T GETHER W RKING South Central Ambulance Service

South Central Ambulance Service
NHS Trust
W RKING
T GETHER
Caring • Team work • Professionalism • Innovation
Issue 74 • January 2012
Contents
SCAS in numbers
December 11
Year to date
Number of calls................. 46,264
Number of calls............... 372,430
Total activity...................... 38,814
Total activity.................... 319,809
Activity variance............... -2.74%
Activity variance................ 2.77%
Non conveyance................ 43.7%
Non conveyance................ 42.3%
Red8 performance.......... 72.15%
Red8 performance.......... 77.52%
Ask Ed....................................... 3
RED19 performance........ 93.25%
RED19 performance........ 95.76%
Summary of the year
Number of CFR responses... 1,392
Number of CFR responses.10,559
HART..................................... 4
Patient care.......................... 5
Fleet...................................... 6
Co-responders and CFRs...... 8
Our FT journey
Misuse costs lives.................... 11
SCAS wins ‘Ambulance Trust
of the Year’ award................. 13
Counter fraud investigations.14
Over 1,000 reasons to get
an Athens username!............. 16
Incident report CO poisoning.......................... 17
We are listening..................... 18
RAF Halton’s heroes
save lives................................. 19
Swallowfield and Spencers
Woods CFRs launch 4x4
response care.......................... 20
And much more....
Number of calls equates to the number of calls received in our
three emergency operations centres (EOCs).
Total activity equates to the number of calls which received a
SCAS response or were dealt with our by clinical support desks.
Activity variance over the same period last year.
Non conveyance is the number of incidents we responded to
where the patient was not taken to hospital.
RED8 performance - indicates a performance target for an
emergency response, which is categorised as immediately lifethreatening, to reach an incident within 8 minutes from the time
a call is connected to the ambulance emergency control centre.
The national target is to respond to 75% of all these calls within 8
minutes.
RED19 performance - indicates a performance target for a
conveying response (ambulance or rapid response vehicle) to
reach an incident of a life-threatening nature within 19 minutes
from the time a call is connected to an ambulance emergency
control centre. The national target is to respond to 95% of all
these calls within 19 minutes.
CFR stands for community first responder.
PTS stands for Patient Transport Service.
� All figures are provisional. For more information, email
[email protected]
Next Board Meetings
Editor Georgie Sutton
0118 936 5679
[email protected]
Communications Department
[email protected]
Our next meetings well be held on Wednesday 25 January and Wednesday 28
March 2012, 10am-3pm.
For more information and to check the venue of the meeting , visit our website
at www.southcentralambulance.nhs.uk or email Jill Hall, our corporate
secretary, at [email protected]
2
Ed England
Pharmacy Adviser
 Pharma Q&A
Why are morphine
ampoules stored in
a safe, but the oral
morphine solution is carried in
the medicine modules?
Q
Paramedics can
administer up to 20mg
of morphine injection,
which is supplied in ampoules
of morphine 10mg in 1ml. This
is a Schedule 2 Controlled Drug,
which means there are stringent
legal requirements for the
storage and record keeping of
the morphine.
A
Paramedics can also administer
morphine sulphate oral solution
10mg in 5ml, in accordance
with the JRCALC guidelines.
This preparation of morphine
is classified as a Schedule 5
Controlled Drug, and it must
be managed in the same way
as prescription only medicines.
This is the same class as codeine
30mg tablets. When the
concentration of morphine
oral solution is above 13mg in
5ml it becomes a Schedule 2
Controlled Drug. Ambulance
services cannot currently possess
morphine oral solution of this
strength.
So, the morphine injection is
a Schedule 2 Controlled Drug
and must be stored in the safes
provided.
Q
When should oral
morphine solution be
administered?
When a patient has
not responded to oral
paracetamol and/or
ibuprofen, a weak opiate may
be appropriate. The simplest
dosage form to administer
is one or two codeine 30mg
tablets (in accordance with the
Patient Group Direction). Some
of the codeine is converted in
the liver to morphine, and this
is thought to be responsible
for part of the analgesic effect.
Codeine tablets have the
advantage of a long shelf life
compared with oral morphine
solution which has an expiry
date of 90 days from the date of
opening.
A
Oral morphine is useful for
patients who cannot swallow a
small tablet – such as children
and those with swallowing
difficulties. There will also be
times when oral paracetamol
and/or ibuprofen combined
with codeine 60mg does
not provide sufficient pain
relief. In these cases it may be
appropriate to administer oral
morphine solution.
Q
A
What are the advantages
of glyceryl trinitrate (GTN)
buccal over GTN spray?
Due to the potential risk
of administering the GTN
3
spray to multiple patients,
SCAS is slowly replacing GTN
spray with buccal GTN tablets.
The advantage of the buccal
preparation is that it allows the
slow and continuous absorption
of a low dose of GTN, rather
than the rapid absorption of a
high dose with the spray. The
GTN is then metabolised to nitric
oxide which causes peripheral
and coronary venous and arterial
vasodilation. Vasodilation means
that the vessels are expanded
and this decreases the pressure
of blood returning to the heart
(preload) and the pressure
the heart is pumping against
(afterload), as well as increasing
coronary blood flow.
For patients with left ventricular
failure, the buccal tablets
provide a continuous reduction
in the preload, which helps to
clear pulmonary congestion.
