Memorandum of Understanding

Memorandum of Understanding Partnership Working arrangements between the Scottish Ambulance Service (SAS) and the Mountain Rescue Committee of Scotland ( commonly referred to as Scottish Mountain Rescue) Effective 1 st July 2014 1

Joint Intent This purpose of this document is to outline the general collaborative working arrangements between the Scottish Ambulance Service (SAS) and the teams affiliated to the Mountain Rescue Committee of Scotland (MRCofS). The detail contained in this document should apply to both operational and non operational activity between the two respective organisations, it is recognised however, that not all of the Land based Search and Rescue Teams across Scotland are affiliated with the Mountain Rescue Committee of Scotland and therefore the contents of this document do not apply to those individual teams that are not affiliated with MRCofS. The essence of this MOU is to improve the partnership working arrangements between the two respective organisations to ensure that the public of Scotland receive the most appropriate, timely and professional response should they be unfortunate enough to require rescue and subsequent medical treatment as a result of an adverse event in the most hostile landscapes of Scotland. Management Structure(s) In order to ensure appropriate interaction and dialogue between the two organisations, a brief explanation of the management structure is included for reference: Scottish Ambulance Service. The Scottish Ambulance Service Chief Executive is responsible to the Board of Directors for the running and performance of the ambulance service and leads a team of executive directors, based in Edinburgh. The Director of Service Delivery is responsible for the operational output of the service and leads a cohort of 6 operational general managers (5 territorial managers and the Specialist Operational Services Division comprising of Risk, Resilience, Special Operations and Ambulance Control Centres Head of ScotStar (Specialist Transport and Retrieval Service) and reports to the Chief Executive. Its key functions are the provision of both Scheduled and Unscheduled Pre-hospital care to people of Scotland utilising both land and air assets to facilitate this duty, additionally, SAS is a Category 1 responder under the Civil Contingencies Act and is duty bound to work with partner agencies to protect the people of Scotland. Mountain Rescue Committee of Scotland The MRCofS is the representative and liaison body for Scottish Mountain Rescue. It is administered by a volunteer Executive Committee and supported by a part time member of staff. It works on behalf of the General Committee whose voting members are representatives from all operational Mountain Rescue teams and a selection nonvoting members with a partnership interest in Scottish Mountain Rescue. One of it s key functions is to facilitate the provision of a civilian mountain rescue service in Scotland and to liaise closely with the Scottish Government, Police Scotland and Fire and Rescue Services across Scotland, Royal Air Force, Royal Navy, Maritime and 2

Coastguard Agency, Scottish Ambulance Service, and other partner agencies involved in Land based search and Rescue. Competencies & Assets SAS Across Scotland, the SAS has available for deployment the following assets to support unscheduled care which includes casualties involved in rescue scenarios; Over 2500 accident and emergency Ambulance staff and 900 Patient Transport Staff. A variety of road based response vehicles; o Accident & Emergency Units o Paramedic Response Units / Car & Motorcycle o Patient Transport Vehicles 3 dedicated wholetime SORT bases (North, South & East) and 2 part time teams (Inverness & Dumfries) which can deploy o SORT Response Units (based at 3 full time NRRD bases). o Specialist SORT vehicles - Forward Command & Control, Emergency Support Units, Land-rover & Polaris All Terrain Vehicles (based at 3 full time NRRD bases). 2 dedicated Air Ambulance Bases (North & West) which can deploy; o 2 x rotary wing air ambulances based at Inverness and Glasgow o 2 x fixed wing air ambulances based at Aberdeen and Glasgow o Can call on Scottish Charity Air Ambulance (rotary) based at Perth o Can also call on support from SAR/MOD helicopters when required. 3 Regional Ambulance Control Centres (ACC s) in the North, East & West of Scotland which co-ordinates the activity of Ambulance assets. Scottish Transport and Retrieval Service (ScotSTAR) that coordinates high dependency transfers of adults, paediatrics and neonates. This includes the Emergency Medical Retrieval Service (EMRS) that is able to provide consultant led medical teams with specific training in pre-hospital emergency care British Association of Immediate Care Schemes (BASICS) volunteer responders principally doctor led responses to pre-hospital emergencies Community First Responders over 1000 volunteer responders within the community The above assets are manned with staff with competencies at varying levels depending on their primary operational role; Clinical Training to Technician, Paramedic, Community Paramedic and Specialist Retrieval Paramedic Standard Air Ambulance Paramedic s are fully trained aircrew. SORT Team members in addition to clinical training, also have specialist training in; incident command, scene safety, enhanced situational awareness, safe working at height, confined space, swift water rescue [inland water 3

