AIR AMBULANCE RE-PROCUREMENT PROJECT

Transcription

1 AIR AMBULANCE RE-PROCUREMENT PROJECT Analysis of Consultation Findings Final Report October 2010 Prepared by the Communications and Engagement Team

2 1. Introduction In order to inform the procurement of air ambulances for , the Scottish Ambulance Service has been engaging with patients, clinicians and other partners. By listening to the public, our patients, clinical partners, public bodies, other emergency services and charities and voluntary organisations, the Scottish Ambulance Service is helping to achieve a more mutual health service by giving our stakeholders a chance to share their views about the kind of Air Ambulance Service required for the future. This document represents the findings of Phase I and II of the Scottish Ambulance Service s Air Ambulance Re-procurement Consultation. Phase I took place between October 2009 and April 2010 and Phase II took place between May and July The feedback and comments received will help to inform the development of the air ambulance tender specification document. It is worth noting that some of the feedback received about the quality of service is already being addressed through training and development of staff as well as reviews and improvements of operational procedures. The Service has built a robust picture of anticipated demand for the Air Ambulance Service based on historic demand data and has contacted territorial NHS Boards for information about future development plans for healthcare provision in their areas in order to predict demand trends for Air Ambulance support., This is being incorporated into the tender specification, alongside the views gathered from the 600 groups and individuals estimated to have contributed to the consultation. The Scottish Ambulance Service will then tender the Air Ambulance Service in the first quarter of 2011, in accordance with the Official Journal of the European Union (OJEU). It is anticipated that the aviation market will then respond to the requirements laid out in the tender specification document. Responses will be assessed against this specification and a preferred supplier selected, which will allow the Scottish Ambulance Service to provide the most effective Air Ambulance Service for patients from Unst to Uist and Aberdeen to Arran. Acknowledgements: The Scottish Ambulance Service would like to the all of those who gave generously of their time to provide feedback and attend discussions about the Air Ambulance Service. Working together on the Air Ambulance Service of the future will be instrumental in providing better patient care. 1

3 2. Background Overview The Scottish Ambulance Service provides air ambulance services to all of Scotland and its Islands. Clinical staffing is provided by the Scottish Ambulance Service. The aircraft are provided on a managed service basis by a third party. The current aircraft provider is Gama Aviation, which subcontracts helicopter provision to Bond Air Services. The current contract expires on 31 March The Service is developing a tender specification for its next generation Air Ambulance Service. In advance of procuring a new fleet of air ambulances for , the Scottish Ambulance Service conducted an extensive programme of consultation. This feedback has been reviewed against the requirement to design and implement an effective, safe and affordable air ambulance service for, at least, the 7 years , which specifically continues to meet the needs of patients and clinicians provides the most appropriate response for the clinical need of our patients improves the Performance Management process within the contract ensuring that Key Performance Indicators (KPIs) are fit for purpose and widely understood continues to provide a value for money service ensures meaningful engagement with all the relevant stakeholders ensures that air ambulances and road ambulances offer comparable facilities in terms of clinical environment, space and equipment ensures appropriate conditions for patients and staff, that comply with current Health and Safety Regulations, including infection control requirements seeks flexible contractual arrangements that are responsive to changing models of health care delivery. Response to Feedback All feedback received has been reviewed against the above requirements, which are set out in the Air Ambulance Re-procurement Board s Project Initiation Document. Feedback which supports these objectives will be incorporated in the tender Any feedback which is out of scope, for example, has been recorded and explained as such. Members of the Clinical User Forum have produced a Clinical Specification paper, which includes a review of clinical triage and tasking protocols for air ambulance requests. This has identified some key operational improvements which the Service is now addressing, as well as feedback for the tender Section 4, below, outlines all feedback received throughout this consultation and engagement programme. This has been grouped by a range of common 2

4 2. Background themes which emerged during phase I and phase II of the consultation. The Service s response to each piece of feedback and any actions to be undertaken are in the adjacent columns, to demonstrate how all feedback received has been considered for this project. For clarity, and accompanying glossary of terms is in Section 3. Feedback has been sub-divided and addressed in the following way: A NATIONAL SERVICE MEETING LOCAL NEEDS: Base Location of Aircraft p. 7 Community Resilience p. 14 Partnership Working p. 20 Achieving Best Value p. 27 DELIVERING SAFE AND EFFECTIVE CARE Clinical Effectiveness p. 28 Capacity of Aircraft p. 31 Patient Comfort p. 35 COMMUNICATIONS AND CONTACTING US Communication Between Healthcare Providers p. 37 Public Awareness p. 40 Contacting the Service p. 41 3

