British Red Cross to help equip Londoners with first aid skills as part of mayor’s emergencies strategy

A leading crisis response organisation has welcomed moves to ensure first aid training will play a key role in better preparing the people of London for emergencies including extreme weather and terror attacks.

The British Red Cross will work alongside City Hall, NHS England and local authorities to increase access to first aid training for Londoners after lifesaving skills were included as an important part of the Mayor for London’s new London City Resilience Strategy.

Members of the public are often first on the scene in the event of an emergency – commonly before the arrival of emergency services.

The better equipped people are to respond, the greater the chances of lives being saved.

British Red Cross executive director for UK operations Norman McKinley said: “First aid skills save lives.

“Whether an emergency is large or small, ordinary people can make a crucial difference so long as they have the skills and confidence to help.

“We welcome the new London City Resilience Strategy and look forward to working with others to see what parts of London and which groups of people might benefit the most from first aid training and how we can reach them.

“The British Red Cross believes that everyone should know how to save a life and looks forward to helping turn London into a city of lifesavers.” 

British Red Cross research shows that 44% of people in London believe they are likely to be affected by an emergency such as a flood, severe storm or terror attack.

As part of the development of the London City Resilience Strategy, the British Red Cross and Deputy Mayor for London Fiona Twycross, held a workshop for people working in the voluntary and community sector.

At the session, people came together to discuss the key challenges facing London and what community-based organisations could do to help make the city more resilient.

The British Red Cross would now like to see a review of the 2004 Civil Contingencies Act so that the role of the community and voluntary sector during emergencies can be enshrined in law.

That way we can all work together to better identify what a particular community’s needs are during a crisis and tap into the knowledge, skills and resources of individuals and organisations within that community

Norman McKinley said: “The voluntary and community sector has an important role to play in helping local people prepare for emergencies, responding to crises when they happen and supporting communities as they recover.

“Local authorities can miss opportunities to mobilise people where they live so we are encouraged to see City Hall looking to identify opportunities for collaboration that harness that potential.

“It’s crucial that the people affected by an emergency are at the heart of the community’s response to it.”

For more information visit www.redcross.org.uk

Researchers to investigate method of growing new blood vessels

A new treatment for stimulating the growth of new blood vessels in the heart will be investigated by researchers at the University of Bristol thanks to funding of over £100,000 from national charity Heart Research UK.

A heart attack is caused by a blockage of one or more coronary arteries of the heart, which prevents blood and oxygen reaching the heart muscle.

Treatment for heart attacks include reopening the blocked coronary artery with stents or bypass surgery, though there are limitations with these treatments. Reopening coronary arteries is often insufficient to achieve a complete salvage of the heart, and the damage caused by a heart attack can lead to heart failure.

A potential new treatment is to increase the blood flow to damaged heart tissue by using drugs that encourage the body to grow new blood vessels.

The project will be led by Prof Paolo Madeddu, Chair of Experimental Cardiovascular Medicine at the University of Bristol, who, along with his team, discovered that an excess of a protein called BACH1 can prevent blood vessel formation.

Prof Madeddu and his team hope to show that the use of BACH1 inhibitors can stimulate the growth of new blood vessels. If successful, this would be the first step in developing them into drug treatments for heart disease. This would result in improved quality of life and reduced risk of developing heart failure.

Also, this treatment may benefit people suffering from other diseases where new vessel growth is needed, such as poor blood circulation in the legs, or damage to other organs, such as the kidney, brain and eyes.

Prof Madeddu said: “The use of BACH1 inhibitors is a very promising area of study that promises to have a huge impact on the way that we treat a wide range of conditions.

“If we are successful, the door will be opened for a whole new method of treating people who have suffered damage to their hearts. The ability to stimulate the growth of new blood vessels will allow us to drastically improve the quality of life of patients who may be at risk of heart failure.

“We’re very grateful to Heart Research UK for allowing us to undertake this research.”

Kate Bratt-Farrar, Chief Executive of Heart Research UK, said: “We are delighted to be supporting the research of Prof Madeddu and his team, which has the potential to significantly reduce the risk of people developing heart failure after a heart attack.

“Our Translational Research Project Grants are all about bridging the gap between laboratory-based scientific research and patient care – they aim to bring the latest developments to patients as soon as possible.

 “The dedication we see from UK researchers is both encouraging and impressive and Heart Research UK is so proud to be part of it.”

The £107,726 Translational Research Project grant was awarded to the University of Bristol as part of Heart Research UK’s annual awards for research into the prevention, treatment and cure of heart disease.

Last year, Heart Research UK awarded more than £1.6 million in grants for medical research projects across the UK. To date, the charity has invested more than £25 million in medical research via its grants programme.

AN EPiCC RESPONSE TO EMERGENCIES AND DISASTERS

THE FUTURE media and communication response to emergencies and disasters within the UK will be shaped by a new not for profit organisation launched today (Tuesday, 4th February).  

EPiCC (Emergency Practitioners in Crisis Communication) will support the development and delivery of effective crisis communication by providing a network for all who practice and operate in this arena to share good practice, train, learn and exercise within a safe environment.  

