From the Africa Desk of Ambulance Today: A Case Presentation of Electrical Alternans in the Field

By Michael Emmerich
Published in Ambulance Today, Issue 1, Volume 16, Around the World in 80 Questions, Global Clinical EMS Special, Autumn 2019

For this Africa quarterly, I will be discussing a cardiac patient encountered on a remote site in Africa and the unique challenges faced by the paramedic and his support team.

Patient Presentation: A patient presents at a remote site in the Southern DRC around 07:15 on a Saturday morning, with the patient’s chief complaint being shortness of breath (SOB) and swollen legs. The patient is brought into the emergency room and the consultation process commences. On first examination the findings are as follows:

Observations/Vital Signs on Initial Assessment

  • Heart Rate: 108 – Regular
  • Blood Pressure: 158/91
  • Temperature: 36.8
  • Pupils: PEARL
  • Oxygen Saturation: 75% on an FiO2 of room air
  • Respiratory Rate: 32 bpm
  • Respiratory Effort: Rapid and labored
  • Skin Colour & Appearance: Flushed and warm
  • Blood Sugar: 7.1 mmol/li
  • Malaria Rapid Diagnostic Test: TDR –

Physical Examination

  • Head & Neck: NAD
  • Chest: Cardiac Auscultation detects Miåtral Regurgitation – Lungs clear Abdomen Distend, Pitted Oedema on all Quads – No Ascites
  • Pelvis: NAD
  • Upper Limbs: Oedema in fingers and wrists – no pitting
  • Lower Limbs: Pitted Oedema up to the knees
  • Back: NAD
  • ECG – 12 lead: Electrical alternans and Atrial hypertrophy
  • Other: Pulsus Paradoxus noted in both radial pulses

Preliminary Diagnosis

  • Date/Time: Acute Pericardial Effusion
  • Date/Time: Differential Diagnosis of Mitral Regurgitation

The ECG findings of electrical alternans are usually associated with pericardial effusion (with the potential to lead to pericardial tamponade) and is due to the periodic wobbling of the heart in the pericardium. The significance of the pulsus paradoxus adds strength to this initial diagnosis. Without access to an ultrasound or X-ray, a definitive diagnosis could not be made and based upon the entire patient presentation, including excessive weight, short neck and history of two malaria positive tests over the past 7 months, a decision is made to evacuate the patient off-site to a cardiac ICU unit in Johannesburg, South Africa. In further consultation with the top cover support Dr, palliative care, maintaining oxygen saturation by means of supplemental oxygen (done via nasal prongs at 3 to 4li/min to maintain Sat’s of 90 to 93%) and the insertion of a TKVO IV line is agreed upon.

Initial 12 Lead ECG Done at Mine Clinic

If this patient was in an urban setting or even a rural setting with rapid access to a Cardiac ICU, a definitive diagnosis and ACLS treatment could be initiated forthwith in a controlled multi-team clinical setting.

The Challenges Faced by the Team

Plans are put in place to begin evacuating the patient, the nearest landing strip only has daylight landing rating, so the patient would need to be there before 16:00 to facilitate the fixed wing evacuation. Before this can happen, multiple processes need to be initiated: approval gained from the insurers, an evacuation company needs to be appointed to do the flight, landing clearances must be granted by the DRC aviation authorities and the patient needs to be taken there by road—a 2-hour road trip in a 4X4 ambulance on a muddy, wet and potholed gravel road. In this instance, for a variety of reasons, landing clearances are taking longer than usual so a decision is made to charter a light aircraft—the Cessna Caravan (non-pressurised)—and to move the patient from the landing strip to the nearest largest town with night landing capability (so clearances can be obtained for that evening and because it has a good hospital nearby where the paramedic can keep the patient stable).

It must be noted that once the paramedic leaves the work site, he is working alone with the patient, with only the equipment he chooses to take for the road transfer, the chartered flight and the hospital stay. They eventually arrive at the neighbouring large city in the DRC and move the patient from the airport to the nominated holding hospital, where the paramedic settles the patient in—managing, monitoring, and continuing to co-ordinate the evacuation with various flight and insurance desks. Due to ongoing political instability in the region, the airport with night landing capability is shut down for the evening and the paramedic must sit it out until sunrise with his patient.

At sunrise the whole process starts all over again, to get clearances and wait for the fixed wing ICU jet from South Africa.