In myocardial infarction ,the
sustained nitrates reduce
the infarct size, limit infarct
expansion and improve left
ventricular function.
The continuous vasodilation
will put the patient at risk of
hypotension. The patient’s blood
pressure should be regularly
monitored and if the patient
becomes hypotensive the buccal
GTN tablet should be removed.
If you would like more
information or have a query,
please email, Ed England,
pharmacy adviser, at
[email protected]
Review of the year
Hazardous Area
Response Team
Twelve months and over 600 jobs later, HART has become an
established additional resource for SCAS. As with any new
change, it takes time to become integrated and accepted.
HART is no different, yet slowly but surely it has been finding
its feet within operations.
Every seventh week is training week for HART. This is an
opportunity to keep on top of all our initial training and to
forge new relationships with our counterparts in Hampshire
Fire and Rescue and their USAR team, Military Dockyard Fire
and Rescue teams, Hampshire Police, MOD Police, Coastguard
and the Force Support Unit to name but a few. Exercises
include rescuing casualties from fast flowing water, a collapsed
casualty tower (Calshott) or a Civil Response rescue.
Throughout the year HART has attended many varied
incidents and provided support for fire crews at multiple
pump fires, strengthened multi-agency relationships and
given clinical support to operational staff when required. Jobs have included the fire at Winchester Hospital, a fire at a
Basingstoke warehouse, RTCs and a dock rescue.
It’s hard to say what 2012 will bring, other than more of the
same. Although, it will include the Olympics - the big event on
the agenda. Whatever may happen, it should not be forgotten
that HART was formed to provide a nationalised specialised
response to major incidents requiring a specialised ambulance
response.
4
Patient Care
Review of the year
ce Service
South Central Ambulan
NHS Trust
eet
communication sh
During the past year there have been some significant
developments introduced across SCAS to improve the quality
of care we provide for our patients.
SCAS is now recognised by all social service areas as a major
partner in safeguarding both children and adults. This is due
to the standard of referrals made to social services by our
staff, and the importance they demonstrate with regard to
the wider safeguarding agenda.
We are now able to provide a better response to babies
and young children who have stopped breathing. Protocols
have been changed to enable community first responders
to attend paediatric emergencies (for babies and children
of any age) and the Air Ambulance will now routinely
be dispatched for all major paediatric incidents traumas
requiring paramedic skills.
Vehicle Communication
Sheet. Widgit Health
are 2011
Symbols. ©Widgit Softw
New communication tools (pictured left) have been
developed to assist in communicating with people who
have reduced communication skills for any reason; these
are most likely to help people who have dementia or
learning disabilities and will significantly improve the
ability to assess and manage pain for this group of people.
Other highlights for the Patient Care Directorate are:
• Standardised medicines across SCAS, including an extended range of analgesics to enable pain to
be treated appropriately.
• Agreed Patient Group Direction for prednisolone, so that appropriate patients with chronic
obstructive pulmonary disease can be treated at home by emergency care practitioners.
• Updated and extended the range of equipment, including provision of tympanic thermometers
on all vehicles, and the T-Pod pelvic splints on all double crewed ambulances.
• Supported research in SCAS, including a pharmacoeconomic study of the management of
diabetes, and the ongoing PARAMEDIC (Lucas device) trial.
• Increased the number of criminal sanctions and warning flags against the perpetrators of violence
and aggression towards staff.
• Improved the closure rate for IR1s and the amount of feedback given to staff.
• Introduced a single fax number for submitting all IR1s across SCAS.
• Set up stroke pathways across South Central.
• Established TIA referral pathways across South Central.
• Made significant improvement in the pPCI Call to Door <80 minutes across SCAS.
5
FLEET
Review of the year
Fleet management system
generally released. This also facilitates access
to file processes and manuals.
The system developments to achieve integration of the Fleet system such as the
Proactis finance system, the introduction of
RFID equipment tagging and integration
with the Make Ready systems are continuing.
Van Excellence Scheme
SCAS’s processes were the subject of an
external audit completed by the Freight
Transport Association in August and, as a
result, SCAS became the first NHS body to
achieve Van Excellence accreditation, closely
followed by the National Blood Services.
While thre have been difficulties with the
integration with the Proactis system, the
enhancement is now progressing and is at an
advanced stage.
The basic structure for the clinical equipment
enhancement has been agreed. The clinical
equipment lists have been assembled and
the tagging of equipment by the Make
Ready teams is ongoing.
Accreditation confirms that our processes
and compliance with those processes can be
held up as examples of best practice for fleet
operators.
As of January 2012, only 18 operators in the
UK have achieved accreditation. These are:
Fleet intranet pages
•
•
•
•
•
•
•
•
•
•
•
Fleet intranet pages have been established
with the content being regularly updated. This has facilitated easier access for staff to
forms and policies, particularly those covering
vehicle operations and fleet policies.
A private Fleet intranet page has also
been established to help the workshops
and administration departments interact.
The private intranet group members can
now contribute to policies before they are
6
AAH Pharmaceuticals
Balfour Beatty
British Gas
Clancy Docwra
DHL Express
Electricity North West
Enterprise
HSS Hire
Iron Mountain
J Murphy & Sons
Kelly Communications
system. This system is now being adopted by
other trusts and some police forces.