Director of EPiCC, Chris Webb, the former Head of News and Deputy Director of Public Affairs with the Metropolitan Police said: “EPiCC is built around three core principles. The need to Prepare, Plan and Practice.  Having led the media and comms response to emergencies and major incidents for almost 30 years, I understand the benefits that an organisation like this will bring.

“In 2017 and 2018 I was invited to deliver key note speeches to EMPA (Emergency Media and Public Affairs) a not for profit organisation in Australia and New Zealand who work with comms professionals from the public and private sectors to enhance and improve their response to disasters. EMPA has made a real difference to how those two countries now handle such incidents.

“Over the last 12 months I have been working with partners involved in the emergency response at a national level here in the UK to set up a similar model and I’m delighted that the vision has now become a reality. There will continue to be a close working relationship between EPICC and EMPA.”

EPiCC is supported by a Board of Advocates with wide-ranging and extensive experience of emergency management and crisis communication across a broad range of incidents and sectors. As well as enhancing what they deliver, through their knowledge, skills and international networks, they help to ensure EPiCC stays up to date, relevant and responsive to the rapidly changing nature of emergency management and crisis communication in today’s society.

Advocate Alec Wood, the former Chief Constable of Cambridgeshire Police said: “Effective crisis communication must be at the heart of an effective emergency management response for any organisation that provides services to the public. Ultimately the quality and timeliness of information during an emergency can save lives and keep people safe.”

“Developing and enhancing the skills of your people is key. If you fail to plan, you will plan to fail. One can only fully prepare when decisions are based on a sound understanding and comprehensive knowledge of what to expect during an emergency or crisis. The training and coaching from EPiCC gives greater confidence, should the worst happen.”

You can find out more about EPiCC by visiting www.epicc.org.uk or follow us on Twitter @UKEPiCC

Recognising Domestic Violence A Vital Requirement For Health Professionals

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IRISi is a social enterprise established in 2017, providing expert advice and consultancy in the field of domestic violence, abuse and health.

They specialise in training local partners and health care professionals to identify and refer patients affected by domestic violence and abuse through their flagship intervention, IRIS (Identification and Referral to Improve Safety).

They support the local commissioning, implementation and growth of the IRIS programme, including bid development, training for trainers, ongoing support, national analysis and monitoring whilst also collaborating with partners to develop innovative, evidence-based health interventions for those affected by gender-based violence.

Our vision is a world in which gender-based violence is consistently recognised and addressed as a health issue. Our mission is to improve the healthcare response to gender-based violence through health and specialist services working together.”

Medina Johnson, CEO IRISi

The IRIS programme has helped refer over 15,500 women to date. An IRIS programme is first commissioned within a certain geographical area.

Local IRIS teams are then recruited and trained and these teams go on to train local GPs, healthcare professionals and clinicians in recognising the signs and symptoms of Domestic Violence and Abuse (DVA) as well as how to ask the patient the right questions.

If the patient requires help, they are referred to an Advocate Educators (AE), who provides support to both the practice and the patients that are recognised and referred. 

“Many of us know the statistics” says Medina Johnson, CEO at IRISi.

Medina Johnson, CEO, IRISi

“25% of women will experience Domestic Violence and Abuse (DVA) at some point in their lives. Two women are killed every week at the hands of a current or former partner, or adult family member. 

Behind each statistic is a woman, a friend, a sister, a daughter, a mother, a grandmother, an auntie; most of these women will have had recent contact with health services.

How many of them will have found it difficult to say what was happening for them at home during their appointment?  How many of them wanted someone to look beyond what they were saying?

How many women will have sat with a doctor or nurse who felt uncomfortable to look beyond and ask their patients about what was happening for them at home or whether they felt frightened or controlled by anyone because they didn’t think they had the right words or knowledge of the next steps to take? How many women were missed?”  

“We know that DVA impacts both the mental and physical health of those it affects and that this has ramifications throughout the family.” Continues Medina. “In cold, hard business speak, we also know that DVA also costs the NHS a lot of money in terms of appointments, chronic illness and prescriptions.

Clinicians want to know how to best support patients and how to offer support.  This is why they become medics.  We can’t expect them to simply know what to do to support patients affected by DVA without offering training and support and onward referral pathways.  

We need to support our clinical colleagues to look beyond and we need commissioners to fund this support in a sustainable way.”

The IRIS model rests on five principles:

  • Recognise when a patient is affected by DVA
  • Ask them about it
  • Respond in an understanding way
  • Refer the patient into specialist support
  • Make a record of the consultation and disclosure.

IRIS teams provide in-house specialist domestic violence training sessions to enable staff to become better equipped to respond to concerns and disclosures of DVA from all patients and perpetrators. Staff then receive ongoing support and DVA consultancy after training is completed from a named Advocate Educator.

Regular attendance from the Advocate Educator at team meetings helps remind staff about the service and also provides health care workers with support for any challenging cases.  

If you are concerned a patient might be affected by DVA, only ask them about this if they are alone.  It is not safe to ask when a patient is accompanied, even by a child. 

