Ambulance UK April 2022
Ambulance UK April 2022
Ambulance UK April 2022
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Volume 37 No. 2<br />
<strong>April</strong> <strong>2022</strong><br />
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CONTENTS<br />
CONTENTS<br />
<strong>Ambulance</strong> <strong>UK</strong><br />
36 EDITOR’S COMMENT<br />
40 FEATURES<br />
Assessing spinal movement during four extrication methods:<br />
a biomechanical study using healthy volunteers<br />
48 NEWSLINE<br />
59 IN PERSON<br />
61 COMPANY NEWS<br />
This issue edited by:<br />
Dr Matt House<br />
c/o Media Publishing Company<br />
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35
EDITOR’S COMMENT<br />
EDITOR’S COMMENT<br />
Hello All. It’s been a while since I sat down to write this editorial, as I’ve been out<br />
of the Country for a while, and only just returned to work. I was lucky enough to<br />
be deployed as a Reservist on a three-month tour of operations with the military.<br />
This wasn’t my first tour, but I must say, as someone who is not the spring chicken<br />
I used to be, I was surprised and pleased to get the opportunity again.<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
“With all the<br />
uncertainty<br />
and<br />
negativity<br />
in the world<br />
now, it’s good<br />
to be part of<br />
a team you<br />
can trust. We<br />
will make<br />
mistakes,<br />
as everyone<br />
does, but we<br />
know that we<br />
will look after<br />
each other.”<br />
I always enjoy working with the military, and particularly on operations. I’m not entirely sure why, but I saw<br />
something when I was heading down a YouTube rabbit hole the other day that might go some way to<br />
explain it. Simon Sinek gave a presentation where he said if you mapped performance against trust, it is<br />
preferrable to have someone you trust highly, and who may only be an average performer, against someone<br />
who was a high performer but who was not as trustworthy. Now, I have paraphrased the talk a lot here, and<br />
I would highly recommend watching the presentation (Performance vs Trust). I think Sinek has put his finger<br />
on it there. In a military environment there are good, bad and indifferent, like anywhere. What there is in<br />
bucketloads though, is trust. Trust goes a long way to making sure the team works well together.<br />
Back at work today and I was talking to one of my colleagues, Gill, and we were discussing the current<br />
pressures in the NHS and talked about the team we work with. Again, not all of us are top performers, by<br />
any stretch, but that word came up again: trust. We have a team who are there for each other professionally<br />
and personally. A lot of us have had wobbles of one sort or another over the years, but those people are<br />
given help, or time-out, if required, and then continue where they left off.<br />
With all the uncertainty and negativity in the world now, it’s good to be part of a team you can trust. We will<br />
make mistakes, as everyone does, but we know that we will look after each other.<br />
Dr Matt House, Co-Editor <strong>Ambulance</strong> <strong>UK</strong><br />
36<br />
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39
FEATURE<br />
ASSESSING SPINAL MOVEMENT DURING FOUR<br />
EXTRICATION METHODS: A BIOMECHANICAL<br />
STUDY USING HEALTHY VOLUNTEERS<br />
Tim Nutbeam 1,2,3* , Rob Fenwick 4 , Barbara May 5 , Willem Stassen 3 , Jason E. Smith 1,6 , Jono Bowdler 7 ,<br />
Lee Wallis 3 and James Shippen 5<br />
Scand J Trauma Resusc Emerg Med (<strong>2022</strong>) 30:7 https://doi.org/10.1186/s13049-022-00996-5 © The Author(s) <strong>2022</strong>.<br />
Abstract<br />
Background: Motor vehicle collisions are a common cause of death<br />
and serious injury. Many casualties will remain in their vehicle following<br />
a collision. Trapped patients have more injuries and are more likely to<br />
die than their untrapped counterparts. Current extrication methods<br />
are time consuming and have a focus on movement minimisation and<br />
mitigation. The optimal extrication strategy and the effect this extrication<br />
method has on spinal movement is unknown. The aim of this study<br />
was to evaluate the movement at the cervical and lumbar spine for four<br />
commonly utilised extrication techniques.<br />
Methods: Biomechanical data was collected using inertial Measurement<br />
Units on 6 healthy volunteers. The extrication types examined<br />
were: roof removal, b-post rip, rapid removal and self-extrication.<br />
Measurements were recorded at the cervical and lumbar spine, and in<br />
the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel),<br />
maximal movement, mean, standard deviation and confidence intervals<br />
are reported for each extrication type.<br />
Results: Data from a total of 230 extrications were collected for<br />
analysis. The smallest maximal and total movement (travel) were seen<br />
when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm).<br />
The largest maximal movement and travel were seen in rapid extrication<br />
extricated (AP max = 6.21 mm, travel 20.51 mm).<br />
The differences between self-extrication and all other methods were<br />
significant (p < 0.001), small non-significant differences existed between<br />
roof removal, b-post rip and rapid removal.<br />
Self-extrication was significantly quicker than the other extrication<br />
methods (mean 6.4 s).<br />
Conclusions: In healthy volunteers, self-extrication is associated<br />
with the smallest spinal movement and the fastest time to complete<br />
extrication. Rapid, B-post rip and roof off extrication types are all<br />
associated with similar movements and time to extrication in prepared<br />
vehicles.<br />
Background<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
Motor vehicle collisions (MVC’s) are a common cause of serious injury<br />
and death—accounting for 1.3 million deaths and 50 million serious<br />
injuries per annum worldwide [1]. Up to 40% of casualties injured<br />
following an MVC will remain trapped—these casualties are more likely<br />
to die than their un-trapped counterparts [2-8].<br />
Casualties who remain in their vehicle following an MVC will belong in<br />
one of four groups: (i) The casualty can self-extricate or extricate with<br />
minimal assistance (self-extrication), (ii) the casualty is unable to selfextricate<br />
due to pain, their psychological response to the incident or<br />
their injuries but can be assisted from the vehicle (assisted extrication)<br />
(iii) the casualty is either advised or chooses not to self-extricate due to<br />
concern of exacerbating injury (particularly spinal injury) by movement<br />
(medically trapped), (iv) the casualty is physically trapped in the vehicle<br />
(e.g. due to displaced road furniture) or requires disentanglement from<br />
the vehicle wreckage by rescue services (disentanglement and rescue)<br />
[9]. These groups are not mutually exclusive and a patient may belong in<br />
more than one group across their extrication experience.<br />
The role of the rescue services will be different for each casualty group.<br />
For example, casualties who can self-extricate will require minimal or no<br />
intervention from rescue services but those needing disentanglement and<br />
rescue will require the use of cutting and spreading tools [10]. Casualties<br />
in the assisted extrication (assisted) and medically trapped (medical)<br />
groups can be encouraged to self-extricate, have a rapid extrication<br />
(without the use of tools, sometimes referred to as a B plan) or can<br />
alternatively have a more traditional extrication, where the vehicle is cut<br />
away from around the casualty to improve access and offer an alternative<br />
route of egress (sometimes referred to as an A plan extrication) [10].<br />
The approach of the rescue service is based on movement minimisation<br />
and mitigation, primarily to avoid exacerbating a primary spinal injury<br />
[11].The role of small movements in this is unknown and a challenge to<br />
accurately quantify. Large or forceful movements are considered higher<br />
risk than smaller movements 1 . Rescue service teaching recommends<br />
that casualties in the assisted or medical groups receive a traditional<br />
extrication method, as it is understood that these result in less spinal<br />
movement than other techniques [11]. Recently these principles<br />
have been challenged; with a number of small biomechanical studies<br />
demonstrating that self-extrication may cause less movement than more<br />
traditional extrication techniques [12-14].<br />
Self-extrication or rapid techniques may be superior to traditional A<br />
plan techniques in relation to casualty and operational factors. Firstly<br />
40<br />
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FEATURE<br />
the use of extrication tools is not a benign intervention and may cause<br />
considerable and costly vehicular damage, will have significant resource<br />
implications (both human and equipment), is physically demanding and<br />
may also subject casualties and rescuers to a real risk of harm [15].<br />
Secondly, traditional extrication techniques can take a significant amount<br />
of time, with a median time of 30 min across traditional extrication<br />
types [16]. Whilst a patient remains entrapped the ability of clinicians to<br />
provide meaningful patient assessment and intervention is limited [17].<br />
The extended time frame associated with traditional extrication and the<br />
delays this causes in accessing care may be factors that contribute to<br />
the excess mortality and morbidity seen in trapped patients [8]<br />
We have previously demonstrated that spinal cord injuries occur in<br />
0.7% of patients trapped following an MVC [8]. However, before any<br />
change in practice can be recommended, a detailed understanding<br />
of the movement of the spine associated with each of the commonly<br />
used extrication techniques to support a rigorous comparison of such<br />
techniques is important. This study will assess the three most commonly<br />
performed extrication techniques along with self-extrication and the<br />
resulting spinal movement (Box 1) [18].<br />
to a participant information sheet in advance and completed written<br />
informed consent prior to participation.<br />
Data collection<br />
Each participant’s height and weight were recorded prior to being<br />
fitted with the Inertial Measurement Unit (IMU) (Xsens Awinda; Xsens<br />
Technologies B.V., Enschede, Netherlands). The characteristics of IMU’s<br />
and their suitability to extrication research are described in our previous<br />
work [19]. The IMU sensor was attached to the head using a headband.<br />
The thorax was assumed to be rigid and sensors were positioned over<br />
the clavicular notch on the sternum, and over each scapula using a<br />
tight-fitting elastic vest. A sensor was positioned on the sacrum by<br />
attaching the sensor to shorts using hook-and-loop fastening, to prevent<br />
upward travel, and securing the sensor against the body with an elastic<br />
belt. Orientation data were collected from each sensor via a wi-fi link and<br />
sampled at a rate of 40 Hz. Collars were used throughout this study as<br />
we have previously demonstrated that they reduce movement during<br />
extrication [19]. The Laerdal (Laerdal Medical Corp., Stavanger, Norway)<br />
Stifneck collars were fitted by a member of the study team trained in<br />
their use in accordance with manufacturer guidance.<br />
Methods<br />
This is an experimental crossover biomechanical study which builds<br />
on previous exploratory work and compares spinal movement at both<br />
the cervical spine and lumbar spine across each of four extrication<br />
techniques: (i) Roof removal extrication, (ii) B-post rip extrication, (iii)<br />
Rapid side door extrication, (iv) Self-extrication without instructions.<br />
The vehicle type was pre-specified as a 5-door hatchback as this<br />
represents the commonest vehicle type on <strong>UK</strong> roads [20]. Three similar<br />
vehicles were used (Box 1). The same intact vehicle was used for the<br />
self-extrication and rapid side door extrication arms of the study, with<br />
separate pre-prepared vehicles being used for the side-rip and roofremoval<br />
arms of the study. Each of these vehicles were prepared with<br />
all extrication stages involving cutting equipment and removal of vehicle<br />
structure being completed before the study began (Box 1 and Fig. 1).<br />
Participants<br />
Six healthy volunteers were recruited to participate in this study. The<br />
volunteers had no previous knowledge of extrication, had no back or<br />
neck conditions that may be exacerbated by extrication and had a mass<br />
of less than 100 kg. Participants were briefed on the study, had access<br />
Sample size<br />
Previous work has identified self-extrication with collar and no<br />
instructions to be associated with the least spinal movement during selfextrication;<br />
we used the means and standard deviations to power this<br />
study [19].<br />
BOX 1 Extrication procedures assessed and method of assessment<br />
Roof removal: The A, B and C posts and the roof removed facilitating a vertical extrication technique (Fig. 1)<br />
Study car preparation: the vehicle was stabilised, all posts were cut, the roof was removed and sharp edges were made safe<br />
Study vehicle: Peugeot 307 5 door, 2004<br />
Technique: The participant was provided with Manual In-Line Neck Stabilisation (MILNS) throughout, the back support of the driver’s seat was<br />
reclined mechanically and the Long Spinal Board (LSB) inserted to the seat base. The participant was then slid up the board until they were<br />
horizontally situated (securely) on the LSB<br />
B-post rip: The B-post, drivers and drivers side rear door are removed to facilitate patient access and horizontal extrication (Fig. 1)<br />
Study car preparation: The vehicle was stabilised, B-post was removed completely using two cuts and all sharps were made safe<br />
Study vehicle: Peugeot 307 5 door, 2006<br />
Technique: The participant was provided with MILNS throughout. The back support of the driver’s seat was reclined mechanically. The LSB was<br />
inserted at an oblique angle (pointed towards front centre console) and inserted to the seat base. Participant was then slid up the LSB until fully<br />
on the board at which point the LSB is rotated 45 degrees and placed horizontally onto the floor, next to the vehicle<br />
Rapid: The driver’s door is opened and the casualty assisted with a lateral extrication technique<br />
Study car preparation: The driver’s door was opened and the maximal opening angle enhanced using firefighter body weight only<br />
Study vehicle: Seat Ibiza 5 door, 1999<br />
Technique: The drivers door is opened. The participant was provided with MILNS throughout. The LSB was inserted under the right thigh and hip,<br />
through an open door on the driver’s side. Hereafter, the participant wasthen lifted up the LSB in a lateral position until the feet are released from<br />
under the steering column, allowing rotation onto back and then finally, slid into position further up the LSB (Fig. 1)<br />
Self-extrication: The casualty leaves the vehicle without assistance<br />
Study car preparation: The drivers door was opened<br />
Study vehicle: Seat Ibiza 5 door, 1999<br />
Technique: The participant is asked to get out of the vehicle and take one step away. The fire crew offered no instructions on how the participant<br />
should exit the vehicle<br />
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41
FEATURE<br />
