Ambulance UK February 2016 by Media Publishing Company

Volume 31 No. 1

February 2016

DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS

In this issue A Revolution to Support Clinicians developing Future Practice Clinical Scores - How Good Are They? Newsline

Focus on creating and maintaining optimised crew rosters

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CONTENTS

CONTENTS 4

EDITOR’S COMMENT

FEATURES

6 A Revolution to Support Clinicians developing Future Practice

Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street SWANLEY BR8 8BQ ADVERTISING & CIRCULATION: Media Publishing Company

9 Clincial Scores for Predicting Recurrence after Transient Ischemic Attack or Stroke - How Good Are They?

Environment Shapes our Care

Media House, 48 High Street SWANLEY, Kent, BR8 8BQ Tel: 01322 660434 Fax: 01322 666539 E: info@mediapublishingcompany.com www.ambulanceukonline.com PUBLISHED BI-MONTHLY:

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February, April, June, August, October, December COPYRIGHT: Media Publishing Company Media House 48 High Street

COVER STORY

SWANLEY, Kent, BR8 8BQ PUBLISHERS STATEMENT:

Rostering insight and technology for ambulance services With many Ambulance Trusts facing staffing shortages, rationalising rosters and ensuring they are closely aligned to demand is essential. Working Time Solutions use accurate demand data, expert insight and powerful specialist software to create and manage optimised rosters.

The views and opinions expressed in this issue are not necessarily those of the Publisher, the Editors or Media Publishing Company. Next Issue April 2016 Subscription Information – February 2016

Through a combination of consultancy, technology and engagement, we help design, implement and maintain demand-led crewing patterns that reduce private ambulance costs, help tackle overworking and ensure high service standards are maintained.

Ambulance UK is available through

Our work with London Ambulance Service to rationalise its rosters was able to create significant cost savings by releasing thousands more hours from the same core workforce.

UK:

a personal, company or institutional subscription in both the UK and overseas. Individuals - £24.00 (inc postage) Companies - £60.00 (inc postage)

The visual, interactive elements of our rota design software enabled crews to co-create their rosters, encouraging deep engagement and high levels of satisfaction with the change process.

The roster management and self-service elements of our software also make it easy to administer shift swaps and holidays, whilst providing a single view over working time that is essential to strategic planning and compliance monitoring. Crucially, Working Time Solutions’ experienced consultants will be with you every step of the way, from advising on project planning and roster design through to facilitating effective employee engagement and providing ongoing insight and support.

£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. Designed in the UK by Hansell Design

If you would like help creating and maintaining efficient crew rosters, contact us now on T: 0161 720 50 50, E: enquiries@workingtime-solutions.com or visit workingtime-solutions.com.

AMBULANCE UK - FEBRUARY

This tool can also help improve the wellbeing and work-life balance needs of Paramedics, supporting a Trusts’ recruitment and retention efforts without adding complexity or compromising service-levels.

Rest of the World:

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EDITOR’S COMMENT

EDITOR’S COMMENT Welcome to this issue of AUK and best wishes for the coming year from all of the team. So, the wrapping paper is filling the bins and a million used Christmas trees are waiting for the re-cycling collection, the NHS had a busy winter and many of you would have spent much of the holiday queuing in A&E. Whilst a happy (and expensive!) time, it does seem that each year has its share of tragic stories, from the unexpected death of colleagues, the sad loss of life of those for whom Christmas is not so happy to the heart wrenching tales of child and family incidents which litter the papers. This year Cumbria and the North of England suffered perhaps the most and Christmas 2015 will not doubt hold sad memories for many. As we move into the new year our thoughts are with all those people but also with the attending ambulance staff who also share the burden of sadness despite their valuable and tireless efforts to assist.

AMBULANCE UK - FEBRUARY

“Despite some excellent effort from the CoP, HEE and others, the Commission on Human Medicines was unable to recommend IP for the Profession.”

I’m somewhat fatalistic in that whilst my wife insists on New Year resolutions (usually involving more exercise for me...), the fragility of our existence on this planet triggers more ‘enjoy life now’ feelings and less planning for rainy days that I might never see... at least that’s my excuse for not buying a 12 month gym pass! I suppose the burning issue on all our minds has got to be independent prescribing. Despite some excellent effort from the CoP, HEE and others, the Commission on Human Medicines was unable to recommend IP for the Profession. Sadly disappointing as a judgement when you consider all the work that brought the proposal to this point. Citing a ‘lack of clarity’ in the definition of an advanced practitioner and concerned about ‘the wide range of conditions’ requiring diagnosis the panel didn’t feel they could move forward. I’ve read the presentation and, I suppose, yes these are a wide variety of ‘advanced paramedic practitioners’, there are also a wide variety of clinical situations where independent nurse prescribers find themselves working! I do feel that rather than a blanket ‘no’, a much fairer solution might well have been to recommend in principle then add conditions to enable Trusts to ‘work toward’ meeting the Commissions’ concerns. The question I personally am left with is, does this point towards a national role? And if so what pressure is it possible to put on every Trust to ensure equal opportunities for development... So what does 2016 have in store... well firstly congratulations to colleagues receiving honours, but my favourite story surrounds one Brent Kenny at NWAS, who managed to resuscitate Father Christmas thus saving the day and the future. For the ambulance services the big talking point is around meal breaks, with the Government talking about paying for 12 hours work and losing the unpaid ‘protected’ meal break, I wonder if someone has costed out the additional hours that would be worked? I tried simple math and it came out around £10 million, in times of austerity, it may well be back to the drawing board! Looking forward, start saving for LC2016 which promises to be bigger and better than ever, and as ever enjoy what we do out there... the public would be lost without us. Enjoy this months content and my sincere best wishes to you all.

Sam English, Co-Editor Ambulance UK

4 For more news visit: www.ambulanceukonline.com

PEN

NEW

FEATURE

Advancing Acute Pain Management

At last, PENTHROX® is here...

Fast, effective pain management designed for fast, efficient patient management. PENTHROX is indicated for the emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain1

Now there’s a new PCA* in a lightweight, portable, handheld inhaler for emergency relief of moderate to severe pain in conscious adults with trauma. With minimal set-up and no need for cylinders, cannulas or mandatory opioid-related A&E attendances, PENTHROX offers you the potential to reduce dedicated treatment time and improve patient management. less than 3 months, may increase the potential for hepatic injury. Cautious clinical judgement should be exercised when PENTHROX is to be used more frequently than on one occasion every 3 months. Potential effects on blood pressure and heart rate are known class-effects of high-dose methoxyflurane used in anaesthesia and other anaesthetics. Caution required in elderly due to possible reduction in blood pressure. Potential CNS effects such as sedation, euphoria, amnesia, ability to concentrate, altered sensorimotor co-ordination and change in mood are known class-effects. The CNS effects can be a risk factor for potential abuse. To reduce occupational exposure to methoxyflurane, the PENTHROX Inhaler should always be used with the AC Chamber which adsorbs exhaled methoxyflurane. Multiple use of PENTHROX Inhaler without the AC Chamber creates additional risk. Elevation of liver enzymes, blood urea nitrogen and serum uric acid have been reported in exposed maternity ward staff when methoxyflurane was used in the past at the time of labour and delivery. PENTHROX is not appropriate for providing relief of break-through pain/ exacerbations in chronic pain conditions or for the relief of trauma related pain in closely repeated episodes for the same patient. Interactions: Methoxyflurane is metabolised by the CYP 450 enzymes, particularly CYP 2E1 and to some extent CYP 2A6. It is possible that enzyme inducers (such as alcohol or isoniazid for CYP 2E1 and phenobarbital or rifampicin for CYP 2A6) which increase the rate of methoxyflurane metabolism might increase its potential toxicity and they should be avoided concomitantly with methoxyflurane. Concomitant use of PENTHROX with CNS depressants, such as opioids, sedatives or hypnotics, general anaesthetics, phenothiazines, tranquillisers, skeletal muscle relaxants, sedating antihistamines and alcohol may produce additive depressant effects. If opioids are given concomitantly with PENTHROX, the patient should be observed closely. Concomitant use of methoxyflurane with medicines (eg contrast agents and some antibiotics) which are known to have a nephrotoxic effect should be avoided as there may be an additive effect on nephrotoxicity; tetracycline, gentamicin, colistin, polymyxin B and amphotericin B have known nephrotoxic potential. Sevoflurane anaesthesia should be avoided following methoxyflurane analgesia, as sevoflurane increases serum fluoride levels and methoxyflurane nephrotoxicity is associated with raised serum fluoride. When methoxyflurane was used for anaesthesia at the higher doses of 40–60mL, there were reports of drug interaction with hepatic enzyme inducers (eg barbiturates) increasing metabolism of methoxyflurane and resulting in a few reported cases of nephrotoxicity; reduction of renal blood flow and hence anticipated enhanced renal effect when used in combination with drugs (eg barbiturates) reducing cardiac output; and class effect on cardiac depression, which may be enhanced by other cardiac depressant drugs, eg intravenous practolol during cardiac surgery. Fertility, pregnancy and lactation: No clinical data on effects of methoxyflurane on fertility are available. As with all medicines care should be exercised when administered during pregnancy especially the first

trimester. There is insufficient information on the excretion of methoxyflurane in human milk. Caution should be exercised when methoxyflurane is administered to a nursing mother. Effects on ability to drive and use machines: Methoxyflurane may have a minor influence on the ability to drive and use machines. Patients should be advised not to drive or operate machinery if they are feeling drowsy or dizzy. Undesirable effects: The most common non-serious reactions are CNS type reactions such as dizziness and somnolence (≥1/100 to <1/10) and are generally easily reversible. Serious dose-related nephrotoxicity has only been associated with methoxyflurane when used in large doses over prolonged periods during general anaesthesia. Adverse drug reactions observed in PENTHROX clinical trials in analgesia: Common (≥1/100 to <1/10): Amnesia, anxiety, depression, dizziness, dysarthria, dysgeusia, euphoria, headache, sensory neuropathy, somnolence, hypotension, coughing, dry mouth, nausea, feeling drunk, sweating; uncommon (≥1/1,000 to <1/100): paraesthesia, diplopia, oral discomfort, fatigue, feeling abnormal, increased appetite and shivering. Post-marketing experience: rare (≥1/10,000 to <1/1,000) reports of hepatic failure/hepatitis have been observed with analgesic use of methoxyflurane. Other events linked to methoxyflurane use in analgesia include drowsiness, agitation, restlessness, dissociation, affect lability, disorientation, altered state of consciousness, choking, hypoxia, oxygen saturation decreased, blood pressure fluctuation, vomiting, hepatitis, increased liver enzymes, jaundice, liver injury, increased serum uric acid, urea nitrogen and creatinine, renal failure, blurred vision and nystagmus. Overdose: Refer to SPC. Legal Category: POM. NHS Price: £17.89. Marketing Authorisation Holder: Medical Developments UK Limited c/o Price Bailey LLP, Causeway House, 1 Dane Street, Bishop’s Stortford, Herts, CM23 3BT, United Kingdom. MA Number: PL 42467/0001. Full prescribing information available from: Galen Limited, Seagoe Industrial Estate, Craigavon, BT63 5UA, United Kingdom. Date of Preparation: November 2015.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Galen Limited on 028 3833 4974 and select the customer services option, or e-mail customer.services@galen-pharma.com. Medical information enquiries should also be directed to Galen Limited.

AMBULANCE UK - FEBRUARY

PENTHROX 3mL inhalation vapour, liquid: Please refer to the Summary of Product Characteristics (SPC) before prescribing. Abbreviated Prescribing Information. Presentation: Each vial of PENTHROX contains 3mL of methoxyflurane 99.9%, a clear, almost colourless, volatile liquid, with a characteristic fruity odour. Each PENTHROX combination pack consists of one 3mL bottle, one PENTHROX Inhaler and one Activated Carbon (AC) chamber. Indications: Emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain. Dosage and administration: PENTHROX should be selfadministered under supervision of a person trained in its administration, using the hand held PENTHROX Inhaler. Adults: One bottle of 3mL PENTHROX to be vaporised in a PENTHROX Inhaler. On finishing the 3mL dose, another 3mL may be used. The dose should not exceed 6mL in a single administration. Methoxyflurane may cause renal failure if the recommended dose is exceeded. The lowest effective dosage to provide analgesia should be used. Onset of pain relief is rapid and occurs after 6-10 inhalations. Patients are able to titrate the amount of PENTHROX inhaled and should be instructed to inhale intermittently to achieve adequate analgesia. Continuous inhalation provides analgesic relief for up to 25-30 minutes; intermittent inhalation may provide longer analgesic relief. Administration on consecutive days is not recommended and the total dose to a patient in a week should not exceed 15mL. Children: PENTHROX should not be used in children under 18 years. For detailed information on the method of administration refer to the SPC. Contraindications: Use as an anaesthetic agent. Hypersensitivity to PENTHROX or any fluorinated anaesthetic. Patients with known or genetically susceptible to malignant hyperthermia or a history of severe adverse reactions in either patient or relatives. Patients who have a history of showing signs of liver damage after previous methoxyflurane use or halogenated hydrocarbon anaesthesia. Clinically significant renal impairment. Altered level of consciousness due to any cause including head injury, drugs or alcohol. Clinically evident cardiovascular instability. Clinically evident respiratory depression. Warnings and Precautions: Methoxyflurane causes significant nephrotoxicity at high doses. Nephrotoxicity is also related to the rate of metabolism. Factors that increase the rate of metabolism such as drugs that induce hepatic enzymes can increase the risk of toxicity with methoxyflurane as well as sub-groups of people with genetic variations that may result in fast metaboliser status. The lowest effective dose should be administered, especially in the elderly or patients with other known risk factors of renal disease. Methoxyflurane should be cautiously used in patients with conditions that would pre-dispose to renal injury. Methoxyflurane is metabolised in the liver, therefore increased exposures in patients with hepatic impairment can cause toxicity. PENTHROX should be used with care in patients with underlying hepatic conditions or with risks for hepatic dysfunction. Previous exposure to halogenated hydrocarbon anaesthetics (including methoxyflurane when used as an anaesthetic agent), especially if the interval is

Reference: 1. Penthrox Summary of Product Characteristics. October 2015. Date of preparation: December 2015. PMR-JUL-2015-0239

Before administering PENTHROX, make sure you have read and fully understood the SmPC and educational materials, which provide important information about how to safely use the device to minimise risk of serious side effects. PENTHROX educational materials and training on its administration are available from Galen on request. *PENTHROX should be self-administered under supervision of a person trained in its administration, using the handheld PENTHROX Inhaler.1

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

PEN-15-075 Penthrox RTA Ambulance UK 297x210.indd 1

22/01/2016 16:22

FEATURE

CLINICAL SKILLS LOG - A REVOLUTION TO SUPPORT CLINICIANS DEVELOPING FUTURE PRACTICE By Andy Thomas & Andrew Ormerod

Introduction The Clinical Skills Log supported by MedTree and CPDCloud was

The research and technology behind the app are designed to monitor and

launched on the 23 Dec 15 for IOS devices. This app based system

support the clinician and allow access to clinical case history and aid you in

allows clinicians to swiftly log their patient exposures, examinations

developing learning opportunities to encourage professional practice.

conducted and clinical skills performed. By creating a comprehensive log of skills performed it is envisaged this will support clinical staff in

It gives you the ability to log all clinical interventions from airway

developing future CPD and learning strategies.

management, to drugs administered and examinations complete (see figures 1). The app is designed to evolve from feedback and will be

By having the ability to record, learn and develop through analysing

updated regularly to ensure its fit for purpose for those who are using

your clinical activity the clinical skills log hopes to signpost individuals to

it. An example of this is on launch day we received feedback from

potential gaps in practice, record mandatory skills and provide a single

paramedics in Australia and within a few hours the drugs they requested

easy to use app to assist in your life long learning process.

for inclusion were available on the app including Box Jelly fish antivenom. The app allows you to build clinical reports at the touch of your fingers

History

and has a mixture of graphical and descriptive reporting functions, including a UK ambulance service compliant airway log.