5 3. Glossary of Terms A & E Accident and Emergency AAR Air Ambulance Re-Procurement ARCC Aeronautical Rescue Co-ordination Centre ARCC is based at RAF Kinloss and handles requests for air assistance for all emergency services throughout the UK ARI Aberdeen Royal Infirmary Basics British Association for Immediate Care Scotland Basics is an organisation, which comprises doctors who are able to provide care in a pre-hospital setting, who in partnership with the Scottish Ambulance Service CAA Civil Aviation Authority Clinical Specifications Specifications relating to the provision of air ambulance services, drawn up after discussion with the Clinical User Forum Clinical User Forum This is a forum comprising a wide range of clinical users of the Air Ambulance Service DATIX an electronic system for recording data, including adverse incidents EC135 the model of helicopter currently operated by the Scottish Ambulance Service EMDC Emergency Medical Dispatch Centre The Scottish Ambulance Service dispatches medical assistance from one of three EMDCs, based in Cardonald (West), South Queensferry (East) and Inverness (North). EMRS Emergency Medical Retrieval Service A physician-led aeromedical service, which provides patients suffering life or limb- threatening conditions in remote and rural areas of Scotland, with rapid access to the skills of a consultant in emergency or intensive care medicine. EMRS uses the aircraft of the Scottish Ambulance Service. 4

6 3. Glossary of Terms ETA Estimated Time of Arrival HMCG Her Majesty s Coastguard GPU Ground Power Unit Equipment found at airports to provide on ground electrical aircraft power KPI Key Performance Indicators King Air The model of fixed-wing aircraft currently operated by the Scottish Ambulance Service MCA Maritime and Coastguard Agency MOD Ministry of Defence RTA Road traffic accident SAR Search and Rescue SAR-H Integrated Search and Rescue service to be provided by a company called Soteria from 2012, which is creating a single entity helicopter Search and Rescue service, jointly operated by the MOD and Coastguard SAS - Scottish Ambulance Service SOP Standard Operating Procedure STEMI ST elevated myocardial infarction A heart attack caused by interruption of the blood supply to a part of the heart, often caused by a blockage of a coronary artery Tasking the action of deciding the most appropriate way to respond to a patients needs after a call to the Scottish Ambulance Service Triage the process of prioritising an appropriate response to the needs of each patient 5

7 A NATIONAL SERVICE MEETING LOCAL NEEDS BASE LOCATION OF AIRCRAFT The aircraft that serves the route from Shetland to the mainland should be no further away than Aberdeen. The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots Standards in the specification will be applicable to the whole of Scotland, including its islands. Aircraft which currently operate on Shetland should be kept there. This should include the Coastguard and BP Jigsaw (or equivalent) Would prefer air ambulance requests to be coordinated locally on Shetland which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. This will be determined by the market s response to the tender Air Ambulance is a national service which takes account of demand across the whole of Scotland at any given time. National Co-ordination centre has been established and review after six months indicates significantly improved coordination compared to local coordination.. Standards in the specification will be applicable to the whole of Scotland, including its islands. Standards in the specification will be applicable to the whole of Scotland, including its islands. Would like air ambulance based on The Scottish Ambulance Service is a Standards in the specification will be 6

8 Shetland for quick response and evacuation to ARI The Islander aircraft was a popular service on Orkney. It provided a faster response for interisland transfers. It is felt that a Kirkwall-based service would be more responsive to the needs of Orkney patients. It is felt that locally-based pilots would have better understanding of capabilities in weather conditions Financial savings could be made from using locally-based fixed-wing service for inter-island transfers on Orkney national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. A proposal has been made for a community aircraft, which would serve multiple uses across the community. applicable to the whole of Scotland, including its islands. Standards in the specification will be applicable to the whole of Scotland, including its islands. The Service will review potential demand for this in partnership with NHS Orkney and Orkney Islands Council 7

9 Many Orkney residents would like a Kirkwall-based service could resources be shared with Council and NHS Orkney to achieve this? It is felt that a Kirkwall-based service would benefit outer Orkney isles for nonemergencies and would free-up resources from Inverness. This might reduce the need for Search and Rescue resources The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital Following the meeting on 8 th July between Orkney Islands Council and the Service to look into this option. Analysis undertaken last year identified 368 air missions from Orkney, 60 of which were from the outer islands (full year data) Air ambulance demand this year (2010) identified 6 patients from the outer isles for April, 5 patients in May, and 11 in June. On average there are circa 60 missions per year. The Service will review this option in partnership with NHS Orkney and OIC. The Clinical User Forum has produced a Clinical Specification Paper. This includes a review of clinical triaging and tasking for air ambulance requests. This feedback will be considered in the clinical triaging and tasking work, alongside the review with NHS Orkney and OIC. 8

