Volume 34 No. 5
October 2019
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CONTENTS
CONTENTS 164
EDITOR’S COMMENT
166
FEATURES
Ambulance UK This issue edited by: Sam English c/o Media Publishing Company 48 High Street
166 Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study
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COVER STORY OFFICIALLY LAUNCHED & READY FOR NHSi EVALUATION The innovative 3.5t ‘WAS’ ambulance is now production-ready and furthermore, it’s ready for evaluation. John Rumsey, Commercial Manager at WAS UK, comments: “This innovative 3.5t ambulance has been developed as a direct result of Lord Carter’s report and the recently-launched national ambulance specification. The report set out a challenge to all ambulance convertors to provide more innovative designs, we have now achieved this”. In order to truly evaluate this new concept against the current national specification, Ambulance Trusts can trial this frontline vehicle within their fleet.
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EDITOR’S COMMENT
EDITOR’S COMMENT Welcome to this issue of AUK. I hope you all had time out over the last few months with friends and family and got some well earned respite. It’ll probably be needed as we head into the annually ‘unexpected’ winter period pressures that necessitate hours of planning each year. If you’re involved in this, as I am, you’ll no doubt empathise and feel that the additional work is a necessary but thoroughly aggravating evil amidst the myriad of other pressing matters that need to be placed on the back burner for the next couple of months.
“Halloween has its issues for us but there are far more unknown and scary things surrounding Brexit”
In between all this, and just to really drive home the knife, it won’t be long before the supermarket shelves are full of goodies for Christmas. This one will be my 29th as a Paramedic and due to the vagaries of rotas and other things, I’ve worked most of them or at least it feels that way. There is a simple test to see if you’re becoming an ancient ambulanceman (or person these days), its when you find yourself describing what it was like for all the crews to sit down to a proper Christmas dinner made on station without getting disturbed by a 999 call. Today, you’re unlikely to see a station over Christmas let alone eat or celebrate, even in a small way, with colleagues such is the pressure and expectation placed on the modern service. So, even though its September at the moment may I wish you all a good one. It doesn’t seem two minutes since summer came and went, now looking forward to the next major event in the UK ambulance calendar, I can see October 31st fast approaching. Halloween has its issues for us but there are far more unknown and scary things surrounding Brexit, at any rate it will mirror the problems voiced many years ago by the Clash in their song ‘Should I stay or should I go’, with either continued uncertainty or the as yet unknown challenges of parting ways. As an apolitical individual in general terms, I have sympathies with both arguments, the reality though in either scenario for the ambulance service is, likely as not, to be just as challenging in terms of staff resource, patient concern and pressure on crews to enter all these anxieties surrounding the future into the already complex soup of patient assessment and management. I’m sure by now everyone is aware of preparations to support the inevitable or continuing problems and their impact on both staff and patients but spare a thought for those who perhaps have more invested in stability than others, those who have left family and friends to move to other parts of Europe and in turn those Europeans who have left their families to work as part of our health and other services. I cannot conceive of anything worse than uncertainty especially when so much has been committed to a new life. Or perhaps I can, the uncertainty of almost every patient under the care of the NHS about the future of their care in a new world or at best in a fundamentally changed old one.
Sam English, Co-Editor Ambulance UK
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FEATURE
NON-TECHNICAL SKILLS EVALUATION IN THE CRITICAL CARE AIR AMBULANCE ENVIRONMENT: INTRODUCTION OF AN ADAPTED RATING INSTRUMENT - AN OBSERVATIONAL STUDY Julia A. Myers1*, David M. C. Powell1, Alex Psirides2, Karyn Hathaway3, Sarah Aldington4 and Michael F. Haney5 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:24 https://doi.org/10.1186/s13049-016-0216-5 © The Author(s). 2016, Published online 08 March 2016 Reproduced with permission from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Abstract
Results The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase
Background In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. Methods In the first phase of the project the anaesthetists’ non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published
two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (rs = 0.4, p = 0.11) or observed non-technical skills performance (rs = 0.4, p = 0.1). Discussion This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance.
literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed
Conclusion
a simulated critical care air transport scenario, and their non-
The AeroNOTS framework could be used to facilitate education and
technical skills performance was independently rated by two blinded
training in non-technical skills for air ambulance clinicians, and further
assessors. Observed and self-rated general clinical performance
evaluation of this rating system is merited.
ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced
Keywords
and inexperienced clinicians, and relationships between different
Non-technical skills, Air ambulance, Intensive care, Patient transport,
assessment approaches and assessors.
Clinical training
Background
AMBULANCE UK - OCTOBER
In health care, preventing errors and avoidable adverse events
with low tolerance for error (such as aviation and the nuclear power
for patients (patient safety) is paramount. High quality clinical
industry) were early to recognise the importance of non-technical
performance requires adequate knowledge and technical ability, but
skills for safety; these industries developed rating frameworks to
also relies on non-technical skills such as the ability to adapt to a
evaluate crew performance based on observable behaviours [4, 5].
rapidly changing clinical situation and to function as part of a team
This approach has also been implemented in high-risk health care
[1, 2]. Non-technical skills can be defined as “the cognitive, social
domains, where behavioural marker systems are increasingly utilised
and personal resource skills that complement technical skills and
as part of training or assessment of clinical competence [6, 7].
contribute to safe and efficient task performance” [3]. Even though a high degree of technical expertise in important, this alone is not
The air ambulance environment is a complex and dynamic health-care
enough to prevent clinician error or mishap. Non-technical skills are
setting, where clinicians work with limited resources to provide very
more likely, compared to technical skills, to be sensitive to individual
advanced levels of care [8-10]. Highly specialised care is centralised
human factors such as fatigue and stress [3]. High risk industries
in many modern health care systems and critically ill patients are
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FEATURE routinely transported large distances to tertiary hospitals to provide
teamwork [3], however specific skill elements and behavioural
timely access to intensive care [11, 12]. Air ambulance transport
descriptors vary according to the clinical requirements of the specific
teams tend to be small and comprise different professional categories
domain [20]. An existing behavioural rating framework can be
such as nurses, emergency medical technicians, and physicians.
adapted to another clinical setting using data gathered directly from
Challenges for maintaining patient safety in an aviation environment
the new setting [7]. In the aeromedical setting, the well-established
include managing sometimes acutely life-threatening and rapidly
Anaesthetists’ Non-Technical Skills (ANTS) framework [17] is suitable
evolving medical issues without the support and facilities available
for this purpose [21, 22]. The ANTS system provides a framework
in a hospital environment [13, 14]. High noise levels in the cabin
for describing the individual non-technical skills of clinicians as well
may preclude traditional options for clinical surveillance such as
as a tool to guide their assessment within the clinical workplace
auscultation or audible alarms, and make communication challenging.
for anaesthesia [23]. The overall goal of this study was to assess a
Clinicians cannot always access additional assistance, resources,
newly adapted non-technical skills rating system based on the ANTS
or expertise, should problems arise or clinical status change while
system but modified for the air ambulance clinical environment. Our
the patient is in transit. In this context, while good technical expertise
hypothesis was that a non-technical skills framework adapted to a
is certainly required, it may be non-technical factors such as how
critical care air ambulance environment could discriminate between
well clinicians have planned and anticipated, or how quickly they
stronger and weaker non-technical skills performances. We aimed
recognise, understand, and make decisions, that most strongly
to test this with a volunteer cohort of lesser and more experienced
influence eventual outcome. Well-designed training for air ambulance
intensive care physicians in a challenging air ambulance transfer
clinicians should aim to prepare them for the recognised risks
simulation, where non-technical skills assessors were blinded to
to patient care during all phases of transfer, and an assessment
clinician experience.
framework based on non-technical skills would clearly have a high degree of relevance for this purpose. However there are no published reports identifying or applying a non-technical skills framework specific
Method
to an intensive care air ambulance setting. The project was undertaken in two phases. First, a non-technical skills A number of non-technical skills rating frameworks have been
framework was adapted to the critical care air ambulance setting
developed for health-care domains closely related to the air
using the ANTS system as the foundation. The adapted framework
ambulance setting, including emergency care [6, 15], critical
was referred to as an aeromedical non-technical skills framework, or
care [16], and anaesthesia [17-19]. Each of these frameworks is
AeroNOTS. In the second phase the adapted AeroNOTS framework
broadly similar, reflecting the generic nature of non-technical skills’
was utilised to evaluate the non-technical skills observed in clinicians
categories such as situational awareness, decision making, and
working in simulated inter-hospital transport scenarios.
AMBULANCE UK - OCTOBER
Fig. 1 Literature search to identify tasks and non-technical skills associated with safe and effective clinical practice in the air ambulance clinical environment
167 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE Adaptation of a non-technical skills framework to the critical care air
university hospital-based air ambulance services as well as larger and
ambulance setting
smaller private air ambulance organisations in the United Kingdom,
Using the ANTS framework as the starting point, a selected and broadly
Australia and New Zealand. Any behaviour not rated by at least 75 % of
representative group of experienced critical care transport and aviation
respondents as either “very important” or “essential” was considered
medicine clinicians agreed definitions for each non-technical skills
to potentially lack content validity [24] and was therefore revised. All
category and element as they pertained to critical care air transfer.
free-text comments were reviewed to inform behavioural descriptor
They also provided suggestions for good and poor clinical behaviours.
modifications and confirm they could be coded to an existing skills
This work was initiated with a scoping review of the literature to
element. The prototype framework was also field tested in two critical
identify skill elements and observable behaviours essential for the air
care flight services in New Zealand and Sweden. Transport missions
ambulance environment, and to understand the range and nature of
were observed from start to finish noting essential tasks observed or
existing evidence. A search utilising online databases (Ovid Medline,
required but not covered by the framework, elements missing from or
Ovid Nursing, AMED, PsychInfo and Embase) was undertaken in two
superfluous to the four main categories, and behavioural descriptions
stages. The following search terms and all derivatives were used for
that may have needed modifying. A change was made from the ANTS
the initial search: aero, air medical, air ambulance, transportation of
scale to introduce a five-point scale for each element or category and
patients, patient safety, error, patient transfer, retrieval, non-technical,
a seven-point global rating (Fig. 2), following suggestions that the four
crew resource management skills, clinicians. In the second stage
point ANTS rating scale may lack sensitivity for measuring changes in
of the search the ANTS tool and other derivatives were used as the
performance [25] and that an overall non-technical skills scale may also
basis for describing specific non-technical skills categories, which
be a useful addition [18, 26].
were then added as the following search terms: behaviour, teamwork, decision making, situation awareness, communication, leadership.
Evaluation of non-technical skills using clinical simulation: study
There were no date restrictions and the search was conducted in March
setting and participants
2014 (Fig. 1) [Additional file 1]. Four focus group interviews were also
The observational study took place in the simulation suite of a New
undertaken, three with experienced New Zealand and Australian-based
Zealand tertiary hospital; it was timed to take place around a training
air ambulance clinicians (physicians, flight nurses, paramedics) and
placement changeover with the aim of recruiting a convenience
one with a group from an international post-graduate aeromedical
sample of minimally experienced intensive care transport physicians.
education programme. Open ended questions were used to facilitate
Experienced intensive care transport physicians were also recruited
discussion concerning the essential tasks undertaken from beginning
and assessed. Prior to the simulations, the intensive care unit (ICU)
to end of a patient transport, and examples of the relevant good or poor
flight service medical director categorised all the participants as either
‘observable’ behaviours associated with those tasks. Behaviours and
‘experienced’ or ‘inexperienced’ in ICU inter-hospital transport. All
tasks arising out of the focus group data and literature were integrated
participants provided informed consent and completed an enrolment
with the developing AeroNOTS prototype to complete and inform the
questionnaire which included details of training, transport and simulation
behaviour descriptions.
experience.
A content evaluation survey was undertaken using a purposive sampling
Simulation scenario
method and Qualtrics electronic survey software (version 9340538,
Following orientation to the simulator all clinicians completed a critical
Copyright © 2015 Qualtrics., Provo, UT, USA). Clinicians from a range of
care inter-hospital transport scenario with a highly experienced flight
critical care flight services rated the importance of positive behaviours
nurse serving as a ‘confederate’ and standardised team member.
from the prototype AeroNOTS framework and suggested key skills or
The scenario took approximately 20 minutes, with an initial phase set
behaviours they believed had been missed. The services were selected
in a high-fidelity regional emergency department where the transport
via contact with our Aviation Medicine teaching section including
physician and flight nurse took over care of a ventilated patient requiring
air ambulance organisations associated with previous students
air ambulance transfer to a tertiary hospital ICU in another city. The
and current teachers in our international programme. This included
second phase was set in a low fidelity helicopter fuselage with actual
AMBULANCE UK - OCTOBER
Fig. 2 Rating scale descriptors for aeromedical non-technical skills performance
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FEATURE transport equipment (stretcher, ventilator, monitors) and comparable
Statistical analysis
space restrictions, but no aircraft noise or vibration. In the scenario the
The AeroNOTS scores from two assessors for each participant
patient’s condition deteriorated rapidly, and a life-saving intervention
were averaged for further analysis within participant groups. A priori
was required [Additional file 2]. Following the scenario an observing ICU
assumptions were that non-technical skills ratings for clinicians more
consultant facilitated a de-brief, which was not recorded.
experienced in air transports would be higher than for less experienced clinicians, and that general clinical performance levels would correlate
Assessment of non-technical skills
with non-technical skills performance levels. Statistical analysis was
Clinicians were informed that purpose of the study was to evaluate
undertaken using SPSS software (IBM SPSS Statistics for Windows,
methods for assessing clinical performance. They were not specifically
Version 22.0. Armonk, New York). Demographic variables were
told that the key focus for that assessment was on non-technical
compared using t-tests or Fisher exact tests. AeroNOTS ratings scores
skills. As recommended when undertaking formal assessment of
(summed total scores between 4 and 20, and individual category scores
non-technical skills performance, each skill element was initially rated
between 1 and 5) were treated as ordinal data and analysed using rank-
separately, then final ratings were made at the level of the four main skill
based methods. These included Mann–Whitney U to test for differences
categories of task management, team working, situation awareness and
in performance between groups, Spearman’s rank correlation to
decision making [27]. Since communication is required to demonstrate
examine relationships between different assessment approaches and
skill elements across all categories there was no specific category for
assessors, and Wilcoxon signed-rank to examine individual scoring
communication in the AeroNOTS system, as with the ANTS system
from the two assessors. Spearman’s rank correlation was also used
[17]. Possible scores for each skill category and element ranged
to test for association between the immediate general rating of clinical
between 1 and 5, where a rating of ‘5’ was “Excellent – extremely good
performance compared to non-technical skills rating. The level of
performance which could serve as a model example for others; patient
statistical significance was set at p < 0.05.
safety enhanced”, down to ‘1’ which was “Poor - absence of behaviour required by the situation; performance endangered or potentially
Ethical approval
endangered patient safety” (Fig. 2). Category scores were analysed
Ethical approval was provided by the University of Otago (Health)
separately giving a score for each category of between 1 and 5, and
Human Ethics Committee, New Zealand (HD12/233 and HD14/44).
then added to give a single summed score (providing an overall non-
All clinicians who participated in the clinical simulation study provided
technical skills score between 4 and 20) [25, 28]. Half marks on the
signed informed consent.
scale were not permitted; assessors were instructed to score at the lower level if they felt the performance fell between two levels on the scale [Additional file 3]. The assessments were carried out independently by two observers who viewed video recordings of the scenarios; assessors were blinded to the experience level of the participants. Assessment of general clinical performance Immediately after the simulation (prior to the debrief) one of the investigators, who was also playing the role of the confederate flight nurse, rated the general clinical performance of each participant on a five point scale ranging from a highest score of “5 = Excellent performed at the highest level; all issues well managed and patient safety enhanced”, down to “1 = Poor - performed well below the expected standard; significant lapses in skills or safety” (Fig. 3). Participants rated their own clinical performance on the same five point scale slightly re-worded to reflect self-rating, rather than observed rating of others.
