Issue 20 - Resuscitation Council (UK)

Resuscitation Council (UK)
news
letter
In this issue …
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Issue 20
summer 2010
Chairman’s annual report
Annual reports from
the Chairmen of
the subcommittees:
ALS
ILS
EPLS and PILS
NLS
BLS/AED Subcommittee annual report
Research Subcommittee annual report
Paediatric Committee annual report
New Executive and Honorary Members
Scientific Symposium 2010
Resuscitation Guidelines 2010
National Cardiac Arrest Audit (NCAA) – Progress update
Hazardous Area Response Teams (HART)
Group photo after 2010 Annual General Meeting
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Issue 20
summer 2010
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From the
Chairman
Chairman’s
annual
report
At the end of my first year as Chair, I am pleased
to report that the RC(UK) continues to go from
strength to strength and spread its influence in an
increasing number of areas. This is thanks to the
highly efficient team at the RC(UK) and the large
number of individuals who volunteer their time and
effort. Despite the economic downturn, I think the
RC(UK) remains in a good position to continue its
important role in delivering high quality
resuscitation guidelines, standards and training
for the benefit of patients.
We are all eagerly looking forward to Guidelines 2010. The International
Liaison Committee for Resuscitation (ILCOR) will publish the Consensus on
Science and Treatment Recommendations (CoSTR) on 18 October 2010.
The European Resuscitation Council (ERC) Guidelines based on the ILCOR
CoSTR will be published at the same time. We plan to publish the RC(UK)
guidelines shortly after this. We are fortunate to have had a large number of
individuals from the UK involved in the ILCOR and ERC guidelines processes.
We will make every effort to ensure that we post updates on the process on our website and
newsletters. The RC(UK) Guidelines 2010 project team chaired by Jerry Nolan will oversee the
process.
The RC(UK) continues to spread its influence in a number of areas. This includes working with
NICE as stakeholders, the NHS Litigation Authority about CNST standards, and the Royal
College of Anaesthetists on its continuing professional development matrix and training syllabus.
We have also collaborated with the National Patients Safety Agency (NPSA) on several projects.
David Gabbott has worked with the NPSA to produce a report on incidents in mental health
settings, and commented on rapid response reports on oxygen therapy. We have also reviewed
critical incidents related to resuscitation that have been reported to the NPSA’s national reporting
and learning system (NRLS). I am hoping the information gleaned from the reports will help us
improve resuscitation practice and where possible we can incorporate the key issues in to our
course materials. The Council produced guidance for CPR during the swine flu outbreak in
collaboration with the Health Protection Agency. Guidance on Safer Handling was also updated.
We are currently updating the ‘Legal status of those who attempt resuscitation’ document.
The annual symposium at the College of Physicians in London was again well attended. In the
Asmund Laerdal lecture, Bob Bingham reminded us all that when it comes to resuscitation
‘children are different, but they are not a different species’. The 2010 symposium will be on
18 November. This will be a good opportunity to hear the new guidelines and also find out about
changes to our courses. The guidelines 2005 meeting was oversubscribed, so book early to
avoid disappointment.
Issue 20
summer 2010
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2

Chairman’s annual
report (continued)
iResus is the new RC(UK) iPhone ‘app’. It was
launched at the beginning of the year and enables
rapid access to the latest resuscitation guidelines
and updates. It is free and has so far been
downloaded by over 25,000 users.
The e-ALS study also continues and I thank all those centres involved in recruiting patients. The
Australian Resuscitation Council has joined the e-ALS project. The experience of the pilot phase
and results of the trial comparing the current ALS course with e-ALS will help with decision
making regarding how the Resuscitation Council (UK) delivers its courses in the future.
The National Cardiac Arrest Audit (NCAA) is now up and running with over 50 hospitals signed up
and the numbers still growing. If your hospital has not yet joined NCAA, I strongly encourage you
to join. Analysis of good quality local and national cardiac arrest data will help us all identify areas
where we can improve the care of patients who need resuscitation.
A brief historical note before I end – CPR celebrates its 50th birthday this year. On 9 July 1960
Kouwenhoven, Jude and Knickerbocker published their landmark paper on chest compressions
and as they say ‘ the rest is history’.
Finally, I would like to thank Sarah Mitchell, Sara Harris, all the RC(UK) staff, the Officers, and
members our Committees; these individuals all devote much of their own time to the work of the
Council and I am very grateful for their help. The success of the Council also depends on the
large number of individuals who help spread our guidelines and teach our courses. Their work
has no doubt saved numerous lives – I would like to thank these individuals on behalf of the
Resuscitation Council (UK).
Jasmeet Soar,
Chairman, Resuscitation Council (UK)
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3

