Ambulance UK October 2020

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Volume 35 No. 5<br />

<strong>October</strong> <strong>2020</strong><br />


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142 FEATURES<br />

142 Clinical Skills for Police Officers in Specialist Role:<br />

An Audit of Patient Report Forms in 2019<br />

146 Why a simple blood test could identify those most<br />

at risk of Covid-19 complications<br />

148 NEWSLINE<br />

166 COMPANY NEWS<br />

This issue edited by:<br />

Sam English<br />

c/o Media Publishing Company<br />

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Terry Gardner, Samantha Marsh<br />


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Welcome to this issue of A<strong>UK</strong><br />

So here we are in <strong>October</strong> still haunted by the ghost of Christmas future, the other big ‘C’, and reeling from a<br />

summer not of whoa but woe. I don’t know about anyone else but sometimes I find writing somewhat cathartic<br />

so sitting here writing this I thought I might reflect on the year thus far in the fond hope I can find something<br />

positive.<br />

“Surprise,<br />

surprise,<br />

numbers<br />

began to<br />

increase and<br />

the strategy<br />

seemed<br />

obvious.<br />

A little like<br />

watching<br />

numbers<br />

fly up the<br />

tube in the<br />

National<br />

Lottery,<br />

area by area<br />

‘hot spots’<br />

were closed<br />

down.”<br />

Let’s begin with last Christmas when everyone I knew had a weird flu-like illness, my GP friend told me it had<br />

even surprised him in its “different to the normal”presentation, lo and behold, enter stage left a brand new<br />

coronavirus. Now I’m not really into politics but come mid February it was, I think, obvious to everyone that<br />

things were not looking good. My parents boarded themselves into the house and haven’t been out since, Then<br />

mid March the politicians started listening to “science” and convinced the nation to close its doors…that worked!<br />

…I can remember working in my day job on the last weekend in March when our demand hit 100% increase on<br />

normal and thinking well this is going to need some creative thinking, this just isn’t working the way they said it<br />

would. I’ve found a positive ! The weather over Spring made working from home a distinct pleasure but then I’m<br />

lucky to work for the health service, thousands of others lost their jobs, their lives and their sanity so really not a<br />

positive, just a sobering reminder that sometimes the cure creates more issues than the disease.<br />

Everyone looks forward to Summer, so as restrictions eased and bars re-opened, I think most people breathed<br />

a sigh of relief. Surprise, surprise, numbers began to increase and the strategy seemed obvious. A little like<br />

watching numbers fly up the tube in the National Lottery, area by area ‘hot spots’ were closed down. I’m<br />

cynical, with a third of the country now ‘closed’ again, I’m not convinced that was successful, however, putting<br />

the cynicism to the side let’s consider my favourite intervention, the mask! So now everyone has a little piece<br />

of cloth that comes in and out of their pocket every two minutes, can be worn under the nose or chin, can be<br />

hung on the car mirror so it isn’t forgotten next time at the shops and protects others even though the rules<br />

that probably did protect people, hand washing and distance are pretty much obsolete because of the power<br />

of the mask and the psychological confidence it brings. Worse still, the fomitic things are all over the place, I’m<br />

just waiting for a dolphin to end up with one wrapped round its snout.<br />

Time for the second wave. What on earth did they think would happen when the kids got back to school.<br />

History perhaps might have given them a clue, since kids are the flu season super spreaders every single<br />

year. I’m not sure how many students there are in the <strong>UK</strong> but again not entirely surprising when you send<br />

them all over the country for the first time with a full grant and no parental oversight that within a fortnight every<br />

university had hundreds of new cases…now wasn’t that a surprise!<br />

And here we are, you just know its bad when the supermarkets are putting Easter eggs on their shelves, no<br />

family Christmas this year, although I suppose technically if you cremate the Turkey like my wife does each<br />

year you could get a few people round for its funeral.<br />

Did I say this was a cathartic exercise, it isn’t really, it just makes me sad to think of the people who have lost a<br />

year of their lives, the kids who should be enjoying life, the families who had their lives ruined, the people who<br />

have died not only of the disease but of fear to have that ‘lump’, that ‘weakness’, that ‘chest pain’ investigated.<br />

Those who have had operations cancelled, those that cannot see their grandchildren or grandparents. The<br />

vulnerable who might as well have been imprisoned for perhaps one of their last remaining years. And finally,<br />

let’s not forget the perhaps irreparable damage to the <strong>UK</strong> economy, the unemployment, the lost businesses<br />

and the debt that will probably have to be repaid for the next century, the next budget will be interesting. Will<br />

we look back when this is all over, if it ever is, they’ve never cured another coronavirus, the common cold, and<br />

say “I’m not sure our scientific decisions were that great.”<br />

Stay safe, stay distance, stay hygienic and of course, don’t leave the house without your shield of invincibility…<br />

Sam English, Co-Editor <strong>Ambulance</strong> <strong>UK</strong><br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />





REPORT FORMS IN 2019<br />

Abstract<br />

officers in specialist roles (referred to as officers in this report) are<br />

particularly proficient. It also evaluates components of the form itself.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

Some specialist police officers, predominantly from firearms units, are<br />

trained in pre-hospital medicine to a national standard curriculum initially<br />

developed in 2009. The incidents are recorded in Patient Report Forms,<br />

which are subsequently reviewed by their clinical governance oversight<br />

to quality assure the treatment given and to inform future training or<br />

curriculum development. This is a retrospective review of 298 Patient<br />

Report Forms from 2019 from five police forces covering a mixture<br />

of metropolitan and semi-rural areas. Patients were predominantly<br />

male and the mechanisms of injury were mainly stabbings, road traffic<br />

collisions or alcohol/ drug-related. There were 42 (14%) medical callouts<br />

which were mostly cardiac in nature. Other non-trauma incidents<br />

included mental health problems. The most frequent injuries sustained<br />

by patients were lacerations, stab wounds and abrasions and 116 (31%)<br />

patients were reported as being in pain. 55 (18%) patients required<br />

airway support. Cardiopulmonary resuscitation (CPR) was required in<br />

40 (13%) patients with a Return of Spontaneous Circulation (ROSC)<br />

on scene achieved in 17 patients (43%). More focus on medical<br />

emergencies and mental health in training could be valuable. Airway<br />

management has improved compared to previous audits and there<br />

is potential for supraglottic airways to be used more frequently. The<br />

relatively high numbers of ROSC on scene is commendable. These<br />

officers are well-trained and serial audits show a steady increase in use<br />

of skills, which makes them an important medical resource, although it<br />

is important to remember that they are police officers first.<br />

Introduction<br />

The year 2019 saw a 7% increase in knife & sharp object offences in<br />

England and Wales 1 ; the highest on record (however, this figure does not<br />

include statistics from Greater Manchester). There were 6060 incidents<br />

involving firearms and a terrorist attack on London Bridge 1 . It is, therefore,<br />

more important than ever for the police officers responding to such<br />

incidents to have a high degree of medical capability. In 2010, firearms<br />

police officers began training to a national curriculum in basic but essential<br />

life-saving skills. ‘Clinical Skills for Police Officers in Specialist Role’ is a<br />

module (previously named D-13), which involves the assessment and<br />

treatment of casualties using the ABCDE paradigm 2 .<br />

Patient Report Forms (PFRs) record details of the care provided each<br />

time an officer is called to a patient. They are reviewed by a registered<br />

medical professional for assurance of the treatment given and are<br />

used to inform future training for the continual quality improvement of<br />

medical care. This audit aims to examine the PRFs completed in 2019<br />

and compare the data to previous years using earlier audits. It will look<br />

for emerging trends, identify areas for improvement and where police<br />

Method<br />

This is a retrospective audit of 298 PRFs completed by predominantly<br />

police firearms officers in 2019. The PRFs are from five police forces<br />

in England, all under the same clinical governance structure 3 , covering<br />

a mixture of urban and semi-rural areas. Anonymised data was<br />

categorised into the mechanisms of injury, types of injuries, sex of the<br />

patient, observations recorded and interventions provided by officers.<br />

Results<br />

There were 217 male patients, accounting for 73% of PRFs. There were<br />

51 firearms deployments, making up 18% of PRFs. 16 PRFs did not<br />

record whether the incident was a firearms operation or not. Officers<br />

spent an average of 51 minutes on scene.<br />

Mechanism of Injury<br />

The three most common mechanisms of injury were stabbing, alcohol/<br />

drug-related, or road traffic collisions (RTCs) (Figure 1). While there were<br />

11 incidents (4% of PRFs) where the mechanism of injury was alcohol<br />

or drugs alone, 66 incidents (22% of all call-outs) involved drugs or<br />

alcohol, including 13 self-harm/ parasuicides (59%) and 13 stabbings<br />

(19%). The ‘other’ category included three patients with hypothermia,<br />

Number of Patients<br />

70<br />

60<br />

50<br />

40<br />

30<br />

20<br />

10<br />

0<br />

Mechanism of Injury<br />

Alcohol/ drug-related<br />

Not alcohol/ drug-related<br />

Figure 1: Number of most commonly reported mechanisms of injury,<br />

including the proportion of incidents in each category where alcohol/<br />

drugs were also reported in the PRF.<br />

142<br />

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Number of Patients<br />

12<br />

11<br />

10<br />

9<br />

8<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

Pain<br />

116 patients (39%) suffered from pain. The analgesic Methoxyflurane<br />

(Penthrox) was used in 23 patients (8% of all patients), mainly in<br />

RTC (seven patients) or assault (seven patients). 83% of the patients<br />

(19) were given only one dose. Before administration of Penthrox,<br />

the majority of these patients reported ‘severe pain,’ which is rated<br />

at 8-10/10, and mostly reduced to ‘moderate pain’ (rated at 4-7/10),<br />

although one patient reported no change in pain levels. Two patients<br />

were identified as candidates for Penthrox but refused it or their care<br />

was taken over by paramedics.<br />

Number of Patients<br />

Medical Incidents<br />

Figure 2: The number of patients reported for each medical incident.<br />

Assessment<br />

- Catastrophic haemorrhage:<br />

137 patients (47%) had an external bleed, which was mainly treated with<br />

direct pressure. On one occasion, where a man had a heavily bleeding<br />

head wound after an assault, the application of a pressure bandage<br />

was commended by the Emergency Department. 12% of those who had<br />

an external bleed had a tourniquet applied (16 patients). One man had<br />

three fractures (two wrists and one hip), two completed suicides, two<br />

a catastrophic bleed from a deep laceration on his forearm which was<br />

12minor cuts, two welfare concerns, someone who was pushed through a<br />

treated with a tourniquet on his upper arm, stemming the bleed. The<br />

11<br />

window, one industrial accident, a fall from a horse and a casualty from<br />

10<br />

patient was identified as very unwell as a result of blood loss (confusion,<br />

9a police operation. Six incidents were unspecified.<br />

8<br />

pale complexion) and the two officers were complimented on the<br />

7<br />

application of a tourniquet by the Helimed doctor taking over care.<br />

642 PRFs (14%) were medical call-outs (this excludes mental health). The<br />

5<br />

As the first responders, their quick assessment and decision-making<br />

Amputation<br />

4majority of these incidents involved cardiac arrest or patients with chest<br />

0.9%<br />

markedly improved the outcome for this patient.<br />

3<br />

pain (Figure 2). Mental health problems were noted explicitly in the free-<br />

of 10 PRFs (3%), although the true number of incidents where mental<br />

2<br />

1text<br />

0<br />

Abrasion Burns A - Airway:<br />

health played a part is likely to be much higher, considering 14.8% that the 0.3%<br />

Abrasion<br />

55 patients (18%) had obstructed airways, which were often managed<br />

total number of suicides, para-suicides, missing persons and domestic<br />

Burns<br />

using a combination of manoeuvres (Table 1). Positioning the patient<br />

incidents was 35 (which would Laceration make it involved in 15% of PRFs).<br />

Bruising<br />

31.1%<br />

on their side or turning the patient was commonly used to manage<br />

Bruising<br />

Open Fracture<br />

Medical Incidents<br />

obstruction. All patients with a reported initial AVPU Score (Alert, Verbal,<br />

11.3%<br />

Injuries<br />

Closed Fracture<br />

Pain, Unresponsive Puncture Score) of Pain or Unresponsive (74 patients) were<br />

The most frequently reported injuries were lacerations, stab wounds and Open given airway support where required. 24 (8%) patients had suspected<br />

abrasions (Figure 3). 46 patients (11%) sustained fractures and three Fracture<br />

Stab Wound<br />

2.2% bony GSW injuries Entry to the face, mainly from falls over six feet or from RTCs.<br />

patients had amputations (one hand, one finger and one foot). Closed One Fracture patient<br />

GSW Exit<br />

12.3%<br />

A supraglottic GSW Exit airway was used on one occasion for a child in cardiac<br />

suffered self-inflicted 0.9% disembowelment, where officers sealed large wounds<br />

arrest. Laceration In two patients who had substantial facial trauma and were<br />

with clingfilm. The GSW doctors Entry and surgeons at the hospital were grateful for<br />

Stab Wound Wound<br />

unresponsive, Amputation<br />

3.8%<br />

the ambulance crews replaced oropharyngeal airways<br />

their resourceful actions, which helped to 16.0% save the young Puncture man’s life.<br />

6.3%<br />

that had been placed by police with supraglottic airways.<br />

GSW Exit<br />

0.9%<br />

GSW Entry<br />

3.8%<br />

Laceration<br />

31.1%<br />

Amputation<br />

0.9%<br />

Stab Wound Wound<br />

16.0%<br />

Abrasion<br />

14.8%<br />

Puncture<br />

6.3%<br />

Burns<br />

0.3%<br />

Bruising<br />

11.3%<br />

Closed Fracture<br />

12.3%<br />

Open<br />

Fracture<br />

2.2%<br />

Abrasion<br />

Burns<br />

Bruising<br />

Open Fracture<br />

Closed Fracture<br />

Puncture<br />

Stab Wound<br />

GSW Entry<br />

GSW Exit<br />

Laceration<br />

Amputation<br />

Figure 3: The proportions of injuries, out of all injuries sustained by<br />

patients reported in the PRFs. (N.B. patients may have had more than<br />

one injury).<br />

B - Breathing:<br />

Table 1: Number of times officers used<br />

each airway manoeuvre.<br />

Airway Management Frequency<br />

Repositioning patient 28<br />

Suction 10<br />

Chin lift 15<br />

Jaw thrust 20<br />

Nasopharyngeal airway 15<br />

Oropharyngeal airway 16<br />

Supraglottic airway 1<br />

The respiratory rate was recorded in 265 (89%) PRFs. 33 (11%) patients<br />

had chest seals (vented or non-vented) and only one had a suspected<br />

flail chest. 121 patients were treated with oxygen (40% of patients). 39<br />

patients had breathing recorded as ‘not normal’ but were not given<br />

oxygen by police. This was mainly because it was refused, not available,<br />

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or given by the ambulance or fire service, so was not recorded. In three<br />

RTC patients with abnormal breathing and in two patients who had been<br />

stabbed and had chest seals applied, oxygen was not given.<br />

C - Circulation:<br />

141 (47%) PRFs had an exact heart rate filled in rather than only indicating<br />

the presence or absence of a pulse. CPR was required in 40 patients<br />

(13%) and 75% of those patients had an Automated External Defibrillator<br />

(AED) applied. ROSC on scene was achieved in 17 patients (43%).<br />

Pre-hospital oxygen treatment is mandatory in all major trauma; shock;<br />

cardiac arrest; convulsions; smoke inhalation; carbon monoxoide<br />

poisoning and in unwell paediatric patients 2 . Audits from 2010-15 and<br />

2017 indicate that oxygen delivery was generally lower than expected 4,9 .<br />

Data from this audit suggests that officers are very capable of identifying<br />

which patients require oxygen, but its use can be limited by the situation<br />

on scene. Oxygen delivery may be impractical, the patient may refuse it,<br />

or other emergency services may provide it. Considering that excessive<br />

oxygen can be detrimental to patient outcome 10 , its use in 2019<br />

generally seems appropriate.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