Acknowledging its limitations, we used a minimally clinically important<br />
difference (MCID) derived from cadaveric work (2.7 mm) [21]. The power<br />
calculation was based on finding an anterior–posterior translational<br />
movement of 2.7 mm with a significance level of 1% and a power<br />
of 80%, giving a sample size per group of 57. At each stage, each<br />
extrication type was repeated a maximum of ten times with each of the<br />
6 volunteers.<br />
Analysis<br />
The IMU directly measures the segmental orientations from which<br />
relative motions can be calculated and reported, by assuming<br />
the relative rotations of adjacent vertebrae across the lumbar and<br />
cervical region are constant. Maximum excursions (movement from a<br />
hypothetical midline) were calculated for anterior/posterior (AP) and<br />
lateral (Lat) movement of the cervical and lumbar spine, respectively.<br />
In addition to reporting maximum excursions (the single largest<br />
movement) we report “travel”—the cumulative total of all movements<br />
throughout the extrication.<br />
The time taken for extrication is also considered as a patientorientated<br />
metric. Time for completion of each experiment was<br />
therefore also recorded, with the timer starting when the crew<br />
declared ready to begin and finishing when the patient was fully<br />
extricated and stationary.<br />
Data were captured and analysed using the Biomechanics of Bodies<br />
(BoB Biomechanics Ltd,, Bromsgrove, <strong>UK</strong>) software interface before<br />
being exported to Excel (Microsoft v. 16.9) and SPSS (IBM v. 25,<br />
Armonk NY) for further analysis and reporting. Total excursions,<br />
standard deviation and confidence intervals are reported for each<br />
extrication type. P values were calculated using a two tailed t-test<br />
comparing each extrication method with the current standard (roof<br />
removal) extrication type.<br />
The study protocol was reviewed and approved by the University of<br />
Coventry Research Ethics Committee (reference number P88416)<br />
and the University of Cape Town, Human Research Ethics Committee<br />
(reference number 530/2021).<br />
The largest overall mean movements were seen in the cervical spine<br />
AP with the rapid side door extrication (6.2 mm). For cervical spine<br />
lateral movements, the side-rip resulted in the greatest movement<br />
(6.9 mm). For the lumbar spine, the greatest movement was<br />
recorded with the rapid side door extrication (12.5 mm AP and<br />
11.6 mm LAT).<br />
Self-extrication was significantly quicker than the other extrication<br />
methods (mean 6.4 s, Fig. 6). B-post rip extrication (66.9 s) was<br />
slower than roof-off (53.8 s) and self-extrication.<br />
Discussion<br />
This is the first study to define spinal movements associated with<br />
each of the commonly used extrication techniques and to perform<br />
a powered comparative analysis. This study demonstrates that<br />
in healthy volunteers self-extrication results in significantly less<br />
movement at the cervical and lumbar spine than other extrication<br />
methods.<br />
Results in relation to other studies: Biomechanical studies of<br />
extrication are widely heterogenous in design. Similar to the studies<br />
of Gabrieli and Dixon we find that self-extrication results in the<br />
smallest range of motion at the cervical spine – we offer additional<br />
data across a range of volunteers and movements [12, 13]. Dixon’s<br />
team also considered rapid extrication through the driver’s door<br />
and found as we did that this was associated with the largest<br />
movements of the techniques that they considered [12]. Ours is<br />
the first study to report movements with the ‘roof off’ technique<br />
or the B post rip which are commonly performed in the <strong>UK</strong> and in<br />
international practice [18].<br />
Clinical and operational interpretation: Rescue service personnel<br />
are taught that unstable spinal injury should be assumed following<br />
an MVC and that traditional extrication techniques deliver minimal<br />
spinal movement, which are preferentially utilised because of this<br />
assumed benefit. As a result of this teaching, formal extrications are<br />
commonly performed for patients who could self-extricate [9].<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
Results<br />
Data from a total of 230 extrications were successfully collected for<br />
analysis (95.8% data capture success rate). Three of the six participants<br />
were female, with a mean age across all of the participants of 52 years<br />
(range 28–68) and BMI of 27.7 (range 21.5–34.6).<br />
The results are summarised in Tables 1, 2 and Figs. 2, 3, 4, 5, 6. The<br />
mean movements across the four extrication types were 4.4 mm<br />
(Cervical AP), 4.2 mm (Cervical Lat), 7.9 mm (Lumbar AP) and 7.8 mm<br />
(Lumbar Lat). Mean cervical roll was 16.6°, cervical pitch 12.4° and<br />
cervical yaw 17.1°. Mean lumbar roll was 16.6°, lumbar pitch 16.0° and<br />
lumbar yaw 25.4°.<br />
For the cervical spine, the smallest overall movements were recorded<br />
during self-extrication (2.6 mm AP and 2.4 mm LAT). These were also<br />
the conditions producing the smallest movements at the lumbar spine<br />
(4.5 mm AP and 5.7 mm LAT).<br />
This study demonstrates that self-extrication is associated with<br />
least spinal movement and the quickest time to extrication. Rapid,<br />
B-post rip and roof off extrication types are all associated with<br />
similar movements and time to extrication in preprepared vehicles.<br />
Trapped patients are more likely to die than patients who are not<br />
trapped [8]. Trapped patients may have serious and time dependent<br />
injuries and therefore will benefit from an extrication technique<br />
which results in the minimum time spent in the vehicle [8]. Current<br />
operational practice favours techniques that are time consuming<br />
and do not result in the smallest possible patient movement—they<br />
do not achieve their intended objectives and as a result their use<br />
should be urgently reconsidered. In patients who can self-extricate,<br />
this should be the preferred method of extrication as it is associated<br />
with the smallest amount (maximal and total) of movement and least<br />
time. Self-extrication has many other secondary benefits including<br />
potential risk to patient and rescuer, human and equipment<br />
resource utilisation and minimises additional damage to the vehicles<br />
42<br />
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FEATURE<br />
Fig. Vehicle preparation and data collection<br />
Fig. 1 Vehicle preparation and data collection<br />
Table Participant demographics, extrications and mean AP movement<br />
Table 1 Participant demographics, extrications and mean AP movement<br />
Participant Sex Age (years) Weight (kg) Height (cm) BMI (kg/m 2 Extrications Mean AP cervical movement (mm)<br />
Participant Sex Age (years) Weight (kg) Height (cm) BMI (kg/m 2 ) suitable Extrications for Mean AP cervical movement (mm)<br />
analysis suitable for Roof off post rip Rapid Self<br />
analysis<br />
Roof off B post rip Rapid Self<br />
40 89 167 31.9 39 4.2 7.0 11.0 2.2<br />
1 F 40 89 167 31.9 39 4.2 7.0 11.0 2.2<br />
52 100 170 34.6 38 7.6 7.8 6.5 6.9<br />
2 F 52 100 170 34.6 38 7.6 7.8 6.5 6.9<br />
57 89 168 31.5 39 6.6 4.8 7.8 3.0<br />
3 M 57 89 168 31.5 39 6.6 4.8 7.8 3.0<br />
28 62 167 22.2 36 7.4 3.9 6.7 0.9<br />
4 F 28 62 167 22.2 36 7.4 3.9 6.7 0.9<br />
68 80 181 24.4 38 2.5 5.1 2.3 1.2<br />
5 M 68 80 181 24.4 38 2.5 5.1 2.3 1.2<br />
57 69 179 21.5 40 3.0 6.4 3.1 1.6<br />
6 M 57 69 179 21.5 40 3.0 6.4 3.1 1.6<br />
50.3 81.5 172.0 27.7 230 5.2 5.8 6.2 2.6<br />
50.3 81.5 172.0 27.7 230 5.2 5.8 6.2 2.6<br />
involved. An alternative extrication approach will be required<br />
for the very small minority of patients who are entangled in the<br />
vehicle or cannot self-extricate [8, 9]. Such patients are likely to be<br />
significantly injured and have time critical needs: for these patients,<br />
following disentanglement, the quickest deliverable extrication<br />
method should be chosen; the correct choice of technique in this<br />
context will depend on the actions required to disentangle the<br />
patient.<br />
Strengths and weaknesses: Strengths of this study include efforts to<br />
maximise internal and external validity by recruiting male and female<br />
volunteers inexperienced in extrication with a range of weights,<br />
heights and ages. The study methods supported data collection from<br />
real vehicles, prepared as they would be for a ‘real life’ extrication,<br />
using active-duty rescue personnel. We successfully collected data<br />
from a large number of extrications to meet the pre-specified power<br />
calculation, supporting confidence in the reported results.<br />
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FEATURE<br />
Table 2 Maximal movement and travel<br />
Table Table Maximal 2 Maximal movement and and travel travel<br />
Table 2 Maximal movement Maximal movement and travelduring extrication<br />
Travel (total movement) during extrication<br />
Table 2 Maximal Maximal<br />
Roof<br />
Maximal movement off B<br />
movement<br />
post and p travel during<br />
value<br />
during Rapid<br />
extrication<br />
Maximal movement during extricationp value Self p value<br />
Travel<br />
Roof<br />
Travel (total<br />
off<br />
(total<br />
B post<br />
movement)<br />
p value<br />
during during<br />
Rapid extrication<br />
Travel (total movement) during extrication p valve Self p value<br />
Roof Roof off off post B post value p value Rapid Rapid value p value Self Self value p value Roof Roof off off post B post value p value Rapid Rapid valve p valve Self Self value p value<br />
Lumbar A/P[mm] Roof 9.65<br />
Maximal<br />
off B post 10.73<br />
movement<br />
p 0.45 value<br />
during<br />
Rapid 12.47<br />
extrication<br />
p value 0.09 Self 4.47 p value < 0.001 Roof 26.56<br />
Travel<br />
off B<br />
(total<br />
post 30.25<br />
movement)<br />
p value 0.28 Rapid<br />
during<br />
36.07<br />
extrication<br />
p valve 0.02 Self 8.49 p value < 0.001<br />
Lumbar Lumbar A/P[mm] Lat A/P[mm] 9.65 8.63 Roof 9.65 off 10.73 10.79 10.73 B post 0.45 0.27 0.45 p value 12.47 11.62 12.47 Rapid 0.09 p 0.13 value 0.094.47 5.67 Self 4.47 0.03 0.001 p < value 0.00126.56 21.80 26.56 Roof off30.25 30.70 B 30.25 post 0.28 0.06 0.28 p value36.07 37.67 Rapid 36.07 0.02 0.008 0.02 p valve8.49 10.69 Self 8.49 0.001 < p < value 0.001<br />
Lumbar A/P[mm] 9.65 10.73 0.45 12.47 0.09 4.47 < 0.001 26.56 30.25 0.28 36.07 0.02 8.49 < 0.001<br />
Lumbar Cervical Lumbar Lat A/P [mm] Lat [mm] 8.63 5.23 8.63 10.79 5.86 10.790.27 < 0.27 0.001 11.62 6.21 11.62 0.13 < 0.001 0.135.67 2.61 5.67 0.03 < 0.03 0.001 21.80 16.69 21.80 30.70 17.72 30.70.06 0.65 0.06 37.67 20.51 37.67 0.008 0.13 0.008 10.69 4.97 10.69 0.001 < 0.001<br />
Lumbar Lumbar Lat A/P[mm] 8.639.65 10.79 10.730.270.45 11.62 12.47 0.130.095.674.47 0.03< 0.00121.80 26.56 30.70 30.25 0.060.28 37.67 36.07 0.008 0.02 10.698.49 < 0.001 < 0.001<br />
Cervical Cervical A/P Lat A/P [mm] [mm] 5.23 5.11 5.23 5.86 6.88 5.86 0.05 0.001 < 0.0016.21 5.60 6.21 0.001 0.59 < 0.0012.61 2.38 2.61 0.001 < 0.0016.69 14.56 16.69 17.72 19.02 17.72 0.65 0.09 0.65 20.51 17.68 20.51 0.13 0.28 0.13 4.97 4.46 4.97 0.001 < 0.001<br />
Cervical Lumbar A/P Lat [mm] [mm] 5.238.63 5.86 10.79< 0.001 0.27 6.211.62 < 0.001 0.132.615.67 < 0.001 0.03 16.69 21.80 17.72 30.70.650.06 20.51 37.67 0.130.008 4.97 10.69 < 0.001 < 0.001<br />
Cervical Lumbar Cervical Lat roll [mm] Lat [°][mm] 5.11 18.83 5.11 6.88 23.47 6.880.05 0.31 0.05 5.60 25.46 5.60 0.59 0.14 0.592.38 11.25 2.38 0.01 0.001 0.0014.56 47.59 14.56 19.02 66.83 19.02 0.09 0.10 0.09 17.68 82.49 17.68 0.28 0.02 0.28 4.46 21.09 4.46 0.001 < 0.001<br />
Cervical Cervical Lat [mm] A/P [mm] 5.115.23 6.885.860.05< 0.0015.606.21 0.59 < 0.0012.382.61 < 0.001 < 0.0014.56 16.69 19.02 17.72 0.090.65 17.68 20.51 0.280.13 4.464.97 < 0.001 < 0.001<br />
Lumbar Lumbar roll pitch [°] roll [°] 18.83 22.91 18.83 23.47 22.55 23.470.31 0.94 0.31 25.46 22.33 25.46 0.14 0.89 0.1411.25 8.20 11.25 0.01 < 0.01 0.001 47.59 61.63 47.59 66.83 65.59 66.83 0.10 0.74 0.10 82.49 75.97 82.49 0.02 0.38 0.02 21.09 15.63 21.09 0.001 < 0.001<br />
Lumbar Cervical roll [°] Lat [mm] 18.835.11 23.476.880.310.05 25.465.60 0.140.5911.252.38 0.01< 0.00147.59 14.56 66.83 19.02 0.100.09 82.49 17.68 0.020.28 21.094.46 < 0.001 < 0.001<br />
Lumbar Lumbar pitch yaw pitch [°] [°] [°] 22.91 29.80 22.91 22.55 42.59 22.550.94 0.14 0.94 22.33 31.65 22.33 0.89 0.78 0.898.20 11.23 8.20 0.001 < 0.00161.63 74.73 61.63 65.59 109.69 65.59 0.74 0.12 0.74 75.97 101.09 75.97 0.38 0.27 0.38 15.63 21.13 15.63 0.001 < 0.001<br />
Lumbar Lumbar pitch roll [°] [°] 22.918.83 22.55 23.470.940.31 22.33 25.46 0.890.148.20 11.25 < 0.001 0.01 61.63 47.59 65.59 66.83 0.740.10 75.97 82.49 0.380.02 15.63 21.09 < 0.001 < 0.001<br />
Lumbar Cervical Lumbar yaw roll yaw [°] [°] [°] 29.80 15.55 29.80 42.59 20.54 42.590.14 0.08 0.14 31.65 16.62 31.65 0.78 0.68 0.7811.23 7.07 11.23 0.001 < 0.00174.73 44.52 74.73 109.69 55.79 109.69 0.12 0.16 0.12 101.09 53.92 101.09 0.27 0.28 0.27 21.13 13.31 21.13 0.001 < 0.001<br />
Lumbar Lumbar yaw pitch [°] [°] 29.80 22.91 42.59 22.550.140.94 31.65 22.33 0.780.8911.238.20 < 0.001 < 0.00174.73 61.63 109.69 65.59 0.120.74 101.09 75.97 0.270.38 21.13 15.63 < 0.001 < 0.001<br />
Cervical Cervical roll pitch [°] roll [°] 15.55 14.90 15.55 20.54 16.29 20.540.08 0.48 0.08 16.62 17.55 16.62 0.68 0.21 0.687.07 7.34 7.07 0.001 < 0.00144.52 47.32 44.52 55.79 48.67 55.79 0.16 0.82 0.16 53.92 56.51 53.92 0.28 0.15 0.28 13.31 13.99 13.31 0.001 < 0.001<br />
Cervical Lumbar roll [°] yaw [°] 15.55 29.80 20.542.590.080.14 16.62 31.65 0.680.787.07 11.23 < 0.001 < 0.00144.52 74.73 55.79 109.69 0.160.12 53.92 101.09 0.280.27 13.31 21.13 < 0.001 < 0.001<br />
Cervical Cervical pitch yaw pitch [°] [°] [°] 14.90 20.45 14.90 16.29 26.60 16.290.48 .098 0.48 17.55 22.98 17.55 0.21 0.53 0.217.34 6.10 7.34 0.001 < 0.00147.32 52.46 47.32 48.67 69.31 48.67 0.82 0.07 0.82 56.51 64.41 56.51 0.15 0.25 0.15 13.99 12.14 13.99 0.001 < 0.001<br />
Cervical Cervical pitch roll [°] [°] 14.90 15.55 16.29 20.540.480.08 17.55 16.62 0.210.687.347.07 < 0.001 < 0.00147.32 44.52 48.67 55.79 0.820.16 56.51 53.92 0.150.28 13.99 13.31 < 0.001 < 0.001<br />
Cervical Cervical yaw yaw [°] [°] 20.45 20.45 26.60 26.60 .098 .098 22.98 22.98 0.53 0.536.106.10 0.001 0.00152.46 52.46 69.31 69.31 0.07 0.07 64.41 64.41 0.25 0.25 12.14 12.14 0.001<br />
0.001<br />
Cervical Cervical yaw pitch [°] [°] 20.45 14.90 26.60 16.29.0980.48 22.98 17.55 0.530.216.107.34 < 0.001 < 0.00152.46 47.32 69.31 48.67 0.070.82 64.41 56.51 0.250.15 12.14 13.99 < 0.001 < 0.001<br />
Cervical yaw [°] 20.45 26.60 .098 22.98 0.53 6.10 < 0.001 52.46 69.31 0.07 64.41 0.25 12.14 < 0.001<br />
Roof off<br />
Roof off Roof off<br />
Roof off<br />
B post<br />
Roof off<br />
B post B post<br />
B post<br />
Rapid ex<br />
B post<br />
Rapid Rapid ex ex<br />
Rapid ex<br />
Self ex<br />
Rapid ex<br />
Self ex Self ex<br />
Self ex 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0<br />
Self Mean excursion (mm) and 95% confidence intervals<br />
0.0ex<br />
0.0 1.0 1.0 2.0 2.0 3.0 3.0 4.0 4.0 5.0 5.0 6.0 6.0 7.0 7.0 8.0 8.0<br />
Fig. 20.0Mean 1.0<br />
excursion Mean Mean excursion 2.0 excursion and (mm) 3.0<br />
confidence (mm) and 4.0 95% and 95% confidence intervals<br />
5.0 confidence for intervals 6.0anterior–<br />
intervals 7.0 8.0<br />
Mean excursion (mm) and 95% confidence intervals<br />
posterior Fig. 2 Mean movement 0.0<br />
excursion<br />
1.0 at the 2.0<br />
and cervical confidence<br />
3.0 spine 4.0<br />
intervals<br />
5.0<br />
for<br />
6.0<br />
anterior–<br />
