Ambulance UK December 2020
Ambulance UK December 2020
Ambulance UK December 2020
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Volume 35 No. 6<br />
<strong>December</strong> <strong>2020</strong><br />
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CONTENTS<br />
CONTENTS<br />
172 EDITOR’S COMMENT<br />
174 FEATURES<br />
174 In conversation with... Daren Mochrie<br />
178 The Challenge of Transformational Training During<br />
the Pandemic and Beyond<br />
180 Refl ection on NHS Nightingale London<br />
184 NEWSLINE<br />
198 IN PERSON<br />
COVER STORY<br />
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Your Training<br />
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their business development involves working alongside rescue teams to observe training<br />
– which allows continual product evaluation, giving you the best possible manikins for<br />
your training.<br />
In 2019, Ruth Lee Ltd worked with the eight2o water alliance to provide them with a<br />
solution for a confi ned space rescue scenario.<br />
The team at Ruth Lee provided a Confi ned Space manikin for the exercise which could<br />
be carried and easily positioned within a poor access location, thanks to its clever design<br />
where it splits into several components. They also liaised with South Central <strong>Ambulance</strong><br />
Service HART Team and specialist technical rescue crews from Oxfordshire Fire and<br />
Rescue to arrange their attendance at the training day, so that a collaborative approach<br />
could be adopted for best practise.<br />
Mike Green, Senior Health, Safety and Wellbeing Advisor at MWH Treatment Limited said,<br />
“It was a great day where our site team could put in to practice what should be done if<br />
we need to evacuate a casualty from the 5 metre deep excavation.<br />
As we don’t want to put any of our employees at risk, the use of a manikin was the right<br />
thing to do to, allowing the team to practice the evacuation safely.<br />
It was great to be able to offer the emergency services the opportunity to come on to a<br />
‘live’ operational site, to allow them to put in to practice the recovery of the manikin from<br />
the tunnel and share their own experience.”<br />
<strong>Ambulance</strong> <strong>UK</strong><br />
This issue edited by:<br />
Dr Matt House<br />
c/o Media Publishing Company<br />
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171
EDITOR’S COMMENT<br />
EDITOR’S COMMENT<br />
My last two editorials have spoken about the COVID-19 pandemic, and as I write<br />
this, we have just learned that England will be moving back into full lock-down,<br />
with the devolved Nations likely to follow suit.<br />
I’m sure you are all more than aware of the impact of this. The news reports in this edition also show how<br />
the pandemic has affected us in a variety of ways. Whether this is the result of people refusing to seek<br />
medical help when they should, or the increased numbers of suicides ambulance clinicians are being called<br />
to.<br />
“...a<br />
common<br />
theme<br />
these days<br />
is that<br />
people are<br />
saying they<br />
are tired.”<br />
Just as importantly, the impact on ambulance staff is evident. Whether this is the strain on students, whose<br />
education has been affected, or the effect on our road clinicians and control room staff from the increased<br />
pressures.<br />
I am not telling you anything you don’t already know, when I say that a common theme these days is that<br />
people are saying they are tired. The changing rules and the increase in workload, combined with the<br />
effects of the track and trace process have meant that everyone from front-line staff to support services<br />
are feeling exhausted. When we add the fact that holidays have had to be cancelled this year, and the<br />
uncertainty of the situation going forward, it is completely understandable that people are feeling drained.<br />
Unfortunately, I don’t have any words of wisdom that can help in times like this. What I can say, though, is<br />
that it is important to recognise and acknowledge these feelings in you, your family and your colleagues.<br />
Health and wellbeing has been a focus for some time now. As we move into the festive period, and a<br />
second lockdown, this is probably more important than ever. What that means in practice will be different<br />
for everyone. Whether it’s taking time out, or simply having a chat, I think the important bit is the recognition.<br />
Spot the problem early, acknowledge it and look after each other.<br />
I would like to think that when I sit down to write my next editorial that this pandemic will be behind us. That<br />
may be wishful thinking. In the meantime, please look after each other and be kind to yourself.<br />
Dr Matt House, Co-Editor <strong>Ambulance</strong> <strong>UK</strong><br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
172<br />
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FEATURE<br />
IN CONVERSATION WITH...<br />
DAREN MOCHRIE<br />
Chief Executive, North West <strong>Ambulance</strong> Service and Chair, Association of <strong>Ambulance</strong> Chief Executives<br />
The NHS Providers team recently spoke to Daren Mochrie, chief<br />
executive of the North West <strong>Ambulance</strong> Service (NWAS) and newly<br />
appointed chair of the Association of <strong>Ambulance</strong> Chief Executives<br />
(AACE).<br />
We asked Daren about his reflections and learnings from the pandemic<br />
to date, the challenges faced by the ambulance sector, how trusts have<br />
come together to overcome these challenges, and what trusts need<br />
from national/regional bodies to support their response to future COVIDrelated<br />
demand and returning to near-normal levels of non-COVID<br />
health services. We are grateful to Daren and the AACE team for taking<br />
the time to contribute to this publication.<br />
Introduction<br />
The ambulance service has played a pivotal role in the nation’s<br />
response to the coronavirus pandemic. The surge in coronavirusrelated<br />
demand was felt acutely by ambulance trusts at the start of<br />
the outbreak, with pressure increasing rapidly on 999 and NHS 111<br />
services. <strong>Ambulance</strong> trust leaders were immediately focused on<br />
ensuring their services were resilient and able to provide the same level<br />
of care for patients while also protecting and caring for their staff.<br />
As the heath and care sector moves firmly to management of a second<br />
wave of the disease, it is timely to look at trust leaders’ reflections on<br />
the first wave. Over the summer we heard from Heather Lawrence<br />
OBE, Chair of the London <strong>Ambulance</strong> Service, about the importance<br />
of supporting staff during these extremely challenging times. This<br />
continues to be a primary focus for trust leaders.<br />
Context<br />
The sector has many reasons to be proud of its staff and volunteers given<br />
the vital role they have played in the COVID response. It is important to<br />
remember the context that ambulance services were working in prior to<br />
the pandemic, with trusts facing rises in demand against a background<br />
of severe workforce and funding pressures. Shortly before the pandemic<br />
hit, the number of 999 contacts in the month of <strong>December</strong> 2019 broke<br />
records by reaching 1.15m and NHS 111 also saw a rise in demand<br />
with the number of calls increasing by 12% annually, reaching 1.84m<br />
in <strong>December</strong> 2019. As Daren reflects below, it is telling that ambulance<br />
trusts saw performance against targets improve in May to July this year<br />
and this begs the question of whether there needs to be a detailed review<br />
of how ambulance services are resourced and commissioned.<br />
It is also clear from our conversation that that there is further scope for<br />
national and regional policy makers to work closely with the ambulance<br />
sector to identify and drive successful initiatives focused on improving<br />
patient experience and outcomes. The recently announced NHS 111 First<br />
pilot scheme is just one example of where strategic and operational insights<br />
from ambulance trusts will be vital to the successful delivery, evaluation and<br />
potential roll-out of the scheme. The skills, scale and reach of ambulance<br />
services mean they are particularly well placed to play a leading role in the<br />
design and delivery of integrated urgent and emergency care services.<br />
Q&A<br />
What are your main reflections and learnings from the pandemic<br />
to date, on the challenges faced by the ambulance sector and how<br />
trusts have responded?<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
The ambulance sector has also been busy identifying lessons from the<br />
pandemic and AACE has been working with trusts to collate examples<br />
of what has gone well and what innovations need to be sustained. As<br />
the following conversation shows, the ambulance service is uniquely<br />
positioned to offer a joined-up perspective at a regional level to identify<br />
successes and the challenges that lie ahead as we approach winter and<br />
in longer term planning around the future shape of healthcare services.<br />
I will start off by saying how proud I am of AACE, NWAS and all our staff<br />
across the ambulance sector, as well as all the volunteers, who have<br />
worked so hard and tirelessly over the last eight or nine months to deal with<br />
the COVID pandemic response. This has been the biggest challenge ever<br />
faced by the ambulance sector, the whole of the NHS and the country.<br />
I have been in the ambulance sector for nearly 30 years and I didn’t think for<br />
one minute we would be dealing with a pandemic on this scale.<br />
“Everyone has come together in the best interest of looking after patients and<br />
colleagues. What really struck me [during the first wave] was how everybody<br />
dropped what they were doing and made themselves available to provide support<br />
and take on additional roles and functions that they wouldn’t normally do.”<br />
174<br />
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FEATURE<br />
My main reflection has been the speed with which the ambulance<br />
sector was able to increase its level of resourcing, for example our<br />
999 and NHS 111 contact centres and our operations out in the local<br />
community. In the early days, the 999 and 111 call volumes increased<br />
significantly as COVID started to become prevalent in the community<br />
but, as lockdown took effect, 999 activity reduced considerably. This<br />
was unsurprising due to fewer people moving about – this meant fewer<br />
accidents, road traffic collisions and fewer alcohol-related calls.<br />
I was very impressed at how the ambulance sector was able to recruit<br />
and train additional staff and volunteers to support frontline operations.<br />
In my trust, we were able to recruit an extra 450 staff.<br />
I was pleased to see how the ambulance sector came together to share<br />
learning and divert resources across the country as needed. I know<br />
that other ambulance trusts were able to support London during peak<br />
demand through the national ambulance coordination arrangements.<br />
Are the national coordination arrangements still ongoing?<br />
We have certainly got them in place, and they will continue into the<br />
winter. This allows for demand, activity levels and resources to be<br />
monitored and coordinated across the ten ambulance trusts and allows<br />
us to be much more responsive to pressure points.<br />
AACE, as well as with our other director colleagues, and we will continue<br />
to do so. As AACE chair, my priorities are as follows:<br />
• making sure the sector is prepared to tackle COVID in the winter –<br />
this will be a major challenge for all providers<br />
• looking after the mental health and wellbeing of our staff and volunteers<br />
• system leadership and the role that ambulance trusts can play to<br />
support this across regions<br />
• digital capability within the ambulance service – for example, tracking<br />
vehicles, electronic clinical records, command and control systems<br />
and video consultations<br />
• improving equality and diversity in the ambulance sector.<br />
I think we also need to make it easier for patients and their families<br />
by having fewer access points to care – 999, NHS 111 and GP – and<br />
explaining what the offer is across these access points. If we also look<br />
at public sector finances, why would we have multiple workforces,<br />
estates and IT platforms across some NHS providers which mean<br />
inefficiency, less resilience and more opportunities for things to go<br />
wrong? An integrated workforce, digital platform and estate is the right<br />
thing to do. At NWAS our strategy is about having one triage platform<br />
which allows you to have integrated estate and digital systems with a<br />
workforce that can work flexibly across the NHS 111 and 999 services.<br />
Another thing that worked well was the AACE national groups of medical<br />
directors, HR directors, operations directors and so on. These groups<br />
kicked in as part of the national command and control arrangements<br />
and were able to lead some changes and policy directions nationally<br />
on behalf of the ambulance sector. For example, we were able to work<br />
with NHS England and NHS Improvement to develop sector-specific<br />
guidance on infection prevention and control.<br />
Do you think the experience of COVID has accelerated the role of<br />
the ambulance sector in system working?<br />
I would like to think it has, and this has certainly been the case in the<br />
north west. One of my ambitions as AACE chair will be to work with chief<br />
executive colleagues to see what more of a role we can play in that<br />
system leadership role.<br />
The early adopter sites for the NHS 111 First model are a great example<br />
of where we’re seeing this in practice. The sites I am involved in are<br />
very much focused on system working and design to increase NHS 111<br />
capacity and manage the booking process effectively.<br />
We’ve also seen it in the ambulance sector’s ability to put in place<br />
significant command and control arrangements 24/7, locally, regionally<br />
and nationally. As regional providers, ambulance commanders and<br />
leaders have had to work across multiple local resilience forum structures,<br />
sustainability and transformation partnerships (STPs) and integrated care<br />
systems (ICSs) and have had to do so for some months now.<br />
What are your reflections on how ambulance trust leaders have<br />
worked together during the pandemic and what are your priorities<br />
as AACE chair?<br />
Trust chief executives have continually worked collaboratively through<br />
What are the examples of innovations or beneficial changes<br />
developed during the pandemic that have stood out for you?<br />
AACE has developed a publication setting out what went well and the<br />
requirements for sustaining these changes for the future. <strong>Ambulance</strong><br />
trusts will also be undertaking a lessons learned review. As the new<br />
chair of AACE I am taking the opportunity to review our strategic<br />
priorities and to take into account learning from COVID.<br />
An example of a positive change has been our ability to retrain our<br />
patient transport staff, training them to work alongside paramedics and<br />
emergency technicians and increase our 999 response capacity during<br />
COVID. This gave us real flexibility and surge capacity in those trusts<br />
with patient transport services. Something else we may want to keep in<br />
the future, particularly in our NHS 111 service, is the way we were able<br />
to deploy nursing, paramedic and medical students to support our NHS<br />
111 and 999 emergency operation centres.<br />
These workforce-related changes will also help to inform our future work<br />
with local STPs and ICSs on our staffing model and engagement with<br />
primary care networks (PCNs) on rotational models.<br />
Another change is around video consultations, particularly in the 999<br />
and NHS 111 centres, to increase our ability to safely keep patients in<br />
their local communities without the need to send an ambulance or take<br />
them to emergency departments. A mixture of face to face and video<br />
meetings is something which we want to keep and upscale in the future.<br />
Do you have any reflections on supporting staff and wellbeing?<br />
Staff and volunteers have found the last eight or nine months very<br />
difficult. We are going into unknown situations and staff are putting<br />