Results Non-technical skills framework adapted for the critical care air ambulance setting The final prototype of the AeroNOTS framework was produced from expert working group, literature review, focus group, clinician survey, and field testing data (Fig. 4a and b). The content evaluation survey was fully completed by 38 clinicians; 20 flight nurses, 12 specialist transport physicians and six paramedics, who had a median aeromedical transport experience of 8 (IQR 4 – 13) years. Based on responses there were no skills or behaviours added, though five existing behaviour descriptors were revised [Additional file 4]. Field testers expressed a preference for being able to distinguish between good and exemplary performance preferring a five-point performance rating scale over a four-point scale, and they confirmed that a “not applicable” category was required as some transport missions either do not require all skill elements or they just could not be observed. Evaluation of non-technical skills using clinical simulation intensive care, emergency medicine and anaesthesia took part in the clinical simulation study (Table 1). Eight of the participants practiced at a senior trainee level or higher and were categorised as ‘experienced’, having undertaken a median of 45 (IQR 25 – 51.5) previous inter-hospital patient transports. The other eight practiced at a senior trainee level or lower and were categorised as ‘inexperienced’ in patient inter-hospital transport (median 0.5, IQR 0 – 4.5). The mean age for the experienced group was 36.1 (SD
Fig. 3 Rating scale descriptors for general clinical performance
5.6) years and 50 % of them were male. The inexperienced group
AMBULANCE UK - OCTOBER
A total of 16 physicians from speciality training programmes in
were younger (p = 0.009) with a mean age of 29.8 (SD 2.1) years,
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FEATURE a
b
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Fig. 4 a Aeromedical non-technical skill categories and elements; Definitions of skill categories and elements in the aeromedical non-technical skills framework b; Illustrative behaviours for aeromedical non-technical skills; Examples of positive and negative illustrative behaviours for non-technical skill elements in the aeromedical non-technical skills framework
and all were male. There was no difference in any other baseline
Assessment of non-technical skills
characteristics including previous experience of simulator training,
Performance ratings from the two assessors were similar, with a high
the number of hours they had worked or slept in the 24 hours prior to
degree of correlation (rs = 0.65, p = 0.006) and no significant difference in
the simulation, and their fatigue level at the time of simulation.
overall scores (AeroNOTS summed scores, Wilcoxon signed-ranks test,
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FEATURE p = 0.21). These results stayed consistent across the four individual skill
a high risk medical environment, and both improve with good training
categories (correlation coefficients ranging between rs = 0.54 and 0.76, all
[29-31]. Necessary elements for improving clinical performance include
significantly greater than 0 at p = 0.05). However for the category of ‘task
identifying specific skills directly relevant to performance quality,
management’ the scores from one assessor rated higher than the other
then measuring or assessing those skills in a standardised manner
(Wilcoxon signed-ranks test, p = 0.02). The averages of the 2 assessors’
[32]. The results of this study indicate that by characterising the non-
scores were used for the analyses.
technical skills requirements for clinicians, and distinguishing higher and lower levels of non-technical performance, the prototype AeroNOTS
Non-technical skills ratings for all participants (Table 2) showed that
framework could be used to facilitate good education and training in
clinicians with experience in patient transfer had higher non-technical
non-technical skills. Published standards (on which training curricula
skills (AeroNOTS) scores than less experienced clinicians (Mann Whitney
may be based) from Europe [33], New Zealand [34], and the US [35],
U, p = 0.001) (Fig. 5). The experienced clinicians also had higher general
all mandate crew resource management (CRM) training in areas such
performance ratings than inexperienced clinicians (Mann Whitney U,
as decision making, communications processes, team building and
p = 0.003) (Fig. 6). For all clinicians, ratings for non-technical skills were
maintenance, workload management, and situation awareness, but they
highly correlated with general performance ratings (rs = 0.9, p = 0.001).
include little specific detail to define these skills. The specific behaviours
Self-ratings of clinical performance did not discriminate in the same way
identified in the AeroNOTS instrument can facilitate identification of
as ‘observed’ performance measures, and the self-rated performance of
specific areas for individuals where further training might be beneficial.
experienced clinicians was no different to that of inexperienced clinicians (Mann Whitney U, p = 0.32) (Fig. 7). In addition, self-rated performance was
In this study, ‘self-ratings’ of performance were not useful in
not strongly associated with either observed general performance (rs = 0.4,
distinguishing different levels of performance, with inexperienced
p = 0.11) or observed non-technical skills performance (rs = 0.4, p = 0.1).
clinicians tending to over-estimate their performance level. Limitations in clinicians’ ability to self-assess performance have been reported previously [36], but it is possible that our findings were partly a
Discussion
result of recruiting one group of inexperienced clinicians who lacked appropriate inter-hospital transport experience on which to base their
This study describes the development and evaluation of a framework
self-assessments. It is also possible that self-ratings are more accurate
to assess non-technical skills in aeromedical transport. The framework
at the extremes, such as when performance is significantly degraded
discriminated between more and less experienced clinicians, based
[36]. Further examination of ‘self-rating’ is warranted in light of the fact
on their non-technical skill performance during simulated transfer of
that critical care air ambulance clinicians are particularly vulnerable to
a critical patient. Both technical and non-technical skills are needed
factors like fatigue [37], and risk management systems generally rely on
in tandem for good medical team performance and patient safety in
clinicians ‘self-identifying’ if their performance is compromised [38].
Table 1 Clinical simulation study: baseline characteristics of participants Characteristic
Experiencedgroup
Inexperiencedgroup
P value
Age (mean ± SD)
36.1 ± 5.6
29.8 ± 2.1
0.009
Male gender, n (%)
4 (50 %)
8 (100 %)
0.08
Consultant
2 (25 %)
0 (0 %)
Registrar (senior)
6 (75 %)
2 (25 %)
Registrar (junior)
0
5 (62.5 %)
Intern
0
1 (12.5 %)
ICU and Anaesthetics
1 (12.5 %)
2 (25 %)
Anaesthetics
0 (0 %)
3 (37.5 %)
Critical and Intensive Care Medicine
3 (37.5 %)
0 (0 %)
Emergency Medicine
3 (37.5 %)
2 (25 %)
General Medicine
Training level, n (%)
Specialty training programme, n (%)
1 (12.5 %)
45 (25 – 51.5)
0.5 (0 – 4.5)
0.001
Number of previous simulations, median (IQR)
15 (2.25 – 20)
5 (5 – 16)
0.57
Sleep in 24 hrs pre-scenario, median hours (IQR)
7.0 (6.6 – 7.9)
7.0 (7–8)
0.80
Work in 24 hrs pre-scenario, median hours (IQR)
8 (1 – 13.5)
6 (1.75 – 7.75)
0.51
Samn-Perelli Fatigue Scorea, median (IQR)
3 (1.25 – 4.75)
2.5 (1.25 – 3.75)
0.57
a Samn-Perelli Fatigue checklist - possible scores between 1 and 7 where 1 is “fully alert wide awake” through to 7 which is “completely exhausted, unable to function effectively” (Samn SW, Perelli LP. Estimating aircrew fatigue: a technique with implications to airlift operations. Brooks AFB,TX: USAF School of Aerospace Medicine; 1982. Technical Report No. SAM-TR- 82–21.)
AMBULANCE UK - OCTOBER
1 (12.5 %)
Number of previous inter-hospital patient transports, median (IQR)
171 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE Table 2 Assessment scores: Non-technical skills and general clinical performance Performance measure
Experienced group
Inexperienced group
Non-technical skills (AeroNOTS)a, median (IQR)
16 (15.125 – 17.125)
11.75 (8.75 – 14.25)
0.001
b Table 2 Assessment scores:(IQR) Non-technical skills and general performance Task Management , median 3.75 clinical (3.5 – 4.375)
2.5 (2.125 – 3)
0.001
Performance bmeasure
3Inexperienced (2.5 – 3.5) group 11.75 – 14.25) 3 (2.5 (8.75 – 3.375) 2.5 (2.125 – 2.75 (2.125 –3)3)
Teamwork , median (IQR) a b Non-technical skills (AeroNOTS) , median Situational Awareness , median (IQR) (IQR) b b, median (IQR) Task Management Decision Making , median (IQR)
4Experienced (3.625 – 4.5)group 16 (15.125 17.125) 3.75 (3.5 – –4.375) 3.75 (3.5 – 4.375) 4 (3.625 – 4.375)
b Teamwork (IQR) c, median (IQR) General clinical, median performance b c Situational Awareness , median (IQR) (IQR) Self-rated clinical performance , median
P value*
P 0.002 value* 0.001 0.03 0.001 0.02
(3.625 3 (2.5(2––3.5) 44 (4 – 4) – 4.5) 2.75 3) 3.75 (3.5 – 4.375) 3 (2.5 – 3.375) 4 (3 – 4) 3.5 (2.125 – 4) a Decision Makingb, median (IQR) 4 (3.625 4.375) 4 and 20, higher scores 2.75 (2.125 –a higher 3) Median Aeromedical Non-technical Skills rating (summed score, possible range–between represent level of performance)
0.002 0.003 0.03 0.32 0.02
Median non-technical skills category rating (possible range between 1 and 5, higher scores represent a higher level of performance) 4 (4 – 4) 2.75 (2 – 3) Overall clinical performance rating (self-rated or observed - possible range between 1 and 5, higher scores represent a higher level of performance) c *Mann-Whitey U, two-tailed test , median (IQR) Self-rated clinical performance 4 (3 – 4) 3.5 (2.125 – 4)
0.003
b
General clinical performancec, median (IQR)
c
0.32
a
Median Aeromedical Non-technical Skills rating (summed score, possible range between 4 and 20, higher scores represent a higher level of performance) b Median non-technical skills category rating (possible range between 1 and 5, higher scores represent a higher level of performance) c clinical performance rating (self-rated or observed - possible range betweenfrom 1 and higher scores transport represent domain a higher level of performance) the5,aeromedical (clinician experts and relevant ThereOverall is a paucity of literature and no published skills taxonomy, so *Mann-Whitey U, two-tailed test
collecting additional data from the critical care air ambulance domain to
literature). For example, based on literature an addition to the ‘using authority
adapt the well-established ANTS system was essential [7]. Anaesthesia
or assertiveness’ element of Teamwork was: “questions others regardless
is a medical speciality with a leading role in addressing patient safety and
of seniority when they are unsure the right decision has been made”; and
taking a human factors approach to training and safety [39], and while a
a negative behaviour for the ‘gathering information’ element of Situational
behavioural rating system cannot simply be applied to another specialty
Awareness: “does not alter layout of the workplace to improve data visibility
area [27] non-technical skills are broadly generic [3]. As previous authors
or audibility” (ability to hear in aircraft is limited so clinicians need to be able
report significant overlap in the non-technical skills requirements of
to see monitors to make up for this). From focus groups a recurrent theme
intensive care and anaesthesia [20], it was reasonable to expect similarity
emerged that experienced air ambulance clinicians “plan for things to go
between the skills required of intensive care air ambulance clinicians and
wrong” and “plan for every eventuality”. They also develop strategies for
anaesthesia specialists. Both function in teams of variable professional
potential vulnerable points in the transfer, such as communication strategies
makeup, and so require frameworks where the fundamental focus is on
for working with unknown team members, being assertive in acquiring
the non-technical skills of individual clinicians, but encompassing how
information when working in unfamiliar surroundings, and ensuring they
they function as part of a team.
are being listened to. Results from the clinical simulation study provided support for the construct validity of the AeroNOTS framework as a tool for
A measurement system suitable for evaluating the non-technical skills of air
assessing non-technical skills performance. In accordance with the a priori
ambulance clinicians should provide a true (valid) and consistent (reliable)
expectations we set, experienced clinicians received higher scores from
representation of those skills. Face and content validity for the AeroNOTS
blinded assessors than inexperienced clinicians, and AeroNOTS scores
system were addressed during development by collecting data directly
were strongly correlated with general performance scores.
