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AIR AMBULANCE RE-PROCUREMENT PROJECT Analysis of Consultation Findings Final Report October 2010 Prepared by the Communications and Engagement Team 1. Introduction In order to inform the procurement of air ambulances for 2013 – 2020, 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 2010. 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 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 2013. 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 2013 – 2020, 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 2013 – 2020, 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 specification. 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 specification. Section 4, below, outlines all feedback received throughout this consultation and engagement programme. This has been grouped by a range of common 2 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 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 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 4. Feedback received during consultation Comment SAS Response Action A NATIONAL SERVICE MEETING LOCAL NEEDS BASE LOCATION OF AIRCRAFT The aircraft that serves the route from The Scottish Ambulance Service is a Standards in the specification will be Shetland to the mainland should be no national service, operating against a applicable to the whole of Scotland, further away than Aberdeen. national response time target of 95% including its islands. 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. Aircraft which currently operate on This will be determined by the market’s . Standards in the specification will be Shetland should be kept there. This response to the tender specification. applicable to the whole of Scotland, should include the Coastguard and BP including its islands. Jigsaw (or equivalent) Would prefer air ambulance requests to Air Ambulance is a national service which Standards in the specification will be be coordinated locally on Shetland takes account of demand across the applicable to the whole of Scotland, whole of Scotland at any given time. including its islands. National Co-ordination centre has been established and review after six months indicates significantly improved co- ordination compared to local co- ordination. Would like air ambulance based on The Scottish Ambulance Service is a Standards in the specification will be 6 4. Feedback received during consultation Comment SAS Response Action Shetland for quick response and national service, operating against a applicable to the whole of Scotland, evacuation to ARI national response time target of 95% including its islands. 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 Islander aircraft was a popular The Scottish Ambulance Service is a Standards in the specification will be service on Orkney. national service, operating against a applicable to the whole of Scotland, It provided a faster response for inter- national response time target of 95% including its islands. island transfers. coverage in 60 minutes. It is felt that a Kirkwall-based service would be more responsive to the needs of The market response to the tender Orkney patients. specification will propose: It is felt that locally-based pilots would have better understanding of capabilities Location in weather conditions Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. Financial savings could be made from A proposal has been made for a The Service will review potential demand using locally-based fixed-wing service for community aircraft, which would serve for this in partnership with NHS Orkney inter-island transfers on Orkney multiple uses across the community. and Orkney Islands Council 7 4. Feedback received during consultation Comment SAS Response Action Many Orkney residents would like a The Scottish Ambulance Service is a Following the meeting on 8th July between Kirkwall-based service – could resources national service, operating against a Orkney Islands Council and the Service to be shared with Council and NHS Orkney national response time target of 95% look into this option. to achieve this? coverage in 60 minutes. Analysis undertaken last year identified The market response to the tender 368 air missions from Orkney, 60 of which specification will propose: were from the outer islands (full year data) Location Air ambulance demand this year (2010) Base for pilots identified 6 patients from the outer isles for April, 5 patients in May, and 11 in which is based on Air Ambulance Key June. Performance Indicators (KPIs), historical and predicted demand data and hospital On average there are circa 60 missions destinations. per year. The Service will review this option in partnership with NHS Orkney and OIC. It is felt that a Kirkwall-based service The Scottish Ambulance Service is a The Clinical User Forum has produced a would benefit outer Orkney isles for non- national service, operating against a Clinical Specification Paper. This includes emergencies and would free-up resources national response time target of 95% a review of clinical triaging and tasking for from Inverness. This might reduce the coverage in 60 minutes. air ambulance requests. This feedback need for Search and Rescue resources will be considered in the clinical triaging The market response to the tender and tasking work, alongside the review specification will propose: with NHS Orkney and OIC. Location Base for pilots which is based on Air Ambulance Key Performance Indicators (KPIs), historical and predicted demand data and hospital 8 4. Feedback received during