The Patient on (Ongoing) Re-Examination

Throughout the night the paramedic kept watch, monitoring and keeping the patient attached to the various monitors he dragged with him from the work site. Upon early morning re-examination a few new flags have popped up: abdominal cellulitis, a raised fever (37.8 C) and a positive malaria test result. They are also able to do a chest X-ray and notice a widened mediastinum and the presence of early pulmonary oedema developing in the base of the lungs. A third 12 lead ECG is done to see if there is developing ischemia or signs of an infarct – none are present. The fever is managed with IV parfalgan (paracetamol) while oral antibiotics and coartem are started for the infection and malaria. The paramedic discusses the ongoing care with his top cover Dr life line, and a Dr in the hospital. The diagnosis does now appear to be definitive – that of pericardial effusion.

Chest X-Ray of the EA Patient

The Flight Evacuation

Finally landing clearances are obtained (which is another story in itself) and a landing ETA is finalised, for around 17:00 on the Sunday afternoon. The patient is loaded into an ambulance with the paramedic and all his medical gear and is moved to the airport. As the plane is on final approach, the heavens open and it starts raining. After a detailed, comprehensive and wet handover, the patient is loaded onto the jet and they depart for the awaiting Cardiac ICU team in Johannesburg, South Africa.

En Route in the Cesena Caravan, Fixed Wing Evacuation

Case Close Out

12 Lead ECG the following day, taken at a local hospital

34 hours have now elapsed since the patient was initially seen by the paramedic back at the work site. Throughout this time the medic has been by his patient’s side, giving comfort, reassurance and medical care as needed. Finally, sleep is possible but getting out of the wet and dirty work clothes, followed by a hot shower and a decent meal, must happen.

The patient arrived in Johannesburg and was admitted into care at around 23:00 on the Sunday evening – almost 40 hours since the original provisional diagnosis was made. Treating and moving the sick and injured in Africa presents one with unique challenges not normally encountered in the developed world, or discussed at most cardiac symposiums. Welcome to the life of the remote and austere paramedic in Africa.

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Supporting patients living with mental health problems and/or dementia, North West Ambulance Service (NWAS) has officially launched its new Mental Health and Dementia Strategic Plan (2019 – 2022). 

Put in place as part of the trust’s aim is to be the best ambulance service in the country by delivering the right care, at the right time, in the right place; every time; the plan supersedes NWAS’ previous Mental Health Improvement Plan (2017–2022).  It details 17 recommendations, including a range of actions for each of these recommendations, which collectively aim to shape and transform mental health and dementia care within the trust over the next three years.  

The plan is reflective of the relevant mental health and dementia related aspirations detailed within the Five Year Forward Plan for Mental Health (2016), the NHS Long Term Plan (2019) and the Prime Ministers Challenge for Dementia (2015).

The recommendations and associated actions are based on extensive scoping and appraisal of care provision between January and July 2019 including feedback from staff, patients and partners within mental health across the North West region.

One example of the 17 recommendations is to review and learn from the mental health triage car pilots currently taking place within the Merseyside and Lancashire areas, and agree a trust wide plan for the future.   

The current pilot operating in Lancashire is called Psynergy and was launched last December in Blackpool, Fylde and Wyre, and involves a paramedic, a senior mental health nurse from Lancashire Care and a police officer coming together as a crew in a vehicle to jointly respond to people experiencing a mental health crisis.  The aim is to provide appropriate triage, offer the right care and advice, improve patient experience and avoid unnecessary hospital admissions.

The pilot has already proven to improve outcomes for appropriate patients, and results in better use of ambulance resources and multi-agency working, ultimately leading to financial benefit to the wider NHS.    

In year one of this particular recommendation, the trust will undertake a detailed and comprehensive review of the two pilots and work collaboratively with partners and commissioners to secure funding streams to widen this excellent service. 

Gill Drummond, Mental Health and Dementia Lead for NWAS said: “The work regarding mental health and dementia care already being undertaken by the trust is fantastic, but there is so much more we can do to.  The number of related 999 calls is increasing significantly, which is why one of the trust’s key priority areas is to improve care in this area, and why we have developed a plan to take this forward.”

To read more about the other 16 recommendations, the full plan is available to download here.

Dementia patients of the Welsh Ambulance Service to benefit from dementia cannula sleeves

THE Welsh Ambulance Service has received its first dementia cannula sleeves, devised and made by volunteers at Handmade for Dementia. The sleeves have proven to keep dementia patients calm and stop them from pulling needles out of their arms during treatment.

Ambulance staff on both emergency and non-emergency services will be using them when they are out on the road treating patients. It is the first time that the Trust will be using such objects to care for our patients.

During the mid to late stages of dementia, a person can become very anxious and fidgety. Having a cannula sleeve knitted with different wools, with different textures and ‘twiddle’ detail, has proven to make a difference in keeping patients calm.

