Ambulance UK April 2022

Ambulance UK April 2022

Ambulance UK April 2022


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Volume 37 No. 2

April 2022




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Ambulance UK



Assessing spinal movement during four extrication methods:

a biomechanical study using healthy volunteers




This issue edited by:

Dr Matt House

c/o Media Publishing Company

Greenoaks, Lockhill

Upper Sapey, Worcester, WR6 6XR


Terry Gardner, Samantha Marsh


Media Publishing Company

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February, April, June, August,

October, December


Ring Carnation, established in 1995, are experts in electrical power

switching and control systems for the specialist vehicle conversion

market. A large proportion of their business is providing solutions for

emergency and rescue vehicles, and as such they are a key component

to the ambulance converter industry using genisys - the premier

switching and power management system for specialist vehicles.

The programme meets in full the specification of the current NHSEI Framework for

double crewed ambulances and is being utilised by UK ambulance builders to fulfil the

future needs of the English Ambulance Trusts, much as it has for all UK and Ireland

Ambulance Trusts over an extended period.

By using these technologically advanced ECUs, Ambulance Trusts are ensuring they

future-proof their fleet – these proven power and task management systems are the

modular ‘building blocks’ which give flexible expandable solutions. As well as providing

a standardised solution right across the fleet, genisys can also be re-programmed or

upgraded as operational and legislative needs change across the life of the vehicle.

The programme is designed, manufactured and supported at the Leeds headquarters

of Ring Carnation, now a wholly owned subsidiary of the ams OSRAM group, the global

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support before, during and after system specification and are proud to support the UK

emergency sector.


Media Publishing Company



Upper Sapey, Worcester, WR6 6XR


The views and opinions expressed in

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the Publisher, the Editors or Media

Publishing Company.

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Hello All. It’s been a while since I sat down to write this editorial, as I’ve been out

of the Country for a while, and only just returned to work. I was lucky enough to

be deployed as a Reservist on a three-month tour of operations with the military.

This wasn’t my first tour, but I must say, as someone who is not the spring chicken

I used to be, I was surprised and pleased to get the opportunity again.


“With all the




in the world

now, it’s good

to be part of

a team you

can trust. We

will make


as everyone

does, but we

know that we

will look after

each other.”

I always enjoy working with the military, and particularly on operations. I’m not entirely sure why, but I saw

something when I was heading down a YouTube rabbit hole the other day that might go some way to

explain it. Simon Sinek gave a presentation where he said if you mapped performance against trust, it is

preferrable to have someone you trust highly, and who may only be an average performer, against someone

who was a high performer but who was not as trustworthy. Now, I have paraphrased the talk a lot here, and

I would highly recommend watching the presentation (Performance vs Trust). I think Sinek has put his finger

on it there. In a military environment there are good, bad and indifferent, like anywhere. What there is in

bucketloads though, is trust. Trust goes a long way to making sure the team works well together.

Back at work today and I was talking to one of my colleagues, Gill, and we were discussing the current

pressures in the NHS and talked about the team we work with. Again, not all of us are top performers, by

any stretch, but that word came up again: trust. We have a team who are there for each other professionally

and personally. A lot of us have had wobbles of one sort or another over the years, but those people are

given help, or time-out, if required, and then continue where they left off.

With all the uncertainty and negativity in the world now, it’s good to be part of a team you can trust. We will

make mistakes, as everyone does, but we know that we will look after each other.

Dr Matt House, Co-Editor Ambulance UK


For more news visit: www.ambulanceukonline.com


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Tim Nutbeam 1,2,3* , Rob Fenwick 4 , Barbara May 5 , Willem Stassen 3 , Jason E. Smith 1,6 , Jono Bowdler 7 ,

Lee Wallis 3 and James Shippen 5

Scand J Trauma Resusc Emerg Med (2022) 30:7 https://doi.org/10.1186/s13049-022-00996-5 © The Author(s) 2022.


Background: Motor vehicle collisions are a common cause of death

and serious injury. Many casualties will remain in their vehicle following

a collision. Trapped patients have more injuries and are more likely to

die than their untrapped counterparts. Current extrication methods

are time consuming and have a focus on movement minimisation and

mitigation. The optimal extrication strategy and the effect this extrication

method has on spinal movement is unknown. The aim of this study

was to evaluate the movement at the cervical and lumbar spine for four

commonly utilised extrication techniques.

Methods: Biomechanical data was collected using inertial Measurement

Units on 6 healthy volunteers. The extrication types examined

were: roof removal, b-post rip, rapid removal and self-extrication.

Measurements were recorded at the cervical and lumbar spine, and in

the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel),

maximal movement, mean, standard deviation and confidence intervals

are reported for each extrication type.

Results: Data from a total of 230 extrications were collected for

analysis. The smallest maximal and total movement (travel) were seen

when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm).

The largest maximal movement and travel were seen in rapid extrication

extricated (AP max = 6.21 mm, travel 20.51 mm).

The differences between self-extrication and all other methods were

significant (p < 0.001), small non-significant differences existed between

roof removal, b-post rip and rapid removal.

Self-extrication was significantly quicker than the other extrication

methods (mean 6.4 s).

Conclusions: In healthy volunteers, self-extrication is associated

with the smallest spinal movement and the fastest time to complete

extrication. Rapid, B-post rip and roof off extrication types are all

associated with similar movements and time to extrication in prepared




Motor vehicle collisions (MVC’s) are a common cause of serious injury

and death—accounting for 1.3 million deaths and 50 million serious

injuries per annum worldwide [1]. Up to 40% of casualties injured

following an MVC will remain trapped—these casualties are more likely

to die than their un-trapped counterparts [2-8].

Casualties who remain in their vehicle following an MVC will belong in

one of four groups: (i) The casualty can self-extricate or extricate with

minimal assistance (self-extrication), (ii) the casualty is unable to selfextricate

due to pain, their psychological response to the incident or

their injuries but can be assisted from the vehicle (assisted extrication)

(iii) the casualty is either advised or chooses not to self-extricate due to

concern of exacerbating injury (particularly spinal injury) by movement

(medically trapped), (iv) the casualty is physically trapped in the vehicle

(e.g. due to displaced road furniture) or requires disentanglement from

the vehicle wreckage by rescue services (disentanglement and rescue)

[9]. These groups are not mutually exclusive and a patient may belong in

more than one group across their extrication experience.

The role of the rescue services will be different for each casualty group.

For example, casualties who can self-extricate will require minimal or no

intervention from rescue services but those needing disentanglement and

rescue will require the use of cutting and spreading tools [10]. Casualties

in the assisted extrication (assisted) and medically trapped (medical)

groups can be encouraged to self-extricate, have a rapid extrication

(without the use of tools, sometimes referred to as a B plan) or can

alternatively have a more traditional extrication, where the vehicle is cut

away from around the casualty to improve access and offer an alternative

route of egress (sometimes referred to as an A plan extrication) [10].

The approach of the rescue service is based on movement minimisation

and mitigation, primarily to avoid exacerbating a primary spinal injury

[11].The role of small movements in this is unknown and a challenge to

accurately quantify. Large or forceful movements are considered higher

risk than smaller movements 1 . Rescue service teaching recommends

that casualties in the assisted or medical groups receive a traditional

extrication method, as it is understood that these result in less spinal

movement than other techniques [11]. Recently these principles

have been challenged; with a number of small biomechanical studies

demonstrating that self-extrication may cause less movement than more

traditional extrication techniques [12-14].

Self-extrication or rapid techniques may be superior to traditional A

plan techniques in relation to casualty and operational factors. Firstly


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the use of extrication tools is not a benign intervention and may cause

considerable and costly vehicular damage, will have significant resource

implications (both human and equipment), is physically demanding and

may also subject casualties and rescuers to a real risk of harm [15].

Secondly, traditional extrication techniques can take a significant amount

of time, with a median time of 30 min across traditional extrication

types [16]. Whilst a patient remains entrapped the ability of clinicians to

provide meaningful patient assessment and intervention is limited [17].

The extended time frame associated with traditional extrication and the

delays this causes in accessing care may be factors that contribute to

the excess mortality and morbidity seen in trapped patients [8]

We have previously demonstrated that spinal cord injuries occur in

0.7% of patients trapped following an MVC [8]. However, before any

change in practice can be recommended, a detailed understanding

of the movement of the spine associated with each of the commonly

used extrication techniques to support a rigorous comparison of such

techniques is important. This study will assess the three most commonly

performed extrication techniques along with self-extrication and the

resulting spinal movement (Box 1) [18].

to a participant information sheet in advance and completed written

informed consent prior to participation.

Data collection

Each participant’s height and weight were recorded prior to being

fitted with the Inertial Measurement Unit (IMU) (Xsens Awinda; Xsens

Technologies B.V., Enschede, Netherlands). The characteristics of IMU’s

and their suitability to extrication research are described in our previous

work [19]. The IMU sensor was attached to the head using a headband.

The thorax was assumed to be rigid and sensors were positioned over

the clavicular notch on the sternum, and over each scapula using a

tight-fitting elastic vest. A sensor was positioned on the sacrum by

attaching the sensor to shorts using hook-and-loop fastening, to prevent

upward travel, and securing the sensor against the body with an elastic

belt. Orientation data were collected from each sensor via a wi-fi link and

sampled at a rate of 40 Hz. Collars were used throughout this study as

we have previously demonstrated that they reduce movement during

extrication [19]. The Laerdal (Laerdal Medical Corp., Stavanger, Norway)

Stifneck collars were fitted by a member of the study team trained in

their use in accordance with manufacturer guidance.


This is an experimental crossover biomechanical study which builds

on previous exploratory work and compares spinal movement at both

the cervical spine and lumbar spine across each of four extrication

techniques: (i) Roof removal extrication, (ii) B-post rip extrication, (iii)

Rapid side door extrication, (iv) Self-extrication without instructions.

The vehicle type was pre-specified as a 5-door hatchback as this

represents the commonest vehicle type on UK roads [20]. Three similar

vehicles were used (Box 1). The same intact vehicle was used for the

self-extrication and rapid side door extrication arms of the study, with

separate pre-prepared vehicles being used for the side-rip and roofremoval

arms of the study. Each of these vehicles were prepared with

all extrication stages involving cutting equipment and removal of vehicle

structure being completed before the study began (Box 1 and Fig. 1).


Six healthy volunteers were recruited to participate in this study. The

volunteers had no previous knowledge of extrication, had no back or

neck conditions that may be exacerbated by extrication and had a mass

of less than 100 kg. Participants were briefed on the study, had access

Sample size

Previous work has identified self-extrication with collar and no

instructions to be associated with the least spinal movement during selfextrication;

we used the means and standard deviations to power this

study [19].

