Ambulance UK - June 2019

Volume 34 No. 3

June 2019

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THURSDAY OCTOBER 17 2019 Kettering Conference Centre, Kettering, Northants NN15 6PB For the benefit of NHS staff, the following conference / individual workshops will be taking place on the above mentioned date which we hope will be of interest.

First Responder Conference - start time 09.30, finish 12.45. Topics include: Epilepsy Awareness, Mental Health, Sepsis etc. Thanks to the generosity of Future Awards & Qualifications, a delegate rate of £24 will be offered.

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Haemorrhage Control - Step Wise Approach Workshop - run by Toni Murch, this half day morning workshop, repeated in the afternoon, will be covering: What is Catastrophic Bleeding, Changes to FPHC, JRCALC and ERC Guidelines, The Use of Pressure Dressings and their Limitations, Haemostatic Devices, Tourniquets, etc. Delegate rate £36 - only 10 places available on each workshop.

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CONTENTS

CONTENTS 85

EDITOR’S COMMENT

86

FEATURES 86

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

Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid

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COVER STORY O&H: Building British ambulances in Britain Since the beginning of 2019, O&H Vehicle Technology has undergone a total transformation. Externally, it has a new name and a fresh brand. But it’s on the shop floor where the biggest shift can be seen. Oliver North, the new managing director who has spearheaded these changes, has completely overhauled the culture – to one which is focused on manufacturing quality, British products.

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According to Mr North, it represents UK taxpayers building UK assets – a key component to a successful Brexit. He said: “We are driving manufacturing, employment and apprenticeships within our own economy. We’re proud to build in Britain for our world-class NHS.

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EDITOR’S COMMENT

EDITOR’S COMMENT Welcome to this issue of AUK.

It’s nearly summer and I’m guessing most of you will be looking forward to a well earned break. So, here I am in the middle of the Ionian Sea on a boat. The best thing about sailing is the leisurely pace which allows you to philosophise about life, the world and just things in general. Not surprisingly work couldn’t be further from my mind, but, having said that I can’t help thinking that for most of us it’s work that allows us space to enjoy life. For many people, too often, that freedom is taken away by illness or accident and in picking up the pieces, each of us will harbour a small part of the grief and loss that follow. Try as we may to keep these bottled up, at times the lid comes off and we cease to be the carer and become the patient. Spare a thought for colleagues and friends who have experienced this and at the same time take time out to enjoy and use the sunshine and time with your family to wipe away some of those potentially destructive feelings.

Have a great break....

Sam English, Co-Editor Ambulance UK

AMBULANCE UK - JUNE

“For many people, too often, that freedom is taken away by illness or accident and in picking up the pieces, each of us will harbour a small part of the grief and loss that follow.”

It’s been interesting watching the European elections this week, especially as I’m abroad and seeing it from a completely different perspective. I’m not really that interested in politics but having seen the entire population of a Greek village gather firstly to vote and then secondly to retire to a taverna, it makes you wonder why it all seems so different at home. I suppose you wouldn’t necessarily advocate the first bit but there is something in the second that makes you wonder why we can’t realise that life goes on irrespective of your political views and therefore you probably should just get on with it and work together. It can be like that if we try and it gets spelled out during major incidents and their aftermath. This month remembers the anniversary of the Manchester bombing and I’m betting to all those who gathered in Manchester for the remembrance service, Brexit was the last thing in mind. It’s a pity though that it takes tragedy for people to come together and share a common purpose irrespective of their individual stance.

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FEATURE

MORTALITY OF CIVILIAN PATIENTS WITH SUSPECTED TRAUMATIC HAEMORRHAGE RECEIVING PREHOSPITAL TRANSFUSION OF PACKED RED BLOOD CELLS COMPARED TO PRE-HOSPITAL CRYSTALLOID J. E. Griggs1*, J. Jeyanathan1,2, M. Joy3, M. Q. Russell1, N. Durge1,4, D. Bootland1,5, S. Dunn1, E. D. Sausmarez1, G. Wareham1, A. Weaver4, R. M. Lyon1,3 and on behalf of Kent, Surrey & Sussex Air Ambulance Trust Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2018 26:100 https://doi.org/10.1186/s13049-018-0567-1 © The Author(s). 2018, Published online 20 November 2018 Reproduced with permission from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Abstract Background Major haemorrhage is a leading cause of mortality following major trauma. Increasingly, Helicopter Emergency Medical Services (HEMS) in the United Kingdom provide pre-hospital transfusion with blood products, although the evidence to support this is equivocal. This study compares mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital packed red blood cells (PRBC) compared to crystalloid.

Methods A single centre retrospective observational cohort study between 1 January 2010 and 1 February 2015. Patients triggering a pre-hospital Code Red activation were eligible. The primary outcome measure was all-cause mortality at 6 hours (h) and 28 days (d), including a sub-analysis of patients receiving a major and massive transfusion.

Multivariable regression models predicted mortality. Multiple Imputation was employed, and logistic regression models were constructed for all imputed datasets.

Results The crystalloid (n = 103) and PRBC (n = 92) group were comparable for demographics, Injury Severity Score (p = 0.67) and mechanism of injury (p = 0.73). Observed 6 h mortality was smaller in the PRBC group (n = 10, 10%) compared to crystalloid group (n = 19, 18%).

Adjusted OR was not statistically significant (OR 0.48, CI 0.19–1.19, p = 0.11). Observed mortality at 28 days was smaller in the PRBC group (n = 21, 26%) compared to crystalloid group (n = 31, 40%), p = 0.09. Adjusted OR was not statistically significant (OR 0.66, CI 0.32–1.35, p = 0.26). A statistically significant greater proportion of the crystalloid group required a major transfusion (n = 62, 60%) compared to the PRBC group (n = 41, 40%), p = 0.02. For patients requiring a massive transfusion observed mortality was smaller in the PRBC group at 28 days (p = 0.07).

Conclusion In a single centre UK HEMS study, in patients with suspected traumatic haemorrhage who received a PRBC transfusion there was an observed, but non-significant, reduction in mortality at 6 h and 28 days, also reflected in a massive transfusion subgroup. Patients receiving prehospital PRBC were significantly less likely to require an in-hospital major transfusion. Further adequately powered multi-centre prospective research is required to establish the optimum strategy for pre-hospital volume replacement in patients with traumatic haemorrhage.

Keywords Transfusion, Packed Red Blood Cells, Crystalloid, Mortality, Traumatic Haemorrhage, Helicopter Emergency Medical Services

Background

AMBULANCE UK - JUNE

Traumatic haemorrhage is the leading cause of preventable death

Historically, the hypotensive trauma patient with suspected traumatic

in major trauma patients [1, 2]. Approximately half of all patient

haemorrhage was administered crystalloid [10, 11]; however, not without

deaths in the first 24-h are due to haemorrhage [3]. Survival from

significant adverse effects [6, 12, 13]. Trauma Induced Coagulopathy

major traumatic haemorrhage is poor. Trauma patients who require substantial transfusion have a mortality greater than 30 % [4]. National epidemiology studies in England and Wales estimate the annual incidence of major traumatic haemorrhage as 4700 patients, with 1300 patients proceeding to massive haemorrhage [5]. Traumatic

(TIC) can be sub-divided to endogenous acute traumatic coagulopathy (ATC) and subsequent dilutional coagulopathy [14]. Crystalloid infusion can worsen dilutional coagulopathy [15], endothelial damage and tissue oedema [7], further compounding multiple organ dysfunction and

haemorrhage is further compounded by coagulopathy [6, 7]. Targeted

trauma–related bleeding [16, 17]. In-hospital literature highlights worse

resuscitation of patients in a post-traumatic coagulopathic state is

outcomes for patients receiving greater volumes of crystalloid [18];

critical to improving patient outcome [8, 9].

negating its administration [11].

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FEATURE Increasingly, Helicopter Emergency Medical Services (HEMS) in the

The Kent, Surrey and Sussex Air Ambulance Trust (KSSAAT) provides

United Kingdom (UK) provide pre-hospital blood product transfusion.

a HEMS service in southeast England, UK. The HEMS clinicians

Administration of packed red blood cells (PRBC) has emulated from military

(Physician and Paramedic) deploy by aircraft or response vehicle.

[19] to civilian practice [20, 21]. The transfusion of PRBC transfusion has

Operational teams cover the region over 24 h, with a second team

become the fluid resuscitation method of choice, and more recently, the

providing operational cover over a further 18 h day. Enhanced

addition of freeze dried plasma (FDP) or fresh frozen plasma (FFP) [22].

medical care is provided to approximately 2000 patients per year in a

Early transfusion therapy is postulated to bridge the gap to damage control

predominantly rural and static population of 4.5 million, with a transient

resuscitation [21, 23]. Literature reports that a delay in transfusion of PRBC

population of 10 million. Patients were conveyed to one of five Major

(> 10 min) was associated with increased odds of death for transfused

Trauma Centres (MTC).

patients; supporting expedient transfusion capability [24].

Code red standard operating procedure Heterogeneity exists in the UK, with approximately 50% of HEMS

In this service, where there is a clinical suspicion of major haemorrhage

services administering blood products versus crystalloid (0.9% sodium

and signs of haemodynamic compromise ‘Code Red’ is declared. Code

chloride) [25]. Equivocal literature, and the combined logistical

Red is informed by pre-hospital clinical assessment and declared at

complexities, storage and clinician availability to provide pre-hospital

the discretion of the attending HEMS clinicians. A Code Red activation

transfusion of PRBC, has led to widespread heterogeneity across

comprised of the following parameters during the study period.

UK HEMS practice. Naumann et al. (25) assert that evidence-based justification of pre-hospital PRBC would see approximately 800 eligible

In hypotensive patients with suspected traumatic haemorrhage (systolic

transfusions per year. Despite blood product transfusion being noted

blood pressure (SBP) < 80 mmHg or absence of a radial pulse) the

as a clinically logical step, PRBC transfusion itself is not without clinical

concept of ‘permissive hypotension’ is targeted, i.e. SBP of ≥80 mmHg,

complications. Transfusion reactions, independent association to acute

or the return of a radial pulse. In patients with polytrauma and suspected

respiratory distress syndrome, incremental infectious complications [26]

traumatic brain injury an SBP of ≥100 mmHg is targeted, and in patients

and multiple organ dysfunction is noted [7, 27].

with penetrating torso trauma, a carotid pulse. Alternative causes of hypotension are excluded, such as tension pneumothorax.

Clinical literature for the use of pre-hospital PRBC is ambiguous [2, 16]. Systematic review identifies no published prospective, blinded

From January 2013, following a robust programme of work at KSSAAT,

or randomised studies comparing pre-hospital crystalloid and PRBC

and pragmatic view of available in-hospital and military literature, a

resuscitation [2, 28]. Furthermore, studies have focused on small patient

decision was made to introduce pre-hospital PRBC transfusion as

cohorts highlighting only the feasibility and safety of pre-hospital PRBC

a clinical logical step in the management of patients with suspected

transfusion [6, 29, 30, 31, 32].

traumatic haemorrhage. A Code Red activation ensured PRBC transfusion through a Belmont Buddy Lite™ fluid warmer (Belmont

Pre-hospital studies include disparate patient cohorts with confounding

Instrument Corporation, M. A, USA) and the administration of tranexamic

interventions and contrasting outcomes [6, 33, 34], which limits meta-

acid. The activation enables a titrated transfusion of up to four units

analysis [28, 35]. Subsequently, substantial heterogeneity limits long

of O Rhesus negative PRBC from the CREDO CUBE™ (Series 4, 2 l

term mortality statistical analysis, this is further hampered by loss to

Insulation 15, VIP Golden Hour). Subsequently, a ‘pre-alert’ call to the

follow up ranging from 18% [36] to 67% [37], respectively. A prospective

receiving hospital triggers a predefined in-hospital major haemorrhage

randomised controlled trial (RCT), Resuscitation with Pre-hospital Blood

protocol; ensuring blood and clotting factors are immediately available

Products [38] will compare crystalloid (0.9% sodium chloride) against

[30, 32]. Adherence and compliance to the Blood Safety and Quality

PRBC and FDP, with the primary outcome measures of lactate clearance

Regulations (2017) [40] and Medicines and Healthcare Regulatory

and all-cause mortality.

To date, clinical literature regarding transfusion of PRBC in civilian patients is equivocal. The objective of this retrospective observational study is to ascertain any association between mortality and patients transfused with pre-hospital PRBC compared to crystalloid (0.9% sodium chloride) in civilian patients with suspected traumatic haemorrhage.

Agency was ensured [41].

Data collection Between 1 January 2010 and 31 January 2013, Code Red patients were administered crystalloid (crystalloid group, sodium chloride 0.9%, in 250 ml boluses titrated to effect). Between 1 February 2013 and 1 February 2015 Code Red patients were transfused with PRBC (PRBC group, transfused up to a maximum of 4 units O Rhesus negative PRBC). Paper clinical records were interrogated from January 2010

Methods

system was introduced (HEMSBase, Medic One Systems Limited, UK) [42]. HEMSBase was interrogated from July 2013 to February 2015.

Study design and pre-hospital care system

In February 2015, freeze dried plasma (FDP) was introduced into the

This is a single centre, retrospective observational cohort study of

service, at this point data collection for eligible patients was ceased.

patients triggering a pre-hospital ‘Code Red’ activation. The study was registered with the University of Surrey and met UK National Institute

Patient demographics and clinical data were collected for eligible patients.

of Healthcare Research (NIHR) criteria as a service evaluation. The

The SBP (mmHg) reflects the first HEMS recorded value. The recorded

study applied Strengthening the Reporting of Observational Studies in

volume (mL) of crystalloid is that administered by HEMS clinicians only,

Epidemiology (STROBE) Guidelines [39].

and not pre-existing administration by the attending ambulance clinicians.