As a minimum, have national helpline numbers to offer or the contact information for your local, specialist service.  If you have safeguarding concerns then follow your usual safeguarding procedures. 

Do not prescribe what the patient should do but let them know that support is available.  Be sure to record the consultation in the electronic medical record. These are useful numbers for you:

  • National 24 Hour Helpline: 0808 200 0247
  • Men’s Advice Line: 0808 8010 327
  • Respect: 0808 801 0327

Click here for more information or to make direct contact with IRISi to obtain their services.

Helping to boost the Restart a Heart campaign in Sri Lanka

A Yorkshire Ambulance Service manager, who leads the Restart a Heart campaign, is heading to Sri Lanka to help improve cardiopulmonary resuscitation (CPR) training across the country. 

Jason Carlyon, senior engagement lead for Yorkshire Ambulance Service based in Wakefield and project manager for the Resuscitation Council, has been asked for help by Dr Nilmini Wijesuriya of the College of Anaesthesiologists and Intensivists of Sri Lanka. 

The country took part in the World Restart a Heart campaign for the first time in 2019 and more than 3,700 people were trained in CPR. Their first campaign was launched with support from Jason by phone, Skype and email and his advice and input was recognised by making him a founder member of the project.  

The college is now keen to develop the campaign to make it bigger and better in 2020 and has asked Jason to spend a week in Sri Lanka to share his knowledge and experience with colleagues.

Jason will be visiting the capital city of Colombo at the end of January and will be teaching medics how to train others in CPR as well as providing advice on how to roll-out the campaign across the country.

Jason, who lives in Scarborough, said: “I am absolutely delighted to be invited to Colombo to help the college develop this important work. We have seen here in Yorkshire how successful the campaign can be and we are happy to support more people to learn this important life-saving skill with the aim of improving out-of-hospital cardiac arrest survival rates.”

Dr Wijesuriya said: “We look forward to Jason’s assistance with the development of this project, in order to raise public awareness in bystander CPR and also his expertise to make World Restart a Heart Day 2020 even more successful.” 

On Restart a Heart Day 2019 in Yorkshire more than 860 volunteers provided CPR training to more than 46,000 students at 163 secondary schools across the region. 

The concept of Restart a Heart Day was first developed in 2013 by the European Resuscitation Council. On 16 October 2014, Yorkshire Ambulance Service visited 49 schools and taught CPR to 11,500 youngsters – with the help of hundreds of volunteers, mostly off-duty staff and community first responders.

In 2016 Yorkshire Ambulance Service supported the roll-out of the event to all UK ambulance services and two years later it was adopted by the International Liaison Committee on Resuscitation to encourage mass CPR training on a global scale under a World Restart a Heart Day banner. 

The Yorkshire event is sponsored by the Yorkshire Ambulance Service Charity and organised in partnership with the Resuscitation Council (UK), British Heart Foundation, St John Ambulance and other partners.

St John Ambulance Service in East Midlands Rated ‘Good’ by CQC: First Official Rating for the First Aid Charity

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Today St John Ambulance East Midlands received its first rating from the Quality Care Commission and was awarded ‘good’.

The rating comes after an inspection was announced at short notice in August last year and the CQC acknowledged improvements that have been made in the charitable service since the previous inspection in 2017.

Both the Patient Transport Service and Emergency & Urgent Care Service were reviewed, and both were found to provide safe, caring, effective and responsive care to patients.

As part of this review, the rating takes into account the regional office in Chesterfield, satellite stations at Newark and Northampton and also reviews one event in the region.

Eight ambulances were inspected across the three regions, along with twelve sets of patient records.

To finish off the in-depth review, twenty-one members of staff were spoken to, including registered paramedics, emergency care technicians, the operations coordinator, the safeguarding lead, the fleet manager, the regional accountable officer for controlled drugs, and both registered managers for the East Midlands.

The ‘well-led’ criterion was found to be ‘needing improvement’, but the announcement comes in the middle of a re-structuring period for St John Ambulance and the CQC has acknowledged further improvements in the five-month period since the inspection took place.

Feedback from the CQC reported St John Ambulance East Midlands to be safe, effective, responsive, well-lead and caring towards patients: “Staff spoke to patients with compassion and kindness, showing they respected their privacy and dignity, and took account of their individual needs.”

St John is now implementing its 2020 business strategy for ambulance provision and looks forward to welcoming the CQC back to see further improvements; not only in the East Midlands, but across the country.

St John Ambulance is exceptionally proud of the work it does, providing urgent care and support to communities across the country.

This rating proves that this work more than meets the expectations of the independent regulator of health and social care in England.

Craig Harman, the National Ambulance & Community Response Director at St John Ambulance comments: “I am pleased that the CQC found our leaders to be visible and approachable and that our people felt supported, respected and valued.’

Craig Harman, National Ambulance & Community Response Director, St John Ambulance

I was also pleased that the inspectors witnessed good care, witnessing our people speaking to patients with compassion and kindness. Since the inspection in August we have restructured, moving to a national operational structure.’

We will use the feedback provided by the inspection team to underpin our new national processes as we build on the hard work already carried out by our people and continuously improve the service we provide in our communities.