BOX 1 Extrication procedures assessed and method of assessment

Roof removal: The A, B and C posts and the roof removed facilitating a vertical extrication technique (Fig. 1)

Study car preparation: the vehicle was stabilised, all posts were cut, the roof was removed and sharp edges were made safe

Study vehicle: Peugeot 307 5 door, 2004

Technique: The participant was provided with Manual In-Line Neck Stabilisation (MILNS) throughout, the back support of the driver’s seat was

reclined mechanically and the Long Spinal Board (LSB) inserted to the seat base. The participant was then slid up the board until they were

horizontally situated (securely) on the LSB

B-post rip: The B-post, drivers and drivers side rear door are removed to facilitate patient access and horizontal extrication (Fig. 1)

Study car preparation: The vehicle was stabilised, B-post was removed completely using two cuts and all sharps were made safe

Study vehicle: Peugeot 307 5 door, 2006

Technique: The participant was provided with MILNS throughout. The back support of the driver’s seat was reclined mechanically. The LSB was

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

on the board at which point the LSB is rotated 45 degrees and placed horizontally onto the floor, next to the vehicle

Rapid: The driver’s door is opened and the casualty assisted with a lateral extrication technique

Study car preparation: The driver’s door was opened and the maximal opening angle enhanced using firefighter body weight only

Study vehicle: Seat Ibiza 5 door, 1999

Technique: The drivers door is opened. The participant was provided with MILNS throughout. The LSB was inserted under the right thigh and hip,

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

under the steering column, allowing rotation onto back and then finally, slid into position further up the LSB (Fig. 1)

Self-extrication: The casualty leaves the vehicle without assistance

Study car preparation: The drivers door was opened

Study vehicle: Seat Ibiza 5 door, 1999

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

should exit the vehicle


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Acknowledging its limitations, we used a minimally clinically important

difference (MCID) derived from cadaveric work (2.7 mm) [21]. The power

calculation was based on finding an anterior–posterior translational

movement of 2.7 mm with a significance level of 1% and a power

of 80%, giving a sample size per group of 57. At each stage, each

extrication type was repeated a maximum of ten times with each of the

6 volunteers.


The IMU directly measures the segmental orientations from which

relative motions can be calculated and reported, by assuming

the relative rotations of adjacent vertebrae across the lumbar and

cervical region are constant. Maximum excursions (movement from a

hypothetical midline) were calculated for anterior/posterior (AP) and

lateral (Lat) movement of the cervical and lumbar spine, respectively.

In addition to reporting maximum excursions (the single largest

movement) we report “travel”—the cumulative total of all movements

throughout the extrication.

The time taken for extrication is also considered as a patientorientated

metric. Time for completion of each experiment was

therefore also recorded, with the timer starting when the crew

declared ready to begin and finishing when the patient was fully

extricated and stationary.

Data were captured and analysed using the Biomechanics of Bodies

(BoB Biomechanics Ltd,, Bromsgrove, UK) software interface before

being exported to Excel (Microsoft v. 16.9) and SPSS (IBM v. 25,

Armonk NY) for further analysis and reporting. Total excursions,

standard deviation and confidence intervals are reported for each

extrication type. P values were calculated using a two tailed t-test

comparing each extrication method with the current standard (roof

removal) extrication type.

The study protocol was reviewed and approved by the University of

Coventry Research Ethics Committee (reference number P88416)

and the University of Cape Town, Human Research Ethics Committee

(reference number 530/2021).

The largest overall mean movements were seen in the cervical spine

AP with the rapid side door extrication (6.2 mm). For cervical spine

lateral movements, the side-rip resulted in the greatest movement

(6.9 mm). For the lumbar spine, the greatest movement was

recorded with the rapid side door extrication (12.5 mm AP and

11.6 mm LAT).

Self-extrication was significantly quicker than the other extrication

methods (mean 6.4 s, Fig. 6). B-post rip extrication (66.9 s) was

slower than roof-off (53.8 s) and self-extrication.


This is the first study to define spinal movements associated with

each of the commonly used extrication techniques and to perform

a powered comparative analysis. This study demonstrates that

in healthy volunteers self-extrication results in significantly less

movement at the cervical and lumbar spine than other extrication


Results in relation to other studies: Biomechanical studies of

extrication are widely heterogenous in design. Similar to the studies

of Gabrieli and Dixon we find that self-extrication results in the

smallest range of motion at the cervical spine – we offer additional

data across a range of volunteers and movements [12, 13]. Dixon’s

team also considered rapid extrication through the driver’s door

and found as we did that this was associated with the largest

movements of the techniques that they considered [12]. Ours is

the first study to report movements with the ‘roof off’ technique

or the B post rip which are commonly performed in the UK and in

international practice [18].

Clinical and operational interpretation: Rescue service personnel

are taught that unstable spinal injury should be assumed following

an MVC and that traditional extrication techniques deliver minimal

spinal movement, which are preferentially utilised because of this

assumed benefit. As a result of this teaching, formal extrications are

commonly performed for patients who could self-extricate [9].



Data from a total of 230 extrications were successfully collected for

analysis (95.8% data capture success rate). Three of the six participants

were female, with a mean age across all of the participants of 52 years

(range 28–68) and BMI of 27.7 (range 21.5–34.6).

The results are summarised in Tables 1, 2 and Figs. 2, 3, 4, 5, 6. The

mean movements across the four extrication types were 4.4 mm

(Cervical AP), 4.2 mm (Cervical Lat), 7.9 mm (Lumbar AP) and 7.8 mm

(Lumbar Lat). Mean cervical roll was 16.6°, cervical pitch 12.4° and

cervical yaw 17.1°. Mean lumbar roll was 16.6°, lumbar pitch 16.0° and

lumbar yaw 25.4°.

For the cervical spine, the smallest overall movements were recorded

during self-extrication (2.6 mm AP and 2.4 mm LAT). These were also

the conditions producing the smallest movements at the lumbar spine

(4.5 mm AP and 5.7 mm LAT).

This study demonstrates that self-extrication is associated with

least spinal movement and the quickest time to extrication. Rapid,

B-post rip and roof off extrication types are all associated with

similar movements and time to extrication in preprepared vehicles.

Trapped patients are more likely to die than patients who are not

trapped [8]. Trapped patients may have serious and time dependent

injuries and therefore will benefit from an extrication technique

which results in the minimum time spent in the vehicle [8]. Current

operational practice favours techniques that are time consuming

and do not result in the smallest possible patient movement—they

do not achieve their intended objectives and as a result their use

should be urgently reconsidered. In patients who can self-extricate,

this should be the preferred method of extrication as it is associated

with the smallest amount (maximal and total) of movement and least

time. Self-extrication has many other secondary benefits including

potential risk to patient and rescuer, human and equipment

resource utilisation and minimises additional damage to the vehicles


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Fig. Vehicle preparation and data collection

Fig. 1 Vehicle preparation and data collection

Table Participant demographics, extrications and mean AP movement

Table 1 Participant demographics, extrications and mean AP movement

Participant Sex Age (years) Weight (kg) Height (cm) BMI (kg/m 2 Extrications Mean AP cervical movement (mm)

Participant Sex Age (years) Weight (kg) Height (cm) BMI (kg/m 2 ) suitable Extrications for Mean AP cervical movement (mm)

analysis suitable for Roof off post rip Rapid Self


Roof off B post rip Rapid Self

40 89 167 31.9 39 4.2 7.0 11.0 2.2

1 F 40 89 167 31.9 39 4.2 7.0 11.0 2.2

52 100 170 34.6 38 7.6 7.8 6.5 6.9

2 F 52 100 170 34.6 38 7.6 7.8 6.5 6.9

57 89 168 31.5 39 6.6 4.8 7.8 3.0

3 M 57 89 168 31.5 39 6.6 4.8 7.8 3.0

28 62 167 22.2 36 7.4 3.9 6.7 0.9

4 F 28 62 167 22.2 36 7.4 3.9 6.7 0.9

68 80 181 24.4 38 2.5 5.1 2.3 1.2

5 M 68 80 181 24.4 38 2.5 5.1 2.3 1.2

57 69 179 21.5 40 3.0 6.4 3.1 1.6

6 M 57 69 179 21.5 40 3.0 6.4 3.1 1.6

50.3 81.5 172.0 27.7 230 5.2 5.8 6.2 2.6

50.3 81.5 172.0 27.7 230 5.2 5.8 6.2 2.6

involved. An alternative extrication approach will be required

for the very small minority of patients who are entangled in the

vehicle or cannot self-extricate [8, 9]. Such patients are likely to be

significantly injured and have time critical needs: for these patients,

following disentanglement, the quickest deliverable extrication

method should be chosen; the correct choice of technique in this

context will depend on the actions required to disentangle the


Strengths and weaknesses: Strengths of this study include efforts to

maximise internal and external validity by recruiting male and female

volunteers inexperienced in extrication with a range of weights,

heights and ages. The study methods supported data collection from

real vehicles, prepared as they would be for a ‘real life’ extrication,

using active-duty rescue personnel. We successfully collected data

from a large number of extrications to meet the pre-specified power

calculation, supporting confidence in the reported results.


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Table 2 Maximal movement and travel

Table Table Maximal 2 Maximal movement and and travel travel

Table 2 Maximal movement Maximal movement and travelduring extrication

Travel (total movement) during extrication

Table 2 Maximal Maximal


Maximal movement off B


post and p travel during


during Rapid


Maximal movement during extricationp value Self p value



Travel (total



B post


p value

during during

Rapid extrication

Travel (total movement) during extrication p valve Self p value

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

Lumbar A/P[mm] Roof 9.65


off B post 10.73


p 0.45 value


Rapid 12.47


p value 0.09 Self 4.47 p value < 0.001 Roof 26.56


off B


post 30.25


p value 0.28 Rapid




p valve 0.02 Self 8.49 p value < 0.001

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

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

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

Lumbar Lumbar Lat A/P[mm] 8.639.65 10.79 10.730.270.45 11.62 12.47 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

Roof off

Roof off Roof off

Roof off

B post

Roof off

B post B post

B post

Rapid ex

B post

Rapid Rapid ex ex

Rapid ex

Self ex

Rapid ex

Self ex Self ex

Self ex 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0

Self Mean excursion (mm) and 95% confidence intervals


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

Fig. 20.0Mean 1.0

excursion Mean Mean excursion 2.0 excursion and (mm) 3.0

confidence (mm) and 4.0 95% and 95% confidence intervals

5.0 confidence for intervals 6.0anterior–

intervals 7.0 8.0

Mean excursion (mm) and 95% confidence intervals

posterior Fig. 2 Mean movement 0.0


1.0 at the 2.0

and cervical confidence

3.0 spine 4.0






7.0 8.0

Mean excursion (mm) and 95% confidence intervals

Fig. Mean excursion and confidence intervals for anterior–


posterior posterior

2 Mean excursion

movement at


the at the cervical


cervical spine spine

intervals for anterior–

posterior Fig. 2 movement Mean excursion at the and cervical confidence spine intervals for anterior–

posterior movement at the cervical spine

Roof off

Roof off Roof off

Roof off

B post

Roof off

B post B post

B post

Rapid ex

B post

Rapid Rapid ex ex

Rapid ex

Self ex

Rapid ex

Self ex Self ex

Self ex 0 2 4 6 8 10 12 14 16

Self 0ex

0 2


2 4


4 6






8 10


10 12


12 14 14 16 16

0 2 4 6 8 10 12 14 16

Fig. 4 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals anterior– intervals