consultation Comment SAS Response Action 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. Clinicians would like an aircraft based in As above As Above Orkney but fully aware of the issues regarding clinical governance and costs. It was asked if there is capacity for The Scottish Ambulance Service is a The Clinical User Forum has produced a resource to be moveable, i.e. having a national service, operating against a Clinical Specification Paper. This includes resource available locally for Orkney national response time target of 95% a review of clinical triaging and tasking for sometimes. coverage in 60 minutes. air ambulance requests. This feedback It was asked to make sure that the will be considered in the clinical triaging aviation expertise on the contract The market response to the tender and tasking work, alongside the review understands the challenges of the island specification will propose: with NHS Orkney and OIC. The training and familiarisation Location programme which will be put in place for Base for pilots the new contract will ensure the aviation expertise on the contract understands the which is based on Air Ambulance Key challenges of the island Performance Indicators (KPIs), historical and predicted demand data and hospital destinations. There is concern that the farthest north Please see the above response. As above 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 Please see the above response. As above 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 9 4. Feedback received during consultation Comment SAS Response Action present, i.e. mechanical and maintenance site. Air ambulance support is vital for the Demand trend and coverage will dictate As per response Ardnamurchan Peninsula and service the response by the market to the tender levels should be maintained. specification. The second part of the feedback is A service with critical care doctors is a The Scottish Ambulance Service is already being addressed through current provision. working in partnership with NHS Boards to partnership working with NHS Boards. deliver appropriate service provision. A helicopter could be based at Dundee to The Scottish Ambulance Service is a As per response respond to RTAs, farming accidents in the national service, operating against a east and north east of Scotland, as national response time target of 95% patients generally transferred to coverage in 60 minutes. Ninewells. 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. Acknowledge that funding for a third The market response to the tender As per response helicopter unlikely but consideration specification will propose: should be given to a Tayside base. Location Base for pilots Tender specification will include Air Ambulance Key Performance Indicators 10 4. Feedback received during consultation Comment SAS Response Action (KPIs), historical and predicted demand data and hospital destinations Would like to see physician-staffed Please see the response above. The EMRS will cover this from October helicopter based in Tayside, especially for 2010. trauma response, ST elevation MI and stroke for the east of Scotland. Passenger-only ferry to Lismore not Please see the response above. As per response 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 This will be passed on to the Scottish The DTZ report into the Emergency Aberdeen, co-located with King Air. Can Government who is leading a review of Medical Retrieval Service determined that provide primary retrieval service that the specialist retrieval services. the retrieval team should be based at one cannot be provided to North and East site in Glasgow. However this comment Scotland by Glasgow EMRS. has been fed into the specialist retrieval review. Suggest exploring sharing rotary There is currently sharing of engineering, resources with police for both financial ground staff and pilots, as well as Members of the air ambulance and operational benefits, i.e. Reducing accommodation at the Glasgow helicopter management team keep abreast of other need for ground resources and providing base. air ambulance service activities, through clinical service to rural areas. participation in a number of working groups for air ambulance services across Merit in exploring charitable funding There are ongoing discussions in the UK. These include charity-funded options, relative to industry in the North Scotland relating to the possibility of helicopters in England and Wales. The East. Est. running costs of £1.4 - £1.7m charity funded helicopters although no Clinical Users Specification states that p.a. to run a retrieval service, but could be decision has been taken. should the market recommend fixed wing reduced through co-location of King-Air and rotary aircraft in the same and rotary aircraft, and sharing resource. geographical location, then SAS supports 11 4. Feedback received during consultation Comment SAS Response Action co-location where this is practical. 