Tag: Ambulance

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Ambulance services ‘not coping’ as demand rises

demand on Ambulance Service

Ambulance crews are finding it “increasingly difficult to cope”, an audit of the service in England says.

The warning by the National Audit Office comes just two months after a BBC investigation highlighted increasing delays answering 999 calls.

The NAO said rising demand, recruitment problems and wider NHS pressures meant crews were failing to hit targets.

It comes as NHS bosses are looking at relaxing the eight-minute target for calls where it may not be necessary.

In November the BBC revealed ambulances were increasingly being delayed outside A&E units as hospital staff were too busy to take on the patients being brought in.

And the investigation found just one of the 13 services in the UK was meeting its key target – the eight-minute goal to reach the most life-threatening cases.

This NAO review just looked at performance in England. It too highlighted these problems and urged NHS bosses to review what was happening.

It pointed to the discrepancy between the rise in demand – 30% over four years – compared to the rise in budget – 16% over the same period.

NAO head Amyas Morse said action was needed as ambulances were a “vital” part of the service.

Christina McAnea, of Unison, which represents ambulance staff, said: “There’s simply not enough money to cope.”

NHS England said steps were being taken. Ambulances have been given longer to assess calls before a response needs to be sent – about a quarter of crews are called back before they reach the scene because call handlers have to make quick decisions about who needs an emergency response.

Three ambulance services – South Western, Yorkshire and West Midlands – are piloting a scheme which is seeing some urgent calls, such as strokes and fits, re-categorised as not needing an eight-minute response. Evidence suggests such quick responses are not necessary in these cases.

Prof Keith Willett, of NHS England, said: “These trials are designed to makes sure ambulances focus on the right priority – getting to the most urgent patients in the quickest possible time and improving the service to all patients who dial 999.”

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V Festival: More than 1,200 treated by ambulance staff at Weston Park

More than 1,200 people were treated by ambulance staff at this year’s V Festival at Weston Park – with 40 having to be taken to hospital.

A total of 1,218 patients were treated, a slight increase on last year.

West Midlands Ambulance Service and St John Ambulance provided medical cover which included a medical centre staffed by doctors and nurses, as well as a command and control centre which co-ordinated the responses of ambulances and other medical staff stationed across the site to patients in need of medical assistance.

West Midlands Ambulance Service spokeswoman Claire Brown saied: “The wet weather didn’t let up much throughout the weekend for revellers and consequently played a part, with many injuring themselves after slips, trips and falls.

“A number of patients were also treated for the effects of too much alcohol and people with a flare up of pre-existing medical conditions were also seen.”

Steve Wheaton, Assistant Chief Ambulance Officer, added: “With tens of thousands of people all in one place, we’re always prepared for the unexpected as it’s inevitable that people will fall ill and require our help.

“The team of staff and volunteers have worked extremely hard to ensure every patient received the very best care. A special thank you to the day staff that remained onsite after their shift had ended last night to lend an extra pair of hands during a particularly busy period in the medical centre.

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“As a trust, we’ve provided medical cover at V Festival for several years now and are proud when months of planning culminate into a smooth and successful operation.

“Thank you to St John Ambulance and all of our staff for their hard work throughout the weekend which ensured it was another safe festival. We’ll remain on site all day today, until the last of the campers have left.”

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New South East Coast Ambulance Service’s Make Ready Centre to begin operations

SECAMB South East Coast Ambulance paramedic attacks

New Make Ready Centre to begin operations

Make Ready Centre

Tangmere Make Ready Centre Ambulance crews will begin operating out of South East Coast Ambulance Service’s (SECAmb’s) newest Make Ready Centre in Tangmere, near Chichester, West Sussex, next week.

A phased opening will see the first crews begin to report to the new centre on the Chichester Business Park on Tuesday 9 August. From Tuesday, staff from Midhurst and Pulborough will begin their shifts from the new centre with crews from Bognor Regis and Chichester ambulance stations joining their colleagues on Wednesday 10 August and Thursday 11 August respectively.

SECAmb’s Make Ready system minimises the risk of cross-infection; frees up front-line staff, who historically have cleaned and re-stocked ambulances, to spend more time treating patients; and keeps vehicles on the road for longer. Specially-trained operatives regularly deep-clean, restock and check vehicles for mechanical faults.

While ambulance staff will start and end their shifts from the new centre the service provided to the region will be maintained with a number of dedicated Ambulance Community Response Posts, (ACRPs). Shifts will also begin and end on a staggered basis to ensure that ambulance cover is maintained in all areas served by the new centre.