“Driving standards across the independent ambulance sector and within the event industry is a key strategic objective for St John and this CQC report is an excellent example of the work we are already doing to help us get there”.

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United in Benevolence: An Interview with Eli Beer, Founder & President of United Hatzalah of Israel

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By Mark Weiner, in conversation with Eli Beer (pictured) Founder & President of United Hatzalah, Published in Ambulance Today, Issue 4, Volume 13, Priceless EMS: The Volunteers At The Heart Of Prehospital Care, Winter 2019

MARK WEINER: What sort of person volunteers with United Hatzalah–do your volunteers share a common social background or professional profile? In the United States, for instance, many EMS volunteers come from families who have generations of volunteer EMS service.

ELI BEER: The amazing thing about United Hatzalah (U.H) is that everyone volunteers with us. We have volunteers from all segments of Israeli society, Jewish, Muslim, Christian, Druze, Bedouin etc.

The volunteers are doctors, nurses, bankers, lawyers, truck drivers, garbage workers, people who work in city hall; we have a Mayor, Deputy mayor, an MK, a sandwich store owner, a spice maker etc…

We do have some families with many of their members volunteering—I think the most is 6 volunteers from one family. But, in truth, all of the volunteers throughout the country feel a kinship with one another.

When they meet in any setting, professional or social, they feel an immediate sense of family even if they have never met one another before. The unity of mission really surpasses all other dividing lines. It overrides politics, religion and even nationality. The goal brings us all together.

The Jaffe family rescuers. EMT, Psychotrauma Therapist and Psychotrauma therapeutic K-9

M.W: Of course, using volunteers reduces the cost of service but does the volunteer character of U.H provide other goods that can’t be so easily quantified? For instance, are there distinctive medical benefits that a volunteer service might be able to provide better than a fully professionalized service?

E.B: Yes, in the field of EMS it is greatly beneficial to have volunteers in addition to paid personnel. The volunteers add so much with their spirit. The extra passion and motivation which they bring to the profession helps motivate the paid staffers as well.

In Israel, we have incredible EMS personnel who work in the eld for a living but if it wasn’t for volunteers rushing out to emergencies and supporting their efforts, their own motivation would be much lower.

We all know that the paycheques for EMS work aren’t that lucrative but having volunteers around who support the work of the paid staff is crucial for raising the level of motivation across the board.

When I see services that don’t have a volunteer component, there is a much larger danger of paid first responders getting worn out, especially as the salaries are as low as they are.

In terms of benefits in a medical sense, the fact that we have people coming from other fields and joining the EMS profession as a volunteer means that they have a high level of drive and desire to help.

They bring a wealth of knowledge and experience from their own eld to emergency medicine and that knowledge juxtaposing with the knowledge of emergency medicine leads to a lot of innovation in the operational sphere, both on the macro and micro-level.

We’ve had two major projects emanate from this type of hybrid innovation. The first began with an EMT who is a therapist.

She noticed that the people witnessing a medical emergency often suffer from shock and emotional stress and need treatment in addition to the patient who suffered the emergency.

She created a specialized unit of therapists, psychologists, and psychiatrists who are tasked with responding in the eld to medical emergencies where someone is suffering a severe emotional or psychological stress reaction.

This early intervention has been shown to prevent the onset of ASR, ASD and hopefully prevents PTSD from developing. This unit is called the Psychotrauma and Crisis Response Unit and is a unique innovation of our organization.

Members of the Psychotrauma and Crisis Response Unit in Jerusalem

Another project which came from responder innovation in the field is our Ten Kavod (Giving Honor) project, where trained EMTs visit elderly people who live alone once a week.

The Ten Kavod project aims to prevent older people who live alone from feeling abandoned by society and passing away without anyone noticing.

Having a trained EMT visit them once a week provides a much-needed social outlet as well as monitoring their medical status on a regular basis. The program is run in partnership with social services on a city-wide or community-based level.

M.W: How about benefits for the individual volunteers? Does volunteering with U.H increase the civic standing of volunteers within their communities?

E.B: United Hatzalah cares very deeply for its volunteers. An integral part of our organization is making sure the volunteers feel connected to each other and to the organization.

We do this by dividing the country into 75 regional chapters based on geography and make-up of each area.

These chapters are responsible for holding social and educational meet-ups for the volunteers every six weeks, and twice a year they must have an event geared towards the families of the volunteers.

Each volunteer receives annual gifts for their families, providing the families of the volunteers with a sense of connectedness to the organization. Without the family supporting the volunteer’s work, the volunteer would not be able to drop everything at a moment’s notice and rush out to save lives.

Psychotrauma and Crisis Response Unit team members provide psychological and emotional stabilization following building fire in Jerusalem along side medical first responders

Additionally, the Psychotrauma and Crisis Response Unit contact each of the volunteers after a medical emergency that is considered to be traumatic for the responders.

The unit is tasked with checking in with the volunteer and ascertaining that they are okay from a mental health perspective following the incident.

With regards to the community itself, our volunteers are respected by their community and people look to them when they have emergencies.