12 4. Feedback received during consultation Comment SAS Response Action A NATIONAL SERVICE MEETING LOCAL NEEDS COMMUNITY RESILIENCE The Service should give consideration for This feedback is noted for the tender This feedback is noted for the tender aircraft that are more suited to island specification. specification. communities, in addition to fixed-wing. Different fixed winged aircraft needed to The tender specification will detail the Noted for the tender specification service the smaller islands. geography and logistics to be covered Island-specific needs should be This feedback is acknowledged. SAS The Clinical User Forum has produced a considered carefully when tendering. The have put in place a triage and tasking Clinical Specification Paper. This includes local hospital on Barra needs to be protocol to ensure more effective a review of clinical triaging and tasking for defined as no more than a GP practice; it deployment of air services to those air ambulance requests. does not have the facilities of a normal communities who require it. On top of this, This feedback will be considered in the hospital. Coordinating centre should have GPs will have access to the EMRS clinical triaging and tasking work. benefit of localised knowledge. consultant for additional clinical support. Would like to see faster air ambulance The response to the tender specification This feedback will be picked up through a response from the market will be based on demand review of operations, which is currently trends, coverage and KPIs. underway. Response time should be appropriate to the clinical condition of the patient. Current issues experienced on Barra were The previous Islander service was As part of the tender specification, not as pronounced when Islander service dependent on the timings of tide for potential suppliers will be asked to meet operated landing, which the EC135 is not affected key performance indicators, which are by. applicable in Barra and other Island communities Delays caused by crew changeover Response times are agreed with This feedback will be looked at during a means response time can be over 6hrs on clinicians. The average response time to review of operations, which is underway. Barra. Shift patterns should be looked at Barra is 65 minutes. SAS is currently in 13 4. Feedback received during consultation Comment SAS Response Action so that the challenges at shift changeover the process of changing the air can be mitigated. Time from call to at ambulance management team. The two patient needs to improve, more so around air area service managers will be shift change times. responsible for reviewing monthly demand in NHS Board areas including the Western ‘Standby’ pilot use should be considered Isles. Meetings will be arranged with NHS to reduce delays “out of flying hours” Boards to discuss referral patterns and pathways. 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 How will time-critical interventions such as The Scottish Ambulance Service works Will be reviewed by Clinical Users Forum thrombolysis and PCI be accounted for closely with regional services, such as when transferring to mainland centres Optimal Reperfusion Services. from Barra? 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). 14 4. Feedback received during consultation Comment SAS Response Action There are concerns about EC135 needing Standards should be applicable to all This will be built into specification to refuel, lengthy response times and parts of Scotland. inability to take escorts at times. There is a belief that this helicopter is not suited to needs of Barra, especially in poor weather. EC135 cannot fly to Orkney in icing Standards should be applicable to all This comment is noted for the tender conditions and needs to refuel. Therefore, parts of Scotland specification. response times lengthier. Helicopter use is limited by weather and This feedback is noted for the tender would like it to have capacity to fly in The Air Ambulances of the Scottish specification. adverse conditions Ambulance Service fly according to CAA rules and regulations, which limits flying in adverse weather. The contingency for adverse weather remains MOD/Coastguard Is there a real time weather system in Full consideration to all navigational This feedback is noted. place on the islands? Often the islands issues, including weather, is considered are clear but do not get an aircraft before dispatching resource. because of bad weather. It is felt that patients requiring urgent Non-emergency transfers are responded This feedback will be looked into as part transfers on Orkney often face lengthy to within a timeframe agreed with the of the operation review, which is waits as they “appear to fall to the end of ordering clinician. The average response underway, specifically in the clinical the queue” time for urgent transfers is shorter than triaging and tasking work outlined above. previously due to an increase in requests This will include a definition of “urgent” from clinicians for quicker transfers. and “emergency.” 15 4. Feedback received during consultation Comment SAS Response Action As expected, emergencies will always be prioritised over urgent jobs. Is there an option to relax clinical Patient Safety is our top priority. Clinical As per response governance guidelines for inter-isle Governance guidelines have patient transfers for Orkney? safety at their core and this should never be compromised. It was pointed out by a healthcare The triage and tasking SOP 6 sets out the As per response manager that there can be ‘misuse’ of the protocols for the use of air ambulances. air ambulance service by ordering parties Regular reviews of Orkney usage have on Orkney, as a result of occasional now been established. application more urgency than is clinically necessary ,to ensure a faster response. Highland Council would like a list of This feedback is noted. This has been picked up as an action by locations in Lochaber where we have the AAR project team. landing sites Can a Helipad be based at Campbeltown This comment is noted. This comment will be picked up as part of hospital? a review looking at landing sites across Scotland. The Service should consider