7.0 8.0<br />
Mean excursion (mm) and 95% confidence intervals<br />
Fig. Mean excursion and confidence intervals for anterior–<br />
Fig.<br />
posterior posterior<br />
2 Mean excursion<br />
movement at<br />
and<br />
the at the cervical<br />
confidence<br />
cervical spine spine<br />
intervals for anterior–<br />
posterior Fig. 2 movement Mean excursion at the and cervical confidence spine intervals for anterior–<br />
posterior movement at the cervical spine<br />
Roof off<br />
Roof off Roof off<br />
Roof off<br />
B post<br />
Roof off<br />
B post B post<br />
B post<br />
Rapid ex<br />
B post<br />
Rapid Rapid ex ex<br />
Rapid ex<br />
Self ex<br />
Rapid ex<br />
Self ex Self ex<br />
Self ex 0 2 4 6 8 10 12 14 16<br />
Self 0ex<br />
0 2<br />
Mean<br />
2 4<br />
excursion<br />
4 6<br />
(mm)<br />
6<br />
and<br />
8<br />
95%<br />
8 10<br />
confidence<br />
10 12<br />
intervals<br />
12 14 14 16 16<br />
0 2 4 6 8 10 12 14 16<br />
Fig. 4 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals anterior– intervals<br />
Fig. posterior Mean movement 0<br />
Mean<br />
2<br />
excursion<br />
Fig. 4 Mean excursion excursion at and the 4<br />
(mm)<br />
and lumbar 6<br />
and 95%<br />
confidence spine8 confidence<br />
10<br />
intervals<br />
12 14 16<br />
intervals intervals for anterior– for anterior–<br />
posterior<br />
Fig.<br />
posterior<br />
4 Mean excursion Mean<br />
movement at<br />
and excursion<br />
the at the lumbar<br />
confidence (mm) and<br />
lumbar spine spine<br />
intervals 95% confidence for anterior– intervals<br />
posterior Fig. 4 movement Mean excursion at the and lumbar confidence spine intervals for anterior–<br />
posterior movement at the lumbar spine<br />
Roof off<br />
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Roof off<br />
Roof off Roof off<br />
Roof off<br />
B post<br />
Roof off<br />
B post B post<br />
B post<br />
Rapid ex<br />
B post<br />
Rapid Rapid ex ex<br />
Rapid ex<br />
Self ex<br />
Rapid ex<br />
Self ex Self ex<br />
Self ex 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0<br />
Self 0.0ex<br />
0.01.0 1.0<br />
Mean<br />
2.0<br />
excursion<br />
2.03.0 3.0<br />
(mm)<br />
4.0<br />
and<br />
4.05.0 95%<br />
5.0<br />
confidence<br />
6.0 6.07.0 intervals<br />
7.0 8.0 8.09.0<br />
9.0<br />
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0<br />
Fig. 3 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals lateral intervals movement<br />
Fig. at Fig. the Mean cervical 0.0<br />
Mean<br />
3 Mean excursion spine 1.0<br />
excursion<br />
2.0<br />
(mm)<br />
3.0<br />
and<br />
4.0<br />
95% confidence<br />
5.0 6.0<br />
intervals<br />
7.0 8.0 9.0<br />
excursion and and confidence intervals intervals for lateral for lateral movement<br />
Fig.<br />
at the at<br />
3<br />
the cervical<br />
Mean<br />
cervical<br />
excursion Mean<br />
spine spine<br />
and excursion confidence (mm) and intervals 95% confidence for lateral intervals movement<br />
at the Fig. cervical 3 Mean spine excursion and confidence intervals for lateral movement<br />
at the cervical spine<br />
Our volunteers were uninjured, fully conscious and had not recently<br />
experienced a motor vehicle collision and did not have ‘true’<br />
entrapment requiring disentanglement, as such the applicability of<br />
these results to the injured post collision population needs careful<br />
consideration. The volunteers were subjected to multiple extrications<br />
across a short time; we could find no evidence of ‘learning’ in the<br />
movements recorded but this could have influenced our results<br />
unknowingly. The rescue personnel also performed multiple<br />
Roof off Roof off<br />
Roof off<br />
B post<br />
Roof off<br />
B post B post<br />
B post<br />
Rapid ex<br />
B post<br />
Rapid Rapid ex ex<br />
Rapid ex<br />
Self ex<br />
Rapid ex<br />
Self ex Self ex<br />
Self ex 0 2 4 6 8 10 12 14 16<br />
Self 0ex<br />
0 2<br />
Mean<br />
2 4<br />
excursion<br />
4 6<br />
(mm)<br />
6<br />
and<br />
8<br />
95%<br />
8 10<br />
confidence<br />
10 12<br />
intervals<br />
12 14 14 16 16<br />
0 2 4 6 8 10 12 14 16<br />
Fig. 5 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals lateral intervals movement<br />
Fig. at the Mean lumbar 0<br />
Mean<br />
Fig. 5 Mean excursion spine 2<br />
excursion<br />
4<br />
(mm)<br />
6<br />
and 95%<br />
8<br />
confidence<br />
10<br />
intervals<br />
12 14 16<br />
excursion and and confidence intervals intervals for lateral for lateral movement<br />
at<br />
Fig.<br />
the at<br />
5<br />
the lumbar<br />
Mean<br />
lumbar<br />
excursion Mean<br />
spine spine<br />
and excursion confidence (mm) and intervals 95% confidence for lateral intervals movement<br />
at the Fig. lumbar 5 Mean spine excursion and confidence intervals for lateral movement<br />
at the lumbar spine<br />
extrications over the day—a far greater exposure than in operational<br />
practice. We did see faster extrications as the teams became<br />
increasingly familiar both with the techniques and working together<br />
as a team. Fatigue of the extrication team may also have influenced<br />
our results.<br />
Further work: Additional biomechanical work could evaluate<br />
alternative extrication techniques (such as Scandinavian chain<br />
44<br />
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FEATURE<br />
Declarations<br />
Roof off<br />
B post<br />
Rapid ex<br />
Self ex<br />
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0<br />
Time to extricate (seconds)<br />
Fig. 6 Time taken and confidence intervals (s)<br />
Ethics approval and consent to participate<br />
This analysis was approved by the Coventry University Research Ethics<br />
Committee, reference P88416 and the University of Cape Town, Human<br />
Research Ethics Committee (reference number 530/2021).<br />
Consent for publication<br />
Not applicable.<br />
Competing interests<br />
The authors declare that they have no competing interests.<br />
Author details<br />
*<br />
Correspondence: timnutbeam@nhs.net 1 Emergency Department,<br />
cabling [22]. Biomechanical models using healthy volunteers<br />
are unlikely to offer definitive answers; evolving technology has<br />
supported the collection of data in ‘near operational’ scenarios but is<br />
unlikely to be successful in collecting data on actual injured patients.<br />
As the paradigms of spinal immobilisation are challenged and<br />
additional data is made available as to the rarity of isolated unstable<br />
spinal injury in the context of other time critical injuries [8], those with<br />
responsibility for guidance and expertise in the area of extrication,<br />
trauma care and spinal injuries must work with patients and their<br />
representatives to evolve new approaches to extrication which<br />
improve the care of and outcome for our patients.<br />
Conclusions<br />
In healthy volunteers, self-extrication is associated with the smallest<br />
patient spinal movement and the fastest time to complete extrication.<br />
Rapid, B-post rip and roof off extrication types are all associated with<br />
similar movements and time to extrication in preprepared vehicles.<br />
In patients who can self-extricate, this should be the preferred<br />
extrication method. In patients who can’t self-extricate, following<br />
disentanglement the most rapid method of extrication should be<br />
delivered.<br />
Acknowledgements<br />
This work is kindly supported by the National Fire Chiefs Council,<br />
Avon Fire and Rescue Service and Severn Park Fire and Rescue<br />
Centre<br />
Authors’ contributions<br />
All authors contributed to the conception and study design. Logistics,<br />
data collection and reporting by JS, BM, JB, RF and TN. Initial<br />
analysis by TN with clinical interpretation by TN, RF, JES, LW and WS.<br />
All authors have contributed to and approved the manuscript.<br />
Funding<br />
Research funded by a charitable grant from the Road Safety Trust.<br />
The Road Safety Trust had no role in the design, data collection,<br />
analysis or writing of this manuscript.<br />
Availability of data and materials<br />
The datasets used and/or analysed during the current study are<br />
available from the corresponding author on reasonable request.<br />
University Hospitals Plymouth NHS Trust, Plymouth, <strong>UK</strong>. 2 Devon<br />
Air <strong>Ambulance</strong> Trust, Exeter, <strong>UK</strong>. 3 Division of Emergency Medicine,<br />
University of Cape Town, Cape Town, South Africa. 4 University Hospitals<br />
Birmingham, Birmingham, <strong>UK</strong>. 5 Institute for Future Transport and Cities,<br />
University of Coventry, Coventry, <strong>UK</strong>. 6 Academic Department of Military<br />
Emergency Medicine, Royal Centre for Defence Medicine, Birmingham,<br />
<strong>UK</strong>. 7 Fire and Rescue Service Trainer, Severn Park Fire and Rescue<br />
Centre, Bristol, <strong>UK</strong>.<br />
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9. Fenwick R, Nutbeam T. Medical vs. true physical traffic collision<br />
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Emerg Med J Emj. 2015;32:939–45.<br />
13. Gabrieli A, Nardello F, Geronazzo M, Marchetti P, Liberto A, Arcozzi<br />
D, et al. Cervical spine motion during vehicle extrication of healthy<br />
volunteers. Prehosp Emerg Care. 2019;24:1–14.<br />
14. Häske D, Schier L, Weerts JON, Groß B, Rittmann A, Grützner PA,<br />
et al. An explorative, biomechanical analysis of spine motion during<br />
out-of-hospital extrication procedures. Inj. 2020;51:185–92.<br />
15. NFCC. National Operational Guidance [Internet]. National<br />
Operational Guidance. 2021 [cited 2021 Oct 21]. Available from:<br />
https://www.ukfrs.com/guidance/<br />
16. Nutbeam T, Fenwick R, Hobson C, Holland V, Palmer M. The stages<br />
of extrication: a prospective study. Emerg Med J. 2013;31:1006–8.<br />
18. R F, T N, M D. A 10-year time series analysis of roof removal<br />
extrications by Fire and Rescue Services in England. Faculty of<br />
Prehospital Care Scientific Conference. 2020;<br />
19. Nutbeam T, Fenwick R, May B, Stassen W, Smith JE, Wallis L, et<br />
al. The role of cervical collars and verbal instructions in minimising<br />
spinal movement during self-extrication following a motor vehicle<br />
collision - a biomechanical study using healthy volunteers. Scand J<br />
Trauma Resusc Emerg Med. 2021;29:108.<br />
20. Transport D of. Vehicle licensing statistics 2019. 2019; Available from:<br />
https://www.gov.uk/government/statistics/vehicle-licensing-statistics-2019<br />
21. Aebli N, Rüegg TB, Wicki AG, Petrou N, Krebs J. Predicting the risk<br />
and severity of acute spinal cord injury after a minor trauma to the<br />
cervical spine. Spine J. 2013;13:597–604.<br />
22. Fattah S, Johnsen AS, Andersen JE, Vigerust T, Olsen T, Rehn M.<br />
Rapid extrication of entrapped victims in motor vehicle wreckage<br />
using a Norwegian chain method – cross-sectional and feasibility<br />
study. BMC Emerg Med. 2014;14:14–14.<br />
Publisher’s Note<br />
Springer Nature remains neutral with regard to jurisdictional claims in<br />
published maps and institutional affiliations.<br />
17. Wilmink AB, Samra GS, Watson LM, Wilson AW. Vehicle entrapment<br />
rescue and pre-hospital trauma care. Injury. 1996;27:21–5.<br />
Received: 15 November 2021 Accepted: 7 January <strong>2022</strong><br />
Published online: 15 January <strong>2022</strong><br />
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46<br />
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47
NEWSLINE<br />
Seriously injured<br />
trauma patients have<br />
an increased chance<br />
of survival thanks to<br />
Wales Air <strong>Ambulance</strong><br />
On the day that the Wales Air<br />
<strong>Ambulance</strong> Charity marked<br />
its 21st birthday, a report<br />
published on 01/03/22 has<br />
revealed that seriously injured<br />
trauma patients attended by<br />
the service have a significantly<br />
increased chance of survival.<br />
Wales Air <strong>Ambulance</strong>, which<br />
attends life and limb-threatening<br />
emergencies, has become an<br />
important part of the critical care<br />
provision within Wales. It attends<br />
patients who have suffered a<br />
serious medical issue as well as<br />
those who have received a trauma<br />
to the body.<br />
The findings of an in-depth fiveyear<br />
evaluation of the service show<br />
that there is a significant 37%<br />
reduction in deaths within 30 days<br />
amongst patients who received the<br />
emergency department-standard<br />
care provided by the service’s<br />
medics at the scene of an incident.<br />
The service has also seen a 41%<br />
reduction in secondary transfers<br />
for patients, vastly exceeding its<br />
original target of 30%. A secondary<br />
transfer is when an emergency<br />
patient is taken to a healthcare<br />
facility, usually the nearest to the<br />
incident, who then requires a<br />
transfer to another hospital that<br />
can offer them the specialist care<br />
that they need. Due to advanced<br />
decision-making at the scene of an<br />
incident, the service’s medics are<br />
able to diagnose the specific needs<br />
of a patient and take them directly<br />
to the appropriate healthcare facility.<br />
This further reduces the time it<br />
takes for a patient to receive the<br />
specialist care that they need while<br />
saving the NHS time and money by<br />
avoiding a secondary transfer.<br />
The introduction of an advanced<br />
service has also attracted<br />
more medics to work in Wales.<br />
In the last five years, twelve<br />
consultants have taken up roles<br />
in Welsh hospitals because of<br />
the opportunity to work with the<br />
Wales Air <strong>Ambulance</strong>.<br />
The evaluation has been<br />
independently scrutinised by<br />
Swansea University, with support<br />
from Health Data Research<br />
<strong>UK</strong> and Monash University in<br />
Australia. It included the use of<br />
Swansea University’s world-class<br />
anonymised databank called<br />
SAIL to compare the service’s<br />
operational and patient recovery<br />
figures with data from 9 billion<br />
patient records worldwide.<br />
The report, which examined the<br />
9,952 missions attended by the<br />
service between 2015 and 2020,<br />
also reveals that 63% (6,018)<br />
of patients received advanced<br />
lifesaving treatments. This<br />
included 313 people who required<br />
a blood transfusion and 790<br />
people who received anaesthesia.<br />
The evaluation covers a five-year<br />
period starting in 2015, the year<br />
when an enhanced medical<br />
operation was introduced to the<br />
Wales Air <strong>Ambulance</strong>. A unique<br />
Third Sector and Public Sector<br />
partnership between the Wales<br />
Air <strong>Ambulance</strong> Charity and<br />
NHS Wales saw the creation<br />
of the Emergency Medical<br />
Retrieval and Transfer Service<br />
(EMRTS Cymru). As a result, the<br />
service became consultant-led<br />
and transformed into a ‘flying<br />
emergency department’, taking<br />
hospital-standard treatments to<br />
the patient at the scene of an<br />
incident.<br />
The service’s consultants and<br />
critical care practitioners are able<br />
to deliver innovative emergency<br />
treatment across Wales,<br />
including minor operations, blood<br />
transfusions and anaesthesia.<br />
These were previously not available<br />
outside of a hospital environment.<br />
However, the service is not just<br />
provided by air. The medics<br />
can also deliver their lifesaving<br />
treatments by road in the Charity’s<br />
fleet of rapid response vehicles.<br />
While NHS Wales supplies the<br />
medics, the Wales Air <strong>Ambulance</strong><br />
