Ambulance UK December 2019

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Volume 34 No. 6

December 2019

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In this issue

Derivation and internal validation of the screening to enhance

prehospital identification of sepsis (SEPSIS) score in adults on

arrival at the emergency department



CONTENTS

CONTENTS

Ambulance UK

204 EDITOR’S COMMENT

206 FEATURES

206 Derivation and internal validation of the screening

to enhance prehospital identification of sepsis

(SEPSIS) score in adults on arrival at the

emergency department

220 NEWSLINE

236 IN PERSON

238 COMPANY NEWS

This issue edited by:

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CQC inspections have become much simpler thanks to Apex Networks

Patient Transport Management Software.

During their last inspection, North West Private Ambulance Liaison Services (NWPALS)

discovered they were streets ahead having subscribed to it.

The CQC were impressed with how the software offers high levels of operational control

and keeps audited records of the entire fleet and its vehicle maintenance. Required

vehicle checks are highlighted, including MOT testing, and it records daily cleaning,

which can be difficult to find a reliable audit trail for.

Jamie Smith of NWPALS reported that it was one of the best inspections that the

CQC had seen in the private sector.

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The inspection showed that staff were using the software for job sheets and reporting

incidents on their tablets before uploading to the reporting system. They were

impressed by safeguarding prompts on drop-down menus which indicate additional

needs such as dementia conditions, reduced mobility, mental health concerns, infections

or if a ‘do not attempt cardio-pulmonary resuscitation’ is in place.

Electronic reports show details of when a job is received, pick up through to drop off,

including timings and any incidents recorded. Satellite navigation systems on tablets,

help drivers to plan journeys efficiently.

“Safeguarding and a good referral system is imperative,” says Jamie Smith. “Apex PTS

allows a crew to report any issues online instantly using their PDA app, which will be

delivered into the right persons inbox to be actioned accordingly to triage, leaving a clear

audit trail. The CQC was really impressed that it could be reported and in my inbox within

minutes. Apex has only made our CQC review stronger. It’s amazing – what else can I say?”

For more information please contact Suzanne Winham on 0203 195 6772

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Subscription Information – December 2019

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203


EDITOR’S COMMENT

EDITOR’S COMMENT

I am writing this editorial in November. For me, November has been very much

a month of remembrance. As usual we had Remembrance Weekend, and I was

hosting a large meeting on 11 November, where we all stood in silence for two

minutes at eleven o’clock to consider those who gave the ultimate sacrifice during

the world’s conflicts. As we did, I remembered some of my friends who didn’t

come back from recent deployments around the world.

AMBULANCE UK - DECEMBER

“...take a few

minutes to

think about

the jobs

you have

attended;

the impact

you have

on people;

and the very

special work

you do. It is

something

to be very

proud of.”

Today was a multi-faith service hosted by Road Peace, this time remembering those who have died as a

result of road traffic accidents. I had been invited by one of our paramedics, Nadia, who attends this event,

and speaks on the Trust’s behalf every year. Nadia read some of her own words that shared her thoughts

and feelings as a responder to such incidents. A mother spoke about her thoughts of her son, who was

killed in a car accident. Both were very moving.

Again we had a two minute silence to remember those no longer with us. As we did, I reflected on the

unusual position we, as ambulance people find ourselves in. Whilst my military colleagues may encounter

death as part of their duties, for those of us in the ambulance service, we do encounter death; it is a

common part of our daily work. For all sorts of reasons, and in a range of circumstances, we see people

who have died, or who die in front of us. We also see the intense emotion that this creates in the families,

friends, and others on scene.

Although this becomes almost normal for us, it is not a normal thing for the vast majority of people. I wonder

if we recognise just how different that makes our work, when compared to others. It puts us in a strangely

unique position. It can be stressful, and it can be emotional, but it is definitely privileged. Another colleague,

Dave, who was also at the service, highlighted how easy it is not to take time to reflect on these incidents.

Yet it is probably very important that we take a few minutes now and again to think about the importance of

these moments in our lives.

So as we head towards Christmas and the New Year, take a few minutes to think about the jobs you have

attended; the impact you have on people; and the very special work you do. It is something to be very

proud of.

But also, just as importantly, take some time out to be with your family and friends. If November has taught

me anything, it is that any of our lives can change in an instant. It’s not something to dwell on, but it’s

something to remember.

Dr Matt House, Co-Editor Ambulance UK

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FEATURE

DERIVATION AND INTERNAL VALIDATION OF THE

SCREENING TO ENHANCE PREHOSPITAL IDENTIFICATION

OF SEPSIS (SEPSIS) SCORE IN ADULTS ON ARRIVAL AT

THE EMERGENCY DEPARTMENT

Michael A. Smyth 1,2,3* , Daniel Gallacher 1 , Peter K. Kimani 1 , Mark Ragoo 4 , Matthew Ward 2 and Gavin D. Perkins 1,5

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2019 27:67 https://doi.org/10.1186/s13049-019-0642-2

© The Author(s). 2019, Published online 16 July 2019

Reproduced with permission from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Abstract

Background

Prehospital recognition of sepsis may inform case management

by ambulance clinicians, as well as inform transport decisions. The

objective of this study was to develop a prehospital sepsis screening

tool for use by ambulance clinicians.

Methods

We derived and validated a sepsis screening tool, utilising

univariable logistic regression models to identify predictors for

inclusion, and multivariable logistic regression to generate the

SEPSIS score. We utilised a retrospective cohort of adult patients

transported by ambulance (n = 38483) to hospital between 01

July 2013 and 30 June 2014. Records were linked using LinkPlus ®

software. Successful linkage was achieved in 33289 cases (86%).

Eligible patients included adult, non-trauma, non-mental health,

non-cardiac arrest cases. Of 33289 linked cases, 22945 cases

were eligible. Eligible cases were divided into derivation (n = 16063,

70%) and validation (n = 6882, 30%) cohorts. The primary outcome

measure was high risk of severe illness or death from sepsis, as

defined by the National Institute for Health and Care Excellence

Sepsis guideline.

Results

‘High risk of severe illness or death from sepsis’ was present in 3.7% of

derivation (n = 593) and validation (n = 254) cohorts. The SEPSIS score

comprises the following variables: age, respiratory rate, peripheral oxygen

saturations, heart rate, systolic blood pressure, temperature and level of

consciousness (p < 0.001 for all variables). Area under the curve was 0.87

(95%CI 0.85–0.88) for the derivation cohort, and 0.86 (95%CI 0.84–0.88)

for the validation cohort. In an undifferentiated adult medical population,

for a SEPSIS score ≥ 5, sensitivity was 0.37 (0.31–0.44), specificity was

0.96 (0.96–0.97), positive predictive value was 0.27 (0.23–0.32), negative

predictive value was 0.97 (0.96–0.97), positive likelihood value was 13.5

(9.7–18.73) and the negative likelihood value was 0.83 (0.78–0.88).

Conclusion

This is the first screening tool developed to identify NICE high risk of

severe illness or death from sepsis. The SEPSIS score is significantly

associated with high risk of severe illness or death from sepsis on

arrival at the Emergency Department. It may assist ambulance clinicians

to identify those patients with sepsis in need of antibiotic therapy.

However, it requires external validation, in clinical practice by ambulance

clinicians, in an independent population.

Keywords

Sepsis, Prehospital, Ambulance, Screening tool, Prediction model

Introduction

AMBULANCE UK - DECEMBER

Sepsis is a common and potentially life threatening response to an

infection [1]. Worldwide there are an estimated 31.5 million cases

of uncomplicated sepsis and 19.4 million cases of severe sepsis or

septic shock resulting in 5.3 million deaths each year [2]. The majority

of these cases originate in the community and will present to hospital

via the Emergency Department (ED) [3, 4]. More than half of ED

sepsis cases will arrive via Emergency Medical Services (EMS) [5-

10]. These patients are likely to be sicker than those arriving by other

means [6, 8-11].

International guidelines for sepsis advocate that treatment be initiated

at the earliest possible opportunity [1, 12]. Recent data suggest each

hour delay to antibiotic therapy results in an increase in mortality

among patients with septic shock of 2.8% [13] whereas for each hour

delay in delivering a 3 h resuscitation bundle (intravenous antibiotics,

vascular therapy and obtaining blood cultures) sees a 4% increase

in mortality [14]. Early EMS intervention has helped to improve

outcomes for other time critical, life-threatening conditions such as

acute myocardial infarction [15], stroke [16] and major trauma [17].

It remains to be seen if early EMS intervention in sepsis improves

outcomes.

Small observational studies indicate prehospital care reduces time

to antibiotics for patients with sepsis, without improving clinical

outcomes [5, 18, 19]. Thus far, trials of prehospital antibiotics have

failed to demonstrate improved clinical outcomes [20, 21]. One

potential reason for this is inclusion of low acuity sepsis patients within

prehospital studies [21].

Despite frequent exposure to patients with potentially life-threatening

206

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FEATURE

sepsis [22], prehospital recognition of sepsis is challenging [18,

23-27]. Indeed, a recent analysis of 240 patients transported by

Ambulance Victoria, who were subsequently enrolled in the ARISE

study, showed that despite the presence of demonstrable physiologic

abnormalities, only 165 patients had documentation of infection in their

prehospital record [28]. There are several reasons why this may be

so, including, suboptimal teaching and understanding of the condition

[6, 29-31], encountering sepsis cases earlier in the disease process

when the clinical presentation is less obvious [32], lack of in-hospital

diagnostic capability [18] and dependence upon SIRS criteria to

formulate a diagnosis [33, 34]. Reliance upon paramedic gestalt may

therefore mean patients with significant pathology are not identified

until after arrival at hospital. It has been argued that a prehospital

sepsis screening tool to assist prehospital clinicians identify ‘sick’

sepsis patients would be helpful [6, 35].

The NICE guideline “Recognition and management of sepsis (NG51)”,

stratifies the risk of “severe illness or death from sepsis” (see Table 1)

[12]. It recommends that patients categorised as “high risk of severe

illness or death from sepsis” should receive antibiotics within 1 h [12].

The aim of this study was to develop a simple scoring system that

would help identify those adult patients who might benefit most from

early intervention. For brevity we refer to the NICE categorisation of

“high risk of severe illness or death from sepsis” as ‘high risk’.

Methods

Study design and population

This study was conducted and reported consistent with TRIPOD

reporting guidelines [36]. We utilised a retrospective sample of

consecutive adult patients (age ≥ 18 years) transported by West

Midlands Ambulance Service NHS Foundation Trust (WMAS) to Royal

Stoke University Hospital NHS Trust (previously University Hospital

North Staffordshire NHS Foundation Trust) between 01 July 2013 and 30

June 2014. Exclusion criteria were age under 18 years, cardiac arrest,

trauma or mental health aetiology (determined from hospital discharge

diagnosis). No interventions were undertaken as part of this study.

Patient involvement

A study committee was convened to oversee the Clinical Doctoral

Research Fellowship awarded to MAS. This committee included a

patient representative who contributed to the initial research plan,

and commented on chapters of the doctoral thesis. The patient

representative did not contribute to writing or reviewing this manuscript.

Primary outcome measure

The primary outcome measure was categorisation as ‘high risk of

severe illness or death from sepsis’, as per the National Institute

for Health and Care Excellence (NICE) Guideline “Recognition and

management of sepsis (NG51)” [12], on arrival at the ED. For each

included patient, category of ‘risk of severe illness or death from sepsis’

was assigned as ‘no risk’ i.e. no infection present, ‘low risk’, ‘moderate

risk’ or ‘high risk’, dependent upon presence of infection and presenting

vital signs. Presence of infection was determined using the ED

discharge diagnosis. Classification of the risk of severe illness or death

from sepsis was determined utilising clinical data recorded in the ED in

accordance with Table 1.

Record linkage

LinkPlus ® software (version 3.0 beta, Centres for Disease Control and

Prevention Cancer Division, Atlanta, Georgia), a probabilistic linkage

program was used to link ambulance and ED records. First name,

surname, gender, date of birth, home address post code and incident

date were used to link records. All candidate record pairs were manually

reviewed. Following linkage patient identifiable data were deleted.

Missing data

Statistical analyses were performed using R (version 3.3.1) in R Studio

(version 0.99.903). Missing data were processed by multiple imputation

using the R package Multiple Imputation by Chained Equations

(MICE) (version 2.25) [37] with a Fully Conditional Specification. To

ensure robust imputation of missing values, the number of imputed

datasets required was slightly higher than the percentage of cases with

incomplete data. For example if 18% of cases had incomplete data 20

imputations would be required. Variables that were functions of another

variable were not imputed, rather their component variables were

imputed and the function determined after imputation. For example,

Glasgow Coma Score (GCS) sum is a function of three variables GCS

eye, GCS verbal and GCS motor. GCS sum was not imputed, rather

GCS eye, GCS verbal and GCS motor were imputed and GCS sum was

calculated from the component values.

Satisfactory imputation of missing data was confirmed by inspection

of both convergence plots and density plots of imputed values

and observed data (R package MICE (version 2.25) [37] as well as

calculation of R-hat convergence statistics using the R package

MICEadds (version 1.9–0) [38].

Model development

Following the imputation of missing data we developed a multivariable

logistic model for high risk of severe illness or death from sepsis (‘high

risk’) on arrival at the ED using several steps. First, the data were

divided into derivation and validation cohorts using the R package Caret

(version 6.0–71) [39]. The number of cases assigned to the derivation

and validation cohorts were based upon recommendations by Harrell,

Royston, Steyerberg and Vergouwe [40-47]. It has been argued that,

when developing a predictive model, at least ten instances of the

outcome of interest are required, per candidate predictor included in the

model, to ensure statistically valid results [40-46]. Similarly, Vergouwe et

al [47] argue that at least 100 events and 100 non-events are required

to assess model performance in the validation dataset. However,

Steyerberg [45] suggests that, to detect small differences in model

performance, the validation dataset should contain at least 250 cases of

the outcome of interest.

Derivation of the SEPSIS score was undertaken using the derivation

dataset. We assessed the quality of candidate predictor variables

using univariable logistic regression. Then, we constructed candidate

parsimonious multivariable logistic models. Next, we assigned weighted

point scores to included predictor variables. Thereafter we compared

the performance of candidate models. Finally, we undertook internal

validation of the SEPSIS score using the validation dataset.

Simple logistic regression was undertaken in an attempt to quantify the

relationship between individual candidate predictor variables and the

primary outcome measure (‘high risk’). It is common at this stage to

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207


FEATURE

Table 1 NICE Risk of severe illness or death from sepsis

Category High risk criteria Moderate to high risk criteria Low risk criteria

History Objective evidence of new altered mental state History from patient, friend or relative of new

onset of altered behaviour or mental state

History of acute deterioration of functional ability

Impaired immune system (illness or drugs

including oral steroids)

Trauma, surgery or invasive procedures in the last

6 weeks

Respiratory

Blood

pressure

Circulation

and

hydration

Raised respiratory rate: 25 breaths per minute or more

New need for oxygen (more than 40% FiO2) to maintain

saturation more than 92% (or more than 88% in known

chronic obstructive pulmonary disease)

Systolic blood pressure 90 mmHg or less or systolic blood

pressure more than 40 mmHg below normal

Raised heart rate: more than 130 beats per minute Not

passed urine in previous 18 h.

