twenty four seven
Edition 1 July 2006 www.swast.nhs.uk
New AmbulANce Service for South weSt
"I am pleased to announce that the new ambulance service for the South West became operational on 1 July 2006. The headquarters of the new Trust are at Abbey Court, Eagle Way in Exeter with two divisional headquarter
bases. East division will be located at St Leonards in Dorset and West division will be located at Trust HQ, Exeter.
The combination of the two very successful Ambulance Trusts formerly known as Dorset Ambulance Services NHS Trust and Westcountry Ambulance Services NHS Trust will bring about a radical new change to ambulance services in the South West.
Both Trusts have always had an extremely strong and positive working relationship. In fact, they have been working together for many months towards the successful merger. I would like to personally thank all the numerous staff from each of the former Trusts who have played a pivotal role in the planning and preparatory work behind the scenes.
The ongoing smooth transition of both organisations into the combination of one brand new and modern ambulance service would not have been possible without the tremendous hard work and commitment of these staff. Without their support none of these changes would have been possible."
The new Trust plays an important part in the government’s modernisation of the NHS and will help
Ken Wenman, Chief Executive of the newly formed South Western Ambulance Service Trust welcomes the opportunity to lead the new and modern style ambulance service for the four distinct counties of Cornwall & Isles of Scilly, Devon,
Somerset and Dorset.
(See page 8 & 9 for pull out and keep map).
New Ambulance Trust for
South West
Ken Wenman
Chief Executive South Western Ambulance Service NHS Trust
Pull out centre page for map
1 2
3 4 5
6 7
8 9 10 11
12
13 14
15
16 18
21
22
23 24
25 26
27 2829 30
A B
C
31 32 33 34 35 36
37
44 49
47 46 45
48 51
52 53
38 57 39
42 41
43 54
55 56
59 58
62 60
61
63 64 65
40 19
17 20
Continued on page 2
Ambulance staff save lives
PAGE 11
Staff unite
BACK PAGE
Trust HQ, Abbey Court, Eagle Way, Sowton Industrial Estate, Exeter, Devon, EX2 7HY
Tel 01392 261500 Fax 01392 261560 Find out more on www.swast.nhs.uk
If you would like to receive a copy of this newsletter in another format please ring 01392 261635.
Publication
Twentyfourseven will published four times a year for South Western Ambulance Services NHS staff, members of the public, partner organizations both statutory and non statutory, and anyone who wishes to gain an insight into our work. It will be displayed in a variety of settings to gain maximum coverage, such as libraries and NHS outlets.
Policy - Editorial Aims
Twentyfourseven aims to spread good practice, share information and views, stimulate debate and feedback and keep everyone up to date with all the latest issues and events. It will give bite sized pieces of information which signposts readers to more in- depth reading.
Ideas, comments and written or photographic contributions are welcomed from staff, whether these are personal or professional. Articles will be edited for jargon and length.
The Editor reserves the right not to use material deemed unsuitable for publication or likely to cause offence.
Authorisation
Twentyfourseven is authorised by the Chief Executive, Ken Wenman, as the official South Western Ambulance Services NHS Trust newsletter.
Distribution
Twentyfourseven will be sent to work bases by internal distribution and to community outlets eg libaries.
Copyright
© 2006 – All rights reserved Disclaimer
The opinions expressed in this newsletter are not necessarily those of the Editor or of the Southern West Ambulance Services NHS Trust.
Where to find us
Chairman announced
Name of OSC Authority Status Chairman
Bournemouth Unitary Authority Bill Brandwood
Isles of Scilly Unitary authority Anne Oyler
Cornwall County Council Mike Nicholls
Devon County Council Stuart Baker
Dorset County Council To be confirmed
Plymouth Unitary authority Mary Aspinall
Torbay Unitary authority Jean Cope
Somerset Unitary authority Stephen Martin Scott
Poole Unitary authority Mary Hillman
The newly formed ambulance service is delighted that it will interface and work together with:
2 twentyfourseven www.swast.nhs.uk
news
www.swast.nhs.uk twentyfourseven 3
news
Editor's Comment
PR & Communication Manager
Lynne Paramor
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
contribute to a strengthening of health services in the community setting for the people who live in the South West, as well as the thousands of tourists who visit the area throughout the year.
“Improving the delivery of ‘out of hospital’ care including developing new services will see patients treated more appropriately by highly qualified healthcare professionals, reducing the need for attending accident and emergency departments where this is safe to do so. The first step has been to identify where bureaucracy can be reduced using savings to reinvest in front line services.
I feel extremely positive about the reconfiguration of ambulance services within England, as the sole focus of this initiative has been to improve care to patients enabling ambulance services to work closer with other healthcare professionals to manage
the treatment provided to patients in a more appropriate way.
‘Taking Healthcare to the Patient’
is part of a government initiative aimed at personalising patient care by treating individuals in a situation most suited to their needs, whether that is in a hospital or home environment, which our operational staff are more frequently doing.”
South Western Ambulance Service is proud to have such a diverse workforce with many staff already equipped with modern skills, or working towards broader competencies, as highlighted in the Bradley report, as the way forward for ambulance services.
For the people of the South West, this means that their local ambulance staff will continue to play an even greater role in caring for them and their families out in the heart of the communities they work
and live in.
The new ambulance service for the South West will also bring together the very best initiatives from each Trust and will continue to invest in equipping staff with the right skills to deliver first class health services. This will include ambulance staff being able to interpret more diagnostic tests and undertake basic procedures in patients’ homes avoiding the need for unnecessary hospital admissions.
Ambulance staff will also continue to build on current partnership working arrangements with local GPs and their nursing teams to assess and support patients with long term conditions. Health promotion will play an even greater role for some staff to support and promote the government’s new and re-emerging public health work that aims to tackle a range of health determinants including obesity, diet, healthy lifestyles, exercise, smoking cessation
programmes, teenage pregnancy and numerous other high profile health campaigns.
South Western Ambulance Service NHS Trust will employ approximately 2000 staff.
The new Trust will have 65 Ambulance stations serving a static population of approximately 3 million, during the summer this figure almost doubles with holidaymakers.
The four air ambulances that cover the area will continue to work in partnership with South Western Ambulance Service and operate their lifesaving services across the counties of Isles of Scilly, Cornwall, Devon, Somerset and Dorset.