community This feedback is noted. This feedback will be looked at in a review resilience: e.g. landing pads & of landing sites and against night-times transportable lights standard operating procedure. The Service should improve access by This feedback is noted. This feedback will be incorporated into a maximising landing capabilities review of landing sites. Can the Service investigate designating The air ambulance management team This comment will be picked up as part of more landing sites with requisite lights for has recently introduced Standard a review looking at landing sites. helicopters to land after dark? Operating Procedure 4: ‘Helicopter Landing Site Request’ to ensure that landing sites are developed as appropriate. Night flights seem to be an issue with the This feedback is noted. This feedback will be looked at in a review islands in general i.e. length of time the of landing sites and against night-times patient has to wait to be taken off the standard operating procedure. 16 4. Feedback received during consultation Comment SAS Response Action island by helicopter. The restriction of landing sites at night has been raised. The helicopter is not significantly faster SAS acknowledges this may be the case The Clinical User Forum has produced a than a road ambulance in Dumfries & in certain locations in Dumfries and Clinical Specification Paper. This includes Galloway. Galloway. a review of clinical triaging and tasking for In some remote and rural areas Air air ambulance requests. This feedback Ambulance is faster than a road will be considered in the clinical triaging There is a view that it is being used to ambulance response. and tasking work and improvements made achieve targets, which results in reduced when agreed, in advance of re- availability. Deployment of the Air Ambulance is not procurement used to meet response targets. New There is no published medical evidence to National co-ordination desk new support the use of helicopter transfer established at Cardonald EMDC to ensure instead of road ambulances. Therefore, a appropriate co-ordination with land coordinated local response would be ambulances. preferable. Delays are caused Demand for Air Ambulance is rising year This feedback will be looked at in the by aircraft being elsewhere, on year. course of the review of operations, which by the aircraft’s inability to fly at night and The current review of operations will look is underway. by lack of availability of crews during at triaging and tasking. working hours The Clinical User Forum is taking steps towards a solution for night-time flying. The Service should take account that All clinicians, including nurses, who make The Remote and Rural Implementation greater demand is likely in single-handed, a request for air ambulance services, will Group Strategic Options Framework is nurse practitioner practices in Orkney. be asked the clinical triage questions to designed in such a way that NHS Boards determine the best use of national air and the Scottish Ambulance Service will ambulance assets, to meet the clinical work together to undertake a gap analysis needs of the patient. and design joint services to meet the needs of remote and rural communities. As part of communication and engagement process, NHS Boards were An Air ambulance response is just one of asked what service redesign changes a number of options available and through 17 4. Feedback received during consultation Comment SAS Response Action were likely to affect future demand for the appropriate triage this will determine the air ambulance service. There was no most appropriate road and/or air indication of this issue in the reply from response. NHS Orkney. Are there contingency plans in the event Yes, The Air Ambulance management As per response of prolonged volcanic ash disruption? 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. Is hovercraft a viable back up for air A hovercraft is not in scope for this This feedback is noted. ambulance? 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. 18 4. Feedback received during consultation Comment SAS Response Action A NATIONAL SERVICE MEETING LOCAL NEEDS PARTNERSHIP WORKING Transport issues on Orkney cannot be This feedback is noted. This feedback will be picked up by the addressed by SAS by itself. NHS Orkney General Manager for the North. 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 non- emergency cases. The Service should engage with those There is a project team responsible for engagement will continue tendering for SAR to achieve efficiencies. 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 19 4. Feedback received during consultation Comment SAS Response Action is to ensure that SAR aircraft activity is co- ordinated efficiently. There will be a reduction in military assets The Ministry of Defence has assured the This feedback is noted. in future, due to ongoing foreign conflicts. Scottish Ambulance Service that military This should be considered in tendering. assets will not be reduced. SAR co-ordination is forecast to continue by the ARCC. Further comments on this can only be made following the Strategic Defence Review. It has been commented that there could A condition of the SAR-H programme to This feedback is noted. be military downsizing, which may affect replace existing SAR assets is that the on Search and Rescue capacity and could new service should be no less capable lead to a gap in resilience. 