Ambulance

TODAY 

Spring 2016 - Issue 1 | Volume 13 

Ambulance 

The global magazine for all people involved in ambulance provision 

Now going out globally to over 300,000 ambulance workers 

in partnership with NAEMT, IAED and UNISON 

Un 

This issue is supported by 

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in the Making 

On May 30th EMS leaders from 

across Europe will gather in 

Copenhagen for the first ever 

European EMS congress and to 

launch the new European EMS 

Leadership Network 

Will you be there? 

This special edition celebrates both momentous events 

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Guest Editor’s Comment 

Now is the moment to put co-operation 

at the heart of European EMS 

Freddy Lippert, MD 

CEO Capital Region Copenhagen 

and co-founder of EMS2016 

Produced in partnership with 

This issue of Ambulance Today is a historic one. It 

is the spring issue preceding the first European 

Emergency Medical Services Congress, EMS2016, 

which will be taking place in Copenhagen from May 

30th until June 1st. EMS2016 will not only be the 

first of its kind, it will also be a platform for obtaining 

further much-needed co-operation between EMSsystems. 

Significant things are happening in Europe right 

now - not only the recent terror attacks in Paris, 

Ankara and Brussels but also the surge of refugees 

moving through Europe. The tragic and worrying 

nature of these events should remind us all that 

the role of EMS is becoming increasingly more vital 

to the individuals and communities we serve. We 

experience a growing public expectation of the level 

of healthcare we provide to our communities 24-7. 

All of which means that now - more than ever - it 

is important that we make a special effort to share 

the latest knowledge and technology and to cooperate 

across Europe and beyond to identify best 

practice. This is vital if we intend to find effective new 

solutions to the healthcare challenges we all face. 

This understanding of the urgent need to share 

knowledge with each other is one of the primary 

reasons we are organizing the first European EMS 

congress. A European EMS Leadership Network will 

also be launched at EMS2016. The primary purpose 

of this new network will be to allow EMS countries 

to explore each other’s strengths and limitations 

and to outline a shared vision for our European 

emergency care system. This new European 

Leadership Network will come together regularly to 

identify and develop the strategies needed to reach 

both our common and local EMS goals. You can read 

more about our exciting new network inside this 

edition. 

The area of pre-hospital emergency care and EMS 

has advanced at a steady but increasingly rapid pace 

during the last decades. This development is due 

to the dedicated efforts of ardent EMS pioneers 

who have given careful thought to the shaping 

of our modern EMS systems. There is no better 

example of this than the person we have invited 

to open EMS2016. We are greatly honored that 

our inaugural keynote speaker will be Professor 

Douglas Chamberlain. Douglas is also known as the 

father of modern paramedic practice. He was the 

first to recognize the need for, and then implement, 

resuscitation training for British ambulance personnel. 

Furthermore over more than five decades he has 

led the way by encouraging EMS leaders globally to 

recognize the value of sharing good practice and 

innovations in pre-hospital care. Modern EMSsystems 

and pre-hospital medicine are now emerging 

further towards an evidence-based practice. But the 

question is: How can we best translate knowledge 

and science into clinical practice? 

This exact question was put sharply in focus when 

Emergency Medical Services leaders, researchers, 

and experts from across the world convened in 

June 2015 at Utstein Abbey in Norway, to address 

the challenge of how to increase community cardiac 

arrest survival and how to achieve implementation of 

best practices and worthwhile programs. The answer: 

a call to establish a Global Resuscitation Alliance as a 

concrete means to catalyze improvements in survival. 

The Global Resuscitation Alliance will provide the 

tools and support needed for communities to put 

on local programs modelled after the Resuscitation 

Academy and thereby promote and implement best 

practices. 

The Global Resuscitation Alliance will be established 

at a follow-up Utstein meeting with additional 

experts, preceding EMS2016 and will be announced 

during the congress. This is a giant achievement. 

The first Utstein meeting 25 years ago defined 

the terminology and standard for reporting results. 

Since then the International Liaison Committee on 

Resuscitation (ILCOR) are collecting, reviewing and 

sharing international scientific data on resuscitation 

and emergency care. And now the new Global 

Resuscitation Alliance progresses by implementation 

of science and best practices internationally. You can 

read more about the Alliance and the Resuscitation 

Academy in this issue. In line with this you can also 

read about the aspiring Scottish 2020-strategy which 

aims to double OHCA survival rates across Scotland. 

Inside this edition you will find new articles on 

ventilation, pain management and pre-hospital 

cardiac care alongside interesting articles from 

some of the world’s most respected and influential 

EMS leaders. To mention a few: articles by Dr Jeff 

Clawson, founder of the International Academies 

of Emergency Dispatch (IAED), Peter Bradley, CBE, 

CEO of St John New Zealand and Chuck Kearns, 

President of the USA’s National Association of 

Emergency Medical Technicians (NAEMT). The 

theme in this issue of Ambulance Today is that no 

matter how hard we all strive in our respective EMS 

silos, unless we make time to share our experiences 

and challenges and to co-operate with each 

other to take that vital next step forward, much 

of our well-intentioned effort will regrettably be 

wasted. Therefore, EMS2016 will provide a unique 

opportunity for us all to meet and network in 

Copenhagen and share our EMS knowledge and 

influence the future of EMS in Europe and abroad. 

Thanks to Ambulance Today for the persistent work it 

has done to encourage EMS groups across the world 

to share knowledge, forge innovation partnerships 

and provide an editorial platform which showcases 

new EMS developments to all of us who are eager 

to build strong EMS partnerships. 

On behalf of all of those who have worked tirelessly 

to make EMS2016 a success – particularly our hardworking 

team in Copenhagen and my co-founders 

of the congress, Dr Fionna Moore of London 

Ambulance Service and Jerry Overton of IAED and 

our Scientific Committee including Professor Lars 

S. Rasmussen and Professor Doris Østergaard. We 

should also appreciate the support we receive from 

our partner the Danish foundation TrygFonden, the 

Laerdal Foundation and our main sponsors and 

exhibitors who warmly welcome you all to a new 

and innovative congress. Be prepared for surprises 

and don’t miss it. 

Freddy Lippert, MD 

CEO, EMS Copenhagen, co-founder of EMS2016 

and co-chair of Utstein Implementation 

Spring 2016 | Ambulancetoday 

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Issue 1, Volume 13: Spring 2016 Next Issue: Summer 2016 

CONTENTS 

www.ambulancetoday.co.uk 

This Issue is 

Supported by: 

VISIT OUR AMBULANCE TODAY WEBSITE AND REGISTER FOR YOUR FREE 

DIGITAL COPY AT: www.ambulancetoday.co.uk 

INSIDE YOUR SPRING EMS2016 SPECIAL: 

P7. Welcome to EMS2016 in 

Copenhagen 

Congress Keynote Speaker, Professor Douglas 

Chamberlain, looks back on the history of EMS and 

reminds us that we can all learn from each other 

Chair of Congress Host, Capital Region Copenhagen, 

Sophie Hæstorp Andersen reflects on the benefits of 

forming Europe-wide partnerships 

Overview of the Scientific programme, From ‘Science to Survival,’ and 

social highlights of Europe’s newest and largest conference for EMS 

leaders 

Founders Dr Freddy Lippert, Dr Fionna Moore and Jerry Overton offer 

an insight into the new EMS Leadership Network for Europe to be 

unveiled at EMS2016 

P29. Penthrox – the newest tool in the 

prehospital pain management kit 

SECamb’s Medicines Management Lead, Paul Cloves, 

gives an overview of how Penthrox, the newest analgesia 

available to EMS crews, has been received by one of 

Europe’s most clinically-innovative ambulance services 

P35. Out-of-Hospital Cardiac Arrest – Scotland’s 

Story 

HEMS Paramedic and national clinical advisor to the Scottish 

Government, Paul Gowens, reports on the impressive success story 

which has seen Scotland boost its OHCA survival rates through joinedup-working 

P41. Refreshing the values of EMS in 

New Zealand 

CEO of St John New Zealand, Peter Bradley, CBE, 

gives a run-down of the technologies boosting EMS 

performance in New Zealand 

P47. Entonox - Making the most 

of the basics in prehospital pain 

management 

Pain management researcher, Lucas Hawkes- 

Frost of London Ambulance Service reviews 

the contribution that ENTONOX has made to 

prehospital clinical care in the UK 

P50. Optima: Split-Second deployment decisionmaking 

in Dutch EMS 

Duncan Bänffer of Safety Region AZRR Rotterdam reports on how 

Optima Predict is helping develop accurate real-world simulations to 

improve EMS planning across the Netherlands 

P54. Problems associated with the Use of Self- 

Reforming Bags in Emergency Artificial Ventilation 

Professor David Baker, Emeritus Consultant Anaesthesiologist with 

SAMU de Paris, reviews the published evidence concerning the use of 

BVM in emergency care and discusses the need for better training and 

awareness of the associated problems 

P59. The Happy Haus of Baus 

We visited the Baus AT plant in Toruń, Poland 

to find out how Europe’s fastest-growing 

ambulance builder is expanding globally 

P73. Isn’t it Time that Patients Take Responsibility 

as Well? 

Dutch Correspondent, Thijs Gras, tackles the thorny question of how 

much legal responsibility patients should take for co-operating with their 

ambulance carers 

P76. IAED Founder Dr Jeff Clawson 

Welcomes new European EMS Network 

Joe Smith finds out about the creation and growth of the 

International Academies of Emergency Dispatch from its 

founder, Dr Jeff Clawson 

P79 Watson, I Presume? 

UMCG’s Jaap Hatenboer offers a Dutch perspective on the importance 

of EMS managers understanding the impact of the fourth industrial 

revolution on ambulance care 

P82. USA’s NAEMT President Chuck Kearns on 

Global EMT Partnership 

Joe Smith quizzes President, Chuck Kearns on NAEMT’s global activities 

and finds out how American EMS works with partners worldwide to 

share innovation ideas 

Also inside: 

UNISON Update 

Alan Lofthouse says “Keep your promise to ambulance staff!” 

TASC News 

TASC receives funding boost at ALF 2016 

Out & about 

The latest EMS news from around the world 

Products & Suppliers News 

Latest in New Products, Services & Technology 

Give us your feedback on this edition by emailing to: editor@ambulancetoday.co.uk 

EDITOR: Declan Heneghan email: editor@ambulancetoday.co.uk CORRESPONDENCE: All correspondence should be sent to: The Editor, Ambulance Today, 

41 Canning Street, Liverpool L8 7NN BUSINESS DEVELOPMENT MANAGER (Europe): Joseph Heneghan CALL: +31 2977 853 95 ASSISTANT-EDITOR: Joseph Smith 

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DESIGN & Production: L1 Media email: L1media@yahoo.co.uk 

COPYRIGHT: All materials reproduced within are the copyright of Ambulance Today. Permission for reproduction of any images or text, in full or in part, should be sought from the Editor. 

PUBLISHER’S STATEMENT: Ambulance Today magazine is published by Ambulance Today Ltd, 41 Canning Street, Liverpool L8 7NN. The views and opinions expressed in this issue are not necessarily those of our Editor or Ambulance Today. No 

responsibility is accepted for omissions or errors. Every effort is made to ensure accuracy at all times. Advertisements placed in this publication marked “CRB Registered” with the organisation’s “CRB Registration No.” means that the Organisation/Company meets with the 

requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974. All applicants offered employment will be subject to a Criminal Record Check from the Criminal Records Bureau before appointment is confirmed. This will include details of 

cautions, reprimands or final warnings, as well as convictions and information held by the Department of Health and Education and Employment

The first European 

Emergency Medical Services Congress 

Join us for EMS2016 in Copenhagen 30th May to 1st June 2016 

As the first of its kind, the European Emergency 

Medical Services Congress - EMS 2016 in 

Copenhagen will bring together researchers, health care 

professionals and managers in the area of emergency 

medical services and pre-hospital care. 

Through innovation, involvement and a creative 

approach, this new congress will provide the latest 

knowledge, showcase the newest equipment and 

demonstrate best practices in the area of emergency 

care: From the citizen’s emergency call, through the 

emergency medical dispatch process, the pre-hospital 

care by doctors, paramedics and nurses and finally the 

emergency care in the emergency department. 

The congress will take place in the Tivoli Hotel & 

Congress Center 30th May to 1st June 2016 in the 

vibrant, progressive and green city of Copenhagen, 

Denmark. 

Get updated at EMS 2016 in Copenhagen, greet old and 

new friends and meet the experts. 

We look forward to seeing YOU in Copenhagen, where 

we will shape the future of emergency medical services 

together. 

Read more on our website www.ems2016.org where 

news will be posted continuously. 

Follow EMS2016 on social media 

o Facebook: EMS2016 

o Twitter: @EMS_CPH2016 

o Instagram: EMS_CPH2016 

…or use the #ems2016 or #ambulancesoftheworld 

Copenhagen thrives on a mixture of its beautiful 

medieval city centre, brave new architecture, a rich 

cultural life and an extraordinary culinary scene. The city 

is renowned for its take on biking and eco-friendly way of 

living.

Some thoughts from EMS2016 keynote speaker Professor Douglas Chamberlain 

Our European 

Ambulance Services: 

We Can Learn so much 

from Each Other 

By Professor Douglas Chamberlain, leading pioneer 

of paramedic practice 

The wish to assist the sick and wounded goes back millennia in our history. Possibly the first wellorganised 

attempts came in the 18th century with the formation of the Humane Societies, set up 

principally to save victims from drowning. The first was in Holland, but this development influenced 

other countries to develop similar schemes. In the 19th century, the Order of St John spread from 

France to many parts of the world ‘to relieve sickness and injury.’ Progressively through the 20th century, 

statutory ambulance services were set up wherever a sound civic structure exists. But have we continued 

adequately to learn from each other in our own era when communication can be rapid and effective? 

Systems have evolved or been developed 

purposefully in countries, or not infrequently 

in smaller areas, that vary in structure, 

in types of organisation, and in efficiency. 

Perceived local needs are generally the 

driving force, but other influences are 

sometimes powerful. Emergency services 

may depend on unpaid volunteers, but within 

professional organisations the educational 

background and required academic levels at 

entry vary widely, as do the complexity of 

service that can be provided. One major 

difference depends on whether or not 

physicians play a leading role, either in an 

advisory capacity or as active responders. 

Of course, there is room for variation within 

a service but it is likely that some structures 

match local requirements better than others. 

Few even in Europe would claim that they 

have the best possible system. Deficiencies 

may arise partly from financial constraints 

but there are other impediments to possible 

improvements. Managers, for example, 

may have personal reasons for accepting 

the status quo or simply be unaware of 

unnecessary shortcomings. Such problems 

are commonplace in all organisations, but 

progress within healthcare impinges strongly 

on the well-being and lives of individuals, 

and so demands our close attention. 

Many of us who have lived through decades 

of evolution in medical provision can take 

lessons from recent history. Knowledge 

within my own specialty of cardiology 50 

years ago was circumscribed by geography 

and more particularly by language. We did 

not dwell on the fact that progress in some 

areas may be well in advance of our own 

even in closely neighbouring countries, yet 

Book your place at EMS2016 now at: www.ems2016.org 


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Some thoughts from EMS2016 keynote speaker Professor Douglas Chamberlain 

Ambulance in use in Odense in 1919. Such horse-drawn 

ambulances were used in some provincial cities right up 

until the beginning of the 1940s. Source unknown. 

this was indeed the case. The creation of 

the European Society of Cardiology (ESC) 

led to major improvements in this regard 

and continues to do so. Within resuscitation 

medicine, a breakthrough came when the 

Laerdal Foundation invited members of 

national groups from many countries to 

a meeting in Stavangar where we met 

each other for the first time. International 

meetings then became commonplace. Not 

only did we learn from each other, but a 

consensus on best practice was passed 

on from a new international committee 

(ILCOR) to regional bodies that used them 

to create guidelines suitable for local needs. 

Our own regional body, within Europe, was 

conceived initially as a working group of 

the ESC, but fortunately this did not work 

out and instead the European Resuscitation 

Council (ERC) was formed. This body 

has considerable relevance to ambulance 

services because it issues important and 

definitive advice on the management 

of prehospital as well as in-hospital 

emergencies. But its remit does not include 

organisation. 

The question arises as to whether we 

need an international group devoted 

to ambulance services that may help 

them learn from each other in terms of 

organisation, scope, and objectives. One 

pattern will not suit all, but there will still 

be ideas that can be shared to the benefit 

of many. Meetings need not be frequent 

but occasional direct contact is essential 

Red Cross ambulance from the Holbaek approx. 1950. 

Source: The Danish Museum of Science, the Zonen 

Collection. 

so that colleagues from other countries 

will be known and indeed friendships built 

up. We do already have some national 

and local groups but these may have their 

own agendas that may not represent views 

of the majority of providers. It would be 

worth exploring the feasibility of individual 

administrative units having membership, 

despite large variations in size across nations. 

Whilst the intention should not be 

pressure to harmonise the types of service, 

discussions would have an influence in the 

medium or long term. Some principles are 

worth mentioning. In all advanced countries, 

services should be rapidly available to all 

through a common national or international 

phone number. Only one service should 

exist within any one region. Whilst high 

degrees of clinical expertise should be 

available, patient transport without the 

requirement for immediate treatment 

must also be provided. These leave room 

for other differences some of which will 

depend on other aspects of health care 

outside ambulance services; here there is 

room for evolution. In some areas of the 

United Kingdom, we have practitioners with 

advanced training in critical care and others 

in domiciliary care. How many levels of 

expertise are optimal? Would it be useful 

to discuss the criteria for non-conveyance, 

the maximum time on scene for different 

heart rhythms, the need for widespread 

use of emergency ultrasound, the use of 

mechanical compression or the availability 

of ECMO? In particular, we need additional 

Ambulance care in the UK began to develop rapidly in the 

late 1970S 

emphasis on immediate or retrospective 

feedback on compression quality, liaison with 

community first responders, the necessary 

skills of dispatchers, and the immediate 

availability of medical or other advice. The 

list of course does not end there. 

We do have an opportunity to discuss 

these matters at the up-coming EMS2016 

Congress in Copenhagen in late May. This is 

particularly appropriate in that colleagues in 

Denmark have shown not only how rapidly 

progress can be made but demonstrated 

too the impact on benefit to patients. 

We can all learn from each other. Let us try 

harder to do so. 

Pre-hospital cardiac care is now far more advanced 

Electrocardiograph patient with technician, c.1929 

Medical students watching an operation in theatre, 

c.1950-1960 


Professor 

Douglas 

Chamberlain’s 

keynote address entitled: The 

History of EMS will take place at 

10.30am on Monday 30th May and 

will open EMS2016. 


9

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Welcome from the Chairman of the Regional Council of Capital Region Denmark 

Welcome to 

Copenhagen! 

By Sophie Hæstorp Andersen 

Chairman of the Regional Council of the Capital Region 

of Denmark 

In 2012 Denmark was on the cover of Ambulance Today under the headline “Let’s go Danish.” This spring 

Denmark is once again on the cover of the magazine due to the first European Emergency Services 

Congress that will be held in Copenhagen. 

In Europe emergency medical services 

are undergoing development to reflect 

changes in healthcare delivery with the 

centralization of highly specialized medical 

care to fewer and more specialized hospitals 

and emergency departments. The emphasis 

in the past was mainly on providing safe and 

comfortable transportation, rather than on 

delivering high-levels of acute clinical care. 

This change over the last two decades has 

led to an increased focus on pre-hospital 

care. 

It is extremely complicated and difficult to 

save a life. Though it may be individuals who 

perform CPR, attach the defibrillator, secure 

the airway, and administer medications, 

it is a system that makes it all possible. 

Cooperation between the dispatch center, 

the ambulance services and the emergency 

department is essential in saving lives. Lives 

are saved not just by highly trained EMS 

professionals, but by highly efficient EMS 

systems. 

There exists incredible variety and diversity 

among EMS systems. No two systems are 

the same. In Denmark there are five health 

care regions and even though we are a small 

country there are differences between the 

regions. 

In Denmark just as in all of Europe we need 

to address common challenges and establish 

cooperation. In the wake of the terrible 

events in both Brussells and Paris it is more 


important than ever that we can learn from 

each other. This will in the end strengthen 

our systems and save lives. 

I’m incredibly proud that the first European 

Emergency Medical Services Congress will 

be held in Copenhagen from 30th May to 

1st June 2016. EMS2016 will bring together 

scientists and professionals in the areas of 

emergency medical services and pre-hospital 

care. Through innovation, involvement and a 

creative approach, the congress will provide 

the latest knowledge in the area – from the 

citizen’s emergency call all the way to the 

actual pre-hospital treatment. 

EMS2016 will be held in Greater 

Copenhagen. Greater Copenhagen is 

where Denmark meets Sweden and 

Scandinavia meets the world. It is where 

we cooperate and connect people, access 

sectors, industries, cultures and countries. It 

is freedom and happiness. 

To all the first responders, emergency 

medical technicians, paramedics, emergency 

tele-communicators, doctors, nurses and all 

who work in emergency medical services: 

Thank you for your work! 

I look forward to seeing you in Copenhagen. 

Warm regards, 

Sophie Hæstorp Andersen 

Chairman of the Regional Council of the 

Capital Region of Denmark 

Capital Region of Denmark 

– Some facts and figures: 

• 1.8 M. inhabitants 

• 2,561 square km - approx. 6% of Denmark 

• 29 municipalities 

• Population density five times higher than the 

country’s average 

• Approx. 40,000 employees 

• Total budget approx. 5 billion euros 

(38 billion dkk.) 

• The Capital Region of Denmark is one of five 

regional administrative units in Denmark. It 

provides healthcare, mental healthcare services 

and also carries out research and regional 

development for 30% of the population in 

Denmark. 

• In addition to hosting the largest health care 

system in Denmark, the region is also home to 

one of the world’s strongest life science clusters, 

and 70% of Denmark’s biotech companies are 

located in the area. 

• Denmark is in fourth place among the OECD 

countries regarding scientific publications per 

inhabitant and similarly in third place regarding 

citations. Accordingly health research in the 

Capital Region ranks among the best in Europe. 

Biography: 

Sophie Hæstorp Andersen 

Sophie Hæstorp Andersen, is a member of 

the Social Democratic Party and has served 

as chairman of the Regional Council in the 

Capital Region since 2014. Before that she was 

Chairman of the Health Committee in the 

Danish Parliament from 2013-2014. 

Sophie was born in Copenhagen in 1974, 

where she lives today with her spouse and 

their two children Rolf and Rosa. Educated as 

a political scientist she wrote a thesis on the 

Danish Quality Improvement Accreditation 

system in the public health care sector. She has 

been the Chairwoman of the management 

board of ‘Plejebo’ Nursing Centre since 2004 

and a Member of the governing body of the 

AIDS Foundation from 2004-2012. Sophie was 

officially appointed “User Friend” of the Danish 

Drug Users Union in 2008. 

Winter 2014 | Ambulancetoday3 11

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EC3A 7JB. Registered No. 02006558 (England).

Focus on Establishing a Global Resuscitation Alliance 

We Must Work Tirelessly to “Snatch 

Life from the Jaws of Death” 

A Call to Establish a Global 

Resuscitation Alliance 

In June 2015 at the Utstein Abbey near Stavanger, Norway, 36 Emergency Medical Services leaders, 

researchers, and experts from throughout the world convened to address the challenge of how to 

increase survival from out-of-hospital cardiac arrest. We have science and solutions but how do we 

achieve implementation of best practices? The answer: a Call to Establish a Global Resuscitation Alliance. 

By Freddy K. Lippert, CEO EMS Copenhagen, Denmark; Sang Do Shin, Medical Director Seoul 

Metropolitan Fire Department, Seoul South Korea; Tore Laerdal, Director Laerdal Foundation, Norway; 

Mickey Eisenberg, Director Medical Quality Improvement, King County EMS, Seattle USA. 

The history of Utstein 

In 1990 at the historic Utstein Abbey near 

Stavanger, Norway, international researchers 

and Emergency Medical Service (EMS) 

program and medical directors gathered 

to solve a problem. There was either a lack 

of data or inconsistencies in data about 

cardiac arrest survival. Attempts to measure 

performance with various case definitions led 

to inconsistencies in calculating survival rates. 

In short, there was insufficient data and no 

common terminology. 

The meeting resulted in a consensus 

recommendation on terminology and on 

how to report survival data. A paper was 

published in 1991 simultaneously in several 

leading scientific journals which became 

a landmark paper for research within 

resuscitation. 

This process of defining the essential 

elements of a cardiac arrest registry came to 

be known variously as the Utstein method, 

the Utstein template, the Utstein style, or 

merely Utstein. All resuscitation scientists 

have adopted it, and the original Utstein 

article remains one of the most cited articles 

in resuscitation science. 

Since the first Utstein meeting in 1990, 16 

consensus papers have been issued and 

25 meetings held on various topics relating 

to resuscitation and resuscitation research. 

The original paper was updated in 2004 

and again in 2014 and continues to have 

a major impact on science and reporting 

data. 

The Utstein meeting in 2015 on 

implementation 

In 2015, twenty five years after the first 

Utstein meeting, 36 resuscitation leaders 

gathered at Utstein to solve another 

problem – how best to implement best 

practices and successful strategies in 

managing cardiac arrest and how to spread 

the lessons of best practices to EMS systems 

and communities. 

Biography: 

Freddy K. Lippert, MD 

Freddy K. Lippert, MD, 

Associate Professor, FERC, 

is CEO of the Emergency 

Medical Services in 

Copenhagen, Denmark. The 

EMS Copenhagen covers a 

population of 1.7 million, i.e. 

one third of the Danish population. The EMS 

Copenhagen includes the following: Emergency 

Medical Dispatch, ambulance services including 

physician manned mobile critical care units, 

psychiatric mobile unit, a medical hotline 24/7, 

responsibility and coordination of medical 

preparedness on behalf of all hospitals in the 

Capital Region. 

Biography: 

Sang Do Shin, MD, MPH, PhD 

Sang Do Shin, MD, MPH, PhD, 

is associate professor in the 

Department of Emergency 

Medicine at the Seoul 

National University College 

of Medicine in Seoul, Korea. 

He’s also the director of 

the Laboratory of EMS at the Seoul National 

University Biomedical Research Institute. 

The results of the meeting are a call for 

the establishment of a Global Resuscitation 

Alliance in order to expand internationally 

the reach and utility of the Resuscitation 

Academy concept developed in King County, 

Seattle beginning in 2008. Such a global 

effort will promote best practices and offer 

help with implementation to countless 

communities. 

Biography: 

Tore Laerdal 

Tore Laerdal is Executive 

Director of the Laerdal 

Foundation, chairman of 

Laerdal Medical, and managing 

director of Laerdal Global 

Health. In recent years he 

has focused on helping 

reduce maternal and newborn mortality in 

low resource settings. For this purpose Laerdal 

Global Health has partnered with USAID, NIH, 

Save the Children, the American Academy of 

Pediatrics and others in the Helping Babies 

Breathe alliance and the Survive & Thrive 

alliance. 

Biography: 

Mickey Eisenberg, MD, Ph.D 

Mickey Eisenberg, MD, Ph.D, 

is Director of Medical QI at 

the King County Emergency 

Medicine Services and 

Professor of Medicine at the 

University of Washington. He 

has studied cardiac arrest and 

developed innovative programs to treat this 

condition for 40 years. His book, ‘Resuscitate! 

How your Community can Improve Survival 

from Sudden Cardiac Arrest – second edition’ 

was published by University of Washington 

Press in 2013. 




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Focus on Establishing a Global Resuscitation Alliance 

The famous Utstein Abbey near Stavanger in Norway 

This call to action declares the current 

situation to be unacceptable and states: 

• We believe communities can and must do 

better. 

• We believe, based upon current 

knowledge, that with adherence to 

and implementation of best practices 

communities can increase survival from 

cardiac arrest by 50%. 

• We believe the establishment of a Global 

Resuscitation Alliance will help educate EMS 

leaders about best practices and provide 

tools to help improve survival in their 

communities. 

Interventions that determine the 

outcome from cardiac arrest 

Several critical interventions and their 

timely application determine the outcome 

from cardiac arrest. In cardiac arrest 

the likelihood of surviving declines by 

approximately 10% for every minute. Thus 

the intervals from collapse to application 

of key interventions largely determine the 

likelihood of survival. The main interventions 

include: rapid dispatch of EMS, telephoneassisted 

cardiopulmonary resuscitation 

(T-CPR), bystander CPR, provision of high 

performance CPR, and early defibrillation. 

Both rapid time of application and high 

quality of these interventions define best 

performing EMS systems. 

Global Resuscitation Alliance 

It is now time to turn our attention to 

programmatic improvement. Ideally best 

practices should become the standard 

of care; thereby leading to dramatic 

improvements in survival. Best practice is a 

dynamic concept since new therapies and 

programs begin to define new best practices. 

Therein lays the power of “measure and 

improve”. Constant measuring enables 

determination of what needs improving, and 

demonstrates if improvement occurs - which 

can define new best practices. 

The coming decades should become the 

era of using measurement to help define 

and implement best practices. It appears 

from the literature that it commonly takes 

5-10 years before new knowledge and 

guidelines are generally implemented even 

after scientific consensus. That process 

must be speeded up! This requires better 

understanding of what factors stimulate and 

what factors hinder implementation of new 

knowledge and best practices. 

The establishment of a Global Resuscitation 

Alliance is a concrete means to catalyze 

progress in survival. A Global Resuscitation 

Alliance can provide the tools and support 

for communities to put on local programs 

modeled after the Resuscitation Academy 

and thereby promote best practices locally. 

The ongoing process, typified by the Utstein 

meeting on implementation, promises yet 

more advances in resuscitation and survival. 

To these individuals and to the hundreds of 

thousands of first responders, emergency 

medical technicians, paramedics, emergency 

tele-communicators, doctors, nurses and all 

Ten Steps to Improve 

Cardiac Arrest Survival 

1. Establish a cardiac arrest registry 

2. Begin Telephone-CPR with ongoing 

training and QI 

3. Begin high-performance EMS CPR 

with ongoing training and QI 

4. Begin rapid dispatch 

5. Measure professional resuscitatiion 

using the defibrillator recording 

(and voice if possible) 

6. Begin an AED program for first 

responders, including police officers, 

guards, and other security personnel. 

7. Use smart technologies to extend 

CPR and public access defibrillation 

programs to notify volunteer 

bystanders who can respond to nearby 

arrest to provide early CPR and 

defibrillation 

8. Make CPR and AED training 

mandatory in schools and the 

community 

9. Work toward accountability – submit 

annual reports to the community 

10. Work toward a culture of excellence 

Figure 2. Ten steps to improve Cardiac Arrest survival 

who work so tirelessly to snatch life from 

the jaws of death, we dedicate this call to 

action. 

EMS2016 to promote the Global 

Resuscitation Alliance 

Prior to the European EMS2016 congress a 

second Utstein Meeting on implementation 

will be held in Copenhagen with experts 

and representatives from major international 

EMS systems and international organizations. 

The meeting will further bring the Global 

Resuscitation Alliance to reality and begin to 

provide tools for implementation. 

• Cardiac arrest registry 

• Telephone CPR 

• High performance CPR 

• Rapid dispatch 

• Measurement of 

professional resuscitation 

• AED program for 

first responders 

• Smart technologies 

for CPR and AED 

• Accountability 

• Culture of excellence 

Improved 

Survival 

Figure 1. Programs and actions to implement best practices 

• Form a team 

• Select programs 

• Plan implementation 

strategy 

• Set specific goals 

• Achieve buy-in 

• Establish standards 

• Pilot the program 

• Consult experts 

• Communicate 

progress 

• Support, advocate 

celebrate 

Therefore: Join us for the 1st 

European Emergency Medical 

Services Congress to be held in 

Copenhagen 30th May to 1st June 

2016 where the results from the 

Utstein meeting will be presented. 

This short paper is based upon the full paper: 

Improving Survival from Out-of-Hospital 

Cardiac Arrest: A Call to Establish a Global 

Resuscitation Alliance. The full paper can be 

downloaded from the Resuscitation Academy 

homepage: www.resuscitationacademy.com 

www.resuscitationacademy.com/wp-content/ 

uploads/2016/03/A-Call-to-Establish-a-Global- 

Resuscitation-Alliance1.pdf 

Citation: “It takes a system to save a 

life” from Resuscitation Academy 



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Focus on Resuscitation Academy 

Resuscitation Academy - Improving survival 

from out of hospital cardiac arrest through 

implementation of best practices 

Sudden cardiac arrest is the leading cause of death among adults, yet it need not be fatal. Though survival 

in most communities is very poor, some communities and Emergency Medical Services Systems have 

accomplished outstanding improvement and results. Why are some communities and EMS systems so 

successful when others are not? And which steps can we take to improve outcomes? 

These are some of the questions addressed by the Resuscitation Academy. 

By Ann Doll, Executive Director, Resuscitation Academy, Seattle USA: and Tom Rea, Medical Director, 

King County EMS, Washington USA; Mickey Eisenberg, Director, Medical QI, King County EMS, 

Washington USA; Sang Do Shin, Medical Director Seoul Metropolitan Fire Department, South Korea; 

Freddy K. Lippert, Chief Executive Director, Emergency Medical Services, Copenhagen, Denmark 

A leading cause of death despites 

advances 

Sudden cardiac arrest remains a leading 

cause of death in most modern societies, 

despite important advances in prevention. 

As disturbing as the magnitude of the 

problem is, the disparity in survival among 

communities is tremendous, even though 

resuscitation guidelines provide an evidencebased 

approach for treatment. For example 

there is often a 10-fold difference in survival 

among communities adhering to best 

practices compared to communities with 

poor adherence and some have improved 

considerable while others are haven’t. 

“It takes a system so save a life” 

Whether an individual lives or dies following 

sudden cardiac arrest is a function of many 

factors and circumstances. These factors 

may conveniently be grouped into patient 

factors, event factors, and system factors. 

Most patient and event factors, while very 

important, are not changeable or alterable by 

the responding emergency medical service 

personnel. What is alterable, however, is 

the configuration and quality of the system 

responding to the cardiac arrest. 

The chain of survival describes time-sensitive, 

coordinated steps in community response 

that need to occur to achieve the best 

chances of survival. If just one link is missing 

or weak the chances of survival decrease 

tremendously. Every community’s EMS 

system already incorporates some if not 

all of these system factors at least to some 

degree – but even these factors, although 

they’re necessary, are not sufficient. 

The history of the Resuscitation 

Academy 

The Resuscitation Academy was established 

in 2008 in King County, Seattle, USA with 

the goal to improve cardiac arrest survival. 

It was apparent from the first Resuscitation 

Academy class in 2008 that the lectures, 

breakout sessions and workshops could only 

go so far. The faculty needed to spell out 

the details of how to implement the various 

programs locally. The Resuscitation Academy 

Tool Kits were developed to do just this. 

Resuscitation Academy provides “How to?” 

guides, for setting up various programs 

Biography: 

Ann Doll 

Director, Resuscitation Academy 

Ann helped to create the 

Resuscitation Academy in 

2008 as a way for Seattle 

& King County to share 

best practices for improving 

cardiac arrest survival. Her 

background includes 20 years 

of program management and patient education. 

Email: Ann.Doll@kingcounty.gov 

Biography: 

Thomas D. Rea, MD, MPH 

Thomas D. Rea, MD, MPH 

Dr. Thomas Rea is Medical 

Program Director for King 

County EMS and Professor of 

Medicine at the University of 

Washington and Harborview 

Medical Center. He has the 

good fortune of spending the past decade 

working with the King County Medic One 

Paramedic group and looks forward to working 

more closely with the Fire Departments in 

King County to continue the high standard of 

EMS care. 

Email: rea123@u.washington.edu 




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Focus on Resuscitation Academy 

within local communities . A key publication 

for the concept is the book: Ten Steps for 

Improving Survival from out-of-hospital 

Cardiac Arrest. The Resuscitation Academy 

is offered tuition-free and attendees come 

from throughout the world. The small class 

size allows for a two-way exchange of 

information – the faculty provides evidencebased 

information and tools to improve 

cardiac arrest survival and the attendees 

share the real-life challenges they face. A 

Resuscitation Academy session could be a 

two-day full course for managers and leaders 

looking at all components in the chain of 

survival or it could be a 2-4 hour workshop 

during a congress to focus on quality CPR 

for paramedics. 

Every community has a different 

constellation of culture, leadership, resources, 

and opportunity. The faculty of the 

Resuscitation Academy has learned that 

change is very challenging, and one should 

never assume that just because you present 

a good idea that it will be embraced and 

implemented next day in another setting. 

Impediments to change, whether they 

stem from habit, inertia, malaise, or lack 

of resources, will overwhelm the best of 

intentions. 

From Resuscitation Academy in 

Seattle to a Global Resuscitation 

Alliance 

The Resuscitation Academy is providing 

examples of best practices and at the same 

time tools for local implementation. This is 

part of its success in the USA. Resuscitation 

Academy as a concept has also been 

introduced in various countries in Europe 

and Asia. It is now time to ensure further 

implementation worldwide and to do this in 

an organized way. The recommendation from 

a recent Utstein meeting on implementation 

of best practices is to disseminate the 

concept of Resuscitation Academy 

internationally by establishing a Global 

Resuscitation Alliance. 

Photographs courtesy Thomas Voss 

This paper is a short summary of the 

concept of Resuscitation Academy. 

More information can be found and 

downloaded from the website of 

Resuscitation Academy in Seattle. 

