20 Years By Your Side

For the last 20 years we have been by the side of people across Dorset and Somerset and you have been with us all the way. We have been tasked to thousands of missions and have helped to save so many lives. During this time, our service has been able to improve and enhance beyond recognition; none of this would have been possible without your support!

The need for our service is rising year on year; we must make sure we continue to be there for the next 20 years and beyond. Your support is vital; we simply can’t do this without you!

We would love you to join us today and support our '20 Years By Your Side' Campaign!

Your donations and brilliant fundraising really do make a difference to patients' lives, thank you!

Changing our clinical model of operation from the twin-paramedic model to that of a critical care team took time, planning, investment and teamwork...

Dr Farhad Islam (Izzy) was the first doctor to fly with DSAA, joining in 2007 on a part-time basis, having just started as an Emergency Medicine Consultant at the Royal Bournemouth and Poole Hospitals. As a junior doctor learning his trade, Izzy had attended the Paddington rail crash and was amazed at the service provided by the London HEMS team. He geared his whole career from then on to make sure he became an air ambulance doctor. During his time as a HEMS doctor, Izzy realised that most air ambulance paramedics did not get much recognition for what they could do.

They were often more experienced than doctors simply because of the nature of the cases they were seeing, yet they were unable to perform the same range of clinical procedures. Izzy was determined to change this and was responsible for initiating a project that would see DSAA fund a unique, university-accredited education programme for eight paramedics.

In 2011 we started looking at ways to develop our clinical capability. Bearing in mind, we were still strategically committed to a twin-paramedic model of delivery, we decided that the best way forward was to look at ways of ‘upskilling’ our paramedics; helping them to be the best that they could possibly be. We elected for a unique post-graduate education programme resulting in a three-year MSc Advanced Paramedic Practice (Critical Care) qualification, funded by the charity and run in partnership with the University of Hertfordshire, SWASFT and a number of NHS hospital trusts across the region. Increasing a paramedic’s patient assessment skills, widening their knowledge of drugs, improving their diagnostic abilities, advancing their management of pain and becoming better at clinical decision-making, were deemed as key factors behind the project.

To set things in motion, we had to recruit a group of senior critical care doctors to come and work with the paramedics, although not many doctors were trained in HEMS in Dorset and Somerset at this stage. Service level agreements were set up with local hospitals and consultants were employed for three days a week to help train the paramedics.

The programme started in 2013. One of the unique elements was that the education and training was largely delivered at our  Henstridge airbase and not in the university classroom. This enabled mentoring to take place both on land and in the air. Hospitals provided short placements for the paramedics, to help them gain first-hand experience of conditions and treatments that they may not necessarily have encountered with the air ambulance. This involved practical, on the job learning with a senior clinician, either an anaesthetist, an intensivist (a physician who specialises in critically ill patients) or an emergency physician. To gain competencies, the paramedics spent time in intensive care units, in theatres observing operations and anaesthetics and in the emergency departments of district hospitals and major trauma centres.

From the outset, we gathered data to examine what impact adding doctors to the mix had on our clinical delivery. What was soon apparent was that this was very much a two-way learning process, with the doctors learning just as much from the paramedics. Paramedics, for example, are well-versed in scene management and are used to leadership at the roadside; dealing with the police, the public, fire and rescue and other professionals on scene. They are also experienced in dealing with multiple casualties or treating patients in challenging locations, such as a car that has rolled over, whereas most doctors were more used to operating within a  relatively safe hospital environment. Within a very short time, it was clear that the enthusiasm of the paramedics for the exposure they were getting to high-grade consultant mentorship in real-world experience, coupled with the consultant’s complete buy-in was delivering much more than the sum of the parts.

Our investment into education and training has undoubtedly improved the quality of care we are delivering to patients across the south west of England. In 2015, our commitment to the project was recognised nationally when we won a Health Service Journal Award for ‘Improving Outcomes through Learning and Development’. Another consequence of its success was the establishment of a new tier of paramedic within the South Western Ambulance Service; the critical care paramedic.

We were, of course, not the first air ambulance charity to have doctors as part of our team. However, others often use the term ‘doctor on board’ or ‘doctor led’ and this did not sit comfortably with our team ethos. Therefore, in 2015, we embarked on a restructuring exercise which saw the formal creation of a ‘critical care team’.

NEXT: A busy year: 2016