie Coutts MBE as its new Non-
the Safety Manager at Devon Air
Executive Director (Designate).
Ambulance Trust (DAAT).
(DAATCL) were the first Air Ambulance to have developed and been awarded an AOC fully compliant with the new EASA regulations. “I am delighted that Rob has agreed to continue in this role and will be overseeing the surveying of all the community helipads needed to introduce night flying next winter.” Devon born, former Army pilot and Falklands veteran Rob, added: “It will take some adjusting to give up flying after a lifetime in the pilot’s seat but what better way to do so than continue with DAAT in a highly significant role. I am greatly looking forward to the challenges my new role
Ronnie is currently a Capability Director at
Captain Rob Mackie has flown with DAAT
will generate especially as it allows me to
Serco Defence leading their resilience, fire
for 23 years recording an amazing 7890
continue working with a great team.”
and defence training portfolio. A former Chief Executive of the UK Emergency Planning College Ronnie brings wide experience of the UK emergency services. Ronnie is an apprenticeship ambassador developing opportunities for apprentices in all organisations. Before joining Serco, Ronnie had a varied Army career serving in Iraq, Afghanistan and the Balkans. His non-operational roles included human resources, training and recruitment.
2006 for his services in Iraq. Chairman of the Board Ms Della M Cannings QPM said, “I am delighted that Ronnie has joined us. He has a very varied experience which will be extremely relevant as we move forward and his strategic focus and clear focus on results is critical to us at
AMBULANCE UK - OCTOBER
Ronnie was awarded an MBE in October
this time.
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AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254 AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254
THE CLASSIFIED SITE For For further further information information or or to to make make aa reservation reservation please please contact contact
Terry Terry or Rachel
Tel: Tel: 01322 660434 Fax: Fax: 01322 666539 email:
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Life Connections Connections 2014 Life Exmed Study Study Day Day Exmed
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AMBULANCE UK - OCTOBER
282
TIME: A.M TIME: A.M
PRESENTATION PRESENTATION
TIME:P.M P.M TIME:
08.30 - 09.00 08.30 - 09.00
Registration Registration
12.00 - 12.30 12.00 - 12.30
09.00 - 09.15 Introduction & History of the Course 09.00 - 09.15 Introduction & History of the Course 12.30 - 13.30 09.15 - 09.45 The Airway Algorithms 12.30 - 13.30 09.15 - 09.45 The Airway Algorithms 13.30 - 14.00 09-45 - 10.30 Prediction of the Difficult Airway 13.30 - 14.00 09-45 - 10.30 Prediction of the Difficult Airway 10.30 - 11.15 BVM and Laryngoscopy 10.30 - 11.15 BVM and Laryngoscopy 11.15 - 11.30 Tea/Coffee, Exhibition 14.00 - 14.30 11.15 - 11.30 Tea/Coffee, Exhibition 14.00 - 14.30 11.30 - 12.00 Skills Stations (4 rotations/30 min. each) 11.30 - 12.00 Skills Stations (4 rotations/30 min. each) 14.30 - 14.45 Group 1 BVM, ETI 14.30 - 14.45 Group 1 BVM, ETI Group 2 EGD’s & Rescue Airways 14.45 - 15.00 Group 2 EGD’s & Rescue Airways 14.45 - 15.00 Group 3 Needle & Surgical Airway 15.00 - 17.00 Group 3 Needle & Surgical Airway 15.00 - 17.00 Group 4 Video Laryngoscopy 17.00 Group 4 Video Laryngoscopy 17.00 Topics and Speakers correct at the time of press but may be subject to change Topics and Speakers correct at the time of press but may be subject to change
PRESENTATION PRESENTATION Skill Stations Skill Stations Rotation 2 Rotation 2 Lunch, Exhibition Lunch, Exhibition Skill Stations Skill Stations Rotation 3 Rotation 3 Skill Stations Skill Stations Rotation 4 Rotation 4 Airway Self Scope Video Airway Self Scope Video Tea/Coffee, Exhibition Tea/Coffee, Exhibition Practical Moulages Practical Moulages Wrap up Wrap up CPD certificate provider CPD certificate provider
Delegate Rate: £72.00 (inc VAT) Delegate Rate: £72.00 (inc VAT)to visit over 60 trade stands. includes: delegate bag, refreshments and the opportunity includes: delegate bag, refreshments and the opportunity to visit over 60 trade stands.
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1 2
Bobrow BJ, et al. Ann Emerg Med. 2013 Mar 7. doi: 10.1016/j.annemergmed.2012.12.020. [Epub ahead of print]. Sell RE, et al. Circulation. 2009;120 (18 Supplement): S1441.
MCN EP 1410 0063