No frontline staff will see any cut backs or reductions as a result of the reconfiguration. Any savings will be made by the restructuring of the management teams and support staff of the two Trusts.
New Ambulance Trust for South West Continued from page 1
Newsletter launched to celebrate new Trust
Welcome to the first official South Western Ambulance Service NHS Trust newsletter called twentyfourseven.
The launch of the newsletter coincides with the creation of a new ambulance service for the people of the south west. The new and stronger Trust spans right from the Isles of Scilly, Cornwall, Devon, Somerset and up to Dorset which means the stories in this newsletter will too.
Covering such a huge geographical area makes the quarterly publication of news from South Western Ambulance Service vital so that we can reach out and encourage two way
communication to all our staff and the populations that make up the diverse and distinct four counties that we will serve.
Twentyfourseven is aimed at providing the most up to date information from across the four counties to all groups of staff within the new Trust. However, to ensure we make the very best use of this resource a database is being created to include key stakeholders such as other NHS and partner organisations,
all tiers of councils, MPs, community or voluntary groups, special interest groups and members of the public.
Sending our news to as many people as possible will help us transform our services under much welcomed public scrutiny.
By celebrating and showcasing our work we can help all our audiences understand just how much the ambulance service has and continues to change. Long gone are the days of just being a transport service. Staff
are much more skilled today with ongoing professional development and training that is enabling them to treat more and more patients out in the community. However, members of the public are not always aware of just how much we have changed our workforce. Twentyfourseven aims to help educate our public about the new and innovative ways we are taking healthcare to the patient.
Just as we have a new Trust we also have a new editorial team to ensure the timely and accurate production of twentyfourseven. Communications Manager, Lynne Paramor and Melodie Juste, Press Officer for South Western Ambulance Service NHS Trust, will manage the quarterly publication.
Both officers will be working within the Chief Executive’s Directorate.
If you wish to feature in twentyfourseven, have a project to share, or know about a new innovation that is making a difference and is bringing real benefits to patient care then let the news team know by contacting them below.
Finally, remember to visit the South Western Ambulance Service new website at www.swast.nhs.uk. The site is still under development but is crammed full of all the very lastest news on services and performance.
We hope you like it and encourage feedback on the links provided within the site.
Twentyfourseven newsteam are Lynne Paramor, PR & Communication Manager on 01392 261635 or lynne.paramor@swast.nhs.uk and Melodie Juste, Press Officer on 01392 261506 or melodie.juste@swast.nhs.uk
A
s this newsletter goes to press many changes are taking place across the south west, especially in the NHS.The ambulance services across the UK have just reduced from 31 to 12 and this publication has been launched to help explain those changes and what that means locally.
The new South Western Ambulance Service NHS Trust boundary can be seen on the centre pages and has been designed as a handy pull out and keep poster. Please display on your local notice board.
By reading twentyfourseven and sharing the very latest news with colleagues and friends or sending in your views and stories to the news team (see opposite) you will help build an effective communication for the ambulance service.
Thank you for your support.
The new Chairman for the South Western Ambulance Service NHS Trust was announced at the end of May by the Appointments Commission as Heather Strawbridge.
Heather lives in Puriton, Bridgwater, Somerset with her husband and teenage son.
Heather Strawbridge was previously the Chairman of the Westcountry Ambulance Service for four years.
She is the current Chairman of Connexions Somerset Limited
which provides advice, guidance and support for 13-19 year olds. She is also Vice Chairman of Somerset Strategic Partnership and has been a governor at Bridgwater College of Further Education since 1999.
Previously Heather was director for the National Association of Connexions Partnerships and Councillor for Somerset County Council where she held positions including Chairman of Finance and Development, Chairman of the Public Protection Committee and deputy
leader of the Council.
Heather Strawbridge, the trust Chairman is extremely optimistic with regard to the trust transformation,
“South Western Ambulance Service brings together two extremely successful trusts and I have no doubt that by combining the positive working practices enjoyed by both, this new organisation will offer a fantastic service at all levels. We are all working towards a common goal, which is ultimately to enhance patient
treatment and services.
However, emphasis must also be placed on trust staff by ensuring they are trained to optimum standards and content with working practices. I am also looking forward to working within the new ambulance framework and in conjunction with health partners on a multi-disciplinary level by sharing good practice.”
Overview and
Scrutiny Committees
South Western Ambulance Service is proud to be in a privileged position that will see senior managers working with a total of nine Overview and Scrutiny Committees across the four
counties it serves.
South Western Ambulance Service is one of the few NHS Trusts in the country to relate to so many Overview and Scrutiny Committees because its operational services cover a massive geographical area which spans four counties from the beautiful and rugged Isles of Scilly right up to the equally stunning countryside of Dorset. (See centre pages.
The Health and Social Care Act 2001 signalled new scrutiny powers for councils responsible for Social Services. This saw a much welcomed scrutiny process come into being that enabled locally elected members the ability to connect up with local NHS leaders to scrutinise the modernisation of local NHS services.
A great deal of important partnership work has taken place by former ambulance services in Dorset and the West Country with their relevant Overview and Scrutiny Committee members.
Particular focus in the past 12 months has been on the NHS annual health check which is governed under the Standards for Better Health process led by the Healthcare Commission.
This replaces the previous star rating
system for Trusts.
Members have the opportunity to comment on NHS organisations performance once a year and these are called ‘annual declarations’.
South Western Ambulance Service is really pleased to be able to take this scrutiny work forward by ensuring information on its services is regularly provided to all committees.
One way of streamlining this information share and developing an effective information sharing protocol is the production of this newsletter.
By exploiting creative media we will ensure up-to-date, timely and accurate information is shared across the four counties we serve to showcase our pioneering services as well as provoke debate and comments on modernisation proposals.
Breaking News
Powers of Overview and Scrutiny Committees to encompass the work of Crime and Disorder Reduction Strategies and Community Safety Partnerships has recently been announced in a national review of the Partnership Provisions of the
Crime and disorder Act 1998. Royal assent is to be sought in the autumn of 2006.
A form of scrutiny plus involving partner agencies such as the Police and Fire and Rescue Services will allow scrutiny committees to reflect the multi-agency nature of community safety work.
