Brothers rewarded for their brave efforts in getting their mum emergency help

23 July 2019

Three brothers from Newcastle have been awarded bravery certificates by the North East Ambulance Service for their actions in helping to get emergency help for their mum after she collapsed at home.

Seven year old twins Charlie Duke and Dylan Duke, and their four year old brother Jayden Douglas, were at home when their mum Lisa Hefferin collapsed at the bottom of the stairs and became unresponsive.

Dylan rang 999 by using his mum’s mobile but it was Charlie that spoke with call handler Vikki Wightman, to ensure the door was unlocked for the ambulance crew to arrive and that he and his brothers stayed safe.

Vikki said, “The call came in and I was alarmed that it was a young boy ringing about his parent. All three of the boys spoke on the phone and gave a clear account as to what had happened, but it was Charlie that gave me clear details of his mum’s condition and what their address was.

“If children know the basic information of what to do during an emergency, it makes it that little bit easier for us to find out exactly what is going on.

“It was a privilege to be able to award Charlie and his brothers for their actions. They were all so brave in getting their mum the help she needed. It’s not every day we get to see the outcome of a patient and as a call handler, being able to meet the person on the other end of the phone, really puts into perspective the work that we do.”

Lisa suffers with low blood pressure and has to take iron tablets. Her blood pressure dropped so low that day that she collapsed and didn’t regain full consciousness until she was in the back of the ambulance, on her way to hospital. 

Lisa said, “It was me and the three boys in the house at the time and it was absolutely amazing what they did.  Charlie looked after his siblings and called for help for me when I needed it the most. I couldn’t believe it.

“I think every parent should learn from my story and educate their children in what to do during an emergency. I taught them what to do and they got me the help I needed.

“I’m so proud of all of my sons.”

The ambulance crew members that attended to Lisa were paramedics Craig Hurst, Victoria Landale and Daniel Price as well as rapid response paramedic Paul Jackson.

Craig has worked at NEAS for seven years and has been a qualified paramedic for two and a half years. He remembers the job well, “We got a serious life threatening call about a female in cardiac arrest at her home and that one of her children had called 999.

“When we arrived he had unlocked the door for us and we saw Lisa in a semi-conscious state. Thankfully she wasn’t in cardiac arrest. Charlie had found blankets and pillows to make his mother comfortable and stayed by her side the whole time. Whilst we were there he was looking after his brothers and gave us exceptional information about what had happened. As it turned out, she collapsed with low blood pressure.

“He continued to look after his brothers and got them ready for school whilst we were helping Lisa and kept their family dog calm. 

“I feel the efforts of this young gentleman and his brothers deserve recognition and I could not go without presenting them a bravery certificate.”

Victoria Landale has worked at NEAS for five years, first beginning as a dispatch officer in in the emergency operations centre. She said, “It’s great to meet Lisa and to see how she is getting on from what happened. It’s also closure for us to hear the outcome of patients that we have treated, which we don’t always get to hear about.

“Many schools now are implementing CPR within their curriculum and I think this case highlights the simple things that young children can do to save their parents or someone else’s life.”

Daniel Price said, “Charlie was a really grounded little boy as he kept reassuring his brothers that mummy was going to be alright. He also got them ready for school, he was really mature for his age.

“We don’t get a thank you very often but when we do it’s really nice to get one. My job is to help people and when someone recognises that, it’s really inspiring for me.”

The Trust is hosting a CPR training day called Restart a Heart Day in October, that encourages schools, organisations and communities to sign up to receive lifesaving skills in CPR.

Over 30,000 people suffer a cardiac arrest out of hospital in the UK every year.   Currently, less than one in 10 survive. The earlier a patient can receive CPR and a shock from a defibrillator, the greater their chance of survival. We know that the major difference is widespread training in CPR. Find out more and sign up to Restart a Heart Day:

“Waiting on a Friend”

Author: Jerry Overton

Published in Spring 2019 Edition of Ambulance Today Magazine

In this column, Jerry Overton- who is viewed by many world EMS and healthcare leaders as one of the best when it comes to improving ambulance systems globally- gives his opinion on the allocation of funding in theEMS system. He identifies some of the issues within EMS systems globally and, whether it’s saving ambulance hours or reallocating funds, you can trust Jerry to have a pretty good idea on how to improve on the system.