Homepage of Resuscitation Academy: 

www.resuscitationacademy.org/ 

Ten Steps for improving survival: 

www.resuscitationacademy.org/ 

downloads/ebook/TenStepsforImproving 

SurvivalFromSuddenCardiacArrest-RAeBook-PDFFinal-v1_2.pdf 

Utstein paper on Global Resuscitation 

Alliance: www.resuscitationacademy. 

org/wp-content/uploads/2016/03/A-Call- 

to-Establish-a-Global-Resuscitation- 

Alliance1.pdf 


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EMS2016 – Welcome from Congress Organisers 

Let’s shape 

the future for 

Emergency 

Medical 

Services in 

Europe! 

Pre-hospital emergency care and emergency medical services (EMS) have advanced at a steady but 

increasingly rapid pace during the last decades. With growing public expectations of emergency care - 

now - more than ever, it is important that we learn from the latest knowledge, evidence, training, and 

technology and that we cooperate across Europe to identify best practice and find new solutions. That’s 

why we are organizing the first European EMS congress. 

By Freddy K. Lippert, Fionna Moore and Jerry Overton 

The important role of EMS today 

Emergency medical services (EMS) have 

transformed over the last decades from 

patient transport to advanced medical care 

provided at scene and during transport to 

definitive care. Emergency medical dispatch 

is now the gatekeeper to emergency 

care in many EMS systems. The role of 

the emergency call and dispatch centre is 

more than identification, prioritizing and 

dispatching the right resources to the patient, 

now serving as an important clinical hub. In 

addition, it provides instruction for the lay 

person to begin care, the most important 

of which is telephone-assisted lifesaving 

CPR instructions. Some EMS systems are 

providing enhanced assessment by clinicians 

enabling referral to alternative appropriate 

pathways for patients with lower acuity 

symptoms. The focus is always on maintaining 

patient safety and using emergency resources 

more efficiently. 

Emergency medical services are also 

undergoing development which reflect 

changes in healthcare delivery with 

centralization of highly specialized medical 

care to fewer and more specialized hospitals 

and emergency departments and a greater 

emphasis on locally provided care where 

appropriate. This has led to an increased 

focus on pre-hospital care and is also why 

EMS plays an even more important role 

today. 

Why an EMS congress in Europe? 

There has been no dedicated EMS congress 

in Europe to address our common 

challenges. Therefore it is essential that 

we create an overview of and establish 

cooperation between the EMS systems in 

Europe. We need to explore each other’s 

strengths, limitations and current challenges. 

We need to describe a desired vision of 

the European emergency care system and 

recommend strategies to reach our goals. 

That is why we have organized an EMS 

congress in Europe – the first of its kind. The 

first European Emergency Medical Services 

Congress will be held in Copenhagen from 

30th May to 1st June 2016. 

Our ambitions – your ambitions 

It is our ambition that the first European 

EMS2016 should make such a significant 

impact and be such a success that it creates 

expectations for similar events in the future. 

In so doing, we aim to set the standard for 

future EMS congresses in Europe and for the 

development of a network of EMS leaders. 

EMS2016 will be a catalyst for future 

research, education and product 

development by disseminating 

existing knowledge and proposing the 

implementation of best practice, thus 

resulting in better care for the patients. 

EMS2016 will also have a strong focus 

on clinical practice, leadership and 

development. 

At EMS2016 we will create a setting where 

the leading experts in the field will share 

their experiences and where you as a 

participant will be given the opportunity to 

contribute with professional input across 

different fields. In the various forums you will 

be able to learn new practices or develop 

ideas for new research areas, the latest in 

product development as well as educational 

qualifications in various areas. 

A different Congress – for you! 

The congress will be characterized by its 

desire to encourage involvement and active 

participation. As a participant or exhibitor 


20 Spring 2016 | Ambulancetoday

EMS2016 – Welcome from Congress Organisers 

you will be asked to contribute as this is all 

for you! 

Through workshops, poster presentations 

and events– you as a participant will be 

asked to contribute. You will be given the 

opportunity to speak up and use social 

media at debates as well as to network and 

meet in small forums to develop ideas, for 

e.g. on product innovation and debates on 

specific topics. 

This also applies to the exhibition and 

the sponsors. The exhibitors will be an 

important part of the Congress and we 

are encouraging them to make their stands 

interactive with a focus on learning. Ideas 

for developing new solutions depend on 

interaction between clinicians, managers and 

exhibitors – we want to encourage this. 

The new Global Resuscitation 

Alliance 

EMS2016 is also proud to present and 

promote implementation of the new Global 

Resuscitation Alliance as part of the program. 

The Global Resuscitation Alliance is being 

established as a recommendation from an 

Utstein meeting on implementation held at 

Biography: 

Freddy K. Lippert 

Freddy K. Lippert, MD, 

Associate Professor, FERC, 

is CEO of the Emergency 

Medical Services in 

Copenhagen, Denmark. 

Freddy has served as board 

member of the European 

Resuscitation Council 

and as General Assembly 

member for years and is a founding member 

of the European Trauma Course. Freddy is 

chair of the regional Resuscitation Committee 

in Copenhagen, covering the Emergency 

Medical Services and five hospitals. Freddy is 

an associate professor, Faculty of Health and 

Medical Sciences, University of Copenhagen. 

Freddy has as a physician more than twenty 

years of experience in resuscitation, trauma 

care and emergency care and has published 

more than one hundred scientific publications 

and contributions to books. Recent research 

and publications include improved outcome 

from Out-of-Hospital Cardiac Arrest and 

implementation and use of public access 

defibrillation programs. 

Ustein near Stavanger in Norway in 2015. A 

follow-up meeting with international experts 

takes place 2 days prior to the EMS2016 

Congress and the result will be announced 

during the Congress. 

The new European EMS Leadership 

Network 

One of the key goals of the Congress is 

to establish a European EMS Leadership 

Network. The network will consist of initially 

limited numbers, but will be comprised 

of strongly committed CEOs, medical 

directors and managers from across 

European emergency medical services, 

including medical dispatch. 

In the wake of the recent Brussels and Paris 

attacks, and utilizing the learning from the 

recent multinational exercises (Exercise 

Unified Response) now more than ever 

– it is important that we have a highly 

active European EMS Leadership network. 

Therefore it is essential that we create 

an overview of and establish cooperation 

between the EMS systems in Europe to 

explore each other’s strengths, limitations 

and future challenges. 

Biography: 

Jerry Overton 

Jerry Overton serves as the 

Chair of the International 

Academies of Emergency 

Dispatch, the organization 

charged with setting 

standards, establishing 

curriculum, and conducting 

research for public safety 

dispatch worldwide. 

Previously, he served as the Chief Executive 

Officer, Richmond Ambulance Authority (RAA), 

Richmond, Virginia, for 18 years and had overall 

responsibility for the EMS system. Jerry is a 

Past President of the American Ambulance 

Association, was a member of the Institute 

of Medicine’s Committee on the Future of 

Emergency Care in the U. S. Health System, and 

is the Treasurer for the World Association of 

Disaster and Emergency Medicine. 

He serves on the editorial boards of two 

leading prehospital care journals and has 

received numerous recognitions. As an 

expert in EMS system design and deployment 

strategies, Jerry was named one of the 20 most 

influential leaders in EMS by JEMS magazine 

This makes the timing of the unveiling of 

the EMS Leadership Network at EMS2016 

in Copenhagen very timely. The network 

will be dynamic and agile, responding to the 

changing needs and priorities of participating 

EMS organizations. The European EMS 

network will bring the future EMS congresses 

forward and will support the implementation 

of the coming Global Resuscitation Alliance. 

As part of EMS2016 we will have a session 

for you and international EMS leaders to 

discuss the future for EMS. At EMS2016 

we aim to shape the future for EMS in 

Europe. That is why EMS2016 will provide 

an unparalleled opportunity for you to have 

your say and to influence EMS leadership in 

Europe! 

So join us for the 1st European 

Emergency Medical Services 

Congress in Copenhagen from 

30th May to 1st June 2016 where 

together we will shape the future 

for emergency medical services and 

pre-hospital emergency care. We 

all look forward to seeing you all in 

Copenhagen! 

Biography: 

Fionna Moore 

Fiona Moore, MD, is 

Chief Executive Officer of 

the London Ambulance 

Service. Fionna has been a 

Consultant in Emergency 

Medicine since 1985, 

holding appointments at 

University College Hospital, 

the John Radcliffe in Oxford 

and most recently Imperial College Healthcare 

Trust. She is an Honorary Consultant to 

London’s Air Ambulance. 

Fionna was appointed to Healthcare for 

London’s Clinical Advisory Group in 2007 and 

was London’s first Trauma Director from 2009. 

She is a member of the London Clinical Senate 

and the National Clinical Reference Group for 

Major Trauma. 

Fionna developed and implemented London’s 

Major Trauma System 2009-2013. She has an 

unparalleled experience in major incidents and 

planned events in London from 1988 and she 

is recognized internationally for improving pre 

hospital care (Gathering of Eagles award 2015). 




Focus on EMS2016 Scientific Programme 

EMS 2016 Scientific Programme: 

From Science to Survival 

The EMS2016 Scientific Committee has created a programme that will inspire, encourage and provide 

participants with the latest knowledge in the area. 

The programme will place strong emphasis on our shared challenges in emergency care, the sessions 

will focus on research and clinical practice and the speakers are leading figures within their fields. 

Furthermore the programme will set the scene for networking between all European EMS providers, 

researchers and exhibitors. 

The full programme can be found at: http://ems2016.org/scientific-programme/ 

Monday, May 30, 2016 

10:30 AM 

Opening Ceremony and Keynote speaker 

Freddy Lippert, Douglas Chamberlain, Sophie 

Hæstorp Andersen, and Sophie Løhde 

Tivoli Hotel & Congress Center, 

May 30, 10:30 AM 11:30 AM 

11:30 AM 

Coffee Break 

Exhibition Areas 

May 30, 11:30 AM 12:00 PM 

12:00 PM 

Triage, referral and advice 

Andrew Lockey, Philipp Schuetz, Torben Wisborg, 

Andy Newton, and Philip D. Anderson 

Carstensen 

May 30, 12:00 PM 1:15 PM 

Emergency neurology 

Corey Slovis, M.D., Caroline L. Watkins, Hans 

Morten Lossius, HML, Jana Seblova, and Maren 

Ranhoff Hov 

Pjerrot 

May 30, 12:00 PM 1:15 PM 

Breakout session: Best Abstract – Oral 

presentationLars S. Rasmussen and Joost Bierens 

Akvariet 4+5, 

May 30, 12:00 PM 1:15 PM 

Workshop: Resuscitation Academy 

Ann Doll 

Karavanen 9+10 

May 30, 12:00 PM 1:15 PM 

Optimal response for the individual patient 

Paul Gowens, FCPara. MSc. AASI.DipIMC,RCSEd. 

MCMI, Gavin Perkins, Stephen Sollid, Peter 

Kudenchuk, and Wolfgang Voelckel 

Harlekin & Columbine, 

May 30, 12:00 PM 1:15 PM 

Emergency Medical Dispatch – the gatekeeper 

to emergency care Maaret Castrén, Marcus Ong, 

Jerry Overton, Leif Svensson, and Paul Sutton 

Tivoli Congress Hall, 

May 30, 12:00 PM 1:15 PM 

Workshop: Pre hospital quality – Nordic 

Collaboration on EMS data collection, quality 

indicators and benchmarking 

Erika Frischknecht Christensen and Steinar Olsen 

Karavanen 6 

May 30, 12:00 PM 1:15 PM 

1:15 PM 

Lunch Exhibition Areas 

1:30 PM 

Poster Walks 

Foyer, lower floor 

May 30, 1:30 PM - 2:20 PM 

2:30 PM 

Best Emergency Medical Service 

practice 

Fionna Moore, Marcus Ong, Freddy 

Lippert, and Jerry Overton 

Carstensen 

May 30, 2:30 PM - 3:45 PM 

Workshop: Setting focus on 

situational awareness in emergency care 

Peter Dieckmann, Rhona Flin, Stephen 

Sollid, Torben Wisborg, Bodil Thorsager 

Svendsen, and Doris Østergaard 


May 30, 2:30 PM - 3:45 PM 

Breakout session: To be announced 

Akvariet 4+5 

May 30, 2:30 PM - 3:45 PM 

Major Incidents 

Paul Sutton, Steven Bland, and David 

Zideman, LVO, QHP(C), BSc, MBBS, 

FRCA, FRCP, FIMC, FERC 

Tivoli Congress Hall 

May 30, 2:30 PM - 3:45 PM 

Workshop: Essential Emergency 

Ultrasonography workshop 

Morten Thingemann Bøtker 

Karavanen 6 

May 30, 2:30 PM - 3:45 PM 

The elderly patient in the emergency 

setting 

Roland Bingisser, Kate Cantwell, Simon 

Mooijaart, MD PhD, Lars S. Rasmussen, 

and Caroline L. Watkins 

Harlekin & Columbine 

May 30, 2:30 PM - 3:45 PM 

HEMS as part of EMS 

David Lockey, Hans Morten Lossius, HML, 

and Wolfgang Voelckel 

Pjerrot 

May 30, 2:30 PM - 3:45 PM 

3:45 PM 

Coffee Break 


May 30, 3:45 PM - 4:15 PM 

4:15 PM 

End of first day and Keynote speaker 

Lars S. Rasmussen, Pierre Carli, and Hjalte Aaberg 


May 30, 4:15 PM - 5:15 PM 

6:30 PM 

Welcome Reception 

Copenhagen City Hall 

May 30, 6:30 PM - 8:00 PM 

Tuesday, May 31, 2016 

9:00 AM 

Keynote speaker: Global Resuscitation Alliance 

Freddy Lippert 


May 31, 9:00 AM - 10:00 AM 

10:00 AM 

Coffee Break 


May 31, 10:00 AM - 10:30 AM 

10:30 AM 

Safety at scene and during transport 

Anne Kristine Bergem, Andy Newton, 

Stephen Sollid, Hans Morten Lossius, 

HML, and Paul Gowens, FCPara. MSc. 

AASI.DipIMC,RCSEd.MCMI 

Carstensen 

May 31, 10:30 AM - 11:45 AM 

Communication when time is critical 

Doris Østergaard, Martine C. De Bruijne, 

Michaela Kolbe, Andrew Lockey, and 

Peter Dieckmann 


May 31, 10:30 AM - 11:45 AM 

EMS and the infectious patient 

Erika Vlieghe, MD PhD, Erika 

Frischknecht Christensen, Philip D. 

Anderson, and Steven Bland 

Pjerrot 

May 31, 10:30 AM - 11:45 AM 

Workshop: Cardiac arrest and 

emergency medical dispatching – 

how do you monitor and improve 

Tonje Søraas Birkenes, Helge Myklebust, 

Thea Palsgaard Møller, and Søren 

Viereck 


May 31, 10:30 AM - 11:45 AM 

Workshop: Ethics and Prehospital 

care – questions and dilemas 

Jana Seblova 

Karavanen 6 

May 31, 10:30 AM - 11:45 AM 

Industrysponsored 

symposium 

Lumbye 

May 31, 10:30 AM - 11:45 AM 

Cardiopulmonary resuscitation 

David Lockey, Koen Monsieurs, Leif 

Svensson, Maaret Castrén, and David 




May 31, 10:30 AM - 11:45 AM 

Cardiopulmonary resuscitation 

David Lockey, Koen Monsieurs, Leif 

Svensson, Maaret Castrén, and David 




May 31, 10:30 AM - 11:45 AM 

11:45 AM 

Lunch 


May 31, 11:45 AM - 1:15 PM 

12:00 PM 

Poster Walks 


May 31, 12:00 PM - 12:50 PM 

1:15 PM 

New perspectives on education 

Phaedra Boinodiris, Andy Newton, 

Charlotte Ringsted, Doris Østergaard, 

and Andrew Lockey 


May 31, 1:15 PM - 2:30 PM 

Workshop: Get foam´ed 

Sandra Rosemarie Viggers 

Karavanen 6 

May 31, 1:15 PM - 2:30 PM 

Breakout session: The most 

important EMS articles 20152016 

Corey Slovis, M.D., Jacob Steinmetz, 

Koen Monsieurs, and Paul Gowens, 

FCPara. MSc. AASI.DipIMC,RCSEd.MCMI 

Akvariet 4+5 

May 31, 1:15 PM - 2:30 PM 

The critically ill child 

Anne Kristine Bergem, Joost Bierens, Ian 

Maconochie, Lars S. Rasmussen, and 


Focus on Front-Line Mental Health 

Gavin Perkins 

Carstensen 

May 31, 1:15 PM - 2:30 PM 

Workshop: Technology in Telephone 

CPR – To measure and improve 

quality 

Helge Myklebust, Tonje Søraas Birkenes, 

Thea Palsgaard Møller, and Søren 

Viereck 


May 31, 1:15 PM - 2:30 PM 

CEO and Medical directors’ session 

Jerry Overton 

Pjerrot 

May 31, 1:15 PM - 2:30 PM 

Inequality in health care 

Mads Gilbert, Dan Brun Petersen, and 

Torben Wisborg 

Lumbye 

May 31, 1:15 PM - 2:30 PM 

2:30 PM 

Coffee Break 


May 31, 2:30 PM - 3:00 PM 

3:00 PM 

End of second day and EMS Championship finals 

Doris Østergaard 


May 31, 3:00 PM - 4:30 PM 

6:30 PM 

EMS2016 Gala Dinner 

The Circus Building 

May 31, 6:30 PM - 11:59 PM 

Wednesday, June 01, 2016 

9:00 AM 

Keynote: Resuscitation Academy Overview 


Jun 01, 9:00 AM - 10:00 AM 

10:00 AM 

Coffee Break 


Jun 01, 10:00 AM - 10:30 AM 

Workshop: Controlling the surge Comparing 

European policies to 

manage increasing emergency care 

demand 

Thomas Krafft, Jerry Overton, Alexandra 

Ziemann, Janette Turner, and Freddy 

Lippert 

Karavanen 6 

Jun 01, 10:30 AM - 11:45 AM 

Quality and patient safety 

Paul Gowens, FCPara. MSc. 

AASI.DipIMC,RCSEd.MCMI, Steinar 

Olsen, Erika Frischknecht Christensen, 

Jana Seblova, and Beth Lilja 


Jun 01, 10:30 AM - 11:45 AM 

Critical cardiac diseases 

Hideharu Tanaka, Christian Terkelsen, 

Leif Svensson, and Koen Monsieurs 

Pjerrot 

Jun 01, 10:30 AM - 11:45 AM 

Workshop: Simulation Unplugged A 

mass casualty triage workshop 

Andreas Ravn, Theo Walther Jensen, 

Sandra Rosemarie Viggers, and Thomas 

Lynge Andersen 


Jun 01, 10:30 AM - 11:45 AM 

The global challenge in acute illness 

and injury 

Tore Laerdal, Ramana Rao, Mads Gilbert, 

Ian Maconochie, and Philip D. Anderson 


Jun 01, 10:30 AM - 11:45 AM 

Critical decision making 

Peter Dieckmann, Rhona Flin, Doris 

Østergaard, and Torben Wisborg 

Carstensen 

Jun 01, 10:30 AM - 11:45 AM 

Industry sponsored symposium 

Akvariet 4+5 

Jun 01, 10:30 AM - 11:45 AM 

11:45 AM 

Lunch 


Jun 01, 11:45 AM - 1:15 PM 

12:00 PM 

Poster Walks 


Jun 01, 12:00 PM - 12:50 PM 

1:15 PM 

Closing Ceremony and Keynote 

Freddy Lippert, Fionna Moore, Marcus Ong, Jerry 

Overton 


Jun 01, 1:15 PM - 3:00 PM 

Who takes care of people helping people? 

Steen Visholm, Professor at the Danish University in Roskilde, specializes in group psychology 

and organizational psychology. In addition to his role as professor, he is a member of the 

international organizations ISPSO and OPUS. He has written several books and articles on 

organizational psychology. 

Steen will be preparing a study gathering all previous research on mental health in the EMS 

business in order to find out how to organize and manage to obtain both good mental health 

and performance of tasks. Steen will be presenting a pre-conference workshop at Herlev 

Hospital on Sunday 29th May and a shorter workshop at EMS2016 on Wednesday 1st June. 

Frederik Madsen, Falck’s VP Group Human Relations and Corporate Culture, will appear as a 

consultant at the earlier event. 

When interviewed about his work, a 

paramedic in Falck once said: “A rescuer acts 

upon his instincts, trusting that he is making 

the right decision in a split second. The 

reflection and contemplation happens later. 

It happens at night when we get back home, 

perhaps even after a few days when we look 

back. Different thoughts run through our 

head: ‘Could I have done anything differently? 

Did I do enough?’” 

Behind a profession of meticulous work 

helping others lies a spectrum of emotions. 

EMS front-liners are exposed to incidents 

that can be psychologically challenging, 

and some rescue officers can experience 

negative long-term effects physically and 

mentally. They take care of patients, victims, 

relatives and sometimes even bystanders. 

But who takes care of them? 

A review of ten recent studies reveals 

that about 20% of paramedics and 17% 

of firefighters are at risk of developing 

accumulated stress and PTSD (Post 

Traumatic Stress Disorder) where the 

prevalence in the normal population is 2-3%. 


During the EMS 2016 Conference in 

Copenhagen, Falck wants to deal with 

managing front-liners in pre-hospital 

organisations, especially focusing on how to 

ensure the right managerial competencies 

for handling emotional and psychological 

health. The results of a pilot study that 

covers both public and private providers 

in the Copenhagen area will be presented 

by Steen Visholm, Professor MSO at 

Roskilde University. Additionally, at the 

Copenhagen Academy for Medical Education 

and Simulation participants will have the 

opportunity to discuss and reflect upon 

emotions and reflections within emergency 

services. This will take place during a precourse 

on Sunday 29 May. 

The target group for these events are 

researchers, managers and front liners within 

the EMS business interested in learning 

more about working with psychological and 

emotional health and influencing future steps 

in broadening knowledge and processes 

within this area. 

“We want to gather interested parties from 

around the world to discuss setting up a 

society dedicated to developing knowledge 

about how to manage and organise EMS 

organisations, specifically in connection with 

emotional and psychological health, and we 

hope to see many interested participants,” 

says Frederik Madsen, Vice President of 

Group Human Relations at Falck. The project 

is sponsored by the Lundbeck Foundation. 

Steen Visholm will host the workshop, 

How to Take Care of People Helping 

People on Sunday 29th May from 13.00 

to 17.00 at CAMES, Herlev Hospital, 

Herlev Ringvej 75, 2730 Herlev. 


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Focus on EMS2016 Social Programme 

Social 

networking 

at EMS2016 

Besides the scientific programme, participants at EMS2016 will be able to network and enjoy themselves 

in the extensive social programme. 

Welcome reception 

- Monday evening 

Danish and international circus troupes. Today 

the Circus Building is used for professional and 

social events. 

Included in the Gala event is a welcome 

drink, a three course dinner with wine and 

beverages, a spectacular show performed by 

professional artists as well as the EMS2016 

award show. 

After the end of the first day EMS2016 

invites all participants to the official welcome 

reception. 

The reception will take place in the centre 

of Copenhagen at the beautiful Copenhagen 

City Hall on Monday the 30th May from 

06.30 PM - 08:00 PM. 

Morning run 

- Tuesday morning 

On Tuesday morning participants will be able 

to sign up for a guided morning run together 

with their fellow congress delegates. At the 

run participants will be able to experience 

Copenhagen slowly waking up while they get 

moving before a long day at the conference 

center. 


Gala dinner 

- Tuesday evening 

On the second day of the EMS2016, a 

Gala dinner will be held for everybody to 

join. The Gala dinner will take place at the 

famous Circus Building, right in the middle 

of Copenhagen. The Circus Building is the 

oldest of its kind in Europe. It was inaugurated 

with an enormous public celebration in 

Copenhagen on 8 May 1886. Since then, the 

building has played host to a wide variety of 

Morning swim 

in the Copenhagen Harbor Bath 

- Wednesday morning 

In Copenhagen, citizens are fortunate that 

the water in the harbor is so clean that you 

can swim in it. Every summer there are three 

harbor baths where one can take a cool dip. 

At EMS2016 participants will be able to 

get a nice refreshing start to the day when 

all delegates are invited to a morning swim 

before the last day of the congress. 

More information about the social 

programme can be found at: 

http://ems2016.org/social-events/ 


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Focus on EMS2016 Championship 

EMS Championship - Who will be the best 

under pressure? 

During the EMS2016 Congress in Copenhagen you will we be able to challenge yourself and your team 

of EMS colleagues in the competition: European EMS Championship 2016. The Championship will be a 

fun, challenging and educational experience for emergency medical personnel. The competition will be all 

about team work, skills, experience and the ability to find a solution, when challenged. 

By Anne Lippert and Doris Østergaard, Copenhagen Academy for Medical Education and Simulation (CAMES) 

The European EMS Championship 

introduces competitors and audiences to 

new techniques and technology that can 

be used to manage patients and settings of 

different levels of urgency and complexity. 

The competition also enables participants 

to share their expertise, experience, 

techniques and technology with EMS 

colleagues from all over the world. 

The competition will consist of scenariobased 

events that test each team’s ability to 

manage patients in various circumstances 

with common critical medical conditions 

and trauma. The teams will compete in 

two rounds. The first round will identify the 

teams to compete in the final round on 

Tuesday afternoon at a spectacular plenum 

setting in the congress hall. All scenarios 

will be followed by feedback from the 

international panel of judges. 

The winning team will take home the 

honor, the EMS Championship trophy 

as well as free congress passes for the 

EMS2017. 

Who can join, and what does it take? 

A team must consist of three people with 

a healthcare background; the points given 

will be adjusted according to their level of 

education. In this way, it will be possible 

for a team consisting of three EMT’s to 

compete on an equal footing with a team 

consisting of advanced paramedics or 

emergency physicians. The teams will bring 

their own uniform and prehospital kit/ 

bag, while all additional equipment will be 

provided by the organizers. 

The teams will be assessed according to 

their demonstrated technical skills as well 

as non-technical skills such as teamwork, 

communication, and leadership. 

How do I get my team signed up? 

You can now sign up for the EMS 

Championship at www.ems2016.org. 

The number of teams is, due to logistic 

challenges, limited to a total of 16. 


Participation will be offered on a first-come 

first-served basis, the spots are nearly fully 

booked, so do not hesitate to sign up for 

this exciting event. 

If you have questions or any problems 

registering you can always contact the 

congress secretariat on: 

ems2016@regionh.dk 

The European EMS Championship is 

organized by Copenhagen Academy for 

Medical Education and Simulation (CAMES) 

and EMS Copenhagen and is sponsored by 

Laerdal Medical and Falck Emergency as the 

main sponsors for EMS2016. 

Biography: 

Dr Anne Lippert 

Anne Lippert, MD, FERC, 

is Deputy Director of the 

Copenhagen Academy 

for Medical Education and 

Simulation (CAMES), a 

position, which she has held 

full-time for the last 8 years. 

She is trained as a specialist in anaesthesiology 

with subspecialty in Intensive Care Medicine. 

Anne has been involved with simulation training 

for more than 18 years and has been part of 

the development of the current largest institute 

for simulation in Denmark. 

Anne Lippert holds a Certificate in Health 

Professions Education from the University 

of Dundee (2010). Anne has worked with 

Rapid Response Systems for many years and 

has been the author of Guidelines for the 

introduction of RRS in Denmark as well as a 

member of the Regional board for RRS and is 

a member of the board in International Society 

for Rapid Response Systems and head of the 

meeting committee. 

Start getting your team together 

and join us for the 1st European 

Emergency Medical Services 

Congress to be held in Copenhagen 

30th May to 1st June 2016, where 

we together will shape the future 

for emergency medical services 

and pre-hospital emergency care. 

We all look forward to seeing you in 

Copenhagen! 

Biography: 

Doris Østergaard 

Doris Østergaard, is Professor 

in Medical Education and 

Simulation, and Head of the 

Regional Simulation Center, 

CAMES – Copenhagen 

Academy for Medical 

Education and Simulation, in 

the Capital Region of Denmark. 

Doris is an anesthesiologist with a special 

interest in education. Doris works full time 

with medical education and simulation based 

training. Doris has a Master’s in Medical 

Education and in the last 15 years her research 

activities have been related to the link between 

patient safety, simulation based training and 

emergency situations. She is supervising several 

Ph.D. projects within these fields. She is an 

Associate Editor for the European Journal of 

Anesthesiology. 

Doris is a member of the Educational Board of 

the Danish Society for Anesthesia and Intensive 

Care and is responsible for the national training 

program for specialist training in anesthesia. 


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Clinical Focus on the use of Penthrox in Pain Management 

21st Century First-on-Scene Pain Relief 

By Paul Cloves, Medicines Management Lead, 

South East Coast Ambulance Service NHS Foundation Trust 

The effective treatment of pain is a fundamental component of quality patient care, yet in the 

pre-hospital setting the management of pain is a complex mix of multiple resources, medicines 

and techniques, which are often vastly ineffective. 

Below Paul Cloves reports on SECAmb’s recent introduction of new analgesia Penthrox for their pain 

management formulary. 

During 2014/15, 6.5 million patients received 

treatment from ambulance personnel, of 

which 63% required transportation to an 

Emergency Department in England. 1 

We all understand that inadequately 

managed pain can have psychological, 

physiological and socioeconomic 

consequences that can worsen patient 

suffering, clinical outcome, and increase 

the financial costs of healthcare 2 but in a 

modern health service, where resources are 

at a premium, how do you ensure that the 

right treatment is available at the right time? 

Until recently, the ability to provide 

immediate analgesia was limited to 

morphine sulphate for injection, with 

this being the most reliable, fast-acting 

analgesic. However, if you add in the delays 

for cannulation, removing morphine from 

secure storage and administration time, the 

patient still has to wait at least 10 minutes to 

receive effective analgesia even if we ensure 

a paramedic arrives on scene first. So what 

happens when there is no paramedic? Or in 

the time you wait for a paramedic to arrive? 

In November 2015 South East Coast 

Ambulance Service NHS Foundation 

Trust (SECAmb) introduced Penthrox 

(methoxyflurane) into the Trust formulary 

aimed at enabling non-paramedics to 

provide analgesia prior to paramedic arrival 

as well as enabling paramedics to administer 

an immediate analgesia while they prepare 

the patient for cannulation. 

The initial review of our first administrations 

is making interesting reading! On average 

patients present with a patient score 8.7 


out of 10, all patients were provided with 

Penthrox for the immediate treatment 

of their pain whilst further analgesia was 

prepared, after one minute of Penthrox the 

average pain score had dropped to 4.5 out 

of 10. 

Once a patient started using Penthrox, 

the majority were then able to receive a 

further 20 minutes of analgesia before the 

device ran out by which time the patient 

was able to receive additional longer acting 

analgesics. Figure 1 identifies which other 

analgesics were administered to patients 

either before or after administration of 

Penthrox. An important observation was 

that 20% of patients still required Entonox 

despite Penthrox; digging deeper into the 

patient care records, this 20% represents a 

group of patients who were cared for and 

transported by non-paramedic staff, where 

the Penthrox device had run out leaving 

Entonox as the only available analgesia for 

the remaining journey time. For the initial 

introduction, patients were limited to one 

dose of Penthrox in an episode of trauma. 

Figure 1. Use of other analgesics. During 

this study some patients received additional 

analgesia after administration of Penthrox. The 

diagram depicts the types of analgesics used 

and the frequency at which each analgesia 

was administered. 

What about side effects? Understanding 

that the current pre-hospital analgesics all 

have notable side effects we were expecting 

to see similar for Penthrox however there 

were relatively few side effects and certainly 

none that had any clinical impact. 

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Clinical Focus on the use of Penthrox in Pain Management 

None 

Vomiting 

Dizzy Cough Bad Taste 

Figure 2. Side effect profile. This diagram 

depicts the frequency and type of side effects 

experienced by patients using Penthrox. 

Penthrox is new to the UK however it has 

been used in Australasia for over 30 years. 

It has been used extensively in the prehospital 

setting and is used by the Australian 

Ambulance Services, Australian Defence 

Forces, first-aid officers, ski fields, mines and 

more. In Australia it is more commonly 

known as the ‘green whistle’ due to its 

characteristic green colour and shape. It is a 

lightweight, hand-held inhaler which is selfadministered 

by the patient. 

The safety and efficacy of Penthrox has 

also been assessed in a randomised, 

multi-centre, double-blinded, placebocontrolled 

study conducted in the UK. 3 

This study was conducted across six sites in 

the UK and included 300 trauma patients 

in the Emergency Department (ED). It 

demonstrated the effectiveness and safety 

of Penthrox for the treatment of acute pain. 

A total of 303 patients were screened for 

the study; 149 patients received inhaled 

methoxyflurane and 149 patients received 

placebo. Patients were able to request 

rescue analgesia, if required. The primary 

endpoint was the change in pain intensity 

as measured using a visual analogue scale 

[VAS] from baseline to 5, 10, 15 and 20 

minutes after the start of study drug 

inhalation. Methoxyflurane reduced pain 

severity significantly more than placebo 

(p

Focus on Improving Cardiac Arrest Survival 

The Danish Fairytale: more than 

doubling survival in a decade 

By Fredrik Folke, Associate Professor, Emergency Medical Services, 

University of Copenhagen, Denmark; 

Christian Torp-Pedersen, Professor, Aalborg University, Denmark; 

Mads Wissenberg, MD, PhD, Emergency Medical Services, 

University of Copenhagen, Denmark; 

Freddy K. Lippert, Chief Executive Director, Emergency Medical Services, 

University of Copenhagen, Denmark 

Out-of-hospital cardiac arrest (OHCA) is a major health problem in the Western World - not only in 

Denmark with 3500 arrests every year - but also on a worldwide level with more than 700,000 arrests in 

the United States and Europe with often only 5-8 % survival rate. Since 2001, Denmark has succeeded 

in raising bystander CPR from 19% to 65%. In the same period, survival has increased from 4% to 12%. 

Tripling both bystander cardiopulmonary resuscitation (CPR) and survival from OHCA in just a decade is 

an extraordinary improvement, and it is the result of targeted action from many stakeholders in Danish 

society and a number of important initiatives. 

A goal was set 

The Danish Cardiac Arrest Register 

documented that in 2001 bystanders 

provided CPR in only 19% of OHCA cases; 

defibrillation before ambulance arrival was 

anecdotal and the 30-day survival rate was 

merely 4%. The common culture was only 

to perform CPR if you had attended a first 

aid course, and laymen did not know what 

an automated external defibrillator (AED) 

was. It was an untenable situation. To save 

more lives, help from laypeople was needed. 

An ambitious goal was set in 2003: to get 

bystanders to provide CPR in more than 

50% of cardiac arrests and improve cardiac 

arrest survival. These goals were to be 

achieved by several national initiatives to 

strengthen bystander resuscitation, public 

access defibrillation and advanced cardiac 

arrest care. 

Danish initiatives 

In 2005 resuscitation training became 

mandatory in Danish elementary schools 

and from 2006 CPR courses became 

mandatory when taking a driver’s license. 

Furthermore, approximately 150,000 

CPR self-instruction kits were distributed 

between 2005 and 2010 along with an 

increase in CPR course certificates from 

175,000 annually in 2001-2004 to 300,000 

annually 2008-2010. 

The Danish AED network 

In 2008, the non-commercial Danish 

Foundation TrygFonden founded the Danish 

AED network where all private and public 

owners of an AED can register their devices 

and everybody can see where the nearest 

AED is located (www.hjertestarter.dk). 

Also, the Danish Resuscitation Council, The 

National Board of Health and TrygFonden 

hosted the first national AED conference. At 

the conference The National Board of Health 

launched important recommendations 

to all owners of AEDs. Significant 

recommendations are to register the AEDs 

in the national AED network (Hjertestarter. 

dk) and to place AEDs outdoors so that 

they are accessible 24/7. To further support 

bystander defibrillation, TrygFonden launched 

a smart-phone app in 2010 with online 

information on all available AEDs from the 

AED network (hjertestarter.dk) 

Role of the emergency dispatch 

centre 

The Danish emergency medical dispatch 

centres were given access to the AED 

register in 2011, allowing the dispatchers 

to help bystanders to the nearest available 

AED. In addition, the Danish emergency 

dispatch centres were staffed by medically 

trained health care professionals the 

same year (instead of firefighters or police 

officers), offering telephone assisted CPR, 

which increased bystander CPR even further. 

Post cardiac arrest treatment 

Along with the pre-hospital initiatives of 

improving OHCA resuscitation, there has 

been an increased focus on the in-hospital 

effort to improve cardiac arrest care 

according to the newest guidelines, including 

introduction of therapeutic hypothermia and 

early revascularization. 

Research as a cornerstone 

Four emergency medicine professors 

have been appointed to enhance research 

within the pre-hospital field. Numerous 

PhD-students are conducting research and 

winning international awards – including 2 x 

ERC Young Investigator Award and an AHA 

Young Investigator Award. Their research 

has been published in recognized journals 

like Journal of American Medical Association 

(JAMA), Circulation, The Journal of the 

American Heart Association, Resuscitation, 

and the journal of the European 

Resuscitation Council. 

Funding for research 

A main contributor to the massive change in 

the Danish public’s perception about CPR is 

TrygFonden. Only 15 years ago, the first-aidculture 

was articulated as something very 

serious and the perception in the general 

public was that you should only perform 

CPR if you had attended a first aid course; 

laymen did not know what an AED was. 