A responsive framework will be developed based on the aims and principles of the Police National Intelligence Model (NIM). This is a system for using intelligence and information to direct Police activity enabling Police forces to trace the continuum between anti-social behaviour and the most serious crime, and to identify those issues most in need of attention.
In place of crime and disorder and drugs misuse three year audits, a regular strategic assessment, at least on a six monthly basis will take place. These will tie in with six monthly progress reports for the strategic multi agency partnerships known as Local Area Agreements and managed at a county wide level under the groups known as Local Strategic Partnerships.
Effective patient and public involvement is fundamental to an NHS based on choice, responsiveness and equity. Delivering and designing health services around the needs of patients is key to the modernisation of the whole NHS and is integral to improving patients’ experiences of health services.
South Western Ambulance Service intends to put public involvement at the top of its agenda by ensuring its involvement work influences its policies, plans and service delivery.
A combination of approaches are highlighted in this article which are critical success factors for involvement work. All of the below are included in patient and public involvement courses on staff core induction programmes (non exhaustive list):
Good consultations
To feel involved in their own treatment and care, patients must feel that they are being listened to by the professional, being treated as an equal partner and being given appropriate information about procedures and the process of their care. Privacy and time for discussion are both required to achieve this.
Working together, sharing values Personal values and beliefs play a crucial role in shaping patient and staff attitudes to involvement and equally the diversity of values that inspire involvement work can be a source of strength. Patient involvement is driven by values such as respect, responsibility and dignity, but may also be constrained by other values, particularly those associated with professional authority and control.
For example, staff who are impatient, patronising or disrespectful, or who appear to be too busy.
Communication and Information Good communication is an essential ingredient of patient involvement.
High quality information enables both self-management and patient involvement, but identifying the right information at the right time can be difficult.
The groups perceived to be the most difficult to involve are the general
‘healthy’ public, ethnic minorities, poorer people, young adults and patient groups without established local groups or campaigning bodies.
Collaboration and Leadership Relationships are at the heart of both patient and public involvement.
Collaboration with the voluntary and community sectors is an effective route to building community relationships and achieving public involvement.
Leadership and commitment at board level will be vital to the progress of public involvement.
Feeding Back
For those who do get involved, failure to feedback the result of involvement is very discouraging. Feedback needs to cover the actions taken in response to involvement, reasons why ideas are not taken forward and details of progress.
Experience, education and training
For any member of staff, gaining confidence and skills in patient and public involvement work typically requires experience of the benefits of involvement and training and education in the methods of involvement. Initiatives to improve patient and public involvement will address the knowledge, attitudes and skills of professionals and staff at all levels of the service
Patient
and Public
Involvement
Congratulations
twentyfourseven www.swast.nhs.uk
feature Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
John Baxter
patient
After parking in the High Street to collect some computer supplies I found I had a few minutes to kill before driving to an outlying village were I was booked to photograph a family in their home. It is important to arrive neither early nor late for such things so I decided to sit in my car and dip into my copy of the Independent.
It was just after three pm.
By three-fifteen I started to feel odd. An unfamiliar constricting pain was spreading across my chest and there was an unpleasant ringing in my ears. I certainly stopped reading the latest story about global warming.
Definitely something peculiar was happening to me. Was it perhaps the chilli powder I had added to my lunch- time helping of Morrison’s Mexican Soup or was it something else? Better be safe, I thought, and take some aspirin. I started the car and drove down the road to our nearby home, but a panicky search of the bathroom cupboard failed to reveal any.
The odd feelings were becoming most uncomfortable so I made a crucial decision. I rang the family and told them that I had no idea what was happening to me, but I would
have to cancel our appointment and go and see a doctor. I then jumped back into my car and drove as fast as was safe (I hope) to the Wincanton Health Centre. I got there just after three thirty.
Receptionists are naturally a protective lot, but at the risk of upsetting them I insisted somewhat forcefully on seeing a doctor immediately. They moved quite quickly and the practice nurse was alerted to see me in a medical consulting room while the only doctor on site who was with a patient was alerted. By this time the discomfort in my chest and ringing in my ears was so acute I knew this was not chilli powder. I was told to get on the bed, my shoes and shirt removed, an ECG machine wheeled in and the nurse taped me to it. The doctor, a blonde woman I had not met before, examined the print-out and calmly told me I was having a heart attack. Immediately the nurse went to phone the ambulance service. I asked if aspirin might be a good idea and that I preferred to be told straight what was happening.
She said that yes they were about to give me aspirin and that it meant I had
a blood clot in my heart. By that time my discomfort was really acute and they were mentioning morphine.
Almost immediately it seemed three enthusiastic young women arrived, smiling brightly. Dressed in fresh, crisp, green and white uniforms they announced that I had got “the all-women ambulance team.” They introduced themselves by first names and asked if they should call me John.
Formalities over I was rapidly moved onto their mobile stretcher, an oxygen mask pushed over my face, and I was wheeled out through the Health Centre waiting area to the evident surprise of the assembled walking wounded. I thought I must look like Hannibal Lecter. I was then loaded into the waiting ambulance.
The paramedic in charge was Nicola and as she and her technician Emma unpacked shiny metal boxes of complicate equipment they explained that they would now take a second ECG with their machine, as this, unlike the Wincanton one, was linked to a computer in the Coronary Care Unit at Yeovil Hospital (some twelve miles away) This would enable the consultant there to tell them what to do
next. Again I was wired up, and immediately the Wincanton doctor’s diagnosis was confirmed. I think it was then that I was given a shot of morphine which immediately reduced the discomfort.
Next Nicola explained that the recommended treatment was an injection of a thrombolysis busting drug, Tenectoplase, which would go into my heart and dissolve the clot.
Rather gravely she went on to say that this treatment, while strongly recommended, incurred an element of risk as it was possible that in some people it could cause massive bleeding in the head. This - rightly or wrongly - I interpreted as meaning that the results could be fatal. Before proceeding then, she said, my consent was needed. Recognising immediately that I was being faced with a choice between possible, but unlikely death and less heart damage if I said yes, and likely severe disablement and possible death if I said no, I did not hesitate and agreed that she go ahead. At twelve minutes past four (as the record shows) the drug was injected and I was thrombolysed.