Fig. posterior Mean movement 0




Fig. 4 Mean excursion excursion at and the 4


and lumbar 6

and 95%

confidence spine8 confidence



12 14 16

intervals intervals for anterior– for anterior–




4 Mean excursion Mean

movement at

and excursion

the at the lumbar

confidence (mm) and

lumbar spine spine

intervals 95% confidence for anterior– intervals

posterior Fig. 4 movement Mean excursion at the and lumbar confidence spine intervals for anterior–

posterior movement at the lumbar spine

Roof off


Roof off

Roof off Roof off

Roof off

B post

Roof off

B post B post

B post

Rapid ex

B post

Rapid Rapid ex ex

Rapid ex

Self ex

Rapid ex

Self ex Self ex

Self ex 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0

Self 0.0ex

0.01.0 1.0




2.03.0 3.0




4.05.0 95%



6.0 6.07.0 intervals

7.0 8.0 8.09.0


0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0

Fig. 3 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals lateral intervals movement

Fig. at Fig. the Mean cervical 0.0


3 Mean excursion spine 1.0







95% confidence

5.0 6.0


7.0 8.0 9.0

excursion and and confidence intervals intervals for lateral for lateral movement


at the at


the cervical



excursion Mean

spine spine

and excursion confidence (mm) and intervals 95% confidence for lateral intervals movement

at the Fig. cervical 3 Mean spine excursion and confidence intervals for lateral movement

at the cervical spine

Our volunteers were uninjured, fully conscious and had not recently

experienced a motor vehicle collision and did not have ‘true’

entrapment requiring disentanglement, as such the applicability of

these results to the injured post collision population needs careful

consideration. The volunteers were subjected to multiple extrications

across a short time; we could find no evidence of ‘learning’ in the

movements recorded but this could have influenced our results

unknowingly. The rescue personnel also performed multiple

Roof off Roof off

Roof off

B post

Roof off

B post B post

B post

Rapid ex

B post

Rapid Rapid ex ex

Rapid ex

Self ex

Rapid ex

Self ex Self ex

Self ex 0 2 4 6 8 10 12 14 16

Self 0ex

0 2


2 4


4 6






8 10


10 12


12 14 14 16 16

0 2 4 6 8 10 12 14 16

Fig. 5 Mean excursion Mean Mean excursion and excursion confidence (mm) (mm) and 95% and intervals confidence 95% confidence for intervals lateral intervals movement

Fig. at the Mean lumbar 0


Fig. 5 Mean excursion spine 2





and 95%





12 14 16

excursion and and confidence intervals intervals for lateral for lateral movement



the at


the lumbar



excursion Mean

spine spine

and excursion confidence (mm) and intervals 95% confidence for lateral intervals movement

at the Fig. lumbar 5 Mean spine excursion and confidence intervals for lateral movement

at the lumbar spine

extrications over the day—a far greater exposure than in operational

practice. We did see faster extrications as the teams became

increasingly familiar both with the techniques and working together

as a team. Fatigue of the extrication team may also have influenced

our results.

Further work: Additional biomechanical work could evaluate

alternative extrication techniques (such as Scandinavian chain


For more news visit: www.ambulanceukonline.com



Roof off

B post

Rapid ex

Self ex

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

Time to extricate (seconds)

Fig. 6 Time taken and confidence intervals (s)

Ethics approval and consent to participate

This analysis was approved by the Coventry University Research Ethics

Committee, reference P88416 and the University of Cape Town, Human

Research Ethics Committee (reference number 530/2021).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author details


Correspondence: timnutbeam@nhs.net 1 Emergency Department,

cabling [22]. Biomechanical models using healthy volunteers

are unlikely to offer definitive answers; evolving technology has

supported the collection of data in ‘near operational’ scenarios but is

unlikely to be successful in collecting data on actual injured patients.

As the paradigms of spinal immobilisation are challenged and

additional data is made available as to the rarity of isolated unstable

spinal injury in the context of other time critical injuries [8], those with

responsibility for guidance and expertise in the area of extrication,

trauma care and spinal injuries must work with patients and their

representatives to evolve new approaches to extrication which

improve the care of and outcome for our patients.


In healthy volunteers, self-extrication is associated with the smallest

patient spinal movement and the fastest time to complete extrication.

Rapid, B-post rip and roof off extrication types are all associated with

similar movements and time to extrication in preprepared vehicles.

In patients who can self-extricate, this should be the preferred

extrication method. In patients who can’t self-extricate, following

disentanglement the most rapid method of extrication should be



This work is kindly supported by the National Fire Chiefs Council,

Avon Fire and Rescue Service and Severn Park Fire and Rescue


Authors’ contributions

All authors contributed to the conception and study design. Logistics,

data collection and reporting by JS, BM, JB, RF and TN. Initial

analysis by TN with clinical interpretation by TN, RF, JES, LW and WS.

All authors have contributed to and approved the manuscript.


Research funded by a charitable grant from the Road Safety Trust.

The Road Safety Trust had no role in the design, data collection,

analysis or writing of this manuscript.

Availability of data and materials

The datasets used and/or analysed during the current study are

available from the corresponding author on reasonable request.

University Hospitals Plymouth NHS Trust, Plymouth, UK. 2 Devon

Air Ambulance Trust, Exeter, UK. 3 Division of Emergency Medicine,

University of Cape Town, Cape Town, South Africa. 4 University Hospitals

Birmingham, Birmingham, UK. 5 Institute for Future Transport and Cities,

University of Coventry, Coventry, UK. 6 Academic Department of Military

Emergency Medicine, Royal Centre for Defence Medicine, Birmingham,

UK. 7 Fire and Rescue Service Trainer, Severn Park Fire and Rescue

Centre, Bristol, UK.


1. WHO. Global status report on road safety 2015. 2015; Available

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

2. Siegel JH, Mason-Gonzalez S, Dischinger PC, Read KM, Cushing

BM, Badellino MC, et al. Causes and costs of injuries in multiple

trauma patients requiring extrication from motor vehicle crashes. J

Trauma. 1993;35:920–31.

3. Palanca S, Taylor DM, Bailey M, Cameron PA. Mechanisms of

motor vehicle accidents that predict major injury. Emergen Med.


4. Conroy C, Tominaga GT, Erwin S, Pacyna S, Velky T, Kennedy F, et

al. The influence of vehicle damage on injury severity of drivers in

head-on motor vehicle crashes. Accid Anal Prev. 2008;40:1589–94.

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

al. Does mechanism of injury predict trauma center need? Prehosp

Emerg Care. 2011;15:518–25.

6. Dias ARN, Abib S de CV, Poli‐de‐Figueiredo LF, Perfeito JAJ.

Entrapped victims in motor vehicle collisions: characteristics and

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

7. Weninger P, Hertz H. Factors influencing the injury pattern and injury

severity after high speed motor vehicle accident—A retrospective

study. Resuscitation. 2007;75:35–41.

8. Nutbeam T, Fenwick R, Smith J, Bouamra O, Wallis L, Stassen W.

A comparison of the demographics, injury patterns and outcome

data for patients injured in motor vehicle collisions who are trapped

compared to those patients who are not trapped. Scand J Trauma

Resusc Emerg Medicine. 2021;29:17.


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



9. Fenwick R, Nutbeam T. Medical vs. true physical traffic collision

entrapment. J Paramedic Pract. 2018;10:158–62.

10. Dunbar I. Vehicle Extrication – The Next Generation. LUKAS; 2021.

11. NDFFAEM. Road Traffic Accident Handbook. 2009.

12. Dixon M, O’Halloran J, Hannigan A, Keenan S, Cummins NM.

Confirmation of suboptimal protocols in spinal immobilisation?

Emerg Med J Emj. 2015;32:939–45.

13. Gabrieli A, Nardello F, Geronazzo M, Marchetti P, Liberto A, Arcozzi

D, et al. Cervical spine motion during vehicle extrication of healthy

volunteers. Prehosp Emerg Care. 2019;24:1–14.

14. Häske D, Schier L, Weerts JON, Groß B, Rittmann A, Grützner PA,

et al. An explorative, biomechanical analysis of spine motion during

out-of-hospital extrication procedures. Inj. 2020;51:185–92.

15. NFCC. National Operational Guidance [Internet]. National

Operational Guidance. 2021 [cited 2021 Oct 21]. Available from:


16. Nutbeam T, Fenwick R, Hobson C, Holland V, Palmer M. The stages

of extrication: a prospective study. Emerg Med J. 2013;31:1006–8.

18. R F, T N, M D. A 10-year time series analysis of roof removal

extrications by Fire and Rescue Services in England. Faculty of

Prehospital Care Scientific Conference. 2020;

19. Nutbeam T, Fenwick R, May B, Stassen W, Smith JE, Wallis L, et

al. The role of cervical collars and verbal instructions in minimising

spinal movement during self-extrication following a motor vehicle

collision - a biomechanical study using healthy volunteers. Scand J

Trauma Resusc Emerg Med. 2021;29:108.

20. Transport D of. Vehicle licensing statistics 2019. 2019; Available from:


21. Aebli N, Rüegg TB, Wicki AG, Petrou N, Krebs J. Predicting the risk

and severity of acute spinal cord injury after a minor trauma to the

cervical spine. Spine J. 2013;13:597–604.

22. Fattah S, Johnsen AS, Andersen JE, Vigerust T, Olsen T, Rehn M.

Rapid extrication of entrapped victims in motor vehicle wreckage

using a Norwegian chain method – cross-sectional and feasibility

study. BMC Emerg Med. 2014;14:14–14.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in

published maps and institutional affiliations.

17. Wilmink AB, Samra GS, Watson LM, Wilson AW. Vehicle entrapment

rescue and pre-hospital trauma care. Injury. 1996;27:21–5.

Received: 15 November 2021 Accepted: 7 January 2022

Published online: 15 January 2022


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Seriously injured

trauma patients have

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of survival thanks to

Wales Air Ambulance

On the day that the Wales Air

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its 21st birthday, a report

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revealed that seriously injured

trauma patients attended by

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increased chance of survival.

Wales Air Ambulance, which

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patients who have suffered a

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to the body.

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reduction in deaths within 30 days

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The service has also seen a 41%

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transfer is when an emergency

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incident, who then requires a

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able to diagnose the specific needs

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This further reduces the time it

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specialist care that they need while

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avoiding a secondary transfer.

The introduction of an advanced

service has also attracted

more medics to work in Wales.

In the last five years, twelve

consultants have taken up roles

in Welsh hospitals because of

the opportunity to work with the

Wales Air Ambulance.

The evaluation has been

independently scrutinised by

Swansea University, with support

from Health Data Research

UK and Monash University in

Australia. It included the use of

Swansea University’s world-class

anonymised databank called

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operational and patient recovery

figures with data from 9 billion

patient records worldwide.

The report, which examined the

9,952 missions attended by the

service between 2015 and 2020,

also reveals that 63% (6,018)

of patients received advanced

lifesaving treatments. This

included 313 people who required

a blood transfusion and 790

people who received anaesthesia.