•
•
•
•
•
•
London Borough of Redbridge
Menzies
Morgan Sindall
National Blood Services
Network Rail
South Central Ambulance Service NHS
Trust
• Wakefield DH.
The points system is used to identify
operational drivers who have driving styles
that require adjustment.
There are plans to reconfigure the driving
standards department with a view to
improving performance and becoming more
proactive with driver behaviour monitoring
processes.
Fleet News - Public Sector
Fleet Safety Champion Award
Quality engineer
Following the work done towards the
Van Excellence Scheme, Head of Fleet Rick
Stillman received an award from Fleet
News for Fleet Safety Champion 2011 Public
Sector. While this was a personal award, it
is a reflection of the work done in Fleet,
Driving standards and the Driver Training
departments.
The role of quality engineer has been
introduced. The quality engineer’s role
includes the following functions:
• to monitor standards of work for both
internal and external workshops
• to train and monitor Make Ready teams
• to check vehicles, as part of the Make
Ready process
• to audit workshops and admin
department to ensure compliance with
processes
• to monitor fleet department legal
compliance, such as MoT LOLER
• Investigation of serious untoward
incidents and premature component
failure.
Driving standards
The driving standards team has been
performing well. SCAS has received a 23%
rebate, amounting to £293,000 from the
insurers QBE.
This is a reflection of our staff safe driving
habits. This has been achieved by effective
driver training and monitoring through
use of the internal driving incident points
7
Co-responders
&
community
first
responders
in 2011
It has been yet another
successful year for
the community first
responders in SCAS.
As a result of radio
advertising, we have
successfully recruited
volunteers who are
representative of the
communities we serve. We
are working in partnership
with Thames Valley Police
and their police community
support officers and have
various schemes in place
throughout our region.
We have had some new
public relations material
and, equipment has been
bought through a variety
of fundraising events and
put to good use. A further
three community responder
schemes have raised money
for the purchase of new
vehicles for their schemes.
A CFR won a sudden
arrhythmic death syndrome
(SADS) achievement award
- this shows how dedicated
our responders are.
RAF schemes have increased
in size and a further fire
scheme in Buckinghamshire
was introduced. We have
increased our static sites
and have rolled out our
paediatric training to cover
under one year old.
New administrative
processes have been put
in place and will continue
to create consistency
throughout SCAS. We have
been in attendance at many
foundation trust events,
8
recruiting members and
raising awareness about
community first responders.
Schemes have also been
raising money continually
to support themselves. Fundraising include running
recent marathons, having
quiz nights and organising
raffles in their villages.
These have proven to be
worthwhile.
In 2012, we will continue to
recruit new members, raise
awareness and continue to
work in partnership with
the Fire Service, Military,
Coastguard, RAF, local
authorities and Thames
Valley Police.
Our foundation trust journey
in 2011
Our journey towards becoming an NHS foundation trust is near completion and it is
expected that we will reach the status in March 2012.
This has entailed an intensive period of assessment by the health regulator Monitor and an
equally challenging period of commitment and dedication from staff members.
Our main milestones in 2011
February
End of our three-month public consultation.
April onsultation results published.
C
http://www.southcentralambulance.nhs.uk/foundation-trust/
foundationtrustconsultation.ashx to access the results.
April
Submission of our application to the Department of Health.
July
Our application was passed to our independent regulator Monitor for approval.
Oct-Nov Council of Governors election.
http://www.southcentralambulance.nhs.uk/foundation-trust/
governorselectionresults.ashx to view the results.
12,000
12,000
to be achieved by
11,000
31 March 2013
10,000
9,000
Gill Hodgetts, Head of Communications and
PR said: ‘We have successfully recruited new
members to the trust but we are keen to
ensure our membership is truly representative
of the communities we serve.
8,000
8,000
to be achieved by
31 March 2012
7,000
6,000
5,000
‘We need your help and local knowledge to
help us reach communities that we have had
limited contact with previously. If you can offer
us some of your time to help with recruitment
events or to tell us about contacts in local
groups this would help tremendously. Thank
you’.
� To get involved or for more information
email [email protected]
9
4,000
3,000
2,000
1,000
0
7,681
public members
to date
4,500
to be achieved by
31 March 2011
FOUNDATION TRUST MEMBERSHIP
SCAS is on the verge of reaching its
membership target of 8,000 members by
March 2012, as we have over 7,600 members to
date.
Have you completed your annual online
Information Governance assessment?
Every member of staff must complete
an online Information Governance (IG)
assessment every twelve months. If you
haven’t, you need to do so straight away!
Please log on to the Connecting for Health
website
https://www.igte-learning.
connectingforhealth.nhs.uk/igte/index.cfm
If you’ve previously done the ‘Introduction
to Information Governance’ module, then
you are required to complete the ‘refresher’
training module for this year and subsequent
years.
Please make sure you have done your
training (or refresher training) by 29
February 2012.
If you’ve not already registered, please use
your SCAS email address as your username
and generate a password
Select “learning tools”
If you haven’t already done so, complete
“Introduction to Information Governance”
If you have already done “Introduction
to Information Governance”, then please
complete “Information Governance: The
Refresher Module”
Good luck with your assessment and thank you.
