Volume 34 No. 3
June 2019
DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS
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. Ultrasound Workshop - start time 09.30, finish 16.00. Supported by NEMUS Education & Training, this full day workshop is covering: The Common Uses of Ultrasound in Pre-Hospital and Hospital Practice and is suitable for all non doctor clinicians who want to see how point of care ultrasound can actually enhance your practice. Delegate rate £90. Limited places available Minor Injuries Workshop - start time 10.00, finish 16.30. Delivered by current NHS emergency medicine doctors, this minor injuries workshop will cover a range of common conditions, including eyes and ears, nose and throat, joint injuries and wound closure, their assessment and immediate management. Delegate rate £96. 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. All of the above rates include: lunch, tea/coffee and, as workshop places are limited, early registration is recommended. To secure your place please visit: www.lifeconnections.uk.com - combined discounted workshop rates are available, call The Organsiers on: 01322 660434.
Media Publishing Co, Media House, 48 High Street, Swanley, Kent, BR8 8BQ. Tel: 01322 660434
www.lifeconnections.uk.com
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
SWANLEY BR8 8BQ ADVERTISING: Terry Gardner, Brenda Pickering CIRCULATION:
96
NEWSLINE
Media Publishing Company
116
IN PERSON
SWANLEY, Kent, BR8 8BQ
Media House, 48 High Street Tel: 01322 660434 Fax: 01322 666539 E: info@mediapublishingcompany.com www.ambulanceukonline.com PUBLISHED BI-MONTHLY: February, April, June, August, October, December
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. In its 30-year history, O&H has never had such a buzz about the place. The 90-strong shop floor team are happy, engaged and proud to work for Britain’s largest dedicated ambulance manufacturer. It is this sense of pride for building British ambulances, for British roads, which is also one of the motivating factors behind O&H’s rebirth. 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.
“It’s not just a strapline. It’s a way of thinking which will help Britain to flourish.”
Media Publishing Company Media House 48 High Street SWANLEY, Kent, BR8 8BQ PUBLISHERS STATEMENT: The views and opinions expressed in this issue are not necessarily those of the Publisher, the Editors or Media Publishing Company. Next Issue August 2019 Subscription Information – June 2019 Ambulance UK is available through a personal, company or institutional subscription in both the UK and overseas. UK: Individuals - £24.00 (inc postage) Companies - £60.00 (inc postage) Rest of the World: £50.00 (inc. surface postage) £75.00 (airmail) We are also able to process your subscriptions via most major credit cards. Please ask for details. Cheques should be made payable to MEDIA PUBLISHING.
AMBULANCE UK - JUNE
“And we’re excited about the changes that the Lord Carter Review and NHSI are set to bring. They level the playing field, and offer opportunities for engineering excellence, from right here in the UK.
COPYRIGHT:
Designed in the UK by me&you creative
83 Do you have anything you would like to add or include? Please contact us and let us know.
Built In Britain
BUILT IN BRITAIN
ohvc.co.uk
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.
85 For all your equipment needs visit: www.ambulanceservicesuppliers.co.uk
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].
86 For further recruitment vacancies visit: www.ambulanceukonline.com
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
87 Do you have anything you would like to add or include in Features? Please contact us and let us know.
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.
AMBULANCE UK - JUNE
Fig. 1 Study population meeting inclusion criteria
88 For more news visit: www.ambulanceukonline.com
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].
AMBULANCE UK - JUNE
PRBC received over the first in-hospital 24 h is documented for the
Discussion
89 Do you have anything you would like to add or include in Features? Please contact us and let us know.
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.
AMBULANCE UK - JUNE
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.
References
20. Bailey JA, Morrison JJ, Rasmussen TE. Military trauma system in Afghanistan: lessons for civil systems? Curr Opin Crit Care. 2013;19(6):569–77.
1. Holcomb JB, Donathan DP, Cotton BA, del Junco DJ, Brown G, von Wenckstern T, et al. Prehospital transfusion of plasma and red blood cells in trauma patients. Prehosp Emerg Care. 2015;19(1):1–9. 2. Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma. 2017;7(2):17–26. 3. Kauvar DS, Holcomb JB, Norris GC, Hess JR. Fresh whole blood transfusion: a controversial military practice. J Trauma Inj Infect Crit Care. 2006;61(1):181–4. 4. Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, et al. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost. 2012;10(7):1342–51.