For catheterised patients, passed less than 0.5 ml/kg of urine

per hour

Raised respiratory rate: 21–24 breaths per minute

Systolic blood pressure 91–100 mmHg

Raised heart rate: 91–130 beats per minute (for

pregnant women 100–130 beats per minute) or

new onset arrhythmia

Not passed urine in the past 12–18 h

For catheterised patients, passed 0.5–1 ml/kg of

urine per hour

Temperature Tympanic temperature less than 36 °C

Skin

Mottled or ashen appearance Cyanosis of skin, lips or

tongue Non-blanching rash of skin

Signs of potential infection, including redness,

swelling or discharge at surgical site or

breakdown of wound

Normal behaviour

No high risk or

moderate to high

risk criteria met

No high risk or

moderate to high

risk criteria met

No high risk or

moderate to high

risk criteria met

No non-blanching

rash

AMBULANCE UK - DECEMBER

exclude variables that are not statistically associated with the outcome

of interest however we did not, as to do so may exclude clinically

important variables [45]. Candidate predictor variables were assessed

for multicollinearity using the R package Caret (version 6.0–71) [39], any

variables with a correlation coefficient above 0.9 (positive or negative)

were considered to be highly collinear. Inclusion of multiple variables

with high collinearity was avoided, either by exclusion of redundant

variables, or by generation of parallel candidate models that did not

contain multiple highly collinear variables.

Selection of independent predictor variables was informed by

previously demonstrated clinical usefulness and by backward stepwise

selection using the Akaike Information Criterion (AIC) and the Wald test

p-value. Relative performance of candidate models was assessed by

determining the AIC and Brier Score for each model.

Many paramedics will not have access to resources to calculate a

complex model in clinical practice. Therefore, to simplify the models

for use at the roadside, continuous variables were transformed into

categorical variables by subdividing the variable range into intervals.

Variable intervals were determined by visual inspection of Loess curves

and cut points were calculated using R the package OptimalCutPoints

(version 1.1–3) [48]. We also considered normal physiologic ranges

and intervals utilised in alternate sepsis screening tools. We recognise

that conversion of continuous variables to categorical variables results

in loss of precision. To guard against the loss of precision, continuous

predictor variables were initially subdivided into multiple small intervals.

Weighted scores were assigned to each interval by rounding the

regression coefficient for each interval to the nearest integer. Intervals

with equally weighted scores were subsequently merged to generate

fewer, wider intervals, to simplify use by bed-side clinicians.

Model performance

Model performance was assessed using the validation dataset.

Model calibration (goodness of fit) was assessed by calculation of the

calibration slope (R package ResourceSelection (version 0.3–1)) [49].

The calibration slope is a graphical assessment of the relationship

between predicted and observed outcomes [50], with predictions

represented on the x-axis, and outcomes represented on the y-axis.

Perfect predictions fall on the 45° line (calibration slope = 1) [51].

The Hosmer-Lemeshow goodness of fit test was not used to assess

goodness of fit as a significant result, suggesting inadequate fit,

is common when using large datasets [52]. Model discrimination

was assessed by calculating the area under the receiver operating

characteristic curve (AUROC) (R package ROCR (version 1.0–5) [53].

Model performance was assessed by calculating sensitivity, specificity,

positive predictive value, negative predictive value, positive likelihood

ratio and negative likelihood ratio (R package epiR (version 0.9–77)

[54]).

Ethical approval

Permission to access patient identifiable data without consent was

granted by the Health Research Authority (HRA) Confidentiality Advisory

Committee (CAG) (CAG 4–03(PR2)2014). A favourable ethical opinion

was obtained from the National Research Ethics Service (NRES)

Committee South Central - Oxford C (14/SC/0163). Data storage and

handling were conducted in accordance with WMAS standard operating

procedures.

Results

From 38,483 unique ambulance records, LinkPlus ® generated 35,382

candidate record pairs. Manual review of all candidate pairs confirmed

208

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FEATURE

Fig. 1 Included cases

33,289 (86.5%) were correctly linked with their corresponding ED

record. Following removal of excluded case aetiologies, 22,945 cases

remained (see Fig. 1). Of the 5,194 (13.5%) unlinked ambulance cases,

a significant proportion were transported to hospital destinations

other than the ED, for example the Medical Admission Unit (MAU).

An initial review of 120 unlinked cases confirmed that 97 (80.8%)

were transported to hospital destinations other than the ED. A small

proportion of unlinked cases result from an ambulance crew being

unable to identify a patient in the early stages of their health care

episode, for example when a patient is unconscious and their name

cannot be determined. There were 58 instances (1.1% of unlinked

cases) where the name or surname fields of the ambulance record were

“missing” or “unknown”.

Of 54 potential variables, 30 were deemed inappropriate for inclusion

in the model (Additional file 1: Table S1). Of 24 included variables, four

(blood sugar, temperature, capillary bed refill time (CBRT) and skin) had

greater than 10% missing values; and four (left pupil reaction, left pupil

size, right pupil reaction and right pupil size) had between 5 and 10%

missing values. The remaining 16 variables had fewer than 2% missing

values. There were no cases where the ED discharge diagnosis field

was empty.

Of the 22,945 included cases, only 12,517 (54.6%) had complete data,

all other cases had at least one missing data point. To ensure robust

imputation 50 imputed datasets were generated. Convergence plots

(Additional file 1: Figure S1), density plots (Additional file 1: Figure S2),

Box and whisker plots (Additional file 1: Figure S3) and R-hat statistics

(Additional file 1: Table S2) indicate that healthy convergence was

achieved for all imputed variables except Left Pupil Size and Right Pupil

size.

The dataset used comprised 24 variables, therefore to calculate reliable

estimates, the derivation dataset must include at least 240 instances

of ‘high risk’. The imputed dataset was divided into a derivation

dataset of 16063 cases (70%) and a validation dataset of 6882 cases

(30%). The derivation dataset contained 593 instances of ‘high risk’

(3.7%), sufficient cases to accommodate a model with 59 variables.

The validation dataset contained 254 instances of ‘high risk’ (3.7%),

sufficient cases to accommodate 25 variables and to detect small

differences in model performance [45]. Patient characteristics were

consistent across derivation and validation cohorts (Table 2).

Univariable logistic regression analysis identified the following variables

to be statistically significant predictors of ‘high risk’ in the derivation

dataset: EMS impression, location, age, respirations, oxygen saturations

(SpO2), pulse, systolic blood pressure (SBP), diastolic blood pressure

(DBP), temperature, blood sugar (BM), Skin, CBRT, left pupil reaction,

right pupil reaction, left pupils size, right pupil size, GCS sum, GCS eye,

GCS verbal, GCS motor, AVPU score (Additional file 1: Tables S3 & S4).

A perfect correlation was identified between left and right pupil

reactions, and a near perfect correlation was noted between left and

right pupil size (Additional file 1: Figure S4). Differences in pupil size or

pupil reactions are not known to be associated with sepsis. To avoid

issues arising from inclusion of highly correlated variables,

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FEATURE

Table 2 Patient characteristics

Variable

Location

Derivation

n = 16,063 (70%)

Validation

n = 6,882 (30%)

Home, n (%) 11,408 (71) 4,964 (72)

Nursing home, n (%) 1,028 (6) 414 (6)

Other, n (%) 3,627 (23) 1,504 (22)

Age (years), mean (SD) 63 (21) 62 (21)

Gender

Male, n (%) 7,884 (49) 3,346 (49)

Respirations (breaths/min), mean (SD) 20 (6) 20 (6)

Oxygen saturation (%), mean (SD) 96 (5) 96 (5)

Heart rate (beats/min), mean (SD) 92 (24) 92 (24)

Systolic blood pressure (mmHg), mean (SD) 133 (27) 133 (27)

Diastolic blood pressure (mmHg), mean (SD) 78 (17) 78 (17)

Temperature (°C), mean (SD) 36.8 (0.9) 36.8 (0.9)

Blood sugar (mmol/L), mean (SD) 7.0 (3.4) 7.0 (3.3)

Glasgow Coma Score, median (IQR) 15 (15–15) 15 (15–15)

Capillary bed refill time

Skin

Normal (< 2 s), n (%) 15,319 (95) 6,567 (95)

Delayed (> 2 s), n (%) 744 (5) 315 (5)

Normal, n (%) 10,366 (73) 5,320 (77)

Pallor, n (%) 2,669 (19) 1,037 (15)

Flushed, n (%) 856 (6) 359 (5)

Cyanosed, n (%) 181 (1) 83 (1)

Jaundice, n (%) 92 (0.6) 51 (0.7)

Mottled, n (%) 53 (0.4) 20 (0.2)

Rash, n (%) 21 (0.1) 12 (0.1)

Pupil size (mm), median (IQR) 3 (3–4) 3 (3–4)

Pupil reaction

Brisk, n (%) 13,447 (93) 6,462 (94)

Sluggish, n (%) 923 (6) 381 (6)

Fixed, n (%) 128 (0.8) 39 (0.5)

NICE risk

No risk (no infection), n (%) 13,083 (81.4) 5,607 (81.5)

Infection, n(%) 2980 (18.6) 1275 (18.5)

Low risk, n (%) 1,048 (6.5) 448 (6.5)

Moderate risk, n (%) 1,339 (8.3) 573 (8.3)

High risk, n (%) 593 (3.7) 254 (3.7)

AMBULANCE UK - DECEMBER

data concerning the left pupil were excluded from further analysis.

Strong correlations between GCS sum, GCS components (GCS eye,

GCS verbal and GCS motor) and AVPU score (used to document level

of consciousness) were identified. It is unclear which measure of level

of consciousness would generate the most effective predictive model

of sepsis. Three candidate models, using GCS sum, GCS components

and AVPU score as their respective measure of consciousness, were

generated.

Multivariable logistic regression analysis identified the following variables

to be significant: location, age, respirations, oxygen saturations, pulse

rate, systolic blood pressure, temperature, skin colour and level of

consciousness. The number of instances each variable was selected, and

the related Wald test statistic, for each model is reported in Table 3.

Categorisation of continuous variables is summarised in Table 4.

Simple weighted scores to enable calculation of the SEPSIS score were

obtained by rounding regression coefficients to the nearest integer

(Additional file 1: Tables S5, S6 & S7). Intervals for continuous variables

with the same weighted score were merged to simplify calculation of

the SEPSIS score (Additional file 1: Tables S8, S9 & S10). The SEPSIS

score is defined as the sum of the simplified weighted scores for each

variable.

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FEATURE

Table 3 Selection of variables for inclusion in multivariable models

Predictor

variable

Incidence of variable selection

Wald test p-value

GCS (sum) model GCS (components) model AVPU model GCS (sum) model GCS (components) model AVPU model

Location 50 50 50 0.002 0.004 0.003

Age 50 50 50 < 0.001 < 0.001 < 0.001

Gender 0 0 0 – – –

Resps 50 50 50 < 0.001 < 0.001 < 0.001

SpO2 50 50 50 < 0.001 < 0.001 < 0.001

Pulse 50 50 50 < 0.001 < 0.001 < 0.001

SBP 50 50 50 < 0.001 < 0.001 < 0.001

DBP 0 0 0 – – –

Temp 50 50 50 < 0.001 < 0.001 < 0.01

BM 1 1 0 0.86 * 0.85 * 0.87 *

Skin 50 50 50 0.007 0.007 0.014

CBRT 0 0 0 – – –

RPupilReact 11 12 8 0.42 * 0.41 * 0.46 *

RPupilSize 0 0 0 – – –

GCS_sum 50 NA NA < 0.001 NA NA

GCS_eye NA 0 NA NA – NA

GCS_verbal NA 50 NA NA < 0.001 NA

GCS_motor NA 0 NA NA – NA

AVPU NA NA 50 NA NA < 0.001

SpO2 peripheral oxygen saturation, SBP systolic blood pressure, DBP diastolic blood pressure, Temp temperature (C), BM blood sugar mmol/L, CBRT capillary bed

refill time, GCS Glasgow coma score, AVPU alert, verbal, pain or unresponsive

* Did not reach statistical significance

Relative performance of the three parallel models is reported in Table

5. The model utilising GCS sum as the measure of consciousness

was calculated to have the best performance statistically. The final

parsimonious model, with merged intervals and weighted scores, is

reported in Table 6.

patients identified as not septic, 6528 (95.6%) did not have sepsis (true

negative), while 159 (62.6%) did have ‘high risk’ on arrival at the ED but

were incorrectly classified by the SEPSIS score as not having sepsis

(false negatives).

The calibration slope for the derivation and validation datasets was 1.0

and 0.97 respectively, suggesting the SEPSIS score has adequate fit.

The AUROC was 0.87 (95% CI 0.85–0.88) for the derivation dataset

and 0.86 (95% CI 0.84–0.88) for the validation dataset. We report

performance measures for each point score of the SEPSIS score in

Additional file 1: Table S11, and categorise patients as low likelihood

(< 10%), moderate likelihood (10–20%) or high likelihood (> 20%) by

applying different thresholds for the SEPSIS score (see Fig. 2).

Where the SEPSIS score indicates greater than 20% likelihood of ‘high

risk’ at ED (SEPSIS score ≥ 5), we observed satisfactory performance

characteristics as reported in Table 7. If, as per the NICE sepsis

guideline [NG51], the presence of infection is required before a

diagnosis of sepsis can be made [12], then in the validation cohort of

6882 adult patients, 195 (2.8%) patients were classified as being having

‘high risk’, and 6687 (97.2%) were classified as not having ‘high risk’.

Among those patients classified as ‘high risk’, 95 (48.7%) did have ‘high

risk’ (true positive), while 100 (51.3%) patients had their risk of sepsis

overestimated i.e. were incorrectly identified as having ‘high risk’ (false

positive). Within the 100 false positive cases, 79 (40.5%) patients had

‘moderate risk’ and 21 (10.8%) had ‘low risk’ on arrival at the ED. Among

Discussion

Screening tool performance is commonly described in terms of

sensitivity, specificity, positive predictive value (PPV) and positive

likelihood ratio (PLR). Sensitivity describes the ability of a test to

correctly identify those with the disease (true positive rate), whereas

specificity describes the ability of a test to correctly identify those

without the disease (true negative rate). PPV represents the proportion

of patients with positive test who actually have the disease, while the

PLR shows how much more likely someone is to get a positive test if he/

she has the disease, compared with a person without disease [55].

