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Volume 37 No. 1
February 2022
DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS
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CONTENTS
CONTENTS
Ambulance UK
4 EDITOR’S COMMENT
7 FEATURES
Lessons learned from the first 50 COVID-19 critical care transfer
missions
16 NEWSLINE
26 IN PERSON
31 COMPANY NEWS
COVER STORY
SEAMLESS SYNCHRONISATION – THE PERFECT INTERACTION
BETWEEN CORPULS 3 & CORPULS CPR DURING RESUSCITATION
corpuls 3 / C3T
With its revolutionary modular design, the corpuls3 & C3T can be used
as a compact unit or separated into the Monitoring Unit, Patient Box and
Defi brillator/Pacer. The modules communicate wirelessly and adapt to
the requirements of the paramedic on scene, or inside the ambulance.
This issue edited by:
Sam English
c/o Media Publishing Company
Greenoaks, Lockhill
Upper Sapey, Worcester, WR6 6XR
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corpuls cpr
The unique rotating arm of the corpuls cpr grants free access to the patient’s thorax
at all times, meaning the emergency responders are able to provide additional lifesaving
therapy during CPR. The various back boards are designed for fl exibility on scene and
during patient transport.
The corpuls cpr ensures fully automatic, fatigue proof thorax compressions, and the
compression depth, rate and mode can be tailored to the patient. The device can
accommodate a thorax height of 14-34cm with no restrictions regarding the patient’s
weight and breadth of the thorax.
Synchronised Therapy
Thanks to the Bluetooth connectivity, the corpuls cpr is effectively the fourth module of the
corpuls 3 . The modular design of the corpuls 3 allows the monitor to be taken by a medic to
a safe distance to observe the patient’s vitals and control the corpuls cpr and defi brillator.
With corpuls synchronised resuscitation, chances of ROSC can be higher thanks to
automatic pre-shock CPR capabilities. Stress amongst the team can also be signifi cantly
reduced with shorter hands-off time.
This can reduce the number of rescuers needed in the event of a
cardiac arrest. It is a huge benefi t during prolonged resuscitation,
especially when providing treatment in small, confi ned spaces
and during patient transport in an ambulance. Built-in connectivity
functions of the corpuls 3 / C3T are ideal for telemedicine and the
corpuls communication platform corpuls.mission.
Learn more at: https://pages.theortusgroup.com/synchronisation
PUBLISHERS STATEMENT:
The views and opinions expressed in
this issue are not necessarily those of
the Publisher, the Editors or Media
Publishing Company.
Next Issue April 2022
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EDITOR’S COMMENT
EDITOR’S COMMENT
Welcome to this issue of AUK.
Let me start by passing on condolences from the team here at AUK to the family, friends, colleagues and all
at SECAM on the tragic loss of a young Paramedic, Alice Clark, who lost her life in a crash early in January.
Our thoughts are with you all at this sad time and we wish her colleagues, who were also involved, a speedy
recovery. At times like these you reflect on the family that is the ambulance service and share in the shock
and grief.
“But we
must look
forward, not
backward, and
remember
the Chinese
proverb, ‘in
the midst of
chaos there
is always
opportunity’...”
February is a particularly grim month, not just because of the post New Year lull and the gloomy outlook
with little hope of decent weather for another two months, but also because the pressures do not get any
better. I’ve just watched a story on TV about the mother of a young man who died waiting for a delayed
response. There was nothing that could have been done to match demand and supply during that awful
couple of months around Christmas, especially with the staff absence factor created by Covid. It was not an
isolated incident, nor specific to any particular region, the point is that there doesn’t seem to be any way to
keep up with rising demand and public expectations.
Furthermore the vicious circle of delayed discharge, delayed admission, delayed handover is seemingly
impossible to break without significant input into a social care system which has been broken for years
and will not get any better with the staffing pressures brought into place with mandatory vaccination.
It’s just my opinion but when I hear such stories I’m disappointed and saddened because no-one wants
to make patients wait. I’ve been in the Control room and watched the pressure on dispatchers struggling
to find something, anything, to send out and I’ve seen them cry when there isn’t anything available.
They take it personally as do the Paramedics who know they’re arriving way out of the time frame and
spend the first minutes of an interaction apologising and sometimes, as the front end, becoming the object
of their frustrations for those who have had to wait. I don’t know what the answer is, I’m not sure anyone
really does. We work at handover schemes and put as much into resource as we can but the simple truth
is there is a clear gap between what we need and when we can have it. It takes two years to address the
increased Paramedic resource needed to meet this year’s growth, not to mention the funding. But we must
look forward, not backward, and remember the Chinese proverb, ‘in the midst of chaos there is always
opportunity’…
Anyway, on a less depressing note, travel restrictions are slowly being removed so with luck some of you
might get a well-deserved holiday abroad this year. It’s been a long slog over the last two years and it really
is time for all of us to recharge the batteries…
Sam English, Co-Editor Ambulance UK
AMBULANCE UK - FEBRUARY
4
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FEATURE
LESSONS LEARNED FROM THE FIRST 50 COVID-19 CRITICAL
CARE TRANSFER MISSIONS CONDUCTED BY A CIVILIAN UK
HELICOPTER EMERGENCY MEDICAL SERVICE TEAM
J. Jeyanathan 1 , D. Bootland 1 , A. Al-Rais 1 , J. Leung 1 , J. Wijesuriya 1 , L. Banks 1 , T. Breen 1 , R. DeCoverly 1 , L. Curtis 1 ,
A. McHenry 1 , D. Wright 1 , J. E. Griggs 1,2 and R. M. Lyon 1,2*
Scand J Trauma Resusc Emerg Med (2022) 30:6 https://doi.org/10.1186/s13049-022-00994-7 © The Author(s) 2022.
Abstract
Background: The COVID-19 pandemic has placed exceptional
demand on Intensive Care Units, necessitating the critical care
transfer of patients on a regional and national scale. Performing these
transfers required specialist expertise and involved moving patients
over signifi cant distances. Air Ambulance Kent Surrey Sussex
created a designated critical care transfer team and was one of the
fi rst civilian air ambulances in the United Kingdom to move ventilated
COVID-19 patients by air. We describe the practical set up of such a
service and the key lessons learned from the fi rst 50 transfers.
Methods: Retrospective review of air critical care transfer service set
up and case review of fi rst 50 transfers.
Results: We describe key elements of the critical care transfer
service, including coordination and activation; case interrogation;
workforce; training; equipment; aircraft modifications; human factors
and clinical governance. A total of 50 missions are described
between 18 December 2020 and 1 February 2021. 94% of the
transfer missions were conducted by road. The mean age of these
patients was 58 years (29–83). 30 (60%) were male and 20 (40%)
were female. The mean total mission cycle (time of referral until the
time team declared free at receiving hospital) was 264 min (range
149–440 min). The mean time spent at the referring hospital prior
to leaving for the receiving unit was 72 min (31–158). The mean
transfer transit time between referring and receiving units was
72 min (9–182).
Conclusion: Critically ill COVID-19 patients have highly complex
medical needs during transport. Critical care transfer of COVID-19-
positive patients by civilian HEMS services, including air transfer, can
be achieved safely with specifi c planning, protocols and precautions.
Regional planning of COVID-19 critical care transfers is required to
optimise the time available of critical care transfer teams.
Keywords: COVID-19, Critical care, Transfer medicine, Helicopter
Emergency Medical Services, Intensive care
Background
The coronavirus (SARS-CoV-2) pandemic (COVID-19) has challenged
health systems across the globe [1]. In particular, a major demand
has been placed on critical care facilities. A signifi cant proportion of
COVID-19 patients required treatment with critical care interventions,
including ventilatory support [2]. This unprecedented demand led to
Intensive Care Unit (ICU) resources being put under signifi cant strain
on both regional and national levels. At a local level, ICU bed pressures
necessitated the rapid creation of acute surge capacity. Despite
these expanded footprints, the critical care capacity in many hospitals
remained under signifi cant pressure. In order to preserve standards
of critical care and mitigate these demands, it became necessary for
hospitals experiencing acute demand to request critical care transfers
to other ICUs, utilising system resources across the region and then
beyond. During the height of the pandemic in early 2021, there were
several requests on a daily basis within our region requesting critical
care transfers of COVID-19 patients. These demands could not be met
by the existing hospital workforce. The unprecedented level of demand
led to resource strain at both regional and national levels and mandated
the creation of de novo critical care transport teams in order to maintain
equitable access to intensive care. The number of necessitated transfers
also meant that many of these were undertaken over large distances to
other regions [3].
The demand for critical care transfers during the height of the pandemic
was unprecedented [2]. Emergency Medical Services (EMS) with
experience and capability to undertake critical care transfers were
asked, at very short notice, to increase their capacity and adapt to being
able to transfer critically unwell COVID-19 positive patients. The highly
infectious nature of COVID-19, particularly in relation to performing
Aerosol Generating Procedures (AGPs), required specifi c protective
measures to be taken to safely transfer COVID-19 patients, without
putting EMS or associated personnel, such as pilots, at risk [4]. In the
UK, pre-hospital critical care teams such as Helicopter Emergency
Medical Services (HEMS) have adapted, overcome, and continued to
deliver high acuity trauma and medical care to patients at their time of
need. In addition, several HEMS services rapidly adapted to provide
a critical care transfer capability. Indeed, the combination of highly
experienced senior clinicians working within a mature governance
framework alongside an established transport platform, lent itself well to
HEMS services adapting to undertake work of this nature.
Critical care transfer medicine has several essential areas which
require careful consideration [5]. These considerations were especially
highlighted in the context of ICU-level COVID-19 patients, due to their
need for complex multi-organ support, particularly advanced ventilatory
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7
FEATURE
support, and their physiological fragility. The challenge of these
transfer cases was often exacerbated by short notice, urgent referrals
for transfers over significant distances and the need for escorting
clinicians to wear level 3 /ICU Personal Protective Equipment (PPE)
throughout. This paper provides a descriptive overview of how our UK
HEMS service, in collaboration with our local National Health Service
(NHS) ambulance provider (South East Coast Ambulance Service NHS
Foundation Trust—SECAmb), rapidly evolved to provide an aeromedical
transfer capability for COVID-19 patients. We present a pragmatic
review of the first 50 COVID-19 transfers undertaken by Air Ambulance
Kent Surrey Sussex and highlight key lessons learned that would be
useful to other EMS services tasked with setting up such a service.
Methods
Air Ambulance Kent Surrey Sussex (AAKSS) delivers care to a mixed
urban and rural area, covering 4.5 million people across the south east
of England. The HEMS team comprises of an experienced physician
and paramedic, capable of delivering enhanced care, including
pre-hospital emergency anaesthesia, blood product administration,
procedural sedation and emergency surgery. These interventions
cannot be routinely performed by land ambulance crews. The HEMS
service operates from two separate bases, responds 24/7 and can
respond in either a helicopter or response car, depending on geography
and weather limitations. Patients are transported to hospital either by
helicopter or land ambulance.
In December 2020, a so-called “Kent” variant (subsequently known as
B.1.1.7.) of COVID-19 which appeared more contagious than other
variants, rapidly spread through the south east of England, the region
which AAKSS serves. The number of critically unwell patients rapidly
challenged the intensive care unit (ICU) capacities within many of the
hospitals of Kent, Surrey and Sussex. As part of a national strategy,
overseen by the NHS, to maintain equitable access to critical care,
coordination and provision of a robust critical care transfer capability
became a necessity [3]. With a notice period of just a few weeks,
AAKSS developed a Critical Care Transfer Service to dovetail with
its primary pre-hospital emergency medicine (PHEM) duties. To build
in layers of safety, a number of standardised processes were rapidly
implemented.
Results
The key elements that needed to be established for a dedicated
aeromedical transfer service to launch are described below. These
elements were considered by all authors as the most important when
having to rapidly adapt from primary HEMS work to secondary COVID
transfers.
Coordination and activation of a specifically tailored and
rehearsed level 3 COVID-19 transfer process
Transfer requests were identified via a central process to SECAmb
following a daily regional meeting and subsequently passed to the
AAKSS Duty Clinical Manager. This would commence a chain of defined
concurrent activity in order to plan the conduct of the tasking. Each
individual transfer request was overseen by the Duty Clinical Manager
and an on-call AAKSS HEMS Transfer Consultant (with experience
in both pre-hospital emergency medicine and current ICU COVID-19
care). The Duty Transfer crew consisted of a Transfer Doctor (who
was an AAKSS HEMS doctor from an ICU-Anaesthesia specialty) and
an AAKSS Transfer Paramedic. The temporal nature of identifying
and tasking a transfer following the receipt of requests after regional
meetings meant that transfers typically occurred in the afternoon and
evening. The process overview is shown in Fig. 1.