AMBULANCE UK - OCTOBER
Fig. 5 Non-technical skills ratings for experienced versus inexperienced intensive care transport clinicians
Fig. 5 Non-technical skills ratings for experienced versus inexperienced intensive care transport clinicians
172 For more news visit: www.ambulanceukonline.com
FEATURE
Fig. 6 General clinical performance ratings for experienced versus inexperienced intensive care transport clinicians
not the same in all countries [40]. We aimed to provide that international One limitation in the study design was that while data from all air Fig. 6 General clinical performance ratings for experienced versus inexperienced intensive care transport clinicians perspective through assessment of the literature, content evaluation ambulance clinician groups were informative concerning the phase one AeroNOTS adaptation process, only physicians participated in the second
survey and field testing, all of which provided support for validity. However
phase clinical simulation study. It was not possible to recruit comparative
more wide-spread evaluation may be required.
groups containing inexperienced flight nurses or air ambulance paramedics locally. Ongoing evaluation should therefore include all
This study was not designed to test the reliability of the AeroNOTS rating
clinician groups routinely involved in critical care transfer. Another potential
system. Based on results from studies of non-technical skills in other
limitation is that much of the initial adaptation work and evaluation for
domains, some variability between assessor ratings, such as in our
the AeroNOTS framework involved clinicians and services based in New
findings, was not unexpected [16, 41, 42]. The assessors were trained
Zealand or Australia and it is possible that roles and responsibilities of air
in non-technical skills concepts and use of the rating system [23], but
ambulance clinicians, and therefore the required non-technical skills, are
no attempt was made to calibrate their ratings before the study. This will
Fig. 7 Self-rated clinical performance of experienced and inexperienced intensive care transport clinicians
AMBULANCE UK - OCTOBER
Fig. 7 Self-rated clinical performance of experienced and inexperienced intensive care transport clinicians
173 Do you have anything you would like to add or include in Features? Please contact us and let us know.
FEATURE require further examination if the AeroNOTS framework is to be used for formal assessment of clinical competence.
References 1. Gordon M, Darbyshire D, Baker P. Non-technical skills training to enhance patient safety: a systematic review. Med Educ. 2012;46(11):1042–54.
Conclusion
2. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143–51.
An air ambulance non-technical skills framework derived from the
3. Flin RH, O’Connor P, Crichton M. Safety at the sharp end: A guide to non-technical skills. Farnham, UK: Ashgate; 2008.
ANTS tool is capable of distinguishing good and poor performers in a simulated inter-hospital transport setting. Scores can be highly correlated with observed general performance, and also with the general experience of the clinician. Our findings confirm that selfratings are not useful for distinguishing between higher and lower levels of performance. This framework could be useful in identifying when specific non-technical factors are likely to break down in the air ambulance environment, and facilitating a more structured approach to training and assessment. The AeroNOTS rating system shows utility and applicability for a critical care air ambulance environment, and further evaluation of this framework is merited. Abbreviations AeroNOTS: Aeromedical non-technical skills; ANTS: Anaesthetists’ non-technical skills; ICU: Intensive Care Unit; CRM: Crew resource management
5. Helmreich RL. Managing human error in aviation. Sci Am. 1997;276(5):62–7. 6. Flowerdew L, Brown R, Vincent C, Woloshynowych M. Development and validation of a tool to assess emergency physicians’ nontechnical skills. Ann Emerg Med. 2012;59(5):376–85. 7. Kodate N, Ross A, Anderson JE, Flin R. Non-Technical Skills (NTS) for enhancing patient safety: achievements and future directions. Jap J Qual Saf Health Care. 2012;7(4):360–70. 8. Flabouris A, Runciman WB, Levings B. Incidents during outof-hospital patient transportation. Anaesth Intensive Care. 2006;34(2):228–36. 9. Freebairn R. Interhospital and emergency transfers in New Zealand. N Z Med J. 2012;125(1351):7–10. 10. MacDonald RD, Banks BA, Morrison M. Epidemiology of adverse events in air medical transport. Acad Emerg Med. 2008;15(10):923–31.
Competing interests There are no financial or non-financial competing interests to declare. Author contributions Each author contributed to the study. JM conceived of the study, participated in study design, data collection, data analysis and manuscript writing. DP participated in study design, data collection, data analysis and manuscript writing. AP participated in study design, data collection, data analysis and critical review of the manuscript. KH participated in study design, data collection, data analysis and critical review of the manuscript. SA participated in study design, data analysis and manuscript writing. MH conceived of the study, and participated in study design, data collection, data analysis and manuscript writing. All authors read and approved the final manuscript. Acknowledgements This project was supported by funding from the University of Otago, New Zealand and Umeå University, Sweden. The authors would also like to thank the staff of the Simulation & Skills Centre, Wellington Regional Hospital, for their help with data collection. Author details Correspondence: julie.myers@otago.ac.nz 1Occupational and Aviation
*
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Medicine Unit, University of Otago Wellington, Newtown, Wellington 6021, New Zealand. 2Department of Intensive Care Medicine, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington 6021, New Zealand. 3Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington 6021, New Zealand. Department of Emergency Medicine, Wellington Regional Hospital,
4
Wellington, New Zealand. 5Anesthesia and Intensive Care Medicine, Umeå University Medical Faculty, Umeå Sweden; Occupational and Aviation Medicine Unit, University of Otago Wellington, Newtown, Wellington 6021, New Zealand.
4. Flin R, O’Connor P, Mearns K. Crew resource management: improving team work in high reliability industries. Team Perform Manag. 2002;8(3/4):68–78.
11. Warren J, Fromm RE, Orr RA, Rotello LC, Horst HM. Guidelines for the inter-and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256–62. 12. Brandstrom H, Winso O, Lindholm L, Haney M. Regional intensive care transports: a prospective analysis of distance, time and cost for road, helicopter and fixed-wing ambulances. Scand J Trauma Resusc Emerg Med. 2014;22(1):36. 13. Hearns S, Shirley PJ. Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems. Emerg Med J. 2006;23(12):943–7. 14. Abrahamsen HB, Sollid SJ, Öhlund LS, Røisli J, Bondevik GT. Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a crosssectional survey. Emerg Med J. 2015;32(8):647–53. 15. Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation. 2010;81(4):446–52. 16. Weller J, Frengley R, Torrie J, Shulruf B, Jolly B, Hopley L, et al. Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams. BMJ Qual Saf. 2011;20(3):216–22. 17. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth. 2003;90(5):580–8. 18. Lyk-Jensen H, Jepsen R, Spanager L, Dieckmann P, Østergaard D. Assessing Nurse Anaesthetists’ Non-Technical Skills in the operating room. Acta Anaesthesiol Scand. 2014;58(7):794–801. 19. Rutherford JS, Flin R, Irwin A, McFadyen AK. Evaluation of the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system: A behavioural rating system to assess the non-technical skills used by staff assisting the anaesthetist. Anaesthesia. 2015;70(8):907–14. 20. Reader T, Flin R, Lauche K, Cuthbertson BH. Non-technical skills in the intensive care unit. Br J Anaesth. 2006;96(5):551–9. 21. Wax R. The ABC’s of Air Medical Resource Management. In: Fredriksen K, editor. Principles and direction of Air Medical Transport. Salt Lake City: Air Medical Physician Association; 2006.
174 For further recruitment vacancies visit: www.ambulanceukonline.com
22. Martinsen J. Observation and rating HEMS Crew in Non-Technical Skills, CRM Medical Simulation in Norwegian Air Ambulance. Scand J Trauma Resusc Emerg Med. 2015;23 Suppl 2:A21. 23. Flin R, Patey R. Non-technical skills for anaesthetists: developing and applying ANTS. Best Pract Res Clin Anaesthesiol. 2011;25(2):215–27. 24. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459–67. 25. Riem N, Boet S, Bould MD, Tavares W, Naik VN. Do technical skills correlate with non-technical skills in crisis resource management: a simulation study. Br J Anaesth. 2012;109(5):723–8. 26. Jepsen RM, Spanager L, Lyk-Jensen HT, Dieckmann P, Østergaard D. Customisation of an instrument to assess anaesthesiologists’ non-technical skills. Int J Med Educ. 2015;6:17. 27. Flin R, Patey R, Glavin R, Maran N. Anaesthetists’ non-technical skills. Br J Anaesth. 2010;105(1):38–44. 28. Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre. Qual Saf Health Care. 2009;18(2):104–8. 29. Aggarwal R, Grantcharov TP, Darzi A. Framework for systematic training and assessment of technical skills. J Am Coll Surg. 2007;204(4):697–705. 30. Pena G, Altree M, Field J, Sainsbury D, Babidge W, Hewett P, et al. Nontechnical skills training for the operating room: A prospective study using simulation and didactic workshop. Surgery. 2015;158(1):300–9. 31. Yee B, Naik VN, Joo HS, Savoldelli GL, Chung DY, Houston PL, et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology. 2005;103(2):241–8. 32. Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth. 2012 Dec;109 Suppl 1:i3–i16. 33. European Aeromedical Institute EURAMI. Standards Version (2013) 4.0. www.eurami.org. Accessed July 22 2015.
Resuscitation and Emergency Care A full range of products for use in an emergency and resuscitation situation. • • • • •
Bag-Valve-Mask (BVM) Pocket Resuscitation Mask Airway Management Devices Video Laryngoscopy Oxygen Therapy Masks
34. Ambulance New Zealand. Air Ambulance/Air Search and Rescue Service Standard Version 2. http://www.ambulancenz.co.nz/ standards/ (2013). Accessed July 22 2015. 35. Commission for Accreditation of Transport Services. 10th Edition Draft Standards. 2015. http://www.camts.org/. Accessed July 22 2015. 36. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102. 37. Myers JA, Haney MF, Griffiths RF, Pierse NF, Powell DM. Fatigue in air medical clinicians undertaking high-acuity patient transports. Prehosp Emerg Care. 2015;19(1):36–43. 38. Lerman SE, Eskin E, Flower DJ, George EC, Gerson B, Hartenbaum N, et al. Fatigue Risk Management in the Workplace. J Occup Environ Med. 2012;54(2):231–58. 39. Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ. 2000;320(7237):785. 40. Wisborg T, Manser T. Assessment of non-technical skills in the operating room–one assessment tool per specialty. Acta Anaesthesiol Scand. 2014;58(7):773–4. 41. Flowerdew L, Gaunt A, Spedding J, Bhargava A, Brown R, Vincent C, et al. A multicentre observational study to evaluate a new tool to assess emergency physicians’ non-technical skills. Emerg Med J. 2013;30(6):437–43. 42. Yule S, Rowley D, Flin R, Maran N, Youngson G, Duncan J, et al. Experience matters: comparing novice and expert ratings of non-technical skills using the NOTSS system. ANZ J Surg. 2009;79(3):154–60.
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NEWSLINE HART in the country. The team
point of injury so that life-saving
and effective working relationships
Ambulance service’s specialist response team celebrates ten years
members are trained and
medical intervention can begin
and providing a streamlined and
equipped to safely work at
immediately. They can then
strategic response to complex
heights, in confined spaces, in
continually manage the patient’s
situations.
both swift and still water and use
condition to avoid further injury
breathing apparatus, refreshing
whilst partner agencies provide
Joe continues: “Over the last ten
these skills every seven weeks.
the rescue element.”
years, the team has gone from
Set up in 2009 in response to
Joe Barrett, Head of Special
In a large scale or major incident,
training the paramedics undergo,
the national terrorist threat,
Operations for NWAS, said: “Prior
the team is able to quickly
along with the equipment they
North West Ambulance Service’s
to HART, ambulance clinicians
identify the most seriously injured
use, is second to none and
(NWAS) Hazardous Area
would often have to stand back
patients, prioritising and treating
has proven to be life-saving on
Response Team (HART) this year
when faced with a hazardous
those patients in need of help the
numerous occasions.
celebrates its tenth birthday.
incident and wait for specialist
quickest. HART paramedics are
NWAS
strength to strength. The constant
support from fire and rescue
then able to relay back information
“Using their unique problem
Trained up to a national standard,
services or police for them to
regarding the situation and
solving skills, teamwork and
the team of 84 experienced
bring the patient back to a place
size of the required ambulance
co-ordination, they are able to
paramedics, split between two
of safety.
response to control as well as set
keep calm under pressure and
up a casualty collection point and
apply their skills and training to
sites in Manchester and Liverpool, use specialist equipment and
“By providing specialist
provide life-saving clinical early
help patients in a wide-range
skills to safely access and treat
paramedics with the training
interventions.
of unexpected and difficult
patients in difficult and hazardous
and equipment to be able to
conditions.
risk assess and manoeuvre
By training and exercising with their
situations.
through difficult and hazardous
emergency services colleagues,
“I am extremely proud of the
NWAS was one of the first
environments, they are now
they are able to plan and prepare
whole team, they work together
ambulance services to implement
able to access patients at the
for major incidents, creating strong
amazingly, knowing each
AMBULANCE UK - OCTOBER
176 For more news visit: www.ambulanceukonline.com
NEWSLINE
other’s individual strengths and
Outside of responding to
that the ‘Two Uniforms, One Job’
the skills and experience gained
supporting each other after
emergencies, the team members
initiative has had on patients and
within the NHS benefits their
difficult incidents, they’re like one
keep busy making sure that their
staff experiences within the health
military careers.
big family!”
equipment is fully compliant, their
sector. Director of Workforce and Military
clinical skills are refreshed and Introducing its second fleet
they are kept up to date on key
Over 3% of our workforce have
Champion at WMAS, Kim Nurse,
of high-specification vehicles
changes nationally and within the
previously served with the military,
added: “We are delighted to have
in December 2018, the team
trust. They also undertake regular
be that Navy, airforce or army and
been shortlisted as this recognises
has advanced equipment and
fitness tests and often attend
the Trust actively encourages staff
the collaborative efforts and
technology which allows the
community events promoting the
to continue their military career
dedication of our staff members over
paramedics to set up their own
work of the ambulance service.
as well as their work with the
the last 12 months implementing
ambulance service.
‘Two Uniforms One Job’.
HR Manager, Maria Watson, said:
HSJ editor Alistair Mclellan, said
“Candidates from the military and
“We would like to congratulate
reserve forces come with structure
WMAS on being nominated in
and purpose and a definite sense
the category of Reservist Support
communications network in remote locations, provide an ongoing response over days and months if necessary and travel over difficult terrain.
WMAS
TWO UNIFORMS, ONE JOB
HART is primarily reserved for
The work West Midlands
of belonging. Many of their skills
Initiative Award recognising
complex, large scale or major
Ambulance Service undertakes
are extremely transferrable which
their outstanding contribution
incidents such as serious road
supporting former members
means many find it an easy
ahead of this year’s 2019 HSJ
traffic collisions or entrapments.
of the military and serving
transition.
awards. Each of the finalists in
The team will respond to
reservists has been recognised
incidents were the patient would
by making the shortlist of a
“We believe that WMAS offers
based on their outstanding
benefit from additional skills
prestigious award.
a long-term career option as
commitment to excellence in
they come back into civilian life.
healthcare.”
assistance is required.