Each sleeve is knitted following a copyrighted pattern and are individually risk-assessed before being donated to NHS Trusts across the UK.

Alison Johnstone, Dementia Manager at the Welsh Ambulance Service said: “Donations of such innovative items enable us to support our patients and provide person centred-care to people living with dementia.

Alison Johnstone, Dementia Manager at the Welsh Ambulance Service said: “Donations of such innovative items enable us to support our patients and provide person centred-care to people living with dementia.

“We cannot thank Handmade for Dementia enough for providing us with their dementia cannula sleeves as these will improve the experiences of people living with dementia at times of anxiety.

“As we’ve learned, it’s not necessarily the facts of the experience a person with dementia will retain, but the emotion, and these will go a long way to improving the emotional experience of using our service.”

Sharon (Wallace) Holdstock founded Handmade for Dementia in 2016 and started by recruiting a knitter to make ‘twiddle mits’ before moving on to devising and making dementia cannula sleeves following the suggestion of retired District Nurse, Eileen Copeland.

The group, which today has more than 5,000 members has knitted close to 8,000 cannula sleeves since January 2018.

Sharon Holdstock, founder of Handmade for Dementia said: “I am thrilled that our dementia cannula sleeves are making such a difference to people affected by dementia across the UK, saving the NHS thousands of pounds.

“After having sent thousands of sleeves to hospitals, now collaborating with the Welsh Ambulance Service is really exciting for us.  We hope that that result of our work will prove to be just as efficient on the road as it is in hospitals.”

Everyone can join Handmade for Dementia as long as they can knit. To do so, they must first join the group’s Facebook Page. If you would like to do so, head to –

The Welsh Ambulance Service hopes to develop its partnership with Handmade for Dementia in the months and years to come.

The i-view™ Video Laryngoscope from Intersurgical: The Key Considerations

By David Chapman,
Airway Group Product Manager,
Intersurgical Ltd.
Published in Ambulance Today, Issue 3, Volume 13, Ahead of the Curve, Education and Technology Special, Autumn 2019

Video laryngoscopy represents one of the most significant advances in airway management in recent years. With the increased emphasis placed on ensuring the first attempt at intubation is the best attempt, the role of video laryngoscopy in airway management seems secure, at least for the foreseeable future1.

Video laryngoscopes utilise the latest video and camera technology to provide an optimal (indirect) view of the larynx during the process to insert an endotracheal tube in to the patient’s trachea. There are many video laryngoscopes available, but the i-viewTM from Intersurgical is the first single use adult video laryngoscope with a Macintosh type blade. i-viewTM provides the option of video laryngoscopy, wherever and whenever the clinician may need to intubate, whether in a pre-hospital setting on a patient with a difficult airway or in the emergency room on a patient with respiratory failure. Where availability of a video laryngoscope may be limited due to the cost implications of purchasing reusable devices for multiple sites, i-viewTM provides a cost-effective solution, by combining all the advantages of a fully integrated video laryngoscope in a single use, disposable product. As i-viewTM incorporates a Macintosh blade, it can be used for direct as well as video laryngoscopy, making it ideal for use in the emergency sector, where there may be a greater potential for the airway to become soiled with blood or other fluids, obscuring the view on the screen. In such circumstances, the operator can immediately switch from indirect to direct laryngoscopy.

As with all medical devices, whether single use or reusable, deciding on the most appropriate video laryngoscope to use is not straightforward, and consideration may need to be given to a number of factors. These may include evaluation of financial, environmental and infection control related issues, as well as the clinical requirements, evidence and preferences. It is important to recognise this assessment may change according to where, when and how often the device is to be used.

The i-viewTM


Whilst a single use video laryngoscope may not initially appear to be the optimal choice from a financial perspective, in circumstances where multiple units are required, but it may not be used frequently, it may prove to be the most economic option. This might include use by a Helicopter Emergency Medical Service (HEMS) or by a paramedic on an ambulance.

Infection Control

In their safety guideline booklet (2008), ‘Infection Control in Anaesthesia 2’, The Association of Anaesthetists of Great Britain and Ireland (AAGBI)2, confirmed that, in relation to standard laryngoscopes, ‘Current practices for decontamination and disinfection between patients are frequently ineffective, leaving residual contamination that has been implicated as a source of cross-infection.’ They went on to note that, ‘Blades are also regularly contaminated with blood, indicating penetration of mucous membranes, which places these items into a high-risk category.’ They concluded that the use of single use blades was ‘to be encouraged’.

Laryngoscope handles may also become contaminated. The AAGBI’s recommendation in relation to laryngoscope handles is that they should be, ‘washed/disinfected and, if suitable, sterilised by SSDs after every use.’

