Elderly need to take responsibility for their own long-term health

My Post (6)Elderly people are not doing enough to protect their long-term health and it is having a knock on effect on the NHS. A recent survey found almost a quarter of people aged 65 and over do no strengthening activities at all, and only 9% do them once a week (Chartered Society of Physiotherapy, 2017).

Along with 150 minutes of moderate aerobic activity, national activity guidelines recommend adults over 65 do strength training at least two times a week (NHS Choices, 2015). Working all the major muscles on a regular basis has the benefit of improving daily movement, maintaining strong bones and regulating blood pressure. It is also known to reduce the risk of falls.

Falls cost the NHS more than £2.3 billion a year, not to mention the human cost of pain, injury, and loss of confidence (National Institute for Health and Care Excellence, 2013). It has regularly been highlighted that physiotherapists can greatly reduce the number of falls in the elderly if utilised properly. This is done by a multifactorial assessment of those who may be at risk, followed by a multifactorial intervention to improve strength and balance. As many as 160 000 falls could be prevented if everyone 65 and over at risk of falling was referred to physiotherapy. This would save the NHS £250 million a year (Chartered Society of Physiotherapy, 2014).

While these figures are substantial and illustrate how physiotherapists play a key role in the pathway of care, a simpler solution would be to increase the amount of education in the community in the benefits of strengthening activities. If people were encouraged more and realised how including strengthening activities as part of their weekly routine would affect them, it would reduce the number of people requiring medical attention for falls and take the pressure off health care professionals. The public should be taking responsibility for their own health, yet evidently they are not.

Many adults are put off by the idea of traditional strength training and squirm at the thought of hitting the gym to lift weights. However, this is by no means the only way to gain strength. Recent evidence highlights the benefit of both recreational and non-recreational activities in improving overall health (Lear et al, 2017). Recreational activities that can help to improve strength include yoga, dancing or even heavy gardening. If time is a concern, non-recreational activities such as carrying heavy shopping or doing the housework offer a practical way to build strength. By being mindful of these sorts of activities, the national recommended target can easily be reached.

People need to be inspired to meet these targets, but that is no easy task. However, more can and must be done. The Chartered Society of Physiotherapy’s poll found that advice from a GP or physiotherapist would be effective in encouraging people to meet national guidelines so this needs to be pushed. Additionally, more information is needed, both online and in the community. The public must take responsibility for their own health, but to do that they need to be properly educated.


Chartered Society of Physiotherapy. Cost of falls [Internet]. London: CSP; 2014 Sep 2 [cited 2017 Oct 11]. Available from: http://www.csp.org.uk/professional-union/practice/your-business/evidence-base/cost-falls

Chartered Society of Physiotherapy. Too many people letting muscle waste as they age, physiotherapists warn [Internet]. London: CSP; 2017 Sep 29 [cited 2017 Oct 11]. Available from http://www.csp.org.uk/press-releases/2017/09/28/too-many-peopleletting-muscle-waste-they-age-physiotherapists-warn

Lear SA, Hu W, Rangarajan S. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;pii:S0140-6736(17)31634-3. http://dx.doi.org/10.1016/S0140-6736(17)31634-3

National Institute for Health and Care Excellence. Falls in older people: assessing risk and prevention (CG 161). London: NICE; 2013

NHS Choices. Physical activity guidelines for older adults [Internet]. London: NHS Choices; 2015 July 11 [cited 2017 Oc 12]. Available from http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-older-adults.aspx

Taken from International Journal of Therapy and Rehabilitation, published November 2017.

Passing the mantle: a parting farewell

Adobe SparkThis issue of the Journal of Paramedic Practice will be my last as editor. It has been an honour and privilege to edit a publication aimed at one of the most exciting healthcare professions, and I am grateful for being given this fantastic opportunity. I took over the journal in 2013, having previously worked on a nursing title, and in those few short years have witnessed a notable change within the paramedic profession.

The publication of the Francis report marked the beginning of my time as editor, and although not directly concerned with paramedics, it highlighted a need for cultural change within the NHS, with an emphasis on patient-focused care. This was followed by the long overdue update to the UK Ambulance Services Clinical Practice Guidelines, which was welcomed by the profession. The latest update was published earlier this year.

The publication of the end of study report for the Paramedic Evidence Based Project (PEEP), which called for the introduction of a national education and training framework for paramedics, marked a turning point for the profession and highlighted how its needs were changing. This was cemented in Sir Bruce Keogh’s Urgent and Emergency Care Review, which called for the development of 999 ambulance services so that they become mobile urgent treatment services. Illustrating an appreciation of the skill set of paramedics, their potential in the delivery of pre-hospital care was finally being recognised.