This doesn’t necessarily give them a higher standing in the community but it helps the community as a whole become more resilient by knowing that, when there is an emergency, there is a person in the community whom they can turn to for help.

M.W: So, there are quite a few ways in which you believe a community benefits from having EMS provided by volunteers. Do you think that the decentralized organizational structure of United Hatzalah contributes to these benefits?

E.B: Yes. The fact that the organization is run by volunteers who come from the community means they are in touch with the needs of that community and are more concerned with patient care than a government service whose primary concern is paying the bills and thereby strongly recommends ambulance transport for any and all incidents.

A United Hatzalah beach rescue

Such a system not only overloads the hospital ERs but doesn’t always have patient care as its top priority. When EMS is a business and dependent on the bottom line of financial solvency in order to function, patient care can sometimes take a backseat to the need to transport a patient.

When service is always free of charge to the patient, nothing takes away from the high level of patient care offered by the provider. As everything in United Hatzalah is provided to the patient free of charge and done by a volunteer, the patient’s well-being is the sole motive for treatment.

M.W: Is there a distinctively Jewish ethical justification for EMS volunteerism? United Hatzalah provides services to all people, regardless of their religion, and its volunteers come from diverse religious backgrounds. But is there a way of thinking about volunteering as an EMT from the perspective of the Jewish tradition?

E.B: I think that there is a Jewish ethos of volunteering to help others in less fortunate situations across the board. Israel, as well as Jewish communities in the diaspora, has a plethora of volunteer organizations that deal with almost every aspect of life.

From free loan societies to helping with automotive troubles on the road, to EMS, to a volunteer police force—the Jewish people have always placed high importance on helping others, especially members of their own community.

There are plenty of references to this in the Bible, as well as Rabbinic literature, but I believe that the main reason for this is our unique history. We were a people apart who were, for 2,000 years, strangers in other lands.

We needed to help each other in order to survive and there has always been an understanding that no one from our community can make it on their own, so we need to band together to make it together.

United Hatzalah fleet of ambucycles

I believe that this ideology has translated into a national and individual subconscious need to help others. Our forefather Abraham was known for his acts of loving kindness.

His examples are told to all of our children throughout the ages as actions to exemplify.

M.W: Finally, Eli, is there something that other nations can learn from the historical experience of Israel about the social and cultural importance of emergency medical volunteerism or public emergency medical training?

E.B: I think that our message has resonated across the globe. When I spoke at the Ted Med event in 2013 I was asked by people from countries all over the world to come and explain our model so that they could copy it.

We have been working with other cities in many places to develop a model of our volunteer network in a way that works for them; usually in a style that is non-threatening to existing response systems and working with, rather than against, the current system.

Currently, we have active chapters in five other countries and we are always looking to expand into other cities and other countries to help save as many lives as possible.

It is my dream that no one should ever die because they were waiting for help to arrive.

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Voluntarily Independent: An Interview with Magnus Hagiwara, Ph.D.

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By Mark Weiner, in conversation with 
Magnus Andersson Hagiwara, Ph.D (pictured) of the Centre for Prehospital Research at the University of Borås, Published in Ambulance Today, Issue 4, Volume 13, Priceless EMS: The Volunteers At The Heart Of Prehospital Care, Winter 2019

Magnus Andersson Hagiwara, Ph.D., is Associate Professor at PreHospen, the Center for Prehospital Research, in the Department of Caring Science, Work Life and Social Welfare at the University of Borås, Sweden.

MARK WEINER: What role do volunteers hold within Swedish EMS? Are there any volunteers within either the re or ambulance services?

MAGNUS ANDERSSON HAGIWARA: In EMS there are no volunteers in Sweden. When it comes to the fire department the question is trickier. There are three levels of fire personnel: 1) fire fighters working full time. They live at the re station during work; 2) part-time fire fighters who have other ordinary work but are on call one week at time. They need to be at the fire station within five minutes after the call. They have the same responsibilities as the full-time fire fighters; and 3) standby fire fighters. These fire fighters have an emergency alert at home and it is voluntarily for them to respond to a call or not. They are paid only when they respond to a call. I suppose you can call the last category volunteers.

I think that EMS workers in Sweden are not seen as heroes. They are just workers doing what they are paid for. Personnel in the fire brigade have a higher status

M.W: Turning specifically to the ambulance service, how many years of training are required of personnel before they ride in an ambulance? Could you describe what it takes to become a Swedish EMT?

M.A.H: In the past, ambulance care was executed by EMTs with a short education in prehospital care (20–40weeks), but since 2005 all ambulances are staffed by at least one Registered Nurse (RN) with medical responsibility, in accordance with Swedish law. EMTs need have a three-year high school education and then a 40-week EMT education.

RNs have three years’ additional education leading to a bachelor’s degree. A specialist nurse in prehospital emergency care has one year of additional training.

Swedish ambulance nurses in a training exercise

An ambulance team in Sweden includes an EMT along with an RN, a prehospital emergency care nurse, or an RN with another specialist education such as anaesthesia or intensive care. The RN independently administers around 30 different drugs according to written guidelines and general delegation.