themselves at risk. Many people are worried about bringing the<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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175
FEATURE<br />
disease back with them to their family and loved ones. I don’t think the<br />
ambulance sector is unique in this respect. Other parts of the health and<br />
care sector will continue to be worried – it’s not just the frontline staff<br />
and volunteers but also the corporate teams, procurement, fleet, IT to<br />
name but a few and the senior leadership teams and managers who<br />
have been working flat out during this pandemic.<br />
In the north west we have five local resilience forums all running concurrently<br />
with one another at strategic, tactical and operational levels as well as the<br />
many other NHS cells and our own internal national, regional and local<br />
command and control structures in place, which has taken its toll on leaders.<br />
up further the directory of services to make sure we can book patients to<br />
emergency departments or sign post them appropriately to other parts<br />
of health and social care.<br />
We still have some of the same challenges around workforce. In line<br />
with national guidance, some staff are shielding, self-isolating or are<br />
taking additional precautions due to being in vulnerable groups. Another<br />
challenge includes the equality and diversity within our workforce and<br />
how we continue to keep our Black, Asian and minority ethnic staff and<br />
volunteers safe. We also recognise that we need to continue to do more<br />
to support our local Black, Asian and minority ethnic staff communities.<br />
We need to continue with the health and wellbeing support we have<br />
provided for staff and volunteers and keep this enhanced support in<br />
place. Some of the initiatives have included welfare vehicles, enhanced<br />
occupational health, peer support and counselling. In the north west, we<br />
have been doing additional things like bespoke podcasts around stress,<br />
anxiety, sleep and nutrition and holding Facebook live sessions to<br />
support staff. We have also extended our mental health support. Some<br />
trusts were using therapy dogs before COVID and are planning to bring<br />
them back post COVID. There is never enough you can do and we will<br />
continue to review, listen to our staff and learn going forward.<br />
Looking ahead, what support do you think the ambulance service<br />
needs from national and regional bodies to help manage COVIDrelated<br />
challenges and navigate the return to near-normal levels of<br />
non-COVID healthcare?<br />
We need a consistent seat at the table nationally, regionally and at<br />
system level as we have a huge contribution to make. I would like to see<br />
the regional and national teams ensuring that the ambulance service<br />
takes a more prominent role in the urgent and emergency care space<br />
and delivering further integration of NHS 111, 999 and patient transport<br />
services. You can see this is happening in some regions.<br />
We are heading into unknown territory and a busy period. I think that<br />
if we are able to access some of the same support we had during the<br />
earlier stages of the pandemic and are able to put resources in the right<br />
place, it could help the ambulance sector get through winter. All ten<br />
ambulance trusts were able to turn their performance green in May to<br />
early July but now performance has started to become challenged again<br />
in a number of ambulance trusts. This begs the question of whether the<br />
national and regional bodies need to review how ambulance services<br />
are commissioned and resourced.<br />
Have you been part of the NHS 111 First pilot?<br />
A number of NHS 111 providers have gone live recently with NHS 111<br />
First early adopter sites. We went live recently in the North West in<br />
Blackpool and Warrington and will be keeping a close eye on what the<br />
data from the pilot are telling us. The hope is that these pilots will show<br />
the 111 first approach to be an effective way of supporting patients<br />
to access the right care as quickly as possible and help us to better<br />
manage the ever-increasing demand for NHS services.<br />
<strong>Ambulance</strong> trusts including the north west that run both 999 and NHS 111<br />
are also speeding up how they integrate their 999 and NHS 111 services<br />
and working with commissioners to commission these services in a more<br />
strategic joined up way. It’s a complex picture currently, with one contract<br />
for NHS 111, one for 999 and different contracts with different clinical<br />
commissioning groups for patient transport. They all have different start<br />
and end dates with different lengths of contract duration.<br />
What has struck you most about the challenges you have seen<br />
during the pandemic and the ways colleagues have coped. Do you<br />
have any further personal reflections?<br />
I think it has been how everyone across the organisation has come<br />
together in the best interest of looking after patients and colleagues.<br />
What really struck me was how everybody dropped what they were<br />
doing and made themselves available to provide support and take on<br />
additional roles and functions that they wouldn’t normally do. This can<br />
also be said for how providers and others have really come together<br />
to break down organisational boundaries, overcome blockages, and<br />
worked together to open up new alternative pathways for patients and<br />
shared workforce to deal with some real pressure points.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
Are you getting a sense that activity is returning to a pre-COVID<br />
level or is activity still different?<br />
It did start to return to normal levels but is now increasingly busy again<br />
with the type of activity you would see at this time of the year. So that<br />
coupled with flu and COVID will mean we’re in for a busy winter.<br />
What are the additional challenges that you’re likely to face over the<br />
winter period?<br />
Some of it will be the demand placed on the ambulance and NHS 111<br />
services. In the north west, we are planning for at least a 20% increase<br />
in call volumes and we’re working with our system partners on opening<br />
Conclusion<br />
As we approach what is certain to be a challenging winter, it is clear<br />
that ambulance trusts have an integral role to play in the ongoing Covid<br />
response and effectively managing the increasing demand across health<br />
services. Trust leaders will be acutely focused on supporting their staff<br />
and volunteers and delivering the high quality service that their local<br />
communities need. Longer term, it is vital that ambulance trusts continue<br />
to have a seat at the table to support decision-making at national,<br />
regional and system level, recognising the value that they can bring.<br />
For more information:<br />
www.nhsproviders.org/in-conversation-with-daren-mochrie<br />
176<br />
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A Huge Thank You to The NHS from the<br />
<strong>Ambulance</strong> <strong>UK</strong> Junior Team<br />
Carys - Age 6<br />
Zoe - Age 7<br />
Luke - Age 10<br />
Joseph - Age 5<br />
Thank You<br />
Thank You<br />
Thank You<br />
Aoife - Age 4<br />
Charlotte - Age 3<br />
Rory - Age 2
FEATURE<br />
THE CHALLENGE OF TRANSFORMATIONAL<br />
TRAINING DURING THE PANDEMIC AND BEYOND<br />
“But we’ve always done it that way…” surely one of the most dangerous<br />
phrases in terms of training.<br />
and we are proud to provide a solution which allows trainees to<br />
minimise person-to-person contact.<br />
Whilst the “if it’s not broke, don’t fix it” mentality does have some<br />
credence, it can be very damaging to have a fixed, inflexible vision<br />
which never looks to the future to see what we can do to improve<br />
training, and ultimately, patient outcomes.<br />
If the pandemic has taught us anything it is that the world can change<br />
in the blink of an eye. Whilst the detrimental effect of Covid across<br />
the world cannot be understated, we should acknowledge that some<br />
benefits have arisen from the crisis, including our ability to rapidly adapt<br />
and accept new approaches to working.<br />
At Ruth Lee Ltd, we are certainly seeing an accelerating transformation<br />
process and we are especially keen to work with experts in rescue and<br />
medical sectors to develop the very best tools for effective training.<br />
You may know us for our range of rescue training manikins – for the past<br />
quarter of a century we have been working with professionals who save<br />
lives to develop manikins for a variety of simulated training exercises.<br />
From technical rescue and CPR, to water rescue and manual handling.<br />
Increasingly, during the pandemic we have been approached by teams<br />
in many sectors who need to continue with essential training whilst still<br />
maintaining safe distancing. Nowhere has this been more prevalent than<br />
the healthcare sector – demand for manikins has grown exponentially<br />
But we are always looking to the future and we’re committed to meeting<br />
the needs of your future training.<br />
With this in mind, we recently hosted several panel discussions with<br />
leading experts from the healthcare, aviation, maritime and fire and<br />
rescue sectors. These were aimed at guiding us over the next 5 years<br />
to make sure that we are giving teams the tools they need to train in<br />
the most innovative and challenging ways, which will ultimately lead to<br />
improved skills.<br />
The Future of Rescue Training<br />
One thing we have always known, is that for training to be effective,<br />
it needs to be realistic. Gone are the days of leaving a “this car is<br />
on fire” sign and expecting first responders to act in a certain way.<br />
It is unrealistic and not likely to yield any kind of realistic response.<br />
Therefore, in a genuine emergency, how can we expect these same<br />
professionals to behave positively, with confidence and skill?<br />
Likewise, how can we expect a paramedic to perform lifesaving airway<br />
management if they are under pressure from different environmental<br />
factors that they have never experienced? It’s one thing to learn how to<br />
cannulate a patient in a nice warm classroom, and quite another to put<br />
that paramedic under a partially collapsed building in a USAR drill!<br />
During our panel discussions “The Future of Rescue Training”, we<br />
discussed many aspects of training and how this has changed over the<br />
past 10 years, before looking forward to the next 10 and predicting what<br />
changes we could realistically expect across all sectors. Here are just<br />
some of our findings:<br />
Accountability and avoiding Litigation<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
Grenfell certainly sent shockwaves through the whole emergency<br />
services community. Not only was it a tragedy of epic proportions, but it<br />
opened our colleagues up to a very public enquiry where every aspect<br />
of the operation was dissected in minute detail – all in the name of<br />
accountability and liability.<br />
It is very sad to think that rescuers can be put in this position. But it<br />
has focused our minds on the importance of training to ensure that<br />
accountability is paramount through the proof of acquisition of diverse<br />
skills, at all levels.<br />
Of the experts we spoke to, all agreed that incident command and<br />
disaster management training would be a huge focus moving forwards.<br />
Working on a High Risk, Low Frequency model of training, this means<br />
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FEATURE<br />
that training needs to be increasingly dynamic, with opportunity for<br />
adaptation and interaction at all stages – allowing commanders to<br />
intensely challenge their teams whilst also stretching their own comfort<br />
zones in terms of operational preparedness.<br />
Certainly, a growing fear of litigation within the healthcare sector has<br />
impacted our growth as a business. On a weekly basis the trade press<br />
reports fines in health and social care settings which could have been<br />
avoided, or at least minimised by producing evidence of a robust and<br />
considered manual handling training programme.<br />
Improving Cross-Sector Collaboration<br />
Everyone agreed that best-practise and collaborative working is the<br />
ideal. It makes sense that we all learn from one another as many of the<br />
medical and specialist rescue skills cross over into different sectors.<br />
Increasingly, rescue teams are expected to perform medical skills to a<br />
much higher standard and vice versa, paramedics are expected to carry<br />
out lifesaving skills in a technical rescue setting such as confined space,<br />
whilst maintaining the safety of themselves, their colleagues and their<br />
patients.<br />
Therefore, it makes sense, where possible to make use of the expertise<br />
in different sectors and undertaking joint training and even policy writing.<br />
people come in all shapes and sizes and equipment must reflect this so<br />
that learners are well prepared to deal with all eventualities.<br />
Training in a Virtual World<br />
Some sectors are clearly better at adopting a ‘virtual’ world that<br />
others! In particular, the fire service and maritime sector appear to<br />
have embraced this approach which allows them to greatly increase<br />
the outcomes of their incident command training. It also addresses<br />
logistical issues, letting teams from all over the country, or in some<br />
instances, all around the world, take part in the same training scenarios<br />
for a joined-up learning experience.<br />
Of course, there is often no substitute for hands on practical training,<br />
but advancements in virtual reality and augmented reality mean that<br />
complex simulations which would previously have been extremely<br />
expensive to set up and take lots of time to prepare can be replayed<br />
over and over, whilst adapting to the responses of the learner. This<br />
clearly opens many learning opportunities, especially during the<br />
pandemic when meeting face-to-face can be problematic.<br />
Clearly, the future of training is an evolving picture – with more realism,<br />
technology and accountability key priorities for all. At Ruth Lee, we are<br />
proud to be part of that picture.<br />
Within the emergency services at least, merging of services and pooling<br />
of resources is becoming more prevalent, which can be a positive when<br />
training budget restraints mean that purchasing new and increasingly<br />
more technologically advanced equipment is hampered.<br />
Realism – addressing all demographics<br />
The arrival of high-fidelity manikins meant that it’s not just healthcare<br />
learners that increasingly expect more and more sophisticated manikins,<br />
and ones which cover all demographics from gender and race, to age<br />
and even BMI! It is important that training in all sectors considers that<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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179
FEATURE<br />
REFLECTION ON NHS NIGHTINGALE<br />
LONDON<br />
by Dr Tim Collins EdD, MSc, BSc, PGCLT, RN, Colette Laws-Chapman Pg Dip Advanced Practice, RN RNT<br />
& Louise Houslip BSc, RN<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
COVID-19 Extreme Education in Extreme<br />
Circumstances! A reflection on NHS<br />
Nightingale London<br />
The impact of COVID-19 across the globe has been unprecedented<br />
with extraordinary demands place upon healthcare professionals and<br />
organisations. During this pandemic hospitals and clinicians have had<br />
to adopt unique and innovative strategies to deal with the mass number<br />
of patients requiring hospitalisation and critical care treatment. With<br />
the initial scientific modelling suggesting that the <strong>UK</strong> would not have<br />
enough critical care capacity for the influx of COVID-19 patients, an<br />
emergency surge planning approach was taken and the cancellation<br />
of elective activity to increase potential capacity. In addition to local<br />
hospital escalation plans, the Government instructed the construction of<br />
temporary NHS Nightingale hospitals to add extra critical care capacity.<br />
The first of these hospitals was NHS Nightingale in London that was<br />
constructed in the Excel London Exhibition Centre. The hospital<br />
was announced on the 24th March <strong>2020</strong> but required considerable<br />