operations], breathing apparatus, decontamination and other inner cordon hot zone operations MRCofS MRCofS membership teams are made up of all volunteers and can deploy the following assets; 27 volunteer Mountain Rescue Teams (includes Scottish Cave Rescue) Approximately 1,000 volunteer team members 3 Police MR teams 1 RAF MR team Provide a 365 day a year, 24/7 response The above assets have the capability to provide the following; Rescue of casualties from any land scenario with particular expertise in hill and mountainous terrain Capable of deploying in adverse and extreme weather conditions. Rescue of casualties from Avalanches All terrain Search and Rescue including remote transport incidents Technical Rope Rescue Advanced Casualty Care Support to a declared major emergency It should be noted that in general, SAS staff are neither trained nor equipped to undertake search and rescue duties for casualties that are located in hostile, remote from vehicle or dangerous environments such as Mountains or Caves, rescue from these environments must be facilitated by appropriately trained and equipped individuals such as MRCofS teams, or in certain situations, SFRS and SAS SORT teams. Operational Response Requests Deployment of the Assets operated by the respective organisations is achieved as follows; Request for SAS attendance The first point of contact to request activation and support from SAS resources is via one of the three Regional ACC s, this can be achieved by either a MRCofS team member calling 999 resulting the call going to the nearest ACC or alternatively via Police Scotland who will have activated the MRCofS team to the respective incident. Details of the incident should be passed to the ACC and a rendezvous point identified (including OS grid reference if known). The ACC will task the most appropriate resource to attend the rendezvous point. Once on scene, this resource will report back to ACC using the S.A.D C.H.A.L.E.T (Survey, Assess, Disseminate; Casualties, Hazards, Access and egress, Liaison, Emergency services required, 4

Type of incident) methodology and further resource assistance will be assessed and if required, arranged and dispatched by ACC. The normal route should be for the MR team to task the Police with coordinating requests for Air Support (either HEMS or SAR), but circumstances may also dictate that requests should be directed to ACC who will pass request onto the air dispatcher at the Specialist Services Desk. Attendance of Helimed will be determined by the air dispatcher who will require identification of a suitable landing site including OS map reference. Multi-agency incidents will require the attendance of an Operational or preferably, a Tactical level Ambulance Officer to attend.. Requests for MRCofS attendance The first point of contact for SAS to request assistance from MRCofS teams will be via Police Scotland. ACC will contact Police Scotland to request activation of MRCofS team(s) to attend and support SAS resources when required. A rendezvous point will be identified for SAS and MRCofS teams to meet up and formulate and agree an incident management plan. Clinical Governance & Co-ordination It is the responsibility for each respective organisation to ensure that their staff and/or volunteers are appropriately trained and equipped to carry out the duties and pre-hospital care they are undertaking, it is that individuals responsibility to operate within their scope of practice. Appropriate Governance arrangements must be established to ensure safe and clinically effective practice is undertaken by individual team members of each organisation. This includes BASICS and EMRS staff who will operate under their respective organisation s clinical governance assurance frameworks. Scottish Ambulance Service Accident & Emergency staff are educated to Technician and Paramedic standard at Glasgow Caledonian University to Certificate in Higher Education and Diploma in Higher Education standard respectively. Clinical procedures are informed by the UK Ambulance Clinical Practice guidelines.and SAS specific guidance. In addition, all Paramedics are registered with the Health and Care Professions Council (HCPC) and Technicians must operate within the Health Care Support Worker (Scotland) Standards. First Responders will not be activated to trauma calls, but should they become involved (they may, for example, be called to a cardiac arrest) then they work under Scottish Ambulance Service guidelines and training within their scope of practice. MRC of S affiliated Team Members receive all training in house and invite external experts to deliver training as appropriate. Teams also participate in international exchanges to gain experience and expertise from other countries. Some team members are trained to deliver pre hospital first aid and trauma care and are authorised for the administration of opiate pain relief to casualties, via the existing casualty care assessment process. It is essential to ensure that a clear, concise and documented handover of casualties is carried out between MRC of S teams and SAS teams when casualties are handed over to 5

