Archive for month: August, 2019

Date: 16 August 2019

Set up in 2009 in response to the national terrorist threat, North West Ambulance Service’s (NWAS) Hazardous Area Response Team (HART) this year celebrates its tenth birthday.

Trained up to a national standard, the team of 84 experienced paramedics, split between two sites in Manchester and Liverpool, use specialist equipment and skills to safely access and treat patients in difficult and hazardous conditions.

NWAS was one of the first ambulance services to implement HART in the country. The team members are trained and equipped to safely work at heights, in confined spaces, in both swift and still water and use breathing apparatus, refreshing these skills every seven weeks.

Joe Barrett, Head of Special Operations for NWAS, said: “Prior to HART, ambulance clinicians would often have to stand back when faced with a hazardous incident and wait for specialist support from fire and rescue services or police for them to bring the patient back to a place of safety.

“By providing specialist paramedics with the training and equipment to be able to risk assess and manoeuvre through difficult and hazardous environments, they are now able to access patients at the point of injury so that life-saving medical intervention can begin immediately. They can then continually manage the patient’s condition to avoid further injury whilst partner agencies provide the rescue element.”

In a large scale or major incident, the team is able to quickly identify the most seriously injured patients, prioritising and treating those patients in need of help the quickest. HART paramedics are then able to relay back information regarding the situation and size of the required ambulance response to control as well as set up a casualty collection point and provide life-saving clinical early interventions. 

By training and exercising with their emergency services colleagues, they are able to plan and prepare for major incidents, creating strong and effective working relationships and providing a streamlined and strategic response to complex situations.

Joe continues: “Over the last ten years, the team has gone from strength to strength. The constant training the paramedics undergo, along with the equipment they use, is second to none and has proven to be life-saving on numerous occasions.

 “Using their unique problem solving skills, teamwork and co-ordination, they are able to keep calm under pressure and apply their skills and training to help patients in a wide-range of unexpected and difficult situations.

“I am extremely proud of the whole team, they work together amazingly, knowing each other’s individual strengths and supporting each other after difficult incidents, they’re like one big family!”

Introducing its second fleet of high-specification vehicles in December 2018, the team has advanced equipment and technology which allows the paramedics to set up their own communications network in remote locations, provide an ongoing response over days and months if necessary and travel over difficult terrain.

HART is primarily reserved for complex, large scale or major incidents such as serious road traffic collisions or entrapments. The team will respond to incidents were the patient would benefit from additional skills and equipment or if additional assistance is required.

Notable incidents in recent years include major flooding in Cumbria and Greater Manchester as well as gas explosions, rescues from cranes, the Manchester Arena attack and the Bosley Mill explosion.

Outside of responding to emergencies, the team members keep busy making sure that their equipment is fully compliant, their clinical skills are refreshed and they are kept up to date on key changes nationally and within the trust. They also undertake regular fitness tests and often attend community events promoting the work of the ambulance service.

Author: Michael Emmerich

Published in: Winter 2017 Edition of Ambulance Today Magazine

The Africa Quarterly editorial discusses the challenges facing emergency medicine educators in The Democratic Republic of Congo (DRC). The DRC is the second largest country on the African continent with a population of almost 80 million. It is a major crossroad through Africa as it borders nine countries. The DRC continues to experience current political and social instability, as it has over its chequered past; and active fighting is still prevalent in certain regions today. The last two decades of conflict, mainly in the North-Eastern regions, has devastated the civilian population and led to the collapse of the healthcare infrastructure.

Government expenditure on health per capita remains one of the lowest in the world and Emergency Medicine has yet to be established as a specialty in the DRC. While most hospitals have emergency rooms or salle des urgences, this designation is more in name than an actual ER room; many have no standardised format, no recognised emergency medical equipment and they are rarely staffed by doctors or nurses with hardly any trained in emergency care. Lack of formal, structured training,lack of (emergency) equipment and fee- for-service for all patients entering the healthcare system are cited as barriersto care. Pre-hospital care is also not an established specialty, with no EMT colleges, ambulances being a rarity and no outside major centres. Where there are ambulances they are at best staffed by a nurse or just a driver with no medical training.

The 39 nationally-recognised medical schools, most of which are in urbanareas, are typically underfunded and all medical studies including residency arefully self-funded. There has been a recent proliferation of technical schools (more than 500) which offer varied levels of medical training. These institutes are not regulated, open without official approval and often operate as for-profit enterprises. Few students from any of the schools can spend the required years in clinical rotations due to a lack of participating hospitals. The overall result is an education of doubtful quality. There is currently no dedicated emergencycare training integrated into medical or graduate schools.