Midhurst Ambulance Station is being marketed for sale with the option for part of the site to be retained by SECAmb as a response post. There will be a new response post at a site in Pulborough and in Bognor Regis and Chichester the Trust will move from having one ambulance station in each town to two response posts, thereby giving it greater spread of cover. Crews will continue to use Chichester and Bognor stations while the additional response posts are commissioned. The Trust will also continue to explore other potential sites across its region for additional response posts based on patient demand.

The introduction of Make Ready means that the Trust does not require large stations in which to store equipment and restock and maintain vehicles. In addition crews will no longer have to clean and restock their own vehicles thereby taking them away from their main patient care duties. The new centre will also provide modern training and meeting facilities.

SECAmb Paramedic and Operating Unit Manager Lorna Stuart said: “A huge amount of work has taken place prior to the new centre becoming operational and we’re looking forward to the first crews entering the new system. This way of working ensures we have a system in place where our staff are spending more time doing the job they are trained to do – treating patients.

“The aim is to minimise the time when crews are not available to respond to patients. Crews will still respond from the same towns under this system but will begin and end their shifts at staggered times at the new centre with a vehicle prepared for them that is fully operational. The facilities that the new centre provides will also ensure crews have access to improved training opportunities and increased support from management.”

SECAmb has already developed three purpose-built Make Ready centres in Ashford and Paddock Wood in Kent and in Crawley, West Sussex. It also has Make Ready Centres in Chertsey, Hastings and Thanet. Another centre is due to open in Polegate, East Sussex later this year with a further planned for Brighton.

What is Make Ready?

The Make Ready initiative significantly enhances and improves the service SECAmb provides to the community.

It minimises the risk of cross-infection; frees up front-line staff, who currently clean and re-stock ambulances, to spend more time treating patients; and keeps vehicles on the road for longer.

The initiative ensures that specially-trained operatives regularly deep-clean, restock and check vehicles for mechanical faults.

Make Ready Centres are supported by a network of ambulance community responses posts (ACRPs) across the area with staff beginning and ending their shifts at the new centre.

During their shifts, staff will respond from the ACRPs which will provide facilities for staff. These are located based on patient demand.

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‘Safety risk’ at ambulance trust

SECAMB South East Coast Ambulance paramedic attacks

South East Coast Ambulance SECAMB

An ambulance trust SECAMB is being investigated after reports of bullying and harassment and an “unfit for purpose” dispatch system.
Long call waits and out-of-date maps affected the service offered by the South East Coast Ambulance Trust (Secamb), which now faces investigation by the Care Quality Commission (CQC).

The Department of Health said: “poor leadership” had “put safety at risk”.

The trust said it was working hard to address the issues raised.

Last October it emerged that Secamb, which covers Sussex, Surrey and Kent, had delayed sending help for certain calls to allow extra time for patient assessments.
Its chairman, Tony Thorne, resigned in March, and chief executive Paul Sutton left the trust in May
The latest revelations concern the computer-aided dispatch system (CAD) used to send out ambulances to emergency calls.
Staff have told the BBC about problems with the ambulance dispatch system, with calls not answered quickly enough and out-of-date maps for crews.
An internal memo sent in May this year said there had been continuous problems with the system.
Targets missed

Preliminary findings during a CQC inspection the same month were leaked to the BBC, and include concerns that the system did not appear to have been updated to provide “the most contemporaneous record of addresses.”
In addition, it said it had “received a number of calls from staff following the inspection indicating a continuing culture of bullying and harassment” and that “accountability is absent in many areas”.

Call handlers told the BBC they were “missing” 1,000 calls a week – a term used when callers are held on the line for longer than the five-second target.
Ambulances were also widely missing key arrival time targets of eight minutes for the most serious cases, which include patients not breathing and cardiac arrests.
And an internal memo seen by the BBC, sent by Geraint Davies, the acting chief executive, said that having reviewed the initial feedback of the CQC, there were “very serious concerns” including “serious system weaknesses”.

Mr Davies added: “It’s fair to say that many of these won’t come as a surprise and are areas of weakness that the trust has been aware of for some time.
“It’s equally fair to say that, despite awareness, not a great deal has been done to really address these issues adequately.”
‘Subject to review’

Staff said that bullying had contributed to the problems, while the CQC said: “The number of outstanding grievances within the executive team itself is also a serious concern.”

Linda Southouse, who worked at the trust as an emergency call handler, said: “You could be in the middle of a call and the computer system will fail – you have to go into the emergency screen, which is not conducive to good practice – it doesn’t help you with your call.
“I ended up in tears most days. And the pressure just builds up and it gets so bad. I had chest pain which I thought was a heart attack and I was admitted to hospital, but it was stress that was causing it, not heart pain.”

