three of a kind€¦ · between 1995 and 2013, the mean age for patients suffering life threatening...

Preferred exhibitionsof the AAA

THREE OF A KIND Three aircraft launch in one day

The magazine of the Association of Air Ambulances

ISSUE 20 JUNE 2017

Internationalstandards in the UK

Professor SirKeith Porter onthe new traumaepidemic

Air AmbulanceNorthern Irelandlaunch

AAA-Airway Magazine-Issue20-16pp_Layout 1 30/06/2017 21:47

NETWORKING SESSIONS AVAILABLE


3www.aoaa.org.uk

Our cover photo this issue is unusual as it does notfeature our main story but sometimes a photo is so goodthat there's really no choice but to use it. So it was whenwe heard that three members' brand new AW169helicopters would receive their official launchsimultaneously. Our cover shows the new AW169 beinglaunched at Specialist Aviation Services HQ in the liveriesof Kent, Surrey, Sussex Air Ambulance, Lincs & Notts AirAmbulance and Dorset & Somerset Air Ambulance. Weheld off publication for a few days when we knew thisshot was coming and I hope you'll agree it was worth it.

Now, if you work in the air ambulance sector - and ifyou're reading this, there's a fair chance you do - youprobably experience the complexities of our regulatorysystems every single day. The CAA, EASA, NICE, the CQC,not to mention the numerous fundraising bodies. It maybe news to you, then, that some organisations havechosen to be accredited for their standards byinternational bodies such as EURAMI and CAMTS.

Our lead feature this issue (pages 9-11) explores thisphenomenon and solicits opinion from all sides. It's acomplex issue and our three-page story can only reallyscratch the surface but it's clear that this is anincreasingly relevant discussion. I'd be delighted to hearyour views.

I'm pleased to feature in this issue an article by one ofthe pre-eminent names in Trauma, Professor Sir KeithPorter. Professor Porter wrote this article for Airway,exploring how trauma is changing - and fast. Somestatistics reveal just how significant this change is:between 1995 and 2013, the mean age for patientssuffering life threatening trauma rose from 36.1 years to53.8 years; the percentage of patients over 75 years oldrose from 8.1% in 1990 to 26.9% in 2013; in 1990 thepercentage of major trauma due to low falls (falls fromstanding height) was 4.7%, by 2013 this had risen to39.1%. What does this mean for trauma treatment andthe effect on pre-hospital care? Read more on page 13.

With the growth of Airway, we have more space for newsas well as features, so you can get yourself up to datewith all the latest information on pages 4 to 8. We reportthat media personnel are now allowed back on boardaircraft following an agreement with the CAA, and wespeak to Air Ambulance Northern Ireland as their firstflight becomes imminent; this is quite a moment for theprovince and is only thanks to a great deal of work sincethe idea was first mooted back in 2003. AANI aregrateful to AAA and all members for their support alongthe way.

I hope you enjoy our biggest magazine yet. Do let meknow if there is anything in particular you'd like to see inthese pages. We also welcome new advertisers, whethermembers or not, who can speak directly to their targetmarket through these pages, and help support thegrowth of Airway as a voice for the industry.

From the editor

From the Editor ........................................................................................ 3

News: Media on board ...................................................... 4N.I. lift-off ............................................................................ 5Flight Time Limitations .................................... 5New Awards judge .............................................. 6Analgesia and sedation guide ........ 7

News from the Nation .................................................................. 8

Raising the standard .................................................................... 9

The new trauma epidemic .............................................. 13

Member Spotlight: Rotor & Aircraft .................... 14

National Director's Report ................................................ 15

In this issue…

13 July 2017 Ambulance Service Members' Forum

11-17 September 2017 National Air Ambulance Week

20-21 September 2017 Emergency Services Show, Birmingham

26 September 2017 AAA Members’ Forum

3-5 October 2017 Helitech, London

31 October 2017 APPGAA Reception

13 November 2017 AAA National Conference

13 November 2017 Air Ambulance Awards of Excellence

Dates For Your Diary

Contact DetailsAssociation of Air Ambulances Ltd.50 High Street, Henley in Arden, Warwickshire, B95 5AN.

Email: [email protected]: www.aoaa.org.ukTelephone: +44 (0)1564 339959

Editor - Nick [email protected], 07958 695778

Advertising - Andrew [email protected] 339957

Cover photo - Ed Hicks

Disclaimer Whilst we take every care to ensure all details in Airway are correct, the AAA takes no responsibility for errors or omissions. Theopinions expressed by authors in Airway do not necessarily reflect those of the AAA or the editor. Where prices or dates arequoted, they are correct at the time of publication and are subject to change. Links to third party websites are by no wayan endorsement of the linked material and the publisher takes no responsibility for the content or security of any third partywebsite. Airway and the AAA do not endorse any product or service appearing in editorial or advertising. Permission shouldbe sought to reproduce any article from Airway and the magazine should be acknowledged as the source.

Nick Campion, Editor


4 www.aoaa.org.uk

Specialist media personnel can once againbegin filming with air ambulance servicesfollowing the successful conclusion of talks withthe Civil Aviation Authority (CAA). The AAA,through its membership of the British HelicopterAssociation (BHA) and alongside the All PartyParliamentary Group for Air Ambulances, hadbeen seeking a solution ever since the CAA'sclarification on the regulations resulted in operators stopping air ambulancescarrying accredited and appropriately trained media personnel on board in themiddle of last year.

The Association worked closely with operators and the CAA initially to develop analternative means of compliance, also known as an AltMOC. However, this form ofcompliance gave rise to a number of legislative issues, so as a result the CAA hasdeveloped guidance that allows operators to apply for media personnel to fly asmedical personnel, as they are critical to the economics of HEMS in the UK.

The AAA is now working with the CAA to ensure all relevant parties receive andunderstand the new guidance so they can resume working closely with the media,an exercise which brings much greater awareness amongst the general public ofthe work done by HEMS operations.

The new guidance is designed to ensure standardisation and clarity foroperators conducting HEMS flights and carrying people other than crew on board.The guidance says that the operator must demonstrate, through their safetymanagement system, that the risks of carrying additional passengers have beenproperly identified and justified, and that the necessary mitigation is in place. Theoperator must also ensure that appropriate requirements are incorporated into theoperations manual, detailing any briefing and training elements.