Since 2004, TrygFonden has continuously 

pushed these messages to the Danes: “Just 

do it. It is better to do something than not 

to do anything,” and: “you can’t do any more 

harm to a person who is already dead, so 

do your best.” 


Focus on Improving Cardiac Arrest Survival 

Source: M. Wissenberg et. al. in JAMA 2013, “Association of National Initiatives to Improve Cardiac Arrest 

Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest” 

http://jama.jamanetwork.com/article.aspx?articleid=1745678 

The Danish experience 

In 2011 the ambitious goal from 2003 

was reached. Bystanders provided CPR in 

58% of all OHCA incidents. This result was 

presented to the Danish Public through 

extensive media coverage at the first 

‘Restart a Heart Day’ in October 2012. In 

2013, bystander CPR further increased to 

65% and OHCA survival reached 12%. 

Furthermore, more than 13,000 publicly 

available AEDs across the nation - for a 

population of 5.7 million - were registered at 

the AED network at the beginning of 2016 

and defibrillation by lay-first-responders 

before EMS arrival reached more than 12% 

in public locations. It is also documented that 

75% of cardiac arrest survivors who were 

at work before their cardiac arrest returned 

back to work after successful resuscitation. 

The figure below shows the temporal 

increase of bystander CPR (green line), 

the 30-day survival rate (red bars) and the 

increase in defibrillation before EMS arrival 

(blue line) from 2001-2013 in Denmark. 

The ugly duckling turning into a 

beautiful swan 

The case of Denmark is a story about 

how far you can move societal behavior 

within a decade by combining a high level 

of research, by establishing nationwide 

systems including community programs, by 

motivating citizens through communication 

and by changing public policy through 

lobbying. Through all of these interventions, 

Denmark has tripled both bystander CPR 

and survival within a period of 12 years. 

New goals 

The new ambition for Denmark is to raise 

bystander CPR to 85%, to further improve 

defibrillation before EMS arrival and to 

improve 30-day OHCA survival to more 

than 15%. 

To achieve this, Denmark is hosting a 

prestigious Utstein meeting on cardiac arrest 

in May where a Global Resuscitation Alliance 

is to be established, aiming at increasing 

community cardiac arrest survival by an 

ambitious 50%. This meeting is followed 

by another new and prestigious event - 

the first international Emergency Medical 

Services congress in Europe. The Danish 

fairy tale, its results and experiences will be 

presented and discussed. TrygFonden and 

the Laerdal Foundation are key partners for 

the international Utstein meeting and for 

EMS2016. 

Source: Utstein paper on Global Resuscitation Alliance: www.resuscitationacademy.org/wp-content/ 

uploads/2016/03/A-Call-to-Establish-a-Global-Resuscitation-Alliance1.pdf 

You can read more about EMS2016 

and about the Global Resuscitation 

Alliance in this edition of Ambulance 

Today. 


33 3

NEW 

Advancing Acute Pain Management 

At last, PENTHROX ® is here... 

Fast, effective pain management designed 

for fast, efficient patient management. 

PENTHROX is indicated for the emergency relief of moderate to severe pain in 

conscious adult patients with trauma and associated pain 1 

Now there’s a new PCA * in a lightweight, portable, handheld inhaler for emergency relief of moderate 

to severe pain in conscious adults with trauma. With minimal set-up and no need for cylinders, cannulas 

or mandatory opioid-related A&E attendances, PENTHROX offers you the potential to reduce 

dedicated treatment time and improve patient management. 

PENTHROX 3mL inhalation vapour, liquid: Please refer to the Summary of Product Characteristics (SPC) before 

prescribing. Abbreviated Prescribing Information. Presentation: Each vial of PENTHROX contains 3mL of methoxyflurane 

99.9%, a clear, almost colourless, volatile liquid, with a characteristic fruity odour. Each PENTHROX combination pack consists of 

one 3mL bottle, one PENTHROX Inhaler and one Activated Carbon (AC) chamber. Indications: Emergency relief of moderate to 

severe pain in conscious adult patients with trauma and associated pain. Dosage and administration: PENTHROX should be selfadministered 

under supervision of a person trained in its administration, using the hand held PENTHROX Inhaler. Adults: One 

bottle of 3mL PENTHROX to be vaporised in a PENTHROX Inhaler. On finishing the 3mL dose, another 3mL may be used. The dose 

should not exceed 6mL in a single administration. Methoxyflurane may cause renal failure if the recommended dose is exceeded. 

The lowest effective dosage to provide analgesia should be used. Onset of pain relief is rapid and occurs after 6-10 inhalations. 

Patients are able to titrate the amount of PENTHROX inhaled and should be instructed to inhale intermittently to achieve adequate 

analgesia. Continuous inhalation provides analgesic relief for up to 25-30 minutes; intermittent inhalation may provide longer 

analgesic relief. Administration on consecutive days is not recommended and the total dose to a patient in a week should not 

exceed 15mL. Children: PENTHROX should not be used in children under 18 years. For detailed information on the method of 

administration refer to the SPC. Contraindications: Use as an anaesthetic agent. Hypersensitivity to PENTHROX or any fluorinated 

anaesthetic. Patients with known or genetically susceptible to malignant hyperthermia or a history of severe adverse reactions in 

either patient or relatives. Patients who have a history of showing signs of liver damage after previous methoxyflurane use or 

halogenated hydrocarbon anaesthesia. Clinically significant renal impairment. Altered level of consciousness due to any cause 

including head injury, drugs or alcohol. Clinically evident cardiovascular instability. Clinically evident respiratory depression. 

Warnings and Precautions: Methoxyflurane causes significant nephrotoxicity at high doses. Nephrotoxicity is also related to the 

rate of metabolism. Factors that increase the rate of metabolism such as drugs that induce hepatic enzymes can increase the risk of 

toxicity with methoxyflurane as well as sub-groups of people with genetic variations that may result in fast metaboliser status. The 

lowest effective dose should be administered, especially in the elderly or patients with other known risk factors of renal disease. 

Methoxyflurane should be cautiously used in patients with conditions that would pre-dispose to renal injury. Methoxyflurane is 

metabolised in the liver, therefore increased exposures in patients with hepatic impairment can cause toxicity. PENTHROX should 

be used with care in patients with underlying hepatic conditions or with risks for hepatic dysfunction. Previous exposure to 

halogenated hydrocarbon anaesthetics (including methoxyflurane when used as an anaesthetic agent), especially if the interval is 

less than 3 months, may increase the potential for hepatic injury. Cautious clinical judgement should be exercised when PENTHROX 

is to be used more frequently than on one occasion every 3 months. Potential effects on blood pressure and heart rate are known 

class-effects of high-dose methoxyflurane used in anaesthesia and other anaesthetics. Caution required in elderly due to possible 

reduction in blood pressure. Potential CNS effects such as sedation, euphoria, amnesia, ability to concentrate, altered sensorimotor 

co-ordination and change in mood are known class-effects. The CNS effects can be a risk factor for potential abuse. To reduce 

occupational exposure to methoxyflurane, the PENTHROX Inhaler should always be used with the AC Chamber which adsorbs 

exhaled methoxyflurane. Multiple use of PENTHROX Inhaler without the AC Chamber creates additional risk. Elevation of liver 

enzymes, blood urea nitrogen and serum uric acid have been reported in exposed maternity ward staff when methoxyflurane was 

used in the past at the time of labour and delivery. PENTHROX is not appropriate for providing relief of break-through pain/ 

exacerbations in chronic pain conditions or for the relief of trauma related pain in closely repeated episodes for the same patient. 

Interactions: Methoxyflurane is metabolised by the CYP 450 enzymes, particularly CYP 2E1 and to some extent CYP 2A6. It is 

possible that enzyme inducers (such as alcohol or isoniazid for CYP 2E1 and phenobarbital or rifampicin for CYP 2A6) which increase 

the rate of methoxyflurane metabolism might increase its potential toxicity and they should be avoided concomitantly with 

methoxyflurane. Concomitant use of PENTHROX with CNS depressants, such as opioids, sedatives or hypnotics, general 

anaesthetics, phenothiazines, tranquillisers, skeletal muscle relaxants, sedating antihistamines and alcohol may produce additive 

depressant effects. If opioids are given concomitantly with PENTHROX, the patient should be observed closely. Concomitant use 

of methoxyflurane with medicines (eg contrast agents and some antibiotics) which are known to have a nephrotoxic effect should 

be avoided as there may be an additive effect on nephrotoxicity; tetracycline, gentamicin, colistin, polymyxin B and amphotericin 

B have known nephrotoxic potential. Sevoflurane anaesthesia should be avoided following methoxyflurane analgesia, as 

sevoflurane increases serum fluoride levels and methoxyflurane nephrotoxicity is associated with raised serum fluoride. When 

methoxyflurane was used for anaesthesia at the higher doses of 40–60mL, there were reports of drug interaction with hepatic 

enzyme inducers (eg barbiturates) increasing metabolism of methoxyflurane and resulting in a few reported cases of nephrotoxicity; 

reduction of renal blood flow and hence anticipated enhanced renal effect when used in combination with drugs (eg barbiturates) 

reducing cardiac output; and class effect on cardiac depression, which may be enhanced by other cardiac depressant drugs, eg 

intravenous practolol during cardiac surgery. Fertility, pregnancy and lactation: No clinical data on effects of methoxyflurane on 

fertility are available. As with all medicines care should be exercised when administered during pregnancy especially the first 

trimester. There is insufficient information on the excretion of methoxyflurane in human milk. Caution should be exercised when 

methoxyflurane is administered to a nursing mother. Effects on ability to drive and use machines: Methoxyflurane may have a 

minor influence on the ability to drive and use machines. Patients should be advised not to drive or operate machinery if they are 

feeling drowsy or dizzy. Undesirable effects: The most common non-serious reactions are CNS type reactions such as dizziness and 

somnolence (≥1/100 to

Focus on Scottish Ambulance Service 

Out of Hospital Cardiac Arrest – 

Scotland’s Story 

“Out-of-Hospital Cardiac Arrest: A Strategy for Scotland” was launched by the Minister for Public Health 

at the Scottish Cardiac Arrest Symposium on 27 March 2015. The strategy was produced by a broad 

coalition of stakeholders and sets out a commitment to improve outcomes after out-of-hospital cardiac 

arrest and an ambition that by 2020 Scotland will be an international leader in the management of 

OHCA. 

The strategy aims to increase survival rates 

after OHCA by 10% across the country 

within five years. Reaching this level of 

performance would mean around 300 

more lives being saved every year resulting 

in a total of 1,000 additional lives saved by 

2020. Increasing the incidence of bystander 

CPR is the cornerstone of improving 

outcomes because it can increase the 

likelihood of survival after OHCA by 2 or 

3 times. The strategy included the goal of 

equipping an additional 500,000 people 

with CPR skills by 2020. 

Across Scotland around 3,500 patients 

undergo attempted resuscitation each 

year after OHCA making it a significant 

healthcare challenge. European centres 

with the best survival rates return almost 

a quarter of OHCA victims home alive 

but in Scotland in 2013/14 around 1 in 

20 survived to hospital discharge with 

considerable variation in different parts of 

the country. 

In many centres around the world, including 

Scotland, initiatives to improve OHCA 

outcomes have been implemented at city 

level with dramatic results. Our challenge 

was to put in place the world’s first national 

programme. The key was nationwide multisector 

engagement including Emergency 

Services (Scottish Ambulance Service, 

Scottish Fire and Rescue and Police 

Scotland), key third sector organisations 

(including British Heart Foundation, Chest 

Heart and Stroke Scotland, St Andrews 

Ambulance, British Red Cross), and 

academic partners (The Resuscitation 

Research Group at the University of 

Edinburgh) and many others. We brought 

together both policy-makers and those at 

the cutting edge of operational delivery to 

make a difference to both delivery of care 

and patient outcomes. 

Edinburgh University’s Resuscitation 

Research Group helped us adapt the best 

evidence and inform decision-making to 

finalise the strategic aims. We learnt from 


patients, academics, healthcare workers, 

public services, and the third sector and 

built on good practice from around the 

world. A patient story film provides vivid 

evidence of the impact of increasing 

survival rate on patients and families. 

One patient’s story: 

“It’s Not Just A Theory“ 

https://vimeo.com/123213458 

A steering group with senior decision 

makers from a broad range of partner 

Biography: 

Paul Gowens, FCPara, MSc. PGCert. 

DipIMC, RCSEd. AASI. MCMI 

Scottish Ambulance Service 

Paul is a Health Foundation 

Fellow and currently 

undertaking a secondment 

to the Scottish Government, 

Health and Social Care 

Directorate as a national 

clinical advisor with portfolio 

including, out of hospital cardiac arrest and 

major trauma systems. With over twentyfive 

years of experience within the Scottish 

Ambulance Service Paul has fulfilled a number 

of key roles from a HEMS paramedic through 

to his current strategic role at Scottish 

Government. 

Biography: 

Karen McNee, Policy Analyst, Planning 

and Quality Division, 

Scottish Government 

Karen is a senior policy 

analyst working on health 

and innovation in the 

Strategic Planning and 

Clinical Priorities team within 

Scottish Government Health 

Directorates where she has 

been since 2013. 

Karen began her career in the Scottish 

Government in the late 1980s and has 

worked in a number of Departments as a 

social researcher. She has spent the last 9 

years working in Scottish Government Health 

Directorates; 7 years as head of the Public 

Health and Sport Team within Health Analytical 

Services Division before moving to her current 

policy post. She is policy lead for Out of 

Hospital Cardiac Arrest. 

organisations supported the team and 

enabled the input of key stakeholders as 

the strategy developed. 

At the launch of the strategy the team 

actively used social media to publicise the 

event, generating 5,000 tweets and creating 

3 million impressions. Scotland’s strategy for 

Biography: 

Lisa MacInnes, BSc (Hons), MSc, 

RGN, AFHEA 

Save a Life for Scotland 

Lisa is a nurse and member 

of the Resuscitation Research 

Group in Edinburgh She 

has a passion for research, 

education and training 

previously holding a teaching 

fellow role within medical 

education before joining RRG to lead on a 

CHSS project (live video streaming to augment 

decision making in COPD and OHCA). She is 

the National Programme Manager for Save a 

Life for Scotland. 

Biography: 

Dr Gareth Clegg, 

Resuscitation Research Group 

Gareth Clegg trained in 

Emergency Medicine in 

Edinburgh having completed 

undergraduate degrees in 

Medicine and Psychology. He 

started research work early 

in the course of EM training - 

initially looking with Professor Colin Robertson 

at whether the ventricular fibrillation ECG 

waveform could be used to guide real time 

resuscitation of patients in cardiac arrest. 

Gareth is co-founder of the Emergency 

Medicine Research Group in Edinburgh 

(EMERGE) and leads the Resuscitation 

Research Group, a collaborative involving 

Edinburgh University, the Scottish Ambulance 

Service and NHS Lothian. Research interests 

include the physiology and clinical management 

of out-of-hospital cardiac arrest, non-technical 

skills in time critical resuscitation, and the 

physiology of fluid resuscitation. The group 

coordinates the TOPCAT2 project and 3RU 

team along with a range of other projects 

relating to all elements of the OHCA response 

‘system’ summarised in the Chain of Survival. 


Do I need to worry 

about respiratory failure? 

You’re dispatched to a 10-year-old girl having difficulty 

breathing. She looks terrified, audibly wheezes, and speaks in 

one-word sentences. 

This kind of patient can be very challenging to care for, and often you are presented with 

several reasonable diagnoses. How can you take this guesswork out of decision making? 

Strong assessment skills and the right technology can make all the difference in accurately 

diagnosing and treating the patient. The ZOLL X Series ® , with its advanced tools for CO 2 

and SpO 2 

monitoring, provides early indication of respiratory compromise, feedback on 

the patient’s oxygenation and ventilation status, and their responsiveness to treatments. 

Insight for informed decisions. 

www.zoll.com/uk/respiratory-care 

©2016 ZOLL Medical Corporation, Chelmsford, MA, USA. X Series and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. 

MCN IP 1603 0113


OHCA can be downloaded here: 

www.gov.scot/scottishohcastrategy 

There are seven key strands of work 

outlined in the strategy which are now 

being progressed: early recognition, CPR, 

defibrillation, pre-hospital advanced 

life support, post resuscitation care, 

rehabilitation and aftercare, culture and 

context. We have developed a delivery 

plan that sets out intermediate outcomes 

and related indicators to allow us to 

monitor and drive forward progress against 

these priority areas. 

Early results are encouraging. Ambulance 

Control Centres across the country are 

prioritising cardiac arrest: the cardiac arrest 

8 minute response is 5% higher and triple 

responding is up by 15%. Overall the 

percentage of patients in cardiac arrest with 

a shockable rhythm arriving at hospital 

with a pulse has increased from 34% to 

40%. 

Save a Life for Scotland (SALFS) 

Save a Life for Scotland is the public facing 

strand of the OHCA strategy aimed at 

increasing public awareness of OHCA and 

encouraging people to learn CPR. It was 

launched at an event on Princes Street 

in central Edinburgh on 16th October 

2015, by Gregor Newton, a cardiac arrest 

survivor on behalf of the Resuscitation 

Research Group. The event was also 

attended by Maureen Watt, Minister 

of Public Health and over 20 partner 

organisations and industry sponsors. 

“This multi agency approach is great, it’s a 

huge marquee, All these organisations are 

here and the general public are coming to 

learn and it’s great to see this happening.” 

—Maureen Watt MSP 

The launch event was a great success 

with over 1400 people learning the basic 

skills of CPR in Edinburgh alone. Members 

of the public were invited into the tent 

to meet with volunteer CPR trainers 

from a wide variety of organisations and 

backgrounds. They received a basic ‘hands 

on’ introduction to CPR using Mini-Anne 

manikins. 


Participants were invited to signal a 

commitment to undertaking training in 

CPR and their willingness to perform 

basic life support should the need arise. 

In the SALFS photo suite many had their 

photograph taken and signed their name, 

or simply ‘I’ll do it’ across the print as 

their pledge. These photographs made an 

impressive photo wall and record of the 

day. Many were tweeted and are visible at 

the SALFS website www.savealife.scot 

Small cards with SALFS website information 

were handed to many on the streets and 

those who entered the marquee. Since 

the event we have been contacted by 

many organisations and individuals around 

Scotland requesting further information 

about the availability of CPR training. 

Launching Save a Life for Scotland 

around the country 

In addition to the Edinburgh event, over 70 

Fire Stations across Scotland opened their 

doors to the public and provided ‘hands-on’ 

CPR training to local communities. Scottish 

Ambulance Service held events at National 

HQ, the Scottish Borders, West Lothian and 

Glasgow Centre. Glasgow Science Centre 

while Glasgow Dental School provided 

training in the Glasgow Science Centre. 

Heartstart, BASICS and Community 

First Responder groups provided events 

in Aberdeen, Neilston, Orkney, Falkirk, 

Dalbeattie, Bathgate, Lanarkshire and Perth. 

Video footage from the day can viewed at 

the following link: www.rrg-edinburgh. 

com/rrg-coordinates-save-a-life-forscotland/ 

Plans are being developed for a 

similarly ambitious event in 2016. 

Triple Responding (3RU) 

The Scottish Ambulance Service is central 

to the delivery of high quality pre-hospital 

care and to improving OHCA performance 

and outcomes. One of the important areas 

they are supporting is the roll out of 3RU 

in urban communities across Scotland. 

In 2007, the Resuscitation Research Group 

(RRG) at the University of Edinburgh 

identified the need to improve the chain-ofsurvival 

for OHCA patients in south-east 

Scotland, where the national Heartstart 

Scotland database showed local survival to 

discharge rate at the time was less than 1%. 

The group identified the requirement to 

improve all elements of the local chain of 

survival in order to save lives. Following on 

from the initial TOPCAT study on OHCA, 

the team identified a unique opportunity 

to dramatically improve the quality of 

prehospital resuscitation practice, through 

defibrillator downloads, resuscitation 

feedback to EMS crews, simulation 

training and supporting resuscitation team 

leadership. 

In collaboration with the Scottish 

Ambulance Service, RRG set up the unique 

Resuscitation Rapid Response Unit (3RU). 

The response unit sends a specially trained 

3RU paramedic as a second-tier resource 

to lead OHCA resuscitation on-scene. 

The 3RU support-team consists of two 

doctors, 13 paramedics, a resuscitation 

officer, a research nurse and several medical 

students. The team volunteers to meet 

on a bi-monthly basis in their own time 

to maintain a high level of enthusiasm. 

The team was the first in the UK to 

pioneer a unique system of defibrillator 

data download and resuscitation feedback. 

Following every cardiac arrest, detailed 

resuscitation quality data is captured. 

The defibrillator data is analysed and 

fed back to the attending ambulance 

crew so performance can be continually 

improved. The team meets in the clinical 

simulation centre to undertake advanced 


SimMan ALS 

is designed to offer highly realistic training on the 10 vital first minutes of 

detection and stabilization of a rapidly deteriorating adult patient. 

@LaerdalEurope 

www.laerdal.com


resuscitation skills training, which is open 

to any paramedic. This not only includes 

technical skills practice but all non-technical 

skills such as resuscitation team leadership, 

communication and decision-making. Video 

analysis is used to inform training and 

optimise team performance. 

The team communicate with regional 

ambulance control dispatch at the start 

of each shift to maintain awareness and 

utilisation of the 3RU resource for OHCA. 

The team is collaborating with Psychologists 

from Edinburgh University, analysing original 

999 calls in order to improve the uptake of 

telephone-assisted CPR. 

Having established a solid foundation in the 

‘basics’ of prehospital resuscitation, the 3RU 

team is now using a mechanical CPR device, 

intra-arrest ultrasound and prehospital 

video recording in order to provide the 

highest possible care and inform future 

development needs. The overall aim is to 

improve outcome from OHCA, directly 

saving lives. 

The introduction of 3RU has made a 

significant contribution to the improvement 

in the number of patients now surviving 

out-of-hospital cardiac arrest in Edinburgh. 

In 2007, the overall survival to discharge 

rate from OHCA in south-east Scotland 

was 0.7% and it is now consistently 

over 17%. In 2013, 24% of all OHCA in 

Edinburgh were discharged neurologically 

intact from hospital. This extraordinary 

improvement in survival rate translates into 

scores of patients, who would otherwise 

have died, returning home to their families. 

Survival from OHCA in Edinburgh is now 

consistently the highest in the country and 

amongst the highest in the UK. 

The Scottish Ambulance Service is now 

rolling out the 3RU programme across the 

country and if the success can be replicated, 

this will be an important contribution to 

achieving the target of saving over 300 

additional lives per year. 

There has also been interest in extending 

the 3RU model from further afield. 

Ambulance services from Wales, East 

Midlands, the North East and the South- 

East coast have all visited Edinburgh, with 

many adopting their own resuscitation 

improvement programs based on the 

Edinburgh-model. The RRG and 3RU team 

have attracted attention internationally, 

winning a ‘best of the best’ research prize 

at the European Resuscitation Council 

meeting in Vienna, and Emergency Team of 

the year from the British Medical Journal. 

Co-reponding 

We are also carrying out a national trial 

for co-response to OHCA. The Scottish 

Fire and Rescue Service are working 

with the Scottish Ambulance Service in 7 

areas of the country where firefighters in 

community fire and rescue stations have 

received enhanced training in life-support. 

There has been a very positive response 

overall with around 70 call-outs in the first 

6 months and at least 2 known survivors 

to discharge directly related to the coresponder 

pilot. 

PAD mapping 

Enabling prompt access to defibrillators is 

a key strand of the OHCA strategy and 

the mapping of Public Access Defibrillators 

is being taken forward to ensure these 

are made available to the public. Work is 

ongoing to map defibrillators and ensure 

interoperability with existing CAD systems. 

Protecting Ambulance Personnel with 

Body Worn Cameras 

The VideoBadge from Edesix offers protection from threats and abusive behaviour, 

and has proven to be a valuable asset for facilitating training and operational debrief. 

Paired with Edesix’s VideoManager software, the VideoBadge captures video and 

audio footage when required, and stores the data securely for future training 

purposes, or as court-ready evidence. 

“VideoBadge has made it 

possible to evaluate new 

equipment while out in 

the field.” 

Resuscitation Research 

Group, Edinburgh 

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Focus on Evolutionary Change within St John New Zealand 

Refreshing Our Values to Benefit 

Our Patients and Our People 

By Peter Bradley, CBE, CEO of St. John, New Zealand. 

Peter Bradley, CBE is known globally across EMS as the author of the “Bradley Report,” the groundbreaking 

2005 strategic review of NHS ambulance services in England, Taking Healthcare to the Patient, 

which was the catalyst for a major transformation in UK ambulance services. After a highly-successful 

decade-plus tenure as CEO of London Ambulance Service (LAS), Peter returned to New Zealand in 2012 

to take on the challenging role of CEO of St John New Zealand at a time of organisational change and 

development. The last three years have seen improvements in clinical and operational service delivery at 

SJNZ but, as Peter explains below, the job isn’t finished and nobody at SJNZ, least of all himself, is resting 

on their laurels. 

It’s been an interesting transition, moving 

from CEO of the London Ambulance 

Service to CEO of the main ambulance 

service in New Zealand (NZ) – St John. I 

have been back here three-and-a-half years 

having left NZ for London in 1996. 

St John is a worldwide organisation 

operating in many countries, but we are 

one of only three that run the frontline 

emergency ambulance service – the other 

two are both in Australia (Western Australia 

and Northern Territory). 


Our five year strategy – which we have 

called the ‘Bigger Picture’ (a version of 

which appeared in a recent edition of this 

magazine) has five ambitions over five years 

and these are shown below. Most of these 

would align well with other ambulance 

services, however our fifth – ‘Partner of 

Choice’ focuses on our partners and reflects 

the much wider role that St John plays 

beyond running an ambulance service. 

- Right care right time 

- Local pathways 

- Quality care 

- People prepared for change 

- Partner of choice 

In terms of our ambulance service, I will start 

by outlining what is similar to the UK: well 

clearly the types of patients we see are the 

same, although we do get more traumarelated 

calls. We have similar ambulances, 

uniforms, kit and clinical guidelines. We 

have five frontline ambulance roles, starting 

with First Responder, then Emergency 

Medical Assistant (EMA), Emergency 

Medical Technician, Paramedic and finally 

Intensive Care Paramedic (ICP). All but First 

Responder and EMA must have an Authority 

to Practice (ATP), undertake annual refresher 

training and be exposed to a specific number 

of patient contacts each year to maintain 

their ATP. Our Medical Director has overall 

responsibility for approving ATP and the 

Clinical Procedures and Guidelines. 

Paramedics are not a registered health 

profession in NZ, however it is likely that this 

will happen over the next 18 to 24 months. 

Biography: 

Peter Bradley, CBE, 

CEO of St. John, New Zealand 

Peter was a paramedic 

in Auckland in the early 

stages of his career, and 

became Regional Director of 

Ambulance Services for St 

John New Zealand’s Northern 

Region before taking time 

out in 1995 to complete an MBA at Otago 

University. In 1996 he joined LAS as Director 

of Operations, and served as Chief Executive 

of the LAS from 2000 until his return to New 

Zealand. 

During his time in the UK, Peter was also the 

Chairman of the Association of Ambulance 

Chief Executives (AACE), and National 

Director of Ambulance Services for the 

Department of Health in England. He led the 

strategic review of NHS ambulance services in 

England, Taking Healthcare to the Patient, which 

was the catalyst for a major transformation in 

UK ambulance services. 



- Supporting our volunteers – we expect 

a lot from our volunteers and they provide 

fantastic support. But we can’ t take this for 

granted and we need to ensure they feel 

valued and supported. 

- The nature of our terrain means that 

we sometimes don’t have the level of 

communications that we would like. 

- Taking patients to the right place first time 

by both road and air remains a challenge at 

times and is something we are working to 

improve. 

All new Paramedics must have a Bachelor’s 

Degree in Paramedicine and all new ICPs 

must have a Post-Graduate Paramedic 

qualification. 

We operate out of three Clinical Control 

Centres across NZ, using MPDS as our 

triage software and a Tri-Tech CAD system. 

We have an old analogue radio network and 

have a number of other communications 

challenges linked to our geography. 

In terms of what is different? Unlike the 

NHS in the UK healthcare isn’t free at the 

point of delivery over here so, for example, 

you pay around 15 pounds to see your 

GP and if you call an ambulance and it’s 

a medically-related call, patients are billed 

around 40 pounds. We don’t enforce 

payment and around 30% of patients do 

not pay their bills. St John is funded to about 

70% by the Government and the remainder 

is paid for through a combination of the 

patient’s part-charge, fundraising, sponsorship 

and our commercial activities. There is 

much debate over here as to whether or 

not the ambulance service should be fully 

funded by the Government or whether the 

current arrangements should remain. My 

own view is that there is no reason why the 

current funding arrangements can’t remain 

in place, as long as the contribution from the 

Government keeps pace with the cost of 

running the service, and this is the subject of 

an official review as I write this. 


Looking at some benchmarking information 

recently, it appears that St John costs the 

Government around 15 pounds per head of 

population in NZ, in the UK it’s around 35 

pounds per head and in Australia it’s around 

45 pounds. The reasons why St John is so 

much cheaper is in large part due to three 

things: firstly, the funding model mentioned 

above relies on significant support from the 

public. Secondly, we have a large number 

of volunteer ambulance staff (over 3,000) 

who support the day-to-day running of 

the service. Finally, (and surprisingly to all 

who read this I am sure) we are currently 

unable to put two staff on all our emergency 

ambulances. Around 100 times a day we 

send an ambulance out single-crewed and 

although the recruitment of over 150 extra 

ambulance staff over the last two years has 

improved the situation, it remains a very 

real risk for our staff and patients. We are 

committed to fully eliminating single-crewing 

by 2018 and are currently in discussions with 

the Government as to how they can help us 

achieve this. 

In addition, although we do have response 

time targets they are not as stringent as the 

UK, i.e. reaching 50% of patients in 8 minutes, 

and we don’t have Call Connect so the 

whole performance management regime 

feels less onerous. This doesn’t seem to have 

had a detrimental impact on our cardiac 

arrest survival-to-discharge results as our last 

report indicated survival-to-discharge results 

of 15%. We also have some control over 

what calls fall into what category. 

Challenges? 

- Single-crewing of emergency ambulances 

is the biggest single challenge facing our 

service with around 10% (40,000 responses 

a year) single-crewed. This issue has been 

around forever and we have seen an 

improvement in recent years with the extra 

recruitment. 

- Getting the baseline funding of the service 

to a level that means we can sustain a good 

service. 

- Taking patients with a primary care need 

to somewhere other than ED when it either 

costs the patients to go somewhere else, or 

where no referral pathways exist 

- Educating the public around the roll out 

of the clinical hub when they expect an 

ambulance. 

What we do well: 

- Virtual call-taking - our 111 (999) calls 

can be answered in any one of three control 

rooms across NZ. 

- We recently rolled out a national spinal 

cord impairment policy which allows 

patients in such a situation to be transported 

directly to one of two specialist spinal units 

in NZ 

- Our cardiac arrest survival-to-discharge 

results compare well with many other 

services 

- St John has been NZ’s most trusted 

charity for the last two years and ambulance 

staff and volunteers enjoy a very high level of 

respect in the community 

- We have a 24/7 Clinical Desk that all 

ambulance staff (including volunteers) can 

access for advice and information and this 

receives great reviews 

- Electronic patient report form (ePRF) 

– we recently rolled this out across our 

almost 400 ambulances in New Zealand. 

This is a Valentia Technologies product and I 

am reliably told from our current CIO Barry 

Thurston (who many of you will have heard 

of) that this is the best ePRF set up he has 

ever seen. The game-changer over the next 


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12 months is that we will have access to a 

summary health care record. 

In the future, we aim to: 

- Achieve a reduction of 100,000 

Emergency Department presentations over 

5 years. 

- Ensure double-crewing for every 

ambulance in NZ. 

- Roll out the national major trauma system 

and STEMI pathway. 

- Introduce a national Air Desk to improve 

dispatching of air ambulances across NZ. 

- Review the call prioritisation system 

(MPDS) and see what system works better 

for us. 

- Really leverage the benefits of ePRF - 

both in terms of clinical audit and research 

and the summary care record. 

- Introduce a new set of Clinical Quality 

indicators. 

- Roll out new single stretcher ambulances. 

- Look to introduce a national Community 

First Responder scheme – much like in the 

UK. 

- Improve the equity of our service 

provision. 

- Further diversify - we are a bi-cultural 

nation and we need to reflect this in how 

we deliver our services and to ensure we 

provide an equitable service across the 

country. 

The above is all good bread-and-butter stuff 

and central to this is having a healthy culture, 

where our paid staff and volunteers feel wellsupported. 

As part of this we have recently 

rolled out a new set of values: 

- We do the Right Thing - Whakaaro Tika 

- We stand Side by Side - Whakakoha 

- We Make it Better - Whakawerohia 

- We have Open Minds - 

Whakahangahanga 

- We are Straight Up – Whakapono 

- Upgrade our current version of CAD to Our refreshed values were developed 

achieve ACE accreditation for our Clinical following consultations with the whole 

Control Centres. 

organisation, and we have a whole 

- Roll out our electronic staff appraisal programme in place over a couple of 

Ambulance-today-winter system. 

2015-132x185-v2:Layout years to make 1 these 3/12/15 values 10:56 meaningful Page and 1 

influence how we act and behave to towards 

each other. 

Finally, despite some of the challenges we 

face, we are still in a unique position of 

influence in the health service in NZ and we 

know that over the next three to five years 

we need to use our position to the best 

effect for the benefit of our patients and our 

people. 

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Clinical Focus on the use of ENTONOX in Pain Management 

Entonox – Making the 

most of the basics 

in pre-hospital pain 

management 

By Lucas Hawkes-Frost, Paramedic 

and Assistant Director of Operations 

London Ambulance Service 

Entonox: the dusty weather-worn barrel bag in the side cupboard of more or less every ambulance in 

the UK, has been a mainstay of pre-hospital pain management since the 1970s; a loyal friend to the 

Ambulance Service, there at the birth of the Paramedic profession and along for the ride ever since. 

Nitrous oxide, a remarkable substance, 

used in rocket fuel among other things, has 

long been identified as having analgesic and 

anaesthetic properties with use reported 

for the relief of pain during labour since 

the 1930s, delivered at a concentration of 

50% in air, which delivered a useful analgesic 

effect with few side effects. 

ENTONOX as we know it today, was 

developed in 1961 by Dr Mike Tunstall, then 

an Anaesthetics Registrar at the Portsmouth 

and Oxford United Hospitals, who wrote 

to BOC asking about the feasibility of mixing 

oxygen and nitrous oxide together under 

pressure in a single gas cylinder. BOC duly 


provided him with grey 48 cu.ft (F-size) 

cylinders to continue his development 

of portable anaesthetic machines and 

ENTONOX was born. 

The story of ENTONOX, however, 

was very nearly a very short one; at 

Oxford, a physicist to the Nuffield Dept 

of Anaesthetics and an anaesthetist 

exploring this new mix, Drs Epstein and 

Cole, discovered that after cooling, the 

gas mixture separated and was not stable, 

even when re-warmed. ENTONOX was 

regarded as being unsafe and it was felt 

that it had no future, until Dr Tunstall took 

his new development to Aberdeen in 1962 

as a consultant. After much development 

and experimentation (with the assistance 

of Donald’s ice-cream factory), the safety 

of ENTONOX was demonstrated through 

MRC trials and introduced for pre-hospital 

use by unsupervised midwives in 1965. 

Since then, ENTONOX has become an 

indispensible tool in the formulary of 

clinicians working in and out of hospitals, 

being a fast-acting, convenient and safe 

analgesic ideally suited to managing pain in 

a wide range of clinical contexts including 

labour, emergency care, procedural 

pain, wound care and of course burns. 

ENTONOX is especially useful in managing 

pain in children without the need for 

vascular access or other invasive procedures. 

One study, spanning 40 children’s and 

general hospitals analysed for children who 

received nitrous oxide as a primary sedative. 

In total, 1634 nitrous oxide administrations 

were identified in the course of the 

study, most of which were performed by 

advanced nurse practitioners or physician 

assistants. The study concludes that while 

the likelihood of vomiting increased when 

opioids concomitantly, the prevalence of 

serious adverse events was very low in the 

course of nitrous oxide administration. 

Physiologically, the analgesic effect of 

ENTONOX and nitrous oxide are not 

understood, however the prevailing 

evidence suggests that the action is 

associated with interaction between 

endogenous opioid substances and 

noradrenergic systems. This theory has been 

developed through observation of a number 

of phenomena whereby animals with a 

significant morphine tolerance are given 

nitrous oxide, the analgesic effects of nitrous 

oxide are equally reduced as with opiates, 

suggesting similar actions. Indeed, it has 

further been observed that the inhibition 

or potentiation of specific endogenous 

opioid receptors has a similar inhibition or 

potentiation of the effects of nitrous oxide 

Biography: 

Lucas Hawkes-Frost 

Lucas Hawkes-Frost is a 

Paramedic and an Assistant 

Director of Operations for 

London Ambulance Service. 

Professionally, Lucas has 

a background in clinical 

operations, clinical education, 

quality and patient safety and in addition to 

working within the NHS, works with a number 

of regulatory agencies and academic bodies 

nationally. Lucas has a long standing clinical 

interest in pain assessment and management 

and has spoken and published around the 

subject for a number of years. As a passionate 

advocate for the Paramedic profession, Lucas is 

a champion for the development of specialist 

clinical practice and better collaboration 

between professionals and agencies providing 

urgent and emergency care. 