Discussion<br />

Airway Management<br />

The airway ladder used to protect the airway begins with repositioning the<br />

patient, using a chin lift or a jaw thrust, then progressing to airway adjuncts 2 .<br />

Often, simple manoeuvres such as positioning the patient on their side<br />

provided an adequate airway in the patients included in this audit.<br />

An audit in 2017 found some PRFs involving unresponsive casualties<br />

had the ‘Airway’ section of the form left blank. The report stressed<br />

that a patient’s reduced consciousness should always lead to prompt<br />

airway protection 4 . As in the manual, airway obstruction in unconscious<br />

patients is most commonly caused by the tongue and early, often<br />

simple actions can re-open the airway 2 . In 2019, all unresponsive<br />

patients’ airways were assessed and the majority were successfully<br />

managed with positional support or an adjunct. This indicates an<br />

improvement in airway management across all forces.<br />

There was only one occasion in which a supraglottic airway was used<br />

by an officer, although they were used by ambulance staff in two<br />

patients with major facial injuries. The low usage of these airways may<br />

be explained by the effectiveness of the commonly used adjuncts<br />

paired with careful patient positioning which protects the airway in<br />

the short-term before paramedics arrive. However, there may be an<br />

argument for using supraglottic airways more during CPR. In out of<br />

hospital cardiac arrest, there is evidence that asynchronous CPR has<br />

an improved outcome compared to conventional compressions and<br />

ventilation in a 30:2 ratio when CPR is not performed by an emergency<br />

medical service (EMS) professional 5, 6, 7 . In the context of these officers,<br />

it may be appropriate to use bag-valve-masks and supraglottic airways<br />

for asynchronous CPR in cardiac arrest. The technique is also useful if<br />

the number of responders is limited, as the airway can be maintained<br />

and good ventilation provided by only one person, whilst the other can<br />

deliver compressions. This is suitable for officers in specialist roles<br />

who may be alone or medically unsupported in more rural locations. If<br />

not frequently used, it may be a difficult skill to keep current. However,<br />

considering the number of cardiac arrests officers attend compared<br />

to some other incidents, it would become fairly common if used in<br />

most cardiac arrests. Certainly, those officers in specialist roles may<br />

benefit from this training. In the context of the Covid-19 pandemic,<br />

first responders should be wearing aerosol-generating procedure<br />

(AGP) personal protective equipment (PPE) if carrying out AGPs 8 . In<br />

light of this, it is unlikely that officers have adequate PPE to perform<br />

safe asynchronous CPR currently. This may mean that for the time<br />

being, officers get limited opportunities to use supraglottic airways and<br />

improve this skill.<br />

Non-Trauma Incidents<br />

There was an increased proportion of medical incidents in 2019<br />

compared to previous years 4,9 . 19 (8%) PRFs filled in between 2010-15<br />

were medical in nature, compared to 42 (14%) incidents in 2019. The<br />

types of medical problems encountered are comparable to previous<br />

years: mainly cardiac arrest or chest pain. Officers are trained in basic<br />

life support so are competent at managing medical cardiac arrests.<br />

However, 12 patients (29% of patients with medical problems) had<br />

(non-traumatic) chest pain, which is not covered to the same extent in<br />

training. This represents more than the combined number of patients with<br />

burns, found hanging or who had fallen from a height of greater than six<br />

feet (a combined total of 11 patients), and almost equals the number of<br />

shootings attended (14 patients). Although police officers are generally<br />

more likely to be called to trauma incidents, it is interesting that the most<br />

common medical emergencies are more frequent than some types of<br />

trauma. Perhaps this should be acknowledged more in training.<br />

There was a comparative increase in incidents related to drugs or<br />

alcohol. Between 2010-15, 31 PRFs (13%) reported alcohol/ drugs<br />

as the mechanism of injury 9 . Based on audits in 2017, 24 PRFs were<br />

in this category, 4,11 which made up 11% of incidents. In 2019 it rose<br />

to 67 PRFs (22%). However, alcohol/ drug use among patients may<br />

be underreported as, where it is not the main mechanism of injury, it<br />

may not be detailed in the PRF. The PRFs, which are specific to the<br />

patients, may not reflect the use of alcohol/ drugs in some situations.<br />

For example, in assaults, the victim may not be under the influence, but<br />

others involved may be.<br />

Pain<br />

Pain was very frequently reported in PRFs. However, the number is likely<br />

to be inaccurate, as it is clear that some injuries which would have been<br />

painful did not have pain recorded in the PRF, as noted in a 2017 audit 11 .<br />

Penthrox was only introduced in 2017 and it is difficult to compare<br />

trends due to differences in forms. In 2018, it was used in 10 (6%) patients<br />

compared to 23 (8%) in 2019. Generally, it appears to be effective in<br />

reducing pain score from severe to moderate, but its use by officers is<br />

currently limited by strict protocols. An audit of the use of Penthrox in<br />

these five forces 12 (Franklin, Elford et al, in preparation) looks at whether<br />

these protocols might be safely loosened to improve availability.<br />

Return of Spontaneous Circulation on Scene<br />

A report into out of hospital cardiac arrests 13 found that ROSC was<br />

achieved in 29.8% of all cases and in 41.8% of those who arrested in the<br />

presence of EMS. This indicates that the rate of 43% ROSC achieved by<br />

officers on scene is in line with the national standard. However, this is not<br />

directly comparable because the national report included all out of hospital<br />

cardiac arrest ROSCs rather than just ROSC on scene. Considering that<br />

144<br />

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these officers often deliver CPR in challenging circumstances, in a prehospital<br />

environment without the kit of an ambulance, it is a credit to their<br />

training and abilities that the rate is so high.<br />

Improvements to the PRF<br />

It is a pity that the comparability of PRFs is limited by subtle differences<br />

in the forms between forces. It would be easier to audit data if there was<br />

a national standard of form. Better still, an online version would reduce<br />

errors in audits and save time. That said, the difficulty of agreeing on a<br />

national form has previously been documented 4 . It is more likely that a<br />

national reporting template might be used to inform the development of<br />

PRFs toward a standard format.<br />

The components of the PRF could also be improved. The respiratory<br />

rate was almost always recorded, but less than half of PRFs recorded<br />

an exact heart rate. Perhaps if the form had tick box categories for heart<br />

rate, as it does currently for respiratory rate, it could improve the number<br />

filled out. Although it is less important than recording a respiratory<br />

rate, heart rate of over 120 beats per minute is currently part of the<br />

exclusion criteria for use of Penthrox, so it would be useful if this was<br />

incorporated in the PRF.<br />

The PRFs included in this audit may not reflect all of the medical care<br />

given by the units in 2019. For instance, some forms were not filled<br />

in completely. Many of the incomplete observations, examinations or<br />

interventions were carried out by other members of the emergency<br />

services (as often noted in the free-text). Adding a tick-box to indicate<br />

when this was the case would avoid care appearing insufficient and<br />

would highlight the admirable teamwork between police and medical<br />

practitioners on scene.<br />

The free text section is a valuable part of the form that to some degree<br />

bypasses the problems with the form itself. The level of detail in the freetext<br />

section of the PRFs is often high and also acknowledges the PRF as a<br />

feedback mechanism to improve on care given. However, in some PRFs,<br />

the free text contradicted the boxes ticked, which leads to flawed reporting.<br />

This audit reveals a substantial number of incidents involving mental<br />

health, but this is based on analysis of the free-text material and clinical<br />

judgement of the incidents. Unfortunately, as there is no standard way of<br />

reporting mental health incidents on the PRFs, it is difficult to compare<br />

this to previous years but it could be an interesting component of future<br />

audits. An important addition would be a tick-box option for mental<br />

health, to enable a more reliable audit of these cases.<br />

Conclusion<br />

highlights the importance of medical and mental health training.<br />

There is no doubt that the skill of these officers saves lives and the<br />

quality of care given is commendable.<br />

References<br />

1. Ons.gov.uk. <strong>2020</strong>. Crime In England And Wales - Office For National Statistics. [online]<br />

Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/<br />

bulletins/crimeinenglandandwales/yearendingdecember2019 [Accessed 02 May <strong>2020</strong>].<br />

2. Faculty of Pre-Hospital Care. Clinical material for police officers in specialist role,<br />

D13.2019.<br />

3. Williams, C., 2010. Police Clinical Governance. South Wales Police. Version 3.0<br />

4. Serebriakoff, P., Hartley, F., Hall, J. and Porter, K., 2019. An update on firearm police<br />

medical response. Trauma, 22(1), pp.76-77.<br />

5. Sanson, G., Ristagno, G., Caggegi, G., Patsoura, A., Xu, V., Zambon, M., Montalbano,<br />

D., Vukanovic, S. and Antonaglia, V., 2019. Impact of ‘synchronous’ and ‘asynchronous’<br />

CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest<br />

patients. Internal and Emergency Medicine, 14(7), pp.1129-1137. Available at: https://<br />

europepmc.org/article/med/31273676 [Accessed: 25 May <strong>2020</strong>].<br />

6. Zhan, L., Yang, L., Huang, Y., He, Q. and Liu, G., 2017. Continuous chest compression<br />

versus interrupted chest compression for cardiopulmonary resuscitation of nonasphyxial<br />

out-of-hospital cardiac arrest. Cochrane Database of Systematic Reviews.<br />

27(3). Available at: https://www.cochrane.org/CD010134/EMERG_continuous-chestcompression-versus-interrupted-chest-compression-cardiopulmonary-resuscitation-cpr<br />

[Accessed: 25 May <strong>2020</strong>].<br />

7. Hüpfl, M., Selig, H. and Nagele, P., 2010. Chest-compression-only versus standard<br />

cardiopulmonary resuscitation: a meta-analysis. The Lancet, 376(9752), pp.1552-<br />

1557. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-<br />

6736(10)61454-7/fulltext [Accessed: 25 May <strong>2020</strong>].<br />

8. Fphc.rcsed.ac.uk. <strong>2020</strong>. Statement From The FPHC Regarding Resuscitation During<br />

The COVID Pandemic - The Faculty Of Pre-Hospital Care. [online] Available at: https://<br />

fphc.rcsed.ac.uk/about/about-us/news/<strong>2020</strong>/statement-from-the-fphc-regardingresuscitation-during-the-covid-pandemic<br />

https://fphc.rcsed.ac.uk/my-fphc/about-us/<br />

news/<strong>2020</strong>/statement-from-the-fphc-regarding-resuscitation-during-the-covidpandemic.<br />

[Accessed 03 June <strong>2020</strong>].<br />

9. Hartley, F., Howells, A., Thurgood, A., Hall, F. and Porter, K., 2017. Medical training for<br />

police officers in specialist role (D13): A retrospective review of patient report forms<br />

from 2010–2015. Trauma, 20(1), pp.20-24.<br />

10. O’Driscoll, B., Howard, L., Earis, J., et al. British Thoracic Society Guideline for oxygen<br />

use in adults in healthcare and emergency settings . BMJ Open Resp Res 2017;4<br />

11. Rhimes, P., Williams, S., Hall, J., Porter, K, <strong>2020</strong>. Retrospective Audit of Patient Report<br />

Forms (PRFs) from semi rural specialist police firearms units January to December<br />

2017. Faculty Published Resources - The Faculty of Pre-Hospital Care. Available at:<br />

https://fphc.rcsed.ac.uk/media/2883/retrospective-audit-of-patient-report-forms-prfsfrom-semi-rural-specialist-police.pdf<br />

[Accessed: 30 June <strong>2020</strong>].<br />

12. Franklin, M., Elford, J. Hall, J., Porter, K., <strong>2020</strong>. Penthrox Audit <strong>2020</strong>. Due for<br />

publication. Available at: https://fphc.rcsed.ac.uk/media/2898/administration-ofmethoxyflurane-penthrox-as-a-pre-hospital-analgesic-by-specialist-police-officers-aretrospective-audit-of-patient-report-forms.pdf<br />

13. Out-of-Hospital Cardiac Arrest Outcomes Registry Epidemiology Report, 2018. English<br />

<strong>Ambulance</strong> Services. [online] Available at: https://warwick.ac.uk/fac/sci/med/research/<br />

ctu/trials/ohcao/publications/epidemiologyreports/ohcao_epidemiology_report_2018_<br />

published.pdf [Accessed: 25 May <strong>2020</strong>].<br />

PRFs recording the management of patients are essential tools for<br />

governing their clinical activities, aiding the training of specialist<br />

officers and enabling quality improvement of the care they provide.<br />

Simple modifications to the forms could enable police officers to<br />

more accurately and reliably record information. Officers showed<br />

improvements in airway management compared to previous years<br />

and there is possibly scope for increased use of supraglottic airway<br />

devices, primarily for asynchronous CPR. Generally, oxygen was used<br />

appropriately and the frequency of ROSC achieved demonstrates sound<br />

resuscitation skills. Incidents are frequently not trauma-related, which<br />

Authors<br />

Corresponding author<br />

Dr Jane Elford MBChB BSc (Hons), Foundation Year 1 Doctor, Ysbyty<br />

Gwynedd, Bangor. jane.elford@doctors.org.uk<br />

Miss Maggie Franklin, Medical Student, University of Liverpool.<br />

Miss Amy Elford BSc (Hons), University of Durham.<br />

Dr J Hall MBE, Hon Secretary FPHC RCS Ed.<br />

Prof. Sir K Porter, Professor of Clinical Traumatology, University Hospital<br />

Birmingham.<br />

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Abstract<br />

One of the biggest challenges facing medical teams treating Covid-19 patients<br />

is identifying which ones are likely to suffer the most extreme responses to the<br />

virus. Knowing this would make it possible to direct resources more efficiently<br />

and begin potentially life-saving treatment earlier.<br />

A large proportion of Covid-19 patients recover without a serious illness, and<br />

while certain factors such as age, diabetes or obesity are known to increase<br />

the chances that a patient will have more serious complications, these alone<br />

do not give a clear prediction of how the disease will progress.<br />

Now scientists believe they have an answer: a simple, affordable well<br />

established blood test which essentially measures the thickness of blood<br />

and makes it possible to separate the patients that are mildly affected, on the<br />

road to recovery or who are likely to deteriorate.<br />

The test in question is clinical viscosity. Scientists have been measuring<br />

viscosity for over 100 years and easy to use analysers have been available<br />

for 50 years. Interest in and demand for clinical viscometers has increased<br />

following the discovery that severe Covid-19 patients have very significantly<br />

raised plasma and serum viscosity levels.<br />

This is reported in the publication of a paper in the Lancet on 25 May <strong>2020</strong> by<br />