ALS
Subcommittee
annual
report
ALS provider course statistics for 2009
It has been another successful year for the ALS
Course. Despite concerns with regards to study
leave and professional leave availability, the
number of courses still exceeds 700 and the
number of candidates processed is similar to
previous years. The number of course centres has
reduced compared to last year (274) as the
database has been amended to remove inactive
course centres.
Number of ALS and e-ALS courses 676 + 104 = 780 (745 in 2008)
Number of Recertification courses 45 (48 in 2008)
Number of Course Centres 197
New Course Centres 3
Number of candidates 16,422 (16,759 in 2008)
Number of ALS Instructors 5,945
Number of Instructor Candidates (ICs) 1,501
Projected number of courses for 2010 567 ALS + 113 e-ALS / 42 Recert
e-ALS
The electronic ALS course project (e-ALS) led by Dr Gavin Perkins (Vice Chair ALS
Subcommittee) is exploring the effectiveness of delivering some of the components of the
traditional ALS Course in an e-learning format thus allowing a reduction in the duration of face-toface
training. The study is randomizing participants to either an e-learning course (1 day
e-learning material and 1 day face-to-face tuition) or traditional ALS course (2 day face- to-face).
The Resuscitation Council (UK) was delighted that the Australian Resuscitation Council agreed to
join this project late last year and we are looking forward to a successful collaboration. The trial is
on target to complete accrual by the end of September 2010. We anticipate having the results
ready for presentation at the Resuscitation Council (UK) Scientific Symposium in November 2010.
Two representatives from each participating centre have been invited to attend the symposium in
order to hear the results of the trial first hand.
I am indebted to Gavin Perkins, Robin Davies, Jenny Lam, Sara Harris and Sarah Mitchell for all
the work they have been putting in behind the scenes to make this project a success.
Issue 20
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4

ALS Subcommittee
annual report
(continued)
Generic instructor course (GIC) statistics for 2009
Number of GICs 68 (59 in 2008)
Number of candidates 910 (771 in 2008)
Number of GIC Course Centres 51
New Course Centres 3
After an extensive period of planning by the Educator Group and a successful pilot period, a new
programme has been developed for the GIC which will be implemented in September. The
principle differences include a different format for feedback and greater emphasis on mentoring
skills. The new course is now ready to be rolled out and I am extremely grateful for the hard work
of all the Educators from the Resuscitation Council (UK) and ALSG under the leadership of Ian
Bullock and Mike Davis.
New ALS course materials
The 2010 Guidelines are due to be released on 18 October and work is already ongoing to update
the ALS Manual and course materials. We should have all this work completed so that the first
courses can be run in January 2011. We do not envisage any change to the structure of the
course at this stage. There is no moratorium planned for courses up until this date.
Thanks
The ALS Course could not function without the hard work and dedication of all of the Instructors. It
is becoming increasingly difficult for them to secure time off to teach and yet they continue to do so
to a high standard and I am extremely grateful for this. In addition, we have a strong cadre of
Regional Representatives who also deserve credit for their hard work.
It is with some sadness that I complete this report as it is my last one as ALS Subcommittee Chair.
By the end of the year, I will have completed seven years as Chair including overseeing two sets of
guideline changes. In this time, I have seen the course flourish and the Subcommittee embrace a
proactive approach to technological developments. As always, I must register my grateful thanks
to all members of the ALS Subcommittee. My thanks go also to the course co-ordinators Dami
Daramola and Helen Keen, as well as the administrative staff at the Resuscitation Council (UK).
I am looking forward to fresh challenges within the Resuscitation Council (UK) and will continue to
represent the specialty of Emergency Medicine on the ALS Subcommittee.
Andy Lockey
Chairman, ALS Course Subcommittee
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5