The performance characteristics of several existing screening tools used

to support paramedic recognition of sepsis are reported in Table 8.

Existing data may suggest the PreSep score is the best performing

sepsis screening tool. However, when applied to the same validation

dataset used to test the SEPSIS score, the PreSep score remains more

sensitive (0.61 (95%CI 0.55–0.67)), but has poorer specificity 0.95

(95%CI 0.95–0.96), PPV 0.33 (95%CI 0.29–0.37) and PLR 12.76 (95%CI

11.03–14.76). These data suggest the PreSep score may not in fact be

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FEATURE

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Table Table 4 4 Continuous variable variable intervals intervals

Variable Variable

Interval Interval

Age Age

below below 40 40 (reference)

Table 4 Continuous variable intervals 40 to 4049

to 49

Variable

50 to 50 Interval 59 to 59

Age

60 to 60

below

69 to 69

40 (reference)

70 to 70

40

79 to

to

79

49

80 to 80

50

89 to

to

89

59

90 to 90

60

99 to

to

99

69

100 100

70

plus

to

plus

79

Respirations below

80

below

to

10

89

10

10 to

90

1020 to

to 99

20 (reference)

21 to

100

2125

to

plus

25

Respirations

26 to 26

below

30 to 30

10

31 to 31

10

35 to

to

35

20 (reference)

36 to 36

21

40 to

to

40

25

41 to 41

26

45 to

to

45

30

46 to 46

31

50 to

to

50

35

51 to 51

36

55 to

to

55

40

56 to 56

41

60 to

to

60

45

60 plus 60

46

plus

to 50

Pulse Pulse below

51

below

to

60

55

60

60 to

56

60100 to

to

60

100 (reference)

101

60

101 to

plus

110 to 110

Pulse

111 111

below

to 120 to

60

120

21 to 21

60

130 to

to

130

100 (reference)

131 131

101

to 140 to

to

140

110

141 141

111

to 150 to

to

150

120

151 151

21

to

to

160 to

130

160

161 161

131

to 170 to

to

170

140

171 171

141

to 180 to

to

180

150

180 180

151

plus plus

to 160

SBP SBP below below

161

60

to

60

170

60 to 60

171

69 to

to

69

180

70 to 70

180

79 to

plus

79

SBP

80 to 80

below

89 to 89

60

90 to 90

60

99 to

to

99

69

100 100

70

to

to

120 to

79

120 (reference)

121 121

80

to

to

129 to

89

129

130 130

90

to

to

139 to

99

139

140 140

100

to 149 to

to

149

120 (reference)

150 150

121

to 159 to

to

159

129

160 160

130

plus plus

to 139

SpO2 SpO2

above

140

above 93

to 93

149

(reference)

89 to

150

8993

to

to

93

159

85 to

160

8588

to

plus

88

SpO2

above 93 (reference)

89 to 93

85 to 88

Table Table 4 4 Continuous variable variable intervals intervals (Continued)

Variable Variable

Interval Interval

below below 85 85

Temperature Table 4 Continuous variable intervals (Continued) below below 35 35

Variable

35.0 35.0 Interval to 35.5 to 35.5

35.6 35.6

below

to 36.0 to

85

36.0

Temperature

36.1 36.1

below

to 36.5 to

35

36.5

36.6 36.6

35.0

to 37.4 to

to

37.4

35.5

(reference)

37.5 37.5

35.6

to 38.0 to

to

38.0

36.0

38.1 38.1

36.1

to 38.5 to

to

38.5

36.5

38.6 38.6

36.6

to 39.0 to

to

39.0

37.4 (reference)

39.1 39.1

37.5

to 39.5 to

to

39.5

38.0

39.6 39.6

38.1

to 40.0 to

to

40.0

38.5

above above

38.6

40

to

40

39.0

GCS GCS 3–9 3–9

39.1 to 39.5

10–12 10–12

39.6 to 40.0

13–14 13–14

above 40

GCS

15 15

3–9

(reference)

SBP SBP systolic systolic blood blood pressure, pressure, SpO2 SpO2 peripheral peripheral oxygen oxygen saturations, 10–12GCSGCS Glasgow Glasgow

coma coma score score

13–14

15 (reference)

the

SBP

most

systolic

useful

blood

for

pressure,

identifying

SpO2

those

peripheral

patients

oxygen

at risk

saturations,

of severe

GCS

illness

Glasgow

or

coma score

death from sepsis by the bedside paramedic.

In this work, a threshold of SEPSIS score ≥ 3 has a sensitivity of 0.80

(95CI 0.74–0.84) specificity of 0.93 (95%CI 0.93–0.94), PPV of 0.32

(95%CI 0.28–0.36) and PLR of 12.17 (95%CI 10.90–13.59). Adopting a

threshold of SEPSIS score ≥ 5 has a sensitivity of 0.37 (95%CI 0.31–0.44)

specificity of 0.98 (95%CI 0.98–0.99), PPV of 0.49 (95%CI 0.42–0.56)

and PLR of 24.8 (95%CI 19.3–31.9). In terms of patients, a SEPSIS

score ≥ 3 correctly identified 202 patients with ‘high risk’, missed 52

patients and incorrectly identified that 433 had sepsis when in fact they

did not. When adopting a threshold of SEPSIS score ≥ 5 95 patients with

‘high risk’ were correctly identified and 159 patients missed and the

number of patients incorrectly classified as ‘high risk’ was lower at 100.

Deciding what threshold to adopt for a ‘positive’ identification is a

system level decision. Many systems will favour sensitivity to ensure

cases are not missed but this needs to be balanced against significant

over triage and the impact on resources this may have. Indeed, previous

definitions for sepsis have been criticised for being overly sensitive with

inadequate specificity [33, 34]. On this basis we suggest adopting a

cut-off SEPSIS≥5 to favour specificity and reduce false positive cases

Table as Table reflected 5 5 Comparison in the increased of models of models PLR. However, we recognise that many

Model Model AIC AIC statistic statistic Brier Brier score score

Model Model using using GCS GCS sum sum 2,854.1 2,854.1 0.0321 0.0321

Model Model Table using using 5GCS Comparison GCS components of models 2,864.4 2,864.4 0.0321 0.0321

Model Model using using AVPU AVPU 3,315.0 3,315.0 AIC statistic 0.0325 0.0325 Brier score

GCS GCS Model Glasgow Glasgow using coma coma GCS score, sum score, AVPU AVPU alert, alert, verbal, verbal, pain2,854.1 or or unresponsive 0.0321

Model using GCS components 2,864.4 0.0321

Model using AVPU 3,315.0 0.0325

GCS Glasgow coma score, AVPU alert, verbal, pain or unresponsive

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Table 6 SEPSIS score

95% CI Score

Variable ß i lower upper p value

assigned

Age

systems/clinicians may prefer to adopt a lower cut-off to increase

sensitivity.

Below 40 reference 0

40 to 60 0.35 −0.15 0.86 0.17 0

Over 60 0.94 0.51 1.36 < 0.001 1

Respirations

Below 10 −12.44 − 559.61 534.73 0.96 0

10 to 20 reference 0

21 to 40 0.90 0.66 1.14 < 0.001 1

40 to 60 1.72 1.26 2.18 < 0.001 2

60 plus −11.77 − 1970.04 1946.51 0.99 0

SpO2

Above 93 reference 0

Below 94 1.03 0.80 1.26 < 0.001 1

Pulse

SBP

Below 60 −0.56 −1.40 0.28 0.19 0

60 to 100 reference 0

101 to 140 0.75 0.51 0.99 < 0.001 1

141 to 160 1.67 1.27 2.08 < 0.001 2

Over 160 0.60 −0.16 1.35 0.12 0

Below 60 0.50 −1.53 2.52 0.63 0

60 to 99 0.65 0.33 0.97 < 0.001 1

100 to 120 reference 0

121 to 160 −0.21 −0.47 0.05 0.11 0

Over 160 −0.72 −1.10 −0.34 < 0.001 −1

GCS (sum)

15 reference 0

13 to 15 −0.13 −0.48 0.21 0.45 0

3 to 12 0.78 0.47 1.09 < 0.001 1

Temperature

Skin

Below 36.6 −0.20 −0.48 0.09 0.18 0

36.6 to 37.4 reference 0

37.5 to 39.5 0.97 0.71 1.23 < 0.001 1

Above 39.5 1.71 1.23 2.18 < 0.001 2

Normal reference 0

Jaundice, pallor, mottling 0.51 0.27 0.75 < 0.001 1

Any other 0.23 −0.08 0.55 0.14 0

SBP systolic blood pressure, SpO2 peripheral oxygen saturations, GCS Glasgow coma score

Potentially important variables have been omitted from the

SEPSIS score. Lactate is commonly used to help stratify severity

Maximum score 11

among patients with sepsis [12, 61]. Lactate is not measured

by ambulance crews in the participating ambulance service,

therefore it was not available for consideration during SEPSIS

score development. However, it has been reported that inclusion

of prehospital lactate does not improve prehospital identification

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Fig. 2 Observed vs expected probability of sepsis. Mod.-moderate, HRS-high risk of severe illness or death from sepsis, ED-emergency department

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of sepsis [62]. Secondly, Hunter et al. argued that end-tidal carbon Stratification of the likelihood of ‘high risk’ on arrival at the

Fig. 2 Observed vs expected probability of sepsis. Mod.-moderate, HRS-high risk of severe illness or death from sepsis, ED-emergency department

dioxide (EtCO 2

) measured by EMS was an important predictor ED, using the SEPSIS score, may help inform the provision of

of sepsis, severe sepsis and mortality, reporting an AUROC of

0.99 (95%CI 0.99–1.0), 0.80 (95%CI 0.73–0.86) and 0.70 (95%CI

0.57–0.83) respectively [63]. Although EtCO 2

can be measured by

EMS personnel in the participating ambulance service, it is currently

prehospital care, and/or the destination to which the patient is

transferred. Although a SEPSIS score ≥ 5 has high specificity,

careful consideration is warranted before utilising the SEPSIS

score to initiate treatment. Current evidence does not support

routine prehospital administration of antibiotics [21]. In addition,

only measured when undertaking advanced airway interventions. It

appropriate antibiotic stewardship, and the need to obtain

was thus seldom available for consideration in the SEPSIS score.

venous blood samples to culture pathogens prior to antibiotic

It remains Table to 7 Comparison be seen if inclusion of performance of either between of these datasets variables (SEPSIS would

administration, must be considered before implementing

improve scorethe ≥ 5) performance of the SEPSIS score.

intervention strategies.

Estimate

Derivation cohort Validation cohort

n = 16063

n = 6882

Ours is the first study to develop a prehospital sepsis screening

Table Undifferentiated 7 Comparison medical of cases performance (estimate(95% between confidence datasets interval)) (SEPSIS

tool using data from a UK ambulance service and the first to

score ≥ 5)

Sensitivity 0.39 (0.35–0.43) 0.37 (0.31–0.44)

utilise the NICE high risk of severe illness or death from sepsis

Estimate

Derivation cohort Validation cohort

Specificity

n =

0.96

16063

(0.96–0.96)

n =

0.96

6882

(0.96–0.97) classification as the primary outcome measure. Ours is also the

Undifferentiated Positive predictive medical value cases (estimate(95% 0.27 (0.24–0.30) confidence 0.27 interval)) (0.23–0.32) only such study to employ multiple imputation to manage missing

data. A strength of this study is the primary outcome measure was

Sensitivity Negative predictive value 0.39 0.98 (0.35–0.43) (0.97–0.98) 0.37 0.98 (0.31–0.44) (0.97–0.98)

determined using objective data from the ED record, rather than ED

Specificity Positive likelihood ratio 0.96 9.48 (0.96–0.96) (8.35–10.76) 0.96 9.72 (0.96–0.97) (7.96–11.87)

clinician diagnosis or International Classification of Disease (ICD)

Positive Negative predictive likelihood value ratio 0.27 0.64 (0.24–0.30) (0.60–0.68) 0.27 0.65 (0.23–0.32) (0.59–0.72)

code, maximising specificity for the outcome measure. However,

Infection Negativepresent predictive (estimate(95% value 0.98 confidence (0.97–0.98) interval)) 0.98 (0.97–0.98) the SEPSIS score has been derived and internally validated with

Positive Sensitivity likelihood ratio

Negative Specificity likelihood ratio

9.48 0.39 (8.35–10.76) (0.35–0.43)

0.64 0.99 (0.60–0.68) (0.98–0.99)

9.72 0.37 (7.96–11.87) (0.31–0.44)

0.65 0.98 (0.59–0.72) (0.98–0.99)

a retrospective data sample from a single centre which limits

generalisability of the findings. In addition, it has not yet been

Infection Positive present predictive (estimate(95% value confidence 0.50 (0.45–0.55) interval)) 0.49 (0.42–0.56) clinically demonstrated that patients with high risk of serious illness

Negative predictive value 0.98 (0.97–0.98) 0.98 (0.97–0.98)

or death from sepsis, as per the NICE guideline, benefit from early

Sensitivity 0.39 (0.35–0.43) 0.37 (0.31–0.44)

antibiotic therapy.

Specificity Positive likelihood ratio 0.99 26.1 (0.98–0.99) (22.2–30.1) 0.98 24.8 (0.98–0.99) (19.3–31.9)

Positive Negative predictive likelihood value ratio 0.50 0.62 (0.45–0.55) (0.58–0.66) 0.49 0.64 (0.42–0.56) (0.58–0.70)

Negative predictive value 0.98 (0.97–0.98) 0.98 (0.97–0.98)

Positive likelihood ratio 26.1 (22.2–30.1) 24.8 (19.3–31.9)

Negative likelihood ratio 0.62 (0.58–0.66) 0.64 (0.58–0.70)

Conclusion

We derived and internally validated a prehospital model that predicts

risk of severe illness or death from sepsis as per NICE guideline

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Table 8 Reported performance of alternate screening tools

Screening tool Sensitivity (95% CI) Specificity (95% CI) PPV (95% CI) NPV (95% CI)

PreSS

Polito [56] 0.85 (NR) 0.47 (NR) 0.19 (NR) 0.96 (NR)

PreSep

Bayer [57] 0.85 (0.77–0.92) 0.86 (0.82–0.90) 0.63 (NR) 0.95 (NR)

Jouffrey [58] 0.92 (NR) 0.29 (NR) 0.41 (NR) 0.88 (NR)

Robson tool (severe sepsis)

McClelland [24] 0.30 (0.12–0.47) 0.77 (0.60–0.95) NR NR

Wallgren [27] 0.93 (NR) NR NR NR

Robson tool (sepsis)

McClelland [24] 0.43 (0.28–0.58) 0.14 (0.0–0.40) NR NR

Bayer [57] 0.95 (NR) 0.43 (NR) 0.32 (NR) 0.97 (NR)

Wallgren [27] 0.75 (NR) NR NR NR

Dorsett [59] 0.47 (0.31–0.62) 0.80 (0.71–0.87) NR NR

qSOFA

Dorsett [59] 0.16 (0.07–0.31) 0.97 (0.92–0.99) NR NR

Jouffroy [58] 0.62 (NR) 0.16 (NR) 0.29 (NR) 0.44 (NR)

Tusgul (ICU admission) [60] 0.36 (0.27–0.47) NR NR NR

CI confidence interval, NR not reported, ICU intensive care unit

NG51 on arrival at the ED. We used routine EMS data, linked to

ED records, in a heterogeneous medical population, to develop

the SEPSIS score. The SEPSIS score could be a valuable tool for

identifying sepsis patients in need of early antibiotic therapy. It

requires external validation and assessment of performance when in

use by ambulance clinicians.