21. Penn-Barwell JG, Roberts SAG, Midwinter MJ, Bishop JRB. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma Acute Care Surg. 2015;78(5):1014–20. 22. Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;0(0) Available from: https://www. thelancet.com/journals/lancet/article/PIIS0140-6736(18)31553-8/ abstract. Cited 23 Jul 2018. 23. Ball CG. Damage control resuscitation: history, theory and technique. Can J Surg. 2014;57(1):55–60.
5. Stanworth SJ, Davenport R, Curry N, Seeney F, Eaglestone S, Edwards A, et al. Mortality from trauma haemorrhage and opportunities for improvement in transfusion practice. BJS. 2016;103(4):357–65.
24. Powell EK, Hinckley WR, Gottula A, Hart KW, Lindsell CJ, McMullan JT. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. J Trauma Acute Care Surg. 2016;81(3):458–62.
6. Brown JB, Cohen MJ, Minei JP, Maier RV, West MA, Billiar TR, et al. Pretrauma center red blood cell transfusion is associated with reduced mortality and coagulopathy in severely injured patients with blunt trauma. Ann Surg. 2015;261(5):997–1005.
25. Naumann DN, Hancox JM, Raitt J, Smith IM, Crombie N, Doughty H, et al. What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study. BMJ Open. 2018;8(1):e019627.
7. Harris T, Davenport R, Mak M, Brohi K. The evolving science of trauma resuscitation. Emerg Med Clin North Am. 2018;36(1):85– 106. 8. Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet J-F. Acute traumatic coagulopathy: initiated by Hypoperfusion. Ann Surg. 2007;245(5):812–8. 9. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, FernándezMondéjar E, et al. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010;14(2):R52. 10. Carrick MM, Leonard J, Slone DS, Mains CW, Bar-Or D. Hypotensive Resuscitation among Trauma Patients. BioMed Res Int. 2016;2016:8901938 Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4993927/. Cited 8 Dec 2017. 11. Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol. 2015;31(3):308–16.
AMBULANCE UK - JUNE
12. Bickell WH, Wall MJJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105–9. 13. Kasotakis G, Sideris A, Yang Y, de Moya M, Alam H, King DR, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the glue Grant database. J Trauma Acute Care Surg. 2013;74(5):1215–22. 14. Brohi K, Eaglestone S. Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood. Southampton: NIHR Journals Library; 2017. (Programme Grants for Applied Research). Available from: http://www.ncbi.nlm.nih.gov/books/ NBK464933/. Cited 1 Jun 2018
26. Johnson JL, Moore EE, Kashuk JL, Banerjee A, Cothren CC, Biffl WL, et al. Effect of blood products transfusion on the development of postinjury multiple organ failure. Arch Surg Chic Ill 1960. 2010;145(10):973–7. 27. Bodnar D, Rashford S, Williams S, Enraght-Moony E, Parker L, Clarke B. The feasibility of civilian prehospital trauma teams carrying and administering packed red blood cells. Emerg Med J. 2014;31(2):93–5. 28. Smith IM, James RH, Dretzke J, Midwinter MJ. Prehospital blood product resuscitation for trauma: a systematic review. Shock Augusta Ga. 2016;46(1):3–16. 29. Lyon RM, de Sausmarez E, McWhirter E, Wareham G, Nelson M, Matthies A, et al. Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2017;25:12. 30. Rehn M, Weaver A, Eshelby S, Lockey D. London’s air ambulance: 3 year experience with pre-hospital transfusion. Resuscitation. 2015;96:156. 31. Raitt JE, Norris-Cervetto E, Hawksley O. A report of two years of pre-hospital blood transfusions by Thames Valley air ambulance. Trauma. 2017;24:1460408617706388. 32. Weaver A, Eshelby S, Norton J, Lockey D. The introduction of on-scene blood transfusion in a civilian physician-led prehospital trauma service. Scand J Trauma Resusc Emerg Med. 2013;21(Suppl 1):S27. 33. Morrison JJ, Oh J, Dubose JJ, O’reilly DJ, Russell RJ, Blackbourne LH, et al. En-route care capability from point of injury impacts mortality after severe wartime injury. Ann Surg. 2013;257(2):330–4.