APPGAAFollowing the announcement of the GeneralElection, the All Party Parliamentary Group forAir Ambulances (APPGAA) had to be dissolvedin line with all APPGs. As we go to press it isbeing reformed and will continue its importantwork. The group is planning its first meeting inlate June and will keep members of the AAAupdated on its formation and the adoption ofthe AAA’s Key Issues.

Before the election campaign, the APPGAAhad been making good progress and wasinstrumental in pressing for the formulation of asolution to the issue of carrying mediapersonnel on board aircraft (see left). Otherissues remain ongoing, including Flight TimeLimitations (see p5) and Helipads.The popular annual APPGAAReception at the Houses ofParliament has been rescheduledto 31 October 2017.

AAA SEEKS EXHIBITION SUPPORTThe AAA will once again be exhibiting at theEmergency Services Show in Birmingham (20-21 September) and Helitech in London (3-5October) and is encouraging members toattend and participate at the UK HEMS village.The shows are an excellent opportunity formembers to network and update themselveson products and service providers. The AAA willbe calling on members to assist on the standsto share their models of operation, and toinform visitors about the UK HEMS and airambulance sector.

The Association will be creating a UK HEMSvillage at each exhibition where the UK sectorcan present a unified and clear messageabout the UK's air ambulance community toour European and global colleagues - and toUK colleagues from the Police, Search &Rescue, and other complementary services.Clive Dickin, National Director, comments:"From the outside, the UK HEMS sector canappear intricate, thanks to the way it is funded,how it is structured with a third sector-publicsector mix, how it is integrated into the NHS,the different models each region uses andtheir responses to their unique geography anddemographics. Exhibitions such as these areideal opportunities for us to share informationabout what the sector does and to share bestpractice. We lead the way in many areas ofHEMS and are keen to share our knowledge -and we are always keen to keep learning fromour colleagues both in the UK in other servicesand around the globe.”

AW169 FLIES INTO SERVICE

NEWS

MEDIA BACK ON BOARD

In UK air ambulance history, a totally new aircraft has been a rarity. What'seven more rare is for three aircraft for three charities working with threeambulance services all being signed off simultaneously, with one of thembecoming operational just a few hours later.

Leonardo Helicopters first brought the AW169 cab and news of its potentialperformance, size and capability to the AAA Conference in November 2012. Fiveyears later, the AW169 is here and it's in use in Kent, Surrey, Sussex; Lincs & Notts;and Dorset & Somerset, with Essex and Herts soon to follow.

Lincs & Notts Air Ambulance CEO Karen Jobling said: “The AW169 will put ourcharities at the forefront of medical aviation as we strive to provide the very bestcritical care possible, giving some of the most critically ill and injured patientstheir very best chance of survival.”


5www.aoaa.org.uk

Statistics supplied to the Association bymembers regarding the hours worked by airambulance crews have reinforced theargument that EASA (European Air SafetyAgency) must provide a suitable way tomanage fatigue without impacting onincreased personnel numbers through theestablishment of set Flight Time Limitations(FTL) for Technical Crew Members.

The AAA has already conducted a survey

revealing the numbers of personnel that willbe affected and will be submitting a paperto the British Helicopter Association and theAll Party Parliamentary Group for AirAmbulances (APPGAA) on the potentialimpact of FTL being applied to UK HEMSoperations. Until now, EASA had exemptedHEMS operations from the regulations but isnow pressing to regulate the hours workedby crew members on the aircraft - thispotentially includes doctors and paramedicswho carry out elements of the aviationactivity of the aircraft.

This could have a major impact on

members, who would need to employ morecrew members and absorb the significantextra cost of their employment, training andcertification. It would undoubtedly have anegative effect on the number of patientseach technical crew member is exposed toif the number of crew have to be increasedto ensure they do not exceed their dutyhours.

The AAA continues to make the case toEASA, and the APPGAA will resume its role inthe discussions once it is reformed after theGeneral Election.

Delight for Northern Ireland

FTL IS OTT

“Relief, satisfaction, pride, excitement, delight...”These are the words of Ian Crowe, Chairman of AirAmbulance Northern Ireland (AANI), as he reflects on thefact that the charity is on the cusp of making its maidenoperational flight.

It’s been a long time coming. Northern Ireland, with apopulation of 1.8 million people across an area of 14,000 km2,has been the only region in the UK that is not serviced by an airambulance. It has been ‘a long hard journey’ in Ian’s words -indeed the idea of an air ambulance was first discussed with theambulance service as far back as 2003. The current campaignbegan in December 2013 with the coming together of the fivecurrent Trustees and gained significant momentum following thedeath in July 2015 of Dr John Hinds, a motorcycle doctor withthe Motorcycle Union of Ireland. The previous campaign for anair ambulance suffered through a failed attempt by others in2009 when a significant amount of money was raised but aservice never materialized. It was because of this that the Boardof AANI stated publicly that they would not raise a penny offunds from the public until a helicopter was guaranteed.

The £4.5m LIBOR fund money promised to the charity by theChancellor in March 2016 provided a huge boost to thecampaign and in March this year, the Minister for Health inNorthern Ireland, Michelle O’Neill, approved Northern Ireland’sfirst ever HEMS.

As its base, the charity has secured a hangar at the formerMaze Long Kesh prison site, which has a history of aviationincluding use as a World War Two airfield and former U.S. airbase.Within three years, the plan is to build a brand new, integratedbase for aircraft, crew and executive team. From this base, thefurthest point in the province can be reached in no more than25 minutes.

The charity is now stepping up its fundraising efforts. Since its

first helicopter (an Airbus EC135 supplied by Babcock) waseffectively guaranteed by the LIBOR announcement, it has beenaccepting money - although not actively campaigning - sinceMarch last year and has amassed more than £300,000 inunsolicited donations. The target is £2.5m a year to cover annualrunning costs and help build charity reserves.