Cheryl Maier from Emory University, Georgia, Atlanta which demonstrated a<br />

dramatic rise of blood viscosity in severe Covid-19 patients. The sickest patients<br />

had the highest plasma viscosity levels, more than double normal values, and<br />

were also more likely to have a blood clot.<br />

Despite having prescribed medications, known as blood thinners, to prevent<br />

blood clots in Covid-19 patients, clotting unusually still occurred. Although<br />

referred to as blood thinners, these medications would normally block factors<br />

involved in the clotting process as opposed to thinning the blood. As a result<br />

of this, it is believed that there is more to investigate within the coagulation<br />

process. Hyperviscosity may be an important piece of the puzzle in linking<br />

inflammation to clotting. Cheryl Maier said: “One thing that stood out was the<br />

extremely high levels of fibrinogen, a big sticky protein that increases with<br />

inflammation and is a key building block for making blood clots.”<br />

Performing plasma viscosity measurements is a simple procedure when<br />

using viscometers specifically designed for clinical analysis. However, it<br />

appears that in north America, (USA and Canada) the majority of clinical<br />

laboratories are having to use viscometers that are designed for commercial<br />

use or for whole blood analysis. Many publications on clinical viscosity<br />

from north America actually report a “relative” viscosity rather than a true<br />

viscosity. This is because the analysers in use have not been designed to be<br />

calibrated, to standardised international values, SI units.<br />

The advantage of reporting an absolute viscosity value rather than a<br />

relative viscosity, is that absolute viscosities are scientifically a true value,<br />

independent of testing method and removes the potential for errors due to<br />

contamination of the water standard or the requirement to specify type of<br />

water used; e.g. tap water, distilled water, sterile water, de-ionised water etc.<br />

Results are then capable of being expressed in an internationally agreed<br />

standard format of Pascals second (Pa-s).<br />

The main advantage of using a viscosity system which has been designed,<br />

calibrated and controlled for clinical analysis, compared to an adapted<br />

industrial viscometer is that a clinical viscometer has increased precision<br />

and sensitivity in the clinical relevant range of 1.2 to 10 mPa-s. Commercial<br />

viscometers tend to have an operating range of between 10 and 100,000 Pa-s.<br />

Introducing clinical viscometers to pathology laboratories will enable<br />

clinicians to rapidly obtain results which can be easily interpreted for both<br />

plasma and serum viscosity, which for covid-19 patients will allow a simple<br />

rapid decision on which patients require more intensive therapy.<br />

Further advantages include:<br />

• Systems designed for closed vial sampling to reduce biohazard risk to<br />

operators<br />

• Systems designed for high sample throughput by fully automated<br />

sampling and cleaning<br />

• Automated cleaning designed to remove sample contamination and carry over<br />

• Software designed to highlight clinically abnormal/significant results<br />

• Systems designed to analyse small sample volumes under 0.5ml<br />

• As only 50µl is used per test, repeat tests can be carried out on 0.5ml sample<br />

• Integration to clinical laboratory Information Management Systems (LIMS)<br />

standard<br />

• Systems designed to be compliant with clinical laboratory regulatory<br />

requirements such as ISO:151489<br />

How can a combined plasma and serum viscosity be used and<br />

interpreted?<br />

The key to predicting how a patient’s illness is progressing lies in comparing two<br />

different viscosity measurements, blood plasma and blood serum both of which<br />

can be carried out on modern clinical viscometers.<br />

Plasma viscosity is mainly determined by the level of a blood clotting protein<br />

called fibrinogen and antibody concentrations produced by the body’s<br />

immune system, when it detects and neutralises harmful substances.<br />

Dr.Cheryl Maier’s Covid-19 patients had fibrinogen levels of up to five times<br />

the normal value.<br />

Serum is a clear fluid released from blood when blood clots. There is no<br />

fibrinogen in serum as this is all used in the production of the clot. Serum<br />

viscosity levels are mainly dependent upon the number of antibodies, the<br />

‘fighting proteins’ present. So, an increased serum viscosity can indicate a<br />

strong antibody response to Covid-19.<br />

If both plasma and serum results are normal and the patient has a diagnosis of<br />

Covid-19, they are probably asymptomatic, an infected patient who does not<br />

present with serious symptoms but is possibly a carrier.<br />

If only the serum viscosity is raised, this indicates increased antibody<br />

production and may indicate a recovering patient.<br />

If the plasma and serum viscosity analysis reveals that both results are<br />

raised, then the patient has raised antibody levels, and may also have a<br />

raised fibrinogen level. These patients should have their fibrinogen monitored<br />

to see if it is rising or falling.<br />

A raised plasma viscosity with normal serum viscosity indicates raised<br />

fibrinogen with no antibody response. These patients are probably<br />

deteriorating and will therefore be more likely to require intensive therapy.<br />

146<br />

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Just brew-ti-ful:<br />

firefighter<br />

entrepreneurs serve<br />

up 20,000 cups of<br />

coffee to Covid-19<br />

key workers<br />

Two firefighter entrepreneurs<br />

handed out over 20,000 cups<br />

of coffee to frontline key<br />

workers, including <strong>Ambulance</strong><br />

staff, during the peak of the<br />

coronavirus in the <strong>UK</strong> as they<br />

gear up for a second spike in<br />

the pandemic.<br />

Matt Broxton, 28, and Tom Taylor,<br />

28, decided to set up an online<br />

coffee company because the<br />

instant coffee at the fire stations<br />

they both worked at was ‘terrible’<br />

and ‘tasted like tarmac’.<br />

The pair has sold 4741.25kg of<br />

coffee so far which at 7g a cup<br />

is the equivalent of 677,321 cups<br />

of coffee with 20,000 of those<br />

going direct to the frontline for<br />

free during the <strong>UK</strong> lockdown in<br />

the spring.<br />

Frontline Coffee aims to support<br />

frontline charities ‘one coffee bean<br />

at a time’ and has so far raised<br />

over £17,000 with donations<br />

made to NHS Charities Together,<br />

the RNLI (Royal National Lifeboat<br />

Institution), TASC (The <strong>Ambulance</strong><br />

Staff Charity) and The Firefighters<br />

Charity.<br />

Matt said: “Our emergency and<br />

health services are the best in<br />

the world, but they are only the<br />

best because of the people that<br />

make them up. We strive to be<br />

a company that supports these<br />

amazing people.<br />

“In the fire service after you’ve<br />

been out on a ‘shout’ to a house<br />

fire or had to deal with a difficult<br />

situation, it’s a typically British<br />

thing to do to have a coffee or<br />

cup of tea.<br />

“When lockdown happened and<br />

key workers were having to deal<br />

with the enormity of Covid-19,<br />

we felt these people would be in<br />

even more need of a good cup of<br />

coffee when they finally sat down<br />

for a break.<br />

“That is why we made it our<br />

mission to get good coffee to key<br />

workers working exceptionally<br />

hard during these troubling times<br />

in hospitals, police, fire and<br />

ambulance stations during the <strong>UK</strong><br />

lockdown.<br />

“Our soul mission is also to raise<br />

awareness about the great work<br />

They felt all key workers involved<br />

in dealing with the Covid-19<br />

pandemic ‘deserved a decent cup<br />

of coffee’. The young founders set<br />

up Frontline Coffee with its profits<br />

donated to emergency service<br />

and health charities.<br />

“Me and Tom both have a passion<br />

for real coffee so we always<br />

used to joke about how terrible<br />

the instant coffee was at the fire<br />

station and how it used to taste<br />

like tarmac.<br />

our frontline services do and<br />

raise money for their respective<br />

charities. We’re absolutely<br />

delighted to have raised more<br />

than £17,000 so far.”<br />

Frontline Coffee has taken off so<br />

rapidly that Matt has left his job<br />

as a firefighter with the London<br />

Fire Brigade to focus on their<br />

social enterprise full-time. Tom,<br />

meanwhile, still works for the<br />

Devon and Somerset fire service.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

148<br />

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i-view <br />

Matt and Tom’s collection<br />

includes a blend for each<br />

emergency service such as First<br />

Response supporting TASC, the<br />

Bevan Blend for NHS Charities<br />

Together named after its creator,<br />

Aneurin Bevan and The Thin Red<br />

Line for Firefighter Charity and<br />

more. Frontline Coffee also sell<br />

grinders, brewing kits, specialist<br />

tea and merchandise.<br />

The pair got started with one<br />

second hand industrial roaster<br />

and it is now manufactured<br />

on a grand scale in the south<br />

west of England. Matt and<br />

Tom hand-picked the coffee<br />

beans to match the exact taste<br />

the pair were looking for. They<br />

hand-pack orders themselves<br />

before arranging deliveries to<br />

customers.<br />

Tom said: “We never expected<br />

Frontline Coffee to take off like<br />

this but it grew legs so we had to<br />

make a decision that one of us<br />

would have to take it on full-time.<br />

We decided that Matt would be<br />

better pushing it further on a dayto-day<br />

basis as he had created<br />

the website and runs all of our<br />

social media.<br />

“We didn’t want to look back in<br />

10 years’ time and say ‘what if?’.<br />

We had spoken quite a few times<br />

about setting up something for<br />

charity and giving something<br />

back. The sudden arrival of<br />

Covid-19 brought Frontline Coffee<br />

forward quicker than either of us<br />

ever imagined. It has just been an<br />

amazing journey so far.”<br />

Working in the Frontline services<br />

clearly runs in both families. Matt’s<br />

mum, Jannette was a nurse, and<br />

his Dad, Gary and uncle, Ron,<br />

were both in the Royal Navy, while<br />

girlfriend Rosie, who is Tom’s<br />

cousin, is also a nurse. Tom’s<br />

wife, Kirsty, meanwhile, is a police<br />

detective.<br />

Matt added: “Both mine and<br />

Tom’s families both have a history<br />

of working for frontline services so<br />

I guess we all have it in our blood<br />

to help people. Now more than<br />

ever, we aim to support our key<br />

workers through this next set of<br />

challenging times.”<br />

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WMAS<br />

<strong>Ambulance</strong>: Code<br />

Red, the new<br />

documentary on<br />

paramedics<br />

The first episode of the new<br />

documentary on paramedics<br />

“<strong>Ambulance</strong>: Code Red” went<br />

on air on Channel 5. The<br />

EMS protagonist is the West<br />

Midlands <strong>Ambulance</strong> Service.<br />

Critical care paramedic Tom<br />

Waters speaks about his<br />

experience as a paramedic on<br />

the ambulance, but also about his<br />

experience on stage. Indeed, he<br />

starred in this new documentary<br />

series on paramedics and<br />

ambulance life.<br />

In 2015, Tom alongside Dr Dave<br />

Cooper was involved in the rescue<br />

and treatment of 18-year-old Leah<br />

Washington and 20-year-old Vicky<br />

Cooper during the Alton Towers<br />

rollercoaster crash. Together they<br />

climbed 40ft to treat Leah and<br />

Vicky, who both had to have part<br />

of their legs amputated following<br />

the horrific accident. They were<br />

given a national award for their<br />

efforts.<br />

In this new series, Tom will<br />

appears with specially trained<br />

paramedics battling at the<br />

roadside to save a 13-year-old<br />

boy left with suspected brain<br />

injuries following a road accident.<br />

Time is ticking for the patient<br />

and the critical care paramedics<br />

will have to use their diagnostic<br />

and life-saving skills to prioritise<br />

treatment so he can make it to the<br />

hospital.<br />

Without giving further spoilers,<br />

the chief executive of West<br />

Midlands <strong>Ambulance</strong> Service,<br />

Anthony Marsh, reported that “the<br />

programme gives a real insight<br />

into the support that critical-care<br />

paramedics and doctors provided<br />

by the air ambulance charity<br />

can give to its own ambulance<br />

crews who are dealing with some<br />

of the most complex patients.<br />

It demonstrates how they work<br />

with the crews on scene to use<br />

their enhanced skills to benefit<br />

patients. Without the work of the<br />

staff on scene, the teams wouldn’t<br />

be able to use those skills, so it<br />

really is all about working together.<br />

The teams provide critical care<br />

at the scene that saves lives,<br />

brains and limbs, including prehospital<br />

surgery and pre-hospital<br />

anaesthesia.”<br />

EEAST<br />

<strong>Ambulance</strong> service<br />

strikes back<br />

with hard-hitting<br />

campaign against<br />

abuse<br />

The EAST of England<br />

<strong>Ambulance</strong> Service NHS Trust<br />

has responded to increased<br />

assaults and abuse against<br />

staff with a tough publicity<br />

campaign that spells out the<br />

impact that abuse has on<br />

crews – and their ability to do<br />

their job.<br />

The Choose Respect!<br />

campaign features shocking<br />

images of ambulance crew<br />

members – accompanied by<br />

text describing being violently<br />

or sexually assaulted while on<br />

duty, along with facts about how<br />

it affected their ability to work.<br />

Alex, 27, is an Emergency<br />

Medical Technician, working out<br />

of Thetford, who volunteered to<br />

feature in the campaign.<br />

He was assaulted on Boxing<br />

Day 2019 by a violent drunk,<br />

causing him to be off work for<br />

more than a week. He said:<br />

assistance, and the police took<br />

him away.<br />

“There was no major damage,<br />

but I was off work for a week<br />

and a half as I couldn’t drive<br />

because of headaches. And<br />

I had a black eye for three<br />

weeks.<br />

“I’m more hesitant now about<br />

going into situations that are<br />

flagged as potentially violent…<br />

instead of going in and seeing<br />

what the situation is, I’ll wait<br />

until the Police arrive.”<br />

Chief Executive Dorothy<br />

Hosein said the campaign was<br />

intended to make people aware<br />

that assaults against staff were<br />

not without consequences:<br />

“We are seeing a steady<br />

increase in assaults and abuse,<br />

year-on-year from just over<br />

1,000 incidents in 2015-16 to<br />

over 1,300 in 2018-19.<br />

“This has to stop. There were<br />

250 incidents between March 1<br />

and June 11 this year alone.<br />

Not only does this cause<br />

terrible long-term physical<br />

and psychological harm to our<br />

“We had taken our patient to<br />

West Suffolk Hospital, when<br />

there was a problem with<br />

another patient being admitted<br />

in front of us. The patient<br />

became aggressive to the duty<br />

sister and the students, and<br />

when I went over to him, he<br />

punched my colleague.<br />

employees, but clinicians and<br />

other essential staff needing<br />

time off work because of<br />

assaults or abuse affects our<br />

capacity to serve the public<br />

during the pandemic.<br />

“No-one deserves to be abused<br />

at work, but we will not tolerate<br />

our staff – who are only ever<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

“I managed to push him out the<br />

of door, where he began to try<br />

and break into the back of an<br />

ambulance before he returned<br />

and tried to hit me.<br />

“I dodged the punch, but didn’t<br />

expect the head-butt. The<br />

security team and two passing<br />

prison guards came to my<br />

there to help people – being<br />

abused and left unable to work,<br />

at a time when the public really<br />

needs them.<br />

“We will always support our<br />

staff and work with the police<br />

to secure convictions and the<br />

strongest penalties wherever<br />

appropriate.”<br />

150<br />

For further recruitment vacancies visit: www.ambulanceukonline.com

www.theortusgroup.com T: +44 (0)845 459 4706<br />


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For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />

We aim to support, engage, and debate all<br />

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AMBULANCE <strong>UK</strong> - OCTOBER<br />