10 Clinicians would like an aircraft based in Orkney but fully aware of the issues regarding clinical governance and costs. It was asked if there is capacity for resource to be moveable, i.e. having a resource available locally for Orkney sometimes. It was asked to make sure that the aviation expertise on the contract understands the challenges of the island There is concern that the farthest north based air resource is Inverness. It was felt that the far North of the Highlands and Islands needed a closer resource. Has there been any consideration of having a helicopter based in the West, i.e. Fort William? It is felt there is a lack of supporting infrastructure in the area at destinations. Clinical operational changes to triaging and tasking, which is emerging from the Clinical User Forum work will pick up the requirements for SAR resources. As above The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. Please see the above response. Please see the above response. As Above The Clinical User Forum has produced a Clinical Specification Paper. This includes a review of clinical triaging and tasking for air ambulance requests. This feedback will be considered in the clinical triaging and tasking work, alongside the review with NHS Orkney and OIC. The training and familiarisation programme which will be put in place for the new contract will ensure the aviation expertise on the contract understands the challenges of the island As above As above 9

11 present, i.e. mechanical and maintenance site. Air ambulance support is vital for the Ardnamurchan Peninsula and service levels should be maintained. A service with critical care doctors is a provision. A helicopter could be based at Dundee to respond to RTAs, farming accidents in the east and north east of Scotland, as patients generally transferred to Ninewells. Acknowledge that funding for a third helicopter unlikely but consideration should be given to a Tayside base. Demand trend and coverage will dictate the response by the market to the tender The Scottish Ambulance Service is working in partnership with NHS Boards to deliver appropriate service provision. The Scottish Ambulance Service is a national service, operating against a national response time target of 95% coverage in 60 minutes. The market response to the tender specification will propose: Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. The market response to the tender specification will propose: Location Base for pilots Tender specification will include Air Ambulance Key Performance Indicators As per response The second part of the feedback is already being addressed through current partnership working with NHS Boards. As per response As per response 10

12 Would like to see physician-staffed helicopter based in Tayside, especially for trauma response, ST elevation MI and stroke for the east of Scotland. Passenger-only ferry to Lismore not adapted for securing patients; vehicle ferry takes 50mins each way so is unsuited for emergency call-out. Would like aircraft based in Argyll & Bute to ensure life-threatening emergencies are attended to in clinically effective time. Potential to base retrieval service in Aberdeen, co-located with King Air. Can provide primary retrieval service that cannot be provided to North and East Scotland by Glasgow EMRS. Suggest exploring sharing rotary resources with police for both financial and operational benefits, i.e. Reducing need for ground resources and providing clinical service to rural areas. Merit in exploring charitable funding options, relative to industry in the North East. Est. running costs of m p.a. to run a retrieval service, but could be reduced through co-location of King-Air and rotary aircraft, and sharing resource. (KPIs), historical and predicted demand data and hospital destinations Please see the response above. Please see the response above. This will be passed on to the Scottish Government who is leading a review of the specialist retrieval services. There is currently sharing of engineering, ground staff and pilots, as well as accommodation at the Glasgow helicopter base. There are ongoing discussions in Scotland relating to the possibility of charity funded helicopters although no decision has been taken. The EMRS will cover this from October As per response The DTZ report into the Emergency Medical Retrieval Service determined that the retrieval team should be based at one site in Glasgow. However this comment has been fed into the specialist retrieval review. Members of the air ambulance management team keep abreast of other air ambulance service activities, through participation in a number of working groups for air ambulance services across the UK. These include charity-funded helicopters in England and Wales. The Clinical Users Specification states that should the market recommend fixed wing and rotary aircraft in the same geographical location, then SAS supports 11

13 co-location where this is practical. 12

14 A NATIONAL SERVICE MEETING LOCAL NEEDS COMMUNITY RESILIENCE The Service should give consideration for aircraft that are more suited to island communities, in addition to fixed-wing. Different fixed winged aircraft needed to service the smaller islands. Island-specific needs should be considered carefully when tendering. The local hospital on Barra needs to be defined as no more than a GP practice; it does not have the facilities of a normal hospital. Coordinating centre should have benefit of localised knowledge. Would like to see faster air ambulance response Current issues experienced on Barra were not as pronounced when Islander service operated Delays caused by crew changeover means response time can be over 6hrs on Barra. Shift patterns should be looked at This feedback is noted for the tender The tender specification will detail the geography and logistics to be covered This feedback is acknowledged. SAS have put in place a triage and tasking protocol to ensure more effective deployment of air services to those communities who require it. On top of this, GPs will have access to the EMRS consultant for additional clinical support. The response to the tender specification from the market will be based on demand trends, coverage and KPIs. Response time should be appropriate to the clinical condition of the patient. The previous Islander service was dependent on the timings of tide for landing, which the EC135 is not affected by. Response times are agreed with clinicians. The average response time to Barra is 65 minutes. SAS is currently in This feedback is noted for the tender Noted for the tender specification The Clinical User Forum has produced a Clinical Specification Paper. This includes a review of clinical triaging and tasking for air ambulance requests. This feedback will be considered in the clinical triaging and tasking work. This feedback will be picked up through a review of operations, which is currently underway. As part of the tender specification, potential suppliers will be asked to meet key performance indicators, which are applicable in Barra and other Island communities This feedback will be looked at during a review of operations, which is underway. 13