10
Misuse costs lives
On Thursday 5
January 2012, SCAS
launched a campaign
to discourage misuse
of the ambulance
service.
Responding to your stories of
people misusing the service
and the audit run earlier
this year, the campaign has
been designed to highlight
all major types of ambulance
misuse.
The campaign has gone live
with a short hard-hitting film
on YouTube. As part of the campaign we
will also be working with
nursing homes, businesses,
primary care organisations
and healthcare professionals
in our area to encourage
appropriate use of the
ambulance service.
We have had massive coverage
as it has been featured in 84
different outlets across our
region so far. It has also been
broadcast on local BBC
channels and Meridian TV.
Thank you to everyone
who has helped with the
campaign, from those
involved in the initial audit
to those who enabled the
creation of the ‘viral’ video
and case studies. Please
continue to show your
support for the campaign by
spreading the message. This
hard hitting film, as well as a
crew’s views video, which can
be found at:
www.999southcentral.co.uk
You can also follow us on
Twitter: @scas999.
� The next steps of the
campaign include production
of posters, visuals appearing
on our vehicles and screening
of the video on cinema
screens across our area.
11
Results
so far...
• More than 50,000
people have viewed the
campaign
• More than 5,000 people
have watched the
Crews’ views video.
• More than 300 people
follow us on Twitter
Encourage people to
watch both videos as they
highlight the key areas of
misuse, give a personal
perspective of our crews’
experience and capture the
great work you perform on
a daily basis.
Scas Supports
Award Winning Ice Bus
South Central Ambulance
Service NHS Trust (SCAS) is
pleased to announce that
the Home Office Tilley Award
this year was awarded to
a Southampton’s Safe City
Partners scheme which includes
the In Case of Emergency (ICE)
bus. Led by Southampton City
Council, and supported by
various partner organisations
including SCAS, the scheme
won the award for its
partnership work in the Night
Time Economy to reduce crime
and disorder since 2009. The
award was hotly contested and
the Southampton scheme was
shortlisted among hundreds of
nominations from across the
country.
Area Manager South West
Hampshire Rob Kemp, said ‘We
are pleased and honoured to
accept this award on behalf
of all those at SCAS who have
contributed to the success of
this project.’
The nomination from
Southampton showcased
partnerships like the ICE bus,
Yellow Card scheme, Taxi
Marshals and Street Pastors.
SCAS actively supports the ICE
bus and ongoing partnership
work in the city. The ICE bus
is a special resource dedicated
in part to reducing demand
on A&E through providing on
the scene care and treatment
to patients injured or ill in
Southampton city centre. This
ensures all patients get the
right treatment and that those
who are injured in the city
centre on busy nights are not
dialling 999 or being taken to
A&E unnecessarily. The medical care and
treatment in the ICE bus is
provided by emergency care
12
practitioners and paramedics
from SCAS. This year the ICE
bus has led to a 22% reduction
of hospital admissions of
patients with alcohol related
injuries.
Councillor Royston Smith, from
Southampton City Council, said:
‘I am very proud that we have
won the prestigious Tilley
Award from the Home Office.
It puts Southampton on the
map as a role model in tackling
crime and setting best practice
in partnership working. We
were selected from more than
one hundred applicants in the
whole country and won first
prize out of the eight finalists.
This award acknowledges the
concerted effort all Safe City
Partners give every night in the
city centre to continue to keep
residents and visitors safe in
Southampton.’
BBC Presenter Juliet
Morris presenting
the award to Mark
Roberts (second from
left) and Neil Cook
(third from left) from
SCAS. Also pictured
is a representative
(right) from the
award sponsor
Thames Group.
SCAS WINS
‘Ambulance Trust of the Year’ award
On 8 December 2011, South
Central Ambulance Service
NHS Trust (SCAS) won
‘Ambulance Trust of the
Year’ at the 2011 Health
Business Awards ceremony,
held at the Emirates
Stadium in London.
SCAS was nominated for the
award this summer because
NHS figures showed that
it was the best performing
ambulance trust in England
in terms of response times.
The award also recognised
that SCAS continued to
improve its non-conveyance
rates, and is the national
leader in the field with
42.5% of patients being
treated without having to
be transported to hospital an increase of 3.9% over last
year.
The other trusts nominated
for the ‘Ambulance Trust
of the Year’ award were:
West Midlands Ambulance
Service, South Western
Ambulance Service and
London Ambulance Service.
Speaking about the awards,
CEO Will Hancock said,
‘Response times make a real
difference to the survival
of critically ill patients,
particularly those who have
suffered a heart attack.
Ensuring that only those
who require hospital
treatment are taken to A&E
13
keeps this service free for
those who really need it.
‘I am, therefore, proud that
SCAS has been awarded
‘Ambulance Trust of the
Year’ for achieving real
improvements in response
times and non-conveyance
rates.
‘It is a testament to all
the hard work of our staff
and partners and their
commitment to continually
strive to improve patient
care. I would to thank our
staff for embodying our
values of professionalism,
team work, innovation and
caring and congratulate
them for winning this well
deserved award.’
Fraud Focus
Counter fraud
investigations
Tracey Spragg, local counter fraud specialist
The role of the Local Counter Fraud Specialist (LCFS) incorporates all aspects of counter fraud
work - awareness, deterrence, prevention, detection, redress and inevitably the investigation
element.