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. There are concerns about the level of The SAR-H programme should ensure Contact has been made with Mountain SAR cover, and it is felt that the new that the next SAR helicopter is fit for Rescue and a follow-up call by Air proposed helicopters for SAR are not purpose, although different characteristics Ambulance management to discuss this suitable for the Mountain Rescue role. with the new helicopter might lead to an matter has been planned. There is a concern about the contracting adjustment of existing local operating and possible effects that an unsuitable procedures.* aircraft may have as part of the overall air provision covering the North West. 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 4. Feedback received during consultation Comment SAS Response Action search and rescue helicopters be Ambulance tender. The SAR-H contract Ambulance Service will continue to developed? has been awarded, but is not yet signed, maintain its joint working activities with pending a spending review by the new SARH and MOD, using their combined government. Its duration is 20 years. The assets to respond to a variety of MOD contract is not under review till circumstances. 2012. At time of starting this process, SAR-H contract had been provisionally awarded in January 2010. 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. 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 This feedback is noted. Response provided by ARCC, RAF Kinloss 21 4. Feedback received during consultation Comment SAS Response Action thought should be given to the UK SAR aircraft for SAR operations is the Coastguard Resources being “merged” UK ARCC based at Kinloss. The into future Air Ambulance contracts or company operating the Maritime and more formal access arrangements. 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.* The Service should minimise use of While feasible, there would be cost and This feedback is noted for the search and rescue resources, since these regulatory implications associated with specification. are expensive and potentially risky, if expanding air ambulance operations to used in difficult conditions. The Service include specialist skills, such as night- should analyse alternatives: e.g. dual vision capabilities. For example, the piloting of air ambulances, night-vision Service would require CAA air operators’ capabilities. certificates, The charging policy for the use of SAR helicopters for immediate life- saving 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.* Is there a chance of overlap with other Where possible, the Scottish Ambulance The Scottish Ambulance Service will agencies, e.g. fire, police, commercial? Service works in partnership with other continue to work in partnership with other * Response provided by ARCC, RAF Kinloss 22 4. Feedback received during consultation Comment SAS Response Action agencies: e.g. with Strathclyde Police, use agencies, where possible. of BP Jigsaw helicopter. There are, however, limitations and issues around governance. For example, Strathclyde Police only cover the Strathclyde area. Where night flights are required, or flights Demand from SAS on MOD/HM This feedback will be looked at during the requiring a larger aircraft than those Coastguard is extremely variable and current operational review. operated by SAS, could the need for measures such as newly developed triage cross-charging between public sector and tasking Standard Operating organizations and administration be Procedures (SOP) as well as the landing reduced by estimating potential usage light SOP are likely to help reduce the and factoring these charges into the dependency on MOD/HM Coastguard contract funding of each body (e.g. MOD, resources and reduce this demand/cost. HM Coastguard) in advance? Many people on Orkney have highlighted The Air Ambulance of the Scottish This comment is noted. their belief that use of coastguard Ambulance Service flies according to CAA indicates that current service cannot cope rules and regulations, which means it is with current demand for air ambulance 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. The Coastguard helicopter is often MCA SAR helicopters and in many cases This feedback will be incorporated into the deployed because it is closest to scene or MOD SAR helicopters fly with a qualified Operational Review outlined above. can fly in weather/bad light, but patient paramedic on board. Additionally, the does not receive paramedic skills as a requirement for a paramedic has been result. This raises questions about equity taken into consideration within SAR-H. * of access to healthcare. The Service needs to improve Co-ordination of activity already takes Air Ambulance management will meet * Response provided by ARCC, RAF Kinloss 23 4. Feedback received during consultation Comment SAS Response Action communications between HMCG and air place between the UK ARCC, which tasks with HMCG to discuss this specific ambulance, including: SAR aircraft and Gama which tasks feedback and agree actions. visiting each other as part of training, Scottish air ambulances. contacting HMCG when on flights near Additionally, a common radio frequency coastal and remote areas to avoid conflict already exists with which air ambulances in flight paths and SAR helicopters can communicate. and maintaining current radio frequency. 