15 so that the challenges at shift changeover can be mitigated. Time from call to at patient needs to improve, more so around shift change times. Standby pilot use should be considered to reduce delays out of flying hours the process of changing the air ambulance management team. The two air area service managers will be responsible for reviewing monthly demand in NHS Board areas including the Western Isles. Meetings will be arranged with NHS Boards to discuss referral patterns and pathways. How will time-critical interventions such as thrombolysis and PCI be accounted for when transferring to mainland centres from Barra? In 2009/10 there were 90 missions to Barra representing 2.1% of total air ambulance activity and 16% of total Western Isles activity. Shift patterns are in line with Civil Aviation Authority rules and regulations The Scottish Ambulance Service works closely with regional services, such as Optimal Reperfusion Services. All SAS paramedics and rural GPs have the capability to administer thrombolysis and to triage patients to the respective Health Board s agreed clinical pathway (e.g. hospital facility). Will be reviewed by Clinical Users Forum 14

16 There are concerns about EC135 needing to refuel, lengthy response times and inability to take escorts at times. There is a belief that this helicopter is not suited to needs of Barra, especially in poor weather. Standards should be applicable to all parts of Scotland. This will be built into specification EC135 cannot fly to Orkney in icing conditions and needs to refuel. Therefore, response times lengthier. Helicopter use is limited by weather and would like it to have capacity to fly in adverse conditions Is there a real time weather system in place on the islands? Often the islands are clear but do not get an aircraft because of bad weather. It is felt that patients requiring urgent transfers on Orkney often face lengthy waits as they appear to fall to the end of the queue Standards should be applicable to all parts of Scotland The Air Ambulances of the Scottish Ambulance Service fly according to CAA rules and regulations, which limits flying in adverse weather. The contingency for adverse weather remains MOD/Coastguard Full consideration to all navigational issues, including weather, is considered before dispatching resource. Non-emergency transfers are responded to within a timeframe agreed with the ordering clinician. The average response time for urgent transfers is shorter than previously due to an increase in requests from clinicians for quicker transfers. This comment is noted for the tender This feedback is noted for the tender This feedback will be looked into as part of the operation review, which is underway, specifically in the clinical triaging and tasking work outlined above. This will include a definition of urgent and emergency. 15

17 Is there an option to relax clinical governance guidelines for inter-isle transfers for Orkney? It was pointed out by a healthcare manager that there can be misuse of the air ambulance service by ordering parties on Orkney, as a result of occasional application more urgency than is clinically necessary,to ensure a faster response. Highland Council would like a list of locations in Lochaber where we have landing sites Can a Helipad be based at Campbeltown hospital? The Service should consider community resilience: e.g. landing pads & transportable lights The Service should improve access by maximising landing capabilities Can the Service investigate designating more landing sites with requisite lights for helicopters to land after dark? Night flights seem to be an issue with the islands in general i.e. length of time the patient has to wait to be taken off the Patient Safety is our top priority. Clinical Governance guidelines have patient safety at their core and this should never be compromised. The triage and tasking SOP 6 sets out the protocols for the use of air ambulances. Regular reviews of Orkney usage have now been established. This comment is noted. The air ambulance management team has recently introduced Standard Operating Procedure 4: Helicopter Landing Site Request to ensure that landing sites are developed as appropriate. As expected, emergencies will always be prioritised over urgent jobs. As per response As per response This has been picked up as an action by the AAR project team. This comment will be picked up as part of a review looking at landing sites across Scotland. This feedback will be looked at in a review of landing sites and against night-times standard operating procedure. This feedback will be incorporated into a review of landing sites. This comment will be picked up as part of a review looking at landing sites. This feedback will be looked at in a review of landing sites and against night-times standard operating procedure. 16