Case “Interrogation” process
Requests for COVID-19 transfers were coordinated at regional level
by the NHS England Improvement critical care coordination cell and
SECAmb. Each request was considered on an individual basis by
AAKSS. A patient selection proforma utilised a specifically tailored case
interrogation template, as shown in Fig. 2. The complexity, instability and
physiological fragility of COVID-19 patients meant that rigorous clinical
interrogation, with case-by-case consideration of the challenges posed
by moving these patients was required on each occasion.
Prior to deploying on a transfer tasking, a “command huddle” was
conducted. At the command huddle the transfer team, duty transfer
consultant and duty clinical manager would appraise the clinical and
logistic aspects of the case, identify potential risks and pitfalls, discuss
mitigation strategies, and decide the most appropriate course of action.
Particularly complex or high risk transfers were escalated to the Medical
Director for further review and final decision making.
AMBULANCE UK - FEBRUARY
At the time of implementation, ICUs in the south east of England were
under unprecedented pressure. There would often be several patients
on particular hospital sites requiring admission to ICU when the local
unit was already at capacity. To manage system capacity, patients were
transferred between ICUs, with the most stable patients being selected
for transfer. These would often involve non-COVID patients.
We review the steps required to set up an aeromedical transfer service
capable of safely and robustly moving Level 3 COVID-19 positive
patients; the training, operational and medical elements needed to
deliver such a service safely and effectively and we present key lessons
learned from the first 50 COVID-19 transfers. The key elements were
based on internal expert opinion and we sought to present a pragmatic,
descriptive approach to inform other pre-hospital services involved in the
transport of COVID-19 patients.
Workforce
The AAKSS crew was a doctor and paramedic. The doctors were all
experienced, long-standing AAKSS PHEM doctors and were additionally
Consultants in Anaesthesia and Intensive Care Medicine and had recent
and regular ongoing exposure to patients who were critically unwell with
COVID-19. The AAKSS paramedics had undertaken concurrent training
in specific elements of critical care and COVID-19 [6]. This specific crew
configuration allowed for a familiarity in caring for the critically unwell
patient in the out-of-hospital environment. Familiarity between members
of the workforce was a particularly important factor in overcoming the
additional and significant challenges posed by operating in full Level 3
PPE. Personal protective equipment need to be in-line with standard
hospital practice including eye protection, FFP3 masks and surgical
gowns. Crews were also given the option of wearing Positive Airway
Pressure Respirator hoods.
8
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FEATURE
AAKSSCCTT Request
AAKSS Critical Care Transfer Team (CCTT) Process
SECAmb Critical Care Transfer desk
request
Duty Manager
Initial AAKSS Call Handler. Attains:-
1)Patient demographics and basic clinical
synopsis. 2) Details and contacts of
Referring and Receiving ICU Consultants
andNurses-In-Charge
Critical Care
Transfer Team
Activation
Flowchart
CCTT Pre-Alert
Transfer Doctor Paramedic Duty Manager&HEMS Pilot
Case Interrogation &Preparation
Communication&CCTT Activation
Clinical Interrogation
Process, viaReferring
andreceiving ICU
Consultants.
Issue Transfer “Wish-
List” request
Equipmentand
logistical
preparation.
CCTT Pre-missionCommand Huddle
Tactical &Logistic
assessment:-
Land
Aviation
Hybrid –Land-
Aviation
Oncall Transfer Consultant,Critical Care Transfer Team,Duty Manager
+/- Pilots.
Discussthe case together,assessing theclinical, transfer andaviation
riskswithappropriate mitigation strategies. Concludewitha“plan
proposed”for theTransferMission Cycle
Transfer Doctor
Inform ReferringICU of
CCTT activation andETA
Reaffirm Communication
on Comprehensive
DischargeSummary,
Equipment, Packaging
andDrugpreparation:-
- Infusions
- Emergency drug
Transfer accepted
Paramedic
Inform HEMS desk
on CCTT activation
andthe proposed
logistical details
Pre-Departure
Checklist
Transfer declined
Duty Managerinforms
HEMS desk &SECAmb
Critical Care transfer
desk
Doctor informs
ReferringICU
30 mins
15 mins 10 mins
Team Activation
Team StandDown
Fig. 1 AAKSS critical care transfer process
Training
A competency-based critical care transfer training module was
developed and instituted to ensure specific training and currency in
critical care practice and the management of patients with multi-organ
dysfunction. Training built upon the pre-existing PHEM practices and
expertise and, as the service developed, was further enhanced, and
standardised to a formal training pathway for Critical Care Transfer
Medicine. All transfer team members undertook a HEMS Transfer
Training day, alongside a half day Critical Care COVID Transfer Medicine
Package, with a specific focus on the physiology, pharmacology and
practical techniques required to manage complex and critically ill
patients. Individual crew members were then required to complete a
curriculum of core clinical topics, equipment competencies and logistic
considerations. It took varying amounts of time for crew members to
develop competence and confidence in critical care transfer and while
there was no set time to complete the training log, 2–4 weeks was
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9
FEATURE
AAKSSCriticalCareTransfer TeamInterrogation Template
Transfer Details [Completed by HEMS Duty Clinical Manager]
Date of transfer
Time
request
Referring
Name andcontact
Hospital
Referringhospital
Consultant and
Nurse-in-charge
Contactnumber:
Receiving
Hospital
Precise
DestinationDetails
Name andcontact
Receiving hospital
Consultant and
Nurse-in-charge
PatientDetails [Completed by HEMS Duty Clinical Manager]
Name : DoB :
Reasonsfor
Transfer
Specialist
requirement:
COVIDStatus
Briefclinical
synopsis
Capacity
Clinical
Repatriation
Positive
Negative
Patient’sWeight
(Kg)
Specific access
instruction:
Clinical information [Completed by Duty Crew Transfer Doctor]
ReferringHospital
ReceivingHospital
andprecise
andprecise
location
location
Referring
Consultant
Receiving
Consultant
AMBULANCE UK - FEBRUARY
Family informed
Clinical Overview
Clinical history:
Fig. 2 AAKSS critical care transfer planning sheet
Yes
No
suggested. During this period the crew member also undertook at
least four transfer shifts under the supervision of a Transfer Consultant.
Family Contacts
[Ifavailable]
Name:
Contactnumber:
Training culminated in a full day sign-off assessment, including a clinical
viva, equipment test and clinical long case discussion.
10
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FEATURE
Equipment
A specific, dedicated set of transfer equipment and bags were
assembled. The content was based on the need to maintain the highest
standards of intensive care throughout the duration of the transfer.
Ventilation was provided with a Dräger Oxylog 3000 ventilator in line with
our primary HEMS work and monitoring maintained using the Tempus
Pro Monitor (Phillips RDT). This allowed for the added advantage of
recording physiological data directly into the electronic clinical record.
Infused medicines were delivered via Braun perfusor syringe drivers.
Using identical equipment to that used in primary HEMS work was
an important consideration in order to enhance the safety of this type
of work and minimise the cognitive load that comes with managing
patients of this complexity. The transfer kit was physically entirely
separate to the HEMS kit and could be deployed onto a land ambulance
or helicopter.
Transfer platform and infrastructure
All critical care transfers were considered for transfer via land, air or
a land-air hybrid. Given the complicated geography in our region,
with a mix of urban areas within rural and coastal settings, the
potential opportunity for air or hybrid transfer mission cycles allowed
an enhancement in care by decreasing the period a sick COVID-19
patient was out of a hospital ICU environment. This also accelerated the
regeneration of the critical care transfer crew. Several transfers, including
the long distance mission cycles, whilst considered for air transfers,
often resulted in either pure land or hybrid transfers. Overall, 94% of the
transfer missions were conducted by land. This was due to the time
of year being winter (December-February), with both light and weather
restrictions, which made long distance critical care transfers by air using
visual flight rules challenging to undertake.
Care of the COVID-19 patient during transfer
Meticulous handling of the COVID-19 patient was required prior to,
during, and after transfer. Respiratory failure was the overwhelming
organ failure, requiring multi-faceted management strategies, particularly
for refractory hypoxia. Stabilising the patient on the transport ventilator
was a particular challenge for some patients and was typically
attempted early in the transfer process. In practice, our transfer team
most commonly encountered pressure-controlled ventilation. Our team
mirror the pressure setting as the initial step of ventilator transition.
We then closely observe the changes of the patient’s minute volume.
If minute volume reduced, our team will implement an incremental
increase to inspiratory pressure until the desired minute volume is
achieved. We allowed permissive hypercapnia. We obtained an arterial
blood gas sample 15 min after the transition to the transport ventilator
(Oxylog 3000). To avoid patient-ventilator asynchrony during the mission,
deep sedation and paralysis were used for the entire transfer journey.
Interpersonal relationships, human factors and communication
The management of a COVID-19 patient is made harder by the need
to work carefully in full PPE. Clear communication was therefore
imperative. As a Critical Care Transfer Team, it was important to forge
relationships with referring critical care teams, clearly communicate
with the receiving ICU and work cohesively alongside a number of new
groups of health professionals and team members. The primary PHEM
training and practices, particularly in crew resource management (CRM)
and communication skills, proved a core strength and foundation for the
critical care transfer capability response.
Aircraft modification
To protect the pilots, a sealed barrier curtain was installed between
the cockpit and cabin section of the AW169 helicopter. This achieved
a hermetic seal with different air supplies to the pilot and patient cabin
sections. Pilots flew with standard surgical masks, following testing
and approval of radio communications whilst wearing them. The size
and specification of the AW169 cabin allowed for excellent access to
the patients throughout flight, and the ability to maintain monitoring
and titrate infusions presented no problems. A closed suction system
allowed for in-flight suction of the trachea if required.
Clinical Governance
A specific Clinical Governance framework was established that
mirrored that of AAKSS primary missions but stood as an independent
framework. Whilst this specific process was created de novo to address
a specific challenge in the critical care transfer of level 3 COVID-19
patients (Fig. 1), it was embedded in a mature system of standard
operating procedures, governance and logistics. A dedicated Transfer
Consultant was on-call for remote support and all cases underwent
detailed case review.
Analysis of the 50 critical care transfers
during the UK COVID-19 s wave
Between 18 December 2020 and 1 February 2021, AAKSS in
collaboration with SECAmb performed 50 adult critical care transfers in
support of the UK COVID-19 response.
All 50 of these critical care transfers were undertaken to urgently help
with ICU capacity across the region. These ICUs were all managing
patient numbers significantly beyond their normal footprint. As a result,
through a nationally coordinated initiative, other ICUs with capacity were
identified to provide mutual aid, often in areas a significant distance
away.
The complex implications of COVID-19 on the vascular structure and
haematological dynamics, often with a pro-thrombotic propensity,
gave these patients a uniquely precarious physiological fragility. The
interrogation process between the referring ICU consultant and transfer
team was important, but a further dynamic assessment of the patient
was essential on transfer team arrival at the referring ICU. Gentle
bridging on to transfer specific infusion pumps, ventilator, monitoring
and bed was essential followed by careful handling of the patient’s
complex pathophysiology. Pre-arrival requests were structured, as
shown in Fig. 3.
Of the 50 critical care transfers, 45 (90%) were critically unwell patients
receiving Level 3 multi-organ support. 5 (10%) patients were receiving
Level 2 care and all of these were for non-COVID-19 disease processes.
All missions had data entered in real time into the AAKSS patient record/
mission data system (HEMSbase, Medic One Systems Ltd). A specific
section had already been created to record secondary transfer missions.
All data were then analysed retrospectively.
The mean age of these patients was 58 years (range 29–83). 30 (60%)
were male and 20 (40%) were female.