ILS
Subcommittee
annual
report
Course statistics
2002 2003 2004 2005 2006 2007 2008 2009 2010*
Centres 137 160 189 206 219 233 245 247 240
Number of
candidates
ILS
17,281
29,805
37,704
44,733
50,816
56,041
55,851
61,743
21,740
Recertification
127
2,136
4,260
6,895
3,889
6,277
11,383
14,222
5,025
Number of
ILS
courses
Number of
recertification
courses
1,887 3,259 4,260 4,948 5,297 6,047 6,005 6,628 2,289
18 381 714 1,158 553 894 1,538 1,904 676
* 2010 data based on course returns up to 18 May 2010
1. The ILS course continued to grow in terms of numbers of candidates.
2. The results of a detailed survey of all course centres in 2009 will be used to help update
course materials.
3. All course centres have been contacted regarding changes to the faculty regulations
that will be implemented over 2011/2012. All those who teach ILS will have to have
completed either the Generic Instructor Course (GIC) or the ILS instructor course.
4. The continuing success of ILS depends on the hard work of a large number of individuals
whom I wish to thank:
The resuscitation officers, instructors and staff at course centres across the UK.
The ILS subcommittee members.
Karla Wright, ILS co-ordinator, and the team in the RC(UK) office.
Dr Jasmeet Soar
Chairman, ILS course Subcommittee
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6

EPLS
Subcommittee
annual
report
The courses, EPLS and PILS, continue to go
from strength to strength. As can be seen from
the figures below, the PILS course continues to
increase considerably in terms of popularity.
EPLS
PILS
2008 2009 2008 2009
Centres 79 72 132 131
Courses 101 104 810 1185
Cancelled
courses
20 20 0 0
Candidates 2152 2157 7250 9980
… of which:
Doctors 1013 1009 1226 1659
Nurses 917 926 5564 7646
Others 222 222 460 675
The subcommittee has met regularly this last year to consider and begin work on updating the
courses with Guidelines 2010. The timetable for the incorporation of these new guidelines is that
the new course materials for EPLS and PILS will be with the course centres for courses in May
2011.
Work has continued on producing a robust MCQ paper for EPLS – and many thanks are due to
the instructors who have worked hard in sitting the test paper and providing their feedback.
I would like to thank Jackie Younker and John Trounce for their work. They are unable to remain
on the subcommittee due to other commitments. I am delighted that Sophie Skellett, Serena
Cottrell and Liz Norris have joined the subcommittee and I would like to thank them and all the
other members for the enormous amount of their own time they put in to all the projects we
embark upon. And finally, my thanks to Karen Cooper, EPLS co-ordinator, and to Sara Harris
and Sarah Mitchell for their support.
Ian Maconochie
Chairman, EPLS Subcommittee
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7