Statement in<br />

response to CQC<br />

inspection report<br />

Today’s Care Quality<br />

Commission report is<br />

clear that the Trust has<br />

not addressed some longstanding<br />

concerns around<br />

culture, leadership and<br />

governance. The Trust’s<br />

executive team absolutely<br />

recognise the seriousness<br />

of the concerns raised by<br />

the CQC, and have set out to<br />

improve the organisation’s<br />

culture, strengthen<br />

safeguarding, and tackle<br />

inappropriate behaviour, as<br />

urgent priorities.<br />

Since the inspection during June<br />

and July this summer, the Trust<br />

has:<br />

• updated safeguarding policies;<br />

now using new procedures<br />

to record, manage and audit<br />

concerns<br />

• increased support and<br />

mentoring for staff raising<br />

concerns and clearer routes<br />

for mental health support<br />

identified;<br />

• introduced more robust<br />

complaints procedures to<br />

ensure effective investigations<br />

and lessons are learned<br />

systematically.<br />

During the next month the Trust<br />

will:<br />

• increase the visibility of the<br />

Freedom to Speak Up Guardian<br />

and encourage staff to speak<br />

up<br />

• introduce campaigns to<br />

encourage positive cultural<br />

change and behaviour<br />

• survey all staff on their<br />

experience of the Trust’s<br />

culture including inappropriate<br />

behaviour.<br />

The Chair of the East of England<br />

<strong>Ambulance</strong> Service, Nicola<br />

Scrivings said:<br />

“Today’s report calls out where<br />

we need to improve and we will<br />

now do everything possible, as<br />

fast as possible, to make the<br />

improvements required.<br />

“We are working closely with the<br />

CQC, NHS colleagues and other<br />

partners to take action right now<br />

to address these concerns and<br />

put this right for the long-term.<br />

“The trust aims to provide<br />

outstanding quality of care and<br />

performance for patients and be<br />

an exceptional place to work,<br />

volunteer and learn. In a message<br />

to staff today, the executive<br />

team has again reinforced its<br />

commitment to listen to and<br />

support anyone who raises<br />

concerns.<br />

“It is clear from the CQC staff<br />

survey that the majority of staff<br />

at the Trust are proud to work for<br />

EEAST. The role of the leaders<br />

is to make sure every member<br />

of the team feels that pride, with<br />

the support and culture they<br />

deserve.”<br />

SECAMB<br />

<strong>Ambulance</strong> crews<br />

return to improved<br />

and modernised<br />

Sheppey station<br />

South East Coast <strong>Ambulance</strong><br />

Service (SECAmb) staff have<br />

returned to Sheppey <strong>Ambulance</strong><br />

Station following a six-month<br />

major refurbishment project.<br />

The station modernisation forms<br />

part of the Trust’s ongoing work<br />

to convert all of its estate to its<br />

Make Ready system – a vehicle<br />

preparation system which sees<br />

specialist teams of staff employed<br />

to clean, restock and maintain<br />

vehicles, meaning staff, who<br />

previously undertook these tasks,<br />

can spend more time treating<br />

patients.<br />

The improvement work at the<br />

Main Road site in Queenborough<br />

means the station now boasts<br />

modern rest, educational and<br />

training facilities including a<br />

training room including named<br />

in memory of Rhod Prosser, a<br />

SECAmb paramedic who sadly<br />

died following a battle with cancer<br />

earlier this year.<br />

<strong>Ambulance</strong> crews, who<br />

temporarily began shifts in<br />

Sittingbourne while the works<br />

took place, and responded<br />

from response posts including<br />

Sheppey Fire Station, will now<br />

start their shifts at the new base<br />

before being posted to respond<br />

from a number of <strong>Ambulance</strong><br />

Community Response Posts<br />

across the region.<br />

As part of wider improvements<br />

in the area, and as announced<br />

last month, ambulance crews<br />

starting and ending their shifts<br />

at Medway and Sittingbourne<br />

ambulance stations will, instead,<br />

start and finish at a new facility<br />

in Gillingham, which expected to<br />

become operational in 2022.<br />

The new centre will house a<br />

Make Ready Centre as well as<br />

999 and 111 operations centres.<br />

Sheppey vehicles will feed into<br />

the Gillingham centre regularly<br />

for restocking, cleaning and<br />

maintenance.<br />

SECAmb Operating Unit Manager<br />

for Dartford and Medway, Will<br />

Bellamy, said: “It’s been great to<br />

welcome crews back to the muchimproved<br />

station. Our staff, and in<br />

turn our patients, will benefit from<br />

this development which ensures<br />

our site on the island is modern<br />

and provides us with a building<br />

and facilities which are fit for the<br />

future.<br />

“I would like to thank staff for their<br />

patience while the work took place<br />

and also Kent Fire and Rescue for<br />

their continued support which has<br />

included us using their premises<br />

as a rest point for crews.”<br />

SECAMB<br />

Trust achieves<br />

gold award for<br />

commitment to<br />

equality and diversity<br />

South East Coast <strong>Ambulance</strong><br />

Service NHS Foundation Trust<br />

(SECAmb) is pleased to have<br />

achieved a gold award from<br />

enei (Employers Network for<br />

Equality and Inclusion).<br />

The TIDE (Talent Inclusion and<br />

Diversity Evaluation) gold award is<br />

the third year in a row SECAmb has<br />

been recognised by the organisation<br />

following two silver awards.<br />

SECAmb is the only ambulance<br />

trust in a record 98 entries from<br />

organisations from across 26<br />

sectors. A total of 51 achieved an<br />

award with SECAmb among 13<br />

achieving the highly-coveted gold<br />

award.<br />

Other gold winners include IBM<br />

<strong>UK</strong> ltd, the Ministry of Justice and<br />

fellow NHS organisation, North East<br />

London NHS Foundation Trust.<br />

SECAmb will use the benchmark<br />

report to implement further<br />

improvements in how diversity<br />

and inclusion is thoroughly<br />

embedded throughout the<br />

whole organisation and a part of<br />

everything it does.<br />

SECAmb Executive Director of<br />

HR & Organisation Development,<br />

Ali Mohammed said: “I’m really<br />

pleased that our approach to<br />

diversity and inclusion has once<br />

again been recognised, this year<br />

with an enei gold benchmark.<br />

We know that we must do lots<br />

more to ensure this is embedded<br />

throughout the whole organisation<br />

but it’s great to see our continued<br />

progress recognised in this way.”<br />

152<br />

For more news visit: www.ambulanceukonline.com

Solution Sheet<br />



Insights from next-generation tools<br />

Next-generation (NG9-1-1 / 112) technologies open new<br />

In today’s world, headline-grabbing emergencies are happening<br />

more communications frequently in more channels places. (e.g., It is hard texting to watch and messaging<br />

television, listen<br />

to apps) the radio, between or read the a news public article and without public safety learning answering about another<br />

incident points impacting (PSAPs). And communities because in PSAPs both the are short the and first long link term. in<br />

the public safety chain, many next-generation solutions<br />

Unfortunately, are designed those with responding call-takers to complex in mind. emergencies often have very<br />

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explosion, terrorist<br />

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a fill need operational for clear, immediate blind spots insights with that assistive can inform insights, swift and effective helping<br />

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data, Once it considered promotes confident a futuristic decision-making.<br />

science fiction concept,<br />

Hexagon’s artificial Safety intelligence & Infrastructure (AI) division plays identified critical this roles gap in and developed<br />

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When complex emergencies occur, anyone working in a public safety<br />

suspects, of new enterprise suspect vehicles, apps will unsafe have embedded incident scenes, AI by 2025. or a<br />

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field But what gives is first it, responders exactly? The invaluable National information.<br />

Institute of Justice<br />

members of the same team may hold different fragments of information.<br />

describes AI as a machine’s ability to independently<br />

These fragments need to be filtered and pieced together to understand<br />

Organizations perceive and respond commonly to tasks utilize that AI in would other typically ways,<br />

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those types of<br />

situations emails, that preventing are keeping banking agency supervisors fraud, and even directors diagnosing up at night.<br />

medical conditions.<br />

Many agencies have analytics solutions that mine data and give clarity<br />

to How past AI events processes in order data to prepare varies for because the future. it A can recent be survey autonomous of<br />

public (i.e., safety applied professionals across an in the entire US found business 81 percent process) of respondents or<br />

said assistive AI somewhat, (i.e., applied very, or extremely in specific important stages). to their IDC organisations.*<br />

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a helipad so close to our highly<br />

Patients were previously flown to<br />

Measuring 30 metres by 30<br />

£600,000 helipad<br />

operational at Hull<br />

Royal Infirmary<br />

Helicopters are now able to fly<br />

critically ill and injured patients<br />

directly to Hull Royal Infirmary<br />

after its new £600,000 helipad<br />

was declared operational.<br />

Hull University Teaching Hospitals<br />

NHS Trust has completed the<br />

major construction project<br />

so patients seriously hurt in<br />

accidents across East and North<br />

Yorkshire and parts of Lincolnshire<br />

can be flown into the hospital<br />

grounds, the Major Trauma Centre<br />

(MTC) for the area.<br />

The helipad, behind Hull Royal<br />

Infirmary’s £12m Emergency<br />

Department (ED), had been<br />

funded entirely by the HELP<br />

Appeal, the only charity in the<br />

country dedicated to funding NHS<br />

hospital helipads.<br />

Trust Chief Executive Chris<br />

Long said: “We are deeply<br />

grateful to the HELP Appeal for<br />

its £600,000 donation which<br />

has allowed us to construct<br />

the helipad directly behind our<br />

Emergency Department.<br />

skilled major trauma team means<br />

we will be able to save more lives<br />

in situations where every second<br />

counts.”<br />

Robert Bertram, Chief Executive<br />

of the HELP Appeal, said:<br />

“As the Major Trauma Centre<br />

for the whole region, funding<br />

a helipad outside ED was<br />

essential. Everyone is aware of<br />

the vital roles that hospitals and<br />

air ambulances play in treating<br />

a critically ill patient but having<br />

a helipad outside the ED can<br />

play a significant part in saving<br />

vital minutes when transporting<br />

a patient to the expert care they<br />

need to save lives.<br />

“As the only charity in the country<br />

funding live-saving helipads, we<br />

are pleased to be able to cover<br />

the entire cost of the helipad.<br />

We know the difference having a<br />

ground-level helipad right outside<br />

ED would make.<br />

“With the support of the air<br />

ambulances and the excellent<br />

emergency care team at Hull<br />

Royal Infirmary, this unique mix of<br />

helicopters, helipad and hospital<br />

medical staff will make a huge<br />

difference to those people who<br />

may need life-saving treatment<br />

the helipad on the other side of<br />

the hospital car park on Argyle<br />

Street and had to be transferred<br />

to Hull Royal in an ambulance<br />

along Anlaby Road, one of the<br />

busiest roads in the city centre.<br />

Intensive Care Consultant Dr<br />

Tom Cowlam, the trust’s clinical<br />

lead for the MTC, said: “The new<br />

helipad will shorten the journey<br />

by a quarter of an hour and<br />

remove the need for the patient<br />

to be transferred in a second<br />

ambulance to the Emergency<br />

Department.<br />

“It will make the transfer quicker<br />

and more seamless for the trauma<br />

patient.<br />

“When you have a really poorly<br />

person, this might be the<br />

difference between life and death<br />

because this could be the time<br />

when they are having surgery or a<br />

massive blood transfusion to save<br />

them.”<br />

Duncan Taylor, Director of Estates,<br />

Facilities and Development, said<br />

the trust funded the demolition<br />

of the Haughton building among<br />

others and clearance of the site<br />

before main contractor Unico<br />

Construction could begin work on<br />

metres, 900 tonnes of concrete<br />

were brought onto the hospital<br />

site, over the course of one day.<br />

An access road for fire engines<br />

and service vehicles has been<br />

built alongside a second<br />

pedestrian route where patients<br />

will be carried out of the air<br />

ambulance and rushed into the<br />

ED.<br />

Special double fences have been<br />

erected around the helipad as<br />

“baffles” to reduce noise pollution,<br />

provide security and the majority<br />

of the site has been turfed with<br />

pinned grass covered with mesh<br />

overlay to act as a “soakaway” to<br />

remove water from the helipad.<br />

Lights have been imported<br />

from Holland to be set into<br />

the concrete, now covered in<br />

specialist paint.<br />

Hull is one of the country’s 27<br />

Major Trauma Centres (MTCs),<br />

credited with saving an additional<br />

1,600 people’s lives since they<br />

were established in 2012.<br />

Lincs and Nott Air <strong>Ambulance</strong><br />

use the Hull helipad most often,<br />

with Yorkshire Air <strong>Ambulance</strong><br />

and Derbyshire, Leicester and<br />

Rutland Air <strong>Ambulance</strong> also flying<br />

casualties to the city.<br />

“There is no doubt that having<br />

urgently.”<br />

the helipad.<br />

The Search and Rescue<br />

helicopter, based at Humberside<br />

Airport, also lands in Hull with<br />

people winched off mountains or<br />

those injured on oil rigs or out at<br />

sea.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

The helipad will also be used by<br />

the Children’s Air <strong>Ambulance</strong>,<br />

which can fly specialist medical<br />

teams into Hull to treat seriously<br />

ill children as well as fly children<br />

from here to hospital with<br />

specialist paediatric services.<br />

To support the HELP Appeal<br />

please call the donation helpline<br />

on 0800 389 8999 or text HPAD22<br />

plus the amount and send to<br />

70070.<br />

154<br />

For further recruitment vacancies visit: www.ambulanceukonline.com


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> Training and training equipment<br />

> Vehicles and ancillary kit<br />

> ICT<br />

> Road safety services and kit<br />

> Infection control<br />

> Control rooms<br />

> Facilities<br />

> Health & safety<br />

> Emergency planning/resilience<br />

> Recruitment<br />

NEW FOR 2021<br />

“<br />

It’s the best show that I can recall<br />

coming to. There’s a buzz about<br />

the show and a lot of energy.<br />

The quality of the people who have<br />

come and who are genuinely<br />

interested in what we are doing,<br />

we can offer them a genuine benefit.<br />

It’s been a real roaring success.<br />

Colin Hanna, Head of National Sales,<br />

St John <strong>Ambulance</strong><br />


”<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

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LAS<br />

Service introduces<br />

new measures<br />

to help lead to<br />

tougher staff assault<br />

sentences<br />

We have recruited two Violence<br />

Reduction Officers as part of our<br />

ongoing work to protect staff.<br />

The officers will work closely with<br />

the Met Police as they support<br />

victims who want to take their<br />

cases to court.<br />

Louise Murray is one of the new<br />

Violence Reduction Officers and<br />

also works as an emergency<br />

medical technician out of Bromley<br />

<strong>Ambulance</strong> Station.<br />

She said: “Aggression against our<br />

staff can leave them in fear, it can<br />

lead to PTSD and cause all sorts<br />

of mental health problems.<br />

“I’ve seen the increase in assaults<br />

and know the impact it can have –<br />

I’ve been assaulted myself. That’s<br />

why I’m so passionate about<br />

what we are doing – making sure<br />

people have the support they<br />

need and also getting as much<br />

evidence as we can so we can<br />

push for prosecutions.”<br />

“We will do everything to support<br />

someone who has been attacked<br />

and that includes trying to ensure<br />

the attacker is prosecuted.”<br />

<strong>Ambulance</strong> crews in London were<br />

physically attacked 59 times in<br />

August alone.<br />

New figures from the Service<br />

show assaults dropped during<br />

March and April but as lockdown<br />

restrictions began easing,<br />

physical abuse has been on<br />

the rise with an average of two<br />

attacks a day.<br />

There have been 260 violent<br />

incidents since April – usually<br />

patients or their families attacking<br />

the ambulance crews who are<br />

there to help.<br />

Attacks include kicking, punching,<br />

head-butting and biting and there<br />

have also been nine assaults with<br />

weapons.<br />

There were 625 reported physical<br />

attacks last year and a further<br />

713 non-physical assaults, which<br />

include threats and verbal abuse.<br />

Managers fear the true scale of<br />

the problem could be worse as<br />

incidents are often not reported –<br />

despite a campaign to encourage<br />

staff to report all abuse.<br />

Chief Executive Garrett Emmerson<br />

said: “Protecting our people and<br />

ensuring they are safe while they<br />

are working is a highest priority.<br />

“Our crews and call handlers<br />

have made huge sacrifices to<br />

care for patients with courage<br />

and compassion – it is absolutely<br />

disgusting for them to be attacked<br />

while doing so and should not be<br />

seen as something which goes<br />

with the job.<br />

“We will push for the prosecution<br />

of anyone who attacks our staff.”<br />

saying exactly where you are can<br />

be challenging. Emergencies<br />

can happen anywhere, from<br />

Northumberland countryside to<br />

heritage North East beaches;<br />

these all present a challenge to<br />

locate patients in rural areas for<br />

NEAS.<br />

Explaining where you are can<br />

be difficult over the phone and<br />

landmark-based descriptions<br />

are prone to errors and GPS<br />

coordinates are long and difficult<br />

to communicate. Finding your<br />

location quickly can mean the<br />

difference between life and<br />

death in some cases. In winter<br />

especially, if you are not found<br />

quick enough outside you can<br />

suffer from hypothermia, which is<br />

a series condition when your body<br />

temperature drops dangerously<br />

low.<br />

The what3words platform has<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