AMBULANCE UK - FEBRUARY
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11
FEATURE
Transfer team communicationchecklist and“wish list”
Airway
ETT/ Tracheostomy well secured
Sparetracheostomypackwithinner cannula
In-linesuction catheter
NewHME filter made ready for transfer
Blue Soft-tooth blue clamp/metalclamp with gauze
Breathing
Stable on ventilator
CD cylinder
Circulation
CentralAccess(ideallyright Internal jugular)
Twoperipheralcannula (ideally oneright sided)
Arterial line (ideally rightradial)
Rationalisenon-essential infusions
Capoff allunusedlines
1x 1000ml Crystalloidattachedtodedicated line (orlumen of CVC)
Disability
Ensure patientsedation+/- muscle relaxation
Exposure and NG tube aspirated&capped
packaging
Urinarycatheterinsitu&Catheter bagemptied
2x sheets /blankets
Drugs&infusion preparation Will need to be Tailored to MissionCycle
Infusions
Propofol 1% in 50ml Luer lock syringex2
Fentanyl 50mcg/ml in 50ml Luer lock syringes x1
Noradrenaline4mg in 50ml Luer lock syringes x2
Otheressential drug spareinfusion
Boluses
Rocuronium 100mgin10mlx2
Propofol 1% in 20ml x1
Fentanyl 500mcg in 10ml x1
Emergencydrugs Metaraminol10mgin20mlx1
Adrenaline 1mgin10mlmini-jet
Documentation&Communication
Comprehensivedischarge summarycopiesx2
Allclinicalnotes photocopied/printed
Family informed
Fig. 3 Transfer team communication checklist
AMBULANCE UK - FEBRUARY
The AAKSS aircraft was used for 3 (6%) transfers and 47 (94%) were
moved by road. To our knowledge, this represented the first civilian air
transfers of COVID-19 positive patients in the UK.
All of these patients were invasively ventilated with mandatory or
pressure support ventilation. 45 (90%) of these patients had an
endotracheal tube in situ and 5 (10%) had a tracheostomy sited to
facilitate weaning from mechanical ventilation.
The mean FiO 2
at referral was 0.45 (0.21–0.8). 17 (34%) patients were
established on vasopressor support at the point of referral, versus 33
(66%) on no cardiovascular support. All 17 patients on vasopressor
support were receiving noradrenaline, with 1 patient also receiving
dobutamine.
The mean total mission cycle (time of referral until the time team
declared free at receiving hospital) was 264 min (range 149–440 min).
The mean time spent at the referring hospital prior to leaving for the
receiving unit was 72 min (31–158). The mean transfer transit time
between referring and receiving units was 72 min (9–182).
During this period, no significant adverse events occurred and there
were no instances of transfer team members or pilots contracting
COVID-19 as a result of a transfer mission.
Discussion
AAKSS successfully implemented a fully functional critical care
transfer service capable of moving critically ill COVID-19 patients by
air. The majority of these patients were in multi-organ failure due to
COVID-19 infection. The adherence to a standardised pathway with an
interrogation process allowed for an efficient service, which focussed on
patient safety. The investment in the workforce and subsequent crew
configuration was labour intensive, but ensured a robust and consistent
service. The training elements and governance were imperative in
12
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FEATURE
ensuring responsive practices, especially as our clinical approach to
COVID-19 evolved. Having a dedicated AAKSS Transfer Consultant and
the ability to activate “Command Huddles” throughout a critical care
mission were both useful for patient care but also for supporting crews
and fostering interpersonal relationships across healthcare providers
during a very challenging time. The authors of this paper would
recommend using these interventions, which we believe enhanced
mission and organisational safety.
The need for local, regional and national coordination of critical care
assets and transfer requirements is imperative for future pandemic
initiatives. To optimise the available time of the critical care transfer
teams, planning should ideally occur on an ongoing basis, with patients
identified for transfer the preceding night. This allows transfer teams
to maximise their impact. This is particularly important for aeromedical
teams who may be better operated in daylight conditions. The
number of COVID-19 transfers conducted by air was limited, largely
by environmental factors. As familiarity and efficiency of the transfer
systems evolves, we anticipate increased air transfers.
To our knowledge, AAKSS was the first civilian air ambulance service to
move COVID-19 patients by air in the UK. This was achieved through
early engagement with the required authorities to gain approval for the
safety procedures put in place to protect pilots from the risk of infection.
The use of an aeromedical transport platform has the potential to
confer a significant advantage for patients moved over large distances.
Any concerns regarding the potential physiological insult posed by
altitude are negligible by helicopter transport in our region, with flights
undertaken at around 1000 ft above sea level.
Our teams spent a significant amount of time on arrival at the referring
hospital when compared to our scene times for primary HEMS work.
The time was largely due to the physiological complexity of COVID-19
patients, including, for example, the careful transfer of the patient from an
ICU to a transport ventilator and the associated interventions required to
ensure a safe and stable critical care transfer. In this particular example,
although the assessment of stability and suitability to be moved on a
transport ventilator could be streamlined by having the referring hospital
undertake ventilator exchange prior to transfer team arrival.
presented in this paper will likely be useful to other services.
Further research is warranted, particularly with regards PPE and how
best to prevent cross-infection during transfer of COVID-19 patients [9,
10]. As further waves of COVID-19 patients stretch emergency medical
services globally, sharing of experience will be invaluable.
Conclusions
The COVID-19 pandemic has placed unprecedented pressures on
critical care resources, necessitating the rapid establishment of adult
critical care transfer services to decompress overwhelmed hospitals,
to support clinicians and minimise preventable loss of life due to
resource depletion. Critically ill COVID-19 patients have highly complex
medical needs during transport. Critical care transfer of COVID-19
positive patients by civilian HEMS services, including air-transfer, can
be achieved safely with specific planning, protocols and precautions.
Regional planning of COVID-19 critical care transfers is required to
optimise the time available of critical care transfer teams.
Abbreviations
AAKSS: Air Ambulance Kent Surrey Sussex; AGP: Aerosol generating
procedure; EMS: Emergency Medical Service; HEMS: Helicopter
Emergency Medical Service; ICU: Intensive Care Unit; PHEM: Pre-hospital
emergency medicine; PIU: Patient isolation unit; PPE: Personal protective
equipment; SECAmb: South East Coast Ambulance Service Trust.
Acknowledgements
At AAKSS we would like to acknowledge and thank South East Coast
Ambulance Service NHS Trust for its support in setting up of our Critical
Care Transfer capability. Similarly, thank you to the Independent Ambulance
Providers, Platinum and Medi-4. We also wish to thank Specialist Aviation
Services, who supported the aircraft modification process, allowing for air
transfer of COVID-19 confirmed or suspected patients.
Authors’ contributions
All authors were involved in the service provision, data collection, analysis
and manuscript writing. All authors read and approved the final manuscript.
Other pre-hospital services have published their experience of
transferring critical COVID-19 patients [1, 7]. Several providers described
the effective use of patient isolation units (PIU) [1]. AAKSS was
concerned about the limitations of being able to treat critically unwell
patients whilst in a PIU and therefore focussed on securing the entire
rear of the helicopter to prevent infection. Similar to other published
research, only a minority of transfers were completed by air, highlighting
the technical challenges of air transport of COVID-19 patients. However,
for long distance transfer of COVID-19 patients, air is likely to be the
faster and more effective transport platform [8].
We recognise that this is a relatively small descriptive study over a short
time period. We acknowledge that our experience will not necessarily be
applicable to all services, particularly outside the UK. However, we have
demonstrated a method for a HEMS service to rapidly, effectively and
safely stand up a critical care transfer service capable of moving level 3
COVID-19 patients by both land, air or a hybrid model. We have shown
this is possible in the civilian setting and the policies and protocols
Funding
No funding was received for this study.
Availability of data and materials
All data is presented.
Declarations
Ethical approval and consent to participate
This study met criteria for service evaluation, as defined by the UK National
Institute of Healthcare Research. Formal ethical approval was therefore
not required. All data was sourced from the internal AAKSS database. No
competing interests were declared. No funding was received for this study.
All authors contributed to data review and manuscript writing.
Consent for publication
All authors give consent for publication. Patient consent is not required
as this paper met UK NIHR criteria as a service evaluation.
AMBULANCE UK - FEBRUARY
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13
FEATURE
Competing interests
None to declare.
Author details
*
Correspondence: RichardL@aakss.org.uk
1
Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey
RH1 5YP, UK.
2
University of Surrey, Guildford, UK.
Received: 25 September 2021 Accepted: 4 January 2022
Published online: 15 January 2022
References
1. Hilbert-Carius P, Braun J, Abu-Zidan F, Adler J, Knapp J,
Dandrifosse D, et al. Pre-hospital care & interfacility transport of
385 COVID-19 emergency patients: an air ambulance perspective.
Scand J Trauma Resusc Emerg Med. 2020;28(1):94.
2. Martin-Loeches I, Arabi Y, Citerio G. If not now, when? A clinical
perspective on the unprecedented challenges facing ICUs during
the COVID-19 pandemic. Intensive Care Med. 2021;47(5):588–90.
3. Pett E, Leung HL, Taylor E, Chong MSF, Hla TTW, Sartori G,
Sathianathan V, Husain T, Suntharalingam G, Rosenberg A, Walsh
A, Wigmore T. Critical care transfers and COVID-19: managing
capacity challenges through critical care networks. 2020.
2020100125. https://doi.org/10.20944/preprints202010.0125.v1.
4. El-Boghdadly K, Wong DJN, Owen R, Neuman MD, Pocock S,
Carlisle JB, et al. Risks to healthcare workers following tracheal
intubation of patients with COVID-19: a prospective international
multicentre cohort study. Anaesthesia. 2020;75(11):1437–47.
5. Intensive Care Society. Clinical Guidance: Assessing
whether COVID-19 patients will benefi t from critical care,
and an objective approach to capacity challenges. 2020.
www.wcctn.wales.nhs.uk/sitesplus/documents/1210/
COVID%5F19%5Fcare%5Fguidance%5F5may%5Fendorsed.pdf.
Accessed 13 July 2020.
6. Foex B, Van Zwanenberg G, Handy J et al. Guidance on: the
transfer of the critically ill adult. The Faculty of Intensive Care
Medicine. 2019. www.fi cm.ac.uk/sites/default/fi les/transfer_
critically_ill_adult_2019.pdf. Accessed 15 June 2020.
7. Albrecht R, Knapp J, Theiler L, Eder M, Pietsch U. Transport of
COVID-19 and other highly contagious patients by helicopter and
fi xed-wing air ambulance: a narrative review and experience of
the Swiss air rescue Rega. Scand J Trauma Resusc Emerg Med.
2020;28(1):40.
8. Reimer AP, Dalton JE. Predictive accuracy of medical transport
information for in-hospital mortality. J Crit Care. 2018;44:238–42.
9. COVID-19 infection prevention and control guidance: aerosol
generating procedures [Internet]. GOV.UK. Cited 8 May 2021.
https://www.gov.uk/government/publications/wuhan-novelcoronavirus-infection-prevention-and-control/covid-19-infectionprevention-and-control-guidance-aerosol-generating-procedures
10. Liu Z, Wu Z, Zhao H, Zuo M. Personal protective equipment during
tracheal intubation in patients with COVID-19 in China: a crosssectional
survey. Br J Anaesth. 2020;125(5):e420–2.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affi liations.
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15
NEWSLINE
County Air
Ambulance HELP
Appeal makes third
£250,000 donation to
British Association
for Immediate Care
In addition to new RRVs
and PPE, the main focus for
schemes eligible for funding this
year, will be acquiring lifesaving
capital equipment such as
defibrillators and monitors.
The County Air Ambulance HELP
Appeal, the only charity in the
country dedicated to funding
hospital helipads and to ensuring
patients with life threatening
conditions get the fastest
treatment possible, has given its
third annual grant of £250,000
to the British Association for
Immediate Care.
Divided into 32 regional schemes,
the Association is a national
network of medical, nursing and
paramedic volunteers, who give
up their free time to be on call to
help NHS Ambulance Services,
ensuring they get support for
critical incidents 24 / 7. This
third grant from the County Air
Ambulance HELP Appeal, brings
the total amount donated to
£750,000.
All schemes across the country
were invited to apply for a share
of the latest £250,000 donation.
Previous grant rounds have funded
emergency response vehicles in
different parts of the UK along with
essential clinical and protective
equipment. This round of funds
has been similarly available with the
focus being on capital equipment
such as defibrillators and monitors
- each costing in the region of
£12,000 to £15,000.