NLS
Subcommittee
annual
report
The NLS course is well established in the UK and
successful completion of a course is expected of all
junior paediatric medical staff during the first two
years of specialisation. Numbers of midwives and
nurses have continued to balance medical staff attending courses. During 2009 and 2010 the
number of courses in the UK has increased yet again and courses in Europe have continued to
develop. At the present time there are now 90 course centres spread throughout England,
Scotland, Wales and Northern Ireland.
This success since the launch of the NLS course has been due to the work and enthusiasm of
many, but none more than Sam Richmond who in 2010 has stepped down as chair of the NLS
working group after 8 years. He has chaired the working group from the first pilot courses though
to its present position and will continue as co-author of the 2010 ERC neonatal guidelines and as
the editor of the next version of the NLS Manual due out early in 2011. The whole working group
wish to register their thanks for Sam’s leadership, encyclopaedic knowledge of resuscitation
research and almost boundless enthusiasm.
NLS Working Group
With the retirement of Sam Richmond, I have taken over as chair of the working group which has
also welcomed Dr Sean Ainsworth, a neonatologist from Kirkaldy.
Courses held and providers trained
The number of candidates undertaking the NLS course under RC(UK) administration has increased
through 2009 with 4527 candidates attending 223 courses. The proportion of doctors (36.5%),
midwives (30.2%), nurses (30.3%) and allied professions (3%) remained similar to recent years.
The failure rate for candidates attending the course in 2009 year was 4%. At present there are a
total of 162 course directors, 1114 NLS instructors and 369 instructor candidates in the UK. It
would appear that there is still room for growth in NLS courses and places, although the present
financial climate may make it more difficult for midwifery and nursing candidates.
ILCOR 2010 and Guidelines 2010
Several members of the working group have been heavily involved in the neonatal subsection of
the ILCOR 2010 process, culminating in the CoSTR document which will be published in October
2010. This document forms the evidential basis for new RC(UK) guidelines for newborn
resuscitation which will be published on-line simultaneously. The ERC newborn resuscitation
guidelines will also be published at the same time and the new NLS manual will be available for
courses in May 2011.
Jonathan Wyllie
Chairman, NLS Course Subcommittee
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8

BLS / AED
Subcommittee
annual
report
The Subcommittee met face-to-face on two
occasions over the year.
Changes in membership
Two members, Mary Richardson and Dr Richard Elliott, have resigned for work-related reasons.
Dr Mick Colquhoun has taken on the role of Deputy Chairman.
Discussions and statements
The statement on ‘Training required to use an AED’ was reviewed, and additional wording
recommended. The revised statement is on the Council web site.
Considerable discussion has taken place regarding the statement ‘Legal status of those who
provide CPR’ with input from the Council’s solicitor. The work is ongoing, but it is anticipated that
the final draft will be ready shortly for approval by the Executive Committee.
The Subcommittee agreed a statement on ‘Swine flu: first aid advice on cardiopulmonary
resuscitation’ to supplement the Council’s statement on swine flu, which is aimed mainly at the inhospital
/ ALS environment.
The Council received an enquiry about AEDs being kept in locked cabinets. The Subcommittee
recommended that AEDs should be readily accessible and well-signed. Following contact with the
BHF, a statement is now on the Council’s web site.
Following a specific enquiry on how to manage a patient who vomits (regurgitates) during CPR, the
Chairman presented the advice contained in the RLSS UK publication. This will now form the
formal recommendation of the Subcommittee.
Guidelines 2010
A number of topics, not covered by the current RC(UK) BLS/AED guidelines, have been identified,
and will be considered for inclusion in the forthcoming 2010 guidelines. These topics include:
What to do if the patient vomits; how to resuscitate obese or pregnant patients; defibrillation on wet
or metal surfaces; storage of AEDs; AED signage; who can use an AED; risk assessment and
cost-effectiveness when deciding if an AED is required.
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BLS/AED
Subcommittee
annual report
(continued)
Future work
The following tasks have been identified as priorities:
1. Interpret guideline changes and advise on implementation
2. Promote awareness of guideline changes and their dissemination
3. Answer enquiries relating to adult BLS and use of an AED
4. Liaise with ERC, ILCOR, and national and international organisations involved in
BLS/AED training
5. Support the national database on AEDs
6. Provide an RC(UK) CPR/AED training manual, syllabus, and competences.
Anthony J Handley
Chairman, BLS/AED Subcommittee
Research
Subcommittee
annual
report
This is the report of the Research subcommittee for the year 2009 - 2010. The Resuscitation
Council (UK) has always supported research into the science of resuscitation and in order to further
these aims, the Research subcommittee considers all reasonable and appropriate applications for
research funding in this area. We have a yearly budget for both Grants and Fellowship awards.
This last financial year the Research subcommittee budget was £150,000 which was made
generally available to support external Grant and Fellowship awards. The Resuscitation Council
(UK) continues to meet the criteria for NIHR Partner Organisation status.
During 2009 - 2010 the subcommittee has dealt with all its matters via the telephone and
electronically. The pages on the Resuscitation Council (UK) website have been updated. We have
offered advice to potential applicants throughout this time and we have formally considered seven
applications during this financial year.
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10