92 For more news visit: www.ambulanceukonline.com
TESTED
FEATURE
34. O’Reilly DJ, Morrison JJ, Jansen JO, Apodaca AN, Rasmussen TE, Midwinter MJ. Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study. J Trauma Acute Care Surg. 2014;77(3 Suppl 2):S114–20. 35. Holcomb JB, Swartz MD, DeSantis SM, Greene TJ, Fox EE, Stein DM, et al. Multicenter observational prehospital resuscitation on helicopter study. J Trauma Acute Care Surg. 2017;83(1):S83.
ADVANCED AMBULANCE SEATING
36. Dalton AM. Use of blood transfusions by helicopter emergency medical services: is it safe? Injury. 1993;24(8):509–10. 37. Malsby RF, Quesada J, Powell-Dunford N, Kinoshita R, Kurtz J, Gehlen W, et al. Prehospital blood product transfusion by U.S. army MEDEVAC during combat operations in Afghanistan: a process improvement initiative. Mil Med. 2013;178(7):785–91. 38. Smith IM, Crombie N, Bishop JR, McLaughlin A, Naumann DN, Herbert M, et al. RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma. Transfus Med. 2017; Available from: http://onlinelibrary.wiley.com/ doi/10.1111/tme.12486/abstract. Cited 28 Nov 2017. 39. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. 40. The Blood Safety and Quality (Amendment) Regulations 2017. Available from: http://www.legislation.gov.uk/uksi/2017/1320/made. Cited 1 Jun 2018. 41. MHRA Requirements. Available from: https://www.transfusionguidelines. org/regulations/archive/mhra-requirements. Cited 23 Nov 2017. 42. HEMSbase | Medic One Systems. Available from: http://www. mediconesystems.com/hemsbase.html. Cited 1 Jun 2018. 43. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763. 44. Hayati Rezvan P, Lee KJ, Simpson JA. The rise of multiple imputation: a review of the reporting and implementation of the method in medical research. BMC Med Res Methodol. 2015;15:30 Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4396150/. Cited 10 Jul 2018. 45. Rehn M, Weaver A, Brohi K, Eshelby S, Green L, Røislien J, et al. Effect of pre-hospital red blood cell transfusion on mortality and time of death in civilian trauma patients. Shock. 2018; Publish Ahead of Print. Available from: https://journals.lww.com/ shockjournal/Abstract/publishahead/Effect_of_Pre_Hospital_Red_ Blood_Cell_Transfusion.97840.aspx. Cited 1 Jun 2018.
M1 SEATS APPROVED TO LATEST R44.04 CHILD SEAT STANDARDS
46. Sumida MP, Quinn K, Lewis PL, Jones Y, Baker DE, Ciraulo DL, et al. Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients. Air Med J. 2000;19(4):140–3. 47. Shackelford SA, del Junco DJ, Powell-Dunford N, Mazuchowski EL, Howard JT, Kotwal RS, et al. Association of Prehospital Blood Product Transfusion during Medical Evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581–91. 48. del Junco DJ, Fox EE, Camp EA, Rahbar MH, Holcomb JB, PROMMTT Study Group. Seven deadly sins in trauma outcomes research: an epidemiologic post mortem for major causes of bias. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S97–103.
Contact us for further information and brochures
50. Chesser TJS, Cross AM, Ward AJ. The use of pelvic binders in the emergent management of potential pelvic trauma. Injury. 2012;43(6):667–9. 51. Pedersen AB, Mikkelsen EM, Cronin-Fenton D, Kristensen NR, Pham TM, Pedersen L, et al. Missing data and multiple imputation in clinical epidemiological research. Clin Epidemiol. 2017;9:157–66. 52. Lockey DJ. Research questions in pre-hospital trauma care. PLoS Med. 2017;14(7):e1002345 Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5515397/. Cited 1 Jun 2018.
AMBULANCE UK - JUNE
49. Davenport R, Khan S. Management of major trauma haemorrhage: treatment priorities and controversies. Br J Haematol. 2011;155(5):537–48.