The evaluation covers a five-year

period starting in 2015, the year

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partnership between the Wales

Air Ambulance Charity and

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(EMRTS Cymru). As a result, the

service became consultant-led

and transformed into a ‘flying

emergency department’, taking

hospital-standard treatments to

the patient at the scene of an


The service’s consultants and

critical care practitioners are able

to deliver innovative emergency

treatment across Wales,

including minor operations, blood

transfusions and anaesthesia.

These were previously not available

outside of a hospital environment.

However, the service is not just

provided by air. The medics

can also deliver their lifesaving

treatments by road in the Charity’s

fleet of rapid response vehicles.

While NHS Wales supplies the

medics, the Wales Air Ambulance

Charity needs to raise £8 million

a year to fund the helicopters and

rapid response vehicles.

Wales Air Ambulance now operates

24/7, with the introduction of an

overnight service in 2020.

Dr Sue Barnes, Wales Air

Ambulance Charity Chief

Executive, said: “In the two

decades since the launch of the

Wales Air Ambulance Charity

on this day in 2001, we have

evolved into a vital critical care

operation. Our mission and

vision are focused on delivering

our lifesaving medical service

whenever and wherever it is

needed, alongside improving the

lives of those we serve by being a

world leader in what we do. This

report offers tangible evidence of

how we are achieving our aims.



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“Our ability to do this is thanks to

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generosity that we have one of

the most advanced air ambulance

operations in the world and there

are no words to convey our


“The key for us now is to ensure

that as many people as possible

in Wales can benefit from our

lifesaving care. With our medical

partners, we continually monitor

and evaluate our mission data and

areas of unmet need to identify


any service improvements that

can be made.”

Professor David Lockey, EMRTS

Cymru National Director, said

“This evaluation is one of

the most extensive done by

any air ambulance operation

anywhere in the world. It clearly

demonstrates that the advanced

medical provision we offer is

delivering benefits for the people

of Wales, as well as the NHS.

We must pay tribute to those

in the Charity, NHS Wales and

Welsh Government who set up

and supported the introduction

of our consultant-led service. We

also recognise the passion and

commitment of all those, past and

present, who have worked hard

to deliver this service, as well as

the Charity’s supporters, without

whom our service would not exist.

“We are also incredibly proud

and grateful to work alongside

our colleagues in the Welsh

Ambulance Service and in health

boards across Wales. Together,

we are able to offer the best

possible care for people across

the country.”


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to decarbonise the NHS fleet

while im-proving patient care.

Instructors from the Trust’s driver

training team have already put

the Skoda Enyaq iV 80x all-wheel

vehicle to the test and found that

it compares favourably with diesel

equivalents being currently used.

One of the Skodas will be used

asa ‘standard’ Rapid Response

Vehicle (RRV), used to get a

paramedic response to patients

quickly. The sec-ond will be used

in a similar role in conjunction

with our other blue-light partners

(RAF, Fire and Police), initially

in Bedfordshire, but later in

Cambridgeshire, Norfolk and

Essex, as different programmes

and infrastructure configurations

are tested.

The Vauxhall Vicaro-E van, built in

the UK at Ellesmere Port, will be

trialled in various roles, including

a falls response vehicle and a

mental health response vehicle.

Tom Abell, Chief Executive of

EEAST, said: “The NHS has

committed to being net-zero of

car-bon emissions by 2045–five

years ahead of the UK’s nationally

set target. It is vital that we

understand how this modern

technology can help to improve

our response times to patients

and deliver cost savings over the

longer term.”

James Cook, Director for

Community Care, Mental Health

and Ambulance Improvement

Support, NHS England and

NHS Improvement said: “Air

pollution alone contributes to

1 in 20 deaths in the UK and

reducing emissions will support

the reduction of cases of asthma,

cancer and heart disease.

“Cleaner transport means cleaner

air for our patients, and we’re very

proud to be work-ing with East of

England Ambulance Service and

others across the country to begin

the introduction of these new

electric vehicles.”



No reusable components

Fully disposable

No reprocessing

Minimises the risk

of cross contamination


video laryngoscopy

wherever and whenever you intubate


Quality, innovation and choice

lnteract with us







London Ambulance

staff make

plea clear: We

should be able to


London Ambulance Service

is playing a vital part in a new

national campaign to highlight

the profound impact of physical

and verbal abuse on ambulance

staff and volunteers, as figures

show that cases of violence

against staff and volunteers

reached a record high last year.

As part of the national

#WorkWithoutFear campaign,

London Ambulance staff and

volunteers were invited to meet

with Chief Executive Daniel Elkeles

to share their personal experiences

of abuse while on duty and their

suggestions for what could be

done differently, helping to create

and shape a brand new action

plan to bring down the number of

incidents and secure the toughest

possible convictions for those who

commit them.

In a roundtable conversation

held recently, just days

before the official launch of

#WorkWithoutFear, staff gathered

with Daniel to explain the impact

that abusive patients and their

families can have. Speaking

bravely and openly, these staff

members (who are all being

offered support and are still

serving with the Service) detailed

instances of being physically

attacked, verbally abused,

threatened with weapons, and

sexually assaulted. During the

meeting, a 999 call handler shared

the homophobic and threatening

verbal abuse he had recently

received, while one paramedic

told the group about the time

she was held at knifepoint for 25

minutes and feared for her life

while performing cardiopulmonary

resuscitation (also known as CPR,

this is the life-saving medical

procedure of chest compressions

and rescue breaths performed

when someone’s heart has

stopped pumping blood around

the body). Daniel also heard from

a paramedic who was attacked by

a drunk patient and was left with a

broken bone in his neck and, as a

result, needed to take two months

off work.

Chief Executive Daniel Elkeles

said: “Our staff and volunteers

come to work to help Londoners

in their time of need. They work

to save lives, help the injured and

make sure people get the medical

care they need quickly. They

should not, in any circumstance,

experience physical or verbal

abuse. But sadly, that is not the

reality our teams face. There are a

minority of patients (and members

of the public) who behave hatefully

or violently towards our staff and

volunteers, and that situation has

to change.

“We‘ve already put extra

measures in place – such as

rolling out body worn cameras to

our ambulance crews so they can

record abusive incidents and use

footage as evidence in court, and

working with the police to increase

convictions for hate crimes

(such as people using racist or

homophobic language when

speaking to our call handlers). We

have also created two new roles,

Violence Reduction Officers, who

provide dedicated support for staff

and volunteers to take their case

to court, providing a link between

the victim and the Metropolitan

Police Service, and making sure

they are supported through the

process, every step of the way.

“But, we recognise that we have

to do more – the roundtable

conversation I had with staff has

given us a really strong foundation

to build on, and I – along with the

Board of the London Ambulance

Service – am committed to

making real change.”

Sadly, latest figures show that

cases of physical assaults against

London Ambulance Staff have

risen by almost 40% since the

pandemic began. During 2018-19

staff and volunteers experienced

468 physical assaults, rising

to 650 in 2020-21 – that’s an

increase of 38%. Over the same

period, verbal assaults almost

doubled, rising from 695 in 2018-

19 to 1,025 in 2020-21.

Director of Quality Jaqui Lindridge

(who joined the Service in 2000

and has 19 years of experience as

a paramedic) said: “Our medics

and call handlers face stressful

and challenging situations every

single day, and yet, they remain

calm and steadfastly professional.

But that doesn’t mean the threats

and insults that they hear, or the

physical intimidation or harm

they experience, does not have

a deep and lasting impact. It’s

heart breaking, and we will do

everything in our power to stop


“Our staff and volunteers have

the right to #WorkWithoutFear,

and so as we work hard to build

a new action plan, I would like to

take this opportunity to publicly

thank our staff and volunteers,

and ambulance service colleagues

across the country for all that they

do. We remain incredibly grateful

for their hard work in challenging

circumstances, and in awe of their

bravery and resilience.”


Local air ambulance

is called to more

children and

teenagers in 2021

than ever before

Great Western Air Ambulance

Charity (GWAAC) has

announced that 2021 was

its second busiest year on

record. The Critical Care Team

received a total of 1,964 callouts

to incidents across the

region which includes Bath

and North East Somerset,

Bristol, South Gloucestershire,

Gloucestershire, North

Somerset, and parts of


The most significant increase in

tasked incidents was to children

and teenagers in urgent need.

In 2021, 14% of GWAAC’s total

call-outs were to children and

teenagers. That’s almost two in

every ten of GWAAC’s callouts

to South Gloucestershire

and B&NES, and more than

one in ten call-outs to Bristol,

Gloucestershire, and North

Somerset. Dispatches to children

and teenagers doubled from 7%

in the preceding years.

Alfie needed GWAAC when he

was three years old. His Mum,

Becky, said: “If it wasn’t for this

fabulous team, Alfie would not be

with us today.”

The air ambulance and critical

care service, which is charity

funded, provides emergency

medical care to the most seriously

ill or injured in the region.

GWAAC’s crew of Critical Care

Doctors, Advanced Practitioners

and Specialist Paramedics

bring the expertise of a hospital

emergency department to the

scene of an incident. These

skills can make the difference

between life and death. From

roadside blood transfusions to

performing emergency surgery to

anaesthesia, the crew is specially

trained to deliver pre-hospital

emergency care to both children

and adults.

The increasing demand for

GWAAC’s service means the

charity needs to raise over

£4 million a year to remain

operational, yet it receives no

day-to-day funding from the

Government or National Lottery,

relying on the generosity and


For more news visit: www.ambulanceukonline.com


support from local communities.

“Having experienced our second

busiest year on record and with

higher than average call-outs

to children, I feel very proud of

the crew. They have once again

shown resilience and courage,

and continue to put themselves

on the frontline whilst making

patients the heart of everything

they do.”

Anna Perry, CEO, Great Western

Air Ambulance Charity.

To find out more about Great

Western Air Ambulance Charity’s

work, its mission numbers in 2021,

and how you can support the

charity, visit www.gwaac.com.

Primarily established to work in

the world of international

medical repatriation, the

business has evolved to provide

expert clinical solutions across

a variety of specialist sectors

and services.

IPRS Aeromed are now recruiting Paramedics & Nurses

What sets us apart is the

experience and skills of our

valued clinicians who are

well-versed in managing

repatriations to and from

some of the most interesting

countries around the world.

Join a team that's really going places!

https://iprsaeromed.com/jobs/ or email IPRS Aeromed

Recruitment aeromed.recruitment@iprsgroup.com


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



Peterborough City

Hospital helipad

lighting provides

24 hour service for

emergency response

Seriously ill or injured patients

from across the region will

benefit from extended air

ambulance flying hours thanks

to a generous donation of

nearly £47,000 to Peterborough

City Hospital from the HELP

Appeal, the only charity in the

country dedicated to funding

hospital helipads.

State-of-the-art helipad lighting

will enable air ambulances to

land throughout the night and

support immediate access to the

Emergency Department during

darkness hours.

The lighting installation is solar

Aerial shot of the helipad lit up, photo by the EAAA

powered therefore reducing the Emergency Department can now

hospital’s carbon footprint. All air deliver high quality emergency

ambulance pilots can activate the care across the full 24-hour

lighting system via a VHF radio period. Their generosity will have

transponder miles away from the a very positive impact for our

helipad. Alternatively, staff on-site patients.”

can operate the system from the

ground control panel.

