Ambulance UK April 2022

Volume 37 No. 2
April 2022
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CONTENTS
CONTENTS
Ambulance UK
36 EDITOR’S COMMENT
40 FEATURES
Assessing spinal movement during four extrication methods:
a biomechanical study using healthy volunteers
48 NEWSLINE
59 IN PERSON
61 COMPANY NEWS
This issue edited by:
Dr Matt House
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COVER STORY
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The programme meets in full the specification of the current NHSEI Framework for
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Ambulance Trusts over an extended period.
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35

EDITOR’S COMMENT
EDITOR’S COMMENT
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.
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“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.”
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
36
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FEATURE
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FEATURE
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39

FEATURE
ASSESSING SPINAL MOVEMENT DURING FOUR
EXTRICATION METHODS: A BIOMECHANICAL
STUDY USING HEALTHY VOLUNTEERS
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.
Abstract
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
vehicles.
Background
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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
40
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FEATURE
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.
Methods
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).
Participants
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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41

FEATURE
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.
Analysis
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.
Discussion
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
methods.
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].
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Results
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
42
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FEATURE
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
analysis
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
patient.
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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FEATURE
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
Roof
Maximal movement off B
movement
post and p travel during
value
during Rapid
extrication
Maximal movement during extricationp value Self p value
Travel
Roof
Travel (total
off
(total
B post
movement)
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
Maximal
off B post 10.73
movement
p 0.45 value
during
Rapid 12.47
extrication
p value 0.09 Self 4.47 p value < 0.001 Roof 26.56
Travel
off B
(total
post 30.25
movement)
p value 0.28 Rapid
during
36.07
extrication
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 0.130.095.674.47 0.03< 0.00121.80 26.56 30.70 30.25 0.060.28 37.67 36.07 0.008 0.02 10.698.49 < 0.001 < 0.001
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
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
0.0ex
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
excursion
1.0 at the 2.0
and cervical confidence
3.0 spine 4.0
intervals
5.0
for
6.0
anterior–
7.0 8.0
Mean excursion (mm) and 95% confidence intervals
Fig. Mean excursion and confidence intervals for anterior–
Fig.
posterior posterior
2 Mean excursion
movement at
and
the at the cervical
confidence
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
Mean
2 4
excursion
4 6
(mm)
6
and
8
95%
8 10
confidence
10 12
intervals
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
Mean
2
excursion
Fig. 4 Mean excursion excursion at and the 4
(mm)
and lumbar 6
and 95%
confidence spine8 confidence
10
intervals
12 14 16
intervals intervals for anterior– for anterior–
posterior
Fig.
posterior
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
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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
Mean
2.0
excursion
2.03.0 3.0
(mm)
4.0
and
4.05.0 95%
5.0
confidence
6.0 6.07.0 intervals
7.0 8.0 8.09.0
9.0
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
Mean
3 Mean excursion spine 1.0
excursion
2.0
(mm)
3.0
and
4.0
95% confidence
5.0 6.0
intervals
7.0 8.0 9.0
excursion and and confidence intervals intervals for lateral for lateral movement
Fig.
at the at
3
the cervical
Mean
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
Mean
2 4
excursion
4 6
(mm)
6
and
8
95%
8 10
confidence
10 12
intervals
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
Mean
Fig. 5 Mean excursion spine 2
excursion
4
(mm)
6
and 95%
8
confidence
10
intervals
12 14 16
excursion and and confidence intervals intervals for lateral for lateral movement
at
Fig.
the at
5
the lumbar
Mean
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
44
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Declarations
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.
Conclusions
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
delivered.
Acknowledgements
This work is kindly supported by the National Fire Chiefs Council,
Avon Fire and Rescue Service and Severn Park Fire and Rescue
Centre
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.
Funding
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.
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FEATURE
9. Fenwick R, Nutbeam T. Medical vs. true physical traffic collision
entrapment. J Paramedic Pract. 2018;10:158–62.
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D, et al. Cervical spine motion during vehicle extrication of healthy
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et al. An explorative, biomechanical analysis of spine motion during
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Springer Nature remains neutral with regard to jurisdictional claims in
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Received: 15 November 2021 Accepted: 7 January 2022
Published online: 15 January 2022
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emergency department’, taking
hospital-standard treatments to
the patient at the scene of an
incident.
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.
AMBULANCE UK - APRIL
48
A Wales Air Ambulance helicopter and rapid response vehicle
For further recruitment vacancies visit: www.ambulanceukonline.com
“Our ability to do this is thanks to
our dedicated Charity, medical
and aviation teams, however, it
would not be possible without the
incredible support from the people
of Wales. It is because of their
generosity that we have one of
the most advanced air ambulance
operations in the world and there
are no words to convey our
thanks.
“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