construction and adaptation by engineers, construction workers and<br />
the British Armed Forces. The hospital officially opened on the 3rd April<br />
under the responsibility and governance of Barts Health NHS Trust and<br />
took its first patients on the 7th April <strong>2020</strong>. The hospitals initial capacity<br />
was for 500 patients which could be expanded to take 4,000 patients,<br />
which at full capacity would require in excess of 16,000 workforce to<br />
staff and run the hospital what would be the largest hospital in the <strong>UK</strong>.<br />
Regardless of any criticism that the NHS Nightingale was afforded,<br />
what was achieved in terms of adapting an exhibition centre into a<br />
fully functional hospital within 9 days was truly remarkable and was<br />
testimony to whole systems working, effective teamwork and multiagency<br />
collaboration. Ironically the last time we had been to the Excel<br />
was to attend the Intensive Care Society (ICS) State of the Art Congress.<br />
Never in our dreams, whilst attending the ICS congress learning about<br />
the latest research in critical care would we have thought we would be<br />
returning to support with the development of a new critical care hospital<br />
in the Excel.<br />
Working as part of a multi-professional team, we were contributors to<br />
the NHS Nightingale London Education Faculty that was responsible<br />
for establishing and delivering education to support the orientation and<br />
induction of the multi-professional clinical and volunteer workforce.<br />
The design of the education programme included the use of variety of<br />
delivery modalities including didactic, simulation, workshops, clinical<br />
skills stations, discussion groups and debriefing as well as bedside<br />
clinical coaching and induction. The multi-professional faculty of<br />
educators consisting of 300 volunteer Doctors, Nurses, Allied Health<br />
Professionals and technical staff were from all areas of healthcare<br />
and healthcare education, from trainee status to retired. In addition,<br />
we had expertise from NHS Learning & Development and Health<br />
Education England staff and other agencies. It was impressive but<br />
also reassuring at the same time, that the faculty had specific expertise<br />
from psychological and well-being practitioners who were able to<br />
provide self-care support and well-being for both learners and faculty.<br />
The education faculty were supported by a core education team of 20<br />
Education & HR leads and 400 volunteers from the Mayor of London’s<br />
Team London volunteers and NHS redeployed staff whom provided<br />
valuable support with co-ordination of groups, delegate registration and<br />
attendee pathways. On reflection, the mobilisation of this education<br />
faculty who had previously not worked together, that had to urgently<br />
design, develop and implement an education curriculum within 5 days is<br />
testimony to their phenomenal teamwork, dedication and commitment.<br />
We felt extremely proud and humbled to be part of this team which in<br />
our eyes demonstrates what is great about the NHS creating a team<br />
with a common mission to unite for our patients and support the NHS!<br />
There were lots of challenges and successes on the way. Initially the<br />
education centre was set up in the Excel, but it soon became evident<br />
that the large numbers of people requiring education and the layout<br />
out of the rooms meant it was extremely difficult to maintain social<br />
distancing practices. This then led to the education facility being moved<br />
south of the Thames to The 02 Arena. Similar to the Excel, we had all<br />
seen lots of iconic bands at The 02 and never thought we would be<br />
sharing The 02 arena floor, following in the footsteps of some of the<br />
greatest performers in the world but now it was our turn to put on a<br />
performance! The 02 arena provided sufficient space to allow social<br />
distancing and was quickly established to allow up to 600 learners<br />
to attend the Nightingale Education Induction day. The curriculum<br />
involved sessions relating to corporate & clinical induction, COVID-19<br />
Resuscitation, Simulation, Critical Care Clinical and patient care Skills,<br />
Communication and Psychological PPE and well-being. Attendees<br />
were streamlined depending on their experience or anticipated role<br />
within critical care and then allocated to a curriculum pathway which<br />
was designed to meet their skill set and expertise. The groups were<br />
multi-professional that consisted of current critical care practitioners to<br />
volunteers who may have no background or training in healthcare such<br />
as musicians and airline cabin crew.<br />
As a team we were responsible for designing and writing the simulation<br />
curriculum as part of the NHS Nightingale London induction curriculum.<br />
We designed a suite of 10 simulation scenarios with lesson plans, which<br />
the faculty would use depending upon the experience of the group<br />
and pathway they had been streamed into. The simulation lesson<br />
plans focused upon clinical scenarios and non-technical skills. The<br />
aim of the education was to prepare learners for anticipated COVID-19<br />
emergencies through developing effective bedside problem-solving<br />
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FEATURE<br />
skills whilst developing social and cognitive skills to enhance team<br />
working and patient safety within the NHS Nightingale.<br />
The clinical simulations focused specifically upon COVID-19 adaptions<br />
to care which included emergency de-proning following ET tube<br />
dislodgement, ventilation failure, COVID-19 Advanced Life Support<br />
in breach of PPE, Inter-hospital transfer of a patient for ECMO and<br />
deteriorating patient. For learners with no or limited critical care<br />
experience, the modality of simulation was used to orientate them to<br />
an invasive ventilated patient and equipment that is used within critical<br />
care. The non-technical skills focused upon verbal and non-verbal<br />
communication with focus on working with PPE insitu and providing<br />
critical care in a large acoustically challenging exhibition hall that was<br />
not originally constructed as a hospital. Other non-technical skills<br />
focused upon leadership with emphasis placed on working with new<br />
team members they were not familiar with or knowing their clinical<br />
expertise. All learners were taught the principles of using a graded<br />
assertive escalation approach, closed loop communication and the use<br />
of SBAR.<br />
Providing simulation in The 02 arena provided social distancing and<br />
multiple concurrent simulation opportunities but also challenges. We<br />
had an extremely large space to provide simulation but the acoustics<br />
in the arena were challenging, making it difficult to establish rapport<br />
and to hear debriefs. The positive outcome of the Simulation area<br />
transferring to The 02 was that we were able to replicate the design of<br />
the Nightingale wards, an open critical care area in a noisy and large<br />
exhibition hall, which allowed learners the opportunity to experience as<br />
close to clinical reality as possible. Due to time restrictions, the decision<br />
was made to use the plus/delta method of facilitating simulation debrief<br />
as this provided a swift but outcome-based simulation debrief. This<br />
debrief method was also chosen as we did not know in advance the<br />
expertise of the faculty and this model allows novice and experts to<br />
debrief to successful outcome. The faculty had to be skilled to adapt to<br />
the individual needs of learners and we implemented a rapid learning<br />
improvement cycle with daily faculty briefings to allow feedback and<br />
improvements to be incorporated into the curriculum following learning<br />
incidents from the hospital as well as learner evaluations.<br />
The evaluation feedback from the learners was extremely positive with<br />
comments from attendees indicating that the education was relevant<br />
and pertinent for preparing them for their roles in the hospital. Overall in<br />
excess of 2700 people went through the education programme, which<br />
was stood down on 13th May <strong>2020</strong>. Currently, the Nightingale is in<br />
hibernation but if extra capacity is required due to an additional surge<br />
in COVID patients, the hospital could be re-opened, and the education<br />
programme restarted within short notice should the call to action be<br />
requested.<br />
Being a part of this project was a huge personal learning journey for<br />
us and we were privileged to witness what can be achieved within a<br />
short time frame, with the commitment and dedication from a multiprofessional<br />
team. We have to acknowledge all the NHS Nightingale<br />
Education Faculty who all played their role in bringing this curriculum<br />
together. We all certainly went on a learning journey together.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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181
ADVERTORIAL FEATURE<br />
The i-view, videolaryngoscopy and<br />
tracheal intubation for patients with<br />
suspected or confirmed Covid-19<br />
David Chapman, Airway Group Product Manager at Intersurgical<br />
For patients with suspected or confirmed Covid-19 who require<br />
intubation, a number of guidelines and reviews have recommended<br />
tracheal intubation is conducted with a video laryngoscope in<br />
preference to a direct laryngoscope. 1,2,3<br />
A video laryngoscope allows the clinician to view the anatomical<br />
structures on a screen or monitor, positioning them further away from<br />
the face of the patient than a direct laryngoscope, thereby potentially<br />
reducing the risk of exposure to patient respiratory aerosols and<br />
transmission of infection. 4,5<br />
Video laryngoscopy may also offer additional benefits to the clinician<br />
when intubating patients with Covid-19, where the objective is to<br />
achieve first-pass success and multiple attempts at intubation are likely<br />
to increase risk to both healthcare personnel and patients. 1<br />
A set of guidelines for managing the airway in patients with Covid-19<br />
from the <strong>UK</strong> Difficult Airway Society, the Association of Anaesthetists, the<br />
Intensive Care Society, Royal College of Anaesthetists and the Faculty of<br />
Intensive Care Medicine, has been published in the journal Anaesthesia.<br />
In a section regarding the fundamentals of airway management for<br />
a patient with suspected or confirmed Covid-19, it is recommended<br />
to, ‘Use techniques that are known to work reliably across a range of<br />
patients, including when difficulty is encountered.’ The list includes<br />
videolaryngoscopy for tracheal intubation, and a 2nd generation<br />
supraglottic airway for airway rescue. For emergency tracheal intubation,<br />
the authors confirm that, ‘laryngoscopy should be undertaken with the<br />
device most likely to achieve prompt first-pass tracheal intubation in all<br />
circumstances in that operator’s hands – in most fully trained airway<br />
managers this is likely to be a video laryngoscope.’ 1<br />
that, ‘Experienced airway staff should insert a supraglottic airway or<br />
intubate the trachea early so that the period of bag-mask ventilation<br />
is minimised. Consider video-laryngoscopy for tracheal intubation by<br />
providers familiar with its use – this will enable the intubator to remain<br />
further from the patient’s mouth.’ 6<br />
Whilst none of the above papers recommend a specific video<br />
laryngoscope, it has been suggested in some articles there may<br />
be a benefit to devices with a separate screen. In one paper, this is<br />
recommended on the basis that it enables the user to stay further<br />
away from the airway 1 . However, whether this is correct has yet to<br />
be established, since the operator is still required to hold the video<br />
laryngoscope in place, limiting the distance they can be from the<br />
patient’s head during the procedure. A separate screen may also<br />
have disadvantages, particularly if it is not optimally positioned<br />
and may draw the attention of the operator away from the patient’s<br />
head if it is not located centrally. A separate screen also introduces<br />
additional components to the intubation room and, unless single use,<br />
will be another piece of equipment requiring some form of cleaning,<br />
disinfection and reprocessing prior to reuse.<br />
With regard to the use of single use devices; recent consensus<br />
guidelines published in the journal Anaesthesia do not consider this<br />
question specifically in relation to video laryngoscopes, but they do<br />
discuss the issue in more general terms, and confirm that, ‘where<br />
practical, single-use equipment should be used.’ Of course, there are<br />
caveats to this, particularly where quality may vary between devices and<br />
the authors qualify their statement, acknowledging that, ‘where single<br />
use equipment is not of the same quality as re-usable equipment this<br />
creates a conflict.’ 1<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
In regard to resuscitation, The European Resuscitation Council<br />
Covid-19 Guidelines for Advanced Life Support in Adults, confirm<br />
Interestingly, a recently produced guidance document, entitled,<br />
‘Guidelines – Infection prevention and control <strong>2020</strong>’, (published<br />
before the Covid-19 outbreak) which does comment directly on<br />
video laryngoscopes in the context of infection control, confirming<br />
that, ‘Single-use video laryngoscopes minimise any chance of<br />
cross contamination and would be ideal, but many single-use<br />
video laryngoscopes have reusable components that need to be<br />
decontaminated after each use.’ 7 This is correct, since many devices<br />
incorporate single use blades, but still have reusable screens, monitors<br />
and handles. However, a completely single use and fully integrated<br />
disposable video laryngoscope is available to the clinician.<br />
The i-view is a single use, fully disposable video laryngoscope from<br />
Intersurgical and offers the clinician the only adult, one size, single use,<br />
disposable and fully integrated video laryngoscope with a Macintosh<br />
blade. 8 It requires no accessory products such as external monitors,<br />
cables or power source. As a result, it minimises any chance of cross<br />
182<br />
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ADVERTORIAL FEATURE<br />
contamination and eliminates concern related to the cost, availability<br />
or effectiveness of appropriate methods of decontamination and<br />
reprocessing.<br />
In addition to the infection control benefits, i-view also offers the<br />
opportunity for videolaryngoscopy wherever and whenever the clinician<br />
needs to intubate. By incorporating a Macintosh blade, i-view can<br />
also be used for direct as well as videolaryngoscopy. Where availability<br />
of a video laryngoscope may be limited due to the cost implications of<br />
purchasing reusable devices for multiple sites, i-view provides a cost<br />
effective solution, by combining all the advantages of a fully integrated<br />
video laryngoscope in a single use, disposable product. This makes<br />
i-view ideal for use in resuscitation, pre-hospital, emergency medicine,<br />
intensive care as well as for difficult airway cases and anaesthesia.<br />
Whilst there are not yet, to our knowledge, any robust randomised<br />
controlled trials (RCTs) evaluating and comparing the performance<br />
of different video laryngoscopes during the current pandemic,<br />
particularly when wearing Personal Protective Equipment (PPE), a<br />
recent RCT published in April assessed visual grading of the glottis and<br />
hemodynamic response to laryngoscopy for the i-view compared<br />
to another video laryngoscope in patients with a BMI >50kg/m 2 . This<br />
concluded that both devices allowed for safe and effective intubation<br />
in this patient group. 9 This study was conducted before the current<br />
pandemic and without PPE.<br />
As highlighted in the consensus guidelines for managing the airway<br />
in patients with Covid-19, it is important that clinicians do not use<br />
techniques that they have not used before or been properly trained<br />
in and managing the airway of a patient with confirmed or suspected<br />
Covid-19 is not the time to test new techniques. 1<br />
In conclusion, a number of guidelines regarding airway management<br />