The proportion of RNs in Swedish prehospital care has been estimated at 68–78%. The proportion of RNs with specialist education varies widely between regions from 20 to 85%.

M.W: Do ambulance services have a civic presence in their communities beyond their immediate role of responding to emergencies and treating patients?

M.A.H: Sadly no. I think that most of the EMS workers in Sweden want to have a greater civic presence. Today, it is the fire brigade which does this kind of work. They have CPR courses in the streets. They talk about risks at home and so on.

Many EMS workers feel that they are better prepared to do this. But the reason they don’t is organizational. All ambulances in Sweden are hosted by a hospital and they are not willing to pay for this kind of activity. The fire brigades have a national organization (MSB) which sees this kind of activity as a part of the mission.

M.W: Could you describe the general cultural perception of Swedish ambulance personnel and EMS more generally? Do they tend to be seen more as heroes or as simply another class of professional doing a job?

A Swedish ambulance nurse on standby

M.A.H: I think that EMS workers in Sweden are not seen as heroes. They are just workers doing what they are paid for. Personnel in the fire brigade have a higher status and are more “heroes.” The reason is that they have taken that role and have been successful in promoting their important role in society. Fire brigade have a government agency (MSB) which controls their operations, while EMS is controlled by their respective area hospitals.

M.W: Sweden has long been renowned for the great deference that people give to elite experts—it’s the land of social engineering, after all. How might you describe the lack of a volunteer tradition in the medical field (as opposed to, for instance, local sports clubs, in which Swedes are avid volunteers) as an outgrowth of this aspect of modern Swedish society? Do you think this is positive or negative?

M.A.H: Sweden is a country with a high social protection network where we pay high taxes for health care, school and other social services to function. I think we have for a long time become accustomed to the state taking care of this for us.

Another reason may be that we have not been at war for the last 150 years. For example, if you compare with Finland who was severely affected during World War II, the Finnish people have a completely different approach to civil defense.

In the summer of 2018, we had severe forest fires in Sweden. Then people realized that the state may not be so reliable after all. After that summer, there has been a big increase for various volunteer groups who can move out and help in crises.

I myself was extinguishing fires in northern Sweden then and was impressed with how civil society took over when the state failed.

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High Prestige: Volunteers in the Mountaintops

An Interview with Dr. Joachim Schiefer

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By Mark Weiner, in conversation with Dr.med. Joachim Schiefer, MSc. (pictured) of the Austrian Mountain Rescue Services, Published in Ambulance Today, Issue 4, Volume 13, Priceless EMS: The Volunteers At The Heart Of Prehospital Care, Winter 2019

Dr.med. Joachim Schiefer, MSc., is a specialist in trauma and orthopedic surgery and sports medicine with Praxisgesund in Tamsweg, Austria. He is senior physician and head of medical training for the mountain rescue service in the region of Salzburg.

MARK WEINER: What role do volunteers play in the Austrian mountain rescue service? About what percentage of the ground-level personnel are volunteers? Do those volunteers have training in wilderness emergency medicine?

JOACHIM SCHIEFER: The Austrian mountain rescue is nearly 100% voluntary, there are only some administraton workers in the offices who are paid. In Salzburg for example, there are 3 persons for the main office and 1415 volunteers in 44 local organizations. All volunteers get a free training in all aspects of wilderness rescue.

That starts after a trial year with a three-day medicine course, followed by a weeklong winter course, and weeklong summer course, and ends with a glacier course.

All courses have medical parts with theory and practice, for example in the winter course we teach avalanche rescue and hypothermia in theory and praxis. After four years of learning and passing all exams you get a Bergretter.

Austria is a mountain region and all kinds of sports are done there. Being a Bergretter is a great honor and lots of people are interested in their exciting work.

M.W: Is there a role for volunteers in the Austrian urban ambulance corps?

J.S: There is a clear role for both terrestrial mountain rescue and urban rescue. Some volunteers do both and therefore are double educated. Some also work in hospitals and do rescuing in their free time.

The helicopter services are separate and also are staffed with people from the Bergrettung. If you work for them you get paid and also get paid for course lessons.

M.W: What type of person joins the mountain rescue service? Are volunteers drawn from the communities in which they live? How do you recruit and retain them?

Manouvering the patient uphill

J.S: Usually they come from the communities they live, so it is possible to fulfill their commitments in the region they know well.

Normally they are young mountaineers when they start the work in the rescue.

There is a strong fellowship in the organizations and lots of climbing and ski mountaineering is done together. The recruitment is organized by the local organization and if the new members do well in the trial year they start with the courses.

M.W: Are Austrians generally, and patients in particular, aware that the service is significantly based on volunteers? How do you promote awareness that it is?

J.S: The Austrians know that this is based on volunteers and lots of companies support mountain rescue, so the volunteers can leave their working place for rescuing or get free holidays for courses and teaching, especially military or police.

Working with avalanche probes, volunteer rescuers from SDMA can find victims who have been buried in snow

There are also some efforts by the Austrian government to get volunteers one week’s extra vacation or an early old age pension.