Charity needs to raise £8 million<br />
a year to fund the helicopters and<br />
rapid response vehicles.<br />
Wales Air <strong>Ambulance</strong> now operates<br />
24/7, with the introduction of an<br />
overnight service in 2020.<br />
Dr Sue Barnes, Wales Air<br />
<strong>Ambulance</strong> Charity Chief<br />
Executive, said: “In the two<br />
decades since the launch of the<br />
Wales Air <strong>Ambulance</strong> Charity<br />
on this day in 2001, we have<br />
evolved into a vital critical care<br />
operation. Our mission and<br />
vision are focused on delivering<br />
our lifesaving medical service<br />
whenever and wherever it is<br />
needed, alongside improving the<br />
lives of those we serve by being a<br />
world leader in what we do. This<br />
report offers tangible evidence of<br />
how we are achieving our aims.<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
48<br />
A Wales Air <strong>Ambulance</strong> helicopter and rapid response vehicle<br />
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“Our ability to do this is thanks to<br />
our dedicated Charity, medical<br />
and aviation teams, however, it<br />
would not be possible without the<br />
incredible support from the people<br />
of Wales. It is because of their<br />
generosity that we have one of<br />
the most advanced air ambulance<br />
operations in the world and there<br />
are no words to convey our<br />
thanks.<br />
“The key for us now is to ensure<br />
that as many people as possible<br />
in Wales can benefit from our<br />
lifesaving care. With our medical<br />
partners, we continually monitor<br />
and evaluate our mission data and<br />
areas of unmet need to identify
NEWSLINE<br />
any service improvements that<br />
can be made.”<br />
Professor David Lockey, EMRTS<br />
Cymru National Director, said<br />
“This evaluation is one of<br />
the most extensive done by<br />
any air ambulance operation<br />
anywhere in the world. It clearly<br />
demonstrates that the advanced<br />
medical provision we offer is<br />
delivering benefits for the people<br />
of Wales, as well as the NHS.<br />
We must pay tribute to those<br />
in the Charity, NHS Wales and<br />
Welsh Government who set up<br />
and supported the introduction<br />
of our consultant-led service. We<br />
also recognise the passion and<br />
commitment of all those, past and<br />
present, who have worked hard<br />
to deliver this service, as well as<br />
the Charity’s supporters, without<br />
whom our service would not exist.<br />
“We are also incredibly proud<br />
and grateful to work alongside<br />
our colleagues in the Welsh<br />
<strong>Ambulance</strong> Service and in health<br />
boards across Wales. Together,<br />
we are able to offer the best<br />
possible care for people across<br />
the country.”<br />
EEAST<br />
East of England<br />
<strong>Ambulance</strong> Service<br />
to hit top gear with<br />
electric vehicle trial<br />
Three Rapid Response Vehicles<br />
(RRVs) will be trialled by East<br />
of England <strong>Ambulance</strong> Ser-vice<br />
NHS Trust (EEAST) as part of<br />
the NHS’s move towards zero<br />
emissions vehicles.<br />
EEAST has successfully bid for<br />
£250,000 from NHS England<br />
which will fund two electric Skoda<br />
all-wheel drive cars, an electric<br />
Vauxhall van, their conversion<br />
to medically equipped response<br />
vehicles and the necessary<br />
charging infrastructure for each<br />
of the vehicles. The funding is<br />
part of a new NHS England pilot<br />
to support ambulance trusts to<br />
trial a range of new zero emission<br />
response vehicles. The 12-month<br />
pilot will be subject to rigorous<br />
evaluation to inform the next steps<br />
to decarbonise the NHS fleet<br />
while im-proving patient care.<br />
Instructors from the Trust’s driver<br />
training team have already put<br />
the Skoda Enyaq iV 80x all-wheel<br />
vehicle to the test and found that<br />
it compares favourably with diesel<br />
equivalents being currently used.<br />
One of the Skodas will be used<br />
asa ‘standard’ Rapid Response<br />
Vehicle (RRV), used to get a<br />
paramedic response to patients<br />
quickly. The sec-ond will be used<br />
in a similar role in conjunction<br />
with our other blue-light partners<br />
(RAF, Fire and Police), initially<br />
in Bedfordshire, but later in<br />
Cambridgeshire, Norfolk and<br />
Essex, as different programmes<br />
and infrastructure configurations<br />
are tested.<br />
The Vauxhall Vicaro-E van, built in<br />
the <strong>UK</strong> at Ellesmere Port, will be<br />
trialled in various roles, including<br />
a falls response vehicle and a<br />
mental health response vehicle.<br />
Tom Abell, Chief Executive of<br />
EEAST, said: “The NHS has<br />
committed to being net-zero of<br />
car-bon emissions by 2045–five<br />
years ahead of the <strong>UK</strong>’s nationally<br />
set target. It is vital that we<br />
understand how this modern<br />
technology can help to improve<br />
our response times to patients<br />
and deliver cost savings over the<br />
longer term.”<br />
James Cook, Director for<br />
Community Care, Mental Health<br />
and <strong>Ambulance</strong> Improvement<br />
Support, NHS England and<br />
NHS Improvement said: “Air<br />
pollution alone contributes to<br />
1 in 20 deaths in the <strong>UK</strong> and<br />
reducing emissions will support<br />
the reduction of cases of asthma,<br />
cancer and heart disease.<br />
“Cleaner transport means cleaner<br />
air for our patients, and we’re very<br />
proud to be work-ing with East of<br />
England <strong>Ambulance</strong> Service and<br />
others across the country to begin<br />
the introduction of these new<br />
electric vehicles.”<br />
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49
NEWSLINE<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
LAS<br />
London <strong>Ambulance</strong><br />
staff make<br />
plea clear: We<br />
should be able to<br />
#WorkWithoutFear<br />
London <strong>Ambulance</strong> Service<br />
is playing a vital part in a new<br />
national campaign to highlight<br />
the profound impact of physical<br />
and verbal abuse on ambulance<br />
staff and volunteers, as figures<br />
show that cases of violence<br />
against staff and volunteers<br />
reached a record high last year.<br />
As part of the national<br />
#WorkWithoutFear campaign,<br />
London <strong>Ambulance</strong> staff and<br />
volunteers were invited to meet<br />
with Chief Executive Daniel Elkeles<br />
to share their personal experiences<br />
of abuse while on duty and their<br />
suggestions for what could be<br />
done differently, helping to create<br />
and shape a brand new action<br />
plan to bring down the number of<br />
incidents and secure the toughest<br />
possible convictions for those who<br />
commit them.<br />
In a roundtable conversation<br />
held recently, just days<br />
before the official launch of<br />
#WorkWithoutFear, staff gathered<br />
with Daniel to explain the impact<br />
that abusive patients and their<br />
families can have. Speaking<br />
bravely and openly, these staff<br />
members (who are all being<br />
offered support and are still<br />
serving with the Service) detailed<br />
instances of being physically<br />
attacked, verbally abused,<br />
threatened with weapons, and<br />
sexually assaulted. During the<br />
meeting, a 999 call handler shared<br />
the homophobic and threatening<br />
verbal abuse he had recently<br />
received, while one paramedic<br />
told the group about the time<br />
she was held at knifepoint for 25<br />
minutes and feared for her life<br />
while performing cardiopulmonary<br />
resuscitation (also known as CPR,<br />
this is the life-saving medical<br />
procedure of chest compressions<br />
and rescue breaths performed<br />
when someone’s heart has<br />
stopped pumping blood around<br />
the body). Daniel also heard from<br />
a paramedic who was attacked by<br />
a drunk patient and was left with a<br />
broken bone in his neck and, as a<br />
result, needed to take two months<br />
off work.<br />
Chief Executive Daniel Elkeles<br />
said: “Our staff and volunteers<br />
come to work to help Londoners<br />
in their time of need. They work<br />
to save lives, help the injured and<br />
make sure people get the medical<br />
care they need quickly. They<br />
should not, in any circumstance,<br />
experience physical or verbal<br />
abuse. But sadly, that is not the<br />
reality our teams face. There are a<br />
minority of patients (and members<br />
of the public) who behave hatefully<br />
or violently towards our staff and<br />
volunteers, and that situation has<br />
to change.<br />
“We‘ve already put extra<br />
measures in place – such as<br />
rolling out body worn cameras to<br />
our ambulance crews so they can<br />
record abusive incidents and use<br />
footage as evidence in court, and<br />
working with the police to increase<br />
convictions for hate crimes<br />
(such as people using racist or<br />
homophobic language when<br />
speaking to our call handlers). We<br />
have also created two new roles,<br />
Violence Reduction Officers, who<br />
provide dedicated support for staff<br />
and volunteers to take their case<br />
to court, providing a link between<br />
the victim and the Metropolitan<br />
Police Service, and making sure<br />
they are supported through the<br />
process, every step of the way.<br />
“But, we recognise that we have<br />
to do more – the roundtable<br />
conversation I had with staff has<br />
given us a really strong foundation<br />
to build on, and I – along with the<br />
Board of the London <strong>Ambulance</strong><br />
Service – am committed to<br />
making real change.”<br />
Sadly, latest figures show that<br />
cases of physical assaults against<br />
London <strong>Ambulance</strong> Staff have<br />
risen by almost 40% since the<br />
pandemic began. During 2018-19<br />
staff and volunteers experienced<br />
468 physical assaults, rising<br />
to 650 in 2020-21 – that’s an<br />
increase of 38%. Over the same<br />
period, verbal assaults almost<br />
doubled, rising from 695 in 2018-<br />
19 to 1,025 in 2020-21.<br />
Director of Quality Jaqui Lindridge<br />
(who joined the Service in 2000<br />
and has 19 years of experience as<br />
a paramedic) said: “Our medics<br />
and call handlers face stressful<br />
and challenging situations every<br />
single day, and yet, they remain<br />
calm and steadfastly professional.<br />
But that doesn’t mean the threats<br />
and insults that they hear, or the<br />
physical intimidation or harm<br />
they experience, does not have<br />
a deep and lasting impact. It’s<br />
heart breaking, and we will do<br />
everything in our power to stop<br />
this.<br />
“Our staff and volunteers have<br />
the right to #WorkWithoutFear,<br />
and so as we work hard to build<br />
a new action plan, I would like to<br />
take this opportunity to publicly<br />
thank our staff and volunteers,<br />
and ambulance service colleagues<br />
across the country for all that they<br />
do. We remain incredibly grateful<br />
for their hard work in challenging<br />
circumstances, and in awe of their<br />
bravery and resilience.”<br />
GWAAC<br />
Local air ambulance<br />
is called to more<br />
children and<br />
teenagers in 2021<br />
than ever before<br />
Great Western Air <strong>Ambulance</strong><br />
Charity (GWAAC) has<br />
announced that 2021 was<br />
its second busiest year on<br />
record. The Critical Care Team<br />
received a total of 1,964 callouts<br />
to incidents across the<br />
region which includes Bath<br />
and North East Somerset,<br />
Bristol, South Gloucestershire,<br />
Gloucestershire, North<br />
Somerset, and parts of<br />
Wiltshire.<br />
The most significant increase in<br />
tasked incidents was to children<br />
and teenagers in urgent need.<br />
In 2021, 14% of GWAAC’s total<br />
call-outs were to children and<br />
teenagers. That’s almost two in<br />
every ten of GWAAC’s callouts<br />
to South Gloucestershire<br />
and B&NES, and more than<br />
one in ten call-outs to Bristol,<br />
Gloucestershire, and North<br />
Somerset. Dispatches to children<br />
and teenagers doubled from 7%<br />
in the preceding years.<br />
Alfie needed GWAAC when he<br />
was three years old. His Mum,<br />
Becky, said: “If it wasn’t for this<br />
fabulous team, Alfie would not be<br />
with us today.”<br />
The air ambulance and critical<br />
care service, which is charity<br />
funded, provides emergency<br />
medical care to the most seriously<br />
ill or injured in the region.<br />
GWAAC’s crew of Critical Care<br />
Doctors, Advanced Practitioners<br />
and Specialist Paramedics<br />
bring the expertise of a hospital<br />
emergency department to the<br />
scene of an incident. These<br />
skills can make the difference<br />
between life and death. From<br />
roadside blood transfusions to<br />
performing emergency surgery to<br />
anaesthesia, the crew is specially<br />
trained to deliver pre-hospital<br />
emergency care to both children<br />
and adults.<br />
The increasing demand for<br />
GWAAC’s service means the<br />
charity needs to raise over<br />
£4 million a year to remain<br />
operational, yet it receives no<br />
day-to-day funding from the<br />
Government or National Lottery,<br />
relying on the generosity and<br />
50<br />
For more news visit: www.ambulanceukonline.com
NEWSLINE<br />
support from local communities.<br />
“Having experienced our second<br />
busiest year on record and with<br />
higher than average call-outs<br />
to children, I feel very proud of<br />
the crew. They have once again<br />
shown resilience and courage,<br />
and continue to put themselves<br />
on the frontline whilst making<br />
patients the heart of everything<br />
they do.”<br />
Anna Perry, CEO, Great Western<br />
Air <strong>Ambulance</strong> Charity.<br />
To find out more about Great<br />
Western Air <strong>Ambulance</strong> Charity’s<br />
work, its mission numbers in 2021,<br />
and how you can support the<br />
charity, visit www.gwaac.com.<br />
Primarily established to work in<br />
the world of international<br />
medical repatriation, the<br />
business has evolved to provide<br />
expert clinical solutions across<br />
a variety of specialist sectors<br />
and services.<br />
IPRS Aeromed are now recruiting Paramedics & Nurses<br />
What sets us apart is the<br />
experience and skills of our<br />
valued clinicians who are<br />
well-versed in managing<br />
repatriations to and from<br />
some of the most interesting<br />
countries around the world.<br />
Join a team that's really going places!<br />
https://iprsaeromed.com/jobs/ or email IPRS Aeromed<br />
Recruitment aeromed.recruitment@iprsgroup.com<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />
51
NEWSLINE<br />
Peterborough City<br />
Hospital helipad<br />
lighting provides<br />
24 hour service for<br />
emergency response<br />
Seriously ill or injured patients<br />
from across the region will<br />
benefit from extended air<br />
ambulance flying hours thanks<br />
to a generous donation of<br />
nearly £47,000 to Peterborough<br />
City Hospital from the HELP<br />
Appeal, the only charity in the<br />
country dedicated to funding<br />
hospital helipads.<br />
State-of-the-art helipad lighting<br />
will enable air ambulances to<br />
land throughout the night and<br />
support immediate access to the<br />
Emergency Department during<br />
darkness hours.<br />
The lighting installation is solar<br />
Aerial shot of the helipad lit up, photo by the EAAA<br />
powered therefore reducing the Emergency Department can now<br />
