Air ambulance and pre-hospital care day tackles key topics in trauma medicine

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The eighth London Trauma Conference took place at the Royal Geographical Society, Kensington Gore, between 9 December and 12 December 2014. In a similar vein to previous years, a main programme of presentations was supplemented by breakaway sessions held parallel to the main conference. Speakers addressed a number of topical questions in trauma and emergency medicine. This year, conference organisers decided to run the concurrent London Cardiac Arrest Symposium over two days rather than the usual one, and an advanced paramedic masterclass was introduced covering areas such as analgesia, education, governance, plus a variety of clinical topics. The Journal of Paramedic Practice attended the Air Ambulance and Pre-hospital Care Day held on 11 December, which focused on trauma issues directly relevant to professionals working in the pre-hospital setting.

Proceedings began with Prof Wolfgang Voelckel outlining challenges to pre-hospital critical care. Voelckel argued that the ‘golden hour’ of emergency medicine has little scientific basis, and that rather than the traditional trimodal distribution of death that is often referred to in advanced trauma life support, there is a mono-modal peak of mortality in trauma in the first hour from time of injury.

Assoc Prof Cliff Reid then gave a talk on quality education in pre-hospital care. Highlighting that medicine needs evidence to improve clinical outcome, he stressed that pre-hospital critical care can be improved through clinical competence. One of the standout talks of the day, he emphasised that education is not about teaching people knowledge, but training people to perform.

Prof Guy Rutty then delivered a fascinating presentation on the way road traffic collisions are examined by forensic pathologists. Rutty highlighted how the role of the pathologist is to answer questions of who, where, when and how the person involved in a fatal accident came by their death. This includes medical interventions at scene/hospital, survivability, restraint systems, speed and direction of impact. Rutty gave an overview of post-mortem imaging using CT scans, explaining that the level of detail in imaging is so detailed that one could argue that a real autopsy is no longer necessary.

Dr Samy Sadek replaced the planned talk by Prof Ben Bobrow, and gave a presentation on the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the management of trauma patients. Sadek highlighted the benefits of using REBOA for shocked pelvic and junctional injuries, explaining how half of these patients that die do so before intervention. Pre-hospital options in London before REBOA were pre-hospital transfusion and/or thoracotomy, yet evidence suggests that REBOA causes less harm than thoracotomy. Sadek emphasised that REBOA is not a standalone intervention but part of a system response; however, complications include dissection, rupture, emboli and misplacement.

Dr Andreas Krüger followed with a discussion on the current status of physician-manned emergency medical services. Krüger established that the benefits of having a health professional qualified in advanced pre-hospital care include: the ability to carry out advanced procedures, manage more difficult cases, and administer a wider range of analgesics.

Dr Dan Ellis and Prof Mårten Sandberg then debated clinical governance in pre-hospital care under the motion ‘tight systems are best’. Ellis argued for the value of tight governance, while Sandberg defended loose governance. Ellis highlighted that both Australia and UK critical care guidelines include ‘good’ clinical governance and argued that if we advocate the use of clinical governance then surely we should do it well? Sandberg countered this by defending the benefit for having permanent staff. Besides the need for regularly training new staff, Sandberg argued that experienced staff offer the ability to tailor treatment to each individual patient and not rely on checklists, strict SOPs and rigid algorithms. A vote taken at the end of the session showed a unanimous preference for tight clinical governance; however, perhaps this was due to a biased, predominantly UK audience.

Dr Stefan Mazur gave the final pre-lunch talk on the transport of difficult patients, taking into account psychiatric patients, obese patients and infectious patients. For the acutely unwell psychiatric patient, Mazur highlighted the potential benefit of an anaesthetic in these patients to facilitate transport. He argued that ketamine sedation for those who are acutely psychotic is apparently safe and doesn’t worsen mental outcomes. Consideration for the transport of obese patients includes limitations of your airframe—will the patient actually fit?; loading and unloading; and using a vac mat for ramping a patient to allow for ear-to-sternal notch positioning. With regards the transportation of infectious patients—of notable relevance given increasing reported caes of ebola patients—aeromedical considerations include correct PPE, aircrew protection, and an awareness that motion sickness may increase your exposure to patients’ body fluids.