Research
Subcommittee
annual report
(continued)
NCAA (National Cardiac Arrest Audit)
RC(UK) continues to jointly fund this project with ICNARC and significant progress has been made
in 2009/10. The two organisations have collaborated to develop a nationwide database of cardiac
arrests that take place in hospital. The project went live this financial year and as of April 2010
over 50 hospitals have signed up. The aim is to enable analysis of all in-hospital cardiac arrests
and to compare the frequency of, and outcome from, cardiac arrest between hospitals.
The Council continues to fund and oversee the national Automated External Defibrillator Event
database which logs the outcomes following resuscitation attempts by lay people. This project is in
collaboration with the Department of Health and the British Heart Foundation.
iResus Application for the iPhone
RC(UK) has funded the development and launch of this resuscitation application in conjunction with
iMobileMedic for the iPhone. The application is free and will be continuously updated and
expanded. To date there have been over 25,000 downloads.
The Research subcommittee is keen to support future projects and would welcome applications for
research funds for the current financial year. We are also happy to advise prospective applicants
prior to making a formal application for funds as to whether their application is appropriate.
Scientific Symposium
Research abstracts for the 2010 Annual Scientific Symposium on 18 November must be submitted
by 31 August, 2010 – full details are on the website. This is a great opportunity for presenting new
research or preliminary data to a large audience of interested resuscitation enthusiasts. This year
as well as the best 5 oral presentations we will be accepting posters for presentation at the
meeting.
Once again I would like to thank all the Research subcommittee members for their time throughout
the year, Sara Harris in particular for all her hard work and support and Sarah Mitchell for her
invaluable advice.
David Gabbott
Chairman, Research Subcommittee
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11

Membership:
Paediatric
Committee
annual
report
Name
Bob Bingham (Chair)
Serena Cottrell
Peter Mark-Fortune
Fiona Jewkes
Ian Maconochie
Sheila Simpson
Jonathan Wyllie
David Zideman
Representing
Paediatric anaesthesia
Paediatric intensive care
Paediatric intensive care
Pre-hospital care
Paediatric emergency medicine
Paediatric nursing and ROs
Neonatal resuscitation
Paediatric anaesthesia and Olympic sport!
The main duty of the paediatric committee is to ensure that the Council fully considers the needs
of children in the conduct of its business. The committee offers advice, prepares statements and
answers questions on paediatric matters addressed to the Council.
Activities
In the last year, committee members have been primarily involved in the preparation of guideline
and educational materials for the release of Guidelines 2010. David Zideman, Ian Maconochie,
Bob Bingham and Jonathan Wyllie have conducted ILCOR worksheet reviews and were present
at the consensus conference in Dallas and participated in the preparation of the Consensus on
Science and Treatment Recommendations (CoSTR). These members have also been involved
in the writing of the ERC guidelines.
Fiona Jewkes and David Zideman have been preparing statements to provide answers to FAQs,
which may arise from the release of Guidelines 2010. Serena Cottrell and Peter Mark-Fortune
have contributed to the discussion over the paediatric content of the DNAR document and a
paediatric statement and form has been included. Bob Bingham has been attending the NCAA
meetings to provide paediatric input into the audit.
A list of research questions, which the committee considers a priority, is also being prepared. It
is envisaged that this will eventually form a resource for potential researchers and a guide for
review of grant applications.
As mentioned in the EPLS course subcommittee report, preparations for the revision of the UK
EPLS and NLS course materials are well under way and members of the paediatric
subcommittee, particularly Ian Maconochie, Sheila Simpson and Jonathan Wyllie are fully
involved.
Bob Bingham
Chairman, Paediatric Committee
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12