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. * Response time standards should be The Scottish Ambulance Service operates Response time standards are applicable developed that can be achieved and are against response time targets which cover to all of Scotland and its islands. transparent. All islands should be included the islands. The target is a national one: in the response time targets and none 95% coverage in 60 minutes. We have should be excluded. An aircraft needs to reported against this standard for be able to respond within these times. individual inhabited islands on Orkney and The Coastguard and the MoD do not will continue to do so. provide a response any better than a Coastguard and MOD response is locally-based resource. required when SAS are unable to respond The reasons behind the need to maintain due to adverse weather, night-time flying, Infection Control will be considered in the infection control are understood, but or no resource is available. tender evaluation process urgency should be considered as more . important. Infection Control standards that limit the The use of MOD and Coastguard aircraft The Service is waiting for feedback from EC135 do not apply to MOD/CG aircraft. should only occur in the event of a life or the MOD and HM Coastguard, as well as Is this a double standard? limb-threatening emergency. Whilst it the outcome of the SAR-H contract award. would be desirable that these aircraft met * Response provided by ARCC, RAF Kinloss 24 4. Feedback received during consultation Comment SAS Response Action the same infection control standards as The air ambulance management team will Scottish Ambulance Service aircraft, due continue to work with MOD and HM to the different roles that they undertake, Coastguard managers to ensure that this is not always possible. standards are of an appropriate quality. This not only includes control of infection, The air ambulance management team but clinical standards, too. 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. 25 4. Feedback received during consultation Comment SAS Response Action A NATIONAL SERVICE MEETING LOCAL NEEDS ACHIEVING BEST VALUE In view of the fact that the Scottish Air The core activities of the Scottish This comment is noted Ambulance Service is the only one which Ambulance Service, including the Air is publicly funded, does the Air Ambulance Service, are funded by an Ambulance receive an uplift from the annual allocation from the Scottish Westminster Government to Holyrood, by Government. The Scottish Government way of compensation? gives a total amount to SAS, but does not specify how this is split between the different parts of the Service. Does the service have any charity-based There are currently no charity based air This feedback is noted. helicopter options? ambulance providers operating in Scotland There are concerns that air ambulance Air ambulance costs per journey are This feedback will be looked at as part of use is not cost-effective when compared significantly higher than land ambulance; the operational review, which is to using road ambulance / ferries. however for many clinical conditions their underway. cost effectiveness has been demonstrated. It is recognised that there is tension This comment is noted. This comment is noted. between achieving ‘best value’ in terms of public money and providing the service to local communities. 26 4. Feedback received during consultation Comment SAS Response Action DELIVERING SAFE AND EFFECTIVE CARE CLINICAL EFFECTIVENESS Has an evaluation been carried out on the There are many models of air ambulance As per response clinical benefits and possible increased services across the world, which have chance of survival which comes from the been researched and evaluated. The use of Air Ambulance resources, Scottish Government review of Specialist particularly in remote and rural areas? Retrieval services is considering such research. Does the Service measure time from call The overall patient journey is measured The Clinical User Forum is developing a to arrival at receiving hospital? There is a from time of call to time aircraft is clear at set of appropriate response time view that this timeframe should be no the end of the journey. The patient’s standards, based upon clinical condition, more than four hours journey time is dependent on the urgency which will be included in the specification of their clinical condition. for the new contract. The Service should ensure prioritisation of The Service agrees that prioritisation of The triage and tasking work of the Clinical patients takes place with clinicians, based patients should always be based upon User Forum will look at prioritisation of on clinical need. Can the retrieval team clinical need. patients. (EMRS) play a role in prioritisation? EMRS will have a role in prioritisation of This feedback is noted for the tender patients specification. There is a preference for physician-co- This feedback is already being explored This will be picked up through the Clinical ordinated system based at 4 sites with through the Clinical User Forum. User Forum’s Clinical Specification Paper specialist paediatric / neonatal unit. There for the tender. should also be physician in the EMDC for tasking. PTS should not use specialist assets. Physicians should co-ordinate the The Scottish Government Review of The first comment will be accommodated dispatch of resources according to clinical Specialist Retrieval services is as part of the clinical triaging and tasking need. considering this. review work referred to above. 