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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 />

Greenoaks, Lockhill<br />

Upper Sapey, Worcester, WR6 6XR<br />

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The programme meets in full the specification of the current NHSEI Framework for<br />

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lighting and technology business. The team in Leeds provide accessible technical<br />

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emergency sector.<br />

COPYRIGHT:<br />

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PUBLISHERS STATEMENT:<br />

The views and opinions expressed in<br />

this issue are not necessarily those of<br />

the Publisher, the Editors or Media<br />

Publishing Company.<br />

Next Issue June <strong>2022</strong><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 />

For more news visit: www.ambulanceukonline.com


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38<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 />

For more news visit: www.ambulanceukonline.com


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 />

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

Do you have anything you would like to add or include in Features? Please contact us and let us know.<br />

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 />

References<br />

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from: https://apps.who.int/iris/handle/10665/189242<br />

2. Siegel JH, Mason-Gonzalez S, Dischinger PC, Read KM, Cushing<br />

BM, Badellino MC, et al. Causes and costs of injuries in multiple<br />

trauma patients requiring extrication from motor vehicle crashes. J<br />

Trauma. 1993;35:920–31.<br />

3. Palanca S, Taylor DM, Bailey M, Cameron PA. Mechanisms of<br />

motor vehicle accidents that predict major injury. Emergen Med.<br />

2003;15:423–8.<br />

4. Conroy C, Tominaga GT, Erwin S, Pacyna S, Velky T, Kennedy F, et<br />

al. The influence of vehicle damage on injury severity of drivers in<br />

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5. Lerner EB, Shah MN, Cushman JT, Swor RA, Guse CE, Brasel K, et<br />

al. Does mechanism of injury predict trauma center need? Prehosp<br />

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prehospital care in the city of São Paulo, Brazil. Clinics. 2011;66:21–5.<br />

7. Weninger P, Hertz H. Factors influencing the injury pattern and injury<br />

severity after high speed motor vehicle accident—A retrospective<br />

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8. Nutbeam T, Fenwick R, Smith J, Bouamra O, Wallis L, Stassen W.<br />

A comparison of the demographics, injury patterns and outcome<br />

data for patients injured in motor vehicle collisions who are trapped<br />

compared to those patients who are not trapped. Scand J Trauma<br />

Resusc Emerg Medicine. 2021;29:17.<br />

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9. Fenwick R, Nutbeam T. Medical vs. true physical traffic collision<br />

entrapment. J Paramedic Pract. 2018;10:158–62.<br />

10. Dunbar I. Vehicle Extrication – The Next Generation. L<strong>UK</strong>AS; 2021.<br />

11. NDFFAEM. Road Traffic Accident Handbook. 2009.<br />

12. Dixon M, O’Halloran J, Hannigan A, Keenan S, Cummins NM.<br />

Confirmation of suboptimal protocols in spinal immobilisation?<br />

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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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 />

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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 />

For more news visit: www.ambulanceukonline.com


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 />

WHY NOT WRITE FOR US?<br />

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clinical papers and case reports or news that<br />

you feel will be of interest to your colleagues.<br />

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

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

AMBULANCE <strong>UK</strong> - APRIL<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 />

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enables the smart use of digital<br />

services and the connectivity of<br />

components for fleet operators,<br />

among others.<br />

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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 />

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installed in the vehicle, information<br />

like temperature, site, and<br />

vibrations is collected. The cloudbased<br />

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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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