Lotteries, which are such a staple for many air ambulancecharities, are a different proposition in Northern Ireland wherelegal restrictions mean an organisation can’t raise more than£80,000 a year and can’t spend more than 18% of moneyraised on administering the scheme. Instead, AANI willconcentrate on public and corporate fundraising, where thereseems to be considerable appetite.

The service will begin with a pool of highly skilled paramedicsand consultants. Northern Ireland Ambulance Service (NIAS) areproviding the paramedics and various heath trusts are providingthe consultants. There will always be a doctor on board, withfifteen being appointed from six local hospitals, along with sevenparamedics.

Reflecting on the long journey to this point, Ian Croweconcludes: “The Board of AANI have been humbled by thesupport we’ve had so far from the public. We are also gratefulto the Department of Health, the Department of Health andSocial Care Board and NIAS, without whose help andcooperation this wouldn’t have been possible. I’m also gratefulto the AAA and Clive Dickin in particular for all the supportthey’ve given us both in terms of assisting with our LIBOR fundsbid and much else. There has also been so much support,goodwill and offers of help from the other UK air ambulancecharities which has been invaluable on our journey.”

NEWS

(l to r) Glenn O’Rorke,

Paramedic Operational

Lead; Dr Darren

Monaghan, Clinical Lead

Consultant;

Dave O’Toole, Pilot


6 www.aoaa.org.uk

NEW JUDGE JOINS AWARDS PANELThe Air Ambulance Awards of Excellence welcomes anew independent judge to the judging panel for thisyear’s awards. Adding further knowledge andexperience to the team is Debra Allcock-Tyler, ChiefExecutive of the Directory of Social Change. Debra,who said she was ‘absolutely delighted’ to join thepanel, brings huge charitable sector experience tothe role. For more information on Debra and all thejudges, see right.

Debra and her fellow judges will judge entries from across the sector in elevencategories, including the new Air Operations Support Staff Member of the Yearcategory, might see nominations of dispatchers, engineers, back office staff andother non-flying personnel whose roles are not covered by other Award categories.

With scores of people missing out on a place at the Awards Gala Dinner in thelast couple of years, the move to the larger Millennium Chelsea Harbour Hotelmeans significantly more guests can enjoy the best evening of the year. PutMonday 13 November in your diary now and book your tickets by going tohttp://www..aoaa.org.uk/aaae

Awards are open for nominations now and will close at 5pm on 1 September2017. Categories you can nominate in are:

★ Air Ambulance Campaign of the Year Award

★ Air Ambulance Doctor of the Year

★ Air Ambulance Innovation of the Year Award

★ Air Ambulance Paramedic of the Year

★ Air Ambulance Pilot of the Year

★ Air Operations Support Staff Member of the Year

★ Charity Staff Member of the Year

★ Charity Volunteer of the Year Award

★ Lifetime Achievement Award

★ Outstanding Young Person Award

★ Special Incident Award

Don’t leave it too late - get your nominations in now!Visit http://www.aoaa.org.uk/aaae/nominate-now/ for the free and simple to complete nomination forms.

Your judgesDebra Allcock TylerDebra has been the Chief Executive of theDirectory of Social Change (DSC) since 2001. DSCsupports around 15,000 charities a year. Debra hasspent most of her career in the charitable sector inleadership roles in campaigning, policydevelopment, sales, product development, mediarelations and training. She is a mentor to a numberof CEOs and Chairs of Trustee Boards. Debra is arenowned authority in the field of leadership andgovernance in civil society.

Mark DochertyMark was appointed as Director at West MidlandsAmbulance Service NHS Foundation Trust inNovember 2014, leading on ClinicalCommissioning and Service Development as wellas being the Executive Nurse. Previously Mark wasDirector of Ambulance Commissioning in Londonand in 2012 was elected Chair of the NationalAmbulance Commissioners Group; in 2013 hegave evidence to the House of Commons HealthSelect Committee inquiry into urgent andemergency health services.

Tim FauchonIn a 37-year career in the Royal Air Force, Tim flewmany different types of helicopter and served inthe Falkland Islands, Cyprus, Germany, Hong Kong,Oman, Jordan and the USA. He served as theCommander of the SAR Flight, based at RAFLossiemouth in Scotland. Tim graduated from CityUniversity London with an MSc in Aviation SafetyManagement in 2015 and was appointed ChiefExecutive Officer of the British HelicopterAssociation in mid-2016.

Jim Fitzpatrick MP (Chair)Jim Fitzpatrick is MP for Poplar and Limehouse,having first entered Parliament in 1997. Previously afirefighter with the London Fire Brigade, he wasawarded the Long Service and Good ConductMedal. During Government, he was Minister ofState for Farming and the Environment, Under-Secretary of State for Transport, Under-Secretary ofState at the Office of the Deputy Prime Minister,Government Whip and Minister for London. He isthe Chair of the All Party Parliamentary Group for AirAmbulances.

Steve IrvingSteve is Executive Officer at the Association ofAmbulance Chief Executives (AACE). He isa paramedic and manager with over thirty years’experience at the London Ambulance Service,including a period with London’s Air AmbulanceHEMS team. Steve is the lead for planning andhosting the Ambulance Leadership Forum (ALF)each year and also works closely with Departmentof Health and other stakeholders on a range ofissues.

Hanna SebrightHanna is the Chair of the AAA. After a spelltravelling the world as long haul cabin crew for BA,she has worked in healthcare ever since, includingat the Atomic Energy Authority, where she wassenior health consultant. In 2006, Hanna set up herown company to develop Electronic Health Mediascreens for hospitals and GP surgeries; she latersold it to Lord Sugar and became MD of AmscreenHealthcare. Hanna has been Chief Executive ofMidlands Air Ambulance Charity since 2011.

The AAA already has a number of outstanding speakers lined up to speak at the AAANational Conference 2017. The Conference will again see charity, operational and clinicalspeakers take to the stage to deliver presentations on contemporary topics within the airambulance and ambulance service sectors. The four topics for 2017 will be Sharing BestPractice, Future Technology, Performance Excellence, and Under The Surface.

Speakers are currently being finalised but are expected to include high-profile anddynamic experts in their fields - keep an eye on the AAA website for the latest news.