Robert Bertram, Chief Executive
of the County Air Ambulance
HELP Appeal said: “Our donations
support these wonderful
volunteers in making huge,
practical improvements to their
lifesaving services. New rapid
response vehicles enable more
medics to join their schemes,
which increases the number of
emergency incidents they can
respond to. Meanwhile, new
state-of-the-art technology for
volunteers’ own vehicles, help
them to arrive at a critical scene
quickly and safely – a must during
the winter months when driving
conditions can be treacherous.
I’m delighted that our funding this
year will support patients directly
through the purchase of lifesaving
defibrillators and monitors.”
Tony Kemp, Chief Officer, British
Association for Immediate Care
said: “The work of the British
Association for Immediate Care
has benefited so much from
the previous two donations
from the HELP Appeal and I am
delighted that once again, on the
back of what has been a very
difficult 18-months, we are again
beneficiaries of a further £250,000
donation. The work of the
Association’s affiliated schemes
has continued throughout the
pandemic and in common with
so many other areas of life, the
cost of lifesaving equipment has
increased. This donation, being
shared by a number of schemes
will ensure that their lifesaving
work continues, we are so grateful
to the HELP Appeal for their
ongoing generosity.”
Paul Gates, Chairman, British
Association for Immediate Care
said: “This year the grant will be
used for a range of lifesaving
equipment to be used as our
volunteers respond to 999 calls for
their local NHS Ambulance service.”
The County Air Ambulance
HELP Appeal’s latest grant has
been distributed to the following
schemes, which so far totals
£134,000:
• BASICS Dorset
• BASICS Essex
• BHECCS (Bedfordshire &
Hertfordshire)
• BRAVO Medics (Bristol)
• CSI BASICS (Cheshire &
Shropshire)
• LIVES (Lincolnshire)
• MARS BASICS (Mercia)
• SWIFT Medics (Wiltshire)
• West Yorkshire Medic
Response Team
The remaining £116,000 will be
distributed to schemes early next
year.
Joe Blissett from LIVES in
Lincolnshire said on receiving
£10,000, which will fund
dedicated blood transport bags
for transporting blood to the
scene of accidents across the
county, “Fantastic news…this
project is going to save many lives
every year.”
AMBULANCE UK - FEBRUARY
(L-R) Dr Jon Barratt (Trustee), Mr Paul Gates (chair) & Dr Andy Pountney (vice-chair) with a cheque
from the County Air Ambulance HELP Appeal.
Junaid Mughal, speaking on
behalf of the newly formed Beds
and Herts Emergency Critical
Care Scheme (BHECCS) said:
“This is fantastic news, it will help
a new scheme like BHECCS go a
long way. It’s an early Christmas
present for us as this grant will
definitely be put to good use
serving the people of Bedfordshire
and Hertfordshire.”
16
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NEWSLINE
Gordon Tollefson, West Yorkshire
Medic Response Team added:
“This grant from BASICS, enabled
by a donation from the HELP
appeal, allows us to go ahead
with the purchase of the ventilator
and this will be a major step for
us in saving lives when West
Yorkshire Medic Response Team
is first on scene.”
NWAS
NWAS helps develop
a new mental health
support programme
for male NHS
frontline workers
We will be involved in the codevelopment
of a new research
project to support male NHS
frontline workers, particularly
those who have experienced
emotional and mental health
problems due to the COVID-19
pandemic.
The programme, called behavioural
activation for low mood and
anxiety in male NHS frontline
workers, know and BALM, is
funded by Movember and The
Distinguished Gentleman’s
Ride. BALM is being led by the
University of York, delivered in
partnership with our trust, York
and Scarborough Teaching
Hospitals NHS Foundation Trust
and Tees Esk & Wear Valleys NHS
Foundation Trust.
Research from previous infectious
disease epidemics shows that
frontline health workers are at
increased risk of developing
both short and long-term mental
health problems, with up to onethird
experiencing high levels of
distress.
To combat this, the researchers
will develop, deliver and evaluate
this early intervention programme
that aims to improve common
mental health challenges such as
low mood, burn-out, anxiety and
depression faced by male frontline
NHS workers. Around 45 male
NHS frontline workers at risk of
low mood will be recruited for the
pilot, which starts in 2022.
They will receive a behavioural
activation booklet and support
from specially trained experts on
how to get the most out of the
programme. It’s expected to be
rolled out across the NHS towards
the end of the project in two
years’ time.
Consultant Paramedic, Steve
Bell, who is a co-investigator
of this programme and our
Research Lead said, “It is clear
that the COVID-19 pandemic has
placed extreme demands on the
emergency services provided
by the NHS, and those frontline
workers in these services have
faced unprecedented pressures
over this time. Ensuring male
frontline workers, who are often
disinclined to speak out and seek
help, are supported is vital and
this project offers the opportunity
to study proven behavioural
activation methods to support
this potentially vulnerable group of
NHS staff.”
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17
NEWSLINE
YAS
‘Significant progress’
for apprenticeships at
region’s ambulance
service
benefi cial impact on learners.
Less than 10% of apprenticeship
providers have achieved
signifi cant progress across all
three inspection themes.
The Trust has been offering
apprentices developing a wide
range of substantial new skills and
knowledge which they successfully
put into practice in their jobs.
Dawn Adams, Head of YAS
Academy, said:
Earlier last year, the Trust’s
Ambulance Support Worker role
won the gold Apprenticeship
Programme of the Year award,
ahead of seven other public and
private sector fi nalists, at the
national 2021 Learning Awards.
Following an Ofsted (Office
for Standards in Education,
Children’s Services and Skills)
inspection which took place
in October 2021, Yorkshire
Ambulance Service NHS Trust
(YAS) has formally achieved
significant progress in the three
themes assessed.
apprenticeships since October
2018 and there are currently
298 apprentices enrolled on
level 3 and level 4 standardsbased
apprenticeships including
Ambulance Support Worker and
Associate Ambulance Practitioner.
The Ofsted inspection lasted two
days and the areas which were
“We are delighted with the
outcome of the Ofsted inspection,
and I am very proud of our
Academy team. The Trust is
highly committed to the provision
of learning and apprenticeships,
and the excellent support we
have from stakeholders, learners
and clinicians has helped us
In addition, Morrisons has
agreed to transfer £2.1m of its
Apprenticeship Levy fund to
Yorkshire Ambulance Service NHS
Trust to help train the county’s
future paramedics. The two-year
programme is helping to pay for
200 apprentices to be trained and
means that the Trust will not have
The Trust was commended for
having a clear vision, an ambitious
curriculum for apprenticeship
provision which goes beyond
the requirements of the
qualifi cation, and experienced
and knowledgeable educators
delivering high quality training.
assessed were quality of education,
leadership and management and
effectiveness of safeguarding
arrangements in place.
The inspection report highlighted
many positives, including
helpful careers guidance with
a clear progression pathway to
to develop and deliver the
programmes.
“We started the journey three
years ago and, after a lot of
hard work, being recognised
by Ofsted with this rating is a
huge achievement for everyone
involved. We welcome the
to access additional Government
Apprenticeship Levy funding; the
cost of this to the Trust would
have been £100,000 (5%) and this
is now being re-invested in patient
care in the region.
Mike Long, ESFA (Education and
Skills Funding Agency) Senior
Progress is deemed signifi cant
paramedic, rigorous governance
very positive feedback and look
Skills Development Manager, said:
when it has been rapid and is
arrangements, exceptionally
forward to building future success
“It is great to see a new employer
already having considerable
well-planned curriculum with
on this fi rm foundation.”
provider being recognised as
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making signifi cant progress
with the implementation of
an ambitious and high-quality
apprenticeship programme which
shows how apprenticeships can
help tackle skills shortages in
critical roles in the community.
The programme has been
well planned and excellently
implemented in the most
challenging of circumstances and
times and the Academy team fully
deserves this recognition and I
look forward to continuing to work
with the team as the programme
develops further.”
Information on both clinical and
non-clinical apprenticeships
is available on the Yorkshire
Ambulance Service website:
www.yas.nhs.uk
The Inspection report can be
viewed at:
https://reports.ofsted.gov.uk/
provider/30/2539228
WAST
New technology
to better support
victims of domestic
violence
The Welsh Ambulance Service
has introduced new technology
to better support victims of
domestic violence.
Ambulance crews have been
supporting patients to access
Live Fear Free for help and advice
on domestic violence since
its creation using a bespoke
telephone number.
Now crews now have the ability to
assist patients via an app on their
Trust-issue iPad to speed up and
streamline the process.
Live Fear Free is a 24/7 helpline
for women, children and men
experiencing domestic abuse,
sexual violence or other forms of
violence against women.
It is a main point of contact
in Wales to access support,
information, safety-planning,
advocacy, refuge and counselling
services.
Nikki Harvey, the Welsh
Ambulance Service’s Head of
Safeguarding, said: “The Live Fear
Free helpline is a free, confi dential
24/7 specialist resource that
anyone can access, at any time.
“Welsh Ambulance Service crews
have been using it for some
years to signpost patients to help
and support, using the good old
fashioned telephone – until now.
“Having the technology to refer
patients digitally using iPads is not
only more effi cient for crews, but
it means that vulnerable patients
get the support they need more
quickly.
“We all deserve to live without fear
and in an environment which is
safe, and modernising this referral
pathway brings us a step closer
to that.”
Live Fear Free helpline manager,
Ann Williams, said: “We are
delighted to be working alongside
the Welsh Ambulance Service,
making our joint support of those
most in need across Wales even
more effi cient.
“For staff at the helpline and the
ambulance service alike, time is
critical.
“Using updated technology means
that we can strengthen vital, timesaving
communication methods,
which will directly benefi t the
women, men and children getting
in touch, for whom support can
often be life changing or even
life-saving.”
You can contact Live Fear Free by
calling 0808 80 10 800, texting
07860 077333, emailing info@
livefearfreehelpline.wales or by
using its 24/7 live chat service.
NEWSLINE
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19
NEWSLINE
AMBULANCE UK - FEBRUARY
Stroke Association
warns number of
untreated strokes
likely to increase
during winter, due to
rise in Omicron cases
The UK’s largest stroke charity
is warning people not to delay
seeking treatment for stroke
due to fear of Omicron.
The Stroke Association is
concerned that public fear of
increasing COVID-19 rates, due to
the Omicron variant, is likely to see
a similar drop in stroke admissions
seen at the start of the pandemic.
During the first wave of the
pandemic there was a significant
decrease in admissions to stroke
wards, when the COVID-19
infection rate rose rapidly. The
Stroke Association’s Recoveries
at Risk report found this was due
to patient worries over catching
COVID-19 or being a burden on
the NHS. Nearly a third (32%)
of people who survived a stroke
between March and June 2020
said they delayed seeking medical
attention due to COVID-19 (i) .
With the added impact of reported
ambulance delays, this is likely to
intensify feelings of being a burden
on the NHS, causing people to
delay seeking medical treatment.
To add to this potential crisis,
new data shows that more
people are living with unmanaged
hypertension (high blood pressure)
and other major stroke risk
factors due to fewer regular
in-person appointments where
cardiovascular conditions (like
high blood pressure) are spotted.
Hypertension is the biggest risk
factor for stroke, contributing to
55.4% of stroke cases (ii) . This
means that the stroke rate could
rise as more people live with
unmanaged hypertension than in
previous years.
In the UK there are over 100,000
strokes per year and 1.3 million
stroke survivors. A stroke is a
medical emergency which is
caused by a blockage or bleed
in the brain cutting off blood
supply. For every minute a stroke
is untreated, 1.9 million brain cells
die (iii) . Stroke is fatal in over one in
eight (13.1%) patients (iv) . The main
treatments for stroke, thrombolysis
and thrombectomy, must be
delivered as soon as possible
within four and a half hours of
symptoms starting, which is why
is it vital to call 999 as soon as any
sign of stroke appears. Stroke is
the UK’s fourth biggest killer and
the leading cause of adult disability.
Key stats:
• Acute stroke admissions fell by
10.3% in England, Wales and
Northern Ireland in the period
23rd March to the end of May
2020 (iv) , meaning a drop of over
2,000 admissions in just over
two months
• This may have caused the
54% rise in at home deaths for
stroke in England and Wales (v) .