Robert Bertram, Chief Executive

of the HELP Appeal commented:

Stuart Toulson, Matron for

“People can become seriously ill

Urgent & Emergency Care at or injured anytime of the day or

Peterborough City Hospital, said: night. This new, state-of-the-art

“’We are extremely grateful to our lighting system on Peterborough

friends at the HELP Appeal for City Hospital’s helipad, allows air

ensuring that our team within the ambulances to land, even when

it’s dark, so patients can get the

urgent treatment they need 24 /

7 – which will save many more


Paul Ferguson, Peterborough

City Hospital’s Heli-Ops Manager

added: “We are eternally thankful

to the HELP Appeal and support

agencies for the installation of

the night lighting system. This

enhances our ability to accept

aircraft at night. We average

5-10 day time movements per

month which will increase with the

lighting in place.”

The helipad, which was built in

September 2011, now offers a

24-hour service meaning that

MAGPAS, the East Anglian Air

Ambulance, the Coastguard

Service, and other specialist units

can access the hospital at any

time of the day and night.

For more information please visit




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Just breathe


trauma pain

from severe

to moderate


2x faster


IV morphine 1


1. Data on file MAPIT study. 2.Penthrox UK Summary of Product Characteristics. March 2021.

It’s About Time

Penthrox is indicated for the emergency relief of moderate to severe pain in conscious adult

patients with trauma and associated pain. 2

PENTHROX 99.9%, 3 ml inhalation vapour,

liquid: Please refer to the Summary of Product

Characteristics (SmPC) before prescribing.

Abbreviated Prescribing Information.

Presentation: Each bottle of PENTHROX contains 3 ml

of methoxyflurane 99.9%, a clear, almost colourless,

volatile liquid, with a characteristic fruity odour. Each

PENTHROX combination pack consists of one bottle of

3 ml PENTHROX, one PENTHROX Inhaler and one

Activated Carbon (AC) chamber. Indications: Emergency

relief of moderate to severe pain in conscious adult

patients with trauma and associated pain. Dosage and

administration: PENTHROX should be self-administered

under supervision of a person trained in its

administration, using the hand held PENTHROX Inhaler.

It is inhaled through the custom-built PENTHROX

inhaler. Adults: One bottle of 3 ml PENTHROX as a

single dose, administered using the device provided. A

second bottle should only be used where needed. The

frequency at which PENTHROX can be safely used is

not established. The following administration schedule

is recommended: no more than 6 ml in a single day,

administration on consecutive days is not recommended

and the total dose to a patient in a week should not

exceed 15 ml. Onset of pain relief is rapid and occurs

after 6-10 inhalations. Patients are able to titrate the

amount of PENTHROX inhaled and should be instructed

to inhale intermittently to achieve adequate analgesia.

Continuous inhalation of a bottle containing 3 ml

provides analgesic relief for up to 25-30 minutes;

intermittent inhalation may provide longer analgesic

relief. Patients should be advised to use the lowest

possible dose to achieve pain relief. Renal impairment:

Methoxyflurane may cause renal failure if the

recommended dose is exceeded. Caution should be

exercised for patients diagnosed with clinical conditions

that would pre-dispose to renal injury. Hepatic

impairment: Cautious clinical judgement should be

exercised when PENTHROX is to be used more

frequently than on one occasion every 3 months.

Paediatric population: PENTHROX should not be used

in children and adolescents under 18 years. For detailed

information on the method of administration refer to

the SmPC. Contraindications: Use as an anaesthetic

agent. Hypersensitivity to methoxyflurane, any

fluorinated anaesthetic or to any of the excipients.

Patients who are known to be or genetically susceptible

to malignant hyperthermia. Patients or patients with a

known family history of severe adverse reactions after

being administered with inhaled anaesthetics. Patients

who have a history of showing signs of liver damage

after previous methoxyflurane use or halogenated

hydrocarbon anaesthesia. Clinically significant renal

impairment. Altered level of consciousness due to any

cause including head injury, drugs or alcohol. Clinically

evident cardiovascular instability. Clinically evident

respiratory depression.Warnings and Precautions: To

ensure the safe use of PENTHROX as an analgesic the

lowest effective dose to control pain should be used

and it should be used with caution in the elderly or other

patients with known risk factors for renal disease, and

in patients diagnosed with clinical conditions which may

pre-dispose to renal injury. Methoxyflurane causes

significant nephrotoxicity at high doses. Nephrotoxicity

is thought to be associated with inorganic fluoride ions,

a metabolic breakdown product. When administered

as instructed for the analgesic indication, a single dose

of 3 ml methoxyflurane produces serum levels of

inorganic fluoride ions below 10 micromol/l. In the past

when used as an anaesthetic agent, methoxyflurane at

high doses caused significant nephrotoxicity, which was

determined to occur at serum levels of inorganic fluoride

ions greater than 40 micromol/l. Nephrotoxicity is also

related to the rate of metabolism. Factors that increase

the rate of metabolism such as drugs that induce hepatic

enzymes can increase the risk of toxicity with

methoxyflurane as well as sub-groups of people with

genetic variations that may result in fast metaboliser

status. Methoxyflurane is metabolised in the liver,

therefore increased exposures in patients with hepatic

impairment can cause toxicity. PENTHROX should be

used with care in patients with underlying hepatic

conditions or with risks for hepatic dysfunction. Previous

exposure to halogenated hydrocarbon anaesthetics

(including methoxyflurane when used as an anaesthetic

agent), especially if the interval is less than 3 months,

may increase the potential for hepatic injury. Potential

effects on blood pressure and heart rate are known

class-effects of high-dose methoxyflurane used in

anaesthesia and other anaesthetics. Caution is required

with use in the elderly due to possible reduction in blood

pressure. Potential CNS effects such as sedation,

euphoria, amnesia, ability to concentrate, altered

sensorimotor co-ordination and change in mood are

known class-effects. The possibility of CNS effects may

be seen as a risk factor for potential abuse, however

reports are very rare in post-marketing use. PENTHROX

is not appropriate for providing relief of break-through

pain/exacerbations in chronic pain conditions or for the

relief of trauma related pain in closely repeated episodes

for the same patient. PENTHROX contains the excipient,

butylated hydroxytoluene (E321) which may cause local

skin reactions (e.g. contact dermatitis), or irritation to

the eyes and mucous membranes. To reduce

occupational exposure to methoxyflurane, the

PENTHROX Inhaler should always be used with the AC

Chamber which adsorbs exhaled methoxyflurane.

Multiple use of PENTHROX Inhaler without the AC

Chamber creates additional risk. Elevation of liver

enzymes, blood urea nitrogen and serum uric acid have

been reported in exposed maternity ward staff when

methoxyflurane was used in the past at the time of

labour and delivery. Interactions: There are no reported

drug interactions when used at the analgesic dosage (3

– 6 ml). Methoxyflurane is metabolised by the CYP 450

enzymes, particularly CYP 2E1, CYP 2B6 and to some

extent CYP 2A6. It is possible that enzyme inducers

(such as alcohol or isoniazid for CYP 2E1 and

phenobarbital or rifampicin for CYP 2A6 and

carbamazepine, efavirenz, rifampicin or nevirapine for

CYP 2B6) which increase the rate of methoxyflurane

metabolism might increase its potential toxicity and they

should be avoided concomitantly with methoxyflurane.

Concomitant use of methoxyflurane with medicines (e.g.

contrast agents and some antibiotics) which are known

to have a nephrotoxic effect should be avoided as there

may be an additive effect on nephrotoxicity; tetracycline,

gentamicin, colistin, polymyxin B and amphotericin B

have known nephrotoxic potential. Sevoflurane

anaesthesia should be avoided following methoxyflurane

analgesia, as sevoflurane increases serum fluoride levels

and methoxyflurane nephrotoxicity is associated with

raised serum fluoride. Concomitant use of PENTHROX

with CNS depressants, such as opioids, sedatives or

hypnotics, general anaesthetics, phenothiazines,

tranquillisers, skeletal muscle relaxants, sedating

antihistamines and alcohol may produce additive

depressant effects. If opioids are given concomitantly

with PENTHROX, the patient should be observed

closely. When methoxyflurane was used for anaesthesia

at the higher doses of 40–60 ml, there were reports of

drug interaction with hepatic enzyme inducers (e.g.

barbiturates) increasing metabolism of methoxyflurane

and resulting in a few reported cases of nephrotoxicity;

reduction of renal blood flow and hence anticipated

enhanced renal effect when used in combination with

drugs (e.g. barbiturates) reducing cardiac output; and

class effect on cardiac depression, which may be

enhanced by other cardiac depressant drugs, e.g.

intravenous practolol during cardiac surgery. Fertility,

pregnancy and lactation: No clinical data on effects of

methoxyflurane on fertility are available. Studies in

animals have shown reproduction toxicity. As with all

medicines care should be exercised when administered

during pregnancy especially the first trimester. There is

insufficient information on the excretion of

methoxyflurane in human milk. Caution should be

exercised when methoxyflurane is administered to a

nursing mother. Effects on ability to drive and use

Before administering PENTHROX, make sure you have read and fully understood the SmPC and educational materials, which provide important information about how to

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-UK-000509 Date of Preparation: March 2022

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

machines: Methoxyflurane may have a minor influence

on the ability to drive and use machines. Patients should

be advised not to drive or operate machinery if they are

feeling drowsy or dizzy.Undesirable effects: The

common non-serious reactions are CNS type reactions

such as dizziness and somnolence and are generally

easily reversible. Serious dose-related nephrotoxicity

has only been associated with methoxyflurane when

used in large doses over prolonged periods during

general anaesthesia. The following adverse drug

reactions have either been observed in PENTHROX

clinical trials in analgesia, with analgesic use of

methoxyflurane following post-marketing experience

or are linked to methoxyflurane use in analgesia found

in post-marketing experience and in scientific literature

(refer to the SmPC for further details): Very common

(≥1/10): dizziness; common (≥1/100 to




East of England

Ambulance Service

signs up to antiracism


The East of England Ambulance

Service (EEAST) has become

the first NHS trust to have

signed up to UNISON’s new

Anti-Racism Charter which

aims to help tackle racism in

the public sector.

The charter commits

organisations and their leaders

to a raft of pledges designed to

prevent all forms of conscious or

unconscious racial bias.

This includes championing

a racially diverse workforce,

recognising the impact of racism

on staff wellbeing and regularly

reviewing its strategies to improve

racial equality, diversity and

inclusion so that the organisation

reflects the communities it serves.

The charter also states that

organisations should have a clear

and visible anti-racism programme

in place, while unconscious bias

training should be provided for all

staff and robust equality training

for managers.

Organisations will also report

on their ethnicity pay gaps and

monitor disciplinary and grievance

processes to ensure outcomes

are fair.

Tom Abell, Chief Executive of

the East of England Ambulance

Service, said: “I am delighted

that EEAST is among the first

NHS trusts to have signed this

important Anti-Racism Charter.