A comprehensive study was undertaken1, jointly by the DRC Government and various international role players. Key findings ofthis 2012 report by USAID and Nursing Education Partnership Initiative (NEPI) noted the barriers to learning were as follows, including inadequate quality of health worker education:

• Lack of budget for maintenance and renovation of the existing infrastructures.

• Limited number of opening hours of libraries, skills labs and other infrastructures to students and teachers.

• Insufficient support of stakeholders including government and development partners regarding funding for construction.

• Insufficient budget for renovation of existing infrastructure.

• Lack of anatomic models in skills labs.

• Insufficient budget for purchasing basic materials and consumables that are necessary for clinical practice without necessarily relaying on what is found in clinical training sites.

• Inadequate system supply of books and other learning materials

• Lack of policy and budget for using the internet and computers in schools to encourage students and teachers to access information.

Although the report focuses on nurses and midwives, it must be stated that they serve at the frontline of most medical emergencies in the field and in hospitals and clinics. Therefore, the challenges they face in learning, will impact severely ontheir ability to work in an emergency medicine environment; added to the fact that emergency medicine is not part of their recognised curriculum.

I have been travelling and working in The DRC since 1999, across various provinces and regions, primarily teaching at a BLS, ILS and ALS level, (both pre- and in-hospital facilitating) and doing clinical governance and medical project management, so I can attest to the challenges. Short courses such as ACLS, PALS, ITLS, ATLS etc. which form the backbone of annual refresher training for many emergency medicine practitioners is relatively unknown, and only presentedin a few regions of The DRC by training providers from other countries.

I have been travelling and working in The DRC since 1999, across various provinces and regions, primarily teaching at a BLS, ILS and ALS level, (both pre- and in-hospital facilitating) and doing clinical governance and medical project management, so I can attest to the challenges. Short courses such as ACLS, PALS, ITLS, ATLS etc. which form the backbone of annual refresher training for many emergency medicine practitioners is relatively unknown, and only presentedin a few regions of The DRC by training providers from other countries.

References:

1. Assessment of Nursing and Midwifery Education and Training Capacity at Seven Training Institutes in the Democratic Republic of Congo (2012)

Access the full report at: http://files.icap. columbia.edu/nepi/files/uploads/DRC._Needs_ assessment._2012.pdf

Tell Michael what you think about this article by emailing him at: [email protected]

Author: Thijs Gras

Published in: Spring 2018 Edition of Ambulance Today Magazine

In one of my earlier columns (Spring 2017) I wrote about an undesirable development in the Netherlands in the domain of integration of control rooms and the strong ‘blue’ (police) influence in this respect. A recent interesting court case shines new light on my point and will certainly raise eyebrows (and mouth corners) with a number of colleagues.

Suppose you are a nurse working in the control room and an emergency call comes in. You talk to the caller and send an ambulance to what later turns out to bea crime scene: a woman is murdered and the caller – her ex-husband – is suspected to be the perpetrator. The police are very interested in this call and think they have the right to listen to it and, out of decency, ask the ambulance service for the recording. But to the utter disappointment of the police, the ambulance service refuses to hand over the call to them stating this is a matter of patient confidentiality. The police go to court but the court rules that the ambulance service is right and is not required to hand over the call. But this is murder! Surely this is important enough to violate the professional confidentiality of the nurse?

The police then appeal to the High Court. The ruling of this court - the highest we have in our country, so its decision is final and there are no further appeal options - is very interesting: they confirm the verdictof the lower court. The key point is patient confidentiality and the fact that the caller spoke to a certified nurse who has a duty to professional secrecy.

An important issue that is raised in this particular case is that of the two conflicting interests that oppose each other. On the one side it is in the interest of the police to find the truth, to conduct an inquiry and to bring culprits to justice. Everybody will agree this is a very important interest.

But on the other hand, there is the interest of – in this case - the ambulance service (but it could also have been a doctor or nursein the A&E department) that everybody should be able to call for emergency medical help no matter what the circumstances are and without fear that the call, or anything that is said to the medical caregiver, will have juridical consequences.

Both courts have been very clear in their ruling and I completely agree with them: patient confidentiality almost always prevails over finding the truth. In one of our laws about the medical profession it is stated very clearly that if one of the professionals mentioned in the law (such as doctors and nurses) is convinced that information given to him or her as a professional, specificallyif it is confided as secret or the professional can guess it is confidential, the professional can call upon the right of non-disclosure. Only in very rare and special cases can a doctor or registered nurse be forced to break this right.