Additional file

Additional file 1 (https://doi.org/10.1186/s13049-019-0642-2):

Table S1. Excluded candidate predictor variables. Table S2. R-Hat

statistics. Table S3. Logistic Regression of continuous candidate

predictor variables. Table S4. Logistic regression of categorical

candidate predictor variables. Table S5. Multivariable logistic

regression model utilising GCS sum Table S6. Multivariable logistic

regression model utilising GCS components. Table S7. Multivariable

logistic regression model utilising AVPU. Table S8. Final weighted

scores for candidate model using GCS sum. Table S9. Final

weighted scores for candidate model using GCS components. Table

S10. Final weighted scores for candidate model using AVPU. Table

S11. Operating characteristics for the SEPSIS score. Figure S1.

Convergence plots. Figure S2. Density plots. Figure S3. Box and

whisker plots. Figure S4. Colinearity between candidate predictor

variables. (DOCX 3170 kb)

Acknowledgements

The team is indebted to Krupa Suthar and Catherine White for their

input concerning patient and public perspective while developing

the project, Jenny Lumley-Holmes and Bhupinder Patel for their

efforts in locating the relevant ambulance data fields and to Andrew

Fraser and Sevilay Nizam-Basha for their help in locating the relevant

hospital data.

Authors’ Contributions

MAS, GDP, PKK conceived the study idea. MR and MW facilitated

data extraction at UHNS and WMAS respectively. MAS cleaned the

data, performed all statistical analyses and drafted the manuscript.

PKK supervised the study, advised on statistical methods and

revised the manuscript for important intellectual content. GDP

supervised the study and revised the manuscript for important

intellectual content. DG advised on use of R packages, assisted

with statistical analysis and revised the manuscript for important

intellectual content. MR and MW revised the manuscript for important

intellectual content. All authors approved the final manuscript.

Funding

This study was supported by a National Institute for Health Research

Clinical Doctoral Research Fellowship awarded to MAS (CDRF-2012-

05-058). The funders had no role in study design, data collection and

analysis, decision to publish, or preparation of the manuscript.

Competing interests

GDP is a NIHR Senior Investigator. The remaining authors have no

competing interests.

Author details

*

Correspondence: m.a.smyth@warwick.ac.uk. 1 Clinical Trials Unit,

University of Warwick, Coventry, UK. 2 West Midlands Ambulance

Service NHS Foundation Trust, Dudley, UK. 3 Midlands Air Ambulance,

Dudley, UK. 4 Royal Stoke University Hospital, Stoke on Trent, UK.

5

Heart of England NHS Foundation Trust, Birmingham, UK.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in

published maps and institutional affiliations.

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26. Travers A, et al. Can paramedics diagnose sepsis in the prehospital

setting? A feasibility study. Can J Emerg Med. 2013;15:S55.

27. Wallgren UM, et al. Identification of adult septic patients in the

prehospital setting: a comparison of two screening tools and clinical

judgment. Eur J Emerg Med. 2014;21(4):260–5.

28. Cudini D, Smith K, Bernard S, Stephenson M, Andrew E, Cameron

P, Board J. Can pre-hospital administration reduce time to initial

antibiotic therapy in septic patients? Emerg Med Aust. 2019. https://

doi.org/10.1111/1742-6723.13282.

29. Báez AA, et al. Prehospital Sepsis project (PSP): knowledge and

attitudes of United States advanced out-of-hospital care providers.

Prehosp Disaster Med. 2013;28(02):104–6.

30. Kaukonen KM, et al. Systemic inflammatory response syndrome criteria

in defining severe sepsis. N Engl J Med. 2015;372(17):1629–38.

31. Shime N. A survey of the competency of ambulance service

personnel in the diagnosis and management of Sepsis. J Emerg

Med. 2015;49(2):147–51.

32. Smyth MA, Brace-McDonnell SJ, Perkins GD. Identification of adults

with sepsis in the prehospital environment: a systematic review.

BMJ Open. 2016;6(8):e011218.

33. Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson

DP. Incidence and prognostic value of the systemic inflammatory

response syndrome and organ dysfunctions in Ward patients. Am J

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34. Vincent JL, Beumier M. Diagnostic and prognostic markers in

sepsis. Expert Rev Antibiotics Infection Ther. 2013;11(3):265–75.

35. Robson W, Nutbeam T, Daniels R. Sepsis: a need for prehospital

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36. Collins GS, et al. Transparent reporting of a multivariable prediction

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37. van Buuren S, et al. Package ‘mice’. [Computer software]. 2015.

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Epidemiol. 1996;49(7):819.

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models, logistic and ordinal regression, and survival analysis. New

York: Springer; 2015.

42. Harrell FE, Lee KL, Mark DB. Tutorial in biostatistics multivariable

prognostic models: issues in developing models, evaluating

assumptions and adequacy, and measuring and reducing errors.

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216

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ordinal outcome: the World Health Organization multicentre study

of clinical signs and etiological agents of pneumonia, Sepsis and

meningitis in young infants. Stat Med. 1998;17(8):909–44.

44. Royston P, et al. Prognosis and prognostic research: developing a

prognostic model. Br Med J. 2009;338:b604.

45. Steyerberg E. Clinical prediction models: a practical approach to

development, validation, and updating. New York: Springer Science

& Business Media; 2008.

46. Steyerberg EW, et al. Internal validation of predictive models:

efficiency of some procedures for logistic regression analysis. J Clin

Epidemiol. 2001;54(8):774–81.

47. Vergouwe Y, et al. Substantial effective sample sizes were required

for external validation studies of predictive logistic regression

models. J Clin Epidemiol. 2005;58(5):475–83.

48. López-Ratón M, et al. OptimalCutpoints: an R package for selecting

optimal cutpoints in diagnostic tests. J Stat Softw. 2014;61(8):1–36.

49. Lele SR, et al., Package ‘ResourceSelection’. [Computer

software]. 2016. Retrieved from: http://CRAN.R-project.org/

package=ResourceSelection.

50. Hilden J, Habbema JD, Bjerregaard B. The measurement of

performance in probabilistic diagnosis. II Trustworthiness of the

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51. Steyerberg EW, et al. Assessing the performance of prediction

models: a framework for some traditional and novel measures.

Epidemiology (Cambridge, Mass). 2010;21(1):128–38.

52. Kramer AA, Zimmerman JE. Assessing the calibration of mortality

benchmarks in critical care: the Hosmer-Lemeshow test revisited.

Crit Care Med. 2007;35(9):2052–6.

53. Sing T, et al. ROCR: visualizing classifier performance in R.

Bioinformatics. 2005;21(20):3940–1.

54. Stevenson, M., M.M. Stevenson, I. BiasedUrn, Package ‘epiR’. 2018,

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55. Sedighi I. Interpretation of diagnostic tests: likelihood ratio vs.

predictive value. Iran J Pediatr. 2013;23(6):717.

56. Polito CC, et al. Prehospital recognition of severe sepsis:

development and validation of a novel EMS screening tool. Am J

Emerg Med. 2015;33(9):1119–25.

57. Bayer O, Schwarzkopf D, Stumme C, Stacke A, Hartog CS,

Hohenstein C, Winning J. An early warning scoring system to

identify septic patients in the prehospital setting: the PRESEP score.

Acad Emerg Med. 2015;22(7):868–71.

58. Jouffroy R, et al. Prehospital triage of septic patients at the SAMU

regulation: comparison of qSOFA, MRST, MEWS and PRESEP

scores. Am J Emerg Med. 2017.

59. Dorsett M, et al. qSOFA has poor sensitivity for prehospital

identification of severe sepsis and septic shock. Prehosp Emerg

Care. 2017;21(4):489–97.

60. Tusgul S, et al. Low sensitivity of qSOFA, SIRS criteria and sepsis

definition to identify infected patients at risk of complication in the

prehospital setting and at the emergency department triage. Scand

J Trauma Resusc Emerg Med. 2017;25(1):108.

61. Singer M, et al. The third international consensus definitions for sepsis

and septic shock (sepsis-3). J Am Med Assoc. 2016;315(8):801–10.

62. Boland LL, et al. Prehospital lactate measurement by emergency

medical Services in Patients Meeting Sepsis Criteria. West J Emerg

Med. 2016;17(5):648–55.

63. Hunter CL, et al. A prehospital screening tool utilizing end-tidal

carbon dioxide predicts sepsis and severe sepsis. Am J Emerg

Med. 2016;34(5):813–9.

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217


ADVERTORIAL FEATURE

OFFICIALLY LAUNCHED & READY

FOR NHSI EVALUATION

The new WAS 3.5 tonne DCA was officially launched at the

Emergency Services Show (ESS) in Birmingham on the 18th

September. As expected, this once unachievable vehicle created

a great deal of interest within the ambulance market.

The innovative 3.5t

ambulance is now

production-ready and

furthermore, it’s ready for

evaluation. John Rumsey,

Commercial Manager

at WAS UK, comments:

“This innovative 3.5t

ambulance has been

developed as a direct

result of Lord Carter’s

report and the recentlylaunched

national

ambulance specification.

The report set out a challenge

to all ambulance convertors to provide more innovative designs,

which in turn provide a more environmentally-friendly vehicle which

lowers whole-life costs into the NHS.”

In order to truly evaluate this new concept against the current national

specification, Ambulance Trusts can trial this frontline vehicle within their fleet.

This could be achieved under the NHS Standard Contract Service

Condition 39.4: ‘Ambulance trusts can trial the vehicle if they have

received written approval from NHS England and NHS Improvement

to derogate from the national specification, on an order by order basis,

which is subject to a business case from the lead CCG and trust to

that effect, clearly outlining the expected benefits and

Return on Investment’.

We also aim to have the vehicle evaluated

within NHSi’s Innovation Hub with

an intention to be included in the

national specification.

Tom Howlett, Sales

Engineering Manager at

WAS UK, explains: “This

is very much stage one

of the weight reduction

‘journey’ - we are focused

on making further savings.

Stage one gave us an

unladen vehicle weight of 2696Kg

with a full tank of fuel, our calculations then include: 450Kg of people (five

persons at 90Kg), 245Kg operational medical equipment (Current SWAST

Kit) and 30Kg of communications equipment, which totals a combined

weight of 3421Kg. We are now confident that we can include a sixth seat

in the next iteration of the vehicle.

AMBULANCE UK - DECEMBER

218

For further recruitment vacancies visit: www.ambulanceukonline.com


ADVERTORIAL FEATURE

“Plans are already advanced for stage two of the WAS 3.5t ambulance,

the concept is proven on the Fiat base vehicle. Our conversion weight

has now opened the door to other OE chassis manufacturers which

were recently locked out of the ambulance market because of the

national specification’s minimum 4.25t Gross Vehicle Weight (GVW).

This enables healthy competition between vehicle manufacturers which

is key for NHS efficiency.

“The next WAS 3.5t ambulance will be based on the MAN TGE low

frame chassis which will also include a fully automatic gearbox. We are

very excited to be working with the commercial supplier of MAN.”

John Rumsey explains: “This weight reduction delivers massive savings

of up to 20% on emissions and fuel consumption compared to the

average NHS front line fleet. According to our Millbrook tests, this will

deliver savings of approximately 2,500 tonnes of CO2 and £1.5 million

in fuel savings per annum for a typical NHS front line fleet. We are

now working hard to improve these savings while working with other

base vehicle manufactures to ensure the UK ambulance market stays

competitive and at the forefront of ambulance design.”

The WAS 3.5t DCA Ambulance was officially launched early this year at

the emergency services show in Birmingham, as expected this ground

breaking vehicle created a great deal of interest at the show and within

the ambulance market going forwards

All of the WAS UK test data has been independently validated by

Millbrook testing ground. Emissions and fuel consumption were

compared for normal driving, emergency driving and overall.

Neil Le Chevalier, Executive Officer at South Western Ambulance

Trust adds: “In the South Western Ambulance Trust we’d welcome the

opportunity to evaluate this innovative new 3.5t vehicle. A lightweight,

3.5t vehicle helps to address the issues we’re facing in the service in the

longer term together with improved environmental and safety credentials.”

John Rumsey adds: “The 3.5 tonne DCA is the new vanguard in terms

of ambulance design and judging by the results of our recent poll,

conducted on social media, more than 60%1 of respondents would like

to see the vehicle added to the new ambulance specification.

In the future all newly qualified paramedics, technicians and workshop

staff will be automatically licensed to drive our vehicles and there will

be no need for costly C1 licence tests. We hope that this is a significant

development in supporting the NHS recruitment of young paramedics

into the Ambulance Service.”

If you’d like to find out more information about the new WAS 3.5 tonne

vehicle, please contact wasukinfo@was-vehicles.co.uk, or speak with

Tom Howlett on 07496 982199 or 0845 459 2785.

References

1. Twitter poll of 511 people, 62% responded yes to including a 3.5

tonne box in the National Ambulance Specification.

AMBULANCE UK - DECEMBER

For the latest Ambulance Service News visit: www.ambulancenewsdesk.com

219


NEWSLINE

YAS

Redrow to donate

site defibrillators to

communities where

it builds

Redrow is working with

Yorkshire Ambulance

Service NHS Trust to reuse

defibrillators from completed

construction sites across the

region and re-home them

within local communities as a

lasting legacy.

To kick start the initiative, it has

paid for a brand-new defibrillator

which has been installed at

Sherburn High School, in

Sherburn-in-Elmet, North

Yorkshire.

Redrow Homes’ Wakefieldbased

operation was originally

contacted by Jason Carlyon,

community engagement

coordinator at Yorkshire

Ambulance Service, to discuss

the idea of leaving a life-saving

legacy in the cities, towns and

villages where it builds.

Sales director Steve Jackson

explained more: “This was a

great opportunity to explore

how we could transfer the

defibrillators from our sites to

elsewhere in the community and

we have worked with Yorkshire

Ambulance Service to develop

a plan.

“The aim now for us is

that every time a Redrow

development is completed,

the defibrillator will be donated

to the local community. At the

moment it’s a Yorkshire-wide

initiative but we’re hoping it will

be embraced by our colleagues

in other parts of the country.”