18 island by helicopter. The restriction of landing sites at night has been raised. The helicopter is not significantly faster than a road ambulance in Dumfries & Galloway. There is a view that it is being used to achieve targets, which results in reduced availability. There is no published medical evidence to support the use of helicopter transfer instead of road ambulances. Therefore, a coordinated local response would be preferable. Delays are caused by aircraft being elsewhere, by the aircraft s inability to fly at night and by lack of availability of crews during working hours The Service should take account that greater demand is likely in single-handed, nurse practitioner practices in Orkney. SAS acknowledges this may be the case in certain locations in Dumfries and Galloway. In some remote and rural areas Air Ambulance is faster than a road ambulance response. Deployment of the Air Ambulance is not used to meet response targets. New National co-ordination desk new established at Cardonald EMDC to ensure appropriate co-ordination with land ambulances. Demand for Air Ambulance is rising year on year. The current review of operations will look at triaging and tasking. The Clinical User Forum is taking steps towards a solution for night-time flying. All clinicians, including nurses, who make a request for air ambulance services, will be asked the clinical triage questions to determine the best use of national air ambulance assets, to meet the clinical needs of the patient. As part of communication and engagement process, NHS Boards were asked what service redesign changes The Clinical User Forum has produced a Clinical Specification Paper. This includes a review of clinical triaging and tasking for air ambulance requests. This feedback will be considered in the clinical triaging and tasking work and improvements made when agreed, in advance of reprocurement This feedback will be looked at in the course of the review of operations, which is underway. The Remote and Rural Implementation Group Strategic Options Framework is designed in such a way that NHS Boards and the Scottish Ambulance Service will work together to undertake a gap analysis and design joint services to meet the needs of remote and rural communities. An Air ambulance response is just one of a number of options available and through 17

19 Are there contingency plans in the event of prolonged volcanic ash disruption? Is hovercraft a viable back up for air ambulance? were likely to affect future demand for the air ambulance service. There was no indication of this issue in the reply from NHS Orkney. Yes, The Air Ambulance management team would work closely with our air ambulance service provider and with clinicians to prioritise patients and our resources to meet their needs. We also are able to request additional support from other organisations, such as the MOD and Coastguard. A hovercraft is not in scope for this project. However as part of the Remote and Rural Implementation Group Strategic Options Framework which is being implemented across Scotland, ferry crossings and support are considered. appropriate triage this will determine the most appropriate road and/or air response. As per response 18

20 A NATIONAL SERVICE MEETING LOCAL NEEDS PARTNERSHIP WORKING Transport issues on Orkney cannot be addressed by SAS by itself. NHS Orkney and Orkney Islands Council should look at jointly. We need to look at opportunities to utilise capacity with council purchased resources. SAS should examine contracts with local public sector agencies to provide multi-level responses. The specification needs to look at an integrated service provision, which should involve road ambulances and ferries. The Council currently procures inter-island service; this could be expanded to nonemergency cases. The Service should engage with those tendering for SAR to achieve efficiencies. There is a project team responsible for implementing the new SAR helicopter service (SAR-H) and the contract has already been awarded (not yet signed, pending a review by the new government). The team is engaged widely with industry, emergency responders and the CAA to ensure the provision of a SAR service that is efficient and effective. Part of the ARCC s function This feedback will be picked up by the General Manager for the North. engagement will continue 19

21 There will be a reduction in military assets in future, due to ongoing foreign conflicts. This should be considered in tendering. is to ensure that SAR aircraft activity is coordinated efficiently. The Ministry of Defence has assured the Scottish Ambulance Service that military assets will not be reduced. It has been commented that there could be military downsizing, which may affect on Search and Rescue capacity and could lead to a gap in resilience. There are concerns about the level of SAR cover, and it is felt that the new proposed helicopters for SAR are not suitable for the Mountain Rescue role. There is a concern about the contracting and possible effects that an unsuitable aircraft may have as part of the overall air provision covering the North West. SAR co-ordination is forecast to continue by the ARCC. Further comments on this can only be made following the Strategic Defence Review. A condition of the SAR-H programme to replace existing SAR assets is that the new service should be no less capable than the present one. In the short term, the SAR aeronautical framework is not forecast to change, but the SAR-H programme is under review and the MoD provision of SAR is likely to be included in the Strategic Defence Review. The SAR-H programme should ensure that the next SAR helicopter is fit for purpose, although different characteristics with the new helicopter might lead to an adjustment of existing local operating procedures.* Contact has been made with Mountain Rescue and a follow-up call by Air Ambulance management to discuss this matter has been planned. Could dual-purpose air ambulance / This is not possible for the current Air This comment is noted. The Scottish Response provided by ARCC, RAF Kinloss Response provided by ARCC, RAF Kinloss 20

22 search and rescue helicopters be developed? Ambulance tender. The SAR-H contract has been awarded, but is not yet signed, pending a spending review by the new government. Its duration is 20 years. The MOD contract is not under review till At time of starting this process, SAR-H contract had been provisionally awarded in January It was suspended in June 2010 by the new government to undertake a review of spending under the previous administration. This is a UK-wide contract. Ambulance Service will continue to maintain its joint working activities with SARH and MOD, using their combined assets to respond to a variety of circumstances. There are helicopters that could fulfil both roles and search and rescue helicopters are an example of this. However, Search and Rescue (SAR) operations inherently carry more risk than other activity; they frequently require large helicopters, specialist equipment and skilled aircrew, which are expensive and complex to operate compared with air ambulances. Provided that it continues to function effectively, the existing aeronautical SAR framework across the UK should preclude the need to establish a SAR capability for an air ambulance. To ensure best use of public funds, The only organisation which can task any Response provided by ARCC, RAF Kinloss 21