I am glad and relieved because this meansI am better protected on the streets. Not against knives and bullets of course, but our neutrality and trust that everything we do is in our patient’s interest is a key point in our safety and security. This is why I am so critical about the growing influence of the police in our control rooms. I sincerely hope we as an ambulance service work well with the police on the street; we may share, on the control room level, buildings or even rooms but we must be very careful to keep everything elseseparate so that we as professional nurses can use our right of non-disclosure. This is not only important in individual cases forthe persons involved, but on a broader scale, for the trust of the public in the ambulance service and therefore for the safety of ambulance personnel. Any association with the police should be avoided.

Of course, we as ambulance people need the police for our safety and to protect us. They are the only ones in our society (apart from the military) who are allowed to use violence. They have the training and the means. That is okay. We both want to help people in need, but we both have our interests and sometimes these interests differ or even conflict with each other.

We tend to look at the emergency services in colours: white for the ambulance, blue for the police and red for the fire brigade. But what do you get when you mix these colours? An ugly sort of light brown. If we paint with this colour we get a very dull, inexpressive painting. If we want to createa beautiful and harmonious picture, it is far better to use the separate colours. Together, but distinct. That is the best way to serve the interests of the personnel and of the people we serve, in our case patients.

Date: 14 August 2019

Harrogate-based Yorkshire Care Equipment has supplied Yorkshire Ambulance Service (YAS) with over 50 Raizer emergency lifting chairs that are now being used by first responders, falls teams and care homes in the Sheffield area.

YAS and NHS Sheffield Clinical Commissioning Group (CCG) have started a project in the city that aims to get people who have fallen back on their feet as soon as possible. The Raizer chairs are part of this joint project which provides staff with appropriate lifting equipment and focuses on residents having an improved experience. The results will be shared with other ambulance services, some of which are also trialling the equipment.

Yorkshire Ambulance Service responds to nearly 800,000 emergencies every year with around 10% of these related to people who have fallen. Many of these calls come from care homes where staff are either physically unable to lift the person back to their feet or are unable to do so because of lack of training and access to appropriate equipment.

Karen Owens, Director of Urgent Care and Integration at Yorkshire Ambulance Service NHS Trust, said:

“Feedback from the care home staff and residents in the project described the Raizer chair as something which will help staff move people safely and with dignity and will give staff the confidence to assess injury prior to making the decision to moving someone. 

“We very much appreciate the collaborative working and funding provided by the CCG on this project.”

The Raizer is completely unique from other falls lifting products because it only takes one carer to operate it. In turn, this saves money and time for care staff.

Steve Ellis, Yorkshire Care’s Raizer Specialist, said:

“When we worked with YAS last year, we knew that the Raizer could make a real difference to the level of care they were providing. Even when I’ve carried out training with their staff, you can see how much more confident the staff feel when they know they have a device that will genuinely improve the quality of care they provide.”

Date: 2 June 2019

Jerusalem, June 2nd, 2019 - A new project has been taking place over the past few weeks in Jerusalem. During the hot days of Ramadan, United Hatzalah volunteer EMTs have been asked to join Israel’s border police and the military police in safeguarding the passage of Palestinians entering into Israel at two Jerusalem crossings, Kalandia and the 300 crossing by Rachel’s Tomb near Bethlehem. 

The request was initiated by the police in an effort to have a fully trained and equipped medical responder on hand at the checkpoint due to the heat of the past few weeks. The purpose of the additional personnel at the checkpoint was to safeguard the Palestinians who were crossing into Jerusalem should any of them suffer from the heat or the fast or a combination of both.

For the past few weeks, United Hatzalah volunteers have been on hand and treated numerous Palestinians at the checkpoint who were suffering from a variety of illnesses. This past Friday, the injuries included an asthma attack, high blood pressure, dehydration, chest pain, and shortness of breath.

“The crossings into Jerusalem are incredibly efficient now and Palestinians wishing to cross into Jerusalem are usually in and out relatively quickly,” said Vice President of Operations for United Hatzalah Dov Maisel. “We were asked to help provide medical coverage to the crossings should a medical emergency occur due to the fast of Ramadan, and the heat that Israel has experienced these past few weeks. We provide the first medical response and then if needed request an ambulance to transport the patient if needed.” 

Maisel said that just before Ramadan, United Hatzalah volunteers had responded to a cardiac arrest case at the 300 crossing and it was at this point that the Military Police began to ask whether or not the organization could send volunteers to be stationed at the crossings on a permanent basis during Ramadan and the days following during peak hours on Fridays, the  holiest day of the week for  Muslims.

“We were more than happy to help in this matter. Helping people stay safe and providing initial medical response is what United Hatzalah is all about. This is our mission and our volunteers were more than happy to jump at the chance to help with this important matter of safeguarding the lives of those who want to enter the city during their holiday,” Maisel concluded.

United Hatzalah volunteers have been stationed at the crossings for the past few weeks and will continue to provide emergency medical coverage again this coming Friday.