The app has been predominately developed by the authors who are both practising paramedics within the UK. This app was developed

Figures 1:

from 2 main areas, firstly to support data collection for a masters degree level research into the continued exposure of RAF paramedics to certain clinical skills and the effect that has on confidence and understanding toward practice. In addition, during this research phase the Association of Ambulance Chief Executives (AACE) with in the UK mandated that UK paramedics must keep a log of airway skills. Following this research, the authors then proceeded to develop an app based system that would assist clinical staff in recording clinical skills exposure for mainly the pre-hospital and EMS market. This was clinically developed by the authors with CPDcloud and MedTree to ensure this could be brought to market free for the end user. Following extensive research and extensive internal development the clinical skills log was launched. AMBULANCE UK - FEBRUARY

The Clinical Skills Log App The clinical skills log app is available now on IOS devices and can be downloaded by visiting http://www.clinicalskillslog.co.uk . It will be available on android devices by Feb 15 and you can register at the bottom of the website to receive updates. The clinical skills log allows you to accurately record your skills and clinical interventions in a simple, customisable and intuitive mobile app.

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

FEATURE

The app also allows for you to deselect whole sections of the log and

encourage all who are using it to give us your suggestions and those

therefore customise to your individual needs (See figure 2). By having

who are not yet using download it and start your journey.

this ability the app is relevant to all pre-hospital and EMS providers, regardless of skill level or clinical backgrounds.

We also have the potential to develop this from other health care professional outside of the pre-hospital and EMS environment.

Also if you have been keeping paper records, spreadsheets etc the app allows you to back date entries.

One of the unique features of the Clinical Skills Log is the support system. The team have also arranged a monthly free webinar that allows app users to feedback live comments and suggestions and discuss

Figure 2:

future development with both the medical team and also the IT team behind the app. Along side this, support tickets asked from within the app are all answered within 12 hours. On the next update to the app, we will also be featuring the opportunity to subscribe to ReelDx, Trauma Care Videos and Skill Guides to enable you to both use the app to take part in learning and development but also use this in the future to assist with clinical practice.

Summary The clinical skills app has been developed by clinicians for clinicians and we hope to continue the innovation by reviewing and development feedback both the clinical team, CPDcloud and MedTree aim to ensure this is the must have app for years to come. So donâ&#x20AC;&#x2122;t delay, download now and begin your clinical skills log.

The future

www.cpdme.com

The future of this app is endless and we have already been planning

www.medtree.co.uk

hard on working on new sections, adding to sections from feedback and progressing the early development of this unique app.

www.clinicalskillslog.co.uk

The sky is truly the limit and we welcome feedback through the app and

https://clinicalskillslog.zendesk.com/hc/en-us

AMBULANCE UK - FEBRUARY

Useful links relating to this article:

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FEATURE

AMBULANCE UK - FEBRUARY

8 For more news visit: www.ambulanceukonline.com

FEATURE

CLINICAL SCORES FOR PREDICTING RECURRENCE AFTER TRANSIENT ISCHEMIC ATTACK OR STROKE HOW GOOD ARE THEY? Robin Lemmens MD, PhD; Stephanie Smet MD; Vincent N. Thijs MD, PhD

Risk scores are commonly used in the prediction of disease outcome. In the context of cerebrovascular diseases, risk scores have been created to identify stroke risk after transient ischemic attack (TIA) and (minor) stroke, to identify subgroups of patients with high risk of stroke (for instance, correlated with grade of carotid stenosis), or to predict functional outcome after stroke.

Results We identified 17 risk scores that were derived from TIA or stroke cohorts (Table 1) to predict short-term or long-term recurrence and one that was derived from a prospective population-based study in the general population but was validated in a TIA/stroke cohort. The characteristics and quality criteria for the risk scores are shown in Tables II and III

Identifying high-risk patients after TIA is important because early assessment and management of these patients is pivotal. Confident detection of the low-risk patient, however, is of similar importance. Performing multiple acute diagnostic investigations for all suspected TIA and stroke patients might overwhelm the medical system and might not be feasible because of resource limitations. Simple and reliable risk estimation of recurrence might be beneficial to high-risk patients to be admitted and investigated

in the online-only Data Supplement. The studies were performed in heterogeneous study populations with various designs and inclusion/ exclusion criteria. Qualification of these reports was, therefore, not always possible according to the criteria presented in Table I in the online-only Data Supplement. Ten of the predictive models were derived in cohorts that used TIA as an index event, 5 models included both TIA and (minor) stroke, whereas 2 scales were developed in a population that only included stroke patients. In general, cardiovascular risk profiles were adequately collected in the majority of the study populations.

early. Additionally, the medical health system might benefit as well, because lowrisk patients can be seen in less expensive outpatient

The diagnostic work-up after the incident event varied largely between

clinics.

studies, which might have indirectly influenced recurrence rates; for instance, performing ECG or holter monitoring to identify atrial

We performed a systematic review of published risk scores that

fibrillation likely has an effect on the treatment of patients and the

predict recurrence risk after stroke or TIA. We checked the quality

frequency of recurrence. Primary end points were rarely adjudicated

of the risk scores based on the characteristics of the various

by 2 independent persons and were often not determined by a patient

derivation and replication studies.

visit, but by patient file review. Different studies used various clinical end points: recurrence of stroke, vascular disease, (vascular) death, or combined end points. The nature of the recurrent stroke (ischemic

Methods

vs hemorrhagic) was frequently not specified. Race characteristics were rarely provided, which is of relevance because recurrence rates

One investigator (S.S.) performed a PubMed search with the search terms prognostic models stroke and prognostic scores

could differ between races.4-6 The various risk scores and their clinical applicability will be discussed.

reference lists of the identified articles. We excluded specific risk scores for stroke risk in atrial fibrillation, for instance, CHADS2,1

Californian Risk Score

CHADS2VASC2, or global vascular estimates, such as the QRISK2 and SCORE.3 The other exclusion criteria, internal and external

A simple 5-point score using age, diabetes mellitus, symptom duration,

validity, statistical methodology, validation of the models, and

the presence of weakness, and speech impairment was found predictive

clinical applicability were evaluated (for details, see Methods and

of stroke within 90 days in a retrospective study of 1000 patients admitted

Table I in the online-only Data Supplement) by 3 independent

with TIA to an emergency department.7 This risk score was externally

researchers (R.L., S.S., and V.T.). All results were compared

validated in large cohorts and population-based studies, although

between researchers and inconsistencies were resolved by

c-statistics did not reach 0.8.8,9 Whether addition of brain imaging to the

reevaluation of the original article.

score might be of additive value has not been determined.10

AMBULANCE UK - FEBRUARY

stroke for the period 1992 to 2011, and additionally explored the

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FEATURE Table 1.

Study Design of Index Event, Follow-up in Derivation Cohorts, and Performance in Validation Cohorts of Predictive Models Risk Score

TIA

Minor Stroke

Stroke

Short-term Recurrence (≤90 d)

Long-term Recurrence (≥1 y)

Validated in Replication Study*

California risk score

3/3

ABCD

9/12

ABCD2

19/23

ABCDI

1/1

AB2CD(2) (3)

1/1

ABCD2I

0/0

ABCD2 and DWI (including CIP)

2/2

ABCD2+MRI

0/0

ABCD3

1/1

ABCD3I

1/1

ABCD +

Oxford TIA (Hankey score)

Stroke Prognostic Instrument (SPI)

SPI-II

Dutch TIA

LiLAC

Essen Stroke Risk Score

Recurrence risk estimator at 90 d

1/2

2/2

3/4

0/2

0/1

3/4

1/1

AB2CD(2)(3) indicates AB2CD/AB2CD2/AB2CD3CIP; clinical- and imaging-based predictive algorithm; DWI, diffusion-weighted imaging; LiLAC, Life long after cerebral ischemia trial; and TIA, transient ischemic attack. *Risk score model used for replication needed to be similar as initially reported by the authors of the original article, based on stratification of patients or c-statistics. Numbers are studies validating the score over total replication studies (original studies on derivation of the risk score, which included an external validation cohort, are also included).

ABCD, ABCD2, and Additional Variables

across scores has less direct implications; therefore, in most studies, a dichotomization was analyzed and proposed that could be used

The 7-day risk for stroke after TIA was estimated based on clinical characteristics within the OXVASC study. The following significant predictors were included in calculation of the score (with different weights, as indicated in parentheses): age >60 years (1); blood pressure ≥140/90 mm Hg (1); unilateral weakness (2); speech impairment without weakness (1); duration ≥60 minutes (2); or 10 to 59 minutes (1).11 Since publication, this ABCD score has been replicated in most studies, which included >200 patients, with some of these also extending the prediction horizon to 90 days after the incident TIA (or minor stroke).8,9,12–20 In none of the replication cohorts, c-statistics reached 0.8, with the exception of one validation cohort8 (Table III in the online-only Data Supplement).

for individual patients. Based on the data in the original article, which divided the values of the ABCD2 score into 3 categories (0–3, 4–5, and 6–7), a score ≥4 would urge medical doctors to initiate adequate medical attention (eg, admission). Two observational studies and 1 prospective study, all with large sample sizes, however, failed to convincingly validate the ABCD2 score, which was reflected in observed higher recurrence rates in the low-risk groups.25,33,34 In summary, the ABCD2 has rather low specificity and positive predictive value but good sensitivity and negative predictive value. C-statistics in none of the publication reached 0.8, with the exception of one

Pooling of the studies deriving the Californian and the ABCD scores led to the ABCD2 score, which includes the following 5 factors (with AMBULANCE UK - FEBRUARY

different weights, as indicated in parentheses): age ≥60 years (1); blood

validation cohort8 (Table III in the online-only Data Supplement). The score can be used to identify those patients at increased risk who need admission, but caution is warranted because several studies identified recurrence in patients with low scores25,33,34 and high-risk disease has

pressure ≥140/90 mm Hg (1); clinical features: unilateral weakness (2)

been shown to be present in patients in the low-risk group.39 This

and speech impairment without weakness (1); duration ≥60 minutes (2)

was underscored by additional data from the discovery cohort of the

or 10 to 59 minutes (1); and diabetes mellitus (1).8 The ABCD2 score

ABCD/ABCD2 score, which showed the ABCD2 score to be predictive

was validated in 2 independent cohorts8 and has been the subject of

for severity of recurrence rather than risk.27 Potentially adding other

replication and modification in various other populations.

9,16,19–38

In a

characteristics, such as hyperglycemia, history of hypertension (AB2CD/

reasonable percentage (9/23 or 39%) of study protocols, imaging data

AB2CD2/AB2CD3),19 or dual TIA (ABCD3),31 might increase the negative

were required for additional analysis. This inclusion criterion enabled

predictive value, but validation is lacking.

researchers to refine the score by including imaging (MRI or computed tomography) data. Risk stratification seemed to be independent of

Additionally, several groups have explored whether adding imaging

follow-up duration (7, 28, or 90 days). In clinical practice, a trend

findings to the ABCD/ABCD2 scores might improve their performance.

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

FEATURE Computed tomography, diffusion-weighted imaging (DWI), and vessel occlusion status data were analyzed.

18,21â&#x20AC;&#x201C;24,28,31,35

Initially, imaging data

on any evidence of infarction and leukoaraiosis were joined to the ABCD

In 3 additional large cohort studies, the SPI-II was evaluated. 36,38,42,45 The results were disparate, with both confirming the risk score as well as showing poor predictive power.

score to create the ABCDI, which resulted in similar accuracy compared with ABCD.18,35 The ABCD2I score, which included the presence of brain infarction on computed tomography or DWI, has been extensively studied in a multicentric approach.28 Three studies included acute DWI lesions on MRI in the prediction of stroke model, which clearly improved the accuracy to c-statistics >0.8 in all cohorts.22â&#x20AC;&#x201C;24 Moreover, the ABCD3I, which includes carotid stenosis in addition to abnormal DWI, also showed a superior prediction and was validated in a separate sample set, although c-statistics were less convincing in the validation set.31 Adding data regarding intracranial vessel stenosis to DWI lesions led to similar higher accuracy (c-statistics of 0.88), although no validation population was included in this study. These findings clearly support a role for 21

imaging data, in particular DWI lesions, to increase the reliability.