Oh, a storm is threat’ning

My very life today

If I don’t get some shelter

Oh yeah, I’m gonna fade away

 -“Gimme Shelter”

Yes, it is a storm that is constantly threatening, and it threatens us all. Cardiac events know no shelter; they
do not “fade away”. How sadly ironic
it is that the emphasis on this issue
of Ambulance Today is the recent London Cardiac Arrest Symposium last December, an event that Dec, lover of the Rolling Stones, had planned to cover. This all still just does not make any sense.

As always, the symposium was excellent, and I am sure the specifics will be comprehensively reported elsewhere. From this perspective, the welcome change was less on research and more on resources; human resources. The first, “Community CPR”, and second, “Kids Saving Lives”, really hit the mark.

This does not mean that cardiac research is not important, because itis. But, at the end of the day, whenone considers the amount of money committed to research compared to the amount of money needed to increaseour resources, one wonders if it is not time to discuss priorities.

Back in the day (okay, my day), the initial intervention for an out of hospital cardiac arrest was the precordial thump and if that did not work, there was always intracardiac epinephrine and sodium bicarb. Other meds came and went, depending on the latest research, and sometimes even who did the research. The contents of the drug box varied from system to system and the decisions of the local medical director. Sadly, ROSC rates failed to show any real improvement, whether in the United States, the United Kingdom, or Asia.

Today, every responder knows that two interventions make a difference, timely CPR and timely defibrillation, stressing the word “timely”. The question now, though, is what constitutes “timely”. It sure is not an eight-minute requirement. As has long been stressed by any paramedic, there will be little difference in outcome if the response time is 9 minutes 1 second rather than 8 minutes 59 seconds.

Response times are outputs, and what is needed are outcomes. And to achieve outcomes, we need resources. That, clearly, requires our most important resource, which is our people. If we really do have money for new programs, it is time to invest in the “research” necessary to seriously examine howwe can better recruit and retain those that can change patient outcomes. And if we do not have any “new”, perhaps reallocation of funds is in order.

There can be no debate that shaving seconds in telephone CPR instruction is important, but if there are insufficient dispatchers to answer the increasing number of calls, those seconds will make little difference. It is an under appreciated, almost invisible position, that drives the first link of the Chain of Survival.

The shortage of paramedics is even more acute. In the U.K., a 2017 report by the Comptroller and Auditor General of NHS England, reported 10 percent vacancy rate, with Trusts “struggling to recruit the staff they need and then retain them.” The U.S. is facing a similar problem. A recent broadcast from CNBC news reported that in the next six years, a 15 percent increase of paramedics would be required at a time “when unemployment continues to hover near historic lows”.

Of course, it is not just the out of hospital care world that is facing a crisis, other sectors of health care are also, and it directly impacts our ability to respond. That same 2017 report by the Comptroller and Auditor General found that in “2015-16, approximately 500,000 ambulance hours were lostdue to turnaround at accident and emergency departments taking more than 30 minutes, which equates to 41,000 12-hour ambulance shifts.”That is an almost unbelievable (but it is) staggering waste of both human AND financial resources.

Longer hours, more responsibility, higher utilization, fatigue, inequitable pay, and, of course, working conditions when considered together would make any sane person wonder why another sane person would ever consider makingthe commitment to a dispatcher or paramedic. The answer is, obviously, EMS personnel give a damn.

All too often, that is forgotten. It was just under three years ago that the first European congress dedicated to EMS was held in Copenhagen, EMS2016. The theme of that congress, and the subsequent congresses, was “It takesa system to save a life,” and indeed,it does. But the foundation for that system, or any system, is its people. In other words, without you, it is nothing.

That is my point. If we are ever to increase cardiac arrest outcomes,it will be done by human resources that have the education, experience, and motivation to make a difference. Telephone CPR does little good if a call goes unanswered. A medication has little impact if there is no paramedic to administer it.

Just like human resources, economic resources are limited. And it is a basic tenet of EMS that “nothing in life is free”. That includes community and kids’ CPR. Wisely using the financial resources that we do have is key, and if that means reallocating research grant funds away from the latest in drone delivery systems that could potentially increase survival one-half of one-half percent (yes, that is sarcasm), it needs to happen if those same funds can help us better find the keys to retain the human resources that WILL make a difference (No, I am not naive, higher wages is definitely a major key!!!).