Moments later Emma climbed into the driver’s seat and we roared off, siren blaring through the streets of Wincanton, then on to the A303 bound for Yeovil.
Nicola sat close by me, steadying me and issuing instructions to the others and checking how I was. She emanated calm and authority as the ambulance bumped and swung about which was very impressive in someone who looked so young. She asked how, on a scale of one to ten, I would rate the pain. I said four - for it was nothing like as bad as acute toothache.
That drive though was unforgettable for I was acutely aware that I might never arrive and that my life was hanging by a thread. This could be it. She asked if I felt frightened and rather to my surprise I had to say no.
Fear was not what I was experiencing, rather feelings of irritation and anger at this terrible intrusion into my rather happy life. I thought of Elizabeth and the things we planned to do together - how much more she deserved and how much I wanted to share with her.
My past did not flash by me as it
An afternoon in the
Somerset Sun
Well, that was how it started. I am a photographer, and Tuesday in Wincanton was a lovely sunny afternoon.
does for some, except for my recent experiences at my old college in Oxford and the photographic project I had done there. At least, I thought, my images will remain in the Trinity archive.
There was though little time for such reflection as we bumped across Somerset. I knew I faced wipe-out - just that - a complete end - a full stop - nothing - and it felt as if it was only seconds away and that it was irritatingly meaningless. The thought that clearly came to me was,
“How banal.”
Next to that black void it was easier to enjoy talking and looking at Nicola, noting that though so calm and in control, her face was flushed and excited and it was good and re-assuring to feel the touch of her hand on my shoulder. It amazed me how strongly I reacted to the professionalism, concern and sympathy of this young stranger even as I was acutely aware of possible imminent extinction.
As we neared Yeovil I realised that the pain and tightness in my chest and the ringing in my ears was diminishing, so that by the time the ambulance came to a stop at the entrance to the
A&E Department I almost felt like a fraud as the gently unloaded me. I chatted easily to the three of them thanking them for the impressive and efficient way they had worked. They said they loved their job and it gave them a huge sense of satisfaction being able to help. It was then, as I was being pushed down corridors and loaded into a lift, that Nicola confided that I was in fact the first person she had treated like that for thrombosis since qualifying as a paramedic.
With that revelation we arrived at the Coronary Care Unit where my attempt to climb on the bed from the stretcher was brushed aside and I was given a full ceremonial slide across from the one to the other by a team of six, ambulance crew on one side, nurses on the other. Logs handed over, the ambulance team’s work was done, we said quick goodbyes and they withdrew as the nurses took over.
Immediately I was being hooked up to various drips, bleeping machines and yet another ECG. By then I felt sure my proximity to death was receding and I would see another day.
My arrival on the ward was timed at four-forty, an hour and
www.swast.nhs.uk twentyfourseven 5
Swanage crew get married! Matin Prouten, a student Technician and Dawn Coward a Paramedic, recently got married in June at Swanage.
They met when they both turned up for a shift on a Swanage ambulance..
Dawn really wanted the vehicle to be involved in the wedding so wrote to the Chief Executive Ken Wenman with the request. He immediately agreed and congratulated the couple.
Colleague, Paramedic Mathew Trant performed chauffeur duties delivering Dawn to the Church and then the happy couple to the reception.
Many of their colleagues from the station attended the wedding.
Both happy crew members were last seen honeymooning in the Caribbean.
Once again congratulations Martin and Dawn who can been seen here looking fantastic.
In February 2006, Torbay hospital launched a stroke thrombolysis fast- track protocol for stroke patients.
When the necessary criteria are met, patients are fast tracked through A&E, undertake a CT scan and receive thrombolytic treatment. This is proving to be highly effective in reversing a patient’s stroke symptoms if given early enough.
Twentyfourseven is delighted to report that very recently, the fifth patient was successfully thrombolysed under this new protocol.
In the latest case at Torbay hospital, a male presenting with left sided weakness had a CT scan and was thrombolysed within two hours.
As a result, the weakness has resolved and his overall condition
has improved considerably. Once again, another fantastic patient centred experience took place for a South Western Ambulance Service NHS Trust patient. Healthcare staff are getting real job satisfaction by continuing to exploit the very latest techniques and protocols which are making a real difference for residents and visitors.
All the staff who work in Torbay Hospital connected with this initiative would like to sincerely thank all those staff from the ambulance service involved in this new protocol for their continued support and extremely speedy treatment.
They look forward to working together on more success stories like this one in the future. Well done to everyone involved!
Torbay Hospital
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Nicola Woodland and Emma Kelly crew members based in Yeovil can be seen here with patient John Baxter.
twenty-five minutes after the onset of the attack.
Tuesday 30th May.
3.55pm Wincanton contacted Yeovil Ambulance Service 4.04pm Ambulance calls Yeovil from
Wincanton.
4.06pm Yeovil returns call for check list and ECG
4.12pm Thrombilised 4.40pm Admitted to CCU
Asssitance over details in writing this from paramedic Valerie Godfrey seconded for observation to the CCU and members of the nursing staff.
First version of this written on my second day in the CCU
Nursed on CCU by among others Lucy Davies, Karen White, Judith Williams and Sophie
Paramedic Nicola Woodland, Technician Emma
Diagnosed in Wincanton by Dr Zoe Fox and practice nurse Liz Corley.
Consultant in Yeovil, Dr Chung.
In all I feel better care could not have been given. A sincere thank you to everyone. Heartfelt thanks to those healthcare staff who helped me.
■
■
■
■
6 twentyfourseven www.swast.nhs.uk
feature
www.swast.nhs.uk twentyfourseven 7
feature
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Cot death
leaflet launch
The A5 leaflet comprises a number of FAQ’s and includes a host of general tips which can help parents in reducing the risks associated in previous cases where babies have suffered from cot death.
The leaflet was produced in conjunction with an ongoing initiative which has been run by Emergency Care Practitioner William Berkley for the past 16 years. Trainee Technician, Nick Pearse has also been instrumental in the development of the new and informative leaflet.
The paediatric training team has operated from Derriford ambulance station since its inception in 1990.
The main aim of the project is to provide paediatric and infant
resuscitation training to parents with children deemed to be ‘at risk’
through a variety of infant conditions and illnesses.