All referrals or complaints are evaluated. Once an allegation has been substantiated and
evidence obtained, a course of action is followed which may lead to a criminal sanction
and/or be dealt with through the Disciplinary Policy of both SCAS and the professional
organisation of the subject, if appropriate.
To give further insight into the breadth of issues encountered within the NHS, the following
case studies are examples of issues investigated by CEAC’s LCFS team within the last few
months.
Case study 1 - Ancillary worker working while sick
The LCFS received an allegation that an individual who was employed as a part-time ancillary
worker was believed to be working via an agency at numerous local care homes while on
long term sick. The case was investigated and the LCFS established the subject had worked at
four care homes during the period of sickness. The individual was interviewed under caution
and at the conclusion of the investigation the matter was referred to HR to be dealt with
through the Disciplinary Procedure. The subject was subsequently dismissed.
14
Case study 2 - Patient false travel claims
The subject of this investigation was a patient who submitted falsified claims for
reimbursement of travel expenses. The subject was filling in blank claim forms and forging
staff signatures, authorising reimbursement for travelling to clinics they hadn’t attended.
They obtained over £500 from the trust but failed to appear for an interview. The LCFS
sought police assistance to arrest the subject and they were subsequently charged.
At court, the subject was sentenced to two months imprisonment, which was suspended for
12 months. An order to pay compensation in excess of £500 to the trust was also made.
Case study 3 - Forged documents
A Trust employee was dismissed as a direct result of the annual National Fraud Initiative
(NFI). This is a data matching exercise undertaken by the Audit Commission, the results of
which are fed back to the respective organisations for further cross referencing. The LCFS
undertook an investigation as it had been identified that the individual was a failed asylum
seeker with no entitlement to remain in the UK and no entitlement to work.
Case study 4 - Patient fraudulently obtaining
controlled drugs
An investigation showed that a patient had provided false information in order to register
with GP practices on a temporary basis. The subject stated that they were working in the
area but usually resided in Scotland. The patient also stated that their mother had been
taken ill in Spain and that they would require supply of medication for three months, while
they were out of the UK dealing with this.
A prescription for a large quantity of medicine was given and dispensed. Further
enquiries established that the subject had targeted other surgeries in Cambridgeshire
and Northamptonshire. A total of six surgeries were visited 25 times in six months. The
patient used five different names, four different dates of birth and five different temporary
addresses. Enquiries later revealed that the patient had been convicted for exactly the same
offence the previous year when they obtained in excess of 5,700 tablets.
The LCFS identified a pattern to the dates, times and frequency of the surgery visits. The
local police assisted and were present when the subject walked into surgery and arrested
them. The subject was charged with three counts of fraud and sentenced to three years
conditional discharge plus £87 costs.
Fraud is not acceptable, as ultimately it takes our valuable resource away from patient care. If you have any suspicions of fraud or corruption, please don’t be afraid to contact our Local
Counter Fraud Specialist Tracey Spragg on 01993 811634 or 07870 582196. Or email Tracey at
[email protected]
15
Over 1,000
reasons
to get an
Athens
username!
Did you know that you can have
access to over 1,000 electronic
journals, over 400 electronic
books and six key databases just
by registering for an NHS Athens
username?
For those of you needing management
information, Harvard Business Review is one
of the electronic journals available to you,
as well as databases such as Health Business
Elite and HMIC (the latter is a compilation of
data from the libraries of the DH and Kings
Fund).
The journals include BMJ and Nursing Times
and, new for 2012, The Lancet and NEJM,
plus four journals purchased specifically for
SCAS:
Registering for an Athens username is simple.
Just go to www.evidence.nhs.uk and click
on ‘Register for NHS Athens’. It works best
if you register from a computer at work.
You will then receive an email, which will
include a link. To complete setting up your
username, click on the link and give yourself
a password.
• Annals of Emergency Medicine
• European Journal of Emergency Medicine
• Journal of Emergency Nursing
• Pediatric Emergency Care.
The electronic books include a range of
general titles, plus books bought for SCAS
covering topics such as telephone triage;
airway management; wound care and study
skills.
The databases include Medline, British
Nursing Index and Embase.
Once you have your Athens username you
can use it to access the resources from any
computer with an internet connection.
For more information, and for guides on how
to access the resources, visit our intranet at
http://scasha-mcweb/core/info/content_team.
asp?team_id=194&team=Library
or from outside the SCAS network, visit the
Library website at http://www.royalberkshire.
nhs.uk/about_us/library/scas.aspx
16
incident report
CO POISONING
Robin Cruse, motorcycle paramedic
Date
27/11/2011
Location
Horndean, Waterlooville.
I was despatched to an incident
involving an elderly man,
who was found in a collapsed
state in the Horndean area of
Hampshire.
On arrival, I was taken to the
man who was unresponsive
and slumped in the corner of
an outbuilding at the rear of a
garage.
The man was vomiting, and not
responding to any commands.
He was moved into the
recovery position to ensure his
airway remained open. He was
still non responsive Glasgow
Coma Score (GCS) 3 with a
decorticate posture. Base line
observations showed a BP
and pulse rate within normal
bounds, pupils equal but with
a slower than normal response,
O2 saturations were lower than
expected at 87% on air, and
respiratory rate 30pm.