New Executive
and Honorary
Members
At the annual general meeting Jerry Nolan’s tenure as Vice Chairman was complete and he was
re-elected as a member of the Executive. David Pitcher was elected Vice-Chairman (Chairmanelect)
and will become Chairman of the Resuscitation Council (UK) in June 2012. Andy Lockey
was elected Honorary Secretary. Jamie Fulton was elected as a new member of the Executive.
Four members were nominated for Honorary membership: Dr Andrew Marsden, Dr Jerry
Nolan, Dr Robert Bingham, and Dr Sam Richmond. Jas Soar recommended all as highly
deserving of the nomination for their invaluable contributions to the Resuscitation Council (UK).
These nominations had been approved by the Executive and were ratified at the AGM.
Scientific
2010 Symposium
View the group photo
taken after the AGM
Click here
The Scientific Symposium meeting is on Thursday 18 November at the National Motorcycle
Museum, Solihull.
At this meeting the new guidelines and the science will be presented. The full programme is
available on our website. Six hundred delegates have already registered and we will be closing
registration soon.
Presentation of Free Papers and Posters
LAST CALL
This year’s presentations can be presented either as an oral presentation or as a poster. The
Research Subcommittee will decide which presentations will be oral and which will be posters
(unless you express your wish not to present orally). If you would like the opportunity to present
at the Symposium please submit your application no later than 31 August. Full details and an
application form can be downloaded from the website. Please return your application to Sara
Harris at sara.harris@resus.org.uk
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13

Resuscitation
2010 Guidelines
A Guidelines 2010 project team, chaired by Jerry Nolan, was set up last year to look at implementing
the new guidelines and producing updated course materials. Our aim is to deliver the guidelines
quickly, without confusion, and to disseminate the course material in a timely manner. The new
guidelines will be published on our website on 18 October 2010.
The Resuscitation Council (UK) is not imposing a moratorium on its courses; it is in the best interests
of healthcare staff and patients that centres continue providing training right up until the new material
is available. This strategy worked well in 2005. We have been in discussion with the NPSA on
implementation, and have written to all Trusts and instructors, and other relevant organisations to
keep them informed.
We are aiming that the first of each of the new courses shall be held as follows:
ALS and ILS January 2011
EPLS and PILS May 2011
NLS May 2011
The RC(UK) has not increased its registration costs since 1998. As the new courses are introduced
the price of the course ALS/EPLS and NLS manuals will increase by £3 each and each candidate
registration will increase by £2. The GIC registration will also increase to £22 in January 2011.
There is no increase in the cost of annual registration for PILS and ILS although the manuals will
increase by 50 pence each. Instructors and Instructor candidates will be invited to apply on line to
receive a complimentary copy of new course manuals.
National
Cardiac
Arrest
Audit (NCAA) Progress update 4
NCAA is a joint initiative between the Resuscitation Council (UK) and ICNARC (Intensive Care
National Audit & Research Centre) to establish an audit of in-hospital cardiac arrests with a view
to improving resuscitation care and patient outcomes.
Since NCAA began in September 2009, a total of 60 hospitals have signed up to participate.
A list of these hospitals is available to download from the ICNARC website (www.icnarc.org).
Follow the quick link ‘National Cardiac Arrest Audit (NCAA)’.
Recruitment is ongoing so if your hospital would like more information about the audit please
contact the NCAA Team on ncaa@icnarc.org
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15 14