AMBULANCE UK - JUNE

until July 2013, subsequently a bespoke electronic patient record

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FEATURE Incident descriptors (mechanism of injury (MOI)), 999 time to HEMS on scene time, and Injury Severity Score (ISS) were reported. Primary outcome of all-cause mortality at 6 h (h) and 28 days (d) was recorded.

A sub-analysis of patients receiving in-hospital major transfusion (≥4 units PRBC in 24 h) and massive transfusion (≥10 units PRBC in 24 h), not including pre-hospital PRBC, was reported [15].

Risk adjustment was performed by creating a multivariate logistic regression model to predict both mortalities, utilising the covariates age, SBP, ISS, MOI. Adjusted Odds Ratios (OR) and Confidence Intervals (CI) are reported.

Pre-hospital and in-hospital data were reviewed retrospectively. Inhospital data was collected from the Trauma Audit and Research Network (TARN) database. Pre-existing data sharing agreements enabled interrogation of hospital-specific computer-based records for supplementary data. Data was abstracted by the first reviewer (JG); inaccuracies and discrepancies were resolved by a second reviewer (JJ).

data in several covariates using the MICE package in R. Predictive Crystalloid PRBC P value mean matching was used, and ten data sets were imputed. Kernel Group Group density plots revealed a satisfactory n = 103 imputation nfor = ISS, 92 MOI, massive transfusion, major transfusion and 28 d mortality.

Gender

Table 1 Categorical variables and covariates for the crystalloid and PRBC group; SBP, Systolic Blood Pressure; ISS, Injury Severity Statistical analysis was performed using R, version 3.4.0 [43].

Score; MOI, Mechanism of Injury; RTC, Road Traffic Collision; IQR, Multiple imputation (MI) was employed to limit the effect of missing Interquartile Range; N/A, Not Available

Female (n, %) 26 (25) 24 (26) Logistic regression models were constructed for all imputed datasets, Male (n, %) 77 (74) (73) rules [44].

1.00 and coefficients estimates pooled according to 68 Rubin’s Age (mean,significance SD) 45 (20) as p < 0.05.

43 (20) Statistical was assumed

Inclusion criteria Inclusion criteria comprised: 1) blunt and/or penetrating traumatic injury with suspected traumatic haemorrhage, 2) pre-hospital Code Red declaration with transfusion of crystalloid and/or PRBC, 3) patient conveyed to an MTC, 4) traumatic cardiac arrests (TCAs) where return of spontaneous circulation (ROSC) was gained, declared Code Red and conveyed to an MTC. Exclusion criteria comprised: 1) paediatrics (< 16 years), 2) patients declared Code Red with a suspected medical aetiology, 2) TCA; where patients were pronounced life extinct, 3) patients transferred to nonMTCs, 4) inter-hospital and/or secondary transfers.

Primary outcome measure The co-primary outcome measures were in-hospital all-cause mortality at 6 h and 28 d. In order to identify patients with ‘true’ ongoing haemorrhage a sub-analysis of all-cause mortality for patients receiving a massive transfusion or major transfusion over the first 24 h period was reported.

Statistical analysis Descriptive statistics are reported; counts, percentages and ages are presented for categorical data. Continuous data is reported by mean and median (IQR). Chi squared tests were performed for categorical variables. Kruskal-Wallis tests compared continuous variables between the crystalloid and PRBC group.

0.50

SBP (mean, SD) 88.21 (25) 90.65 (32) 0.56 Ethical approval ISS (mean, SD) 31.37 (14) 32.26 (12) 0.67 This study met National Institute of Health Research (UK) criteria for Median 999 time to HEMS 30 35 Service Internal

by KSSAAT(IQR Research on sceneEvaluation. time (minutes, IQR) approval (IQR 23.25–41.75) 24–51.5)Audit and Development Committee was gained.

Formal ethical approval was MOI (n, %) not required. Patient identifiable data was anonymised and stored on RTC Driver 17 (16) 18 (19) 0.73 electronic devices with technical encryption (Data Protection Act, 1998).

RTC Passenger 10 (9) 11 (11) RTC Pedestrian

8 (7)

18 (19)

RTC Motorcyclist

22 (21)

13 (14)

Fall

10 (9)

9 (9)

Results

Penetrating Injury 2 (1) 5 (5) During the study period, 218 patients met the inclusion criteria (Fig. 1).

ThePedal crystalloid group comprised 109 patients, with 6 patients excluded Cyclist 6 (5) 5 (5) forOther missing data (n = 103). The PRBC group comprised 109 patients, of 9 (8) 7 (7) which 17 patients were excluded for missing data (n = 92).

N/A 19 (18) 6 (6) Mortality The reasons for exclusion comprised: 1) incomplete pre-hospital data, from patient clinical records, and 2) incomplete in-hospital data, 6 h mortality from TARN and/or in-hospital electronic records. During the study Nothere (n, %)were no immediate 84 (81) 82 (89) 0.2100% period transfusion complications, and Yes (n, of %)pre-hospital PRBC 19 (18) traceability was achieved.10 (10) 28 d mortality Missing group for(73) 28 d mortality (26%); No data (n, %)in the crystalloid45 (59) was noted 57 0.09 major transfusion (5%) and massive transfusion (5%). Missing data in Yes (n, %) 31 (40) 21 (26) the PRBC group is noted for 28 d mortality (15%); major transfusion (3%) and massive transfusion (3%). MI was therefore employed.

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Fig. 1 Study population meeting inclusion criteria

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FEATURE Table 1 Categorical variables and covariates for the crystalloid and PRBC group; SBP, Systolic Blood Pressure; ISS, Injury Severity Score; MOI, Mechanism of Injury; RTC, Road Traffic Collision; IQR, Interquartile Range; N/A, Not Available P value

Table 2 Odds ratios for 6 h and 28 d mortality (after multiple imputation adjusted for age, ISS, SBP, MOI) Mortality

OR

Lower 95% CI

Upper 95% CI

P value

6h

0.48

0.19

1.19

0.11

28 d

0.66

0.32

1.35

0.26

Crystalloid Group

PRBC Group

n = 103

n = 92

Female (n, %)

26 (25)

24 (26)

Male (n, %)

77 (74)

68 (73)

1.00

Age (mean, SD)

45 (20)

43 (20)

0.50

Massive and major transfusion sub-analysis

SBP (mean, SD)

88.21 (25)

90.65 (32)

0.56

Observed frequencies report a statistically significant, greater

ISS (mean, SD)

31.37 (14)

32.26 (12)

0.67

proportion, of the crystalloid group requiring a major transfusion

Gender

adjusted odds ratios (OR), after MI for both 6 h and 28 d mortality show no statistically significant association (Table 2).

(n = 62, 60% versus, n = 41, 40%), p = 0.02. There was no statistical

Median 999 time to HEMS 30 35 on scene time (minutes, IQR) (IQR 23.25–41.75) (IQR 24–51.5)

difference in the proportion of the crystalloid group requiring a massive

MOI (n, %)

transfusion (n = 22, 22%) compared to the PRBC group (n = 14, 15%),

RTC Driver

17 (16)

18 (19)

RTC Passenger

10 (9)

11 (11)

RTC Pedestrian

8 (7)

18 (19)

RTC Motorcyclist

22 (21)

13 (14)

Fall

10 (9)

9 (9)

Penetrating Injury

2 (1)

5 (5)

Pedal Cyclist

6 (5)

5 (5)

Other

9 (8)

7 (7)

N/A

19 (18)

6 (6)

0.73

p = 0.31.

Adjusted odds ratios, after MI, show no statistically significant association for major transfusion in 6 h mortality (p = 0.11) and 28 d mortality (p = 0.22). For massive transfusion, there is no statistically significant association for massive transfusion in 6 h mortality (p = 0.11). For massive transfusion, there is a non-statistically significant association for transfusion of PRBC and 28 d mortality (p = 0.07) (Table 3).

Table 3 Odds ratios for 6 h and 28 d mortality in the massive transfusion and major transfusion (after multiple imputation adjusted for age, ISS, SBP, MOI)

Mortality 6 h mortality No (n, %)

84 (81)

82 (89)

Yes (n, %)

19 (18)

10 (10)

No (n, %)

45 (59)

57 (73)

Yes (n, %)

31 (40)

21 (26)

0.2

28 d mortality 0.09

OR

Lower 95% CI

Upper 95% CI

P- value

6 h mortality

0.35

0.10

1.27

0.11

28 d mortality

0.55

0.21

1.43

0.22

Major Transfusion

Massive Transfusion 6 h mortality

0.04

0.00

2.10

0.11

28 d mortality

0.02

0.00

1.48

0.07

Demographics and incident descriptors Patient demographics are reported (Table 1). Both groups were predominantly male (p = 1.0) and similar in age, mean 44 years (p = 0.50). Patient characteristics were comparable for SBP (p = 0.56) and ISS, 31 and 32, respectively (p = 0.67). Incident descriptors report no difference between the MOI in each group (p = 0.73).

In the crystalloid group, an average of 737 mL (IQR 250–1000 mL) of crystalloid was administered by HEMS, compared to 52 mL crystalloid and a median 2.3 PRBC units (IQR 1–3) in the PRBC group. The median crystalloid group as 4.5 units (IQR 2–9) and for the PRBC group as 3

Observed mortality rates are less in the PRBC group at 6 h and 28 days, but not significantly so. Equally, mortality of patients in the major and massive transfusion sub-analysis shows an observed reduction, but not significantly so. Patients receiving pre-hospital PRBC were significantly less likely to receive a major transfusion. To our knowledge this is the first UK HEMS paper to report on patient outcomes following the introduction of pre-hospital PRBC transfusion.

units (IQR 1–8).

Patient demographics in our study were consistent with published Primary outcome measure

literature. A large proportion of the patients were male [29, 31, 45]

Unadjusted analysis for observed 6 h mortality was less in the PRBC

with a mean age of 44 years [29, 31, 45]. The ISS of 31 (crystalloid

group (n = 10, 10%) versus the crystalloid group (n = 19, 18%) but not

group) and 32 (PRBC group) is close to the mean ISS of 27.5 reported

significantly so, p = 0.2. Similarly, for unadjusted 28 d mortality, there

in a systematic review [2] and other studies on pre-hospital fluid

was an observed reduction in mortality in the PRBC group (n = 21,

resuscitation [32, 45], confirming that substantial anatomical injuries are

26%) versus the crystalloid group (n = 31, 40%), p = 0.09. However,

present in patients with traumatic haemorrhage [2].

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PRBC received over the first in-hospital 24 h is documented for the

Discussion

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FEATURE Incident descriptors in this study are consistent with the published

mortality (p = 0.04), and 88% reduction in the risk of 30 d mortality (p

literature, with a high proportion of blunt traumatic injuries [31]. Median

= 0.01). However, raw mortality was not reported, nor were variables

pre-hospital PRBC transfusion comprised 2 units; similar to other

used in multivariate regression analysis. In addition, overall mortality

UK data [45], consistent with HEMS clinicians focusing on a short

for patients requiring a pre-hospital transfusion is reported as 4%,

scene time to deliver a package of care derived from damage control

inconsistent with, and considerably lower than, our study and other

resuscitation techniques. Overall mortality is approaching 40% for the

literature [2]. Notably, half of the transfused patients were inter-hospital

crystalloid group, consistent with published literature [2], and 27% for

transfusions introducing survival bias and reducing external validity in

the PRBC group.

comparison to a primary HEMS cohort of patients.

There was an observed reduction in the crude frequency for mortality

Conversely, the Pre-hospital Resuscitation on Helicopter Study (PROHS)

at 6 h in the PRBC group, however, adjusted OR after MI was not

group reported a multicentre prospective observational study of pre-

statistically significant (p = 0.11). Other studies have demonstrated

hospital transfusion in civilian patients [35]. Propensity score matching

no statistically significant difference in 6 h mortality [8]. Early deaths

of 109 patients identified no significant difference between pre-hospital

are likely due to exsanguination; requiring future innovation early in the

transfusions in a PRBC and plasma group, compared to crystalloid for

critical window [14]. In the absence of other pre-hospital homeostatic

mortality at 3 h, 24 h and 30 d [35]. Of these patients, 24% received

interventions, transfusing large volumes of blood product pre-hospital

plasma only and 7% PRBC only. Coupled with unexpected differences

[45] may ‘bridge the gap’ to definite haemorrhagic control. Equally, in

in SBP, GCS and ISS, only 10% of patients could be matched leading to

future studies, blood product transfusion in addition to such techniques

inconclusive results.

may well provide survival benefit [45].

Early haemorrhagic death comprises a notable proportion of patients There was an observed reduction in the crude frequency for mortality

who may benefit from early transfusion; therefore, including these

at 28 d in the PRBC group, however, adjusted OR after MI was

deaths is critical [47]. By adopting a conditional 30-day survival analysis

not statistically significant (p = 0.26). One systematic review of 27

among 24 h survivors, studies have introduced a survival bias by

observational studies suggests no overall statistically significant survival

excluding early haemorrhagic deaths [47, 48]. Rehn et al. (2018) report

benefit; however, the review evidences improved survival at 24 h [38].

increased survival to hospital in a before and after study of pre-hospital

Other small single centre pilot studies found no difference in 24 h (OR

PRBC transfusion [45]. The ‘delayed death’ concept would result in a

0.57, p = 0.12) or 30 d mortality (OR 0.71, p = 0.44), despite improved

larger proportion of patients surviving to hospital, but then going on to

early outcomes. Group characteristics and mode of transport make

die shortly after, resulting in the observed mortality at 6 h shown in our

group comparability difficult. Other studies have revealed no survival

study. This concept provides impetus to advancing in-hospital strategies

benefit [6, 46]. We hypothesise that the number of patients in our study

to improve survival [45].

resulted in insufficient power to detect a true difference. As reported by Smith et al. (28), review of ‘grey’ low quality evidence with small patient

There was a significant difference between the frequency of patients

populations may hide any survival benefit.

receiving a major transfusion in the crystalloid (63%) versus PRBC group (46%), p = 0.02. This is consistent with previous work [45]. Critically,

AMBULANCE UK - JUNE

Interestingly we note a reduction in 6 h mortality in the major

this likely reflects advancing in-hospital major haemorrhage protocols.

transfusion and massive transfusion subgroup (p = 0.11). In the

The authors are aware that stratification on post-treatment surrogates

massive transfusion subgroup 28 d mortality shows mild evidence

for injury severity (massive transfusion, ISS) introduces bias [47]. For

for improved survival (p = 0.07). Arguably at 28 days, death is not

example, even an international multi-centre retrospective analysis of over

due to exsanguination alone; instead coagulopathy, inflammation,

3000 patients could not define a threshold at which massive transfusion

immunosuppression and MODS are intrinsically linked [14]. It is

equals poorer outcomes [5]. However, in the absence of other measures,

plausible that early PRBC transfusion in the immediate resuscitation

massive and major transfusion was used here to retrospectively identify

phase mitigates elements of the post-traumatic coagulopathy by

haemorrhagic patients [49]. Arguably, there is no universal approach to

avoiding the haemodilution of erythrocytes with oxygen carrying

massive transfusion; hence, emerging evidence for the clinical application

capability noted in aggressive crystalloid resuscitation [14].

of TEG and ROTEM to detect ATC [49].

