Clinical Update Autumn 2019 Last year, DSAA were tasked to 1,394 incidents. We administered pre-hospital anaesthesia to 140 patients, 41 patients were given 138 units of blood and plasma to treat their life-threatening bleeding and we flew 15 time-critical inter-hospital transfers. Our team continues to provide 19 hours a day coverage with two shifts per day, seven days a week. This 100% Critical Care Team (consisting of at least a Doctor and Practitioner on each shift) has been continuously maintained since April 2016 and provides our ambulance service colleagues with an absolute dependable pre-hospital service. There are some excellent examples of how patients’ lives have been made better by the work of our team throughout this edition of Beeline. Outreach and Training Our Outreach programme continues to be popular, with many other agencies joining our extensive programme of events. Every opportunity we have to interact with our ambulance service colleagues, emergency services agencies and the general public is an opportunity to share the full extent of the capabilities of our team. It continues to build trust and promotes teamwork between all parties; this in turn enables us to reach and treat so many more patients that might need our help. Alongside our normal Outreach programme, we began a five-month trial of a road-based enhanced care capability, which began in April 2019, led by Neil Bizzell and Owen Hammett. A car has been based at St Leonards in Dorset, operational 12 hours a day, seven days a week. The primary intent of this trial is to provide a tangible outreach resource to the region. The service has been very busy, with at least two incidents per day being attended by a DSAA practitioner in the enhanced care car. This has provided the most powerful of outreach opportunities, demonstrating what care pathways are available for patients and building further trust between the region’s clinicians. Many collaborative education sessions have been achieved and the service has received excellent feedback from emergency service teams in the Bournemouth and Poole area. The enhanced care car trial is also proving extremely helpful to patients; our practitioners have provided rapid resuscitation, advanced pain relief and procedural sedation for traumatic injuries, and early antibiotics for sepsis. When patients are assessed by the practitioner as needing critical care, the practitioner mobilises the DSAA Critical Care Team. In this way, patient pathways for critical care delivery have been streamlined. Team training over the past few months has covered inter-hospital transfer for children and adults, surgical skills, airway management, team resilience and communication, crew resource management and aviation. The aviation training provided an essential update to crew resource management and an important insight into the use of drones by the police. Simulated Training at Compton Abbas In June, our Critical Care Team took part in a joint simulated training exercise with Compton Abbas Airfield, along with firefighters from Dorset and Wiltshire Fire and Rescue Service. The evening was a great success and enabled all teams to work together in order to manage a challenging incident; in this case it involved a ‘mayday call’ being received from a light aircraft in distress. The exercise began with the operational staff at Compton Abbas Airfield taking details of the mayday call, followed by activation of their Incident Response Team and on-site fire appliance. Shortly afterwards, Dorset and Wiltshire Fire and Rescue Service attended in their own appliance and assisted with the management and safety aspects on scene. Our team were next to attend and were faced with three casualties who had been extricated from the aircraft; one with a severe head injury, one walking wounded and another with less severe injuries. Our clinicians provided critical care interventions including airway management and drug administration. The evening concluded with a debrief session and group discussions. Our thanks go to Peter Beange at Compton Abbas Airfield for such a successful collaborative exercise and we hope to be able to participate in more training exercises in the future. Watchet Sea Scouts We were delighted to welcome a group of explorer scouts from 1st Watchet Sea Scout Group (RN63) to Henstridge back in February. Jo Hernandez gave them a fantastic presentation, which detailed the planning of missions, both during the day and at night. She then demonstrated various pieces of medical equipment and allowed the youngsters to see and practise the intubation of a simulated manikin with a video laryngoscope. “The visit to Dorset and Somerset Air Ambulance was a massive eye opener for us all. Our scouts have recently completed their RYA First Aid Course, so it was wonderful for them to see how their newly learned life-saving skills can be combined with the advanced skills, equipment and speed of response from Dorset and Somerset Air Ambulance. “Some of our scouts have previously gone on to become coastguards and RNLI crew, so it stands to reason that, in the future, some of these young people may well work with the air ambulance. Having an insight into the work and capabilities of the Critical Care Team may well prove vital in the future. “In our party, we also had a young leader who happens to be a first year Student Nurse and she was really interested in the career opportunities available within the sector. Another one of our explorers is very keen to become a paramedic and this trip really spurred on his ambition. Seeing the levels of dedication and service provided by Dorset and Somerset Air Ambulance and knowing that it is funded by the kindness of the public is difficult to comprehend. Personally, I found the visit very humbling.” Simon Greenway, Group Leader RNLI Lifeguards Stuart Cox and Lauren Dyson hosted a group visit of RNLI lifeguards from Weymouth in June. Both are ex-RNLI lifeguards themselves, so they knew some of the specific learning objectives that might complement the youngsters’ training programme. They discussed the clinical capabilities of our team, helicopter landing site procedures, aircraft familiarisation and assistance in loading a patient onboard the aircraft. The group also went through a typical scenario, which would benefit the air ambulance attending if it was to occur near the beach and while the lifeguards were on shift. “A big thank you to Stu and Lauren for once again facilitating our visit to Henstridge. It was, as always, extremely beneficial. We hope to not see you during the summer (in the nicest possible way), but great to know that you are there if we need you.” Alice, Dom and the Weymouth and West Dorset RNLI Lifeguards. Welcome Our Training Team has recently been strengthened with the addition of Mark Case. Mark is an Advanced Nurse Practitioner working within the Emergency Department at the Southampton Major Trauma Centre and has more than 10 years of experience running medical education programmes across the Wessex region. Training is of central importance as it binds the team together, helps to standardise and innovate care and provides psychological resilience. The latter is increasingly important as our team attend more and more terribly injured or ill patients. From April, our Research Team has been led by Professor Rob Crouch. Rob is a Consultant Nurse within University Hospital Southampton and has extensive experience in emergency practice and within emergency care research. Rob also has strong links into the National Institute for Health Research (NIHR) at a regional and national level. Commitment Our thanks go to everyone based at Henstridge and the part they play in making sure that our service is the best it can be. The team’s commitment, detail and professionalism is exceptional and every member either leads or supports significant projects for the benefit of our patients.