• Of those who delayed seeking
emergency medical attention,
42% hadn’t wanted to burden
emergency services (i)
• And 34% of those who delayed
seeking emergency medical
attention were afraid of catching
COVID-19 in hospital. (i)
• 43% reduction in the rate of
diagnosis of cardiovascular
conditions (including high
blood pressure) and a 29-52%
reduction in first prescriptions
of medications in March – May
2020 (vi)
• In 2015, it was reported that
high blood pressure affected
more than 1 in 4 adults in
England (31% of men; 26% of
women), which is around 13.5
million people (vii)
Juliet Bouverie, Chief Executive of
the Stroke Association said: “When
COVID cases rise as quickly as
they are doing now, that sets
off alarm bells at our charity and
everyone involved in the treatment
of stroke. More Omicron cases is
likely to mean more preventable
deaths and disability due to
stroke, as people delay seeking
emergency medical attention.
“We know that people get scared to
go to hospital when cases rise but
stroke is a life-threatening condition.
Fear of catching COVID and feeling
like a burden on the NHS stopped
people calling 999 in the past. This
is likely to be even worse due to
the news about ambulance delays.
Stroke is an emergency medical
condition and should be treated as
an emergency from the moment
you ring 999.
“You have to remember that stroke
is a brain attack and when you see
any of the FAST signs of stroke in
someone, this means that their brain
is dying. You must raise the alarm;
you must call 999 immediately.
“After nearly two years in the
pandemic we know that many
people haven’t had their high blood
pressure diagnosed because there
haven’t been as many regular, inperson
appointments with medical
professionals such as GPs. That
means more people are living with
undetected high blood pressure
and are at high risk of stroke. As
a result, we could see even more
people having a stroke than in
previous years.”
“Stroke clinicians and nurses as
well as paramedics and therapists
have worked tirelessly throughout
the pandemic to maintain stroke
services. Everyone at our charity
is thankful for their hard work and
support.”
Gerald McMullen, Cardiff: “I had
my stroke during lockdown and
I’m so glad that my wife called
999. It was a lifesaver. If you’re
with someone who might be
showing the symptoms of stroke,
please make that 999 call. It’s vital
that you do.
“I got up in the morning and
felt OK. I was sitting in my chair
having a cup of tea when my wife,
Linda, suddenly asked if I was OK.
I said ‘yes’. However, she noticed
that something was amiss. My
outstretched arm, holding my cup,
seemed rigid to her.”
McMullen’s speech became “a little
slurry”, and despite his insistence
he was fine, his wife ignored him
and called an ambulance. “Thank
goodness,” he says.
“She was on the phone to 999
and was asked if my face had
dropped – it hadn’t – and whether
I could lift my arms, which by then
I couldn’t. My speech did not
make sense by this time either.”
About 15 minutes later, two
paramedics arrived and examined
McMullen in his chair. “One of the
paramedics got on the phone to
hurry the ambulance along. The
ambulance arrived and I managed
to walk to it with support from a
paramedic and my wife,”
Due to the coronavirus pandemic,
Linda could not accompany
McMullen to the hospital, adding
to an already scary situation. In
the ambulance, his symptoms
worsened.
On arrival, he was taken for a
scan, then taken to another
department where his head
was taped to a table and the
thrombectomy carried out.
“The stroke has left me with a
legacy of a weak right arm,”
McMullen says, “but I’m getting
that back now too.” A minor
inconvenience, he notes, which is
much better than the alternative.
“My foot is slightly swollen but
that’s nothing, nothing at all.
Without the thrombectomy I
would have been in a much
worse state. The doctors said I
would have been catastrophically
damaged. I could have died. I
came through and I’m here now.
“I thought ‘my God, I’ve had a
stroke’. I’m so grateful that I was
able to be up and about so quickly.
Friends couldn’t believe it.”
20
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NEWSLINE
London’s Air
Ambulance launches
extra team to reach
more critically-injured
patients during winter
months
• New advanced trauma team
on call for London during peak
hours, bringing the hospital to
the roadside
• Additional team, ‘Medic 3’, will
help London’s Air Ambulance
reach hundreds more trauma
patients
For the first time in its 32-year
history, London’s Air Ambulance
is now operating with two duty
teams on call for London this
winter. Beginning in December,
an additional medical team will
support the service, responding
to the most critically injured
trauma patients in the capital
by rapid response car.
The extra team, known as
‘Medic 3’, will operate Monday
to Saturday from 14:00 to 24:00
helping the advanced trauma
teams of London’s Air Ambulance
be more resilient and ultimately
reach more critically injured
patients and respond more quickly
during the winter rush hour. The
team will consist of one senior
doctor and one paramedic and
the arrangement will be trialled
for twelve months to analyse its
impact.
London’s Air Ambulance currently
provides one advanced trauma
team 24 hours per day, 365 days
per year and attends around
1,700 patients each year. The
service uses a helicopter from
08:00 to sunset switching to
rapid response cars at night or
in adverse weather conditions.
London’s Air Ambulance expert
teams can deliver complex lifesaving
interventions at the scene
of an incident such as pre-hospital
emergency anaesthesia; blood
transfusion; thoracotomy (a
surgical procedure which opens
up the rib cage cavity to manually
massage the heart) and REBOA
(where a balloon is fed into the
major blood vessels through an
injection into the leg), all of which
are known to have increased
patient survival rates after
traumatic injury.
London’s Air Ambulance forms
part of the blue light community
alongside its partners Barts NHS
Health Trust and the London
Ambulance Service (LAS), working
collaboratively to deliver the best
possible care to all major trauma
patients, and this additional
resource will operate as part of
this wider team.
As winter evenings draw in
the aircraft goes offline earlier,
currently around 16:00, meaning
the team moves to deliver
the service by rapid response
vehicle at this time, significantly
before rush hour and leaving the
service reliant on only one team
operating by road for the whole of
London. Analysis of response time
data, based on a single team,
demonstrates that patients more
distant from central London are
not always reached as quickly
during this window. Alongside
this, the team may already be
on scene with a patient when
required elsewhere which results
in cancelled missions for the
service.
This has meant that London’s Air
Ambulance has been unable to
attend all the patients who could
have benefited from their expertise
and on-scene interventions. The
service estimates that in 2019,
there were 195 additional patients
to whom London’s Air Ambulance
would have gone to, which
equates to around 60 additional
emergency anaesthetics, 5
thoracotomies and 18 code
red patients (when a patient is
bleeding to death and needs
immediate intervention). The extra
team will be able to respond to
these sorts of emergencies as
well as providing greater resilience
for the service in the event of a
major incident. Currently in these
instances the London Ambulance
Service (LAS) will work alongside
London’s Air Ambulance to ensure
patients are treated as quickly as
possible.
Medical Director of London’s Air
Ambulance, Dr Tom Hurst, said:
“Time is precious when a life is on
the line and we know that during
the winter when the hours of dark
overlap with peak travel times we
are constrained in our response,
particularly when our one team is
already on scene with a patient.
This additional team will help
us reach more critically injured
patients quickly when time is of
the essence.
“London’s Air Ambulance does
not stand still and is constantly
striving to better the service we
provide to the people of London.
Thanks to our partners at Barts
NHS Health Trust and the London
Ambulance Service and of course
to our incredible supporters
we’ve been able to get this extra
team up and running, providing
much-needed clinical support
and helping ensure that, should
the worst happen, London’s Air
Ambulance will be there.”
London Ambulance Service
Deputy Chief Executive and Chief
Medical Officer, Dr Fenella Wrigley
said:
“The introduction of an additional
advanced trauma team this winter
will be an incredibly valuable
resource for the people of
London.
“The team, operated by a London
Ambulance paramedic and
Barts Health senior doctor, is an
excellent example of collaborative
working to help achieve the best
possible care for trauma patients
in the capital. The timing of
this new expansion is also very
welcome as the reduction in day
light hours reduces the time the
aircraft can operate. As we head
into a challenging winter it will
help us continue to bring clinical
expertise to trauma scenes to
help our most seriously injured
patients.”
Alistair Chesser, Group Chief
Medical Officer at Barts Health
NHS Trust, said:
“The extra London Air Ambulance
team is well timed coming into
winter and will be a great help
in ensuring the most seriously
injured patients get the specialist,
life-saving care they need as
soon as possible, both on the
scene and in hospital.
“We’re very happy to be working
in collaboration with the London
Ambulance Service and London
Air Ambulance to allow us to
reach hundreds more trauma
patients.”
London’s Air Ambulance is a
charity, operating in partnership
with Barts NHS Health Trust
and London Ambulance Service
(LAS) NHS Trust. Barts Health
NHS Trust employs and pays
the doctors who will form part
of the Medic 3 team and LAS
provide the paramedics who will
also form part of the duty team,
as well as the flight paramedic
situated in the control room who
is responsible for dispatching
London’s Air Ambulance to the
most critically injured people in
London, 24 hours a day.
Since its inception London’s
Air Ambulance has developed
cutting-edge medical care
normally only found in the
hospital Emergency Department
for use at the roadside. The
innovations and procedures it has
developed have been adopted
across the world.
AMBULANCE UK - FEBRUARY
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21
NEWSLINE
AMBULANCE UK - FEBRUARY
HELP Appeal funds
new rapid response
vehicle for BASICS
Devon
Thanks to the HELP Appeal
- BASICS Devon, a network
of volunteer doctors,
who support the South
Western Ambulance Service
NHS Foundation Trust at
emergency incidents, have
launched their very own rapid
response vehicle to support
their emergency responders
across Devon.
BASICS Devon is one of a
national network of 32 regional
schemes across the UK, which
operates under the umbrella
of the British Association for
Immediate Care. The new
vehicle has been made possible
after the group successfully
bid for a total of £44,000 from
a grant of £250,000, which
is given to the Association
every year by the County Air
Ambulance HELP Appeal - the
only charity in the country
dedicated to funding NHS
hospital helipads.
The vehicle has hi-visibility and
reflective markings; fitted with
communication and navigation
equipment; blue lights, sirens,
and a dash cam, to ensure its
volunteer doctors can drive
safely to an emergency incident.
The 4 x 4 Skoda Kodiaq, is now
active across Devon, carrying
volunteer doctors, to the
scene of critically ill or injured
patients in the community or
at the roadside. This vehicle
also provides the opportunity
for education in pre-hospital
medicine to other healthcare
professionals.
This will be the first scheme
response vehicle for BASICS
Devon. Having their own
emergency response vehicle
to access critical, isolated,
sick, and injured patients will
help to ease pain and suffering
and save lives across one of
the most rural counties in the
country. It will enable their
volunteers to reach remote
communities with ease, safely
and quickly, in all weather
conditions and in most cases
arrive before the ambulance.
Since January the volunteer
doctors have responded to 415
call outs, 144 of which were at
night, arriving first on the scene
at 31% of them.
BASICS Devon volunteer
Immediate Care Doctor and
Chair, Dr Simon Scott Hayward
said: ‘The doctors are all so
pleased with the vehicle. It has
already been put to good use
with 31 shifts, responding to
callouts across the county. With
winter setting in, we are pleased
to have a vehicle fit for purpose
both practical and safe. It is
also a platform for clinicians
interested in pre-hospital care
to attend as observers. The
recent branding of the car we
hope, reflects the community
that we serve. We would like to
thank our funders and everyone
that helped to get the car on
the road.’
Robert Bertram, Chief Executive
of the County Air Ambulance
HELP Appeal added: “These
volunteers are the unsung
heroes of emergency care
– giving up their free time to
support their local ambulance
service. This donation ensures
they have the highest standard
of transport at their disposal to
ensure they can treat patients
quickly and safely, giving them
the best possible chance of
survival and recovery.”
Last year, BASICS Devon
also secured £39,000 from
the County Air Ambulance
HELP Appeal’s annual grant of
£250,000 given to the British
Association of Immediate
Care. It was used to equip
members’ existing vehicles for
an emergency role, such as the
installation of CCTV technology
and winter tyres. The funding
also enabled one new doctor
to join the scheme after their
vehicles were equipped to
reach emergency incidents. This
has helped with callouts in the
North Devon area enabling the
scheme to reach more people in
the community to save lives.
The HELP Appeal was created
12 years ago by the County
Air Ambulance Trust. It is the
only charity in the country
dedicated to funding NHS
hospital helipads. To date it
has funded over 40 helipads,
which have received almost
20,000 landings, including at
Derriford Hospital, Plymouth
and the Royal Devon and Exeter
Hospital. The HELP Appeal
relies solely on charitable
donations and does not receive
any government funding or
money from the National
Lottery.