The Five Year Forward View expanded on these ideas and proposed a broadened role for ambulance services. It was becoming apparent that out-of-hospital care was becoming an increasingly important part of the work the NHS undertakes.

One of the most significant changes within the profession over the last few years has been the growth of its professional body. As of January 2016 there were 6 458 full members of the College of Paramedics. This represents 29.7% of all paramedic registrants of the Health and Care Professions Council, the regulatory body for the paramedic profession. The increase in members show the College is one step closer to its aim of becoming a Royal College, which requires that 50% of the profession are members of the professional body.

However, this evolution has not been without its difficulties. Reports of staff facing burnout, time taken off work due to stress-related illnesses, problems with staff retention, disputes over pay, and the fundamental problem of how ambulance services can cope with year-on-year increases in demand, mean the workforce is facing all manner of pressures.

Despite this, I believe these are exciting times for paramedics. As we gradually see a move to an all-graduate profession and changes to the paramedic scope of practice, the opportunities for work outside of the ambulance service are growing.

As I pass the mantle, I look forward to seeing the journal reach new heights following my departure under a new editor. It only remains for me to personally thank my consultant editors, the editorial board, and of course, you the readers, who have ensured the publication could continue.

Taken from Journal of Paramedic Practice, published 5 August 2016.

Working together to improve efficiencies

Adobe Spark (4)It was recently announced that the North East Ambulance Service NHS Foundation Trust, North West Ambulance Service NHS Trust and Yorkshire Ambulance Service NHS Trust will be coming together to form an alliance across the North of England (Association of Ambulance Chief Executives (AACE), 2016). The services have said the launch of the Northern Ambulance Alliance will help to improve the efficiency of ambulance services in the areas covered by all three Trusts.

It is important to stress that it is not a merger but an attempt by all three organisations to work closer together to improve patient care. Additionally, it is felt the alliance should help identify savings through collaborative procurement and offer improved resilience. So, in effect, the boards of each of the individual Trusts will still have responsibility for their individual service, but will also consider the work and objectives of the Northern Ambulance Alliance when making decisions.

One of the key driving forces behind the inception of the alliance was the Lord Carter Review (2015)into productivity in NHS hospitals, which supports identification of efficiencies and reduction of unwarranted variances. Some of the areas already identified where the Trusts can work together include looking at ‘efficiency through joint procurement exercises, major changes to IT, assessing specialist expertise and learning from each other’s achievements’ (AACE, 2016).

This alliance should be commended and highlights the overall commitment from each of the Trust’s to improve patient care. While demand for each service will inevitably differ due to considerations such as population and community, their strategic priorities are inextricably linked. It therefore makes sense that they should be considered together. More than anything, the alliance offers an excellent opportunity for the sharing of best practice and to tackle mutual difficulties. An example was highlighted by Rod Barnes, chief executive officer of Yorkshire Ambulance Service NHS Trust, of how the Trusts could come together to deliver on a single issue: ‘This might mean the procurement of a single agreed vehicle specification for all three services, identifying savings through the standardisation of maintenance and equipment contracts, which is something that has proved elusive at a national level’ (AACE, 2016).

It has been assured that there will be no direct staff consequences as a result of the alliance. However, it may mean in the future that the three organisations consider joint appointments or shared working for new roles and replacements.

It is hoped that other services will follow and create their own alliances. Who knows, it may even be one step closer to a single national ambulance service.


Association of Ambulance Chief Executives (2016) Three Northern Ambulance Trusts Form Alliance “That Will Improve Efficiencies”. http://aace.org.uk/ambulance-alliance-will-improve-efficiencies/ (accessed 27 June 2016)

Carter PR (2015) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles. The Stationery Office, London

Taken from Journal of Paramedic Practice, published 1 July 2016.

It takes a system to save a life

Adobe Spark (3)Last month saw pre-hospital and emergency care professionals from around the globe gather for the first European Emergency Medical Services (EMS) Congress in Copenhagen. Opened by Her Royal Highness Crown Princess Mary of Denmark, the 3-day event aimed to set new standards for research and treatment, as well as to establish an EMS Leadership Network in Europe, targeted at strengthening cross-national collaboration. Running under the theme of ‘It takes a system to save a life’, presentations emphasised the need for cooperation between the dispatch centre, ambulance services and the emergency departments for lives to be saved.