In recent literature the mortality rate for patients with a major

Study limitations

haemorrhage approached 50%, this evidence has a similar proportion

Methodological limitations are inherent within an observational

of patients requiring a massive transfusion to those in our study [14]. It

retrospective study. The results of any post hoc design is to be

was discussed that during the critical window, blood component therapy

appraised with caution, due to inherent confounding and uncontrolled

was below recommended thresholds, thus, haemostatic competence

bias. Although there were no pre-hospital system alterations during

was not maintained. This may also be one explanation for our observed

the study period other than the resuscitation fluid, there is a natural

values.

assumption of unaccounted, uncontrolled change and general improvement to resuscitation care and clinical practice. By excluding

Brown’s multicentre prospective cohort study (2015) found an

the PRBC introduction and implementation phase, variability in clinical

independent association between PRBC and the reduction in risk

practice could have been limited during this study period [45].

of mortality in a civilian population. Of 1415 patients, 50 received PRBC transfusion and were matched to a cohort of 113 subjects [6].

The authors are cognisant that this paper crosses a study period where,

Propensity score matching documented 98% reduction in odds of 24 h

by virtue of time, there were considerable in-hospital advances. Major

90 For further recruitment vacancies visit: www.ambulanceukonline.com

FEATURE Trauma Networks, including MTCs were introduced across London

multi-centre prospective research, with adequate power to detect a

during 2010 and extended throughout in the UK in 2012 which would

true difference in patient survival, is required to establish the optimum

have enabled wide clinical benefit for patients requiring time critical

strategy for pre-hospital volume replacement in patients with traumatic

intervention. More specifically, massive transfusion protocols have

haemorrhage.

moved away from managing a late dilutional coagulopathy. Historically in-hospital transfusion protocol managed the result of large volume

Abbreviations

crystalloid and PRBC transfusion [14]. To illustrate this, in one UK MTC,

ATC: Acute Trauma Coagulopathy; CI: Confidence Interval; FDP: Freeze

mortality reduced from 50 to 26% over a 6-year period and transfusion

dried plasma; FFP: Fresh frozen plasma; GCS: Glasgow Coma Score;

of blood product halved [14]. Local variation in major transfusion

HEMS: Helicopter Emergency Medical Services; IQR: Interquartile

protocols confounds comparisons between each MTC.

Range; ISS: Injury Severity Score; KSSAAT: Kent, Surrey & Sussex

Similarly, advances in pre-hospital ambulance practice, such as: technical skills around appreciation of clot preservation, pelvic binding, prioritisation of TXA administration and intra-osseous access have developed [50]. The CRASH-2 trial has shown that administration of TXA to bleeding trauma patients who are within 3 h of injury, significantly reduces all-cause mortality and death due to bleeding (risk ratio (RR) = 0.72, 95% CI 0.63, 0.83). Other potential confounders such as body temperature and pre-hospital anaesthetic agents/co-medications are not reported.

Air Ambulance Trust; MI: Multiple Imputation; MODS: Multiple organ dysfunction; MOI: Mechanism of injury; MTC: Major Trauma Centre; NIHR: National Institute for Health Research; OR: Odds Ratio; PRBC: Packed red blood cells; ROSC: Return of spontaneous circulation; ROTEM: Rotational Thromboelastometry; SBP: Systolic blood pressure; SD: Standard deviation; TARN: Trauma Audit Research Network; TEG: Thromboelastography; TIC: Trauma Induced Coagulopathy Acknowledgments The authors wish to thank KSSAAT for supporting this study and the

Loss to follow up, and incomplete patient records from both the prehospital and in-hospital phases, produced substantial missing data.

Notably, 26% of follow up data is missing in the crystalloid group. To address this, MI of 10 datasets was employed [39, 44, 51]. However, it is likely that the incidence of Code Red patients in the region is slightly underestimated; due to incident proximity some patients will be transferred directly to an MTC by land ambulance, without HEMS input. In addition, if the transit time was short, patients seen by HEMS may trigger a massive transfusion on arrival at hospital, with no time to perform pre-hospital transfusion, therefore effectively removing the patient from the inclusion criteria used in this study. This study would be strengthened if the approximate point of injury (999 time) had been recorded in relation to the transfusion of PRBC, and total pre-hospital time, as opposed to the ‘on scene’ surrogate given.

crews for assisting with data collection.

The authors also wish to thank staff at Royal London Hospital, Barts Health NHS Trust; St Georges University Hospital NHS Foundation Trust; Kings College Hospital NHS Foundation Trust; Brighton and Sussex University Hospital NHS Trust, and University Hospital Southampton NHS Trust; South East Coast Ambulance NHS Foundation Trust (SECAMB).

Funding No funding was received for this study.

Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

A case can be argued for following the intensive care principle of ‘critical care without walls’; treating the Code Red patient on the basis

Authors’ contributions

of clinical need and not geographical location [52]. Future comparison

JG, JJ and RL were involved in study design. JG, SD and EDS

studies are likely complicated by the administration of different types

performed data collection. MJ performed statistical analysis. Data

and quantity of blood product across services (e.g. Fibrinogen, FFP,

analysis was reviewed by all authors. All authors involved in manuscript

FDP), however, collaborative prospective research amongst UK HEMS

preparation and submission. All authors read and approved the final

will provide larger sample sizes and generate further discussion. It may

manuscript.

be more important that future work targets precision resuscitation in the coagulopathic patient. Improved diagnostics and therapeutics at the

Ethics approval and consent to participate

scene as adjuncts to current strategies are warranted, enabling focused

National Institute of Health Research criteria for Service Evaluation was

delivery of blood products at the point of injury.

met. Internal approval by KSSAAT Research Audit and Development Committee was gained. Formal ethical approval was not required.

Conclusion

devices with technical encryption (Data Protection Act, 1998).

In a single centre, retrospective UK HEMS study, observed mortality

Consent for publication

at 6 h and 28 days is reduced in a group of patients with suspected

Not applicable.

traumatic haemorrhage who received a PRBC transfusion compared to crystalloid. This is also reflected in a massive transfusion subgroup;

Competing interests

however, both are statistically non-significant. Patients receiving pre-

JG, JJ, RL, MQR, ND, SD, DB and GW are all employees of Kent, Surrey

hospital PRBC were significantly less likely to need an in-hospital major

and Sussex Air Ambulance Trust. There were no other financial or non-

transfusion compared to those receiving pre-hospital crystalloid. Further

financial conflicts of interest.

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Patient identifiable data was anonymised and stored on electronic

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

FEATURE Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in

15. Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaesth. 2014;58(5):590.

published maps and institutional affiliations.

16. Cantle PM, Cotton BA. Prediction of massive transfusion in trauma.

Crit Care Clin. 2017;33(1):71–84.

Author details

17. Geeraedts LMG, Pothof LAH, Caldwell E, de L ESM K, D’Amours SK. Prehospital fluid resuscitation in hypotensive trauma patients: do we need a tailored approach? Injury. 2015;46(1):4–9.

Correspondence: JoG@aakss.org.uk Kent, Surrey & Sussex Air

*

1

Ambulance Trust, Redhill Aerodrome, Redhill RH1 5YP, UK. 2Academic Department of Military Anaesthesia and Critical Care, London, UK. 3

University of Surrey, Guildford GU2 7XH, UK. 4Royal London Hospital,

Whitechapel Road, Whitechapel, London E1 1BB, UK. 5Royal Sussex

18. Neal MD, Hoffman MK, Cuschieri J, Minei JP, Maier RV, Harbrecht BG, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little Goes along way. J Trauma Acute Care Surg. 2012;72(4):892–8.

County Hospital, Eastern Road, Brighton BN2 5BE, UK.

19. Dawes R, Thomas GOR. Battlefield resuscitation. Curr Opin Crit Care. 2009;15(6):527–35.

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TESTED

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M1 SEATS APPROVED TO LATEST R44.04 CHILD SEAT STANDARDS

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ADVERTORIAL

THE NEW 3.5 TONNE DCA PROVES A POPULAR CHOICE According to a new poll conducted by WAS UK, more than 60% of responders would like to see the new 3.5 tonne double crew ambulance (DCA) added to the NHSI national ambulance specification.

The new 3.5 tonne WAS DCA vehicle is the first DCA in a generation that can be operated at full capacity and still be driven on a standard type ‘B’ driving licence. Director of Operational Services at South Western Ambulance Service NHS Foundation Trust, Neil Le Chevalier, tells us about some of the key issues affecting ambulance trusts in England and shows how the arrival of this new vehicle can address them head-on: Prior to the 1990s ambulances in the UK were based on a 3.5 tonne weight capacity, but with the introduction of more and more life-saving medical equipment the operating weight of ambulances has continued to increase. The WAS innovative lightweight aluminium body combined with a state-of-the art chassis system has enabled this previously out of reach goal once again to be a reality, putting the UK at the very forefront of mobile medical technology.

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“In the South Western Ambulance Trust we’d welcome the opportunity to pilot this innovative new 3.5 tonne vehicle. A light weight, 3.5 tonne vehicle helps to address the issues we’re facing in the service in the longer term: recruitment of paramedics and Emergency Care Assistants who are already licensed to drive, together with improved environmental and safety credentials.”

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MAKING BLUE LIGHTS GO GREEN The 3.5 tonne DCA driven on a standard ‘B’ driving licence.

WAS®. The leading light in innovation.

WAS UK Ltd • Email : wasukinfo@was-vehicles.co.uk • Phone : 0845 45 927 85 Website : www.was-vehicles.com • Twitter : @WASAmbulances • Facebook : www.facebook.com/was.vehicles Do you have anything you would like to add or include in Features? Please contact us and let us know.

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Reducing emissions.

Reducing fuel consumption.

Driving recruitment.

95

NEWSLINE increase in 999 incidents year-on-

members of the public to consider

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year, almost 39,000 fewer patients

carefully which health service

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of patients across the region, of

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problem is not a life-threatening

which many face communication

emergency, please call 111, visit

barriers, such as a hearing

As well as enabling patients to

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impairment, information in easy

stay at home in many cases

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Almost 80,000 people across

to hospital, this approach helps

serious incidents.”

the North West avoided an

to keep emergency ambulance

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resources free to respond quickly

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services as open as possible, and

last year thanks to enhanced

to those who have life-threatening

initiatives contributed to an

to support frontline clinicians is

telephone assessment and

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increase of 6,600 people last year

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hospital is estimated to have freed

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of clinicians with various areas

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guidance for communicating with

when safe to do so, avoiding an

mean an emergency ambulance

incidents in a non-emergency

patients with specific needs, such

unnecessary trip to hospital.

to hospital.

vehicle equipped to ‘see and

as visually impaired and deaf

treat’. This means care for the

blind patients, as well as basic

why, and what will happen next.

AMBULANCE UK - JUNE

As part of its two-year

“To meet the rising demand on

patient is delivered where they

information about customs relating

‘Transforming Patient Care’

our service, we should only send

are or a referral is made to an

to entering homes, treatment and

programme, which began in

an ambulance when it is clinically

alternative local community

death for some faith groups.

summer 2017, NWAS focused

required and not everyone who

health or care service.

on introducing initiatives to make

calls 999 needs an emergency

sure patients who called 999

ambulance response. The

but did not need immediate or

expansion of the Clinical Hub,

more than 90% of all paramedics

emergency hospital treatment

along with other improvements

and emergency medical

could receive the right care and

under the Transforming Care

technicians to support them to

Yvonne Ormston, NEAS chief

support in the community.

Programme, has increased our

triage patients more effectively

executive, said: “We aim to provide

capability to manage this demand

on scene and understand the

by helping to keep our emergency

best alternative service in the

safe, effective and responsive

This included developing the 24/7 Clinical Hub to have more

resources available to respond

area for their needs.

clinicians – including paramedics,

to life-threatening incidents while

nurses, mental health practitioners

still delivering high quality care to

and clinical pharmacists -

patients with less urgent needs.

available to offer clinical support

Avoiding unnecessary hospital

to people who need clinical

trips also helps our colleagues

assistance but do not require

in other parts of the NHS, by

an ambulance. This is known as

reducing pressure on busy A&E

‘hear and treat’.

departments.

In 2018/19, NWAS was able to

“It’s important to highlight that in

provide ‘hear and treat’ support

many cases, the Clinical Hub will

in 38,000 more incidents than

refer patients to other services

North East patients in need of

the previous year, reducing

in the community which is

an ambulance are being given

the number of people taken

something individuals may have

additional communication support

“We have a strong record of

to hospital in an emergency

been able to do more quickly

thanks to the launch of a new

innovation and this new guide

ambulance. Despite an overall

themselves. Therefore we ask

guide.

is a perfect example of how we

NEAS is believed to be the first • Additional training delivered to

ambulance services in the country to produce such a guide.

care for all patients throughout the North East, regardless of their communication needs.