hospital’s carbon footprint. All air deliver high quality emergency<br />
ambulance pilots can activate the care across the full 24-hour<br />
lighting system via a VHF radio period. Their generosity will have<br />
transponder miles away from the a very positive impact for our<br />
helipad. Alternatively, staff on-site patients.”<br />
can operate the system from the<br />
ground control panel.<br />
Robert Bertram, Chief Executive<br />
of the HELP Appeal commented:<br />
Stuart Toulson, Matron for<br />
“People can become seriously ill<br />
Urgent & Emergency Care at or injured anytime of the day or<br />
Peterborough City Hospital, said: night. This new, state-of-the-art<br />
“’We are extremely grateful to our lighting system on Peterborough<br />
friends at the HELP Appeal for City Hospital’s helipad, allows air<br />
ensuring that our team within the ambulances to land, even when<br />
it’s dark, so patients can get the<br />
urgent treatment they need 24 /<br />
7 – which will save many more<br />
lives.”<br />
Paul Ferguson, Peterborough<br />
City Hospital’s Heli-Ops Manager<br />
added: “We are eternally thankful<br />
to the HELP Appeal and support<br />
agencies for the installation of<br />
the night lighting system. This<br />
enhances our ability to accept<br />
aircraft at night. We average<br />
5-10 day time movements per<br />
month which will increase with the<br />
lighting in place.”<br />
The helipad, which was built in<br />
September 2011, now offers a<br />
24-hour service meaning that<br />
MAGPAS, the East Anglian Air<br />
<strong>Ambulance</strong>, the Coastguard<br />
Service, and other specialist units<br />
can access the hospital at any<br />
time of the day and night.<br />
For more information please visit<br />
www.helpappeal.org.uk<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
52<br />
AVS STEPS_<strong>Ambulance</strong> <strong>UK</strong> Half Page Advert_June 2021_FINAL.indd 1 01/07/2021 18:04<br />
For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE<br />
Just breathe<br />
Reduces<br />
trauma pain<br />
from severe<br />
to moderate<br />
levels<br />
2x faster<br />
than<br />
IV morphine 1<br />
References:<br />
1. Data on file MAPIT study. 2.Penthrox <strong>UK</strong> Summary of Product Characteristics. March 2021.<br />
It’s About Time<br />
Penthrox is indicated for the emergency relief of moderate to severe pain in conscious adult<br />
patients with trauma and associated pain. 2<br />
PENTHROX 99.9%, 3 ml inhalation vapour,<br />
liquid: Please refer to the Summary of Product<br />
Characteristics (SmPC) before prescribing.<br />
Abbreviated Prescribing Information.<br />
Presentation: Each bottle of PENTHROX contains 3 ml<br />
of methoxyflurane 99.9%, a clear, almost colourless,<br />
volatile liquid, with a characteristic fruity odour. Each<br />
PENTHROX combination pack consists of one bottle of<br />
3 ml PENTHROX, one PENTHROX Inhaler and one<br />
Activated Carbon (AC) chamber. Indications: Emergency<br />
relief of moderate to severe pain in conscious adult<br />
patients with trauma and associated pain. Dosage and<br />
administration: PENTHROX should be self-administered<br />
under supervision of a person trained in its<br />
administration, using the hand held PENTHROX Inhaler.<br />
It is inhaled through the custom-built PENTHROX<br />
inhaler. Adults: One bottle of 3 ml PENTHROX as a<br />
single dose, administered using the device provided. A<br />
second bottle should only be used where needed. The<br />
frequency at which PENTHROX can be safely used is<br />
not established. The following administration schedule<br />
is recommended: no more than 6 ml in a single day,<br />
administration on consecutive days is not recommended<br />
and the total dose to a patient in a week should not<br />
exceed 15 ml. Onset of pain relief is rapid and occurs<br />
after 6-10 inhalations. Patients are able to titrate the<br />
amount of PENTHROX inhaled and should be instructed<br />
to inhale intermittently to achieve adequate analgesia.<br />
Continuous inhalation of a bottle containing 3 ml<br />
provides analgesic relief for up to 25-30 minutes;<br />
intermittent inhalation may provide longer analgesic<br />
relief. Patients should be advised to use the lowest<br />
possible dose to achieve pain relief. Renal impairment:<br />
Methoxyflurane may cause renal failure if the<br />
recommended dose is exceeded. Caution should be<br />
exercised for patients diagnosed with clinical conditions<br />
that would pre-dispose to renal injury. Hepatic<br />
impairment: Cautious clinical judgement should be<br />
exercised when PENTHROX is to be used more<br />
frequently than on one occasion every 3 months.<br />
Paediatric population: PENTHROX should not be used<br />
in children and adolescents under 18 years. For detailed<br />
information on the method of administration refer to<br />
the SmPC. Contraindications: Use as an anaesthetic<br />
agent. Hypersensitivity to methoxyflurane, any<br />
fluorinated anaesthetic or to any of the excipients.<br />
Patients who are known to be or genetically susceptible<br />
to malignant hyperthermia. Patients or patients with a<br />
known family history of severe adverse reactions after<br />
being administered with inhaled anaesthetics. Patients<br />
who have a history of showing signs of liver damage<br />
after previous methoxyflurane use or halogenated<br />
hydrocarbon anaesthesia. Clinically significant renal<br />
impairment. Altered level of consciousness due to any<br />
cause including head injury, drugs or alcohol. Clinically<br />
evident cardiovascular instability. Clinically evident<br />
respiratory depression.Warnings and Precautions: To<br />
ensure the safe use of PENTHROX as an analgesic the<br />
lowest effective dose to control pain should be used<br />
and it should be used with caution in the elderly or other<br />
patients with known risk factors for renal disease, and<br />
in patients diagnosed with clinical conditions which may<br />
pre-dispose to renal injury. Methoxyflurane causes<br />
significant nephrotoxicity at high doses. Nephrotoxicity<br />
is thought to be associated with inorganic fluoride ions,<br />
a metabolic breakdown product. When administered<br />
as instructed for the analgesic indication, a single dose<br />
of 3 ml methoxyflurane produces serum levels of<br />
inorganic fluoride ions below 10 micromol/l. In the past<br />
when used as an anaesthetic agent, methoxyflurane at<br />
high doses caused significant nephrotoxicity, which was<br />
determined to occur at serum levels of inorganic fluoride<br />
ions greater than 40 micromol/l. Nephrotoxicity is also<br />
related to the rate of metabolism. Factors that increase<br />
the rate of metabolism such as drugs that induce hepatic<br />
enzymes can increase the risk of toxicity with<br />
methoxyflurane as well as sub-groups of people with<br />
genetic variations that may result in fast metaboliser<br />
status. Methoxyflurane is metabolised in the liver,<br />
therefore increased exposures in patients with hepatic<br />
impairment can cause toxicity. PENTHROX should be<br />
used with care in patients with underlying hepatic<br />
conditions or with risks for hepatic dysfunction. Previous<br />
exposure to halogenated hydrocarbon anaesthetics<br />
(including methoxyflurane when used as an anaesthetic<br />
agent), especially if the interval is less than 3 months,<br />
may increase the potential for hepatic injury. Potential<br />
effects on blood pressure and heart rate are known<br />
class-effects of high-dose methoxyflurane used in<br />
anaesthesia and other anaesthetics. Caution is required<br />
with use in the elderly due to possible reduction in blood<br />
pressure. Potential CNS effects such as sedation,<br />
euphoria, amnesia, ability to concentrate, altered<br />
sensorimotor co-ordination and change in mood are<br />
known class-effects. The possibility of CNS effects may<br />
be seen as a risk factor for potential abuse, however<br />
reports are very rare in post-marketing use. PENTHROX<br />
is not appropriate for providing relief of break-through<br />
pain/exacerbations in chronic pain conditions or for the<br />
relief of trauma related pain in closely repeated episodes<br />
for the same patient. PENTHROX contains the excipient,<br />
butylated hydroxytoluene (E321) which may cause local<br />
skin reactions (e.g. contact dermatitis), or irritation to<br />
the eyes and mucous membranes. To reduce<br />
occupational exposure to methoxyflurane, the<br />
PENTHROX Inhaler should always be used with the AC<br />
Chamber which adsorbs exhaled methoxyflurane.<br />
Multiple use of PENTHROX Inhaler without the AC<br />
Chamber creates additional risk. Elevation of liver<br />
enzymes, blood urea nitrogen and serum uric acid have<br />
been reported in exposed maternity ward staff when<br />
methoxyflurane was used in the past at the time of<br />
labour and delivery. Interactions: There are no reported<br />
drug interactions when used at the analgesic dosage (3<br />
– 6 ml). Methoxyflurane is metabolised by the CYP 450<br />
enzymes, particularly CYP 2E1, CYP 2B6 and to some<br />
extent CYP 2A6. It is possible that enzyme inducers<br />
(such as alcohol or isoniazid for CYP 2E1 and<br />
phenobarbital or rifampicin for CYP 2A6 and<br />
carbamazepine, efavirenz, rifampicin or nevirapine for<br />
CYP 2B6) which increase the rate of methoxyflurane<br />
metabolism might increase its potential toxicity and they<br />
should be avoided concomitantly with methoxyflurane.<br />
Concomitant use of methoxyflurane with medicines (e.g.<br />
contrast agents and some antibiotics) which are known<br />
to have a nephrotoxic effect should be avoided as there<br />
may be an additive effect on nephrotoxicity; tetracycline,<br />
gentamicin, colistin, polymyxin B and amphotericin B<br />
have known nephrotoxic potential. Sevoflurane<br />
anaesthesia should be avoided following methoxyflurane<br />
analgesia, as sevoflurane increases serum fluoride levels<br />
and methoxyflurane nephrotoxicity is associated with<br />
raised serum fluoride. Concomitant use of PENTHROX<br />
with CNS depressants, such as opioids, sedatives or<br />
hypnotics, general anaesthetics, phenothiazines,<br />
tranquillisers, skeletal muscle relaxants, sedating<br />
antihistamines and alcohol may produce additive<br />
depressant effects. If opioids are given concomitantly<br />
with PENTHROX, the patient should be observed<br />
closely. When methoxyflurane was used for anaesthesia<br />
at the higher doses of 40–60 ml, there were reports of<br />
drug interaction with hepatic enzyme inducers (e.g.<br />
barbiturates) increasing metabolism of methoxyflurane<br />
and resulting in a few reported cases of nephrotoxicity;<br />
reduction of renal blood flow and hence anticipated<br />
enhanced renal effect when used in combination with<br />
drugs (e.g. barbiturates) reducing cardiac output; and<br />
class effect on cardiac depression, which may be<br />
enhanced by other cardiac depressant drugs, e.g.<br />
intravenous practolol during cardiac surgery. Fertility,<br />
pregnancy and lactation: No clinical data on effects of<br />
methoxyflurane on fertility are available. Studies in<br />
animals have shown reproduction toxicity. As with all<br />
medicines care should be exercised when administered<br />
during pregnancy especially the first trimester. There is<br />
insufficient information on the excretion of<br />
methoxyflurane in human milk. Caution should be<br />
exercised when methoxyflurane is administered to a<br />
nursing mother. Effects on ability to drive and use<br />
Before administering PENTHROX, make sure you have read and fully understood the SmPC and educational materials, which provide important information about how to<br />
safely use the device to minimise risk of serious side effects. PENTHROX educational materials and training on its administration are available from Galen on request. MAT-PEN-<strong>UK</strong>-000509 Date of Preparation: March <strong>2022</strong><br />
For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />
machines: Methoxyflurane may have a minor influence<br />
on the ability to drive and use machines. Patients should<br />
be advised not to drive or operate machinery if they are<br />
feeling drowsy or dizzy.Undesirable effects: The<br />
common non-serious reactions are CNS type reactions<br />
such as dizziness and somnolence and are generally<br />
easily reversible. Serious dose-related nephrotoxicity<br />
has only been associated with methoxyflurane when<br />
used in large doses over prolonged periods during<br />
general anaesthesia. The following adverse drug<br />
reactions have either been observed in PENTHROX<br />
clinical trials in analgesia, with analgesic use of<br />
methoxyflurane following post-marketing experience<br />
or are linked to methoxyflurane use in analgesia found<br />
in post-marketing experience and in scientific literature<br />
(refer to the SmPC for further details): Very common<br />
(≥1/10): dizziness; common (≥1/100 to
NEWSLINE<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
EEAST<br />
East of England<br />
<strong>Ambulance</strong> Service<br />
signs up to antiracism<br />
pledge<br />
The East of England <strong>Ambulance</strong><br />
Service (EEAST) has become<br />
the first NHS trust to have<br />
signed up to UNISON’s new<br />
Anti-Racism Charter which<br />
aims to help tackle racism in<br />
the public sector.<br />
The charter commits<br />
organisations and their leaders<br />
to a raft of pledges designed to<br />
prevent all forms of conscious or<br />
unconscious racial bias.<br />
This includes championing<br />
a racially diverse workforce,<br />
recognising the impact of racism<br />
on staff wellbeing and regularly<br />
reviewing its strategies to improve<br />
racial equality, diversity and<br />
inclusion so that the organisation<br />
reflects the communities it serves.<br />
The charter also states that<br />
organisations should have a clear<br />
and visible anti-racism programme<br />
in place, while unconscious bias<br />
training should be provided for all<br />
staff and robust equality training<br />
for managers.<br />
Organisations will also report<br />
on their ethnicity pay gaps and<br />
monitor disciplinary and grievance<br />
processes to ensure outcomes<br />
are fair.<br />
Tom Abell, Chief Executive of<br />
the East of England <strong>Ambulance</strong><br />
Service, said: “I am delighted<br />
that EEAST is among the first<br />
NHS trusts to have signed this<br />
important Anti-Racism Charter.<br />
It underlines our commitment to<br />
eliminating discrimination in all<br />
forms at the Trust.<br />
“Signing this charter is an important<br />
part of our inclusion work as we<br />
work to make EEAST a better place<br />
to work and receive care.”<br />
Paramedic and UNISON EEAST<br />
chair Glenn Carrington said:<br />
“Official figures show that Black<br />
and ethnic minority employees<br />
often have a different experience<br />
to their white colleagues, even in<br />
the public sector. By signing this<br />
charter, the ambulance service<br />
is making a real commitment to<br />
tackling the disparities which exist<br />
between different groups.<br />
“A fairer workplace is a better<br />
workplace so by actively<br />
combatting discrimination,<br />
EEAST will be ensuring a better<br />
ambulance service for people<br />
across the east of England.”<br />
LAS<br />
Calling Londoners to<br />
Save a Life<br />
London <strong>Ambulance</strong> Service is<br />
calling on Londoners to join<br />
a life-saving movement that<br />
will create 100,000 every day<br />
heroes, who–with some simple<br />