47 3


administration. Despite these observed 

phenomena, it remains unclear how the 

administration of nitrous oxide causes the 

release of endogenous opioids. 

The analgesic effects of ENTONOX are 

rapid, observable and reported by users 

after only four to five breaths. Indeed, the 

duration of action is very short, making 

the drug ideal for short procedures and of 

course allowing a patient to self-manage 

the administration of their own pain relief. 

In practice, ENTONOX has very few side 

effects or contraindications to use and is 

easily administered. 

The role of the NHS ambulance service 

and indeed of the Paramedic profession 

is developing quickly within the context 

of the modern NHS. In addition to 

NHS staff, voluntary services and other 

providers of urgent and emergency care 

are developing clinicians and indeed the 

resources being used to care for patients. 

Pain remains among the most commonly 

reported symptoms for the ambulance 

service and while the technical skill and 

capability of clinicians increases as well as 

pharmacological options for managing pain, 

it is important to remember that basic 

interventions have the potential to make a 

significant positive impact on the onward 

management of many patients in pain. 

Assessment and scoring of pain is an 

incredibly important element of treating any 

pain presentation, whether acute, chronic or 

acute on chronic. Pain assessment and basic 

pharmacological and non pharmacological 

approaches to the management of pain 

are important as they help not only to 

calm and engage a patient in the process 

of further assessment, but help patients to 

better describe symptomologies, recognise 

previously undisclosed pain and to better 

inform the clinician in crafting a care plan 

which meets the needs of the individual 

pain sufferer. ENTONOX administration 

provides a great opportunity, in many cases, 

to begin the process of pain management 

quickly and efficiently without the need for 

ancillary equipment or invasive procedures. 

The analgesic effect of ENTONOX may in 

many cases be sufficient to settle a patient 

adequately to better describe the illness or 

injury and indeed allow an attending clinician 

to better develop a multi-modal pain 

management plan which better suits the 

pain presentation the patient is experiencing. 

A significant number of pain assessment 

strategies exist, for children (Wong-Baker 

scale, FLACC), adults (Pain analogue scale, 

pain thermometer) and indeed those with 

cognitive impairment (Abbey Pain score, 

DOLORPLUS) and choosing the best scale 

is imperative in supporting a patient in 

identifying the nature and severity of their 

pain as well as supporting the clinician in 

best managing it. 

Clinically, ENTONOX administration 

provides patients with a fast onset and 

highly effective analgesia without heavy 

sedation, has anxiolytic and euphoric 

effects and supports patient relaxation 

and better patient engagement, providing 

in many cases a better opportunity for 

quality patient assessment and patient 

history. Across available literature, patients 

report occasional adverse effects, including 

nausea and vomiting, dizziness, dry mouth 

(most likely due to the administration of 

dry gas), tinnitus and rarely more significant 

symptoms including numbness, dreams or 

drowsiness the incidence of such effects 

ranges in literature between 0 and around 

30%. 

The efficacy of ENTONOX as a pain 

relieving agent and indeed quantifying actual 

clinical effectiveness is an area with a relative 

paucity of evidence. Donen et al. (1982) 

reviewed the cases of 240 patients to whom 

ENTONOX had been administered. The 

population studied had all presented with 

traumatic injuries to the chest, abdomen 

or back and were reporting pain. Of those 

reviewed, over 90% of patients reported 

reduced pain, with few adverse effects 

described. 

Further, in 2007, Descamps et al concluded 

that the administration of ENTONOX to 

patients presenting with acute traumatic 

shoulder dislocations, irrespective of the 

administration of a further oral analgesic, 

correlated strongly with markedly reduced 

time spent within the Accident and 

Emergency department in contrast to those 

patients to whom intravenous morphine 

an intravenous benzodiazepine had been 

administered. Descamps concluded that 

the use of morphine and or midazolam 



was linked with dramatically increased 

department stays; 177 minutes for 

intravenous morphine and / or midazolam 

and 77 minutes for ENTONOX alone. 

The paper does not explore the relative 

efficacy of either option in terms of pain 

scoring, however does underscore the fast 

onset and fast resolution of effects of the 

administration of ENTONOX as well as 

the clinical utility when used for traumatic 

injuries. 

Traditionally, ENTONOX has been a drug 

used primarily in the management of 

patients suffering with pain of a traumatic 

nature or indeed children and labour, 

however increasingly, evidence supports the 

use of ENTONOX as an analgesic option 

for patients suffering a range of conditions 

including acute heart attack. 

Nitrous oxide has been observed as 

exerting relatively minor effects on 

cardiovascular function in patients diagnosed 

with coronary artery disease. Two papers, 

published by Thornton et al. and Wynne 

et al. concluded that the administration 

of the nitrous oxide had very little effect 

on the circulatory system. Further, Wynne 

postulated that the weak depressant effect 

exerted on myocardial tissue by nitrous 

oxide could provide benefit in terms of 

improving myocardial oxygenation. This, 

however has not been established as fact, 

though ENTONOX is a credible and 

clinically useful option for managing patients 

by non-registrant clinicians without recourse 

to opiates and in addition to routine 

interventions such as nitrates, etc. 

Pain assessment and management is a 

major element of the role of the ambulance 

service and indeed of all those involved 

with the provision of urgent and emergency 

care in the UK. ENTONOX remains a highly 

credible and extremely effective means of 

rapid pain relief with few side effects or 

contraindications for use and should remain 

a cornerstone option for the provision of 

multimodal pain management in patients 

presenting with a range of pain conditions. 

From rocket fuel to pain relief in child 

birth, nitrous oxide as ENTONOX will 

likely remain a familiar tool in the side 

compartment of ambulances, clinics, 

voluntary agencies and sports clubs up and 

down the country. 

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Focus on Performance Optimization 

Split-Second Deployment 

Decision-Making! 

By Duncan Bänffer, General Manager Finance & Controlling 

and ICT at AmbulanceZorg Rotterdam-Rijnmond (AZRR) 

AmbulanceZorg Rotterdam-Rijnmond (AZRR) is one of the Netherlands’ busiest ambulance services. 

Serving a population in excess of 1.2 M it provides urgent and emergency medical cover to the hectic 

Port of Rotterdam area as well as to remote rural areas. General Manager of Finance, Controlling and 

ICT, Duncan Bänffer was given the challenge of further developing a project to improve the deployment 

of front-line ambulance crews while improving response times and increasing cost-efficiencies. The start 

of the project was years ago in a fact finding visit of the AZRR to see Optima Live and Optima Predict 

working in action. The ability of Optima Live and Predict to provide accurate split-second deployment 

information and their popularity among dispatchers made the decision on where to seek an IT-driven 

solution much easier. Read on to find out what happened next… 

Introduction to AZRR 

In the Rotterdam metro area 

“AmbulanceZorg Rotterdam-Rijnmond” 

(AZRR) provides Emergency Medical 

Transport and Planned Medical Transport. 

AZRR is a cooperative of two contractors, 

Veiligheidsregio Rotterdam-Rijnmond (VRR), 

a public organisation, and the Bios Group, 

a private company. In total nearly 400 

employees are 24/7 available for medical 

support for approximately 1.2 million 

population of the Rotterdam metro area, 

and the tens of thousands of workers in 

the Port of Rotterdam and surrounding 

industrial areas. South of Rotterdam there 

is a more rural area, which is also serviced 

and supported by AZRR with acute and 

planned medical care. In 2015, AZRR 

handled 107.380 deployments with 85 

ambulance vehicles. During day time around 

37 ambulances are on duty. 

The Rotterdam-Rijnmond Dispatch Center 

hosts the ambulance service, fire and police 

departments. During the day, AZRR has six 

medical dispatchers on duty. Three nurses 

act as call-takers, one dispatcher handles 

low-care ambulances and two dispatchers 

take care of the Emergency Medical Care 

ambulances. 

First Contact with Optima 

The first contact with Optima dates back 

to 2009, resulting in a visit to Houston to 

see Optima Predict and Optima Live in 

an actual, live situation. At that moment 

AZRR was looking for a system to support 

the dispatch room in deploying the most 

suitable ambulance, taking into account the 

optimal distribution of vehicles over the area 

for the next 20 minutes. The dispatchers 

experienced a very high workload, and we 

envisioned Optima to decrease that. The 

general idea was that in hectic moments, 

with many simultaneous deployments to be 

handled by the dispatch room, dispatchers 

were not able to cope fully with the 

workload. There was not enough time for 

the dispatchers to get hold of the new 

locations of the vehicles before selecting the 

most suitable ones and also making sure the 

vehicles were distributed optimally across 

the service area. The mix of rural and urban 

settings complicated optimal deployments of 

vehicles and was an extra hurdle to be taken 

in the process. This resulted in the general 

idea that the solution had to be an IT-driven 

one, instead of increasing the number of 

ambulances. The costs of Optima compared 

to the investment and operational expenses 

related to adding ambulances, makes Optima 

the better economical choice. Although 

there was a lot of enthusiasm for Optima in 

2009, many other operational issues meant 

that the decision to implement Optima was 

delayed until 2011. 

What is Optima? 


Optima provides software solutions 

drawing on operations research to analyse 

historic data and providing modelling 

to support a range of strategic and 

operational decisions. Optima provides two 

solutions: Optima Predict and Optima Live. 

Both solutions are made up of a number of 

modules. 

Optima is a planning software package that 

statistically and dynamically determines the 

optimal distribution of vehicles or posts over 

a region. The Optima solution consists of 

Biography: 

Duncan Bänffer 

Duncan Bänffer is the 

General Manager Finance 

& Controlling and ICT for 

AmbulanceZorg Rotterdam- 

Rijnmond (AZRR) in the 

Netherlands. He oversees 

all financial, accounting and 

IT efforts of this 24/7 operational ambulance 

service with 400 employees. He is also the 

overall project manager for the Optima 

implementation project at AZRR. He has 

worked for a number of smaller and larger 

companies after graduating in Business 

Economics at the Erasmus University in 

Rotterdam. Duncan’s specialty is leading 

transition processes, supported by his 

combined financial and logistical expertise. 



two main software modules: Optima Predict 

and Optima Live. Optima Live is made up of 

four submodules. 

Optima Predict 

Optima Predict is the more static version, 

which predicts the response time within an 

area, considering the number of vehicles and 

posts plus historical data of deployments. 

By changing the variables of vehicles and 

posts, one can create the optimal distribution 

of vehicles over the area. This optimal 

distribution can be summarised in a post 

plan top 20, indicating in which order the 

post should be populated with ambulances. 

The most critical location is placed at the 

top. 

Optima Live 

Optima Live is a real-time decision support 

solution that provides an operational picture 

of the live situation for the service area. It 

can also predict how this actual situation will 

evolve, considering the known deployment 

history for the region. The Optima software’s 

database contains preloaded historical data. 

Optima Live in AZRR has for main modules: 

Real Time View, Look Ahead, Deployment 

and Dispatch. Real Time View presents the 

current position of each vehicle. Colour 

coding depicts the ability to service the 

patient within 15 minutes (the Dutch 

standard). Look Ahead shows the coverage 

Optima Predict is an interactive strategic 

planning solution that gives users the 

ability to generate evidence for strategic 

and operational decisions, quantifying the 

impact of any changes in response time 

performance, vehicle utilisation and other 

key operational metrics. The model uses 

historic data to produce a highly accurate 

simulation model of the operation; a 

user can then make changes to the 

operation and evaluate the impact of these 

changes against the general performance 

requirement of being on time in 95 % of 

the acute deployments. For example, by 

changing the variables of vehicles and posts, 

one can create the optimal distribution 

of vehicles over the area. This optimal 

distribution can be summarised in a post 

plan top 20, indicating in which order the 

post should be populated with ambulances. 

The most critical location is placed at the 

top. 

as it will be 20 minutes from now and 

indicates where to expect new incidents, 

based on historical data. The third module, 

Deployment, combines Real Time View and 

Look Ahead and the post plans to propose 

deployments while maintaining an optimal 

distribution of the vehicles across the region. 

It indicates which posts lack resources, 

attracting the dispatcher’s attention using a 

red-coloured symbol, urging the dispatcher 

to assign a vehicle to this location (see 

picture below at the left side, underresourced 

locations in red). The Deployment 

module also suggests corrective actions to 

restore the desired situation, by displaying 

action arrows. 

The last module, Dispatch, proposes the 

deployment of a specific vehicle as most 

suitable to respond to an incident. This 

deployment proposal is generated very 

quickly, taking all constraints, including 

maintaining service area coverage and 

response time, into account. It can directly be 

used for deployment. 

Government Funding 

In the Netherlands, the ambulance budget 

is dictated by the government. For every 

region, there is one organisation with an 

exclusive licence for the ambulance service. 

In our region, AZRR has obtained the 

licence. The budget used to be primarily 

output-oriented but has evolved towards 

a lump sum budget based on locations and 

performance (95% of acute deployments 

within 15 minutes). 

The picture shows a screen shot of Optima Deployment. On the left-hand side is the real-time view, showing a 

location in red with insufficient resourcing of vehicles. On the right-hand side, Optima’s Look Ahead is shown. It 

presents the situation as anticipated 20 minutes into the future, with arrows indicating the required moves to 

reach that goal. In this example, ambulance 116 should be moved from the location “Haringvlietdam” to the 

location “Goedereede”. 


Working with Optima 

We started working with Optima Predict 

in 2012, to increase our understanding of 

what the optimal distribution of posts and 

vehicles across the service area would be. In 

our budgeting process, it is very important to 

be able to recalculate the budget as granted 

to us by the government. The government 

budget dictates how many costs we are 

allowed to make, based on the regionspecific 

indicators such as demographics and 

infrastructural complexity, keeping in mind 

that 95% of the acute deployments have 

to be coped with within 15 minutes (12 

minutes driving time plus 3 minutes response 

time). 

One output from Optima Predict is a Post 

Plan, summarising the optimal location of 

posts and vehicles; this plan indicates the 



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priority in assigning vehicles to the posts. 

The Post Plan is also the basis for the 

calculations which are being made in Optima 

Deployment, indicating sufficient coverage 

with ambulances of the various locations. 

The locations which are not sufficiently 

populated are shown in red, continuously 

presenting the dispatchers a clear overview 

of the situation. Currently, the Deployment 

module is going live in the dispatch room 

after thorough testing. 

Introducing Optima Live and getting 

the commitment of the dispatchers in 

Rotterdam 

For AZRR, it was extremely important that 

the decision to deploy Optima was not 

only made top-down but together with the 

people in the dispatch room, who would be 

working with Optima on a daily basis. For 

that reason there was an additional visit to 

the Denver location in November of 2012, 

to show a selected group of dispatchers 

an actual live working Optima solution. 

As a result of this visit AZRR decided to 

implement the first modules of Optima, with 

an option for the Dispatch module. Not 

part of the solution in Denver, we added the 

Deployment module. With Deployment, it is 

very easy to see which possible deployments 

maintain an optimal distribution of vehicles 

over the service area. And, it gives the 

dispatchers the possibility to look “under 

the hood” of the Optima software and 

gain a better understanding of the process 

leading to Optima’s results. This gives the 

dispatchers more comfort and trust in the 

calculations Optima makes. Deployment 

makes its calculations solely based on the 

AZRR Post Plan and business rules as these 

were previously used by the dispatchers, 

providing the staff with a sense of 

recognition. Also, we decided to take more 

time going through the implementation 

stages to give the dispatchers enough time 

to understand the use and the impact of 

Optima Live. Certainly for Optima Live 

Dispatch, it is important that the dispatchers 

are comfortable with Optima’s deployment 

proposals. If they are not confident with the 

Optima recommendations, they will keep 

questioning these. With the approach taken, 

the commitment of the workforce to the 

Optima solution is strengthened. 

Added value of Optima 

The Dispatch module adds significant value 

to our total dispatch solution and helps 

the dispatchers in their job. Every day we 

analyse our over-due deployments, and 

our analysis shows that especially at times 

with many simultaneous deployments it is 

difficult for the dispatcher to create and 

value a new mental picture of the situation 

and assign the most suitable vehicle while 

considering the optimal distribution of 

the ambulances across the various areas. 

It is normal, and human nature, that when 

the dispatcher has to cope with too many 

deployments, he reverts to a basic mode of 

planning, and assign the vehicle nearest to 

the incident. But what the dispatcher cannot 

do is possible with Optima Live; it can 

recalculate in a split second, even under the 

pressure of a high workload of simultaneous 

deployment requests. Using the Optima Live 

recommendations, the dispatcher can comply 

with our Post Plan and at the same time 

understand what to expect, based on the 

historical of deployment patterns presented 

by the software. As a result, we reduced 

the workload of the dispatchers by helping 

them make excellent deployments in hectic 

situations, allowing them time to be more 

supportive towards ambulance crews. 

The solid implementation approach starts 

with making a coverage plan in Optima 

Predict. This plan is taken to the test in the 

real operational environment using Optima 

Live modules Deployment and Dispatch, 

where it is fine-tuned even further. The result 

is a truly optimal coverage plan. This is where 

Optima adds real value. After thorough 

testing AZRR obtained good results with 

the Optima Live Deployment module. The 

next step involved the implementation of 

Optima Live Deployment in the production 

environment. In May, we plan to start 

implementing Optima Live Dispatch. We aim 

to have all Optima modules operational at 

the end of the year. It is needless to say that 

we have high expectations of using Optima 

and we will gladly tell you more after we 

have finished implementing. 

I would like to thank Aad Romijn and 

especially Willem Grool who as previous 

project leaders helped me to get up to speed 

as project leaders for Optima Dispatch. Also 

I would like to thank the Optima project 

group, Henry Oudshoorn, Hans Bontekoe, 

Marjolein Westerdijk and Hans Kuiper for their 

tremendous effort. 

Duncan Bänffer, Project Leader Optima 

Dispatch, Rotterdam 1st of April. 

To find out more about how the 

Optima solutions can help improve 

operational performance and 

dispatch effectiveness call Intermedix 

on: +44 (0) 1189 036 602 

or visit the Intermedix website at: 

www.intermedix.co.uk 




Clinical Focus on Emergency Artificial Ventilation 

Problems associated with the use 

of self – reforming bags in emergency 

artificial ventilation 

By Dr David J Baker, M Phil DM FRCA FRSM 

Emeritus Consultant Anaesthesiologist 

SAMU de Paris 

Hôpital Necker – Enfants Malades, Paris 

Artificial ventilation of the lungs goes back to antiquity but the modern use of bag-valve-mask (BVM) 

ventilation dates from the 1950s with the development of the self-reforming bag and non-return valve 

by the Dutch anaesthetist Henning Ruben. Since then, BVM ventilation in emergency has been widelyaccepted 

by emergency medical services throughout the world. The device is generally regarded as being 

safe and effective. This view may be related to training experience in anaesthetic rooms on patients who 

were asleep, had muscle relaxation and normal lung and airway characteristics. However, the use of BVM 

in emergency has increasingly been shown to be associated with a number of potentially serious problems 

including hypo - and hyperventilation, a view supported by a number of published studies. Portable 

gas-powered ventilators, developed over the past 40 years have been shown to deliver more consistent 

and effective ventilation while freeing an emergency responder from the requirement of squeezing a bag. 

This paper reviews the published evidence concerning the use of BVM in emergency and discusses the 

need for better training and awareness of the associated problems. 

Introduction 

Artificial ventilation of the lungs has long 

been an established part of both basic and 

advanced life support 1,2 . Although positive 

pressure ventilation has only become an 

integral part of medical practice over the 

past 60 years its origins go back to antiquity. 

Interest developed during the 17th and 18th 

centuries with experiments on ventilating 

animals and humans using bellows devices. 

At that time the essential negative pressure 

nature of normal breathing was not entirely 

understood but ventilation of the lungs 

was recognised as being an essential in the 

resuscitation of drowned persons, and led 

to the formation of societies such as the 

Royal Humane Society in London and the 

Society for the Resuscitation of Drowned 

Persons in Amsterdam. Work continued 

on positive pressure ventilation and the 

protection of the airway through intubation 

during the 19th century 3 . At the beginning 

of the 20th century the first mechanical 

ventilator, the Drager pulmoflator appeared. 

At that time however mechanical ventilation 

concentrated on reproducing the 

physiological conditions of normal breathing 

by creating a negative pressure around the 

patient. This led to the development of the 

cabinet ventilator (or ‘iron lung’) which was 

widely used in hospital ventilation until the 

1950s. 

The requirement for mass ventilation 

in Copenhagen during the 1952 polio 

epidemic overwhelmed the supply 

of cabinet ventilators available. The 

anaesthetist Bjorn Ibsen had the idea of 

using anaesthetic circuits containing a Boyles 

bag to provide intermittent positive pressure 

ventilation 4 . The bag was kept inflated by 

a positive pressure of gas within the circuit 

and could be squeezed by hand to provide 

inflation. (Figure 1) Later the bag would 

be modified to become self-reforming so 

that it could be used independently of an 

anaesthetic machine. 

Figure 1: Bjorn Ibsen and the first manual 

resuscitation circuit 

The first bag ventilation circuits used a 

canister of soda lime to absorb the exhaled 

carbon dioxide. The incorporation of a 

non-return valve, invented by the Dutch 

anaesthetist Henning Ruben 5 led to 

the development of the modern self – 

reforming bag, the first example of which 

was the Ambu bag in the late 1950s. 

Biography: 

Dr David J Baker 

M Phil DM FRCA FRSM 

David Baker was born in London 

and studied medicine at St 

Bartholomew’s Hospital. After 

qualification he served as a 

medical officer in the Royal Navy 

for nearly 20 years specializing in 

anaesthesia. He served in surface 

vessels and in the hospital ship 

Uganda during the Falklands War in 1982. Later he 

worked for several years at the United Kingdom 

Chemical Defence Establishment, where he conducted 

research on the neurophysiology of organophosphate 

poisoning, leading to a doctorate in medicine in 1986. 

After leaving the navy in 1992, David moved to France 

where he worked for many years as a consultant 

in anaesthesia for the Paris emergency medical 

service (SAMU) at the Necker University Hospital, 

specializing in the management of mass toxic incidents. 

From 2004 he also worked as a consultant medical 

toxicologist for the Centre for Radiation, Chemical 

and Environmental Hazards of the United Kingdom 

Health Protection Agency. 

David Baker has been a visiting professor at the 

Universities of Harvard and Surabaya. He has 

lectured in over 40 countries around the world and 

is the author of numerous journal articles, textbook 

chapters and monographs ,including the recently – 

published ‘Toxic Trauma: a Basic Clinical Guide. He 

was a Board Member of the World Association 

for Disaster and Emergency Medicine and has 

consulted for the World Health Organisation and the 

International Committee of the Red Cross in Geneva. 

Currently, he is continuing work on his long - standing 

interest in emergency and transport ventilation and is 

a consultant adviser in this area to Pneupac Ventilation, 

a part of Smiths Medical International. 



This device and others like it have been 

widely used in anaesthetic rooms and in 

both hospital and prehospital emergency 

medicine since that time 6 . In conjunction 

with a pharyngeal mask, the bag-valve-mask 

is probably the mostly widely-used device to 

provide positive pressure ventilation in the 

world today. (Figure 2) 

Figure 2: The BV device with the Ruben 

non-return valve (1) pharyngeal mask (2) 

filter and non-return valve (3) self-reforming 

bag. (Photograph by courtesy of AMBU, 

Copenhagen, Denmark) 

Perceptions of safety and 

effectiveness of bag valve mask 

ventilation 

There are a number of reasons for the 

widespread adoption of the BVM by 

paramedical and other emergency services 

which include the following: 

1 It had an apparent simplicity of action 

with either one hand holding the mask 

while the other squeezed the bag (single 

operator) or two hands holding the mask 

( the so-called ‘ double C ‘ position) and 

another person squeezing the bag 2 . 

2 There was a belief that in squeezing the 

bag manually there was a feeling of being in 

‘direct contact ‘ with the patient’s lungs and 

therefore over-ventilation would be avoided 

3 There was a conviction that the device 

was essentially safe to use and could provide 

effective ventilation. This was probably 

based upon the fact that that bag ventilation 

is used following the induction of general 

anaesthesia in the anaesthetic room on 

patients who are asleep, have muscle 

relaxation and usually an empty stomach. 

Many of these patients would also have 

normal values of airway resistance and lung 

compliance. It was in this environment that 

many paramedics first received their airway 

and ventilation training. 

4 Compared with mechanical ventilators 

providing BVM involved a low financial 

outlay. The development of disposable BVM 

at the end of the 20th century provided 

a solution to sterilisation with increasing 

concerns about cross-infection. 

Problems associated with the use of 

the bag-valve-mask device 

Despite continuing widespread use of the 

BVM in emergency ventilation (particularly 


in the United States, where the adoption of 

alternative portable automatic ventilation 

has been relatively slow) there has been 

increasing concern over the past decade 

about potential serious problems that 

may be associated with this type of 

positive pressure ventilation. These may 

be summarised as hypo - and hyper - 

ventilation. 

Hypoventilation 

The BVM usually operates using air as 

the main gas with supplemental free-flow 

oxygen provided to increase the oxygen 

concentration. However this can cause 

considerable wastage of bottled oxygen due 

to leaks around the mask (particularly if held 

with only one hand). In addition, if the mask 

seal is not effective too low a tidal volume 

will be delivered to the patient leading to 

hypoventilation and hypoxia. 

Hyperventilation 

Inappropriate use of the BVM may cause 

(1) high ventilation frequency and tidal and 

minute volumes and (2) excessive inflation 

pressures. These can cause gastic insufflation, 

barotrauma, where weak sections of the 

lung parenchyma are disrupted, leading 

to pneumothorax and the more recently 

recognised problem of volutrauma, 

where damage is caused to the alveoli 

by over-distension. In addition, excessive 

intrathoracic inflation pressures have 

important haemodynamic consequences. 

High ventilation rates 

Ventilating the patient too quickly, even if the 

tidal volume is correct leads to an excessive 

minute volume and hypocapnia. Even with 

trained and experienced operators the 

stressful nature of the emergency situations 

where BVM are used can lead to high 

ventilation rates. Cooper et al 7 noted that 

keeping artificial ventilation rates low is 

difficult because the high adrenaline state of 

the rescuer alters time perception, and that 

the rapidly refilling bag provokes a reflex 

in which rescuers are inclined to deliver 

breaths as soon as the bag inflates. 

Aufterheide et al 8 reported a clinical 

study observing ventilation rates in cardiac 

arrest patients. They found that emergency 

medical services (EMS) rescuers using a bag 

valve device who were trained to follow 

the American Heart Association (AHA) 

guidelines were delivering on average 37±4 

breaths per minute, not the 10–12 breaths 

per minute prescribed by the guidelines. 

Even after the rescuers were re-trained to 

deliver 12 breaths per minute, they were 

observed delivering an average of 22±3 

breaths per minute. 

Losert et al 9 demonstrated excessive 

ventilation rates with BV devices even 

among trained intensivists, most of whom 

were basic or advanced life support 

instructors. Their study demonstrated that 

the respiration target rate was achieved 

only 18% of the time in patients receiving 

cardiopulmonary resuscitation, even when 

performed in a hospital setting. On average 

the guideline for correct ventilation rate was 

exceeded by 33%. 

O’Niell and Deakin 10 studied BVM in 

comparison with a manually triggered 

ventilator and an automatic transport 

ventilation. They found that hyperventilation 

was common with the BVM but mainly due 

to high respiratory rates (ranging from 9 

– 41 breaths per minute) rather than from 

excessive tidal volumes. 

Excessive inspiration pressure 

Several studies have demonstrated excessive 

inspiration pressures using bag valve devices 

which can cause barotrauma and gastric 

insufflation 

There has been a long-standing fear that 

in patients with an unprotected airway 

excessive airway pressure caused by 

squeezing the bag too hard would open 

the oesophageal sphincter and cause 

inflation of the stomach, leading to potential 

regurgitation and aspiration into the lungs. 

This was a particular concern in patients 

being resuscitated following cardiac arrest 

Updike and colleagues 11 studied the use of 

the BVM in comparison with a manuallytriggered 

ventilators and an automatic 

transport ventilator. All three devices 

delivered similar tidal volumes when used 

by emergency medical technicians the BV 

device was associated with a high PAP, 

mask leak and gastric insufflation. The latter 

problem has long been a major concern 

when ventilating through an unprotected 

airway such as a pharyngeal mask 12 – 14 . Salas 

et al 12 , reporting a study measuring the 

differences between a bag valve device and 

a transport ventilator used with a mask 

found that almost 10 times the amount 

of air was insufflated into the simulated 

stomach per breath when the subjects used 

a bag valve device. 

Haemodynamic effects of increased 

intra thoracic pressure when using a 

bag valve device 

There are a number of studies which 

have investigated the effects of excessive 

intrathoracic pressure on the circulation 

when venous return to the heart is 

impaired. These can have serious 

consequences in hypovolaemic patients 

following physical trauma. Cheifz et al 15 

noted that hyperventilation results in 

high intrathoracic pressure during the 

decompression phase of cardiopulmonary 

resuscitation (CPR), which decreases cardiac 

pre-load and cardiac output and impedes 

right ventricular function. Increased tidal 

volume is also known to adversely affect 

cardiac output. These authors believe that 

“the elevated mean intrathoracic pressures 

caused by excessive ventilation inhibited 

venous blood flow back to the right heart, 

as there was insufficient time to allow for 

55 3


the development of negative intrathoracic 

pressure between compressions.” 

Reduced pre-load results in lower stroke 

volume and, ultimately, decreased cardiac 

output. 

Emergency ventilation using portable 

automatic ventilators 

The alternative to using a BV device in 

emergency is the portable automatic 

ventilator. These are widely used in some 

areas of the world and have a number 

of advantages over bag-valve devices. 

The International Liaison Committee on 

Resuscitation ( ILCOR ) reviewed the 

relatively limited literature about automatic 

ventilators in 2010 2 and produced the 

following observations. 

1 Automatic ventilators or resuscitators 

provide a constant flow of gas to the patient 

during inspiration; the volume delivered 

is dependent on the inspiratory time (a 

longer time provides a greater tidal volume). 

Because pressure in the airway rises 

during inspiration, these devices are often 

pressure limited to protect the lungs against 

barotrauma. 

2 An automatic ventilator can be used with 

either a facemask or other airway device 

(e.g., tracheal tube, supraglottic airway 

device). 

3 An automatic resuscitator should be set 

initially to deliver a tidal volume of 6–7 ml 

kg−1 at 10 breaths min−1. Some ventilators 

have co-ordinated markings on the controls 

to facilitate easy and rapid adjustment 

for patients of different sizes, and others 

are capable of sophisticated variation in 

respiratory parameters. In the presence 

of a spontaneous circulation, the correct 

setting will be determined by analysis of the 

patient’s arterial blood gases. 

4 Automatic resuscitators provide many 

advantages over alternative methods of 

ventilation. 

• In unintubated patients, the rescuer 

has both hands free for mask and airway 

alignment. 

• Cricoid pressure can be applied with one 

hand while the other seals the mask on the 

face. 

• In intubated patients they free the rescuer 

for other tasks. 

• Once set, they provide a constant tidal 

volume, respiratory rate and minute 

ventilation; thus, they may help to avoid 

excessive ventilation. 

• They are associated with lower peak 

airway pressures than manual ventilation, 

which reduces intrathoracic pressure and 

facilitates improved venous return and 

subsequent cardiac output. 

A manikin study of simulated cardiac arrest 

and a study involving fire-fighters ventilating 

the lungs of anaesthetised patients both 

showed a significant decrease in gastric 

inflation with manually triggered flow-limited 

oxygen-powered resuscitators and mask 

compared with a BVM 16,17 

Figure 3 shows a modern resuscitation 

ventilator which is currently used by a 

number of emergency medical services. 

Figure 3. The Pneupac VR1 resuscitation 

ventilator. This device can replace the BVM 

and can deliver single manually – controlled 

breaths during cardiopulmonary resuscitation 

or continuous automatic ventilation. 

(Photograph by courtesy of Smiths Medical International 

(Luton, UK) 

The need for more studies on 

automatic ventilators 

It is worth noting that the 2010 ILCOR 

guidelines cited 23 papers which studied 

ventilation as opposed to more than 

93 papers concerned with airway 

management. Of the ventilation papers 

cited, only 3 directly concerned the use 

of automatic ventilators. The reason for 

there being so few studies on manual and 

automatic ventilation is unclear but may be 

as a result of ventilation being seen as an 

‘obvious’ technique which does not require 

investigation. In this respect it is similar to 

suction aspiration which is an essential part 

of clearing the airway of secretions and 

vomitus but which appears never to have 

been the subject of a controlled trial. 

The evidence available shows that the use 

of bag-valve devices is associated with 

hyperventilation, in terms of both frequency 

and delivered tidal and minute volumes as 

well as the peak airway pressure delivered. 

The consequences of this in terms of 

possible gastric insufflation and barotrauma 

are understood. The potential dangers 

from volutrauma however has received less 

attention, although the damage caused to 

the lung parenchyma and subsequent acute 

respiratory distress syndrome (ARDS) in the 

intensive care setting have been recognized 

for many years and have led to the use of 

smaller tidal volumes with PEEP to keep 

the alveoli open, (the ‘open lung’ strategy 

first described by Lachmann 18 ). Given the 

potential vulnerability of the lungs and other 

organs in a patient with major trauma and 

shock, the question of induced volutrauma 

in emergency ventilation deserves greater 

study. 

Bag – valve ventilation compared 

with automatic ventilation 

There have been some studies which 

compare the quality of ventilation delivered 

by portable automatic ventilators (known 

as ‘automatic transport ventilators’ in US 

despite the fact that they are widely used 

in emergency ventilation as well as in the 

transport of a ventilator-dependent patient 

from one location to another). 

Salas et al 12 found no differences in delivered 

tidal volume between a bag, a valve device 

and an automatic ventilator (Impact 730) 

using a facemask in a model of adult cardiac 

arrest. However, as noted above, they also 

found less gastric insufflation and a reduced 

mask leak using the ventilator. Their overall 

conclusion was ‘that compared with the 

BVM the ventilator is at least as effective, is 

easier to use, and limits gastric insufflation. 

Weiss et al 19 in a study of paramedical 

personnel using a BVM or an automatic 

ventilator in cardiac arrest concluded that 

they were able to accomplish more tasks 

and provide better patient care when using 

the automatic ventilator. Goedeke et al 20 

compared ventilation with a bag valve device 

and the Oxylator ventilator. They found the 

the bag valve device delivered higher peak 

airway pressures and was associated with a 

lower SaO 2. They found no differences in 

the tidal volumes delivered. 

In another study comparing the Oxylator 

with bag valve ventilation Noordergraaf 

et al 21 found that the bag valve device was 

associated with better airway management 

and that the Oxylator in automatic 

mode delivered hyperventilation. They 

recommended that the ventilator should 

only be used in manual mode during 

resuscitation. 



The function of the automatic ventilator is 

important (whether the device is a pressure 

or a volume generator) in replacing BV 

ventilation. Pressure cycled ventilators 

have been shown to be unreliable in 

emergency use. L’Her and Roy 22 have 

conducted laboratory trials of a number of 

portable ventilators. They concluded that 

while most of the volume-cycled ventilators 

proved to be technically efficient and reliable 

pressure cycled ventilators (they examined 

the Oxylator EMX and the Vortran RTM) 

gave rise to concern since they did not 

deliver consistent tidal volumes and under 

certain conditions could be unsafe. Further 

comment on this is found in a review by 

Branson 23 . 

Recently, Kreft 24 has conducted bench 

studies using a calibrated test lung to 

assess BV vs automatic ventilation. Trained 

responders using the bag-valve device 

showed considerable variation in the rate 

and volumes of the ventilation delivered 

(Figures 4 and 5). 

Conclusions 

There is increasing evidence to show the 

variability of ventilation delivered by bag 

– valve devices when used in emergency 

ventilation. In particular, high inflation 

pressures and large tidal volumes may be 

delivered which can cause barotraumas and 

volutrauma, as well as gastric insufflation 

if the BV device is being used with a 

pharyngeal mask. 

These findings are accompanied by the 

scarcity of studies about emergency 

ventilation in the literature. 

There is a need for greater awareness of 

the potential problems of intermittent 

positive pressure ventilation in emergency. 

To achieve this better training is required 

for the use of the BVM and also automatic 

emergency ventilators. 

A better understanding of the limitations 

of the BV device and the advantages of 

the portable ventilator is also required. 

In addition more research studies are 

needed to provide a better evidence base 

for ventilation in emergency, to support 

international guidelines, and to bring 

emergency ventilation skills in line with basic 

and advanced airway management. 

Figure 4. The Ventcheck (IngMar Medical, 

USA) experimental set –up. Ventilation of a 

manikin using a BVM is monitored using an 

Ingmar test lung linked to a computer display 

of the ventilation parameters. 

(Photograph courtesy of Smiths Medical International (Luton, 

UK) 

Figure 5 (a) Variation in tidal volume delivered 

by BVM for two operators. There is significant 

variation from the target volume of 600 ml, 

both for individual ventilations and in the mean 

delivered ventilation over a period of 5 minutes 

Figure 5 (b) Ventcheck recording with the 

test lung ventilated by a volume targeted 

automatic ventilator ( Pneupac Parapac Plus) 

set to deliver a tidal volume of 600ml. The 

individual variation in tidal volume between 

delivered breaths is negligible compared with 

the bag valve recordings of tidal volume from 

two subjects shown above. 