The submission, ‘Two Uniforms,
Equally, the skills they gain as a
One Job’ has made it through to
Reservists has great benefit for
The full list of nominees for
Notable incidents in recent years
the final of the 2019 Health Service
the patients they treat and for their
the 2019 HSJ awards can be
include major flooding in Cumbria
Journal Awards in the Reservist
work with the Trust in general.
found at https://awards.hsj.
and Greater Manchester as
Support Initiative category.
well as gas explosions, rescues
co.uk/2019-shortlist - winners will “We firmly believe that supporting
be presented at the HSJ awards
from cranes, the Manchester
The panel recognised the
our Reservists has a positive
ceremony, at the Battersea
Arena attack and the Bosley Mill
ambition, visionary spirit and
effect on their jobs in the
Evolution Centre, London on
explosion.
demonstrably positive impact
ambulance service and equally
Wednesday 6th November.
AMBULANCE UK - OCTOBER
and equipment or if additional
this category have been chosen
177 For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
NEWSLINE counts, administering life-saving first aid while an ambulance is on its way. A patient who suffers a cardiac arrest stands a much better chance of survival if someone with a defibrillator can attend the patient in the first minutes of collapse.”
NEAS
Improving the chances of surviving a cardiac arrest in the North East Improving the chances of survival for cardiac arrest patients is something close to North East Ambulance Service’s heart and their latest initiative is set to do just that. If you or someone you cared about was having a cardiac arrest and just a short walk away from where you were, there was someone trained in lifesaving skills, would you want them to come and help? Approximately 60,000 people suffer a cardiac arrest out of hospital in England every year and of these, 28,000 patients will have resuscitation started or continued by the ambulance service. Survival rates for these patients is 8.6%. This is significantly lower than for populations in other developed countries like Holland (21%), Seattle (20%) and Norway (25%). The current rate of initial bystander CPR in England is reported as being 43% compared to up to 73% in other countries. North East Ambulance Service has now switched on GoodSam, a mobile app that alerts community first responders to an incident, in an attempt to boost the numbers of people who survive cardiac arrest in the region.
AMBULANCE UK - OCTOBER
GoodSAM connects with a community of first aid trained responders, willing to assist during a cardiac arrest. NEAS will be switching on the system in the North East and inviting its clinically trained staff, trained in basic first aid and qualified to perform lifesaving cardiopulmonary resuscitation, to register initially.
GoodSAM will automatically notify nearby GoodSAM responders of a medical emergency. The platform connects those in need with those who have the skills to provide critical help before the emergency services arrive. The app is free to download on all smartphones. GoodSAM is already working in partnership with ambulance services in London, North West, Wales and East Midlands as well as further afield in Australia, New Zealand, Ireland, USA, Canada and South Africa. Gareth Campbell, Emergency Care Operations Manager says, “This is excellent news for the North East population and means that those special skills our workforce uses every day to help save lives are even more accessible. By ensuring a patient has a clear airway and quality CPR is in place in those first few minutes, they are more likely to achieve a good outcome.” With the system now switched on, the NEAS emergency operations centre will alert the three nearest responders to life threatening incidents and simultaneously dispatch an ambulance, giving the patient the best possible chance of survival. The partnership will not impact on or substitute standard ambulance dispatch, with crews continuing to be sent to scene in the usual way. When a volunteer is alerted, they
will be able to accept the alert via the GoodSAM app and make their way to the location of the incident. If a volunteer responder is not in a position to accept the alert, it can be declined and diverted to the next nearest responder. Campbell continues, “Having seen how successfully this app works elsewhere, we wanted to bring GoodSAM to the North East for the benefit of our region’s patients. Thanks to funding from NESTA, we have been able to work in partnership with the GoodSAM team to bring this app to the North East.” NEAS already has a team of Community First Responders who are everyday members of the general public trained by NEAS in basic first aid and life support. They are provided with oxygen and a defibrillator and are deployed by NEAS to life threatening emergencies, such as chest pain, breathing difficulties, cardiac arrests, and unconsciousness, if they are the nearest resource, followed by the next nearest emergency care crew. This app provides an opportunity for those with first aid skills who volunteer and work for the service to join the robust community of first responders already working within the North East. Campbell adds, “Responders will be able to provide immediate care to a patient where every second
178 For further recruitment vacancies visit: www.ambulanceukonline.com
Professor Mark Wilson, GoodSAM’s Medical Director and Co-Founder, said: “If a patient has a cardiac arrest, it’s the first few minutes after the incident that determine the outcome – life, death, or long-term brain damage”. “There are first aid trained people all around us but usually the first they know of a neighbour having a cardiac arrest is an ambulance appearing in their street. Our work with Ambulance Services, allows us to harness the lifesaving skills in the minutes before ambulance arrival. GoodSAM has saved lives globally and we look forward to working with NEAS to bring the benefits to the North East.” Steve Dunn from Newton Aycliffe in County Durham has been a community first responder in the North East for eight years after he found himself coincidentally at the scene of two serious road traffic collisions in which he assisted patients whilst an ambulance was travelling. Having formerly been registered with GoodSam in London, he’s really pleased to be able to connect in his own region. He explains, “I was alerted by GoodSAM to an incident in St Pancras when I was in London recently on a business trip and I was really overwhelmed by the number of people nearby who also got the alert. I was first on scene and between those of us who attended, the patient had the best chance of a good outcome. On this occasion it wasn’t a cardiac arrest luckily. It was really surprising and reassuring that so many people were willing to stop what they were doing and help and it’s great that we can do the same here.”
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179
NEWSLINE NWAS
Ambulance service celebrates clinical excellence across Cheshire and Mersey Celebrating those who have demonstrated the highest levels of patient care and innovation across Cheshire and Merseyside, North West Ambulance Service (NWAS) has held its second ever Achieving Clinical Excellence (ACE) Awards. The ceremony, which took place on Tuesday 30 July at Formby Hall Golf Club, was hosted by Dave Kitchin, Head of Service. Chief Executive, Daren Mochrie and Chair, Peter White presented eleven awards to individuals, teams of staff and also external agencies. Winners were rewarded for their clinical excellence and achievements over the past year. Daren Mochrie, Chief Executive says: “The awards are an opportunity to reward our professional employees who are committed to delivering the highest quality of patient care as well as members of the public who have stepped in to make a real difference. As chief executive I am extremely proud to recognise such outstanding achievements.” The categories and award winners were:
AMBULANCE UK - OCTOBER
• Consultant Paramedic Award – Leona Blayney, Craig Butterworth, Gary Fitzpatrick, Gareth Owen, Jade Parry, Danielle Shaw • Advanced Paramedic Award – Wayne Evans, Dylan Hughes, Jessica Heath • Clinical Leadership Award – Andy Baines • Supporting Clinical Excellence Award – Cheshire & Mersey Fleet Team • Mentor of the Year – Paul Campbell
• Student of the Year – Samuel Hebden • Communication Centre Award – EOC Orange Team • Innovation and Change Award – Darren Earley • Patient Choice Award – Sarah Camplin, Andrew Hazley, Michael Jackson, Diane McGann, Aaron Murray, Michael Quirk, Stephen Rickards • Everyday Hero Award – Total Fitness, Crewe • The John Harrison Award for Outstanding Achievement – Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney Winners were selected from peer nominations by a judging panel consisting of Head of Service, Dave Kitchin, Consultant Paramedics for Cheshire and Mersey, Nick Sutcliffe and John Collins alongside the trust’s Medical Director, Dr Chris Grant. Maxine Power, Director of Quality, Innovation and Improvement chose the winner of the Innovation and Change Award. This was presented to Senior Paramedic Team Leader, Darren Earley who has developed a tool to support NWAS clinicians when treating patients with mental health concerns. The John Harrison Award is in memory of Dr John Harrison, the trust’s former associate medical director who exemplified the highest clinical standards of care. The recipient of this award was emergency services team, Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney who were recognised for outstanding professionalism when faced with a colleague having a medical emergency. Their award was presented by John Harrison’s wife, Margaret, along with their colleague who thanked the team for their lifesaving actions.
Staff from Total Fitness in Crewe were given this year’s Everyday Hero Award. Thanks to their training, quick thinking and use of the defibrillator on site, the team were able to help save the lives of two people in separate incidents just three months apart. All winners were presented with a certificate and award to recognise their actions.
SECAMB
Trust welcomes much-improved CQC rating and exits special measures South East Coast Ambulance Service NHS Foundation Trust (SECAmb) has warmly welcomed the Care Quality Commission (CQC) report on its services, published on 15 August 2019, which sees the Trust rated as ‘Good’ overall and it’s Urgent & Emergency Care service rated as ‘Outstanding’ overall, including ‘Outstanding’ for Caring.
patients and pleased that the big improvements we have made as a Trust during the past couple of years have been acknowledged.” Across emergency and urgent care, several areas were highlighted as ‘Outstanding’ including work to reduce hospital handover times and improve services for mental health patients, with staff receiving particular praise. Inspectors also commended the introduction of Joint Response Units with police services and the Trust’s Wellbeing Hub, which provides a range of resources to assist staff with their physical and mental health. Throughout the report, the CQC spoke positively about a number of aspects of the Trust’s service including: • Staff treating patients with compassion and kindness, respecting their privacy and dignity and taking account of individual needs • A strong, visible person-centred culture and that staff were highly motivated
The report, which follows planned inspections of the Trust’s services in June and July, sees the Trust rated as ‘Good’ overall in each of the inspection areas – safe, effective, caring, responsive and well-led. The Trust is pleased that the NHS 111 service has retained its overall rating of ‘Good’.
• The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff
SECAmb also welcomes the announcement by NHS Improvement today that, following the CQC’s recommendation, the Trust should exit Special Measures.
• Staff were supported following traumatic experiences and events
Acting Chief Executive Dr Fionna Moore said: “This positive report is testament to the huge amount of work that has been ongoing at SECAmb for the past couple of years. I am delighted, but not surprised, that staff have been recognised for the fantastic care they provide to
180 For more news visit: www.ambulanceukonline.com
• There were clear systems and processes to safely prescribe, administer, record and store medicines. Inspectors observed outstanding practice in the management of controlled drugs.
• Trust leaders, new to the organisation at the last inspection, had now embedded into their roles. The changes had had a positive impact on the organisation. • Staff told inspectors they felt respected, supported and valued. They were focused on the needs of patients receiving care.
NEWSLINE Rigloo QP.qxp_Layout 1 31/07/2019 16:33 Page 1
• The service promoted equality and diversity in daily work and provided opportunities for career development. While the Trust is pleased that the CQC has evidenced such significant improvements, it is aware that there are areas where further work is required. The Trust is working hard to improve its response times to less seriously ill and injured patients. While SECAmb is performing well against the national average in responding to the most serious call categories (category one and two), at times of high demand patients in lower priority categories can sometimes wait longer than they should. Recent weeks have seen an improvement in the Trust’s response times to these patients and it is committed to further improvements. It is also committed to improving staffing levels across the Trust, including in its Emergency Operations Centres.
Acting Chief Executive Dr Fionna Moore added “I would like to thank everyone at SECAmb for the dedication and commitment they show, day-in, day-out and hope they take a moment to celebrate how much we have achieved.
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“I am very aware that there remains work to be done to ensure we meet the high standards rightly expected. I am, however, very confident that we are on the right path to deliver further progress.” Trust Chair, David Astley added: “I would like to thank everyone who has worked so hard to get SECAmb to where it is today. Every single member of staff and our volunteers contribute to the assessment made by the CQC and everyone should be very proud of what has been achieved. We are very aware that there remains a lot of hard work ahead and we will expect to deliver even higher standards in the years ahead.”
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NEWSLINE NIAS
Northern Ireland Paramedics get formal recognition as Allied Health Professionals (AHP) Paramedics have been formally recognised as members of the Allied Health Professional (AHP) group by the Department of Health (DoH).
colleagues and their peers in the
Ambulance Service, also
“I congratulate all paramedics on
rest of the UK, and recognise the
welcomed the recognition of
having attained this recognition,
contribution paramedics currently
paramedics as Allied Health
which brings them into line with
make as inter-professional
Professionals. He said:
colleagues across the UK, and
clinicians working across
“Paramedics are, day and daily,
would like to thank everyone
urgent, emergency, primary and
the first contact that many patients
involved in bringing about this
community care provision here.
have with the Health Service and
AHP recognition.”
often at times when they are most “This change is also in line with
anxious and vulnerable, including
the values within the new DoH
requiring the highest levels
Workforce Strategy. It is important
of clinical intervention due to
that paramedics feel supported
trauma or medical emergencies.
in their challenging roles and this
Paramedics are increasingly
move will assist in that.
bringing the initial treatment to the patient at the scene of the
The move follows recent discussions with the Department of Health Permanent Secretary Richard Pengelly, DoH officials and the NI Ambulance Service (NIAS). Richard Pengelly welcomed the change. “Formal recognition of paramedics in Northern Ireland is essential to professionalise the profession so paramedics know just how much they are valued as members of the Health Service. “This recognition will align paramedics with other AHP
“Over recent years paramedics
emergency.
have taken responsibility for
The Allied Health Professions (AHP) currently consists of 12 distinct and unique disciplines. These professionals provide key services and add critical value across primary and secondary prevention, diagnostics, treatment and care.
greater clinical decision making
“This recognition is testament
and are providing an increasing
to the increasing role of
range of interventions as part of
paramedicine in the provision
the wider transformational agenda.
of health and social care within
This is being underpinned by the
Northern Ireland. Paramedic
move to Higher education for
Education has been evolving,
paramedic practice. By including
and will continue to evolve,
the health service and has the
paramedics as AHPs will enable
as part of the transformation
potential to influence patient
them to expand their networks
agenda ensuring that those who
pathways and make huge
within the wider group of other
have need of our service can be
differences to patients’ lives. It
AHP professions.”
confident that their clinical care
can help make use of skills to
is delivered by individuals and
develop a more flexible workforce
Michael Bloomfield, Chief
teams operating to the highest
and provide more responsive
Executive of Northern Ireland
professional standards.
services to service users.”