NEWSLINE
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.”
EEAST
East of England
Ambulance Service
to hit top gear with
electric vehicle trial
Three Rapid Response Vehicles
(RRVs) will be trialled by East
of England Ambulance Ser-vice
NHS Trust (EEAST) as part of
the NHS’s move towards zero
emissions vehicles.
EEAST has successfully bid for
£250,000 from NHS England
which will fund two electric Skoda
all-wheel drive cars, an electric
Vauxhall van, their conversion
to medically equipped response
vehicles and the necessary
charging infrastructure for each
of the vehicles. The funding is
part of a new NHS England pilot
to support ambulance trusts to
trial a range of new zero emission
response vehicles. The 12-month
pilot will be subject to rigorous
evaluation to inform the next steps
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.”
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49

NEWSLINE
AMBULANCE UK - APRIL
LAS
London Ambulance
staff make
plea clear: We
should be able to
#WorkWithoutFear
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
this.
“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.”
GWAAC
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
Wiltshire.
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
50
For more news visit: www.ambulanceukonline.com

NEWSLINE
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
AMBULANCE UK - APRIL
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
51

NEWSLINE
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
lives.”
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
www.helpappeal.org.uk
AMBULANCE UK - APRIL
52
AVS STEPS_Ambulance UK Half Page Advert_June 2021_FINAL.indd 1 01/07/2021 18:04
For further recruitment vacancies visit: www.ambulanceukonline.com

NEWSLINE
Just breathe
Reduces
trauma pain
from severe
to moderate
levels
2x faster
than
IV morphine 1
References:
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

NEWSLINE
AMBULANCE UK - APRIL
EEAST
East of England
Ambulance Service
signs up to antiracism
pledge
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.”
LAS
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
defibrillator.
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
them.
“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
54
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55

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AMBULANCE UK - APRIL
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
loved.
“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
photography.
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.
org.uk/get-involved/volunteeropportunities
NEAS
Beloved Berwick
community
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
funding.
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
community;
• 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
permanently’.
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
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NEWSLINE
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
need.
“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.”
SCAS
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
minutes.
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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57

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AMBULANCE UK - APRIL
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
participating.
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
problem.”
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.”
EHAAT
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
pandemic.
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
58
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IN PERSON
News
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
said:
“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
2022.
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
fleet.
Jane Redman – Jane is a Fundraising
Consultant who helps fundraising teams and
leadership work effectively together to achieve
income growth, improve relationships with
AMBULANCE UK - APRIL
Top left: Nick Hall, Top right: Richard Lee, Bottom left: David Morgan, Bottom right: Jane Redman
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59

IN PERSON
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:
www.aakss.org.uk
WHY NOT WRITE FOR US?
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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.
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COMPANY NEWS
RETTmobil
International 2022:
Eberspaecher
presents solutions
for greater climate
comfort and digital
connectivity
• Comfortable temperatures
for paramedics and
patients
• 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
data.
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
space.
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
element.
CLICK AND CONNECT:
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.
rhinoproducts.co.uk.
AMBULANCE UK - APRIL
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
61

COMPANY NEWS
AMBULANCE UK - APRIL
How Radio Over
IP is becoming
the most trusted
method for critical
communications,
with BroadNet
leading the UK
market
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
Conversions.
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.”
62
For more news visit: www.ambulanceukonline.com

COMPANY NEWS
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AMBULANCE UK - APRIL
For the latest Ambulance Service News visit: www.ambulancenewsdesk.com
63

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