The patient had stopped
vomiting; O2 was administered
to improve his O2 sats. The
history of the afternoon was
that the gentleman’s wife
had taken him a cup of tea
at 14:30, two hours later she
again had taken him a cup of
tea, only to find him collapsed.
No explanation of why he was
in the location was given. The
patient had a past medical
history of hypertension and
hyper cholesterol.
The patient had now been
on high flow O2 for a few
minutes when he began to
respond well, with no obvious
explanation. My first thoughts:
a CVA or a cardiac event was
unlikely. The electrocardiogram
showed normal sinus rhythm
(NSR), the patient became
more responsive to GCS 14.
At this point, I was joined by
a DMA crew, I turned to the
patient’s family to try and
establish what the patient had
been doing in the outbuilding.
No unusual odour was evident,
however the door had been
opened prior to my arrival.
The patient, a keen
engineering modeller and,
unusually for him, had been
inside the area with the outer
door shut as the weather was
cold. The DMA crew found
beneath a quilt cover that
had been put on the worktop
a bottle of butane/propane
gas and alongside this a small
locomotive.
over a period of possibly up to
two hours.
As the response motorcycles
in Hampshire are equipped
with CO monitors, I decided
to check the patient using
this device. The patient had
now been moved to the DMA.
Having removed the high
flow O2 for one minute, the
patient was asked to blow into
the meter after being given
an explanation of why and
how the monitor worked. The
patient, now GCS 15 and O2
sats 95%, was completely able
to understand.
Having given an adequate
breath into the monitor, the
readings showed as 25.2 %
CoHB or 171 ppm. The normal
range for a non smoker should
be 0-1% .
These readings therefore
were abnormally high, and
the patient was conveyed to
hospital for further checks.
The patient now had improved
O2 sats 93% but was still GCS
14, he was still unable to
explain what he had been
doing.
Although this was a non fatal
incident, it does highlight
how a team working together,
piecing clues together and,
having the right equipment
- in this case the CO monitor can make a difference to the
correct diagnosis of a patient
and can lead to a positive
outcome.
The evidence was pointing
to an incident that involved
the use of butane/propane
gas to fuel and run a model
locomotive in a confined area
� My thanks to the DMA crew,
Jo Robb and James Hansford,
whose keen eyes spotted the
items under the quilt.
17
We are listening
Service Improvements across SCAS - We are continually looking to improve the
care we provide to patients and the welfare of our staff . So, whether things go well
or go wrong, we actively encourage feedback to help us develop better practices and
processes.
The following examples provide information on actions we have taken from feedback
and concerns and what we have done as a result.
YOU SAID
A member of the public expressed frustration about how calls are processed in EOC and
the length of time taken to do this.
WE DID
A senior manager from EOC spent time speaking with the complainant and was able to
explain the process fully and reassure them.
A visit to EOC was arranged.
OUTCOME
Greater public involvement.
Increased opportunities for members of the public to visit one of our EOCs to see the
process first hand.
YOU SAID
It would be good to treat more patients who have chronic obstructive pulmonary Disease
(COPD), in their own homes and not have to take them to hospital.
WE DID
We trained our emergency care practitioners to administer Prednisolone to patients who
have COPD, and authorised them to do this by means of a specific Patient Group Directive.
OUTCOME
This means that more patients will be treated at home without the need for hospital
admission.
18
Flight Lieutenant Andy Davidson (left)
and Sergeant Jon Bliss
Raf halton’s heroes save lives
Members of RAF Halton’s
First Response team saved a
life when called to assist a
man having a heart attack in
November.
Flight Lieutenant Andy
Davidson and Sergeant Jon
Bliss responded to the call in
Chesham and immediately
diagnosed the problem as
a heart issue. Immediately
they sprang into action and
performed two rounds of
cardio pulmonary resuscitation
(CPR) and defibrillated the
patient. An ambulance
arrived shortly after and
the paramedics took over
compressions. After one more
round of CPR, the patient was
breathing again and the Halton
crew was able to help the
ambulance crew in moving him
and taking his wife to hospital.
The patient had suffered
an anterior myocardiac
infarction (heart-attack) - a life
threatening condition which
could have turned out very
differently if the first responders
had not been able to provide
such a fast and high quality
professional medical care.
Dave Baker, a student
paramedic from Stoke
Mandeville said: ‘ I feel that
without the quick recognition
of the pre-arrest patient and
effective CPR, the outcome
would have been very
different for the patient.
The RAF guys did a fantastic
job. They remained calm and
professional throughout. I
know from personal experience
on the road that it is rare when
praise is given and feel this is
an occasion to give it.’
SCAS Training and Liaison
Officer Amanda Cundy,
responsible for the RAF
co-responder groups
in Oxfordshire and
Buckinghamshire, said: ‘I
would like to add my own
congratulations to the coresponder crew, whom I have
had the pleasure of training
and working with on the
scheme for some time now.
‘This incident demonstrates
the importance of early
intervention and is a classic
example of how a positive
19
outcome is achievable given this
early arrival at the patient’s side.
The team has also received a
letter from our Medical Director
Dr John Black, congratulating
them on their success.’
Jon said: ‘We are trained to
be open-minded and respond
to what we see. The patient
in question had lost sensation
in his left arm and was
experiencing chest pain. Within
minutes of us arriving he went
rapidly down hill and into full
cardiac arrest so we treated
him as per our training. It was
a good outcome.’