of the patient with Covid-19 have recommended the use of video<br />
laryngoscopy in preference to direct laryngoscopy for tracheal<br />
intubation, providing the operator is competent in the technique, familiar<br />
with the device to be used and has the appropriate training. 1 In general,<br />
single use devices should be used where practical, although a conflict<br />
may be created where quality of a single use device is not the same<br />
as an alternative reusable option. 1 The i-view is a single use, fully<br />
integrated and disposable video laryngoscope with a Macintosh blade<br />
and may be ideal for use where there is a concern regarding infection<br />
control, such as during the current pandemic. Any potential user of<br />
i-view needs to be competent and fully trained with regard to its use,<br />
and i-view must always be used in accordance with the Instructions<br />
For Use supplied with the device.<br />
Information regarding i-view and a short instructional video providing<br />
an overview of the device and an introduction to the basic steps for<br />
correct use can be found at https://www.intersurgical.com/info/iview<br />
References:<br />
1. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus<br />
guidelines for managing the airway in patients with COVID-19: Guidelines from the<br />
Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society,<br />
the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists.<br />
Anaesthesia. <strong>2020</strong>;75(6):785-799. doi:10.1111/anae.15054<br />
2. Yao W, Wang T, Jiang B, et al. Emergency tracheal intubation in 202 patients<br />
with COVID-19 in Wuhan, China: lessons learnt and international expert<br />
recommendations [published online ahead of print, <strong>2020</strong> Apr 10]. Br J Anaesth.<br />
<strong>2020</strong>;S0007-0912(20)30203-8. doi:10.1016/j.bja.<strong>2020</strong>.03.026<br />
3. The World Federation of Societies of Anaesthesiologists (WFSA): Coronovirus<br />
– guidance for anaesthesia and perioperative providers https://www.wfsahq.org/<br />
latest-news/latestnews/943-coronavirus-staying-safe#covid19<br />
4. Wax RS, Christian MD. Practical recommendations for critical care and<br />
anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J<br />
Anaesth <strong>2020</strong>; 67:568–76<br />
5. Zeidan A, Bamadhaj M, Al-Faraidy M, Ali M. Videolaryngoscopy Intubation in<br />
Patients with COVID-19: How to Minimize Risk of Aerosolization? [published<br />
online ahead of print, <strong>2020</strong> May 20]. Anesthesiology. <strong>2020</strong>;10.1097/<br />
ALN.0000000000003389. doi:10.1097/ALN.0000000000003389<br />
6. European Resuscitation Council Covid-19 Guidelines. Section 3. Advanced<br />
Life Support In Adults: https://erc.edu/sites/5714e77d5e615861f00f7d18/<br />
pages/5e9ac62b4c84867335e4d1eb/files/ERC_covid19_spreads.pdf?1592906300<br />
7. Guidelines – Infection prevention & control <strong>2020</strong>. Association of Anaesthetists.<br />
<strong>2020</strong><br />
8. i-view video laryngoscope. Intersurgical. https://www.intersurgical.com/info/iview<br />
(web-site accessed 17.06.20)<br />
9. Gaszynski T. A randomized controlled study on the visual grading of the glottis and<br />
the hemodynamics response to laryngoscopy when using I-View and MacGrath Mac<br />
videolaryngoscopes in super obese patients [published online ahead of print, <strong>2020</strong><br />
Apr 2]. J Clin Monit Comput. <strong>2020</strong>;10.1007/s10877-020-00503-0. doi:10.1007/<br />
s10877-020-00503-0<br />
Contact information:<br />
Intersurgical<br />
Crane House<br />
Molly Millars Lane<br />
Wokingham<br />
Berkshire RG41 2RZ<br />
England<br />
Tel: 0118 9656 300<br />
Email: info@intersurgical.co.uk<br />
Website: www.intersurgical.co.uk/info/iview<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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183
NEWSLINE<br />
SECAMB<br />
Enhanced NHS111<br />
service launches<br />
for Kent, Medway &<br />
Sussex<br />
The NHS111 service in Kent,<br />
Medway and Sussex is being<br />
enhanced and patients can now<br />
expect a more robust response<br />
with the same expert advice<br />
now delivered by a wider range<br />
of healthcare professionals.<br />
GPs, paramedics, nurses, mental<br />
health professionals, dental<br />
nurses and pharmacists will be<br />
part of the enhanced NHS111<br />
clinical assessment service which<br />
launched today (1 October <strong>2020</strong>).<br />
People who call 111 – free from<br />
mobiles or landlines 24/7 - or<br />
access the service via www.111.<br />
nhs.uk will speak to call handlers<br />
and/or healthcare professionals<br />
who will be able to assess<br />
symptoms over the phone,<br />
issue prescriptions and directly<br />
book people into onward care<br />
appointments if they need one.<br />
summer season allowing the<br />
team to focus on the immediate<br />
response. At the peak of the<br />
pandemic, 111 health advisors<br />
were handling almost four times<br />
the usual daily call numbers.<br />
NHS111 continues to play an<br />
integral role during the pandemic,<br />
helping patients access essential<br />
NHS services and receive the<br />
care they need from the most<br />
appropriate place.<br />
The launch of the contract and<br />
clinical assessment service is the<br />
first of several enhancements via<br />
the NHS 111 service for patients<br />
across Kent, Medway and Sussex.<br />
Over the coming months,<br />
NHS111 will integrate more<br />
closely with SECAmb’s 999<br />
service and existing out-of-hours<br />
care, including providing access<br />
to evening and weekend GP<br />
appointments, home visiting<br />
services, minor injury units,<br />
urgent treatment centres and A&E<br />
departments. Across the NHS,<br />
by the end of the year, patients<br />
will also be booked a timeslot at<br />
Emergency Departments if this<br />
is deemed the most appropriate<br />
service to help and support them.<br />
SECAmb Deputy Chief Executive<br />
and Senior Responsible Officer<br />
for NHS111, David Hammond,<br />
said: “The SECAmb 111 and<br />
Integrated Urgent Care team<br />
have done an exceptional<br />
job in expanding our call<br />
handling capability and clinical<br />
assessment service, to include<br />
a wider spectrum of healthcare<br />
professionals and onward care<br />
services, whilst delivering a solid<br />
interim service under the most<br />
challenging of circumstances.<br />
I would like to thank everyone<br />
involved in achieving this and for<br />
continuing to develop NHS111 so<br />
as to better support our patients<br />
and NHS partners across Kent,<br />
Medway and Sussex.”<br />
Andrew Catto, Chief Executive<br />
of Integrated Care 24 said: “This<br />
enhanced service provides us<br />
with a really exciting opportunity<br />
to partner with South East Coast<br />
<strong>Ambulance</strong> Service to continue<br />
to deliver high quality care across<br />
the south east. We have a long<br />
history of providing services<br />
across Kent and Sussex and are<br />
delighted to have the opportunity<br />
to continue to serve patients<br />
across two large counties.<br />
“NHS111 is increasingly being seen<br />
as the gateway to urgent care and<br />
we are proud to be able to support<br />
our patients on a 24/7 basis<br />
through the delivery of this service.”<br />
NHS111 Clinical Lead for Sussex,<br />
Dr Victoria Beattie said: “NHS111<br />
will be pivotal in ensuring patients<br />
get access to the right care, at<br />
the right time and place for their<br />
symptoms. The new clinical<br />
assessment service will mean<br />
patients can talk to a doctor or<br />
healthcare professional sooner,<br />
As the lead provider, South East<br />
Coast <strong>Ambulance</strong> Service NHS<br />
Foundation Trust (SECAmb)<br />
is working in conjunction with<br />
not-for-profit social enterprise<br />
Integrated Care 24 (IC24) to<br />
deliver the enhanced service.<br />
giving patients real confidence in<br />
the care they will receive.”<br />
Senior Responsible Officer for<br />
NHS111 in Kent and Medway,<br />
Stuart Jeffery added: “We are<br />
confident that by working with<br />
the ambulance service and IC24,<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
The new five-year contract was<br />
awarded in August 2019 by NHS<br />
commissioners in Kent, Medway<br />
and Sussex and is valued at<br />
£90.5m (£18.1million in <strong>2020</strong>/21).<br />
SECAmb and IC24 already<br />
provided NHS111 to parts of the<br />
south east separately but will now<br />
work together to deliver a more<br />
joined up service.<br />
The original go-live date of 1<br />
April <strong>2020</strong> was postponed due to<br />
heightened demand brought on<br />
by the Covid-19 pandemic, and<br />
SECAmb’s interim contract was<br />
extended to bridge the spring/<br />
we will be in a good position<br />
to build the foundations for<br />
integrating urgent care across our<br />
regions and are looking forward<br />
to improvements to help people<br />
receive the right care in the right<br />
place at the right time. NHS111<br />
should be the first call for urgent<br />
medical needs.”<br />
SECAmb and IC24 continue to<br />
develop their workforces and offer<br />
a range of exciting roles, spanning<br />
both emergency and urgent care<br />
services, which can be viewed via<br />
www.secamb.nhs.uk and<br />
www.ic24.org.uk<br />
184<br />
For more news visit: www.ambulanceukonline.com
NEWSLINE<br />
Student Cathy proves<br />
it’s never too late to<br />
achieve your dreams<br />
am scared of. I feel so much more<br />
confi dent in being able to do my<br />
job and help people. At the end of<br />
the day, that’s what it’s all about,<br />
although I do look a bit like a<br />
Tellytubby in the full PPE suit!”<br />
As part of Allied Health<br />
Professions Day <strong>2020</strong> the<br />
University of Northampton was<br />
profiling each of its AHP subject<br />
areas. Wednesday 14 October<br />
was the turn of Paramedic<br />
Science.<br />
Student Cathy Goldsmith is on<br />
the cusp of fulfilling a decadesheld<br />
dream.<br />
Cathy – 58 years young and<br />
proudly one of the older members<br />
of her student cohort – originally<br />
applied to study Paramedic Science<br />
20 years ago, but for personal<br />
reasons moved into nursing.<br />
Most recently, she worked at<br />
UON’s Competence Test Centre<br />
(CTC) before fi nally enrolling<br />
on the Foundation degree in<br />
Paramedic Science in 2018.<br />
Cathy explains: “If you had asked<br />
me fi ve years ago, I would never<br />
have said I’d get to the point where<br />
I would start the degree, let alone<br />
complete all of the exams for it.<br />
I’m wonderfully surprised to say I<br />
passed all of them…I even picked<br />
up some A’s along the way!<br />
“The pandemic has made all of<br />
us ‘wobble’ a bit, but there’s been<br />
so much more to do and learn<br />
during coronavirus. All Paramedic<br />
Science students had the<br />
opportunity to join East Midlands<br />
<strong>Ambulance</strong> Service as technicians<br />
during the lockdown, due to our<br />
placements being cancelled.<br />
“My thoughts are always with<br />
the people affected by it, but<br />
as someone training to be an<br />
emergency care professional, I’ve<br />
had many opportunities to better<br />
prepare for being a paramedic.<br />
For instance, I was a lead clinician<br />
and made clinical and care<br />
decisions, but always with the<br />
back-up of a supervisor if needed.<br />
“COVID has changed our way of<br />
working, but it’s not something I<br />
Even with the pandemic and<br />
having a family, Cathy has kept<br />
herself continually busy, juggling<br />
her studies with part-time work<br />
at the CTC and continuing as a<br />
volunteer fi rst responder.<br />
In recognition of her good deeds,<br />
she was named ‘Northampton’s<br />
2019 Inspirational Woman of the<br />
Year’ as part of Northampton<br />
Borough Council’s annual<br />
International Women’s Day<br />
Celebration last year.<br />
Even though she’s nearing the<br />
end of her time as a student,<br />
Cathy will always think fondly<br />
on her time with the UON team<br />
and how the switch to ‘lockdown<br />
learning’ was handled so well.<br />
She concludes: “I am excited, sad<br />
and a little nervous about coming<br />
to the end of the course but also<br />
so proud to have shown everyone<br />
I could do it! You just have to put<br />
your mind to achieving things.<br />
“The lecturers have been<br />
amazing, always keeping in touch<br />
and keeping us motivated. COVID<br />
has been just as challenging for<br />
them as us, but we are all in the<br />
business of adapting and coping.<br />
“We had little online study groups<br />
prior to our exams, setting each<br />
other quizzes and discussing<br />
different scenarios. Our lecturers<br />
also arranged special sign-off skills<br />
sessions with a consultant from the<br />
hospital, which were very helpful.<br />
“I miss the close contact of our<br />
cohort; working with younger<br />
people certainly kept me young.<br />
For now, hugging hello is virtual or<br />
through elbow taps. That’s hard<br />
when you are in a profession that<br />
is a caring one and used to being<br />
more up close and personal. But<br />
it’s still a privilege to walk into<br />
someone’s home to help them<br />
when they most need it; I still get a<br />
buzz about this and knowing I have<br />
made it and fulfi lled my dream.”<br />
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AMBULANCE <strong>UK</strong> - DECEMBER<br />
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185
NEWSLINE<br />
St John <strong>Ambulance</strong><br />
unveils new<br />
ambulance<br />
New ‘box-body’ vehicle will<br />
fuel effi cient. They can also be<br />
driven on a B-licence. This will<br />
in time make them much more<br />
cost-effective for the charity. The<br />
environmental impact has also<br />
been improved, when comparing<br />
them to other style ambulances.<br />
revolutionise the charity’s<br />
existing fleet<br />
St John <strong>Ambulance</strong> has launched<br />
a new ‘box-body’ ambulance<br />
which will help transform the work<br />
undertaken by the charity, both<br />
as an emergency support for the<br />
NHS and at events.<br />
From a patient perspective, the<br />
smoother drive and improved<br />
handling combined with the built-in<br />
Stryker Power-LOAD and Power-<br />
PRO XT stretcher make for a much<br />
more comfortable experience. It<br />
is also less daunting for older or<br />
nervous users, as the old tail-lift<br />
alternative was particularly noisy.<br />
The new design has taken 14<br />
months to create, in collaboration<br />
with Wietmarscher Ambulanz,<br />
MAN Group, and a number of the<br />
volunteers and staff who will be<br />
using them - ensuring they are<br />
comfortable as well as practical,<br />
catering to every need of both<br />
patients and caregivers.<br />
There are many advantages to<br />
the new vehicles, they are more<br />
spacious, enabling crews to work<br />
better, and lighter with a fully<br />
automatic gearbox which makes<br />
them easier to drive and more<br />
The work that St John carries out is<br />
varied, and the previous fl eet was<br />
divided between emergency and<br />
event vehicles. These new multipurpose<br />
ambulances will rotate<br />
across both offerings, meaning they<br />
will be much more durable and will<br />
not require so much maintenance,<br />
as mileage management will be<br />
able to be maintained - another<br />
long-term reduction of cost. The<br />
modular design means that they<br />
will be much more intuitive for<br />
volunteers, which brings the added<br />
benefi t of extra safety for patients,<br />
and ease of cleaning and re-kitting.<br />
Craig Harman, National <strong>Ambulance</strong><br />
& Community Response Director<br />
comments: “Having consulted with<br />
staff and volunteers at every stage<br />
of the development of our new fl eet,<br />
we are confi dent that they provide a<br />
much-improved experience for both<br />
them and our patients. The new<br />
design gives us a larger operating<br />
space and familiarity across all<br />
vehicles which will save time and<br />
enhance the patient experience.<br />
All in all, they will make a huge<br />
difference to the work that we do,<br />
and I can’t wait to see them out on<br />
the road”.<br />
Rob Macintosh, National<br />
Fleet Manager adds: “Adding<br />
these vehicles to our fleet is<br />
a huge step forward for us,<br />
they use less fuel, require less<br />
maintenance and the upgraded<br />