Dutch TIA Trial and Life Long After Cerebral Ischemia Trial Data from >3000 patients enrolled in the Dutch TIA trial were analyzed for their prognostic value for a 2-year risk analysis.46,47 Based on the hazard ratios in the initial publication, the predictive value of 13 parameters (Table IV in the online-only Data Supplement) was calculated in the same population but showed no strong discriminative value.47 This was confirmed in another cohort comparing 7 models in which this score was found to overestimate risk.36 The original Dutch TIA cohort was followed-up during a mean period of 10 years, and the data were reanalyzed (Life long after cerebral ischemia trial [LiLAC]). Three

Oxford TIA (Hankey Score) In a population-based cohort from Oxford, several vascular risk rates were calculated, and prognostic factors were determined for stroke, myocardial infarction, and combined end points, and they were translated into a 5-year risk percentage. The model for stroke was established by using the following 8 clinical factors: age, sex, affected region (amaurosis fugax as well as carotid and

different models were designed based on subcategories of variables: demographics (sex and age) and medical history (myocardial infarction, intermittent claudication, diabetes mellitus, peripheral vascular surgery, and hypertension) in model 1; addition of event characteristics (TIA vs stroke, Rankin grade, and vertigo) in model 2; and addition of brain imaging (white matter lesions and any infarct) and ECG data (Q wave on ECG and negative T wave) in model 3. Areas under the curve were clearly improved and reached values >0.8 for all 3 models48; however, this could not be confirmed in a validation cohort.42

vertebrobasilar), frequency of TIA, residual neurological deficits, peripheral vascular disease, and left ventricular hypertrophy.40 Although the risk score was able to discriminate high-risk patients from low-risk patients

Framingham: Stroke-Specific

(depending on the cut-off), a clear cut-off that was able to divide patients in high-risk vs low-risk groups could not be confidently recommended.41

A stroke risk score was derived based on 472 stroke events occurring

In 2 other studies, the Hankey score was found to overestimate the

within the initially stroke-free subjects from the Framingham study.

risk; although the model could be used for prediction of recurrence, the

A sex-specific risk model was developed that included age, systolic blood

accuracy seemed relatively weak

36,42

(Table III in the online-only Data

pressure, use of antihypertensive therapy, diabetes mellitus, smoking,

Supplement). Additionally, the risk prediction did not simply involve the

previous cardiovascular disease, atrial fibrillation, and left ventricular

collection of several clinical data set, but also a calculation of these

hypertrophy (on ECG). There is only 1 publication that evaluated the

variables in a formula probably reducing its clinical applicability.

Framingham stroke risk score in a cohort of patients with previous TIA and stroke. The score was not validated and had poor c-statistics.36

Stroke Prognosis Instrument

Essen Stroke Risk Score

The Stroke Prognosis Instrument (SPI-I) was developed in patients The Essen Stroke Risk Score (ESRS) was derived from the stroke

sample of 142 patients, 5 predictors (age, diabetes mellitus,

subgroup of the CAPRIE (clopidogrel vs aspirin in patients at risk of

hypertension, coronary heart disease, and distinction between TIA

ischemic events) trial, which compared the effect of clopidogrel over

and stroke) were included to define 3 risk groups for recurrence

aspirin in patients with vascular disease during a mean follow-up of 1.9

in a 2-year follow-up.43 Ten years later, this score was externally

years. This model used 8 clinical parameters: age, hypertension, diabetes

validated in 4 cohorts, and although the risk score was validated,

mellitus, myocardial infarction, other cardiovascular disease, peripheral

even in the lowrisk group, the recurrence rate was 10%.44

artery disease, smoking status, and history of TIA or stroke.49 Patients

A modified SPI-II was created that included the additional variables

with indications for oral anticoagulants were not enrolled in CAPRIE.

previous stroke and congestive heart failure. The patients were

In a validation cohort, this score was unable to significantly distinguish

more evenly distributed, and the c-statistics improved moderately,

between high-risk and low-risk patients.50 Thereafter, the ESRS was

although they remained <0.8. Still, the recurrence rate remained

calculated in various study populations in which the dichotomization

10% in the lowest-risk group. Furthermore, application of this score

cut-off between high risk and low risk was either confirmed42,51 or

was restricted to patients with carotid territory TIA or minor stroke

refuted.38 However, even in the replication cohorts, which confirmed the

based on clinical characteristics, impeding the clinical utility for

predictability, the positive predictive values were low, questioning the

primary care physicians.

usefulness of these risk scores in daily clinical practice.

AMBULANCE UK - FEBRUARY

with suspected carotid TIA or minor stroke. In a small patient

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

FEATURE Recurrence Risk Estimator at 90 Days

Studies replicating only 1 risk score occasionally evaluated risk in patients with a dissimilar preceding event compared with the derivation

A Web-based prognostic 6-point score (the recurrence risk estimator at 90 days) was derived from a sample of 1500 stroke patients to estimate the 90-day risk of recurrence. Recurrent stroke was confirmed by MRI. 45

Two models, either with or without baseline imaging data, were validated in derivation and validation cohorts. The area under the curve for the 90-day risk of recurrence was 0.80 for the derivation cohort, which was

population or used longer or shorter duration of follow-up to determine recurrence. Additionally, patient characteristics varied between studies because patients with atrial fibrillation were sometimes excluded or imaging was used as an inclusion criteria. Many studies lacked a clear clinical confirmation of a recurrent event by a physician because patient files were used to obtain end points. This was illustrated by the

reasonably well-replicated in the validation cohort (0.76).

fact that a difference between hemorrhagic and ischemic stroke was

The models include the following factors: presence of multiple infarcts

added in the study design to validate recurrent stroke.

rarely reported. Furthermore, it is only recently that imaging has been

of different ages, simultaneous infarcts in different circulations, multiple acute infarcts, isolated cortical infarcts, history of stroke or TIA, and stroke subtype based on the Causative Classification of Stroke System. Stroke attributable to other causes, as typed by Classification of

When designing a predictive model, high event rates are desirable, with occurrence of at least 10 events per studied prediction variable; in several derivations and in half of the validation cohorts, this criterion

Stroke System, was identified as the highest-risk subtype. Interestingly,

was not met. Almost all models suffer from low c-statistics (<0.8) and,

conventional risk factors identified by scores estimating the risk after

therefore, cannot be confidently used in the clinic, because this implies

TIA (such as hypertension and diabetes mellitus) were not identified as

that cutoffs cannot be reliably introduced to make decisions regarding

short-term (90 days) risk factors for recurrence after ischemic stroke.

individual patients. This is reflected by the relatively high event rates in low-risk patients in some studies. Individual treatment decisions based on the current prognostic models cannot be justified.

Discussion

In efforts to improve the precision of the predictive models, researchers have increased the number of variables into risk models.

Several prediction models have been developed to evaluate the stroke

Although adding more factors to a model can increase accuracy and

recurrence risk after TIA and (minor) stroke (Table IV in the online-only Data Supplement). Ideally, one would like to know which is the best score. However, comparison of risk scores is hampered by the different study paradigms, particularly inclusion criteria of the index event (TIA vs stroke) and duration of follow-up to determine recurrence (Table 1). Therefore,

reliability, this often compromises its utility in daily clinical practice. Including imaging findings, such as diffusion lesions and the presence of vessel stenoses, increases accuracy. However, the initial purpose of risk stratification scores was to support emergency doctors and primary care doctors to identify patients at high risk for recurrence

studies that directly compare various scores need to be interpreted

with limited resources. Therefore, the addition of costly imaging will

with some caution. In an independent Dutch cohort, the 2-year risk was

face resistance by emergency doctors and primary care physicians.

obtained in patients after TIA or minor stroke, and the SPI-II, Hankey,

One can wonder whether the addition of MRI data interferes with the

Dutch TIA, and ABCD2 scores were validated. However, the ABCD2 36

was not developed to estimate the long-term risk of recurrence, and both the ABCD2 and Hankey derivation cohorts only included TIA patients. Another prospective study assessed the prognostic value of the ABCD2, ESRS, and SPI-II in patients presenting with minor stroke. The accuracy of all 3 models was poor in predicting recurrence rate at 7 and 90 days.

However, the ESRS and SPI-II were developed in stroke, not TIA, patients to predict long-term recurrence. It can be assumed that risk factors of a second cerebrovascular event differ between early and late recurrence,

purpose of these models. Therefore, adjusted models with increased accuracy might be more useful in epidemiological studies or clinical trials rather than in aiding clinicians in therapeutic decision-making. Additionally, requirement of neuroimaging may result in selection bias. For instance, one of the first studies to report on imaging data and ABCD score in TIA patients identified a substantial age difference between patient with and without MRI.12 Furthermore, in the assessment of recurrence risks of TIA, the yield of diffusion in addition

as well as between TIA and stroke as the index event. This is underscored

to the ABCD2 versus the yield of commonly recommended diagnostic

by the recurrence risk estimator at 90 days, a model predicting recurrence

tests, such as ECG and carotid ultrasound, has not been specifically

after stroke in a period of 90 days, which includes other prognostic

assessed.

factors compared with the ABCD2 score (which evaluates recurrence

AMBULANCE UK - FEBRUARY

at 90 days after TIA). Only a large prospective study in German stroke

Direct comparison studies evaluating various predictive models can

centers evaluated the risk in patients after TIA or minor stroke (with a

be criticized for the reasons mentioned above; however, the existence

median follow-up of 1 year) with scores that were derived to estimate the

of multiple models, including different index events for the evaluation

recurrence rate after follow-up of at least 1 year in patients with TIA or

of short-term as well as long-term recurrence, does reflect the real-life

minor stroke: the ESRS, SPI-II, Oxford TIA, and LiLAC scores.42

clinical experience. It is not likely that 1 model will be developed to evaluate short-term and long-term risk after stroke or TIA. Moreover,

None of these models could convincingly reproduce the prediction

given the various causes of stroke, a one-size-fits-all prediction

models. The finding that risk factors might differ in patients, based on

risk model is unlikely to be perfect under all circumstances. The

either TIA or stroke as index event, might explain the difficulty in replicating

heterogeneity of predictive models can be helpful to evaluate diverse

the accuracy of a scale, especially in the 5 models that were derived from

patients in various scenarios. Therefore, it may be less relevant to

cohorts that included both TIA and stroke patients. Potentially, variations

directly compare the models, but more important to validate each

in proportions of TIA and stroke patients could have resulted in different

model in the population cohort for which it was designed and for the

findings in the replication cohorts compared with the derivation sample.

end point that was chosen in the derivation study.

12 For more news visit: www.ambulanceukonline.com

FEATURE Table 2.

Key Points

Predictive models for recurrent stroke ultimately should be able to guide physicians in early decision-making after TIA and stroke A variety of models have been developed in various populations with different index events and methodology, complicating direct comparison, but probably mimicking the real-life experience Risk factors for recurrence differ between TIA and stroke as initial event The majority of predictive scales have been derived from cohorts that include patients with TIA as the index event Adding neuroimaging to predictive models increases accuracy but reduces simplicity High event rates have been reported in predicted low-risk categories The ABCD2 with diffusion imaging data seems most reliable to estimate the early risk of recurrence after TIA; RRE-90 might be an interesting tool to establish the early risk of recurrence after stroke by stroke specialists Validation in large sample sizes with adequate and similar inclusion criteria of the index event and end points as in the derivation study is of importance to confidently use these tools in daily clinical practice Stratification of the best therapeutic and diagnostic pathway for an individual patient based on simple predictive scales might be difficult to achieve When evaluating risk models, changes in diagnostic and therapeutic avenues need to be investigated to identify a correlation with improved patient care; thus far, this has not been clearly determined RRE-90 indicates recurrence risk estimator at 90 days; and TIA, transient ischemic attack.

At present, the early risk of stroke after TIA, the issue that has been

3. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer

most extensively studied, seems to be predicted best by the ABCD2

G, et al; SCORE project group. Estimation of ten-year risk of fatal

combined with DWI data. For early recurrence risk after stroke in

cardiovascular disease in Europe: the SCORE project. Eur Heart J.

the 2 models developed, the recurrence risk estimator at 90 days

2003;24:987–1003.

is optimally suited, but it requires both very accurate subtyping and neuroradiological assessment (Table 2). Long-term risk after TIA and

4. Kono Y, Yamada S, Kamisaka K, Araki A, Fujioka Y, Yasui K, et al.

stroke cannot be reliably assessed based on the current knowledge.

Recurrence risk after noncardioembolic mild ischemic stroke in a

Whether these models can be used for decision-making on an

Japanese population. Cerebrovasc Dis. 2011;31:365–372.

individualpatient level remains speculative. Further large prospective studies involving TIA and stroke patients using various models are still necessary to strongly validate the predictive models and, even more importantly, to evaluate the added value regarding improving care.

5. Levine DA, Neidecker MV, Kiefe CI, Karve S, Williams LS, Allison JJ. Racial/ethnic disparities in access to physician care and medications among US stroke survivors. Neurology. 2011;76:53–61. 6. Waddy SP, Cotsonis G, Lynn MJ, Frankel MR, Chaturvedi S, Williams

Sources of funding Drs Lemmens and Thijs are Senior Clinical Investigators for FWO Flanders.

JE, et al. Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. Stroke. 2009;40:719–725. 7. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA.

Disclosures

2000;284:2901–2906.

Dr Thijs has declared to have received modest support from Boehringer Ingelheim (Speakers’ Bureau) and from Boehringer Ingelheim, Sygnis, Bayer, and Pfizer (Consultant/Advisory Board). The other authors have no conflicts to report.

8. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369:283–292. 9. Nguyen H, Kerr D, Kelly AM. Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. Eur J Emerg Med. 2010;17:346–348.

1. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford

10. Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L,

MJ. Validation of clinical classification schemes for predicting

et al. The California, ABCD, and unified ABCD2 risk scores and the

stroke: results from the National Registry of Atrial Fibrillation. JAMA.

presence of acute ischemic lesions on diffusion-weighted imaging

2001;285:2864–2870.

in TIA patients. Stroke. 2009;40:2229–2232.

2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M,

11. Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN,

Brindle P. Derivation and validation of QRISK, a new cardiovascular

Warlow CP, et al. A simple score (ABCD) to identify individuals at

disease risk score for the United Kingdom: prospective open cohort

high early risk of stroke after transient ischaemic attack. Lancet.

study. BMJ. 2007;335:136.

2005;366:29–36.

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

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AMBULANCE UK - FEBRUARY

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

FEATURE 39. Amarenco P, Labreuche J, Lavallée PC, Meseguer E, Cabrejo L, Slaoui T, et al. Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack? Stroke. 2009;40:3091–3095.

VISIT US College of Paramedics National Conference

40. Hankey GJ, Slattery JM, Warlow CP. Transient ischaemic attacks: which patients are at high (and low) risk of serious vascular events? J Neurol Neurosurg Psychiatr. 1992;55:640–652.