And just when you think that all of us have at least a basic understanding for the need for a resource, any resource, that can respond and make a difference, comes this from the western section of the United States. It seems that officials in a Pacific Northwestern state have decided that call taking in dispatch centers has become so structured, and telephone CPR so protocol driven that they are proposing a rule change that would permit local agencies to no longer require its dispatchers to be certified in CPR. Yes, you read that correctly, public safety responders will not need to know CPR.

It is not like a fellow dispatcher has not arrested in a control center, because it has happened. It is notlike a fellow public safety officer has not arrested at headquarters, becauseit has happened. And it is not likea dispatcher has never witnessed a cardiac arrest as a layperson, because it has happened. Whether the proposal passes will be decided in early spring. And, interestingly, most local public safety agencies are AGAINST it. Perhaps those state officials need to take a step back and consider this from the Rolling Stones. It certainly fits.

You can’t always get what you want

You can’t always get what you want

You can’t always get what you want

 But if you try sometimes well you just might find

 You get what you need

“You Can’t Always Get What You Want”

MDA Education: The skills to save a life

Published in: Summer 2018 Edition of Ambulance Today Magazine

Magen David Adom (MDA), Israel’s National EMS organisation and Blood Services provider, is also Israel’s largest volunteer organisation. On its way to gaining this formidable title, MDA has taken upon itself the vital role of educating not only its employees in basic and advanced life-saving skills, but also a large number of Israel’s general population. Youth, medical staff and many others from around the world benefit from Magen David Adom’s professional and experienced trainers. 

Our youngest volunteers are 15-years-old, and begin studying towards a First Aid Provider certificate that allows them to volunteer on front-line ambulances. Often these teenagers undertake this course as part of a national volunteering scheme which requires all of those leaving school to have served a certain number of volunteer hours in order to receive their matriculation certificates.

MDA volunteers go well beyond their required hours, with just the 60-hour course itself almost entirely filling their quota. Nevertheless, many of the young volunteers work several times a week in eight-hour shifts, assisting the EMS crews in their life-saving duties.

These young volunteers often run training sessions of their own, either for the next youth volunteers or for members of the public, at CPR stands in malls, train stations, schools and other public places. 

Within the MDA framework, there are other short courses provided to the general public, beginning with a 22-hour “Life Guardian” course. This teaches the basic life-saving skills required in order to begin treatment in life-threatening cases such as cardiac arrest. Volunteers on this scheme are provided with basic life-saving equipment and then download an “MDA Teams” mobile phone app that notifies them if there is a call nearby and sends them details of the address and nature of the incident. This has helped to reduce response times in many cases to a matter of seconds, thus increasing patients’ chances of survival. 

Courses provided to medical staff are conducted around the country, both in their medical facilities and in MDA stations. These courses include refresher courses, Basic Life Support (BLS) courses, Advanced Cardiac Life Support (ACLS) courses, and tailor-made training sessions. 

ACLS, PHTLS and PALS courses are all run under the auspices of the American Heart Association, with MDA being one of the few non-American organisations with AHA accreditation for running their courses and issuing certificates. These courses are run across the country for nurses and doctors who are required to attend refresher courses every two-to-three years. 

Magen David Adom runs several courses a year aimed at international teams of doctors who come to Israel to learn from the wealth of MDA’s experience particularly, but not exclusively, in the field of mass casualty incidents. There have been teams from as far apart as France, Canada and Mexico who have joined specialised courses set in an Israeli background. There are, of course, EMT courses being constantly run, providing a flowing stream of qualified staff, including both volunteers and employees, for our ambulances. 

Arguably, the pinnacle of Magen David Adom’s education services lie within the Paramedic Education Centre, located in MDA’s Ramat Gan station, but branches are located all across the country. All of Israel’s Paramedics undertake their training with Magen David Adom, either in part or in its entirety, regardless of which course or courses they may have joined. There are courses for volunteers, EMTs who wish to take the next step in their career, military Paramedics, university degree Paramedics, those who are undertaking their national service in MDA, and many others. There have been courses run for all sections of society, irrespective of gender, race or religion, often tailored towards specific communities.