The Conference is being held this year on Monday 13 November at the new, largervenue of the Millennium Chelsea Harbour Hotel. This means the Conference will becomfortable and spacious for delegates and there will also be a dedicated space fornetworking and a high quality exhibition area.The early bird rate is still available for Conference bookings. Go tohttp://www.aoaa.org.uk/event/40/ for more information and to book.

WORLD-CLASS SPEAKERS LINE UP FOR CONFERENCE

NEWS


7www.aoaa.org.uk

New analgesia and sedation guide

The JRCALC Guidelines, or to give them their proper title, “The UKAmbulance Services Clinical Practice Guidelines”, are thebedrock of ambulance service practice throughout the UK.

When Class Professional Publishing published the 2013Guidelines in print formats, they soon discovered that more andmore people wanted their guidelines on their smartphones andtablets. So in 2014 the eBook version was delivered. However,users then said they wanted to get to the information even faster,even when there was no signal and also wanted extra featuressuch as the ability to filter the guidelines by the age of thepatient, to flag up the guidelines and drug tables that they usedmost, to record the details of each case anonymously for laterreflective research, and to be kept up to date, whenever theguidelines changed.

Three years of discussion, research andconsultation has resulted in an app forsmartphone and tablet. The app isavailable from the App Store and GooglePlay. You can either subscribe for a monthor for a year. Visit www.icpg.co.uk for moreinformation on iCPG and download links.

Class Professional Publishing is offeringthe app with 20% off to AAA membersonly. If you want to have access to thelatest content and information in theGuidelines direct to your phone, [email protected] by 4 August with ‘Appoffer’ in the subject line and AAA will dothe rest.

Member discount forJRCALC Guidelines app

NEWS

Barry was Chief Executive Officer of the West MidlandsAmbulance Service for 24 years, pioneering many of themodern approaches to delivering emergency medical services.In 1990 he introduced the first air ambulance in the Midlandsregion, initially called Air 5, then County Air Ambulance and nowMidlands Air Ambulance Charity.

Barry was also a key supporter and adviser to the GreatWestern Air Ambulance Charity since its inception in 2008 andwas instrumental in helping to build the charity into what it istoday. Barry was a founder member of the Confederation ofHelicopter Ambulance Services in 2002 and was awarded theQueen’s Medal for long service and the Queen’s Jubilee Medalfor services to the Ambulance Service.

West Midlands Ambulance Service Trust's current chiefexecutive Anthony Marsh paid tribute: “Mr Johns was one ofthe leading modernisers of the ambulance service, playing aleading role locally, nationally and internationally. He had anuncanny knack for remembering names and details of theindividual staff members' family, making him popularamongst staff.

“As a young ambulance officer in the 90s, I was very awareof the work Mr Johns was putting into developing ambulanceservices. There can’t be any services in the country that didn’tbenefit from his vision of how modern ambulance servicesshould work. It was an honour and a privilege to succeed himin this area.”

The air ambulancecommunity has reactedwith great sadness to thenews that Barry Johnspassed away on 21 May.

BARRYJOHNS

The Association has issued a new Clinical Best Practice Guidance document on ‘Advancedanalgesia and sedation’ for UK HEMS operators.

The new Best Practice Guide joins three other Guides being republished following updates:‘Defibrillation and Pacing during Aeromedical Transport’, ‘Post Return of Spontaneous Circulation(ROSC) Care’ and ‘Photography and Video Imagery’. All four documents were developed andpublished by the AAA’s Clinical subcommittee.

Each of the documents provides an introduction, guidance and treatment recommendations forair ambulances, enabling them to adopt best practice in the topics they cover. Best PracticeGuides issued by the AAA draw on the experience of clinicians working on helicopters around the whole of the UKand form a benchmark for excellent care.

Dr Gareth Davies, Chair of the AAA Clinical Subcommittee, said: “Improving patient outcomesthrough shared knowledge is essential and each of the Best Practice Guidance documents publishedby the Clinical Subcommittee aims to share knowledge and promote best practice. Pain control andsedation are fundamental elements of patient care but in the complex environment can easily gowrong; hopefully this document will encourage safe and effective practices around the UK.

“The Best Practice Guides are reviewed and updated annually. The committee has an amazingamount of talent and experience around the table which means the documents are distillations ofmany years of experience, taking the best bits from services all over the UK. These latest guides will nowbe added to the growing list of best practice guides available to the HEMS community.”

Dr Gareth Davies


SCAA extends hoursScotland’s Charity Air Ambulance (SCAA) has increased its operationalhours by 20% and is now operating a 12 hour shift each day. The charityhas recruited a sixth paramedic to support crew shifts.

SCAA Chief Executive David Craig said, “Since 2013, SCAA has responded tohundreds of time-critical emergencies across the whole of Scotland, 10 hours aday, seven days a week. When a shift ends, however, so does our responsecapability. Thanks to the generosity of a very supportive public in Scotland, wenow have the resources to extend our crew’s shift to their maximum 12 hours.This has the potential to see us respond to even more emergencies within thatexpanded timeframe.”

Celebrating 30 years of saving livesAround 200 people gathered at Cornwall Air Ambulance(CAA) headquarters to celebrate 30 years of saving lives.Cornwall launched the UK’s first air ambulance helicopterservice and now 30 years on and more than 26,000 missionslater, a roster of crew past and present, former patients,trustees and supporters gathered to celebrate the milestone.

The guests included the CAA’s first pilot Geoff Newman andits first paramedic Paul Westaway. Geoff said: “For the past 30 years, I’ve felt a quietcontentment that the Cornwall Air Ambulance has continued to thrive and inspired otherservices. It’s not often you get to make a small scratch on the world. We’re very, veryproud of what we achieved.”

EHAAT’S New LookAhead of EHAAT’s 20th anniversary event on 25 June,the charity unveiled its new brand. This year marks adecade of the Air Ambulances of Essex and Hertfordshire operating in partnership andnow they have a brand and logo to match. The rebrand unifies the existing aircraftcolour schemes – red for Hertfordshire, and yellow for Essex.