The Station Commander of RAF
Halton, Group Captain Chris
Elliot, added her praise among
the many messages flooding in.
She said: ‘The volunteers who
commit to the first responder
schemes do so with extreme
professionalism and pride. Their role is an important one
in the local community and,
as we saw from this incident,
a life-saving one. I have seen
some of our volunteers work
at first hand and I have been
impressed.’
Swallowfield and Spencers Wood
CFRs launch 4x4 response car
On Tuesday 29 November
Swallowfield and Spencers Wood
Community First Responder (CFR)
scheme officially launched their brand
new BMW X3 at an event in their
local community hall.
each scheme member and the tenacity of
one in particular: Gary Clark.
CFR Gary Clark, speaking about the scheme
and fundraising for the car said, ‘When I
first joined the Swallowfield and Spencers
Wood CFRs in October 2010, I never thought
it would be so much fun, that I would
meet such great people and that I would
be spearheading a fundraising project that
has raised over £30,000 in less than a year!
We had never done this before, but with
determined hard work we did it and we
are now able to respond to any call in any
weather for our community.’
The past two winters have demonstrated
the need for 4x4 response vehicles in rural
locations, and now this CFR scheme will be
able to respond to 999 medical emergencies
in any weather in their area.
CFRs, ambulance staff, contributors to the
scheme and local patients, who have been
treated by the volunteers, turned out to see
the new vehicle which will greatly benefit
the local community.
Ian Hammond added, ‘Gary has been a major
force in our fundraising efforts. This car is a
first for CFR schemes in Berkshire; a brilliant
achievement where community participation
effectively works to help that same
community. We have also been nominated
for a Prime Minister’s Big Society Award.
The Swallowfield and Spencers Wood CFR
scheme was set up in 2008 by Ian Hammond,
who has built the team from a one-manresponse-unit to a scheme with six members.
They put their fundraising success down to
the full utilisation of the diverse skills of
20
Congratulations to the Crowthorne and Wokingham Without Community First
Responders who have been awarded in November 2011 a Community Award
for their hard work.
Welsh Ambulance Open
Whitchurch Golf Club
Cardiff - 26 April 2012
• 18 Hole Stableford Competition Max
Handicap 18
• Bacon roll and coffee on arrival
• First Tee: 09.30am
• Two-course dinner (vegetarian option
available)
• Presentation of prizes
• (Order of dress – Lounge suites, NO jeans)
• £40, includes twos and longest drive and
nearest the pin prizes.
• Raffle Tickets on the day.
For more information, please contact
Andy Gambles 07969 921403
[email protected]
Ian Price 07973118188
[email protected] Richard Timothy 07515 191347
[email protected]
21
What others say about us
l I am to the
‘I would like to say how gratefu
scene to help
the
on
t
paramedic who was firs
she did for
at
wh
e
me. Words cannot describ
it was not for
If
n.
me and she was all on her ow
Because of the
her, I would not be alive today.
e me I have
excellent life saving care she gav
edic. Cannot
decided on a career as a param
thank her enough.’
Buckinghamshire
‘I cannot speak too highly of the way in which [the
crew] dealt with the situation. I was confident that
I was receiving the correct care and attention in
a very professional way. Thank you to them both
and their colleagues who strive to maintain high
standards often in difficult situations.’
Hampshire
‘The crew that came out to me I cannot
speak more highly of them. They treated
me with total respect. I think in this day
and age too many people complain and
not enough people say thank you. So, many
many thanks to the team who looked after
me on that day.’
Berkshire
‘Thank you for your help with regard to this letter.
Needless to say the motorway jammed up, but
remarkably the police, some paramedics and a
support unit were with us within about 8 minutes.
My friend and I were shown into the ambulance to
be checked over. We were both hugely impressed
by the kindness, courtesy and professionalism with
which we were treated. I would like you to pass on
to the two paramedics our grateful thanks for all
they did for us. As I say, please thank both so much
for us and say how impressed we were with our
first experience of the service.’
I would like to compliment you on the
excellent and speedy attention received.
[The crew] arrived incredibly quickly and
gave him pain relief and much assistance and
then drove to the hospital very considerately,
so that we were able to follow [the crew]
without any difficulty. We are delighted in
every way with the way in which [the crew]
handled the matter and wish to express our
great appreciation.’
Oxfordshire
Oxfordshire
to thank the
‘Me and my husband would like
life when he
paramedics that saved out son’s
ng staff our
azi
choked. If it wasn’t for your am
d. We can’t
two year old son would have die
rything they
thank paramedics enough for eve
a fantastic job
did on that day. You all do such
and you really are all heroes.’
Berkshire
to myself.
‘I had to have an ambulance out
were from
I’m sure the crew told me they
nk them very
Milton Keynes, I just want to tha
reassurance
much for their quick response,
and know we
and kindness. I’m a carer myself
n we deserve.’
don’t always get the recognitio
Buckinghamshire
Commercial Training
‘The trainer was excellent, answered all our
questions and used his own experiences,
which helped to picture different situations.’
Delegate from Slough Borough Council
‘Thought trainer was brilliant! Very
engaging, very good tutor.’