23 thought should be given to the Coastguard Resources being merged into future Air Ambulance contracts or more formal access arrangements. The Service should minimise use of search and rescue resources, since these are expensive and potentially risky, if used in difficult conditions. The Service should analyse alternatives: e.g. dual piloting of air ambulances, night-vision capabilities. Is there a chance of overlap with other agencies, e.g. fire, police, commercial? UK SAR aircraft for SAR operations is the UK ARCC based at Kinloss. The company operating the Maritime and Coastguard Agency (MCA) helicopters at Stornoway and Sumburgh may carry out non-sar activities, but these occasions are rare, since it is undesirable to use resource which could be required for search and rescue activity. On these rare occasions, ARCC and MCA are required to give their approval. There are also regulatory implications for a company that undertook both SAR and air ambulance work, as the CAA treats these activities separately. * While feasible, there would be cost and regulatory implications associated with expanding air ambulance operations to include specialist skills, such as nightvision capabilities. For example, the Service would require CAA air operators certificates, The charging policy for the use of SAR helicopters for immediate lifesaving medical transfers under SAR-H has not formally been announced. Currently, charges for medical transfers carried out by MoD SAR aircraft are set at a minimum rate.* Where possible, the Scottish Ambulance Service works in partnership with other This feedback is noted for the The Scottish Ambulance Service will continue to work in partnership with other * Response provided by ARCC, RAF Kinloss 22

24 Where night flights are required, or flights requiring a larger aircraft than those operated by SAS, could the need for cross-charging between public sector organizations and administration be reduced by estimating potential usage and factoring these charges into the contract funding of each body (e.g. MOD, HM Coastguard) in advance? Many people on Orkney have highlighted their belief that use of coastguard indicates that current service cannot cope with current demand for air ambulance The Coastguard helicopter is often deployed because it is closest to scene or can fly in weather/bad light, but patient does not receive paramedic skills as a result. This raises questions about equity of access to healthcare. agencies: e.g. with Strathclyde Police, use of BP Jigsaw helicopter. There are, however, limitations and issues around governance. For example, Strathclyde Police only cover the Strathclyde area. Demand from SAS on MOD/HM Coastguard is extremely variable and measures such as newly developed triage and tasking Standard Operating Procedures (SOP) as well as the landing light SOP are likely to help reduce the dependency on MOD/HM Coastguard resources and reduce this demand/cost. The Air Ambulance of the Scottish Ambulance Service flies according to CAA rules and regulations, which means it is not permitted to carry out night-time flights or fly in certain weather conditions. The Service, therefore, is required to work in partnership with the Coastguard, which flies according to Search and Rescue regulations. MCA SAR helicopters and in many cases MOD SAR helicopters fly with a qualified paramedic on board. Additionally, the requirement for a paramedic has been taken into consideration within SAR-H. * agencies, where possible. This feedback will be looked at during the current operational review. This comment is noted. This feedback will be incorporated into the Operational Review outlined above. The Service needs to improve Co-ordination of activity already takes Air Ambulance management will meet * Response provided by ARCC, RAF Kinloss 23

25 communications between HMCG and air ambulance, including: visiting each other as part of training, contacting HMCG when on flights near coastal and remote areas to avoid conflict in flight paths and maintaining current radio frequency. place between the UK ARCC, which tasks SAR aircraft and Gama which tasks Scottish air ambulances. Additionally, a common radio frequency already exists with which air ambulances and SAR helicopters can communicate. The ARCC is working to improve the methods by which the movement of SAR helicopters and air ambulances can be tracked, with the resulting information displayed on screens within the ARCC. * with HMCG to discuss this specific feedback and agree actions. Response time standards should be developed that can be achieved and are transparent. All islands should be included in the response time targets and none should be excluded. An aircraft needs to be able to respond within these times. The Coastguard and the MoD do not provide a response any better than a locally-based resource. The reasons behind the need to maintain infection control are understood, but urgency should be considered as more important. Infection Control standards that limit the EC135 do not apply to MOD/CG aircraft. Is this a double standard? The Scottish Ambulance Service operates against response time targets which cover the islands. The target is a national one: 95% coverage in 60 minutes. We have reported against this standard for individual inhabited islands on Orkney and will continue to do so. Coastguard and MOD response is required when SAS are unable to respond due to adverse weather, night-time flying, or no resource is available.. The use of MOD and Coastguard aircraft should only occur in the event of a life or limb-threatening emergency. Whilst it would be desirable that these aircraft met Response time standards are applicable to all of Scotland and its islands. Infection Control will be considered in the tender evaluation process The Service is waiting for feedback from the MOD and HM Coastguard, as well as the outcome of the SAR-H contract award. * Response provided by ARCC, RAF Kinloss 24