training–would be able to save<br />
a life. The London Lifesavers<br />
campaign aims to recruit and<br />
train 100,000 lifesavers who<br />
are able to perform chest<br />
compressions and use a<br />
defibrillator.<br />
Across the capital last year,<br />
London <strong>Ambulance</strong> Service<br />
responded to almost 14,000<br />
cardiac arrests, and in the few<br />
minutes it takes for an ambulance<br />
crew to arrive at the scene,<br />
the actions of passers-by can<br />
make the difference between<br />
life and death. Without lifesaving<br />
intervention like CPR (cardiopulmonary<br />
resuscitation) and<br />
defibrillators the chances of<br />
survival decrease by about 10%<br />
with every passing minute.<br />
Dr Fenella Wrigley, Chief Medical<br />
Officer, said: “To save a life is<br />
an incredible thing. I speak<br />
from experience when I say that<br />
knowing you have helped bring an<br />
individual back to life will stay with<br />
you forever. With a bit of training,<br />
performing chest compressions<br />
and using a defibrillator is actually<br />
very straightforward and you will<br />
not harm a patient trying to help<br />
them.<br />
“We want to equip the people of<br />
London with the knowledge and<br />
the confidence to be able to help<br />
when it truly matters–training to<br />
do chest compressions and using<br />
a defibrillator doesn’t take long,<br />
but the impact it can have can last<br />
a lifetime”<br />
Attending a free public pop-up<br />
training session delivered by the<br />
ambulance service. The London<br />
<strong>Ambulance</strong> Service also offers<br />
support and advice on how to<br />
buy and use defibrillators for<br />
communities and organisations in<br />
London. In the longer term, as the<br />
number of recruits begins to grow,<br />
London <strong>Ambulance</strong> Service will<br />
consider other ways their London<br />
Lifesavers might help communities<br />
from checking in on the elderly<br />
and vulnerable in periods of<br />
extreme weather to collecting<br />
prescriptions or driving mobile<br />
patients to treatment centres.<br />
Prime Minister<br />
recognises St John<br />
<strong>Ambulance</strong> student<br />
volunteer with Points<br />
of Light Award<br />
St John <strong>Ambulance</strong> student<br />
volunteer Amy Hughes, 21, has<br />
been awarded a prestigious<br />
Points of Light award by the<br />
Prime Minister in recognition for<br />
her outstanding contribution to<br />
the health and first aid charity.<br />
Amy, a University of Portsmouth<br />
student, has volunteered tirelessly<br />
throughout St John <strong>Ambulance</strong>’s<br />
ongoing response to the Covid-19<br />
pandemic. Working on the<br />
frontline, she cared for patients<br />
at the NHS London Nightingale<br />
Hospital for more than a month<br />
before volunteering in Accident<br />
and Emergency Departments<br />
where she regularly did 12-hour<br />
shifts. She also qualified as a<br />
volunteer vaccinator and gave<br />
hundreds of jabs.<br />
In addition to this extraordinary<br />
contribution, Amy, who comes<br />
from Abergavenny, South Wales,<br />
last year led her university student<br />
unit in training 300 members of<br />
the public in life saving CPR skills<br />
as well as qualifying as ambulance<br />
crew. She is now volunteering on<br />
ambulances responding to 999<br />
calls across the south of England<br />
from London to Bristol.<br />
Amy, who has volunteered with St<br />
John <strong>Ambulance</strong> since she was<br />
18 years old, said: “I am really<br />
honoured that the Prime Minister<br />
has written to me personally<br />
to thank me for my work as a<br />
volunteer. The last two years have<br />
been tough at times, and I have<br />
experienced unforgettable things<br />
54<br />
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NEWSLINE<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
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55
NEWSLINE<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
like holding someone’s hand as<br />
they unexpectedly passed away in<br />
A&E, but it has also been a really<br />
rewarding experience which I have<br />
loved.<br />
“I have really grown as a person<br />
volunteering for St John. Each<br />
day I learn something new that I<br />
can use in everyday life, not just<br />
about first aid, but also how to<br />
communicate with people and<br />
deal with pressure. I have also<br />
made some amazing friends<br />
through my volunteering and have<br />
created long-lasting memories<br />
with them.”<br />
Amy has gained so much from her<br />
experiences volunteering through<br />
the pandemic that she is now<br />
pursuing a Master’s degree in<br />
paramedic science, after she has<br />
completed her current studies in<br />
photography.<br />
Jon Knight, director of youth &<br />
volunteer development, St John<br />
<strong>Ambulance</strong> said:<br />
“Huge congratulations to Amy<br />
who truly deserves this award.<br />
Amy is a shining example of<br />
the excellent service St John<br />
student volunteers have given<br />
to communities throughout the<br />
pandemic. As well as supporting<br />
the NHS on an ambulance<br />
and completing over 1,200<br />
volunteering hours in 2020, she<br />
also leads a team of student<br />
volunteers – and all while studying!<br />
I’m so proud of her for all she’s<br />
achieved, and grateful for the<br />
hundreds of student volunteers<br />
like her around the country.”<br />
Amy is the daily Point of Light<br />
award winner for Friday 25<br />
February <strong>2022</strong> – she is the <strong>UK</strong>’s<br />
1867th Point of Light.<br />
The award is Government crossparty<br />
supported programme<br />
recognising outstanding individual<br />
volunteers and highlighting the<br />
positive change people are<br />
making in their communities and<br />
to inspire others to volunteer.<br />
St John is one of the largest<br />
volunteering organisations in the<br />
country, offering many different<br />
volunteering opportunities from<br />
vaccination support for the<br />
NHS programme to first aiders<br />
and support team members.<br />
Recruitment is open now and full<br />
details can be found at www.sja.<br />
org.uk/get-involved/volunteeropportunities<br />
NEAS<br />
Beloved Berwick<br />
community<br />
paramedic scheme<br />
made permanent<br />
following its success<br />
The scheme which has serviced<br />
the Berwick area since its<br />
launch in July 2019 has been a<br />
major success and lifeline for<br />
the community.<br />
Following a successful two and<br />
a half years of work, the Berwick<br />
community paramedic scheme<br />
has been granted permanent<br />
funding.<br />
The scheme, run by North East<br />
<strong>Ambulance</strong> Service (NEAS),<br />
entails a small team of paramedics<br />
who respond to calls in and<br />
around the Berwick area, as well<br />
as offering additional support to<br />
the local NHS services.<br />
The scheme initially began as a<br />
three-month pilot in July 2019 and<br />
has continued to be extended<br />
since then as permanent funding<br />
was sought. In that time, the<br />
scheme has led to:<br />
• A reduction in the response<br />
time by the ambulance service<br />
for life-threatening cases;<br />
halving the average Category 1<br />
wait times to 06.02 minutes;<br />
• More than 5,800 patients being<br />
seen and treated at home<br />
by paramedics; freeing up<br />
GP services so that they can<br />
see more people in the local<br />
community;<br />
• Fewer patient transfers from<br />
Berwick to the Northumberland<br />
Specialist Emergency<br />
Care Hospital (NSECH) in<br />
Cramlington and Borders<br />
General Hospital;<br />
• Extra support for care homes<br />
in and around Berwick during<br />
evenings and weekends<br />
Following its success, the<br />
NHS Northumberland Clinical<br />
Commissioning Group (CCG) has<br />
agreed to commission the service<br />
permanently’.<br />
The team of three paramedics<br />
work in and around the Berwick<br />
area from 9am-9pm seven days<br />
a week. The team use a rapid<br />
response vehicle and work with<br />
the primary care teams at Wells<br />
Close Medical Group, and Union<br />
Brae and Norham Practice. They<br />
also work within Berwick Infirmary<br />
Minor Injuries Unit (MIU) out of<br />
hours and at weekends.<br />
As well as responding to<br />
emergencies in the area, the<br />
team of paramedics also support<br />
the local GPs by making urgent<br />
home visits to patients, help with<br />
the care plans for patients with<br />
long-term medical conditions, and<br />
work with other healthcare staff<br />
such as the district nursing team.<br />
In addition to this, the paramedics<br />
have an extended scope of<br />
practice to include the ability to<br />
request X-rays and take swabs<br />
and samples. Following the<br />
successful funding of the scheme,<br />
the team will receive additional<br />
training to further support their<br />
work in the community; allowing<br />
them to respond to more jobs,<br />
and further reduce the number<br />
of unnecessary hospital transfers<br />
and lighten the workload of local<br />
GP practices. By the end of their<br />
training, the team will be fully<br />
qualified first contact practitioners<br />
and will be able to conduct more<br />
work in the area to help provide<br />
the best patient experience and<br />
support the wider NHS system.<br />
Paul Liversidge, Chief Operating<br />
Officer at NEAS, said: “When<br />
56<br />
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NEWSLINE<br />
we began to trial this scheme<br />
as a three-month pilot in 2019,<br />
we couldn’t have foreseen just<br />
how large of an impact it would<br />
have on the Berwick community,<br />
although we obviously hoped it<br />
would be the success it has been.<br />
“Two and a half years and<br />
a pandemic later, and our<br />
community paramedic team have<br />
not only been able to improve the<br />
experience of the patients they<br />
see first-hand, but the knock-on<br />
effect of them being there frees<br />
up both GPs and our ambulance<br />
crews to see more patients in<br />
need.<br />
“It’s fantastic to see how well<br />
thought of the team is within the<br />
community and we’re also now<br />
looking at how we might replicate<br />
the service in other areas of the<br />
region. We’re very proud to be<br />
able to provide this service, and<br />
I look forward to seeing how the<br />
project continues to grow in the<br />
coming years.”<br />
Laurie Robson, NHS<br />
Northumberland CCG’s Senior<br />
Head of Commissioning – Urgent<br />
& Emergency Care, said: “This is a<br />
great example of how partnership<br />
working and developing new<br />
ideas to best meet the needs of<br />
patients in different parts of our<br />
county can have really positive<br />
outcomes for our communities.<br />
We are delighted to be able to<br />
commission this service on a<br />
permanent basis, as it has proved<br />
its worth in supporting high-quality<br />
care for patients in Berwick and<br />
the surrounding areas.”<br />
Ruth Corbett, Clinical Operations<br />
Manager for NEAS in North<br />
Northumberland, said: “I’m so<br />
proud of all my teams, but our<br />
Berwick community paramedics<br />
have shown real commitment<br />
over the past two and a half years<br />
to demonstrate that there is a<br />
real need for additional support<br />
in our more rural areas. When I<br />
first developed the team, I had<br />
no idea just how much of an<br />
impact the work they would go<br />
on to do would have on the local<br />
community. The work of the team<br />
has vastly improved not only the<br />
waiting times and pressures on<br />
the service, but also patient care<br />
and experience, which is the<br />
reason we’re here.<br />
“The nearest emergency<br />
department is almost 60 miles<br />
away from Berwick. This is a<br />
long journey for any patient who<br />
needs emergency care, but it is<br />
also a very long way for one of<br />
our vehicles to go and not be<br />
responding to other emergencies<br />
back in the area.<br />
“By having an additional team<br />
based in the Berwick area, we’ve<br />
been able to provide a much more<br />
hands-on approach to patient<br />
care within the community and<br />
prevent unnecessary journeys<br />
to hospital an hour away from<br />
home. Our team is always there to<br />
visit poorly patients, and support<br />
GP practices with their care of<br />
patients with long-term illness.”<br />
Dr Stephen Doherty, partner<br />
at Well Close Medical Group,<br />
said: “As a practice, we were<br />
delighted to hear that this project<br />
had been made a permanent<br />
fixture within the local community.<br />
The community paramedics are<br />
essential in providing urgent<br />
care when needed, as well as<br />
supporting local surgeries, and<br />
we look forward to continuing to<br />
work closely with them”<br />
Dr. Adelle Pears, associate<br />
GP at Well Close Medical<br />
Group, added: The community<br />
paramedics have been a<br />
fantastic addition to the primary<br />
care team. They all bring an<br />
enormous amount of enthusiasm<br />
and experience to the role.<br />
Our patients and the wider<br />
community have benefitted<br />
hugely from the excellent care<br />
that they provide, we are very<br />
lucky to have such an amazing<br />
service and I look forward to<br />
working with them in the future.”<br />
Anna Wood, Modern Matron at<br />
Berwick Infirmary, said: “Staff at<br />
the infirmary have welcomed the<br />
opportunity to build relationships<br />
with the community paramedics,<br />
so it is good news that the<br />
scheme will continue.<br />
“When available, the paramedics<br />
have supported our teams during<br />
busy periods, which in turn has<br />
allowed them to learn more about<br />
how our Minor Injuries Unit works<br />
and to boost their knowledge.<br />
Being able to bring patients into<br />
the MIU for assessment and<br />
treatment has contributed to<br />
the reduction in transfers to the<br />
Northumbria emergency hospital<br />
at Cramlington, which means less<br />
disruption for the patient while<br />
reducing pressure at that site.”<br />
SCAS<br />
Trial of paramedicled<br />
home blood<br />
testing for frail and<br />
elderly halved need<br />
for hospital transfers<br />
A trial of paramedic-led home<br />
blood testing for frail and<br />
elderly patients who required an<br />
ambulance helped to prevent<br />
the need for transfer to hospital<br />
in more than half of cases.<br />
In a pilot study led by South<br />
Central <strong>Ambulance</strong> Service and<br />
Oxford University Hospitals NHS<br />
Foundation Trust, 52% of patients<br />
who were initially identified as<br />
requiring hospital admission were<br />
successfully managed at home.<br />
It was made possible by using<br />
specialist paramedics to take<br />
blood samples at the scene and<br />
discuss the results with hospital<br />
physicians remotely to determine<br />
the next steps.<br />
Although specialist paramedics<br />
receive an additional two years’<br />
education and training and are<br />
able to diagnose a wider range of<br />
conditions and treat many minor<br />
injuries and illnesses, they do not<br />
routinely assess blood test results.<br />
As part of the trial they were given<br />
additional training in taking and<br />
handling blood samples and a<br />
SCAS rapid response vehicle<br />
(RRV) was equipped with a pointof-care<br />
– also known as bedside –<br />
testing device and novel wireless<br />