8-9 March Royal York Hotel

41. Hankey GJ, Slattery JM, Warlow CP. Can the long term outcome of individual patients with transient ischaemic attacks be predicted accurately? J Neurol Neurosurg Psychiatr. 1993;56:752–759. 42. Weimar C, Benemann J, Michalski D, Müller M, Luckner K, Katsarava Z, et al; German Stroke Study Collaboration. Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke: a prospective comparison of validated prognostic scores. Stroke. 2010;41:487–493. 43. Kernan WN, Horwitz RI, Brass LM, Viscoli CM, Taylor KJ. A prognostic system for transient ischemia or minor stroke. Ann Intern Med. 1991;114:552–557. 44. Kernan WN, Viscoli CM, Brass LM, Makuch RW, Sarrel PM, Roberts RS, et al. The stroke prognosis instrument II (SPI-II): a clinical prediction instrument for patients with transient ischemia and nondisabling ischemic stroke. Stroke. 2000;31:456–462. 45. Ay H, Gungor L, Arsava EM, Rosand J, Vangel M, Benner T, et al. A score to predict early risk of recurrence after ischemic stroke. Neurology. 2010;74:128–135. 46. Predictors of major vascular events in patients with a transient ischemic attack or nondisabling stroke. The dutch tia trial study group. Stroke. 1993;24:527–531 47. Dippel DW, Koudstaal PJ. We need stronger predictors of major vascular events in patients with a recent transient ischemic attack or nondisabling stroke. Dutch TIA Trial Study Group. Stroke. 1997;28:774–776.

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48. van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, et al; LiLAC study group. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005;365:2098–2104. 49. Diener HC, Ringleb PA, Savi P. Clopidogrel for the secondary prevention of stroke. Expert Opin Pharmacother. 2005;6:755–764.

51. Weimar C, Diener HC, Alberts MJ, Steg PG, Bhatt DL, Wilson PW, et al; REduction of Atherothrombosis for Continued Health Registry Investigators. The Essen stroke risk score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for Continued Health (REACH) registry. Stroke. 2009;40:350–354.

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50. Weimar C, Goertler M, Röther J, Ringelstein EB, Darius H, Nabavi DG, et al; SCALA Study Group. Predictive value of the Essen Stroke Risk Score and Ankle Brachial Index in acute ischaemic stroke patients from 85 German stroke units. J Neurol Neurosurg Psychiatr. 2008;79:1339–1343.

Key Words: clinical score • predictive model • recurrence risk • review

15 AMBULANCE_UK_01.16_resus.indd 1

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14/01/2016 11:16

FEATURE

One of the UK’s newest simulation companies MDT Global Solutions have been developing new solutions for Ambulance Education and are busy developing new clinical technologies • Smart and easy to use scenario builder Working closely with a number of NHS trusts and the Private Sector • Over 50 ECG waveforms - Mdt global solutions are a UK based company focused on the • Over 20 support of Ambulance projects but also involved withadditional developing parameter settings infrastructures worldwide - including UK, UAE, Qatar, Lebanon, • Ability to useequipment 12-lead is Australia and USA - MDT focus is to ensure that where ECG, import video and supplied the staff are suitably equipped with the education x-ray images to use it.

“Environment Shapes our Care.” “Immersive Interactive technology produces far more engagement for students” - and seems to reduce the false feeds often associated with simulation. The feedback from learners has been incredible…because the students are able to practice in situations that look and sound dangerous. The team at St Georges have added smoke generators to their classroom, whilst smells can also be added with the addition of an atomising ‘smell machine”.

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Our immersive strategy transformed this boring classroom below

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We have saved many UK NHS ambulance Trusts approximately £1,700,000 in 2014-15 by transitioning education teams away from expensive manikin and defibrillator strategies towards iPad based trainingeducation solutions. Our clients equipment include East of England,enterprise SECAMb, and Yorkshire Ambulance and more than 20 UK Universities and Helicopter teams. Into this amazing learning space Resuscitation Training equipment is expensive and fragile and MDT have developed robust solutions that are now used AMBULANCE UK - FEBRUARY

to educate paramedics worldwide. Our other Ambulance education projects include supporting Yorkshire Ambulance with its immersive classroom solution used by their HART team - also used in St Georges (Kingston) University London, and other universities worldwide to teach paramedics the hazards associated with the pre hospital environment. Immersive Education as a strategy is a great way to get student involvement and create real debate about the needs to modify our approach to clinical care based on the Environment.

16 For more news visit: www.ambulanceukonline.com

FEATURE RFID technology

With 9 fully equipped classrooms the Director team have invested in an EMS academy that is the envy of many an ambulance Trust - MDT have invested in 3 immersive classrooms and have the ability to train 108 paramedics a day

MDT are transforming the vehicle checking and maintenance strategy for its Ambulance and Education clients worldwide - with projects underway in the Gulf region for Radio frequency tagging of ambulance equipment. Rob Clark an MDT director explained “We use RFID tagging and scanning linked to the ECRI database and can complete a vehicle check in 11 seconds!” “Having the confidence that vehicles are equipped and the equipment is all serviced with no manufacturer recalls or missing equipment is an incredible challenge that the MDT Team have now overcome!”

The Academy has an amazing array of courses available and seek NHS partners wishing to use the academy for their training. MDT have Hotel accommodation nearby and their clients from overseas are only 20 minutes drive from Heathrow.

The MDT solution is robust due to its links with ECRI and the updated

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MDT are constantly Innovating to provide solutions for the Emergency Care Sector, and work with colleagues from around the world - TRIBALCO, (Military Medicine USA), Deployed Logix (Disaster Relief USA), PEKE (Biological transportation USA) and TSG (UK)

MDT’s latest investment is the development of the education now academy near High Wycombe.

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FEATURE

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LUCAS 2 is designed to provide continuous, uninterrupted compressions while helping to reduce scene complexity.

The 15 provides the power of 360J, plus the most advanced monitoring parameters available.

For further recruitment vacancies visit: www.ambulanceukonline.com

NEWSLINE Ambulance Service headquarters in

NWAS

Abbey Foregate. He later qualified

Senior Paramedic Saved Christmas!

as an ambulanceman and was based at the former Tweedale ambulance station in Telford.

Christmas could have been cut short when Santa was struck

In the 1990s, Steve became the

down with heart failure just a

first appointed media officer

few months ago. Thanks to a

for the 999 service and was

brave paramedic from the North

instrumental in winning national

West Ambulance Service Brent

recognition for Shropshire’s

Kenny Christmas was saved!

fledgling volunteer community first responder scheme with a coveted NHS Health and Social

Last August, David Hollowell was

Care award. When Shropshire

struggling to breathe at his home in Blackpool when Brent arrived

One of our Centres, Thames

their skills and training to offer

Ambulance Service merged with

on the scene to commence

Valley Ambulance & Paramedic

more than just basic first aid.”

its larger neighbour in the West

treatment. An ambulance crew

Service, who delivered this

followed and took him to hospital.

course for the first time received

On completion of the qualification

Santa’s life was saved and he’s

feedback from their learners on

the learner will be eligible to apply

now back in full flow giving out

how up to date and relevant the

to the Faculty of Pre-hospital Care

In 2006, Steve became

presents to children in Blackpool.

topics were stating, whilst reading

for Level 3 membership.

Head of Press for County Air

Midlands, he became its Head of Press and Communications.

Ambulance and was responsible

the syllabus it became apparent David makes a guest appearance

just how in-depth the course is

This qualification is aimed at:

for rebranding the popular

as Santa every year for Blackpool

compared with FAW and similar

Community first responders,

helicopter service to Midlands Air

Ambulance Station’s Christmas

courses. This is a reflection on the

Co responder e.g. police, fire

Ambulance Charity.

party. After last year’s scare he

nature of a level 3 qualification.

and other emergency services, Military, Security, Close protection,

In recent years he has been

costume for the celebrations and

The aim of the qualification is

Event medical cover, Cabin Crew,

credited with organising the highly

reunion with his lifesaver Brent.

to provide learners with the

Stewards as well as Voluntary sector.

rated WMAS award ceremonies

was raring to put on his Santa

and the National Air Ambulance

knowledge and skills required to After the reunion Brent said:

operate within a scope of practice

Any new centres wishing to offer

“It was great to see David fully

to stabilise and treat a patient in

this qualification please contact

recovered and back in his Santa

need of care for up to forty minutes

the number below.

costume. It was hard work at the

until an ambulance or other pre-

time, but I wasn’t letting him go – we needed him fit for Christmas!”

AOFAQ Centre delivers first courses in Level 3 Award in First Person on Scene

Awards of Excellence in London. Contemplating his retirement, Steve said: “When the office

For information on AoFAQ Level

apprentice tells you that she was

3 Award in First Person on Scene

far from a twinkle in her parent’s

Subjects covered include airway

please contact AoFAQualifications

eye, and they themselves had just

management and the recognition

on 01908 610093 or go to:

started primary school when I first

features of sepsis. The learners

http://aofaqualifications.org/

joined the Service, then it’s time to

hospital care provider arrives.

call it a day and retire gracefully to

undertook assessments and exam questions. They all agreed on the benefits of learning extra skills

WMAS

enjoy the finer things in life.”

patient care.

Long serving spokesman set to retire

of early intervention in terms

Clinically endorsed by the Royal

After providing thousands of

when dealing with often tragic and

of survival and recovery rates,

College of Surgeons Edinburgh,

quotes, interviews and stories

complex incidents as well helping to

so improving skills at this point

Faculty of Pre-hospital (FPHC)

to the media, one of the longest

highlight the excellent work carried

is crucial. This is where the

Care and meets the Level 3

serving press officers in the

out by our staff.

AOFAQ Level 3 Award in First

FPHC Pre-hospital Emergency

NHS is set to retire from West

Person on Scene is positioned.

Medical Skills Framework,

Midlands Ambulance Service

“He has been such an important

The Level 3 represents the more

the Director of Thames Valley

(WMAS) on Friday after a career

part of the team using his

‘Autonomous’ nature of the

Ambulance & Paramedic Service

spanning 39 years.

experience to provide help and

responder, this new regulated

said, “Both as an operational

qualification consists of 16

Paramedic and course trainer,

Steve Parry, 58 from Shrewsbury,

over the years. I know everyone

major learning outcomes which

this qualification is excellent for

started his career as a control

in the team will miss him, but we

is trained over 30 hrs.

anyone who wants to enhance

assistant at the former Shropshire

wish him well in his retirement.”

with underpinning knowledge to

We are all aware of the impact

WMAS Communications Director, Murray MacGregor, said: “Steve has always shown great compassion

AMBULANCE UK - FEBRUARY

advice to newer members of staff

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

NEWSLINE Philanthropist Supports the Future of Pre-Hospital Medicine Beaverbrook pledges £60K to support The Institute of PreHospital Care at London’s Air Ambulance Lord Beaverbrook visited London’s Air Ambulance, the charity that delivers an advanced trauma team to critically injured people in London at its helipad atop The Royal London Hospital in recognition of his support for the charity through the Beaverbrook Foundation. The Foundation, which supports charitable causes both in the UK and overseas, has generously committed to donate £20,000 per year for the next three years to the Institute of Pre-Hospital Care at London’s Air Ambulance (“The Institute”). The money donated will support two students with £10,000 each per annum, as part of the scholarship programme for its Intercalated BSc (“The iBSc”) in

is open for application to all

students with a passion for

and this is a fantastic charity

students studying Medicine in

prehospital care too.”

that does an amazing job

the UK. The course is dedicated The Institute was founded

every day but relies totally on

serious injury and illness in the

in 2013 to build on and

public donations.

pre-hospital environment. An

expand the charity’s research,

innovative and growing field, it

innovation and education

“We have a fantastic

is recognised as a sub-specialty

activities, with a mission to

partnership with Yorkshire Air

by the General Medical Council

drive excellence in pre-hospital

Ambulance and are genuinely

and provides students with a

care standards. It supports

humbled by the work they do

strong foundation in the science

and fosters collaboration

every day. I’m delighted to

and practical skills required

across medical disciplines

say we will be raising as much

for success in pre-hospital

and institutions dedicated to

money as possible for them

medicine.

improving outcomes for people

again next year.”

afflicted by critical injury and Lord Beaverbrook and the

illness.

Foundation’s Chief Executive

Yorkshire Air Ambulance (YAA) has carried more than 6,400

Officer Jane Ford met with

The scholarship programmes

people in its 15-year history.

The Institute’s Clinical

will cover the full cost of The iBSc tuition fees for the

The rapid response emergency

Director, Dr Gareth Grier, and London’s Air Ambulance Chief Executive Officer, Graham Hodgkin. They also met The Institute’s two scholars for this current academic year, Oliver Malpass and Robert Willmore, who are benefiting from the

duration of the programme from the start of the academic year to its finish for each scholar. It will also provide additional financial support for successful applicants to attend international or national

Foundation’s generous support.

conferences related to their

Oliver Malpass said: “I feel

about The Institute visit

delighted and very grateful

studies. For more information iophc.co.uk/about-us/the-institute.

to have been selected for the YAA

without it, it wouldn’t have been

Asda fundraising tops £200,000 for Yorkshire Air Ambulance

financially possible for me to study in London. I am most

Pre-Hospital Medicine. Dr Gareth Grier said: “The

recommend that future students

experts in this field, and would apply for this opportunity too.”

service relies on the generosity of individuals and organisations to help save lives across Yorkshire. To keep both its helicopters in the air the charity needs to raise £12,000 every day - equivalent to £4.4 million a year. The charity has just placed an order for a state-of-the-art replacement aircraft that will take to the skies over Yorkshire

Beaverbrook scholarship, as

excited about learning from the

Intercalated BSc in Pre-Hospital

saving lives across Yorkshire

to educating on the treatment of

Yorkshire Air Ambulance

next year. The latest generation Airbus H145 helicopter will replace the older of the charity’s two aircraft, G-SASH, and providing paramedics with a much more modern medical fit-out to treat

is flying high after another

and transport often critically

Robert Willmore said: “I feel

fantastic fundraising feat

injured patients.

studying the scientific basis

hugely privileged to have been

by Asda staff and shoppers

of this ever-expanding and

awarded the scholarship, not

across the region.

innovative field of medicine,

only due to its prestigious

offering an exciting insight into

nature, but also due to the

During 2015, the supermarket

and South Yorkshire, said: “To

this fascinating specialty for

undoubtedly high standard of

chain’s stores in the region

have raised £200,000 over the

doctors of the future. On behalf

the other applicants.

