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.

Minister for Civil Society assures air ambulances his ‘door is always open’

L to R Bill Sivewright AAA - Nick Hurd MP Minister for Civil Society - G...

From left to right: Bill Sivewright, NIck Hurd MP, Guy Opperman MP, Clive Dickin. Photo credit: Association of Air Ambulances

The Minister for Civil Society, Nick Hurd MP, has told members of air ambulance charities that his ‘door is always open’.

Speaking at a reception held by the All Party Parliamentary Group for Air Ambulances (APPGAA) on 9 June on the House of Commons Terrace, Westminster, Mr Hurd MP extended an open invitation to all air ambulance charities:

‘My offer is this, it is a very simple one: my door is always open. Please come and see me. My job is to advocate on behalf of civil society on behalf of the voluntary sector. If you don’t feel you’re getting heard, if you feel you have got an argument that you really want to make, or you have got a brilliant creative idea, please come and see me.’

Mr Hurd MP praised the work being undertaken by air ambulance charities in the UK, who together raised £96.4 million last year through public donations and on average treat 70 patients a day by the 20 charity-funded services.

He expressed his admiration for air ambulance services as a result of the passion and enthusiasm underlying the organisations, as well as their pride and desire to do more to help people. In a sector that relies on public generosity, and people’s willingness and ability to give time and money, Mr Hurd MP said:

‘There is a lot the Government can do to make it easier to give.’

The event, hosted by the chairman of the APPGAA, Guy Opperman MP, allowed local air ambulance charities and ambulance services from the UK to meet with members of Westminster to discuss their operations and key issues affecting the industry.

The APPGAA, a cross-party group of MPs, was set up in 2010 to support air ambulances. Its aim is to raise the quality of care, effectiveness and efficiency of air ambulance services through closer engagement with policy leaders and policy makers. It recently led a successful campaign in the House of Commons on the relief of VAT on air ambulance aviation fuel, and is currently calling on the Government to endorse a policy of recognition of parity for all patients arrival facilities, following a report published by the APPGAA, which highlighted that 60% of air ambulance facilities in the UK are inadequate.

In his opening speech, Mr Opperman MP explained how he had needed an air ambulance following a horse riding accident during his days as a jockey. He went on to explain how the group acts as a champion for air ambulances, ensuring that they have a strong voice in the House of Commons. By bringing members of Westminster together with the various air ambulance charities, Mr Opperman MP said that air ambulances could:

‘Promote innovation, different ideas, and take what I consider to be the fourth emergency service and then say: how can these incredible voluntary organisations harmonise, work together, come up with innovations, look to learn the lessons—whether it is from 7/7 or individual disasters and accidents that take place—so that there is a cohorted body working together and pushing forward the standards, because we are the best in the world?’

Nick Hurd MP addresses the reception

Nick Hurd MP addresses the reception. Photo credit: Association of Air Ambulances

The Association of Air Ambulances (AAA) supported the reception for the second year, bringing patients, charities, ambulance services and legislators together.

Bill Sivewright, chairman of the AAA, welcomed the Minister’s comments and thanked everyone in attendance, before issuing a challenge to all those present:

‘We must rise to the challenge of ensuring that the patient remains the focus for all our efforts. Air ambulances need to work with their local NHS Trusts, leveraged through the influence of local MPs when appropriate, to ensure that the patient journey from the point of injury or medical incident through to leaving the hospital is as seamless as possible.’

Speaking to the Journal of Paramedic Practice after the event, Graham Hodgkin, chief executive of London’s Air Ambulance, said:

‘As active supporters of the AAA, we’re always appreciative of the opportunity to meet with our sector colleagues, as well as some key supporters. The APPGAA reception is an important event where we can collectively highlight the common issues that impact on our operations and funding to our stakeholders in public office that can positively influence outcomes on our behalf. The APPGAA was instrumental in securing the recent VAT rebate on aviation fuel and it was really encouraging to hear the Minister for Civil Society, Nick Hurd MP, say his door is always open to us as charities.’