technology to transmit a patient’s<br />
blood results to hospital within<br />
minutes.<br />
Potential patients were identified<br />
by 999 call handlers as requiring<br />
more detailed clinical assessment<br />
and selected if they were 65 years<br />
or older and had either fallen from<br />
a standing height without obvious<br />
injury, had collapsed, were<br />
confused, had reduced mobility or<br />
suspected infection.<br />
They were then assessed by the<br />
paramedic on scene and only<br />
non-critically unwell frail or elderly<br />
patients who were deemed to<br />
potentially require transfer to<br />
hospital for further investigation<br />
were enrolled in the study to see<br />
if they could be managed safely<br />
at home.<br />
These patients then had bloods<br />
taken for immediate diagnostics<br />
in addition to the usual bedside<br />
investigations including urinalysis,<br />
electrocardiogram and blood<br />
sugar levels, with the results<br />
discussed with a senior physician<br />
by telephone for decision support.<br />
The outcomes were to either<br />
enable the patient to remain at<br />
home after a comprehensive<br />
assessment without the need<br />
for further intervention, leave<br />
the patient at home with further<br />
intervention from community<br />
or hospital at home services<br />
or transfer to hospital via the<br />
emergency department or acute<br />
medical unit.<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
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57
NEWSLINE<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
Critically unwell patients<br />
continued to be taken to hospital<br />
after assessment without having<br />
diagnostic blood tests and<br />
patients who did not require any<br />
further clinical input were referred<br />
to community services without<br />
participating.<br />
The study, published in the<br />
Journal of Paramedic Practice,<br />
showed that over a three-month<br />
period the frailty response unit<br />
saw 42 patients who were either<br />
too critically unwell or not in need<br />
of hospital assessment and 56<br />
selected for point-of-care testing.<br />
Out of the 56 enrolled, 27 were<br />
transferred for further assessment<br />
in hospital but 29 (52%) remained<br />
in their usual care environment. Of<br />
these, four presented to hospital<br />
within the next 30 days but with<br />
no adverse events recorded as a<br />
result of non-transfer to hospital.<br />
Dr John Black (pictured), Medical<br />
Director for SCAS and one of<br />
the study authors, said: “These<br />
results suggest it is feasible to<br />
perform bedside diagnostics in<br />
the community as part of the<br />
clinical assessment offered by<br />
ambulance services and that a<br />
proportion of older patients could<br />
potentially be managed in a home<br />
or community setting without<br />
physically attending hospital and<br />
without adding significantly to the<br />
burden on community services.<br />
“The beauty of this model is<br />
that the potentially complex<br />
interpretation of the blood tests<br />
is undertaken by a hospital<br />
medical team remotely who can<br />
contextualise the results with the<br />
paramedic’s clinical findings and<br />
observations in the community at<br />
the time of referral.<br />
“As well as the benefits of keeping<br />
frail and elderly patients out of<br />
hospital if clinically appropriate<br />
to do so, there is a real potential<br />
for this to relieve pressure and<br />
financial costs on busy hospital<br />
emergency departments and<br />
acute medical units.”<br />
He added: “Serious consideration<br />
must be given to innovations<br />
such as this to ensure the best<br />
possible care and environment for<br />
patients but also to help address<br />
the ongoing issue of hospital<br />
pressures and capacity which<br />
continues to be such a significant<br />
problem.”<br />
Dr Alex Novak, Consultant<br />
in Emergency Medicine and<br />
Ambulatory Care at Oxford<br />
University Hospitals NHS<br />
Foundation Trust and coauthor<br />
of the study, said: “This<br />
pilot project demonstrated the<br />
feasibility of providing linked<br />
community-based diagnostic<br />
testing with acute secondary care<br />
decision support and indicates<br />
the potential for this to have a<br />
positive impact on the healthcare<br />
provided to some of our most<br />
vulnerable patients.”<br />
EHAAT<br />
Their Royal<br />
Highnesses the Earl<br />
and Countess of<br />
Wessex visit Essex &<br />
Herts Air <strong>Ambulance</strong><br />
On Tuesday 1st March <strong>2022</strong>,<br />
North Weald: Essex and<br />
Herts Air <strong>Ambulance</strong> (EHAAT)<br />
hosted a visit by Their Royal<br />
Highnesses The Earl and<br />
Countess of Wessex.<br />
EHAAT is a local life-saving<br />
charity and works alongside the<br />
hospitals, emergency services<br />
and supporting organisations<br />
across the region. Today’s visit<br />
was an opportunity to bring<br />
everyone together at EHAAT’s<br />
new airbase at North Weald,<br />
enabling The Earl and Countess<br />
to say thank you to some of<br />
these organisations for their<br />
outstanding hard work during the<br />
pandemic.<br />
On first arriving at North<br />
thank them for the work they do.<br />
Weald, The Lord Lieutenant<br />
of Hertfordshire and Vice Lord Jane Gurney was thrilled that The<br />
Lieutenant of Essex greeted The Earl and Countess of Wessex had<br />
Earl and Countess of Wessex, visited. She said:<br />
and introduced them to Jane<br />
Gurney, CEO of EHAAT. Their “This is a real milestone in our<br />
Royal Highnesses then toured charity’s history, as it is the first<br />
the new airbase, where they met time that Essex and Herts Air<br />
members of EHAAT’s critical care <strong>Ambulance</strong> has hosted a Royal<br />
team, charity staff and volunteers. visit. It was a fantastic opportunity<br />
The Earl and Countess also to bring together all of the<br />
heard about EHAAT’s vision for a organisations who have worked<br />
‘Centre for Excellence’ at North so hard during these challenging<br />
Weald, which would enable the times of the pandemic. I am truly<br />
charity to push the boundaries honoured that we have been able<br />
in innovation, research and to showcase our new airbase at<br />
education for the advancement of North Weald and share our vision<br />
pre-hospital care.<br />
for a Centre for Excellence that will<br />
continue to develop pre-hospital<br />
Their Royal Highnesses spent care into the future.”<br />
time with representatives from the Chair of Trustees at EHAAT,<br />
local hospitals in the region and Jonathan Trower, added:<br />
then spoke to air lifted patients<br />
and their families to hear firsthand<br />
about their experiences. to have welcomed Their Royal<br />
“We are absolutely delighted<br />
Highnesses The Earl and<br />
The highlight of the Royal visit Countess of Wessex to our new<br />
took place at the front of the airbase in North Weald, and we<br />
building where people had are very grateful for their interest<br />
gathered representing the<br />
and support for our charity. We<br />
emergency services and voluntary were able to show them our<br />
support organisations, together outstanding new facilities for our<br />
with the members of the armed team and to discuss our exciting<br />
forces and many EHAAT charity plans for the further development<br />
staff and volunteers. The Earl and of our emergency medical<br />
Countess took the opportunity to services across Essex and<br />
stop and speak to individuals and Hertfordshire.”<br />
Photo courtesy of Doug Blanks<br />
58<br />
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IN PERSON<br />
News<br />
Appointment of Bob Forsyth<br />
as the new Chair of London’s<br />
Air <strong>Ambulance</strong> Charity<br />
The Board of London’s Air <strong>Ambulance</strong><br />
Charity has announced the appointment of<br />
Bob Forsyth as the new Chair of its Board<br />
of Trustees. The appointment comes after<br />
a far reaching and competitive process,<br />
involving external and internal candidates<br />
facilitated and guided by Inclusive Boards.<br />
Bob has been a trustee of the Charity<br />
since 2017, leading the establishment of<br />
the Board’s Audit and Risk Committee and<br />
chairing it for over four years.<br />
As the Charity continues its implementation of<br />
an ambitious programme of transformational<br />
change, including the replacement of its two<br />
helicopters, the replacement and expansion<br />
of its rapid response car fleet, supporting<br />
the service’s frontline medical teams and<br />
enhancing the Charity’s culture, diversity<br />
and inclusion outreach, Bob will bring strong<br />
leadership, experience and organisational<br />
empathy to these fundamental priorities.<br />
Bob’s appointment will take effect when Mark<br />
Vickers, the current Chair of Trustees, retire by<br />
rotation on31 March, after seven years in the<br />
role. Outgoing Chair of Trustees, Mark Vickers<br />
said:<br />
“It has been a huge honour and privilege to be<br />
Chair of the Board, and in handing over these<br />
responsibilities to Bob I am inspired by the<br />
ambitious plans the Charity has for serving the<br />
people of London under his leadership.”<br />
KSS News<br />
Air <strong>Ambulance</strong> Charity Kent<br />
Surrey Sussex appoints four<br />
new trustees<br />
Air <strong>Ambulance</strong> Charity Kent Surrey Sussex<br />
(KSS) has strengthened its Board with the<br />
appointment of four new Trustees, with<br />
appointments taking effect from 8th March<br />
<strong>2022</strong>.<br />
The new Trustees are:<br />
Nick Hall - Nick’s interest in Air <strong>Ambulance</strong><br />
services began with the Royal Flying Doctor<br />
Service - providing medical support in remote<br />
communities in Australia. He became more<br />
passionate about what happens in the front<br />
of the aircraft than the back and so studied<br />
a B.Sc (Aviation) before joining the Australian<br />
Army to fly Black Hawk helicopters in<br />
operational roles.<br />
He left the military to study an MBA and<br />
worked as a corporate consultant in<br />
Australasia for several years before returning to<br />
the aviation industry.<br />
Nick now has over 30 years in the<br />
helicopter industry in strategic, operational,<br />
transformational and entrepreneurial roles as<br />
an executive, management consultant or line<br />
manager, providing services for end users,<br />
operators, maintenance, repair and operations<br />
(MROs) and innovators in some of the world’s<br />
largest and smallest helicopter organisations.<br />
Richard Lee - As Chief Operating Officer/<br />
Deputy Chief Executive for St John <strong>Ambulance</strong><br />
and former Director of Operations for Welsh<br />
<strong>Ambulance</strong> Services NHS Trust, registered<br />
Paramedic Richard has a strong track record<br />
in leadership, delivering improved patient and<br />
staff outcomes, operational performance,<br />
quality and cost efficiency. He also has<br />
experience of leading national policy.<br />
David Morgan – David is an aviation executive<br />
with substantial experience in flight operations,<br />
training and safety management. He is also<br />
an industry leading expert on addressing the<br />
climate impact of aviation. David is currently<br />
Group Director of Flight Operations at easyJet,<br />
with seven years’ experience at the airline<br />
including twelve months as interim Chief<br />
Operating Officer.<br />
During this time – the busiest and most<br />
successful year in easyJet’s history – David<br />
was responsible for all operations and<br />
customer service, leading a team of over<br />
15,000 staff. David has also been Flight<br />
Operations lead for the creation of easyJet<br />
Europe and had responsibility for the safe<br />
introduction of new aircraft types into the airline<br />
fleet.<br />
Jane Redman – Jane is a Fundraising<br />
Consultant who helps fundraising teams and<br />
leadership work effectively together to achieve<br />
income growth, improve relationships with<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
Top left: Nick Hall, Top right: Richard Lee, Bottom left: David Morgan, Bottom right: Jane Redman<br />
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59
IN PERSON<br />
donors and colleagues and create change<br />
for the people they support. Over the last 25<br />
years, Jane has developed income generation<br />
strategies and campaigns for a wide range of<br />
charities including Mencap, Children’s Hospice<br />
South West and Kent MS Therapy Centre.<br />
Barney Burgess, Chair of KSS’s Board of<br />
Trustees said: “Our new trustees all stood<br />
out for their tremendous expertise, the<br />
positive impact they have demonstrated,<br />
their commitment to the highest quality<br />
governance and their belief in KSS’s vision - an<br />
end to preventable loss of life from medical<br />
emergency. I look forward to working with<br />
Nick, Richard, David and Jane as we continue<br />
to work with David Welch and his team in<br />
delivering excellence whilst also evolving and<br />
continuing to push boundaries.”<br />
David Welch, CEO of KSS, said: “On behalf<br />
of Team KSS, I would like to welcome Nick,<br />
Richard, David and Jane to our Board of<br />
Trustees. I am incredibly excited about the<br />
breadth and depth of experience which our<br />
new Trustees bring to the charity, and I am<br />
confident they will all add significant value to<br />
our Board.”<br />
Nick Hall, KSS Trustee, said: “I am excited to<br />
have the opportunity to help shape the future<br />
of KSS. Air <strong>Ambulance</strong>s and helicopter aviation<br />
have played a significant part in my career, so<br />
I am looking forward to sharing my experience<br />
to support the Board. I’m delighted to be part<br />
of a world-leading provider of pre-hospital<br />
emergency care which puts the patient at the<br />
heart of everything it does.”<br />
Richard Lee, KSS Trustee, said: “Being able<br />
to play a small part in this mighty team is a<br />
fantastic opportunity. I’m looking forward<br />
to meeting KSS’s people, patients and the<br />
communities we serve.”<br />
David Morgan, KSS Trustee, said: “I’m thrilled<br />
to be joining the KSS board, an organisation<br />
that has the united purpose of saving lives.<br />
As a former helicopter and Air <strong>Ambulance</strong><br />
Pilot myself, I know how much it means for<br />
a community to have the support of rapid<br />
response critical care, by day and by night.<br />
With over 35 years of aviation experience, I<br />
hope to be able to support KSS as they further<br />
develop this capability, as one of the world’s<br />
leading Air <strong>Ambulance</strong> organisations.”<br />
Jane Redman, KSS Trustee, said: “I am so<br />
happy to be joining KSS as a Trustee. I’m<br />
blown away by the amazing work the charity<br />
does and the difference the team make to so<br />
many lives. I’ve worked in the charity sector as<br />
a fundraiser for many years. My hope is that<br />
I can bring that knowledge and experience to<br />
support the Board and Team KSS as we grow<br />
the charity’s income and build ever stronger<br />
relationships with our dedicated supporters<br />
and funders.”<br />
KSS provides world-leading pre-hospital<br />
emergency care whenever and wherever<br />
required to save lives and ensure the best<br />
possible patient outcomes. It is a multi-award<br />
winning charity that must raise £15.2M to<br />
operate its life-saving service. 86% of its total<br />