There is no reason to believe the same considerations and arguments that apply to standard laryngoscope blades & handles regarding infection control, would not also apply to video laryngoscopes, since all laryngoscopes, whether direct or indirect, incorporate some form of blade and handle.

In the EMS sector, where it can be particularly difficult to determine the potential cross-infection risk prior to treatment, a single use video laryngoscope offers an ideal solution.

I understand new infection prevention and control guidelines from the AAGBI are in the final draft stage, and after comments from members have been reviewed, a final version is to be presented to the Associations Board for approval.


Environmental considerations are more complex and less easily assessed. Whilst it is appropriate for healthcare professionals, as well as anyone else with environmental concerns, to consider the implications of using single use devices in relation to product disposal, any assessment of the environmental impact of any medical device, whether single use or reusable, needs to consider a number of factors. This should include disposal of single use devices, and reprocessing or decontamination of reusable devices, in the context of a complete Life Cycle Assessment (LCA). The considerations of an LCA may vary depending on the type of product being assessed, the range and type of information and data available and the objective of the assessment. However, typically, an LCA will usually consider the following areas:

  • Raw material acquisition
  • Processing & manufacturing
  • Distribution & transportation
  • Use, reuse and maintenance
  • Recycling
  • Waste management

Assessing just one element of an LCA, such as waste management, may result in misleading conclusions as to the overall environmental impact of a device. A decision also needs to be taken as to what impact factors are to be assessed and how much weight is to be given to each. Is the focus primarily on climate change and water use, or is there an interest in assessing other or additional factors, such as, ecotoxicity, eutrophication, ozone depletion or urban and natural land transformation?

A number of LCA’s have been conducted for anaesthetic and airway devices. Their conclusions vary, and the complexity of any such assessment means the LCA usually needs to be considered as hospital or organisation specific; any variation in reprocessing practices, such as the volume of water used during manual washing, the electricity consumption of different types of washer/disinfection unit, or the type of packaging material used for repacking after reprocessing, will all have an effect on the overall environmental impact. Decisions also need to be taken as to what to include and exclude. For example, should energy recovery from waste incineration or the environmental impact of Personal Protective Equipment (PPE) used by healthcare workers involved in reprocessing be included?

The i-viewTM in use

Of course, all products have an impact on the environment, but it is important to ensure the environmental assessment is considered alongside other key factors, such as infection control considerations and the clinical benefits offered by the device.

For example, the weight given to the clinical benefit of having a single use video laryngoscope available in a life-threatening road-side emergency, perhaps when this might be the only viable VL option economically, might be quite different than the assessment made for regular routine use in the operating theatre.

In an interesting paper published in the British Journal of Anaesthesia, entitled, ‘A national survey of video laryngoscopy in the United Kingdom’, Cook & Kelly3 reported on the results of an electronic survey sent to all UK National Health Service Hospitals. With regard to availability of video laryngoscopy (VL) by clinical area, 91% of operating theatres reported availability of VL. In contrast, only 55% of Obstetric departments, 54% of Intensive Care Units and 35% of Emergency departments reported availability of VL. The authors noted that, ‘The distribution of availability is notable because the incidence of difficult or failed intubation increases in those places where video laryngoscopy is less available; in order, main theatres, obstetric, ICU, and the ED.’

It is not known why VL was less available in these areas, but it is possible that with less frequent use than in the OR, the financial implications of purchasing a reusable VL may have been a factor. If so, availability of a single use device might provide a more economically viable option due to its lower unit cost, which as discussed earlier, may be more economic when use is infrequent.

In summary, the i-viewTM video laryngoscope from Intersurgical is the first single use adult video laryngoscope with a Macintosh type blade. It provides the option of video laryngoscopy, wherever and whenever the clinician may need to intubate. This makes VL a viable option in places where the higher initial costs of purchasing a reusable device may previously have been prohibitive. With the new focus in airway management of ensuring the first attempt at intubation is the best attempt, i-viewTM may have a contribution to make to support this objective. Whilst it may not be suitable in all situations, such as when a hyper-angulated blade is required, it may be ideal in situations where use is infrequent, standard blade geometry is preferable and the nature of use makes it a more viable option economically.

Image taken at the ATACC Course in May 2019

Deciding on the most appropriate video laryngoscope to purchase and use is not straightforward, and in addition to the clinical requirements and preferences, consideration may need to be given to a number of other factors, including financial, environmental and infection control related issues. It is important to recognise this assessment may change according to where, when and how often the device is to be used.