SAS
SAS’s Mobile Testing
Units deliver 2 million
tests
The Scottish Ambulance
Service’s Mobile Testing
Units (MTUs) have reached
the monumental milestone
of delivering 2 million tests
across Scotland, since the
service was launched at the
end of August 2020.
As the country faces further
challenges with the Omicron
variant of the Covid-19 virus,
the MTUs have been delivering
15,000 tests a day, helping the
country to tackle the newest
threat in the ongoing pandemic.
The MTUs have been one of
biggest projects ever carried
out at the Scottish Ambulance
Service (SAS) and is one of
the key measures in place to
support the UK’s action plan
against COVID-19. There are
now 39 SAS-run MTU teams
across the country and more
than 1100 people employed
by the Scottish Ambulance
Service, providing a vital service
to Scotland.
The MTUS can be dispatched
quickly across the country
so people in urban, rural and
remote areas have easy access
to a coronavirus test. The
location of the units, which are
22
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NEWSLINE
requested by National Services
Scotland through the Scottish
Government, local authorities
and health Boards, changes
regularly to reflect demand.
John Alexander, General
Manager for the
Mobile Testing Units
(MTUs), said: “Our
dedicated MTU staff
have been working
tirelessly across
Scotland to deliver
tests, particularly
over the last month
as the programme
has been ramped
up to combat the
Omicron virus.
“All of our MTU
staff have done
a fantastic job in
providing tests
to the people of
Scotland over the
past year and I’m
extremely proud
they’ve delivered
two million tests
since August 2020.
We reached the
1 million mark on
1st September
2021, one year and
one day from the
date of the MTUs
going live, so to
carry out another
million tests in just
over four months
is a considerable
achievement, and
it’s testament to
their dedication and
hard work.”
Cabinet Secretary
for Health and
Social Care Humza
Yousaf said:
“Our COVID-19
Mobile Testing
units continue
to play a crucial
role in bringing
testing capacity
to communities who need it
most. And reaching two million
tests is incredible work. This is
a reflection of the hard work,
dedication and professionalism
of Scottish Ambulance
Service staff who are doing
a challenging job in difficult
circumstances.
“Through the work they are
doing they are helping to
identify and isolate cases and
breaking chains of transmission.
My thanks goes to every
member of SAS staff for all
that they are doing to care and
support people across Scotland
– and for working throughout
the festive break to ensure that
testing continued.”
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AMBULANCE UK - FEBRUARY
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
23
NEWSLINE
SWAST
Patient helps buy
defibrillator after
community first
responder and
paramedic save her
life
A grateful patient inspired by
the South Western Ambulance
Service NHS Foundation Trust
(SWASFT) team who saved her
life, has helped raised funds to
buy a defibrillator.
Dulcie, from Penzance, Cornwall,
suffered a cardiac arrest and
collapsed, falling off her fixed
exercise bike at home. She was
treated with a defibrillator by a
community first responder and a
paramedic, convincing her that
a community defibrillator was
needed at her gym.
Luckily for her, expert help
was only seconds away when
SWASFT volunteer community
first responder Jack Bushell
responded to a 999 call on his
way from helping another casualty.
He took over from Dulcie’s partner
who was giving effective CPR and
immediately applied defibrillator
pads and gave CPR himself to try
and restart her heart and breathing.
the ambulance service is, but
when there is a life-threatening
emergency they are still able to
respond magnificently.
“I can’t really put into words
how grateful I am to my partner,
to Jack, and to the ambulance
service for their quick response,
skill, professionalism and kindness
that they showed. I clearly would
not be here today was it not for all
of them.’’
Jack said: “I was just heading
back from another incident when
I received the top priority category
1 response call to Dulcie. At the
time the only details I had was that
it was a person who’d fallen off a
bike and was in cardiac arrest.
“I’ve been to a number of arrests
so felt calm and collected enroute
and on arrival, this meant I
could think about what I’d need
to do and whether this may be a
traumatic or medical arrest.’’
He said Dulcie was fighting to
recover as she was being treated
and he was confident at the time
that emergency treatment would
get results. His patient had also
been given the best chance of
recovery due to the prompt and
effective CPR care by her partner.
“It was an incredibly surreal
and rare moment to go from a
resuscitation attempt to talking
to that patient. It was a fantastic
outcome and I’m proud to be part
of the team which treated Dulcie.
WMAS
Top award for going
above and beyond
during the pandemic
A University of Wolverhampton
Paramedic Science graduate
has scooped a top award
recently for going above and
beyond during the pandemic.
Will Matthews, 22 from Gloucester,
graduated from the Paramedic
Science degree course which was
delivered at the University’s Walsall
Campus earlier last year and was
named Outstanding Direct Entry
Student Paramedic of the Year by
West Midlands Ambulance Service
(WMAS).
He picked up his award from
Anthony Marsh, Chief Executive
Officer at WMAS.
Will was nominated by his
lecturer, Richard Howarth, for his
commitment and dedication to
learning and his excellent grades
and he was chosen as the winner
out of hundreds of nominations from
five universities across the region.
Will said: “When I heard that I’d
won the award I just sat smiling
and couldn’t believe it - especially
considering how competitive
these awards are locally.
biomedical science, and I’m so
glad I didn’t.
“I really loved Paramedic the
course, it was the most difficult
thing I’ve ever done, but I put
myself forward for all kinds of
things, helping out in lecturers and
mentoring other students.
“I love my job. There’s something
different happening every
day, the team bonding and
spirit is amazing and you build
relationships really quickly.
“I’m hoping to continue to expand
on my knowledge, gain more
experience, and then hopefully move
fields to specialise in minor injuries.”
Richard Howarth, Lecturer in
Paramedic Science at the University,
said: “I was Will’s personal tutor
throughout the majority of his course
and he is an exemplary student who
always strives for the best in both
his academic work and practice
placement.
“The feedback received from Will’s
mentors has been amazing and
despite the pandemic causing
Will to miss a period of placement
he has never lost his drive and
determination to succeed. He is
always a highly reflective student
who is always looking at ways
to improve himself in an effort to
improve the patient care he delivers.
AMBULANCE UK - FEBRUARY
When his colleague, paramedic
Jess Leah arrived, they delivered a
further defibrillator shock and Dulcie
started breathing herself shortly
before regaining consciousness
and soon began talking to the
paramedics. Further help arrived
with a second ambulance crew and
the air ambulance with a doctor on
board to help stabilise Dulcie and
take over her care.
Dulcie, a public health doctor
working for Cornwall Council,
thanked the SWASFT team
and stressed how important
defibrillators and trained
community volunteer paramedics
were to saving her life. She said:
“We all know how under pressure
“Having since spoken to Dulcie
and found out she’s fully recovered
and raised money to fund a
defibrillator, I think it’s amazing and
an important reminder of good
“bystander” CPR. These outcomes
are very rare and it reminded me of
why I do this job.’’
The public defibrillator, outside
Crossfit Penzance, was paid
through a community effort
including a sponsored gym
competition and prize raffle
donated to by local businesses.
“I had kind of fallen into the career
as no one in my immediate family is
medically trained. I just went for it.
“I studied chemistry and biology
at A Level but didn’t get into my
first-choice university to study
“Will is always willing to go above
and beyond in the support of
his peers, he is a peer mentor
for both First and Second year
students and is always happy
to share his knowledge and
experiences with them. I have
24
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NEWSLINE
no doubt that Will is going to be
an exemplary paramedic and an
asset to the profession.”
West Midlands Ambulance Service
Chief Executive, Anthony Marsh,
said: “I wanted to demonstrate
my personal appreciation for
everything the winners of these
awards, like Will, have done and
continue to do. The NHS is under
more pressure now than it has
been before, and I know that
each of our staff, students and
volunteers, feel that every day.
“The last 18 months or so have not
been easy for external students,
with tough decisions having to be
made around their placements in
order to best protect the patients
we serve. However, people like
Will are an absolute testament to
the NHS, always striving to do
their utmost regardless of any
adversities that come their way.
“The winners of last year’s awards
have demonstrated a dedication
to their role and the patients of
the West Midlands, whether that
be out on the road or behind the
scenes. A huge congratulations
once again to all the winners.”
Anyone looking to study at the
University of Wolverhampton
should register for one of our
forthcoming Open Days.
For more information contact the
Corporate Communications Team
comms@wlv.ac.uk.
Guernsey’s
Emergency
Ambulance Service
takes delivery of two
new ambulances
Guernsey’s Emergency
Ambulance Service has taken
delivery of two new ambulances
in a ceremony that recreated
the scenes of 84 years ago,
when the St John Ambulance
Brigade received its new Morris
ambulance.
As the reprint of a Guernsey
Press article from June 1937
illustrates, a dedication ceremony
was held on the Albert Pier, St
Peter Port where the Morris
ambulance was handed over, by
the island government (the States
of Guernsey) to St John which
had taken on the responsibility of
running the ambulance service for
the island just a year before.
The two modern day, state-ofthe-art
WAS 500 Mercedes Benz
Sprinter emergency ambulances
were officially presented to St John
Emergency Ambulance Service by
the States of Guernsey and were
blessed by the Chaplain of St John
Guernsey, in a similar event at
virtually the same spot in St Peter
Port. The ceremony was attended
by local dignitaries, representatives
of the States of Guernsey and
frontline staff from the Emergency
Ambulance Service.
Mark Mapp, Guernsey’s Chief
Ambulance Officer, took official
delivery of two new vehicles for St
John. “I am delighted and grateful
to take delivery of two new
emergency ambulances funded
by the States of Guernsey. These
two new ambulances replace two
of our existing fleet which are now
over 12 years old and which have
now exceeded the practical lives
as frontline ambulances with high
demands we place on them.”
He added, “My colleagues and
I at St John thank the States for
their responsive procurement
efforts, which have enabled
this to happen more promptly
than we had initially feared.
These are specialist vehicles,
somewhat narrower than standard
international vehicles in order to
better operate on Guernsey’s
narrow roads. Delivery timescales
can sometimes be prolonged,
because these specialist versions
are produced in Germany,
generally in change-over gaps
between longer production runs.
However, with the assistance of
the States, we have managed to
secure delivery more promptly
than usual.”
The new ambulances are fitted
with state-of-the-art diagnostic
and treatment equipment which
allows clinicians to administer
urgent and emergency prehospital
care on scene at a
patient’s home or by the roadside.
The vehicles are designed to give
maximum comfort for patients and
a practical working environment
for medical crews.
Guernsey is not part of the NHS
so under current arrangements,
users of an Emergency
Ambulance in Guernsey are
charged a government-subsidised
cost for call-outs and treatment by
paramedics, and for conveyance
to hospital. However, St John
offers an annual subscription
scheme which covers individuals
for up to 50 emergency
ambulance call outs in that year.
The States of Guernsey provides
an annual grant to fund the
balance of the costs of St
John providing the Emergency
Ambulance Service, subject to
various operational performance
indicators being met.
Deputy Al Brouard, President of
Health & Social Care (HSC) was
the senior politician present at
the new ambulance handover
ceremony. “As we are seeing in
many jurisdictions, the funding of
health and social care services
is one of the most challenging
issues for governments in our
time. Difficult priorities have to be
set as we aim to provide the full
range of services needed by the
community in the most costeffective
manner. St John is a key
partner and I am pleased that
we are able to invest to keep our
services properly equipped for the
demands they face.”
Mark de Garis, interim CEO of the
States of Guernsey and former
Chief Secretary for HSC said:
“During 2018, HSC worked with a
range of service providers to offer
better coordination for the care
islanders receive on a daily basis.
Our joint aim was to provide new
ways of working and solutions
which address the core pressures
of an ageing demographic, fewer
working age tax payers, and the
long-term inherent trend of above
inflation healthcare cost increases
which lead to real term impacts
upon public expenditure unless
positively addressed. Later that
year, HSC and St John defined and
agreed a future operating model
for ‘Patient-intense Emergency
Response’ and ambulance services
over the following years and we
continue to implement that model
in a phased manner. As with many
things, the arrival of Covid-19
delayed some initiatives, but we are
grateful for the responsiveness of
all parts of the St John operation
during the pandemic.
During the Covid pandemic
frontline ambulance crews were
supported by St John volunteers
who took on tasks including the
deep cleaning of ambulance
vehicles.