Consolidating the Charity’s identity will also have cost-saving benefits for EHAAT.Instead of operating two separate websites, the Charity will have one brand newwebsite; similarly, where merchandise, staff and volunteer clothing and other assets wereoriginally divided into separate colours and designs for Essex and Hertfordshire,everything will now carry the new definitive brand.

EMAS leads the way on treatment for stroke patientsEast Midlands Ambulance Service (EMAS) is the lead ambulance service for the trial of anew patch which contains a drug that helps lower blood pressure and open up bloodvessels, allowing oxygen to reach the brain. This action can reduce damage caused inthe immediate minutes and hours following a stroke. Strokes are one of the leadingcauses of death, killing around 40,000 people each year in the UK.

EMAS has 186 paramedics signed up to the trial across the East Midlands. Paramedicsare given extra training around stroke care as well as being able to administer the smallmedicine patch. Results will be published towards the end of the year.

Biking bloodHampshire and Isle of Wight Air Ambulance (HIOWAA) havegrant funded the purchase of a dedicated blood bike for useby SERV-Wessex, whose volunteer blood bikers operate a regulartransportation service from University Hospital Southampton tothe HIOWAA airbase in Thruxton, changing the blood carried bythe Air Ambulance every 48 hours. The dedicated blood bike, a Yamaha FJR 1300, isone of the first of its kind and is liveried in the distinctive branding of HIOWAA.

Using temperature controlled packaging, which keeps the blood safe to use,volunteer blood bikers carry one fresh box of two units of blood to Thruxton three times aweek. Any blood unused within 48 hours is then transported back to University HospitalSouthampton for use in theatres.

8 www.aoaa.org.uk

NEWS

Pride of DerbyThree East Midlands Ambulance Serviceambulance staff have been nominated forPride of Derby Awards for providingexceptionally reassuring and supportive careto patients in Derbyshire. Rosie Cowburn, PaulReed and Shaun Barsby have all beennominated.

LAA’s New CEO Jonathan Jenkins has now taken up his role asCEO of London’s Air Ambulance. LAA has alsolaunched ‘Working Smarter Together for OurPatients’, which outlines its strategic directionfor the next five years, which Jonathan will beresponsible for driving forward. The focus is onfurther improving patient care, developinglong term pre-hospital emergency medicalexpertise through the Institute of Pre-HospitalCare, working more efficiently, improving thepercentage spent on frontline operations, andenhancing sustainability and resilience.

HELP AppealThe HELP Appeal, the charity that providesfunding for helicopter landing facilities, hashanded over its three latest donations. At theRoyal Bournemouth Hospital, work has begunon their upgraded helipad, funded by a£119,000 grant from the HELP Appeal. CentralManchester University Hospitals NHSFoundation Trust has received its secondinstalment of £250,000 from the HELPAppeal’s £1,000,000 pledge for its helipad;and the Royal Sussex County Hospital inBrighton has received its first donation, aninstalment of £500,000 of its £1m pledge.

Special treatmentIn what is believed to be the first suchpartnership in the country, a six month trial willsee special constables trained by SouthCentral Ambulance Service being sent tomedical emergencies to carry out initiallifesaving treatment for some patients whilstan ambulance response is en route.

Medal presentedNigel Rees, the Welsh Ambulance ServiceTrust’s Head of Research and Innovation, hasbeen presented with the Queen’s AmbulanceService Medal by Prince Charles at aceremony held at Buckingham Palace. Nigelwas recognised in the New Year’s Honours Listfor exemplary service and exceptionaldevotion to duty.

News in Brief

Do you have any news you'd like to

share in Airway?

Then email [email protected] to be

considered for the next issue.


9www.aoaa.org.uk

The UK’s air ambulance sector is tightly and rigorously regulated. So why are we hearing more and moreabout international accreditation bodies such as EURAMI and CAMTS starting to make their presence felt?In the UK, the air ambulance services and ambulance services are regulated by a number of bodies. TheCivil Aviation Authority (CAA) and EASA (European Aviation Safety Agency) run a strict rule over all aviationelements, while the Care Quality Commission (CQC) and National Institute for Health and Care Excellence(NICE) cast a beady eye over all things medical. (Charity and fundraising regulation is equally tightlyregulated but that is a topic for another day.)

Why, then, are we suddenly seeing European and American certification schemes being used in the UK? European-focusedEURAMI and US-focused CAMTS both have fully accredited members in the UK. In some parts of Europe and the U.S., theschemes are very popular and undoubtedly useful when rationalising standards across states and nations. CAMTS has recentlycreated CAMTS EU to focus more on European sectors.

The benefits of accreditation, say these organisations, are both internal and external. An accredited medical transport servicedemonstrates to its employees and to the public that it cares about the quality of patient care and safety and is committed todoing things to a high level of quality, efficiency and safety. Accreditation organisations deliver comprehensive auditsto determine compliance with the standards; these audits allow the audited organisation to identify opportunities to streamlinecosts and enhance effectiveness. Accreditation organisations would argue that ultimately there is a positive impact on theservice’s bottom line in terms of future earnings and preventive strategies that far outweigh the actual costs of accreditation.

But do we need them here in the UK?Bill Sivewright, Chief Executive Officer, Dorset & Somerset Air Ambulance, does not seethe benefit of adopting standards that may not be relevant in the national environment.“It does not make sense to pay a significant amount for accreditation by a body whosestandards are shaped by a different environment,” says Bill. “Whilst the majority of thestandards these bodies demand are very similar to those we already meet, where theyare different, it may not always be for the best. There is, for example, no consensus onthe requirement for two pilots in UK HEMS and the impact on safety or efficiency, yet thisis advocated by some external accreditation bodies. If there is no clear advantage toadopting an international set of standards then why use donated money to finance it?”

Conversely, The Air Ambulance Service (TAAS) is a strong believer in CAMTS because itsclinical partner for The Children’s Air Ambulance, Embrace, is accredited by theorganisation. Head of Operations at TAAS, Philip Bridle, says, “The best part aboutaccreditation is that it provides a standard for everything. These are very specialistteams doing the transfers, it’s a unique environment that calls on a range of differentpeople and organisations to do different aspects of the work. CAMTS accreditationembraces all these elements and demonstrates high standards are being met acrossthe board.