(Photographs courtesy of Smiths Medical International 

(Luton, UK) 

References 

1 Koster RW, Baubin MA, Bossaert L et al. European 

Resuscitation Council Guidelines for Resuscitation 2010, 

section 2 : adult basic life support and the use of the 

automatic external defibrillator. Resuscitation 2010; 

81:1277 – 1292 

2 Deakin CD, Nolan JP, Soar J et al. European 

Resucitation Council Guidelines for Resuscitation 2010, 

section 4: adult advanced life support. Resuscitation 2010; 

81:1305 – 1352 

3 Wilkinson DJ. The History of Trauma Anaesthesia. In 

Grande CM (ed) Textbook of Trauma Anaesthesia and 

Critical Care, 1993; Chapter 1: 10 - 11 

4 Ibsen B. Aanaesthetist’s viewpoint on the treatment 

of respiratory complications in poliomyelitis during the 

epidemic in Copenhagen in 1952. Proc Roy Soc Med 

London 1954; 47:72 – 74 

5 Ruben H. A new non – rebreathing valve. 

Anesthesiology 1955; 16: 643. 

6 Ruben H. The immediate treatment of respiratory 

failure. Brit J Anaesth 1964; 36: 542 – 569. 

7 Cooper JA, Cooper JD, Cooper JM, Cardiopulmonary 

Resuscitation: History, Current Practice, and Future 

Direction, Circulation. 2006:114;2839–49. 

8 Aufterheide TP, Sigurdsson G, Lurie KG et 

al., Hyperventilation-induced hypotension during 

cardiopulmonary resuscitation, Circulation. 

2004;109:1960–65. 

9 Losert H, Sterz F, Koehler K et al. Quality of 

cardiopulmonary resusctitation among highly – trained 


staff in an emergency department setting. Arch Intern 

Med 2006;166:2375 - 80 

10 O’Niell JF, Deakin CD. Do we hyperventilate cardiac 

arrest patients? Resuscitation 2007; 73: 82-85 

11 Updike G, Moesseno VN, Auble TE et al. 

Comparison of bag valve mask, manually – triggered 

ventilator and automatic ventilator devices used while 

ventilating a non – intubated mannikin model. Prehosp 

Emerg Care 1998; 2(1): 52 – 5 

12 Salas N, Wisor B, Agazio J, et al., Comparison of 

Ventilation and Cardiac Compressions When Utilizing 

the Impact Model 730 Automatic Transport Ventilator 

Versus Valve with a Facemask in a Model of Adult 

Cardiopulmonary Arrest, Resuscitation, 2007; 74(1): 

94–101. 

13 Ruben H, Knudsen EJ, Carugati G, Gastric inflation in 

relation to airway pressure, Acta Anaesthesiol Scand, 

1961;5:107–14. 

14 Bowman FP, Menegazzi JJ, Check BD, Duckett TM, 

Lower esophageal sphincter pressure during prolonged 

cardiac arrest and resuscitation, Ann Emerg Med, 

1995;26: 216–19. 

15 Cheiftz IM, Craig DM, Quick G, et al., Increasing tidal 

volumes and pulmonary over distention adversely affect 

pulmonary vascular mechanics and cardiac output in a 

pediatric swine model, Crit Care Med. 1998:26:710–16. 

16. Stallinger A, Wenzel V, Wagner-Berger H, et al. Effects 

of decreasing inspiratory flow rate during simulated basic 

life support ventilation of a cardiac arrest patient on 

lung and stomach tidal volumes. Resuscitation 2002;54: 

167–73. 

17. Noordergraaf GJ, van Dun PJ, Kramer BP, et al. Can 

first responders achieve and maintain normocapnia 

when sequentially ventilating with a bag-valve device and 

two oxygen-driven resuscitators? A controlled clinical 

trial in 104 patients. Eur J Anaesthesiol 2004;21:367–72. 

18 Lachman B. Open up the lung and keep it open. 

Intensive Care Med 1992: 18; 319 - 321 

19 Weiss SJ, Ernst AA Jones R et al. Automatic 

transport ventilator versus bag valve in the EMS setting: 

a prospective randomized trial. South Med J. 2005; 

98(10): 970 – 6. 

20 Goedeke A, Wenzel V, Hoermann S et al. Effects of 

face mask ventilation in apnoeic patients with a with 

resuscitation ventilator in comparison with a bag valve 

mask. Journal Emerg Med 2006; 30(1); 63 – 67 

21 Noordergraaf GJ, Van Dan DJ, Shors MP et al. 

Efficacy and safety in patients on an EM 100 resuscitator 

in comparison with a bag valve device. Am J Emerg Med 

2004; 22(7): 537 - 543 

22 L’Her E, Roy A. Bench tests of simple , handy 

ventilators for pandemics: performance, autonomy and 

ergonomy. Respiratory Care 2011; 56(6) 751 – 767. 

23 Branson R. Patient needs should drive ventilator 

selection for stockpiling; ‘handy’ ventilators may not 

‘lend a hand’ Respiratory Care 2011;56(6) 879 

24 Kreft R. 2014 Personal communication 

57 3

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Focus on Europe’s fastest-growing ambulance builder 

The Happy Haus of BAUS 

– Crafting Bespoke Ambulances 

to Meet Growing Global EMS Demand 

Last year Baus AT designed and built over 800 new EMS vehicles for customers across the world. They 

included Medical Services Units, HDUs and Neo-Natal Ambulances. A family-run ambulance-build 

company, Baus AT have been manufacturing from their Toruń-based plant in Northern Poland since 2007. 

But now, due to the constantly-rising demand created by their outstanding build-quality and superb 

after-sales support service, father, Franz, son, Uwe, and their dedicated team of 200+ workers, face the 

logistically demanding challenge of moving their well-organised ambulance build operation to a custombuilt 

new 17,000 metre square plant over twice the size of their existing facility, also in Toruń. 

Ambulance Today editor, Declan Heneghan, recently went out to the beautiful 12th century medieval city 

of Toruń, birthplace of mathematician and astronomer Copernicus, to see first-hand how Baus build their 

world-beating range of EMS vehicles. 

Photography by Isaac Heneghan 

Franz Baus 


Founder and the driving force behind 

Baus AT, German entrepreneur, Franz, is 

not complaining about the move one bit. 

Supported by Operations Director, Uwe, and 

their happy Polish workforce, 2016 is shaping 

up to be the year in which his three decades 

of hard work and total dedication to the 

craft of ambulance building is beginning to 

reap substantial rewards in terms of both 

global reputation and orders. 

Uwe at work 

When you drive into the Baus AT plant two 

long rows of plain-looking work units are 

separated by a wide tarmacked area along 

which rows of ambulances are parked. The 

decals on the sides of the vehicles tell you 

they are intended for customers from as 

far afield as Germany, the Netherlands, the 

UK, France, Hong Kong and all parts of the 

Middle East. But apart from a modest sign on 

the small main entrance, there’s no clue as to 

what exactly goes on inside any of the units. 

There is no reserved parking for the senior 

managers and cars of all makes and ages are 

scattered up and down. The only evidence 

of activity is the occasional movement of 

ambulances being moved from ‘A’ to ‘B’ and 

men in overalls walking hurriedly between 

each block, usually holding a clip-board or a 

tool of some sort. 

With Baus UK Managing Director, David 

Brophy as my initial tour guide the first stop 

of the day was to call in on founder and 

overall boss, Franz Baus, in his surprisingly 

modest and unfussy office. Franz was 

completing a phone call to Hong Kong. 

Aware that Baus has made a great effort to 

build business in the Asia-Pacific, Middle and 

Far East regions in recent years I inquired 

how things are going? 

“Hong Kong has been a terrific market for us 

in recent years. We currently have an order 

for about 80 units from the government 

Fire Brigade and we have delivered in the 

last 8 years more than 600 units to the 

Fire Brigade, also to different Power Plants, 



St.John’s and the famous Hong Kong Hockey 

club. In terms of ambulance we have a 

100% market-share. We’re also selling well 

to China… about 400 units per year, in 

cooperation with a local manufacturer. It’s a 

mix of Mercedes and Vito chassis on mainly 

box bodies,” Franz explained. 

The next stop was in the Design Unit. 

Staffed by a group of four designers and 

business development managers this hectic 

office space is the technological nervecentre 

of Baus. Filled with display boards 

with draughtsman’s drawings it’s a case study 

in organised chaos. Every work surface is 

dominated by large computer screens and 

crammed with files and diagrams and every 

shelf is stacked with random components, 

such as light-boards, computer boards and 

even distributor caps. 

It is here that the design team develops 

the bespoke designs for each ambulance 

order. Baus don’t work on a ‘one-size-fitsall’ 

business model, instead preferring to 

work closely with each customer so that 

the specification for every order precisely 

meets their individual needs. So even though 

the rudiments of the general design and 

build process may have large elements in 

common, every order will have a number 

of features that make it unique; whether the 

order is for 10 or 100 units, for a straightforward 

emergency care ambulance or 

for a complex High Dependency Unit; 

there may be different seating, alternative 

interior layouts in the patient treatment 

compartment, a different lifting system or 

a customised trolley-loading system. But as 

Business Development Director Robert 

Piotr Królikowski, explained to me: “We focus 

on each customer’s specific needs and then 

help them incorporate the latest technical 

innovations.” With eight years experience at 

Baus nothing fazes Robert. “We stay in touch 

with market trends in build and design and 

learn as much as possible about how the 

vehicles we build are going to be used. The 

more you understand their front-end use, 

the better you can meet the needs of your 

customers,” he explained. “So, for example, 

while we typically recommend either Sarco 

or Whelen light-bar fittings, we’ll look at 

other suppliers if the customer has a need or 

a preference for them.” 

Sat across from Robert were Project 

Manager, Marek Sylwestrowicz, who has 

been with the company 11 years and, 

beside him, Agnieszka Mazur, also a Project 

Manager who, due to her bilingual capabilities 

including French, is responsible for Baus’s 

growing presence in the French EMS 

market. Agnieszka is responsible for working 

with their French distribution partner and 

monitors all their builds. 

After the relative quiet of the Design Unit 

we walked into the first main build area. 

One production worker, Marcin, has been 

a tool-turner for as long as Franz Baus has 

been involved in ambulance-building – thirty 

years. Based in the busy Mounting Room, 

he is one of the engineers responsible 

for hand-crafting the numerous small but 

vital engine parts which form the essential 

bone structure of each Baus ambulance. 

When I caught up with him he was focusing 

intensely on turning an unrecognisable joint 

he was smoothing down for the main plinth 

of what I later learnt would become the 

main suspension supports for one of Baus’s 

in-house-designed under-carriages - that 

invisible part which support the seats in 

the ambulance’s driver compartment. As I 

looked down, I asked Marcin what he was 

making? “It’s a small but difficult part,” he 

replied. Adding with a serious look: “Each 

of these parts has to be crafted to within a 

milimetre… sometimes even more precisely.” 

I squinted in even closer, still trying to 

recognize the precise thing he was making. 

Sensing my lack of mechanical knowledge, 

he added, as if by way of further explanation. 

“It may appear to fit well at a glance but 

you have to inspect it closely. If it doesn’t fit 

perfectly, that’s when you get the wear-andtear… 

But here we build them to last.” 

Also guiding me around the plant was Franz’s 

son, Uwe. Aged just 35, it’s Operations 

Manager Uwe’s responsibility to know each 

of the company’s 200 + staff on first-name 

terms, exactly what their individual work 

manifest requires of them on a given shift 

and which part of each customer’s order 

they are charged with fulfilling that day. To 

achieve this daunting task he must possess an 

intimate knowledge of every single part of 

the design and build process for every one 

of the 800 + vehicles that rolls out of the 

plant each year. Despite his experience of 

the whole build process Uwe takes nothing 

for granted and consequently has nothing 

but admiration for Marcin and his teammates. 

As he explained to me: “In every ambulance 

we build there can be between one-to-twothousand 

small but essential parts, most 

of which are built from scratch in-house.” 

It’s this kind of attention to detail which 

marks Baus out from all other European 

ambulance builders. Working away next to 

Marcin another colleague was machining the 

supports that keep the gas cylinder holders 

in place to ensure maximum safety and, 

of course, total compliance with the rigid 

EC CEN regulations which all European 

ambulance builders must meet in order to 

make their vehicles road-worthy. 

Most of the Baus facility is taken up by 

dedicated manufacturing areas: mounting 

rooms, fixation rooms, furniture shop, 

electrical area, metal-working rooms and 

a huge stock management area. It’s all laid 

out in such a way that as you pass through 

each area, spread over two facing sites, 

you gradually get a picture of how each 

ambulance unit evolves. In some areas you 

might see a bare chassis stood next to a 

work-bench with a large sheet of heavy 

metal laid out on top and random holes 

drilled up and down it. Then you walk 

through to the next unit and see an almost 

identical scenario - but this time electrical 

engineer, Karol Pierukki, 26, is patiently 

threading many different-coloured lines of 

electrical wiring through each hole and you 

realize you are seeing both the inner vehicle 

wall and its electrical circuitry system take 

shape. 

Next we moved on to the Fixation Room 

where much of the stainless steel work is 

done – everything from the outer-skins of 

the ambulance body down to variouslysized 

brackets which hold them together 

are cut here. Huge and spacious it was 

filled with vast pallets of different grades of 

steel and pipes of all lengths and diameters. 

With its high ceiling, the high-pitched whine 

of a ferocious looking computer-operated 

cutting machines echoed off its walls; amid 

all the din and noise I was waved over in 

the most friendly of fashions by Lukas Rata 



Jczak, the metal-worker responsible for the 

impressively high-tech Plasma CNC-mill – a 

highly imposing and hugely expensive cutting 

machine which quite amazingly can cut up to 

10 large panels per shift, down to well below 

a milimetre’s precision. The CNC-mill can 

cut enough steel for the paneling for three 

completed vehicles in less than eight hours 

and, despite its furious whine, do so with the 

delicacy of a haute coutour cutter turning 

fine fabrics into a bespoke Chanel garment. 

Lukas, 32, has that youthful, clean-living 

look, common to most Polish people under 

about eighty, so amid all the unfamiliar noise, 

when I asked his age I misheard his reply 

and, based on his looks alone, I thought I 

heard ’22,’ an easy mistake to make under 

the circumstances. Not unsurprisingly, when 

he told me he had already worked for Baus 

for eight years, I was a little confused. Seeing 

my puzzlement Uwe corrected me, laughing: 

“No. Lukas is 32, not 22! We are dedicated, 

but so far we haven’t felt the need to hire 

children!” Uwe explained that Lukas has 

been with Baus for eight years and most of 

that time has been spent training to operate 

new iterations of this specific machine.” 

Uwe added that although the standards of 

apprenticeship training in Poland for crafts 

relevant to vehicle manufacturing, such as 

electrical installation and metal-working, 

are among the very best in Europe, making 

them exceptionally high by global standards 

– since the degree of precision required for 

ambulance build metal-working is higher still, 

mainly for infection control purposes, much 

of the training and development of staff like 

Lukas, is maintained continuously on the job. 

“We buy these high-tech and, to be honest, 

very expensive cutting devices and with the 

support of their manufacturers, we train 

our cutters to perfectly trim different types 

of sheet metal. Lukas knows which type 

of metal can be cut in a certain way and 

which grade is best for different elements 

of the ambulance’s outer or inner body. 

No matter how highly-skilled they might 

be, you couldn’t just expect another metal 

worker to walk in here, operate this machine 

and then cut the metal so precisely. All the 

information required is fed directly into the 

machine’s computer by our CAD design 

team and it stores the unique information 

for every unit we build.” Uwe finished: “One 

great benefit is that if an ambulance comes 

back to us a couple of years later and its 

side-wall has been written-off in a collision, 

we can replace it completely and identically, 

even using exactly the same grade of metal 

that was used in the original vehicle. This 

machine allows us to cut all major steel and 

aluminium components in-house, reducing 

waiting time for key parts.” 

A pattern was beginning to emerge. Even 

among the younger staff I had spoken with 

the length of service was an average eight 

years and, most of those over forty I had 

spoken to, many had worked for much 

longer – a few having moved to Poland 

from Baus’s original German base –a statistic 

which immediately struck me as unusual 

since many of the people I know who 

work in the ambulance-build industry move 

around frequently – some I have met have 

worked for three or four different builders 

during their careers! I asked Uwe why the 

plant seemed to be staffed with such hardworking 

yet apparently happy workers. “It’s 

because we’re a family business and we see 

all our staff…and their families…as part of 

one big family.” In what way, I wondered? 

“Well, for example, it’s not a big thing but 

every year we have a big Christmas party… 

local food, beer, vodka, music…and it’s not 

just the workers, but all their families who 

come along. This Christmas we had over 

300 at the party. We had a good time!” he 

replied, laughing. 

It was becoming clear just how Baus 

manage to construct such exceptionally 

high-quality ambulances from their 

unremarkable-looking base in Toruń. But as 

Franz stressed, the location wasn’t selected 

solely for the workpool of skilled vehicle 

engineers available in the region. “From 

here in Poland we can easily serve the 

entire European market,” he explained. We 

also have purchasing, sales and aftersales 

sites in Germany, France, the Netherlands, 

Finland, the UK and Ireland. We place a large 

emphasis on preventative maintenance and, 

as you saw in Lukas’s section, our engineers 

always make sure we have impress stock 

readily available for all the vehicles we supply 

to our global customer-base. We could 

be complacent about our three decades 

ambulance build experience, but instead 

we remind ourselves that a large part of 

our current success is based on our aftersales 

support set-up which means we can 

guarantee that our customers’ needs are 

always comprehensively, quickly and expertly 

met, regardless of where they are located in 

the world.” 

The final stop was in the furniture section 

where Franz again explained Baus At’s 

decision to locate their plant in Toruń. “It has 

given us a pool of exceptionally highly-skilled 

vehicle build workers, that I don’t believe 

we could find in any one other industrial 

location in Europe,” said Franz, looking over 

the busy cabinetry room. “So now, we’re 



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busy recruiting over 100 new staff, and we’re 

in the secure position of knowing that, even 

as we create these new jobs, there are still 

plenty of other highly-motivated and eager 

vehicle engineers locally who would be 

happy to join our growing family. One of the 

really impressive things about Poland is that 

there’s a real dedication among virtually all 

work-forces to working hard and doing their 

best. Taking pride in doing the best job you 

can seems to be ingrained in the national 

psyche. Having worked in the past with 

some really highly-skilled ambulance builders 

in different regions of Europe, I’m still 

amazed daily by the positive ‘can-do’ attitude 

of our mainly Polish work-force.” 

My tour ended in the boardroom over 

coffee and delicious locally-baked ginger 

biscuits. I asked Franz, Uwe, Robert and 

David to put my morning into context 

by explaining a little more about their 

extraordinary recent European and global 

growth. I asked Franz which world region 

they are doing best in right now? 

“We’re selling nearly 200 units this year in 

France already, which is pleasing,” he replied. 

“Don’t forget Switzerland, we’re selling 40-50 

units there and, while it’s a small market, 

we’ve got 50% market-share…then there’s 

Turkey and Romania,” Uwe reminded him. 

“We’re also doing very well in Germany, the 

United Kingdom and the Republic of Ireland,” 

replied Franz, pausing to add: “We sold 100 

ambulances in Germany last year and, thanks 

to David and Robert and his team, the UK/ 

Ireland market has risen to 200 units from 

a standing-start two years ago, with a mix 

of boxes and van conversions… Which is 

impressive when you consider what a difficult 

market the UK is.” 

“We’re proud of the progress we’re making 

in the UK and Ireland”, said Robert, adding: 

“The growth of independent ambulance 

providers is the key to this. Major players 

such as UKSAS in England and Murray 

Ambulance in Ireland are highly-valued 

customers. 

“The main thing though,” said Franz quietly, 

“is that we’re gaining more orders in all 

these regions each year… but what makes 

us happiest is that, in every case, we’re 

gaining repeat orders as well. The reason 

that makes us so happy is that we never take 

our customers for granted… So when they 

come back we know that we’re maintaining 

their loyalty and trust.” 

Stretching his arms, Franz finished: “We all 

work very hard at Baus but, as you’ve seen, 

our success is down to having a very loyal 

and very committed work-force – not only 

here in Toruń, but in the UK, in France and 

everywhere else we’re busy developing. I 

think we achieve this because our secret 

ingredient is that we’re a family business… 

which means we have family values.” 

To find out more: 

B.A.U.S. AT SP.Z.O.o 

Tel : +48 662 020 072 

BAUS AT UK: 

Tel: +44 (0) 7974 940 121 

or visit: www.baus-at.com 



Focus on Global Traffic Technologies 

Seeing the Lights: the Traffic Signal 

Technology that can Save Time and Lives 

Tim Hall, market and development director at Global Traffic Technologies, looks at the 

history and technology behind the traffic systems that allow ambulances to respond to 

incidents more swiftly and safely 

When an emergency vehicle arrives at a 

traffic intersection, sirens blaring and lights 

flashing, the result can be a frightening 

disruption. 

Drivers suddenly realise they need 

to manoeuvre their cars to allow the 

emergency vehicle through. Some drivers 

panic, becoming confused and creating 

conflicts that can cause blocked lanes and 

emergency vehicle crashes, increasing 

response times. 

But intelligent transportation technologies 

that provide emergency vehicles with 

a green light at intersections can help 

minimise driver confusion, reduce collisions, 

and improve emergency response times. 

This is an emergency vehicle preemption 

system, or EVP. EVP systems are designed 

to give emergency vehicles a green light 

on their approach to an intersection 

while providing a red light to conflicting 

approaches. 

EVP systems are a simple but powerful 

solution that can rapidly and dramatically 

improve safety and response times. 

History of priority control systems 

Both Europe and North America adopted 

traffic light priority control in the 1960s, but 

developed the technology in contrasting 

directions. 

In North America, the first users of priority 

control were emergency services, including 

fire, police and ambulance companies. Public 

transport agencies did not take up the 

technology until the mid-1970s. In Europe, 

conversely, the public transport segment was 

the early adopter, followed by emergency 

service users. 

One reason for the difference is that in 

North America local police and fire chiefs 

controlled the procurement budgets 

for their agencies and were interested 

in supporting a dedicated EVP signalling 

system approach. Agencies in Europe at the 

time had a stronger focus on mass transit 

priority control using existing loop-based 

vehicle detection systems. These systems, 

however, were not suitable for emergency 

vehicle use. 

Another factor that may have delayed 

widespread introduction of emergency 

vehicle priority systems in the European 

region was the technology used to signal a 

preemption request to the intersection. 

At that time the most popular methods 

being used were strobe lamps, centrally 

activated green-corridors and sound 

based signalling. In North America the 

stroboscopic system emerged as the 

dominant technology. Sound-based systems 

had inconsistent performance, and there 

Similar technology is used for transit signal 

priority systems, which enable public 

transport agencies to extend or truncate 

green cycle times at traffic signals for more 

accurate schedule adherence. This means 

public transport vehicles — including buses, 

light rail trains, street cars, cable cars and 

trams — spend less time waiting, lowering 

fuel and fleet costs and reducing carbon 

emissions. 



Focus on Global Traffic Technologies 

was a lack of communication between 

intersections to implement a central ‘greencorridor’ 

system (manually providing green 

lights along the length of an ambulance’s 

route). Even with communications in place 

the green-corridor systems performed 

poorly and caused severe traffic disruptions. 

Strobe systems offered exceptional signalling 

range and consistent, reliable performance. 

Well suited for North America’s wide and 

straight streets, this line-of-sight system 

was less effective in Europe where curved 

streets and narrow roads reduce range. This 

limited the applications and localities suitable 

for emergency vehicle priority. In Europe, 

sound and green-corridor systems suffered 

from the same issues as in North America 

and were not widely adopted. 

Only with the emergence of radio/GPS 

based priority control systems in the early 

2000s was a solution developed that truly 

began to meet Europe’s emergency vehicle 

preemption requirements. Now, a properly 

configured EVP system can provide: 

• An improvement in response times of up 

to 25 percent 

• A reduction of up to 70 percent in 

intersection crashes involving emergency 

responders 

• A prevention of crash injuries and related 

costs 

• A reduction in property damage costs 

• Decreased liability for crashes with civilian 

motorists 

• A quick demonstrable recovering of the 

investment from the above benefits 

Centralised architectures 

EVP systems can be divided into two main 

categories: those that use a distributed 

architecture and those that implement a 

centralised approach to signalling for a green 

light. 

In a centralised system, the request for 

preemption is sent from the emergency 

vehicle to the intersection via a central office 

that controls if and when a call for a desired 

green phase is made. 

In this scenario, the equipment on the 

vehicle is the priority request generator. The 

vehicle sends its location, speed, heading 

and identification credentials over a radio 

link to the priority request server located 

at a central office. This server validates the 

identity of the sender and determines which 

intersection and what turning movement is 

being requested. The priority request server 

then communicates the request to the traffic 

controller software, which activates the signal 

via a wired or wireless link. 

Distributed architecture 

In a distributed EVP architecture, the priority 

request generator is again located on the 

vehicle, but each intersection now has a 

priority server. When preemption is desired 

the message is sent from the priority request 

generator either directly over a two-way 

radio link or via a cellular or trunked radio 

to the priority request server. The priority 

request server verifies the vehicle location, 

heading, speed and user identification. 

If the call is valid and meets triggering 

requirements, the priority server signals 

the traffic signal controller requesting a 

preemption at the intersection for the 

desired green phase. The priority request 

server may be monitored and configured 

by software located at the central office if 

communications exist between the central 

facility and the intersection. 

Advantages and disadvantages 

Each EVP architecture has advantages and 

prerequisites for proper operation. 

Centralised systems can leverage existing 

central office to intersection control of 

traffic signals, and require no additional 

equipment in the local traffic cabinet, 

making them an attractive proposition for 

European applications where traffic cabinets 

are either limited in space or control of 

the signals is centrally managed. Priority 

request generators on the vehicle can use 

existing public safety radio channels, or GPRS 

networks to communicate with the central 

office priority request server. 

But it’s worth remembering that centralised 

systems do have critical performance 

requirements which must be addressed 

if they are to be effective for EVP. Most 

important is the ability to accurately and 

consistently determine and communicate 

to the priority request server when the 

emergency vehicle (priority request 

generator) has reached the activation point. 

Inaccurate position determination, or latency 

in communications will cause the trip point 

to move forwards and backwards tens of 

metres. The result is preemptions that may 

take more side street green than is really 

necessary and increased traffic disruption. 


Distributed systems, as noted above, may 

use dedicated point-to-point or cellular 

radio links. Dedicated radio links ensure 

low latency and deterministic access to 

the priority server from the emergency 

vehicle. This is important as typically multiple 

vehicles will be approaching the intersection 

at the same time and must all be serviced 

with no delay. Continuous updating is also 

key for optimal performance. By constantly 

signalling the intersection priority request 

server, a map matching verification of the 

vehicles route may be obtained. 

Integration with TSP 

EVP systems can also be integrated with 

TSP systems, meaning users are able to use 

the same intersection equipment. Both EVP 

and TSP can be monitored and controlled 

using Central Management Software (CMS). 

This integration can prove effective in the 

case of large events, which are often served 

by park-and-ride vehicles that efficiently 

transport many attendees. If these public 

transport vehicles are equipped with 

priority control devices, CMS can cause red 

lights to turn green when they approach. 

However, if a high priority vehicle requires 

the other approach, it will override the inprogress 

priority control and give it to the 

emergency responder. 

This capability is also useful for disaster 

evacuation. Event and disaster evacuation 

plans may be set up in advance, ready to 

implement at the touch of a button. 

About Tim Hall and GTT: 

Tim Hall is the market and 

development director at Global 

Traffic Technologies (www.gtt. 

com). Headquartered in St. Paul, 

Minn., GTT is the market leader 

in traffic management systems, 

having an installation base of over 

70,000 intersections and 70,000 

vehicles with over 3,100 customers 

worldwide. 



Unison Comment 

UNISON Update 

AmbulanceTODAY 

Keep your promise to ambulance staff 

There’s an Ambulance Emergency going on! As I have previously reported 

in Ambulance Today, the Secretary of State for Health, the Rt Hon Jeremy 

Hunt MP, offered ambulance staff some additional concessions in the 2015/16 

pay settlement for NHS Staff. These included a review of recruitment and 

retention issues using bandings, recruitment and retention premia, a review 

of the issues rising from the increase in retirement age affecting ambulance 

staff, and a 50:50 employer:employee contribution scheme to reduce the 

deductions made when taking an early pension to allow staff to retire up to 3 

years earlier. 

By Alan Lofthouse 

National 


Officer, UNISON 

Twelve months on and unfortunately, 

there’s not a lot to reassure ambulance staff. 

Employers have gone some way to making 

commitments to look at the banding for 

paramedics, in advance of the introduction 

of the BSc entry-level qualification for 

the HCPC register, but this is dependent 

on securing funding. We now have two 

ambulance services that pay paramedics 

band 6 with more in talks with their staff 

side. Why should Clinical Commissioning 

Groups fund paramedics at Band 6 when 

they get all the skills, responsibilities and 

clinical knowledge for Band 5? 

Retention is the key here. Pay demonstrates 

the value placed on the jobs people do and 

is a reflection of the skills and responsibilities 

asked of staff. Certainly, more needs to be 

done to improve the working conditions for 

ambulance staff – high demand, late finishes 

and missed meal breaks are the obvious 

ones. Just look at the East of England 

Ambulance service which has threatened to 

take draconian and unpalatable measures to 

ensure delivery of safe patient care! What 

better way to sum up the archaic approach 

of some ambulance services when faced 

with demand that outstrips capacity. Short 

term solutions with long term damage 

which will be irreparable beyond a point. 

Are we talking about patient care or do 

we really mean performance? The reality 

is that ambulance staff care about their 

patients, young or old, regardless of their 

background – especially the really sick ones. 

Their main concern is not whether their 

service achieves its performance targets 

but whether they can make a difference to 

someone in pain or suffering. 

We are at a crucial point in ambulance 

service history. Modernisation is happening 

and eyes need to be opened to what will 

happen next. In the rush to please the 

NHS Trust Development Authority, CCGs, 

Trust boards, NHS Improvement, Monitor, 

CQC… are there any more?… Trusts 

are forced to look at how to squeeze 

more from an already over burdened and 

stretched workforce. 

Ambulance staff are loyal, hardworking 

and diligent. They are not fools and should 

not be sacrificed in order to meet their 

Trusts’ performance targets or inspection 

organisations’ requirements. These are 

human beings doing a very human job. The 

problem is that demand is high and the 

resources are not keeping up. 

Where is the central leadership? Where 

is the government? Distracted and not 

listening. Our ambulance services could 

become world class urgent and emergency 

care organisations, but they are having their 

hands tied. Staff are feeling the frustration. 

The NHS 111 service is fragmented and 

being provided by too many different 

organisations. Importantly, it is out of the 

control of those who need it to work. 

Patient Transport Service contracts are 

awarded to the lowest private sector bidder 

and when contracts are not performing 

the CCGs throw good money after bad to 

keep them afloat. The provider then pulls 

out. Why? Because they cannot make a 

profit. Making money by providing a public 

service which caters almost exclusively for 

the elderly, sick and vulnerable in society 

is morally wrong. In all this confusion and 

uncertainty is it any wonder ambulance staff 

are leaving? The government expect more 

from ambulance staff than they can give, 

justifying their actions behind the guise of 

patient care, as if ambulance staff do not 

care about patients! I am not surprised that 

people are leaving. 

How would you feel if you worked 4 

consecutive 12 hour shifts with shift 

overruns and maybe one or two meal 

breaks (if you are lucky), only to be told that 

you are not giving enough; that you need to 

give more? 

UNISON Ambulance - there when you need us 

This is not the fault of staff – they are just 

working in difficult circumstances to help 

those in greatest need. I don’t even think it’s 

the fault of the ambulance services – they 

have their hands tied by central government. 

It’s not the fault of the patients – they are 

calling 999 as they are in a confusing system 

where they cannot get a GP appointment 

or access fragmented providers of urgent 

care. As well as this, A&E departments are 

full or closing. Who do they turn to? The 

ambulance service, because they always 

come. 

The government have been sleepwalking 

into this mess. The warning signs have been 

there for sometime but they haven’t been 

listening. The offer made last year was to 

work with us over issues of recruitment 

and retention but the government failed to 

commit any additional funding. Apparently 

there is no more money. 

Immediate action is needed to stem the 

exodus of staff. In the short term, bandings 

for ambulance staff need to be reviewed 

starting with paramedics. The NHS Pay 

Review Body recognised that this is taking 

too long in their 29th report. They also 

recognise that more needs to be done to 

deal with the holistic issues facing ambulance 

staff. The government could take the bold 

move to make the pension age fair for 

ambulance staff and bring it in line with the 

other emergency services. 

Wider, more comprehensive changes need 

to take place with NHS 111 and how this 

is commissioned to ensure it works in the 

right way for patients. Investment is needed 

to get the clinical support right for NHS 111 

call centres. Returning them to ambulance 

control will give the service the resilience 

to cope with surges in demand and get the 

right care, to the right patient, at the right 

time. 

Failure to listen and take action risks a 

return to industrial unrest with ambulance 

staff having little choice but to vote with 

their feet in greater numbers than before. 

Help them in their emergency. It’s time to 

keep your promises to ambulance staff! 

To find out more about this UNISON 

campaign visit: www.unison.org. 

uk/our-campaigns/ambulanceemergency/ 

Alan welcomes feedback from 

ambulance staff and can be contacted 

at: a.lofthouse@unison.co.uk 

Facebook: 

Facebook.com/unisonambulance 

Twitter: 

Twitter.com/UNISONAmbulance 


67 3

Focus on Cloud-Based Resource Optimization Technology 

EMS Operations transformed 

by Cloud-based platform 

WC EMS, the ambulance service of the Western Cape Department of Health, is one of the largest EMS 

services in South Africa. Covering a land area similar in size to England, it services a population of 6.2 

million, 3.75 million of whom live in the Cape Town metropolitan area. Operating six emergency control 

centres and a fleet of 460 vehicles, WC EMS attends in excess of 500,000 incidents annually. As well as 

emergency medical response, WC EMS comprises HealthNET, which provides non-emergency patient 

transport services across the Western Cape Province. 

Following an intensive 30-month project, 

WC EMS has incrementally implemented 

all main system components of Valentia’s 

CareMonX EMS Suite: Emergency CAD, 

Patient Transport CAD, MDT and ePCR. 

Also implemented are Valentia’s ERP 

systems covering Roster Management, Fleet 

Management and Operational Analytics. 

Together the systems are seamlessly 

integrated in one end-to-end platform 

that addresses all of WC EMS’s clinical and 

operational requirements. 

Being cloud-based and modular, CareMonX 

EMS Suite is highly versatile, scalable and 

future proofed, all of which were key 

selection criteria of WC EMS. All CareMonX 

mobility elements are operating system 

agnostic across Windows, iOS and Android 

systems. Android was selected by WC EMS 

as the preferred platform for all MDT and 

ePCR mobile devices. 

Implemented by Valentia in conjunction with 

its South African partner, Dimension Data, 

the solution replaced Emergency CAD and 

Patient Transport CAD systems used by 

WC EMS in all six control rooms and also 

introduced, for the first time, MDT, ePCR 

and ERP systems. The solution, which has 

been configured as a multi-node survivable 

system, is deployed in a secure private cloud 

environment managed by Dimension Data. 

Immediate benefits of CareMonX Emergency 

CAD included a 20% reduction in call 

registration times as well as a sizeable 

reduction in abandoned calls rates and 

improvements in call classifications. Average 

time-to-dispatch recorded a more than 

40% improvement from over 11 minutes 

to six minutes, assisted by Valentia’s 

location management application which 

provide enterprise-wide views of all vehicle 

locations. CareMonX Emergency CAD also 

incorporates international standards-based 

Disaster Management functionality, including 

rapid activation of mobile control room units 

that utilise multiple wireless communication 

technologies. 

CareMonX Patient Transport CAD 

underpins the complex daily operations of 

the provincial scheduled patient transport 

service, HealthNET, which encompasses 

a fleet of almost 100 vehicles plying 60 

routes extended across 495 collection 

points. CareMonX PTS CAD enables 100+ 

treatment facilities that receive transported 

patients to directly enter patient transport 

bookings via an online portal. An SMS based 

e-Ticketing facility is available for use by 

patients, especially those living in remote or 

rural communities. 

Benefits of CareMonX MDT include 

improved mobilisation times resulting from 

electronic communication of incident data 

rather than via radio, shaving up to 90 

To find out more about Valentia Technologies’ product range visit: valentiatech.com or call them on: +353 1 299 5600 


Focus on Cloud-Based Resource Optimization Technology 

”It has been our privilege 

to have worked closely 

with Western Cape EMS 

management and staff 

to implement our full 

CareMonX EMS Suite which 

has transformed WC EMS 

into one of the most joined-up EMS services 

anywhere in the world today.” 

Peter Nelson 

President Business Development 

Valentia Technologies 

seconds off each initial communication. Use 

of real-time status updates and two-way 

messaging has created additional benefits 

in the form of resource optimisation and 

capacity management. Additionally, intuitive 

navigation (map data provided by TomTom) 

in the MDT application has improved onscene 

arrival performance. 

records from in-field ambulances to hospital 

Emergency Departments where they are 

immediately viewable, thereby optimising 

use of the all-important “golden hour” for 

enhanced treatment outcomes. CareMonX 

ePCR also produces valuable operational 

and clinical data that contribute to improving 

service planning and paramedic staff skilling. 