Thanks to the Guernsey Press for giving permission for the use
of this 1937 photograph
AMBULANCE UK - FEBRUARY
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IN PERSON
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SAS News
Scottish Ambulance Service
staff member awarded
Queen’s Ambulance Medal in
2022 New Year Honours list
A Scottish Ambulance Service (SAS) staff
member who has been instrumental in
dealing with some of Scotland’s biggest
incidents has today been awarded the
Queen’s Ambulance Medal (QAM).
The prestigious honour - which acknowledges
ambulance personnel who have shown
exceptional devotion to duty, merit and
conduct - has been awarded to Patrick (Pat)
O’Meara, General Manager of Events.
Pat, 57, joined SAS in 1998, after 17 years at
the London Ambulance Service.
Throughout the past four decades, he has
been involved in some of the UK’s most
significant incidents, including the Clutha Bar
crash where he was incident commander,
the George Square bin lorry tragedy, and the
Stockline Plastics Factory explosion.
Most recently, he has led the Service’s
planning and response to COP26 and in
the early stages of the pandemic, led on
the development and implementation of the
Service’s Mobile Testing Units.
Speaking of the award, Pat, who lives in East
Kilbride, said: “I am very humbled and grateful
and it’s a great honour to receive the award.
In saying that, you never work on your own
and any success is always down to being a
member of a team.”
Pat started with the Scottish Ambulance
Service as an Operations Room Officer,
where he was responsible for control room
emergency operations across Glasgow. Over
the years at SAS, he has worked as a General
Manager for Ambulance Control Centres,
Community Resilience, and South East
Scotland, which included the responsibility
for the visit of Pope Benedict. Pat is also
the Chief Medical Support Officer of the
Army Cadet Force and is a Trustee of the
Poppyscotland charity.
The dad-of-one joined the London Ambulance
Service in 1981. Growing up wanting to be
a policeman, he said: “I learnt first aid as an
Army Cadet and had to use those skills with a
serious leg wound on a fellow pupil who was
pushed from a second floor window and later
on another pupil having a fit. I then felt that
the ambulance service was a career I should
look at.
“The ambulance service was very different
to today. The skills were not as advanced as
they are now, we did not have defibrillators
and there was no such role as a paramedic,
only advanced trained ambulance men.”
Speaking on some of his memorable jobs
throughout his career - in addition to Clutha
and the Glasgow Bin Lorry incident - he said:
“A young man aged 15 had been stabbed
with a machete and despite my efforts and
those of others, he sadly died. I remember
him pleading with me not to let him die. I have
also attended a bombing, an aircraft crash at
Heathrow Airport, I’ve been held hostage and
attended an incident where I was chased with
a knife!”
SAS Chief Operating Officer Paul Bassett
said: “Pat has been an amazing ambassador
for the Scottish Ambulance Service over the
past 23 years and this award is testament
to Pat’s dedication and professionalism. He
has been heavily involved in several major
incidents, leading as incident commander, and
most recently, he successfully led the Service
provision to COP26. We are truly grateful for
everything he has done for the Service.”
LAS News
LAS appoints new Director of
Strategy & Transformation
London Ambulance Service has appointed
Roger Davidson as its new Director of
Strategy and Transformation.
Roger will join the Service on Monday 31
January from NHS England, where he is
currently Director of System Partnerships,
working to join up health and care and
improve population health through
development of integrated care systems
(ICSs) across England.
In his new leadership role at LAS, he will
focus on developing a strategic vision for
London Ambulance Service to build beyond
the existing organisational strategy which
comes to an end in 2023.
In his most recent position at NHS England,
Roger has played a national leadership role in
the development of the 42 ICSs, which now
cover the whole of England and are set to be
put on a statutory footing next year.
Since the start of 2016, he has worked with
health and care leaders across the country
on system transformation strategy and policy,
system leadership development, clinical and
professional leadership, local government
and voluntary sector partnerships,
public involvement, communications and
stakeholder relationships.
Prior to this, Roger was Director of
Communications and Head of Media and
Public Affairs at NHS England.
In 2013, he helped to establish the newlyindependent
organisation and then to set a
new strategic direction for the NHS focussed
on integrated care through the NHS Five Year
Forward View.
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IN PERSON
Earlier in his career, Roger also held
senior communications and public affairs
roles at organisations including the
NHS Confederation, the Care Quality
Commission and the Confederation of
British Industry.
He is also a Trustee at the English Football
League (EFL) Trust, the charity overseeing
the community organisations of the 72 EFL
football clubs in England which run health
and wellbeing initiatives across the country.
Speaking about his new appointment at
LAS, Roger said:
“As a Londoner, I am excited to be joining
one of the most visible healthcare providers
in the capital and making a positive
difference to the lives of patients.
“It’s a challenging time to be joining and
I am looking forward to working with
dedicated colleagues to help build the
ambulance service London needs in the
years ahead.”
London Ambulance Service chief executive
Daniel Elkeles said:
“While we continue to manage the
unprecedented pressure created by the
coronavirus pandemic, it’s essential we do
not lose sight of the vital change needed
to drive forward our vision for London
Ambulance Service.
“Roger brings a wealth of experience of
strategy, public affairs and transformational
change and I’m delighted to welcome him
to the team.”
WAS News
Long-serving paramedic
recognised in Queen’s New
Year Honours List
A long-serving paramedic at the Welsh
Ambulance Service has been recognised in
the Queen’s New Year Honours List.
Paramedic and Duty Operations Manager
Jenny Lewis has been awarded the Queen’s
Ambulance Service Medal for distinguished
service, which was announced on Friday 31
January 2021.
The mother-of-two, who is based in Dobshill,
Flintshire, has more than 30 years of service
having joined Clwyd Ambulance Service as an
Emergency Medical Technician in 1991.
Jenny played an instrumental role in the move
to the purpose-built Area Ambulance Centre in
Dobshill in 2012, home to the Trust’s flagship
Make Ready Depot.
In November, Jenny and her Operations
Manager colleagues in North East Wales won a
WAST Award for delivering outstanding patient
care and supporting frontline colleagues.
Chief Executive Jason Killens said: “We’re
beyond thrilled that Jenny has been
recognised in the Queen’s New Year Honours
List.
“It is testament not just to her contribution
through the Covid-19 pandemic but to her
broader commitment to the NHS in Wales over
her 30-year career.
“We’re incredibly proud of all colleagues who
go that extra mile for patients and contribute
to the development and progression of the
ambulance service, at all levels.
and management skills, and has led the
Flintshire team through adversity in recent
years following the unexpected death of two
colleagues.
“We are delighted that Jenny is being
celebrated for her enduring and positive
contribution to the Trust and its people.”
The Queen’s New Year Honours List has
recognised 1,278 people for their exceptional
contributions to business, charity, culture,
development, education, foreign policy, health,
security and sport.
Among the other Welsh emergency service
colleagues recognised is South Wales Police
Constable Anne Overton, who has been
awarded the Queen’s Police Medal, and
Jennifer Griffiths, Group Manager at South
Wales Fire and Rescue Service, who is the
recipient of a Queen’s Fire Service Medal.
Meanwhile, Wales’ Chief Medical Officer Dr
Frank Atherton has been given a knighthood
for services to public health.
Prime Minister Boris Johnson said: “These
recipients have inspired and entertained us and
given so much to their communities in the UK
or in many cases around the world.
“The honours are an opportunity for us to
thank them, as a country, for their dedication
and outstanding contribution.”
SCAS News
SCAS Board of Directors –
Appointment of new Chair
and Non-Executive Director
“These awards recognise the hard work and
dedication of some of our very best ambulance
professionals, and I’d like to extend a huge
congratulations to Jenny.”
Jonathan Sweet, Head of Service for the
Trust’s Operational Delivery Unit, who
nominated Jenny, added: “Jenny is a
respected leader and a trusted peer among
colleagues in North Wales, not to mention a
compassionate paramedic.
“She has worked relentlessly throughout her
career to sharpen her clinical knowledge
South Central Ambulance Service NHS
Foundation Trust’s Council of Governors has
approved the appointment of Professor Sir
Keith Willett CBE as the new Chair of SCAS
with effect from 1 April.
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
>>>
AMBULANCE UK - FEBRUARY
27
IN PERSON
He will replace current Chair Lena Samuels
who will be leaving SCAS at the end of March
to take up the role of Chair of the Hampshire
and Isle of Wight Integrated Care System (ICS).
Professor Sir Keith is a highly experienced
and respected clinician having worked in
the NHS for over 40 years. As Professor of
Trauma Surgery at the University of Oxford,
he has extensive experience of trauma and
emergency care, healthcare management
and has been instrumental in driving service
transformation, working collaboratively with
partners in the NHS and beyond.
He will join SCAS from his role as the National
Director for Emergency Planning and Incident
Response at NHSE/I. In January 2020, he was
appointed as the Strategic Incident Director,
responsible for the operational response to the
coronavirus pandemic across the whole NHS
in England. He also led the Covid Vaccination
Deployment programme from July to October
2021.
Professor Sir Keith, who resides in Oxfordshire
and has been appointed initially for three years,
said: “I am delighted and privileged to be
appointed the new Chair of SCAS and build
on the outstanding work of Lena Samuels, the
Board and everyone in SCAS. I am acutely
aware of the enormous contributions and
sacrifices made in recent times. SCAS, like all
the NHS, is made up of people treating people,
so I look forward to working with all of you
as we collectively restore ourselves and our
services for an exciting future.”
In addition, Dr Henrietta Hughes has been
appointed by the Council of Governors as
a new Non-Executive Director for SCAS to
replace Priya Singh who left at the end of
December to take up the role of Chair of
Frimley Integrated Care System. Dr Hughes will
join SCAS on 1 February.
In 2016, Dr Hughes was appointed as the
National Guardian for the NHS and set up
Freedom to Speak Up across England into
more than 400 NHS and Independent sector
organisations. Guardians have handled over
50,000 cases relating to patient safety and
worker wellbeing with a view to making
speaking up business as usual.
Previously a Medical Director at NHS
England, she continues her clinical role as a
GP in central London. She has an excellent
understanding of the health care landscape
and the challenges affecting the NHS.
She said: “I am deeply honoured to be joining
SCAS at this important time and would like
to send my heartfelt thanks to everyone for
the amazing work that you have been doing
throughout the Pandemic. I look forward to
seeing you soon, learning more about your
work and contributing to keeping patients, and
those who care for them, safe and well.”
Dr Hughes resides in London and has also
been appointed for an initial three-year term.
Ms Samuels said: “It has been an enormous
privilege to work for the last five years
with CEO Will Hancock, the SCAS Board,
Governors and a truly amazing body of
professionals who are so passionate about
supporting and delivering the best possible
care for our patients and their families.
“Our vision and values have always placed
the best interests of patients at the very
centre of everything we do and for that reason
we couldn’t be more delighted with these
appointments.”
Mr Hancock said: “I am delighted to welcome
both Keith and Henrietta to the SCAS Board.
These are outstanding appointments for the
Trust and both individuals bring a fabulous
breadth of experience and skills which will
support SCAS with the delivery of its future
strategy and ambitions.”
has been awarded the Queen’s Ambulance
Medal for Distinguished Service (QAM) in
the Queen’s New Year’s Honours List.
Julian qualified in Medicine from Leeds
University in 1994 (BSc Hons, MB ChB)
and has been a senior leader at the region’s
ambulance service for 14 years. He has been
the Trust’s Executive Medical Director since
October 2013.
During the last two years he has been at
the forefront of the UK ambulance sector’s
response to the COVID-19 pandemic, leading
national work, as well as the clinical response
in Yorkshire. He has supported colleagues
through the challenging clinical environment of
COVID-19, rising to the challenge of being at
the helm of the national ambulance response
as Chair of the National Ambulance Service
Medical Directors (NASMeD) group, a subgroup
of the Association of Ambulance Chief
Executives (AACE).
Julian has been Chair of NASMeD since
March 2015 and was unanimously re-elected
for a further three-year term in 2018. His
numerous achievements include developing
national clinical best practice including airway
management, care of children, standardising
equipment for paediatric and maternity care,
leading the establishment of learning from
deaths processes and complex coroners’
inquests.