The project is undertaken with the help of a paediatric health visitor based at Derriford Hospital who advises the paediatric training team of any referrals or admissions of babies and infants whose parents may benefit from the training session. This can then be arranged by a member of the training team, at the parents’ convenience, either at home or on a ward.
A typical training session consists of a comprehensive demonstration on a manikin which is often left with the parents, so they are able continue practicing their newly acquired
resuscitation skills.
Further help is provided by leaving handouts, a feedback form and this new leaflet. All feedback from parents has proved consistently positive.
Another reassuring factor for parents is the established ‘Baby at Risk’ form which is faxed to the Ambulance Service control room with a note put on the system for four years. This gives details of the child’s condition to ensure that if crews are dispatched to that particular address in the future, they are aware of the child’s condition and medical history.
Due to the ongoing popularity
and success of the Devon team, the number of those who provide the training has risen from four to twelve and the total number of ambulance staff involved in the project is around 20. In addition to devoting time to the initiative during working hours, many volunteer their own time to the project attending events, providing training and giving time to fundraising events.
All equipment like the manikins, training manuals and courses are funded by local charities and organizations including; Tavistock Lions Club, the WRVS, Plymouth Sound radio station and Hospital League of Friends. Special thanks to
all these individuals and groups are expressed by everyone involved in the project.
The success of the project has already been evidenced by the fact that three children’s lives have been saved as a direct result of the training provided by members of the training team.
For further information on SIDS visit the website on www.sids.org.uk or call the help line on 02072332090
Dedicated operational staff based at
Derriford ambulance station in Plymouth, Devon have used their own time to write a leaflet aimed at educating parents on the dangers of cot death.
Ambulance staff based in Devon recently welcomed Rajeev Kapoor, a Senior Surgical Consultant from the Christian Medical College (CMC) in Ludhiana, a city in the Punjab, India.
Rajeev’s visit was arranged in conjunction with the Friends of Ludhiana, a London based charity and Gerald Carpinini, an Exeter based Paramedic.
Gerald, who has visited the Christian Medical College in India on two separate occasions, has trained over 20 staff nurses’ in valuable paramedic and emergency life support skills.
Until recently, the city of Ludhiana, which has a large population of 3 million people, had absolutely no emergency ambulance service whatsoever.
This shocking and tragic state of affairs has since changed considerably for the better. These ongoing developments have been supported by Gerald.
During his last visit he coordinated live demonstrations of accident scenarios on the streets of Ludhiana.
This provided interactive opportunities for the medical personnel from the
Christian Medical College. The varied illustrative scenarios were welcomed by the personnel so they could put their recently acquired skills into practice.
Following a brief visit to Kings College in London, Rajeev travelled down to Devon with Deputy Chairman of the Friends of Ludhiana charity, Margaret Howard, where they spent an afternoon at the Ambulance Trust Headquarters.
This provided a tour of Trust Headquarters and an introduction into how the busy control room functions and responds to emergencies. Rajeev also had the opportunity to view an ambulance similar to the ones that will be donated in the forthcoming weeks to the Christian Medical College. This much needed resource will be used in a front line capacity in Ludhiana.
As well as the two ambulances, a variety of other equipment is being shipped to the city including defibrillators, suction units and monitoring units.
Rajeev is not the first visitor from the College in India to visit the South West. Last year, Anupam Rachna- Singh a Senior Staff Nurse from the
College spent three weeks with Gerald exploring the various elements of an ambulance trust in the UK.
Rajeev received a similar comprehensive introduction to the one Anupam enjoyed. This included a shift on the Devon Air Ambulance, several front line shifts on ambulances and rapid response vehicles and a visit to the Training college in Plymouth.
Gerald felt compelled to visit India when he discovered India has one of the highest road traffic accident rates in the world. He wanted to help people who were less fortunate by sharing his first class knowledge and skills acquired in the NHS. He feels very rewarded in equipping as many health personnel in India as possible with the key skills needed to be a
paramedic.
South Western Ambulance Service NHS Trust congratulates Gerald in his enthusiastic work in India.
Strengthening links with developing countries is extremely important and rewarding. Not only can we teach life saving techniques and skills but we can also learn about different cultures and bring that knowledge back to the UK ambulance service.
Numerous staff continue to be involved in worthwhile projects around the world, as well as locally on our doorstep. Twentyfourseven aims to showcase and bring this work to life by spotlighting them in future editions. If you have a project that you would like to share contact the news team (pg 2).
India Gift to
Gerald Carpinini (Devon) and Consultant Rajeev Kapoor from the Punjab, can be seen in the back of one of the donated ambulances.
Not only can we teach life saving techniques and skills but we can also learn about different cultures and bring that knowledge back to the UK ambulance service.
“
”
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Melodie Juste
Press Officer
1
2
3
4 5
6 7
8
9 10
11 12
13 14
15
16 18
21
22
23
24
25
26 27 28 29 30
A B
C
31 32
33 34
35 36
37 44 49
47 46
45
48
51
52 53
38 57
39
42
41
43
54
55 56
59 58
62 60
61
63 64 65
40
19
17 20
South Western Ambulance
Service NHS Trust
Isles of Scilly
A Trust Headquarters Unit 3/4
Abbey Court, Eagle Way
Sowton Industrial Estate Exeter EX2 7HY
01392 261500
HEAD OFFICE
CORNWALL 1 Penzance 2 Carbis Bay 3 Helston 4 Falmouth 5 Redruth 6 Truro
7 St. Mary’s (Isles of Scilly) 8 Newquay
9 St. Austell 10 Wadebridge 11 Bodmin 12 Camelford 13 Liskeard 14 Launceston 15 Saltash 16 Torpoint 17 Bude
WEST DIVISION
DEVON 18 Derriford 19 Tavistock 20 Holsworthy 21 Bideford 22 Okehampton 23 Ashburton 24 Totnes 25 Kingsbridge 26 Dartmouth 27 Brixham 28 Paignton 29 Torquay 30 Newton Abbot 31 Dawlish 32 Exeter 33 Crediton 34 South Molton 35 Barnstaple 36 Ilfracombe 37 Lynton 38 Tiverton 39 Cullompton 40 Exmouth 41 Sidmouth 42 Honiton 43 Axminster
SOMERSET 44 Minehead 45 Taunton 46 Ilminster 47 Yeovil 48 Bridgwater 49 Burnham 50 Castle Cary 51 Glastonbury 52 Shepton Mallet 53 Frome
EAST DIVISION
DORSET 54 Bridport 55 Weymouth 56 Dorchester 57 Sherborne 58 Wareham 59 Swanage 60 Blandford 61 Shaftesbury 62 Wimborne 63 Poole
64 Bournemouth 65 Christchurch
Find out more about the new Ambulance Trust for the South West by clicking
www.swast.nhs.uk
C East
The Acorn Building Ringwood Road St Leonards Nr Ringwood Dorset BH24 2RR 01202 851640
DIVISION HEAD OFFICES
B West Unit 3/4 Abbey Court Eagle Way
Sowton Industrial Estate Exeter
EX2 7HY 01392 261500
8 twentyfourseven www.swast.nhs.uk
feature Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
www.swast.nhs.uk twentyfourseven 9
10 twentyfourseven www.swast.nhs.uk
feature
www.swast.nhs.uk twentyfourseven 11
news
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
FAST Track Recovery
Sadly and shockingly, as every single five minutes ticks by in the UK, someone will experience a stroke.