It underlines our commitment to

eliminating discrimination in all

forms at the Trust.

“Signing this charter is an important

part of our inclusion work as we

work to make EEAST a better place

to work and receive care.”

Paramedic and UNISON EEAST

chair Glenn Carrington said:

“Official figures show that Black

and ethnic minority employees

often have a different experience

to their white colleagues, even in

the public sector. By signing this

charter, the ambulance service

is making a real commitment to

tackling the disparities which exist

between different groups.

“A fairer workplace is a better

workplace so by actively

combatting discrimination,

EEAST will be ensuring a better

ambulance service for people

across the east of England.”


Calling Londoners to

Save a Life

London Ambulance Service is

calling on Londoners to join

a life-saving movement that

will create 100,000 every day

heroes, who–with some simple

training–would be able to save

a life. The London Lifesavers

campaign aims to recruit and

train 100,000 lifesavers who

are able to perform chest

compressions and use a


Across the capital last year,

London Ambulance Service

responded to almost 14,000

cardiac arrests, and in the few

minutes it takes for an ambulance

crew to arrive at the scene,

the actions of passers-by can

make the difference between

life and death. Without lifesaving

intervention like CPR (cardiopulmonary

resuscitation) and

defibrillators the chances of

survival decrease by about 10%

with every passing minute.

Dr Fenella Wrigley, Chief Medical

Officer, said: “To save a life is

an incredible thing. I speak

from experience when I say that

knowing you have helped bring an

individual back to life will stay with

you forever. With a bit of training,

performing chest compressions

and using a defibrillator is actually

very straightforward and you will

not harm a patient trying to help


“We want to equip the people of

London with the knowledge and

the confidence to be able to help

when it truly matters–training to

do chest compressions and using

a defibrillator doesn’t take long,

but the impact it can have can last

a lifetime”

Attending a free public pop-up

training session delivered by the

ambulance service. The London

Ambulance Service also offers

support and advice on how to

buy and use defibrillators for

communities and organisations in

London. In the longer term, as the

number of recruits begins to grow,

London Ambulance Service will

consider other ways their London

Lifesavers might help communities

from checking in on the elderly

and vulnerable in periods of

extreme weather to collecting

prescriptions or driving mobile

patients to treatment centres.

Prime Minister

recognises St John

Ambulance student

volunteer with Points

of Light Award

St John Ambulance student

volunteer Amy Hughes, 21, has

been awarded a prestigious

Points of Light award by the

Prime Minister in recognition for

her outstanding contribution to

the health and first aid charity.

Amy, a University of Portsmouth

student, has volunteered tirelessly

throughout St John Ambulance’s

ongoing response to the Covid-19

pandemic. Working on the

frontline, she cared for patients

at the NHS London Nightingale

Hospital for more than a month

before volunteering in Accident

and Emergency Departments

where she regularly did 12-hour

shifts. She also qualified as a

volunteer vaccinator and gave

hundreds of jabs.

In addition to this extraordinary

contribution, Amy, who comes

from Abergavenny, South Wales,

last year led her university student

unit in training 300 members of

the public in life saving CPR skills

as well as qualifying as ambulance

crew. She is now volunteering on

ambulances responding to 999

calls across the south of England

from London to Bristol.

Amy, who has volunteered with St

John Ambulance since she was

18 years old, said: “I am really

honoured that the Prime Minister

has written to me personally

to thank me for my work as a

volunteer. The last two years have

been tough at times, and I have

experienced unforgettable things


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




like holding someone’s hand as

they unexpectedly passed away in

A&E, but it has also been a really

rewarding experience which I have


“I have really grown as a person

volunteering for St John. Each

day I learn something new that I

can use in everyday life, not just

about first aid, but also how to

communicate with people and

deal with pressure. I have also

made some amazing friends

through my volunteering and have

created long-lasting memories

with them.”

Amy has gained so much from her

experiences volunteering through

the pandemic that she is now

pursuing a Master’s degree in

paramedic science, after she has

completed her current studies in


Jon Knight, director of youth &

volunteer development, St John

Ambulance said:

“Huge congratulations to Amy

who truly deserves this award.

Amy is a shining example of

the excellent service St John

student volunteers have given

to communities throughout the

pandemic. As well as supporting

the NHS on an ambulance

and completing over 1,200

volunteering hours in 2020, she

also leads a team of student

volunteers – and all while studying!

I’m so proud of her for all she’s

achieved, and grateful for the

hundreds of student volunteers

like her around the country.”

Amy is the daily Point of Light

award winner for Friday 25

February 2022 – she is the UK’s

1867th Point of Light.

The award is Government crossparty

supported programme

recognising outstanding individual

volunteers and highlighting the

positive change people are

making in their communities and

to inspire others to volunteer.

St John is one of the largest

volunteering organisations in the

country, offering many different

volunteering opportunities from

vaccination support for the

NHS programme to first aiders

and support team members.

Recruitment is open now and full

details can be found at www.sja.



Beloved Berwick


paramedic scheme

made permanent

following its success

The scheme which has serviced

the Berwick area since its

launch in July 2019 has been a

major success and lifeline for

the community.

Following a successful two and

a half years of work, the Berwick

community paramedic scheme

has been granted permanent


The scheme, run by North East

Ambulance Service (NEAS),

entails a small team of paramedics

who respond to calls in and

around the Berwick area, as well

as offering additional support to

the local NHS services.

The scheme initially began as a

three-month pilot in July 2019 and

has continued to be extended

since then as permanent funding

was sought. In that time, the

scheme has led to:

• A reduction in the response

time by the ambulance service

for life-threatening cases;

halving the average Category 1

wait times to 06.02 minutes;

• More than 5,800 patients being

seen and treated at home

by paramedics; freeing up

GP services so that they can

see more people in the local


• Fewer patient transfers from

Berwick to the Northumberland

Specialist Emergency

Care Hospital (NSECH) in

Cramlington and Borders

General Hospital;

• Extra support for care homes

in and around Berwick during

evenings and weekends

Following its success, the

NHS Northumberland Clinical

Commissioning Group (CCG) has

agreed to commission the service


The team of three paramedics

work in and around the Berwick

area from 9am-9pm seven days

a week. The team use a rapid

response vehicle and work with

the primary care teams at Wells

Close Medical Group, and Union

Brae and Norham Practice. They

also work within Berwick Infirmary

Minor Injuries Unit (MIU) out of

hours and at weekends.

As well as responding to

emergencies in the area, the

team of paramedics also support

the local GPs by making urgent

home visits to patients, help with

the care plans for patients with

long-term medical conditions, and

work with other healthcare staff

such as the district nursing team.

In addition to this, the paramedics

have an extended scope of

practice to include the ability to

request X-rays and take swabs

and samples. Following the

successful funding of the scheme,

the team will receive additional

training to further support their

work in the community; allowing

them to respond to more jobs,

and further reduce the number

of unnecessary hospital transfers

and lighten the workload of local

GP practices. By the end of their

training, the team will be fully

qualified first contact practitioners

and will be able to conduct more

work in the area to help provide

the best patient experience and

support the wider NHS system.

Paul Liversidge, Chief Operating

Officer at NEAS, said: “When


For further recruitment vacancies visit: www.ambulanceukonline.com


we began to trial this scheme

as a three-month pilot in 2019,

we couldn’t have foreseen just

how large of an impact it would

have on the Berwick community,

although we obviously hoped it

would be the success it has been.

“Two and a half years and

a pandemic later, and our

community paramedic team have

not only been able to improve the

experience of the patients they

see first-hand, but the knock-on

effect of them being there frees

up both GPs and our ambulance

crews to see more patients in


“It’s fantastic to see how well

thought of the team is within the

community and we’re also now

looking at how we might replicate

the service in other areas of the

region. We’re very proud to be

able to provide this service, and

I look forward to seeing how the

project continues to grow in the

coming years.”

Laurie Robson, NHS

Northumberland CCG’s Senior

Head of Commissioning – Urgent

& Emergency Care, said: “This is a

great example of how partnership

working and developing new

ideas to best meet the needs of

patients in different parts of our

county can have really positive

outcomes for our communities.

We are delighted to be able to

commission this service on a

permanent basis, as it has proved

its worth in supporting high-quality

care for patients in Berwick and

the surrounding areas.”

Ruth Corbett, Clinical Operations

Manager for NEAS in North

Northumberland, said: “I’m so

proud of all my teams, but our

Berwick community paramedics

have shown real commitment

over the past two and a half years

to demonstrate that there is a

real need for additional support

in our more rural areas. When I

first developed the team, I had

no idea just how much of an

impact the work they would go

on to do would have on the local

community. The work of the team

has vastly improved not only the

waiting times and pressures on

the service, but also patient care

and experience, which is the

reason we’re here.

“The nearest emergency

department is almost 60 miles

away from Berwick. This is a

long journey for any patient who

needs emergency care, but it is

also a very long way for one of

our vehicles to go and not be

responding to other emergencies

back in the area.

“By having an additional team

based in the Berwick area, we’ve

been able to provide a much more

hands-on approach to patient

care within the community and

prevent unnecessary journeys

to hospital an hour away from

home. Our team is always there to

visit poorly patients, and support

GP practices with their care of

patients with long-term illness.”

Dr Stephen Doherty, partner

at Well Close Medical Group,

said: “As a practice, we were

delighted to hear that this project

had been made a permanent

fixture within the local community.

The community paramedics are

essential in providing urgent

care when needed, as well as

supporting local surgeries, and

we look forward to continuing to

work closely with them”

Dr. Adelle Pears, associate

GP at Well Close Medical

Group, added: The community

paramedics have been a

fantastic addition to the primary

care team. They all bring an

enormous amount of enthusiasm

and experience to the role.

Our patients and the wider

community have benefitted

hugely from the excellent care

that they provide, we are very

lucky to have such an amazing

service and I look forward to

working with them in the future.”

Anna Wood, Modern Matron at

Berwick Infirmary, said: “Staff at

the infirmary have welcomed the

opportunity to build relationships

with the community paramedics,

so it is good news that the

scheme will continue.

“When available, the paramedics

have supported our teams during

busy periods, which in turn has

allowed them to learn more about

how our Minor Injuries Unit works

and to boost their knowledge.

Being able to bring patients into

the MIU for assessment and

treatment has contributed to

the reduction in transfers to the

Northumbria emergency hospital

at Cramlington, which means less

disruption for the patient while

reducing pressure at that site.”


Trial of paramedicled

home blood

testing for frail and

elderly halved need

for hospital transfers

A trial of paramedic-led home

blood testing for frail and

elderly patients who required an

ambulance helped to prevent

the need for transfer to hospital

in more than half of cases.

In a pilot study led by South

Central Ambulance Service and

Oxford University Hospitals NHS

Foundation Trust, 52% of patients

who were initially identified as

requiring hospital admission were

successfully managed at home.

It was made possible by using

specialist paramedics to take

blood samples at the scene and

discuss the results with hospital

physicians remotely to determine

the next steps.