Paul Maloney, of the GMB union, said: “The trust has lost the confidence of the public and have lost the confidence of their employees and I think there should now be a public inquiry run by the health service select committee in parliament.
“These people are providing a service to the public and they are in well-paid positions. There are a few people within the trust that’s key to what happened and I don’t think they can be allowed to have responsibility for the running of the trust until there’s a proper full inquiry into this.”

In a statement, Secamb said: “We do recognise that system issues can cause frustration for staff but these matters are subject to review.
“Fortunately critical issues with the system are rare and the impact on patients is minimal. However, the trust is keen to improve the CAD’s reliability and is working hard to address this.”

A spokesman for the Department of Health said: “We await the full report from the CQC, but it seems clear that poor leadership at the South East Coast Ambulance Service has put safety at risk, which is totally unacceptable – patients and staff deserve better.

“The chief executive and the chairman at the trust have recently been replaced and we expect to see immediate improvements made.”
“We await the full report from the CQC, but it seems clear that poor leadership at the South East Coast Ambulance Service has put safety at risk, which is totally unacceptable – patients and staff deserve better.
“The chief executive and the chairman at the trust have recently been replaced and we expect to see immediate improvements made.”

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Simple steps to prevent falls

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SCAS says take simple steps to prevent falls

With autumn not too far away, South Central Ambulance Service NHS Foundation Trust (SCAS) is encouraging everyone to take steps to avoid slips, trips and falls.

Everyone is at risk of falling, slipping or tripping over. These accidents can result in fractures and can lead to serious injury and even death.

However, there are simple measures people can take at home and in other settings to prevent falls.

Avoiding falls at home by:

·         Removing clutter, trailing wires and frayed carpet;

·         Use non-slip mats and rugs;

·         Not walking on slippery floors in socks or tights;

·         Wearing well-fitting shoes with good grip;

·         Organising your home so that climbing, stretching and bending are kept to a minimum.

By adopting some of these helpful tips into a daily routine, people can also integrate regular strength and balance exercises to minimize the chance of falling over.

Keeping active with activities including Tai Chi, gardening and dancing are great ways to boost your core strength and counteract muscle deterioration.

Mark Browning, Technician, SCAS, explained: “Falls are the most common cause of accidental death or serious injury amongst older people.  They affect about one third of all people over 65 and in very elderly people (over 85) this figure is nearly 40%. They cause injury, restrict activity, destroy confidence, increase isolation and reduce independence. As age advances, the incidence of falls increases, with women more likely to sustain a fracture than men.

“An ageing population means that the rate of falls and fractures are increasing. With light activity, walking, gentle exercise, healthy nutrition etc this will help reduce the risk if injury from falling. All falls should be reported to your GP.”

Other avenues of available care to help falls prevention include asking your GP to review your medicines annually if you’re on long term medication, ensuring you have regular sight tests and requesting a home hazard assessment from your local authority.

 

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Who will treat you – Scottish Ambulance

Who Will Treat You

Who will treat you

As soon as we have enough information and we believe you need immediate medical treatment, we will send help.

There are a number of ways in which we respond, depending on the circumstances:

Emergency Ambulance

Frontline emergency ambulances with a crew of two, one of which will be a paramedic, respond to the majority of emergency calls. Ambulance Technicians and Paramedics are trained to deal with life threatening illnesses and injuries. We carry a full range of medical equipment on our ambulances, including electrocardiogram (ECG) machines to monitor a patient’s heart and defibrillators which can restart the heart if a patient goes into cardiac arrest.

Paramedic Response Unit (PRU)

Paramedic Response Units are normally crewed by a paramedic working on their own. They will go to patients by car or motorcycle and carry all of the life saving equipment needed in a medical emergency. In life threatening situations, they can provide a vital, fast response and they will be backed up by an emergency ambulance that can take you to hospital.

Special Operations Team (SORT)

Specialised Paramedics, Technicians and Logistics Staff trained to gain access and administer care for patients in hazardous or difficult environments and at the scene of major incidents. SORT also deploy to provide paramedical support for other agencies involved in potentially hazardous environments.

Community Paramedics

These are paramedics who have undertaken extra clinical training. They are able to thoroughly investigate a patient’s condition and situation and then make a qualified decision about the best way to progress their treatment. They often work with minor injuries units and out of hours doctor services and can refer patients to the most appropriate care if a visit to hospital is not required.