Denmark has made an impressive contribution to the field of resuscitation medicine. The congress was used as a platform to highlight the latest figures from the Danish Cardiac Arrest Registry, which collects nationwide data relating to out-of-hospital cardiac arrest. They revealed that in Denmark nearly one in four survive sudden cardiac arrest in public spaces. This is due, in part, because of the remarkable increase in the number of bystanders performing CPR before the arrival of EMS (19.4%–65.8% from 2001–2014). This is worth taking note, as approximately 1 in 8 out-of-hospital cardiac arrest patients survive if bystander CPR is initiated, compared to 1 in 30 when it is not. This provides a valid argument for implementing CPR training in schools, as well as illustrating how involvement of the community should be an integral part of any EMS.

The congress was also used to launch the Global Resuscitation Alliance, a network focused on collaborating to increase survival from sudden cardiac arrest. This agreement, signed in Copenhagen at an Utstein meeting prior to the congress, constitutes the culmination of three decades of international work, and is a major and decisive step in global efforts to save more lives from sudden cardiac arrest. Participants of the alliance have committed themselves to the ambitious target of increasing survival rates by 50%.

Alongside the scientific programme, sponsored symposia and workshops offered delegates the opportunity to expand their knowledge on areas such as managing the everyday critically ill patient, and improve their competence with a hands-on procedural cadaver lab.

Additionally, 13 teams from around the world competed in the European EMS Championship. The competition consisted of scenario-based events that tested each team’s ability to manage patients in various circumstances with common critical medical conditions and trauma. London Ambulance Service NHS Trust (LAS) walked away with the top prize, fighting off stiff competition from Turkey and Denmark in the final. Judges praised LAS for their extraordinary skills and team work in the final scenario: a canoe accident on a Copenhagen beach.

This would easily have been enough to satisfy those attending the congress, yet a number of excellent social events were also added to the mix. From morning runs and swims to an emergency management scenario at Copenhagen City Hall Square and a Gala Dinner, organisers went to every effort to ensure the event was a success. Delegates will undoubtedly be itching to return in 2017.

Taken from International Paramedic Practice, published 22 June 2016.

Ambulance service at creaking point

Adobe SparkRecent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

It has been a tough year for ambulance services, with London Ambulance Service NHS Trust being placed under special measures by the Care Quality Commission (CQC) in November 2015 and East Midlands Ambulance Service NHS Trust being recently rated inadequate by the CQC for safety due to insufficient staff numbers and a consensus that the skill mix of staff deployed was not always safe (CQC, 2016).

The fact of the matter is that demand for ambulance services continues to rise and services are struggling to keep up. The ambulance service in England received 861 853 phone calls in March 2016, compared to 694 188 in March 2015 (NHS England, 2015; 2016), a rise of 24%. However, Trusts have not been able to increase their numbers of staff to meet this demand. This creates greater work pressures and stress for existing employees, brought on by longer working hours and missed meal breaks. The result? High staff attrition within Trusts. Those that remain will no doubt be questioning whether this is sustainable. With staff currently being balloted by unions over industrial action on pay, the possibility of a crisis within the ambulance service cannot be dismissed as hearsay.

If this is to be avoided, a number of things have to change. Trusts must ensure front-line vacancies are filled and staff do not leave. This can only be done by fostering a work environment in which staff are happy to remain. The over triage of patients must be minimised so that appropriate resources are dispatched. And, where possible, patients’ needs must be addressed at the point of contact and unnecessary transfers to hospital must be avoided. If the ambulance service carries on as it is, it is difficult to see how it will continue to operate in 10 years’ time. By focusing on employee welfare, this crisis may be averted.


Care Quality Commission (2015) London Ambulance Service NHS Trust Quality Report, 27 November 2015. http://tinyurl.com/hxdhwpr (accessed 26 May 2016)

Care Quality Commission (2016) East Midlands Ambulance Service NHS Trust Quality Report, 10 May 2016. http://tinyurl.com/h5r4wfv (accessed 26 May 2016)

NHS England (2015) Ambulance Quality Indicators Data 2014–15. http://tinyurl.com/zf2p5jf (accessed 26 May 2016)

NHS England (2016) Ambulance Quality Indicators Data 2015–16. http://tinyurl.com/jyls6rt (accessed 26 May 2016)

Taken from Journal of Paramedic Practice, published 27 May 2016.