engines mean that we are also<br />
making emissions savings. The<br />
multi-functional aspect of these<br />
new ambulances means that we<br />
can elongate their life span by<br />
rotating them on different types<br />
of duties. They’ll make a big<br />
difference to us now and into<br />
the future”.<br />
WHY NOT WRITE FOR US?<br />
<strong>Ambulance</strong> <strong>UK</strong> welcomes the submission of<br />
clinical papers and case reports or news that<br />
you feel will be of interest to your colleagues.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
Material submitted will be seen by those working within the public and private<br />
sector of the <strong>Ambulance</strong> Service, Air <strong>Ambulance</strong> Operators, BASICS Doctors etc.<br />
All submissions should be forwarded to info@mediapublishingcompany.com<br />
If you have any queries please contact the publisher Terry Gardner via:<br />
info@mediapublishingcompany.com<br />
186<br />
For more news visit: www.ambulanceukonline.com
NEWSLINE<br />
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IS YOUR<br />
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AMBULANCE <strong>UK</strong> - DECEMBER<br />
This document is intended solely for the use of healthcare professionals. A healthcare professional must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense<br />
medical advice and recommends that healthcare professionals be trained in the use of any particular product before using it in surgery. The information presented is intended to demonstrate the breadth of Stryker product offerings. A healthcare professional must always refer<br />
to the package insert, product label and/or instructions for use before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker<br />
representative if you have questions about the availability of Stryker products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker LUCAS, LIFEPAK, Power-PRO<br />
XT, Power-LOAD, SMRT and XPS. All other trademarks are trademarks of their respective owners or holders. The products depicted are CE marked in accordance with applicable EU Regulations and Directives. 2019-22613 10-2019<br />
Do you have anything you would like to add or include in Newsline? Please contact us and let us know.<br />
187
NEWSLINE<br />
LAS<br />
Tragedy of double<br />
bus crash in<br />
Orpington revealed<br />
in latest episode<br />
of award winning<br />
‘<strong>Ambulance</strong>’<br />
documentary<br />
Episode 5 of BAFTA award<br />
winning ‘<strong>Ambulance</strong>’, broadcast<br />
on Wednesday 14 October at<br />
9.00pm on BBC One, caught<br />
on camera the heroic efforts<br />
of London <strong>Ambulance</strong> Service<br />
crews that race to the scene of<br />
a three vehicle crash.<br />
In the middle of an already busy<br />
night shift last year on Halloween,<br />
calls start to come in to the<br />
Emergency Operations Centre<br />
with reports of multiple casualties<br />
from distressed passengers on<br />
two buses that were involved in a<br />
collision with a third vehicle.<br />
Rachel and Pete, two London<br />
<strong>Ambulance</strong> Service (LAS) incident<br />
response officers, each have<br />
around 12 miles to travel to reach<br />
the scene in Orpington where they<br />
will take control of the ambulance<br />
service’s response to the incident,<br />
coordinating the many skilled<br />
clinicians to ensure each patient<br />
gets the right care as soon as<br />
possible.<br />
The crews on scene include 10<br />
double crewed ambulances, two<br />
Advanced Paramedic Practitioners<br />
(APPs), units from the Service’s<br />
Hazardous Area Response<br />
Team (HART) and a London’s<br />
Air <strong>Ambulance</strong> team who have<br />
arrived by road. In all, around 40<br />
London <strong>Ambulance</strong> Service staff<br />
responded to the scene.<br />
Nicola and Maisie, a Mum and<br />
daughter crew who work together<br />
on a double crewed ambulance,<br />
join LAS colleagues on scene to<br />
treat the injured and traumatised.<br />
Maisie tends to one of the bus<br />
drivers, treating his injuries and<br />
comforting him as the enormity of<br />
what has just happened starts to<br />
sink in.<br />
Emergency <strong>Ambulance</strong> Crew<br />
Maisie, who has been with LAS<br />
for two years and was just 20<br />
at the time of the crash said: “A<br />
scene like that is so chaotic, it can<br />
feel overwhelming. When I look<br />
at what other people my age are<br />
seeing and experiencing, it’s very<br />
different to my job. 20 year olds<br />
don’t really find themselves in<br />
those situations.”<br />
In all, LAS treated 15 patients at<br />
the scene of the crash. Sadly, one<br />
of the bus drivers tragically died<br />
from his injuries.<br />
Garrett Emmerson, London<br />
<strong>Ambulance</strong> Service CEO, said:<br />
“It is heart-breaking to see such<br />
a scene of devastation where so<br />
many people have been injured<br />
and tragically, a London bus driver<br />
lost his life.<br />
“The expertise and<br />
professionalism of London<br />
<strong>Ambulance</strong> Service colleagues<br />
is evident for all to see, from the<br />
call handlers talking to the injured<br />
and traumatised on the phone,<br />
to the incident response officers<br />
in charge of the scene, to the<br />
paramedics providing that one to<br />
one care at the roadside.<br />
“We are constantly innovating<br />
so that we can keep pace with<br />
the various and ever-changing<br />
emergency and urgent care<br />
needs of nine million Londoners.<br />
Often today that can mean<br />
sending specialists in midwifery,<br />
or mental health, or elderly fallers.<br />
Sometimes though it means<br />
lots of resources in one place,<br />
making sense of a chaotic scene,<br />
and saving multiple lives at a<br />
significant or major incident.<br />
“We come into our own during<br />
those dark times and I take this<br />
opportunity to say thank you to<br />
everyone involved in responding<br />
to the incident in Orpington last<br />
year, and to those across the<br />
Service who have responded to<br />
any largescale incidents in the<br />
capital.”<br />
As well as the road traffic collision<br />
in Orpington, episode 5 also<br />
featured a raft of other incidents<br />
including the birth of a baby<br />
delivered at home by crew Debbie<br />
and Liam, an 86 year old woman<br />
with breathing difficulties, and a<br />
12 year old who suffered a nonserious<br />
injury in a very delicate<br />
place thanks to a dog jumping up<br />
at him!<br />
As the series passed the half way<br />
mark, it’s gripping audiences up<br />
and down the country with over<br />
3.5million viewers on the night in<br />
addition to those who watch it on<br />
catch up.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
188<br />
For further recruitment vacancies visit: www.ambulanceukonline.com
NEWSLINE<br />
Stars of BBC<br />
<strong>Ambulance</strong> reveal<br />
toll of treating<br />
trauma cases in<br />
London<br />
<strong>Ambulance</strong> crews have<br />
revealed the impact of treating<br />
patients during the course of<br />
a violent “payday” weekend in<br />
London.<br />
The fourth episode of the hit TV<br />
show <strong>Ambulance</strong>, fi lmed after<br />
people have just been paid and<br />
hit the town, gives a glimpse of<br />
what London looks like on a busy<br />
weekend and shows a series of<br />
violent incidents.<br />
It features Incident Response<br />
Offi cer Pete who is only ever sent<br />
to the most challenging jobs.<br />
Just 30 minutes into his nightshift,<br />
Pete is on his way to a woman in<br />
cardiac arrest - the 999 control<br />
room describe her as the “sickest<br />
patient in London”. Her son has<br />
called the police saying he had<br />
stabbed her.<br />
Film crews followed Pete over a<br />
single weekend in the autumn of<br />
2019 and go behind the scenes<br />
as he debriefs his colleagues after<br />
the incredibly distressing incident.<br />
He calls himself the “protector”.<br />
He said:<br />
“I’m there to protect the patient<br />
but also to protect our staff. When<br />
an incident response offi cer turns<br />
up, the crews know they can<br />
concentrate on their patient and<br />
we will keep everyone safe.<br />
“The jobs can be dangerous or<br />
traumatic and sometimes it takes<br />
its toll but crews know I’m always<br />
there for them. Not just at the<br />
scene, but whenever they need<br />
looking after. We have to look<br />
after staff so they can look after<br />
patients.”<br />
When Pete also responds to a<br />
double shooting and a group of<br />
men who have been attacked with<br />
iron bars, he reveals he moved his<br />
family out of the capital although<br />
he continues to work here.<br />
Viewers see him refl ect<br />
that London has changed<br />
dramatically over the years<br />
adding ‘there isn’t a day that<br />
goes by that London doesn’t<br />
surprise me’.<br />
Meanwhile emergency<br />
ambulance crew Stuart and<br />
crewmate paramedic Rachel rush<br />
to treat a grandmother who is<br />
believed to be in cardiac arrest<br />
causing Stuart to open up about<br />
the heartbreak of when London<br />
<strong>Ambulance</strong> Service was called<br />
to treat one of his own family.<br />
He goes on to reveal how that<br />
moment changed his life.<br />
London <strong>Ambulance</strong> Service Chief<br />
Operating Offi cer Khadir Meer<br />
said:<br />
“This episode really shines a<br />
light on the exceptional people<br />
we have working for us. They<br />
all have their individual reasons<br />
for wanting to work for London<br />
<strong>Ambulance</strong> Service but what<br />
they have in common is that they<br />
come to us wanting to make a<br />
difference; wanting to save lives.<br />
“This is true throughout the<br />
Service – on the road, in the<br />
control room or behind the<br />
scenes – everyone plays their<br />
part in caring for our patients.<br />
And as we see, there is no such<br />
thing as a quiet day caring for<br />
London.”<br />
%<br />
3<br />
YEAR<br />
WARRANTY<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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189
NEWSLINE<br />
South Central<br />
<strong>Ambulance</strong> Service<br />
taking on Mount<br />
Kilimanjaro to raise<br />
money for The<br />
<strong>Ambulance</strong> Staff<br />
Charity (TASC)<br />
Coventry, 27th October <strong>2020</strong> –<br />
On 2nd September 2021, over<br />
20 team members from across<br />
SCAS will begin the 10-day trek<br />
to climb almost 6km to the top<br />
of the mountain.<br />
Climbing Mount Kilimanjaro is<br />
a very demanding and physical<br />
undertaking which will see the<br />
team journey through dense<br />
tropical rainforests, all the way<br />
to the snow-capped peaks. The<br />
team, led by paramedics Quoc Vo<br />
and Juliet McGill, are completing<br />
their challenge to raise vital funds<br />
for TASC to continue providing<br />
services to support the <strong>UK</strong>’s<br />
ambulance staff, their family<br />
members and ambulance service<br />
volunteers. Quoc said:<br />
“The Coronavirus pandemic has<br />
taken a toll on my colleagues,<br />
and over the years I’ve seen the<br />
difference TASC can make; they<br />
are always there to help us and<br />
I wanted to do something to<br />
help them. I’ve always wanted<br />
to climb Kilimanjaro and thought<br />
now would be the perfect time to<br />
tick something off my bucket list<br />
while raising funds for a fantastic<br />
cause to help them cope with<br />
the increasing demands on their<br />
services.<br />
Even better is that I’m not doing<br />
it alone as several my colleagues<br />
are joining me on the climb to<br />
help raise money for TASC.<br />
This challenge is a year in the<br />
making. We’re not starting the<br />
climb until September next year,<br />
but the build-up, the training and<br />
the fundraising is key and starts<br />
now. Everyone is really excited<br />
and can’t wait to be on top of the<br />
mountain!”<br />
Juliet said:<br />
“TASC is such a great resource<br />
for us and I and a few of my<br />
colleagues wanted to do<br />
something together to raise<br />
money for such good cause.<br />
Climbing Kilimanjaro as a team<br />
gives us something to work<br />
towards and look forward to after<br />
the hard time we’ve all had in<br />
<strong>2020</strong>. I can’t wait!”<br />
The team are raising funds<br />
through their online JustGiving<br />
page: www.justgiving.com/<br />
fundraising/teamscas<br />
Jasmin Rana, TASC’s Director of<br />
Income Generation and Supporter<br />
Engagement said:<br />
“We’re so excited that the SCAS<br />
Team have chosen to fundraise<br />
for TASC! Demand for our<br />
services is growing year-on-year<br />
and in 2019/20 we provided<br />
56% more interventions than the<br />
previous year. The team have<br />
set themselves a real challenge<br />
which looks set to be our biggest<br />
fundraiser ever, and the vital funds<br />
they raise will make such a big<br />
impact on the people help.”<br />
Hi-Tec Europe Ltd, the creators of<br />
the very popular brand Magnum<br />
boots worn by ambulance staff<br />
across the <strong>UK</strong>, are donating a<br />
pair of boots to each climber to<br />
help them on their way. Helen<br />
Durant, Hi-Tec Europe’s European<br />
Marketing Director said:<br />
“We are delighted to supply the<br />
South Central <strong>Ambulance</strong> Staff<br />
Team with their chosen Magnum<br />
Boots when embarking on their<br />
Kilimanjaro challenge next year. We<br />
wanted to support and recognise<br />
the efforts of these individuals who<br />
been on the frontline during these<br />
unprecedented times. They are<br />
also raising funds for a worthwhile<br />
charity, TASC, The <strong>Ambulance</strong><br />
Staff Charity, that supports<br />
<strong>Ambulance</strong> staff in their time of<br />
need.”<br />
National<br />
resuscitation<br />
organisation updates<br />
process to support<br />
conversations about<br />
an individual’s<br />
care and realistic<br />
treatment choices in<br />
a future emergency<br />
COVID-19 pandemic has drawn<br />
attention to importance of<br />
person-centred discussions<br />
when making decisions about<br />
cardiopulmonary resuscitation<br />
priorities of care or treatment in an<br />
emergency, discussing what they<br />
would want to happen in advance<br />
is essential.<br />
The ReSPECT process is<br />
already widely used by health<br />
and social care organisations<br />
across England and in parts of<br />
Scotland to support them having<br />
important conversations with<br />
patients in advance about their<br />
emergency care, and whether<br />
cardiopulmonary resuscitation<br />
(CPR) should be attempted in a<br />
future emergency.<br />
The ReSPECT process is supported<br />
by a discussion guide and form<br />
and version 3 is being introduced<br />
into clinical practice today. The form<br />
is used to document the discussion<br />
and any recommendations agreed,<br />
is signed by the clinician and can<br />
be signed by the patient/ their legal<br />
proxy or family member if they wish<br />
to do so.<br />
The changes made to the form<br />
have resulted in a more patientcentred<br />
form, with increased<br />
prompts for explicit clinical<br />
reasoning. It addresses areas<br />
where misunderstandings have<br />
been reported and includes more<br />
personable and clearer language.<br />
The COVID-19 pandemic has<br />
highlighted the importance of<br />
sensitive and well-structured<br />
conversations about someone’s<br />
realistic care choices and for<br />
there to be shared understanding<br />
between professionals, patients<br />
and their families.<br />
Resuscitation Council <strong>UK</strong><br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
has updated the ReSPECT<br />
(Recommended Summary<br />
Plan for Emergency Care and<br />
Treatment) process which<br />
supports person-centred<br />
conversations about care in<br />
a future emergency following<br />
feedback from professionals,<br />
patients and their families.<br />
As patients are often not able<br />
to make decisions about their<br />
The ReSPECT process was first<br />
introduced by Resuscitation<br />
Council <strong>UK</strong> in 2016, with design<br />
expertise from the Helix Centre,<br />
Imperial College London,<br />
to support discussions and<br />
clinical recommendations<br />
about emergency care being<br />
made in advance. It was<br />
developed by experts and<br />
patient representatives keen to<br />
develop a process that supports<br />
190<br />