NEAS

New guide to help those in need communicate

Unfortunately, communication barriers can sometimes lead to an unintentional delay in treatment and miscommunication.

“This new resource will help

Electronic guide created to

ensure we are able to effectively

support patients and frontline

communicate with all patients,

ambulance crews

involve them in decisions about their care and treatment, and

96 For more news visit: www.ambulanceukonline.com

keep them informed throughout.

NEWSLINE are using technology to improve

“It is useful on a call or at the scene

services for our patients.”

to use an interpreter rather than try to stumble through a conversation

The guide comes hot on the heels of a new learning disability zone, which has been created on our external website to support patients in making a decision about what service they require. It was developed with support from third sector

with broken English as people might not know some of the medical terms paramedics might use and this can cause confusion.”

Paul Murray, who has a learning

organisations and paramedics and

disability, had reason to dial 999

has been welcomed by community

when he broke his arm.

groups across the region.

He says the attending ambulance Ramin Samadpour, who speaks

crew were able to change their

three languages, interpreted on

communication style to meet his

scene when a member of the public

needs and provide reassurance

in his local community took ill.

but the introduction of the guide

“This guide will mean the service will be better for people whose first language is not English,” he said.

“It will ensure people can more easily access the help and support

using pictures will make it easier for people with learning difficulties when using the service.

“It will help people and give them

they need and the pictures will help

the chance to talk and explain their

many different groups of people to

issues better and explore where it

understand and aid them through

hurts to enable the paramedic to

the process.

help the person,” he said.

“Knowing about the guide will help me if I have to use the ambulance in the future.”

Although Anthony Wright, who also has a learning disability, says he mostly felt included when needing an ambulance recently, the paramedics mostly spoke to his mother due to communication issues.

He said: “Using the guide would have helped the paramedics to have a fuller conversation with me and would have allowed me to give more information to the paramedics using the pictures to help me. It would have meant that I could have been fully involved in all conversations and decisions about my care.

Knowing it’s there gives me confidence when calling the service in future.”

Deaf and British Sign Language (BSL) user Joanne Fortune accessed the NHS111 service

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

using the BSL text relay service used by NEAS. She said: “Every deaf person has different communication needs and skills – some can understand written English, some can’t and some can use lip reading skills if they have them and, for some, these skills may be enough to communicate with a paramedic.

In situations where deaf people don’t have these skills, these skills are limited or there is confusion, the pictorial communication guide will aid all parties to communicate, help to identify what is wrong with the patient, provide some reassurance and tell them about what will happen next.

“It will also help people to be independent and manage their own health needs.”

For more information about the guide, visit www.neas.nhs.uk/ patient-info/communicationssupport

More power to you

AMBULANCE UK - JUNE

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All other trademarks are trademarks of their respective owners or holders. The products depicted are CE marked in accordance with applicable EU Regulations and Directives. 08-2018, 2018-18327

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99

NEWSLINE EEAST

Experts on the end of a phone improve patient care It can be scary being ill or injured.

At the East of England Ambulance Service NHS Trust we understand that sometimes when people call 999 for an ambulance, they don’t actually need an ambulance response.

In some cases reassurance and clinical advice are enough to ensure the patient receives appropriate care and treatment.

That can involve a friend or relative safely taking them to A&E or to another care provider or the person following our self-care tips.

on duty to triage some of the 999

NHS Trust Ambulance service

There are currently over 400

calls coming into one of our three

was in a position to be able to

known defibrillators across the

control rooms.

replace the device, meaning

Island and many of these are

the Island community was once

accessible 24/7. Some are in

Sandra Treacher, Senior

again provided with a 24/7 Public

rural areas, others in town centres

Operations Centre Manager for

Access Defibrillator at the site.

and some are within businesses,

Clinical Services, said: “Around

Now, two and half years later,

residential/nursing homes, dental

350 calls per day are triaged

the stolen defibrillator has been

practices and medical/health

by our clinicians and clinical

handed in to St Mary’s Hospital

centres. Some are in locked

managers.

after being found under a bush

boxes but the owner and the local

by children playing football. The

Ambulance Service have the lock

“They range in need from

live saving piece of equipment is

codes and in an emergency the

someone with a cut finger,

currently undergoing maintenance

999 call taker will give this code to

dislocated shoulder or a minor

to see if it is still useable.

the rescuer.

long term conditions. Whatever

Stealing or vandalising a Public

Although the British Heart

the problem, we ensure that our

Access Defibrillator (PAD) can

Foundation and the Resuscitation

patients receive the right response

mean that someone dies. When

Council UK recommend that

at the right time.”

someone goes into cardiac arrest

we do not put locks on the

(this means they are unconscious

outside wall defibrillator boxes,

and not breathing normally) their

unfortunately we have had to do

survival rate without a defibrillator

so in some areas because of

is likely to be less than 7%

vandalism. We’d rather people

however this can increase up to

run to a locked box than an empty

74% with early defibrillation.

one.

NEAS

illness to patients with serious

IOW

Stolen Defibrillator Found Quote from Louise Walker, Head

That’s the idea behind the trust’s

of the Ambulance Training and

Every minute you delay

hugely successful emergency

Community Response Services

defibrillation to someone who

clinical advice and triage

(ATCoRS) for the Isle of Wight:

needs it, their chance of survival

centre (ECAT). This allows our

decreases by 10%. The first three

ambulances to reach our higher

When Haylands Primary School,

minutes of a cardiac arrest are

need patients more quickly.

Ryde had their defibrillator stolen

the most crucial; when someone

in October 2016 I struggled to

rings 999 for the Ambulance their

Depending on the time of day,

find the words to express my

system automatically flags up the

6-15 paramedics, emergency

shock and huge disappointment.

nearest defibrillator within a 200

care practitioners and nurses are

Thankfully at the time, the IW

metre radius.

North East Ambulance Service retains top Stonewall credentials North East Ambulance Service has retained its place as a top Stonewall employer for the fourth consecutive year.

The Trust, which employs more than 2,500 people, including an estimated 250 lesbian, gay, bisexual and transgender (LGBT) employees, has maintained its position from last year’s Stonewall Top 100 Employer shortlisting as the highest ranked NHS Foundation Trust and the top performing

AMBULANCE UK - JUNE

ambulance service UK wide.

It also continues to be the top ranked emergency service in the North East.

Stonewall’s Top 100 Employers is the definitive list showcasing the best employers for LGBT staff. The list is compiled from submissions to the Workplace

100 For further recruitment vacancies visit: www.ambulanceukonline.com

NEWSLINE Equality Index, which is an

suggest that having happy staff

ambulance service state that

Yvonne continued, “The

annual audit of the workplace

leads to improved outcomes for

97.79% felt they were treated

framework and feedback we

culture and a powerful

patients.

fairly and 98.9% said that staff

receive from Stonewall surveys

treated them with dignity and

helps us to identify the areas we

respect.

perform well and the areas that

benchmarking tool used by employers to create inclusive

“We’re extremely proud of the

workplaces. Now in its 15th year,

work we have done to make

the list celebrates the pioneering

sure our service considers the

To maintain the Trust’s status

also helps us to attract and retain

efforts of leading organisations

needs of lesbian, gay, bisexual

in the Stonewall Top 100

LGBT people in the workplace

to create inclusive workplaces.

and transgender people and we

Employers list, improvements

and provide them with a safe and

will continue to work with local

have been made within the

supportive working environment.

More than 1,000 organisations

communities and the National

organisation, which included a

have taken part in the

Ambulance LGBT Network to

new policy to help employees

“Equality, diversity and inclusion

Workplace Equality Index since

identify further improvements.

better understand transgender

are the foundations of the way

it began. NEAS got involved with

Retaining our place in the

issues, new call taker guidance

we work and we strive to create

the Stonewall Top 100 Employer

Stonewall Top 100 index and as

to improve support for

a safe working environment

nine years ago, because the

the top performing ambulance

transgender and non-binary

where everyone feels confident

Trust in order to benchmark

organisation in the UK serves to

employees and patients, as

bringing their whole selves to

its equality work against other

recognise this work.”

well as more engagement

work. This also includes treating

with LGBT staff and patients

patients with dignity and respect.

organisations in the public, private and third sector.

require further improvements. It

A pride report survey found that

at Pride events. The Trust

80.6% of respondents would

has also reviewed its family

“The Workplace Equality Index

Yvonne Ormston, NEAS chief

consider working for NEAS,

friendly policies, launched a

provides us with assurance

executive, said: “It’s important

which is an increase of 4.4%

reverse mentoring scheme,

that our approach to LGBT

that people are able to be

compared to 2017. Of the 249

provided advice and guidance

equality is delivering success for

themselves in the workplace

respondents, 89.5% of people

to HR colleagues, launched a

employees and patients. This

and that we maintain an

said they would recommend

transgender ally programme

is the best benchmarking tool

environment where people feel

the Trust’s service to family

and improved its collaboration

in class and it should provide

safe, supported and included.

and friends. Replies from LGBT

across the region and the UK on

people with confidence that our

There is strong evidence to

people that have used the

LGBT issues.

approach is effective.”

AMBULANCE UK - JUNE

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DATES FOR Y

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NEWSLINE NWAS

Ambulance service takes steps to become more dementia friendly Pledging to raise awareness of the impact of dementia

Dementia Friends is an initiative

dementia support groups

Improvement Plan running a

set up by the Alzheimer’s

across the region as well as

number of initiatives over the

Society to change people’s

postal and telephone surveys

past twelve months which we

perceptions and challenge

undertaken by those living with

are keen to continue going

the stigma associated with

and affected by dementia.

forward.

the way the nation thinks, acts

Gill Drummond, Mental Health

“By becoming more dementia

and talks about the condition

Manager for NWAS who leads

friendly, we have been able to

through face to face and online

on dementia-related initiatives

improve the care that we give

sessions.

within the trust, said: “The

to these patients by ensuring

common misconception

we have a knowledgeable

dementia. It aims to transform

and support patients living with the condition, over

NWAS also became the

with dementia is that it only

workforce well equipped to

6,000 North West Ambulance

first ambulance service to

affects older people and that

deliver a high standard of care.”

Service (NWAS) staff are now

specifically ask patients

receiving a diagnosis means

‘Dementia Friends’.

booking planned care transport

that the person no longer has

Working with other healthcare

if they have dementia or a

a good quality of life and are

professionals across the region

With one in every six people

memory related condition

unable to still contribute to

and Dementia Action Alliances,

over the age of 80 experiencing

to help give them more

their community and family

NWAS has also held dementia

dementia, NWAS has built

individualised care centered

life, therefore it’s important

hubs in different areas to give

dementia awareness sessions

around their needs.

that our staff are aware of the

patients, families and carers a

importance of living well with

place to drop in and get any

into their annual mandatory training package and all patient-

Understanding the importance

dementia and how their actions

help and advice that they may

facing staff are given classroom

of listening to feedback from

can significantly contribute to

need.

based sessions helping them

patients and people in the

this.

to understand how best to

community, the ambulance

care for patients with dementia

service has also taken a variety

“We have made sure that

Society Dementia Friendly

alongside the opportunity to

of steps to gain their views

dementia is featured strongly

Communities Officer in the

become a Dementia Friend.

and insight including attending

on our Mental Health Strategic

North West said: “It’s great

Alison Wakefield, Alzheimer’s

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

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104 For more news visit: www.ambulanceukonline.com

NEWSLINE to see staff from North West

Dr Caroline Jeffery is a Senior

and Unplanned Care within the

through my studies with

Ambulance Service uniting

Lecturer in Advanced Clinical

Department of Nursing, Midwifery

Northumbria I am able to be

against dementia and making

Practice at Northumbria and is

and Health. He said interviews

a part in this. I really enjoy the

a major stride in raising

also a managing GP partner with

would be conducted with GPs

variety of patients that I see.”

awareness about the condition

Dr Niamh Telford at Cheveley

and paramedics as part of the

by becoming Dementia Friends.

Park Medical Centre which

research.

Dementia is the biggest health

provides care and treatment to

and social care crisis facing

around 4,350 patients in Durham.

“Paramedics are playing an

the next generation of primary

society today. Someone

The centre is a teaching practice

increasing role in the prevention

care clinicians’ and cited ‘the

develops the condition every

for trainee medics.

and management of acute

enthusiasm and commitment

hospital admissions in the

of leaders to offer such wide-

The Care Quality Commission

community, in line with the NHS

ranging opportunities to medical

(CQC), the independent regulator

Long Term Plan. Our research

students’.

“Dementia affects people,

of health and social care services

will examine new perspectives

their carers and families in

in England, has carried out an

on how this will be achieved

Dr Jeffery, a part time Senior

different ways but one thing

inspection at the practice in

by Advanced Paramedics in a

Lecturer at the University who

seems universal: people don’t

Belmont, Durham which rated it

primary care setting.

has been working across GP and

always get the support or

outstanding and praised the work

understanding they deserve.

of Dr Jeffery with her students.

three minutes and too many are facing it alone.

We need more people and organisations like the North West Ambulance Service to help us break down the stigma surrounding the condition by joining our growing movement for change, today. Anyone can become a Dementia Friend by watching a short online video or attending an Information Session. Unite with Alzheimer’s Society today, visit www.dementiafriends.org.uk” The trust now plans to evaluate the effectiveness of the schemes that they have put in place to ensure continuous learning and consider how they can continue to build on their successes going forward.