These communities, such as the Bedouin and Ultra-Orthodox communities, are underrepresented in the ranks of EMS in general, including Paramedics in particular. Providing each community with dedicated conditions allows their members to study in ideal conditions to complete the prestigious Paramedic course, and begin serving not only their communities, but the general public as a whole. 

Magen David Adom strives to educate as many people as possible in our primary, life-saving mission. We welcome all those who wish to learn to join us and be part of our education agenda. As it says in our logo – It’s a Matter of Life. 

Healthier happier staff = healthier patients

Author: Alan Lofthouse

Published in: Summer 2018 Edition of Ambulance Today Magazine

At the end of 2014, and early 2015, we went through a period of industrial action in the NHS over pay involving two 4-hour stoppages. In the ambulance sector, many staff were not prepared to come to work, even under emergency life and limb cover arrangements. This led the government to put the army on standby. So, what happened and what have we learnt? 

Why were staff not prepared to come in? Well the answer lies in the fact that ambulance staff have been raising issues with workload, pressure, demand and lack of support for a number of years. Trouble was no one was listening. Performance dominated Trust boards and finance fixated commissioners missed the warning signs. 

Here came an opportunity for staff to make themselves heard. They voted with their feet in the knowledge that their legal right to take lawful industrial action would protect them. When it came to settling the dispute, we made sure that ambulance staff wellbeing was part of the final settlement. 

So, what has happened since then? Well, we have been working to develop a collaborative approach between Ambulance Employers, Trade Unions and NHS Employers to improve the mental health and wellbeing of the ambulance services workforce. 

We started by bringing together staff and employers to discuss the challenges each group faced. We have to recognise, whether we agree or not, that there is a policy of austerity in government meaning budgets are increasingly tight and the expectation is that employers will do more with less. However, this policy leads to problems for employers as staff leave jobs for less stressful and better paid work leading to recruitment and retention problems. 

Employers listened to staff concerns about working conditions, not just for the operational staff working on ambulances, but also the staff working in the contact centres and corporate services. Fewer people doing more work in an increasingly challenging environment. This is not easy listening for employers, many of whom work in managerial roles to help support staff in the delivery of 999, 111 and PTS services. Ultimately, they have little control of the government’s public sector funding policy. 

However, they do have to deal with the consequences – the dropping job satisfaction, morale and motivation; the loss of organisational commitment and discretionary behaviour. This leads to a worsening engagement, stress symptoms and burnout. Then they have to account for increasing absence rates and unfilled shifts. 

At first it seems like an impossible puzzle with too many pieces that don’t seem to fit together. How do you improve wellbeing, especially when you know what is making people unwell, but it feels out of your control and when taken as a whole it seems an impossible task? 

We started by grouping the pieces of the puzzle together based on the key issues. 

Mental health and resilience. Helped by Mind and the Blue Light Programme we know that ambulance staff are more likely to suffer from mental health problems but less likely to do anything about it. 

Bullying and harassment. Whether it is a manager and staff relationship, a control and road relationship or a hospital and ambulance relationship, we know they are already strained. Cultures in ambulance services need to change. External and internal pressures lead to poor behaviour but we need to eliminate bullying. 

Reducing violence and aggression. Too many times we read reports about staff being assaulted. I have written about this subject before and no one disagrees – we need to tackle this issue. With the right focus on prevention and prosecution we can reduce the harm caused by violence. 

Leadership behaviour. Ambulance staff take on managerial roles and then are not given the support or training needed to discharge their duties. We hear of senior management teams that are out of touch with staff. Line managers have a major role in supporting and developing staff. Senior management need to give them the training, autonomy and trust to support their staff. 

Working patterns and role design. Ambulance work takes years off your life! More and more evidence shows us that long hours, shift working and night working is bad for us and leads to preventable diseases. Some staff like working longer shifts to get longer periods of time off, but with no guaranteed meal breaks and the likelihood of a long shift overrun it’s time we looked seriously at this issue to make work less demanding but recognising peoples’ needs to spend time with their friends and family. 

Equality and inclusion. The experience of BME ambulance staff is of inequality in career progression, increased experiences of harassment and bullying and underrepresentation at senior level. 