“We are not accredited ourselves but we are inspected as part of our partnerEmbrace’s accreditation process. Absolutely everything is inspected including the wayeach party integrates with the others to create a coherent operation. The inspection ofTAAS didn’t change anything we did but it was reassuring in the way it demonstrated wewere doing a good job.”

Embrace is the Yorkshire & Humber Infant & Children’s Transport Service - a transportservice for critically ill infants and children in Yorkshire and the Humber who require carein another hospital in the region or further afield. In July 2014 Embrace gainedaccreditation from CAMTS for ground, fixed wing and rotor wing transport of critically illbabies and children. (In March 2016 the fixed wing accreditation was withdrawn byCAMTS after Embrace’s partner CEGA Air Ambulance ceased to trade. Embrace retainsthe capacity to provide fixed wing transport when required but this is not carried out as aCAMTS accredited organisation.)

Dr Stephen Hancock is Transport Consultant (Paediatric Lead) for Embrace and is alsoon the Board of CAMTS EU. Asked why it has been paediatric and neo-natal transferoperations that have led the way when it comes to external accreditation, he

RAISING THE STANDARD

The best part about

accreditation is that it

provides a standard for

everything.

Philip Bridle


10 www.aoaa.org.uk

comments: “It’s about the wide scope of care and the fact that aeromedical transfer services are low volume and in partnershipwith external organisations. The accreditation means I know that we can do the work safely and to a high quality despite lowfrequency. It helps me build relationships and structures with external agencies. Embrace operates with four different airambulance partners and a ground partner so it’s complex compared with a typical HEMS service which has direct oversightfrom CAA, EASA and CQC, which we don’t have even though our partners do.

“It was fixed-wing air ambulance providers who first looked into international accreditation in the UK, as a means of devisingstructures to enhance safety and quality. With relatively low frequency of air activity, a small number of NHS transport teams havecome to understand that meeting one of the international benchmarks is a good way to ensure standards were maintained. Formany air ambulances, particularly in the US, accreditation has now become a major commercial consideration as it iscompulsory in some jurisdictions.

“When CAMTS come and accredit us, they take three days and visit nine sites - it’s avery comprehensive process. We feel that working with CAMTS is very much apartnership based on self improvement and thanks to the process we have come along way in the last four or five years.”

Modern and RelevantAnother organisation with a focus on children and babies is Lucy’s Air Ambulance, whosepreferred air charter partner is Capital Air Ambulance. Dr Terry Martin is Medical Directorfor Capital Air Ambulance and is also chair of the Standards Committee of EURAMI. Hehad always been interested in regulation of aeromedical transport services and haslectured extensively on the industry standards around the world. Terry became involvedin EURAMI after Capital’s first accreditation in 2012; he says: “I felt that the regulations, atthat time, were somewhat outdated, and I wanted to create a modern and relevantset of standards that all air ambulance companies could aspire to, plus an array ofadvanced standards for those organisations that have the capability to offer thebroadest range of high quality medical transport services.”

Terry, a former RAF doctor, has decades of experience in all aspects of patienttransport by air and is also a helicopter pilot and consultant in both intensive caremedicine and anaesthesia. This experience enables him to design and write standardsfor all aspects of air ambulance operations, including aviation, medical, governanceand business facets of the accreditation process, and in all types of mission profiles, i.e.fixed wing, rotary, HEMS, commercial airline repatriation, as well as specialty servicessuch as paediatrics and neonatal. Terry says: “In the UK, the aviation side is very wellaudited through the CAA and EASA. As part of its accreditation process, EURAMI checksthat the appropriate compliance with the regulations of these bodies is in place butmost of the audit work falls necessarily to the medical side. Most countries don’t havespecific regulations for patient transport, so this is where EURAMI comes into its own.

“On the medical side, we don’t spend a lot of time looking at the management ofeach individual patient. We are more focused on overall patient care, systems in placefor appropriate medical management specific to the mission statement, and scope ofcare in the accredited member’s modus operandi.

“Any opportunity to look at standards and make improvements is good. There doesneed to be some way of bringing together all these standards, not least because the

The accreditation

means I know that we

can do the work safely

and to a high quality

despite low frequency.

It helps me build

relationships and

structures with

external agencies.

Dr Stephen Hancock, Embrace

The Children’s Air Ambulance‘The Children’s Air Ambulance

and Embrace in actionCapital Air Ambulance


11www.aoaa.org.uk

European standards are considered by manyto be lagging behind modern practice. Thisis such an issue that some have consideredthat the European standards are not fit forpurpose in the UK. I’d really like to seeworldwide standards that are acceptable toall countries, but they must take nationaldifferences and limitations into account inorder not to alienate some states.

“In the UK, the AAA could have a crucialrole in aligning standards with EURAMI orCAMTS as well as pursuing input withEuropean Standards through the BSI.”

PracticalitiesBill Sivewright still needs some convincing about the practical realities of how thesestandards might work in the UK. He comments: “I absolutely understand the need forinternational standards where an organisation works internationally or where thosestandards are adopted by UK regulators. However, UK HEMS operations are alreadyregulated by EASA, CAA and CQC. With quite restricted areas of operation, onewonders what benefit UK HEMS being accredited for international operations mightoffer. To use charitable donations to buy into such a system of accreditation, oneshould at least see the benefits that it might bring. Unfortunately, much of theaccreditation standards are statements of opinion and for me there must be a clearerand more rigorous link between the standards being set and the benefits they bring.

“In addition, EURAMI and CAMTS are not set in a UK context. For UK HEMS, I am infavour of identifying a set of UK standards that draw on the experience andrequirements of UK operations.

“I am certainly not in favour of layers of certification - Gold, Silver, Bronze for example- because I don’t see the value of this to the patient. One needs to identify a standardthat meets the needs of the patient and that’s it, that’s all that matters.

“If we are to develop a certified set of standards in this country, a task which shouldnot be underestimated, we need to start from scratch and ask, not only ‘What do weneed?’ but ‘why?’”