Violence Reduction Officer Louise<br />

Violence Reduction Officer Andrew<br />

NEAS<br />

3 words can save<br />

lives<br />

The North East <strong>Ambulance</strong><br />

Service (NEAS) has invested<br />

in new technology to increase<br />

its response time to patients in<br />

hard to reach locations.<br />

‘Where’s the emergency?’ is<br />

one of the first questions you<br />

are asked when calling 999 but<br />

divided coordinates of the world<br />

into a grid of 3m x 3m squares. It<br />

has given each square a unique<br />

combination of three words - a<br />

what3words address, which will<br />

take you to a precise location.<br />

After it was used successfully<br />

used elsewhere in the region<br />

by neighbouring emergency<br />

services, NEAS now joins over 90<br />

emergency services across Great<br />

Britain who are doing the same.<br />

156<br />

For more news visit: www.ambulanceukonline.com


The new app has been<br />

streamlined within the ambulance<br />

service’s Emergency Operations<br />

Centre by integrating the platform<br />

into its system where emergency<br />

calls are taken. Once the three<br />

words have been provided to the<br />

call handler, they will then input<br />

these into the app and track your<br />

location. Emergency help can<br />

then be directed to you.<br />

Systems and resilience dispatch<br />

officer Mark Hagan has been the<br />

lead for NEAS on installing the<br />

what3words app into its system.<br />

He said, “A 999 call could be<br />

one of the worst times of your<br />

life. You might be on your own in<br />

immediate danger, possibly in a<br />

lot of pain or feeling very unwell.<br />

It’s the job of our health advisors<br />

to find where you are as quickly<br />

as possible. As every minute is<br />

delayed getting our frontline crew<br />

to you, the more your condition<br />

will deteriorate.<br />

“It is often assumed that our<br />

call handlers know your location<br />

based on phone signals, but they<br />

don’t and it can be very stressful<br />

at times trying to find the location<br />

of a patient who needs urgent<br />

help.<br />

“Before the new technology, we<br />

relied on people trying to identify<br />

landmarks, shops or junctions<br />

and this often proved difficult. If<br />

people were from outside of the<br />

area this was an added challenge<br />

as they weren’t familiar with where<br />

they were.<br />

“In the week we have been using<br />

what3words, it has been used five<br />

times so far to locate patients and<br />

we anticipate it will be used more<br />

frequently.<br />

“We also rely on resources from<br />

neighbouring partners such as the<br />

Coastguard and Mountain Rescue<br />

Service to locate a patient, but<br />

this app will really cut down on<br />

the time it will take to respond to<br />

patients and potentially save more<br />

lives.”<br />

The app is free to download for<br />

both iOS and Android and works<br />

entirely offline – making it ideal for<br />

use in areas of the <strong>UK</strong>, even with<br />

an unreliable data connection.<br />

What3words can also be used via<br />

the online map at:<br />

https://what3words.com and<br />

the technology is available in over<br />

40 languages, as well as being<br />

accessible anywhere in the world.<br />

Remember, if you are in an<br />

emergency and unable to tell the<br />

call handler of your exact location,<br />

follow these instructions on how<br />

to use what3words:<br />

1. Find the three-word address<br />

for your current location on the<br />

what3words app.<br />

2. Share your three-word address<br />

over the phone to the call<br />

handler.<br />

3. The emergency service can<br />

then coordinate a response<br />

directly to the exact location<br />

where help is needed.<br />

From horse riders, kayakers and<br />

rural walkers to mountain bikers,<br />

car crashes and sailors; the list<br />

is endless for reasons why you<br />

should download the what3words<br />

app as you never know when you<br />

might be in an emergency and it<br />

might just save your life.<br />

SECAMB<br />

Trust appoints new<br />

Non-Executive<br />

Director<br />

1 <strong>October</strong>, subject to the usual<br />

employment checks.<br />

Tom is a passionate supporter of<br />

the NHS. A nurse, he has spent<br />

four decades in healthcare and<br />

has experience in both hospital<br />

and pre-hospital care. Now a<br />

senior academic the majority<br />

of his research has focused on<br />

improving outcomes for patients<br />

under ambulance care.<br />

Tom has a long-standing<br />

relationship with SECAmb and<br />

has previously served as a<br />

SECAmb governor while at the<br />

University of Surrey. He holds a<br />

number of volunteer roles locally<br />

including being Clinical Director<br />

of HeartStart Farnham Lions and<br />

nationally as a Trustee of British<br />

Association for Immediate Care.<br />

He is a Fellow of the Royal<br />

College of Nursing, European<br />

Society of Cardiology, American<br />

Heart Association and American<br />

College of Cardiology. His<br />

contribution to patient care was<br />

recognised in 2019 by election as<br />

an honorary Fellow of the College<br />

of Paramedics.<br />

SECAmb Chairman, David Astley<br />

said: “I am pleased we have<br />

been able to appoint Tom and I<br />

look forward to working closely<br />

with him. I know SECAmb will<br />

benefit from his extensive clinical<br />

experience and his long-standing<br />

relationship with the Trust and<br />

other local partners.”<br />

Tom added: “As a patient I have<br />

South East Coast <strong>Ambulance</strong><br />

Service NHS Foundation<br />

Trust (SECAmb) is pleased to<br />

announce the appointment of a<br />

new Non-Executive Director.<br />

The Trust’s Council of Governors<br />

recently passed a resolution to<br />

appoint Professor Tom Quinn to<br />

the role. Tom, who works at St<br />

George’s, University of London<br />

and Kingston University, will begin<br />

a three-year term of office on<br />

first-hand experienced calling<br />

999, receiving expert care from<br />

call handlers and the ambulance<br />

crew who came to my aid. This<br />

interaction confirmed the highly<br />

professional and compassionate<br />

care which I already knew<br />

SECAmb delivered day-in, dayout.<br />

I am looking forward to taking<br />

up this new role and working<br />

with everyone across the whole<br />

organisation for the benefit of<br />

patients.”<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

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AMBULANCE <strong>UK</strong> - OCTOBER<br />