NEAS

Outstanding academic is spearheading research to shape the future of GP practices

Meanwhile the CQC report found that leaders were ‘keen to inspire

academia roles for two years, “Having Paramedics working

said: “This is testament to the

so closely in GP surgeries is

hard work of the practice team

Dr Jeffery currently has two

certainly new in the North East.

who are very supportive and

trainee Advanced Paramedics

Paramedics work with GPs in

recognise the importance of this

on placements at the practice,

their traditional role however, not

inspection.

as part of an innovative new

as directly and autonomously as

research project - believed to be

the Advanced Paramedics in our

“Being able to inspire the next

the first of its kind - running in

programme. There is a notable

generation of GPs, nurses, and

partnership with the University.

gap in this research area both

everyone that comes through

They are looking at how they can

nationally and internationally

our University doors is a real

help alleviate the pressure on

and our research will begin to

honour and privilege. I had really

GPs and offer a more accessible

develop an understanding of

exceptional teaching when I was

service to patients.

how the GP and Paramedic

a trainee doctor, which inspired

relationship and roles function

me to enter into the field myself.”

She explains: “The GP workforce

in the general practice

is struggling with a national GP

environment.”

Joanne Atkinson, Associate Head of the Department of

shortage whilst at the same time GPs are seeing patients with far

Wesley Scaife, a student on the

Nursing, Midwifery and Health,

more complex cases. Advanced

Advanced Paramedic Master

added: “This is a really good

Paramedics at our practice are

Course at Northumbria, has

opportunity to showcase the

seeing patients independently

worked as a paramedic for 14

collaboration we have working

and we are facilitating that. They

years and is currently training to

with a GP practice and the

have the skills to go on home

be an advanced practitioner.

commitment we are making to primary care with Caroline as a

visits and can alleviate some of the work for GPs, offering

“As part of my training I am

different perspectives.

studying at Northumbria

Senior Lecturer.”

Both women co-authored a

competing a placement within

chapter entitled End of Life Care

impact this is having on the

a GP practice. As a paramedic,

in Dementia in a book called

workforce and is running

working within a GP practice

Namaste Care for People Living

An academic at Northumbria

alongside the placement. It is

has helped me to develop my

with Advanced Dementia, which

University has been praised

linked to equipping the workforce

knowledge and skills within a

is aimed at students and also

by a health and social care

with roles which are articulated

primary care setting. It gives

received praise in the report.

watchdog for her work in

in NHS planning documents the

me a rounded view of the

inspiring the next generation

Five Year Forward View and Ten

NHS healthcare system and

Northumbria is a research-rich,

of healthcare professionals,

Year Plan.”

also enables me to be part of

business-focused, professional

research which could change

university with a global reputation

as she helps to spearhead new research into the role

The research is being led by

the way healthcare is delivered

for academic excellence. To find

paramedics are playing in GP

Senior Lecturer Daniel Monk,

to patients. The NHS is always

out more about our courses go

practices.

Programme Leader for Urgent

changing and evolving and

to www.northumbria.ac.uk

AMBULANCE UK - JUNE

University which involves “Our research is around what

105 For all your equipment needs visit: www.ambulanceservicesuppliers.co.uk

NEWSLINE SAS

Fundraising drive for ‘inspirational’ youngster A Scottish Ambulance Service paramedic is raising £10,000 following his young daughter’s courageous four-year battle with a brain tumour.

Michael Kidd’s daughter, Aoife, now aged five, was diagnosed with high grade glioma when she was just 16 months old.

Since then, she has bravely

“Aoife has been the driving force

Early Years Centre and Primary

across the River Clyde on the

behind everything we have been

school, in Monkton, Prestwick for

24th August. He is also running in

doing with the fundraising. We

all the pupils to benefit from.

the Glencoe Marathon on the 8th September.

are very proud of her – she puts up with an awful lot given the

The room would complement

amount of times she has to attend

teaching and help all pupils

Michael, along with Enice

the hospital. She’s always been

develop their ability to interact with

Vennard, an Ambulance Care

a feisty wee woman and that has

others, learn and solve problems,

Assistant based in Kilmarnock,

stood her well,” he said.

understand and develop their

recently met with Stagecoach,

use of language and improve

who have donated a bus.

“She has a smile that can light up

motor skills. It would also increase

a room. That fight and spirit has

motivation, promoting greater

Once Aoife’s school has been

helped her along the way, through

levels of happiness and wellbeing.

equipped, the intention is to kit the bus out with sensory and

her surgery and chemo, and everything that goes with it. She

So far, he has raised around

interactive equipment and for it to

just gets on with it and does not

£5,000 from public and local

travel around schools in Ayrshire

complain – she’s definitely a wee

business donations. Applications

so that other children benefit.

inspiration.”

for funding through incentives like

Other ambulance stations, the

Persimmon Homes community

Kilmarnock community, and even

undergone surgery, had a total

The youngster is now part of a

champions and Prestwick and

further afield, have dug deep to

of 18 months of chemotherapy

clinical trial in Great Ormond

villages locality group have also

help Michael’s cause. Michael’s

and undergone various other

Street Hospital, London. Since

been successful.

cause – A Space to Make Sense

invasive procedures.

starting the trial drug, the tumour

of School – has also been

has remained stable.

Michael has planned a range of

accepted as a charity for this

Michael of Monkton, who has

Michael, 37, based at Kilmarnock

activities for this year, including

year’s Kiltwalk.

been with SAS for 13 years,

Ambulance Station, is now aiming

a Family Fun Day on Sunday the

said his daughter has been an

to raise money for a sensory and

30thJune at Kilmarnock Rugby

Michael, whose fundraising

“inspiration”.

interactive space at his daughter’s

Club and a sponsored zip-line

efforts started this year, added:

AMBULANCE UK - JUNE

106 For further recruitment vacancies visit: www.ambulanceukonline.com

NEWSLINE “Kilmarnock is a tight knit station

never in a million years would

and even around Ayrshire there

have thought that’s what it was.

has been lots of help. There’s

We thought it might just be a

been a number of folk from other

concussion, but never a brain

stations who have come and

tumour. It was the worst day of

offered their help and support to

my life, without a doubt.”

us as well – the support we’ve received has been a highlight.”

Aoife had an operation – lasting around 12 hours – to have the

Aoife was diagnosed with a brain

brain tumour removed.

tumour in 2015 on February 19 – high grade glioma represents

Michael said after the initial

10% of all child brain tumours.

surgery, the tumour had been examined in the lab and the

Michael, who was at work at

family was told it was cancerous.

the time she was diagnosed,

They then had to start preparing

explained: “She was a normal

her for chemotherapy. Aoife’s

fit and healthy girl and she was

clinical trial, ongoing at Great

down at her child minder’s when

Ormond Street Hospital, involves

she took unwell. At the time, I

taking drugs twice a day.

Resuscitation and Emergency Care

wasn’t sure what had happened and thought she might have fallen

Michael said: “The tumour has

and bumped her head, or maybe

been stable since starting the

collapsed.”

trial drug. It’s not grown, but it has not shrunk. This is definitely

“I was on my day shift, and I

good news – as long as it’s not

had a few missed calls on my

growing, and there are no bad

phone from Aoife’s childminder

side effects, we are happy.

to see if could come down in the ambulance to get her. Initially,

“She does not really understand

when I saw her, she didn’t look

what is going on – because of

well but I never thought for a

the surgery, it has affected and

second about what was to unfold.

delayed her development. Her

A full range of products for use in an emergency and resuscitation situation.

• • • • •

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

development is getting better and “Myself and [Ambulance

better all the time but I don’t think

Technician] Caroline Hodge, my

she knows she’s not well with a

crewmate for past seven years,

brain tumour.

took her to Crosshouse Hospital where she had a scan – that’s

“I think because she has been

when we found out she had a

living with it for most of her life,

brain tumour and the tumour

she thinks it is just normal to go

had caused an intra-ventricular

to the hospital all the time.”

bleed.”

Michael said Aoife’s young sister, Eilidh is wary of what is going

Hospital where she had surgery

on, but understands what her

to have the majority of the tumour

sibling is going through, adding:

removed. A small amount,

“Eilidh doesn’t know she’s doing

however, was not able to be taken

it, but when the two of them

away, as it was too close to a

are playing and having wee

blood vessel. This is all happened

chats and arguments about TV

while Michael’s partner, Evelyn,

programmes, books and toys she

was pregnant with the couple’s

is encouraging her big sister to

second child, Eilidh, now aged

interact and become more vocal.

three.

At times they fight, like most

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sisters probably, but little does Michael added: “We knew

she know the help she is giving

something wasn’t right but

her big sister.”

AMBULANCE UK - JUNE

Aoife was transferred to Yorkhill

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107

NEWSLINE NWAS

North West Ambulance Service recognised for excellent sustainability reporting For the third year running, North West Ambulance Service (NWAS) has been awarded with a certificate of excellence for their sustainability reporting.

Recognised by the Sustainable Development Unit (SDU), NHS Improvement and the Healthcare Financial Management Association (HFMA), NWAS has been commended for its commitment to operating with environmental responsibility.

Amongst a number of initiatives, NWAS has introduced electricity powered vehicles into their ambulance fleet following a successful trial which has seen four BMW i3 models operating as rapid response vehicles (RRVs) in Greater Manchester. This is now being rolled out across the trust and is expected to reduce the carbon contribution from RRVs by 90% with an estimated annual fuel cost saving per vehicle of £3,500.

The SDU, which works across the health and care sector on behalf of NHS England and Public Health England, conducted

“We’ve worked hard to make

organisation. The LTP set clear

The train naming took place in

a number of positive changes

targets for sustainability; carbon,

front of members of Kathryn’s

which have not only made a huge

air pollution and a mandate to in

immediate family, friends and

impact on our carbon footprint

particular, reduce wastage and over

former colleagues at Bristol

but also reduced waste and air

reliance on single use plastics.

Temple Meads, and the name

pollution. Our work doesn’t stop here and we are looking forward to making further improvements going forward.”

Other initiatives the trust has put in place to improve their sustainability include fitting solar roof panels, the use of LED lighting and combined heat and power units.

A dedicated waste control & minimisation officer has also been appointed to ensure that the trust is disposing of its waste efficiently.

High quality reporting on sustainability is recognised as a fundamental way in which organisations can demonstrate their commitment to embedding environmental, social and financial sustainability.

Good sustainability reporting is widely recognised as including the following areas: • Leadership and engagement – Board level, staff and community • Resources - such as energy, water and waste

was unveiled by Kathryn’s SWAST

Train named in honour of Bristol Paramedic Kathryn Osmond Kathryn Osmond, who died two years ago at the age of just 41, was nominated as part of Great Western Railway’s 100 Great Westerners.

Kathryn worked as a paramedic for the South Western Ambulance Service NHS Foundation Trust (SWASFT) for 16 years and passed away aged 41 on her 41st birthday on 18th April 2017 after a battle with melanoma.

While coping with her illness Kathryn fought tirelessly to raise the awareness of melanoma and

partner Sara.

Executive Director of Nursing and Governance for the South Western Ambulance Service, Jenny Winslade, gave a short speech about Kath’s career as a Senior Paramedic. “Looking back across her career, Kath stood out as a dedicated clinician, passionately caring about the patients she treated, as well as caring for her work colleagues. She courageously went onto inspire thousands of people sharing her experience online - as she then became the patient – helping others whilst going through treatment for an aggressive form of malignant melanoma. Kath was an excellent paramedic in every aspect. She was always calm and reassuring during moments

to find the “magic bullet” to beat it.

of crisis and could bring her

Melanoma UK CEO Gill Nuttall

qualities to help any situation.

said: “Kathryn was such a pleasure to have known. She was a very popular character in the melanoma patient community and her efforts to support others, were widely acknowledged.

Kathryn attended a NICE

highly-skilled professional Even in her last moments Kath’s dignity and composure never waivered, coming in to work when she was clearly poorly and never complaining, this just shows what an amazing lady she was. Kath has left a hole

appraisal on behalf of other

in the lives of so many people

• Travel - including staff travel,

patients and because of her help,

she worked with and we were all

(CCG) annual reports to evaluate

patient transport, business

NICE was able to make a positive

devastated by her loss, it was

sustainability sections. 55 trusts

travel

decision on a treatment that was

an honour to know her and to

pivotal for both patients and

have worked with her. “

an analysis of all provider and Clinical Commissioning Group

and 42 CCGs (around 22%) have been selected for recognition

• Procurement – including

clinicians. She is sadly missed

AMBULANCE UK - JUNE

out of 432 organisations across

local, community and ethical

and the Melanoma UK team is

GWR Business Assurance

England.

procurement

delighted she has received such

Director Joe Graham said:

wonderful recognition.”

“Kathryn epitomises the spirit of

Neil Maher, Assistant Director

• Adaptation and transformation

Service Delivery Support for NWAS said: “We all have a duty

• New models of care.

to look after our planet and

the Great Western in so many Alongside colleagues, she helped

ways, and achieved so much

to raise tens of thousands of

in trying to help others. It is an

pounds over the course of a year

honour that we are here today

operating sustainably is a top

The NHS Long Term Plan further

through various challenges, one

to name a train in her memory,

priority for us which is why we’re

strengthens the commitment

of the most memorable was when

and in so doing continue to

extremely proud to have been

of the NHS as a system leader

dozens of her colleagues took to

raise awareness of this terrible

given this recognition for the third

in embedding sustainable

the Clifton Suspension Bridge to

disease not only here in Bristol,

consecutive year.

development across the

do the Running Man Challenge.

but across the Great Western

108 For more news visit: www.ambulanceukonline.com

NEWSLINE network that we serve.”Kathryn studied emergency care at the University of the West of England in Bristol and worked in Bristol and Weston-super-Mare.

GWR’s 100 Great Westerners were nominated by the public through the region’s media and are a mixture of well-known and less celebrated figures who have made a significant contribution to the West Country.

The fleet of Intercity Express Trains first started to be seen on the GWR network in October 2017, and each trains covers approximately 800 miles every day across the Great Western Railway network.

REDUCING ACCIDENTS IN THE EMERGENCY RESPONSE SECTOR The incidence of collisions in the emergency sector remains high around the world. Emily Hardy, from vehicle safety experts Brigade Electronics, runs through the technology that can help prevent accidents and save lives.