National Cardiac
Arrest Audit (NCAR)
Progress update
(continued)
First NCAA Participants Meeting - 28 June 2010
The First NCAA Participants Meeting was held on 28 June in London and was attended by 34
delegates from 29 participating hospitals. This was a great turnout with over half of all hospitals
signed up to NCAA represented. Those attending contributed to the informal and interactive
discussions around the initial scope for NCAA data collection, the current Level A dataset and the
development of NCAA reports. Many thanks to all delegates who attended the meeting and
participated in all of the discussions.
Two members of the NCAA Steering Group; Jerry Nolan (NCAA Steering Group Chair) and Sarah
Mitchell (Director, Resuscitation Council (UK)) also attended the meeting as well as the NCAA Team
from ICNARC.
To facilitate discussions around the development of NCAA reports, some early NCAA analyses were
shared with the group. Those attending were very helpful in contributing their ideas for what they
would like to see in the reports.
Evaluation Forms and post-event feedback indicated that delegates found it to be a useful and
informative meeting.
Current focus
The NCAA Team are currently focusing on data validation and the development of an NCAA Data
Validation Report. This report will inform hospitals about the timeliness of their data entry and the
completeness and validity of their NCAA data, and will help improve the quality of NCAA data. We
will be providing each participating hospital with an NCAA Data Validation Report as soon as
possible.
The current target for the provision of NCAA Activity Reports is by the end of October 2010. It is
hoped that comparative reports will be available by the end of the year.
New developments
The Level A dataset is being reviewed. All participants will be informed of the minor changes to the
dataset in due course.
Date for your diary – NCAA Launch
The Second NCAA Participants Meeting and official NCAA Launch and will be held on Monday,
4 October 2010 in Central London. More details for these events will be circulated in due course.
Sarah Mitchell Kathy Rowan Edel Gallagher
Director Director NCAA Coordinator
Resuscitation Council (UK) ICNARC ICNARC
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15

Hazardous Area
Response Teams
(HART)
The provision of pre-hospital emergency medical care is never more challenging than in confined
spaces or contaminated areas. Clearly these situations put staff at significant risk and the general
aim is therefore to remove the patient from the hazardous environment prior to treating them.
Traditionally the Ambulance Service had always operated within the ‘cold zone’ of an incident; an
area free from contamination and deemed to be a safe working environment. The immediate
responsibility for extracting patients from the inner cordon (also known as ‘the hot zone’) of a major
hazardous incident has fallen to the fire service who are trained and equipped to work in these
environments.
With the limited clinical skills that could be provided with this arrangement, it was recognized that
there was a need to look at providing more advanced medical care during the early stages of a
hazardous incident, particularly if the patient was trapped or extrication was delayed. A number of
recent major incidents, together with an increasing threat of a chemical, biological, radiological or
nuclear (CBRN) incident reinforced the need to look at delivering advanced medical care in more
hazardous environments.
About ten years ago, ambulance services had recognized the need to move clinical care further
forward, and began to train and equip staff to work within a ‘warm zone’ environment, to assist with
immediate medical care and the provision of decontamination to casualties and emergency service
workers.
In 2004, the Department of Health approached the Ambulance Service Association (ASA) to look
into the feasibility of moving clinical care a step nearer to the core of the incident, with ambulance
personnel working alongside other emergency personnel in the ‘hot zone’ of a major hazardous
incident. The following year, experts from UK ambulance services, doctors and CBRN specialists
reported that not being able to deliver advanced clinical care in the ‘hot zone’ of a major incident
was likely to result in an impeded effective ambulance response with an inability to undertake life
saving interventions at the early stages of a CBRN or hazardous material (HAZMAT) incident.
The need to introduce ‘hot zone’ working was reinforced by the subsequent terrorist bombings in
London on 7 July 2005 that demonstrated the life-saving benefits of delivering immediate medical
care in a potentially hazardous environment to patients who were trapped in wreckage.
As a result of the recognized need to deliver clinical care within the ‘hot zone’, the Hazardous Area
Response Team (HART) programme was born which aims to train and equip ambulance
personnel to work safely in contaminated environments or in the presence of serious hazards such
as collapsed structures. Shortly after HART’s inception, the Department of Health was
approached by the Fire and Rescue Service with a request to provide trained paramedics for their
Urban Search and Rescue (USAR) teams. In 2006, it was therefore decided to add a USAR
capability to the HART project.
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16