Mike Page, emergency care practitioner and critical care paramedic for Great Western Air Ambulance, added:

‘This has been an excellent opportunity for the Great Western Air Ambulance Charity (GWACC) and our team of critical care paramedics to meet with and discuss with our local members of parliament some of the important issues affecting the organisation’s ability to deliver the patient-centred care that is so gratefully funded by the kind donations of members of the public.

‘We in the GWACC area are extremely lucky to have the support of so many of the local MPs, a number of whom have visited the base and provide a good level of support. It is always good to know that they have an open door policy for us and are willing to support our charity when needed.’

Looking to the future for air ambulances, Clive Dickin, national director of the AAA, said:

‘The work on our key issues continues. We are in dialogue with NHS England on the issue of helipads and look for continued support through the members of the All Party Parliamentary Group in delivering appropriate landing facilities within the National Health Service Trusts. On other key issues, we continue to lobby for all VAT, not just that on aviation fuel, to be recoverable for charities, and again, we are working hard with the All Party Parliamentary Group to ensure that that actually materialises. At a local level, we encourage our air ambulance members to be engaging with their local MPs and pressing home those messages and reassuring the fundraisers, the volunteers and the patients that we are constantly improving services.’

Mr Opperman MP, added:

‘I think they [air ambulance charities] need to lobby their MPs more, without a shadow of a doubt. They need to to try to realise they’ve got a great deal more critical mass and force then they have actually exercised previously.

The reception was undoubtedly a success, giving the air ambulance community a rare opportunity to engage with legislators and members of Westminster, and make their issues heard.

Taken from Journal of Paramedic Practice, published 4 July 2014.

Report highlights inadequate UK landing facilities for air ambulances

A report produced by the Association of Air Ambulances (AAA) has highlighted that 60% of air ambulance landing facilities are inadequate in the UK, raising concerns that this could lead to greater morbidity and mortality.

The report, which was produced by the AAA after the issue was raised at the All Party Parliamentary Group for Air Ambulances (APPGAA) Annual General Meeting in October 2013, focuses on the treatment of major trauma—the biggest killer of people under 50 years of age.

On average, 70 people are treated by air ambulances in any one day. Patients attended will often be critically ill, suffering from major trauma, burns, cardiac or neurological illness. However, despite the severity of the conditions presented, air ambulances frequently have to land some distances from the hospital in inadequate facilities, which require a land ambulance to complete the journey to definitive care.

The report reviewed the 29 Major Trauma Hospitals for adults and children in the UK and concluded that only seven have suitable helipads. A further eight have landing facilities with operational issues and the remaining 15 sites require a secondary land transfer by land ambulance or vehicle.

The effect this has on the delivery of care to patients is clear: while the care itself isn’t generally affected, it is the delays to the provision of that care that can be potentially life-threatening for the patient.

According to Clive Dickin, National Director of the AAA, one of the ways in which these delays can be reduced is by looking at the most value for money landing facilities:

‘The simple thing you have to consider here is that it is not always about sticking a helipad on a roof. It is important when developing landing facilities to consider a helipad that will be fit for the majority of aircraft that will use it, not the minority.’

Many hospitals have taken a ‘one size fits all’ route so they look for a very large landing facility that can accommodate larger aircraft. However, if you look at the number of actual missions that air ambulances carry out each year (just over 20 000, in comparison to approximately 1 000 for search and rescue), the facilities that are needed are for small helicopters, not large.

The factors that dictate the location of helipads is also something that has to be taken into consideration. ‘There is always restrictions on sites,’ says Dickin.

‘If you look at Addenbrookes [Hospital Cambridge], for example, the hospital has developed and grown over the years, but the actual ED, the MTC, is at the heart of the hospital, so the only option they potentially have is building a rooftop helipad. Apparently that is cost-inhibitive and the hospital cannot justify that at the moment. So you have a landing site that is about half a mile away on the extremities of the actual campus of the hospital, and ultimately you have to have a land ambulance meet the aircraft to convey the patient for about half a mile. And, of course, that takes time.’