The post-lunch sessions looked at the disquieting subject of managing EMS disasters, with two tremendously brave presentations.

In the first talk, Mr Syver Leivestad and Ms Siv Tonje Solfjeld outlined the Norwegian Air Ambulance crash which occurred on 14 January 2014 and the crisis plan that was implemented following the incident. With the first photos of the accident published online by media within 10 minutes, the need for a robust, well-practised crisis plan and a good handling of communication cannot be understated. As well as a plan for updating the service’s website and Twitter account, publishing press releases, and holding a press conference, it was integral that there was a focus on supporting families, honouring colleagues and involving employees.

Dr Stephen Hearns followed with an equally harrowing overview of the Glasgow Police crash which occurred on 29 November 2013. Hearns’ emotional and heartfelt presentation emphasised the emotional impact of treating colleagues, and the priorities that are required beyond the initial response, including: the welfare of colleagues, flight safety and confidence, and business continuity.

The day concluded with a selection of 10 minute ‘quick fire’ sessions on topics related to pre-hospital trauma medicine.

Dr Per Kristian Hyldmo outlined the increasing doubt about the future of cervical collars due to the distinct lack of clinical evidence supporting the claim that they improve neurological outcome. Alternatively, evidence appears to suggest that spinal immobilisation is better with a vacuum mattress.

Dr Jostein Hagemo questioned whether pre-hospital blood without supporting products is bad. He concluded that if you really need red blood cells, then you really need coagulation support.

Dr Dan Ellis followed by asking whether pre-hospital blood gases or electrolytes would change the management of a patient? The i-STAT allows most blood gas results to be deliverable in the pre-hospital setting, so it is theoretically achievable. Ellis argued that even if you don’t have time to act on blood gas results, it can aid decision-making and prove useful at handover.

Dr Stefan Mazur looked at the benefits of pre-hospital tranexamic acid. The CRASH-2 trial indicated that the administration of tranexamic acid up to 3 hours following an incident has clear benefits for the trauma patient; however, this is in contrast to data from the Australian Trauma Registry. The benefit of pre-hospital tranexamic acid administration might therefore be overstated. It is hoped the current Study of Tranexamic Acid during Air Medical Prehospital Transport (STAAMP) trial, and Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH) study, will establish whether or not pre-hospital administration of tranexamic acid really is beneficial.

De Stefan Candelfjord then gave an engaging presentation on pre-hospital diagnosis for stroke and trauma patients using microwave technology. Initial (in vitro) trials suggest that microwave technology seems to be promising in the detection of, and estimation of, size of haematoma.

Mr Mark Wilson then spoke on improving first responder responses to cardiac arrest and trauma through the Good Samaritan smartphone application. The app allows community ‘alerters’ to send out a distress signal to the nearest medically-trained Good Samaritan, while at the same time automatically dialling 999. Medics who are within a few hundred metres can then proceed to the emergency on foot to help before the arrival of emergency services.

This was followed by Assoc Prof Cliff Reid discussing apnoeic oxygenation in pre-hospital RSI. Reid claimed apnoeic oxygenation for preoxygenation in RSI can double time to desaturation, and explained how nasal oxygen during efforts securing a tube (NO DESAT) allows the continued benefits of apnoeic oxygenation while tracheal intubation techniques are performed.

Chief pilot Neil Jeffers of London’s Air Ambulance spoke on considerations regarding night HEMS. He highlighted that the additional cost of running a night service is of notable concern, with many aircraft not being night vision equipped, and thus presenting a notable increase in cost. Not only this, but there are very few appropriately lit helipads on or near hospitals in the UK.

Dr Nils Petter Oveland gave the final talk of the day on novel techniques to diagnose pneumothorax. Oveland outlined promising preliminary results for microwave assessment of pneumothorax. A sensitivity and specificity of 100% was evident in a small animal model study. Clearly more research is needed but it is apparent that it may be a useful clinical tool.

An undeniably action-packed day, providing much food for thought, those who felt they weren’t quite ready to go home headed to the Stand Up Science Evening, an event which allows 5 minutes to convey the significance of a submitted work, and 5 minutes for questions in a busy but informal session.