Health Scholars<br />

and the American<br />

Academy of<br />

Pediatrics Partner<br />

to Develop Pediatric<br />

Emergency Virtual<br />

Reality (VR)<br />

Simulation Training<br />

for First Responders<br />

The new VR applications will<br />

provide a remote, scalable<br />

way for first responders to<br />

practice properly assessing<br />

and providing care during a<br />

pediatric emergency.<br />

Health Scholars, the company<br />

recognized for voice-directed VR<br />

simulations including advanced<br />

cardiovascular life support (ACLS)<br />

training for first responders and<br />

clinicians, and the American<br />

Academy of Pediatrics (AAP),<br />

the 67,000-member organization<br />

dedicated to the optimal health<br />

and well-being for all infants,<br />

children, adolescents and young<br />

adults, are pleased to announce<br />

a partnership to co-develop VR<br />

training applications to equip<br />

first responders with skills vital to<br />

assessing and treating pediatric<br />

medical emergencies.<br />

“Health Scholars is proud to<br />

partner with AAP to bring a truly<br />

meaningful innovation to market,”<br />

noted Cole Sandau, CEO, Health<br />

Scholars. “The partnership will<br />

provide highly differentiated<br />

training to help first responders<br />

better prepare for pediatric<br />

emergency situations.”<br />

The goal of the partnership is to<br />

leverage VR technology to deliver<br />

more active and impactful training<br />

opportunities for first responders.<br />

As a result, EMS providers will<br />

have the first-ever capability to<br />

continuously train on real-to-life<br />

pediatric emergency encounters<br />

using deliberate practice. The use<br />

of VR makes rich, experiencebased<br />

training highly accessible<br />

to all first responders in a low<br />

cost/high yield model. “During the<br />

time of COVID, we need to design<br />

innovative educational methods<br />

that deliver critical content and<br />

skills, while recognizing that<br />

in-person training is not always<br />

feasible,” said AAP member<br />

Sarah Denny, MD, FAAP who<br />

reviewed and provided feedback<br />

to the VR scenarios. “Through this<br />

collaboration, EMS professionals<br />

can participate in distance<br />

learning using virtual reality and<br />

simulation to practice the critical<br />

hands-on skills that are necessary<br />

to treat pediatric emergencies in<br />

the field.”<br />

The two co-developed VR<br />

applications, “Pediatric<br />

Emergency Assessment” and<br />

“Pediatric Emergency Care,” are<br />

the first VR simulations dedicated<br />

to pediatric emergencies for EMS<br />

professionals. Recognizing severe<br />

illness in infants and children<br />

is challenging, and it’s further<br />

compounded by limited exposure<br />

to pediatric emergencies.<br />

Unless providers are practicing<br />

frequently, the nuanced critical<br />

skill sets needed to effectively<br />

treat infants and children decline<br />

over time, leading to significant<br />

readiness challenges.<br />

AAP and Health Scholars<br />

recognized a substantive<br />

gap in preparing for pediatric<br />

emergencies and see VR as<br />

a solution for increasing the<br />

frequency of training in realto-life<br />

scenarios. The new<br />

applications represent an<br />

industry breakthrough in using<br />

converged VR technologies<br />

to address critical outcomes.<br />

The applications use artificial<br />

intelligence (AI-enabled) voice<br />

technology to replicate real-world<br />

interaction and to create highly<br />

sophisticated, self-directed<br />

learning experiences that adapt<br />

to the providers’ proficiency<br />

level to optimize learning gains.<br />

This innovative approach to<br />

learner assessment captures<br />

rich information about individual<br />

learner competencies and the<br />

overall readiness of departments<br />

or regional/national organizations.<br />

The combination of all these<br />

elements creates one of the most<br />

sophisticated and consequential<br />

training platforms in the market.<br />

“Limited exposure to severely<br />

ill infants and children in the<br />

prehospital setting presents a<br />

challenge in terms of training.<br />

Providers need continuous<br />

deliberate practice for pediatric<br />

emergencies in order to maintain<br />

readiness for the subtle symptoms<br />

which severely ill infants and<br />

children often manifest and to<br />

promptly initiate high-quality<br />

resuscitative care. VR enables the<br />

delivery of this training to large<br />

learner populations,” said Brian<br />

Gillett, President & Chief Medical<br />

Officer, Health Scholars.<br />

“Pediatric Emergency<br />

Assessment” is available for<br />

immediate use, and “Pediatric<br />

Emergency Care” is available for<br />

pre-sale. For more information,<br />

visit https://healthscholars.com/<br />

solutions/first-responders/<br />

About Health Scholars<br />

Our mission is to advance<br />

healthcare education through<br />

virtualization, making experiencebased<br />

training scalable,<br />

accessible and affordable to<br />

both Healthcare and Public<br />

Safety providers. Our VR platform<br />

provides management, delivery<br />

and performance analysis<br />

of VR training and our AIenabled<br />

VR simulations deliver<br />

scenarios for resuscitation,<br />

perioperative, obstetrical, and<br />

public emergencies, providing<br />

a risk-free environment for<br />

repeated deliberate practice.<br />

For more information, visit www.<br />

HealthScholars.com.<br />

About the American Academy of<br />

Pediatrics<br />

The American Academy of<br />

Pediatrics is an organization of<br />

67,000 primary care pediatricians,<br />

pediatric medical subspecialists<br />

and pediatric surgical specialists<br />

dedicated to the optimal health<br />

and well-being for all infants,<br />

children, adolescents and young<br />

adults. For more information, visit<br />

www.aap.org.<br />

NEAS<br />

Supporting BAME<br />

communities thanks<br />

to NHS Charities<br />

Together donation<br />

North East <strong>Ambulance</strong> Service<br />

has received a grant of £50,000<br />

from NHS Charities Together to<br />

progress its work with Black,<br />

Asian and minority ethnic<br />

(BAME) communities and<br />

develop initiatives to support<br />

BAME staff in the workplace.<br />

The money will be used to support<br />

a community positive action officer<br />

to raise awareness of the services<br />

we provide and how to access<br />

them. The officer will also help to<br />

set up a community ambassador<br />

scheme working with local BAME<br />

community organisations and<br />

individuals and promote ourselves<br />

as an inclusive employer.<br />

Money for some smaller scale<br />

projects to improve BAME employee<br />

experience in the workplace is also<br />

included in this grant.<br />

Karen O’Brien, director of people<br />

and development, said “This<br />

money will be used to fund a post<br />

to improve our engagement with<br />

BAME people in the region.<br />

“This is especially important at<br />

this time due to the increased risk<br />

of COVID on BAME communities.<br />

It is important we improve our<br />

engagement and communication<br />

and it also gives us an opportunity<br />

to promote the many employment<br />

and volunteering opportunities<br />

available in the Trust.”<br />

158<br />

For more news visit: www.ambulanceukonline.com


EEAST<br />

East of England<br />

<strong>Ambulance</strong> Service<br />

celebrate graduation<br />

of first apprentices<br />

The East of England<br />

<strong>Ambulance</strong> Service (EEAST) is<br />

celebrating after its first group<br />

of apprentices passed their<br />

courses to become qualified<br />

emergency medical technicians.<br />

A national programme, the level 4<br />

associate ambulance practitioner<br />

apprenticeship offers an<br />

innovative way to gain a higherlevel<br />

qualification in emergency<br />

care by combining a full-time job<br />

with study. Apprentices benefit<br />

from earning whilst they study and<br />

having their fees paid for by the<br />

Trust.<br />

The four apprentices – Sarah<br />

Batchelor, Sam Eaton, Mark Jones<br />

and Sarah Pym – passed their<br />

apprenticeship in August and will<br />

now go on to work as emergency<br />

medical technicians as part of<br />

a two-person ambulance crew<br />

responding to emergency (999)<br />

and urgent calls.<br />

required to achieve a level 3<br />

award in emergency response<br />

driving and a level 4 associate<br />

ambulance practitioner (QCF)<br />

diploma.<br />

The apprenticeship opens the<br />

door to higher education and the<br />

opportunity to gain paramedic<br />

qualifications. An apprenticeship<br />

pathway to become a paramedic<br />

is set to be introduced at EEAST<br />

next year, with all four newly<br />

qualified emergency medical<br />

technicians interested in following<br />

that route.<br />

Mark Stead, education manager<br />

at EEAST, said: “We are delighted<br />

to have our first four apprentices<br />

successfully complete their<br />

end point assessment. The<br />

four apprentices have worked<br />

incredibly hard and their<br />

dedication has been recognised<br />

with two merits and two distinction<br />

grades being awarded.<br />

“Many congratulations to Sarah,<br />

Sam, Mark and Sarah and<br />

to everyone in the Trust who<br />

supported them on their learning<br />

journey. We wish them a long and<br />

successful career at the East of<br />

England <strong>Ambulance</strong> Service.”<br />

been with EEAST for four years<br />

and took up the apprenticeship to<br />

progress his career.<br />

“I jumped at the chance of the<br />

apprenticeship to further my<br />

career with the ambulance service<br />

and see it as a stepping stone to<br />

becoming a paramedic,” he said.<br />

“I would say that dedication and<br />

a willingness to learn is crucial to<br />

completing the course, as there is<br />

lot to take in, but there is extensive<br />

support to help you throughout.”<br />

Sarah Pym, 42, was a support<br />

teacher at a SEN (special<br />

educational needs) school before<br />

starting the apprenticeship and<br />

is based at Harlow <strong>Ambulance</strong><br />

Station.<br />

She said: “I learnt so much in<br />

a short space of time in the<br />

apprenticeship programme and<br />

the support we received from<br />

Kevin Cowan [training centre<br />

and quality assurance manager<br />

at Welwyn Garden City] and the<br />

tutors was amazing. I had such a<br />

positive experience from training<br />

to operations and am glad I took<br />

the opportunity to change my<br />

career.<br />

“I have been<br />

interested in<br />

working for<br />

the ambulance<br />

service for<br />

a long time,<br />

but I wasn’t<br />

in a position<br />

to pursue it<br />

until I saw the<br />

advert for the<br />

apprenticeship.”<br />

a paramedic and longer term,<br />

given my background in teaching,<br />

would like to be involved in<br />

training.”<br />

Sam Eaton, 29, who works out of<br />

Potters Bar <strong>Ambulance</strong> Station,<br />

said: “The tutors were excellent<br />

in guiding us through the course<br />

and I would definitely recommend<br />

the apprenticeship to people<br />

looking to further their career with<br />

the ambulance service.”<br />

The course takes 18 months to<br />

complete, with the apprentices<br />

Mark Jones, 25, who is based at<br />

Thurrock <strong>Ambulance</strong> Station, has<br />

“In the future I would like to<br />

undertake the training to become<br />

Sarah Batchelor, 46, who works<br />

out of Huntingdon <strong>Ambulance</strong><br />

Station, said: “I have been<br />

interested in working for the<br />

ambulance service for a long<br />

time, but I wasn’t in a position to<br />

pursue it until I saw the advert for<br />

the apprenticeship.<br />

From left to right: Sarah Batchelor (top), Sam Eaton, Sarah Pym and Mark Jones<br />

“As someone who has come<br />

back to the classroom after an<br />

absence, the course was a bit of<br />

a shock to the system to start off<br />

with but everyone at the training<br />

centre was so supportive and it<br />

was a positive experience.”<br />

If you would like to find out<br />

more about becoming an<br />

apprentice at East of England<br />

<strong>Ambulance</strong> Service, please email<br />

apprenticeships@eastamb.nhs.uk<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

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AMBULANCE <strong>UK</strong> - OCTOBER<br />

SECAMB<br />

New combined<br />

ambulance and 111<br />

centre for Medway<br />

given planning go<br />

ahead<br />

Plans to develop a new multipurpose<br />

ambulance centre in<br />

Gillingham have been given the<br />

green light by planners.<br />

In a first for South East Coast<br />

<strong>Ambulance</strong> Service NHS<br />

Foundation Trust, (SECAmb), the<br />

development at Bredgar Road<br />

would comprise of a new Make<br />

Ready Centre for the Medway<br />

region, as well as 999 and NHS<br />

111 operations centres relocated<br />

from Coxheath and Ashford in<br />

Kent respectively.<br />

Following the approval by Medway<br />

Council planners, and subject to<br />

full business case approval from<br />

SECAmb’s Trust Board, building<br />

work is expected to begin at the<br />

site early next year ahead of it<br />

becoming fully operational in 2022.<br />

The development will be funded<br />

with a previously announced £6.52<br />

million of government capital<br />

funding.<br />

The Trust’s Make Ready system,<br />

which is already in place across<br />

much of SECAmb’s region, is a<br />

vehicle preparation system which<br />

sees specialist teams of staff<br />

employed to clean, restock and<br />

maintain the Trust’s fleet.<br />

<strong>Ambulance</strong> crews currently starting<br />

and ending their shifts at Medway<br />

and Sittingbourne ambulance<br />

stations will, instead, start and<br />

finish at the new centre. They will<br />

then respond from ambulance<br />

community response posts across<br />

the region with suitable rest<br />

facilities for crews between calls<br />

and when on a break.<br />

Staff based in Sheppey will<br />

continue to start and end their<br />

shifts from the ambulance station<br />

on the island which is currently<br />

undergoing a major refurbishment<br />

and upgrade to provide new<br />

educational and training facilities.<br />

The plans would see the new<br />

Make Ready facility in Gillingham<br />

housed on the two lower floors of<br />

the new centre while staff currently<br />

based at the Trust’s East 999<br />

Emergency Operations Centre<br />

(EOC) in Coxheath will benefit<br />

from a modern open plan office<br />

above. The Trust’s NHS 111 staff,<br />

currently based in Ashford, Kent,<br />

will occupy the top floor.<br />

Bringing the 999 and 111<br />

services under one roof will<br />

allow for greater support for<br />

each service, with the modern<br />

facilities matching the Trust’s West<br />

Emergency Operations Centre,<br />

based in Crawley, which opened<br />

in 2017, and reflects the ambitions<br />

of the Trust to deliver new<br />

integrated urgent care services<br />

over a wider area.<br />

Having both of these services<br />

housed in the same building will<br />

facilitate greater sharing of best<br />

practice and, where feasible,<br />

will enable the Trust to optimise<br />

functions between the two.<br />

An integrated region-wide<br />

approach will provide clearer<br />

pathways for patients and a more<br />

efficient and resilient emergency<br />

and urgent care response service.<br />

The development also provides<br />

SECAmb with greater capacity,<br />

allows it to improve the ratio of<br />

999 call taking across its two<br />

Emergency Operations Centres<br />

and will bring local recruitment<br />

opportunities for people across<br />

both 999 and 111 services.<br />

SECAmb currently operates eight<br />

Make Ready Centres across its<br />

region with the latest set to open<br />

in Brighton in the coming months.<br />

SECAmb Associate Director of<br />

Contact Centres and Integrated<br />

Care, John J O’Sullivan said:<br />

“I’m really pleased the project<br />

has been given the go-ahead by<br />

planners. Our current Emergency<br />

Operations Centre for the East<br />

of our region is outdated, lacks<br />

space and is no longer fit for<br />

purpose. In addition, bringing our<br />

999 and 111 operations under<br />

one roof provides us with greater<br />

resilience and enables the two<br />

services to work more closely<br />

together to benefit patients across<br />

our whole region.”<br />

SECAmb Operating Unit Manager<br />

for Dartford & Medway, Will<br />

Bellamy added: “This latest<br />

stage in the roll-out of our Make<br />

Ready system is an important<br />

step in the development of the<br />

service we are able to provide<br />

our patients locally. The system<br />

is more efficient and also means<br />

ambulance crews have access<br />

to improved modern facilities for<br />

training.<br />

“We understand that changes like<br />

this have an impact on staff and<br />

we will fully engage with all those<br />

the development affects ahead of<br />

go live in 2022.”<br />

What is Make Ready?<br />

• The Make Ready initiative<br />

significantly enhances and<br />

improves the service SECAmb<br />

provides to the community.<br />

• It minimises the risk of crossinfection,<br />

frees up front-line<br />

staff - who traditionally cleaned<br />

and re-stocked ambulances<br />

- to spend more time treating<br />

patients, and keeps vehicles on<br />

the road for longer.<br />

• The initiative ensures that<br />

specially-trained operatives<br />

regularly deep-clean, restock<br />

and check vehicles for<br />

mechanical faults.<br />

• Make Ready Centres are<br />

supported by a network<br />

of <strong>Ambulance</strong> Community<br />

Responses Posts (ACRPs)<br />

across the area with staff<br />

beginning and ending their<br />

shifts at the new centre.<br />

• During their shifts, staff will<br />

respond from the ACRPs which<br />

will provide facilities for staff.<br />

These are located based on<br />

patient demand.<br />

• Crews continue to respond<br />

from the same towns under the<br />

system but begin and end their<br />

shifts at staggered times with a<br />

vehicle that is fully prepared for<br />

them.<br />

• The system ensures crews have<br />

access to improved training<br />

facilities and opportunities<br />

and increased support from<br />

managers.<br />

NHS hospital<br />

helipads see 15,500<br />

landings<br />

The HELP Appeal, which<br />

improves helicopter emergency<br />

medical services (HEMS) by<br />

funding the construction of<br />

new or upgraded hospital and<br />

air ambulance helipads, has<br />

announced there have been<br />

15,500 landings on the NHS<br />

hospital helipads it has funded<br />

across the country.<br />

Since the charity’s creation in<br />

2009, it has donated £20 million<br />

towards 39 new or upgraded<br />

helipads, of which 32 have been<br />

NHS hospital helipads - including<br />

17 based at Major Trauma<br />

Centres - and six air ambulance<br />

helipads. The cost of planned<br />

helipad projects equates to<br />

£50.75 million so far.<br />

This year alone, despite the<br />

pandemic, new helipads funded<br />

by the charity opened at the Royal<br />

Devon and Exeter Hospital, Hull<br />

Royal Infirmary and Hereford<br />

County Hospital.<br />

160<br />

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New helipads at the Royal Sussex<br />