93 Do you have anything you would like to add or include in Features? Please contact us and let us know.
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. This launch will enable ambulance trusts all over the UK to address one of the key issues they encounter on a daily basis: that newly qualified paramedics, technicians and emergency care assistants must take a C1 driving licence prior to being able to drive a DCA, at a cost of around £1000. Neil Le Chevalier explains: “With the ambulance service recruiting more younger paramedics now, straight out of university, their driving licence no longer has a C1 category. Until they have their C1 driving licence they can’t drive any vehicle weighing over 3.5 tonne. This can be a limiting factor. There’s also the cost of taking the additional driving test, which new recruits usually have to pay themselves. If we moved to a 3.5 tonne vehicle on a replacement basis we’d solve the problem in the longer term as there is no requirement for any additional license at this weight. “Innovation in design is also critical. The ambulance is the working office of the paramedic and needs to be designed with them in mind. Issues such as infection control, ergonomics and patient and crew safety are all features that have been addressed in the new vehicle.”
AMBULANCE UK - JUNE
Sales Engineering Manager at WAS UK, Tom Howlett, says: “Our new 3.5 tonne vehicle provides 20% more ergonomic working space than a van conversion. Our users tell us that this additional space is essential to the design of the ‘treatment triangle’, the area where the paramedic is seated. It enables medical equipment to be in arms’ reach while crews remain seated with a seat belt on. The increased ergonomic space also provides 360o patient access for enhanced clinical care - this has been a feature of ambulances operated on the continent for many years.” In February 2019, NHS England Chief Executive Simon Stevens challenged vehicle manufacturers to help “blue lights go green” and cut air pollution by developing more environmentally friendly ambulances. The NHS Long Term Plan also makes commitments to cutting mileage and air pollution by a fifth (20%) by 2024 and ensuring nine out of 10 vehicles are low emission within a decade. Neil Le Chevalier says: “In South Western Ambulance Trust we do 24 million miles a year – we’re a rural service – so we’re always interested in new ways to be greener. The 3.5 tonne vehicle is good for fuel economy as well as for the environment.”
Tom Howlett explains: “As you would be expect from a lighter vehicle, the new 3.5 tonne ambulance provides environmental benefits: it reduces air pollution (CO2) by 20% compared to a current national specification van. This enables our customers to meet the target set by Simon Stevens well ahead of the 2024 target. Fuel consumption is also reduced in line with the emissions reduction, in the case of South Western Ambulance Trust this figure will be hundreds of thousands of pounds.” All of the WAS UK test data has been independently validated by Millbrook testing ground. Emissions and fuel consumption were compared for normal driving, emergency driving and overall. Lord Carter’s report into unwarranted variation in the ambulance service identified the need to make efficiencies in the ambulance service, including development of a minimum standard ambulance specification. NHS Improvement’s recently launched national ambulance specification provided an opportunity to set a new standard for vehicle specification, with a focus on innovation, the environment and to address the practical challenges faced by the service up and down the country. Neil Le Chevalier comments: “Trusts would welcome a lighter vehicle – it’s something that’s been talked about for a number of years. The new specification is a minimum standard currently, it has been designed to be constantly renewed and updated. There are plans for an innovation group to be set up and I hope that they will also take into consideration the benefits of this newer, light-weight vehicle. “In the South Western Ambulance Trust we’d welcome the opportunity to pilot this innovative new 3.5 tonne vehicle. A light weight, 3.5 tonne vehicle helps to address the issues we’re facing in the service in the longer term: recruitment of paramedics and Emergency Care Assistants who are already licensed to drive, together with improved environmental and safety credentials.” Commercial Manager at WAS UK, John Rumsey, explains: “The 3.5 tonne DCA really is the ‘Holy Grail’ in terms of ambulance design and judging by the results of our poll, conducted on social media, more than 60% of respondents would like to see the vehicle added to the new ambulance specification. In the future all newly qualified paramedics, technicians and workshop staff will be automatically licensed to drive our vehicles and there will be no need for costly C1 license tests. We hope that this is a significant development in supporting the NHS recruitment of young paramedics into the Ambulance Service. “Our 3.5 tonne DCA was designed to address NHS England Chief Executive Simon Stevens’ challenge for vehicle manufacturers to help “blue lights go green” and our investment in lightweight aircraft grade aluminium extrusions has enabled us to deliver this. Our next step will be working with NHS improvement team to ensure that this design is added to the National Specification to enable Ambulance Trusts to procure this by the end of the summer 2019. Finally, our 3.5 tonne paves the way towards an all-electric version of this lighter-weight vehicle. Watch this space...” If you’d like to find out more information about the new WAS 3.5 tonne vehicle please contact wasukinfo@was-vehicles.co.uk, or contact Tom Howlett on 07496 982199 or 0845 459 2785.