Although specialist paramedics

receive an additional two years’

education and training and are

able to diagnose a wider range of

conditions and treat many minor

injuries and illnesses, they do not

routinely assess blood test results.

As part of the trial they were given

additional training in taking and

handling blood samples and a

SCAS rapid response vehicle

(RRV) was equipped with a pointof-care

– also known as bedside –

testing device and novel wireless

technology to transmit a patient’s

blood results to hospital within


Potential patients were identified

by 999 call handlers as requiring

more detailed clinical assessment

and selected if they were 65 years

or older and had either fallen from

a standing height without obvious

injury, had collapsed, were

confused, had reduced mobility or

suspected infection.

They were then assessed by the

paramedic on scene and only

non-critically unwell frail or elderly

patients who were deemed to

potentially require transfer to

hospital for further investigation

were enrolled in the study to see

if they could be managed safely

at home.

These patients then had bloods

taken for immediate diagnostics

in addition to the usual bedside

investigations including urinalysis,

electrocardiogram and blood

sugar levels, with the results

discussed with a senior physician

by telephone for decision support.

The outcomes were to either

enable the patient to remain at

home after a comprehensive

assessment without the need

for further intervention, leave

the patient at home with further

intervention from community

or hospital at home services

or transfer to hospital via the

emergency department or acute

medical unit.


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Critically unwell patients

continued to be taken to hospital

after assessment without having

diagnostic blood tests and

patients who did not require any

further clinical input were referred

to community services without


The study, published in the

Journal of Paramedic Practice,

showed that over a three-month

period the frailty response unit

saw 42 patients who were either

too critically unwell or not in need

of hospital assessment and 56

selected for point-of-care testing.

Out of the 56 enrolled, 27 were

transferred for further assessment

in hospital but 29 (52%) remained

in their usual care environment. Of

these, four presented to hospital

within the next 30 days but with

no adverse events recorded as a

result of non-transfer to hospital.

Dr John Black (pictured), Medical

Director for SCAS and one of

the study authors, said: “These

results suggest it is feasible to

perform bedside diagnostics in

the community as part of the

clinical assessment offered by

ambulance services and that a

proportion of older patients could

potentially be managed in a home

or community setting without

physically attending hospital and

without adding significantly to the

burden on community services.

“The beauty of this model is

that the potentially complex

interpretation of the blood tests

is undertaken by a hospital

medical team remotely who can

contextualise the results with the

paramedic’s clinical findings and

observations in the community at

the time of referral.

“As well as the benefits of keeping

frail and elderly patients out of

hospital if clinically appropriate

to do so, there is a real potential

for this to relieve pressure and

financial costs on busy hospital

emergency departments and

acute medical units.”

He added: “Serious consideration

must be given to innovations

such as this to ensure the best

possible care and environment for

patients but also to help address

the ongoing issue of hospital

pressures and capacity which

continues to be such a significant


Dr Alex Novak, Consultant

in Emergency Medicine and

Ambulatory Care at Oxford

University Hospitals NHS

Foundation Trust and coauthor

of the study, said: “This

pilot project demonstrated the

feasibility of providing linked

community-based diagnostic

testing with acute secondary care

decision support and indicates

the potential for this to have a

positive impact on the healthcare

provided to some of our most

vulnerable patients.”


Their Royal

Highnesses the Earl

and Countess of

Wessex visit Essex &

Herts Air Ambulance

On Tuesday 1st March 2022,

North Weald: Essex and

Herts Air Ambulance (EHAAT)

hosted a visit by Their Royal

Highnesses The Earl and

Countess of Wessex.

EHAAT is a local life-saving

charity and works alongside the

hospitals, emergency services

and supporting organisations

across the region. Today’s visit

was an opportunity to bring

everyone together at EHAAT’s

new airbase at North Weald,

enabling The Earl and Countess

to say thank you to some of

these organisations for their

outstanding hard work during the


On first arriving at North

thank them for the work they do.

Weald, The Lord Lieutenant

of Hertfordshire and Vice Lord Jane Gurney was thrilled that The

Lieutenant of Essex greeted The Earl and Countess of Wessex had

Earl and Countess of Wessex, visited. She said:

and introduced them to Jane

Gurney, CEO of EHAAT. Their “This is a real milestone in our

Royal Highnesses then toured charity’s history, as it is the first

the new airbase, where they met time that Essex and Herts Air

members of EHAAT’s critical care Ambulance has hosted a Royal

team, charity staff and volunteers. visit. It was a fantastic opportunity

The Earl and Countess also to bring together all of the

heard about EHAAT’s vision for a organisations who have worked

‘Centre for Excellence’ at North so hard during these challenging

Weald, which would enable the times of the pandemic. I am truly

charity to push the boundaries honoured that we have been able

in innovation, research and to showcase our new airbase at

education for the advancement of North Weald and share our vision

pre-hospital care.

for a Centre for Excellence that will

continue to develop pre-hospital

Their Royal Highnesses spent care into the future.”

time with representatives from the Chair of Trustees at EHAAT,

local hospitals in the region and Jonathan Trower, added:

then spoke to air lifted patients

and their families to hear firsthand

about their experiences. to have welcomed Their Royal

“We are absolutely delighted

Highnesses The Earl and

The highlight of the Royal visit Countess of Wessex to our new

took place at the front of the airbase in North Weald, and we

building where people had are very grateful for their interest

gathered representing the

and support for our charity. We

emergency services and voluntary were able to show them our

support organisations, together outstanding new facilities for our

with the members of the armed team and to discuss our exciting

forces and many EHAAT charity plans for the further development

staff and volunteers. The Earl and of our emergency medical

Countess took the opportunity to services across Essex and

stop and speak to individuals and Hertfordshire.”

Photo courtesy of Doug Blanks


For more news visit: www.ambulanceukonline.com



Appointment of Bob Forsyth

as the new Chair of London’s

Air Ambulance Charity

The Board of London’s Air Ambulance

Charity has announced the appointment of

Bob Forsyth as the new Chair of its Board

of Trustees. The appointment comes after

a far reaching and competitive process,

involving external and internal candidates

facilitated and guided by Inclusive Boards.

Bob has been a trustee of the Charity

since 2017, leading the establishment of

the Board’s Audit and Risk Committee and

chairing it for over four years.

As the Charity continues its implementation of

an ambitious programme of transformational

change, including the replacement of its two

helicopters, the replacement and expansion

of its rapid response car fleet, supporting

the service’s frontline medical teams and

enhancing the Charity’s culture, diversity

and inclusion outreach, Bob will bring strong

leadership, experience and organisational

empathy to these fundamental priorities.

Bob’s appointment will take effect when Mark

Vickers, the current Chair of Trustees, retire by

rotation on31 March, after seven years in the

role. Outgoing Chair of Trustees, Mark Vickers


“It has been a huge honour and privilege to be

Chair of the Board, and in handing over these

responsibilities to Bob I am inspired by the

ambitious plans the Charity has for serving the

people of London under his leadership.”

KSS News

Air Ambulance Charity Kent

Surrey Sussex appoints four

new trustees

Air Ambulance Charity Kent Surrey Sussex

(KSS) has strengthened its Board with the

appointment of four new Trustees, with

appointments taking effect from 8th March


The new Trustees are:

Nick Hall - Nick’s interest in Air Ambulance

services began with the Royal Flying Doctor

Service - providing medical support in remote

communities in Australia. He became more

passionate about what happens in the front

of the aircraft than the back and so studied

a B.Sc (Aviation) before joining the Australian

Army to fly Black Hawk helicopters in

operational roles.

He left the military to study an MBA and

worked as a corporate consultant in

Australasia for several years before returning to

the aviation industry.

Nick now has over 30 years in the

helicopter industry in strategic, operational,

transformational and entrepreneurial roles as

an executive, management consultant or line

manager, providing services for end users,

operators, maintenance, repair and operations

(MROs) and innovators in some of the world’s

largest and smallest helicopter organisations.

Richard Lee - As Chief Operating Officer/

Deputy Chief Executive for St John Ambulance

and former Director of Operations for Welsh

Ambulance Services NHS Trust, registered

Paramedic Richard has a strong track record

in leadership, delivering improved patient and

staff outcomes, operational performance,

quality and cost efficiency. He also has

experience of leading national policy.

David Morgan – David is an aviation executive

with substantial experience in flight operations,

training and safety management. He is also

an industry leading expert on addressing the

climate impact of aviation. David is currently

Group Director of Flight Operations at easyJet,

with seven years’ experience at the airline

including twelve months as interim Chief

Operating Officer.

During this time – the busiest and most

successful year in easyJet’s history – David

was responsible for all operations and

customer service, leading a team of over

15,000 staff. David has also been Flight

Operations lead for the creation of easyJet

Europe and had responsibility for the safe

introduction of new aircraft types into the airline


Jane Redman – Jane is a Fundraising

Consultant who helps fundraising teams and

leadership work effectively together to achieve

income growth, improve relationships with


Top left: Nick Hall, Top right: Richard Lee, Bottom left: David Morgan, Bottom right: Jane Redman

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donors and colleagues and create change

for the people they support. Over the last 25

years, Jane has developed income generation

strategies and campaigns for a wide range of

charities including Mencap, Children’s Hospice

South West and Kent MS Therapy Centre.

Barney Burgess, Chair of KSS’s Board of

Trustees said: “Our new trustees all stood

out for their tremendous expertise, the

positive impact they have demonstrated,

their commitment to the highest quality

governance and their belief in KSS’s vision - an

end to preventable loss of life from medical

emergency. I look forward to working with

Nick, Richard, David and Jane as we continue

to work with David Welch and his team in

delivering excellence whilst also evolving and

continuing to push boundaries.”

David Welch, CEO of KSS, said: “On behalf

of Team KSS, I would like to welcome Nick,

Richard, David and Jane to our Board of

Trustees. I am incredibly excited about the

breadth and depth of experience which our

new Trustees bring to the charity, and I am

confident they will all add significant value to

our Board.”

Nick Hall, KSS Trustee, said: “I am excited to

have the opportunity to help shape the future

of KSS. Air Ambulances and helicopter aviation

have played a significant part in my career, so

I am looking forward to sharing my experience

to support the Board. I’m delighted to be part

of a world-leading provider of pre-hospital

emergency care which puts the patient at the

heart of everything it does.”

Richard Lee, KSS Trustee, said: “Being able

to play a small part in this mighty team is a

fantastic opportunity. I’m looking forward

to meeting KSS’s people, patients and the

communities we serve.”

David Morgan, KSS Trustee, said: “I’m thrilled

to be joining the KSS board, an organisation

that has the united purpose of saving lives.

As a former helicopter and Air Ambulance

Pilot myself, I know how much it means for

a community to have the support of rapid

response critical care, by day and by night.

With over 35 years of aviation experience, I

hope to be able to support KSS as they further

develop this capability, as one of the world’s

leading Air Ambulance organisations.”

Jane Redman, KSS Trustee, said: “I am so

happy to be joining KSS as a Trustee. I’m

blown away by the amazing work the charity

does and the difference the team make to so

many lives. I’ve worked in the charity sector as

a fundraiser for many years. My hope is that

I can bring that knowledge and experience to

support the Board and Team KSS as we grow

the charity’s income and build ever stronger

relationships with our dedicated supporters

and funders.”