Taken from Journal of Paramedic Practice, published 9 January 2015.

Sir Bruce Keogh admits health system is ‘creaking’ and ‘under pressure’

Bruce Keogh

Prof Sir Bruce Keogh, medical director of the NHS, has admitted the National Health Service is ‘creaking’ and ‘under pressure’, at a conference held at the King’s Fund on 19 December.

The Urgent and Emergency Care Conference, hosted by the King’s Fund, provided an update on progress with the Urgent and Emergency Care Review, as well as exploring the immediate challenges facing urgent and emergency care services.

Prof Chris Ham, chief executive of the King’s Fund, opened the event by asking delegates: what kind of urgent and emergency care system do we need in the future? Ham proposed that we need a much more joined up and integrated system than the one that is currently in place.

Prof Sir Bruce Keogh delivered the keynote speech on the future of urgent and emergency services in England, placing an emphasis on the long-term vision for transforming urgent and emergency care. Keogh explained that over the past year there has been a steady and relentless growth in the number of A&E attendances, and in light of reports of additional pressures placed on services during the Winter months, he admitted:

‘The system is creaking. A&Es are having to address increasing demand, the ambulance services are struggling in many parts and we have a number of issues to deal with, which we are tackling.’

Keogh acknowledged that responsive services need to be provided closer to home and that highly specialised centres must be made available. It is only through this way that we can ensure patients in life-critical conditions receive the right level of treatment at the right place.

Keogh outlined that the current urgent care system is complex and confusing, and so a simple and intuitive system is needed if patients are to access the right care, at the right place, at the right time. The introduction of urgent care networks, as a means to dissolve boundaries between hospitals and community services, and join up pathways of care, will be integral to ensuring this is possible.

Dr Robert Varnam, head of General Practice Development for NHS England, followed with a talk on the contribution of primary care in the provision of urgent and emergency care. Varnam stressed the need to develop more responsive and joined-up approaches from general practice, noting that only by seeing the whole system can the needs of patients be properly met. He also stressed the importance of primary care colleagues collaborating with the urgent care pathway, and the need to think about access in primary care. Varnam questioned what the point in quick access is if what you get access to doesn’t address need.

Dr Clifford Mann, president of the College of Emergency Medicine, gave the final talk before delegates broke for coffee on the next steps for emergency medicine. Following on from the publication of the College of Emergency Medicine’s CEM10, which outlined 10 priorities for resolving the crisis in emergency departments, Mann gave an overview of the College’s STEPs to rebuilding emergency medicine. These consist of staffing, tariffs and terms, exit block, and primary services.

After coffee, procedings were separated into two streams: one on urgent care, the other on emergency care. Within the urgent care stream, Richard Hunt, chair of the London Ambulance Service NHS Trust, delivered the first talk on supporting the development of ambulance services as out-of-hospital providers. This was given on behalf of the Association of Ambulance Chief Executives (AACE).

After giving a background to the AACE, Hunt outlined the potential role of ambulance services in transforming urgent and emergency care. Through the development of the paramedic workforce—to include more specialist and advance paramedic roles—it is hoped that ambulances could be used as mobile urgent treatment services capable of dealing with complete episodes of care without transport to hospital. Improving the range of clinical assessment and decision-making skills of paramedics so that they can manage patients closer to home, and the introduction of independent prescribing for paramedics could help achieve this.

This was followed by a panel discussion on providing a highly responsive urgent care service outside of hospital. Panellists included: Dr Chaand Nagpaul, chair of the General Practitioners Committee, British Medical Association; Adam Duncan, chief operating officer, London Central and West Unscheduled Care Collaborative; Dr Simon Abrams, GP and chair, Urgent Health UK, Federation of Social Enterprise Out of Hours Providers; and Ashok Soni OBE, clinical network lead, Lambeth Clinical Commissioning Group and president, Royal Pharmaceutical Society.

Key issues discussed in this session included: improving access for patients to ensure they can easily navigate the system; developing and implementing plans to meet predictable surges in demand; the role of GPs in urgent care now and under new plans for two types of urgent care networks: strategic and operational; and aligning 999 and NHS 111.