Recognition and staff engagement. Each year the NHS Staff Survey shows how poorly engaged ambulance staff are. They are the lowest scores across the NHS. I do not honestly think it is deliberate but you get very little recognition for a job well done, whereas you do hear about a missed performance target or a complaint. Ambulance services need to get better and reap the rewards of telling staff they recognise the effort they are making, especially in difficult times. 

Healthy lifestyles. Last but by no means least. Ambulance work does not lend itself to healthy lifestyles. Shift work, late night snacking on poor quality food, combined with lack of consistent exercise and the physical demands of the job are a bad mix. However, looking after your own health is important and we want to see more employers supporting staff to live more healthily. 

The real trick for the national bodies, employers and trade unions will be getting the buy-in from staff and for them to trust that this is more than just a new initiative. The benefits are proven and what we have been saying for a long time. To get good patient care you need to start with good employee care. At the end of the day, healthier happier staff = healthier happier patients. 

Accidents are no film set

Author: Thijs Gras

Published in: Spring 2019 Edition of Ambulance Today Magazine

EMS staff have enough to deal with when responding to a call, the last thing they need is members of the public making harder work of it. In this column, Thijs Gras explains the difference between ‘innocent inquisitiveness’ and ‘sick sensationalism’ when it comes to the scene of an accident.

We got a call: probable resuscitationin a tram. When we arrived we founda man of about 70 years lying on the ground in a tiny space inside the tram. It was cold and rainy, so carrying him outside was not an option, at least not without proper preparation for which we had no time. The police were already performing CPR, all the passengers were out of the tram. We pulled the man a little under to create a bit more space and took over the resuscitation. While I was ballooning the man I suddenly noticed someone on the outside, looking curiously through the window of the tram as to what we were doing there.I was amazed and so were the police. After this guy was chased away, only a couple of moments later a woman took over. She gazed inside.

Now I must admit I have a certain degree of understanding, people being inquisitive when something happens involving lights and sirens. Mankind is naturally curious. In my younger years hearing the fire service acceleratedmy heartbeat and if I knew where they were going to, I went as well. A fire is fascinating to see. Smoke and flames, lights and sirens attract attention, which generally is okay, as long as you do not come too near or hamper rescue and/or fire fighting operations.

Labelling it positively, one could referto this as interest in the community, in society, in other people. The attraction could even have an evolutionary use: it is a way to mobilize help and assistance. It is only relatively recently that rescue and emergency medical care outside the hospital is professionalized and trusted to specially trained people from dedicated organizations and services. But even nowadays we value first responders and bystanders because they have one big advantage over the professionals: time. Professionals need to be informed there is a problem,find out where it is and who shouldbe handling this, and then alert the required units to rush to the scene. All these steps take time, so having people around to extinguish a fire, control a bleeding or perform CPR may be of great value.

But there are boundaries. Some people prefer filming to rendering first aid.This is ridiculous of course. Even after emergency services arrived on the scene and are doing their job, people may come very close, sometimes too close for comfort. Being a historian, I went through a lot of pictures of accidents. One would be amazed by the number of people watching accidents on some of the older pictures. Apparently this is of all ages. In the Netherlands we call this ‘disaster tourism’.

But do not forget, it may be dangerous! Even in The Netherlands we had a nasty experience in this field with the big explosion of a firework factory in the town of Enschede in May 2000. Among the 22 fatalities (including four fire fighters) and about 950 injured, were a number of people that had come to the incident just out of curiosity.

In recent years cell phones and iPhones have taken sensationalism a step further; everything is filmed nowadays. You make your own reality TV and broadcast it among your friends or nasty news channels. With a bit of luck your footage goes viral.

Last year in August there was a big collision on one of the Dutch highways. One person was so seriously injured he had to be resuscitated. People were filming everything. They bashed through the accident scene trying to get the best pictures, destroying important marks for the police investigation. They used lanes, marked with red crosses. A car even stopped on the opposite side of the motorway to film the accident, almost causing another accident with an oncoming lorry. Police noted as many registration plates as possible to give these people a big fine. Will they learn?

There are thin lines between innocent inquisitiveness, caring curiosity,sick sensationalism and pathologic papparazionism. The first two are relatively okay and can be dealt with, the other two are not okay and refutable.

As ambulance crews we ask the right honourable members of the public not to film patients and victims. And if you are struggling against the temptation, just reflect before you film: “What if this was me or my mother or my father? Do I want to go viral?” Accidents are no film sets. . .