– from Harrogate to Hull and

last three years is a remarkable

York to Sheffield – have raised

achievement. We continue to be

Medicine provides medical students with a formal way of

AMBULANCE UK - FEBRUARY

of all of us at the charity I would

Kerry Garner, YAA Regional Fundraising Manager for West

like to thank the Beaverbrook

“Aside from the initial

over £52,000 for the life saving

blown away by the generosity of

Foundation for its support with

excitement of being awarded

charity. That brings the total

Asda, their store staff and amazing

this.”

the scholarship, on reflection it

raised by Asda over the last

customers across Yorkshire.

will hopefully open many doors

three years to a staggering

Offered in partnership with

of opportunity in meeting some

£200,000.

Queen Mary University of

truly inspirational clinicians

London, The BSc is the

working in the pre-hospital

Asda Yorkshire Charity

support of Asda is great news.

equivalent of a full degree

arena. It is also an honour to

Champion Barkat Ali, said: “We

We really cannot thank them

condensed into one year, and

work alongside like-minded

are a Yorkshire-based business

enough.”

“2016 will be a big year for us and to have the continued

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

ADVERTORIAL FRED’s a life saver on the slopes The world’s smallest defibrillator keeps alpinist alive It happened on the Cho Oyu Mountain in Tibet. An alpinist was struck by lightning in a remote camp, lying motionless in her tent and needing immediate medical assistance. Apart from regressive paralysis symptoms and small burns, an initial ECG showed no abnormalities. However as a result

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21 For all your equipment needs visit: www.ambulanceservicesuppliers.com

www.emer

NEWSLINE DAAT

Ground-breaking clinical development degree for air paramedics New qualification will create Devon as a centre of excellence for pre-hospital critical care

be encouraged to contribute to

while benefiting from the very real

wider profession with paramedics

advancing the body of knowledge

experiences of paramedics in

from several other air ambulance

underpinning pre-hospital critical

action.

services joining the course.

“This programme will not only help

“We are in no doubt that we have

practitioners with their decision-

developed a model of Paramedic

Devon Air Ambulance’s Clinical

making and enhance the quality

Support Officer and paramedic,

of critical care, it will help Devon

education that will lead the way

Darren Goodwin said: “The

Air Ambulance paramedics to

world of pre-hospital emergency

become genuine leaders in their

medicine is moving very

field and to make real and positive

quickly with numerous clinical

changes to best practice.”

care through continued research and further study.

A ground-breaking collaboration

papers published each month,

between Devon Air Ambulance

suggesting new and innovative

Amanda Denton, Post-graduate

Trust (DAAT) and Plymouth

procedures and practices. The

Lead at Plymouth University’s

University has resulted in a new

aim of this programme is to

Faculty of Health & Human

Master’s Degree course for

equip already highly experienced

Sciences, said: “The idea for

Paramedic air crew aimed at

paramedics with the knowledge

this degree was only formulated

making them amongst the highest

to appraise, and where necessary

in January last year and it is a

qualified in the profession.

challenge, current thinking and

testament to the commitment

bring their own experience to bear

of everyone involved in the

in advancing clinical practice.

collaboration, that the course is

The first module on the MSc Pre-hospital Critical Care/

up and running within a year.

in clinical development for air ambulance services and create a nationally recognised centre of excellence in pre-hospital critical care. “I must congratulate DAAT for the vision in identifying the need for this degree and the courage to fund it. It will help future proof the clinical work of air ambulance services everywhere.” The three year MSc PreHospital Critical Care – Retrieval and Transfer degree is being

Transport and Retrieval degree

“There are existing ‘off-the-

started in early September and

shelf’ courses but we wanted to

“We have created a platform

delivered by the School of Health

over a three year period studying

design a course that addressed

for personal, academic and

Professions at Plymouth University

for a minimum of 10 hours a

the specific needs identified by

practical advancement in this

and led by Amanda Denton and

week, 20 paramedics will gain

DAAT and one that addresses the

highly specialised area and it has

Peter Allum, with the course

this new qualification and will

application of theory in practice

already caught the attention of the

funded by DAAT.

AMBULANCE UK - FEBRUARY

22 For more news visit: www.ambulanceukonline.com

NEWSLINE

Want to sell to the emergency services? Take a stand at The Emergency Services Show the only UK event you need to be at! The Show continues to grow year on year, and is a firm date in the calendar for all buyers and operational staff across all the emergency services.

www.emergencyuk.com

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Call the sales team today on 01737 824010 to discuss the right package for you.

ESS - the only show for the entire spectrum of the Emergency Services 23 For all your equipment needs visit: www.ambulanceservicesuppliers.com

NEWSLINE the next stage of treatment.

further improve the outcomes

World first: London’s Air Ambulance trialling brain scanner prehospital

It also means medical teams

for our critically injured

know when not to carry out

patients.”

For the first time in the

The device has a 90%

are commonly associated

accuracy rate in hospital

with causing head injury.

world, a brain scanner is being trialled by the London’s Air Ambulance charity in the pre-hospital environment, to detect on scene for potentially lifethreatening head injuries. The Infrascanner works

certain treatments too, and it can also be used while the

Last year London’s Air

patient is being transferred

Ambulance treated 1806

to hospital, saving further

patients, 60% of which

potentially life-critical time for

were involved in road traffic

the patient.

collisions and falls from heights – mechanisms that

for finding clinically relevant blood clots on the brain.

Having treated over

With this trial, London’s Air

33,000 people, London’s

Ambulance is aiming to

Air Ambulance has an

match these figures in the

international reputation

pre-hospital environment.

for pioneering medical procedures which have been

The National Institute for

adopted across the world.

Health Research (NIHR) Brain

It pioneered thoracotomy

Injury Healthcare Technology

(open heart surgery) at the

Co-operative (HTC) has

roadside and was the first air

provided the seed funding

ambulance to carry blood on

through its ‘Innovation

board. Last year it performed

Small Funding Competition

the world’s first pre-hospital

2014-5’ to initiate this ‘Pre

Resuscitative Endovascular

may need once they arrive

Hospital Brain Imaging’ pilot

Balloon Occlusion of the

at hospital.

study. Through extensive

Aorta (REBOA), a pioneering

stakeholder engagement that

technique to prevent patients

Mark Wilson, London’s Air

included patients and carer

from bleeding to death

Ambulance Doctor and

representatives, the Brain

from severe pelvic injury.

Consultant Neurosurgeon

Injury HTC’s had identified

The charity has performed

at Imperial College London,

pre-hospital scanning as

REBOA three times and has

said: “It is really important

a major unmet need. The

had two survivors of the

to be able to find out

pilot Infrascanner trial by

procedure.

what is going on inside a

London’s Air Ambulance

patient’s head, and get

started in Spring 2015 and

London’s Air Ambulance

a clearer picture of any

will complete in Spring 2016

treats on average five

injuries sustained. By doing

– it has been used on over 60

critically injured people in

this during the transfer to

of London’s Air Ambulance

London each day, performing

hospital, we hope to be able

patients to date.

medical interventions at the

by detecting blood clots on the brain, allowing for earlier and more accurate diagnosis of potentially lifethreatening injuries. Early diagnosis will speed up the patient’s access to any further treatment that they

roadside which are normally

to expedite treatments, such

AMBULANCE UK - FEBRUARY

30 Brooklyn Drive Rayleigh, Essex SS6 9LW Tel/Fax : 01268 833666

as surgery, by knowing in

Professor John D Pickard,

only found in a hospital

advance what type of brain

Honorary Director of the

emergency department.

injury the patient has.”

NIHR Brain Injury Healthcare

Barts Health NHS Trust

Technology Co-operative,

provide the doctors and

The Infrascanner is a small

said: “The HTC is delighted

some financial support and

hand held device that takes

to be supporting Dr Wilson’s

the London Ambulance

less than two minutes to

vision of pre-hospital imaging

Service provides the

operate. By using it pre-

of head injured patients

paramedics and expertise

hospital, it is possible to

through this pilot study.

to dispatch the service.

better inform emergency

London’s Air Ambulance

The charity relies heavily on

departments of potentially life-

and other pre-hospital

voluntary donations and has

threatening bleeding on the

emergency providers are to

a world class reputation for

brain. Doing so can enable

be congratulated upon their

delivering clinical innovation

operating theatres to be set

enthusiasm for research to

and excellence at the

up accordingly and ready for

identify affordable ways to

roadside.

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

NEWSLINE WAS

Welsh Ambulance Service awarded prestigious environmental management standard

and work continually to improve

procedures – and improving our

accreditation is due to the support

environmental performance.

performance doesn’t just benefit

and hard work by all staff.”

us, it benefits our patients too.” The Welsh Ambulance Service

Andrew Launn, Service Delivery

is currently the only ambulance

The Trust introduced a catalogue

Director at BSI, added: “The

service in the UK to hold this

of new initiatives in its bid to

Welsh Ambulance Service should

standard.

secure ISO 14001, which include

be proud of their certification to

improving waste management

ISO 14001 which demonstrates

Patsy Roseblade, the Trust’s

and recycling facilities in its

their commitment to being a more

The Welsh Ambulance Service

Executive Director of Finance,

premises and encouraging staff

sustainable organisation.

has been recognised for its

ICT and Estates, said: “This is a

to conserve energy and reduce

commitment to reduce its

significant achievement for the

waste through car sharing and the

“Implementing a management

impact on the environment and

Trust and I’d like to extend a huge

use of video conferencing which

system will now enable them to

become a more sustainable

thanks to everyone who made it

reduces travel time, emissions

control their environmental impact

organisation.

happen.

and costs.

and continually improve their

The Trust has been awarded

“Every organisation should be

The Trust also appointed and

the prestigious ISO 14001

mindful of its impact on the

trained ‘environmental co-

The Trust was accredited following

Environmental Management

environment – but it’s particularly

ordinators’ and ‘environmental

an audit which took place at a

Systems Standard by BSI (British

important for a busy emergency

auditors’ at each of its ambulance

sample of stations and office

Standards Institution) after a

service to do this, especially one

station buildings in North Wales

buildings across North Wales

rigorous eight-day inspection of its

with more than 3,000 staff, 700

to champion environmental

during June, July and August.

environmental governance system.

vehicles and 100 buildings up and

awareness amongst staff and

down Wales.

encourage good practice.

recognised standard which allows

“Working towards ISO 14001 has

Leading the work has been

December and the roll out of the

organisations to identify and control

allowed us to make continuous

Estates Officer Nicola Stephens,

Trust’s environmental governance

their impact on the environment

improvements to our systems and

who said: “Achieving ISO 14001

system in South Wales.

performance.”

ISO 14001 is an internationally

Preparations are now underway for further inspections by BSI in

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NEWSLINE ‘Shoctober’ success set to save lives A social media campaign by North West Ambulance Service NHS Trust (NWAS) helped to identify 290 pieces of life-saving equipment across the region that now be used to help cardiac arrest patients in the future. NWAS’ shoctober campaign, which unsurprisingly ran throughout October, saw the public, schools, organisations and celebrities including Paddy McGuiness using the hashtag #findthedefib to locate defibrillators that could potentially be used to save a life in the event of a cardiac arrest. NWAS asked its followers to ‘send a selfie and save a life’ whenever they came across a defibrillator,

and tweet its location so that it could be checked against the list of defibrillators that 999 call handlers use to direct callers to when trying to save the life of a person in cardiac arrest. Automated external defibrillators (AEDs) are small machines which can ‘shock’ a person’s heart into restarting. They are easy to use as they talk through the process and they won’t deliver a shock unless it is required. There is no clinical training required to be able to use the machine. Tweeted 5,864 times, #findthedefib led the ambulance service to 686 defibrillator locations, some as far as Hong Kong and Australia. Of those identified in the North West of England, 290 were unknown to the Trust and will be added to NWAS’ database to help save the lives of patients in the future.

MPs, schools, gyms, youth groups, fire services, police officers, sports teams, councils, supermarkets, media organisations, business owners and NWAS staff all rose to the challenge to ‘find the defib’ and their efforts will contribute to more lives being saved in the region. NWAS Community Engagement Manager, Andy Redgrave said: “The response from the public and local organisations was absolutely fantastic. We hoped they would get behind us to make this campaign a success as we had zero budget for this, but never imagined it would go global! “During the campaign we took the opportunity to involve our Twitter followers in quizzes and fact or fiction posts to help dispel many of the myths that exists about defibrillators, for example that only trained people can use them and

AMBULANCE UK - FEBRUARY

26 For more news visit: www.ambulanceukonline.com

that you can be prosecuted for using one incorrectly which simply isn’t possible. “It’s heartening to learn that all these people know the importance of having defibrillators in public places. Our ultimate aim is for defibrillators to be installed in areas of high footfall across the UK, including schools and colleges, and for them to be positioned alongside fire extinguishers and first aid kits. “A cardiac arrest can happen to anyone – young or old, at any time and the use of a defibrillator within the first few minutes, while professional help is on the way, can improve the chances of survival by up to 70 per cent.” Last year, the Trust attended 13,636 suspected cardiac arrest incidents in the region and this number increases year on year.

NEWSLINE Finding the right address: a matter of life or death An Ordnance Survey software pilot has helped save lives, so say the Community First Responders (CFRs ) who used it. The prototype mobile web app was used by a sample of CFRs from across the country over an eight week period. During this time the sample group were called out to 440 emergency situations, of which the prototype was used on 270 occasions. Of those 270 cases three involved patients suffering cardiac arrest whose lives were saved following CPR. CFRs are volunteers that respond to emergencies, particularly in rural areas, providing Basic Life Support to patients before the arrival of an ambulance. A major difficulty they encounter is finding patients’ homes, especially when it is dark or if the home is remote or has neither a number nor a name board.

There are approximately 20,000 CFRs supporting communities

Jonathan Benger, National Clinical Director for Urgent Care, NHS England, says: “This initiative has the potential to positively influence the outcome of a patient attended by a Community First Responder. It is often simple pilots like these that have big impacts, and it would be useful if they were explored further. Development of this type of software could be vital to people across the country who find themselves in need of urgent and emergency care.” The prototype features OS’s accurate and up-to-date mapping data that responders can access at no cost under the Public Sector Mapping Agreement (PSMA). This data is accessible to the CFRs on any connected device using two of OS’s new APIs, OS Routes API and OS Places, which is the most comprehensive and up-to-date address database in Great Britain, with over 39 million unique address entries. The CFRs are able to copy and paste or type the patients’ address into the OS pilot app’s search bar which then presents a map with the property’s precise whereabouts, which can also be routed to from the CFRs current position. John Kimmance, Ordnance Survey Director of Public Sector, says: “The trial has ended and we are now seeking the funds to take this forward. Feedback from CFRs have identified a number of ways we can improve on what we have done. Projects like this demonstrate in a very clear way to the public the value of the agreement we have

with Government. Also, because our data is playing a part in saving lives, it clearly demonstrates the value of having the latest and most accurate data picture to work from.”