After lunch, Rob Webster, chief executive of NHS Confederation, spoke on new models for urgent and emergency care. Webster offered a system perspective on challenges and opportunities for urgent and emergency care networks, outlining that urgent and emergency care networks provide increased access to a simplified urgent and emergency care system, and better integration between urgent and emergency care services.

Examining existing evidence on networks, Webster looked at functions for network models, including strategic leadership for urgent and emergency care; to coordinate operational implementation at a local level; and to address fragmentation within the urgent and emergency care pathway.

This was followed by a panel discussion, where speakers gave an overview of existing networks and coordination at local level. Dr Nav Chana, chairman of the National Association of Primary Care, gave an interesting talk where he argued primary care should be defined by its function not its membership.

Stephen Dalton, chief executive of the Mental Health Network, delivered a talk on mental health and crisis care. Explaining that mental health service users have double the A&E attendance rate of the general population, Dalton gave an overview of the Mental Health Crisis Care Concordat, whose vision is for services to work together to deliver a high-quality response when people—of all ages—with mental health problems urgently need help.

Solveig Sansom, head of commissioning for integration, South Devon and Torbay Clinical Commissioning Group spoke on the Newton Abbott Frailty Hub, an initiative aiming to increase the number of patients who are proactively case-managed at home. Utilising a joined-up approach for frail elderly care, its predicted outcomes include a reduction in long-term care placements, as well as a reduction in emergency admissions from care homes.

The closing session of the day saw Adrian Masters, managing director, sector development for Monitor, speak on implementing a new payment approach to support improved delivery of urgent and emergency care. Masters highlighted that payment needs to change to support the service reforms and that Monitor are working with their partners on a wider programme of work on payment, which offers a coordinated and consistent payment approach across all parts of the urgent and emergency care network.

The final talk was given by Prof Keith Willett, director for acute episodes of care, NHS England, on progress made with phase two of the Urgent and Emergency Care Review. Outlining the next steps in delivering change following the review, Willett explained how emergency care networks will connect all services together into a cohesive network so that the system is more than just the sum of its parts. NHS England is now at the stage of moving from design to delivery; however, it faces a number of significant challenges, including payment system reform, information sharing, workforce and skills shift.

Taken from Journal of Paramedic Practice, published 9 January 2015.

The waiting game: resolving the crisis

A&E waiting

Last month saw the highest number of patients who waited more than 4 hours in Type 1 A&E units (major A&E) before they were treated since figures began in 2010 (Campbell, 2014).

Figures from NHS England revealed that for the week ending 7 December, 35 373 patients waited more than 4 hours from arrival to admission, transfer or discharge at Type 1 A&E units (NHS England, 2014a). Of the total number of attendances, only 87.7% were treated in 4 hours or less. This is below the target set by the Government of 95%. This also marks a 66% increase on figures from the same week last year (NHS England, 2013). For the week ending 12 December, this rose to 44 153, which represented a drop in the number of patients treated within 4 hours to 84.7% (NHS England, 2014b).

The number of patients spending between 4 and 12 hours on a trolley from decision to admit to admission was similarly high: 7 760 patients for the week ending 7 December and 10 126 for the week ending 14 December, respectively (NHS England, 2014a; 2014b). This is more than double the numbers of 2013 (NHS England, 2013).

Following a decision made by health secretary Jeremy Hunt not to publish performance figures over the festive period, so as to give staff a break, data published on 6 January revealed that only 92.6% of patients were seen in 4 hours from October to December (Triggle, 2015b). This performance is the worst quarterly result in a decade.

It is undoubted that A&E departments are facing difficult times. At a King’s Fund conference in December, Prof Sir Bruce Keogh admitted that the health system is ‘creaking’ and ‘under pressure’ as a result of the strain brought on by increased attendances during winter months. The need for radical change within the urgent care system, therefore, has never been so apparent.

In England, an extra £700 million has been set aside to help the NHS, through the provision of additional staff. However, Dr Clifford Mann, president of the College of Emergency Medicine, has raised concerns that it has not gone through to all the places it should (Triggle, 2015a).

