Ambulance UK February 2022

Volume 37 No. 1

February 2022

DEDICATED TO THE AMBULANCE SERVICE AND ITS SUPPLIERS

SEAMLESS SYNCHRONISATION

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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

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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.

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3

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


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.


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


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



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


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


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.


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

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


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


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.



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

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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


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


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.”


(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


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.”

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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

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look forward to continuing to work

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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

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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


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.


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

21

NEWSLINE


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


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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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.


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


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


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

25

IN PERSON


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.

26


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.


>>>


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


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,

28


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.”


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

29

IN PERSON

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.


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


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.



31

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Ambulance UK February 2022

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