Collisions involving emergency vehicles are a frequent occurrence across the world. Ambulances, fire appliances and police cars are involved in hundreds of accidents on the road as they respond to emergency situations.

Technology can help Emergency response vehicle drivers face a unique set of challenges.

Travelling at high speeds while weaving through traffic, manoeuvring in tight spaces and operating in dangerous, noisy environments are everyday hazards for emergency responders to negotiate. They also encounter adverse weather conditions and night-time call-outs in often high-risk situations.

This intelligent four-camera technology is designed to eliminate vehicle blind spots and assist manoeuvrability in challenging situations by providing the driver with a complete 360 degree view of their vehicle in a single image. The system combines images from four ultra-wide-angle cameras, providing a real-time view on the driver’s monitor. The result is a ‘bird’s-eye-view’ of the vehicle and surrounding area.

Smart Reversing Alarms Warning alarms are audible devices to alert pedestrians and workers when a vehicle is manoeuvring. Unlike traditional ‘beep beep’ tonal alarms, which can be almost impossible to pinpoint, the latest technology creates a ‘ssh-ssh’ sound and uses smart technology to adjust sound levels in line with the ambient noise in the immediate vicinity. Utilising a wide range of frequencies, smart reversing alarms also enable the listener to instantly locate what direction the sound is coming from. In adverse conditions, for example if rain is pounding down, the warning decibel level will be increased.

Brigade Electronics plc The Mills, Brigade House, Station Road, South Darenth DA4 9BD 01322 420300 www.brigade-Electronics.com Do you have anything you would like to add or include in Newsline? Please contact us and let us know.

AMBULANCE UK - JUNE

In Wales, emergency service vehicles were involved in more than 3,500 crashes in the five years to March 2016. North Wales Police recorded the most incidents – 331 collisions in 2015-16, but the majority of these involved minor damage. The Welsh Ambulance Service recorded 735 incidents.

Safety camera systems Retro-fitting vehicles with commercial vehicle safety systems, such as Brigade Electronics’ best-selling Backeye®360, allows drivers to keep a close eye on all possible blind spots of their vehicle so they can instantly see other vehicles, cyclists or pedestrians.

109

NEWSLINE EEAST

Patient travelling the world after cardiac arrest A patient from Bedfordshire is living her dream of travelling the world, thanks to crews who shocked her 17 times during a cardiac arrest.

On the 15th November, 47-yearold Belinda West began experiencing chest pains at her home in Little Staughton.

Biggleswade crew Emma Winser and Kelly Carpenter, along with Bedfordshire University student Daniella Shoulder, were dispatched from East of England Ambulance Service.

had called back on 999 to say he believed his mum was in cardiac arrest.

a team meant we were able to convey her to Royal Papworth Hospital for immediate treatment.”

His quick thinking to update our control room meant further resources including Leading Operations Manager Tracey Trangmar, MAGPAS medical team and another ambulance with clinicians Ross Stevenson and Alicia Bahra were sent.

On Friday (5th April) Belinda and her son met with some of her lifesavers at Kempston ambulance station.

Emma Winser said that when she and Kelly arrived, Belinda’s breathing was abnormal, so they immediately followed life-saving cardiac arrest protocols.

The team delivered 17 shocks before her cardiac activity returned, 30 minutes after first arriving on scene.

Mrs Carpenter said: “None of As they were approaching the us wanted to give up and were incident Belinda’s son, Brendon, Ambulance Today 2p.fhmx 1/9/17 11:42 1 that all our efforts as soPage pleased

She thanked everyone and said: “It was amazing to meet the crew and get the opportunity to thank them for all their hard work and dedication to what they do, they should be highly commended.

“It is down to them that I owe them my life, there will never be enough thanks that I could offer in return.”

Craig Borrett, Assistant General Manager in North Bedfordshire who organised the reunion, added: “I was totally blown away when I saw how well Belinda looked when she visited us at the station.

AMBULANCE UK - JUNE

110

Composite

For further recruitment vacancies visit: www.ambulanceukonline.com

“It was a truly beautiful moment seeing everyone smiling and sharing their memories of that eventful day in November.”

Belinda has returned to work part time and is now pursuing her dreams of travelling; her next destination is Tasmania.

“It is down to them that I owe them my life, there will never be enough thanks that I could offer in return.”

NEWSLINE which continued en route to

Brompton Hospital where he was

blessed in so many ways. I am

Cardiac arrest survivor thanks lifesaving team

hospital.

placed on a specialist ECMO

just so glad I’m alive to thank the

life-support machine, spending

whole team.”

A cardiac arrest survivor from

SECAMB

“Saroj was being so well

some eight weeks in hospital as

resuscitated, right from the start

his body recovered. Sarah was

The couple also visited the air

from Sarah, and then the whole

told to prepare for the worse

ambulance team recently to

team, that he actually had some

as he experienced additional

express their gratitude.

awareness and was trying to fight

complications with acute kidney

us off,” explained Adam.

failure and respiratory failure.

team who helped save his life.

“It’s obviously strange when

However, with expert hospital

someone is reacting in that way

treatment from both hospitals

Saroj Khadka, 48, who collapsed

when their heart still isn’t beating

Saroj recovered and recently

Sarah said: “I hadn’t had any CPR

normally by itself. Given the

attended SECAmb’s Chertsey

training since I was a young girl

afternoon of 12 October 2018,

situation, we called in the support

Make Ready Centre with his wife

guide so I was so grateful to Ewan

received immediate life-saving

of the air ambulance service and

Sarah to personally thank the

for his clear advice and it was very

CPR from his wife, Sarah, under

the decision was taken to sedate

team.

special and emotional to meet

the instruction of 999 Emergency

Saroj and continue to attempt get

Medical Advisor, Ewan McGlashan.

his heart into a normal rhythm en

“We had written to say thank you

to him for shouting a little on the

route to St George’s Hospital. We

to the crew but we really wanted

999 call! I would urge everyone

achieved this just as we arrived.

to meet them to express our

to take the time to learn CPR as

thanks in person,” said coach

you never know when you may

driver, Saroj.

need it.”

Surrey has been reunited with the South East Coast Ambulance Service, (SECAmb),

at his Cobham home on the

Paramedic, Hannah Kelly, was

Since learning of Saroj’s collapse, villagers have worked together to

first to arrive at the scene, closely

organise a CPR training event.

him – although I do apologise

followed by Community First

“It was a great team effort where

Responder Richard Ayears. The

everything just fell into place.

pair were then backed up by

None of it would have been

“I know that I’d been to the gym

Critical Care Paramedic Adam

colleagues including Critical Care

possible without the quick thinking

the morning of my collapse but in

added: “On behalf of the whole

Paramedic, Adam Heywood, and

and actions of Sarah in the first

terms of the incident itself, I don’t

team I wish Saroj and Sarah all

the Kent Surrey and Sussex Air

instance.”

remember a thing. It’s been quite

the best for the future. It was a

a journey and I’ve still got a way to

pleasure to meet them in better

Saroj was treated for a blocked

go while I recuperate and wait for

circumstances and I’m very proud

Together the team set about a

artery at St George’s before

increased strength and movement

to be just one part of the team

prolonged attempted resuscitation

being transferred to Royal

to return to my legs but I’m so

who helped save his life.”

Ambulance Service.

AMBULANCE UK - JUNE

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

NEWSLINE YAS

Patient Reunited with Hero Colleague and Life-saving Ambulance Staff Ambulance Community First Responder (CFR) John Ibbotson has been hailed a hero after his quick-thinking actions saved a colleague’s life.

for an ambulance. I kept him

all their help and mostly my wife

comfortable and made sure his

Sandra for being my rock.”

airway was clear and we had the work defibrillator on standby in

Mr Ibbotson said: “I’m just so

case we needed it.”

thankful that my CFR training meant I was able to spot the signs

EEAST

Wetherspoon endorses ambulance’s Don’t Choose to Abuse Campaign

The ambulance crew – Ian

and recognise that he needed

Nettleship, Javed Chaudhary

professional help quickly. John

and Alex Robson – arrived and

popped into work a few weeks

confirmed he was having a heart

after it happened and it was great

The East of England Ambulance

attack, treated him on scene and

to see him looking so well.”

Service NHS Trust (EEAST)

stabilised his condition before

campaign highlights the abuse

blue-lighting him to Northern

Mr Beckingham and his wife

which ambulance staff receive

General Hospital. He was

Sandra were given the opportunity

Father-of-three John Beckingham

– and the consequences for

immediately taken for surgery and

to formally thank Mr Ibbotson

was doing an early shift at Rolls-

perpetrators. During 2017-18

had two stents fitted.

and the ambulance crew for

there were more than 1,000

their life-saving efforts when they

incidents reported by EEAST

Mr Beckingham, who is making a

were reunited at Rolls-Royce in

staff, including 252 incidents of

good recovery, said: “I’m just so

Rotherham on Tuesday (21 May).

physical abuse and intimidation –

Royce in Rotherham in February 2019 when he started to feel ill.

Mr Ibbotson was alerted and,

thankful that John was there when

using the skills he has gained

it all happened; if he hadn’t been,

The event was attended by Yorkshire

during his almost five years as a

the outcome could have been very

Ambulance Service Chairman Kath

CFR with Yorkshire Ambulance

The campaign has been

different. His quick response and

Lavery who said the incident was a

Service, soon suspected that he

re-launched across the six

knowledge about what to do and

perfect example of how CFRs and

was having a heart attack.

counties which the Trust serves

when to do it definitely saved my life.

staff work seamlessly for the benefit

(Bedfordshire, Cambridgeshire,

of patients.

Essex, Hertfordshire, Norfolk

eight where weapons were used.

“He was mumbling, his radial

“I owe everything to John, the

pulse was weak and his carotid

ambulance crew and hospital staff

Rolls-Royce Rotherham have

pulse in his neck was irregular; I

that assaulting ambulance crew

– they are all heroes and I can’t

since made a £300 donation to

knew it was serious,” recalled Mr

members can result in a prison

thank them enough.

the Yorkshire Ambulance Service

Ibbotson, who lives in Deepcar,

sentence of up to 12 months.

“I would also like to thank Rolls-

Charity in recognition of the life-

Sheffield. “Then I noticed a

Royce for their continued support

saving work of the service and the

blue tinge in his lips and he

while on my phased return to

efforts of Mr Ibbotson and the YAS

started sweating profusely

work, especially Valerie Jackson

team who treated Mr Beckingham

so I asked a colleague to call

and Gary Lynch, cardio rehab for

on the day.

and Suffolk), reminding people

Forty-seven JD Wetherspoon pubs in the region will be sharing the message through the campaign’s distinctive green Don’t Choose to Abuse posters and drinks mats.

Dorothy Hosein, Chief Executive of EEAST said: “It’s totally unacceptable to abuse ambulance crews and call handlers who are only there to help.

“We are therefore delighted that Wetherspoon has chosen to endorse our message now, as Easter and the May bank holidays

AMBULANCE UK - JUNE

are often a very busy time for us.

It’s a reminder that our staff work through the holidays to help people and keep them safe, and they need your respect and support to do their job.”

Tom Ball, General Manager of Wetherspoon said: “ We are

112 For more news visit: www.ambulanceukonline.com

NEWSLINE pleased to play our part in getting

thankfully the damage was limited

already face when out trying to help

each day, the fact that the

this important message over to

to a chip in the windscreen.

the community.

numbers have remained largely

the public.

Despite being a minor incident,

at the same level shows the

this kind of vandalism is turning

Ged adds, “The safety of our

“The participating Wetherspoon

into a dangerous trend which

staff and patients is always our

who challenge calls and ensure

pubs will display the posters

could have severe consequences

priority. When a patient is ill and

resources are not sent to a good

prominently in order to highlight

for NWAS staff or patients.

being treated in the back of an

proportion of these hoax calls.

tremendous dedication of my staff

ambulance, the prospect of

the campaign to their customers.”

Director of Operations, Ged

missiles coming in through the

“With a Bank Holiday ahead and

Blezard comments: “I was

window should not be something

children off school, we would

absolutely lost for words when

they have to worry about. We will

urge parents and guardians to

I heard of these incidents,

always work with the police to

be mindful that quite a lot of hoax

particularly the case in Liverpool.

push for the full extent of the law

calls do come from youngsters.

Had this member of staff been

to be applied to those who think it

March 2019 saw three incidents

hit harder or in the eye, we could

is amusing to do this.

where youths throwing stones

have been dealing with a serious

at emergency ambulances has

incident and possibly even the

caused disruption and North

death of him, his colleague or the

West Ambulance Service is

young child we were treating.

NWAS

Sticks & stones can break our bones

appealing to them to stop before someone is seriously hurt.