M.W: How important is the mountain rescue service to the civic life of the community? Does it host events to which the public are invited? And does being a mountain rescue volunteer confer community respect and what one might call “social capital”?

J.S: Absolutely, a lot of events are hosted by the mountain rescue, for example training for the local community, or work in avalanche commissions. The communities have an obligation to the organization to give them space for their vehicles and a social room for their meetings.

M.W: Since 2009 the television show “Bergretter” has been a popular television series. Could you reflect on the importance of the show or on other representations of the mountain rescue service in popular culture?

J.S:As mountaineering gets more popular every year people also get more interested, especially in the rescuing part. Austria is a mountain region and all kinds of sports are done there. Being a Bergretter is a great honor and lots of people are interested in their exciting work.

M.W: Are there reasons for the mountain rescue service to substantially involve volunteers in addition to cost savings?

SDMA cliff face extraction

J.S: Yes, a lot of money is saved for the Austrian state. Mountain rescue is traditionally a non-profit organization, it always was voluntary. With the money paid for the rescues and also the sponsoring of companies and national and local communities we can offer teaching on a high level and acquire all the equipment for the local organizations.

It would be much more expensive for the whole of Austria if everyone would be paid. Being a member of mountain rescue is of high prestige in my country. Mountain equipment is cheaper for us if we buy it; we receive preference in job applications; etc.

M.W: What role does the mountain rescue service play in providing local communities a sense of self-governance?

J.S: The mountain rescue is guided by the central organization of the districts (for example Salzburg or Innsbruck); administration and education is organized there and equal for all.

Transporting the patient across the deep snow

This guarantees the same standards for the whole country. There are meetings in Salzburg where everyone comes together to discuss and renew. Every voice is important. For the local community, it is very important to have their own rescue service.

Mountainous Austria has a lot of remote areas, so there are lots of local specialties. As I noted before, for a little town in the mountains it brings prestige to have its own mountain rescue service.

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The Austrian Mountain Rescue Services (SDMA) employ 12,500 rescuers all of whom are volunteers. Whilst Federal Law in Austria dictates that costs must be paid by the person who was rescued, SDMA have somehow managed to work out an insurance policy of just €28 per year for global coverage in mountain rescue which also covers all family members, life partners and children under 18 living in one household. This covers patients for up to €25,000 with a one week rescue operation easily costing around €20,000. At the time of writing, in 2019 SDMA has saved 641 people and undertaken 703 rescue operations.

Community Calling: An Interview with Capt. Dale Drescher of the Virginia Beach Volunteer Rescue Squad

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By Mark Weiner, in conversation with Capt. Dale Drescher (pictured) of the Virginia Beach Volunteer Rescue Squad, Published in Ambulance Today, Issue 4, Volume 13, Priceless EMS: The Volunteers At The Heart Of Prehospital Care, Winter 2019

A retired school teacher, Dale Drescher is Captain of Administration and member of the Executive Committee of the Virginia Beach Volunteer Rescue Squad in Virginia Beach, Virginia, USA. She has been a member of the City of Virginia Beach Emergency Medical Services, and VBVRS, since May 2013.

MARK WEINER: Are there reasons for community EMS organizations to be based on volunteers, or to have a significant volunteer component, other than the cost savings they provide?

DALE DRESCHER: It’s a matter of community pride. We have a saying that we actually print on the side of my squad’s ambulances: “neighbors serving neighbors.”

There’s been a general buy-in here to the idea that community health involves being a part of something larger than yourself. We want to show that we are a community willing to give time and energy to something that we feel is important for the health of our city.

Also, Virginia Beach is a very large resort area. We get about 2.8 million visitors a year, particularly in the summertime. They are often surprised and very pleased when we have to treat and transport to find that they’re not going to get a bill.

We have a very large military contingent, because of the naval and joint forces bases located in our area

I’ve had occasions when a person has said to me, “you all helped my family the first time we ever came on vacation three years ago—and we like it here in part because of that feeling.” We hope that the spirit of VBVRS actually draws visitors to our area.

We give people an opportunity to put a foot in the medical eld as they look toward some kind of medical career. The way we structure volunteering, it’s 48 hours a month required duty time. If we were a paid service they likely wouldn’t be able to gain that kind of experience.

M.W: Is it important to you that residents appreciate you’re a volunteer organization? How do you promote that understanding?

D.D: It is very important to us. We want the community to know. But it’s also a bit of an uphill battle for us. In general, people associate first responders with fire and police and those are traditionally paid services.

If we have a patient in our ambulance and they’re in a comfortable situation and want to talk, we always tell them that this is a free treatment transport, that we’re volunteers and we do not charge for service. It’s word of mouth.

We always participate in any PSA opportunity, particularly during EMS week; local radio stations and the TV stations will offer us the ability to come on and talk about what we do.

We have a rescue foundation for all 10 squads whose mandate is promoting volunteerism. The rescue foundation does a lot of recruitment. Its website is vbrescuefoundation.org.

Two Virginia Beach Rescue crews standing strong

M.W: What kind of people volunteer for the service? Do they tend to have a similar background, or are they from different walks of life?