In fact one in four men and one in five women aged 45 can expect to develop a stroke if they live to the age of 85.
The incidence of stroke is expected to increase by 30 per cent over the next decade.
The majority of strokes occur when a clot blocks one of the blood vessels carrying blood to the brain. If a clot busting drug, known as thrombylosis, is administered within three hours of the stroke, it can dissolve the clot in the brain, reducing long-term disability and improving patient outcome.
However, very few areas in the UK have developed services to provide this treatment.
During 2004, the Royal Bournemouth Hospital and Dorset Ambulance NHS Trust (the latter is now part of South Western Ambulance Service NHS Trust) developed a system to improve the care of patients experiencing a stroke.
Stroke patients now receive a faster response from the ambulance service, and are assessed to establish whether they would benefit from early specialist stroke care.
Suitable patients are then rushed to A&E, where the specialist stroke response team are awaiting the patient’s arrival. If the patient may be suitable for clot-busting treatment, they receive an urgent brain scan before receiving the drug.
The treatment has meant that a number of patients have walked out of hospital without any lasting effects after just 36 hours, instead of requiring weeks or months of rehabilitation and long term care.
Prior to the involvement of the ambulance service, just one patient was thrombolysed in six months. One patient every month now receives thrombolysis at Bournemouth, with many more at the other participating hospitals. The ambulance service has acted as a catalyst in the development of similar services across the County.
During 2005, the scheme won two prestigious awards from the Dorset and Somerset Strategic Health
Authority (now part of the South West Strategic Health Authority).
Since the award, the ambulance service has been working with other hospitals in Dorset to expand the system. The new South Western Ambulance Service will be working towards expanding the FAST system across all its counties. (See opposite page.)
However, in March of 2006, Dorset became the first area in the UK with an organised county-wide system of acute stroke care.
The team of professionals that spearheaded this pioneering new approach in the Dorset consisted of:
Adrian South
Clinical Effectiveness Manager Dr Richard Dunnill
Medical Director David Halliwell Head of Education and Development
Dr Damian Jenkinson Stroke Consultant Dr Toby Black Stroke Clinical Fellow Dr Sue Evans Stroke Clinical Fellow Anna Orpen
Stroke Research Nurse Laura Brookes
Clinical Nursing Leader Dr Julian Tawn
Consultant Radiologist
With the treatment now available at Poole General Hospital and Dorset County Hospital, everyone in Dorset has access to the best possible stroke care.
The Dorset and Somerset air ambulance is also used to ensure that even patients in remote locations can be transported rapidly to one of the three hospitals offering the specialist treatment.
There are also air ambulances in the counties of Cornwall and Devon, the latter having doubled its resource last year with the addition one new aircraft.
■
■
■
■
■
■
■
■
■
Adrian South
Clinical Effectiveness Manager
Did you know?
When a patient is having a heart attack the decision whether to administer thrombolysis
must be made as quickly and accurately
as possible as every one minute delay costs
a patient eleven days of his/her life. Accurate
interpretation of the ECG is also essential.
Team members, Paramedic Katrina Lundy and Technician Emma Goudge
Technician helps save lives
Paramedic, Katrina Lundy, pays tribute to fellow Technician, Emma Goudge, who has just clocked up supporting an incredible twelve pre-hospital
thrombolysis over the last twelve months. Emma certainly is leading the way!
Emma Goudge, a Technician based at Bodmin station in Cornwall deserves special recognition for her fantastic team working with fellow crew members in the delivery of a clot busting drug known as thrombolysis.
Supporting Twelve thombolysis treatments in twelve months is probably a record amount by any Technician in the area. If you know of someone that beats that record please let the news team (pg 2) know so we can report on your achievements and successes too.
Steve Boucher, Manager in Cornwall, was keen to write in and highlight Emma’s contribution to saving the lives of numerous patients in Cornwall. Steve says,
“Emma is an extremely enthusiastic and positive member of staff. She has been instrumental in supporting Paramedics (many for the first time) during this important and sometimes difficult procedure.
I hope this feature will highlight the importance of pre-hospital Thrombolysis and will help to encourage other staff to carry out this lifesaving procedure.
Emma has an especially good working relationship with Paramedic Katrina Lundy and they have worked together on five occasions to deliver the treatment as a team.
Crews know that Thrombolysis is crucial in saving the lives of patients everywhere. It also reduces the severity of morbidity that a patient may suffer as a consequence of a heart attack.
This feature highlights just how
important a role Technician’s have in the ambulance service. The interpersonal relationship between crews at all levels really makes a difference in the speed and success of delivery of the treatment for patients.
Well done Emma and Katrina for really making a difference.”
Case Study
Crew mates Katrina and Emma reported on probably one of the fastest ever times for the administering of the drug. The next sentence then fits
eg They achieved this in an incredible eighteen minutes! They were keen to point out the reasons why.
Crew mates Katrina and Emma reported what they believe could actually be the fastest time for administering the drug. They achieved this in an incredible eighteen minutes!
They were keen to point out the reasons why
The patient was already connected to all relevant monitors in the back of the ambulance which consisted of a 12 lead ECG, a pulse oximetry and
blood pressure monitor.