Delivering a promise over pay

Project M (2)

The junior doctor dispute over pay has taken up a lot of space in the news in recent months, yet they are not the only health professionals who are displeased with Government plans.

In 2014, paramedics were among the thousands of health professionals who took to the picket line in the first NHS strike over pay in 32 years. In a desperate effort to resolve the pay dispute of 2014/15, the Secretary of State for Health, Jeremy Hunt, agreed to a number of commitments to ambulance staff, including a review of the banding system to recognise the skill set of paramedics (Hunt, 2015). Roll on 2016 and there is still no suggestion that Mr Hunt will deliver on his promise. Understandably this has angered many ambulance staff.

As a result, the unions UNISON, Unite and GMB have announced they will be balloting their ambulance service members to see if they are willing to take industrial action over the Government’s failure to keep its promise.

The numbers of paramedics leaving the profession has been increasing year-on-year (UNISON et al, 2015). This has resulted in the addition of paramedics to the shortage occupation list (SOL), with vacancy rates running at approximately 10% of the total 12 500 paramedic workforce in England (Migration Advisory Committee, 2015). One of the key reasons people cited leaving, or considering leaving, the ambulance service was pay (UNISON et al, 2015).

The proposal set out in the Urgent and Emergency Care Review (NHS England, 2013) to extend paramedic training and skills, and develop 999 ambulances into mobile treatment centres, emphasises how the current scope of practice of paramedics is changing. As paramedics take on increasing responsibilities, it is only fair their pay is amended to reflect this shift. The short supply and high demand of paramedics means that ambulance services are facing a conceivable recruitment and retention crisis. However, while the National Ambulance Strategic Partnership Forum have made a formal request to the National Job Evaluation Group to look at the National Job Evaluation paramedic profile, only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics.

The Journal of Paramedic Practice would like to find out how its readers feel about their current pay and conditions. I therefore urge you to take 3 minutes to complete our online survey.


Hunt J (2015) Letter from the Rt Hon Jeremy Hunt MP, Secretary of State for Health, to Christina McAnea on Agenda for Change Proposal, 27 January 2015. http://tinyurl.com/hcwlk7g (accessed 29 April 2016)

Migration Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and for Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 29 April 2016)

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, Leeds

UNISON, Unite, GMB (2015) NHS Pay Review Body Evidence: Recruitment and retention of ambulance staff. http://tinyurl.com/grd59l2 (accessed 29 April 2016)

Taken from Journal of Paramedic Practice, published 6 May 2016.

Caring for Calais

Photo Credit: Rose Oloumi

Photo Credit: Rose Oloumi

Earlier this month I accompanied a group of student paramedics who were spending their weekend providing first aid at the refugee and migrant camp on the outskirts of Calais, France. Situated adjacent to a motorway and in the vicinity of a chemical factory, the camp is colloquially referred to as the ‘Jungle’ by outsiders, as well as those who have been forced to call it home. While semi-permanent structures made of converted shipping containers were introduced by the French Government at the beginning of the year, the vast majority of people live in makeshift shelters and tents in squalid, overcrowded conditions. Current figures estimate the number of refugees and migrants living in the area as anything between 6000 and 8000, with many more arriving each day.

Médecins du Monde (Doctors of the World) have provided essential medical help to refugees and migrants living in and around Calais and Dunkirk since 2003. Médecins Sans Frontières (Doctors without Borders) have provided aid more recently and run a health clinic that is open Monday to Friday within the main Calais camp. However, there is no official system in place over the weekend. As a result, health professionals offer their time and services, providing first aid from three caravans located within the ‘Jungle’. Patients are predominantly treated for minor ailments such as colds, lice and the various coughs referred to as ‘Jungle lung’, as well as bruises, cuts and broken bones sustained from attempts at crossing the border into the UK. In the case of more serious incidents, patients are transported to an emergency department in the city.

Shadowing the paramedics for two days as they wandered through the camp providing care, one was made acutely aware of how desperate circumstances for those living there are. The recent demolition of the southern part of the camp highlighted the general sentiment that the refugees and migrants are not welcome there. However, by evicting them from their homes the police are simply moving the problem, not addressing it. For the refugees and migrants, this means the Sisyphian task of constantly having to rebuild their homes.