AMBULANCE UK - OCTOBER
182 For further recruitment vacancies visit: www.ambulanceukonline.com
Hazel Winning, the AHP lead in DoH who has worked with NIAS to deliver this recognition, said: “The professional recognition decision would bring opportunities across
NEWSLINE WAS
Welsh Ambulance Service trains team of office-based volunteer Community First Responders The Welsh Ambulance Services NHS Trust has completed the training of eight new Community First Responders (CFR) who will carry out their duties while working from their office in central Cardiff. This initiative was launched by employees and strongly supported by management who see this as the way forward for individual organisations to train its staff with life-saving skills and support the wide NHS workforce. All eight volunteers are employed by the NHS Wales Informatics Service (NWIS) and were trained by the Welsh Ambulance Service CFR trainers directly at their central Cardiff office. The First Responders will always respond in pairs and be placed on a rota covering core working office hours (9 am until 5 pm). They can be called to incidents within 1,000 metres of their office and are trained to deal with 702 different
accident codes including cardiac arrests, strokes, allergic reactions or chest pains. This initiative came from NWIS employee Nicola Turner. Having trained as a CFR a few years prior in a previous organisation, she was keen to bring this initiative to NWIS. With a strong interest and support from her management, Nicola appealed for interest among colleagues and received a large number of positive responses.
counts. Central Cardiff is a busy and crowded area and having First Responders at the ready during working office hours can make a huge difference. They have been brilliant students and I look forward to hearing how they’ll apply their skills.” Given the success of this programme, NWIS would now like to expand the training to its other offices in the North and West of Wales. Employees have viewed this training as an opportunity to achieve personal goals.
Nicola Turner, Senior Product Specialist at NWIS said: “Because we work for the NHS, we want to help. When we started talking about this internally, I happened to be called to an incident and our director decided to tag along. He stayed with us outside in the cold, observing, until the incident was resolved. Shortly after, he gave the green light and we started our training. Now we have eight fully trained Community First Responders on call during working office hours.”
Hafsa Laksari Software Developer at NWIS said: “In the past, I’ve experienced what it was like to have to call an ambulance and I remember the way I felt, not knowing what to do. Thanks to this training, I now have a different mind-set. I now know exactly what I need to do and know that I can help my community. I’m looking forward to my first call. I know it will be daunting, but if I can help someone, this experience will make it a hundred times worth it.”
Jason Sadler, First Responder Trainer Paramedic at the Welsh Ambulance Service said: “In case of a medical emergency, and in particular in the case of a cardiac arrest, every second
Training to become a Community First Responder is a significant commitment. It is classroombased for five days and ‘students’ are also required to complete a total of 15 e-learning modules
“Thanks to this training, I now have a different mind-set. I now know exactly what I need to do and know that I can help my community. I’m looking forward to my first call. I know it will be daunting, but if I can help someone, this experience will make it a hundred times worth it.” which last around 20 hours. All CFRs go on a ride-out with an emergency ambulance crew before becoming operational and are required to attend a one-day assessment once a year. CFRs usually work in pairs – those who would like to operate solo need to go through a further assessment.
our organisation. The Welsh Ambulance Service trainers have been very accommodating and professional and I would recommend other organisations to consider training their staff as First Responders.”
AMBULANCE UK - OCTOBER
Andrew Griffiths, Director at NHS Wales Informatics Service said: “Enabling our staff to receive the necessary training to provide medical assistance was an opportunity to allow our team to learn new skills and support
183 For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
NEWSLINE Appeal to build on-site helipad at Sheffield Children’s Hospital receives £562,500 charity boost The fundraising campaign for a life-saving helipad at Sheffield Children’s Hospital took a major step forward today thanks to a £562,500 charity donation. The HELP Appeal’s Chief Executive Robert Bertram presented the second installment of their £2.25M pledge to David Vernon-Edwards, Director of The Children’s Hospital Charity. It takes the fundraising towards the Helipad to more than £1.3M. The HELP Appeal is the only charity in the country that funds lifesaving NHS hospital helipads. In 2016, it helped fund the helipad
at Sheffield’s Northern General Hospital. Its total donation of £2.25 million will cover half the cost of the helipad. The £6m The Children’s Hospital Charity’s appeal is raising includes a contingency fund should costs rise before its expected completion in 2023. Due to its status as a regional Major Trauma Centre, the Emergency Department at Sheffield Children’s Hospital helps up to 200 children a day. The helipad will ensure a smooth patient transfer for patients who need critical care directly into the hospital without having to cross the road. Currently, air ambulances land in Weston Park and patients are then transported across the busy A57 under a police escort before entering the Emergency Department at Sheffield Children’s Hospital.
One child who knows how important a Helipad would be for the Major Trauma Centre at Sheffield Children’s Hospital is 15-year-old Bradley Duke. In January 2017, Bradley from Middlewood was seriously injured in a car crash on his way to school. Everyone in the car was knocked unconscious and Bradley sustained multiple fractures to his skull, face, spine and wrist. The BMW automatically alerted the emergency services to give rescuers the car’s location. An air ambulance was called to the scene of the crash and Bradley was put into an induced coma before being taken to Sheffield Children’s Hospital. Bradley travelled on his own in the helicopter, landing in Weston Park where he was met by a team of emergency medicine professionals who rushed him across the busy road into the hospital’s resuscitation area.
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Bradley underwent a six-hour long operation and spent more than a month in Sheffield Children’s Hospital, including nine days in a coma, before his discharge. Bradley continues to struggle with his short-term memory, but he has now returned to school, where together with his classmates he is fundraising for the new Helipad. “Building the Helipad and expanding the Emergency Department would help ensure the staff have the facilities they need to save more lives like Bradley’s” Mum Claire said. The new Helipad would ensure air ambulances are able to land in the park after dark, significantly extending its operation throughout winter. It would also have electric trace heating incorporated into the deck to ensure that ice and snow do not disrupt the continued use of the facility during periods of inclement weather.
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AMBULANCE UK - OCTOBER
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184 For more news visit: www.ambulanceukonline.com
NEWSLINE Key developments included:
David Vernon-Edwards, Director
a keynote speech, Mr Griffiths
London Ambulance Service,
of The Children’s Hospital Charity
called for the wider NHS to
agreed that all partners in the
said: “This new helipad has
follow LAS’s example and
NHS and other emergency
never been more needed, to
‘step up’ to prevent stabbing
services had to work together to
integrated urgent care 111
help patients who need critical
injuries in addition to treating the
prevent knife crime in London.
services in North East and South
care arrive at our Emergency
consequences of youth crime.
Department as quickly as possible.
• The launch of two new
East London to nearly 750,000 integrated urgent care calls
She said:
We’re so grateful to Robert and the
Martin Griffiths, a surgeon at Royal
HELP Appeal for their generous
London Hospital, revealed violence
“Our medics are world-leading
support today as we move one
was ‘endemic’ in London and at a
when it comes to helping save the
step closer to making this life-
level not seen for a decade. Last
lives of the victims of knife crime
saving project a reality.”
year, 1,400 wounds were deemed
but they would rather not have to
severe enough to warrant major
use these skills at all.
Robert Bertram, Chief Executive “Seriously ill children throughout
“Prevention is better than a cure. He said:
Sheffield and beyond deserve
than 850 new staff into the organisation, putting the Trust into a stronger staffing position than had been the case for a number of years
trauma care in London.
of the HELP Appeal added:
• The recruitment of more
I am determined the London Ambulance Service continues to
• Improvements in operational performance leading to an average response to the most ill patients of 6 minutes 28 seconds
the best medical care and a
“We have seen knife wounds
play a pioneering role in helping
helipad close to the emergency
happen in people getting younger
our emergency service partners
department, will be one of the
and younger. A quarter of what we
and the wider NHS stem the tide
main ways to achieve this. The
see happens to those 16 years
of these injuries.
HELP Appeal’s second instalment
or under. They don’t happen in
of over £562,000 will hopefully
the middle of the night fuelled
“We will offer our support to Martin
provide a huge boost to The
the 13 performance measures
by alcohol. They happen in the
and his team in the drive to make
Children’s Hospital Charity’s
relating to call handling, response
afternoon between three and
London a healthier place for the
campaign for a helipad.”
times and patient outcomes.
five: school time. This is a youth
capital’s young people.”
services in the country. • Ranking in the top three for all ambulance trusts nationwide in
violence problem.”
At the meeting, visitors could see During the course of the meeting,
a number of stalls showcasing the
Mr Griffiths said the scale of gun
the public heard from Chief
close work with partners that is
and knife injuries over the past ten
Executive Garrett Emmerson who
integrating urgent care across the
years meant trauma services here
outlined progress on the vision
capital to deliver better patient care.
were among the best in the world
set out in the five-year Strategy
with excellent care, innovation and
published in 2018.
LAS
Trauma surgeon hails London Ambulance Service’s pioneering role in curbing knife violence
- one of the fastest responding
Teams were on hand to explain
research. But he said there was
how they work with volunteers in
growing acceptance there has not
Mr Emmerson said significant
the community, how technology
been enough focus on preventing
progress had been made
was improving patient care and
injuries and the NHS had to ‘step
transforming the organisation
how the Service was reducing
One of the country’s leading
up’ to the challenge and listen to
from one seen as ‘the back door’
the environmental impact of its
trauma surgeons has hailed
communities to tackle knife crime.
of the emergency services to one
ambulances. Ambulance crews
acting as the ‘front door’ to the
and control room staff spoke
whole emergency care system.
about their different roles.
the pioneering role of the London Ambulance Service
He added:
(LAS) in helping to tackle knife violence which he describes as
“Prevention is the key… For
‘endemic’ in the capital.
the first time in my lifetime, all agencies – law enforcement, local government, large government,
the Violence Reduction network
education, social services – are
at NHS England and NHS
on the same page. It’s time to
Improvement (NHSE/I) praised
listen and support communities.
AMBULANCE UK - OCTOBER
Martin Griffiths, Clinical Director for
the organisation for world-class trauma care and a ‘tremendous’
“I believe if we give young people
track record delivering prevention
better opportunity and the ability
messages through projects and
to deliver on their potential we
training in schools and communities.
can make London a healthier and happier place.”
The focus on knife crime came at the Service’s annual public
Speaking following the meeting,
meeting on Tuesday night. In
Heather Lawrence, Chair of
Martin Griffiths
185 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE First flight touches down on hospital’s new £500,000 helipad funded by HELP Appeal
signed off last week. And within
“Everyone is aware of the vital
children’s air ambulance have all
minutes of getting the ‘thumbs
roles that hospitals and air
completed at least one landing.
up’, the opportunity for the first
ambulances play in treating a
test landing arose as Lincs &
critically ill patient, but having a
Patients are currently flown to the
Notts Air Ambulance had just
helipad beside the Emergency
helipad on the other side of the
flown a patient in to the existing
Department (ED) can play a
hospital car park at Anlaby Road
helipad, on the opposite side of
significant part in saving vital
and have to be transferred to Hull
Argyle Street, and were awaiting a
minutes when transporting a
Royal in an ambulance. Once
call to their next job.
patient to the expert care they
all agencies have been able to
need to save their lives.
test land successfully, the new
The first helicopter to land on a new £500,000 helipad in
Intensive Care Consultant Dr Tom
Hull touched down on Friday 2
Cowlam, the trust’s clinical lead
“As the only charity in the country
regular use and the current one
August.
for the MTC, said:
funding life-saving helipads we
decommissioned.
helipad will be opened up for
are pleased to be able to cover A five person crew from Lincs &
“The new helipad looks very
the entire cost of the helipad.
Dr Cowlam continues: “The new
Notts Air Ambulance was the first
impressive. The fact that we
We know the difference having a
helipad will shorten the journey by
to fly in and step foot on the newly
were able to complete the first
ground level helipad right outside
a quarter of an hour and remove
completed helipad to the rear of
test landing so quickly after
ED would make.
the need for the patient to be
Hull Royal Infirmary.
construction was completed was
transferred in a second ambulance
down to pure chance, but now
“With the support of the air
Hull University Teaching Hospitals
that we’ve seen the first helicopter
ambulances and the excellent
NHS Trust has undertaken a major
land, we’re looking forward to
emergency care team at Hull
“It will make the transfer quicker
construction project so patients
being able to complete all of the
Royal Infirmary– this incredible
and more seamless for the trauma
seriously hurt in accidents across
tests with our partners and bring
mix of helicopters, helipad and
patient.
East and North Yorkshire and
the helipad into permanent use.”
hospital medical staff – will make
to the Emergency Department.
a huge difference to those people
“When you have a really poorly
into the hospital grounds, the
The helipad, situated behind
who may urgently need life-saving
person, this might be the difference
Major Trauma Centre (MTC) for
Hull Royal Infirmary’s £12m
treatment.”
between life and death because
the area.
Emergency Department, has
parts of Lincolnshire can be flown
this could be the time when they
been funded entirely by the HELP
Test flights will continue over
are having surgery or a massive
Following demolition of the old
Appeal, which is the only charity in
the next few weeks until all
blood transfusion to save them.”
Haughton Building to the rear of
the country dedicated to funding
15 agencies which regularly
the hospital and many months
hospital helipads.
fly patients in to Hull Royal
Trust Chief Executive Chris Long
Infirmary, including Yorkshire Air
said: “We are deeply grateful to
of planning, clearing work and development, the helipad
Robert Bertram, Chief Executive of
Ambulance, the Search & Rescue
the HELP Appeal for its £500,000
construction work was finally
the HELP Appeal said:
helicopter, and the Embrace
donation, which has allowed us to construct the helipad directly behind our Emergency Department. “There is no doubt that having a helipad so close to our highly skilled major trauma team means we will be able to save more lives in situations where every second counts.” Duncan Taylor, Director of Estates,
AMBULANCE UK - OCTOBER
Facilities and Development, said the trust funded the demolition of the Haughton building among others and clearance of the site before main contractor Unico Construction could begin work on the helipad. Measuring 30 metres by 30 metres, 900 tonnes of concrete were brought onto the hospital site, over the course of one day in September.