SAS staff following rescue. A casualty report form should ideally always accompany any casualty who has received treatment, especially if Opiates have been administered. A verbal handover is sufficient if the rescue and recovery operation has meant that the completion of a report has not been possible. Procurement MRC of S affiliated teams have a requirement to procure a wide range of items to support the operation of the various teams across Scotland. These items include consumables, medical gasses, Medicines and patient care equipment such as stretchers etc. To maximise financial efficiency, the Scottish Ambulance Service will assist MRC of S in this area by providing support from the Procurement Specialists in National Headquarters. Where feasible and appropriate, existing SAS suppliers will be accessed to extend SAS discounts to MRC of S purchases where possible. Scottish Ambulance Service will assist MRC of S with their procurement process in the following areas: Medical Gases: MRC of S purchases gases direct from BOC which is priced at SAS rates, invoices are attached to the SAS invoice for medical gases resulting in a significant saving for MRC of S. Medicines: MRC of S will procure medicines direct from Tayside Pharmaceuticals which are then invoice to SAS resulting in a significant savings in comparison to previous arrangements. Equipment & Consumables: Prior to ordering equipment, MRC of S should contact SAS procurement specialists for advice on sourcing their requirements. SAS procurement specialists will assist by reviewing SAS existing suppliers to establish if they can arrange procurement of the required items at a higher discounted price using the contracts / purchasing power of SAS. MRC of S will be responsible for ordering all equipment & consumables directly from suppliers. Financial Governance The Scottish Ambulance Service provides full financial support for the procurement of Medical Gases, Medicines and Equipment & Consumables incurred by Mountain Rescue Teams affiliated to the MRC of S. The Medical Lead for MRC of S (currently Dr Brian Tregaskis), co-ordinates and approves all expenditure that the Scottish Ambulance Service is requested to support on behalf on MRC of S. Scottish Ambulance Service will fund invoices approved by the medical lead only with the exception of medical gases which is already incorporated into the Scottish Ambulance Service supply invoice. 6

SAS receives funding from SGHD to support MRC of S, the funding is to the value of 100,000 recurring. SAS will provide a monthly finance statement to medical lead Dr Brian Trekaskis to assist him in monitoring expenditure from a MRC of S perspective, an example of the monthly statement is detailed as Appendix 1. Joint Training and Debriefing To promote the effective and efficient management of incidents involving both organisations, both organisations should explore and develop joint training opportunities where feasible to practice and clarify the respective roles and responsibilities of each organisation at live incidents. Any live training opportunities must be fully risk assessed and appropriate actions taken to mitigate risk, including the provision of appropriate PPE and implementation of safe systems of work. To ensure that lessons are identified, and where appropriate changes taken forward regarding specific incidents, both parties should develop joint systems and procedures to learn lessons in a structured and constructive manner. Any lessons identified should be shared across the Scottish Ambulance Service and MRCofS affiliated Teams. Monitoring & Review of MOU Both respective agencies will monitor the efficacy of the MOU on an ongoing basis, any issues identified requiring a timely amendment or alteration to the MOU should be highlighted to the signatories of the MOU in the first instance. The document should however, be reviewed on an annual basis by the leads for the respective organisations. Daren Mochrie Director of Service Delivery Scottish Ambulance Service Dr Brian Tregaskis Medical Officer Simon Steer Chair Mountain Rescue Committee of Scotland Version: 1.0 Review Date: 1 st January 2015 7