County Hospital, Brighton;<br />

Manchester University NHS<br />

Foundation Trust; Airedale<br />

General Hospital, Keighley;<br />

Campbeltown Hospital, Worcester<br />

Hospital, Luton & Dunstable<br />

Hospital and Sheffield Children’s<br />

Hospital are planned to open<br />

within the next year or two.<br />

The charity is also currently<br />

funding improvements to existing<br />

helipads at University Hospital<br />

Coventry; University Hospital<br />

Crosshouse, Kilmarnock; Carlise<br />

Hospital, and Peterborough City<br />

Hospital, which will open this year.<br />

The HELP Appeal expanded into<br />

Scotland in 2015, to fund nine<br />

hospital helipads including the<br />

Queen Elizabeth University Hospital<br />

in Glasgow and Edinburgh Royal<br />

Infirmary, and Raigmore Hospital,<br />

Inverness with another three in the<br />

pipeline. It also provided £200,000<br />

over a four-year period to the<br />

Scottish Air <strong>Ambulance</strong> Service<br />

to fund replacement secondary<br />

landing sites throughout Scotland.<br />

The charity pioneered the<br />

introduction and funding of Deck<br />

Integrated Fire Fighting System<br />

(DIFFS) on five rooftop helipads<br />

across the country including<br />

King’s College Hospital and St<br />

George’s hospital, with three more<br />

planned, which save each NHS<br />

hospital around £250,000 every<br />

year in firefighting costs.<br />

It has also funded helipads at<br />

brand new air bases for several<br />

air ambulances, including the<br />

Scotland’s Charity Air <strong>Ambulance</strong>;<br />

Midlands Air <strong>Ambulance</strong> Charity;<br />

Wiltshire Air <strong>Ambulance</strong>; Great<br />

Western Air <strong>Ambulance</strong>; Kent,<br />

Surrey & Sussex Air <strong>Ambulance</strong><br />

and London Air <strong>Ambulance</strong>; and<br />

is funding helipads for Lincs &<br />

Notts Air <strong>Ambulance</strong> in <strong>2020</strong> and<br />

Great North Air <strong>Ambulance</strong>.<br />

The HELP Appeal also funded<br />

lifesaving equipment for the<br />

Midlands Air <strong>Ambulance</strong> Charity<br />

(MAAC) and two Critical Care<br />

Cars in partnership with MAAC,<br />

with a third car launching in <strong>2020</strong>.<br />

It has also provided life-saving<br />

funding for the British Association<br />

for Immediate Care (BASICS)<br />

annually since 2019.<br />

Robert Bertram, Chief Executive<br />

of the HELP Appeal says: “Over<br />

10 years ago, hospital helipad<br />

facilities were severely lacking,<br />

yet finance for hospitals was tight.<br />

There was little doubt that if we<br />

didn’t offer non-repayable funds<br />

towards the cost of helipads,<br />

hospitals would struggle to ever<br />

have one, despite emergency<br />

medics saying they were<br />

desperately needed to save time<br />

and save lives.<br />

“Today, finance for hospitals<br />

remains tight, but the demand<br />

for our helipad grants continues<br />

to grow and we are recognised<br />

as the only charity in the country<br />

dedicated to funding hospital<br />

helipads.”<br />

Of the 15,500 landings, critically ill<br />

patients like 12-year-old George<br />

are alive and recovering well from<br />

their illness or injury, because<br />

the helipads they landed on<br />

were built beside the Emergency<br />

Department.<br />

George’s story<br />

George, who is 12 years old, was<br />

walking to school when he was<br />

hit by a motorbike at speed. He<br />

was flown to St George’s hospital<br />

helipad in 22 mins from Ashford in<br />

Surrey, a journey that would have<br />

taken one hour by road.<br />

Caroline, George’s mother, was<br />

at home when she received the<br />

news. She said: “George and I<br />

always walked to school together.<br />

This was the first time that he was<br />

going off by himself.<br />

“I was just waiting for my boys to<br />

come home, when I got a knock<br />

on the door. The lady said to<br />

me, your son has been in a road<br />

accident. As I walked round, I was<br />

so shocked. The road had been<br />

closed off, there were three police<br />

cars, an ambulance and George<br />

was in the middle of the road.”<br />

“When I went up to him at the<br />

scene, I didn’t know what to say<br />

to him. At the roadside, I just felt<br />

so guilty that he was on his own<br />

when this had happened to him.”<br />

HEMS doctor Sarah was at the<br />

scene: “If a fracture is open, like<br />

George’s was, that means that<br />

there’s also damage to the skin.<br />

If the fracture is displaced the<br />

bone may be facing in the wrong<br />

direction, which may affect blood<br />

supply, cause nerve damage and<br />

could be a lymph threatening<br />

injury.<br />

“It’s really important to reduce<br />

that risk, by putting it back into the<br />

position it was in before it broke.<br />

What we can provide is good<br />

pain relief, immediate reduction<br />

and emergency interventions, but<br />

what the patient actually needs<br />

is an orthopaedic surgeon and a<br />

theatre and it’s important we get<br />

the patient to this as quickly as<br />

possible. “<br />

This is why George was flown<br />

directly to St George’s hospital<br />

helipad which has immediate<br />

access to the Emergency<br />

Department.<br />

Caroline adds: “The helipad’s<br />

location made the process of<br />

getting to A&E as stress free as<br />

possible. This was important<br />

as it was a very stressful time<br />

for us. The alternative of landing<br />

anywhere else and being<br />

transported to hospital by vehicle<br />

would have taken longer and<br />

added to the strain.”<br />

St George’s orthopaedic registrar<br />

explains the danger behind<br />

George breaking his tibia (shin<br />

bone): “Children’s veins are<br />

different from adult’s veins. They<br />

have a weak spot and that’s the<br />

growth plate and it’s particularly<br />

vulnerable to injury. If the growth<br />

plate is damaged too much,<br />

the vein in that region will stop<br />

growing all together. This can<br />

result in lifelong disablement.”<br />

Caroline also adds: “With<br />

regards to George’s treatment<br />

the consultant said that it was<br />

important to get George to theatre<br />

as soon as possible.”<br />

Fortunately, surgeons were able<br />

to perform emergency surgery on<br />

George to repair his growth plate.<br />

He stayed in for two more nights<br />

as he was in a lot of pain and<br />

Caroline stayed by his side the<br />

whole time.<br />

Three months after the accident<br />

George says: “My legs feel<br />

good at the moment. It just felt<br />

good to start walking again. My<br />

mum is probably one of the most<br />

important people to me and I love<br />

her so much.”<br />

Caroline adds: “George has<br />

recovered well and is back to<br />

normal. The doctors are seeing<br />

him every six months to check for<br />

any growth plate issues.<br />

“Thank you to the air ambulance<br />

service for their help and support.<br />

He received first class treatment<br />

and for that we are extremely<br />

appreciative.<br />

“Also, having the helipad at<br />

the hospital made it possible<br />

for George to receive the best<br />

treatment in the quickest time<br />

possible. We will truly be forever<br />

grateful for this.”<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

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SECAMB<br />

Joint police and<br />

ambulance response<br />

service proving<br />

successful in Brighton<br />

Meet the police and ambulance<br />

Joint Response Unit (JRU)<br />

vehicle team which has been<br />

patrolling and responding to<br />

incidents in Brighton and Hove.<br />

National<br />

resuscitation<br />

organisation updates<br />

process to support<br />

conversations about<br />

an individual’s<br />

care and realistic<br />

treatment choices in<br />

a future emergency<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

The vehicle which is staffed by<br />

Sussex Police and South East<br />

Coast <strong>Ambulance</strong> (SECAmb)<br />

allows a response police officer<br />

and a paramedic to work together<br />

to respond to incidents which<br />

require both services.<br />

The SECAmb vehicle, is kitted<br />

out with everything police<br />

need to tackle crime and<br />

medical equipment required by<br />

paramedics.<br />

Police officers working on the<br />

unit receive medical technique<br />

familiarisation and paramedics<br />

benefit from an input on conflict<br />

resolution.<br />

Assaults, collision and alcoholrelated<br />

incidents are the most<br />

common calls the JRU gets.<br />

The unit was started as a trial<br />

project in December 2019 and<br />

runs on Friday and Saturday<br />

twilight shifts from 6pm to 2am to<br />

meet the demands of the night<br />

time economy in the city.<br />

Both police and ambulance<br />

control are aware of the JRU and<br />

will actively seek to deploy the<br />

JRU to incidents that require a<br />

response from both services.<br />

Inspector Steve Hill said:<br />

“The Joint Response Unit is a<br />

worthwhile initiative which involves<br />

police officers and paramedics<br />

travelling together to incidents<br />

which may require both areas<br />

of expertise, resulting in a more<br />

effective and efficient service.<br />

“For example if there has been a<br />

fight and an arrested suspect has<br />

an injury, the medic could treat<br />

them then and there negating<br />

the need for officer to go and<br />

wait with them at hospital or call<br />

a double crewed ambulance.<br />

A cause for concern call could<br />

allow the officer to force entry<br />

to a premises to check and<br />

should a person be located there<br />

needing help, the medic is well<br />

placed to do so. Road collisions<br />

with injury are also an obvious<br />

incident where both services will<br />

be required.<br />

“The JRU also retains the ability<br />

to ‘self-deploy’ to an incident<br />

be it medical or police that they<br />

feel they could readily assist<br />

with. They can be proactively<br />

doing directed patrol activities,<br />

searching for missing people and<br />

if they are the closest unit to a<br />

category 1 medical emergency or<br />

a police assistance call they will<br />

attend.<br />

The unit has been responding<br />

to five or six incidents per shift<br />

and even during the Covid-19<br />

lockdown when the night time<br />

economy was closed, it still<br />

remained busy.<br />

During one shift last month, the<br />

team responded to a four calls in<br />

one Friday night shift including a<br />

man who had taken an overdose,<br />

a woman who was armed with<br />

two large kitchen knives and was<br />

self harming, a woman in distress<br />

on the edge of a cliff and a fight<br />

where a victim had been injured<br />

with a glass bottle.<br />

SECAmb operational team leader<br />

Tim Clark said: “Setting up the<br />

Joint Response Unit in the city of<br />

Brighton and Hove, and working<br />

so closely with the Sussex<br />

Police has been a celebration of<br />

collaborative working, enabling<br />

us to provide a more focused and<br />

specialised response to incidents<br />

requiring both ambulance and<br />

police attendance. While JRUs<br />

are not a new concept to the<br />

South East Coast <strong>Ambulance</strong><br />

Service, developing a joint<br />

working system within a busy and<br />

vibrant city such as Brighton and<br />

Hove presented a new challenge<br />

and the unit has proven to be<br />

an invaluable resource to both<br />

services.<br />

“It ensures a greater<br />

understanding of each services<br />

working practices, builds on<br />

our already robust collaborative<br />

relationship, reduces lost<br />

operational hours and, most<br />

importantly, provides the residents<br />

of Brighton and Hove with a more<br />

streamlined and tailored response<br />

to the varied and unique incidents<br />

we attend.”<br />

A second Sussex JRU is currently<br />

being trialled in Worthing.<br />

COVID-19 pandemic has drawn<br />

attention to importance of<br />

person-centred discussions<br />

when making decisions about<br />

cardiopulmonary resuscitation<br />

Resuscitation Council <strong>UK</strong><br />

has updated the ReSPECT<br />

(Recommended Summary<br />

Plan for Emergency Care and<br />

Treatment) process which<br />

supports person-centred<br />

conversations about care in<br />

a future emergency following<br />

feedback from professionals,<br />

patients and their families.<br />

As patients are often not able<br />

to make decisions about their<br />

priorities of care or treatment in an<br />

emergency, discussing what they<br />

would want to happen in advance<br />

is essential.<br />

The ReSPECT process is<br />

already widely used by health<br />

and social care organisations<br />

across England and in parts of<br />

Scotland to support them having<br />

important conversations with<br />

patients in advance about their<br />

emergency care, and whether<br />

cardiopulmonary resuscitation<br />

(CPR) should be attempted in a<br />

future emergency.<br />

The ReSPECT process is<br />

supported by a discussion<br />

guide and form and version 3<br />

is being introduced into clinical<br />

practice today. The form is used<br />

to document the discussion and<br />

any recommendations agreed, is<br />

signed by the clinician and can be<br />

162<br />

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signed by the patient/ their legal<br />

proxy or family member if they<br />

wish to do so.<br />

The changes made to the form<br />

have resulted in a more patientcentred<br />

form, with increased<br />

prompts for explicit clinical<br />

reasoning. It addresses areas<br />

where misunderstandings have<br />

been reported and includes more<br />

personable and clearer language.<br />

The COVID-19 pandemic has<br />

highlighted the importance of<br />

sensitive and well-structured<br />

conversations about someone’s<br />

realistic care choices and for<br />

there to be shared understanding<br />

between professionals, patients<br />

and their families.<br />

The ReSPECT process was first<br />

introduced by Resuscitation<br />

Council <strong>UK</strong> in 2016, with design<br />

expertise from the Helix Centre,<br />

Imperial College London,<br />

to support discussions and<br />

clinical recommendations<br />

about emergency care being<br />

made in advance. It was<br />

developed by experts and<br />

patient representatives keen to<br />

develop a process that supports<br />

professionals, patients and / or<br />

their families having a carefully<br />

constructed and person-centred<br />

conversation. It aims to develop<br />

a shared understanding between<br />

the healthcare professional and<br />

the patient of their condition,<br />

the outcomes the patient values<br />

and those they fear and then<br />

how realistic treatments and<br />

interventions, such as CPR, fit<br />

into this.<br />

The completed form stays<br />

with the patient and should be<br />

available immediately to health<br />

professionals called to help in an<br />

emergency, whether the patient<br />

is at home, in their community<br />

or in a healthcare setting.<br />

Professionals such as ambulance<br />

crews, out-of-hours doctors, care<br />

home staff and hospital staff will<br />

be better able to make quick<br />

decisions in an emergency about<br />

how best to help if key information<br />

has been recorded on the<br />

ReSPECT form.<br />

Sue Hampshire, Director of<br />

Clinical and Service Development<br />

at Resuscitation Council <strong>UK</strong> said:<br />

“We’re pleased to be introducing<br />

updated documentation to<br />

underpin the ReSPECT process<br />

today.<br />

“Communities in around 70%<br />

of counties in England and<br />

parts of Scotland are already<br />

using the ReSPECT process<br />

and the improvements we have<br />

introduced today are based on<br />

feedback from organisations who<br />

are already using the process as<br />

well as from patients and their<br />

families.<br />

“People have different views<br />

about the care or treatments they<br />

would want if they were suddenly<br />

ill and could not make decisions<br />

about their care or treatment.<br />

The new form will support better<br />

conversations and well-informed<br />

decision-making in advance, and<br />

we are happy to be introducing it<br />

for professionals and patients.”<br />

Dr Zoe Fritz, chair of the ReSPECT<br />

subcommittee, said: “We first<br />

developed the ReSPECT process<br />

to help professionals and<br />

patients or their families achieve<br />

better conversations and better<br />

recording of important treatment<br />

recommendations. The ReSPECT<br />

process encourages discussion<br />

about the individual’s condition,<br />

what’s important to them, what<br />

their realistic options are and<br />

what the likely potential health<br />

outcomes will be.<br />

“A number of misconceptions<br />

exist about CPR and when and<br />

how recommendations not to<br />

attempt CPR are made. So, it is<br />

crucial to have a person-centred<br />

approach and conversations<br />

that aim to ensure shared<br />

understanding between the<br />

professional and patient. By<br />

doing so, any misunderstandings<br />

can be addressed, and<br />

professionals can ensure that<br />

any recommendations made are<br />

based on what’s important to the<br />

patient.”<br />

When completed, the ReSPECT<br />

form provides a clinical<br />

record of agreed and realistic<br />

recommendations that come out<br />

of that conversation between a<br />

professional and the patient or<br />

their legal proxy or family member.<br />

A person’s ReSPECT form<br />

includes recommendations<br />

about emergency treatments<br />

that could be helpful and should<br />

be considered, as well as those<br />

not wanted by or that would not<br />

work for the patient. It includes a<br />

recommendation about CPR, but<br />

that may be a recommendation<br />

that CPR is attempted, or a<br />

recommendation that it is not<br />

attempted.<br />

For more information on the<br />

ReSPECT process, visit:<br />

www.resus.org.uk/respect<br />


<strong>Ambulance</strong> <strong>UK</strong> welcomes the submission of clinical papers and case<br />

reports or news that you feel will be of interest to your colleagues.<br />

Material submitted will be seen by those working within the public and private sector<br />

of the <strong>Ambulance</strong> Service, Air <strong>Ambulance</strong> Operators, BASICS Doctors etc.<br />

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If you have any queries please contact the publisher Terry Gardner via:<br />

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AMBULANCE <strong>UK</strong> - OCTOBER<br />

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AMBULANCE <strong>UK</strong> - OCTOBER<br />