186 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE An access road for fire engines and service vehicles has been
a team from the North East Ambulance Service.
built alongside a second pedestrian route where patients will be carried out of the air ambulance and rushed into the emergency department. Special double fences have been erected around the helipad as
turfed with pinned grass covered
Tristram takes up the story of what happened on the day.
with mesh overlay to act as a “soakaway” to remove water from the helipad. Lights have been imported from Holland to be set into the concrete, now covered in specialist paint. Hull is one of the country’s 27 Major Trauma Centres (MTCs),
“We had cycled to North Shields and got the ferry. He said he felt uncomfortable, with pains in his shoulders, but I put that down to the fact that he hadn’t been on a bike for quite some time. We were going to get the Metro back. We were pushing our bikes up a road to Chichester station.
credited with saving an additional 1,600 people’s lives since they were established in 2012. Lincs & Notts Air Ambulance use the Hull helipad most often, with Yorkshire Air Ambulance and Derbyshire, Leicester and Rutland Air Ambulance also flying casualties to the city. The Search and Rescue helicopter, based at Humberside Airport, also lands in Hull with people winched
doing a really good job with CPR. They were very focussed
Bruce, a 61 year-old selfemployed plumber, suffered a cardiac arrest while out cycling around Tyneside with his brother Tristram. The brothers were reunited with the ambulance crew so Bruce could thank them.
“baffles” to reduce noise pollution and the majority of the site will be
clear he and the passer-by were
“I was slightly ahead of him but when I looked back he was down on the ground. I was expecting him to be dehydrated and suffering from heat exhaustion but when I got to him he was totally lifeless. I started CPR (cardiopulmonary resuscitation). A passer-by called Peter offered to help, so he took over while I rang for an ambulance.”
and it was crucial that CPR was administered so quickly.” The Monkton-based crew of paramedic Michael Hugo, student paramedic Paul Wales and emergency care assistant Emma Newton were only minutes away when they got the call to respond. Michael said: “Paul took over CPR and we realised he was in ventricular fibrillation which is a cardiac arrest and required a defibrillation shock so his heart could then be re-started. After the shock CPR continued and eventually his heart went into a normal rhythm. “We got him on to a stretcher and into the ambulance. By the time he woke up, he was understandably very confused and didn’t know where he was. “Effectively he had died for
Mr Carter was taken to South Tyneside Hospital, and then transferred to the Sunderland Royal Hospital where he had stents inserted. Bruce, from Thorntree Drive in Newcastle, said: “My brother is trained in first aid and used CPR – that’s probably what saved me – meaning my brain wasn’t starved of oxygen. “I’m very grateful to the crew. They were fantastic, helping to treat me and reassuring me. I just wanted to thank them personally for what they did. At first I was making light of what happened, but after a couple of days the seriousness of what happened struck home.”
20 minutes – he had stopped breathing and didn’t have a pulse. His brother and the passer-by helped to save Mr Carter’s life
Clinical advisor Lisa Ahmed took the call from Tristram. “It was
Paul said: “Tristram and the passer-by were doing excellent compressions when we arrived.” While for Emma, it was the most dramatic case after changing jobs a couple of months ago from being an office-based health advisor to working on an ambulance.
– he needed CPR with the initial cardiac arrest.”
Tristram, an RAF Squadron Leader who works in air safety, added: “The ambulance crew were wonderful, they were the ones who brought him round.”
off mountains or those injured on oil rigs or out at sea. The helipad will also be used by the Children’s Air Ambulance, which can fly specialist medical teams into Hull to treat seriously ill children as well as fly children from here to hospital with specialist paediatric services. AMBULANCE UK - OCTOBER
NEAS
Brother and ambulance crew get Carter – just in time A Newcastle man was effectively dead for 20 minutes, but Bruce Carter is alive thanks to his brother, a passer-by and
187 For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
NEWSLINE with the MOD’s Career Transition
YAS
Partnership and the Step Into
Partnership between Yorkshire NHS Trust and ambulance manufacturer delivers £1.7million boost to economy
Health programme to promote the recruitment of service leavers, as well as honouring the individual pledges of support. WMAS employs more than 100 veterans and were the first ambulance service to provide an access course in order to help
The vast majority of ambulances
complete the transition to the
on Yorkshire’s roads have been
Trust.
manufactured by O&H Vehicle Technology. In 2018, Yorkshire Ambulance Service (YAS) placed a further order for over 300 new units, to modernise its fleet of vehicles. 13th August 2019 marked the handing over of the 250th unit, from O&H’s managing director, Oliver North, to YAS Chairman, Kathryn Lavery. During the milestone event, which took place at O&H’s manufacturing facility, Mr North was keen to champion one, key message – the importance of UK ambulances being built in Britain. He used the example of YAS choosing to partner with a UKbased manufacturer, opposed to an international supplier. The 18-month contract has contributed a total of £1.77million back into the UK economy, via employee contributions and
providing a further boost to the UK system.
secure local jobs, and has used a total of 118 local suppliers,
The service also boasts a network
on paramedic and patient safety.
of Military Champions who were instrumental in setting up
Commenting on the event, Oliver said: “Before I joined O&H as MD in January, the business was set to reduce its staff levels because of the impact of internationallybuilt ambulances. With Brexit impending, I knew the time was right to step in and help to grow this magnificent company. “We are so proud of the level of quality in these ambulances and we chose to host this event, as our way of thanking YAS in an official capacity. We’re now already on the path of an intense period of growth and have all of the essential elements in place for a successful Brexit, which is partly due to YAS’ commitment to working with a UK supplier, whilst in turn, recirculating valuable taxpayers’ contributions.”
business tax. It utilised 102,000 skilled labour hours, helping to
impact of a modern, efficient fleet
YAS receives an average of 2,500 emergency and routine calls per day, emphasising the emphatic
Finishing, Oliver said: “This is
the access course and act as
precisely what a positive and
advocates, ensuring all former
fruitful partnership between public
members of the military receive
and private sector looks like, all in
the support they need when
conjunction with the single most
joining and throughout their time
important aspect - improving first
with WMAS.
responder safety in conjunction with casualty care. And the pride
Director of Workforce and
every single one of us at O&H
Military Champion at WMAS,
feel when we see one of our ambulances responding on the streets of Yorkshire, couldn’t be higher.”
WMAS
WMAS strikes gold in recognition of armed forces employer scheme
Kim Nurse, said: “We are thrilled to have been recognised with a Gold Award as it highlights the level of importance the Trust puts on supporting members of the military. “As a service we are able to offer a long-term career option for those coming back into civilian life and the skills they have gained during their military career and whilst serving as
West Midlands Ambulance
Reservists has great benefit
Service has been recognised
for the patients they treat and
for the support it shows to the
for their work with the Trust in
armed forces community by
general.”
being awarded an Employer Recognition Scheme Gold
Defence Secretary, Ben Wallace,
Award.
said: “These awards recognise the outstanding support for our
AMBULANCE UK - OCTOBER
Issued by the Ministry of Defence
armed forces from employers
(MoD), the Gold Award represents
across Britain and I would like to
the highest badge of honour
thank and congratulate each and
available to those that employ
every one.
and support those who serve, veterans, and their families.
“Regardless of size, location or sector, employing ex-forces
As part of the process of
personnel is good for business
achieving the Gold Award, the
and this year we have doubled the
Trust has signed the Armed
number of awards in recognition
Forces Covenant and engaged
of the fantastic support they give.”
188 For more news visit: www.ambulanceukonline.com
NEWSLINE Saving Time Saving Lives appeal receives almost £2million boost to help London’s flying medics deliver their world class care London’s Air Ambulance Charity has announced it has received £250k from the HELP Appeal, the only charity in the country dedicated to funding hospital and air ambulance helipads, and £1.4million from the Department of Health and Social Care towards much needed redevelopment of its helipad base.
£1million to redevelop the team’s
respite, deliver peer-to-peer
help deal with the most critically
helipad base at The Royal London
support and debrief critical
injured patients in London. The
Hospital to enable the medics
missions. This space is
additional facilities and bespoke
to respond even faster, improve
essential to the wellbeing of our
space will allow us to do even
training and ensure crews have
teams helping them to recover
more for our patients. We are
the facilities they need for their
and recuperate after being
passionate about bringing the best
mental health and well-being.
exposed to exceptional levels
treatments available anywhere in
of trauma on a daily basis. This
the world to the people of London
Robert Bertram, Chief Executive of
would also be used for patient
when they suffer their biggest ever
the HELP Appeal said:
and family visits
challenge and this kind donation is
“After visiting London’s Air Ambulance’s helipad base, it was clear that improvements were urgently needed to provide far better and more suitable facilities for the Doctors, paramedics and pilots who are involved in highly stressful situations on a daily basis. We are proud that we are able to help them create a state-of-the-art
A fundraising appeal was launched at the start of 2019 as London’s Air Ambulance Charity marked its 30th anniversary with the campaign 30 Years Saving Lives, of which HRH The Duke of Cambridge is a Patron. The Saving Time Saving Lives appeal aimed to raise at least
facility that will also enable crews to reach critically ill patients even more quickly, helping to save more lives.” The money will go towards providing; • A ready crew room placed closer to the aircraft for faster dispatch • A space for crews to find
• Education and training facilities • Rest accommodation for frontline staff • New storage space to accommodate additional
extremely welcome. Thank you.” Louise Robertshaw, Director of Fundraising and Marketing at London’s Air Ambulance Charity said:
medical and major incident response equipment.
“We had an ambitious target to raise £1million during our 30th
Dr Gareth Grier, Consultant in
anniversary, and are delighted that
Emergency Medicine and Pre-
the generous support from the HELP
hospital care at Barts Health
Appeal and the DHSC has meant
NHS Trust and with London’s Air
we have almost doubled the amount
Ambulance, said:
we can use for redevelopment of our operational space. The money
“We are most grateful for the
will enable our teams to continue
generous support that will help
to provide world-class rapid
us improve our facilities, and
response care, every second of
equipment at London’s Air
every day, and help find the next
Ambulance. We spend a great
clinical developments to create
deal of time training to specifically
the next generation of survivors.”
AMBULANCE UK - OCTOBER
189 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE WMAS
Trust remains only outstanding ambulance service The results are in and the Care Quality Commission (CQC) has once again rated West Midlands Ambulance Service as ‘Outstanding’, the highest possible rating from health and social care
difference to people, and the
hugely pleased that the CQC
be delivered over the next few
trust and its staff should be very
saw a positive, patient centred
months. These vehicles are
proud of what they do.”
culture within the Trust with hard
replacing 30, 2011 registered
working staff proud to work here
non-emergency ambulances
WMAS Chief Executive,
and making a real difference to
as part of the trust’s vehicle
Anthony Marsh said: “This is
patients’ lives.
replacement programme and
fantastic news and is down to
they will be based across the
the hard work of staff and the
“Compassion is a large part of
volunteers who support us, for
our role and I am equally proud
providing the best possible care
that the report highlighted staff
The new vehicles are Fiat
to patients across the West
were outstanding in the way
Doblos which, following
Midlands.
they support people who are
adaption can accommodate a
distressed or overwhelmed in
standard wheelchair and four
stressful situations.
passengers or a specialised
whole NW region.
regulator.
“I am so incredibly proud of
In their report, they say: “The
for helping us to maintain our
“Quality and safety are key
position as the best ambulance
priorities for us; they are
Some of the features include
very proud of what they do.”
service in the country. That’s
essential for running an
a handy USB port for the front
not me saying it, but the
effective ambulance service
seat passenger, a reversing
The CQC inspected the Service
organisation that looks at the
and I’m pleased that this was
camera, which is useful if the
safety and care of our patients.
highlighted by the CQC as
view of the rear windscreen
was our strong and stable
is obstructed, emergency
leadership team.
egress equipment and first aid
Trust and its staff should be
in April and June looking at our core services of urgent and emergency care and patient transport services along with the leadership of the
each and every one of you
“This rating reflects the hard
wheelchair and two passengers.
work and professionalism of our staff and provides the
equipment. “Congratulations to everyone.”
organisation.
recognition they rightly deserve.
We have been rated as
“To have independent
‘Outstanding’ for our services
inspectors make such positive
being effective, caring,
comments about the Trust is
responsive and well-led, and
incredible; it is rare that any
Good for whether our services
Trust has received such high
are safe.
praise from the CQC.
The CQC’s Chief Inspector,
“I am particularly pleased
Professor Ted Baker, said:
that they have specifically
We are delighted to confirm
accommodate wheelchairs of all
“WMAS was the first ambulance
highlighted the work of the
that we have recently taken
types. By moving to a different
service in England to receive
Patient Transport Service, who
delivery of the first eight of 30
model, we have also realised
an Outstanding rating and I
were more challenged the last
brand new Patient Transport
a cost saving, not only on the
am pleased to announce that
time the CQC came. Today’s
Service vehicles which have
procurement of the vehicles
it continues to provide an
report specifically comments on
been specially adapted to
themselves, but also these
excellent service.
how responsive PTS staff are to
accommodate wheelchairs.
vehicles will reduce our need to
the changing needs of patients
The remaining 22 vehicles will
use third party providers.”
“There was a positive culture
and highlights the work of the
that supported and valued
ambulance liaison assistants
staff and a strong and
who support patients waiting for
embedded focus on continuous
transport to minimise distress.
The spacious vehicles have NEAS
Delivery of the first eight of 30 brand new Patient Transport Service vehicles
AMBULANCE UK - OCTOBER
“We do accept that there is
effective systems for identifying
further work to be done and we
risks or plans to eliminate or
will continue to strive to improve
reduce them.
services and support staff even better than we already are.”
“Overwhelmingly this is an Outstanding trust and the hard
Trust Chairman, Sir Graham
work of staff across the trust
Meldrum, added: “Helping
continues to be exemplary.
others is at the heart of
WMAS are making a real
everything we do and I am
rear lifting back doors and fold down ramps, all for easy access. Head of PTS Ian Stringer said: “We are thrilled with the new style of vehicle being introduced, as they can easily
improvement to offer the best quality service for patients, and
sliding side passenger doors,
190 For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE tips on using the changes
“Continuously developing our
device provided with music in
in the ambulance to prompt
service to meet the specific needs
specific decades to allow staff
conversations, how to alter
of our patients is vital and enables
to choose tracks that patients
their communication style to
the response patients receive
are most likely to have positive
meet the needs of the patient
across the East Midlands to be of
reactions/memories to.
and things to keep in mind for
the highest possible standard.”