Make a direct enquiry about Intersurgical’s i-viewTM here

1. Cook TM & Kelly FE. Seeing is believing: getting the best out of videolaryngoscopy. British Journal of Anaesthesia 117 (S1): i9–i13 (2016)
2. Infection Control in Anaesthesia 2. Association of Anaesthetists of Great Britain & Ireland. 2008
3. Cook TE & Kelly FE. A national survey of videolaryngoscopy in the United Kingdom. British Journal of Anaesthesia, 118 (4): 593–600 (2017)

Paramedic Paul Runs UK Best At 24-Hour World Championship

A South Western Ambulance Service NHS Foundation Trust (SWASFT) senior paramedic has become one of the top ultra-runners in the world.

Paul Maskell, 41, competed at the 24 Hour World Championships in France, and managed to run an incredible 156 miles (251km).

He was the first British man in 15th place, after running as far as he could against hundreds of other athletes.

The SWASFT Operations Officer regularly runs 11 miles between home in St Austell and work in Bodmin in between 12-hour shifts.

He was selected in a team of six UK men for the race on October 26-27 after running 154 miles (248km) at another 24-hour event in London.

Paul said: “I loved doing the race. To be able to compete in a world championship was such an amazing experience, and it was a real honour to represent Great Britain. Putting on the vest was such a proud moment.

“There were highs and lows during the 24 hours. It’s a case of enjoying the highs, and battling through the lows by remembering family and friends and having the willpower to keep going. We were running in 27 degree heat during the daytime. I was also encouraged by the team atmosphere in what is usually an individual event.”

He was cheered-on by a group of 10 school friends who travelled to France for the event.  

Paul said: “They flew out and surprised me. I saw them all standing beside the track wearing specially-made t-shifts. They stayed for the whole 24 hours which was a huge boost to me and the other athletes. It was quite emotional at the finish line.

“I lost a toe nail during the race and had sore feet afterwards. Apart from that I felt great!”

Paul, who has worked for the ambulance service for almost 20 years, said: “I’ve never had any serious injuries, and have never had to take a sick day off work.

“Although I love my job, when I returned to work for a night shift there was definitely a feeling of ‘back to reality’.

“Since the race I’ve already done a 10km event in Newquay raising money for Cornwall Air Ambulance.”

“I’m going to keep on running and hope to get re-selected next year.”

The Great British team finished 4th overall and narrowly missed out on a bronze medal.

Since 2012 Paul has competed in multiple long distance and ultra-distance runs, including the London Marathon and 100-mile events.

He has won several ultra-runs in recent years, including the Arc of Attrition along the coast path from Coverack in South East Cornwall.

Jo James, who works with Paul, said: “The race was an extraordinary physical and mental challenge.

“We’ve been so excited by Paul’s journey and have been supporting him all the way. His selection was an achievement in itself. But for him to finish among the top endurance athletes in the world was phenomenal.”

Daughter’s Rescue Leads A Father To Become An EMT

Jerusalem, November 7th, 2019 – Two years ago, Hila Zohar, aged 17 at the time, fell off of the roof of her home in Or Yehuda after she suffered a seizure. The fall, more than 8 meters, caused a serious head injury, massive bleeding and complete loss of consciousness. United Hatzalah volunteer EMT Avi Yosefov, who lives in the same neighborhood, received the emergency alert, rushed over to the scene and arrived in less than a minute. Yosefov treated her for her injuries and his near-immediate response and treatment saved her life. 

Hilah’s father, Yaakov Zohar, witnessed the terrible incident and saw how fast Avi arrived and treated his daughter. At that very moment, Yaakov decided that he too would become a volunteer EMT. On Tuesday night, Yaakov, together with 15 other new EMTs graduated their training course and became United Hatzalah volunteers. 

“I recall very clearly how Avi arrived with incredible speed and fought hard to save my daughter’s life,” recounted Yaakov. “Hila was brought to Tel HaShomer Hospital and was in the intensive care unit for two weeks. After that, she underwent months of arduous rehabilitation. When she had recovered enough and was finally out of danger, I slowly began to understand what exactly had happened and the desire to become a part of United Hatzalah awoke inside me.” 

From right to left: Yaakov Zohar, Hila Zohar and Avi Yosefov at the graduation on Tuesday 
Photo Credit: Oren Cohen

Yaakov, an electrician by profession, underwent the admissions process to participate in a training course and two days ago, came full circle by graduating the course with honors. He will now join the team of volunteers serving the area of Bika’at Ono under the guidance of Yuval Shlafman, United Hatzalah’s Chapter Head of the region. Shlafman, upon presenting Yaakov with the award of excellence in the course said: “I believe that Yaakov’s personal story will push him to become an excellent EMT with a high level of motivation that will help him continually assist others in their times of need.”