WAS<br />

Launch of the South<br />

Wales Trauma<br />

Network<br />

Monday 14 September saw<br />

the official launch of the South<br />

Wales Trauma Network, held at<br />

the new Major Trauma Centre at<br />

the University Hospital of Wales.<br />

Serving the population of South<br />

Wales, West Wales and South<br />

Powys, the network is made up<br />

of hospitals, emergency services<br />

and rehabilitation services<br />

across the region, working<br />

together to ensure patients with<br />

life-threatening or life-changing<br />

injuries receive the best possible<br />

treatment and care.<br />

The Welsh Government has<br />

provided £3.7 million capital<br />

and over £13 million recurrent<br />

revenue funding to support the<br />

pre-hospital, major trauma centre,<br />

specialist services and network<br />

elements of the programme<br />

business case.<br />

Its arrival marks a major step<br />

forward in the delivery of<br />

emergency care in Wales. Across<br />

the network more than 2,000<br />

patients a year are expected to be<br />

treated, and up to 70 lives saved<br />

over the next five years.<br />

Dr Dinendra Gill, Clinical Director<br />

for the South Wales Trauma<br />

Network, explains: “Today marks<br />

a significant milestone in planning<br />

for the network, and represents the<br />

culmination of extensive work by all<br />

NHS partners over many years.<br />

“Major trauma – which refers to<br />

multiple and serious injuries – is<br />

the leading cause of death in<br />

people under the age of 45 and<br />

a significant cause of disability or<br />

poor health. Patients with these type<br />

of injuries will have a better chance<br />

of survival if they are treated within a<br />

major trauma network.<br />

“As well as saving lives, the<br />

network will improve patient<br />

outcomes by preventing<br />

avoidable disability, returning<br />

more patients to their families, to<br />

work and to education.<br />

“I want to thank all those who<br />

have worked incredibly hard to<br />

open the service so that those<br />

who most need specialist care are<br />

able to benefit from it.”<br />

Officially opening the South Wales<br />

Trauma Network, Vaughan Gething<br />

MS, Minister for Health and<br />

Social Services – who attended<br />

the launch event virtually – said:<br />

“I am delighted to formally open<br />

the South Wales Trauma Network<br />

which will save lives and prevent<br />

avoidable disability for people<br />

involved in serious incidents.<br />

“While the new Major Trauma<br />

Centre at University Hospital of<br />

Wales is the setting for today’s<br />

launch event we celebrate the<br />

start of the Network which is a true<br />

collaboration of health services<br />

across the region with services<br />

in trauma units in each health<br />

board area and the major trauma<br />

desk within the Welsh <strong>Ambulance</strong><br />

Service.<br />

“This has been a long journey for<br />

many people and I thank all of<br />

those involved in what has been a<br />

truly collaborative effort to improve<br />

trauma services.”<br />

The University Hospital of Wales<br />

in Cardiff – which is Wales’<br />

only specialist neurosurgery<br />

hospital, and home of Noah’s Ark<br />

Children’s Hospital of Wales –<br />

becomes the region’s adult and<br />

children’s major trauma centre.<br />

As major trauma is relatively<br />

uncommon and complex to<br />

manage, services provided in<br />

the major trauma centre are<br />

highly specialised and available<br />

24 hours a day, seven days a<br />

week. The major trauma centre<br />

will collaborate with and support<br />

hospitals across the network.<br />

Establishing the network has led<br />

to enhanced roles for a number<br />

of other hospitals, including<br />

Morriston Hospital in Swansea,<br />

becoming a trauma unit with<br />

specialist services. Elsewhere, the<br />

network is supported by trauma<br />

units, rural trauma facilities and<br />

local emergency hospitals. The<br />

operational delivery network,<br />

which is hosted by Swansea<br />

Bay University Health Board, will<br />

oversee the running of the South<br />

Wales Trauma Network.<br />

Work to establish the network has<br />

been led by the NHS Wales Health<br />

Collaborative, in collaboration<br />

with health boards, the Welsh<br />

<strong>Ambulance</strong> Service NHS Trust, the<br />

Emergency Medical Retrieval and<br />

Transfer Service, Welsh Health<br />

Specialist Services Committee,<br />

Emergency <strong>Ambulance</strong> Service<br />

Committee, as well as third sector<br />

and community health councils.<br />

LAS<br />

Episode 2 of<br />

‘<strong>Ambulance</strong>’ to<br />

highlighted the<br />

contribution of<br />

voluntary Emergency<br />

Responders<br />

The second episode of the new<br />

series of the BBC documentary<br />

‘<strong>Ambulance</strong>’ highlighted the<br />

contribution of volunteer<br />

responders as London<br />

<strong>Ambulance</strong> Service (LAS) faced<br />

challenges from large protests<br />

and an IT system outage.<br />

The episode went behind the<br />

scenes of two busy weekend<br />

shifts where LAS faces the<br />

challenges of Extinction Rebellion<br />

protests and People’s Vote<br />

marches and an IT systems<br />

outage which meant the Service’s<br />

Emergency Operations Centre<br />

control room teams had to use<br />

pen and paper to take down<br />

information from 999 callers.<br />

Filmed in the autumn of 2019,<br />

viewers saw the variety of what a<br />

weekend day shift can bring for<br />

the country’s busiest ambulance<br />

service – from advanced paramedic<br />

Kevin responding to a cardiac<br />

arrest to crewmates Emily and<br />

Laura treating a 100-year-old who<br />

has fallen. All this while protests<br />

across central London posed the<br />

challenge of how crews can ensure<br />

they reach patients quickly.<br />

Viewers also saw Gary and Fabio –<br />

two of around 150 LAS Emergency<br />

Responders (ERs) - on shift. Retired<br />

police officer Gary and Fabio – who<br />

works in finance – volunteer their<br />

spare time responding to patients in<br />

the capital.<br />

ERs are LAS-trained volunteers<br />

who attend a range of emergency<br />

calls in Service uniform and in<br />

blue-light response cars.<br />

LAS Chief Executive Garrett<br />

Emmerson said:<br />

“This second episode again<br />

showed the breadth and variety of<br />

our Service and the commitment<br />

of all our staff and volunteers –<br />

as they faced challenges from<br />

protests and IT system outages,<br />

but still responded to those who<br />

needed us.<br />

“We were also delighted to see<br />

some of our volunteer Emergency<br />

Responders on the screen.<br />

Volunteers play a key role in our<br />

Service and this show highlights<br />

their commitment, professionalism<br />

and dedication.”<br />

164<br />

For more news visit: www.ambulanceukonline.com


GNAAS<br />

The jet suit<br />

paramedic<br />

Mr. Mawson said the exercise had<br />

demonstrated the huge potential<br />

of utilising Jet Suits to deliver<br />

critical care services.<br />

The Lake District could become<br />

home to the world’s first Jet Suit<br />

paramedic, according to those<br />

behind the concept.<br />

A collaboration between Gravity<br />

Industries, which has developed<br />

and patented a 1050 brake<br />

horsepower Jet Suit, and the<br />

Great North Air <strong>Ambulance</strong><br />

Service (GNAAS), has resulted<br />

in a test flight in the heart of the<br />

Lakes.<br />

He added: “In a time in healthcare<br />

when we are exhausted with<br />

COVID and its effects, it’s<br />

important to still push the<br />

boundaries.<br />

“Our aircraft will remain a vital<br />

part of the emergency response<br />

in this terrain, as will the fantastic<br />

mountain rescue teams. But this<br />

is about looking at supplementing<br />

those resources with something<br />

completely new.<br />

The test at the Langdale Pikes<br />

saw Gravity Industries founder<br />

and Chief Test Pilot Richard<br />

Browning fly from the valley<br />

bottom to a simulated casualty<br />

site on The Band, near Bowfell.<br />

The simulated casualty site would<br />

take around 25 minutes to reach<br />

by foot. The Gravity Jet Suit is<br />

able to cover that distance in 90<br />

seconds, opening a range of<br />

possibilities in the emergency<br />

response arena.<br />

The ground-breaking exercise<br />

was the culmination of a year of<br />

discussion between GNAAS and<br />

Gravity Industries.<br />

Andy Mawson, director of<br />

operations and paramedic at<br />

GNAAS, identified the Lakes<br />

as a possible location for a Jet<br />

Suit paramedic after hearing of<br />

Mr. Browning’s work and then<br />

studying the charity’s own call-out<br />

data.<br />

“We think this technology could<br />

enable our team to reach some<br />

patients much quicker than ever<br />

before. In many cases this would<br />

ease the patient’s suffering. In some<br />

cases, it would save their lives.”<br />

Richard Browning added: “It was<br />

wonderful to be invited to explore<br />

the capabilities of the Gravity Jet<br />

Suit in an emergency response<br />

simulation and work alongside<br />

the team at GNAAS. We are just<br />

scratching the surface in terms<br />

of what is possible to achieve<br />

with our technology. Emergency<br />

response is one of the areas<br />

Gravity are actively pursuing,<br />

alongside launching a new<br />

commercial training location at<br />

the world-renowned Goodwood<br />

Estate.”<br />

With the test complete, GNAAS<br />

and Gravity Industries are now<br />

exploring the next steps in this<br />

collaboration.<br />

He said: “It showed dozens of<br />

patients every month within the<br />

complex but relatively small<br />

geographical footprint of the<br />

Lakes.<br />

“We could see the need. What<br />

we didn’t know for sure is how<br />

this would work in practice. Well<br />

we’ve seen it now and it is, quite<br />

honestly, awesome.”<br />

GNAAS and Gravity Industries<br />

would like to thank Langdale<br />

Mountain Rescue Team, the<br />

National Trust, Stool End Farm<br />

and Cumbria Police for their part<br />

in making the test possible.<br />

GNAAS is a charity and relies on<br />

donations to survive. To find out<br />

more please call 01325 487 263<br />

or visit gna.as/jet-suit<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />



significantly, safely and rapidly;<br />

preferably at the earliest possible<br />

intervention point of injury.<br />

Quantum is a Game-Changing<br />

innovation that has succeeded in<br />

closing a critical capability gap<br />

The Quantum<br />

Solution<br />

previously left exposed by other<br />

commercial off-the-shelf fluid<br />

warmers currently fielded.<br />

The Quantum exceeds all<br />

healthcare and logistical<br />

requirements for the delivery<br />

of warmed blood or fluids<br />

across the defined spectrum<br />

of care.<br />

With the Quantum, size, weight,<br />

performance, and ease of use are<br />

no longer collective barriers to<br />

the delivery of whole blood in far<br />

forward and Point of Injury (POI)<br />

casualty management.<br />

The system consists of unique<br />

thermal administration sets that<br />

incorporate sensing elements<br />

with an integrated heating system<br />

that does not disrupt the fluid<br />

path. With advanced intelligence<br />

throughout the system, the<br />

lightweight Controller modulates<br />

and moderates the energy flow to<br />

the integrated heating elements to<br />

ensure consistent normothermic<br />

fluid delivery to the casualty.<br />

The battery is the smallest in<br />

category, able to rapidly adjust<br />

power distribution based on<br />

the temperature and flow rate<br />

of the input fluid. This creates a<br />

highly efficient system capable of<br />

previously unrealized performance<br />

optimizations.<br />

The Quantum system has an<br />

operational weight of just 624<br />

grams yet can deliver one litre of<br />

4°C Whole Blood (WB) at 100mL/<br />

min with an output temperature<br />

of 38°C+/- 2°C with only a 24<br />

second warm-up period.<br />

The Quantum Blood and Fluid<br />

Warmer provides the Health<br />

Care Professional with significant<br />

technological advantage in the<br />

fight to eliminate preventable<br />

death.<br />

The Problem: Why Warm<br />

Infusion Fluids?<br />

Even a small decrease in body<br />

temperature of an injured patient<br />

starts a cascade of negative<br />

events significantly increasing<br />

morbidity and mortality. A core<br />

temperature of less than 35C<br />

(95F) is a poor prognostic<br />

indicator A core temperature<br />

of 32C (90F) is associated with<br />

100% mortality.<br />

Known as Secondary or<br />

Unintentional Hypothermia (UH).<br />

Once established, UH is very<br />

difficult to correct. Prevention<br />

measures starting from the<br />

earliest point of patient care is the<br />

most effective strategy.<br />

DS Medial have been appointed<br />

as <strong>UK</strong> & Ireland distributor please<br />

contact DS Medical on 01329<br />

311451 or alternatively email<br />

info@dsmedical.co.uk should<br />

you wish to discuss this in greater<br />

detail.<br />

Great Western Air<br />

<strong>Ambulance</strong> Charity<br />

unveil new critical<br />

care car<br />

Great Western Air <strong>Ambulance</strong><br />

Charity (GWAAC) have<br />

unveiled a new critical care<br />

car, which will allow them<br />

to reach more critically ill<br />

patients across the region.<br />

The charity’s critical care cars are<br />

operated alongside the helicopter,<br />

and carry the same equipment as<br />

the helicopter, bringing the crew<br />

and their lifesaving skills to the<br />

side of those in urgent need.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

166<br />

Administration of un-warmed<br />

IV fluids and cold stored blood<br />

products are an established risk<br />

factor for patients to develop<br />

UH. Particularly when initiated<br />

in the uncontrolled prehospital<br />

environment.<br />

Blood must be stored, refrigerated<br />

and kept very cold prior to<br />

transfusion. During transfusion,<br />

blood must be warmed<br />

For more news visit: www.ambulanceukonline.com<br />

The new model, a Skoda<br />

Kodiaq, which is used by South<br />

Western <strong>Ambulance</strong> Service<br />

NHS Foundation Trust, has been<br />

specially converted to meet the<br />

requirements of the Critical Care<br />

Team.<br />

The 720-litre boot has been<br />

redesigned to house essential<br />

lifesaving equipment, including<br />

ventilators, oxygen, controlled


drugs and other specialist<br />

equipment the Critical Care<br />

Team carry. The front of the car<br />

has been adapted, with a 999<br />

response screen installed for the<br />

crew to receive details of call-outs<br />

and navigate to the location of<br />

the patient in need quickly and<br />

efficiently.<br />

The model has also been<br />

kitted out with additional power<br />

supplies, including split charging<br />

and mains shoreline capabilities<br />

to ensure that both the cars and<br />

the kit inside are constantly ready<br />

to respond.<br />

In 2019, GWAAC’s crew received<br />

over 2,000 call-outs, of which over<br />

two thirds were responded to by<br />

critical care car. The cars ensure<br />

that the crew are always ready<br />

to respond in any conditions, for<br />

example when the helicopter is<br />

unable to fly due to bad weather<br />

or maintenance, or when the<br />

location of a patient has limited<br />

safe landing sites nearby and is<br />

easier to access by road.<br />

Air Operations Officer at GWAAC,<br />

John Wood, said: “Having<br />

reliable, appropriate and fully<br />

equipped cars are essential for<br />

us to reach and treat patients in<br />

the most effective way. The new<br />

vehicles will enable our team to<br />

negotiate tougher terrain and<br />

drive safely in challenging weather<br />

conditions to reach patients<br />

quickly and safely, particularly in<br />

rural areas.”<br />

This new car will be one of three<br />

vehicles to join GWAAC’s fleet,<br />

updating the current models that<br />

the service uses, after the charity<br />

successfully bid for a one-off<br />

Government grant from the<br />

Department of Health and Social<br />

Care last year to purchase the<br />

much needed new cars.<br />

To find out more about GWAAC’s<br />

new critical care car, visit: www.<br />

gwaac.com/critical-care-cars<br />

South Central<br />

<strong>Ambulance</strong><br />

Service partners<br />

with GoodSAM to<br />

bring innovative<br />

video streaming<br />

technology into their<br />

Clinical Coordination<br />

Centre 999 Control<br />

Rooms<br />

South Central <strong>Ambulance</strong><br />

Service NHS Foundation Trust<br />

(SCAS) is launching a groundbreaking<br />

digital product -<br />

GoodSAM’s Instant On Scene -<br />

to enable the public to stream<br />

video directly from their<br />

smartphones into the SCAS<br />

999 Clinical Coordination<br />

Centres (CCC). The system<br />

is set to revolutionise triage<br />

for the <strong>Ambulance</strong> Service,<br />

ensuring medics can now see<br />

what the patient sees in just a<br />

few seconds.<br />

It will enable SCAS’s 999 CCC<br />

staff to send a text or email<br />

message to a caller containing<br />

a link which, when clicked on,<br />

enables video to be streamed<br />

live from the caller’s smartphone<br />

directly into the CCC. There’s<br />

nothing to download and no<br />

logins, the system works on any<br />

smartphone and on any network;<br />

its use is entirely voluntary. All<br />

data is securely transmitted with<br />

end-to-end encryption and no<br />

video is recorded, so members<br />

of the public can be absolutely<br />

confident that their information is<br />

safe.<br />

The 999 call continues while the<br />

video is streaming. Instant on<br />

Scene will help ensure patients<br />

are quickly assessed and<br />

given effective medical advice.<br />

It will support SCAS in better<br />

understanding the level of care<br />

or resources which may be<br />

required to deliver the best patient<br />

outcomes.<br />

Luci Stephens, Director of<br />

Operations (CCC) said: “This<br />

marks the start of an exciting new<br />

chapter in patient care by SCAS.<br />

We have previously been able<br />

to resolve patients’ healthcare<br />

issues, either by the dispatch<br />

of an emergency ambulance,<br />

by referring them to other areas<br />

of the NHS to receive ongoing<br />

care or by advising them over<br />

the telephone how to manage<br />

their symptoms at home. Using<br />

GoodSAM’s Instant On Scene<br />

brings an additional visual layer<br />

to our well-practiced processes<br />

and procedures and this will help<br />

to ensure that our patients get the<br />

right care, in the right place and<br />

at the right time. Patient safety<br />

remains at the heart of everything<br />

we do, and video consultations<br />

will provide exceptional support in<br />

allowing us to achieve this goal”.<br />

Ali Ghorbangoli, Technical Director<br />

and Co-Founder of GoodSAM<br />

said: “Developing a highly<br />

accessible and simple to use<br />

system is central to success. Our<br />

products are designed specifically<br />

for emergency situations - no<br />

apps, downloads or logins are<br />

required”.<br />

It is anticipated that the video<br />

solutions will translate into lifechanging<br />

outcomes, enabling<br />

SCAS to respond more rapidly<br />

and appropriately. Instant On<br />

Scene will also support major<br />

incidents and enable emergency<br />

services to share video streams in<br />

real-time.<br />

Medical Director and Co-Founder<br />

of GoodSAM, Professor Mark<br />

Wilson said: ‘In emergencies, time<br />

is vital in saving a person’s life<br />

or reducing long-term disability.<br />

Often <strong>Ambulance</strong> Services<br />

have limited information from<br />

bystanders about a patient’s, or<br />

multiple patients’, injuries to make<br />

decisions. Instantly being able to<br />

see the scene radically improves<br />

situational awareness. We are<br />

incredibly excited to be bringing<br />

this technology to SCAS, and<br />

we look forward to working with<br />

them in ensuring the GoodSAM<br />

system continues to save lives<br />

and further enhance patient care<br />

in the region’.<br />

GoodSAM’s Instant On Scene is<br />

being rolled out as part of SCAS’s<br />

Global Digital Exemplar (GDE)<br />

programme. This initiative is<br />

supported by NHS Digital and is<br />

designed to leverage technology<br />

to improve patient outcomes and<br />

staff working practices.<br />

“Developing<br />

a highly<br />

accessible<br />

and simple to<br />

use system<br />

is central<br />

to success.<br />

Our products<br />

are designed<br />

specifically<br />

for emergency<br />

situations<br />

- no apps,<br />

downloads<br />

or logins are<br />

required”.<br />

AMBULANCE <strong>UK</strong> - OCTOBER<br />

For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />





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