“Implementation of Valentia 

Technologies CareMonX 

EMS Suite has provided 

Western Cape EMS with one 

of the most comprehensive 

and technologically advanced 

EMS business solutions in the 

developed world today.” 

Dr Shaheem De Vries 

Director 

Western Cape EMS 

EMS Suite 

Systems 

• Emergency CAD 

• Patient Transport CAD 

• Repatriation CAD 

• Major Incident CAD 

• Mobile Doctor/Nurse CAD 

• Dispatch Management 

• Mobilisation (MDT) 

• Location Management 

• Community Responder Apps 

• Electronic Patient Care Reporting (ePCR) 

• Roster Management 

• Fleet Management 

• Billing Management 

• Operational Analytics 

Features 

• Service Oriented Architecture 

• Cloud enabled 

• Survivable multi node 

• Multi OS enabled 

• 4G, 3G, Wi-Fi and TETRA enabled 

• Standards-based PBX integration 

• HL7 and health information exchange with 

wider health services 

CareMonX ePCR has enabled WC EMS to 

switch from manual paper recording to realtime 

digital capture for care interventions 

associated with the 500,000+ incidents 

responded to annually. As well as freeing up 

valuable paramedic time, CareMonX ePCR 

facilitates real-time transmission of care 

WESTERN 

CAPE 

Key Facts 

Population 6.20m 

Size 

129,462km2 

Population Density 45.0 per km2 

WC EMS 

Personnel 1,950 

Control Rooms 6 

Stations 55 

Operational Fleet 460 

Calls Received 735,000 

Incidents Attended 515,000 

Patients Transported 620,000 

PTS Transports 95,000 

Director 

Dr. Shaheem de Vries 

Web 

westerncape.gov.za 

As CareMonX EMS Suite includes extensive 

in-built healthcare data sharing capabilities 

that enable EMS services to integrate with 

wider healthcare services, the WC EMS 

solution has been further designed to 

directly support the Service’s strategy of 

playing an increasingly pivotal role in the 

continuum of community-based care across 

urban and rural Western Cape. 

About Valentia Technologies 

Valentia Technologies develops and 

implements innovative software solutions 

and services that transform the way 

healthcare is provided outside of hospital. 

Valentia’s integrated suite of products, 

spanning EMS, urgent and unplanned care, 

community healthcare, and homecare, 

enables new models of joined-up converged 

care that address many of the mounting 

challenges facing healthcare today: rising 

demand, escalating costs, improved quality 

outcomes and accountability, and the need 

for greater efficiency. 

Valentia’s solutions are implemented at scale 

in organisations that provide EMS services, 

patient transport services, urgent care 

services, primary care, community nursing, 

allied healthcare services and homecare 

services in countries in Europe, Australasia, 

the Middle East and Africa. 

To find out more about Valentia 

Technologies visit: 

www.valentiatech.com 

Or email: 

bizdev@valentiatech.com 

Telephone: +353 1 299 5600 

To find out more about Valentia Technologies’ product range visit: valentiatech.com or call them on: +353 1 299 5600 



Focus on Auxilium Systems 

Auxilium Systems 

– Personalised 

Health and Safety 

The Auxilium System is designed to assist Ambulance Staff and First Responders by providing potentially 

vital information about a patient which they would not usually have access to, particularly when the 

patient is unable to provide this information themselves. 

The system allows any individual to store 

their personal information on a website. 

Information such as name, home address, 

next of kin and key medical record data 

which could potentially be very useful 

in some situations when the patient is 

unable to communicate. This information 

can also include NHS Number, GP’s name 

and address, medical history, or even clear 

directions to get to a patient’s house. Unlike 

a simple medical alert system, commonly 

used by aged patients and people with 

existing medical conditions, Auxilium is a 

Health and Safety system intended to be 

used by everybody. A wide range of potential 

users have been consulted including schools 

and the construction industry to appreciate 

what benefits and concerns they believe 

such a system would provide. The system 

is also intended to be used for ‘one off’ 

occasions, such as stewards at a sports or 

entertainment events. 

Each Auxilium user is provided with their 

own unique Auxilium Number, this number 

can be displayed on items carried by the 

user, such as Staff ID Cards, keyrings, or even 

displayed on their mobile phone. There is a 

distinctive Auxilium System logo attached to 

the 10-digit Auxilium number. This logo can 

be easily spotted by the emergency services 

and the public. The number can then be 

provided to the emergency call taker by the 

caller who will have access to the Auxilium 

Database. The operator with then use this 

number to access the relevant information. 

The simplicity of Auxilium’s system of a 

ten-digit number means that it is easy to 

understand and implement, as well as cheap 

(just £1 a year for an individual account). 

It also means that by using well-proven 

technology, unlike a stand-alone device, it is 

easily implemented into existing procedures 

and schemes (i.e. company ID cards, printed 

on sports equipment, written next to school 

pupils’ names on a register). 

The patient (Account Holder) is completely 

in charge of their account, they decide what 

information to put on the system and who 

has the right to view it. They are the only 

people that can see all of the information 

on their account, and there is no data about 

them on the database that they can’t see. 

The patient is responsible for providing 

the information which is why the Auxilium 

System is referred to as a ‘Personalised 

Health & Safety system.’ Further to this, 

the system is completely transparent; the 

Account Holder knows exactly who has 

viewed their data and why. 

The initial idea was developed by Grant 

Moreton, a Director of Auxilium Systems, 

who has a background in the construction 

industry (an industry where such a system 

would be highly applicable). Grant was 

motivated by the deaths of two pupils at his 

former school; it is hoped that in the future 

such incidents can be reduced by a method 

of organization like Auxilium. The concept 

was developed further with the assistance of 

Dr Chris Rowe, also a Director of Auxilium 

Systems, who has 20 years’ experience in 

helping individuals and companies develop 

innovative ideas, particularly in the medical 

device industry. 

The Auxilium system has been developed 

with the assistance of South Central 

Ambulance Service NHS Foundation 

Trust (SCAS) in order to have a clear 

understanding of what information would 


Focus on Auxilium Systems 

be of use to the Ambulance Services. 

The trust has recently launched a trial 

of Auxilium to help to identify and treat 

patients at the site of an incident. 

Luci Stephens, Director of Operations 

– Clinical Coordination Centres, South 

Central Ambulance Service NHS 

Foundation Trust, said: “We are pleased to 

have embarked on this trial of Auxilium 

which we hope will prove to be of benefit 

to patients and staff alike. There are 

occasions when it would be incredibly useful 

to have key details about a patient which 

they might not be able to provide to us due 

to their medical condition and we hope 

that this trial will help demonstrate how 

important these details are in the event of 

an emergency.” 

Initial users are from schools and colleges, 

but the system is available for free to 

all NHS staff and 1 million numbers will 

be made available for free to charitable 

organisations for the first year. Auxilium 

Systems are also currently working with 

a range of other stakeholders from the 

NHS, private medical service providers 

and companies in order to roll out the 

system on a nationwide, and eventually, 

international scale. As well as SCAS, 

Auxilium Systems are seeking to work with 

paramedic providers from both the private 

and charitable sectors, as well as Account- 

Holder-groups from all branches of industry 

and walks of life. 

How can I buy an Auxilium 

Account & Number? 

You can buy them via a Purchasing 

Organisation, such as a school or 

company, or directly from Auxilium 

Systems. You will be sent a link by 

email to your new account so you 

can set a password, enter your data 

and select who can view your data as 

an Authorised Reader. 

How secure is Auxilium Systems? 

Security is of paramount importance 

and the system provides the same levels of 

security used by financial systems. All activity 

on your account is recorded and displayed, 

with email notifications if your account 

is viewed by an Authorised Reader or 

Emergency Service. 

How do I display my Auxilium 

Number? 

In many situations the Auxilium Number 

will be integrated with items you currently 

carry, such as work ID cards, or pupil lists for 

school trips. We have a website where you 

can download an image with your Auxilium 

Number and logo which can used to create 

a sticker or key-ring etc. via many providers. 

How much does it cost? 

For an individual Auxilium Account the cost 

is £1 per year, but if bought via a Purchasing 

Organisation the cost will depend on the 

number of numbers purchased. The cost of 

being an Authorised Reader depends on the 

size of the organization. 

What if the Account Holder 

is a child? 

It is a requirement to provide your date of 

birth, if you are under 18 you will need to 

get parental consent. Consent may also be 

required for other vulnerable people. 

To find out more contact 

Grant Moreton or Chris Rowe: 

Tel: 01865 338020 

Website: www.auxsys.uk 

Email: info@auxsys.uk 



Mobile technology is 

playing an ever more 

central role in the 

emergency services today 

and in some cases can 

enhance the performance 

of the emergency 

professional. Paramedics 

need to be able to rely on 

technology to help them 

seamlessly attend patient 

needs, access information, 

record Electronic Patient 

Report Forms, and send 

and receive data, transfer 

diagnosis and other critical 

details to their destination 

hospital in any condition, 

and from any location. 

Services like Scottish Ambulance 

Service (SAS) are already using 

rugged devices from the global 

designer and manufacturer of 

rugged mobile devices, Getac, 

designs devices specifically for 

critical field performance. 

Focus on Mobile Technology 

Mobile technology 

when using gloves or if it’s wet, 

or with gloves and styluses. For 

added security, the laptop also 

offers multi-factor authentication 

as well as capacitive fingerprint 

touch technology. 

It is resistant to dust and water 

ingress, three foot drops, plus 

it has features that support 

ambulance work, such as a hotswappable 

battery, giving more 

than enough battery to support 

a full day’s shift. The laptop 

has the footprint of a business 

notebook but with the features 

of a full-rugged device, providing 

a combination of design, 

performance and versatility. 

Getac has just launched its latest 

laptop, the S410, a semi-rugged 

device which includes a number 

of features that allow emergency 

crews to focus on mission-critical 

tasks, without worrying about 

reliability and performance. 

The S410 provides the latest 

technologies, processors 

and connectivity features for 

improved RF coexistence 

and comes complete with 

Windows 10 support for faster 

and more reliable data speeds. 

Getac’s LumiBond technology 

provides a high-visibility, sunlightreadable 

touchscreen that works 

The S410 offers the 

functionality and reliability that 

the emergency services can 

depend upon. Tested, reliable, 

dependable, empowering 

medical professionals can do 

what they are trained to: save 

human lives. 

If you would like to discuss 

any aspect of your rugged 

computing solution 

requirements, call: 

01952 207 221 

e-mail: 

Sales-Getac-UK@getac.com 

or visit: 

www.getac.co.uk 


Thijs Gras’ Letter from Amsterdam 

Isn’t it Time that Patients Take Responsibility as Well? 

Below our thoughtful and thought-provoking Dutch correspondent, Thijs Gras, explains the high level 

of legal responsibility for the patient assumed by Dutch ambulance nurses every time they go on-shift. 

He also asks whether or not now is the time we should finally also make patients legally responsible for 

co-operating with the ambulance nurse or paramedic so they can actually provide them with the high 

levels of patient-care that they rightly expect… but without harassment or interference! 

In our work we should always strive for the 

best in caring for a patient. This is pretty 

obvious - so obvious that it has almost 

become a hollow sentence. We know 

that in practice there is tension, especially 

when patients’ interests and colleagues’ 

interests are conflicting. For example, a 

delay of several seconds when one takes 

over the call of another ambulance in order 

to prevent them doing overtime. Will the 

patient notice this? No. Will he or she suffer 

damage from this? I would say ‘no’ to this 

too. Maybe those seconds make it possible 

to take a crossing more smoothly so you 

make up for it. 

More serious are the cases where the team 

disagrees about how to handle a case. 

Luckily this is not very common. We all 

know we should not discuss these things in 

front of a patient. In our Dutch system we 

have a nurse and a driver, so it is clear who 

is medically responsible and whose decision 

in patient care is final. 

Judicially, the patient has a lot of power in 

our country. We are obliged to inform the 

patient about what we are going to do and 

in the end the patient decides if he is treated 

or transported and he or she can even 

indicate the hospital where he or she wants 

to go to. Of course there are some limits, 

for example because that hospital lacks the 

facilities or is too far away. 

We respect people who have indicated that 

they do not want to be resuscitated. These 

always present precarious situations and in 

those cases our family doctor system really 

helps. Patients have spoken beforehand 

to their doctor who generally knows the 

situation well and can safely tell us to stop 

the resuscitation attempt. We also refrain 

from setting IV’s if a patient really opposes 

it even though it deprives him or her from 

effective analgesia. 

In quite a number of cases we just advise 

the patients and we do not transport them 

to the hospital. This happens in about 25- 

30% of cases and this percentage is rising. 

The cause of this is still not clear: do people 

call more often? Is this 

due to the use of triage 

systems in the control 

room? 

There are a few 

possibilities: we were 

really not necessary at 

all (for example a young 

girl with abdominal pain 

due to her periods), we 

may give treatment on 

the scene (reviving a 

diabetic with glucose), 

we may advise people 

to call or visit their 

family doctor or we 

may advise them to 

go to the hospital with their own means of 

transport. 

In all of these cases, legally we are on thin 

ice because we were the last medical 

professionals to have seen the patient 

and until the next professional makes 

contact with the patient; this means we are 

responsible. 

But let us not only talk about the patients’ 

rights, but also about his duties. I think 

more attention is needed on this aspect 

of patient care. First of all the patient is 

obliged to let us help him or her. This is 

sometimes quite tricky with people under 

the influence of alcohol, drugs or mental 

disorders. Then it would certainly help if he 

or she is polite to us. We do not deserve 

swearing and cursing while we help 

someone. 

And then there is the following of our 

advice. Who is to blame when we 

instructed a non-drunken, well behaved 

person to go to the A&E department 

himself and he does not do this but suffers 

from damage as a result? I would say it is 

not the ambulance crew. Who is to blame 

when the control room instructed a caller 

to call his family doctor, but he decides 

to wait and gets into trouble because an 

inflammation that could have been tackled 

earlier now gets the chance to do more 

harm? I would say it is not the control room 

dispatcher, though legally (according to 

Dutch laws) he is. 

It is time to write in the law something 

about patient duties. These involve not 

only behaviour, but also listening well to 

ambulance personnel and doing something 

with the advice given. If the patient refuses 

this, that is his or her own decision and 

it is his or her responsibility. For with 

rights come duties, with power comes 

responsibility. That goes for us ambulance 

people, but also for patients. If the doctor 

says you should stop smoking and you 

refuse this, your next heart attack cannot 

be blamed on the doctor. 

Tell Thijs what you think about this 

article by emailing him at: 

thijsgras@upcmail.nl 

This edition of Ambulance Today goes out to all 25 Dutch Ambulance Regions courtesy of Procentrum 

PROCENTRUM - LEARN TO FEEL THE DRIVE www.procentrum.eu 


73 3

Intelligent Dispatch Solution 

• Easy integration 

• System status management 

• Workflow automation 

• Mobility 

• Voice communication 

TM 

IDS 

Meet us at EMS2016 

Find out more: www.logisids.com

Focus on Ambulance Leadership Forum 2016 

LEADERSHIP THE KEY AT ALF 2016 

A sense of optimism at a time of great challenges for the urgent and emergency care system merged 

with the resounding message that UK NHS ambulance services will need stronger leadership than ever 

to survive and thrive in the future, were two of the key themes to emerge from the highly successful 

Ambulance Leadership Forum (ALF) 2016 held in February. 

The event - produced annually by the 

Association of Ambulance Chief Executives 

(AACE) - is now the major place for senior 

ambulance staff and their colleagues in 

industry and from across the wider NHS 

and academic landscapes to meet, network 

and discuss the topics that are topping the 

agenda for today’s UK ambulance service 

leaders. 

ALF 2016 was held in Leicester and 

attracted over two hundred delegates 

over the two days, drawn from all UK 

NHS ambulance services and their key 

partners from across the health sector. The 

first day saw a busy series of conference 

presentations that sparked some lively 

debates across the floor. 

Chair of the conference – award-winning 

BBC and Channel 4 journalist Liz MacKean 

- was able to persuade the participants to 

provide insight and share knowledge and 

ideas on a range of ambulance management 

topics. 

Never far from the debate, though, was the 

spectre of the unprecedented and growing 

demand for ambulance services, combined 

with the stark reality of the genuine 

pressures being felt throughout the whole 

urgent and emergency care system. 


Prof. Paresh Wankhade, one of the main speakers. 

Professor Keith Willet discussed this in detail 

and outlined what NHS England are doing 

to combat these issues, while simultaneously 

urging ambulance leaders to be brave and 

to adopt innovative approaches to managing 

their resources. 

Privately some audience members may 

have been forgiven for wondering how 

much more they could do and how much 

faster they could go to implement changes, 

although the mood in the room remained 

upbeat and Professor Willet was, as always, a 

most welcome and informative speaker. 

Regrettably, the Secretary of State Jeremy 

Hunt was a last minute cancellation and the 

audience was instead played a recorded 

message from Lord Prior of Brampton, 

Parliamentary Under Secretary of State for 

NHS Productivity (Minister responsible for 

Urgent and Emergency Care) who thanked 

ambulance services for the hard work being 

done to continue to save lives and treat 

patients in such challenging times. 

The evening saw a magnificent gala 

dinner - kindly sponsored by the ALF 

AACE Chair Anthony Marsh thanks outgoing 

NWAS Chief Bob Williams 

2016 main sponsor Ferno ® - where the 

AACE Outstanding Service Awards were 

presented to high performing staff from 

across England. 

Two other features of the evening were a 

charity auction that raised over £1,000 in aid 

of The Ambulance Services Charity (TASC 

- www.theAsc.org.uk) and an amusing 

and light-hearted send-off by AACE chair 

Anthony Marsh for North West Ambulance 

Service Chief Executive Officer Bob Williams 

who is retiring after 36 years in the NHS. 

Day two provided a series of workshops 

where the topics were as follows: ‘Our 

Workforce,’ ‘Technological and Digital 

Enablement’ and ‘Vanguards and Innovation.’ 

These workshops sparked more healthy 

debates and delegates left with new ideas 

and renewed vigour to take back to their 

trusts. The event finished with meetings of 

the national groups. 

A full report on ALF2016 and the 

full workshop presentation slides are 

available at: 

AACE.org.uk/ambulance-leadershipforum 

75 3

Exclusive Interview with IAED Founder Dr Jeff Clawson 

New European EMS Network will 

Contribute to Global EMS Improvement 

Ambulance Today’s Joe Smith quizzed Dr. Jeff Clawson, co-founder of the International 

Academies of Emergency Dispatch (IAED), and inventor of the Priority Dispatch System. 

Recognised globally as the Father of modern dispatch, Dr. Clawson offers his views on 

global partnership in EMS development and provides a fascinating insight into the 

amazing growth of Priority Dispatch Protocols since its formation in the late 1970s. 

JS: What led you to develop the 

first dispatch protocol for the North 

American EMD Network in 1978? 

JC: Priority Dispatch Protocols introduced 

into the public safety communications 

world in 1978 were designed for a specific 

purpose: to ensure that the right thing is 

sent to the right place, in the right way, 

at the right time and the right things are 

done over the phone until the troops 

arrive. This is the most important reason 

these protocols exist. The prioritisation of 

response and the orderliness of treatment is 

the true value of such protocol “plans.” Preplanning 

of emergency response is essential 

science in a healthcare environment that 

stresses efficiency of care, and the medical 

protocols provide a precise and detailed 

plan for the study of a biomedical problem 

or for a regimen of care. 

JS: When you created the North 

American EMD Network did you 

envisage the protocols for prearrival 

instructions for dispatchers 

as a purely regional EMS innovation 

or did you already anticipate its 

adoption by EMS systems globally? 

JC: A unified protocol model for all to 

use was always the goal of the Medical 

Priority Dispatch System (MPDS ® ), now 

in Version 13.0, and the same can be said 

of the Police Priority Dispatch System 

(PPDS ® ) and the Fire Priority Dispatch 

System (FPDS ® ), now in Versions 5.0 and 

6.1, respectively. A unified system of a single 

core protocol, modified through a scientific 

method process and routinely distributed 

to everyone ensures that every protocol 

benefits from the experience and research 

of the other users. In the same way the 

heart and resuscitation councils maintain 

a core protocol for CPR, BLS, and ACLS, 

the College of Fellows, a standards setting 

body within the International Academies 

of Emergency Medical Dispatch ® (IAED ), 

provides stability and reliability to dispatch 

worldwide. Importantly, the Academies 

continue to be a strong professional voice 

for emergency dispatchers and are taking 

an active role in the policies and politics of 

public safety dispatching. 

JS: Can you tell us more about how 

you developed your original priority 

dispatch pre-arrival instructions into 

three separate protocols for Medical, 

Fire and Police services? 

JC: The three sets of protocols—medical, 

fire, and police are based upon the same 

time-proven methods developed over 

30 years of research, testing, and quality 

assurance. These protocols were initiated 

by pre-establishing for Fire and Police, 

the Academy Councils of Standards, and 

Curriculum Boards, populated with world 

experts in those disciplines. Each adhered 

to the protocol structure objectives that we 

learned the hard way over many years in 

Medical. As with any protocols, version 1.0 

is simply a starting point of the evolutionary 

process, and with a scientific method-based 

process, they are guaranteed to evolve and 

improve if that process is maintained and 

supported. 

The FPDS started in 2000 and is now 

at version 6.1, while the PPDS began 

development in 2001 and is at version 5.0. 

Police is the most divergent of the three, as 

it requires early identification of suspect and 

vehicle descriptors, and quick deployment 

of mobile police patrollers, which puts 

them at significant risk. The provision of 

dispatch data to the mobile data computers 

in the cars demands a lot of special sorting, 

filtering, and other human engineering 

factors which are not as essential in the 

Medical and Fire disciplines. The fluidity of 

the events is also a differentiating factor 

in Police that is challenging to account 

accurately and safely for. The Academy 

more recently added a 4th pillar—ECNS 

(Emergency Communication Nurse 

System ) protocols, training, certification, 

and accreditation—just like the other 

disciplines. It is just starting to flower in a 

world with an ever-increasing volume of 

999 calls. 

Visit our website at www.emergencydispatch.org 

JS: How exactly did North American 

EMD grow into IAED? 

JC: The Network was an initial attempt to 

get like minds in dispatch to work together 

as a forum but wasn’t envisioned properly 

for what needed to be done, hence version 

2 – the Academy. Since the Academy was 

first formed in 1988, it was the intent 

of the founders to nurture and develop 

the organisation into an internationally 

recognised and standard-setting scientific 

and academic institution. We are an 

international forum for discussing standards 

and issues relating to medical protocol 

and one of several international EMS 

organisations dedicated to improving 

patient care and maximising the efficiency of 

EMS worldwide. 

JS: Since the formation of IAED 

how rapidly has it grown? What 

is its reach globally? How many 

countries does it reach and how 

many emergency service personnel 

globally use MPDS dispatch 

protocols? 

JC: Founded almost 30 years ago, IAED is 

the world’s foremost standard-setting and 

certification organisation for emergency 

communication centres with over 57,000 

members in 45 countries. More than 

3,400 communication centres use IAED’s 


Exclusive Interview with IAED Founder Dr Jeff Clawson 

protocols and training—translated into 17 

languages/dialects—for medical, fire, and 

police dispatching. Of those, nearly 200 have 

become Accredited Centres of Excellence 

(ACE), which ensures the intent and output 

of the protocols are realised as designed. 

JS: Can you outline a few of the 

improvements to EMS globally that 

IAED has helped to bring about? 

JC: As medical dispatch developed, several 

things have become ingrained in the 

program and the universality of Protocol is 

readily apparent globally. First, emergency 

medical dispatch has evolved from an 

attempt to stop response abuse by not 

sending EMS when it’s not needed, to a 

program that prioritises response. Secondly, 

emergency medical dispatch has become 

properly viewed as part of the medical 

care system and as the vital first step in a 

multi-step process of emergency medical 

care. Thirdly, emergency medical dispatch 

has moved the dispatch centre from a point 

of EMS control to the earliest point of EMS 

assistance. Finally, the dispatcher not only 

assists the public, but the EMS provider as 

well. Studies have shown that emergency 

medical dispatchers, medically controlled 

and trained in an internationally recognised 

dispatcher triage system, are able to provide 

medical triage to incoming emergency 

medical calls with minimal error for undertriage 

of ALS runs and high selectivity for 

non-emergency situations. The assistance 

has been explicit in first founding the use 

of scripted PAIs throughout the history of 

emergency dispatch. 

JS: What is the importance of the 

partnership between good quality 

communications and ambulance 

providers in different world regions? 

JC: Good quality communications directly 

assists EMS organisations in optimising 

their resource use, exploring data volumes 

and data types, and achieving true insight 

and forward vision to improve operational 

efficiency. Partnership emphasises a 

commitment to encourage consistent 

high-quality prehospital care. For example, 

a major advantage is the coordination 

allowing dispatchers to account for ALL 

time intervals from the time an emergency 

call is answered at the emergency 

communication centre until the units 

are back in service. This can only be 

accomplished in the spirit of co-operation 

and shared vision among various types of 

public safety agencies poised to explore 

new ideas in the science of emergency 

medical dispatch. 

JS: Rightly or wrongly, it’s often 

claimed that despite it’s great 

aptitude for innovation, America is a 

country that is too inward-focused. 

Based on IAED’s global project 

work, do you feel that this is a fair 

statement in relation to EMS? 

JC: Considering the history of EMS 

and the EMS movement in the US, EMS 

systems overseas will unavoidably contain 

components in common with those in 

the US. And EMS, as the science of human 

beings in the need of emergency medical 

assistance, has many similarities. The US 

has a leadership obligation to point out 

problems and find the means for their 

actual solution. At the same time, we have 

to understand the limited applicability of 

Western systems to culturally diverse 

regions and, with that in mind, develop 

solutions in EMS that recognise a number 

of components universally required in 

every system. In other words, a global 

program must recognise basic prehospital 

elements that can be integrated into a 

universal system beneficial to the total 

prehospital care system. A unified (same 

core everywhere) protocol system with 

approved cultural modifications has been 

the clearly successful solution to this issue. 

JS: One of the founders of the 

EMS2016 Congress and the soon-tobe-launched 

European EMS Leaders’ 

Network, is IAED’s (and Ambulance 

Today’s) own Jerry Overton. Does 

Jerry’s involvement mean that IAED 

views the EMS Leadership Network 

as an opportunity for working 

even more closely with European 

Ambulance Workers? 

JC: Of course, particularly since the 

EMS Leaders’ Network was developed 

to produce and distribute independent 

research and analysis, and provide an 

international platform with a strong 

emphasis on creating global EMS solutions. 

Jerry Overton is a natural in the European 

EMS Leaders’ Network, considering his 

professional background contributing to 

his expertise in EMS system design and 

deployment strategies. Arguably, he is the 

world expert in the science of System 

Status Management, sometimes referred to 

as fluid deployment. The IAED continues 

to add, involve, and utilise European 

knowledgeable experts. 

JS: And finally Dr. Clawson, do 

you have your own vision in terms 

of the improvements that could 

be achieved if EMS leaders such 

as yourself could work with the 

European EMS Leadership Network 

to bring about innovations in the 

areas of dispatch, frontline clinical 

care, community medicine, and 

operational delivery? 

JC: This is an opportunity to discuss 

and find international solutions to critical 

issues in emergency response through the 

cooperation of EMS experts on the global 

stage. The EMS Leadership Network will 

be in the position to influence future EMS 

practice trends, prehospital research, and 

to advance quality leadership through the 

generations. The international scope of the 

Academy has fostered significant movement 

in the scientific evolution of dispatch 

stands—in protocol, curriculum, logic 

systems, quality improvement, and dispatch 

centre accreditation excellence—assuring 

the protocols are used as designed to get 

their full, envisioned effect. 

For more information contact the 

Academy on: 

Telephone: 0808 234 4896 

Or visit the IAED website at: 

www.emergencydispatch.org 

Visit our website at www.emergencydispatch.org 


77 3

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Focus on Ambulance Innovation 

“Watson, 

I presume?” 


Care 

After the 

Fourth 

Industrial 

Revolution 

By Jaap Hatenboer, 

Strategy & Innovation Manager, 

UMCG Ambulancezorg, 

Netherlands 

The quote: “I know of no way of judging of the future but by the past” is from Patrick Henry. Patrick was 

an American attorney, planter and politician who became known as an orator during the movement for 

independence in Virginia in the 1770s. I suppose he meant that we are walking backwards into the future. 

We judge new developments using our past experiences. 

The title of this article is just an 

illustration of this fact. Interpreting 

the title completely depends on your 

past experiences. You might be a 

Harry Potter or a Sherlock Holmes 

fan. You might like expeditions to the 

heart of Africa. But even if you are 

a Sherlock Holmes fan, it matters 

which version you prefer or which 

version you recently watched. Is it 

Doctor John Watson or Doctor Joan 

Watson, is this about London or New 

York?... and the list goes on if you are 

also interested in the actors; or you 

might be interested in other issues 

and for you there is only one Watson 

and his first name is Paul. 

The simple fact is that we struggle with the 

future and we judge the present based on 

past experience combined with our age 

group, job, hobbies etc. Adding three letters 

the title becomes “IBM Watson, I presume”. 

Just adding IBM makes all the difference. 

Only then most of us would understand 

that this article might be about the IBM 

Analytics. Well it isn’t and it is. 

This article is an attempt to understand 

the relevance of the fourth industrial 

revolution for ambulance care. This 

revolution is sending some very unsettling 

shockwaves through society. For those 

who have missed it, the fourth industrial 

revolution is a collective term embracing 

a number of automation, data exchange 

and manufacturing technologies (https:// 

en.wikipedia.org/wiki/Industry_4.0 ). So this 

is about Google, Apple, Tesla, Olaeris, Uber, 

Facebook, EdX, PrecisionHawk, DNV ReVolt, 

Precision agriculture and the list goes on 

and on. The fourth revolution might be on 

a collision course with our present way of 

working. 

Trekkies will probably remember “We are 

the Borg, resistance is futile, you will be 

assimilated.” Maybe this is the right moment 

to get used to this version “The fourth 

industrial revolution has arrived, resistance 

is …” Well you already know the rest. So 

how might this impact on ambulance care, 

will it actually be the end of ambulance care 

as we know it? Here are some initial ideas 

about how it might work out. 

Anyone who follows the car industry knows 

that Tesla launched some really disturbing 

new functionalities. You need to understand 

that Tesla vehicles have a lot in common 

with iPads and get new functionalities by 

software updates. The 7 series updates 

introduced some useful functionalities that 

point at the fact that vehicles increasingly 

will become (semi) autonomous and 

interconnected. 

Picture left: 

https://commons.wikimedia.org/wiki/ 

File:Industry_4.0.png 


79 3

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Focus on Ambulance Innovation 

Picture: https://www.teslamotors.com/ 

en_GB/blog/your-autopilot-has-arrived 

So why still use lights and sirens if every 

other vehicle recognizes you as a high 

priority vehicle? There is already a platform 

available that matches location data of 

emergency vehicles with connected traffic 

apps. And by the way did you hear that 

Google has a US patent on an Ambulance 

drone system? Maybe the Sky is the limit, 

but delivering emergency care by air will 

become a lot cheaper. 

Of course you are all familiar with Rolls 

Royce as a world renowned engine 

manufacturer. You might not have noticed 

that they have developed a real-time 

intelligent Engine Health Monitoring 

System. That way they keep track of the 

performance and health of thousands of 

engines flying around the world. This is all 

about connectivity, sensors and an awful 

lot of Big data. And it will also be available 

for everyday use in ambulances. The end 

result will probably be a highly connected 

ambulance full of sensors and IoT (Internet 

of Things); equipment that is monitored by 

fleet management and logistics. 

Meet YFAS - Your Friendly Ambulance 

Station. Ever thought about an ambulance 

station that really takes care of you, adjusting 

Picture: http://www.boschpresse.de/presseforum/details. 

htm?txtID=6536&locale=en 

heating, sunshades and lights, cleaning the 

station, running errands, adjusting your 

chair and putting on your favourite music? 

With the smart homes concept it’s not that 

far-fetched. Or don’t you have an automatic 

vacuum cleaner at home that also acts as 

burglar and smoke alarm? 

Now you probably say, I am never at the 

station. It’s all driving and patient care. So 

let’s meet YFA, Your Friendly Ambulance 

that is doing the same as Your Friendly 

Ambulance Station but now mobile. It even 

gives you an extra hand, called (Boston 

Dynamics) Spot that carries your bags and 

equipment. 

Entering the home of the patient you might 

already have a lot of information regarding 

the patient and Spot is of course carrying 

your Telehealth equipment and your mobile 

blood analysis kit. The mobile Stroke Unit 

is kept in the ambulance, but that has also 

turned into a small piece of equipment. I 

personally don’t think you can expect the 

holographic doctor soon, but you should be 

connected with other health professionals. 

Just have a look at the Telehealth system in 

Aachen that has been fully operational on all 

ambulances since 2014. 

Renewable energy is not for the fainthearted. 

It will arrive in due course and it 

will revolutionize the way we use energy 

in our fleet. Maybe it will first arrive as a 

hybrid, but it will at the end take over from 

fossil fuels. With the increasing waiting times 

at A&E you might not even need a fast 

charger to recharge your batteries. Sorry for 

the joke, but in E-ambulances it is all about 

battery charging strategies. The Tesla P90D 

convinced us all that lack of acceleration is 

not an issue. 

How can we best assimilate all these new 

possibilities? I think the approach is straightforward. 

We need to accept and assimilate 

new possibilities. And above all we need 

to do it together. There is no way a single 

organization can handle the speed and 

intensity of change on their own. Teamwork 

becomes the essential new capability of any 

ambulance organization. So if you want to 

avoid ending up as the proverbial ball in the 

soccer game, your only option is to act as a 

team player. 

Maybe we should all read the book Teams 

of Teams to better understand what lies in 

front of us. And for those who might think 

there is still plenty of time, I would strongly 

advise you to NOT watch the Ubulance 

sketch and also NOT read the article “If 

Uber Is Faster than an Ambulance, What’s 

Next for the Ambulance Industry?” by 

Susanna J. Smith. 

Tell Jaap what you think or ask for 

more information by emailing him 

at: j.hatenboer@rav.nl 

Want to stay in touch with global EMS developments? 

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Spring 2016 - Issue 1 | Volume 13 

TODAY 

The global magazine for all people involved in ambulance provision 

Now going out online globally to over 275,000 

ambulance workers in partnership with NAEMT, IAED and UNISON 

Ambulance History 

in the Making 

On May 30th EMS leaders from 

across Europe Will gather in 

Copenhagen for the first ever 

European EMS congress and to 

launch the New European EMS 

Leadership Network 

Will you be there? 

BOOK YOUR PLACE AT EMS 2016 IN COPENHAGEN AT: WWW.EMS2016.ORG 

This issue i supported by 

This special edition celebrates both momentous events 

TO RECEIVE AMBULANCE TODAY FREE OF CHARGE TO YOUR EMAIL BOX JUST VISIT: 

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81 3

FOCUS on NAEMT President Chuck Kearns 

“I place great 

value on NAEMT 

partnering with EMS 

Professionals and 

Agencies from around 

the world.” 

NAEMT President Chuck Kearns answers questions from Ambulance Today’s Joe Smith on 

what America’s leading ambulance organisation is currently doing to ensure they maintain 

positive links with other ambulance providers globally. 

JS: As President of the USA’s 

largest and most important body 

representing EMS workers, how 

much value do you place on working 

in partnership with other EMS 

communities from around the world? 

CK: I place great value in NAEMT 

partnering with EMS Professionals and 

Agencies around the world. Our training 

network is now established in 60 countries. 

We continue to reach out to EMS 

professionals in other countries to expand 

our continuing medical education programs. 

JS: Can you tell us more about 

NAEMT membership globally? I 

understand that your organisation 

has active members spread across 

the globe; what kind of support 

services do you provide for your 

overseas members? 

CK: We have 12,615 international 

members in 56 countries outside of the US. 

Here are some of the benefits that are 

included with NAEMT international 

membership: 

• $125 discount on registration to attend 

EMS World Expo 

• Free online CE credits and discounts on 

several online CE services 

• A voucher for up to $15 on any NAEMT 

course 

• Major discounts off rental cars from Avis, 

Budget and Hertz 

• Free on-line subscription to Ambulance 

Today magazine, free subscription 

to EMS World magazine and discounts 

on subscriptions to many other EMS 

publications. 

• Discounts on EMS products and services 

• Up to 80% discount on Office Depot 

Office Max products 

• 20% discount at Wyndham Hotels 

JS: Much of NAEMT’s membership 

support focuses on education 

programmes. Are these influenced 

to any degree by your strong working 

links with ambulance providers in 

Europe and other world regions? 

CK: The growth of these programmes 

in other countries is due in large part to 

strong working relationships with ambulance 

providers and educators in these other 

countries. We receive requests to form new 

overseas partnerships almost monthly. 

JS: Other than providing support 

to overseas members are there 

any other activities that NAEMT 

is involved in which are specifically 

aimed at developing innovation 

and/or best practice with other 

ambulance deliverers around the 

globe? 