26 the same infection control standards as Scottish Ambulance Service aircraft, due to the different roles that they undertake, this is not always possible. The air ambulance management team has developed a draft Memorandum of Understanding that includes infection control consideration. This draft document has been passed to the MOD and Coastguard for comment. The air ambulance management team will continue to work with MOD and HM Coastguard managers to ensure that standards are of an appropriate quality. This not only includes control of infection, but clinical standards, too. 25

27 A NATIONAL SERVICE MEETING LOCAL NEEDS ACHIEVING BEST VALUE In view of the fact that the Scottish Air Ambulance Service is the only one which is publicly funded, does the Air Ambulance receive an uplift from the Westminster Government to Holyrood, by way of compensation? Does the service have any charity-based helicopter options? There are concerns that air ambulance use is not cost-effective when compared to using road ambulance / ferries. It is recognised that there is tension between achieving best value in terms of public money and providing the service to local communities. The core activities of the Scottish Ambulance Service, including the Air Ambulance Service, are funded by an annual allocation from the Scottish Government. The Scottish Government gives a total amount to SAS, but does not specify how this is split between the different parts of the Service. There are currently no charity based air ambulance providers operating in Scotland Air ambulance costs per journey are significantly higher than land ambulance; however for many clinical conditions their cost effectiveness has been demonstrated. This comment is noted. This comment is noted This feedback will be looked at as part of the operational review, which is underway. This comment is noted. 26

28 DELIVERING SAFE AND EFFECTIVE CARE CLINICAL EFFECTIVENESS Has an evaluation been carried out on the clinical benefits and possible increased chance of survival which comes from the use of Air Ambulance resources, particularly in remote and rural areas? Does the Service measure time from call to arrival at receiving hospital? There is a view that this timeframe should be no more than four hours The Service should ensure prioritisation of patients takes place with clinicians, based on clinical need. Can the retrieval team (EMRS) play a role in prioritisation? There is a preference for physician-coordinated system based at 4 sites with specialist paediatric / neonatal unit. There should also be physician in the EMDC for tasking. PTS should not use specialist assets. Physicians should co-ordinate the dispatch of resources according to clinical need. There are many models of air ambulance services across the world, which have been researched and evaluated. The Scottish Government review of Specialist Retrieval services is considering such research. The overall patient journey is measured from time of call to time aircraft is clear at the end of the journey. The patient s journey time is dependent on the urgency of their clinical condition. The Service agrees that prioritisation of patients should always be based upon clinical need. EMRS will have a role in prioritisation of patients This feedback is already being explored through the Clinical User Forum. The Scottish Government Review of Specialist Retrieval services is considering this. As per response The Clinical User Forum is developing a set of appropriate response time standards, based upon clinical condition, which will be included in the specification for the new contract. The triage and tasking work of the Clinical User Forum will look at prioritisation of patients. This feedback is noted for the tender This will be picked up through the Clinical User Forum s Clinical Specification Paper for the tender. The first comment will be accommodated as part of the clinical triaging and tasking review work referred to above. 27

29 Aircraft should be specially-equipped for care of critically-ill patients and able to accommodate repatriation of medical escorts. The King Air aircraft is a suitable platform, if there are suitable landing strips, but would need extra equipment. Would like to see uniform platform for cross-vehicle transportation of patients. Ideally this should be able to carry oxygen and other equipment across vehicles as well. Emergency aircraft should not be used for repatriating patients Frontline clinical staff should be involved in the design, layout and equipment available on vehicles. Safe transportation of mental health emergencies and pregnancies should be a priority. Mental health patients needs are not being met. Consideration for suicidal and psychiatric patients is required. The aircraft needs to meet the many needs of the population of Barra - not just emergency but planned cases. 95% response target should not exclude outer-isles A suitable air transport platform is currently being reviewed as part of the Clinical User Forum, as the need will differ according to patient condition and clinical specialities. This comment is noted. Consultation with clinicians from a range of clinical specialities has taken place throughout this project through the Clinical User Forum. In addition, Air Ambulance staff have been consulted to gather their views about air ambulance services. The Clinical Specification Paper for the tender, which has been developed by the Clinical User Forum incorporates these issues. The Clinical User Forum is developing a set of appropriate response time The second comment the equipping of aircraft is noted for the tender Repatriation of medical escorts utilises capacity and adds to cost, therefore is not generally possible. This feedback is noted for the tender This comment is noted. This feedback is noted for the tender This feedback is noted for the tender This has been discussed with the clinical user forum and included in the clinical 28