For more news visit: www.ambulanceukonline.com
NEWSLINE<br />
professionals, patients and / or<br />
their families having a carefully<br />
constructed and person-centred<br />
conversation. It aims to develop<br />
a shared understanding between<br />
the healthcare professional and<br />
the patient of their condition,<br />
the outcomes the patient values<br />
and those they fear and then<br />
how realistic treatments and<br />
interventions, such as CPR, fit<br />
into this.<br />
The completed form stays<br />
with the patient and should be<br />
available immediately to health<br />
professionals called to help in an<br />
emergency, whether the patient<br />
is at home, in their community<br />
or in a healthcare setting.<br />
Professionals such as ambulance<br />
crews, out-of-hours doctors, care<br />
home staff and hospital staff will<br />
be better able to make quick<br />
decisions in an emergency about<br />
how best to help if key information<br />
has been recorded on the<br />
ReSPECT form.<br />
Sue Hampshire, Director of<br />
Clinical and Service Development<br />
at Resuscitation Council <strong>UK</strong> said:<br />
“We’re pleased to be introducing<br />
updated documentation to<br />
underpin the ReSPECT process<br />
today.<br />
“Communities in around 70% of<br />
counties in England and parts<br />
of Scotland are already using<br />
the ReSPECT process and the<br />
improvements we have introduced<br />
today are based on feedback from<br />
organisations who are already<br />
using the process as well as from<br />
patients and their families.<br />
“People have different views<br />
about the care or treatments they<br />
would want if they were suddenly<br />
ill and could not make decisions<br />
about their care or treatment.<br />
The new form will support better<br />
conversations and well-informed<br />
decision-making in advance, and<br />
we are happy to be introducing it<br />
for professionals and patients.”<br />
Dr Zoe Fritz, chair of the ReSPECT<br />
subcommittee, said: “We first<br />
developed the ReSPECT process<br />
to help professionals and<br />
patients or their families achieve<br />
better conversations and better<br />
recording of important treatment<br />
recommendations. The ReSPECT<br />
process encourages discussion<br />
about the individual’s condition,<br />
what’s important to them, what<br />
their realistic options are and<br />
what the likely potential health<br />
outcomes will be.<br />
“A number of misconceptions<br />
exist about CPR and when and<br />
how recommendations not to<br />
attempt CPR are made. So, it is<br />
crucial to have a person-centred<br />
approach and conversations<br />
that aim to ensure shared<br />
understanding between the<br />
professional and patient. By<br />
doing so, any misunderstandings<br />
can be addressed, and<br />
professionals can ensure that<br />
any recommendations made are<br />
based on what’s important to the<br />
patient.”<br />
When completed, the ReSPECT<br />
form provides a clinical<br />
record of agreed and realistic<br />
recommendations that come out<br />
of that conversation between a<br />
professional and the patient or<br />
their legal proxy or family member.<br />
A person’s ReSPECT form<br />
includes recommendations<br />
about emergency treatments<br />
that could be helpful and should<br />
be considered, as well as those<br />
not wanted by or that would not<br />
work for the patient. It includes a<br />
recommendation about CPR, but<br />
that may be a recommendation<br />
that CPR is attempted, or a<br />
recommendation that it is not<br />
attempted.<br />
For more information on the<br />
ReSPECT process, visit:<br />
www.resus.org.uk/respect<br />
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AMBULANCE <strong>UK</strong> - DECEMBER<br />
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191
NEWSLINE<br />
LAS<br />
Shocking rise in<br />
suicides revealed in<br />
award-winning TV<br />
documentary<br />
<strong>Ambulance</strong> crews in London<br />
have responded to almost 40<br />
suicides or suicide attempts a<br />
day this year.<br />
Figures from London <strong>Ambulance</strong><br />
Service show crews attended<br />
an average of 37 suicides or<br />
attempted suicides a day this year<br />
compared to an average of 22 a<br />
day the year before. Five years<br />
ago the number was 17.*<br />
In north London, paramedic<br />
Rachel and her crewmate Stuart<br />
reflect on how difficult it is for<br />
crews to respond to suicides.<br />
London <strong>Ambulance</strong> Service Chief<br />
Executive Garrett Emmerson said:<br />
“Viewers will see some of the<br />
very distressing calls we get<br />
and the devastating impact on<br />
the patient’s family but also the<br />
impact on our crews and call<br />
handlers.<br />
“I’m so proud of the care and<br />
compassion shown to every<br />
single one of our patients.<br />
by Chroma, the <strong>UK</strong>’s leading<br />
national provider of arts therapies<br />
services.<br />
Research shows that music<br />
can significantly improve<br />
psychological health and<br />
wellbeing as it engages the<br />
neurochemical systems<br />
responsible for reward,<br />
motivation, pleasure, and stress.<br />
However, music therapy is not<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
The shocking figures come as an<br />
episode of the hit BBC TV show<br />
‘<strong>Ambulance</strong>’ featured a mum who<br />
calls 999 after finding her 36-yearold<br />
son hanging.<br />
Call handler Carly tells Ursula<br />
how to give her son chest<br />
compressions as ambulance<br />
crews are sent to their home.<br />
When advanced paramedic Kevin<br />
arrives he realises they cannot save<br />
Daniel. Instead he comforts Ursula<br />
as she says goodbye to her son.<br />
Kevin said: “I have certainly seen<br />
an increase in suicide over the<br />
past 20 years. The majority of<br />
them tend to be male.<br />
“You feel an empathy for the<br />
family members for what they are<br />
going through and the heartache<br />
they are going to suffer.<br />
“We haven’t found all the answers<br />
in dealing with mental health.”<br />
The same night, a 999 call comes<br />
in from a suicidal woman. The call<br />
handler keeps her on the phone<br />
until help arrives.<br />
They are on their way to a patient<br />
who has cancer. It prompts Stuart<br />
to open up about his own battle<br />
with testicular cancer when he<br />
was just 20 years old.<br />
Now 33, Stuart said: “I left it for<br />
eight months before seeing a<br />
doctor and even then I didn’t tell<br />
them I had found a lump on my<br />
testicles. I said I had belly pain or I<br />
had back pain.<br />
“I got three wrong diagnoses<br />
including appendicitis and IBS<br />
because I didn’t tell them about<br />
the lump on my testicles.”<br />
By the time Stuart did open up to<br />
doctors, the cancer had spread<br />
and he had tumours on his lymph<br />
nodes round his liver.<br />
After treating a toddler who had<br />
fallen from a bunkbed, Stuart talks<br />
candidly about how treatment<br />
left him unable to have a baby<br />
naturally but goes on to reveal<br />
some happy news.<br />
Two-year-old Adam is just one of<br />
several fallers that crews attend<br />
– falls are the biggest cause of<br />
accidental death in Britain.<br />
“This year more than ever we<br />
need to recognise the terrible toll<br />
poor mental health can have and<br />
ensure our patients - and our own<br />
people - can access the support<br />
and care they need.”<br />
Blue Light Symphony<br />
Orchestra awarded<br />
£10,000 funding for<br />
mental health support<br />
Blue Light Symphony Orchestra<br />
(BLSO), the <strong>UK</strong>’s only orchestra<br />
for all emergency services<br />
personnel, has been awarded<br />
£10,000 funding from the<br />
Coronavirus Community<br />
Support Fund, distributed by<br />
The National Lottery Community<br />
Fund.<br />
Covid-19 has given rise to<br />
an increase in mental health<br />
problems, not only in the general<br />
public, but also emergency service<br />
workers who are experiencing<br />
exceptionally increased levels of<br />
stress and anxiety.<br />
First responders need access to<br />
timely and relevant intervention<br />
but for many, finding words<br />
to express and process their<br />
emotions is difficult and the<br />
funding will be used to provide<br />
music therapy to overcome<br />
mental health issues.<br />
A feasibility pilot project, in<br />
partnership with Surrey Police and<br />
Sussex Police, Surrey Fire and<br />
Rescue Service and East Sussex<br />
Fire and Rescue will be delivered<br />
routinely offered to emergency<br />
workers as part of the support<br />
that enables them to deal with the<br />
traumatic events and situations<br />
they deal with each day.<br />
Seb Valentine, a Detective Sergeant<br />
in the Surrey Police Safeguarding<br />
Investigation Unit based in<br />
Guildford and founder of the<br />
Blue Light Symphony Orchestra,<br />
said: “This funding is vital and<br />
will enable us to deliver ground<br />
breaking music therapy sessions<br />
initially in Surrey and Sussex. This<br />
project will provide 12 weeks of<br />
group music therapy, delivered by<br />
Chroma music therapists, to 24<br />
police officers, firefighters and staff<br />
suffering from symptoms of PTSD,<br />
stress or anxiety.”<br />
“This is the first step in developing<br />
the world’s first programme<br />
of music therapy designed<br />
specifically to reduce these<br />
symptoms in emergency workers.”<br />
Daniel Thomas, joint managing<br />
director of Chroma said “We are<br />
delighted to be a part of this project,<br />
which could be the stepping-stone<br />
to providing consistent, effective<br />
therapy for all frontline staff. The<br />
work they do on a day-to-day<br />
basis is invaluable to society and in<br />
running this pilot scheme, we can<br />
begin to support them, long-term,<br />
as and when they require.”<br />
In the summer, Blue Light<br />
Symphony Orchestra held a<br />
999Run raising over £1,000 to<br />
further their aim of improving<br />
mental wellbeing in the emergency<br />
services through music.<br />
192<br />
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NEWSLINE<br />
County Air<br />
<strong>Ambulance</strong> HELP<br />
Appeal makes<br />
second £250,000<br />
donation to British<br />
Association for<br />
Immediate Care<br />
The HELP Appeal charity has<br />
presented its second annual<br />
donation of £250,000 to the<br />
British Association for Immediate<br />
Care Schemes. This 900-strong<br />
organisation, made up of medical,<br />
nursing and paramedic volunteers<br />
are divided into local and regional<br />
immediate care schemes, and are<br />
on call around the clock, seven<br />
days a week to support NHS<br />
<strong>Ambulance</strong> Services across the<br />
country. The presentation was<br />
made virtually and brings the<br />
total amount donated to British<br />
Association for Immediate Care<br />
Schemes to £500,000 so far.<br />
All of the Association’s affiliated<br />
schemes were invited to apply<br />
for grants enabled by the HELP<br />
Appeal, and as a result ten<br />
schemes have benefitted. This<br />
round of grants is funding three<br />
emergency response vehicles<br />
and addressing equipment<br />
needs for over 80 volunteer<br />
members. This includes equipping<br />
vehicles with blue lights and siren<br />
systems, satellite navigation and<br />
communication equipment, winter<br />
tyres for scheme owned vehicles<br />
and personal protective helmets<br />
and clothing for their roadside work.<br />
reach an incident quickly and<br />
safely. Last year twelve schemes<br />
benefitted, and I’m delighted that<br />
more will be receiving the HELP<br />
Appeal’s funding in <strong>2020</strong>.<br />
“The HELP Appeal focuses on<br />
saving time to save patients’<br />
lives, whilst upholding the highest<br />
of safety standards for medical<br />
professionals and the donation<br />
to the British Association for<br />
Immediate care ensures that our<br />
ethos continues.”<br />
Tony Kemp, Chief Officer, British<br />
Association for Immediate Care<br />
said:<br />
“Our schemes are all voluntary and<br />
their funds either come from their<br />
own pockets or charitable donations.<br />
The HELP Appeal’s annual grant is<br />
quite literally a lifesaver and provides<br />
for vital equipment and vehicles that<br />
otherwise would be only a dream<br />
for many.<br />
“The British Association for<br />
Immediate Care through its<br />
affiliated immediate care schemes<br />
have been providing vital life and<br />
limb saving pre-hospital care for<br />
well over 40-years. They are a vital<br />
and often unheralded resource<br />
to the NHS ambulance services<br />
bringing specialist advanced skills<br />
to a wide range of medical and<br />
trauma incidents across the <strong>UK</strong>.”<br />
Daryl Brown, Chief Executive of<br />
Magpas, based in the Mid Anglian<br />
area, which provides a helicopter<br />
and road service and is one of the<br />
BASIC schemes receiving funding<br />
said:<br />
“Magpas is delighted to receive<br />
this funding towards our new<br />
Rapid Response Vehicle for<br />
Bedfordshire. This critical care<br />
provision in Luton is absolutely<br />
essential. With high levels of<br />
traumatic injury, many parts<br />
of Bedfordshire are far away<br />
from major trauma centres and<br />
doctors working at the Luton and<br />
Dunstable Hospital tell us they<br />
are in desperate need of medics<br />
specially trained in pre-hospital<br />
emergency medicine on the<br />
ground in the county. This grant<br />
that will fund a MAGPAS Rapid<br />
Response Vehicle will be a major<br />
benefit for patients in Luton,<br />
Bedfordshire and surrounding<br />
areas, bringing quick lifesaving<br />
care to those in need.”<br />
Dr Theo Weston MBE, Chairman<br />
of BEEP based in the Lake District<br />
said:<br />
“This I fantastic news and will<br />
really give our newly energised &<br />
progressive Fund a massive boost.<br />
I am so grateful to the British<br />
Association for Immediate Care for<br />
this and to the HELP Appeal.<br />
“We are going through a very<br />
exciting period of change and<br />
expansion with several more<br />
Doctors starting to respond for us<br />
so that we are now significantly<br />
increasing our cover throughout<br />
Cumbria. This donation will<br />
consolidate these changes<br />
with immediate effect and will<br />
really help us to move forward<br />
towards providing a much more<br />
comprehensive cover for the<br />
whole of this region.”<br />
The <strong>2020</strong> grant will be<br />
distributed to BASICS Cornwall;<br />
BASICS Devon; BASICS North<br />
Staffordshire; BEEP, Penrith area;<br />
BRAVO Medics, Bristol area; East<br />
Midlands Immediate Care scheme,<br />
(EMICS); LIVES in Lincolnshire;<br />
MAGPAS in Mid Anglia; West<br />
Midlands Care Team and West<br />
Yorkshire Medic Response Team.<br />
A further round of grants from this<br />
years’ funding will be made in the<br />
new year to distribute the rest of<br />
the monies from the donation.<br />
When presenting the £250,000<br />
cheque, Robert Bertram, Chief<br />
Executive of the HELP Appeal,<br />
which also funds NHS hospital<br />
helipads said:<br />
“It’s a pleasure to make this<br />
second donation to the British<br />
Association for Immediate Care,<br />
knowing the huge difference<br />
our first one made - from brand<br />
new rapid response vehicles to<br />
safety equipment that would help<br />
the selfless BASICS’ volunteers<br />
Suffolk Accident and Rescue Service’s new rapid response vehicle, along with staff after it received £40,000<br />
to help buy the car, from the HELP Appeal’s £250,000 grant in 2019.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
For the latest <strong>Ambulance</strong> Service News visit: www.ambulancenewsdesk.com<br />
193
NEWSLINE<br />
The report also shows that<br />
Benzodiazepines,<br />
“<strong>2020</strong> has proven to be a<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
Drug deaths highest<br />
since records began<br />
Experts slam budget cuts to<br />
treatment services and rise in<br />
death toll “not a coincidence”<br />
• 1 in 5 of drug deaths intentional<br />
• Figures reveal stark North-<br />
South divide<br />
• Deaths from prescribed drugs<br />
rocket to 40%<br />
• Cocaine deaths rise for eighth<br />
consecutive year<br />
The number of deaths related<br />
to drug poisoning last year has<br />
reached the highest number since<br />
records began back in 1993, the<br />