Avi Yosefov attended the graduation in order to honor Yaakov’s accomplishment and recall the traumatic incident that brought them together. “We are neighbors and live right down the street from one another. However, until the incident with Hila, we did not know each other very well, just enough to say hello when passing in the street. When the incident occurred, I was at home. When I saw the address of the call I knew that it was my neighbor. I raced outside, ran down the street, and in just a few seconds I was treating Hila. After everything calmed down, we stayed in touch and about a year-and-a-half ago, Yaakov told me that he too wanted to volunteer for the organization. Watching him graduate today with honors brought me a lot of joy.” 

Hila is now 19-years-old and healthy. “First of all, I want to thank United Hatzalah and Avi, for without them, I wouldn’t be alive today. I am also very proud of my father who has decided to volunteer and become a part of the organization so that he can now save others just as I was saved.”

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Brave Crash Victim Raises £6K For Ambulance Charity

A courageous mum whose husband died in a motorway crash has presented a cheque to the South Western Ambulance Charity after raising thousands of pounds in his memory.

Ceri and Rod Walsh, from Cheddar in Somerset, were involved in a multi-vehicle collision on the M5 near Taunton in September 2018.

Ceri sustained serious injuries in the crash, and doctors feared she would not be able to walk again.

But a year later Ceri defied expectations to complete a 10km run with their children Thomas, 14, and Carys, 11, and many other family members and friends.

Ceri handed-over the cheque for £6,387.75 to South Western Ambulance Service NHS Foundation Trust (SWASFT) staff on behalf of the charity at Taunton Ambulance Station on Tuesday 5 November.

She said she was “blown away” by the amount raised.

Ceri said: “I’ve been through a rollercoaster of emotions during the past year. But once I realised I was going to survive, I wanted to do something for the people who responded to the incident.

“The ambulance service deals with incidents that no human being would want to witness. They work professionally to maintain life at the worst possible time. Without the ambulance service my two wonderful children would be living without their mum.”

Two of Ceri’s colleagues also raised more than £2,500 from a skydive in March.

Zoe Later, head of South Western Ambulance Charity, said: “We are so grateful to Ceri, her family, friends and colleagues for their incredible fundraising for the South Western Ambulance Charity.

“Alongside the generous donations, I’ve been honoured to read some of the heart-warming messages from Ceri’s supporters on her fundraising page.

“To raise a total of almost £9,000 for the charity is a fantastic legacy to her husband, Rod, and a real testament to how loved Ceri and her family are. They are such an inspiration to us all.”

The family described Rod as a “gentle fun-loving family man” who was “loved dearly”. They praised his “laughter, love of life, kindness and loyalty”.

Rod was a committed member of the parish church in Cheddar, and had been an NHS worker for almost 40 years.

Ceri has worked as a NHS nurse for more than 30 years.

South Western Ambulance Charity uses gifted monies to benefit those in our communities who use our service, and to improve the welfare of SWASFT staff and volunteers.

At Ceri’s request, the funds she raised will be used specifically to support the staff of ambulance stations in Somerset.

Zoe added: “Every donation to the South Western Ambulance Service Charity makes such a difference, and stories like this one show the impact that SWASFT and the NHS has on our communities.”

If you would like to raise money for South Western Ambulance Charity, please email or call 0300 369 0108.

To donate to the charity, please click on this link:

United Hatzalah: Creating a National Flashmob of EMS Lifesavers Through Education

By Raphael Poch, International Media Spokesman, United Hatzalah
Published in Ambulance Today, Issue 3, Volume 13, Ahead of the Curve, Education and Technology Special, Autumn 2019

One key element in creating what is likely the fastest EMS response time in the world (a national average of less than 3 minutes) was developing what has been termed a national flashmob of EMS first responders, comprised of fully trained EMTs, paramedics, and physicians who immediately drop whatever it is they are doing at a given moment specifically to respond to emergencies within their local vicinity. In order to achieve this national network of volunteers that numbers around 6,000 men and women from all communities, cultures, and religions in Israel, United Hatzalah needs to expand its operation from simply responding to medical emergencies to also include focus on continual training.

United Hatzalah is a national EMS organization serving Israel, fully staffed by volunteers, which provides all of its services completely free of charge. The organisation teaches between 35-40 fully accredited EMT training courses that are recognised and supervised by the country’s Ministry of Health. Each course is comprised of between 25-40 people and is based in speci c regions where the need for additional responders is greatest. “We have a dedicated education department that not only attends to the needs of the instructors and students whilst dealing with the logistical challenges of these courses that are offered across the country, but they also assess where a new course is needed based upon population density, the average number of emergencies in the given area and how many responders are already in that area,” explains President and Founder of United Hatzalah Eli Beer. “The system is incredibly effective. If for example, we see a rise in medical emergencies in a city in the north, say Nahariya, then we will work with our chapter head in that region and open a new training course to increase the number of volunteers we have there. The more volunteers we have, the faster our response time will be.”