EMAS

Patients put pen to paper to say thank you The number of people getting in touch with East Midlands Ambulance Service to say thank you for the care they’ve received has risen significantly. The patient experience team says that while it is common to receive more compliments than complaints, they’re dealing with more compliments this financial year than ever before (from April 2015). Between April and June 2015 (the first quarter), EMAS received 268 compliments compared to 13 complaints. This equates to a ratio of 20 compliments for every complaint (20:1), something never before seen at the Trust. In the second quarter of the year (July, August September), the number of compliments rose again to 302 compared to 34 complaints. Clare Wade, Patient Safety & Experience Manager, says: “To receive so many compliments is a real credit to the hard work of crews who are at the frontline of

patient care. However, we do take every complaint very seriously and aim to learn everything we can in order to improve our services. “When people feel that they’ve received excellent care that has gone above and beyond what they expected, they write in to say thank you and we really appreciate this. People are often most appreciative of our staff being courteous, supportive and showing empathy.” Compliments were for all of the EMAS services; 999 emergency calls, patient transport and call handlers. Words frequently used to praise staff included professional, excellent, caring, kind, grateful and kind. Patients and members of the public are actively encouraged to give feedback about the care they received from the ambulance service. They can do that via the Patient Advice and Liaison Service (PALS) – email: emas.pals@nhs.net or call at local rate on 0333 012 4216 Dominic Ford, Team Leader for North Derbyshire, said: “It’s great that we receive the thank you letters and compliments from the patients that we treat. It’s a credit to all the hard working frontline staff. The thank you letters and compliments make the crews feel appreciated by the many patients that we treat, and sometimes in difficult circumstances.”

Dominic Ford, Paramedic and Team Leader for North Derbyshire, in front of the thank you letter noticeboard at Chesterfield Ambulance Station.

AMBULANCE UK - FEBRUARY

Mark Norbury, National Ambulance Resilience Unit Coordinator, says: “There are three people alive today who might well not have been but for the prototype OS created. In two thirds of cases where the pilot software was used it speeded up the CFRs response to the patient’s side. Whilst it is difficult to identify exactly whether the earlier arrival of a CFR improved a patient’s outcome, it was clear in two thirds of the cases reviewed that the CFR got to patient quicker with less stress because of the ease of finding their patient’s house. CFRs appear to be getting more and more calls in wider areas than historically and the pilot scheme enabled them to respond with confidence in finding their patient. Finding named houses, especially in the dark, is an absolute life saver.”

in Great Britain today, and they respond to around 50,000 emergency calls a year. Each CFR covers an eight mile radius and receives details of the emergency via an SMS. With this information they then search the Internet on their mobile device to try and identify where the address is. The problem CFRs find with Internet mapping is that it only gives an approximation of an address and not an exact location, which, when a life hangs in the balance, loses vital time.

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

NEWSLINE Exceptional’ new volunteers join lifesaving network in Hertfordshire The team of lifesaving

an 18-hour course, the last of

arrests in their communities.

car to attend 999 calls in. CCR

the year, by staff at the East of

Their aim is to reach a potential

is a Community First Responder

England Ambulance Service NHS

life threatening emergency in

scheme whose volunteers

Trust (EEAST) over last weekend,

the first vital minutes before the

are trained by West Midlands

which included learning vital

ambulance crew arrives on scene.

Ambulance Service to a

lifesaving skills such as cardio

If you’re interested in becoming

nationally recognised standard.

pulmonary resuscitation (CPR)

a CFR please visit: http://www.

They can be called upon to

and using a defibrillator.

eastamb.nhs.uk/get-involved/

attend medical emergencies

community-first-responders.htm

in their area while a blue-light

volunteers in Hertfordshire

Community Partnership Training

received one final boost before

Officer for Bedfordshire and

the new year.

Hertfordshire Simon Marshall said: “The group were of an

vehicle is en-route.

New car for lifesavers after big donation from local building society

The keys to the fully equipped Skoda Yeti was handed over

A group of nine new ‘exceptional’

exceptionally high standard

community first responders

in both written and practical

(CFRs) completed their training

assessments; I’m certain these

at Letchworth ambulance station

new volunteers will go on to be

and they will be based throughout

great ambassadors for the Trust

A group of life saving

the county.

and make a real difference within

volunteers were given an early

their communities.”

Christmas present thanks to

Coventry Community Responder

the generosity of a Coventry

Chairman, Mark Tolan, said; “We

based company.

would like to thank Coventry

The nine new recruits are: Victoria

to the group Chairman, Mark Tolan, by the Mayor of Coventry, Michael Hammon, and Anna Cuskin, from Coventry Building Society.

Wadley, Tracy Nicholls, Emily

In total, more than 60 new recruits

Sapsford, Julie Hood, Sally

completed these courses in

Tugulu, Sheryl Kelleher, Daryl

Bedfordshire and Hertfordshire

The Coventry Building Society

for their kind donation; the

Jooste, Andrew Harley, Emma

alone last year. Having been

made a huge £20,000 donation

largest they have ever made

Fulford, and Janine O’Neil.

trained in basic life support, it

to the Coventry Community

to any charity. It will enable our

allows the CFRs to attend medical

Responder group that has

volunteers to attend numerous

emergencies such as cardiac

enabled them to buy a second

999 calls and could help save

The responders were put through

Building Society immensely

AMBULANCE UK - FEBRUARY

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

NEWSLINE numerous lives. We estimate that the car will enable us to attend to about 1,000 more patients every year. The earlier a

EMAS

EMAS sign the Blue Light Pledge

patient in cardiac arrest receives a shock, the much more likely they are to survive. All of our responders are volunteers who give up their spare time in addition to their own jobs. It is very satisfying being a CFR and knowing that you have made a difference to someone’s life.” About the donation, Corporate Responsibility Manager from The Coventry, Anna Cuskin, said: “So many of our members live in Coventry so when we heard about the fantastic work the

East Midlands Ambulance Service (EMAS) signed a ‘Blue Light Pledge’ showing their commitment to fighting mental health stigma and discrimination in the workplace. The pledge is run by Mind, the mental health charity, who are encouraging emergency services and organisations to join the programme to promote a better understanding of mental health problems and improve the support and wellbeing they provide to their staff and volunteers.

community first responders do, we were delighted to be able to support them. They really can make the difference between life and death.” If you would like to volunteer as a community first responder for West Midlands Ambulance Service, you can find out more details at: www.wmas.nhs. uk/Pages/Community-FirstResponders.aspx All vacancies are advertised via the NHS Jobs website www.jobs.nhs.uk

Kevin Charles, EMAS Chaplain and Staff Support Lead said: “Our staff respond to a high volume of emergency calls, often in very challenging circumstances, which can impact their mental and physical health. We want to fight the stigma around mental health whilst supporting our staff to get the help and support they need. We have a number of initiatives across the trust to support staff one of which is our peer to peer scheme which provides

colleagues with training in support techniques and how to signpost colleagues to other services. “We are very proud to be part of the Blue Light Programme and are looking forward to working with Mind.” EMAS joins a long list of emergency services but are the first ambulance service to sign the pledge. Others include Derbyshire Fire and Rescue and Leicestershire Police.

Amazing ambulance staff praised in new report The region’s “amazing” ambulance staff have been praised in a new report. More than 100 people who received emergency medical help in September responded to questionnaires with 97.1% saying they were very satisfied or satisfied with the service they received. Patients described ambulance staff as “very professional”, “amazing”, “faultless”, “very reassuring”, and “wonderful” in the latest patient experience report.

More than 95% of respondents rated the handling of the 999 call by the East of England Ambulance Service NHS Trust (EEAST) as very acceptable or acceptable. And almost 90% said the length of time they had to wait for the service to arrive as very acceptable or acceptable with almost 100% very satisfied or satisfied with the care they received from staff. Nine out of ten respondents described the comfort of their journey in an ambulance as very comfortable or comfortable and 96.2% said the service exceeded or met their expectations. Robert Morton, EEAST Chief Executive, said: “I’m delighted that these results reflect the organisation’s ethos of being innovative, responsive and excellent. I’d like to pay tribute to all the hard working patient facing staff across the East of England and to our support staff without whose excellent work we would not be able to deliver our services as effectively as we clearly do. “We really value the feedback from our patients.”

AMBULANCE UK - FEBRUARY

29 For all your equipment needs visit: www.ambulanceservicesuppliers.com

NEWSLINE TVAA

Thames Valley Air Ambulance pioneers night simulation training course • Air Ambulance crews

in the South Central Region

Ambulance and Hampshire and

Mark McGeown, CEO of Thames

took place at Thames Valley Air

Isle of Wight Air Ambulance crews

Valley Air Ambulance added:

Ambulance’s state-of-the art

undertake three advanced trauma

“This course shows that our

training and simulation centre in

scenarios, working together to

Charity and the South Central

December 2015.

build the ‘paramedic physician

Ambulance Service are committed

partnership’ that is essential for a

to developing and enhancing the

Developed by Dr Syed Masud

truly gold standard delivery of pre-

helicopter emergency service in

(Clinical Governance Lead

hospital emergency medicine.

our region to provide the highest

for TVAA and Consultant in

level of care for patients who need

undertake advanced ‘on

Emergency Medicine & Pre

scene’ and ‘in flight’ training

Using state-of-the-art simulation

Hospital Care at the John

scenarios at night in

mannequins and live recording

Radcliffe Hospital) and Kevin

preparation for night flying

ability, where breathing, vital signs

TVAA’s aviation partner Bond

Letchford (Lead Paramedic for

launch early this year

and reactivity based on medical

Air Services Ltd and their highly

Training and Simulation for TVAA),

decisions can be controlled by

skilled helimed pilots are also

the course prepares medical

IPad software, the crews were

central to the service, ensuring

teams for night-time Helicopter

at the cutting-edge of pre-

tested on full general anaesthesia,

the most effective coverage for

Emergency Medical Services

hospital emergency medicine

immediate pre-hospital blood

the entire region, as well as the

(HEMS) to ensure the highest

transfusion and advanced

training in order to treat

speed, safety and precision of the

level of care is delivered to

ultrasound techniques under the

operation.

and stabilise patients at the

seriously ill and injured patients

conditions and challenges faced

scene.

in the challenging night-time pre-

by night-time operations. The

“We are extremely proud of our

hospital environment.

crews will directly transfer these

air ambulance and its crew.

skills to the field when both air

Night operations will provide a

• Thames Valley Air Ambulance

Specialist night operations

us at any time of the day or night.”

training for pre-hospital

The advanced training model

ambulance services launch night

huge step up to a higher level of

emergency medical doctors

saw doctors and paramedics

HEMS in early 2016.

capability and this is a result of

and critical care paramedics

from both the Thames Valley Air

the very close partnerships we Dr Masud said: “Undertaking

have with the NHS and South

emergency pre-hospital care at

Central Ambulance Service. But it

night brings new challenges to

is also important to remember that

air ambulance operations, most

our ambition of delivering a gold

obviously working with no, or

standard service is dependent

little light. This course paves the

on the generosity of the people,

way for advanced critical trauma

companies and organisations

care that ensures that no matter

who support us.”

what time of the day or night, our crews are equipped with the

roadside.”

Allianz UK announces association of air ambulances as forthcoming charity partner

Kevin Letchford commented

Allianz UK is proud to

“Simulation within the medical

announce that its new charity

world has come on massively over

partner is the Association

the last decade. Many felt it was

of Air Ambulances (AAAC).

confined to in-hospital scenarios

Launching in February 2016,

however technology has allowed

the partnership will initially

us to take it to the next stage

last three years and Allianz

in reference to pre-hospital

employees have set themselves

emergency medicine. On this

the target of raising £1million.

expertise and knowledge to treat and stabilise patients at the scene or in flight. What people thought could only be done in hospital is now being done in minutes by the

AMBULANCE UK - FEBRUARY

course we have simulated night time in flight emergencies as well

As the world’s largest motor

night time roadside scenarios. We

insurer, road safety is a major

have mirrored reality as closely as

issue for Allianz as road traffic

possible specially in reference to

accidents can have a devastating

night operations.”

effect on people’s lives.

30 For more news visit: www.ambulanceukonline.com

NEWSLINE The partnership between Allianz

vital work that the air ambulances

and improve air ambulance

chances of a person’s survival

and the AAAC will have a

do. The charity was voted for

services throughout the UK. We

decrease by 14% for every

positive impact on the ability of

by our employees and through

look forward to working with their

minute that passes without early

air ambulance services to reach

fundraising activities across

many colleagues and having fun

defibrillation. The introduction

critically ill and injured people

our branch network we can

raising vital funds to help our

of the Co-Responders means

across the country giving them

make a real impact in the local

patients.”

that we are able to attend and

the best chance of recovery and

communities that we serve.”

rehabilitation. The fundraising will help expand the service of the

The AAAC is a legally

AAAC by enabling them to update

independent body which is

equipment (for example allowing

designed to funnel national

for the carriage of blood),

donations into individual air

undertake further night flights and

ambulance charities. It allows

enhance clinical training.

air ambulance charities to approach national or large

Allianz UK will make central

regional organisations who may

donations and support its

want to make donations to the air

5000 employees in their local

ambulance sector as a whole.

fundraising activities, engaging with regional air ambulances.

Liz Campbell, Chairman of the

Allianz UK will also work to help

AAAC said: “We are delighted

raise awareness.

to have been chosen by Allianz to be their charity partner. We

Jon Dye, CEO, Allianz UK

share their value of excellence

commented: “We are very

and focus on customers. The

pleased to be supporting the

money that they raise will support

provide basic lifesaving skills

New co-responder partnership launches trial

and support to our patients

New Co-Responder

Central Ambulance Service

partnership launches trial across the Thames Valley between South Central Ambulance Service NHS Foundation Trust Royal Berkshire Fire and Rescue Service Oxfordshire Fire

quicker than ever before. Nic Morecroft, Lead Community Response Manager from South said: “We are pleased to have embarked on this trial with our partner organisations and are incredibly grateful for their commitment and support in order to get it up and running for the benefit of the local

and Rescue Service

communities. Having the

Buckinghamshire and Milton

extra response in Wokingham,

Keynes Fire and Rescue

Buckingham, Abingdon and

Service

Didcot will complement our already existing Community

South Central Ambulance

Responder Schemes and Public

Service NHS Foundation

Accessible Defibrillators which

Trust (SCAS) and fire services

are also in the area helping to

across the Thames Valley

save more lives.”