“I would like to ask those throwing the stones at ambulances – how

“Over the years we have seen all sorts of calls: we’ve had people calling about patients not

WMAS

It’s not smart; it’s not clever; in fact, it could put lives at risk

breathing, serious road traffic collisions, patients committing suicide and claims patients are about to die. Understandably, these can be distressing for my

On 10 March, an ambulance was

can you be sure that ambulance

Bosses at West Midlands

call handlers, but when we then

taken off the road after a bottle

isn’t travelling to save the life of

Ambulance Service are warning

send vital resources on blue lights

was thrown while it was en route to

someone you care about? How

that lives could be at risk if

to these cases only to find that

an emergency – the side window

do you know that your mum, dad,

people continue to make hoax

there is no-one there, you can

shattered covering the interior with

grandparent or sibling isn’t in a life

calls to the service.

imagine what we think.

broken glass, luckily there was no

threatening situation and waiting

patient on board and no-one was

desperately for that ambulance

New data shows that over the last

“Not only has it tied up a call

hurt. The incident, which happened

to arrive? You are delaying critical

five years, there have been almost

handler dealing with the call, it

at 9.20pm on the A6 in Stockport

help to our patients, you are

5,500 malicious callouts.

means those ambulances have

was reported to the police. The

risking the lives of our staff and

ambulance had to be taken off the

our patients. If the stone throwing

This has not only wasted hundreds

often busy streets putting other

road and a second vehicle was

results in serious injury or at

of thousands of pounds of taxpayer

drivers at risk, only to find that

sent to the patient.

worse, a death, you could find

cash, it could have put lives at risk

there was no need. Worse, it

yourself in serious trouble and

because it delayed answering calls

means they weren’t here for

facing a lengthy prison sentence.”

to and responding to patient who

patients who were genuinely

are critically ill or injured.

in need of that response. It is

A fortnight later, the trust was shocked to learn that in West

had to drive on blue lights through

Derby, Liverpool, stones had

In November last year, the

been thrown at an ambulance

trust launched a campaign

Year

carrying a sick child. The incident

highlighting the growing problem

2014-15 1,171

“We have seen a number of

happened at 11.20pm and the

of violence and aggression

2015-16 1,283

people charged and convicted

stone went through an open

towards ambulance staff. Using

2016-17 905

where they have maliciously

window hitting the technician on

the hashtag #GetBehind999, the

2017-18 990

abused the 999 call system and

the head while he was driving on

trust opened an online pledge

2018-19 1,088

we will not hesitate to push for

blue lights. Bravely, he continued

where people could show their

Total 5,437

prosecutions again, if that is

on his way to hospital where he

support to end violence towards

was treated for a minor graze

ambulance staff and businesses

Jeremy Brown, who is charge

before being sent home, having to

could receive posters to display in

of the regions two ambulance

“Considering we now receive

cut short his shift.

their premises. The pledge is still

emergency operations centres

well over a million calls a year,

open to signatures through http://

said: “At a time when we are busier

thankfully the number of these

www.nwas.nhs.uk/stop-abuse

than ever, the fact that some

which are hoaxes is still very low,

people think it is appropriate to

but even one is one too many.

March, a group of youths threw

appropriate.

stones at an ambulance on the

NWAS staff have reported more

deliberately make 999 calls when

We would ask everyone to help

A095 in Preston, Lancashire.

than 730 cases of physical or verbal

there is no need is despicable.

us reduce these numbers further

The ambulance was travelling

assaults in the last 12 months and

on blue lights to a patient in a

this spate of stone throwing adds

“Given we now regularly receive

possible service to the people

life-threatening condition and

a worrying dimension to what they

around 4,000 emergency calls

who need us most.”

so that we can provide the best

AMBULANCE UK - JUNE

Only four days later on 27

appalling.

Number of Hoax Calls

113 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com

NEWSLINE EMAS

Hazardous Area Response Team celebrate 10th anniversary The specialist team of highlytrained paramedics deployed to major incidents and serious emergencies in the East Midlands is marking its 10th anniversary.

Our Hazardous Area Response Team (HART) is a group of specially-recruited paramedics who provide an ambulance response to incidents involving chemical, biological, radiological or nuclear (CBRN) or other hazardous materials.

The team also attend incidents such as train crashes, large-scale

motorway accidents, building collapses, caving incidents or significant fires.

Hazardous Area Response Teams were set up in ambulance services across the UK following a government decision in 2007, and EMAS was one of the first in the country to go live with a fully functioning team in April 2009.

Over the last 10 years, EMAS HART have been deployed to more than 10,000 emergencies including large scale fires, prison disorder, the Hinckley Road explosion, Woodhall Spa mustard gas discovery, and the Leicester City helicopter crash.

They have also provided mutual aid to colleagues in other HART teams, most recently for the Manchester Arena bombings and

the Salisbury chemical attacks.

Sid Murphy, HART and Special Operations Manager, said: “HART teams were first set up to meet the changing needs of the country, predominantly responding to major incidents.

Their job is to triage and treat casualties, to save lives in very difficult circumstances, and look after other emergency personnel who may become injured whilst attending such incidents.

“However, the training and the kit required for major incidents can be used for other emergency calls, so our HART team often provide clinical support for our colleagues in the fire and rescue service, the police force, the military, as well as helping EMAS colleagues at larger scale emergencies.

AMBULANCE UK - JUNE

114 For further recruitment vacancies visit: www.ambulanceukonline.com

“Like any new initiative, it took a while for people to understand what HART is all about, but we are now very much involved in the planning process for big events.

“I look forward to seeing how HART will continue to change and develop in the coming decade to meet the needs of our patients.”

Other changes that have taken place over the last decade include HART’s water response, which was very basic before the Cumbria floods, and now all HART paramedics are trained in Swift Water rescue to a high standard.

HART teams also have firearms training in response to marauding terrorist attacks in recent years.

HART paramedics all receive a minimum of six weeks advanced

NEWSLINE training to give them the additional skills for the types of situations and patients they may be called to.

For example, under authorisation from a doctor, they can use certain surgical skills such as surgical airway incision / tracheotomy to secure an airway and making an incision to drain air or fluid where patients have a chest injury during a prolonged entrapment.

They are also PHTLS (pre-hospital trauma life support) trained so that they can provide enhanced care.

High profile incidents attended

by EMAS HART • Rock City pepper spray gas release in Nottingham, 2018 • Leicester City helicopter crash 2018 • Hinckley Road house explosion, 2018 • Woodhall Spa mustard gas discovery, 2018 • M1 minibus crash, 2018 • Birstall house explosion, 2017 • Coastal floods in Lincolnshire, 2017 • Carlsberg factory explosion in Northampton in 2016 • Stocken Prison riot in 2015

• Ranby Prison riot in 2014

• Cumbria floods, 2017

• House explosion in Newark, 2013

• Commonwealth Games, 2014

• Floods in Boston, 2013

EMAS HART also provided mutual aid at:

complaints,” he added.

• Floods in Somerset, 2013

He went on to say, “Oliver North

• Olympic Games, 2012

at O&H Vehicle Technologies has

• Olympic Torch travelling across East Midlands, 2012

our success has been the lack of

also been working with Baus and

Built in Britain When Bluelight UK first started trading over 15 years ago

ourselves. We now have brand new vehicles in build at the facility in Goole and are confident that postBrexit we will be able to offer an even better, less time-consuming

• Salisbury chemical attacks, 2018

they were supplying preowned ambulances to the

increasing needs. This ‘Built in

• Manchester Arena bombings,

private sector and quickly

Britain’ range of vehicles will soon

established themselves as

be available directly from Bluelight

market leaders. Over the years

UK in varying layouts from Neonatal

they have seen their industry

to HDU and many other specialist

change dramatically with more

patient transport options. Their

private services and less NHS

production line and in-house

Ambulance Service Trusts.

homologation department can

2017

solution to our customers ever-

easily adapt to our requirements.

Over the years, we have supplied

both customers and suppliers,

more O&H products than any other

which have stood the test of time,”

vehicle converter and we already

commented MD Simon Forster.

have a good working relationship

“We have been receiving great

with them. This can only reinforce

feedback from our customers

our position in the marketplace.”

regarding build quality and our partnership with Baus AT in

For details on new vehicle

Poland has allowed us to design

conversions available from

a vehicle durable enough for the

Bluelight UK, contact

UK market with VOR downtime

sales@bluelightuk.co.uk

minimised. The best measure of

or telephone 01942 888800

AMBULANCE UK - JUNE

“We developed relationships with

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

IN PERSON and Sussex, as well as the huge number

Kent Surrey Sussex, added: “We conducted

Air Ambulance appoints anaesthesia expert to its Board

of people that travel through the area on

an open competitive process to recruit a

business or pleasure each year.

Trustee with relevant medical expertise and

An international expert in intensive care and the battle to reduce deaths from Sepsis has joined the Board of Trustees at Air Ambulance Kent Surrey Sussex, the life-saving time critical emergency care charity.

AAKSS News

Professor Andrew Rhodes is a member of the Executive Committee of the Surviving Sepsis Campaign and Professor of Anaesthesia & Intensive Care Medicine at St George’s University Hospitals NHS Foundation Trust in London.

The air ambulance operates 24/7 and serves the 4.7m residents of Kent, Surrey

are delighted that Andy applied and has Commenting on his appointment to the

accepted our invitation to join our Board.

Board of Trustees, Professor Andrew

In our mission to deliver the best possible

Rhodes said: “Air ambulances are an

patient outcomes we very much value

integral part of the emergency care

his clinical experience as a Professor of

community. I’ve seen first-hand how their

Anaesthetics as well as his international

speed of response and the expertise of the

reputation in research and in clinical

on-board doctors and paramedics have

governance.

made a very positive impact on outcomes for patients, most of whom are in seriously

“As we continue to innovate, to deliver

life-threatening conditions.

outstanding patient care and to increase our investment in research he will provide

“I’m delighted to play a small part in

particularly valuable oversight and guidance

helping the team at AAKSS improve patient

as a Trustee.”

procedures still further, and to advise the Board on potential developments such as

In addition to his work for St George’s,

on-board anaesthetics.”

Professor Rhodes is also a Senator and past President of the European Society of

Dr Helen Bowcock, Chair of Air Ambulance

Intensive Care Medicine.

AMBULANCE UK - JUNE (L to R) First Officer Graham Robinson, Dr Magnus Nelson, Andrew Rhodes, Paramedic Caroline Rose, Captain Blaine Ashurst

116 For more news visit: www.ambulanceukonline.com

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80 free CPD-accredited seminars for all services, live demonstrations

to discover emerging technologies and operational solutions,

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AMBULANCE UK - JUNE

Taking place in Hall 5 at the NEC in Birmingham, the two-day event

Find out more at www.emergencyuk.com 117 Do you have anything you would like to add or include? Please contact us and let us know.

IN PERSON EMAS News

From the Middle East to the East Midlands - exArmy doctor named as new ambulance service medical director An ex-Army doctor who regularly flies

and as an urgent care doctor in Corby. He

staff and, in the past four months, EMAS

will continue to work as a GP associate at

has added 27 emergency ambulances to its

Oakham Medical Practice in Rutland.

fleet, alongside 40 replacement vehicles.

Already a familiar face at EMAS, having also

Meanwhile, 47 Urgent Care Ambulances,

worked to support the senior leadership and

staffed by 100 urgent care assistants,

provide clinical guidance for the past two

have been introduced across the region to

years, he says he is relishing the chance to

provide care for patients with urgent but not

drive further improvements during a critical

immediately life-threatening conditions.

and exciting time.

Dr Roberts, who lives near Oakham,

with one of the region’s 999 emergency helicopters has been appointed the

“It is important to me that everybody

Rutland, said: “This is part of the long-term

most senior doctor at East Midlands

delivering care at EMAS felt like they were

transformation of our ambulance service.

Ambulance Service (EMAS).

doing it under a medical director who

We need people who want to be associated

understood, who delivers care in similar

with EMAS, who want to work at EMAS and

As the service’s new medical director,

circumstances and wouldn’t ask crews to do

who want to stay at EMAS.

Dr Leon Roberts MBE, is responsible

anything that he wouldn’t be prepared to do

for maintaining and improving clinical

himself.

“I am extremely proud of the compassion

standards of 999 care across 6,425 square

“The best care happens when different

and commitment shown by teams across

miles and six counties.

parts of the NHS work together, and I am

EMAS every day as they respond to the

keen to combine my primary care skills

challenges we face to provide effective care.

Well versed in being first at the scene of a

and knowledge with my pre-hospital and

medical emergency, Dr Roberts has flown

in-hospital experience to develop the most

“We need to ensure we have highly skilled

weekly with the Derbyshire, Leicestershire

effective care pathways for patients,” said

staff and resources available to provide

Rutland Air Ambulance for the past seven

Dr Roberts.

the swiftest and most effective responses to the most serious 999 calls – people with

years and was awarded the MBE in 2010 for

immediately life-threatening conditions.

his voluntary pre-hospital emergency care

“It is important to me that everyone

work and his military service with the Royal

delivering care at EMAS feels they are

Army Medical Corps.

working under someone who understands

“While many of our calls are for conditions

what they do and wouldn’t ask someone to

that are not immediately life-threatening,

do something they wouldn’t be prepared

they are from patients in considerable

to do themselves. They should know that

distress and need. In these cases it can

I understand the daily challenges they are

often be more important to ensure we get

going through.”

the right level of care to them and take them to the most appropriate place for

“There are great opportunities to collaborate

ongoing care, rather than focussing purely

across the health and social care sector

on getting them to the nearest accident

and I want EMAS to play a leading role,

and emergency department as quickly as

particularly where new technology can play

possible.

a part in improving the way we assess and treat patients.

“It is vital that we maintain the right balance of skills and vehicles available to match the

“I want to develop a culture where we

needs of all the patients we serve.”

develop things that work well but we are not afraid to look at things that haven’t

Dr Roberts previously worked with EMAS as

The 41-year-old served as an Army senior

gone well and we learn from them – lessons

an assistant medical director and strategic

doctor, reaching the rank of Lieutenant

learned and professional development are

medical adviser and has supported the

Colonel, after studying medicine at Leeds

both part of the same process.”

service’s Clinical Assessment Team in the

AMBULANCE UK - JUNE

University. His overseas tours of duty

Emergency Operations Centre to prioritise

include Sierra Leone, Belize, Uganda,

Investment in training and recruitment of

and offer the best and most appropriate

Kenya, Canada, Kosovo, Iraq and

extra frontline crews, alongside additional

care to patients dialling 999.

Afghanistan.

and replacement vehicles, is set to continue at EMAS with up to £10m extra available to

He believes his experience of the local NHS

As well as working as a critical care

the trust over the next 12 months, subject to

from different perspectives will help as the

doctor with the Derbyshire, Leicestershire

it meeting performance and financial targets.

NHS moves towards more effective and collaborative working, finding solutions to

and Rutland Air Ambulance, Dr Roberts has worked as a GP in the Emergency

This follows investment of more than £8m to

patient needs that use skills and expertise

Department at Leicester Royal Infirmary

recruit and train almost 500 extra frontline

from across health and social care sectors.