It is certainly early days in this discussion and opinions vary widely. TAAS’s Philip Bridle isbroadly in line with Bill Sivewright’s view: “I think the use of CAMTS will remain just withspecialist organisations rather than becoming a HEMS-wide phenomenon. The HEMSenvironment has a narrower field of practice than the specialist teams using CAMTS asthe accredited standards, hence current legislation and guidance from the CAA, CQCand other regulatory bodies give the HEMS organisations good levels of assurance.’’

Embrace’s Dr Stephen Hancock, however, says: “I do think accreditation will movefrom secondary transfer operations to primary HEMS services. Most accredited USoperations are primary HEMS, and CAMTS is developing to encompass this area moreoutside of the US through CAMTS EU. It would be a pretty good fit. You’d only look toaccredit under the standards that meet your scope of care.”

Dr Terry Martin from Capital concludes, “Accreditation inevitably leads to higherquality, which means more efficiency and better safety throughout the business. EURAMIis not just a regulator, it helps aspiring organisations to reach the required standards. Allcompanies that I audit around the world are happy to learn of new ways to improve.You can never have too much quality or too much safety can you?”

Do you have a view on standards and accreditation?

Please let us know; email [email protected]

Accreditaion 2012 Terry Martin (left),EURAMI auditor Dr Gert Muurling,

and Capital CEO & Chief Pilot, Malcolm Humphries

The accreditation bodiesEURAMI (European AeroMedical Institute),based in Germany, says its mission is topromote high quality aeromedical transfersthroughout Europe and the world via fixedwing or rotor aircraft. It aims to establish thisthrough promoting research, training andaccreditation in the field of aeromedicaltransfers. EURAMI believes strongly thataccreditation is an effective means ofvalidating quality aeromedical services andinitiating self-evaluation.

CAMTS (Commission on Accreditation ofMedical Transport Systems) is an Americanaccreditation organisation that has nowcreated CAMTS EU, which it describes as anorganization dedicated to improving thequality of patient care and safety of fixedwing, rotorwing, ground and medical escortservices by providing comprehensivestandards and an auditing process todetermine substantial compliance with theaccreditation standards. The organisationwas created to better serve European andinternational medical transportproviders recognizing not only culturaldifferences but government restrictions andlaws of other countries while maintaining theintegrity of the accreditation processworldwide.

NAAMTA is the new kid on the block,seemingly offering a very similar product tothe other two more well establishedorganisations. The US-based organisationdefines itself as the accreditation standardbearer for the medical transport industry,offering guidelines for developing aquality management system focusing ontransport safety, patient care, andcontinuous improvement. Since thecompany’s inception in 2009, it says it hasmade great strides in identifying key bestpractices to improve the standard ofperformance among medical transportsystems at the global level. The organisationsays it embraces a higher standard where allwho fall under the NAAMTA umbrella desire aperfect workplace, a place where safetyand quality of care are paramount.

Bill Sivewright


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13www.aoaa.org.uk

Professor Sir Keith Porter

Professor Sir Keith Porter, Professor of ClinicalTraumatology, writes for Airway on the changingface of trauma.

The new trauma epidemicAre we neglecting our elderly patients?

are at best 50% likely to recognise theinjury.

The magnitude of this problem isdemonstrated by a review of thetrauma data taken from a reviewarticle looking at the period from 1995to 2013. In summary:

• The mean age for patients sufferinglife threatening trauma has risenfrom 36.1 years to 53.8 years.

• The percentage of patients in theover 75 years of age group rosefrom 8.1% in 1990 to 26.9% in2013.

• In 1990 the percentage of majortrauma due to low falls (falls fromstanding height) was 4.7%; by 2013this had risen to 39.1%.

Why is triage only as good asflicking a coin for the elderly?This is because the elderly do notdisplay the classical signs of shock dueto blood loss (due to an ageingcardiovascular system) and many withlife threatening head injury followingtrauma have a normal level ofconsciousness (due to increasedspace in the skull due to brainshrinkage with age), but many go on todive particularly in those patients onanticoagulants and antiplateletmedication.

What is the way forward?Any solution must embrace a networkresponse. As the majority of elderlypatients are not received by a traumateam there is a need for a priorityassessment by a senior doctor,perhaps middle grade, within adefined timeline. The threshold for a CTTraumagram (scan from head to hips)should be lowered as this is the besttriage tool and many injuries are notobvious.

Beyond ED, hospitals should adoptbespoke care pathways for this cohortof patients as detailed in the HECTORpathway(http://www.hra.nhs.uk/news/research-summaries/hector-evaluation). Thebiggest challenge is pre-hospital care.

How can HEMS practitioners help?HEMS practitioners can help by:

• Promoting education and trainingto the wider paramedic populationon the covert injuries related to lowenergy falls.

• Improving examination techniques;as an example, there may besubtle signs of serious injury.

• Considering point of care testinge.g. venous lactate determination,ultrasound techniques.

Taking all elderly falls to a majortrauma centre is not the answer – thereis not capacity.

Facilitating rapid, safe interhospitaltransfer of those elderly patientsneeding lifesaving interventions, mostcommonly head injuries, is one wayHEMS could help.

Finally, case review, data analysisand hospital collaboration maydetermine a more cohesive approachand better outcomes for this deservingcohort of patients.

If you ask the general public aboutpatients suffering major trauma, theywill invariably reply that it is the diseaseof the young, quoting as examples thecar drivers, motorcyclists and victims ofinterpersonal violence. This was thecase a few decades ago but with anincreasingly aged population, manyremaining fully active, the balance ischanging. Falls from a standing heightin the elderly patient group is set tobecome the common cause oftrauma in the UK in the next decade.

What is major trauma, how isit defined and quantified?The Injury Severity Score (ISS) is thesystem used most frequently worldwide.Scores are defined based on theAmerican College of SurgeonsAbbreviated Injury Scale (AIS), whichscores from 1 (minor) to 6 (fatal) forindividual body regions. The ISS isdetermined by adding together thesquare of the AIS scores from the threemost severe body areas.

Life changing injuries are thoseinjuries with an ISS of 9-15 and lifethreatening injuries ISS over 15. Itshould be noted, as an example, ascore of in excess of 15 can beachieved from a single injury or anumber of higher lesser injuries.

Ideally patients with an ISS over 15should be managed in a Major TraumaCentre (MTC) and selected patients,depending on network policy with anISS 9-15 (e.g. open tibial fracture).