With major incidents being declared at a number of hospitals, new measures need to be implemented if targets are to be met. Keogh’s vision for a new urgent and emergency care system outlined in the Urgent and Emergency Care Review could present an answer, but it is expected to take 3–5 years to enact the major transformational changes. Although the Keogh Review wants to avoid risky ‘big bang’ change, that change is needed now. It is, therefore, a neverending waiting game.


Campbell D (2014) Record A&E waits show NHS is cracking under pressure—doctors’ chief. The Guardian. (accessed 5 January 2015)

NHS England (2013) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 8/12/2013. NHS England, London

NHS England (2014a) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 7/12/2014. NHS England, London

NHS England (2014b) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 14/12/2014. NHS England, London

Triggle N (2015a) A&E performance in England ‘likely to hit new low’. BBC. (accessed 5 January 2015)

Triggle N (2015b) A&E waiting in England worst for a decade. BBC. (accessed 6 January 2015)

Taken from Journal of Paramedic Practice, published 9 January 2015.

AAA Conference sees Keith Willett call for more evidence-based research in HEMS

Photo Credit: Association of Air Ambulances


This year’s Association of Air Ambulances (AAA) National Conference took place once again at the Millennium Gloucester Hotel in Kensington, London. In a departure from last year, the organisers removed one theatre to deliver a more interactive workshop programme. Featuring 23 speakers, the one-day conference looked at the future developments of air ambulance fundraising, operation and clinical activity.

Following a brief welcome from AAA national director, Clive Dickin, Hannah Sebright, AAA vice chair, gave delegates an outline of the AAA’s key issues. These included the AAA supporting the call for the European VAT Directive to be amended so all European charities are able to reclaim VAT charges from carrying out their approved activities, and support for local air ambulances and ambulance services through the provision of both financial and clinical help at a local level.

Prof Keith Willett, director for acute episodes of care, NHS England, then gave an update on the Urgent and Emergency Care Review. Explaining developments, findings and the likely impact on pre-hospital aeromedical care, he commended the collaborative work of AAA and the various air ambulance charities. He concluded by highlighting the need for more evidence-based research in helicopter emergency medical services (HEMS).

Mike Shanahan, head of special operations, Yorkshire Ambulance Service NHS Trust (YAS), then provided a review of the preparation and deployment undertaken by YAS for the Grand Départ of the Tour de France.

After the first coffee and networking break of the day, Steve Wheaton, assistant chief ambulance officer, West Midlands Ambulance Service NHS Foundation Trust, gave a report on the Joint Emergency Services Interoperability Programme (JESIP), outlining progress so far and lessons learned from the Exercise Joint Endeavour held in September.

This was followed by an update on the European Aviation Safety Agency by Brian Baldwin, helicopter flight operations, Civil Aviation Authority.

Nicola Stewart ended the pre-lunch talks with a Care Quality Commission update on changes to regulation of care.

Throughout the day there were a number of breakout sessions and workshops, offering delegates the opportunity to discuss key topics and areas of interest. Some of the highlights of these sessions include Dr Paddy Morgan, anaesthetist/intensivist, Great Western Air Ambulance giving a review of the drowning process, and Alistair Wood, GE Medical systems looking at portable ultrasound in the pre-hospital care environment.

After lunch, communications trainer Mark Hogan, who required air ambulance care following a fall, gave an alternative yet engaging talk on how he took on a bet to put on a comedy show at the Edinburgh Fringe Festival.

Lt Col Chris Wright, defence consultant advisor, then spoke on lessons from the theatre of war. A clinician who has spent years treating injured soldiers and civilians, he outlined how lessons learnt in the field can be applied in a civilian setting.

Nigel Hare, operations director, Devon Air Ambulance Trust, gave an overview of European Standards, explaining what they are and issues relevant to them. He explained how he identified a potential problem in EN 13718, the European minimum standard for safety and a specific one for air ambulances, as none of the UK air ambulances services met the standard.

Prof Keith Willett gave an update on the Urgent and Emergency Care Review, explaining developments, findings and the likely impact on pre-hospital aeromedical care

Prof Keith Willett gave an update on the Urgent and Emergency Care Review, explaining developments, findings and the likely impact on pre-hospital aeromedical care. Photo Credit: Association of Air Ambulances

Dr Ben Singer of Royal Brompton Hospital then gave a talk on potential pre-hospital applications of extracorporeal membrane oxygenation (ECMO). He provided an outline of a possible model for pre-hospital ECMO, as well as circumstances where it may be used in the future.