Air Ambulance

We operate two emergency helicopters and two fixed wing planes. They are often asked to assist at incidents where there may problems with inaccessible terrain or where a very fast evacuation to hospital is preferable to a journey by road ambulance.

Community First Responders

These are members of the community who have been trained to provide first aid and other medical skills while the ambulance is on its way to you. They are able to deliver treatments that are time critical, such as using a shock box in cardiac cases.

BASICS Responders (British Association of Immediate Care)

BASICS Responders are Doctor’s, Nurses and Paramedics who have received additional Pre-Hospital Emergency Training through BASICS Scotland. Each of the Responders are provided with a Sandpiper Medical/Trauma Response bag and access to a Defibrillator. Many Responders have also been issued with an Ambulance Service Airwave Radio and a Vehicle Locater System to allow contact and best resourcing via their Emergency Medical Dispatch Centre.

Paramedic Clinical Advisor

If the incident is not life threatening, you may be passed by telephone to one of our Paramedic Clinical Advisors, or to NHS 24, who will give you assistance or point you in the right direction for help.

Whatever your reason for calling us, the Emergency Medical Call Taker who answers your call will ensure that you receive the most appropriate response and liaise with other services and professionals where necessary.

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London to get a second air ambulance helicopter

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London to get second air ambulance

The London Air Ambulance lands near Marble Arch  Image copyright Matthew Bell
The used helicopter which is currently green will be made to match the first one

 

A second air ambulance for London has been purchased, the charity that runs the service has said.

The aircraft should arrive from Qatar this week and be in use by early next year after modifications, a spokeswoman for London’s Air Ambulance said.

About £3m was raised for the purchase and conversion costs.

It means when one helicopter is being maintained, London will still be served by a traffic-beating aircraft.

The second emergency medical helicopter – a used MD902 Explorer – was paid for by donations to the Your London, Your Helicopter campaign which aims to raise a target of £6m to keep it flying for five years.

The helicopters will alternate taking an advanced trauma team to critically injured people.

The spokeswoman said last year there was an accumulated total of 55 days when the charity’s helicopter could not be used because of maintenance work.

London Air Ambulance boss Graham Hodgkin said it was a “truly exciting development for London and the biggest step-change” in the service resilience in the charity’s history.

View of Thames from Air Ambulance  Image copyright London’s Air Ambulance
The second helicopter has been used for medical purposes in Qatar

London’s Air Ambulance facts

  • Founded in 1989, it has treated more than 30,000 critically injured people
  • It serves the 10 million people who live, work and holiday within the M25
  • It operates in partnership with Barts Health NHS Trust and London Ambulance Service
  • In 2014, it treated 1,806 patients: 33% from road traffic incidents, 27% from falls and 24% from penetrating trauma including stabbings and shootings

 

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New Clinical Model Pilot Launch

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Countdown on for new clinical model pilot launch

THE Welsh Ambulance Service will embark on its pioneering new clinical model pilot this week.

Under the new model, those patients in imminent danger of death will get a life-saving response as quickly as possible.

All other patients else will have a response based on their clinical needs, but it might not always equal a trip to hospital – it could be a referral to NHS Direct Wales or their GP.

It is hoped the new model will end the current practice of sending multiple ambulances to a 999 call in order to meet the eight-minute target.

The pilot was established after the McClelland review recommended that Welsh Government move away from the eight-minute target to a more intelligent set of indicators, which put a greater emphasis on patient outcomes and experience.

The changes will come into effect on October 1, 2015.

Dr Brendan Lloyd, Medical Director at the Welsh Ambulance Service, said: “Since 1974 our ambulance service has been measured by the time it takes to reach emergency calls.

“Para-medicine and pre-hospital care has developed rapidly since then, but the focus is still on how many ambulances arrive at calls within eight minutes regardless of the clinical outcome.

“That’s why we’re moving away from time-based targets to look more at the quality of what we do for our patients once we arrive.

“Having an ambulance arrive at a patient’s door quickly does not necessarily translate to a better outcome for the patient, but having the right type of vehicle arrive at a patient’s door and timely transport to a treatment centre does.”

The new model will introduce three new categories of calls – red, amber and green – to replace the current system.

RED calls are immediately life-threatening calls – someone is in imminent danger of death, such as a cardiac arrest.

There is compelling clinical evidence to show an immediate emergency response will make a difference to a person’s outcome.

The eight-minute target will be retained for this group of calls with an initial target of 65% receiving an eight-minute response.

AMBER calls refer to those patients with conditions which may need treatment and care at the scene and fast transport to a healthcare facility, if needed.