A search and rescue training drill for collapsed buildings

Graduates of the EMT courses given by United Hatzalah hold the level of EMT-b and respond to all types of medical emergencies around the country.

Each volunteer responds to medical emergencies in their close proximity in order to arrive at the scene within less than three minutes. The more volunteers that the organisation has, the more widely its lifesaving network will expand and the faster it will have a fully trained first responder in the door whenever and wherever a medical emergency occurs. The volunteers either use their own private vehicles or one of the organisation’s iconic ambucyles or ambulances.

But the basic courses are just the beginning of United Hatzalah’s educational component. As the official training partner in Israel of the American Heart Association and the US- based National Registry of Emergency Medical Technicians (NREMT), United Hatzalah is Israel’s only organisation that can train volunteers to be licensed both in Israel and in the United States. United Hatzalah offers training classes that are certified by both the AHA and the NREMT respectively and has a medical department that continuously oversees the level and quality of training. Each volunteer that wishes to become a first responder in Israel must undergo no less than three rigorous tests administered by seasoned paramedics (EMT-p) whose responsibility it is to ensure that the volunteer has not only a mastery of the information learned and its practical application but also the expertise to manage a scene by themselves, even if that scene is an MCI (mass casualty incident).

A general training exercise for United Hatzalah. Photo courtesy Shira Hershkop

Proper triage and scene management protocols are taught to every first responder as part of the EMT training course. “With a response time as fast as ours, our volunteers often find themselves at the scene of a medical emergency long before an ambulance arrives,” explained Chief Paramedic Avi Marcus. “These scenes can be anything from assisting an elderly patient who is suffering from weakness, to suicides, a major motor vehicle accident and even terror attacks. Our volunteers need to know how to respond to any medical emergency in the appropriate fashion befitting that scene.”

A water rescue training exercise in Tiberias.
Photo courtesy of Shira Hershkop

Together with the head of the medical department, Alon Basker, Marcus is in charge of making sure that each and every one of the 6,000 responders also fulfil their requirements of participating in an annual retraining course. “To be a licensed EMT in Israel, each responder needs to undergo an annual training course that focuses on a number of specific items that the organisation feels need an extra level of attention. We generally focus on techniques that are not commonly used in the field by all first responders. This year we covered some newly developed techniques of wound packing, paying closer attention to the number of questions asked when taking an oral history so as not to belabour the patient, and familiarising the responders with the techniques of applying the Asherman chest seal bandage, an item that was just brought back into the standard protocol of application on open chest wounds in Israel. By focusing on the less used aspects of the tools and techniques an EMT uses, we build the volunteer’s exposure to them so that they can more comfortably use them in the field, should they ever come across a situation in which they are required.”

A water rescue training exercise in Tiberias.
Photo courtesy Shira Hershkop

Other elements that are unique to United Hatzalah’s EMS training program include cultural sensitivity courses that educate responders about how to properly treat patients from other cultures or religions while taking into account their religious sensitivities. This course often bridges the gap between Muslim and Jewish students who often participate in courses together. Another unique element of the course is the addition of a special psychological first aid (PFA) training class given by one of the members of the organisation’s Psychotrauma and Crisis Response Unit that teaches EMTs how to identify patients or other first responders who are suffering from shock or emotional stress reactions at a traumatic scene.

Defensive Ambucycle Training

In the past 12 months, United Hatzalah has graduated 35 training classes, and more than 1,000 new volunteers have joined the national network of first response volunteers. The goal of the organisation is to train enough responders across Israel so that the national average response time goes down to 90 seconds.

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Coming Full Circle: Some Holiday Inspiration From A United Hatzalah Rescue Vehicle

Jerusalem, October 7th, 2019 – Rina and Yacov Kauffman dedicated an ambucycle a number of years ago in honor of Rina’s brother Leon Lebor who was killed in the September 11th attack on the Twin Towers. The couple knew that the donation would go towards saving lives in Israel, but they never imagined that the donation would one day help Yacov’s own father.

 During a wedding that took place in Israel on the 23rd of Elul, the Hebrew date of September 11th attack in 2001, and consequently the Yartzheit of Leon, President and Founder of United Hatzalah Eli Beer was approached by Rina and Yacov’s son Yair Kauffman who wished to relay a special story.