‘MDA Teams’ App

Technology applied to the health sector has made immensely positive strides saving lives in the smartphone era – the proliferation of mobile phones within communities has resulted in faster response times than ever before. Emergency services can be notifiedof incidents significantly quicker with mobile phones than compared to landlines. Smartphone applications have offered the ability to pinpointthe location of callers with a clickof a button so that ambulances can arrive on scene as quickly as possible. Now, smartphones can even minimize unnecessary waiting times at the ER during emergencies.

It is only fitting that Israel’s (thestate affectionately nicknamed the ‘Start-up Nation’) national emergency medical, disaster, ambulance andblood bank service Magen DavidAdom (MDA) represents the pinnacleof this trend of life-saving devicesand applications. Dating back even further than the State of Israel itself, the organization continues until today as a global leader in EMS innovation, including through the development of smartphone applications that provide simple yet innovative solutions to some of the greatest challenges of modern ambulance services.

One of the Israeli organization’s most innovative and recent technological infrastructures is the ‘MDA Teams’ mobile application. With the goal of minimizing any unnecessary waiting or consultation times before ST-segment elevation myocardial infarction (STEMI) treatments, the app streamlines direct communication between field paramedics, responding ambulances, Magen David Adom dispatch centers, on-call cardiologists and receiving hospitals.

With the click of a button, MDA Teams transmits ECGs and patient vitals, combining the main methods used to bypass the time-consuming emergency department in cases of patients suffering acute myocardial infarction ECG showing ST-segment elevation: utilizing automated ECG/ computer interpretation of the ECG and easy transmission to the on-call cardiologists.

For an organization that boasts a 7.6 minutes average response time for ambulances (and half that time forFirst Responders) it is no surprise that Magen David Adom is also working to cut down on the vital minutes between diagnosing the patient and transporting them to any necessary procedures. Developed in collaboration with the intensive cardiac care units, the Magen David Adom technology has shortened the time from symptom onset to catheterization by nearly 40.3%.

The technology also represents a better process to record and document events securely and directly via the smartphone application. First, on-call cardiologists activate their app to indicate they are on-call. When a mobile intensive care unit is calledto a patient having a STEMI, the paramedic can choose the receiving hospitals from a list of hospitals with ICCU and cath labs available. Then, the paramedic can take the ECG and send it securely through the system, also eliminating the risk of a wrong ECG being transferred. The ECG is uploaded via cellular connection from the monitoring device to the patient’s file on the server. The app then sends the ECG directly from the patient’s file to the cardiologist.

Listed in the application are on-call cardiologists, event date and time, ambulance number, main complaint, nearest hospital, urgency level, region and address of the call and patient destination. App features also include documented calls between the paramedic, regional dispatch, medical consult centers, hospitals and on-call cardiologists, along with ECG record and mapped ambulance tracking during transport with the estimated time of arrival. In keeping with privacy standards, no phone numbers are shown on the dialing server.

According to Eli Jaffe, PhD, EMT-P, director of training, PR, volunteer activities, marketing and international relations for Magen David Adom, before the application’s development, Magen David Adom paramedics “used mobile phones to orally describe the patient, symptoms and the ECG. Since smartphones are currently widely used, transmission of the ECG is possible through personal messaging applications such as WhatsApp.”

But this method is not without risks, he noted. “The paramedic may accidentally send the wrong ECG from an earlier patient to the on-call cardiologist, or the paramedic could transmit the ECG to the wrong person, which could lead to a breach in patient confidentiality.”

Additionally, photos taken by phone when in a hurry transporting the patient often results in transmitting a blurry ECG. “These methods are neither effective, secure nor documented”, said Jaffe. “For a true reductionin the symptoms-to-balloon time, EMS-to-balloon time should have a secure, well documented and effective infrastructure.”

Given the grave importance of quick coronary intervention during the deadliest type of heart attack, the combination of clinical diagnosis by trained paramedics and streamlined transportation of the ECG and patient makes the process fast and efficient, substantially decreasing the chance of severe complications, neurological damage, disability and death.

With new smartphone technologies such as the MDA Teams application, such infrastructure is now available to emergency medical teams, yet again highlighting the advantages of mobile tech devices in effectively and efficiently saving lives.