Delegate from Berkshire Healthcare
Foundation Trust
‘Thank you to those who attended me when I
was taken ill, they were really professional but
also very caring in their treatment of me after
my collapse, please give my heartfelt thanks to
them.’
Hampshire
‘Best refresher course I’ve been on – practical
and memorable.’
Delegate from Berkshire Healthcare
Foundation Trust
22
Goodbye to...
Welcome to...
Comings & Goings
First name
Surname
Job title
Location
Julie
Allen
Emergency Care Assistant
Resource Centre - Nursling
Kristian
Bowbrick
Emergency Care Assistant
Resource Centre - Portsmouth
Paul
Bowden
Emergency Care Assistant
Resource Centre - Portsmouth
Simon
Bunting
Emergency Care Assistant
Resource Centre - Nursling
Naomi
Hallett
Emergency Care Assistant
Resource Centre - Nursling
Audrey
Hammond-White Multi Skilled Control Assistant
PTS Ox-Bucks Call Centre
Jonathan
Harvey
Emergency Care Assistant
Resource Centre - Portsmouth
Scott
Jenkins
Emergency Care Assistant
Resource Centre - Portsmouth
Harry
Lane
Emergency Care Assistant
Resource Centre - Nursling
Emma
Lewis
Emergency Care Assistant
Resource Centre - Portsmouth
Lance
Parsons
Emergency Care Assistant
Resource Centre - High Wycombe
Daniel
Reeve
Emergency Care Assistant
Resource Centre - Nursling
Laura
Shepard
Emergency Care Assistant
Resource Centre - Basingstoke
Timothy
Short
Emergency Care Assistant
Resource Centre - Basingstoke
Jamie
Smith
Emergency Care Assistant
Resource Centre - Portsmouth
Craig
Turner
Emergency Care Assistant
Resource Centre - Newbury
First Name
Surname
Job title
Location
David
Bloomer
Driver - NPTS
Logistics Services Oxon
Wendy
Broadley
Finance Manager OxBucks
Finance Dept
Sandra
Caste
Assistant Liaison Manager
PTS Ox-Bucks Milton Keynes
Maxwell
Charlesworth
Emergency Response Assistant
EOC Management
Richard
Cohead
Assistant Operations Manager
PTS Ox-Bucks Oxford
Arthur
Davis
Transcare Supervisor
Logistics Berks West
Lisa
Dimond
Paramedic
Whitchurch RC
Michael
Elkins
Emergency Care Assistant
SW Nursling RC
Jayne
Fairbrother
Clinical Support Desk Practitioner
Clinical Support Desk - Hants
Stanley
Fuller
Non PSV Driver - Transcare
Logistics Berks West
Danella
Galsworthy
Ambulance Care Assistant
PTS Ox-Bucks Oxford
Barney
Glanvill
Emergency Medical Control Assistant
EOC Management - Ox-Bucks
Lorraine
Gorringe
Out of Hours - Comms Operative
Urgent Care Oxford Control
Robert
Jackson
BCES Commercial Logistics Driver
BCES
Paul
Jardine
Control Shift Manager
EOC Management - Ox-Bucks
Callum
Johnson
Emergency Medical Control Assistant
EOC Management - Ox-Bucks
Pierre
Le Cras
Operational Manager
Operations Management
Carl
Lee
Paramedic
Resource Centre - Wexham
Reece
Marchant
Emergency Response Assistant
EOC Management - Hants
Michel
Mayne
Paramedic
Resource Centre - Reading
Margaret
Nunn
Driver - NPTS
Logistics Services Oxon
Karyn
Selfe
Ambulance Technician
Resource Centre - Havant
Robert
Smith
Ambulance Care Assistant
PTS Ox-Bucks Mid and South
Andrew
Spratt
Message Handling Assistant
Urgent Care Berks Control
David
Tucker
Non PSV Driver - Transcare
Logistics Berks West
Jane
Webb
Paramedic
Resource Centre - Adderbury
Margaret
Woods
CSD Practitioner - Nurse
CSD Hants
Peter
Wyatt
Operations Manager
PTS Ox-Bucks Mid and South
Raymond
Wylde
Ambulance Care Assistant
PTS Hants Southampton
23
New year, new challenge
Please support our CFRs
As the new year is a time for new resolutions, our community first responders (CFRs) have set
themselves another challenge to raise awareness and money to purchase more equipment.
On 12 May 2012, four riders will undertake an eight-day 950-mile cycle ride between John
O’Groats to Lands End. To meet the team, visit their website at: http://lejog.foxyrider.co.uk
or go directly to their just giving page at:
https://www.justgiving.com/teams/SCACT-LEJOG-2012 to donate.
� South Central Ambulance NHS Trust (SCAS) has over 1,000 CFRs in four counties. All are
trained in basic life-saving skills, including use of an automated external defibrillator, to
provide early and often vital intervention for patients. Once an ambulance crew arrives
CFRs work alongside a qualified practitioner. If you want to be involved in volunteering as
a CFR and live in Berkshire, Buckinghamshire, Milton Keynes, Hampshire or Oxfordshire,
please eamil [email protected] or ring 0800 587 0207.
The communications team is keen to promote news stories that can be
published in Working Together or in the media.
Please email your news, suggestions and comments to
[email protected]
[email protected]
24