(Royal Berkshire Fire and Rescue Service, Oxfordshire

South Central Ambulance

Fire and Rescue Service and

Service NHS Foundation

Buckinghamshire and Milton

Trust (SCAS) provides

Keynes Fire and Rescue

emergency care for Berkshire,

Service) are celebrating a new

Buckinghamshire, Hampshire

potentially lifesaving trial which

and Oxfordshire. Our area

sees full time fire stations

covers approximately 3,554

responding as Co-Responders.

square miles and has a resident population of over four million

Co-Responders are firefighters

people.

from full time fire stations at Wokingham, Buckingham,

Produced by the South

Abingdon and Didcot trained

Central Ambulance Service

by SCAS to provide a ‘first

NHS Foundation Trust

response’ to specific medical

Communications Department

emergencies where there is an immediate threat to life prior

Visit us at www.scas.nhs.uk

arriving on scene. These

Nigel Wilson, Area Manager for

new Co-Responder schemes

Operations and Resilience for

started running as a trial from

Oxfordshire County Council’s

mid November and aims to

Fire and Rescue Service,

ensure that an appropriately

said: “This pilot scheme is an

trained person is on scene as

excellent example of effective

quickly as possible providing

partnership working, that will

that first response prior to the

see skills and resources shared

arrival of an ambulance. In

to enhance the service being

cases of cardiac arrest the

offered to the local community”.

AMBULANCE UK - FEBRUARY

to an emergency ambulance

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

NEWSLINE NWAS

Double Queen’s honours this new year for North West Ambulance Service North West Ambulance Service’s (NWAS) longest

Steve joined the City of Liverpool Ambulance Service as an Ambulance Cadet in 1971. He became a Paramedic in 1989. He is author of a book now in its third edition, helping people to read heart rhythms and used by student paramedics, student nurses and medical students.

serving Paramedic, Steve Evans, is to receive an MBE in the Queen’s New Year’s honours list for his services to First Response and voluntary service to Young People. In 2001, he set up the ‘Don’t

He has demonstrated consistent drive and enthusiasm, locally, nationally and internationally to raise awareness and reduce risks of harm, particularly for young people.

Walk Away’ campaign to raise awareness amongst young people of the dangers of underage drinking and choking or hypothermia. He started with one poster and since then his enthusiasm and drive have ensured that the campaign has achieved

Steve said: “I’ve been bursting to tell people but of course I couldn’t otherwise it’d be straight down the Tower of London. It’s a great honour, the fact people think I’m worthy of it is beyond words for me.”

extremely high profile through being featured on TV and radio.

A further honour has been

awarded to Burnley Paramedic, Collette Kallee who is to be presented with an OBE for her services to the Ebola response in Sierra Leone. Collette worked in Sierra Leone during early 2015 and has since taken a 12 month career break from April 2015, returning to volunteer in Sierra Leone. Director of Operations, Derek Cartwright, said: “The Trust is extremely proud of our exceptional staff who are real assets to the whole ambulance profession and have proven they have true care and compassion as they are willing to go to extreme lengths for their patients.

SCAS

Review of the year 2015 As another year has come to an end, Will Hancock, Chief Executive of South Central Ambulance Service NHS Foundation Trust (SCAS) takes a look back at some of the achievements and challenges that SCAS has faced over the last 12 months. “I would like to start by thanking all our staff, volunteers, governors and members for their hard work and commitment over the last year. “Like many other areas of the

“These honours are truly deserved and show that working for the ambulance service is so much more than a job, it is a calling.”

AMBULANCE UK - FEBRUARY

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

NHS, 2015 has been challenging for SCAS but I’m pleased to see that since the summer, our focused efforts in turning around our performance against national

NEWSLINE response time targets has started

that a patient who we attended

“The New Year Bank Holiday

to see improvements and we

around 200 times a year for a

Weekend is traditionally a busy

are finishing the year with our

number of years has not called us

period for us and I saw this in

performance level on an upward

in the last 12 months. The patient

the New Year in our Clinical

trajectory that I am confident we

is happier, healthier and making

Co-ordination Centre in Bicester

can continue to sustain in 2016.

great changes to their personal

where demand for our non-

and professional life.

emergency NHS 111 service

“Trying to summarise everything

was particularly high. Whilst

“I’d just like to take this opportunity to thank the ambulance crew that saved my life and help keep me here”

that a 24-7 organisation such as

“Such change has been

there, our staff kept up a very

ours has achieved in the last year

described by the patient’s GP

high call answer performance

is a challenge in itself, but here

as “a miracle” – a rather apt

and as the weekend progressed

are just a few of the successes

description at this festive time of

the NHS 111 service got even

that continue to make me so

year. By ensuring our demand

busier with, at times, demand

very proud to be working with

practitioners understand the

reaching over 850 calls an hour.

the amazing staff we have right

root cause of why such frequent

The lack of a cold spell slightly

across all areas of SCAS.

callers use our service, and

reduced demand on our 999

solving that root cause with our

service this New Year compared

“Last year we have rolled out an

partners, we not only improve the

to 2014/15 but over the four-

Electronic Patient Record system

patient’s health and wellbeing but

day period we still attended

with our local hospital partners

also free up more of our frontline

over 2,500 Red 1 and Red 2

that has improved the speed and

staff and vehicles to attend other

“It was getting worse and I was

incidents and exceeded the

emergencies.

very clammy and sweaty- then it

efficiency of our handovers to

national response time target

became more difficult to breathe.”

A&E teams.

of reaching 75% of those calls “Being able to keep more of our

within eight minutes.

The ambulance crew arrived at

“I’m delighted that we are seeing

people and vehicles available

the efforts of our HR teams

to respond to life-threatening

“I would like to wish all our

assessed that he needed urgent

rewarded and since April 2015

emergencies saves more lives.

staff, volunteers, members and

hospital treatment.

we have increased our frontline

The impact of the speed, skill

everyone we serve in our local

workforce by over 5%. This

and professionalism of our

communities, a happy and

“On the way to the hospital, Kevin

comes at a time when we – like all

frontline teams and air ambulance

healthy New Year.”

suffered a cardiac arrest in the

ambulance trusts – are facing the

colleagues is evident day in, day

challenges of a national shortage

out, and was confirmed earlier this

of paramedics.

year following publication of data

Kevin’s home and immediately

back of the ambulance,” said EMAS

EMAS paramedic Russell NelsonTempest.

“The challenges of matching

Network that showed patients

our resources with forecast

who have a major trauma are now

demand on our service has been

63 per cent more likely to survive

significantly helped by a number

than they were in 2009.

Derby resident to thank ambulance crew for restarting his heart five times

introduced. One such initiative

“Away from the traditional view of

A young Derbyshire resident

“But thankfully, by the time we

has targeted our “frequent callers”

an ambulance service, the other

is set to meet the ambulance

reached the hospital, Kevin had

– who we classify as a patient

areas of our business continue

crew that saved his life after

regained a pretty good level of

who we have attended as an

to thrive. As a result of a number

restarting his heart 5 times

consciousness.”

emergency incident 12 times or

of tender wins, we now provide a

during a sudden heart attack.

more in the past 12 months. We

non-emergency patient transport

have introduced a new role in

service across the whole four

Paramedics from East Midlands

recuperation and rehabilitation,

SCAS of ‘demand practitioners’.

counties we serve. In November,

Ambulance Service (EMAS)

Kevin is now well on his way to

These demand practitioners work

inspectors from the Care Quality

where called by Kevin Payne,

making an amazing recovery.

with frequent callers and a range

Commission conducted a focused

36, after an onset of central

of local health and social care

inspection on our NHS111

chest pain during the evening of

“I’d just like to take this

partners to reduce emergency

service. I am confident that when

Wednesday 12 August.

opportunity to thank the

demand from the individuals and

the inspectors’ report is published

ensure that is sufficient planned

it will show we continue to deliver

“At first I thought it was heart

life and help keep me here,” said

care and support in place.

a high quality, responsive and

burn or indigestion, as I’d been

Kevin.

safe non-emergency telephone

to the gym earlier in the day

“One example of the success

service 24 hours a day, seven

but the pain started radiating to

“They do an incredible job

such innovation has delivered is

days a week which now takes

both of my arms,” said Alvaston

and definitely deserve to be

that we have managed to ensure

over one million calls a year.

resident Kevin.

recognised for it.

by the Trauma Audit Research

“We actually had to use our defibrillator 5 times to shock and restart his heart during the journey.

of innovations the Trust has

After nearly 4 months of

AMBULANCE UK - FEBRUARY

ambulance crew that saved my

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

NEWSLINE Ambulance Service (NWAS)

EMAS

resources arrived on scene

Teaching to save lives in Kenya

within four minutes to commence treatment on Michael before taking him to Chorley District Hospital.

A leading consultant in critical care and major trauma has visited Kenya to teach the country’s

Now fitted with a pacemaker and

people vital lifesaving skills

‘fully recovered’ Michael joined

following major trauma incidents.

three members of the crew who saved his life for the emotional

Medical Director at East Midlands

reunion at Chorley Ambulance

Ambulance Service, Dr Bob

Station. NWAS crew Ronnie

Winter, is a member of the Advanced Trauma Life Support (ATLS) steering group which aims to create a uniformed way to treat trauma patients around the world. “I do it because I can probably save more people through education than I ever will individually,” said Bob.

Barnes-Brown, Liz Perry and means we can make the biggest

around the world including South

potential impact and save even

Africa, Italy, Norway, Denmark and

more lives,” continued Bob.

America.

“They now have most of the

The project is funded by the

essential equipment, so we just

Kenyan Red Cross and Innovative

need to equip them with the skills

Canadians for Change.

to use it.”

include lifesaving techniques during the first hour of a patient suffering major trauma, which means an injury that has the potential to cause prolonged disability or death.” Alongside John Garnham Davis, Clinical Skills Centre Manager for Nottingham University Hospital, Bob visited the Kenyan Red Cross training school in Nairobi during the first stage of establishing the ATLS program in the country. “Bringing this course to a developing country like Kenya

Skinner were part of the group of professionals that helped save Michael’s life. Michael presented each member of the crew with a bottle of champagne on his tour of the

NWAS

“The skills we focus on teaching

Community First Responder Tony

A mix of surgeons, medical officers and anaesthetists are taught during the course, who will then go on to teach more medical professionals throughout the country. “This is the fifth country where our group has done this type of work and Kenya is now half way through the process,” said Bob. “We will fully complete the teaching and training process next summer when we come back and run a course together rather than just presenting it to them. “It’s pleasing to think we’re making a difference in other countries but

‘I can see my kids grow up thanks to you’, says Chorley business owner

station. Ronnie Barnes-Brown, NWAS Paramedic, said: “When we arrived on scene Michael had gone purple. We treated him for about 40 minutes giving

A Chorley businessman

him adrenalin and even drilling

has said he ‘can’t thank the

into the bone on his left arm to

ambulance crew enough’ for

administer treatment – it’s great

their quick response when he

to see Michael has made such an

collapsed.

amazing recovery.”

46 year old Michael Bromley,

An emotional Michael Bromley,

who owns a business in Chorley,

who is a father of two young

collapsed at his premises on

children, said: “I am so very

Leigh Street suffering a cardiac

grateful to each member of the

arrest. After a member of his

crew for everything they did for

staff phoned 999, North West

me.

it also makes me really appreciate the advanced standard of emergency medical and trauma care we have here at home.

AMBULANCE UK - FEBRUARY

“Between the highly skilled ambulance paramedics who treat patients at an incident and the expert clinicians who take over at hospital, we can be reassured that we will always receive the best possible care.” The team that worked with Bob to provide the training was made up of medical professionals from

34 For more news visit: www.ambulanceukonline.com

NEWSLINE My business was moving

He said: “Our staff deal with

“We have nominated a local

“We are fully aware of the

premises that day and I was

stressful and sometimes violent

representative to communicate

challenges staff face and we can

loading a truck at the time I

situations on a day-to-day basis

regularly with the charity and we

provide a range of help including

collapsed. Since the incident I’ve

and the role which they carry

grants to attend rehabilitation

started at the gym and had all my

out is physically and mentally

have promoted their services to

demanding.

our staff so that they are aware

centres, funding for programmes to

staff trained in CPR – I hope one

of the kind of help and support

help with stress and post-traumatic

day they can save a life like this amazing group of people.”

“That can take a toll on their health and wellbeing and they

Emergency Medical Technician,

sometimes need support to help

Liz Perry said: “To find Michael

them deal with the consequences.

in such a bad way and after we

available.” Cliff Randall, who has been Chair of TASC since it was launched in March, said people

stress disorder, welfare support and advice, and bereavement support. “Ambulance staff provide a vital service in our emergency services sector, often in difficult

left him at hospital I thought it

“Until I joined the Welsh

working in caring professions

would be difficult for him to pull

Ambulance Service Trust, I

often didn’t ask for help even

through. Michael left a letter at the

assumed that police, fire and

when they needed it.

ambulance station and we were so

ambulance staff had similar,

happy to hear he was fit and well.

independent welfare support

He said: “TASC is here to

For Michael to see his kids after the

systems to fall back on in times of

The TASC Freephone Support

support past and present

incident and continue to live his life

difficulty.

Line telephone number is

members of the ambulance

0800 1032 999.

normally it’s absolutely incredible.” “However, I now know that until Senior Paramedic Chris Rowan

recently, ambulance service

and Phil King, who was a Student

staff have not enjoyed the same

Paramedic at the time, also

breadth and depth of services

attended the scene to help save

that their emergency services

Michael’s life.

colleagues have.”

Closer ties with a new national charity

Mick was keen to emphasise that

circumstances, and it is great to have the backing of the Welsh Ambulance Services NHS Trust.”

service in times of a crisis or severe difficulty need following

For further information or to

injury, illness, stress or

support the work of the charity,

bereavement.

please visit www.theASC.org.uk

the Welsh Ambulance Service had made significant investment in its occupational health and

A leading figure in the Welsh

wellbeing services in recent years

Ambulance Services NHS Trust

but recognised that the link with

has welcomed closer ties with a

TASC brings a new and different

new national charity dedicated

dimension which is very much

to supporting ambulance staff in

welcomed.

times of need. “We’re keen to support TASC because not everyone wants

chairman of the Trust for the

to talk to someone at work, or

last two years, is a former Chief

someone arranged through

Constable who served in the

work, about how they are

police force for 31 years.

feeling,” he said.