For the younger patient, identifyingthose with likely life threatening injuriescan be obvious, for example theyounger patient with multiple injuries ina road traffic collision, the patient whojumps from a building or the patientwith torso bullet wounds.

In the elderly patient our triage tools


14 www.aoaa.org.uk

ASSOCIATE MEMBER SPOTLIGHT

It’s not often that you get a greatly improved product being offered at avastly lower price but this is what AAA Associate Member Rotor & Aircraft is offering.

With long experience in the helicopter industry, Managing Director of Rotor & Aircraft FrançoisGatineau brought Max Viz Enhanced Vision Systems (EVS) to the emergencyservices in the UK a few years ago. The Max Viz EVS is a Forward Looking Infra-Red (FLIR) system using infra-red technology. The primary objective of the MaxViz EVS is safety.

The system uses infra-red sensors, signal processing and advanced cockpitdisplay to show terrain, runways, taxiways, aircraft and obstacles in poor visibilityconditions including light fog, haze, smoke, brown/whiteout, light precipitationand darkness.

Until this year, the only product available was the Max Viz EVS 1500. Now,though, the Max Viz EVS 1500 is no longer in production, having beenreplaced by two superior products, the EVS 1400 and the EVS 2300. The bigdifference is that the technology is now high resolution and the display has fourtimes as many pixels, making a huge difference to the quality, contrast andclarity of image on the cockpit display. In addition, the Max-Viz EVS 2300 candisplay LED lights on the Long Wave Infra-Red (LWIR) image based uponpatented blended sensor technology.

François says that despite this upgrade to HD, air ambulances are likely tosave money compared to the previous version of EVS. The EVS 1500 cost 60,000 US Dollars and whilethe new EVS 2300 costs the same, the EVS 1400 is just 25,000 USD - and it is this version of the productthat most suits UK HEMS operations.

Francois adds: “The EVS 2300 is of course the higher level product and its advantage is that it hassoftware embedded into it that makes it compatible with Synthetic Vision Systems (SVS), which allowsthe merging of the infra-red image of the map with the infra-red image of the EVS. However, this isperhaps for the future; for an immediate positive impact at a fraction of the cost, I’d recommendAAA members look at the EVS 1400 straight away.

“The EVS 1400 is perfect for those operators already flying with Night Vision Goggles (NVG), beingvery much a complementary technology to enhance vision especially in rural areas where on somedark nights residual lights are not enough.”

The EVS system has already been approved and installed inmany business jets like Falcon, Challenger, Citation andGulfstream, while in the European EMS and SAR sectors, it isalready in operation with several companies including inSwitzerland, Poland and France.

François added: “This is a unique system. Of course it isoutstanding at night and makes night flying far safer but,unlike Night Vision Goggles, it is also invaluable during theday when visibility is low. The crew are able to see obstacles that they simply wouldn’tsee with the naked eye. For example, if a pilot is facing IIMC, the EVS will allow him toescape safely from this difficult situation. The EVS can improve both daytime and night-time visibility by up to ten times compared to the naked eye, depending ontemperature and humidity.

“It is simple to install and very simple to use – in fact EASA has not imposed any trainingrequirements at all. It is a one-off purchase that does not require annual training.”

HIGHER RESOLUTION,LOWER COST


NATIONAL DIRECTOR’S REPORT

This has been an exceptionally busy period, not least becauseof the General Election, which caused a reorganisation of manyevents through the year, as well as the reconstitution of theAPPGAA. Sadly, the other most notable news was the death ofone of our industry's pioneering figures, Barry Johns. He will bemuch missed. You will find an obituary on page 7 of this issue.

Media PersonnelAs covered elsewhere in this publication, the issue of airambulances carrying media personnel has been resolved; theCAA has issued guidance to AOC holders and the AAA hasshared this with all members. I’m delighted at the speed withwhich this has happened and am aware that within days, atleast one television channel has agreed in principle tocommission a number of programmes.

General ElectionThe snap calling of the General Election created a substantialamount of reactive work, reorganising various meetings andevents and dealing with the disruption of our regularcommunication with MPs. A reception at No.11 Downing Street,the June APPGAA Reception and meetings with various Ministerson Key Issues will all need to be rearranged after 8 June.

SubcommitteesThe new AAA Subcommittee structure was approved at ourAGM and the transition process has begun. Further informationwill be reported in the next issue of Airway.

Conference and AwardsPlans for the Conference and Awards continue apace. This is anexciting year as both events continue to evolve, with this year’sevent being held at the new, larger venue of the ChelseaHarbour Hotel. For two years, we have had to turn people away

National Director, Clive Dickin, writes a quarterly report for Airway, which summarises the Association’smost recent activities and priorities so all members can be kept up to date. Clive writes:

15

for the Awards dinner but by moving to the Chelsea HarbourHotel, we will be able to offer more space for Dinner guests, aswell as offering our exhibitors a superior space to exhibit and ourConference delegates an outstanding event.

Ambulance Radio Programme (ESMCP) The emergency services mobile communications programme(ESMCP), also sometimes known as the Ambulance RadioProgramme (ARP), continues to present challenges. At ameeting on 26 April a proposed solution was presented but wastotally unsuitable for all emergency services aircraft. The AAA iswriting to the project director in the hope that the programme’sserious shortcomings can be addressed urgently. TheAssociation’s Operations Subcommittee will continue to beclosely involved in all developments and discussions.

AAACThe Association of Air Ambulances Charity continues to generategreat interest from donors. The Charity’s Donor EngagementPolicy has been changed to improve early potential donorsupport and this has allowed the Charity to engage threepotential donors in preliminary discussions. AAAC continues todevelop its relationship with existing donors.

NEW BRAND, NEW LOOKThe AAA branding has existed for almost adecade. With a major website updateunderway, this was the perfect time toreview our brand. We will send out a paper to members forconsultation in July, detailing the new look and new brand.Please do let us know what you think.

If you would like any more information on any of these issues,please contact Clive Dickin on 01564 339958.


three of a kind€¦ · between 1995 and 2013, the mean age for patients suffering life threatening...

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