KSS provides world-leading pre-hospital

emergency care whenever and wherever

required to save lives and ensure the best

possible patient outcomes. It is a multi-award

winning charity that must raise £15.2M to

operate its life-saving service. 86% of its total

income is raised through the generosity of

KSS’s supporters. For further information:



Ambulance UK welcomes the submission of

clinical papers and case reports or news that

you feel will be of interest to your colleagues.

Material submitted will be seen by those working within the public and private

sector of the Ambulance Service, Air Ambulance Operators, BASICS Doctors etc.


All submissions should be forwarded to info@mediapublishingcompany.com

If you have any queries please contact the publisher Terry Gardner via:



For further recruitment vacancies visit: www.ambulanceukonline.com



International 2022:


presents solutions

for greater climate

comfort and digital


• Comfortable temperatures

for paramedics and


• e-connected: cloud-based

use and connectivity of

digital services

• Customized airconditioning

systems for

the patient compartment

In an emergency vehicle, optimal

temperatures are important. Not

just for the patients with special

medical needs in the patient

compartment, but also for the

concentration of the driver and

the paramedics. At RETTmobil

International 2022 in Fulda

(Germany) from May 11 to 13,

2022 (Stand 710), Eberspaecher

will be presenting its new

e-connected product family that

enables the smart use of digital

services and the connectivity of

components for fleet operators,

among others.

With the cloud-based

e-connected platform,

Eberspaecher will enable

intelligent application and

connectivity of digital components

and services for fleet owners in

the future. The services of the new

product family can be developed

and used according to customer

requirements. Eberspaecher

e-connected consists of three

components: Via a gateway (1)

installed in the vehicle, information

like temperature, site, and

vibrations is collected. The cloudbased

e-connected platform (2)

centrally evaluates the data. It also

forms the technical infrastructure

and ensures the availability of

the digital services (3), which

individually display the collected


Electrical air-conditioning

solutions for ambulances

In addition to efficient heating

solutions, Eberspaecher offers

suitable products for when

it’s warm outside to offer

comfortable climate in the patient

compartment. The broad portfolio

of air-conditioning solutions

includes products especially

developed for vehicles with

electric drives. This includes

Kool, one of Eberspaecher’s

standard evaporator units with

the big advantage of its compact

design and easy installation. In

e-vehicles, it can be connected

to the external condensing unit

Power K, including an electrical

compressor, a condenser and a

The Kool EHAVC evaporator unit provides customized air conditioning

for ambulance driver’s cabs and patient compartments

drier filter. Kool is also available as

an EHVAC version – heat is then

provided by intrinsically safe PTC

elements. The external unit Power

K Reverse is ideal for installing an

air-conditioning system regardless

of the drive type and is mounted

under the vehicle chassis to save


Fast, constant heat thanks to

fuel operated heating solutions

Fuel operated air heaters such as

the Airtronic from Eberspaecher

provide ideal and individually

adjustable heat in the patient

compartment. This is especially

advantageous when transporting

patients with special medical

requirements. The heaters from

Eberspaecher can be controlled

using the EasyStart Web

operating element, for example

– no matter the range. Up to five

pre-heaters can be controlled per

user account, meaning several

vehicles can be warmed up in

the morning before the workday

begins. Another plus: The remote

maintenance function allows

workshops to effortlessly perform

remote diagnosis via the app once

the vehicle owner has approved.

Alternatively, the pre-heaters can

also be operated together with

Eberspaecher air conditioning

solutions using the permanently

installed PCK3 FOH operating



Rhino Products

launch Connect+ for

new vehicles!

Rhino Products, Europe’s

leading manufacturers

of commercial vehicle

accessories, have launched

their extremely popular

rear step parking sensor

integration product,

Connect+, for a range of new

vehicle platforms.

Rear steps are an important

accessory for many emergencies

service vehicles, providing a

safe and secure platform to

enter the vehicle, as well as

access the roof. Reversing

sensors have long been an

expectation for many years now,

however making alterations to

introduce an external step with

parking detection technology

has previously been a timeconsuming

process, often

requiring specialist knowledge,

complicated rewiring and of

course, added expenditure.

Connect+ neatly solves this

problem by integrating each OEM

sensor into the step via a simple

‘plug and play’ cable.

The process could not be simpler,

the existing (OEM) sensors are

removed from the vehicle, before

reconnecting these sensors

directly into the Rhino Products

step. The wiring loom is then

reconnected into the vehicle,

and blanking plugs are provided

to fill the space where the OEM

sensors were previously located.

The sensors then work as normal,

with the added reassurance that

the step at the rear of the vehicle

is also protected when reversing.

Having already proven to be

a hugely popular solution for

emergency service vehicles,

Connect+ has also now been

released for a range of additional

vehicles, including the Renault

Master, alongside Fiat Ducato,

Ford Transit, Mercedes Sprinter

and many more.

Rhino Products continue to be

at the forefront of design and

innovation, providing products of

unrivalled quality and aesthetics

to customers throughout Europe

and beyond. Rhino will be

releasing exciting new products

and upgrading existing customer

product favorites throughout

2022 – to view the current up

to date product ranges and find

out where to buy, visit www.



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




How Radio Over

IP is becoming

the most trusted

method for critical


with BroadNet

leading the UK


From the title, you may gauge

how technical radio systems

are in terms of their operating

systems. It is complicated,

but the technology to transmit

across the country or even

the globe, without installing

dedicated mast infrastructure

exists now, and all we have left

to do is to attempt to understand

it. So, let’s try to unfold how the

technology works.

First, you may ask yourself what

a radio over IP is; it is a radio that

can both transmit and receive

data packets using the existing

mobile phone network. Your

typical radio at home would most

likely be a broadcast receiver,

where you can only receive

content. In short, a Radio over

IP can be a walkie talkie style

handheld or a mobile radio in a

vehicle or even a stationary radio.

What’s the difference between

traditional two-way radio systems

and Radio over IP?

Two-way radio systems are

becoming less essential for

everyday life when it comes

to emergency services, taxis,

security companies or air traffic

controllers. Each channel would

operate for one service in which

all parties using the channel would

be in half-duplex, meaning they

share the channel and therefore

can only use it one at a time.

Radio over IP allows all users to use

all channels all the time, along with

voice, data, even video, you could

have thousands of users all talking at

the same time on the same network.

Traditional two-way radio devices

were developed in the early 20 th

Century, and the first hand-held

radio was created in Australia

and first used by the Victorian

Police since then nothing has

really evolved in the underlying

technology. It is still transmitted

from one radio to another, talkwait-receive

over a very limited

range even using the most up to

date digital devices you could fast

find yourself without reception,

this becomes a greater challenge

if your radios are constantly

moving around into a wider area

that may or may not be covered

by your repeater network.

Radio over IP is different and the

leading UK company is BroadNet

Communication Systems. The

company is preferred by many

services for the quality of its

voice playback, security, and

functionality. BroadNet uses Radio

over IP with its own encryption

algorithms. From the moment you

press your PTT button the journey

starts, the radio will transmit an

authentication handshake with the

closest mobile phone mast (if using

Broadnet’s CSN SIM cards it will

pick any of the 4 strongest network

providers) and use the internet or

wireless mobile telecommunication

(commonly known as 3G, 4G or

even 5G). BroadNet operates with

3G and 4G and will soon operate

with 5G networks using its own

private network.

It uses the two-way radio user

principles but its transmitting and

receiving at the same time and

furthermore its combined with

BroadNet’s Computer Aided

Dispatch system, making BroadNet

a gamechanger for any services

requiring communications outside

of a very small geographical area.

Clients include private ambulance

services, councils, first responder

groups, train and bus companies,

logistic companies and many more.

BroadNet equipment is seamlessly

integrated into the network, and

organizations can grant access

to other users onto their channels

at a click of a couple of buttons

on the CAD. Gone are the days

of having to manually reprogram

radios whenever two organizations

want to work together. Radio

over IP allows a huge increase in

functionality, from integrating other

apps such as mapping, through

to the transmission and receipt

of images all from one device.

No radio system is perfect which

is why, even though the UK now

has 99% population coverage for

cellular devices, BroadNet radios

can also be tethered to any wifi

network, or satellite phone to

alleviate blackspots, something that

traditional radios can never do.

VCS gears up for

growth with several

strategic hires

• Key appointments made

across VCS’s ambulance and

police divisions to facilitate

business growth

• New hires allow VCS to

further develop its operating

efficiency and significantly

increase production output in

coming years

• Recruitment drive follows

major commercial

developments, such as placing

first on the new NHS national

procurement framework

VCS, the UK’s leading emergency

service vehicle conversion

specialist, has welcomed several

key strategic hires across its

ambulance and police divisions.

Its recent recruitment drive is

part of an ongoing business

growth strategy that will see VCS

significantly increase production

output and boost operating

efficiency in the coming years.

New personnel within VCS’s

ambulance division have been

brought on board to facilitate a

structure focused on strengthening

product development, supply chain

management and manufacturing

efficiency. This coincides with VCS

recently placing first on the new

NHS Collaborative Procurement

Hub Framework Agreement for

Ambulance and Specialist Vehicle


Alastair Munro will bring his 40

years’ expertise in the automotive

and transport sectors as VCS’s

Principal Engineering and Product

Development Adviser. In this role he

will advise and support the in-house

engineering team in refining VCS’s

product development strategy and

provide a vital interface between the

company’s technical, manufacturing

and sales divisions.

Chris Watts will become Head

of Procurement and Aftersales,

bringing considerable procurement

experience to the role. Chris’s

previous role of General Manager

will be filled by new recruit, Kevin

Stevens, who boasts 30 years’

experience of manufacturing

excellence across multiple sectors.

Kevin will add huge depth in terms

of operational execution and

pedigree to drive growth.

Simon Ward joins as Process

Engineering Manager, while Simon

Sanderson has been recruited as

Planning Manager. As Process

Engineering Manager, Simon

Ward will leverage his 20 years of

experience to improve production

efficiency and reliability while

retaining VCS’s current highquality

standards. Meanwhile

Simon Sanderson will work across

VCS’s supply chain, engineering,

and internal manufacturing team

to ensure production schedules

consistently run smoothly.

Following on from a successful

2021, VCS’s Police division has also

brought on board Kerry Bick as

Special Projects Manager, who will

help further broaden the scope of

products on offer to police forces.

Meanwhile, sales and procurement

teams will both be bolstered by new

recruits, Jordan Croom and Claire

Fanning, respectively.

Mark Kerrigan, Managing Director

of VCS, said: “This promises to

be a transformative year for VCS

as we continue with plans to

considerably increase production,

while bringing our ambulance

and police divisions closer than

ever before. The key hires we’ve

made in recent months help us to

put the building blocks in place

to facilitate growth throughout

the business while achieving

even greater levels of customer

satisfaction, innovation and

product quality and for us to cope

with current demands and growth

levers in the pipeline we must add

talented people to the VCS team.”


For more news visit: www.ambulanceukonline.com


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