Redrow has defibrillators at all

of its live developments and

regional offices across England

and Wales, which can be

accessed by staff, contractors

and the local community in the

event of a medical emergency.

Redrow has also created an

eLearning module about the

use of the defibrillators, which is

available to all staff.

Jason Carlyon, community

engagement coordinator for

Yorkshire Ambulance Service

said: “I’ve been very keen to get

backing for the initiative from

housebuilders for some time so

I’m delighted that Redrow Homes

(Yorkshire) is supporting us.

“As well as agreeing to provide

a Community Public Access

Defibrillator (CPAD) after

the completion of every new

development by ‘recycling’ the

defibrillators already housed on

site during construction, Redrow

has also agreed to meet any

costs of replacement pads/

batteries to make them ‘rescue

ready’ once the development is

completed.

“We would very much like

to see this scheme rolled

out nationwide with Redrow

and replicated by other

housebuilders.”

Fervent defibrillator campaigner

Lizzie Jones, whose husband,

Rugby League International

player Danny suffered a fatal

cardiac arrest whilst playing for

Keighley Cougars in 2015, has

welcomed the new partnership,

describing its value as

“priceless”.

Lizzie Jones campaigns for

defibrillators to be installed at

all sports pitches, schools and

colleges.

AMBULANCE UK - DECEMBER

Jason Carlyon Yorkshire Ambulance Service, Headteacher Miriam Oakley and Redrow sales consultant Karen Burke

220

For more news visit: www.ambulanceukonline.com


NEWSLINE

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For the latest Ambulance Service News visit: www.ambulancenewsdesk.com

221


NEWSLINE

AMBULANCE UK - DECEMBER

Cellular-connected

Drones to Deliver

Life-saving Emergency

Defibrillators Following

Ground-breaking

Canadian Trial

The County of Renfrew in

Ontario, Canada is working

in partnership with InDro

Robotics, Cradlepoint and

Ericsson to reduce time to

treatment in private, residential

and rural areas; test flights

showed the drones arriving

more than seven minutes

before paramedic vehicles

Ontario, Canada, Oct. 1, 2019

– A ground-breaking trial using

4G LTE cellular connectivity to

enable beyond-visual-line-ofsight

(BVLOS) drones to deliver

automated external defibrillators

(AEDs) to the scene of a cardiac

arrest has taken place in the

County of Renfrew, Ontario,

Canada. Working in partnership

with technology providers,

including InDro Robotics,

Cradlepoint and Ericsson, the

trial demonstrated the drones’

capabilities to arrive more than

seven minutes before paramedic

vehicles during each test flight.

The County of Renfrew Paramedic

Service will use these results

to plan deployment strategies

that reduce time to treatment for

people suffering cardiac arrest,

and for those who need urgent

medications, in private, residential

or rural locations.

Completed in September 2019,

the trial involved the County of

Renfrew Paramedic Service flying

the first LTE-connected drones

equipped with AEDs to locations

in a 10-mile operating radius

that are BVLOS of emergency

services and pilots. This project

is one of the first in the country

to be granted permission for

this capability, which could

significantly expand the reach

of these emergency services.

Successfully delivering AEDs to

remote patients in need has the

potential to improve survival rates

for people suffering cardiac arrest

or other dire medical conditions.

The trials on Sept. 21-22, 2019

were a resounding success, with

the drone arriving at least seven

minutes before the paramedic

vehicles during each test run. The

drone flew over cellular to remote

take-off points selected by GPS

and landed successfully to deliver

an AED to the onsite researchers.

They then utilised the device

to deliver required shocks to a

medical mannequin. Translated

to an actual cardiac arrest, the

extra time provided by the drones

would be crucial in saving the

victim’s life.

As technology partners for the

trial, InDro Robotics supplied

the unmanned aerial vehicles

(UAV), with Cradlepoint providing

its NetCloud Service, including

the on-board, rugged IoT router

that enables LTE connectivity

for control data and video

between the vehicle and its

pilot over a Canadian mobile

carrier’s LTE advanced cellular

network. Ericsson will offer

4G LTE equipment with carrier

aggregation, as well as its cellular

network design support and

drone research.

The advanced drone and

BVLOS traffic management

technologies provided by InDro

Robotics and Ericsson, and use

of LTE for control and real-time

video streaming provided by

Cradlepoint and the mobile

carrier, form the centrepiece

of the County of Renfrew trial

and its objective to increase the

range and reduce time-to-site for

remote cardiac arrest victims.

Previous line-of-sight trials using

drones to assist emergency

services have operated within

the limitations of non-cellular

communications technology

and without the ability to use

video, limiting them to trips of

approximately 4.5 miles. By

using the LTE cellular network,

the County of Renfrew initiative

offers the potential to deliver

AEDs to patients up to 80 miles.

To improve the mission-critical

communications associated

with these deliveries, the drones

share images and video with

operators and employ artificial

intelligence to manage key

functions, such as collision

avoidance, all enabled by the

speed, bandwidth and reliability

of the LTE cellular network.

“Given the large area and

varied terrain that the county

encompasses, it is often

difficult to get paramedics to

patients in a timely fashion,

so we have taken a layered

approach to their response.

We have been successfully

using drones to support our

emergency responders for

several years, but until now, the

operators have had line-of-sight

of the situation. We will now

have further reach than ever,”

explained County of Renfrew

Paramedic Chief Michael Nolan.

“What’s particularly innovative

and exciting about this trial is

the potential of drone-delivered

AEDs to have a transformative

impact on emergency care

for patients suffering cardiac

arrest, especially those in

remote private, residential or

rural settings, where getting

emergency treatment rapidly is

the difference between life and

death.”

“I am very impressed with

the results of these flights,

advancing the science and

operations, delivering life-saving

tools such as a defibrillator

by drone,” said Dr. Sheldon

Cheskes of Sunnybrook Health

Sciences Centre.

“This new drone technology

is especially exciting when

integrated into critical scenarios

for paramedics – effectively

enabling AED ‘on the fly,’”

noted Philip Reece, CEO, InDro

Robotics. “At InDro Robotics,

part of what we focus on is

custom design solutions for

complex missions, and this is a

perfect example of how drone

software and hardware can

provide a scalable solution to a

very real problem. We’re thrilled

to be part of this partnership,

and to be able to demonstrate

the capacity for drones and

cellular technology at this lifesaving

trial.”

“This trial is an amazing

illustration of one of Ericsson’s

core beliefs, Technology for

Good,” said David Everingham,

vice president and chief

technology officer, Ericsson

Canada. “Ericsson’s portfolio

for Critical Broadband Network

capabilities allows service

providers and government

operators to meet the tough

business and mission critical

communication requirements on

a cellular network. We are proud

to partner on this innovative

trial, as multiple companies join

together to test how we can use

4G LTE networks and drones to

help save lives in Canada.”

“The County of Renfrew’s

forward-thinking approach

to using UAVs and on-board

cellular connectivity to extend

the speed and range of delivery

for life-saving emergency

services represents how

connected technology is

transforming public safety,”

commented John Campbell,

vice president, Public Sector

and Canada, Cradlepoint. “We

are honoured to be a part of the

County of Renfrew’s groundbreaking

trial, which promises

to help advance public

safety for rural communities

everywhere.”

222

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223


NEWSLINE

London’s Air

Ambulance Charity

Gala raises record

£550,000

London’s Air Ambulance Charity

has today announced the total

amount raised from its 30th

anniversary Gala, held at the

Rosewood Hotel on Thursday

8th November.

In total over £550,000 was raised

at the event making it the charity’s

most successful Gala ever. This

total translates to 275 potentially lifesaving

missions, helping London’s

Air Ambulance to continue to

provide on-scene emergency care

to the 10 million people who live,

work and travel in the capital. It

costs around £10 million each year

to deliver the service.

His Royal Highness The Duke

of Cambridge attended the

event in his capacity as Patron

of the Charity’s 30th Anniversary

campaign, 30 Years Saving Lives.

The Duke met with medical and

operational crew, former patients

and supporters of the charity, and

delivered a moving speech in

support of the charity’s life-saving

work.

His Royal Highness The Duke of

Cambridge said:

“I was delighted to become your

Patron for the campaign this year

to shine a light on the incredible

work that the charity undertakes

on a daily basis and to help

champion positive mental health

and wellbeing in the emergency

services. Having served as an air

ambulance pilot myself, I am in

no doubt about the crucial life-line

that air ambulances provide all

over the U.K.

“I wish you all the best as you

build on this year’s successes

and continue providing crucial

life-saving support to Londoners

for many years to come.”

The event was also attended by

almost 300 VIP guests, including

Eric Clapton, Fabiana and Bernie

Ecclestone, Jay Rutland, and

Daniella Helayal. Lord Jeffrey

Archer led a live auction, and

presenter Natalie Pinkham hosted

the evening.

Jonathan Jenkins, CEO of

London’s Air Ambulance Charity

said;

“As our 30th Anniversary year

draws to a close we can’t thank

the Duke enough for his heartfelt

support for our Charity, and it was

wonderful to hear him deliver such

a moving speech at our Gala

dinner.

“We are delighted that so many

supporters donated so generously

to our charity, making it our most

successful Gala to date. All the

funds raised will help us be there

for London for the next 30 years,

every second of every day.

“We are also very grateful to our

sponsors Maddox Gallery, Citco and

the Phoenix Group; to each of the

table hosts, and to our auctioneer

Lord Jeffery Archer for helping us

raise so much on the night.”

The charity’s 30 Years Saving

Lives campaign was launched

by The Duke of Cambridge on

9 January 2019 and aims to

highlight the charity’s vital work

delivering lifesaving treatment

across London and raise

support for the development

of new facilities. The campaign

has already successfully raised

almost £2million towards the

development of new facilities and

resulted in a significant boost in

awareness of the work of the lifesaving

charity.

Companies who helped to

support the event include

international contemporary and

modern art galleries Maddox

Gallery, leading provider of asset

servicing solutions to the global

alternative investment industry

Citco Group of Companies and

long standing charity partner

life and pensions consolidator

Phoenix Group.

Event partners were William Grant

& Sons, Dickinson & Doris, Mount

Street Printers, and Château

Marjosse.

AMBULANCE UK - DECEMBER

224

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NEWSLINE

WAA

Schoolchildren learn

lifesaving skills

from Wiltshire Air

Ambulance

Wiltshire Air Ambulance’s mission

of saving lives is being extended

to schools all over the county.

Following a six month pilot scheme

which involved schoolchildren

being taught lifesaving skills, the

charity has made its Emergency

Awareness Training (EAT)

programme permanent.

The EAT programme is an

interactive training session for

children at primary and secondary

schools and the subjects range

from carrying out CPR, making a

999 call, putting an injured person

in the recovery position, helping

someone who is choking and

controlling bleeding.

Richard Miller, Wiltshire Air

Ambulance’s clinical services

and ground base manager, said:

“We’ve been overwhelmed at

the response by schools to our

Emergency Awareness Training

programme and are really

pleased that it will continue.

“It is our ambition to teach every

school age child in Wiltshire

how to deliver CPR and other

emergency skills. Our programme

is a really valuable outreach

project delivering vital lifesaving

skills. We hope that in the event

of a medical emergency the

children who we train will have

the knowledge and confidence

to respond accordingly and

ultimately their actions may help

to save lives.”

In the pilot scheme, which took

place in the first half of this year,

6,153 children from 74 schools

took part. More than 5,500 children

were trained to carry out CPR while

in excess of 4,944 children were

taught how to make a 999 call.

More than 3,600 children learned

how to help someone who was

choking, while 2,286 were taught

the recovery position and just over

500 were taught how to control

bleeding. All received a certificate

of attendance from Wiltshire Air

Ambulance.

Paramedic Simon Stigwood was

involved in the pilot scheme and will

continue to deliver the programme,

supported by volunteers.

Simon, who has joined the charity

as emergency awareness training

officer and has been a paramedic

in Wiltshire for 15 years, said: “It’s

rewarding engaging with young

people and they have enjoyed

learning new skills that are about

preserving life and promoting

recovery. We tailor the sessions to

different age groups and needs of

the schools.”

Pupils Amber, Georgia and Elisha,

of Frogwell Primary School, said:

“We enjoyed learning how to do

CPR and the recovery position.”

Schools which would like to take

part in the Emergency Awareness

Training programme should

email emergencyawareness@

wiltshireairambulance.co.uk

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NEWSLINE

LAS

Biggest ever

celebration of

London Ambulance

Service Staff

More than 2,500 years of

service have been celebrated

by London Ambulance Service

staff.

A record 104 members of staff

from operational and corporate

roles were honoured for a

combined 2,550 years helping to

care for people in the capital at

the ‘Celebration of Service’ event

at Gibson Hall, EC2.

Among them 31 people who are

retiring received gifts to mark

their dedicated service to the

London Ambulance Service and

the NHS. For the first time the

event celebrated staff who had

newly qualified as paramedics

through the Service’s academy,

or completed postgraduate

qualifications relevant to their work.

London Ambulance Service

Chairman Heather Lawrence

MBE, who presented some of the

awards, said:

“All of our staff – from medics

and call handlers to those

maintaining our vehicles or

working in HR – play a part in

saving lives and I am extremely

proud of their achievements.

“We are celebrating colleagues

who have provided years of

dedicated service to London,

the London Ambulance Service,

and the NHS, as well as

welcoming some of the new

generation of paramedics who

are the future of our Service.”

Among those who are retiring,

17 were given ‘The Bell’. These

replicas of the bell found on

ambulances before electronic

sirens were introduced are

presented to staff with more

than 25 years of service. Clinical

Education tutor Allan Bromley is

retiring after an impressive 44

years of service having joined

in 1975.

Husband and wife Donna and

Matt Williams, who met on

their first day at work in August

1999, received The Queen’s

Ambulance Service (emergency

duties) Long Service and

Good Conduct Medal for 20

years of service from Chief

Executive Garrett Emmerson.

Both now play a role in training

and supporting new medics,

but spent many years on the

front line after qualifying as

paramedics in 2003.

Memorable moments in their

careers include responding

to the Paddington Rail crash

shortly after they joined the

Service, and supporting the

emergency response in the

aftermath of the 7/7 attacks in

2005.

While never formally ‘crewed

up’, on rare occasions they did

a shift working in an ambulance

together.

Matt, 46, said:

“The work has changed

dramatically over the past

twenty year. The volume of calls

has increased hugely and the

kit and equipment available now

means we can give much better

help to patients,”

Matt and Donna, who have two

children, have no plans to leave

the London Ambulance Service.

Donna, 41, said:

“It’s a very special place to

work. A few years ago we had a

family emergency and everyone

rallied round. There is always

great support.”

Meanwhile, six newly qualified

paramedics were recognised

with a scroll with a green ribbon

and two staff were honoured

with a scroll with a yellow ribbon

for completing postgraduate

courses funded by the London

Ambulance Service Bursary

Scheme.