income is raised through the generosity of<br />
KSS’s supporters. For further information:<br />
www.aakss.org.uk<br />
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60<br />
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COMPANY NEWS<br />
RETTmobil<br />
International <strong>2022</strong>:<br />
Eberspaecher<br />
presents solutions<br />
for greater climate<br />
comfort and digital<br />
connectivity<br />
• Comfortable temperatures<br />
for paramedics and<br />
patients<br />
• e-connected: cloud-based<br />
use and connectivity of<br />
digital services<br />
• Customized airconditioning<br />
systems for<br />
the patient compartment<br />
In an emergency vehicle, optimal<br />
temperatures are important. Not<br />
just for the patients with special<br />
medical needs in the patient<br />
compartment, but also for the<br />
concentration of the driver and<br />
the paramedics. At RETTmobil<br />
International <strong>2022</strong> in Fulda<br />
(Germany) from May 11 to 13,<br />
<strong>2022</strong> (Stand 710), Eberspaecher<br />
will be presenting its new<br />
e-connected product family that<br />
enables the smart use of digital<br />
services and the connectivity of<br />
components for fleet operators,<br />
among others.<br />
With the cloud-based<br />
e-connected platform,<br />
Eberspaecher will enable<br />
intelligent application and<br />
connectivity of digital components<br />
and services for fleet owners in<br />
the future. The services of the new<br />
product family can be developed<br />
and used according to customer<br />
requirements. Eberspaecher<br />
e-connected consists of three<br />
components: Via a gateway (1)<br />
installed in the vehicle, information<br />
like temperature, site, and<br />
vibrations is collected. The cloudbased<br />
e-connected platform (2)<br />
centrally evaluates the data. It also<br />
forms the technical infrastructure<br />
and ensures the availability of<br />
the digital services (3), which<br />
individually display the collected<br />
data.<br />
Electrical air-conditioning<br />
solutions for ambulances<br />
In addition to efficient heating<br />
solutions, Eberspaecher offers<br />
suitable products for when<br />
it’s warm outside to offer<br />
comfortable climate in the patient<br />
compartment. The broad portfolio<br />
of air-conditioning solutions<br />
includes products especially<br />
developed for vehicles with<br />
electric drives. This includes<br />
Kool, one of Eberspaecher’s<br />
standard evaporator units with<br />
the big advantage of its compact<br />
design and easy installation. In<br />
e-vehicles, it can be connected<br />
to the external condensing unit<br />
Power K, including an electrical<br />
compressor, a condenser and a<br />
The Kool EHAVC evaporator unit provides customized air conditioning<br />
for ambulance driver’s cabs and patient compartments<br />
drier filter. Kool is also available as<br />
an EHVAC version – heat is then<br />
provided by intrinsically safe PTC<br />
elements. The external unit Power<br />
K Reverse is ideal for installing an<br />
air-conditioning system regardless<br />
of the drive type and is mounted<br />
under the vehicle chassis to save<br />
space.<br />
Fast, constant heat thanks to<br />
fuel operated heating solutions<br />
Fuel operated air heaters such as<br />
the Airtronic from Eberspaecher<br />
provide ideal and individually<br />
adjustable heat in the patient<br />
compartment. This is especially<br />
advantageous when transporting<br />
patients with special medical<br />
requirements. The heaters from<br />
Eberspaecher can be controlled<br />
using the EasyStart Web<br />
operating element, for example<br />
– no matter the range. Up to five<br />
pre-heaters can be controlled per<br />
user account, meaning several<br />
vehicles can be warmed up in<br />
the morning before the workday<br />
begins. Another plus: The remote<br />
maintenance function allows<br />
workshops to effortlessly perform<br />
remote diagnosis via the app once<br />
the vehicle owner has approved.<br />
Alternatively, the pre-heaters can<br />
also be operated together with<br />
Eberspaecher air conditioning<br />
solutions using the permanently<br />
installed PCK3 FOH operating<br />
element.<br />
CLICK AND CONNECT:<br />
Rhino Products<br />
launch Connect+ for<br />
new vehicles!<br />
Rhino Products, Europe’s<br />
leading manufacturers<br />
of commercial vehicle<br />
accessories, have launched<br />
their extremely popular<br />
rear step parking sensor<br />
integration product,<br />
Connect+, for a range of new<br />
vehicle platforms.<br />
Rear steps are an important<br />
accessory for many emergencies<br />
service vehicles, providing a<br />
safe and secure platform to<br />
enter the vehicle, as well as<br />
access the roof. Reversing<br />
sensors have long been an<br />
expectation for many years now,<br />
however making alterations to<br />
introduce an external step with<br />
parking detection technology<br />
has previously been a timeconsuming<br />
process, often<br />
requiring specialist knowledge,<br />
complicated rewiring and of<br />
course, added expenditure.<br />
Connect+ neatly solves this<br />
problem by integrating each OEM<br />
sensor into the step via a simple<br />
‘plug and play’ cable.<br />
The process could not be simpler,<br />
the existing (OEM) sensors are<br />
removed from the vehicle, before<br />
reconnecting these sensors<br />
directly into the Rhino Products<br />
step. The wiring loom is then<br />
reconnected into the vehicle,<br />
and blanking plugs are provided<br />
to fill the space where the OEM<br />
sensors were previously located.<br />
The sensors then work as normal,<br />
with the added reassurance that<br />
the step at the rear of the vehicle<br />
is also protected when reversing.<br />
Having already proven to be<br />
a hugely popular solution for<br />
emergency service vehicles,<br />
Connect+ has also now been<br />
released for a range of additional<br />
vehicles, including the Renault<br />
Master, alongside Fiat Ducato,<br />
Ford Transit, Mercedes Sprinter<br />
and many more.<br />
Rhino Products continue to be<br />
at the forefront of design and<br />
innovation, providing products of<br />
unrivalled quality and aesthetics<br />
to customers throughout Europe<br />
and beyond. Rhino will be<br />
releasing exciting new products<br />
and upgrading existing customer<br />
product favorites throughout<br />
<strong>2022</strong> – to view the current up<br />
to date product ranges and find<br />
out where to buy, visit www.<br />
rhinoproducts.co.uk.<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />
61
COMPANY NEWS<br />
AMBULANCE <strong>UK</strong> - APRIL<br />
How Radio Over<br />
IP is becoming<br />
the most trusted<br />
method for critical<br />
communications,<br />
with BroadNet<br />
leading the <strong>UK</strong><br />
market<br />
From the title, you may gauge<br />
how technical radio systems<br />
are in terms of their operating<br />
systems. It is complicated,<br />
but the technology to transmit<br />
across the country or even<br />
the globe, without installing<br />
dedicated mast infrastructure<br />
exists now, and all we have left<br />
to do is to attempt to understand<br />
it. So, let’s try to unfold how the<br />
technology works.<br />
First, you may ask yourself what<br />
a radio over IP is; it is a radio that<br />
can both transmit and receive<br />
data packets using the existing<br />
mobile phone network. Your<br />
typical radio at home would most<br />
likely be a broadcast receiver,<br />
where you can only receive<br />
content. In short, a Radio over<br />
IP can be a walkie talkie style<br />
handheld or a mobile radio in a<br />
vehicle or even a stationary radio.<br />
What’s the difference between<br />
traditional two-way radio systems<br />
and Radio over IP?<br />
Two-way radio systems are<br />
becoming less essential for<br />
everyday life when it comes<br />
to emergency services, taxis,<br />
security companies or air traffic<br />
controllers. Each channel would<br />
operate for one service in which<br />
all parties using the channel would<br />
be in half-duplex, meaning they<br />
share the channel and therefore<br />
can only use it one at a time.<br />
Radio over IP allows all users to use<br />
all channels all the time, along with<br />
voice, data, even video, you could<br />
have thousands of users all talking at<br />
the same time on the same network.<br />
Traditional two-way radio devices<br />
were developed in the early 20 th<br />
Century, and the first hand-held<br />
radio was created in Australia<br />
and first used by the Victorian<br />
Police since then nothing has<br />
really evolved in the underlying<br />
technology. It is still transmitted<br />
from one radio to another, talkwait-receive<br />
over a very limited<br />
range even using the most up to<br />
date digital devices you could fast<br />
find yourself without reception,<br />
this becomes a greater challenge<br />
if your radios are constantly<br />
moving around into a wider area<br />
that may or may not be covered<br />
by your repeater network.<br />
Radio over IP is different and the<br />
leading <strong>UK</strong> company is BroadNet<br />
Communication Systems. The<br />
company is preferred by many<br />
services for the quality of its<br />
voice playback, security, and<br />
functionality. BroadNet uses Radio<br />
over IP with its own encryption<br />
algorithms. From the moment you<br />
press your PTT button the journey<br />
starts, the radio will transmit an<br />
authentication handshake with the<br />
closest mobile phone mast (if using<br />
Broadnet’s CSN SIM cards it will<br />
pick any of the 4 strongest network<br />
providers) and use the internet or<br />
wireless mobile telecommunication<br />
(commonly known as 3G, 4G or<br />
even 5G). BroadNet operates with<br />
3G and 4G and will soon operate<br />
with 5G networks using its own<br />
private network.<br />
It uses the two-way radio user<br />
principles but its transmitting and<br />
receiving at the same time and<br />
furthermore its combined with<br />
BroadNet’s Computer Aided<br />
Dispatch system, making BroadNet<br />
a gamechanger for any services<br />
requiring communications outside<br />
of a very small geographical area.<br />
Clients include private ambulance<br />
services, councils, first responder<br />
groups, train and bus companies,<br />
logistic companies and many more.<br />
BroadNet equipment is seamlessly<br />
integrated into the network, and<br />
organizations can grant access<br />
to other users onto their channels<br />
at a click of a couple of buttons<br />
on the CAD. Gone are the days<br />
of having to manually reprogram<br />
radios whenever two organizations<br />
want to work together. Radio<br />
over IP allows a huge increase in<br />
functionality, from integrating other<br />
apps such as mapping, through<br />
to the transmission and receipt<br />
of images all from one device.<br />
No radio system is perfect which<br />
is why, even though the <strong>UK</strong> now<br />
has 99% population coverage for<br />
cellular devices, BroadNet radios<br />
can also be tethered to any wifi<br />
network, or satellite phone to<br />
alleviate blackspots, something that<br />
traditional radios can never do.<br />
VCS gears up for<br />
growth with several<br />
strategic hires<br />
• Key appointments made<br />
across VCS’s ambulance and<br />
police divisions to facilitate<br />
business growth<br />
• New hires allow VCS to<br />
further develop its operating<br />
efficiency and significantly<br />
increase production output in<br />
coming years<br />
• Recruitment drive follows<br />
major commercial<br />
developments, such as placing<br />
first on the new NHS national<br />
procurement framework<br />
VCS, the <strong>UK</strong>’s leading emergency<br />
service vehicle conversion<br />
specialist, has welcomed several<br />
key strategic hires across its<br />
ambulance and police divisions.<br />
Its recent recruitment drive is<br />
part of an ongoing business<br />
growth strategy that will see VCS<br />
significantly increase production<br />
output and boost operating<br />
efficiency in the coming years.<br />
New personnel within VCS’s<br />
ambulance division have been<br />
brought on board to facilitate a<br />
structure focused on strengthening<br />
product development, supply chain<br />
management and manufacturing<br />
efficiency. This coincides with VCS<br />
recently placing first on the new<br />
NHS Collaborative Procurement<br />
Hub Framework Agreement for<br />
<strong>Ambulance</strong> and Specialist Vehicle<br />
Conversions.<br />
Alastair Munro will bring his 40<br />
years’ expertise in the automotive<br />
and transport sectors as VCS’s<br />
Principal Engineering and Product<br />
Development Adviser. In this role he<br />
will advise and support the in-house<br />
engineering team in refining VCS’s<br />
product development strategy and<br />
provide a vital interface between the<br />
company’s technical, manufacturing<br />
and sales divisions.<br />
Chris Watts will become Head<br />
of Procurement and Aftersales,<br />
bringing considerable procurement<br />
experience to the role. Chris’s<br />
previous role of General Manager<br />
will be filled by new recruit, Kevin<br />
Stevens, who boasts 30 years’<br />
experience of manufacturing<br />
excellence across multiple sectors.<br />
Kevin will add huge depth in terms<br />
of operational execution and<br />
pedigree to drive growth.<br />
Simon Ward joins as Process<br />
Engineering Manager, while Simon<br />
Sanderson has been recruited as<br />
Planning Manager. As Process<br />
Engineering Manager, Simon<br />
Ward will leverage his 20 years of<br />
experience to improve production<br />
efficiency and reliability while<br />
retaining VCS’s current highquality<br />
standards. Meanwhile<br />
Simon Sanderson will work across<br />
VCS’s supply chain, engineering,<br />
and internal manufacturing team<br />
to ensure production schedules<br />
consistently run smoothly.<br />
Following on from a successful<br />
2021, VCS’s Police division has also<br />
brought on board Kerry Bick as<br />
Special Projects Manager, who will<br />
help further broaden the scope of<br />
products on offer to police forces.<br />
Meanwhile, sales and procurement<br />
teams will both be bolstered by new<br />
recruits, Jordan Croom and Claire<br />
Fanning, respectively.<br />
Mark Kerrigan, Managing Director<br />
of VCS, said: “This promises to<br />
be a transformative year for VCS<br />
as we continue with plans to<br />
considerably increase production,<br />
while bringing our ambulance<br />
and police divisions closer than<br />
ever before. The key hires we’ve<br />
made in recent months help us to<br />
put the building blocks in place<br />
to facilitate growth throughout<br />
the business while achieving<br />
even greater levels of customer<br />
satisfaction, innovation and<br />
product quality and for us to cope<br />
with current demands and growth<br />
levers in the pipeline we must add<br />
talented people to the VCS team.”<br />
62<br />
For more news visit: www.ambulanceukonline.com
COMPANY NEWS<br />
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AMBULANCE <strong>UK</strong> - APRIL<br />
For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />
63
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© 2020 ZOLL Medical Corporation. All rights reserved. Smart Help, Ventilation Simplified, Z Vent, and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the<br />
United States and/or other countries.<br />
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