The ECG was normal at first but within minutes it indicated that the gentleman was having a heart attack.
The two girl crew quickly went into action and carried out the rigorous protocol before administering the life saving drug.
Much to the everyone’s delight the patient has since made a full recovery and is living proof that ambulance crews working as a team are doing what they do best, saving lives!
Supporting Twelve
thombolysis treatments in twelve months is probably a record amount by any Technician in the area. If you know of someone that beats that record please let the news team (pg 2) know so we can report on your achievements and successes
too.
“
”
Proud to be taking first class healthcare to the
residents and visitors of Isles of Scilly, Cornwall,
Devon, Somerset and Dorset
Control staff at Exeter HQ can be seen enjoying a day’s filming for an educational DVD being produced by film experts commissioned by Airwave
The increased violence and abuse of emergency care workers has seen the use of Police Taser devices increase throughout the UK. New guidance for emergency care workers has just been issued by the Ambulance Service Association (ASA) to help explain how these devices work.
12 twentyfourseven www.swast.nhs.uk
news
www.swast.nhs.uk twentyfourseven 13
news
All twelve newly formed ambulance services in England are to move across onto a new digital radio system over the next three years. This will enable modern and ongoing improvements in the ambulance communication infrastructure and ultimately benefit the patients we serve.
By the beginning of 2008 the whole of the newly formed South Western Ambulance Service will be operating on the new radio system.
The project is known nationally as the Ambulance Radio Programme (ARP) and is led by an experienced team at the Department of Health.
Two of the team are previous employees of former Westcountry Ambulance Service (Bill Parsons and Ian Hough).
The benefits will include:
A managed digital radio network for voice and data services including connection to the Trust control rooms
Mobile and hand portable radios configured to use the network Control room dispatcher equipment and integration to the network Integration of mobile data services with the new digital radio network
■
■
■
■
The new scheme will assist both control and operational staff in making the provision of high quality care to patients that much more easily achieved.
Operational staff will particularly benefit from the rationalisation of the number of communications devices they need to carry. At present they need to carry a pager, a mobile telephone and a hand portable radio whilst away from their vehicle. In future, one hand portable device will replace these and be capable of voice radio, mobile data and telephone communication.
An impressive feature of the digital network is resilience and fall back in the event of a failure in part of the system. In such circumstances, full service can be recovered in just a matter of minutes.
The Airwave radio service is already
All ambulance services in England are to be supplied with a new
sophisticated radio system over the next three years.
Impressive improvements to radio airwaves
in use by the Police and the Fire and Rescue Services are also due to move onto it in the next few years. This will greatly improve inter-operability between the emergency services and will be of great benefit in larger and more protracted incidents.
Special thanks to Jan Parsons, Project officer for driving this work forward.
There are two models of Taser currently being used by the UK Police service. The original M26 Taser and the newer X26 Taser. Both devices are single shot and use the same cartridges which fire two probes and discharge an electrical current. They aim to incapacitate rather than lethally injure.
Both resemble a pistol but administer an electrical current that temporarily incapacitates an individual.
They both use compressed nitrogen to fire two darts that trail wires back to the Taser.
The M26 Taser delivers an electrical current of 50,000volts / 26watts (1.76 joules per pulse at 25-38 pulses per
second) over five seconds and the X26 delivers 50,000volts / 6watts (0.36 joules per pulse at 19 pulses per second) over five seconds, which temporarily incapacitates the victim by affecting the neuromuscular system.
How does it work?
The Taser is laser-sighted and uses
air cartridges attached to the end of the barrel. The cartridges project a pair of barbed darts, which attach to the skin or clothing and deliver an electrical charge in the form of a sequence of very high voltage pulses.
The Taser has an absolute maximum range of around 21 feet, this being
the length of the wires carrying the current, and which attach the barbed darts to the weapon.
The Taser also has a ‘touch stun’
mode, where it can be operated without firing the barbs. It is very effective while the charge is being applied and the electrical charge can be repeated if needed.
What does it do to someone?
The normal reaction of a person exposed to the discharge of a Taser is the temporary loss of voluntary muscle control resulting in the person falling to the ground or ‘freezing’ on the spot.
The effect is not intended, nor is it likely to render a person intoa state of unconsciousness.
The device is meant to be an alternative to conventional firearms and is not intended to result in a fatal outcome. There are cases where people exposed to the discharge of a Taser have died some time after exposure, although the cause is unlikely to have been the Taser itself.
What happens afterwards?
The effects of the Taser are sudden and only last for as long as the charge is applied (usually five seconds).
Recovery from the direct effects of the Taser should be almost instantaneous.
Advice for emergency care workers Protective examination gloves should be worn. The barbs are designed to penetrate the clothing or skin and direct injuries caused by Taser barbs entering the skin are usually minor.
Ordinarily, the copper wire attached to the skin should be cut close to the barbs so as to avoid trailing wires. The wires are easily cut using paramedic shears, but particular care should be taken to avoid pulling on the wires with the barbs still attached to the skin.
South Western Ambulance Service is proud to continue enforcing a Zero Tolerance policy with regard to assaults on staff following a recent successful prosecution of an assailant in the country of Cornwall.
A Technician was assaulted when attempting to treat a patient back in November 2005. The gentleman in question suffered a dislocated arm and facial injuries when the patient attacked him unexpectedly.
Former, Westcountry Ambulance Service reported the incident to the NHS Security Management Service and took the necessary steps which resulted in a subsequent conviction. The attacker has received a 120 day jail term and the Technician has been awarded £100 compensation.
An ongoing initiative is continuing
across the new South Western Ambulance Service Trust. The high profile work will continue to encourage all staff to report any physical or verbal assaults. They are then provided with a supportive network.
In addition to the provision of psychological support and access to a confidential counselling service, staff are given optimum time to recuperate from any injuries sustained. They are not encouraged to continue frontline duties until they have fully recovered from any assault.
Criminal charges will continue to be pursued against all assailants and civil action will also be taken if necessary.
All assaults are reported to the NHS Security Management Service, an official national body, who may wish to pursue independent prosecutions against assailants in addition to any
lawsuits or prosecutions instigated by the Ambulance Service.
Assaults on Ambulance Service staff across the South West are relatively low. In 2004/5 51 physical assaults were reported, with the number of reported physical assaults on ambulance staff throughout the country standing at 1329 for the same period.