Finally, Dr Gareth Davies, consultant London’s Air Ambulance, spoke on resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital environment.

Speaking after the event, Clive Dickin said:

‘Our conference speakers covered not only detailed topics but also higher level strategic subjects from clinical, air operational and fundraising subjects. This is exclusive to our conference, giving a unique perspective and knowledge base for aeromedical teams, charity staff, management, directors’ trustees. The event is designed as one of the key activities that delivers the Association’s strategy of sharing knowledge across the sector, not only looking at lessons learnt but also new innovation, further improving pre-hospital critical care.’

Awards of Excellence

This year saw the Association of Air Ambulances’ second Awards of Excellence. Held in the evening following the conference, the awards were open to all air ambulance operations within the UK and nominations were made from patients, staff, management and the general public.

BBC television presenter Louise Minchin returned to host the awards, with actor and comedian Robert Llewellyn also on hand to provide support and comic relief.

Nigel Hare, operations director, Devon Air Ambulance Trust, picked up two awards for the evening, including Charity Staff Member of the Year and the AAA Chairman’s Award. He was recognised for his input, commitment and passion in his work not only at Devon Air Ambulance Trust but nationally, including as a director of the Association of Air Ambulances.

The Lifetime Achievement Award went to Gerry Hermer, aviation adviser to the East Anglian Air Ambulance (EAAA). Hermer was recognised for a great number of achievements, including his commitment to continue to develop and improve the aviation capacity of EAAA, despite his supposed retirement.

Air Ambulance Paramedic of the Year went to Mark Fuszard of Cornwall Air Ambulance Trust, Air Ambulance Doctor of the Year went to Dr Rik Thomas of Essex and Herts Air Ambulance Trust, and Air Ambulance Pilot of the Year went to Captain Paul Smith of Lincolnshire and Nottinghamshire Air Ambulance Trust.

Other winners were Jayden ‘JJ’ Butcher for the Outstanding Young Person Award; Janice Flower, who was named Charity Staff Member of the Year; and Gladys Tingle, who was named Charity Volunteer of the Year.

The Air Ambulance Campaign of the Year went to London’s Air Ambulance for their ‘25th Anniversary Campaign’, and the Special Incident Award went to Midland’s Air Ambulance Charity.

Taken from Journal of Paramedic Practice, published 5 December 2014.

Looking forward: the Five Year View

five year forward view

On 23 October, Simon Stevens outlined his Five Year Forward View for the NHS. Developed by the partner organisations that deliver and oversee health and care services, including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority, it offers a look at why change in the NHS is needed, what that change might look like and how we can achieve it (NHS England et al, 2014). This ‘upgrade’ to the public health system will take into account growing problems associated with obesity, smoking and the consumption of alcohol; greater control of patients’ own care through fully interoperable electronic health records that are accessible to the patient; and decisive steps to break down the barriers in how care is provided.

In line with the Urgent and Emergency Care Review (NHS England, 2013), the Five Year Forward View proposes an expanded role for ambulance services, highlighting the increasing need for out-of-hospital care to become a more notable part of the work the NHS undertakes. The plan highlights the need to dissolve traditional boundaries and integrate urgent and emergency care services between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Through empowering ambulance service staff—including paramedics—with the ability to make make more decisions, treat more patients and make referrals in a more flexible way, it is hoped that pressure on other services can be alleviated and patients can receive the care they deserve. Highlighting the success of the introduction of major trauma centres, it emphasises the need for developing networks of linked hospitals that ensure patients with the most serious needs get to specialist emergency centres.

The Five Year Forward View also promotes the need to engage with communities in new ways by involving them directly in decisions about the future of health and care services (NHS England et al, 2014). Through the encouragement of community volunteering, it is hoped that a critical contribution to the provision of health and social care in England can be made. It is suggested that this could be done through further recruitment of community first responders, particulary in more rural areas, who are trained in basic life support. In addition, proposals for new roles include family and carer liaison, educating people in the management of long-term conditions and helping with vaccination programmes.