D.D: It’s very interesting. It’s sort of across the board. There’s a large portion of the demographic that is young, and that makes sense when you think that they are starting out and they are looking to the future and thinking, ‘is a medical career something that I’m interested in’?

We allow people to begin serving with us at age 18, so we have a good portion of people who are in college and we work with those people to allow them to remain active volunteers if they’re at a school outside of our 35-mile range. We really work hard to keep that demographic part of us.

We have a lot of people who volunteer in their 30s, 40s, and 50s. They want to do something outside the home and the family—people who work full time and still manage to volunteer on the weekends.

Everything in your training is taken care of financially—and in return you sign a contract to give the city of Virginia Beach one year of service. The cost for the city is about $3000.

And then we have a very large military contingent, because of the naval and joint forces bases located in our area.

I had someone recently join our squad and she came from a base in San Diego. She said she chose this area as her next duty station because we were a volunteer-based organization. She looked all over the country to find that.

And finally, we have people in the 50-plus range who are looking toward retirement. They want to start thinking of something beyond the working years.

We also have a small portion of people who change careers in midstream. I have someone in my squad right now, who is an orthopedic surgeon; he retired and became an EMT. I have someone else who is an attorney by trade but has decided to go back to medical school.

The Virginia Beach Volunteer Rescue Squad Advanced Life Support Unit, as featured at the 2018 EMS World Expo

M.W: Do you have any volunteers who come from a family tradition of EMS volunteerism?

D.D: Many of them. All ten squads have families with multi-generational members. It is common in my squad because the volunteer system in our city started down near the ocean front area and that’s where we’re located. I very frequently have college students come to volunteer and say, “Oh, my mom and dad both worked here.”

We also have couples that met and married there. I can think of at least three who are active now. They became volunteers and they met at the squad.

One couple consists of the husband, who is in the military, while she’s a stay-at-home mom. When they hand off the baby, one comes off duty and the other one goes on—and the baby is in the carrier!

M.W: Do you have any challenges with recruitment and retention, and how do you address them?

D.D: Traditionally I think the city has seen sort of ups and downs in recruitment and they seem to follow the pattern of employment. If there’s a period of really full employment in the country, our recruitment tends to go down a little bit.

If we have a period of time where there are people who can’t find jobs, then they look to volunteer opportunities. But in the last five or six years, we have had really large classes in our EMS Academy.

The Virginia Beach Volunteer Rescue Squad Advanced Life Support Unit, as featured at the 2018 EMS World Expo

The city has a wonderful program which makes it easier for us to recruit: they pay for the schooling in our academy. You get all of your training for free. Textbooks, lecture time, operational scenario training, practical exams, all of that comes through the class.

When a student passes the class, the Academy is certified to administer the Virginia practical exam, which the student does not pay for; and EMS pays for the student to take the NREMT exam.

Everything in your training is taken care of financially—and in return you sign a contract to give the city of Virginia Beach one year of service. The cost for the city is about $3000.

The city has a wonderful yearly awards program. Each year we have a call-of- the-year award. And we have many scholarship opportunities.

If you come on board and you’re interested in taking the science classes you need to be able to apply to PA school or become a paramedic, then you can apply for a scholarship.

M.W: What’s the public perception of EMS and EMTs in Virginia?

D.D: When we have people who come and settle here they generally expect that whoever is an EMT is part of the re service. That’s common across the country and they are taken aback at times that we have an absolutely separate, standalone EMS system in the city of Virginia Beach.

Drescher and partner Roy White at the station

If we have an EMS call and we have both a re crew and an EMS crew and we’re all in different uniforms, there’s a little bit of confusion as to why we’re all there and looking a little different from one another.

But once they realize that re does an initial assessment if on scene first, and then EMS takes over, they don’t seem to feel that there’s anything negative attached to that separation.

In general, it’s been my experience that the people that I treat in transport feel that the EMTs are knowledgeable. They seem to trust us. We seldom get any really negative response.

M.W: What about the social status of EMTs? Is it high?

D.D: Probably down a step below fire and police because people are more familiar with them. People know police, they see them as heroic in certain circumstances, and I think they certainly do with fire.

With EMS, I don’t think they have the visual. We don’t carry guns, and we’re not running into burning buildings. In terms of public perception, maybe we’re viewed as maybe a step down in terms of heroism.

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Founded by attorney Peter J. Holland III in on May 1st 1952 the Virginia Beach Rescue Squad serves roughly 1,000 volunteers serve 440,000 residents (plus tourists) as part of the City of Virginia Beach EMS Department, offering patients a completely free emergency service.

Acknowledging the voluntary aspects of this vital EMS service to the city, the Virginia Beach Rescue Squad Foundation was created in 1982 by Bernard M. Stanton, in order to give financial support to what are now the 10 rescue squads that make up the City of Virginia Beach EMS Department across the city’s 225 square miles, each squad being a non-profit organization in its own right, relying entirely upon fundraising (and also saving the US taxpayer around 22 million USD per year).

To make a donation to the Virginia Beach Resque Squad Foundation and support the fine work these people do visit https://vbrescuefoundation.org/donate/