• Music provision – a USB
EMAS
First dementia friendly ambulance to launch in the UK EMAS has been working
• ‘Twiddlemuffs’ – a knitted hand
closely with the University
muff, decorated with internal
of Northampton’s dementia
and external items, such as
centre, UnityDEM to update people with dementia feel less frightened or confused when
include information such as
travelling in them.
what people like to be called, where they grew up, how they
The additions to vehicles
take their medication, things
include:
they don’t like and can be completed at home by patients and their carers for paramedic
ambulance stretcher – is now
crews to refer to during future
covered with a scene that
emergency call outs.
contains key points to talk and
University’s NDRIC lead, said: “Sometimes, it’s not just the big
service on Monday 9 September
• This is Me documents – these
• The window nearest the
Professor Jacqui Parkes, the
able to communicate verbally. The ambulances will start
buttons and ribbons.
four current vehicles to make
any patients who may not be
things that make a difference in
in Northamptonshire and
people’s lives, but more subtle
Leicestershire and there are
adjustments and tweaks can
plans for all 104 ambulances
cumulatively, make a big impact.
across the two counties to be dementia friendly by the end of
“For people with dementia, going
October.
into an ambulance can be a sudden, strange and potentially
We respond to emergency calls
frightening experience, but EMAS
from 43,000 patients a year who
have shown with their dementia
are living with a diagnosis of
friendly ambulance – the first of
dementia. Over 5,000 of these
its kind in the UK – that with little
patients live in Northamptonshire.
adjustments, this can be reduced
reminisce about, including
• Communication guide for staff
children playing to remind
– dementia friendly training
people of their youth and
for all front-line EMAS staff
Charlotte Walker, Ambulance
experience. We look forward to
animals for patients to guess
was rolled out from April this
Operations Manager and project
seeing the full fleet in action very
what they are.
year; this guide contains top
lead said:
soon.”
and lead to a much more positive
YEARS IN EUROPE
www.waterjel.com
THE NEW STAY TUNED.
Autumn
24
2019 info@waterjel.net
AMBULANCE UK - OCTOBER
NEXT GENERATION
191 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
NEWSLINE Keith, 46, joined Wiltshire
by Puma, is mirage grey for
care paramedic when he is out
Swindon Town FC kick off 2019/20 sponsorship with Wiltshire Air Ambulance
Air Ambulance in 2015 after
the 2019/20 season and will
saving lives is very powerful.
spending two seasons working
now include the Wiltshire Air
as a paramedic at Swindon’s
Ambulance logo on the neckline
“It gives us great pleasure to
home matches.
above each player’s name and
gift the charity the back of our
squad number.
away shirt sponsorship too.
Wiltshire Air Ambulance’s logo will sit proudly on the back of Swindon Town’s away shirt for the 2019/20 season. The Sky Bet League Two club has chosen Wiltshire Air Ambulance as its Charity of the Year partner for another season and has kindly donated the prominent sponsorship area to the lifesaving service, which is based in Semington, near Melksham.
Wiltshire Air Ambulance chief Last season the Wiltshire club
“Swindon Town have been long-
raised £12,000, along with
term supporters of our charity
primary sponsors Imagine
and we’re very grateful to the
Cruising, to help fit out the
football club and their sponsors
charity’s RRV (Rapid Response
Imagine Cruising for all the
Vehicle).
money they’ve helped to raise to date.
Adam Wainwright, the club’s commercial manager, said:
“We were delighted to welcome
“Last season Imagine Cruising,
Richie Wellens, his staff and
our mainline sponsors,
playing squad to the airbase,
supported us brilliantly with our
where they were able to meet
£12,000 target and are once
Keith, the trainee critical
again fully engaged with us
care paramedic they will be
and Wiltshire Air Ambulance to
sponsoring throughout the
deliver on the new fundraising
season.
total as a three-pronged
campaign justice, their logo needs to be high in terms of profile and we can raise their profile considerably. “A great deal of planning has gone into the unique location for this season’s team photo. It was magnificent to be hosted at the airbase; being pictured by the helicopter and RRV emphasises the strength of the partnership. We have a part to play and genuinely care about the community and are passionate about achieving
partnership.
results off the field of play too.
pride of place on the back
“We are immensely proud as
“We very much look forward to
of the away shirt in what we
a Football Club to be right at
all the partnership activation
all hope will be a memorable
the heart of the community with
planned and to the day when
campaign ahead.”
this partnership and to have
we can announce that we have
our crest embroidered on the
hit the target and as a club we
flight suit of the trainee critical
have funded a trainee critical
In addition, the Robins have
“We’re also very proud to take
pledged to sponsor trainee critical care paramedic Keith Mills, aiming to raise £8,500 throughout the season to fund his training, medical equipment and uniform.
We feel ultimately to do the
executive David Philpott said:
Swindon’s away kit, produced
care paramedic.” Imagine Cruising’s Martin Palmer commented: “As Swindon Town Football Club’s main sponsor for the past five years, we are delighted to help assist them in their fundraising goals to fund a trainee critical care paramedic. “We never know when any of us, our friends or family might need the life-saving services that the Wiltshire Air Ambulance AMBULANCE UK - OCTOBER
provides and look forward to working together to help save more lives in Wiltshire.” Swindon Town fans can contribute towards the sponsorship of paramedic Keith by making a donation Wiltshire Air Ambulance chief executive David Philpott and Swindon Town chief executive Steve Anderson unveil the away shirt with the charity’s logo in front of a team photograph at the airbase. Photo credit – Rob Noyes.
192 For more news visit: www.ambulanceukonline.com
through a special link – simply visit wiltshireairambulance.co.uk/ donate?campaign=SwindonTown
NEWSLINE SWAST
Paramedics Begin Hazardous Environments Degree Paramedics at South Western Ambulance Service NHS Foundation Trust (SWASFT) are beginning a brand new university course to help them to manage patients in hazardous environments. SWASFT has been working with Plymouth University to create the Masters degree in Hazardous Area Response Paramedicine. Last month, 16 paramedics were the first to take up their places on the postgraduate course. The Hazardous Area Response Team (HART) is a specialist unit that provides paramedic care in hazardous environments where previously clinicians would not be able to enter.
for a HART Paramedic has
spending long periods of time
In the weeks and months after
expanded hugely since the role
in hospital. However, ever since
this initial meeting, and as a direct
was created in response to the
the incident, Mr Gibbs always
result of Mr Gibbs speaking with
London bombings in 2005, with
wanted to be reunited with the
other organisations, the PECI team
additional disciplines and clinical
crew that came to his aid.
and in particular Isobel Jones,
skills growing over time. Since In November 2018, Mr Gibbs
Involvement Co-ordinator, received
additional clinical skills and began
approached our Welsh Ambulance
several invitations to community,
delivering enhanced care skills. This
Service’s information stand at a
mental health and carers groups
includes ketamine administration,
carers’ rights event in Maes Manor
to give talks about our services.
finger thoracostomies and surgical
Hotel, Blackwood, and shared his
Through these links, the PECI team
airways. Furthermore, HART also
story of survival from sepsis. He
was also contacted by Geraldine
provide cardiac arrest support for
praised our staff for the quality of the
Powel, Carer Coordinator for
frontline paramedics across the
care he had received which began
Caerphilly Council, who invited her
South West, offering extra staff,
with our call handler and carried
to visit four carers groups in the
equipment and skills for managing
through to the crew who arrived on
Caerphilly, Risca and Blackwood
a cardiac arrest.
his doorstep. He mentioned that he
areas, and was invited to take part in
would like to meet all involved, and
Carers Week events in Newbridge.
This will be the first level 7 bespoke further education course for HART in the country, which will provide the academic foundations for the skills and knowledge that HART paramedics possess, thus aligning HART with other specialist paramedics within the Trust. Staff undertaking this course will also provide the HART teams with
The types of situations that a HART Paramedic can be expected to operate in include: firearms, chemical, water, confined spaces, at height, mud and unstable structures such as collapsed buildings. Bianca Thomas-Mourne, HART Paramedic, said: “This is a really exciting opportunity for the HART speciality to acquire the academic accreditation that it deserves and to align with it’s urgent and
research opportunities through their university work. This will enable South Western Ambulance Service to begin a programme of research in relation to the work of the HART teams – something that has not yet been embarked upon. For more information on the course, go to: https://www.plymouth.ac.uk/ about-us/university-structure/ faculties/health-human-sciences/ patient-management-in-hazardousenvironments
critical care counterparts in the ambulance service.”
Patient Experience and Community
2016, SWAST HART has acquired
thank them in person. This was the beginning of a much longer series of
Most recently, a year-long
positive outcomes.
Carers Engagement Programme throughout 2019-2020 has been
Mr Gibbs and his wife Sharn
developed and covers the whole
were reunited with the crew in
of Wales. Work has been done in
December 2018, two years after
partnership with Geraldine Powell
the incident. Mr Gibbs finally had
and the first event was held in
the opportunity to say ‘thank you’.
Merthyr Tydfil on 18 July, which Mr and Mrs Gibbs attended. The
During the get-together, Mr Gibbs
latter, who are carers for each
got to explore and understand
other, are now taking part in our
the work that we do, and
patient experience improvement
especially how involved we are
programme.
with raising awareness around certain illnesses across Wales.
No one could have ever imagined
He particularly engaged with our
how many positive steps could
Patient Experience and Community
have come from the initial meet-
Involvement (PECI) team who
up back in December 2018.
organise events and educate
However, this story helps us
the public about how the Welsh
highlight how incredibly useful
Ambulance Service responds and
it is for us to receive feedback
prioritises calls, and also explore
from our patients. Our services
symptoms of certain conditions
are, and always will be, patient-
which can be life-threatening such
focused. We wish all the best to
as meningitis and sepsis.
Mr Gibbs and his wife.
WAS
Each HART paramedic is already their basic HART training, which can take up to six months of intense training. They are then
Back in 2016, Mr Gibbs
equipped with personal protective
suffered from sepsis. Struck by
equipment relevant to the
this life-threatening disease,
disciplines which can include items
he received the help of our
such as a drysuits, respirators,
services from ambulance
ballistic vests and ground kit.
crew Robert Morgan, Ross French and Dewi Jones. His
The role and scope of practice
AMBULANCE UK - OCTOBER
highly trained, having completed
A chance meet sparked a series of positive outcomes
recovery was a journey in itself,
193 Do you have anything you would like to add or include in Newsline? Please contact us and let us know.
NEWSLINE WMAS
WMAS to work with commissioners to take 111 service to next level Plans that would see the integration of the 999 and 111 services in the West Midlands will lead to significant improvements for patient care. An agreement has been reached that will see West Midlands Ambulance Service take over the running of NHS 111 service in the majority of the West Midlands in November. The plan will see the 111 and 999 services integrated into a single service and will lead to further developments in integration with local services for the benefit of patients. The first step of this change will be for the service, across
dental nurses, paramedics and midwives. “We would also expect to see
SWAST
Good Samaritan’ App Saving Lives
more calls diverted to GPs
arrive on scene, our crews
treatment centres and rapid
thanks to a new mobile app
work alongside the GoodSAM
response services operated in the
being used by South Western
volunteer to provide lifesaving
community.
Ambulance Service NHS
treatment.
Foundation Trust (SWASFT). WMAS Chief Executive, Anthony
“We continue to strive to
Marsh, said: “We have an
The GoodSAM app alerts
improve the care we provide,
outstanding track record in
trained responders to cardiac
running complex clinical call
and as GoodSAM responders
arrest incidents in their local
handling operations. This
community, so that they can
continue to rush to the aid of
expertise will allow us to bring
provide lifesaving support
real improvements to the 111
before ambulance crews arrive.
service for both patients and our staff.
For every minute that a cardiac arrest patient doesn’t receive
“We will initially deliver the current
CPR or defibrillation, their
service over the winter period but
chance of survival falls by 10%.
will then look to properly integrate the two in 2020. Staff currently
The GoodSAM app is intended
employed by Care UK will
to increase the number of
TUPE (Transfer of Undertakings
people who survive an out-of-
Protection of Employment) to
hospital arrest.
WMAS. Rhys Hancock, SWASFT Clinical GoodSAM app is a fantastic
of staff so that there is more
innovation, which means our
November 2019.
resilience over the winter period.
community of volunteers can
Rachael Ellis, Chief Officer for
“I firmly believe that this will be
patients sooner and help to
positive for both sets of staff
save lives.
Integrated Urgent & Emergency Care, Sandwell and West Birmingham CCG, said: “This is truly a first for the country and will lead to real benefits for patients
enhance the chance of survival for these patients. Once they
significantly increase the number
from Care UK to WMAS in early
is an additional response to
More lives are being saved
Lead (pictured), said: “The
Staffordshire), to be transferred
our ambulance response, but
(in and out of hours), urgent
“We will also be looking to
the West Midlands (except
“The app does not replace
reach the most seriously-ill
for example, providing new opportunities to develop and
“Every second counts when it
progress their careers.
comes to cardiac arrest. That is why it is vital for these patients
their fellow citizens, more and more people will survive cardiac arrest.” The system automatically alerts off-duty frontline staff and community first responders to a cardiac arrest within 500m of their location. If they accept an alert, the responder is given directions to the scene of the emergency, as well as information about the location of the nearest defibrillator. Following its launch by SWASFT earlier this year, GoodSAM has contributed towards various patients surviving cardiac arrest. These include: • A man surviving a cardiac arrest at home in Exmouth, Devon in July after a volunteer Community First
and staff.
“People who need help in an
to receive intervention as early
urgent or emergency situation are
as possible.
“The new service in development
often anxious and may be unsure
will see fewer patients being sent
how to access NHS services. By
ambulances and a reduction in
integrating 111 and 999, patients
the number of patients asked
can be better directed to the most
central Bristol in July with the
to attend A&E. The new model
appropriate care for their needs.
help of a GoodSAM responder.
AMBULANCE UK - OCTOBER
will support more patients being
Responder (CFR) received an alert through the app. • A man being resuscitated in
• A man being kept alive
cared for in the most appropriate
“It won’t matter which number you
place for their needs.
use, it will be handled by a call
by a team of ambulance
handler who will be able to deal
responders, including a
“This will also include more
with either type. Call 999 only
GoodSAM responder, in
patients being provided with
for life threatening conditions.
August when he stopped
care over the phone by a team
Call 111 if it isn’t an immediate
breathing at home in
including GPs; other healthcare
emergency or a life-threatening
Cheltenham. Following
staff including advanced nurse
condition; whatever number you
treatment at the scene, he
practitioners; community mental
ring the ambulance service will
was taken by land ambulance
health teams; pharmacists,
manage your call.”
to hospital for further care.