What is most disheartening on a personal level is that the current situation in places such as Calais in France or Idomeni in Greece appears somewhat hopeless. While countless people offer their time, money and professional expertise to provide care and support for the thousands of refugees and migrants who have come to Europe seeking work or asylum, it does not get to the root of the problem. It reminded me of a line in Nigerian novelist Chinua Achebe’s book Anthills on the Savannah: ‘While we do our good works let us not forget that the real solution lies in a world in which charity will have become unnecessary.’ This dispiriting quote is notably poignant in light of what the Western media has dubbed the ‘migrant crisis’. The lack of willingness for many European countries (including Britain) to grant asylum to people, many of whom have fled their country as a result of their lives or human rights being seriously at risk, means the end result will be the continued living, for many, in conditions that no person should have to experience. Refugees have been present in Calais since 1999 and they continue to be in Calais in 2016. How long will this continue and when will this change?

Taken from International Paramedic Practice, published 30 March 2016.

Ensuring patients get the right response

Bosses at the Welsh Ambulance Service NHS Trust (WAST) will breathe a sigh of relief as the first full set of data to be published measuring clinical care, operational efficiency and patient experience for the service since the implementation of a new clinical response model, were largely positive.

The Welsh Government announced plans to implement a new clinical response model in July 2015, with a pilot trial running for 12 months from October 2015. One of the key changes to the service during this trial is the move to having only the most serious calls—categorised as Red (immediately life-threatening)—as requiring a response time target (Welsh Government, 2016). All other calls still receive an appropriate response, and this is either through face-to-face or telephone assessment, based on clinical need. For example, for Amber calls a range of clinical outcome indicators have been introduced to measure the quality, safety and timeliness of care being delivered, alongside patient experience information (Welsh Government, 2016). This data is to be published quarterly.

Between 1 October 2015 and 31 December 2015, 70.6% of Red calls received a response arriving at scene within 8 minutes or less, against the Wales national target of 65% (Emergency Ambulance Services Committee, 2016). It was also revealed that 14 489 incidents did not result in a conveyance to a hospital or another destination. However, some Ambulance Quality Indicators are still under development and will not be published until the next quarterly report on 27 April 2016. It is then that information will be provided on the reasons for not conveying patients to a hospital or another destination. Also, due to changes to the trial that came into effect from 11 November, as a result of revised technical guidance, data for December is not comparable to that for October or November.

However, it is interesting to note that results from a staff survey, which included responses from 167 EMS front-line staff, revealed an overall feeling within the service that the new clinical response model has not led to more appropriately categorised calls, improved patient safety, improved quality of service delivery or improved patient experience (WAST, 2016). While the number of respondents is low, it does paint a compelling picture of staff conception of the new model, although unfortunately we will have to wait until April before we can gain a greater understanding of its effectiveness.

The move by WAST to a new response model is a brave one, and intended to ensure the service is providing the right response for patients dependent on their clinical need. While some may complain that doing away with almost all response time targets relieves pressure from the service, it is arguable that they are outdated and do not always result in the best care for the patient. Only time will tell whether this is truly the case.


Emergency Ambulance Services Committee (2016) Welsh Ambulance Services NHS Trust National Collaborative Commissioning: Quality and Delivery Framework Ambulance Quality Indicators: October—December 2015. http://bit.ly/1Pj54ds (accessed 1 February 2016)

Welsh Ambulance Service NHS Trust (2016) Clinical Modernisation Programme. http://bit.ly/1P9vBq6 (accessed 1 February 2016)

Welsh Government (2016) Ambulance services in Wales, December 2015. http://bit.ly/1WXbeBH (accessed 1 February 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

Special measures for struggling services

In November of last year, London Ambulance Service NHS Trust (LAS) became the first ambulance Trust to be placed under special measures following an inspection of the service by the Care Quality Commission (CQC) in June 2015. The overall rating given by England’s chief inspector of hospitals, Prof Sir Mike Richards, was that the service was inadequate, and it was acknowledged that improvements were needed on safety, effectiveness, responsiveness and leadership (CQC, 2015b).

Of the key findings, it was noted that LAS had a high number of front-line vacancies, with some employees saying that there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care (CQC, 2015a). As a result of staff working long hours, many reported feeling high levels of stress and fatigue. Additionally, while the CQC recognised that staff were ‘overwhelmingly dedicated, hardworking and compassionate,’ they revealed that ‘some reported a culture of harassment and bullying’ (CQC, 2015a). It was highlighted how until March 2014, LAS was consistently the best performing service in the country to category A calls. However, since then there has been a substantial decline in performance, and the target time of 75% of calls being responded to within 8 minutes has not been met. This is something that has been affecting ambulance services across England, although LAS response times for Red 1 and Red 2 category A calls were reported as being the worst in the country. Serious concerns were also identified about the service’s Hazardous Area Response Team (HART) capability due to an insufficient number of paramedics. The result was the feeling that there was not a safe system of working where an effective HART response could be utilised (CQC, 2015b).