Patients will be prioritised on the basis of clinical need and patients will receive a fast, blue light response.

There will be no time-based target for amber calls, but a range of clinical outcome indicators will be introduced to measure the quality, safety and timeliness of care being delivered alongside patient experience information, which will be published every quarter.

GREEN calls are less urgent calls, which can often be managed by other health services, like GPs, or through self-care.

This category also includes calls from healthcare professionals, which will be handled in a different, planned way in the future.

Dr Lloyd added: “In order to meet the complex and growing demands on our ambulance service, we need to transform the way we deliver our services.

“This new model will make our ambulance service among the most progressive in the world.”

There is a wealth of information about the pilot on the Trust’s website.

You can also keep abreast of news and updates by following the Welsh Ambulance Service on Twitter @WelshAmbulance and on Facebook.

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BHF PocketCPR app

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BHF PocketCPR app

The CPR app

Practise Hands-only CPR with the BHF PocketCPR app for iPhone and Android.

The free app explains how to carry out Hands-only cardiopulmonary resuscitation (CPR) on someone in cardiac arrest using hard and fast chest compressions.

The app allows you to practise by making use of the accelerometer in your smartphone. It means your phone can measure the rate and depth of compressions, telling you if you need to do the compressions faster or slower, or whether you should push harder or softer.

DOWNLOAD THE ANDROID APP

DOWNLOAD THE IPHONE APP

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What happens when you call 999

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What happens when you call 999

In a medical emergency, ask for the ambulance service and you will be put through to one of our call-takers.

In the video below Jules Lockett, Head of Control Services Training, explains how the information you provide to us helps us.

You will need to have the following information available when you call 999:

  • The location where you are, including the area or postcode.
  • The phone number you are calling from.
  • Exactly what has happened.

As soon as we know where you are we will start arranging help for you.

You will also be asked to give some extra information, including:

  • The patient’s age, gender and any medical history;
  • Whether the patient is awake/conscious, breathing and if there is any serious bleeding or chest pain; and
  • Details of the injury and how it happened.

Answering these questions will not delay us, but it will help us give you important first aid advice while our staff are on their way.

The extra information also helps us to make sure you get the most appropriate help.

What can I do before help arrives?

In the video below Jules Lockett, Head of Control Services Training, explains how you can look after the patient until help arrives.

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Before help arrives, you can help us by doing the following:

  • If you are in the street, stay with the patient until help arrives.
  • Call us back if the patient’s condition changes.
  • Call us again if your location changes.
  • If you are calling from home or work, ask someone to open the doors and signal where the ambulance staff are needed.
  • Lock away any family pets.
  • If you can, write down the patient’s GP details and collect any medication that they are taking.
  • Tell us if the patient has any allergies.
  • Stay calm—our staff are there to help. Violence or threatening behaviour aimed at them will not be tolerated and could delay help getting to the patient.

How can I be prepared for an emergency?

There are things you can do today to help us in the future.

  • Check that your house number can be seen from the road.
  • If you live on an estate, check there is a clear sign to direct emergency services and that all lifts are working.
  • If it’s dark outside turn on lights to help our staff to find you quickly.

Karen Uptoon EOC 200x300
What information will I need when I call 999?

When you call 999, an operator will ask you which emergency service you need.
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When to call 999 – LAS

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When to call 999

In a life-threatening emergency

Always call 999 if someone is seriously ill or injured, and their life is at risk.

Examples of medical emergencies include (but are not limited to):

  • chest painWalk in centre sign
  • difficulty in breathing
  • unconsciousness
  • severe loss of blood
  • severe burns or scalds
  • choking
  • fitting or concussion
  • drowning
  • severe allergic reactions.

When it’s not a life-threatening emergency

If it is not a life-threatening emergency and you, or the person you are with, do not need immediate medical attention, consider other options before you dial 999:

  • Look after yourself or the patient at home. If you cannot stay at home, see if family or friends are able to help.
  • Talk to your local pharmacist.
  • Visit or call your GP.
  • Call NHS 111.
  • Visit the NHS Choices website.
  • Make your own way to your local A&E department, walk-in centre, minor injuries unit or urgent care centre. (Arriving in an ambulance does not necessarily mean you will be treated more quickly.)

Choose the best treatment for your needs – choose well. It allows us to make sure that we are able to help the people who need us the most.

Not sure where your nearest health services are? Visit www.nhs.uk.

If you are nearing the end of your pregnancy, the London Ambulance Service have put together some advice if you are due to give birth.

 

With thanks to the London Ambulance Service