He is passionate about ensuring patient
safety and reducing harm. In his quest for
safe, evidence-based, high-quality patient
care, Julian engages and liaises with many
AMBULANCE UK - FEBRUARY
YAS News
Queen’s Ambulance Medal
for Distinguished Service
awarded to Yorkshire
Ambulance Service Doctor
Dr Julian Mark, Executive Medical Director
at Yorkshire Ambulance Service NHS Trust,
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IN PERSON
organisations and partners at local and
national levels, including the Healthcare Safety
Investigation Branch (HSIB), NHS England/
Improvement and the Department of Health
and Social Care. Julian also sits on the UK
Council of Caldicott Guardians and co-chairs
the National Advisory Board for The Circuit
(British Heart Foundation).
Rod Barnes, Chief Executive of Yorkshire
Ambulance Service NHS Trust, said: “This
is a huge honour which recognises Julian’s
tremendous contribution to the ambulance
sector’s response to the pandemic. It also
makes Julian one of a very small number
of ambulance service staff who have been
recognised for exceptional dedication to duty,
outstanding ability, merit and conduct in their
roles.
“Julian is a consummate professional and his
dedication to improving patient care has been
outstanding. He is held in the highest esteem
by his colleagues both within and outside the
ambulance sector. His work with AACE and
NASMeD, as well as other national groups, has
undoubtedly improved the standards of care
delivered to patients by the ambulance sector
nationally and has been pivotal in helping
ambulance services navigate the enormous
clinical challenges of the pandemic.
“On behalf of Yorkshire Ambulance Service
and all ambulance services across the UK, I
would like to thank Julian for all he has done
for the benefit of patients over many years. He
thoroughly deserves this honour and should be
rightly proud of this fantastic achievement.”
Dr Julian Mark said: “I am proud to play my
part in the development of the ambulance
sector response to the public in their time of
greatest need. The past two years have been
particularly challenging and I would like to
pay tribute to all ambulance service staff for
their continued dedication to patient care in
these difficult times. I am humbled for being
recognised for my contribution, which would
have been impossible without the unwavering
support from my colleagues in YAS, NASMeD,
AACE and NHS England.”
Julian also holds the Diploma in Immediate
Medical Care (DIMC) from the Faculty of
Pre-Hospital Care of the Royal College of
Surgeons of Edinburgh (2010) and a Post
Graduate Certificate in Medical Law from
Northumbria University (2012). In 2017 he
was awarded Founding Senior Fellowship
of the Faculty of Medical Leadership and
Management (SFFMLM). His base clinical
speciality was in Anaesthesia and held the
post of honorary Senior Staff Anaesthetist
at Harrogate and District Hospital NHS
Foundation Trust until April 2014, subsequently
continuing to practise clinically in immediate
medical care as a member of his local British
Association for Immediate Care (BASICS)
scheme. He is a former member of the Clinical
Advisory Board for the Faculty of Pre-Hospital
Care (RCSEd), the Clinical Advisory Forum
for NHS Improvement, the Department of
Health Clinical Advisory Group for Major
Trauma in England, and contributed to the
development of the national Hazardous Area
Response Team capability and NHS England’s
Ambulance Response Programme. He is
currently a member of the Out of Hospital
Cardiac Arrest steering group and the Adult
Critical Care Transport oversight group.
Julian will be presented with his medal at
Buckingham Palace in due course.
LAS News
Chief Executive of London
Ambulance Service
appointed permanently
The Chair of the London Ambulance
Service (LAS), Heather Lawrence OBE, has
announced the permanent appointment of
Daniel Elkeles as the Trust’s Chief Executive.
Daniel joined the Service in August 2021 on
secondment, and following a competitive
recruitment process that concluded on
Thursday 27 January, has now been appointed
substantively.
Heather Lawrence OBE, Trust Chair, said: “I
am delighted to announce Daniel’s permanent
appointment as Chief Executive following a
rigorous interview process.
“Daniel joined the Service at a very challenging
time and has led us through the latest wave
of the COVID-19 pandemic which saw
demand for our services increase dramatically,
combined with significant levels of staff and
volunteer sickness and isolations. Working
with teams from across the Service, he has
supported our staff and volunteers to rise to
the challenge and, despite the pressure, deliver
the best possible care for our patients.
“Not only that but in the six months since he
joined us, Daniel has proved a genuine drive to
protect the health and wellbeing of our teams,
kick-starting a dedicated programme of work
with all of our staff that is designed to improve
working lives and make LAS an even better
place to work.
“Daniel has already made a positive impact on
our staff and Service, and as he takes up the
mantle of the permanent position, we can be
confident that is set to continue.”
Daniel Elkeles said: “London Ambulance
Service plays a vital role in providing care for
nearly nine million people across the capital,
and it as an absolute honour to serve as the
Chief Executive of this incredible organisation.
“I am very passionate about the future strategy
for LAS, including ensuring staff and volunteers
receive the best possible support after what
has been the most challenging couple of years
in the NHS’s history.”
The interview panel included representatives
from within the organisation, as well as from
NHS England (London) and the Association
of Ambulance Chief Executives (AACE).
Prior to being interviewed, Daniel addressed
and answered questions from a 30 strong
stakeholder panel including our staff unions
and patient representatives.
Heather added: “Daniel’s 25 years’ experience
in the NHS and his hard work, commitment
and enthusiasm since joining us at the London
Ambulance Service made him the perfect
candidate for the permanent position. The
decision of the interview panel was unanimous.”
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GWAAC News
Air Ambulance Advanced
Practitioner in Critical Care,
Vicki Brown, breaks barriers
Vicki Brown, Advanced Practitioner
in Critical Care at Great Western Air
Ambulance Charity, has become the first
person in the country to get on the Faculty
of Pre Hospital Care (FPHC) Register
of Consultant (Level 8) Practitioners
by qualifying from a purely, paramedic
background. She is also the first female
paramedic on the list.
This is an amazing achievement for Vicki and is
a wonderful recognition of years of hard work
and expertise. This is also a big achievement
for the paramedic profession and is great
for Great Western Air Ambulance Charity
(GWAAC). Its crew’s capabilities and combined
experience as a team are constantly growing
and evolving, meaning the best possible care
can be delivered to patients.
Vicki joins GWAAC Drs Matt Campbell, Matt
Thomas, and Cosmo Scurr on the very short
list of people qualified. Other doctors, who
completed their training with GWAAC, are also
on the register.
Since the first registration in 2015, there
are only 70 individuals on the list. Just 20%
of these are female, which makes Vicki’s
achievement even more unique.
paramedic background, and being the first
female paramedic on the register, means she
will be an inspiration to other paramedics up
and down the country.
After achieving the Diploma in Immediate Care,
Vicki spent a few years going through the
process of providing evidence to the Faculty
of Pre-Hospital Care of her experience and
knowledge. This culminated in submitting
portfolios of clinical and operational
experience, and attending an interview.
She found out she’d made it on the Register
after an interview (on Friday 17th December
2021) with the Faculty of Pre-Hospital Care,
which is associated with the Royal College of
Surgeons of Edinburgh.
Vicki said: “I’m feeling very proud to have
achieved this level and hope other paramedics
will follow as pre-hospital medicine is very
much multi-professional. I hope this shows that
paramedics can achieve this level of practice.
I intend to continue pushing the boundaries
of paramedic practice and hope there is more
success to come.”
Getting on the FPHC Register of Consultant
(Level 8) Practitioners, after just 18 months of
being appointed the first Advanced Practitioner
in Critical Care (APCC) in the South West, is
even more remarkable.
Vicki’s quest to keep on reaching new heights
is why she’s an inspiration to all of us at
GWAAC, as well as aspiring paramedics.
EEAST News
EEAST Paramedic awarded
Station Commander’s
Commendation
EEAST Paramedic, Paul Chittock, has
been awarded a Station Commander’s
Commendation, marking 15 years of
voluntary support for RAF colleagues
based at Marham air force base in Norfolk.
Paul’s volunteering has seen him working on
everything from events and first aid training to
critical incident scenarios, this is all alongside
his day job with EEAST as a Paramedic, based
at Kings Lynn.
Over the years Paul has provided medical cover
and education for Family and Friends Days at the
base, regularly facilitates the use of fully equipped
ambulances and is passionate about passing on
life-saving skills for Marham staff who frequently
come across road traffic incidents on Norfolk’s
roads. He also encourages colleagues from
EEAST to offer their support as well.
In addition, Paul is actively involved with the
Co-Response Team, who offer support at major
incidents, spending hundreds of hours mentoring
and developing them, with members benefitting
from his training and experience as a paramedic.
In 2015, Paul oversaw the training of 30+ RAF
personnel in a large and complex road collision
scene management exercise. His expertise
ensured that the Fire Section, Medical Centre
and Co-Response Team were fully prepared for
challenging winter conditions going forward.
AMBULANCE UK - FEBRUARY
Vicki’s ambitions and desire to be the best she
can be in her profession, is helping GWAAC
meet two strategic objectives:
• To act Locally to provide an excellent and
innovative Pre-Hospital Emergency Care
service that supplements and supports NHS
services
• To impact Nationally and Influence Globally
by improving Pre-Hospital Emergency Care
for the benefit of all patients, identifying
effective interventions, promoting good
practice, and developing innovative new
approaches
On a local level, Vicki is delivering first-class
pre-hospital care to patients wherever they are
and whenever they need it. And on a national
level, her ground-breaking achievement
of being the first to qualify with a purely
Paul received the award from Air Commodore
Townsend. The award citation read:
‘Mr Chittock is the linchpin of the team, keeping
the Station highly trained in first aid response,
and his support to Station major events has
been first class. At no cost to the Station,
advanced life-saving medical care has always
been seconds away. What a great friend and
ally for the Station to have, and what a fantastic
contribution he has made over many years.’
30
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COMPANY NEWS
First electric
ambulance for
Homerton University
Hospital
ERS Medical, the UK’s
leading health and social
care transport provider, has
rolled out its first electric
ambulance for Homerton
University Hospital and its
community services.
transport. The vehicle’s charging
time means that this is a practical
and long-term solution for
greener patient transport.”
Back to life Defibs
Welcoming the first patient on
board on Friday 19 November,
this is another step in supporting
the NHS’s net zero goals.
To mark the occasion, ERS
Medical welcomed Mr Rodrigues
as the very first patient to be
transported on their electric
ambulance. He said: “It’s very
nice and I’ve enjoyed going on it.”
The electric ambulance has a
range of 219/185 miles (city/
combined) and saves over
4000kg of CO 2
emissions per
year when compared to a diesel
vehicle equivalent driving 10,000
miles per annum. This saving of
CO 2
per annum is equivalent to
424 gallons of diesel consumed
or 4769 pounds of coal burned.
Graham Snowling, Environmental
Sustainability Manager at
Homerton, said: “This is another
stage in our journey to net zero.
This new electric ambulance is
dedicated to our patients being
transported to and from the
hospital for their appointments
and also to clinics at our
community sites. It not only
reflects our commitment to net
zero, but it is also a pledge to the
residents of Hackney to improve
the air quality in the area.”
ERS Medical’s electric ambulance
boasts a charging time of 45
minutes to reach 80% battery
with a DC charge – making it
convenient and practical for
continuous use on patient
transport journeys.
Andrew Pooley, Chief Executive
at ERS Medical, added: “As the
leading non-emergency patient
transport provider for the UK,
our electric ambulance paves
the path for greener patient
Horsham based business
Trimbio felt it was time to
stop disposing of Medical
Devices just because they
were deemd to be old, after
seeing many older devices
such as defibrillators
and suction units being
disposed of in landfill
after coming out of the
manufacturer’s warranty.
They decided that this really
was not acceptable and that
they should be recycled. With
a history of over 30 years of
working with Medical Devices
across many sectors, Simon
Francis, the business owner,
invested in additional test
equipment, internal tracking
systems and training for staff
to ensure they conformed to
the insurance requirements for
recycling these devices. The
business now supplies a wide
range of Automated External
Defibrillators and Ambulance
based Defibrillators / Monitors.
During the process, the devices
will have new batteries and
accessories fitted, be fully tested
ready to be deployed back into
the public and medical sectors.
These recycled devices can
deliver many years of continued
service at a fraction of the cost
of new. Price for an AED starts
from around £375+vat for a unit
with new battery & pads. Trimbio -
www.trimbio.co.uk
Tel: 01403 597597.
AMBULANCE UK - FEBRUARY
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
31
VENTILATION SIMPLIFIED
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For more information, visit us at www.zoll.com
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