94 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE
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.
AMBULANCE UK - JUNE
Reducing emissions. Reducing fuel consumption. Driving recruitment.
95
NEWSLINE increase in 999 incidents year-on-
members of the public to consider
Every day, North East Ambulance
year, almost 39,000 fewer patients
carefully which health service
Service NHS Foundation Trust
were taken to hospital by NWAS in
would be most appropriate to help
(NEAS) responds to thousands
2018/19 following the introduction
them before dialing 999 – if the
of patients across the region, of
of Transforming Patient Care.
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
111.nhs.uk or speak to a GP or
impairment, information in easy
stay at home in many cases
pharmacist for advice. This helps
read or little understanding of the
and avoid an unnecessary trip
us keep 999 free for the most
English language.
Almost 80,000 people across
to hospital, this approach helps
serious incidents.”
the North West avoided an
to keep emergency ambulance
unnecessary trip to hospital
resources free to respond quickly
Other Transforming Patient Care
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
illnesses or injuries. The decrease
increase of 6,600 people last year
negotiating such barriers, NEAS
advice from the ambulance
in the number of people taken to
receiving ‘see and treat’ support,
has developed an interactive
service.
hospital is estimated to have freed
which is when NWAS clinicians will
online tool, which contains easy to
up more than 19,000 hours of
attend, assess the patient face-
understand pictures for common
emergency ambulance time.
to-face, and deliver the right care
ailments to allow patients to show
on scene or refer them on to an
the clinician what is wrong and,
NWAS
Expert telephone advice from the ambulance service helps patients receive care closer to home
The North West Ambulance Service (NWAS) has expanded
In order to make access to
its Clinical Hub, which is a team
Mark Newton, who leads
alternative community-based care
in turn, allow the clinician to show
of clinicians with various areas
Transforming Patient Care, said:
service. These initiatives included:
patient what they are doing and
of expertise. These clinicians
“We’re committed to delivering
assess patients on the telephone
the right care, at the right time,
• A pilot of paramedics and
and provide self-care advice or
in the right place for North West
nurses in a new Urgent
The guide also provides direct
arrange for them to get the care
residents and, depending on your
Care Practitioner role which
access to interpreters and contains
they need in the community
symptoms, this doesn’t always
responds to less urgent
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
This document is intended solely for the use of healthcare professionals. A healthcare professional must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that healthcare professionals be trained in the use of any particular product. The information presented is intended to demonstrate the breadth of Stryker product offerings. A healthcare professional must always refer to the package insert, product label and/or instructions for use before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Power-PRO XT, Power-LOAD, Stryker. All other trademarks are trademarks of their respective owners or holders. The products depicted are CE marked in accordance with applicable EU Regulations and Directives. 08-2018, 2018-18327
97 For all your equipment needs visit: www.ambulanceservicesuppliers.co.uk
FEATURE
The Insight Family of Products
AMBULANCE UK - JUNE
98
sales@theortusgroup.com www.theortusgroup.com T: +44 0845 4594705 For further recruitment vacancies visit: www.ambulanceukonline.com
FEATURE
Insight â&#x20AC;&#x201C; Complete Fleet & Asset Protection for Mission-Critical and Specialist Operations
T E L E M AT I C S
AMBULANCE UK - JUNE
sales@theortusgroup.com www.theortusgroup.com T: +44 0845 4594705 Do you have anything you would like to add or include in Features? Please contact us and let us know.