118 For further recruitment vacancies visit: www.ambulanceukonline.com

IN PERSON Dr Leon Roberts, East Midlands

Toughest time in the Army

Most valuable lesson learned in civilian

Ambulance Service Medical Director

Being regularly away from family. During

life

an operational tour of Afghanistan in 2010 I

Never underestimate people’s ability to

Born: 1977, Sheffield

had 12 days at home during a seven-month

Family: Married to Amie, he has two children,

deployment.

Neve, 12, Logan, nine

cope in a crisis. I am always amazed at the strength and resilience members of the public find in distressing circumstances. It really does restore your faith in humanity.

Have you ever been shot at?

You want to do your best for them because

How do you relax? Walking Freddy the dog

While in Afghanistan, I spent much of my

they are having what will for some be their

and supporting a variety of the children’s

time out on foot patrol – we often came

worst moments.

sporting commitments

under fire and it was my job to support

Graduated: Leeds School of Medicine, 2000;

Afghan doctors – mainly treating Afghan

Most satisfying medical moment Being given the chance to do the

Royal Military Academy, 2002

soldiers and the local population.

Career highpoint

Most valuable lesson learned from Army

it before, I was always an Army doctor and

Working in northern Kenya, near Ethiopia,

life

hadn’t thought of much else. One of my first

anaesthetist training needed to become an air ambulance doctor. I hadn’t considered

setting up clinics to provide care for nomadic people. We saw thousands of patients over five weeks, including a nine-year-old suffering

Flexibility – moving location, regiment and home every few years taught me to remain

jobs on the air ambulance was to a young boy who had been hit by a bus. The team provided immediate care and flew him to

from organophosphate poisoning who

flexible, always ready to work with different

was at death’s door. He survived thanks to

colleagues and in different ways in different

survived to get back to school. I haven’t

everyone’s immediate actions.

settings.

looked back since.

a paediatric neurosurgical team rapidly, he

AMBULANCE UK - JUNE

119 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com

IN PERSON saving difference that can be made by rapid

of Fundraising, a former Rotary Club Founder

New Chief Executive for Air Ambulance Kent Surrey Sussex

response to trauma and medical emergency

Secretary and President and former Chair

and providing the emergency medical

of the National Association of Hospice

support patients need. I am incredibly excited

Fundraisers. Outside of work he enjoys

about the opportunity to lead and develop

running, cycling, football and sport in general,

Air Ambulance Kent Surrey and Sussex, an

as well as spending time with family and

A highly experienced leader and Chief

inspirational organisation with an excellent

friends, travelling and enjoying good food in

reputation and an incredible team of staff

local cafés, restaurants and the occasional

and volunteers who together through their

local pub.

AAKSS News

Executive with 25 years’ experience in the health and international aid and development sectors helping people in need – including those living in some of the world’s most troubled hotspots – will be taking over as the new Chief Executive of Air Ambulance Kent Surrey Sussex

experience, hard work and commitment make such a positive impact on the lives of their patients,” he said.

“The frontline crews at AAKSS are recognised

(AAKSS).

as among the very best and most innovative

An honours graduate in history and economics

backed by a first-rate wider staff team, some

at Glasgow University, David Welch pursued a

200 volunteers and an incredibly supportive

successful early career in retail management

and visionary Chair and Board of Trustees.’’

in the country – if not the world – and they are

before switching track to pursue international aid and development work including in conflict-

“I am looking forward to working with

torn countries such as Angola, Rwanda and

this amazing team to build on what has

Bosnia. David then led a number of health-

been achieved to date, and to driving the

related charities in his native Scotland and,

development of the organisation forward,

most recently, the north of England.

working collaboratively with all our partners and stakeholders including in the ambulance,

Currently Chief Executive of Leeds Cares,

healthcare and academic sectors.”

a multi-million pound charity supporting the health and wellbeing of the wider community

David will take over from Michael Docherty,

in partnership with one of the largest and most

who has been the charity’s interim Chief

successful NHS Trusts in the country – Leeds

Executive since August 2018 and will now

Teaching Hospitals – David will be relocating

return to the Board as a Trustee.

to the South East and starting his new role with AAKSS on 1 August.

Dr Helen Bowcock, Chair of Air Ambulance Kent Surrey Sussex, said: “David was the

AAKSS operates 24/7 and serves the 4.7m

outstanding candidate to become our new

residents of Kent, Surrey and Sussex, as well

CEO. He brings a wealth of leadership

as the huge number of people that travel

experience having already served for some

through the area on business or pleasure each

years as a chief executive in the health and

year.

charity sectors with a strong track record of successful income generation and innovation.

“I know from my current role the vital and life-

News

Head of Operations appointed by O&H Vehicle Technology as part of strategic progression O&H Vehicle Technology has appointed a Head of Operations – in a newly-created position – to drive efficiency, strategy and culture; ahead of a period of imminent growth.

Mark Gresty joins O&H at a pivotal point in its 30-year history. Synonymous with the UK’s emergency services vehicle sector, the manufacturer has recently undergone a transformative three months – internally referred to as ‘O&H 2.0’ – whereby its new managing director, Oliver North, has rebranded the company and created a positive culture-shift.

With 35 years’ experience as an army major and with leadership experience across multiple disciplines, including personnel, logistics and operations, Mark is therefore set to continue implementing military precision within the organisation’s shop floor, and to help lead its 150-strong team – alongside its experienced management team.

Oliver North, a former Royal Engineer himself,

“We are very much looking forward to

commented on Mark’s appointment: “Mark

welcoming him to the South East to

Gresty has an incredible record, pedigree and

lead AAKSS in this next exciting stage

legacy in the military and has more recently

of the organisation’s development. We

executed some outstanding projects in the

particularly value his experience of working

private sector.

in collaboration with NHS partners and of AMBULANCE UK - JUNE

developing philanthropic support.

“With the commencement of our ‘O&H 2.0’ project, we required an experienced change

“The Trustees are immensely grateful to

manager with a particular competence for

Michael Docherty who has served as Interim

making our experienced teams work more

CEO. He has provided exemplary leadership

seamlessly together. Mark’s skillset will allow

and has enabled us to attract the best possible

us to absorb said changes whilst increasing

candidate as permanent CEO.”

performance, without disruption.”

David is a Council Member of the Association

Mr Gresty added: “After leaving the military,

of NHS Charities, a member of the Institute

following 35 enjoyable years, I’m delighted to

120 For more news visit: www.ambulanceukonline.com

IN PERSON have joined Oliver at O&H Vehicle Technology.

ambulance response standards and be the

Gateshead Primary Care Group. In 2002, she

We worked together for three years at 21

only ambulance trust to continuously achieve

became locality director of Northumberland

Engineer Regiment in Osnabruck, Germany,

Category 1 performance; and to be the highest

Care Trust, responsible for the strategic

where we redefined standard practice and

rated ambulance service for staff engagement

development and operational management

performance in our discipline. We were a

in the 2017 NHS Staff Survey.

of all primary, community and social care

formidable team then and now we’re even

services in Blyth Valley.

more excited to be part of such an incredible

In 2018, Yvonne was listed in the Top 50 chief

organisation, particularly being that we’re

executives in the Health Service Journal (HSJ),

Yvonne became Deputy Chief Executive of

building essential and critical, life-saving

a trade journal of the NHS, and was runner-up

Gateshead Health NHS Foundation Trust,

vehicles.

in the HSJ provider CEO of the Year award in

based at the Queen Elizabeth Hospital, when

November.

she moved there in 2005 until leaving to lead

“My immediate concern is to drive operational

NEAS in October 2014.

efficiency and culture amongst the highly

Chairman Peter Strachan said: “Yvonne

skilled team at O&H Vehicle Technology’s

is a tremendous asset to the NHS and, in

Yvonne now leads on a number of regional

impressive headquarters.”

particular, the ambulance sector. She has

and national groups. She is a member of the

assured a focus on providing high quality,

Association of Ambulance Chief Executives

compassionate care to our patients.

and leads on Workforce Race Equality

NEAS News

MBE for Chief Executive One of the North East’s leading figures in the NHS has been awarded an MBE in the Queen’s New Year’s Honours.

Yvonne Ormston, Chief Executive of the North East Ambulance Service NHS Foundation Trust, has been recognised for her services to the NHS in a career spanning 33 years.

Yvonne said: “I am honoured to have received this award and have loved working throughout my career in the NHS to develop and support patient care. This award is as much a recognition for those who have helped and supported me throughout the years.

“It is a real privilege to work alongside such dedicated people in the health service and no

Standards for the NHS ambulance sector “She has achieved this by working tirelessly

across the UK and for the North East NHS.

for the benefits of the service and patients, forming new strategic partnerships and

Her profile in the region and leadership drive

embedding values of compassion and care

has been key to the formation of an NHS

across the organisation.”

alliance among providers and commissioners to drive development of the North East clinical

Yvonne joined the NHS in 1985, working

assessment service – the contract which was

within a community unit in Newcastle to

won in a competitive tender in April 2018. The

provide residential care for people with

alliance brings together clinical support and

learning disabilities. She then worked during

leadership to direct urgent and emergency

the 1990s at Gateshead and South Tyneside

care patients to the right care, in the right

Health Authority, eventually holding the post

place and at the right time.

of Assistant Director of Commissioning and Performance Management.

Yvonne has also overseen the integration of emergency care and patient transport within

She moved to Ayrshire and Arran Health

NEAS, ensuring that NEAS is placed at the

Board in 1998 as Executive Director of Primary

heart of urgent and emergency care in the

Care, which she held for a year before moving

North East alongside NHS111 and the clinical

back to the North East as Chief Executive of

assessment service.

more so than in the ambulance service today.

The dedication and commitment of the staff at NEAS is a testament to the fantastic service we have in our region.

“I am extremely lucky to have had endless support and encouragement from my husband Colin and sons, Scott and Adam, without which I could not have dedicated the time and attention needed to support NHS staff and patients.”

AMBULANCE UK - JUNE

Yvonne joined the North East Ambulance Service (NEAS) in October 2014. Under her leadership, tangible results include securing NEAS as one of only three ambulance trusts to be rated “Good” by the health regulator, the Care Quality Commission; to be the highest ranked health and social care provider in the Stonewall Top 100 employers; to have successfully implemented the new

Yvonne Ormston recognised for services to the NHS

121 For all your equipment needs visit: www.ambulanceservicesuppliers.co.uk

IN PERSON News

Farewell to Sue Owen Reflecting on her time within the Service, Sue said she has many highlights. However, three stand out.

She said: “I was part of a North Leaders of the Future event many years ago and on the final day of the event we were all waiting to hear if we had been selected. When Graham Ferguson, our HR manager, told me I had been selected I was so delighted I couldn’t believe it. From this, it led to my lead for rolling out the Palliative Care Plan for the North, which I loved “The second highlight was when I applied for a secondment to the strategy team to help with the amalgamation of the Area Service Offices into the 3 Ambulance Control Centres we now have. As I was driving home from the interview, I heard from David Kinnaird that I had been successful - it was fantastic. This led me to work with Lorraine Tough and we worked together for over a year delivering the strand of the service delivery. Again, I learned so much and met so many passionate people that work with us in the service.”

directed at ensuring each staff member works

“Anyone who knows the emergency vehicle

to their full potential developing strengths and

market knows that O&H is now the most

encouraging weaknesses. She continually

exciting company in the industry since its

works with a glass half full and is an inspiration

re-structure, led by a person who I’ve served

to many staff within and out with the service.

for the past ten years. Under Oliver North, I

“Her encouragement to do and be the best you can be and the complete focus on patient experience and continuing improvement for the service we offer shows no boundaries. Her mentoring skills are recognised throughout the Scheduled Care Team and beyond and ultimately Sue is an inspiration to us all.”

Sam Ritchie added: “Sue’s dedication to the service is overwhelming, this dedication is

UK market leader in the ambulance market, as well as fulfilling some exciting projects with fire and police vehicles too – I want to be part of the success story, which is why I’m here.

“My first impression is that the skillset and experience on our shop floor is unrivalled in the industry. These guys have all the credentials to

News

O&H appoints one of industry’s most experienced vehicle builders, in line with phase of growth Experienced emergency services vehicle builder, Rory Wilde, has joined Goolebased O&H Vehicle Technology as part of the firm’s expected wave of recruitment of production personnel, in line with the company’s current surge in growth.

Rory Wilde brings over 16 years of highly-

“Being nominated for an award in the Staff Recognitions, just being nominated was unbelievable, winning Staff Member of the Year for North and being presented the award by Heather Kenny was very special and humbling as there are many unsung heroes in our world.”

have no doubt that O&H will return to be the

skilled trade experience; the last 10 years of which were served with West Yorkshire-based

dominate the industry.”

O&H Vehicle Technology’s managing director, Oliver North, added: “I was delighted when Rory approached us to join the team – he is the most skilled and the most obsessed coachbuilder I’ve ever seen at work, which will prove essential as we strive for constant improvement in pursuit of perfection. I’m proud of our entire team of tradespeople at O&H and Rory’s acumen bolsters our capability hugely.

“Our NHS Trusts are currently saturated with ambulances which are imported from outside of the UK. As everyone is fully aware, to make Brexit work, we must manufacture more in the

fire truck manufacturer, Rosenbauer UK.

UK. To manufacture more, we must be better in

Commenting on his appointment, Rory said:

currently dominate our market. Key, quality

“I’ve enjoyed ten years serving the emergency

appointments such as this will assist in making

services, which has spurred me on to be as

us stronger, whilst in parallel, we launch our

good as I can be, knowing that what I’m building

next apprenticeship drive to educate the next

is assisting genuine heroes in saving lives.

generation of specialist vehicle builders.”

quality than our international competitors who

AMBULANCE UK - JUNE

122 For further recruitment vacancies visit: www.ambulanceukonline.com

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