He has met with Cliff Randall,

“Sometimes, it is helpful for staff

Chair of The Ambulances Services

to have completely separate

Charity (TASC), to find out more

confidential support, independent

about the UK-wide charity which

of their employer and TASC can

can provide vital advice, counselling

play that vital role.”

and support services to both serving and retired ambulance staff,

He added: “Staff and their families

their families and dependents.

may also need help over an extended period of time.

Mick said that ambulance service staff, both past and present,

“TASC can help to provide that

deserved their own national

longer term support, particularly

charity which is dedicated to their

when dealing with bereavement or

wellbeing and welfare.

post-traumatic stress disorder.

Mick Giannasi, who has welcomed closer ties with The Ambulances Services Charity (TASC)

AMBULANCE UK - FEBRUARY

Mick Giannasi, who has been

35 For all your equipment needs visit: www.ambulanceservicesuppliers.com

NEWSLINE Special pilot scheme The ambulance and fire services in Monmouthshire have begun working closely together in a special pilot scheme. The trial, launched on 21st December sees the two emergency services form a new Fire Medical Response (FMR) in an attempt to address consistently poor ambulance response times across the rural county. Fire Medical Response teams will be mobilised by fire control, as

between the emergency services

“The exact nature of the pilot

WMAS will now work with BCCG

to ensure a better operational

will vary in each Welsh Fire and

and Cheshire commissioners as

response, increase operational

Rescue Service region but the

part of a mobilisation process to

services and improve resilience –

overall aim of working together

ensure a smooth transition takes

adding real value for money whilst

to save lives will be a common

place with the current provider.

working more effectively and

approach in the three regions.” The pilot follows similar schemes

Director, Mark Gough, said:

Greg Lloyd, Head of Clinical

being launched by a total of 43

“We are delighted to have won

Operations at the Welsh

participating fire and rescue

this contract. We have a very

Ambulance Service, said: “Every

services across the UK. At the

strong team with vast experience

second counts in an emergency.

end of the pilot period, detailed

in running PTS operations.

If our fire service colleagues can

evaluation will take place to

Currently we complete around

get to a scene before one of our

determine its success.

700,000 PTS journeys per year.

deliver life-saving treatment –

Long-standing campaigner

“We will be implementing a tried

that’s only going to improve that

for better response times in

and tested service delivery model

patient’s chance of surviving.

Monmouth, Mathew Davies,

that is used elsewhere including

commented: “I am happy to

neighbouring Staffordshire where

hear that the ambulance service

we operate a Patient Transport

is merging with the fire service

Service, Courier Transport

in order to cut waiting times.

Service and Commercial

Paramedics deserve all the help

Services.

ambulances they can begin to

directed by the Welsh Ambulance Service Trust. South Wales Fire and Rescue Service will mobilise fire appliances as part of the FMR pilot, as well as 4x4 vehicles, both of which will proceed under blue light conditions. The vehicles will be equipped with specialised equipment enabling fully trained staff to respond to a set of clinical conditions where their arrival could be achieved the soonest, and where they would be adding the most value with their training and equipment.

“Thankfully, I know that local paramedics and members of the fire service care deeply about the community. I have no doubt that they will do everything they can to make this initiative work for the people of Monmouth”

This includes being mobilised to cardiac arrests, casualties who are reported unconscious or choking, and catastrophic bleeding. The pilot is being rolled out over the three Fire and Rescue Services in Wales and the Welsh

WMAS Commercial Services

efficiently.”

they can get in order to do what they do best. Saving lives!

“We are particularly pleased that we have been able to keep this

“Thankfully, I know that local

important contract within the

paramedics and members of the

NHS family and will be working

fire service care deeply about the

with staff to ensure that we have

community. I have no doubt that

a very strong presence in the

they will do everything they can

county.

to make this initiative work for the people of Monmouth”

“We know that this will be an unsettling time for staff so will

WMAS

Trust scoops new PTS contract

be doing everything we can to ensure that we work as closely as possible with them to reassure them that jobs are safe and that we want to work with them to take

North Wales Fire and Rescue

West Midlands Ambulance

Service’s Assistant Chief Fire

Service has scooped its first out

Officer Richard Fairhead said,

of area non-emergency patient

The new contract incorporates a

“We would like to reassure

transport service contract in a

number of quality improvements

residents across Wales that there

deal worth almost £25 million

following engagement with

will be absolutely no reduction in

over five years.

hospitals, patients and

emergency response and service

the service to the next level.”

commissioners. These include:

delivery, either from the fire and

The Trust has been chosen

and is expected to continue until

rescue services across Wales

by NHS Blackpool Clinical

June 2016.

or from the Welsh Ambulance

Commissioning Group (BCCG),

patients when their transport

Services Trust, during the pilot

Lead ambulance commissioners

will arrive

period.

for the North West, to run the

Ambulance Services NHS Trust AMBULANCE UK - FEBRUARY

Speaking on behalf of the three

service for Cheshire, Warrington

Welsh fire services, South Wales

• Text ahead service, to inform

• Streamlined quality standards,

Assistant Chief Fire Officer,

“The pilot will involve mobilising

Andrew Thomas said: “This pilot

responders who are suitably

is an opportunity for us to work

trained individuals who will work

The decision comes after a

more closely together to the

to preserve life until the arrival

rigorous competitive tendering

benefit of the public in Wales,

of either an ambulance or rapid

process and evaluation of

the eligibility criteria to ensure

improving collaborative working

response vehicle.

potential providers.

equitable access to the service

and the Wirral starting in July 2016.

particularly around the journey arrival and collection times

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

• Revised process for applying

IN PERSON but one thing has remained constant; Milly’s

SCAS News

SCAS says ‘thank you!’ to Milly after 47 years

dedication, enthusiasm and commitment to her patients. She has been an inspiration to many for her fantastic service and we will be very sad to see her go.”

On Thursday, 3 December, friends and colleagues from South Central

And whilst Milly may have ‘hung up her

Ambulance Service NHS Foundation

keys’ for the last time, she has no plans to

Trust’s (SCAS) Patient Transport Service,

put her feet up completely.

came together at Southern House in Otterbourne to say thank you to

“I’ll still keep up my volunteering – I won’t

Hampshire Volunteer Car Driver, Milly

be sitting around on my bottom! I’m already

Stokes, who retired after 47 years and

thinking about volunteering at my local

nine months’ service.

hospital, and maybe I’ll help out at a charity shop too.”

Milly began driving as a volunteer back in 1968 for the ambulance car service in Hampshire and has received six long as well as one from University Hospital Southampton NHS Foundation Trust.

the Trust Board.

Milly said: “In my first 10 years, I used to take three chaps from Netley village to

“He has a wealth of experience within the healthcare and finance sector, and as a NonExecutive Director, and this will be invaluable to the Trust.

Knowle Hospital. Getting them there at 9.30am and transporting them back to Netley for 3.30pm meant I could do my driving and still be there to collect my children from school.”

Non-executive appointments to NHS Trusts made by the NHS TDA are subject to the Code of Practice of the Commissioner for Public Appointments.

Over the years, Milly has driven patients to and from places as far from Hampshire as Liverpool, Plymouth, Norfolk and Birmingham as well as got to know lots

Mark Tattersall has been appointed from 10 December 2015 until December 2017. He has declared no political activity in the last five years.

of ‘regulars’ – patients who she has transported frequently as they attend hospital or treatment centres for dialysis, chemotherapy and radiotherapy.

about her role as a volunteer car driver, Milly said: “I’ll miss meeting all the patients and having so many different and interesting people to talk to. Also, I’ve loved seeing new towns, villages and countryside when I’m out driving so I’ll miss that too.”

James Underhay, Director of Strategy, Business Development, Communications and Engagement, said:

NWAS News

New Non-Executive Director appointed to NWAS The NHS Trust Development Authority (NHS TDA) has confirmed the appointment of Mark Tattersall Non-Executive Director of North West Ambulance Service NHS Trust. Mark is a qualified accountant who worked as a senior executive from 1991 until the end of 2007 in a range of businesses which included

“It’s hard to believe that in the year Milly started volunteering, Harold Wilson was Prime Minister, Dad’s Army first appeared on TV and British Rail’s last steam train service between Liverpool and Carlisle made its final journey. A lot may have changed since then

the Co-operative Bank, Leeds Building Society, the BBC and London Scottish Bank. In the last eight years he has held a number of Non-Executive Director roles within both

AMBULANCE UK - FEBRUARY

At the event to mark Milly’s retirement,

Mark is currently the Deputy Chair of the Your Housing Group where he chairs the Audit and Risk Committee and is a NonExecutive Director of Leasowe Community Homes one of the Group’s subsidiaries. Mark also currently operates as a self-employed consultant delivering financial and general management services to a number of businesses. Chairman for North West Ambulance Service, Wyn Dignan comments: “We’re delighted to welcome Mark to the Service and are confident that he will be a positive addition to

service awards including one from SCAS

When asked about what she’ll miss most

end of September 2015 he was a NonExecutive Director at Manchester Mental Health and Social Care Trust and during his seven years of service, chaired the Audit Committee, the Finance Committee, the Quality Board and acted as Interim Chair for a period of six months.

the public and private sectors. Up until the

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

IN PERSON WAS News

Welsh Ambulance Service leader recognised in New Year’s Honours List A Welsh Ambulance Service boss has been recognised in the New Year’s Honours list. Rob Jeffery, the Trust’s Head of Operations responsible for the Hywel Dda and Powys areas, has been awarded the Queen’s Ambulance Service Medal, it was announced. Pembroke-born Rob, who has dedicated more than 30 years to the service, admits it still hasn’t sunk in.

Chief Executive Tracy Myhill said: “We’re thrilled that Rob has been recognised for his dedication to our ambulance service in Wales. “Rob is a stalwart and such determination, commitment and dedication results in the enormous respect he enjoys from his colleagues. “I’m delighted that his contribution has been recognised in such a distinguished way.” The Queen’s Ambulance Service Medal was introduced in 2012, when now retired Director of Ambulance Services, Dafydd Jones-Morris, was commended in the Queen’s Birthday Honours list.

He said: “I had a letter in November from the Department of Health to say I’d been recommended to receive the Queen’s Ambulance Service Medal. “It was a pleasant surprise and I replied to say that I’d love to receive it, but then kind of forgot about the whole thing. “At about 11.30pm last night I started getting text messages of congratulations and that’s when I realised I’d got the medal. “I have no idea who nominated me. I still don’t to this day!” Rob joined the Pembrokeshire Ambulance Service in 1985 as a relief technician based in Pembroke Dock.

In 2013, Mike Collins, then the Trust’s Head of Service in the Abertawe Bro Morgannwg area, also collected the medal for dedicating his 32year career to the ambulance service in Wales.

He qualified as a paramedic in 1991 and has subsequently held a string of posts and roles including control manager, regional staff officer, regional personnel manager, production manager and national staff side secretary.

There was double delight last year when not one but two members of staff were recognised in the New Year’s Honours list; Andrew Jenkins, Consultant Paramedic and Deputy Director of Medical and Clinical Services, and Advanced Paramedic Practitioner Richard Hook.

He is now the Trust’s Head of Operations in the Hywel Dda and Powys health board areas.

And in June of this year, the Trust’s Interim Assistant Director of Operations, Gordon Roberts, was recognised in the Queen’s Birthday Honours list for dedicating more than

Rob said: “There are others who I feel make a greater contribution than I do, so it’s really quite humbling to have been recognised.

37 years to the service.

AMBULANCE UK - FEBRUARY

“I’m obviously delighted but I’d like to think this medal is recognition of all the staff in the Welsh Ambulance Service; not just those who provide direct services to patients, but those who support our frontline staff too.”

SWASFT News

Rob will celebrate by spending a low-key New Year’s Eve with his family, including wife Paula Jeffery, an Advanced Nurse Paramedic based in Tenby and his 20-year-old son Alex, who has just joined the Trust’s Urgent Care Service.

South Western Ambulance Service NHS Foundation Trust (SWASFT) is delighted to announce that its Chairman, Heather Strawbridge OBE, has been awarded a New Year honour for services to health and care.

New Year honour for Chairman of South Western Ambulance Trust

38 For more news visit: www.ambulanceukonline.com

Heather has worked tirelessly to support and promote the work of ambulance services for 11 years, undertaking both national and regional roles where she is respected for her effectiveness and influence with regard to national policy. Appointed as Chairman of South Western Ambulance Service in 2006, Heather has supported significant management change to deliver ambulance operations from Gloucester to the Isles of Scilly, covering a one fifth of mainland England (10,000 square miles) and serving a population of 5.3 million with some additional 17 million visiting holidaymakers. Most notably, Heather led one of the geographically largest and most complex ambulance services in the UK to achieve Foundation Trust status. This was one of the first such awards for an ambulance trust. She then led the Trust through the acquisition of Great Western Ambulance Service. Under her Chairmanship, SWASFT has been acclaimed for its delivery of performance, as well as managing excessive demand and efficiency requirements over the past 10 years. In that time, £40m of efficiency savings have been achieved. She has also supported the development of new urgent care services, enabling SWASFT to pioneer many urgent care initiatives, ahead of other ambulance services. Chief executive, Ken Wenman said: “Heather has been an exemplary Chairman, steering ambulance services for over a decade through a range of roles in the sector. Under her governance, this Trust has demonstrated consistent innovation in patient care that has produced considerable benefits for the local and national community.” Speaking about the announcement, Heather Strawbridge OBE, said: “Working for the ambulance service is a real privilege, so to receive an OBE is such an honour. I am grateful to everyone in the ambulance service for the way they deliver excellent patient care across the region.” Baroness Watkins of Tavistock, a NonExecutive Director at South Western Ambulance Service, added: “I am delighted that Heather has been recognised with a New Year honour. Heather is well regarded in the ambulance community and her hard work and influence has improved partnerships and relationships across the health and social services, raising awareness of local needs and improving ambulance responses, particularly in more rural and challenging areas.”

AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254 AUK_August_AUK_August_2013 11/10/2013 10:53 Page 254

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