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
101 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
DATES FOR Y
LIFE CONNEC Kettering places
We are pleased to announce our plans for Life Connections 2019 are taking shape and that each of our one day regional events have plenty to offer those wishing to attend. The venues chosen were selected to prevent delegates having to factor in travelling time and costs. Next years one day events are being held in:
Kettering - Thursday October 17 Stoke on Trent - Thursday November 28 First Responder Conference - This Half Day morning Conference will include presentations requested by First Responders, suggested topics include: Airway Management, Epilepsy Awareness, Community Defibrillation - The Loch Lomond Model. Sponsored delegate rate: £24 to include VAT, lunch/refreshments, etc. ONLY 50 PLACES AVAILABLE. FIRST AID Conference - Life Connections are working with Ian Kershaw MBE from The First Aid Industry Body (FAIB) and the Federation of first Aid Training Organisations (FOFATO) and, Rob Shaloe (QNUK) to present 5 Full Day First Aid Conferences in 2019. Each conference will include a number of topical First Aid presentations and workshops as requested by Members of FAIB, FOFATO and QNUK to ensure that they are both relevant and topical. - Usual Member rate of £96 (Including VAT), Lunch and Refreshments provided. ONLY 60 PLACES AVAILABLE. Ultrasound Workshop - Supported by NEMUS Education and Training, a very experienced faculty who have experts in the field of Ultrasound, this full day Workshop is covering the common uses of Ultrasound in contemporary Pre Hospital and Hospital Practice. It is suitable for all Healthcare Professionals especially Paramedics, other AHPs and Nurses as this course is covering FAST Scanning, Focused AAA, Echo and life support, How to diagnose a pneumothorax with Ultrasound, Vascular Access, Basic Ultrasound Science, Reporting, Training and Governance plus Lots of Hands on Scanning - Delegate rate: £90 to include lunch/refreshments, etc. ONLY 40 PLACES AVAILABLE.
Haemorrhage Control - Stepwise Approach Workshop This half day workshop will be running both morning and afternoon, covering: What is Catastrophic Bleeding?, Changes to Guidelines FPHC, JRCALC, ERC, etc., Coagulopathy, Correct use of Direct Pressure, Use of Pressure Dressings & Their Limitations, Haemostatic Devices and the Safe and Effective Use, Tourniquets - The Safe and Effective Use. Delegate rate £36 to include VAT, lunch, refreshments, etc. ONLY 10 PLACES AVAILABLE ON AM & PM WORKSHOPS Combined Conference / Workshop Offers Attend the First Responder half day morning conference plus the afternoon Haemorrhage Control workshop for a special combined rate of £48 (saving £12).
To view all Conferences / Workshops please visit: www.lifeconn
w w w. l i f e c o n n e
YOUR DIARY
CTIONS 2019 filling up fast!!!
nections.uk.com or call the Organisers Office on: 01322 660434
ctions.uk.com
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
www.edesix.com
PROTECTING HEALTHCARE PERSONNEL WITH
BODY WORN CAMERAS AMBULANCE UK - JUNE
Edesix VideoBadge and VideoTag cameras offer protection from threats and abusive behaviour, and have proven to be a valuable asset for facilitating training and operational de-brief. Paired with Edesix’s VideoManager software, the cameras capture video and audio footage when required, and store the data securely for future training purposes, or as court-ready evidence.
For more information, please contact sales@edesix.com / 0131 510 0232
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
To view the full range visit www.intersurgical.co.uk/info/emergency
Quality, innovation and choice
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
The complete solution from the respiratory care specialists
lnteract with us
www.intersurgical.co.uk
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
Where Emergency Services meet to talk business
Learn from the experts and improve your skills
This unique event features over 450 leading suppliers exhibiting,
brings together all disciplines from the emergency services sector
80 free CPD-accredited seminars for all services, live demonstrations
to discover emerging technologies and operational solutions,
and extrication challenges. Visitor entry and visitor parking are free
share their experiences and unite in their collaborative approach
of charge for all trade visitors.
to public safety.
Register online now at www.emergencyuk.com
This an industry-only event and NOT open to the general public. Visitors under the age of 16 will not be admitted. The organisers reserve the right to refuse entry.
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
25-26 June 2019, ExCeL, London
FREE TO ATTEND! GET UP TO 16 CPD POINTS.
Clinical excellence. Operational Innovation. For Paramedics, Health Workers, Managers & Partners
Show partners Join the Largest event in the United Kingdom for Paramedics, First Responders, Emergency Medical Technicians and Health Professionals. Held for the first time, The Emergency Medical Services Show is a 150-speaker conference which takes place in the United Kingdom once a year.
VIEW AGENDA
Our conference provides complete and comprehensive coverage of all the important clinical, operational and business topics and showcases some of the world class solutions from industry leaders.
MORE INFO: www.terrapinn.com/emsshow/AmbulanceUK