Hazardous Area
Response Teams
(HART)
(continued)
Within the HART programme, there are two components:
HART IRU (Incident Response Unit)
The Incident Response Unit provides a team trained to work in HAZMAT and CBRN
environments to support other emergency services and other specialist agencies, and
deliver clinical care in the ‘hot zone’ of an incident. These teams are able to work in
accidental incidents or those involving deliberate harm, e.g. terrorist attacks. Typical
events attended by the HART IRU would include a chemical explosion at a factory, large
fires, explosions or a suspected terrorist attack. The HART IRU can also provide support
for the military (within England) and assist the police with medical support for covert
operations.
HART USAR (Urban Search and Rescue)
HART USAR paramedics are trained to work in dangerous and hazardous environments
such as collapsed buildings or crashed vehicles. HART USAR paramedics are taught
extended clinical skills which enable them to provide advanced clinical intervention during
the rescue of casualties from these environments. HART USAR teams would typically
work at incidents that involve collapsed buildings or structures (e.g. scaffolding), in
tunnels, such as a major evacuation of a tube train, heavy transportation or multiple
vehicle collisions resulting in a number of casualties or at height, e.g. on construction
sites.
Eventually it is anticipated that other specialist groups, such as the Maritime Incident Response
Group (MIRG) will also be incorporated into HART.
HART training
The paramedics selected for these teams are required to pass additional fitness and aptitude
tests before undertaking a rigorous training programming involving all aspects of safe working in
HAZMAT and CBRN incidents. When not working on a HART mission, these paramedics are
integrated into the normal ambulance service response.
Issue 20
summer 2010
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17

Hazardous Area
Response Teams
(HART)
(continued)
HART training session
HART Roll-out
HART are being rolled out across all UK Ambulance Trusts, with 12 bases being established in
England, with similar capabilities being established in Scotland, Wales and Northern Ireland. The
London HART teams have been established for several years and all English teams are planned
to be fully operational by April 2011. Each Ambulance Trust has access to a 24/7 response that
can be backed up with further resources through mutual aid arrangements from neighbouring
Trusts.
Charles Deakin
Issue 20
summer 2010
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18

Group photo
after the 2010
Annual General Meeting
Members of the Executive Committee, Subcommittees and RC(UK) staff after the 2010 Annual
General Meeting.
In this photo (left to right):
Dr James Fullerton, Dami Daramola (staff), Dr Harry Walmsley (Honorary Treasurer), Dr Jamie
Fulton (Executive Committee), Dr Anthony Handley (Company Secretary, Chairman, BLS/AED
Sub-Committee), Dr Mick Colquhoun (Executive Committee), Dr Fiona Jewkes (Executive
Committee), Dr David Gabbott (Chairman, Research Sub-Committee), Dr Jasmeet Soar
(Chairman, Chairman, ILS Course Sub-Committee), Dr Charles Deakin (Executive Committee),
Dr Carl Gwinnutt (Executive Committee), Sarah Mitchell (Director Resuscitation Council (UK)), Dr
Kin Leong Kong (Executive Committee), Dr David Pitcher (Vice Chairman), Dr Serena Cottrell
(Executive Committee), Dr Andy Lockey (Honorary Secretary, Chairman, ALS Course Sub-
Committee), Sara Harris (staff), Dr Jerry Nolan (Executive Committee), Susan Hampshire
(Executive Committee) Dr Peter-Marc Fortune (Executive Committee), Jonathan Wyllie
(Chairman, NLS Course Sub-Committee), Dr Bob Bingham (Chair, Paediatric Committee), Jenny
Lam (staff), Linda Steel (staff), Dr Ian Maconochie (Chairman, EPLS Course Sub-Committee),
Bob Harris (staff).
Let us know what you think:
If you have any comments regarding this newsletter, please
contact us at enquiries@resus.org.uk
Issue 20
summer 2010
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19