Office for National Statistics has<br />
revealed this morning.<br />
4,393 drug related deaths were<br />
registered in 2019 in England and<br />
Wales, equivalent to an agestandardised<br />
mortality rate of 76.7<br />
deaths per million people.<br />
Detailed analysis of ONS data by<br />
drug addiction treatment experts<br />
<strong>UK</strong>AT shows a 52% rise in drug<br />
poisoning deaths in the last ten<br />
years and a 17% rise in just three<br />
years.<br />
Although the majority of deaths<br />
were recorded as accidental,<br />
<strong>UK</strong>AT’s analysis reveals that 1 in<br />
5 of all drug poisoning deaths in<br />
2019 were in fact intentional.<br />
Males accounted for two-thirds (or<br />
2,968) of drug poisoning deaths last<br />
year. 3% of men who died suffered<br />
from a mental and behavioural<br />
disorder due to drug use.<br />
The North East had a statistically<br />
significantly higher rate of deaths<br />
relating to drug misuse than all<br />
other English regions; 95 deaths<br />
per million people. The East of<br />
England had the lowest rate; 33.6<br />
deaths per million people. Today’s<br />
ONS report marks a stark and<br />
frightening north-south divide.<br />
working age people living<br />
in the most deprived areas<br />
of Wales have significantly<br />
higher mortality rates from<br />
drug poisoning. People aged<br />
between 40 and 49 years had<br />
the highest age-specific rate of<br />
drug poisoning (374.3 deaths<br />
per million), nearly seven times<br />
higher than the rate in the least<br />
deprived quintile (53.8 deaths<br />
per million).<br />
Almost half (49.2%) of all drug<br />
related deaths involved opiates<br />
such as Heroin and Morphine.<br />
Prescribed opioids such<br />
as Tramadol, Codeine,<br />
Dihydrocodeine accounted for<br />
10% (470) of all drug related<br />
deaths last year according<br />
to <strong>UK</strong>AT’s analysis; drugs<br />
prescribed to patients by their<br />
GPs.<br />
Similarly, antidepressants,<br />
also prescribed by GPs, also<br />
account for 10% of all drug<br />
deaths last year (443), up by<br />
16% in just 9 years (from 393).<br />
In 2019, there were 140 deaths<br />
from the drug Zopiclone - used<br />
to treat insomnia, a figure which<br />
has risen from just 79 deaths a<br />
decade ago.<br />
Benzodiazepines, sometimes<br />
called “benzos”, are a class<br />
of psychoactive drugs used to<br />
sedate the body and help treat<br />
anxiety. Familiar drugs within<br />
the Benzo family include Valium<br />
and Xanax. <strong>UK</strong>AT’s analysis<br />
of today’s report reveals that<br />
deaths from Benzodiazepines<br />
accounted for 9% of all dug<br />
deaths last year, up from 5% ten<br />
years ago.<br />
Collectively, <strong>UK</strong>AT’s analysis<br />
of the ONS data shows that for<br />
the types of drugs that can be<br />
prescribed by GPs - Tramadol,<br />
Codeine, Dihydrocodeine,<br />
Antidepressants, Zopiclone,<br />
Antipsychotics and even<br />
Paracetamol - the death count<br />
in 2019 stood at 1,805; 40% of<br />
all drug deaths registered last<br />
year. This is significantly higher<br />
than the collective number of<br />
deaths from the same drugs ten<br />
years ago, 1,360.<br />
Their analysis also shows that<br />
the number of deaths from<br />
illegal drugs such as Cannabis<br />
in 2019 are the highest on<br />
record at 31 deaths last year,<br />
compared to 22 in 2018 and<br />
just 7 in 2011- a rise of over<br />
300% in just 8 years.<br />
The most concerning rise is<br />
for drugs relating to Cocaine.<br />
Cocaine deaths rose for the<br />
eighth consecutive year to their<br />
highest level- accounting for<br />
16% of all deaths last year.<br />
<strong>UK</strong>AT’s analysis shows that<br />
drug poisoning deaths involving<br />
Cocaine increased 26.5% for<br />
females and 7.7% for males<br />
between 2018 and 2019.<br />
Nuno Albuquerque, Group<br />
Treatment Lead for the drug<br />
addiction treatment experts<br />
<strong>UK</strong>AT (www.ukat.co.uk)<br />
comments;<br />
“These ONS figures are<br />
saddening but unsurprising<br />
and clearly show, in black and<br />
white, that the problem isn’t<br />
going away, and it’s not getting<br />
any better. The figures show<br />
that more and more people are<br />
dying from drugs that can be<br />
prescribed by their GPs, proving<br />
that the drug problem in this<br />
country is not just one of illegal<br />
substance misuse.<br />
“We must remember that these<br />
aren’t just numbers; they’re<br />
someone’s mother, father, child<br />
or friend and we can’t stress<br />
enough the value of investing in<br />
the treatment of addiction.<br />
difficult year for many. Some will<br />
undoubtedly turn to misusing<br />
drugs as a coping mechanism.<br />
Our fear is that these figures<br />
could tip off the scale in next<br />
year’s report unless Councils<br />
take proactive, preventative<br />
action today in the investment<br />
of drug and alcohol treatment<br />
services in order to save lives.<br />
“We’ve already highlighted the<br />
drastic reduction in budget cuts<br />
to substance misuse services<br />
every year since 2013 and<br />
unfortunately, these figures now<br />
show the impact this is having<br />
on the most vulnerable people<br />
living in society. It is not a<br />
coincidence.”<br />
Help, information and support<br />
for drug misuse can be found at<br />
www.ukat.co.uk/drugs/v58/<br />
World Stroke Day<br />
raises alarm for<br />
‘second wave’ of<br />
pandemic stroke<br />
patients<br />
New statistics from the Stroke<br />
Association reveal that almost<br />
one in three (29%) stroke<br />
survivors who had a stroke<br />
during the pandemic delayed<br />
seeking emergency medical<br />
attention due to Covid-19.<br />
(1)<br />
This World Stroke Day,<br />
Thursday 29th October,<br />
the charity is asking all <strong>UK</strong><br />
governments to commit<br />
to investing in Act FAST<br />
public health messaging in<br />
preparation for any surges in<br />
Covid-19 cases.<br />
Act FAST is one of the <strong>UK</strong>’s<br />
most successful public health<br />
campaigns and has motivated<br />
people to treat stroke as a<br />
medical emergency and call 999<br />
when they see the signs and<br />
symptoms of a stroke.<br />
194<br />
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NEWSLINE<br />
Every year there are 100,000<br />
strokes across the <strong>UK</strong> (2) .<br />
Dr David Hargroves, Consultant<br />
Stroke Physician and Clinical<br />
lead for Stroke across East Kent<br />
Hospitals said: “A stroke is a<br />
life-threatening condition and<br />
a mini-stroke is a warning sign<br />
that a major stroke is likely. By<br />
acting FAST you can save lives.<br />
Remember, Face – is their face<br />
drooping on one side? Arms –<br />
can they lift them? Speech – is<br />
their speech slurred? If you spot<br />
any one of these symptoms then<br />
it’s Time to call 999. The quicker<br />
your loved one receives the right<br />
specialist treatment the better<br />
their chances of avoiding longterm<br />
disability or death.<br />
“I’d like to reassure people that<br />
our specialist stroke units are<br />
equipped and ready to treat<br />
stroke patients. So the best thing<br />
you can do if you see someone<br />
showing the signs of a stroke, is<br />
to call 999 immediately.”<br />
As the <strong>UK</strong> deals with a second<br />
wave of the pandemic, the<br />
charity is highlighting some<br />
impacts that Covid-19 has<br />
already had on public health and<br />
behaviours:<br />
• In the <strong>UK</strong>, attendances to<br />
Emergency Departments were<br />
significantly lower. Between<br />
April and June <strong>2020</strong> hospital<br />
attendances to Emergency<br />
Departments almost halved<br />
(44.7%) when compared<br />
to April to June 2019. This<br />
suggests that there are some<br />
people with potentially life<br />
threatening conditions who<br />
are risking their lives by not<br />
going to the Emergency<br />
Departments. (3-6)<br />
• Admissions to hospital stroke<br />
units in England, Wales and<br />
Northern Ireland continued to<br />
remain down. From 23 March<br />
to 30 June there were a total of<br />
19,106 stroke admissions. This<br />
is a 10.6% (21,379) drop from<br />
1 January to 31 March <strong>2020</strong><br />
and a 13.4% (22,068) drop<br />
compared to the same time<br />
(April to Jun 2019) last year. (7)<br />
• Stroke deaths in care homes<br />
were 39% higher than the fiveyear<br />
average in England and<br />
Wales, and stroke deaths in<br />
private homes doubled (52%),<br />
during the Covid-19 surge<br />
from mid-March until May. (8)<br />
• Despite being most at risk,<br />
a third of over 65s said<br />
they were likely to put off<br />
calling 999 for non-Covid life<br />
threatening conditions. (9)<br />
As new local restrictions continue<br />
to be announced and fears<br />
around contracting Covid-19<br />
mount, the Stroke Association is<br />
urging the public to treat stroke<br />
as the life-threatening condition<br />
it is.<br />
Juliet Bouverie, Chief Executive<br />
of the Stroke Association says:<br />
“We heard from stroke clinicians<br />
in the first wave that as the<br />
number of reported Covid-19<br />
cases went up, the number of<br />
people presenting at A&E with<br />
stroke dropped considerably.<br />
Strokes haven’t stopped<br />
happening, which means that<br />
people are in danger of dying<br />
at home, and not getting the<br />
treatment they need to prevent<br />
long-term disability. As we<br />
prepare for winter along with the<br />
recent increases of Covid-19<br />
cases, we want to ensure<br />
that anybody experiencing or<br />
witnessing any stroke symptoms<br />
dials 999. Stroke is a lifethreatening,<br />
medical emergency<br />
and time lost is brain lost. The<br />
quicker you act the more of a<br />
person you are likely to save,<br />
giving them hope of a better<br />
recovery.<br />
“This World Stroke Day we’re<br />
living and adapting to a new<br />
normal across the globe, just like<br />
thousands of stroke survivors<br />
do on a daily basis. As new<br />
lockdown restrictions are put in<br />
to place across different areas<br />
around the <strong>UK</strong>, everybody needs<br />
to know the signs of a stroke<br />
by using the FAST test (Face<br />
Arms Speech Time to call 999).<br />
A stroke can strike anyone at<br />
any time. It could happen to you<br />
or someone you love, so as a<br />
community let’s not forget those<br />
people who may be living alone.<br />
The NHS remains open and<br />
equipped to treat stroke patients.<br />
It’s vital that anybody who may<br />
be having a stroke is given the<br />
best chance of recovery because<br />
you acted FAST.”<br />
Symptoms such as facial<br />
drooping, arm weakness and<br />
speech difficulties are the most<br />
common, (but not exclusive),<br />
signs of a stroke. The signs of<br />
a TIA/mini-stroke are the same<br />
as a stroke, but leave within 24<br />
hours. A TIA/mini-stroke is a sign<br />
that a full stroke could be on the<br />
way.<br />
Other signs of stroke can<br />
include:<br />
• Sudden weakness or<br />
numbness on one side of the<br />
body, including legs, hands or<br />
feet.<br />
• Difficulty finding words or<br />
speaking in clear sentences.<br />
• Sudden blurred vision or loss<br />
of sight in one or both eyes.<br />
• Sudden memory loss or<br />
confusion, and dizziness or a<br />
sudden fall.<br />
• A sudden, severe headache.<br />
If you spot any one of these<br />
signs of a stroke, don’t wait. Call<br />
999 straight away.<br />
For more information about<br />
stroke and the Act FAST<br />
campaign go to www.stroke.<br />
org.uk/fast.<br />
References<br />
1. Stroke Recoveries at Risk<br />
Report. Stroke Association<br />
<strong>2020</strong>.<br />
2. Stroke Statistics, Stroke<br />
Association <strong>2020</strong>; https://www.<br />
stroke.org.uk/what-is-stroke/<br />
stroke-statistics<br />
3. England: Gov.uk; Emergency<br />
department: weekly bulletins<br />
for <strong>2020</strong>: https://www.gov.<br />
uk/government/publications/<br />
emergency-departmentweekly-bulletins-for-<strong>2020</strong><br />
4. Scotland: ISDA Scotland; NHS<br />
Performs - weekly update of<br />
emergency department activity<br />
and waiting time statistics:<br />
https://beta.isdscotland.org/<br />
find-publications-and-data/<br />
health-services/hospital-care/<br />
nhs-performs-weekly-updateof-emergency-departmentactivity-and-waiting-timestatistics/<br />
5. Wales: StatsWales; Number<br />
of attendances in NHS Wales<br />
accident and emergency<br />
departments by age band, sex<br />
and site: https://statswales.<br />
gov.wales/Catalogue/<br />
Health-and-Social-Care/<br />
NHS-Hospital-Waiting-Times/<br />
Accident-and-Emergency/<br />
accidentemergencyattendancesby-age-sex-site<br />
6. Northern Ireland: Department<br />
of Health; Emergency Care<br />
Waiting Times: https://www.<br />
health-ni.gov.uk/sites/default/<br />
files/publications/health/hsniwts-ecwt-data-q1-20-21.<br />
html#all-types<br />
7. Sentinel Stroke National<br />
Audit Programme (SSNAP)<br />
clinical audit data: https://<br />
www.strokeaudit.org/results/<br />
Clinical-audit/National-<br />
Results.aspx<br />
8. Office of National Statistics<br />
(ONS); Analysis of death<br />
registrations not involving<br />
coronavirus (COVID-19),<br />
England and Wales: 28<br />
<strong>December</strong> 2019 to 1 May<br />
<strong>2020</strong>.<br />
9. Taken from market research<br />
specialists, Eden Stanley,<br />
based on their monthly<br />
survey of 1,000 respondents<br />
conducted 1 – 31 May <strong>2020</strong>.<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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195
NEWSLINE<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
New way of giving lifesaving<br />
drug will help<br />
frontline responders<br />
save the lives of<br />
trauma victims<br />
Intramuscular tranexamic acid<br />
injection could mean more<br />
patients treated in the ‘golden<br />
hour’<br />
A life-saving treatment for<br />
bleeding trauma victims,<br />
tranexamic acid (TXA), can now<br />
be given by a simple injection at<br />
the scene of the injury, according<br />
to a new study in British Journal of<br />
Anaesthesia.<br />
TXA, a drug that prevents severe<br />
bleeding after injury by inhibiting<br />
blood clot breakdown, is most<br />
effective when given soon after<br />
injury. Every 15 minutes treatment<br />
delay reduces its lifesaving potential<br />
by 10%. However, currently only 3%<br />
of <strong>UK</strong> trauma victims get TXA within<br />
an hour of injury.<br />
The drug is usually given by<br />
intravenous injection (IV) but<br />
securing an intravenous line can<br />
take time and the drug has to be<br />
injected slowly. This new research,<br />
led by the London School of<br />
Hygiene & Tropical Medicine<br />
(LSHTM) with partners including<br />
The Royal London Hospital and<br />
St George’s Hospital, shows<br />
that TXA can also be given by<br />
intramuscular injection (IM), just<br />
like a flu jab, which requires less<br />
training and takes less time. They<br />
found that the drug is rapidly<br />
absorbed from muscles and there<br />
were no local adverse effects.<br />
This means TXA can be given<br />
by first responders, greatly<br />
expanding access to urgent<br />
treatment. This could improve<br />
trauma care around the world,<br />
especially in low- and middleincome<br />
countries where most<br />
trauma deaths occur.<br />
Dr Ian Roberts from LSHTM who<br />
led the study said: “An urgent<br />
injection of TXA is life-saving after<br />
serious injury but patients are<br />
not being treated fast enough.<br />
A rapid intramuscular injection<br />
given by first responders or<br />
paramedics could mean the<br />
difference between life and<br />
death. Intramuscular TXA is like a<br />
vaccine against trauma death.”<br />
Every year, around five million<br />
people worldwide die from<br />
injuries. More than 90% of trauma<br />
deaths occurring in low- and<br />
middle-income countries, and up<br />
to 80% of deaths occurring prior<br />
to hospital arrival. Tranexamic<br />
acid is the only proven lifesaving<br />
treatment.<br />
Previously work by a global<br />
collaboration led by LSHTM<br />
showed that TXA can reduce<br />
deaths in injury victims by up to<br />
one third provided that it is given<br />
promptly.<br />
In this study, 30 bleeding trauma<br />
patients admitted into two <strong>UK</strong><br />
trauma hospitals were given the<br />