The key factor then is about looking at locations such as car parks and considering more sensible ground-level approaches that could be more cost-effective. But as Dickin highlights, not all hospitals have found the right balance of what is cost-effective yet best for the patient:

‘If you look at the University Hospital Coventry, car parking has actually taken priority over the landing facilities. If you look at an aerial photo it shows the helipad beyond the car park. Why was it not the other way around and the helipad put closer to the emergency department? Instead it is some 150 metres. That’s not a huge distance, but when you’re having to push a patient, potentially who is in cardiac arrest and not on a chest compression device, that is quite a distance and those minutes are extremely important.’

Some hospitals have found innovative ways in which to combat this problem. For example, Southampton General Hospital has built a raised platform above a car park. Helipads built more than 3 metres from the ground require the presence of fire marshals when helicopters are taking off and landing, which involves an additional revenue cost. However, by building a helipad approximately 2.4 metres above ground, Southampton General Hospital has been able to eliminate this unnecessary cost. A number of hospitals have built helipads only to have restrictions on their operation, resulting in them not being fully manned 24/7. This obviously presents a problem when you have a patient who is treated by a night HEMS aircraft.

The APPGAA have shared the information from the report with all MPs and members of Lords, as well as liaising with the Department of Health, highlighting the report findings and seeking clarification on whether the provision of air ambulance helipads can be addressed. However, in terms of who can implement the change in the provision of helipads, MPs and the Department of Health do not have direct control. Instead it is up to the Boards of the hospitals to recognise that these facilities are extremely important. That being said, this does not mean that MP’s and the Department of Health cannot play their part. As Dickin comments:

‘Through the MPs and Department of Health we are highlighting the fact that you can find very cost-effective, very sensible, but also extremely useful ways of positioning helipads so that they are nearby to the actual entrance to the Major Trauma Centre or the correct care pathway.’

Both the APPGAA and the AAA are calling on the Government to endorse a policy of recognition of parity for all patients arrival facilities. The report argues that it is unacceptable and not in keeping with the principle of ‘Equality of Care’ for patients to have reduced access to definitive care, in comparison to a patient arriving on a land ambulance. This is heightened by the fact that air ambulance patients are typically in need of time-critical care. Just over 50% of patients treated by air ambulances go to MTCs each year, so although it is important to focus on land ambulances, it is equally important to put in as much focus on helipads.

Looking to the future, the AAA is planning to publish a further report in Autumn 2014 exploring all care pathways within England. Once that report is published, it will again be highlighted to the Department of Health. The conversations the AAA is having with the relevant organisations is described by Dickin:

‘We have an ongoing process at the moment, engaging with the Department of Health and the hospitals through the air ambulance charities, that includes also the HELP [Helicopter Emergency Landing Pads] appeal, who are obviously specifically fundraising for helipads throughout the country and we will be looking to step up the profile through this report in making sure landing facilities are treated as high a priority as land transport facilities at these centres.’

Although there are well-developed plans for landing facilities at a number of UK hospitals, including: Bristol Royal Infirmary/Bristol Children’s Hospital/Bristol Southmead; Derriford Hospital, Plymouth; Hull Royal Infirmary; and St George’s Hospital, London, it is clear that improvements are still needed within other areas of the country if appropriate care is to be given.

Taken from Journal of Paramedic Practice, published 2 May 2014.

Association of Air Ambulances issues further clinical guidance SOPs

The Association of Air Ambulances (AAA) has issued two new clinical guidance standard operating procedures (SOPs).

The new SOPs, titled ‘Hypothermia in Major Trauma’ and ‘Management of Pre-Hospital Asthma’ were published by the AAA’s Clinical sub-committee in January, and will join the already extensive list of guidelines.

Speaking on the development, AAA director Clive Dickin, said:

‘These SOPs provide an introduction, guidance and treatment recommendation for air ambulances and ambulance services, enabling them to adopt best practice in the topics they cover.’

He added that 2014 will see the AAA issue a further seven guidance SOPs, while maintaining and improving those currently in use.

Taken from Journal of Paramedic Practice, published 17 February 2014.