CK: NAEMT holds an annual World 

Trauma Symposium in partnership with 

EMS World. 300-400 attendees participate 

in this event each year. It is the leading 

trauma event for the prehospital medical 

care profession. We are the global leader 

in continuing education for prehospital 

practitioners, with courses offered in 60 

countries. 

JS: Arguably one of the greatest 

challenges for NAEMT is influencing 

relevant healthcare legislation in 

a country where laws are set to a 

great degree on a state-by-state 

basis. This must make the task 

of influencing federal legislation 

particularly difficult. It’s clear that 

much of NAEMT’s success in the area 

of influencing relevant prehospital 

legislation comes from helping to 

educate elected officials on the 

anticipating impact of pending 

federal legislation on emergency 

and mobile healthcare through your 

annual ‘EMS On the Hill Day’ – is this 

a model for positively influencing 

prehospital healthcare legislation 

that you would recommend to the 

soon-to-be launched European 

EMS Leaders’ Network in terms of 

their potential ability to positively 

influence EC-wide prehospital 

legislation? 

CK: Absolutely! In my experience elected 

officials rarely have EMS background - 

probably because our modern industry 

is still pretty young. They must be 

educated about our concerns and asked 

for their help to pass beneficial laws and 


FOCUS on NAEMT President Chuck Kearns 

regulations. A well-organized group of EMS 

Practitioners in dress uniforms, armed with 

good educational material goes a long 

way in building better understanding and 

supportive relationships. 

JS: In terms of clinical dispatch 

and operational standards, how do 

you feel that American ambulance 

services in general compare with 

their cousins across the pond? 

CK: I have been an IAEMD-certified 

Advanced Emergency Medical Dispatcher 

for 16 years. Dispatch services vary in their 

staffing and effectiveness in the US. Those 

with good funding and training who practice 

some kind of “priority dispatch” method 

with pre-arrival medical instructions are 

certainly as equally effective as those in any 

other country. 

On the operational side the US has some 

very high performing agencies. I also think 

European Ambulance Agencies are far ahead 

in the attention to safety practices that are 

ingrained in the workforce. 

JS: There’s a great deal happening 

across the USA currently in terms 

of positively reshaping prehospital 

care to create an additional role for 

ambulance services as deliverers 

of community medicine. Is this a 

development that you envisage 

growing across European EMS? 

CK: It seems a logical and natural 

evolution in our industry. I do see it 

expanding and think it provides a new 

career path for EMS Practitioners who no 

longer want to, or are becoming unable to 

lift cots any more. Expanding into Mobile 

Integrated Healthcare can provide needed 

health services in a community and add 

years to EMS Practitioners’ careers. 

JS: Can you think of any examples 

from your own long and distinguished 

career that highlight the benefits of 

global partnerships in EMS? 

CK: Oh yes. Sharing ideas, best practices 

and building relationships are all highlight 

examples for me. I’ve hosted Ambulance 

leaders from London’s LAS, Queensland, 

Australia, Canada, Japan and Caribbean 

nations. 

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visit: www.NAEMT.org 

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Focus on The Ambulance Services Charity 

Ambulance Leaders Support TASC 

An auction at the UK’s leading conference for senior ambulance personnel raised nearly £1,500 

for a Coventry-based charity. 

TASC, The Ambulance Services Charity, 

attended the 2016 Ambulance Leadership 

Forum (ALF) for the first time since they 

were formed last March. 

The UK-wide charity helps to provide 

vital advice and support services to both 

serving and retired ambulance staff and their 

families. 

TASC Chairman Cliff Randall, Trustees 

Roy Norris and Mick Webb, and Director 

of Support Services Jean Hayes attended 

the annual conference at the Hinckley 

Island Hotel for senior ambulance staff 

and their colleagues from the NHS and 

academic institutions to network and hear 

presentations about topics affecting the UK’s 

ambulance service leaders. 

Over 200 delegates attended the two-day 

event which included a gala dinner and 

charity auction with £1,385 raised for TASC 

from the generous guests. 

The charity obtained a number of prizes 

including two hospitality tickets for a future 

Wasps match at the Ricoh Arena, a Land 

Rover Tour and Experience Day for two 

guests from Jaguar Land Rover Community 

Relations, an iPad Mini featuring the brand 

new ‘iCPG’ 2016 Ambulance Clinical 

Practice Guidelines app generously donated 

by Class Professional Publishing, a limited 

edition aviation print from SWA Fine Art 

Publications and two limited edition Maglite 

torches from SP Services. 

The TASC team also signed-up a number 

of TASC supporters to continue raising the 

profile and funds for the UK’s only charity 

From the left, Jean Hayes, Roy Norris, Mik Webb and Cliff Randall from TASC at the 2016 Ambulance 

Leadership Forum 

solely focused on those working in the 

ambulance industry. 

Cliff said: “There is no doubt this is a 

challenging time for ambulance personnel 

because of the demand on the service 

and the presentations at the conference 

certainly provided some lively debates. 

“Attending the Ambulance Leadership 

Forum was an ideal opportunity to spread 

the message further about our work among 

senior personnel in the ambulance sector as 

well as raise a significant amount of money 

to continue making a difference. 

“The proceeds from the auction will help 

TASC to provide grants for rehabilitation 

services to help those recovering from 

work-related injuries, long-term illnesses 

or surgery, provide support to help people 

suffering with stress and Post Traumatic 

Stress Disorder following traumatic 

incidents at work, and bereavement 

support. 

“We signed-up a number of TASC 

supporters during the conference including 

Dr Anthony Marsh, chief executive of West 

Midlands Ambulance Service, Ken Wenman, 

the chief executive of the South Western 

Ambulance Service NHS Foundation Trust 

and Hilary Pillin, who is a consultant in 

healthcare response. 

“Their backing, along with all our other 

supporters, is vital in ensuring we provide 

the support colleagues need in times of 

crisis, bereavement, severe difficulty or 

urgent need.” 

For information about becoming a 

TASC member or supporter, please 

visit: www.theAsc.org.uk 

You can also call +44 (0)2477 987 

922 or the free TASC Support Line 

on +44 (0)800 1032 999 


85 3

Focus on the IPTS Concept Ambulance 

FERNO’s IPTS 

Concept Ambulance 

is Ready to Go Live 

By Jon Ellis, MD, Ferno UK 

We have been sowing the seed of the Integrated Patient Transport System for over two years. Starting 

with ACETECH Vehicle Intelligence, then iN∫X our integrated and transport loading system and finally 

iN∫TRAXX our modular Ambulance interior. Information such as fuel savings, safer driving standards 

and a simple protocol change, making it safer for the patient and easier for the Paramedic. The whole 

concept gives many other major benefits from reduced total vehicle weight, improving carbon footprint, 

easier make-ready and asset protection. 

But perhaps we should tell you more of the story… 

Joe Bourgraf, President & CEO - Ferno 

Group has always had big shoes to fill for 

what we call the FERNO FAMILY, a group 

of worldwide companies and a massive 

distributor network which is ever-growing 

and was started by his father, Elroy. Our 

beginnings stem from making COTS (we 

call them Stretcher Trolleys) to move dead 

or injured people but innovations such as 

the SCOOP®, the KED® and many more 

soon made us the global leader and EMS 

specialist. Developing better products has 

been instrumental in developing the EMS 

market and ambulance industry into what it 

is today. Post 9/11, the American government 

wanted companies like FERNO to make our 

rescue-heroes’ lives even safer, to further 

innovate and take an holistic approach to the 

symptoms of an unsafe world that we live in 

today. 

SafePak System, iN∫TRAXX Wall and equipment mounts 

Joe took that challenge and with some ideas 

and a team of global experts formed a 

think tank, they put a lot of ideas down and 

decided that the concept needed to be in 

three parts: 

1. Technology - areas of advanced 

communication, information and new ideas 

2. Medic - making the working day/life easier 

and safer 

3. Vehicle – looking at making the 

environment smarter and better 

These three parts all wrap around the 

patient experience. 

Ideas started to form and the benefits began 

to hit home and then somebody came up 

with the idea of coining the phrase IPTS - 

Integrated Patient Transport System. We had 

concepts; we had the desire to develop and 

to invest to make them a reality. 

The Journey 

Millions in investment and human 

resource hours have been put into 

bringing these innovations to life. Research 

and Development has been very busy 

throughout our global operations in order 

to achieve our goal of bringing these exciting 

new innovations to market with the support 

of the Global Marketing Team. We all believe 

in the new innovations and it is an exciting 

time to be with FERNO as we are ready to 

launch the most innovative solutions to be 

introduced within the EMS World for over 

60 years! 

Introduction to IPTS 

Are you ready to take the next step? Well 

we know you are because it would have 

been remiss of us to leave it until now to find 

out. We developed Customer Experience 

Centres to showcase our initial concept IPTS 

components and present the FERNO vision 

to the global EMS industry. 

With IPTS you can save £millions and that’s 

the bottom line! FERNO can save the Whole 

Health Economy a fortune in terms of 

time and efficiency. There may be an initial 

increase in capital cost - bringing this kind of 

innovation to market doesn’t come cheap, 

protecting our intellectual property with 

patents, designing new innovations, tooling 

investment, then testing them to the most 

stringent global crash standards at 26G 

forces has been a global endeavor. 


Focus on the IPTS Concept Ambulance 

Hand Over of the IPTS Ambulance. From Left To Right; Jon Ellis, FERNO Managing Director UK; Justin Wand, 

SECAmb, Head of Fleet Operations; James Kennedy, SECAmb Chief Operating Officer; Joe Bourgraf, FERNO 

Group CEO and Richard Smith FERNO Ambulance Systems Manager 

And this is what FERNO have done 

We have developed a global product for a 

safer world and all the UK market needs to 

do is change the way it works – but it is for 

the better and it’s an easier process. In fact 

young children have proven how easy our 

IPTS systems are to operate and with less 

manual handling we have reduced the risk of 

an MSK injury considerably. 

iN∫X Integrated Patient Transport & Loading System 


The first UK Beta trial of the IPTS 

Connected Smart Ambulance is with 

South East Coast Ambulance Service NHS 

Trust and the innovations throughout are 

abundant. Its WiFi communication HUB 

means that critical information can be 

accessed. The Control System monitors 

drug efficacy with Smart Temperature 

Control. The battery management system is 

constantly monitored and the Marine Grade 

Solar Panels ensure a constant power output. 

Asset Protect ensures no equipment is left 

behind at the scene. Equipment changes 

take minutes not hours and make-ready is a 

simple modular process. The whole vehicle 

is safer, lighter and it’s now quicker to get a 

patient loaded safely and administer critical 

care en route with the iN∫X, the most 

advanced patient transport and loading 

system ever introduced to market globally. 

The features, benefits and innovations are 

extensive and the results and feedback so 

far are beyond our expectations. Getting 

the gross vehicle weight under 3.5 tons is 

definitely achievable which means crews have 

no need to pass their Category C1 driving 

tests. 

We are ready to give you the Ambulance of 

the Future today: 

To find out more about the IPTS 

Concept Ambulance call Ferno UK 

on 01274 851 999. Ferno will also be 

demonstrating the ambulance at 

future conferences and exhibitions. 

These will be announced on the 

Ferno UK website when they are 

confirmed. 

• A CONNECTED SMART 

AMBULANCE Integrated Patient Transport 

System 

• NO TAIL-LIFT eliminates weight on the 

Ambulance and high maintenance costs 

• ENHANCED PATIENT EXPERIENCE 

improves patient outcomes 

• REDUCED GVW removed 250kg, saves fuel 

costs, servicing and maintenance reductions 

• TASK TIME saves at least 2 minutes using 

iN∫X to load and unload 

• UNIT HOURS phenomenal savings with less 

downtime and breakdowns 

• REGULATORY REQUIREMENTS 

removes the need for PUWER and LOLER 

• AMBULANCE AVAILABILITY keeping 

vehicles on the road longer 

• WiFi a fully connected environment to work in 

including emails and eLearning 

• 360º CONNECTION providing Supervisor 

support, Manager contact, clinical guidance 

support and connection to other healthcare 

providers 

• PAC-RAC+ Crash tested and certified to CEN 

EN 1789 

• ELIMINATING RISK ancillary equipment 

mounted and secured closer to the patient 

preventing injury and harm 

• WORKING PRACTICES eliminating the 

need to place items down on the floor because 

they can be mounted close to hand 

• MULTIPLE POSITINING OF iN∫X from 

“B offside position” to the “C central position” for 

bariatric and critical care for optimal patient care 

in accordance with CEN 

• iN∫LINE FASTENER automatic in-vehicle 

charger for iN∫X, crash tested and certified to 

CEN EN 1789 

• MEDIC SEAT can be orientated according to 

head-end of patient, allowing good airway, posture 

and position 

• iN∫TRAXX System allows for both user and 

vehicle configurability 

• FLEXIBILITY the vehicle can be configured to 

change rolls to suit the situation, to suit the 

clinician or patient need 

• MEDICAL EQUIPMENT you can move or 

change equipment easily 

• EQUIPMENT CHOICE provides the option 

to move to new technology without the need for 

vehicle modification and reduces downtime 

• INFECTION CONTROL a cleaner more 

clinical environment reducing the risk of cross 

contamination 

• MAKE READY an anticipated 10 minute 

speeding up of the “Make Ready System” saving 

in the region of £1.7 million 

• PIR MOTION SENSOR technology that 

controls certain aspects of the vehicle, particularly 

lighting, and again the Paramedic can focus on 

the patient rather than on the environment 

• SMART TEMERATURE CONTROL 

drives a number of functions in this vehicle, allows 

us to track the cooling efficacy and maintains 

correct temperature of the drug compartment 

• AUDITING OF DRUGS proves beyond 

reasonable doubt the optimum effectiveness of 

the drugs administered 

• ECO RUN control which means we can 

configure the in vehicle environment such as 

temperature, lighting and battery condition 


Out & About News 

Visit the only daily ambulance news site on the net at: 


London Ambulance Service treats over 1,000 casualties 

during Europe’s largest disaster training exercise 

Hundreds of actors - each with 

a different story – recently 

helped to make the scenario 

as realistic as possible and 

test the clinical skills of the 


crews responding to a four day 

exercise, simulating a building 

collapsing onto a tube train. 

Around 175 clinical staff attended 

each day including emergency 

ambulance crews, paramedics, 

advanced paramedics, and specialist 

staff from the Hazardous Area 

Response Team who are trained to 

provide life-saving medical care in 

dangerous environments. 

Director of Operations Paul 

Woodrow said: “Over four days 

ambulance staff treated hundreds 

of injuries that would be typical 

during an incident like this including 

fractures, broken limbs, head injuries, 

amputations, spinal injuries and 

respiratory conditions. 

“Our ambulance crews are highly 

trained clinicians and in the event 

of a major incident would be 

dispatched to the scene quickly start 

assessing and treating patients, saving 

lives and ensuring patients receive 

the treatment they need. 

An incident control room was 

opened where staff from our 

emergency operations centre also 

practiced their response to a major 

incident, which involves managing 

information from staff at the scene, 

ensuring that we dispatch the 

most appropriate resources, and 

coordinating where patients will be 

conveyed. 

Paramedic students and medical 

students are along the large number 

of people volunteering as casualties 

throughout the exercise, to make the 

scenario as realistic as possible for 

emergency teams. 

Paul said: “In the event of a major 

incident we have clear processes 

Determined Dermot wins WAST Management 

Apprentice of the Year Award 

A long-serving WAST 

paramedic has picked up a 

prestigious award for the 

lengths he has gone to further 

his education. 

Dermot O’Leary, who is based in 

Rhyl Ambulance Station, won the 

Management Apprentice of the 

Year Award at Coleg Llandrillo’s 

Apprenticeships Awards Ceremony. 

The father-of-two, who has worked 

for the Welsh Ambulance Service 

for 15 years, was recognised for the 

work he produced while studying 

for his ILM Level 3 Diploma in 

Leadership Management. 

Dermot, who is also a Clinical Team 

Leader, and supervises a team of 14 

colleagues, said: “I was shocked and 

stunned when they called out my 

name at the awards ceremony. 

SWASFT ASPIRES to develop workforce 

South Western Ambulance 

NHS Foundation Trust 

(SWASFT) is firmly committed 

to the development of our 

workforce, ensuring fulfilling 

careers for those who wish 

to progress through the 

variety of clinical roles 

within the Trust. Additionally, 

progression into middle and 

senior management for both 

clinicians and support staff is 

also strongly encouraged. 

Over the past year specialist 

paramedic programmes have been 

introduced to further develop the 

clinical portfolio of an increased 

number of our operational staff. We 

“I thought that the other candidates 

were far more ahead of the game 

than me, and I certainly didn’t expect 

to win. 

“The diploma was tough because 

you’re trying to juggle your studies 

with a full time job, but it was so 

worth it and I’m glad I did it. 

“I was chuffed just to be nominated 

to be honest.” 

The year-long course, which Dermot 

completed at the Rhos-on-Sea 

campus, is for those who are have 

management responsibilities but no 

formal training, and are serious about 

developing their abilities. 

Sonia Thompson, the Trust’s Head 

of Operations in North Wales, said: 

“We’re delighted that Dermot has 

have also assisted a huge number 

of staff to qualify as paramedics and 

delivered an extensive continuing 

professional development (CPD) 

programme across a huge range of 

subjects. 

Continuing the momentum we are 

now proud to launch our new career 

portal – Aspire. Aspire is a bespoke 

website dedicated to supporting 

our staff on their career journey 

and providing them with tools, 

information and helpful hints and tips 

to enable them to take charge of 

their own development. 

Staff can browse this site to find 

information on our appraisal system 

‘My Career Conversation’ how this 

Dermot O’Leary with his award. 

been recognised for his dedication, 

which knows no bounds. 

“Dermot is such a worthy recipient 

for this award, and we’re over the 

moon that his commitment has been 

links with our talent pools and how 

we use our identified ‘talent’ to 

deliver key programmes of work 

whilst providing them with valuable 

experience of working in a new 

area, with new people or at a more 

senior level. The site also provides 

information on how to get the best 

out of applying for jobs, preparing 

for an interview or preparing to 

study for a qualification. The site also 

signposts staff to courses, training 

sessions, webinars and reading 

which may be of use to them in 

their personal and professional 

development. 

We are proud of those we employ 

and the vital role they play in 

and plans in place 

including an alert 

system for staff 

who have proved 

they are always willing to support 

our response - even when not on 

duty. 

“By testing our responses to an 

incident like this we can increase our 

preparedness for any major incident 

that affects London. It was also a 

great opportunity to test how we 

work with emergency services and 

all other partners across London.” 

recognised in such a distinguished 

way.” 

Dermot, who lives in Penmaenmawr, 

joined the Welsh Ambulance 

Service in 2001 as an Emergency 

Medical Technician, and qualified as a 

Paramedic two years later. 

He is also one of the Trust’s road 

safety champions and spends much 

of his own time visiting schools 

and colleges delivering hard-hitting 

lessons in road safety. 

Justine Grew, Work-Based Learning 

Manager at Coleg Llandrillo, said: 

“Dermot is an exemplary student, 

going far beyond what is required. 

“He has demonstrated innovation 

and dedication to his role. His 

assessor and tutor are very proud 

of his success.” 

caring for our patients. We also 

recognise the achievements of many 

of our staff who have developed 

and progressed throughout our 

organisation and the launch of Aspire 

seeks to further develop, encourage 

and open doors to many more. 

Enjoy our daily-updated ambulance news free online at: www.ambulancetoday.co.uk 


The longest Serving 

paramedic for North West 

Ambulance Service (NWAS) 

Steve Evans has retired after 

44 dedicated years in the 

Service. 

In 1971 at the age of 16, a fresh 

faced Steve began his career 

as an ambulance cadet in the 

Merseyside area. Steve remained 

in the Merseyside and Cheshire 

area for his entire career, becoming 

a paramedic in 1989 and in the 

last six years he has trained other 

paramedics across the Trust. 

Steve, 60, has always busied himself 

in undertaking a wide range of 

successful projects outside his 

commitments as a paramedic. 

Writing medical books and his 

world famous ‘Don’t Walk Away’ 

campaign, aimed at protecting young 

people, saw him rewarded with 

an MBE in this year’s New Year’s 

Honours list. 

Saving thousands of lives over his 

many years in the Service and 

delivering 19 babies, including one 

on Christmas day, Steve was given a 

special send off by the Trust with a 

retirement presentation. 

Speaking at the retirement 

presentation Steve said: “It’s been 

an incredible experience watching 

the ambulance service change over 

the years. The main thing I’ve always 

wanted to do as a paramedic is 

to make a difference. Whether 

you’re out on the road saving lives 

or training the next generation of 




NWAS’s dedicated longest serving paramedic retires after 44 years 

Steve Evans at the retirement presentation 

with NWAS Head of Driving Standards 

Paul Jones-Roberts. 

paramedics, you’re always part of a 

team making a huge difference to so 

many lives every day. 

“I didn’t have the qualifications to 

get into the police, so my Mum told 

me to sign up with the ambulance 

service. I’ve never looked back. The 

people in the Service are incredible 

and I’ll definitely miss my colleagues 

the most.” 

SECAmb Fleet success at Fleet News Awards 2016 

South East Coast Ambulance 

Service NHS Foundation 

Trust (SECAmb) is celebrating 

success after winning in three 

categories at the Fleet News 

Awards. 

Nominated in six categories, the Trust 

came out top in three categories 

- Fleet of the Year (251 to 1000 

vehicles), Green Fleet of the Year 

and Fleet Manager of the Year where 

SECAmb’s Justin Wand scooped 

the top award. It was also Highly 

Commended in the Safe Fleet and 

Most Improved Fleet categories. 

About 1,500 attended the ceremony 

in which the SECAmb fleet team, 

which has been on a modernisation 

programme in recent years, was 

directly competing, not with 

other blue light services, but with 

commercial organisations. 

It is the third fleet awards event the 

Trust has been shortlisted for in the 

last six months. Last year SECAmb 

won at the Commercial Fleet Awards 

the Blue Light & Public Sector Fleet 

of the Year and was also Highly 

Commended at the Green Fleet 

Awards in a competition with 600 

other applicants. 

SECAmb’s Head of Fleet 

and Logistics Justin Wand 

said: “This recognition is a 

great achievement for the 

Trust and demonstrates 

Bob McGowan, Interim Head of 

Service for Cheshire and Merseyside 

said: “Steve has been a brilliant 

member of the team and brought a 

great deal of dedication, passion and 

enthusiasm to his roles. He will be 

truly missed in the Trust by colleagues 

up and down the North West. We 

all wish Steve a long and happy 

retirement and thank him for all his 

incredible work over the years.” 

Steve plans to spend his retirement 

continuing his work training street 

pastors and using the lawnmower he 

received from colleagues as a leaving 

gift. Steve will also by cycling Land’s 

End to John o’ Groats in September 

and will be spending the next five 

months training for his ‘epic’ cycle 

ride. 

the hard work the team has put 

in in recent years. The Fleet team 

plays a crucial role in ensuring the 

service is able to respond reliably 

and sustainably to our patients. I am 

immensely proud of all the team 

whose hard work is delivered day in 

day out and which contributes directly 

to patient care. I would also like to 

add that my personal recognition 

is only possible because of my own 

team and wider Trust support.” 

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73 89 3




Finnish study shows high serum omega-6 polyunsaturated fatty acid 

concentrations linked to lower risk of type 2 diabetes 

A new study from the 

University of Eastern Finland 

shows that high serum 

omega-6 polyunsaturated fatty 

acid concentrations are linked 

to a significantly reduced 

risk of type 2 diabetes. The 

findings were published in the 

American Journal of Clinical 

Nutrition. 

It has been speculated that a high 

intake of omega-6 polyunsaturated 

fatty acids may increase the risk of 

several chronic diseases, as these 

fatty acids have been suggested to 

promote low-grade inflammation, 

among other things. However, studies 

conducted on humans have not 

established a link between even a 

high intake of omega-6 fatty acids 

and inflammation. Furthermore, 

omega-6 fatty acids have beneficial 

effects on, for example, glucose 

metabolism. Earlier research has 

systematically linked especially linoleic 

acid, which is the most common 

omega-6 fatty acid, to a reduced risk 

of cardiovascular diseases and type 2 

diabetes. However, scientific evidence 

relating to the health effects of other 

omega-6 polyunsaturated fatty acids 

is not as inconclusive. 

The serum fatty acid concentrations 

of 2,189 men aged between 42 

and 60 years and with no baseline 

type 2 diabetes diagnosis were 

analysed at the onset of the Kuopio 

Ischaemic Heart Disease Risk Factor 

Study, KIHD, in 1984–1989 at the 

University of Eastern Finland. During 

a follow-up of 19 years, 417 men 

were diagnosed with type 2 diabetes. 

The study found that high serum 

omega-6 polyunsaturated fatty acid 

concentrations were associated with 

a 46% lower risk of developing type 

2 diabetes during the follow-up. 

When analysing the independent 

associations of different omega-6 

polyunsaturated fatty acids, a similarly 

significant association was found 

between high serum linoleic and 

arachidonic acid concentrations 

and a lower risk of type 2 diabetes. 

However, high serum gammalinolenic 

and dihomo-γ-linolenic 

acid concentrations were linked to a 

higher risk. 

The study indicates that high 

serum linoleic and arachidonic 

acid concentrations are linked to a 

lower risk of type 2 diabetes. The 

serum linoleic acid concentration 

is determined by the person’s diet, 

and the main sources of linoleic acid 

are vegetable oils, nuts and seeds. 

Arachidonic acid is present in meat 

and eggs; however, the human body 

can also make arachidonic acid from 

linoleic acid. 

Gamma-linolenic acid and dihomoγ-linolenic 

acid are mainly formed 

in the human body from linoleic 

acid. Their concentrations in serum 

are very low in comparison to, for 

example, linoleic acid. The association 

of gamma-linolenic acid and dihomoγ-linolenic 

acid with a higher risk of 

type 2 diabetes has been observed 

in some earlier studies, but the 

underlying reason remains unknown. 

All in all, however, this study as well 

as several earlier ones suggest that 

polyunsaturated omega-6 fatty acids 

have a beneficial impact on the risk 

of type 2 diabetes. 

For further information, 

please contact: 

Jyrki Virtanen, PhD, Adjunct 

Professor in Nutritional 

Epidemiology, University of 

Eastern Finland Institute of 

Public Health and Clinical 

Nutrition, tel. +358294454542, 

jyrki.virtanen(at)uef.fi 

Book your place at EMS 2016 in Copenhagen at: www.ems2016.org 


South Central Ambulance 

Service NHS Foundation 

Trust (SCAS) are pleased to 

have launched a trial with 

Auxilium. This system aims 

to assist us in identifying and 

treating patients at the site 

of an incident, specifically 

for the patients who are 

incapacitated and unable to 

communicate this information 

fully themselves. It allows 

ambulance staff to find out 

valuable information about a 

patient even before they even 

reach the scene of an incident. 

The Auxilium 

system allows any 

individual to store 

their personal 

information 

on a website. 

Information such 

as name, home address, next of kin 

and key medical record data which 

could potentially be very useful in 

some situations when the patient is 

unable to communicate. 

Each Auxilium user is provided with 

their own unique Auxilium Number, 

this number can be displayed on 

items carried by the user, such as 

Staff ID Cards, keyrings, or even 

displayed on their mobile phone. 

There is a distinctive Auxilium 

System logo attached to the 10-digit 

Auxilium number. This logo can be 

easily spotted by the emergency 

services and the public. The number 

can then be provided to the 

emergency call taker by the caller 

who will have access to the Auxilium 

Database. The operator with then 

use this number to access the 

relevant information. 

Luci Stephens, Director of 

Operations – Clinical Coordination 

Centres, South Central Ambulance 

Service NHS Foundation Trust, said 

“We are pleased to have embarked 

on this trial of Auxilium which we 

hope will prove to be of benefit 

to patients and staff alike. There 




Auxilium and South Central Ambulance Service launch a new trial 

are occasions when it would be 

incredibly useful to have key details 

about a patient which they might not 

be able to provide to us due to their 

medical condition and we hope that 

this trial will help demonstrate how 

important these details are in the 

event of an emergency”. 

Grant Moreton, Inventor and 

Director of Auxilium Systems Ltd 

said “Some years ago I was witness 

to a serious incident and it at that 

time it occurred to me that there 

was a benefit of a system which 

would provide peoples contact 

details in the event of an emergency. 

The Auxilium system has been 

initially made available to members 

of the public in the SCAS area (as 

this is where the trial is taking place) 

to enable them to log on and fill out 

the details that they would want the 

ambulance service to have access 

to. Such things as contact details, 

current medications etc can be 

filled out so that staff in our control 

room could have access to them to 

pass on to responding ambulance 

St John New Zealand reaches ePRF milestone 

St John New Zealand has 

successfully completed the 

implementation of its new 

electronic Patient Report Form 

(ePRF) across its emergency 

ambulance service. The worldleading 

technology replaces 

paper patient records and was 

successfully implemented over 

a six month timeframe. 

ePRF was 

developed 

by St John in 

partnership 

with the 

Ministry 

crews. I am delighted 

that we have now 

embarked on this 

with SCAS to assess 

its effectiveness”. 

Auxilium is already 

up and running so 

if members of the public would like 

to know more they can email info@ 

auxsys.uk membership is currently 

free to all schools for the first year 

with a £1 fee per person per year 

for all other members of the public. 

Auxilium are also offering certain 

charities whose members have 

medical conditions over 500,000 

AUXILIUM numbers totally free. It is 

the responsibility of the individual to 

keep the information up to date and 

accurate. 

To find out more contact 

Grant Moreton or Chris 

Rowe: 

Tel: 01865 338020 

Website: www.auxsys.uk 

Email: info@auxsys.uk 

Prof. Douglas Chamberlain ‘father of the paramedic profession’ 

takes centre stage at EHAAT’s Clinical Governance Day 

The founder of the first 

paramedic unit in Europe, 

Prof. Douglas Chamberlain, 

spoke to an 85-strong 

audience of doctors, 

paramedics, nurses, students 

and other emergency services 

personnel at the Essex & 

Herts Air Ambulance Trust’s 

monthly Clinical Governance 

Day held at North Weald 

Airfield on Tuesday 15 March. 

Prof. Chamberlain, who has 

dedicated his career to pioneering 

the resuscitation techniques that are 

now common place amongst the 

emergency services and save lives 

every day, was invited to speak at 

the event hosted at North Weald 

Airfield - home of the Herts Air 

Ambulance. 

After giving his presentation about 

optimising Cardio-Pulmonary 

of Health’s Information Group, 

supported by the Accident 

Compensation Corporation (ACC), 

Valentia Technologies and Samsung 

Electronics. 

ePRF will soon allow the secure 

transmission of patient information 

between ambulances and hospital 

emergency departments, aligning 

St John records with other health 

records using the patient’s NHI 

(national health index) number. 

From 2017, ePRF will enable hospital 

staff to access ambulance care 

summary records directly using their 

computers. 

Resuscitation he remarked: “It was 

a real privilege to have come and 

met so many wonderful dedicated 

people, thank you so very much, an 

inspiring day for us”. 

EHAAT opens its doors to the 

wider healthcare and emergency 

services community on the third 

Tuesday of each month. All those 

with an interest in pre-hospital 

critical care are invited to share its 

The new technology gives 

paramedics access to better patient 

information. Currently, only details 

of previous ambulance call-outs can 

be searched, but with the future 

linkage of other health records, St 

John will be able to provide higher 

quality information to emergency 

department staff, and others in 

the heath sector, improving clinical 

practice and patient care. 

St John Director of Clinical 

Operations, Norma Lane says the 

roll out of ePRF is a key milestone 

in the modernisation of St John’s 

ambulance service. “Moving from 

governance meetings. Every event 

is themed around an element of 

emergency care and, as well as case 

presentations, audits and journal 

reviews, include presentations from 

expert speakers from a variety of 

clinical backgrounds. 

Laurie Phillipson, EHAAT Clinical 

Manager said: “Every paramedic 

across the country has heard of Prof. 

Chamberlain; in many ways he is the 

father of the paramedic profession 

and responsible for saving thousands 

of lives; to have him speak at one 

of our governance days was a real 

honour”. 

Other speakers on the day included 

David and Kaz Fletcher, who spoke of 

the influence that data downloaded 

from defibrillators can have on 

improving resuscitation, and Dr Ben 

Singer who presented forwardthinking 

presentation on Extra- 

pen and paper to 

electronic records 

enables us to share 

higher quality 

patient information 

with District Health Boards (DHBs), 

improving patient care. We can 

also now electronically analyse and 

audit patient records, extracting 

anonymised information that informs 

the ongoing improvement of our 

clinical education and practice.” 

For more information visit: 

http://www.stjohn.org.nz/ 

News--Info/St-John-ePRF/ 

Corporeal Membrane Oxygenation 

and its role in out-of-hospital cardiac 

arrest. 

Dr Alex Rosenberg , Consultant in 

Critical Care at the Royal Brompton 

and Harefield NHS Foundation Trust, 

and some of his colleagues attended 

the Governance Day. He said: “We 

all thought it was a really great day 

and thoroughly enjoyed it. I think the 

real take home message for me was 

the chaos that your team deal with 

day to day and how this impacts 

upon resuscitation.” 

The next Essex and Herts Air 

Ambulance Clinical Governance 

Day will be held on the 19th April 

2016 at North Weald Airfield. Any 

clinicians or emergency services 

personnel interested in attending 

should contact Geraldine.wash@ 

ehaat.uk.com 


91




Essex & Herts Air Ambulance Trust signs-up to 

purchase its own ‘state-of-the-art’ helicopter 

Thanks to the support of 

the people and businesses of 

Essex and Hertfordshire, the 

Essex & Herts Air Ambulance 

Trust (EHAAT) has reached 

a milestone in its fundraising 

– enabling the charity to 

purchase its own helicopter 

for the first time in its 20 year 

history. 

In March, Rob Forsyth, Chair of 

Trustees at EHAAT signed the 

contract with aircraft operator, 

Medical Aviation Services (MAS) to 

secure the purchase and operation 

of the £6 million Agusta Westland 

AW169 - the leading edge helicopter 

for emergency medical service 

operations. 

A 10-year contract to lease an 

MD902 Explorer was also approved. 

The life-saving Charity takes 

possession of both aircraft early next 

EEAST completes regional CAD upgrade 

A brand new system at the 

point of a 999 call to help 

improve the level of service to 

patients has been installed at 

the region’s ambulance service. 

The new computer aided dispatch 

system (CAD) is provided by 

Cleric, a company specialising in the 

development of computer software. 

Executive Officer Jon Moore said it 

was considered as an essential move 

by bosses at the East of England 

Ambulance Service NHS Trust 

(EEAST): “It was a necessary step, 

and an extremely positive one which 

year and will be ready to fly in June 

2017 as the leases on its current 

aircraft come to an end. 

The purchase was made possible 

thanks to the support given to the 

Charity by the people and businesses 

of Essex & Hertfordshire, supported 

by the Charity’s successful bid for 

£1.5 million from the Government’s 

Libor fund. 

The Agusta Westland AW169 will 

be the most advanced aircraft flying 

within the East of England region’s 

air ambulance services. Ideally suited 

to life-saving missions, it offers the 

maximum internal cabin space for 

crew, patients and equipment so that, 

even whilst flying, the Pre-Hospital 

Care Doctors and Critical Care 

Paramedics will have full access to 

the patient if necessary. 

It’s also capable of night flying, giving 

the Charity the capability, if necessary, 

is integral in aiding the Trust on the 

road to recovery.” 

He thanked the 450-plus-people 

involved in the upgrading process 

overall, which saw three regional 

emergency operation centres 

(EOCs) in Bedford, Norwich, and 

to broaden its service into the hours 

of darkness over the coming years. 

The AW169 also boasts an Auxiliary 

Power Unit (APU) to run clinical 

equipment on the ground, including 

the illumination of the cabin to assist 

crews whilst working, and Digital 

Automatic Flight Control to boost 

safety. 

Investment into new generation 

aircraft will enhance the Charity’s 

Air Ambulance provision both 

operationally and clinically and will 

bring huge benefits to the people of 

Essex, Hertfordshire and surrounding 

areas. 

Both aircraft will be flown and 

maintained by Medical Aviation 

Services (MAS) which has been 

working in partnership with EHAAT 

for the last ten years. 

Henk Schaeken, Managing Director 

of MAS, added: “EHAAT has selected 

Chelmsford install the new CAD in 

less than five months. 

Jon added: “It was an ambitious 

target we set ourselves but thanks 

to the tireless effort of everyone 

involved we have been able to 

deliver at an extremely period. This 

is one of the fastest implementations 

of the ambulance service.” 

The new system means that patients 

will be dispatched ambulances in a 

safer, more efficient, and appropriate 

process that is more adept at dealing 

with current levels of demand faced 

by the ambulance service. 

Blue Light Services launch North Yorkshire’s first Emergency 

First Responder scheme 

Fifteen retained firefighters 

at Pickering, Helmsley and 

Lythe are now responding to 

life-threatening emergency 

calls at the same time as 

an ambulance, thanks to 

the official launch of North 

Yorkshire’s first Emergency 

First Responder (EFR) scheme. 

The pilot scheme is a joint initiative 

between Yorkshire Ambulance 

Service NHS Trust (YAS) and North 

Yorkshire Fire & Rescue Service 

(NYFRS). It follows the success of 

the first scheme which has been 

running in Humberside and the East 

Riding of Yorkshire for the last two 

years, the South Yorkshire scheme 

which was launched in October 

2015 and most recently the West 

Yorkshire initiative. 