The national trend demonstrates that the number of physical assaults against ambulance staff is in decline and this can largely be attributed to the campaign as well as police initiatives such as the introduction of Taser guns (see above).
Earlier this year, Patricia Hewitt spoke about the positive elements of enforcing an offence of ‘obstructing ambulance staff responding to emergencies’. It is likely that this will
become a law of the future.
Acting Duty Manager Stuart Hickman, based at South Western Ambulance Service control room in Exeter, was a victim of an assault during a frontline shift in South Devon when he was out on a rapid response vehicle with an Emergency Care Practitioner (ECP).
The patient they were sent to help had been drinking and was extremely aggressive. Swearing at Stuart and his colleague, he threatened them, attempted to grab Stuart in order to assault him before breaking the passenger side window where Stuart sat in the vehicle. He and the ECP were covered with broken glass and drove away from the scene before calling for police back-up. Stuart says,
“The threatening behaviour and
swearing was concerning enough but when the patient’s behaviour turned violent, it was frightening. I was unable to comprehend why an individual could be so intent on assaulting healthcare professionals who only wanted to help him.
Both my colleague and I were concerned about being cut by the glass or worse. When we took the decision to drive away from the scene the group he was part of continued to follow us shouting obscenities.
Another worrying aspect is that the vehicle was out of action due to the broken window, which not only resulted in unnecessary costs but the vehicle was consequently off the road and although the Trust has ample resources, it was unnecessary and the attack definitely unprovoked.”
Police Tasers
Zero tolerance gains momentum
Photo Courtesy of Joe Head, Devon & Cornwall Police
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Melodie Juste
Press Officer
1 twentyfourseven www.swast.nhs.uk
feature Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Please pull out and display on local notice boards
Coughs &
Sneezes
campaign
South Western Ambulance Service NHS Trust is taking part in a new
poster campaign encouraging people to cover their
mouths and noses when coughing or sneezing. This very simple message is being spotlighted by the use of an eye catching poster that was used over 60 years ago. (See opposite page.)
It is envisaged that the hygiene messages contained in the poster will encourage people to take care when coughing and sneezing, to avoid passing on infections to others.
With the possibility of a pandemic flu breaking out in the coming years, South Western Ambulance Service is wholeheartedly backing the campaign.
The Trust’s Communication team will spearhead the campaign, whilst working alongside the Trust’s Emergency Planning team. Together they will highlight one of the main messages promoted by the NHS via the poster and this proactive work will help prevent the spread of a flu pandemic if it occurs.
The poster is based on an original
‘Bateman’ cartoon and slogan – ‘coughs and sneezes spread diseases’ - a phrase first coined by the Ministry of Health during health promotions in the 1940s.
Dr Mark Kealy, Communicable
Disease Consultant with the Health Protection Agency, offers expert advice based on common sense.
People are urged to:
Cover their mouths when coughing and sneezing, preferably using a tissue;
Dispose of dirty tissues promptly in a bin;
Wash hands frequently, not just after visiting the toilet.
Simple precautions are the single most effective way of keeping the spread of pandemic flu to a minimum.
The poster and the slogan sum up the NHS message well, and are relevant at any time of the year, but become hugely significant if pandemic flu arrives in the UK.
Experts are predicting that a quarter of the UK’s population could catch flu during a pandemic. So the NHS has been tasked with preparing for a pandemic locally and nationally to minimise disruption to health services and to plan how best to care for people who are affected by the infection.
Local plans include:
Preparing guidance and information on how to recognise the signs and symptoms of flu;
Ensuring all healthcare workers have up-to-date training on infection control procedures and guidance on how to use personal protective equipment;
Ensuring healthcare workers dealing with flu patients have personal protective equipment, such as masks and clothing;
Planning how to cope with a quarter of NHS staff being off sick.
Other plans to limit the spread of flu include:
Segregation of ‘flu and ‘non flu’
patients;
Deploying staff so as to minimise cross-infection risks;
Maximise and exploit modern
■
■
■
■
■
■
■
■
■
■
technology to support staff in satellite working;
Restricting visitors to hospitals.
Experts estimate that pandemic flu might occur in the next few years based on evidence from past pandemics during the last century. A flu pandemic would be caused by a completely new strain of flu to which humans would have little resistance which spreads rapidly between humans, and from country to country.
If you want to find out more, click on www.swast.nhs.uk
■
www.swast.nhs.uk twentyfourseven 15
Designed by cre8media, Kings Wharf, The Quay, Exeter EX2 4AN Tel: 01392 218 218 website: www.cre8media.co.uk. Printed by The Northcliffe Press, 17 Brest Road, Derriford Business Park, Plymouth PL6 5AA
16 twentyfourseven www.swast.nhs.uk
news
The recent announcement that ambulance trusts would reconfigure and reduce from 31 to 12 has been widely welcomed in the South West. This will unite Staff who work in the counties of Dorset, Cornwall and Isles of Scilly, Devon and Somerset.
South Western Ambulance Service NHS Trust now consists of approximately 2000 staff from two former Trusts known as Dorset Ambulance Service and Westcountry Ambulance Service.
These staff are developing new and positive working relationships to ensure best practice is shared and professional camaraderie is fostered.
Ambulance crews are simply getting on with their usual jobs which is providing responsive and high quality healthcare to patients. The combining of staff from across the four counties actually means that they now form part of a much stronger, united and more resilient team of ambulance personnel serving the people who live in the South West.
Staff unite
Proud to be taking first class healthcare to the residents and visitors of Isles of Scilly, Cornwall, Devon, Somerset and Dorset
Staff pictured on this page are Stuart Hagley and Nicole Hill (Emergency Medical Dispatchers), Rachel Courtrier (Control Assistant), Deb Saunders (Duty Manager), Andy Innis (Control Training Supervisor), Neil Chevalier (Manager) all based in Exeter and Karen Ford and Mandy McIntosh (Emergency Medical Dispatchers), Grahame Laurence (Paramedic Adviser/Telephone Adviser Triage Paramedic (TATP), Steve Smith (Control Officer) all based in Dorset.
Special thanks for the kind support and excellent photographs taken by Steve Smith (Control Officer) based in Dorset.