NWAS

Ambulance

communicators are

‘unsung heroes’

The Communications team

at North West Ambulance

Service NHS Trust has been

shortlisted for an award at the

2020 Unsung Hero Awards.

The awards shine a light onto

the hard work of non-clinical

staff and volunteers in the NHS;

work that is often overlooked,

despite non-clinical employees

making up nearly half of the

workforce nationally.

Shortlisted in the

Communications category,

which recognises individuals or

teams who have gone above

and beyond expectations, the

team faces competition from

Blackpool Teaching Hospitals

and Northamptonshire

Healthcare NHS foundation

trusts.

AMBULANCE UK - DECEMBER

Along with media handling

and staff engagement, the

Communications team at

NWAS is responsible for inhouse

film production, events,

community engagement,

freedom of information, website

and intranet, social media

and political and stakeholder

engagement.

Informing and influencing

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NEWSLINE

over 6,000 members of staff,

a population of over 7 million

people, numerous public

interest groups, MPs, councils

and healthcare professionals

across six counties, the team

was shortlisted by the Unsung

Hero Awards’ judges.

Chief Executive at NWAS, Daren

Mochrie said: “It’s fantastic

that our Communications team

has been recognised for its

innovative work behind the

scenes.

“The team’s recent

achievements show the variety

of projects they support, and

the demand for their expertise

across our organisation, as we

strive to be the best ambulance

service in the country.

“With effective communication

influencing public confidence,

organisational reputation

and the morale of staff, it’s a

tough job to be fresh-thinking

in order to engage with our

diverse range of stakeholders

and predominantly mobile

workforce.

“Congratulations to the team on

this achievement and best of

luck at the awards.”

Winners of the Unsung Hero

Awards will be announced at an

event on 28 February 2020 at

the Hilton Hotel in Manchester.

Taking 111 to next

level

Plans that will eventually

see the full integration of

the 999 and 111 services in

the West Midlands (except

Staffordshire) have taken an

important step forward with

the 111 service transferring

to West Midlands Ambulance

Service.

The change is the first step

of a process that will lead

to significant improvements

for patient care through fully

integrating NHS urgent and

emergency care services.

The new service will see fewer

patients being sent ambulances

and lead to a reduction in the

number of patients asked to

attend A&E.

Instead, the new model

will support more patients

being cared for in the most

appropriate place for their

needs. This will also include

more patients being provided

with care over the phone by a

team including GPs; advanced

nurse practitioners; community

mental health teams;

pharmacists, dental nurses,

paramedics and midwives.

More calls will also be diverted

to GPs (in and out of hours),

urgent treatment centres

and rapid response services

operated in the community.

Rachael Ellis, Chief Officer for

Integrated Urgent & Emergency

Care, Sandwell and West

Birmingham CCG, said:

“Once in place, it won’t matter

whether patients dial 111

for urgent care or 999 for

emergency care, our patients

will all receive the same quality

of care with their calls answered

quickly and they will have

access to the right clinicians for

their need.

“This integration represents a

real opportunity to work as one

system to care for our patients.”

WMAS Chief Executive, Anthony

Marsh, said: “We have an

outstanding track record in

running complex clinical call

handling operations. This

expertise will allow us to bring

real improvements to the 111

service for both patients and

our staff.”

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NEWSLINE

NWAS

Taking mental health

care to the next level

Supporting patients living

with mental health problems

and/or dementia, North West

Ambulance Service (NWAS)

has officially launched its new

Mental Health and Dementia

Strategic Plan (2019 – 2022).

Put in place as part of the

trust’s aim is to be the best

ambulance service in the

country by delivering the right

care, at the right time, in the

right place; every time; the plan

supersedes NWAS’ previous

Mental Health Improvement

Plan (2017–2022). It details 17

recommendations, including

a range of actions for each of

these recommendations, which

collectively aim to shape and

transform mental health and

dementia care within the trust

over the next three years.

The plan is reflective of the

relevant mental health and

dementia related aspirations

detailed within the Five Year

Forward Plan for Mental Health

(2016), the NHS Long Term Plan

(2019) and the Prime Ministers

Challenge for Dementia (2015).

The recommendations and

associated actions are based on

extensive scoping and appraisal

of care provision between

January and July 2019 including

feedback from staff, patients and

partners within mental health

across the North West region.

One example of the 17

recommendations is to

review and learn from the

mental health triage car pilots

currently taking place within

the Merseyside and Lancashire

areas, and agree a trust wide

plan for the future.

The current pilot operating

in Lancashire is called

Psynergy and was launched

last December in Blackpool,

Fylde and Wyre, and involves

a paramedic, a senior mental

health nurse from Lancashire

Care and a police officer

coming together as a crew in

a vehicle to jointly respond to

people experiencing a mental

health crisis. The aim is to

provide appropriate triage,

offer the right care and advice,

improve patient experience and

avoid unnecessary hospital

admissions.

The pilot has already proven

to improve outcomes for

appropriate patients, and

results in better use of

ambulance resources and

multi-agency working, ultimately

leading to financial benefit to

the wider NHS.

In year one of this particular

recommendation, the trust

will undertake a detailed

and comprehensive review

of the two pilots and work

collaboratively with partners

and commissioners to secure

funding streams to widen this

excellent service.

Gill Drummond, Mental Health

and Dementia Lead for NWAS

said: “The work regarding

mental health and dementia

care already being undertaken

by the trust is fantastic, but

there is so much more we

can do to. The number of

related 999 calls is increasing

significantly, which is why one

of the trust’s key priority areas

is to improve care in this area,

and why we have developed a

plan to take this forward.”

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MAA

CCP status boosted

at Midlands Air

Ambulance

Five paramedics working with

Midlands Air Ambulance have

recently fully qualified as critical

care paramedics.

Bekie Chappell, Chris Brooke,

Grant Salsby, Sarah Folley and

Will Meadows, who together have

more than 60 years’ experience

with the ambulance service,

attained CCPs status following

extensive studies at Warwick

University, and further experience

of CAT1 cases.

Ian Roberts, air operations manager

for Midlands Air Ambulance

Charity, said: “This is testament

to the dedication the team shows

towards continuous improvement

and advanced patient care. I am

very proud of our five new critical

care paramedics and what they

have already achieved, having only

been seconded to MAA from West

Midlands Ambulance Service in

May 2018.”

The total number of CCPs working

with MAA now stands at 85 per

cent of the service’s paramedic

intake, with the remaining four

training for their CCP qualifications.

WMAS

They were amazing

“They were amazing.” The words

of a woman when she met the

two ambulance crews who

saved her husband’s life after he

suffered a cardiac arrest.

Jenny and Mark Roberts from

Brierley Hill were staying with friends

on a caravan site in Ombersley,

Worcestershire last November.

During the afternoon, Mark started

to feel unwell but then, without

warning turned grey and passed

out. His heart had stopped; he

was in cardiac arrest.

In such circumstances every

second counts. Every minute

without CPR decreases chances

of survival by 10%! The numbers

speak for themselves:

In Norway, when a patient has a

cardiac arrest outside hospital, in

73% of cases a member of the

public or a family member does CPR

– the survival rate is 25%. Compare

that to the UK where cardiac arrest

patients only get support in around

50% of cases which leads to just a

7% survival rate.

Jenny says Milind Kumar Karday,

the call handler who answered, was

brilliant keeping her calm and telling

her what to do. She says you have

to be ready because Mark had

none of the classic symptoms of a

cardiac arrest or heart attack; chest

pains. He did go clammy and had

a bit of pain in his arm.

Two ambulance crews were

immediately dispatched while

Mark’s friends performed

vital CPR (cardiopulmonary

resuscitation), buying him time

until the crews arrived.

Paramedics John Fryer, Lorraine

McHugh, Michelle Adams and

Anna Borecha were quickly on the

scene, but that was just the start

of the fight to save Mark.

Jenny said: “The caravan isn’t

huge which made everything

much more difficult, but

throughout, the crews never gave

up and made sure everyone was

aware of what was going on.

Jenny and Mark got to meet the

crews who attended to him at a

meeting of the WMAS Trust Board

at the end of January.

Mark and Jenny say it is difficult

to put into words just how much

it means to meet the people who

saved Mark’s life.

Mark’s life was saved by the speedy

recognition that he was in cardiac

arrest and having someone there

to do CPR until the ambulance staff

arrived and took over.

Mark says he hadn’t ever really

considered just how important the

work of the ambulance service

and all of the emergency service

is until this happened.

Both he and Jenny now want

everyone to take note of the

incredible work of ambulance staff

and also do their bit to help and

learn basic life support.

Only 1 in 5 alcoholics

are actually

receiving treatment,

as death rates rise

Public Health England has

released their 2018 to 2019 adult

substance misuse treatment

statistics report, revealing a

worryingly low number of people

with alcohol dependency actually

receiving the treatment they need.

Figures show that an estimated

586,797 adults are suffering

with alcohol dependency across

England and in need of specialist

treatment, yet only 104,153

individuals are actually in treatment,

leaving 82% in need of treatment for

alcohol who were not receiving it.

Nearly half of those who are

receiving the treatment they

need were living in the 30% most

deprived areas of the country,

the majority of which being in the

North of England.

The report also explains that of

the figures for people starting

new treatment journeys in 2018

to 2019, a staggering 60% said

they had a problem with alcohol,

compared to just 32% of new

patients seeking new treatment for

opiates, 22% for crack cocaine,

19% for cannabis, and 15% for

powder cocaine.

Also, of the people who presented

for the first time for alcohol

treatment, 66% said it was their

only problem substance.

The statistics also reveal that of all

people in contact with drug and

alcohol services between 1 April

2018 and 31 March 2019, 40% of

people with alcohol only problems

were female.

Nuno Albuquerque, Group

Treatment Lead at alcohol addiction

treatment experts UKAT comments;

“Alcohol is a legal yet extremely lethal

drug and we believe that today’s

figures only scratch the surface of

this country’s problem with alcohol,

because there will be countless

people out there unwilling to accept

they have a problem with it.”

The report shows that people having

problems with opiates and alcohol

only have the biggest increases in

the number and rate of deaths. They

have seen significant increases

since 2011 to 2012, where the

total number of deaths in these

substance groups has gone up from

1,816 people to 2,696 people.

NWAS

North West

Ambulance Service

sets out ambition to

be the best in UK

North West Ambulance Service

(NWAS) has outlined its plans

to become the best ambulance

service in the UK over the next

five years by delivering the right

care, at the right time, in the

right place; every time.

In an updated strategy for 2019-

2024, NWAS identifies eight areas

of focus which have become the

trust’s priorities: integrated urgent

and emergency care; quality;

digital; workforce; stakeholder

relationships; infrastructure;

environment, and business and

commercial development.

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NEWSLINE

As the only provider organisation

that covers the whole region 365

days of the year, 24/7, NWAS

has a central role to play in the

development and improvement

of urgent and emergency care

services across the North West.

The importance of this is outlined

in the recently published NHS

Long Term plan which describes

how the NHS will move to a new

service model in which patients

get better support and properly

joined-up care at the right time in

the right care setting.

This will require collaboration with

other healthcare services to make

the most of opportunities to treat

more patients by telephone, at

scene and in community settings,

reducing unnecessary journeys

to hospital - a better outcome for

patients and the whole of the NHS

system.

At a recent launch event, NWAS

Chief Executive Daren Mochrie

explained more about the plans

for the future to NWAS colleagues

and representatives from partner

healthcare organisations across

the region.

Daren said: “Patients are at the

heart of everything we do and this

strategy is all about us developing

as an ambulance service and

integrated urgent and emergency

care organisation, embracing

digital technology, and playing

our role in the wider healthcare

system to make sure patients get

the right care for their needs. This

includes continuing to enhance

our readiness in emergency

preparedness and response.

“We can’t achieve our vision

without our people - that’s why one

of our priorities is around workforce

and engaging and empowering

our staff and volunteers to develop,

adapt and embrace new ways of

delivering the right care.

“We have a real opportunity

to shape the future healthcare

system for the North West and

to make NWAS an even greater

place to work than it is today.

We’re looking forward to what the

future holds for the organisation.”

WMAS

Queen presents

honour to assistant

chief

WMAS Assistant Chief

Ambulance Officer Steve

Wheaton has received his

Queens Ambulance Medal

(QAM) from the Monarch herself

at an Investiture ceremony at

Windsor Castle.

Steve, whose career spans almost

30 years, was recognised in the

2019 Queen’s Birthday Honour’s

List.

The Resilience and Specialist

Operations Director was

recognised for his dedication

and distinguished service to

the ambulance sector which

carries the same level of Royal

recognition as other members of

the emergency services.

Steve said: “It was a very proud day

for me and my family who came

to the ceremony with me. Whilst I

received the award, I couldn’t have

done it without the many staff who

I have had the pleasure of working

with in the ambulance service

across our country.

“I would also like to thank the many

people around the country who

have sent me such lovely messages

about the day and receiving the

medal; it really is humbling.”

West Midlands Ambulance

Service Chief Executive Officer,

Anthony Marsh, said:

“I am incredibly proud that Steve

has been recognised in this way

and would like to thank him for

his tremendous service and for

the thousands of patients he has

helped along the way.”

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231


NEWSLINE

County Air

Ambulance HELP

Appeal charity

makes £250,000

donation to British

Association for

Immediate Care

(BASICS)

The County Air Ambulance

HELP Appeal charity has

presented a cheque for a

quarter of a million pounds

to the British Association for

Immediate Care (BASICS), an

organisation made up of 900

medical volunteers organised

into local and regional

schemes who are on call 24/7

to support NHS Ambulance

Services across the country.

The presentation was made

at the BASICS Pre-hospital

Emergency Care Conference

in Warwick, where the HELP

Appeal’s Chief Executive,

Robert Bertram announced

that the charity has pledged

to make the same donation

every year.

When presenting the £250,000

cheque, Robert Bertram, Chief

Executive of the HELP Appeal

said:

“BASICS volunteers are

lifesavers – it’s as simple as

that. Not only do they have

demanding and extremely

challenging jobs helping

patients every day, but they also

give up their free time to help

save lives by supporting the UK

ambulance service, 365 days

of the year. Whether patients

are seriously injured in a traffic

accident or a terrorist attack,

this new funding will help these

amazing volunteers arrive at the

scene as quickly and as safely

as possible to help save lives.”

Simon Scott-Haywood,

Chairman of BASICS Devon,

one of the schemes receiving

funding from this donation said:

“We are enormously grateful

for the support of the HELP

Appeal and BASICS. The grant

will enable BASICS Devon to

continue our vital work in the

coming years.”

The HELP Appeal was created

10 years ago by the County Air

Ambulance Trust. It is the only

charity in the country dedicated

to funding NHS hospital

helipads.