194 For further recruitment vacancies visit: www.ambulanceukonline.com
IN PERSON NEAS News
North East Ambulance Service NHS Foundation Trust (NEAS) has appointed Helen Ray as its new Chief Executive. Helen joins the organisation from
crucial part of our senior leadership team in
operational service delivery and create greater
the future.”
bandwidth at the top of the organisation.
Helen said: “I am absolutely delighted to be
Khadir has more than 10 years’ experience
appointed to a high performing ambulance
working at the regional level of the NHS in
trust. I am keen to further support the staff
London. As Director of Performance and
in the great care that they provide. I am also
Improvement and previously the Chief
keen to explore how we can continue to further
Operating Officer for NHS England (London),
improve and develop services together with
Khadir has provided visible and engaging
patients and other stakeholders.”
leadership during a period of significant
Northumbria Healthcare, where she has
change, including during a number of major
been the Chief Operating Officer since that
Helen has previously been joint managing
post was formed in July 2018, overseeing
executive director (operations) for North
urgent and emergency care, medicine, child
Cumbria acute and community services;
Khadir will oversee all aspects of LAS’s
health and community services with Board
deputy chief executive for North Cumbria
operating business, including:
level responsibility and emergency planning
University Hospitals and Chief Operating
and preparedness.
Officer for South Tyneside NHS Foundation Trust. She trained as a nurse and has held a
Helen, who brings a wealth of knowledge
professional registration for 30 years.
and skill from across the NHS with 36 years’ experience, replaces Yvonne Ormston MBE, who left in May to become Chief Executive at Gateshead Health NHS Foundation Trust. NEAS Chairman Peter Strachan said: “I believe Helen’s experience makes her ideally placed to lead our service and work with our partners
LAS News
We appoint Khadir Meer to coordinate all operational delivery in new Chief Operating Officer role
incidents.
• Integrated patient care (including both 111 and 999 call answering and clinical triage) • Emergency ambulance services • Projects and programme delivery • Technical services • Asset and property management Khadir joins LAS in September. A member of the Service’s Board, Khadir will report to CEO Garrett Emmerson who said: “I’m delighted to
across the region to deliver high quality care to local people. I know she brings a passion
London Ambulance Service has announced
welcome Khadir on behalf of the Board and
for patient care and staff wellbeing, which are
that Khadir Meer, currently Director of
executive leadership team. He will bring a
integral to our Trust values.
Performance and Improvement at NHS
wealth of experience and skills to the Service.
England and Improvement (London), is to
“In the new role of Chief Operating Officer,
“I would also like to acknowledge the
join the Trust as its new Chief Operating
overseeing our operational service delivery,
tremendous efforts of our interim Chief
Officer.
Khadir will lead teams at the forefront of our pioneering work in delivering outstanding
Executive Paul Liversidge, who stepped up from Chief Operating Officer following
The role of Chief Operating Officer is a new
patient care on scene, on the phone and
Yvonne’s departure and has given our service
post at LAS. It has been introduced to ensure
online – and providing patients with the best
a steady transition and will continue to be a
greater focus and more joined up and efficient
care for their needs.”
AMBULANCE UK - OCTOBER
195 Do you have anything you would like to add or include? Please contact us and let us know.
IN PERSON NWAS News
Chairman for North West Ambulance Service,
New Non-Executive Director appointed to NWAS
Peter White said: “I’m really pleased to welcome
NHS England and NHS Improvement,
“Alison’s vast knowledge and expertise in
North West has confirmed the appointment
the healthcare sector along with her passion
of Professor Alison Chambers as
for education will make a really valuable
Non-Executive Director of North West Ambulance Service NHS Trust. Currently Pro Vice Chancellor for Health and Social Care at Manchester Metropolitan University, Alison qualified as a Chartered Physiotherapist in 1985 and worked in clinical practice for 10 years specialising in neurological rehabilitation and older person care. She has over 20 years’ experience of
Alison to the trust and am confident that she will be a really positive addition to our board.
contribution to the organisation.” Alison Chambers has been appointed from 1 August 2019 until 31 July 2021 Alison comments: “It is a privilege and honour to be joining such a well-respected organisation and I am really looking forward to meeting as many new colleagues as possible over the next few months.” “It was upon Wilf’s advice that I applied to join
working in higher education. EMAS News
In 1995, Alison took up her first academic
Wilf Prince pictured (right) outside the City Hospital ambulance admissions entrance in the 1980s
86 years of service at EMAS
post at the University of Salford, as a lecturer in physiotherapy. In 2002, she moved to The
Two paramedics who completed their last
University of Central Lancashire to set up
shift on Saturday 31 August managed to
a department of Allied Health Professions
clock up an impressive 86 years of service
and was Dean of Academic Development
at EMAS.
the ambulance service after I saw an advert for the role of driver attendant in the newspaper in October 1977. “On 27 February 1978 I became an official member of the team.”
and Employability until 2014 when she was appointed Pro Vice Chancellor for Health at
Mark and Wilf, who happen to be brothers-in-
Buckinghamshire New University.
law, both had their last shifts working together at the Nottingham Forest Football Club.
Alison is passionate about higher education and places students at the centre. She believes in providing educational opportunity for everyone who can benefit with a strong emphasis on student outcomes and graduate employability.
Wilf Prince started his career at EMAS first on 12th August 1974 when the service was know as Nottinghamshire Ambulance Service. He said: “I had my job interview at Arnold Ambulance Station on Gedling Road and the interviewer took me on a driving test in one of the ambulances around the block.” “After a few minutes he said he was happy with my driving skills and offered me the job.” The recruitment criteria may be a little bit more stringent these days, but that is not the only thing that the legendary pair remember as
Mark Edwards pictured in front of an ambulance in March 1988 Mark and Wilf have seen a lot change during their times at EMAS, including the introduction of lifesaving equipment such as defibrillators in 1983. Mark said: “I was one of the first members of staff who was trained on how to use the defibs during a ten day course at the coronary care unit at Queen’s Medical Centre.
being different from today. AMBULANCE UK - OCTOBER
“We were then able to give cardiac arrest patients Mark Edwards applied to join the ambulance
more of a fighting chance as we could start
service while he was working in a Newsagents.
shocking the heart to try and regain a rhythm.”
Wilf happened to be dating Mark’s sister at the
Wilf shared one of the call-outs that has stood
time, which introduced Mark to what sounded
out for him against all others - The Kegworth
like a very interesting job.
Air Disaster that happened in January 1989.
Mark said: “I used to overhear Wilf talking to
He said: “It was harder to gain the most accurate
my sister about what he had been doing in the
information in those times and we were told that
job and I was really interested.
it was a light plane that had crashed.
196 For more news visit: www.ambulanceukonline.com
IN PERSON “You can imagine how taken aback I was when
Pads) Appeal, which is the only charity
I arrived and saw that it was a 737 aircraft with
in the country dedicated to funding NHS
people strewn everywhere.
hospital helipads.
“I’ll never forget it.”
Arthur Vestey’s appointment comes at an important time for the charity, which has already funded 36 hospital helipads and seen over 12,250 landings on helipads it has funded. There are now over 40 more helipads planned for hospitals around the country; and it is also funding the construction and upgrade of air ambulance base helipads and new critical care cars. All helipad projects built and planned, will cost £71million in total, and aim to save time in getting a critically ill patient to
Arthur Vestey
the lifesaving treatment they urgently need.
Wilf Prince’s identification badge from the 1970s Their last shift was obviously an emotional one. Mark had been an Events Team Leader for the last 17 years of his career with Wilf working alongside him since 2012. EMAS are recruiting 150 new members of staff between July and September this year. Wilf had some advice to give to the fresh new starters.
Vestey, who was an investment manager for six
“As our charity and the number of projects
years, before joining his family’s business, The
grow, Arthur’s extensive experience in the
Vestey Group in 2012, said:
finance sector will be invaluable. His passion for our mission will also ensure that many more
“I am delighted to have become a Trustee of
people across the country will become aware
such a wonderful charity as the HELP Appeal.
of the importance of the HELP Appeal’s work,
Each new helipad is able to save precious
which helps to save time and save lives.”
minutes for many thousands of patients. I look forward to working with the HELP Appeal
The HELP Appeal relies solely on charitable
as they continue with their vital mission
donations and does not receive any
throughout the country.”
government funding or money from the National Lottery. For more information on the
Michael Henriques, Chairman of the County Air
charity visit www.helpappeal.org.uk or call
Ambulance HELP Appeal added:
0800 3898 999.
He said: “Keep plodding on, do the job with all your best efforts and always take note of what your elders tell you. “If you ask for advice, take it.” We wish Mark and Wilf and long and happy retirement.
News
Arthur Vestey, son of Samuel Vestey, the 3rd Baron Vestey GCVO, has accepted his first Trustee role at the County Air Ambulance Trust – a charity founded in 1994, that supports the Helicopter Emergency Medical Services by funding air ambulances’ operational costs and infrastructure projects. Ten years ago, the charity created
AMBULANCE UK - OCTOBER
The Hon. Arthur Vestey appointed Trustee of hospital helipad charity the HELP Appeal
the HELP (Helicopter Emergency Landing
197 Life Connections - The Affordable CPD Provider: www.lifeconnections.uk.com
COMPANY NEWS Mangar hits record sales lifted by the Camel Inflatable Cushion Powys based Mangar Health has announced record annual sales to the period ending July 2019, after winning additional business for their safe patient lifting range of inflatable cushions. “Growth has come off the back of enhanced focus by the UK Ambulance Sector on improved post fall management procedures in care homes,”
service and care homes with
are to people who have fallen.
Mangar Health was acquired by
an early project evaluation
The Camel lifting cushion is
French medical device company
showing an 80% reduction in
a slightly bigger version of
Winncare Group last December
decisions by care homes to
the ELK and has become the
and has seen revenue growth in
call an ambulance within the
equipment of choice for care
both the UK and export markets.
first month of receiving the
homes because it is so easy
equipment.”
to use. This year we saw a
For more information email
phenomenal 40% uplift in sales
cbirt@mangarhealth.com
of this product line alone.”
or call 0800 2800 485
Mangar Health also launched interactive help for carers earlier this year in the shape of an App called ISTUMBLE™. ISTUMBLE™ is an algorithm used by paramedics to perform a health assessment on patients they treat, and the App takes healthcare workers through a check list of steps to ensure it is safe to lift their fallen resident.
said chief executive Simon
Simon adds, “Our ELK lifting
Claridge. “That’s where our
cushion is a product that has
innovative lifting equipment
been used by Ambulance
is used to enable carers to
Services for more than 15 years
deliver a safe, dignified lift for
because it protects paramedics
residents, without the need to
from back injuries when lifting
call an ambulance for support.
patients. There is an ELK in
We have been delighted to
every emergency ambulance
see some excellent outcomes
in the UK because between
for both the ambulance
10% and 20% of all their calls
WHY NOT WRITE FOR US? Resuscitation Today welcomes the submission of clinical papers, case reports and articles that you feel will be of interest to your colleagues. AMBULANCE UK - OCTOBER
The publication is mailed to all resuscitation, A&E and anaesthetic departments plus all intensive care, critical care, coronary care and cardiology units. All submissions should be forwarded to info@mediapublishingcompany.com
If you have any queries please contact the publisher Terry Gardner via: info@mediapublishingcompany.com
198 For further recruitment vacancies visit: www.ambulanceukonline.com
COMPANY NEWS Firescape launches UK’s smallest aerosol extinguisher ideal for ambulance crews
use, cost-effective and packs the
friendly extinguisher around as
punch of much bigger products.
we recognised there is a need in the market, particularly for
It is also ideal for those who work
organisations like the ambulance
in ambulance fleet maintenance
service, for this product.”
or for crews on the road to keep in their cab as Spray-Safe can
Spray-Safe is a lightweight aerosol
put out engine fires in seconds
extinguisher containing 200ml of
and is a cost-effective solution for
fluid, has no mechanical parts.
Backed by the London Fire Brigade, Firescape is launching a new range of state-of-the-art fire safety equipment, including the UK’s smallest aerosol extinguisher ideal for ambulance crews to stow in their cabs without taking up precious space.
budget-strapped authorities. The Fire Service advice is to Firescape Managing Director
tackle vehicle fires only if it’s
Paul Jameson said: “Every year
safe to do so. If the fire is in the
in the UK there are over 100,000
engine compartment, they advise
vehicles, which is nearly 300 a
people not to open the bonnet but
day, that go up in flames and
aim the extinguisher through the
sadly more than a hundred
radiator grille or under the edge of
people a year die as a result.
the bonnet.
The British-based company has
“Over a third of these (35%) are
Added Paul: “We designed Spray-
spent years developing their
accidental fires so it’s crucial fleet
Safe to be easy to use. Just hold
revolutionary products, which
managers do whatever they can
the bottle firmly and keep your
include the new Spray-Safe
to minimise potential fire risks,
arm out of range of the fire then
aerosol, ideal for all types of
from maintaining their vehicles to
douse the area. SpraySafe is one
vehicles to combat engine or
ensuring they equip their drivers
of the only fire safety products
interior blazes.
with the latest technology.
to work at all angles giving you
Perfect for the ambulance service,
“That’s why Firescape is so
with no loss of pressure. It’s as
Spray-Safe doesn’t require
proud to launch Spray-Safe as
simple as that which is why we
ongoing maintenance, is easy to
the most advanced and user-
are getting so much interest from
a 360-degree spray capability
those businesses and services with vehicles constantly on the road. It also suits companies where there is often imminent danger of further fires such as an accident. That’s why spreading the word to the ambulance service is so important to us.” To find out more visit www.firescape.uk, call 0207 870 4890 or email. kellyf@fireacape.uk
“Every year in the UK there are over 100,000 vehicles, which is nearly 300 a day, that go up in flames and sadly more than a hundred people a year die as a result.
WHY NOT WRITE FOR US? Ambulance UK welcomes the submission of clinical papers and case reports or news that you feel will be of interest to your colleagues.
All submissions should be forwarded to info@mediapublishingcompany.com
If you have any queries please contact the publisher Terry Gardner via: info@mediapublishingcompany.com
AMBULANCE UK - OCTOBER
Material submitted will be seen by those working within the public and private sector of the Ambulance Service, Air Ambulance Operators, BASICS Doctors etc.
199 For the latest Ambulance Service News visit: www.ambulancenewsdesk.com