The Five Year Forward View is a welcome proposal of how the NHS can tackle changing demands in health care. By recognising how and why the health system needs to evolve, it is hoped the NHS will be able to provide better, higher quality, and more integrated care to its patients.


NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England – Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. (accessed 1 December 2014)

Taken from Journal of Paramedic Practice, published 5 December 2014.

Patients and pay: meeting the demand

strike 2

Last month thousands of health workers, including paramedics, took part in the first strike over pay in 32 years.

Workers from seven trade unions were involved in the strike, which lasted from 07:00 to 11:00 BST in England on 13 October.

The dispute came as ministers in England chose to ignore a recommendation from the independent NHS Pay Review Body which called for a 1% pay rise for all staff (UNISON, 2014). The Government claimed that an across-the-board 1% increase in pay was an ‘unaffordable cost’, with the NHS Employers organisation estimating the resulting increase in expenditure would amount to approximately £500 million.

Instead it was announced that staff eligible for incremental ‘progression pay’ increases on the Agenda for Change framework, which usually average at 3.4%, would not receive a 1% rise on top of this. However, staff due to receive an incremental rise of less than 1% would have them lifted to 1%. This amounts to approximately 55% of NHS staff and covers almost one million workers.

Speaking on BBC Radio 4’s Today Programme, Health Secretary Jeremy Hunt said that if all NHS staff were given a 1% pay rise, hospitals would have to sack 14 000 nurses and risk creating another Mid Staffs scandal (Riley-Smith, 2014). This would in turn jeopardise patient care as there would be fewer staff able to attend to the needs of patients.

However, UNISON have argued that the cutting of pay does not save jobs. It claims that last year more than 10 000 jobs were lost as a result of unnecessary structuring of the NHS in England, meaning that the Government in reality is making cuts to both pay and jobs (UNISON, 2014).

As demand for health services continues to grow year-on-year, a balance must be struck if the NHS is to continue to survive as a functional entity. While undoubtedly the patient and their needs must be put at the forefront, unrealistic expectations of staff and a corresponding lack of fair pay would mean this is not possible.

As a one-off payment, a 1% increase would not count towards payments for overtime, unsociable hours or pensions. Staff need to know that they are valued and therefore treated well if they are likely to remain in the NHS. By denying a pay rise the Government runs the risk of losing dedicated staff.

A further four-hour strike in England on 24 November has been announced in the hope that the Government will understand that this is a concern that will not disappear. However, as Mr Hunt continues to stand his ground, staff can only wait in hope to see if a resolution will be reached.


Riley-Smith B (2014) NHS strikes: 14,000 nurses would be sacked if we agreed to 1% pay rise, says Jeremy Hunt. The Telegraph. (accessed 3 November 2014)

Unison (2014) NHS Pay 2014. (accessed 31 October 2014)

Taken from Journal of Paramedic Practice, published 7 November 2014.

Thousands of children learn CPR in Yorkshire


More than 11,800 schoolchildren across Yorkshire have learnt life-saving skills in the biggest event of its kind in the UK.

On 16 October, Yorkshire Ambulance Service NHS Trust (YAS) staff and British Heart Foundation (BHF) volunteers visited 51 secondary schools to provide cardiopulmonary resuscitation (CPR) training as part of European Restart a Heart Day.

The event marks the launch of the BHF’s new quicker and simpler CPR training programme that could lead to thousands more children learning CPR in Yorkshire and across the country.

The new BHF kits will be used to train children on the day and will leave a legacy at schools across Yorkshire so they can continue to train pupils in the future. The charity’s ambition is to create a ‘Nation of Lifesavers’ in which all children leave school with the skills needed to help save a life.

Organiser Jason Carlyon, clinical development manager for YAS, said: ‘Over 30,000 people suffer cardiac arrests outside of hospital in the UK every year. If this happens in front of a bystander who starts CPR immediately before the arrival of the ambulance, the patient’s chances of survival double.

‘By teaming up with the British Heart Foundation’s Nation of Lifesavers campaign and linking with the European Resuscitation Council’s European Restart a Heart Day we will provide thousands of schoolchildren with the skills needed to help save a life.’

Taken from Journal of Paramedic Practice, published 20 October 2014.


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