BASICS provides medical

roadside assistance from

doctors, nurses, paramedics

and others who work on a

voluntary basis to provide

care across the whole country.

Members of BASICS usually

respond from their own

homes and in their own time

to requests from the NHS

Ambulance Services to provide

emergency care in support of

ambulance staff.

GWAAC

Great Western Air

Ambulance Charity

hold Pre-Hospital

Emergency Medicine

(PHEM) conference

Great Western Air Ambulance

Charity (GWAAC) were

pleased to welcome healthcare

professionals to the third

GWAAC Symposium on

Friday 4th October 2019. The

conference, which was the

biggest of its kind in the South

West, took place at Aerospace

Bristol. This was the third

symposium hosted by the

charity, and was well attended

by doctors, paramedics,

nurses, trainees and students

from across the UK.

The attendees had the

opportunity to listen to renowned

speakers in the field of PHEM,

including some of the critical

care team at GWAAC. The day

covered many different aspects

of PHEM, discussing things

such as the psychological

effects of working within PHEM,

medical simulations, helicopter

emergency medical services

(HEMS), learnings from previous

case studies and the future of

Pre-Hospital Care.

Jonathon Search, Paramedic

with South Western Ambulance

Service NHS Foundation Trust,

who attended the event, said:

“The GWAAC Symposium was an

outstanding day of both clinical

and non-clinical education in an

incredible venue, from speakers

who are undoubtedly leaders in

their respective fields. On top of

that the day’s value for money

makes it a strong rival to the

UK’s bigger conferences and

CPD events. An ideal event for

students from all disciplines with

an interest in PHEM.”

GWAAC Critical Care Doctor

Scott Grier who was on the

organisation committee of the

day says: ‘’This is the third

time we have held the GWAAC

Symposium and 2019 was

by far our most ambitious.

In an amazing new venue at

Aerospace Bristol, we heard from

speakers renowned in their fields

from across the country as well

as our own team members.

AMBULANCE UK - DECEMBER

“I am delighted by the success

of the Symposium this year and

am very proud of GWAAC, the

incredibly high standard of the

event and the hugely positive

feedback received. On behalf

of the Symposium organising

committee, I’m delighted that this

will now be an annual event with

our next Symposium on Friday

25th September 2020.’’

To register your interest at next

year’s event, which will be held at

Aerospace Bristol again, please

email pr@gwaac.com

232

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IOW

Trust’s Volunteers

Service is highly

commended at

Helpforce Champions

Awards 2019

IW NHS Trust Volunteers

Service is highly commended

for ‘Innovation in Volunteering

Award’ at the Helpforce

Champions Awards 2019,

providing national recognition

of their fantastic contribution to

volunteering in the NHS.

The awards celebrate the exciting

ways in which volunteers across

the country are giving their time

to benefit patients, staff, and

communities.

a meaningful opportunity and

patients also benefit because

we have more volunteers in

clinical areas showing care and

compassion to patients and

visitors. In the long term we have

supported young people into

a career with the NHS, and are

tackling our recruitment challenges

positively and proactively.

By shining a light on the range of

ways that volunteers are involved in

the NHS, the Helpforce Champions

Awards show that dedicated

volunteers can contribute to

a more compassionate care

system for everyone.

Mark Lever, Chief Executive of

Helpforce, said:

“It is fantastic to see so many

with hospitals and healthcare

workers to help shape the future

of volunteering in the NHS.

Backed by leaders in the world

of healthcare, it aims to make

community-integrated healthcare

the norm across the UK.

NWAS

Ambulance service

volunteers celebrate

20 years

Marking 20 years of community

first responders (CFRs)

across the region, North West

Ambulance Service (NWAS)

held a full day celebration event

on Saturday 12 October to say a

big thank you for the invaluable

service they provide.

Possibly being closer to the

patient than an ambulance,

they can give patients vital extra

minutes when every second

counts, as well as providing

reassurance and assisting

ambulance clinicians.

The celebration took place at

Castle Green Hotel, Kendal and

began with an exhibition to give

guests the opportunity to learn

more about the sponsors for the

day. The event was entirely funded

by sponsorship from organisations

who work within the health sector.

This was followed by a conference

where a number of speakers

took to the stage to show their

appreciation of CFRs and speak

about the past, present and future

of the volunteer role.

The Isle of Wight NHS Trust

Volunteers Service is highly

commended for its work in

attracting students to volunteering.

By working closely and effectively

with Isle of Wight schools and

colleges, the trust has managed

to recruit students as volunteers,

seeing an increase in the

brilliant examples of innovation,

great practice, commitment,

and real passion for patient care

and support for staff across the

NHS in the UK. It is a privilege to

hold these awards and celebrate

volunteers across the UK.”

Helpforce is a national movement

on a mission to improve the

NWAS currently has 870 active

CFRs across the region, these

are members of the public who

volunteer for the trust to attend

emergencies in their local

community.

CFRs don’t need any previous

medical experience and are

trained to start life-saving

Secretary of State for Health and

Social Care, Matt Hancock, sent a

special thank you message which

was played at the conference.

He said: “Your actions make all

the difference and I want to say a

huge thank you not only from me

but from the countless lives you

save and the people you help.”

confidence, skills and knowledge

lives of NHS staff, patients and

intervention in the event of a

In the evening, the room

of the students. We are able

to provide young people with

communities through the power

of volunteering. It is working

cardiac arrest as well as other

emergency situations.

was transformed into a glitzy

awards ceremony, hosted by

ITV Granada’s Paul Crone,

where ‘remarkable responders’

from across the region were

recognised for exemplary service.

This was followed by dinner and

dancing, with music from local

band, Absolutely.

Regional Community Engagement

Manager, Andrew Redgrave, said:

“Over the past 20 years, our CFRs

have undoubtedly saved countless

lives and the fact that these people

give up their time willingly to help

those in need is commendable

and we’re really glad to have been

able to celebrate them at this

fabulous event.”

To find out more about how to

become a CFR, visit

www.nwas.nhs.uk/volunteer.

AMBULANCE UK - DECEMBER

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

233


NEWSLINE

AMBULANCE UK - DECEMBER

YAS

Region’s ambulance

service continues its

positive momentum

and receives ‘Good’

ratings from Care

Quality Commission

Yorkshire Ambulance

Service NHS Trust has

received ‘Good’ ratings for

its non-emergency Patient

Transport Service (PTS) and

Emergency Operations Centre

(EOC), following the recent

independent Care Quality

Commission (CQC) inspection

of these two areas and was

praised for continuing the

significant development of its

patient services*.

Rod Barnes

The CQC, as the regulator

of health and social care in

England, carried out a detailed

inspection in these services

during May 2019 and concluded

that they were ‘Good’ across

all categories – Safe, Effective,

Caring, Responsive and Well

Led - and had shown significant

improvement since the last

inspection in autumn 2016.

The CQC report published today

(14 October 2019) praised

staff for their compassion and

kindness, dignity and respect,

with patients consistently

positive in their comments about

the care they had received.

It also highlighted that the

Trust’s PTS, which makes

just under one million patient

journeys a year, had successfully

addressed the issues raised

three years ago. It has

now moved from ‘Requires

Improvement’ to ‘Good’ and the

inspectors found many areas of

excellent practice.

The EOC, which handles around

2,700 emergency calls every

day, consolidated its ‘Good’

rating and the inspectors

highlighted the service having

the quickest 95th centile call

answering performance rate of

all 11 NHS ambulance providers

from July 2018 to January 2019.

There was also positive

feedback about leadership at

the Trust via the new Well Led

process.

The report comments very

positively on the culture of the

organisation and the delivery

of high quality patient services,

with a clear commitment to

continuous improvement across

the organisation.

The Trust was cited as

engaging proactively with

patients, staff, the public and

local organisations to plan

and manage services in a

collaborative way.

Rod Barnes, Chief Executive of

Yorkshire Ambulance Service

NHS Trust, said:

“We are delighted to see the

continued advances across the

Trust reflected in the latest CQC

inspection report. It reflects the

hard work and commitment of

staff across our PTS, EOC and

leadership team. I’m immensely

proud of our dedicated staff and

the care they provide to patients

every day.

“It’s great to be able to

celebrate the recognition of our

achievements in PTS and EOC

and across all of our services

in the regulator’s report and I

believe this should add further to

the confidence of patients and

the public in the consistently

high quality care provided

by their regional ambulance

service.”

* On this occasion the

inspection carried out did not

include our A&E Operations,

Resilience or NHS 111 services.

One year on

from protect the

protectors bill gmb

launches charter to

prevent attacks on

ambulance workers

12 months ago our members

changed the law, but more

needs to be done says GMB

Union

One year on from the Protect

the Protectors bill becoming law,

GMB has launched a charter to

step up action against those who

attack ambulance workers.

The Charter asks employers to

take a Zero Tolerance approach

to those who assault emergency

workers, and take immediate

steps that will help minimise the

chance of Physical and sexual

assault on emergency workers.

The Assaults on Emergency

Workers (Offences) Act 2018

introduced a new offence

of common assault against

an emergency worker and

requires courts to treat attacks

on emergency workers as an

aggravating factor for sentencing

purposes.

Initially sexual assaults were not

covered by the Bill, until a GMB

investigation revealed reported

sexual assaults on ambulance

workers and other sexually

abusive incidents increased by

211 per cent between 2012/13

and 2016/17.[1] The research

also revealed that on average

234

For more news visit: www.ambulanceukonline.com


NEWSLINE

there are more than eight recorded

attacks (8.2) on ambulance

workers every single day. [2]

GMB’s is calling on employers to

take steps which include:

• Fair & equal treatment for all

staff

• Effective recording of action

taken in response to all assaults.

• Work in partnership to share

data & upgrade flagging

systems.

• Update all policies to better

protect staff from assaults.

• Mandatory training for all

managers and Staff.

• Independent reporting of time

off as a result of assaults

• Support staff in bringing

prosecutions

Rachel Harrison, GMB Organiser,

said:

“We’re calling on employers to do

their bit to protect the protectors.

“Whilst huge steps were taken

last year to protect Ambulance

staff, we think that more has to

be done to ensure their safety

when serving the public. It’s

not right that any person faces

violence and sexual assault in the

workplace, let alone emergency

workers.

“By implementing the charter,

Employers can help minimise the

threats to our brave Emergency

workers and reassure them that

they are taking the necessary

steps to minimise the risks of

violent, common and sexual

assault at the workplace”

Physical & Mental

Health First Aid

One in four people in the UK

will experience at least one

diagnosable mental health issue

in any one year. Suicide is the

biggest killer of men aged 20 to

49. To date over 400,000 people

across England have taken an

MHFA England course. I have,

have you?

In First Aid the mnemonic

DRABC, is a check list, and

this is known as the Primary

Survey. The Primary Survey is

probably the most important

check you will undertake when

dealing with an unconscious,

unresponsive casualty. When

carrying out first aid, it is vital

that you keep yourself out of

danger (D) otherwise you could

become another casualty. We

need to check for a response

(R) by speaking loud and clear

and tapping the casualty’s

shoulder. If there is no response,

check their airway (A) is clear,

by putting one hand on their

forehead and two fingers under

their chin and tilt the head back.

To check for breathing (B), put

your ear as close as possible to

the casualty’s nose and mouth,

and listen for breathing, whilst

looking down their chest, looking

for any movement of their chest

rising and dropping. The final

check is for circulation (C), have

they a severe bleed, this may

need to be treated before CPR is

started if they are not breathing.

When the check is complete, you

can now ring 999 or 112 and get

professional help on the way.

BUT did you know, there is also

a mnemonic and a check to

carry out, when providing first

aid to someone that has mental

ill health. This mnemonic is

known as ALGEE. Approach (A)

the person, assess and assist

with any crisis. Listen (L) and

communicate non-judgmentally.

Give (G) support and information.

Encourage (E) the person to get

appropriate professional help.

Encourage (E) other support.

Wouldn’t it be fantastic, to have

physical and mental health first

aiders in the workplace. It could

save a life.

Red Arrow Training Ltd

www.redarrowtraining.co.uk

WHY NOT WRITE FOR US?

Ambulance UK welcomes the submission of

clinical papers and case reports or news that

you feel will be of interest to your colleagues.

Material submitted will be seen by those working within the public and private

sector of the Ambulance Service, Air Ambulance Operators, BASICS Doctors etc.

All submissions should be forwarded to info@mediapublishingcompany.com

If you have any queries please contact the publisher Terry Gardner via:

info@mediapublishingcompany.com

AMBULANCE UK - DECEMBER

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

235


IN PERSON

NWAS News

New Non-Executive Director

appointed to NWAS

North West Ambulance Service (NWAS)

has confirmed the appointment of

Professor Rod Thomson as Associate Non-

Executive Director (Clinical) for the trust.

Professor Thomson retired from his role as

Director of Public Health for Shropshire in

April 2019 after 40 years of service to the NHS

and local government. He began his career

as a psychiatric nurse working in Glasgow

and later qualified as a health visitor.

Rod’s health visiting role included working

with the homeless, substance misusers and

victims of abuse. Moving to the North West

of England in 1990, he took on a locality

manager role in Cheshire and was also the

clinical lead for child protection. He was

later seconded to Merseyside and then

North West Regional Health Authority to

lead programmes of work regarding child

protection and public health.

Between 1996 and 2010 Rod held a range

of senior public health roles in Liverpool and

Sefton. During this time, he was instrumental

in developing the North West Public Health

Observatory at Liverpool John Moores

University. In 2010 he was appointed as

Director of Public Health for Shropshire.

Professor Thomson is also a member of the

European Commission’s Independent Panel

of Health Experts and was made Fellow of

the Royal College of Nursing in recognition

of his “exceptional contribution to the art

and science of nursing” in 2002. He is also a

Fellow of the Faculty of Public Health and is a

visiting professor at John Moores, Chester and

Staffordshire Universities.

Outside of his professional roles, Rod is a

qualified England hockey umpire and technical

official with British Triathlon. He was a games

maker at the 2012 Olympics and has held

volunteering roles at the 2014 Commonwealth

Games, as well as World and European Sports

Championships including the recent Cricket

World Cup.

Chairman for North West Ambulance Service,

Peter White said: “Rod has had a varied

and successful career and we very pleased

to welcome him to the trust. His clinical

experience will bring valuable expertise to our

board of directors.”

Professor Thomson has been appointed from

1 September 2019 until 31 August 2021.

SECAMB News

Trust announces appointment

of new Executive Director of

HR

South East Coast Ambulance Service NHS

Foundation Trust (SECAmb) is pleased

to announce the appointment of a new

Executive Director of Human Resources

and Organisational Development.

Following an extensive recruitment process,

Ali Mohammed will join the Trust at the end of

January 2020, filling the role currently being

filled on an interim basis by Paul Renshaw.

Since 2018, Ali has led on the transformation

and delivery of the national NHS Graduate

Management Programme, securing

significant additional investment and

increasing the number of internal candidates

being invited onto the scheme.