Each EFR has been trained in basic 

life support, cardiopulmonary 

resuscitation (CPR) and oxygen 

therapy. They are equipped with a 

kit which includes oxygen and an 

automated external defibrillator 

(AED) to help patients in a medical 

emergency such as a heart attack, 

collapse or breathing difficulties. 

An EFR will be dispatched at 

the same time as an ambulance 

and will not replace the usual 

emergency medical response from 

YAS. However, their location within 

local communities could mean they 

are nearer to the scene in those 

first critical minutes of a medical 

emergency, delivering life-saving care 

until an ambulance clinician arrives. 

Paul Stevens, Head of Community 

Resilience at YAS said: “We have a 

responsibility to ensure we explore 

all available options to improve 

clinical outcomes for people in 

Yorkshire and we are delighted to be 

working in partnership with WYFRS 

on this Emergency First Responder 

scheme. 

“We have a very clear ambition 

to improve the survival rate for 

those people who suffer from a 

cardiac arrest in the community 

and we want to have world-class 

levels of survival. The expansion of 

this initiative is another important 

element of this. 

“North Yorkshire is already served by 

our award-winning Community First 

Responder teams who do a fantastic 

job as volunteers in their local areas. 

the latest and best possible aircraft 

available and we are delighted to 

be able to continue our partnership 

with them. The Agusta Westland 

AW169 will ensure the Charity’s 

Helicopter Emergency Medical 

Service (HEMS) crews will be able 

to provide an even greater level of 

service to the people of Essex and 

Hertfordshire.” 

The Agusta Westland 169 will arrive 

in the UK in early 2017 and will 

commence flying from June 2017. 

For more visit information on 

Essex & Herts Air Ambulance 

Trust visit EHAAT.uk.com 

Jon said: “We are already seeing 

benefits which will enable us to 

continue our improvement in the 

coming months. The feedback from 

staff that have been trained to use 

the new system has been fantastic.” 

Want to find out more 

about how a 999 call works? 

The Trust’s Its Your Call 

information pages can be 

found here: 

/www.eastamb.nhs.uk/Newsand-Media/Campaigns/itsyour-call.htm 

The addition of Emergency First 

Responders has further strengthened 

our response in these communities 

and the two models work side-byside 

to save more lives. 

sponders are only available for 

dispatch when staffing levels at their 

Fire Station allow and the scheme 

will not have an adverse impact on 

fire cover. The scheme will be closely 

monitored throughout the pilot and 

fully evaluated prior to any decisions 

being made about the long-term 

future of the scheme. 

Head of Risk Management Owen 

Hayward from North Yorkshire 

Fire & Rescue Service said: “We are 

delighted to be part of this scheme 

and believe that it will deliver real 

benefits to people who require 

medical assistance in these rural 

areas. 

Got a special project you want to share? Please email us at: editor@ambulancetoday.co.uk 


London Ambulance Service appoints new Medical Director 


is pleased to announce that 

Dr Fenella Wrigley has 

been appointed Medical 

Director following a national 

recruitment process. 

Fenella has been 

undertaking the role 

on an interim basis 

since January 2015. 

Prior to that Fenella 

was Deputy Medical 

Director, having 

joined the Service 

in 2008 as Director for Control 

Services. 

Chief Executive, Dr Fionna Moore, 

said: “Fenella brings a wealth of 

clinical experience from both the 

pre hospital setting and as an A&E 

consultant. She is committed and 

passionate about providing the 

best possible patient outcomes for 

Londoners. 

“We are delighted Fenella has 

accepted this role on a permanent 

basis.” 




$1.1m investment to help half a million New Zealand 

children learn first aid skills 

Teaching Kiwi kids how to 

prevent injuries and ensuring 

they have the skills and 

confidence to take action in an 

emergency are the goals of the 

St John in Schools programme, 

formally launched in March by 

the Accident Compensation 

Corporation (ACC) Minister 

Nikki Kaye and St John CEO 

Peter Bradley at Clendon Park 

School in South Auckland. 

St John in Schools was developed by 

the Community Health Services arm 

of St John, the largest emergency 

ambulance service in New Zealand 

(population 4.47 million). 

It aims to improve the emergency 

preparedness and community 

resilience of the next generation, and 

there are numerous examples of 

children who have been through a St 

John in Schools programme making a 

real difference in an emergency. 

St John CEO, Peter Bradley says 

the programme was introduced in 

2015, with 77,000 children taking 

part and over 30,000 kids taught 

CPR. “St John in Schools improves 

the emergency preparedness and 

community resilience of the next 

generation,” he said. 

“This is exciting and significant not 

only for the youth of New Zealand 

but also for their families, friends and 

community who stand to benefit 

from their knowledge.” 

St John in Schools receives 

a significant boost through 

the partnership with ACC, a 

Government organisation that 

provides comprehensive, no-fault 

personal injury cover in New 

Zealand. ACC is investing $1.15 

million to help St John in Schools 

reach 480,000 children over the next 

five years. 

Around 349,000 injury claims 

involving children under 14 are 

received annually by ACC. 

“Giving our kids the confidence to 

call 111 and provide first aid could 

Fenella will continue to work 

clinically one day a week as a 

consultant in emergency medicine 

for Barts Health NHS Trust. 

She said: “It is a privilege to work as 

part of the NHS both at London 

Ambulance Service and for Barts 

Health. 

“The Service has had a challenging 

year and it is vital we continue we 

continue to promote excellent care 

and patient experience, develop all 

of our staff and work closely with 

stakeholders and the wider NHS. 

be the difference 

that saves a life or 

reduces the impact 

of the injury,” says Ms Kaye. 

“This initiative is another example of 

the extra emphasis ACC is putting 

on working in partnership with 

others to prevent injuries and make 

our communities safer.” 

The programme will also be 

aligned to the New Zealand 

School curriculum and Te Whariki, 

the Ministry of Education’s early 

childhood curriculum framework. 

For more information visit: 


What-we-do/Community- 

programmes/St-John-in- 

Schools-Programme/ 

“I look forward to working together 

to continue to improve our clinical 

outcomes and develop our role as a 

leading mobile healthcare provider.” 

Fenella led on the development 

of urgent care within the London 

Ambulance Service, overseeing 

the introduction of a Clinical Hub 

in the control room. Staffed by 

clinicians it provides clinical support 

to ambulance crews at the scene 

as well as telephone treatment for 

patients. 


93




WAS Ambulance Technician’s tragic death 

inspires colleague to run London Marathon 

The sudden death of a longserving 

ambulance technician 

has inspired one of his 

colleagues to run the London 

Marathon in his memory. 

Nigel Dorsett will take on the 

26.2-mile challenge as a tribute 

to his colleague Phil Williams, an 

Emergency Medical Technician based 

in Welshpool, who died in February 

while on duty. 

Nigel’s t-shirt for the London Marathon 

bears Phil’s professional pin number. 

St John New Zealand’s second 

annual Out of Hospital Cardiac 

Arrest (OHCA) report shows 

the organisation maintained a 

strong 15% survival to hospital 

discharge rate for patients who 

are treated for cardiac arrest in 

the year beginning 1 July 2014. 

St John is New Zealand’s largest 

emergency ambulance service, 

serving around 4 million people or 

approximately 90% of the country’s 

population. Cardiac arrest is a 

significant public health issue in New 

Zealand with ischaemic heart disease 

being the second most prevalent 

cause of death; of the 38 people who 

are treated for cardiac arrest by St 

Plucky Nigel has never run a 

marathon before, but completed the 

Cardiff Half Marathon in March in 

preparation for his challenge in the 

English capital. 

The 54-year-old, who works for 

the Welsh Ambulance Service’s 

Patient Care Service, and is based 

in Newtown, said: “Until last year, 

I wouldn’t even run for the bus, 

and now I’m preparing to run a 

marathon. 

“I entered but I didn’t think I’d stand 

a chance of securing a place, then 

the letter landed on my mat and the 

panic set in.” 

Nigel signed up for the marathon 

last year to raise funds for Macmillan 

Cancer Support and the Bracken 

Trust, a Powys-based charity that 

supports those affected by cancer. 

Following Phil’s tragic death, he 

decided he also wanted to use his 

marathon attempt to celebrate 

the life of his friend and colleague, 

and will bear Phil’s professional pin 

number on his running vest. 

John each week, 12 are successfully 

resuscitated and transported to 

hospital and six will later survive to 

be discharged 

Published December 2015, the 

new OHCA data confirms St John’s 

clinical processes continue to be 

of a high standard and compare 

favourably with similar ambulance 

services internationally. The data 

in the report will drive important 

clinical improvements and processes. 

New Zealand’s low rate of public 

access to defibrillators remains an 

issue. While 64% of patients had 

bystander CPR performed, only 4% 

of patients were defibrillated using a 

public access defibrillator. 

He added: “Phil and I only worked 

together for a short time, but he was 

a great guy and very approachable. 

“This is my way of remembering Phil. 

Let’s hope he can get me over the 

finish line.” 

Colleagues of Phil, who was 58 and 

lived in Llanfechain with his partner, 

were offered support via the Trust’s 

Wellbeing Support Service following 

his death. 

Philip Pover, Clinical Team Leader at 

the Welsh Ambulance Service, and 

Phil’s manager, said: “Phil’s death came 

as a huge shock to us all, and we still 

can’t believe that he’s gone. 

Paramedic Phil Williams, who died suddenly 

in February. 

St John New Zealand publishes second Out of Hospital 

Cardiac Arrest report 

OHCA data also identified that 

Māori (New Zealand’s indigenous 

people) are more at risk than non- 

Māori. As a result the organisation 

has developed the ‘Marae Out 

of Hospital Cardiac Arrest 

programme’, which will see St John 

work with Māori communities 

and maraes around NZ supporting 

training and access to defibrillators 

and CPR in 2016. 

Demographic Findings 

• The most common cause of 

cardiac arrest was heart disease 

(77%) 

• 68% of cardiac arrests occur at 

home and 19% happen in public 

“Over the years, Phil helped 

hundreds if not thousands of people, 

many of whom would not be walking 

around Wales today if it wasn’t for 

his skill and dedication. 

“He was a very intelligent, kind and 

laid back man who had a lot of 

respect from his peers. 

“He is missed by all of us who had 

the pleasure of knowing him.” 

If you would like to sponsor 

Nigel’s London Marathon attempt, 

visit uk.virginmoneygiving.com/ 

NigelDorsett 

Nigel is also organising a raffle and 

an auction on Saturday 14 May at 

the Llanerch Inn in Llandrindod Wells, 

the proceeds from which will be split 

between the two charities and Phil’s 

loved ones. 

Nigel is appealing to anyone who 

would like to donate a prize to 

the auction to get in touch via his 

Facebook page: ‘Nigel Marathon 

Dorsett’ 

• Māori were 

disproportionally 

affected with a 

higher incidence 

of cardiac arrest (122.4) compared 

with all other ethnic groups (less 

than 90) per 100,000 person-years 

• Applying CPR and rapid 

defibrillation can increase a 

patient’s chances of survival by up 

to 40% 

SCAS is proud to be the provider of Non-Emergency Patient 

Transport Services across the Thames Valley region 

South Central Ambulance 

Service NHS Foundation Trust 

(SCAS) is proud to announce 

the start of the new contract 

to provide the Non-Emergency 

Patient Transport Service 

(NEPTS) across the Thames 

Valley region from April 2016. 

This is a new contract which brings 

together three existing contracts 

covering Berkshire, 

Oxfordshire and Buckinghamshire. 

SCAS is the existing supplier for 

these three contracts. 

SCAS already operates the NEPTS 

service across many parts of the 

South Central region, providing 

transport for people who are unable 

to use public or other transport due 

to their medical condition, and are: 

• Attending hospital outpatient 

clinics 

• Being admitted to or discharged 

from hospital wards 

• Needing life-saving treatments 

such as radiotherapy, chemotherapy 

or renal dialysis or DVT treatment 

SCAS has over 40 years of 

experience of patient transport, and 

in 2014/15 undertook over 500,000 

patient journeys. A comprehensive 

mobilisation plan for the contract, 

managed by a dedicated project 

team working closely with 

representatives of the commissioning 

group, has ensured a smooth transfer 

to the new contract. 

Director of Strategy, Business 

Development, Communications 

and Engagement for SCAS, James 

Underhay, said: “We are really 

The full Out-of-Hospital 

Cardiac Arrest Report is 

available at: 


Global/18_11_15_OHCA_ 

Report_2015_HQ_released.pdf 

pleased to be providing the Non- 

Emergency Patient Transport Service 

across the Thames Valley and we 

are determined to deliver the best 

possible service to patients. 

“I would like to thank all the people 

who worked so hard to ensure 

a smooth transition to the new 

contract.” 

The service is available to all patients 

who meet the eligibility criteria, 

which are in place to ensure that 

resources are available to those 

patients who need them most. 

Spread your ambulance news across the world by emailing us at: editor@ambulancetoday.co.uk 


Introducing Stryker Powerload system and XPS expandable patient surface 

Stryker Corporation is one of 

the world’s leading medical 

technology companies 

Stryker’s products include 

implants used in joint 

replacement and trauma 

surgeries; surgical equipment 

and surgical navigation 

systems; endoscopic and 

communications systems; 

patient handling and 

emergency medical equipment; 

neurosurgical, neurovascular 

and spinal devices; as well as 

other medical device products 

used in a variety of medical 

specialties. 

Stryker EMS 

Stryker EMS is the global provider 

of industry-first patient transport 

products. If you are working in 

emergency services, you are at risk 

of injury. Whether caused by sudden, 

traumatic acute failure or cumulative 

trauma failure, injury will not only 

shorten careers but will also reduce 

operational efficiency. 

Having established a long 

term relationship with Jigsaw 

Medical since their inception, 

SP Services were keen to 

discuss the idea of designing 

some new medical bags with 

them. 

Mother & Baby Transported 

Together, Problem Solved - the 

only system on the market that 

allows an adult and baby to be 

transported safely together in 

one Ambulance. 

An emotive issue and currently 

incurring major cost to the NHS, 

FERNO KangooFix is the answer to 

this problem; 

• Cost saving – reduce number of 

vehicles and resources required to 

transport mother and baby 

• Safest system ever developed 

– baby securely harnessed to mother 

Stryker EMS is dedicated to 

delivering best-in-class solutions 

for real industry issues that reduce 

risk of injuries to the caregiver and 

patients alike. We have focused our 

efforts to address high risk injury 

areas including: transferring a patient 

up and down stairs, raising and 

lowering a patient on the cot, and 

loading and unloading into and out 

of an ambulance. 

Singular Focus. Global Reach. 

Stryker EMS engineering and 

design teams focus on continuous 

innovation globally with the singular 

goal of improving patient safety and 

reducing injuries among medics 

and caregivers. With scientifically 

proven results, our customers have 

experienced reduced Worker’s 

compensation costs, injuries, and 

lost or modified work days, while 

improving recruitment and retention 

through the development of these 

proven technologies. 

Power-LOAD System: Loading and 

unloading at the touch of a button 

Extensive discussions between 

senior Jigsaw Medical clinicians and 

the SP Parabag development team 

regarding the content and design 

of the bags resulted in a range of 

brand new, fully bespoke bags, made 

specifically for Jigsaw Medical for use 

on their NHS contracted ambulances 

and RRVs. 

By streamlining the equipment to 

only the essential items needed to 

provide the very best in medical 

care, two existing SP bags were 

amalgamated into one, thereby 

reducing the weight and load 

required to carry the bag by the 

ambulance crews. This made both 

the bag and Jigsaw staff more 

responsive in emergency situations. 

Additionally, with Jigsaw experiencing 

laid on an ambulance trolley in a 

vehicle 

• Tested and proven - dynamic 

tested to EN1789 (10G) and 

TSF2010:2 (20G), CEN compliant 

• Intimate contact for mother 

and baby – clinically proven to help 

in patient management and mother 

& baby’s condition during transfers 

• Snug cocoon design with 

integrated skull cap – keeps baby 

warm and secure 

• Lightweight and easy to 

store – only 1 Kg 




Power-LOAD is 

the first automatic 

loading and unloading 

system developed 

by Stryker for 

ambulances. This 

eagerly awaited 

system operates 

at the touch of a 

button and therefore considerably 

reduces the risk of injury to rescue 

workers. The Power-LOAD System 

has been developed systematically in 

accordance with the guiding principle 

of reducing injuries. 

XPS – expandable patient 

surface 

The all-in-one solution for a variety of 

patients and environments. 

XPS is there when you need it. 

XPS provides an expanded patient 

surface area that can easily be 

retrofitted with compatible cots. XPS 

is adjustable with 7 locking positions 

and includes a wider mattress that 

reduces transfer gap and is designed 

with patient comfort in mind. This 

SP Services and Jigsaw Medical unveil bespoke medical bags 

Richard McManus - Jigsaw Medical Director 

of Clinical Services 

a sustained period of unrivalled 

growth in the industry, the bags have 

also been designed to custom fit 

their brand new ambulances that 

been have recently added to the 

Jigsaw medical fleet. SP, Jigsaw and the 

vehicle builder have worked together 

to ensure that all the bags fit the 

new cupboard spaces thus making 

everything more efficient and safer. 

Jigsaw Medical Director of Clinical 

Services, Richard McManus stated: 

“We are pleased to have worked so 

closely with a company as reputable 

as SP Services and we are really 

Ferno Kangoo Fix fixes mother & baby transport problem 

For more information or to 

trial KangooFix please call 

+44(0) 1274 851 999 or email; 

sales@ferno.co.uk 

solution helps address growing 

obesity trends and supports a variety 

of patients and environments. 

Cots with XPS meet current tip 

stability standards for both patient 

and provider safety. Engineered for 

durability and cleanability, with a 

6061-T6 aluminum core and overmold 

design. 

Certified to IEC 60601-1 for Power- 

PRO XT and Power-PRO TL. 

BS-EN 1789 for Power-PRO XT, 

Power-PRO TL, and Performance- 

PRO XT. 

For more information 

contact us at ems.info@ 

stryker.com or visit www. 

strykerems.com. 

happy with 

the results. We 

have received 

nothing but 

positive 

feedback from 

the ambulance teams out around the 

country, and look forward to growing 

and developing our relationship with 

SP and Parabag in the future. 

For further information 

contact: 

SP Service Limited 

T: 01952 288 999 

Check out: 

www.spservices.co.uk, 

www.spservices.co.uk/ 

facebook 

and www.spervices.co.uk/ 

twitter 

Book your place at EMS 2016 in Copenhagen at: www.ems2016.org 


95




The Falck VL challenge 

370 vehicles. 40 stations. 900 new colleagues. 4 months. 

Winning a contract looks good 

on paper but is hardly a walk 

in the park. Just like Father 

Christmas needs his elves, 

behind each contract won lies 

many hardworking colleagues 

striving to put things together 

on time. The same was true for 

Falck VL in Spain. 

In 2015, Falck’s activities in the 

metropolitan area of Barcelona grew 

fivefold. In the span of four months, 

Falck had to acquire, transform and 

deploy more than 380 vehicles; train 

900 workers; contract and build 40 

stations; and prepare to increase 

capacity from managing 600 daily 

services to 3500. How did they 

do it? Why, by dividing the work 

into different areas of action and 

dedicating a team for each, of course. 

1 - Management and 

coordination 

This office is dedicated to the 

deployment process and to the 

control and management of start-up 

operations. It controls more than 300 

If you have a mattress tear 

you can now fix it properly - 

listening to our customers we 

have developed a simple tears 

and cuts clinical repair system, 

which is easy to apply and 

works across a range of softbased 

products; 

• Ambulance Trolley 

Mattresses 

• Vacuum Mattresses & Splints 

• Frac immobilisers 

And even as a clinical patch for 

torn ambulance vehicle seats 

different activities for the deployment 

and performs a continuous follow 

back of dates and KPI to ensure 

all processes, to identify critical 

points, areas or activities that need 

strengthening. 

2 - Human resources 

A specialized call centre personally 

welcomed employees, confirmed 

their personal data and informed 

them about a special online tool 

used by Falck VL. This tool allows 

each worker to receive meeting 

notifications and training courses, 

learn about the company and work 

procedures and resolve any queries. 

First Ambulance bus in the Netherlands 

On a beautiful Friday 

afternoon in April the very 

first Ambulance Bus in the 

Netherlands was unveiled 

at the international airport 

for the Northern part of 

the Netherlands, Groningen 

Airport Eelde. 

The ambulance bus is an essential 

element in a new strategy for 

handling large scale incidents in 

this region of the Netherlands. The 

ambulance bus will be jointly used 

by the three regional ambulance 

services. 

In 2016 the Netherlands has 

changed their large scale incident 

organizational model. One of the 

elements of the new model is the 

introduction of a “100 ambulances” 

standard. The Northern region had 

done extensive simulations based on 

the new standard. It quickly became 

obvious that the national model is 

not well suited for this largely rural 

region. 

The regional capacity is limited and 

regional hospitals would quickly 

reach their maximum capacity, which 

would result in a domino effect of 

ambulances driving to more remote 

hospitals taking them far from their 

designated coverage areas. This 

would lower regional ambulance 

availability for “normal incidents” to 

an unacceptable level. 

Fix it properly with FERNO CleanPatch 

CleanPatch comes in three different 

sizes and can be used for a number 

of applications. 

It patches, protects and prolongs the 

life of a product without having to 

pay for an expensive replacement, 

it has been put through rigorous 

3 - IT 

Falck VL has modernized its IT 

infrastructure. An ERP (Enterprise 

resource planning) tool was put 

in place to improve accounting, 

management and processing of 

corporate resources, a tool for 

managing HR and rosters, fleet 

management and PTS management 

were also put in place. 

4 - Stations: 

40 new stations meant scouting for 

sites, building quality facilities for 

workers, equipment and more. To do 

this, our colleagues worked with one 

of the most important real estate 

companies in Spain. They helped 

them with the different locations and 

renovation projects. 

5 – Patient Transport Services 

(PTS) Dispatch Centre: 

PTS operations in Falck VL represent 

an increase of activity by 500%. 

The control centre has been 

expanded from five positions to 

20, the telephone capacity has 

been increased, as well as back-up 

A large scale table top exercise 

confirmed the results from the 

simulation and confirmed the need 

for more onsite treatment capacity. 

Market research was used to check 

if suitable second-hand buses would 

be available. The answer was yes, 

although not in our preferred hybrid 

drivetrain version. 

A suitable second-hand bus was 

quickly found and bought. The actual 

bus had an ideal lay out for the 

conversion that encompassed a 

new interior with six fully equipped 

treatment stretchers. All stretcher 

are equipped with Corpuls monitors 

and the bus has a cutting edge 

centralised early detection system for 

patient deterioration. 

The Ambulance bus conversion 

was done by Visser Leeuwarden, a 

well-known Dutch manufacturer of 

ambulances and emergency services. 

Visser Leeuwarden is part of the 

clinical trials (white papers available) 

and is ready for immediate use, today. 

CleanPatch saves money and 

improves on infection control 

standards 

lines using digital networks and a 

wireless network. The Computer 

Aided Dispatch software is also used, 

which enables to automatically and 

intelligently schedule vehicles and 

services. 

6 – Vehicles 

140 emergency vehicles, 220 

PTS vehicles and 10 logistics 

and coordination vehicles were 

deployed - all of which were new. 

For their commissioning, processes 

of acquisition, transformation, 

equipment, testing and 

transportation had to be performed. 

Several audits by the regional 

government were also performed to 

ensure tender requirements. 

international operating Albert Ziegler 

GmbH & Co and is partner of the 

German Ambulanz Mobile. 

Contact: 

• Ambulance services 

• http://www. 

ambulancezorggroningen.nl/ 

• http://www.rav-fryslan.nl/ 

• http://www. 

umcgambulancezorg.nl/ 

• Bus conversions 

• https://www. 

visserleeuwarden.nl/ 

• POC Equipment 

• Harry Meijer, h.meijer@rav. 

nl 

• POC Large scale incident 

organization 

• Klaas Jan Hulzebos, 

KlaasJan.Hulsebos@ 

ambulancezorggroningen.nl 

For more information call 

+44(0) 1274 851 999 or email; 

sales@ferno.co.uk 





KARL STORZ: The Leader in the field of Airway Management 

KARL STORZ offers a 

complete range of devices for 

Airway Management which can 

minimize the complications 

associated with difficult 

intubations. 

Designed for pre-hospital settings, 

the waterproof C-MAC ® PM 

(Pocket Monitor) is combined with 

highly durable reusable C-MAC ® 

video laryngoscope blades. The OTI 

(Open-To-Intubate) display gets 

activated automatically when the 

monitor is turned open. 

Standard shaped MAC blades 

for adults and MILLER blades for 

pediatrics are available with the 

Laerdal Launches SimMan ALS 

In an effort to improve 

quality and safety, training is 

increasingly being held in the 

same environment as patients 

would normally be treated. 

In situ simulation training 

has been found to have a 

positive impact on learners’ 

performance but has presented 

challenges to emergency 

healthcare community. 

This is due to the fact emergency 

healthcare providers have to perform 

in many different locations, from 

pre-hospital, on scene assessment 

and management to definitive care in 

a hospital. Laerdal’s newest addition 

to their SimMan family can help fulfil 

these unique training requirements. 

SimMan ALS has a mobile, durable, 

and self-contained design so training 

can be performed wirelessly and “on 

the move”. Designed for complete 

training of ACLS and ALS courses 

it is especially suited to train in the 

rapid detection and stabilisation of a 

deteriorating patient. 

For an entry level simulator, SimMan 

ALS comes well prepared to make 

simulation more clinically relevant 

benefit of a low learning curve 

and the option to look directly if 

needed. The additional D-BLADE 

is highly curved to manage anterior 

airways. 

Part of the set is a backup battery 

pack for emergency situations 

which allows the C-MAC ® blade to 

be used as a direct laryngoscope. 

The additional BOEDEKER- 

MAGILL forceps adapted to the 

MAC blades are designed for 

foreign bodies removals under 

video view. 

to a wide range of healthcare 

disciplines. Technologies have been 

integrated into the simulator’s skin 

so that simple add-ons can be 

used to enhance training when 

needs arise. This means, ultrasound 

diagnostics can be included into 

simulation scenarios. Also, using 

a live defibrillator, defibrillation 

training events can be automatically 

O&H Vehicle Conversions launches ‘TITAN’ platform 

incorporating weight-saving technology 

Innovative design delivers minimum 200kg higher payload and lower converted vehicle weight, across 

multiple platforms 

The first of the Titan-based products is the new, Titan Welfare Vehicle - launching at The Commercial 

Vehicle Show, offering lighter-weight vehicle conversions for moving the transient workforce 

O&H Vehicle Conversions is 

claiming a first-to-market for 

its innovative new welfare 

vehicle (crew vehicle) concept 

– ‘Titan’ – which delivers 

a minimum 200kg higher 

payload capacity as well as 

lower converted-vehicle 

weight, across multiple 

platforms. Titan design uses 

ultra-durable, composite 

materials that reduce vehicle 

wear, improve co2 emissions 

and cut fuel consumption 

according to O&H, which is 

launching Titan today. 

The first Titan welfare vehicles have 

been produced for SHB and will be 

exhibited at this year’s Commercial 

Vehicle Show on the Webasto 

stand. In addition to this, Renault 

will be hosting O&H’s Renault 

Master Titan conversion on the 

Renault stand. 

Key features of the Titan, in addition 

to its weight-saving capabilities and 

higher capacity are a unique power 

re-charge facility; a larger saloon; 

one-piece, fully wash-down interior 

panels; easy-access maintenance, 

designed to reduce vehicle off 

road (VOR) time; smart electrical 

management and euro 6 alternator 

charging systems. 

“The Titan Welfare Vehicle is a winwin 

purchase for any fleet manager, 

Multimover-a safe patient lifting and space saving solution 

Orvecare’s Multimover has 

a unique design that ensures 

the safe, secure lifting and 

movement of patients when 

time and space is a restriction. 

Working with front line paramedics 

and clinicians, to gain first-hand 

experience of the operational 

difficulties, has been crucial in 

the development and design of 

Multimover. 

Manufactured 

in the UK from 

a lightweight, 

fluid resistant, 

latex free 

nonwoven 

material. 

The twelve 

strategically 

placed lifting handles ensures each 

patient’s weight is evenly balanced 

to optimise safe lifting 

positions and has been 

independently tested to 

have a safe lifting weight 

of 250kgs equivalent to 

40 stone. 

Each Multimover is 

individually packaged 

and at only 400g can be 

easily stored either in an equipment 

bag or carried on the person. 

The C-MAC ® PM is widely accepted 

and used in several air-rescue and 

ground based EMS systems. 

Contact: 

KARL STORZ GmbH & Co. KG 

Dr. Karl-Storz-Str. 34, 78532 

Tuttlingen, Germany 

Tel.: +49 7461 708-0 

Fax: +49 7461 708-105 

E-Mail: c-mac@karlstorz.com 

captured for assessment and debrief 

to ensure teams are delivering high 

performance CPR. 

All this should ensure learners’ 

using SimMan ALS can work to 

improve reactions, performance, and 

teamwork in the environments they 

will have to perform. 

For more information, 

visit www.laerdal.com/ 

SimManALS Stay in touch 

with Laerdal Medical on 

Twitter: @LaerdalEurope 

with the lower weight and higher 

capacity that our new technology 

delivers” says O&H Sales and 

Marketing Director Lee Bott. 

For more information on 

O&H Vehicle Conversions 

please visit: 

www.ohvc.co.uk 

or call 01405 769867 

For more information please 

contact: 

Tel: +44 (0) 1482 625 333 

Fax: +44 (0) 1482 625 355 

Email: service@orvec.com 

www.orvecare.com 


97




Introducing the Xplore XSLATE D10 Fully Rugged 

Android Tablet PC for Ambulance and EMS Operations 

The Xplore XSLATE D10 

fully rugged tablet PC is 

uniquely designed to deliver 

the real-time data and rugged 

protection required for fast, 

hands-on EMS response 

capabilities – even in extreme 

conditions. 

Leveraging the flexibility and security 

of Android , the 10.1” sunlightviewable 

D10 works twice as fast 

and stores twice as much as most 

other rugged Android devices 

in support of Electronic Patient 

Care Reporting (ePCR) and other 

mobile clinical applications. It is 

the only device truly capable of 

improving quality care and records 

management long-term. 

As Body Worn Cameras 

(BWC) become more 

prominent - worn by police, 

front line ambulance staff, 

traffic wardens and security 

guards to name a few, we 

can sometimes forget the 

additional benefits these 

wearable cameras offer. 

Edesix provides frontline workers 

across the globe with tools for 

deterring violence, capturing 

evidence and convicting acts of lawbreaking, 

BWCs are also helping our 

emergency services to save lives. 


specialise in the design and 

manufacture of Patient 

Transport, Rapid Response, 

Minibus and Wheelchair 

Accessible Vehicles. We convert 

high quality and bespoke 

vehicles onsite at our purpose 

built factory based in Driffield, 

East Yorkshire. We are also 

the sole UK distributor of the 

RolliBox System and API Flexi- 

Ramp kits. 

The Single wheelchair Patient 

Transport conversions by Alfred 

Bekker which has full European 

Whole Vehicle Type Approval utilises 

Whether they’re in the ambulance, 

treating a patient, or completing an 

electronic health record (EHR) enroute 

to the hospital, medics rely on 

real-time data to be effective at their 

jobs during a patient’s most critical 

moments. 

With eight standard I/O ports 

available all the time and built-in 

4G LTE, Wi-Fi ® and Bluetooth ® 4.0 

technologies, the D10 allows for fast 

retrieval and updating of EHRs and 

constant communication between 

incident response teams and remote 

healthcare advisors. 

Streamlined dispatch channels and 

built-in GPS routing get crews on-site 

faster, and the secure in-ambulance 

Body Worn Cameras – Not Just an Evidence Gathering Tool 

The Resuscitation Research 

Group, University of Edinburgh 

The Resuscitation Research Group 

(RRG) works on improving Out-of- 

Hospital Cardiac Arrest (OHCA) 

outcomes. The whole ‘Chain of 

Survival’ from the emergency call 

through to post-resuscitation care 

the patented Flexi-Ramp. The flat 

fold ramp was the first of its kind and 

allows the boot space to be utilised 

when a Wheelchair is not being 

transported. The conversion uses 

the vehicles original seats meaning 

that the best safety and comfort is 

achieved for the other passengers. 

Winches can be added, along with a 

headrest for the wheelchair user. The 

vehicle can be made fully wipe down 

to adhere to cleaning standards. 

The Large Patient Transport 

conversions offered by Alfred 

Bekker can utilise the unique 

RolliBox System. This system 

allows the vehicle to carry up to 4 

rugged tablet mounting system 

creates a safe, vibration-resistant 

transport environment. 

The Intel®-powered D10 boasts 

high field performance ratings as 

well. It is IP65 rated, MIL-STD- 

810G tested, and ATEX compliant 

to withstand the bumps, bruises, 

and constant disinfection common 

has to be optimised. RRG selected 

the Edesix VideoBadge BWC for 

their Resuscitation Rapid Response 

Unit (3RU). 

The Use of a BWC for 

Assessment and Debrief 

The VideoBadge is securely attached 

to the paramedic’s uniform, 

requiring only a single-touch to 

start recording, leaving hands and 

concentration free to focus on 

clinical tasks. Footage is encrypted 

on the device until it is offloaded to 

the VideoManager, complying with 

medical confidentiality. 

Wheelchair patient transport solutions from Alfred Bekker 

Wheelchairs, 7 Seated Passengers 

or any combination in between. A 

Stretcher can also be added, meaning 

that the system can be adjusted 

depending on the requirements of 

that particular run. The Wheelchairs 

places have headrests and threepoint 

seatbelts, whilst four-point 

secures fold out from the side. This 

keeps the system in the vehicle 

reducing damage and loss. This 

Infection control in under 10 minutes from Sanondaf 

Sanondaf are a specialist 

disinfection company who 

offer advanced environmental 

decontamination of vehicles 

and clinical spaces through our 

highly innovative fogging and 

electrostatic spray 

devices. 

Our process can be 

used in any space 

regardless of size and 

is highly suitable for 

vehicles as we use a 

dry disinfectant mist which does not 

cause any corrosion issues and can 

be used on any equipment inside the 

vehicle including medical devices, soft 

fabrics, electronics and hydraulics. 

A typical treatment process is carried 

out in under 10 minutes and a 

vehicle is available and back in use 

within 30 minutes. 

Sanondaf achieve a kill rate above 

99.99% and our process is used 

within NHS Trusts, laboratories, and 

care facilities. Sanondaf is the ideal 

solution for any decontamination 

needs and our treatments can be 

used to deal with an outbreak or 

as part of a maintenance regime 

to continually reduce and remove 

bio-burden. 

on the job – even in Hazardous 

Locations – and it will keep up with 

fast-paced tempo first responders 

must maintain regardless of the 

rain, bright sunshine, dust, or snow. 

Several data entry options are 

available (via touchscreen, stylus, 

keyboard, barcode, or camera) for 

real-time documentation of patient 

data into multiple applications – all 

of which will run strong for up to 

20 hours with the hot swappable 

battery option. 

Contact: Manjit Dosanjh 

+44 (0) 1926 356 560 

mdosanjh@xploretech.com 

www.xploretech.com 

Footage is used by the team to audit 

team performance, protocols and 

equipment to improve practice. 

“VideoBadge has made it possible to 

evaluate new equipment while out in 

the field. We can measure key aspects 

of performance in ways which were not 

previously possible” Dr Gareth Clegg – 

RRG lead. 

For more information on the 

Edesix solution, or to sign 

up for a free trial, contact a 

member of our team on 

0131 510 0232 quoting code 

‘AMB1’, today! 

system can also be adapted for City 

and Rural Patient Transport and High 

Dependency Vehicles. 

Contact: 

Oliver Shaw 

Business Development 

Alfred Bekker API 

Oli.shaw@alfredbekker.com 

01377 241 700 

07495 455 745 

Contact us now to arrange 

a demonstration and trial of 

the Sanondaf process. We 

have national coverage across 

the UK and internationally 

in Ireland, Malta, Ecuador, 

Mexico, Singapore and 

Thailand. 

Email: 

Stuartwhite@sanondaf.co.uk 

Telephone: 01236 702029 

Website: www.sanondaf.co.uk 


‘Quality without Compromise” 

BAUS AT UK Limited 

Suite F1, 

6 Whittle Road, 

Ferndown Industrial Estate, 

Wimborne, Dorset BH21 7RU 

Mob: +44 (0)7974 940 121 

Tel: +44 (0)1425 602 999 

Fax: +44 (0)1425 602 602 

info@baus-at.co.uk 

www.baus-at.co.uk 

B.A.U.S. AT Sp. z o.o. 

Polna 134 - 136 

PL-87-100 Torun 

Tel: +48 728 891 442 

Fax: +48 56 645 3634 

info@baus-at.com 

www.baus-at.com

The Power 

from Stryker 

For more information contact us at 

ems.info@stryker.com 

www.strykerems.com 

A surgeon must always rely on his or her own clinical judgement when 

deciding which treatments and procedures to use with patients. For 

verifying availability of Stryker products in your area please contact your 

Stryker representative. Copyright © 2016 Stryker. The product shown 

above is CE marked. Stryker Corporation or its divisions or other corporate 

affiliated entities own, use or have applied for the following trademarks or 

Service marks: Stryker, Power-PRO XT, XPS, Power-LOAD.

Ambulance

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