first dose of TXA intravenously,<br />
as per guidelines, but the second<br />
dose by IM injection. The team<br />
then collected blood samples,<br />
monitored injection sites and<br />
measured TXA concentrations.<br />
The team found that intramuscular<br />
TXA is well tolerated with only<br />
mild and transient injection site<br />
reactions – some redness and<br />
transient swelling - nothing else.<br />
Importantly, TXA was rapidly<br />
absorbed from muscle reaching<br />
the levels needed to save lives<br />
within 15 minutes even in the<br />
sickest patients.<br />
Dr Ian Roberts said: “The fact TXA<br />
can be given by intramuscular<br />
injection could be a gamechanger<br />
for increasing the survival<br />
chances of trauma victims.<br />
A simple auto injector device<br />
that could be used by lay first<br />
responders or police officers -<br />
before the ambulance arrives<br />
- could save thousands of lives<br />
each year. It could also be used<br />
by wounded soldiers either on<br />
themselves or a buddy.”<br />
The research team is now working<br />
with the British military on an<br />
autoinjector for battlefield use.<br />
The authors acknowledge that this<br />
would need proper field testing<br />
before adoption.<br />
SECAMB<br />
Sussex couple<br />
thank quick-thinking<br />
ambulance crew<br />
A couple from Felpham, West<br />
Sussex, have praised the<br />
actions of a South East Coast<br />
<strong>Ambulance</strong> (SECAmb) crew<br />
who came to the aid of their<br />
three-year-old son.<br />
Mum, Amy Hickling and dad Ian<br />
Cole, have thanked friend and<br />
neighbour, paramedic Steve<br />
Leggatt and his crew mate Keith<br />
Roskilly for the quick treatment they<br />
provided to son Mason, after he<br />
suffered a severe allergic reaction.<br />
Police officer, Amy and sales<br />
manager Ian were at home eating<br />
dinner with Mason on 18 August<br />
when his face, lips and tongue<br />
became swollen and his breathing<br />
laboured after he ate some curry<br />
and mango chutney.<br />
Looking for some initial<br />
advice, the couple phoned<br />
Steve. Realising the potential<br />
seriousness of the situation, he<br />
called into the control room and<br />
requested he and Keith, who were<br />
by chance on shift in the area, be<br />
diverted from a lower priority call.<br />
Arriving at the family’s home in<br />
less than two minutes, the pair<br />
could see they were going to<br />
have to act swiftly. In that short<br />
time, Mason was now struggling<br />
to breath and needed urgent<br />
treatment.<br />
“We were very aware of how<br />
serious the situation was,” said<br />
Steve. “En route, with Keith<br />
driving, I was thinking ahead to<br />
what the likely course of action<br />
would be. I remember hearing<br />
Mason struggling to breath as we<br />
entered the house.”<br />
Steve and Keith placed Mason on<br />
a nebuliser and administered anti<br />
anaphylactic drugs to stabilise<br />
him. “The initial treatment worked<br />
in that Mason’s condition settled<br />
to an extent,” explained Steve.<br />
“But we knew that it was still<br />
vital that he received hospital<br />
treatment.”<br />
Mason thankfully continued to<br />
recover with further treatment and<br />
an overnight stay at St Richard’s<br />
Hospital in Chichester. While he<br />
had never suffered an allergic<br />
reaction before, despite eating<br />
products containing nuts, allergy<br />
tests have since revealed a severe<br />
peanut allergy and the family must<br />
now never leave the house without<br />
epi pens and antihistamine<br />
medicine.<br />
Ian said: “Within minutes Mason<br />
went from being a bit agitated to<br />
really starting to swell up. Steve<br />
said he could hear him over the<br />
phone and knew he needed<br />
checking quickly. They were with<br />
us so quickly and if it had been<br />
five or 10 minutes later I think we<br />
would have been in real trouble.<br />
We’re just so thankful and feel<br />
extremely lucky. There are no<br />
words to describe how grateful we<br />
are to both Steve and Keith.”<br />
Amy added: “Working for an<br />
emergency service myself I<br />
appreciate that there can often<br />
be little recognition for amazing<br />
work and in this case, life-saving<br />
work. As a family we will never be<br />
able to express our true gratitude<br />
but we hope to raise awareness<br />
to others as to how fortunate we<br />
are to have such brilliant people<br />
working for SECAmb.”<br />
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NEWSLINE<br />
NWAS<br />
North West<br />
<strong>Ambulance</strong> Service<br />
NHS Trust accredited<br />
as first Veteran<br />
Aware ambulance<br />
service.<br />
Following the week that we paid<br />
our respects on Remembrance<br />
Day, we can reveal The North<br />
West <strong>Ambulance</strong> Service NHS<br />
Trust (NWAS) has become the<br />
first Veteran Aware ambulance<br />
service.<br />
The Veterans Covenant<br />
Healthcare Alliance (VCHA) has<br />
given us this accolade as we are<br />
leading the way in improving NHS<br />
care for members of the armed<br />
forces community.<br />
NWAS will deliver care in line<br />
with the NHS commitment to the<br />
Armed Forces Covenant, ensuring<br />
that the armed forces community<br />
does not face disadvantage.<br />
Chief Executive, Daren Mochrie,<br />
said: “This is a real honour for<br />
NWAS. <strong>Ambulance</strong> trusts have<br />
only just become eligible to<br />
apply, and NWAS’ close working<br />
partnership with our armed<br />
forces has stood us in good<br />
stead. The recognition means<br />
that we have demonstrated that<br />
NWAS supports the armed forces<br />
community as an employer,<br />
and we also ensure that<br />
veterans, reservists and cadet<br />
force adult volunteers plus any<br />
other members of the armed<br />
forces community amongst our<br />
workforce are looked after, and<br />
that we have good links with<br />
other local services and service<br />
charities.”<br />
The VCHA was inspired by the<br />
heroism of Captain Noel Godfrey<br />
Chavasse VC, a doctor who<br />
gave his life rescuing men on the<br />
battlefields of the First World War.<br />
In 2014, orthopaedic surgeon<br />
Professor Tim Briggs CBE<br />
wrote The Chavasse Report on<br />
improving armed forces and<br />
veteran care while raising NHS<br />
standards and establishing a<br />
support network of hospitals was<br />
one of its recommendations. The<br />
resulting VCHA works closely<br />
with the Department of Health<br />
and Social Care, NHS England<br />
and Improvement, the Ministry of<br />
Defence, the Office for Veterans<br />
Affairs and service charities.<br />
NWAS is one of four trusts that<br />
have achieved the Veteran<br />
Aware accreditation in the last<br />
couple of weeks and brings the<br />
total number of Veteran Aware<br />
providers across the <strong>UK</strong> to 58.<br />
Professor Briggs, Chair of GIRFT,<br />
NHS National Director for Clinical<br />
Improvement and Chair of the<br />
VCHA, said: “I’m very proud to<br />
welcome four more NHS trusts to<br />
the Veterans Covenant Healthcare<br />
Alliance. They have all made a<br />
clear and important commitment<br />
to the servicemen and women of<br />
this country and their families, and<br />
it’s great to be able to recognise<br />
their hard work through this<br />
accreditation.”<br />
“I am particularly delighted to<br />
announce the accreditation of our<br />
first Veteran Aware ambulance<br />
service, which is setting an<br />
excellent example to other<br />
ambulance services to follow.<br />
Several other ambulance services<br />
are already well underway to<br />
becoming accredited as Veteran<br />
Aware.”<br />
SCAS<br />
Online exhibition by<br />
SCAS paramedic<br />
documents<br />
emergency care in<br />
the time of Covid-19<br />
South Central <strong>Ambulance</strong><br />
Service NHS Foundation<br />
Trust (SCAS) Paramedic and<br />
Photographer, Emma Williams,<br />
has launched an online gallery<br />
of a project she undertook<br />
in Summer <strong>2020</strong> to capture<br />
what it was like delivering<br />
emergency ambulance care in<br />
the COVID-19 era.<br />
Emma, who has worked for first<br />
Oxfordshire <strong>Ambulance</strong> Service<br />
and then SCAS for 26years,<br />
qualified as a paramedic in 2000<br />
having started her career in the<br />
emergency operations control<br />
room. She began to take her<br />
photography seriously around<br />
eight years ago and is completely<br />
self-taught.<br />
“These were extraordinary times<br />
as the first wave of COVID-19<br />
arrived in the <strong>UK</strong> and as a<br />
photographer as well as a<br />
paramedic, I wanted to preserve<br />
forever this snapshot of what<br />
it was like continuing to deliver<br />
compassionate, high-quality<br />
emergency care whilst making<br />
sure both we and our patients<br />
stayed safe from this terrible<br />
virus. A heartfelt thank you to<br />
the patients and colleagues who<br />
allowed me to share their stories.<br />
”With galleries and other cultural<br />
institutions closed, it is fitting<br />
that Emma’s work is being<br />
released online to a global<br />
audience. She has developed a<br />
distinctive, cinematic style to her<br />
photography which comes from<br />
her use of a Canon 5D camera<br />
combined with a freelensing<br />
approach – a method of shooting<br />
with the lens not physically<br />
attached to the camera.<br />
The online gallery is available at<br />
www.scas.nhs.uk/emergencyambulance-care-covid/and<br />
the work was shot across<br />
Oxfordshire in Summer <strong>2020</strong>. It<br />
features a range of medical and<br />
other emergencies that SCAS<br />
responded to involving patients<br />
from the very young to the elderly.<br />
Emma, in her own time, joined<br />
© Emma Williams / Instagram: @lightgreen_emma<br />
colleagues on their operational<br />
ambulance shifts and all patients<br />
and staff seen in the gallery<br />
consented to be photographed.<br />
Emma, who is based at the<br />
Trust’s Adderbury Resource<br />
Centre in Oxfordshire, is hoping to<br />
undertake a similar project across<br />
the Trust’s 999, NHS 111, patient<br />
transport and corporate services<br />
over the next few months.<br />
Her work can also be viewed on<br />
Instagram @lightgreen_emma<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
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197
IN PERSON<br />
AMBULANCE <strong>UK</strong> - DECEMBER<br />
News<br />
Air <strong>Ambulance</strong>s <strong>UK</strong><br />
Welcomes New Board<br />
Members<br />
The Board of Trustees of national charity Air<br />
<strong>Ambulance</strong>s <strong>UK</strong> is delighted to announce<br />
two new Board appointments after a<br />
competitive recruitment process.<br />
Claire Walters and Matthew Williams joined<br />
the Charity on 1st October <strong>2020</strong>, bringing with<br />
them a wealth of experience to compliment<br />
the already broad representation of skills,<br />
backgrounds and knowledge of the existing<br />
Board.<br />
They join the Charity at an exciting time, as it<br />
embarks on a new era following merger with<br />
the former professional body, the Association<br />
of Air <strong>Ambulance</strong>s, early this year; forming one<br />
national organisation to represent, champion<br />
and support the <strong>UK</strong>’s 21 air ambulance<br />
charities.<br />
Claire Walters is Chief Commercial Offi cer for<br />
Unipart Logistics, responsible for business<br />
development, marketing, strategy, leadership<br />
of customer partnerships, digital innovation,<br />
consultancy, and programme delivery across<br />
Technology, Automotive, Health, Consumer<br />
and Utilities customers in the <strong>UK</strong>, US and Asia<br />
Pacifi c. She brings a diversity of experience to<br />
the Board as well as personal experience of an<br />
air ambulance after being airlifted by Cornwall<br />
Air <strong>Ambulance</strong> following a traumatic cycling<br />
accident last summer.<br />
Matthew Williams is a Junior Doctor based<br />
in South Wales with a keen interest in prehospital<br />
emergency medicine, stemming from<br />
his emergency medicine speciality training.<br />
He is currently completing his master’s in<br />
healthcare leadership and has previous<br />
governance experience as Chair of national<br />
charity Sexpression.<br />
Heather Benjamin, Air <strong>Ambulance</strong>s <strong>UK</strong> Chair,<br />
said: “I am delighted that we have Claire and<br />
Matthew joining our Board, as we take forward<br />
the organisation in this pivotal time in our<br />
development. They bring a complimentary<br />
set of skills to the current Board members<br />
with their commercial, clinical, digital and<br />
fundraising experience. Claire and Matthew’s<br />
professional experience and personal traits will<br />
provide board leadership, with an emphasis<br />
on their compassionate and collaborative<br />
approach, which we have been developing as<br />
part of our values and approach with our air<br />
ambulance charity Members.”<br />
EEAST News<br />
Queen’s award for longserving<br />
clinician<br />
A long-serving clinician with the East of<br />
England <strong>Ambulance</strong> Service NHS Trust<br />
(EEAST) has spoken of his pride at being<br />
awarded the Queen’s <strong>Ambulance</strong> Service<br />
Medal (QAM) for the dedication he has<br />
shown to patient care during a career<br />
spanning nearly 40 years.<br />
Paul Henry, Deputy Director of Operations<br />
Support with EEAST, has been given the<br />
accolade in the Queen’s Birthday Honours<br />
list. It comes in recognition of the hard work<br />
and dedication he has shown to caring for<br />
patients and helping train the next generation<br />
of paramedics over nearly four decades.<br />
The announcement was made on Saturday<br />
(10 October) – exactly 37 years after Paul, who<br />
lives in Norwich, joined the NHS on 10 October<br />
1983.<br />
Paul started his career with Norfolk <strong>Ambulance</strong><br />
Service and went on to become one of the<br />
county’s fi rst paramedics in 1987 before taking<br />
responsibility for the training and development<br />
of all of ambulance staff in Norfolk four years’<br />
later.<br />
His dedication to patients, colleagues and<br />
his profession was recognised in 2000 when<br />
he became one of the fi rst paramedics to<br />
join the board of the Council for Professions<br />
Supplementary to Medicine, where he<br />
helped develop regulatory procedures for the<br />
profession.<br />
Since then, Paul has gone onto hold a variety<br />
of senior operational and management roles<br />
with EEAST, as well as taking responsibility<br />
for a range of major projects. These include<br />
developing business continuity plans to help<br />
mitigate the threat of the millennium bug and<br />
driving extensive infrastructure improvements,<br />
such as introducing new make ready services<br />
and new fl eet of ambulances over the past<br />
year.<br />
“I was absolutely delighted to hear the news –<br />
it was such a lovely surprise,” said Paul. “There<br />
are so many people in the ambulance service<br />
who are deserving of an award, so to be<br />
honoured in this way is absolutely fantastic.<br />
“I have fulfi lled many varied roles during nearly<br />
40 years with the service, including clinical<br />
and operational positions, as well as roles in<br />
training and support services. This has given<br />
me a signifi cant insight into the way nearly<br />
every departments works, which has stood me<br />
in good stead throughout my career.<br />
“I am particularly proud of my ability to<br />
shape positive change and keep pace with<br />
developments in the wider service while<br />
always making sure I am ready for the next<br />
challenge.”<br />
Marcus Bailey, Chief Operating Offi cer with<br />
EEAST, said: “We are delighted for Paul and<br />
incredibly proud that he has been awarded this<br />
well-deserved accolade.<br />
“He has dedicated 37 years to the ambulance<br />
service, during which time he has devoted<br />
his energy and ability to serving patients and<br />
helping the Trust to progress and ensure it is<br />
prepared to meet future demands.<br />
“On behalf of everyone at EEAST, I would like<br />
to congratulate Paul on everything he has<br />
achieved during his career and thank him for<br />
his hard work and dedication.”<br />
198<br />
For more news visit: www.ambulanceukonline.com
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