Yair told Eli that his grandfather, Yacov’s father, had suffered a heart attack earlier in the day. Concerned family members called emergency services for help and the first person to arrive was United Hatzalah volunteer EMT and ambucycle rider Dov Bash who rides the very ambucycle that Rina and Yacov had donated. Dov happened to be riding his ambucycle nearby when the call went out and he arrived at the address within 20 seconds of receiving the alert.

Dov Bash with the donated ambucycle
Photo Credit: United Hatzalah

Bash initiated CPR and attached a defibrillator which provided a shock to Rina’s Father-in-law and then Bash was joined by other first responders and the team carried on CPR for close to an hour and finally managed to bring the man’s pulse back. He was taken to the hospital where he stayed alive for another two hours, long enough for his family to gather by his side and say goodbye.

“The good deeds we do come back and repay us in kind,” said Eli Beer once he heard the story. “I am so happy that the ambucycle that was donated by the Kauffman family, which is a truly special family that believes in giving to save others, was able to help someone in this family as well.”

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EMTs Perform Successful CPR on Woman 39 Weeks Pregnant Saving Mom and Baby

Jerusalem, Thursday, October 10th, 2019 – On Motzei Shabbat before Rosh Hashanah, United Hatzalah volunteer EMTs Aharon Avital, Tomer Tzenani, Yossi Cohen, Naftali Friedman, Adi Avivi, and Lior Filshteiner were summoned to the home of Yaron and Limor Golan in Hod Hasharon. Limor had just suffered a heart attack. To complicate matters more, Limor was 39 weeks pregnant when the heart attack occurred. 

“I was sitting in the living room watching TV when I heard a noise in the bedroom,” Yaron recounted. “I saw Limor on the floor and I rushed over to her and tried to wake her up. She didn’t respond. I called a neighbor for help. He began performing CPR on her. I didn’t know what to do so I called the emergency number for an ambulance.”

Aharon Avital, head of the Hod Hasharon team for United Hatzalah together with EMT Yossi Cohen were the first responders at the scene. The pair arrived in less than three minutes and immediately took over CPR from the neighbor. Aharon and Yossi attached a defibrillator and administered an electric shock. The duo spared no resource in their efforts to save the life of the young mother and that of her unborn baby. Moments later they were joined by 4 other volunteer EMTs from their local team who joined their efforts.

A mobile intensive care ambulance arrived sometime later and after more than 30 minutes of active CPR, the combined team managed to restore a steady pulse. Limor even started breathing again independently. She was rushed to the maternity ward at Meir Medical Center for an emergency C-section, which was successful in saving her child’s life. Limor was then treated in the hospital for her heart attack and later regained consciousness in the hospital and awoke to meet her healthy little boy, the couple’s first.

This past Friday, the United Hatzalah volunteers were invited by Yaron to reconnect with the family in the hospital. During the meeting, Yaron and Limor shared their profound gratitude with the team of first responders and thanked them for their quick arrival and lifesaving intervention.

(From left to right) – Aharon Avital, Tomer Tzinani, Yossi Cohen, Yaron Golan, Limor Golan, Adi Avivi, LIor Filshteiner, and Naftali Friedman – During the hospital visit. Photo Credit: United Hatzalah, taken with family’s permission

Yaron thanked the volunteers for saving the lives of his wife and son. “You saved my wife’s life and my son’s and in truth mine as well as I’m not sure I would have survived this had they both died. You arrived so quickly and treated my wife with expertise, commitment and caring that I have no words to thank you. You’ve literally saved us. I now know that I have to do a CPR course. Every family should do this. It is imperative. I was upset at myself that I didn’t know what to do when my wife collapsed. You people, who don’t know me and don’t know my wife came to save her life. You volunteered their time. I too will now volunteer to go out and help others. I am committed to this and it will happen.”

“This was the most moving CPR I have ever done,” said Aharon, who has performed dozens of emergency CPRs during his years volunteering as an EMT. “As I ran into the house I saw what tragedy could befall the family if Limor wasn’t saved. Limor who was unconscious, the baby who was about to be born, and Yaron whose life was literally crashing down around him in a moment. I knew that we needed to save Limor and prevent this tragedy from occurring.”

Aharon added: “When Limor woke up on Monday, two days after the incident, Yaron called me and asked if I could come with the team who saved her to visit them and meet the new baby. I gathered the crew of volunteers and we ended up coming in to visit them a bit later in the week so as to give Limor time to heal after her ordeal and surgery. We spent some time with them and I was pleased to see that everyone was recovering. I have never seen a miracle quite like this.”

Limor and her son, being fully recovered, were released from the hospital before Yom Kippur.

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