30 The majority of inter-island transfers on Orkney do not require paramedic input Patient handling procedures not always carried out by clinical staff on smaller isles There are Health and safety concerns about handling patients, if the helicopter needs to refuel. There is no fire cover and there are inconsistent moving and handling procedures across organisations providing air ambulance response standards, based upon clinical condition, which will be included in the specification for the new contract. Skills of the paramedic may be required, since the resource is part of a national service, and may be called to a wide range of clinical conditions. Since it is operationally-focused, it will be picked up in the operational review, which is underway. The Scottish Ambulance Service complies with Health and Safety regulations. specification document, and will therefore be noted for the tender The skills of the aircraft has been discussed at the Clinical User Forum and it has been agreed that the minimum skills level should be that of a paramedic, given that the air ambulance service meets the needs of a wide spectrum of patient conditions, which are unpredictable. This will be picked up in the operational review outlined above. This feedback is noted and will be fed into the operational review as outlined above. 29

31 DELIVERING SAFE AND EFFECTIVE CARE CAPACITY OF AIRCRAFT Is there a possibility of dual-pickup of patients for patient transfers? It was felt that an increase in aircraft capacity would allow medical and family escorts to accompany the patient. The aircraft need to be bigger in size, especially to manage maternity patients. This should also take account of any feedback from clinicians. There is an issue with the size of aircraft and capacity to carry escorts with children, e.g. parents with young babies cannot both travel. Aircraft cannot take incubators for premature babies. Are guide dogs permitted on board aircraft, both rotary and fixed wing? This is current practice for both types of aircraft where possible. The Scottish Ambulance Service is reviewing its options on aircraft capacity as part of the tender The Scottish Ambulance Service is reviewing its options on aircraft capacity as part of the tender The Service acknowledges competing priorities regarding the size of aircraft: smaller aircraft can land in a greater range of locations; larger aircraft are able to land in a more limited range of locations. The Clinical User Forum has produced a Clinical Specification Paper which incorporates the views of clinicians from a range of specialities into the tender All SAS aircraft can accommodate incubators. This feedback has been passed to the Equality and Diversity Manager at the This comment is noted. This feedback is noted for the tender This feedback is noted for the tender This feedback is picked up in the Clinical Specification paper outlined above, including capacity, and is therefore noted for the tender If it is essential that a guide dog has to travel with a patient, and that the receiving 30

32 Air Ambulance helicopters cannot carry wheelchairs, including specially adapted ones. Scottish Ambulance Service for further exploration. The Service has looked at a range of NHS Boards policy on access of guide dogs to hospital. Policies are not the same across all Boards, so while the Service might be able to take guide dogs on board aircraft, it is possible that the dog will not be allowed access at the destination hospital. In cases of unplanned care, where family or friends are unable to look after the dog, organisations such as The Guide Dogs for the Blind Association can make arrangements for the care of the dog during this time. SAS aircraft are able to carry generic wheelchairs, providing they can be safely stored aboard. NHS Board s policy can accommodate this, the Air Ambulance Service would consider transportation of a guide dog, providing it can be secured according to the minimum standards set out in CAA guidelines. This feedback has been picked up in the Clinical Specification Paper developed by the Clinical User Forum. It is desirable the aircraft are able to accommodate folding wheelchairs, provided they can be safely stored by CAA-approved cargo nets. In the case of specially-adapted wheelchairs, if the user is supplied with a bespoke pressure-relieving cushion, it is essential that this is transported with the patient. The EC135 helicopter is small and not This feedback has been picked up in the 31

33 equipped to allow optimal patient care in transit, monitor patients, or to accommodate escorts. The EC135 helicopter is only suited to transfer stable patients. It could benefit from increased range and cabin size. The bigger aircraft of the Coastguard and MoD seem to cope better for Barra. Aircraft should be bigger than current (EC135 helicopter). Better range is required in order to fly to and from destinations without having to refuel or to leave behind escorts. The aircraft should have enough capacity to cater for more than one patient and their escort(s) The Scottish Ambulance Service is reviewing its options on aircraft capacity as part of the tender The task requirement of each air ambulance mission first needs to be defined, before the attributes of the aircraft required to fulfil the task can be established. The Scottish Ambulance Service is reviewing its options on aircraft capacity as part of the tender As highlighted above, there are competing priorities regarding aircraft size; larger aircraft could mean increased limitations to access because some landing strips may no longer accommodate the size of aircraft. Clinical Specification Paper developed by the Clinical User Forum, so this feedback will be noted for the tender This feedback is noted for the tender This feedback is noted for the tender Greater flying range for air ambulance aircraft is desirable. The weight thresholds of aircraft need to be clear and thought given for those patients who exceed current capabilities. The capacity of aircraft (helicopter) needs The market will determine capacity options. This feedback is noted This feedback is noted for the tender This feedback is noted for the tender 32