SECAmb’s Chief Executive, Philip Astle

said: “I am delighted to welcome Ali to this

important position in our Executive Team

and I know that we will benefit greatly from

his significant knowledge and staff-focused

approach.

“I am sure that his extensive HR experience,

gained in a wide variety of roles and

organisations, will help us to deliver on our

improvement plans and ensure we make

SECAmb a great place to work for our staff

and volunteers.”

Ali said: “I am delighted to be joining

SECAmb as Executive Director of HR and

Organisation Development. It will mean a

return for me to the frontline of the NHS,

having spent some 18 months, by the time

I join the Trust, leading an expansion of the

national NHS Graduate Management Training

Scheme. I have spent practically my whole

career working in NHS trusts and am highly

motivated by a desire to make things better

for staff and thereby better for patients.”

SECAmb Chair David Astley echoed the views

held by the Trust’s Chief Executive and said:

“I am pleased to welcome Ali who will be a

crucial member of our Board.

“Ali has an important portfolio of work to

deliver and with his proven track-record and

extensive NHS HR experience, I am sure he

will help the Trust deliver on its aims for the

future.”

AMBULANCE UK - DECEMBER

Ali is already established as a successful

NHS HR leader, including winning the HSJ HR

Director of the Year award in 2006.

Having begun his NHS career in a junior HR

position at Medway NHS Trust, Ali went on to

hold various senior HR positions at a number

of large trusts including Medway, Brighton and

Sussex University Hospital Trust, Barts Health

NHS Trust and Great Ormond Street Hospital

NHS Foundation Trust.

236

For further recruitment vacancies visit: www.ambulanceukonline.com


IN PERSON

WMAS News

Highly respected NHS Leader

to take up role as Chair of

WMAS

West Midlands Ambulance Service is

delighted to announce that it has appointed

a highly respected NHS Leader as the new

Chair of the Trust.

Professor Ian Cumming OBE will join the

Service, the only Ambulance Trust rated

‘Outstanding’ by the CQC, when he leaves

his current role as Chief Executive of Health

Education England, the education and training

organisation for the NHS, at the end of March

2020. He will also take up a new role as

Professor of Global Healthcare Workforce and

Strategy at Keele University.

Prof. Cumming said: “After 38 years in the

NHS, including 25 years as an NHS Chief

Executive, I feel that the time is right to pursue

new goals. The opportunity to remain in the

NHS while also taking up an academic role is

the perfect opportunity for my next career step.

“I have had a personal interest in pre-hospital

care from many years and well remember

meeting WMAS Chief Executive Anthony Marsh

in 2009 to talk about how we could improve

care at a time when patients are arguably

at their most vulnerable. What is notable

is that WMAS has delivered on all of those

discussions including developing their staff so

that there is a paramedic on every ambulance;

having a modern fleet; and the introduction of

‘Make Ready’ hubs to improve efficiency.

“WMAS already has a real focus on keeping

the Trust at forefront of developing patient

care and I am looking forward to helping them

continue that journey. As we move towards

more care at home, I want to focus with the

team at WMAS on how we can build on the

integration of 111, but also increase the care

that is provided at a time of need.

“As someone who lives within the West Midlands,

I am excited at the prospect of becoming a

part of a high performing organisation that is

innovative and leads the way in so many areas of

development whilst continuing to provide a very

high level of service to patients.”

Anthony Marsh, Chief Executive of WMAS said

“I am delighted our Governors have appointed

Ian to succeed Sir Graham Meldrum as our

Chairman. Ian has worked closely with WMAS

over the last 11 years both as Chief Executive

of NHS West Midlands and then more recently

in his role at HEE and brings with him a wealth

of knowledge about NHS organisations and

the development of the most important part of

our organisation – our staff.

“Prof. Cumming has been hugely supportive

to WMAS in recent years on projects such as

upskilling our workforce so that we became

and remain the only ambulance service to

have a paramedic on every vehicle.

“He has also been very supportive of our move to

become the first University Ambulance Service in

the country and in the setting up of the National

Ambulance Academy and National Improvement

Faculty, all of which champion the development of

ambulance services and our staff.

“I would also like to pay tribute to our current

Chairman, Sir Graham Meldrum, who has

played a pivotal role in the Trust’s development

for more than a decade. His leadership has

brought huge benefits to the organisation, our

staff, and the patients we serve. In particular

his tireless work in the field of diversity and

inclusion has seen us make significant

progress in developing our workforce so that it

truly represents the West Midlands region.”

Current Chairman, Sir Graham Meldrum, added:

“I very much welcome the appointment of Ian

Cumming by the Council of Governors. The

development and wellbeing of staff is clearly

something that Ian holds dearly. At a time when

the NHS is under more pressure than ever before,

having someone who sees such issues as central

to the organisation can only be good news.

“It has been an absolute privilege to lead this

organisation over nearly 14 years; the hard work,

enthusiasm and dedication of the staff here is

exemplary. I have had the pleasure of meeting

hundreds of our staff over that time and each time

I do I am left incredibly proud to be in this position.

“I am absolutely confident that Ian will continue the

good work of the Board of Directors and Council

of Governors to help this organisation maintain it’s

position as a leader within ambulance services.”

Lead Governor, Eileen Cox, who was Chair

of the appointing panel, said: “We were very

impressed by the number, range of experience

and backgrounds of the candidates who put

themselves forward for the position of Chairman.

“As a Foundation Trust, the Governors played

the leading part in the selection process and

our panel was made up of both elected and

staff Governors.

“In the end, our decision was unanimous.

We were very impressed by the range of

experience and enthusiasm Prof. Cumming

had for this organisation. What came through

so strongly was his wish to see staff flourish

both professionally, but also personally.

“He was very clear that by looking after our

staff, they will look after our patients and that will

lead to better care, which at the end of the day

is the driving force of everything that we do.”

Professor Cumming will take up his new role

with WMAS on 1st April 2020. His appointment

is for an initial period of three years.

Professor Ian Cumming Biography

Ian started his career in the NHS as a Biomedical

Scientist and later worked as a Research

Scientist in coagulation disorders before moving

into NHS Leadership in the early 1990’s.

He has held a variety of NHS general

management posts including over 11 years

as Chief Executive of acute hospital Trusts,

followed by three years as the Chief Executive

of a healthcare commissioning organisation

prior to being appointed Chief Executive of the

NHS in the West Midlands in 2009.

In 2012, Ian was appointed Chief Executive

of Health Education England (HEE). Ian has

a particular interest in the development of

leadership skills in clinical staff and is an

Honorary Professor of Healthcare Leadership

in the Medical School at Lancaster University.

In 2003 Ian was awarded the OBE for services

to the NHS and in 2010 Ian was made an

honorary Fellow of the Royal College of

General Practitioners.

Ian has a special interest in sports medicine an

area in which he hold an MSC. Ian became a

board member of Sport England in 2016.

Outside work, Ian is a qualified level 3

swimming coach, working closely with young

people to develop their swimming abilities, a

keen snow skier and enjoys sailing, walking

and watching rugby union.

AMBULANCE UK - DECEMBER

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

237


INTERIOR CABIN FLOOR CLEANING

1

2

3

Gloves Apron Goggles

When completing this task, always ensure the correct

clothing such as protective gloves, apron, safety goggles

and suitable closed shoes are worn at all times.

Apply PPE (where required) before

preparing chemical solutions.

Dispense pre-mixed Hygienic Floor

Cleaner from the ClearTrace Dispensing

System into a Yellow Mop Bucket.

Pre-Clean Floor

Sweep floor area with soft brush or vacuum

and pre-clean to remove all visible soiling.

If required, agitate surface to help remove

stubborn soil.

Clean Floor

Apply Hygienic Floor Cleaner to the floor

area using a Disposable Mop Head and

allow contact time.

Rinse immediately with clean

water down & away from eye.

Keep eye wet.

Seek medical advice.

Wash skin immediately with

clean water. Keep skin wet.

Seek medical advice.

PATIENT COMPARTMENT SURFACE CLEANING

4 Rinse

4

Wipe

Rinse with clean water and remove as much

Wipe surface clean with disposable paper

excess water on surface as possible. Use a

and allow to air dry.

floor squeegee if required.

1

2

3

30 Sec

Rinse mouth with plenty of clean

water. Do not induce vomiting.

Seek medical advice.

Remove contaminated clothes.

Wash skin with plenty of water.

Seek medical advice if necessary.

Apply PPE (where required) before preparing

chemical solutions. Dispense pre-mixed SD50

Broad Spectrum Disinfectant from the ClearTrace

Dispensing System into a SD50 Trigger Bottle

with a Yellow Trigger Head.

Pre-Clean Surface

If required, use MPC20 Multi Surface & Glass

Cleaner to help remove stubborn soiling or

surface scuff marks. Lightly spray SD50 solution

onto the surface area and wipe surface with

disposable paper to remove surface soiling.

San

se Surface

Re-apply SD50 solution to all surfaces;

trolley, stretcher and chairs, taking care

around any electrical equipment and allow

30 seconds contact me.

Move casualty outdoors/fresh

air. Keep warm and at rest.

Seek medical advice.

In case of an accident or if you feel unwell,

seek medical advice immediately and

show the Safety Data Sheet (SDS) and/or

product label where possible.

PRODUCT SELECTION

Always read the

label and follow the

instructions for use.

Always report faulty

equipment or spillages

to your supervisor.

SD50 Broad Spectrum

for use in high risk infection areas.

An outstanding disinfectant with

Bactericidal, Viricidal and Sporicidal

properties.

sanitiser for use on vehicle floors.

An outstanding cleaner sanitiser

with Bactericidal, Viricidal and

Sporicidal properties.

MPC20 Mul Surface

for glass, stainless steel & other water

resistant hard surfaces.

Never mix chemicals.

MIXING CHEMICALS

CAN KILL!

Always store chemicals

safely in a cool, dry and

locked location.

The Provision of Specialist

• Cleaning and Infection Control

HAZARD WHEN USED AT

RECOMMENDED DILUTION

Always wash hands

after use.

Cleartrace ICM | Tel:+44 (0)1254220225 | Email: office@cleartrace.co.uk 110012 WWW.CLEARTRACE.CO.UK

Colour Code

Yellow

LOW

HAZARD

IN USE

HAZARD IN USE: Not classified.

Wear gloves for prolonged use.

LOW

HAZARD

IN USE

HAZARD IN USE: Not classified.

Wear gloves for prolonged use.

LOW

HAZARD

IN USE

HAZARD AS SUPPLIED:

Not classified.

Wear gloves for prolonged use.

Do not wear

jewellery.

COMPANY NEWS

Infection Prevention for

Emergency Services

A new approach to IPC

Among the many pressures

that ambulance operators face

is how to ensure high levels of

service availability while protecting

patients from infections and

sources of illness. This is the

realm of cleaning and hygiene

and processes must be highly

effective, simple and fast due

to the limited time available to

maintain vehicles.

The majority of infections are

spread by hand to hand contact

or by touching a contaminated

surface. The primary defence

against infection involves a

combination of hand hygiene and

surface sanitisation. It follows

that anything that breaks this

sequence will help eliminate these

sources of infections. ClearTrace

offers a complete range of trusted

formulations for use throughout

emergency vehicle fleets.

Effective against pathogens in just

30 seconds, ClearTrace’s SD50

Broad Spectrum Disinfectant

To ensure operators in this sector

can be successful, interactive

training is provided Free of

Charge. These include, nonclinical

IPC training for all staff and

ambulance crews, step-by-step

on-site vehicle deep cleaning to

ISO Standards, product-in-use

and COSHH awareness training.

The flexibility of ClearTrace’s

approach not only mobilises an

operators team in an efficient way

but practically equips them with

the fundamental knowledge to

clean the emergency vehicle fleet

effectively and within the required

regulations.

relationships and adding benefit

as well as enhancing each

operator’s business and their IPC

Systems and Protocols ultimately

transforming relationships into

long-term partnerships.

ClearTrace is extremely proud to

be the IPC Provider to a number

of high profile Ambulance

Providers, these include the NHS

direct, St. John’s Ambulance,

Isle of Man Ambulance Service,

HATS, BEARS, Medi 4 Ambulance

Service, Kent Central Ambulance

Service.

Ambulance operators, deep-clean

and make-ready professionals

need the right system in place

for maintaining IPC compliance.

ClearTrace’s Total Hygiene

System combines the tools and

processes required to enable this to

occur within regulatory frameworks.

is independently proven against

Bacteria, Viruses and Spores

and is only one of the specially

formulated products which

provides effective infection

prevention. Used by ambulance

services for daily and deep-clean

operations, this disinfectant is

effective against Norovirus, VRE,

Influenza, MRSA, HIV, C. diff and

many other pathogens.

Monitoring hygiene standards is

a key element of ClearTrace’s

Total Hygiene System. Both

ATP and swab testing is offered

AMBULANCE UK - DECEMBER

ClearTrace’s Total Hygiene

Systems covers all aspects of

maintaining your fleets from

operating Make Ready Systems,

Vehicle Preparation Systems,

Daily and Deep Cleaning Services,

Broad Spectrum Sanitisers,

Bespoke Real-Time Tracking

Systems for Cleaning and Auditing

to ISO Certified Standards.

The pressure to maintain the

hygiene of emergency vehicles

is vital, therefore the approach to

IPC and hygiene management

must be highly effective, simple

and fast acting too, Products are

only as good as their application

though, that’s why ClearTrace’s

Total Hygiene System places

significant focus on systems,

training and supporting signage

and documentation.

RECOMMENDED PPE

IMMEDIATE FIRST AID ACTIONS

Preven on Control Board

A M B U L A N C E V E H I C L E INT ERIO R S

Disinfectant

Concentrated, low toxicity disinfectant

Hygienic Floor Cleaner

Concentrated, low toxicity cleaner

and Glass Cleaner

Concentrated Multi Surface Cleaner

ISO

9001

by ClearTrace’s team of experts

as part of their own on-site

audits of an operator’s fleet and

Total Hygiene System. This

provides an auditable system that

demonstrates to the regulator

that the operator has; a thorough

and robust IPC system in place,

is well managed and, microbial

cleanliness is achieved and

verified by an independent

supplier.

Having the right systems in

place for maintaining IPC

compliance should not be

about adding additional costs.

ClearTrace recognise this and

are committed to building real

If you’d like to discuss this article

or would like to take advantage

of the ClearTrace Total Hygiene

System please don’t hesitate to

get in touch with one of the team at

ClearTrace or make contact with:

James Staniland

www.ClearTrace.co.uk

or Tel: 01524 220 225

James.Staniland@

ClearTrace.co.uk

238

For more news visit: www.ambulanceukonline.com


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For the latest Ambulance Service News visit: www.ambulancenewsdesk.com


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MCN IP 1910 0295-05

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