The decision to place LAS under special measures is a considerable blow, not just to the service, but to all members of ambulance Trusts. Fundamentally it highlights the CQC’s belief that LAS is unable to provide the level of care expected of it. This is despite the dedication and commitment that is clearly apparent in front-line staff, alluded to in the report. But while it is easy to consider the negative connotations of the CQC’s report, it is important to remember that one of the key reasons why services are placed under special measures is to ensure they get the support they need to improve. External partners such as the NHS Trust Development Authority and NHS England will give LAS access to a package of additional resources and support.

Ambulance services throughout the country are struggling to deal with increasing pressures, a national shortage of paramedics and insufficient funding. It is hoped that other ambulance services will not suffer similar findings from the CQC, but it should be reassuring to know that there is a system in place to offer support to services that are unable to make improvements required of them on their own.


Care Quality Commission (2015a) Chief Inspector of Hospitals recommends London Ambulance Service NHS Trust is placed into special measures. CQC, London. http://www.cqc.org.uk/content/chief-inspector-hospitals-recommends-london-ambulance-service-nhs-trust-placed-special (accessed 4 January 2015)

Care Quality Commission (2015b) London Ambulance Service NHS Trust Quality Report. CQC, London. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5514.pdf (accessed 4 January 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

Managing mass-casualty incidents

As first responders, emergency medical services (EMS) play a key role in the management of mass-casualty incidents, being responsible for the triage, treatment, and transportation of patients to emergency care. Sadly 2015 has been littered with reports in the media of incidents involving large numbers of casualties. For example, the US alone has seen 353 mass shootings this year, the most recent on 2 December at the Inland Regional Center in San Bernardino, California, where 14 people were killed and 17 injured (Mass Shootings Tracker, 2015). Additionally, November will be remembered for the worst attack on France since World War II and the deadliest in the European Union since the Madrid train bombings in 2004. On Friday 13 November, multi-site terrorist shootings in Paris left 130 people killed and over 300 in intensive care. A state of emergency was declared by President François Hollande, and temporary border checks introduced.

Beyond mass shootings, the extent of natural disasters will be most remembered by the 7.8-magnitude earthquake that hit Nepal’s capital Kathmandu and its surrounding areas on 25 April. Here thousands of people lost their lives with many more thousands left injured and homeless.

While the difference between the types of mass-casualty incidents and number of casualties attended by EMS can vary considerably, their fundamental role remains the same. Key to the effective management of these situations is leadership, teamwork and professionalism. Although the outcome of the attacks in Paris left the country devastated, it is worth highlighting the proficiency at which the EMS organised an effective medical response to the attacks, which ensured that many lives could be saved. Triage and pre-hospital care for victims of the attacks was organised by the emergency medical services (service d’aide médical d’urgence, SAMU). SAMU were mobilised immediately following discovery of the attacks, and the crisis cell at the Assistance Publique-Hôpitaux de Paris (APHP) was opened. The APHP crisis unit has the ability to coordinate 40 hospitals with a total of 100 000 health professionals, a capacity of 22 000 beds and 200 operating rooms (Hirsche et al, 2015). Remarkably, it was reported that there were only four deaths (1%) among the 302 injured patients, including two deaths on arrival at hospital (Hirsch et al, 2015).

What is clear from reading about the medical response to these attacks is that professionalism and preparedness lay at the heart of the successful patient outcomes. It is also worth noting that many lessons can be learned from the subsequent scientific publications following mass-casualty incidents, and the role they play in the improvement of medical strategies. Additionally, the importance of effective and unified EMS in mass-casualty situations cannot be underestimated. While the challenge for EMS in managing scenarios involving multiple casualties will remain, through teamwork, adequate training and effective leadership, we can ensure the maximum number of lives can be saved.


Hirsch M, Carli P, Nizard R et al (2015) The medical response to multisite terrorist attacks in Paris. Lancet. Published online first. doi: 10.1016/S0140-6736(15)01063-6

Mass Shooting Tracker (2015) Mass shootings in 2015. http://www.shootingtracker.com/wiki/Mass_Shootings_in_2015 (accessed 16 December 2015)

Taken from International Paramedic Practice, published 22 December 2015.