27 4. Feedback received during consultation Comment SAS Response Action Aircraft should be specially-equipped for The second comment the equipping of care of critically-ill patients and able to aircraft is noted for the tender accommodate repatriation of medical specification. escorts. The King Air aircraft is a suitable platform, Repatriation of medical escorts utilises if there are suitable landing strips, but capacity and adds to cost, therefore is not would need extra equipment. generally possible. Would like to see uniform platform for A suitable air transport platform is This feedback is noted for the tender cross-vehicle transportation of patients. currently being reviewed as part of the specification. Ideally this should be able to carry oxygen Clinical User Forum, as the need will differ and other equipment across vehicles as according to patient condition and clinical well. specialities. Emergency aircraft should not be used for This comment is noted. This comment is noted. repatriating patients Frontline clinical staff should be involved Consultation with clinicians from a range This feedback is noted for the tender in the design, layout and equipment of clinical specialities has taken place specification. available on vehicles. throughout this project through the Clinical User Forum. In addition, Air Ambulance staff have been consulted to gather their views about air ambulance services. Safe transportation of mental health The Clinical Specification Paper for the This feedback is noted for the tender emergencies and pregnancies should be tender, which has been developed by the specification. a priority. Mental health patients’ needs Clinical User Forum incorporates these are not being met. Consideration for issues. 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 The Clinical User Forum is developing a This has been discussed with the clinical outer-isles set of appropriate response time user forum and included in the clinical 28 4. Feedback received during consultation Comment SAS Response Action standards, based upon clinical condition, specification document, and will therefore which will be included in the specification be noted for the tender specification. for the new contract. The majority of inter-island transfers on Skills of the paramedic may be required, The skills of the aircraft has been Orkney do not require paramedic input since the resource is part of a national discussed at the Clinical User Forum and service, and may be called to a wide it has been agreed that the minimum skills range of clinical conditions. 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. Patient handling procedures not always This feedback is noted. Since it is This will be picked up in the operational carried out by clinical staff on smaller isles operationally-focused, it will be picked up review outlined above. in the operational review, which is underway. There are Health and safety concerns The Scottish Ambulance Service complies This feedback is noted and will be fed into about handling patients, if the helicopter with Health and Safety regulations. the operational review as outlined above. needs to refuel. There is no fire cover and there are inconsistent moving and handling procedures across organisations providing air ambulance response 29 4. Feedback received during consultation Comment SAS Response Action DELIVERING SAFE AND EFFECTIVE CARE CAPACITY OF AIRCRAFT Is there a possibility of dual-pickup of This is current practice for both types of This comment is noted. patients for patient transfers? aircraft where possible. It was felt that an increase in aircraft The Scottish Ambulance Service is This feedback is noted for the tender capacity would allow medical and family reviewing its options on aircraft capacity specification. escorts to accompany the patient. as part of the tender specification. The aircraft need to be bigger in size, The Scottish Ambulance Service is This feedback is noted for the tender especially to manage maternity patients. reviewing its options on aircraft capacity specification. This should also take account of any as part of the tender specification. The feedback from clinicians. 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 specification. There is an issue with the size of aircraft All SAS aircraft can accommodate This feedback is picked up in the Clinical and capacity to carry escorts with incubators. Specification paper outlined above, children, e.g. parents with young babies including capacity, and is therefore noted cannot both travel. for the tender specification. Aircraft cannot take incubators for premature babies. Are guide dogs permitted on board This feedback has been passed to the If it is essential that a guide dog has to aircraft, both rotary and fixed wing? Equality and Diversity Manager at the travel with a patient, and that the receiving 30 4. Feedback received during consultation Comment SAS Response Action Scottish Ambulance Service for further NHS Board’s policy can accommodate exploration. this, the Air Ambulance Service would consider transportation of a guide dog, The Service has looked at a range of NHS providing it can be secured according to Boards’ policy on access of guide dogs to the minimum standards set out in CAA hospital. Policies are not the same across guidelines. 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. Air Ambulance helicopters cannot carry SAS aircraft are able to carry generic This feedback has been picked up in the wheelchairs, including specially adapted wheelchairs, providing they can be safely Clinical Specification Paper developed by ones. stored aboard. 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 is noted. This feedback has been picked up in the 31 4. Feedback received during consultation Comment SAS Response Action equipped to allow optimal patient care in Clinical Specification Paper developed by transit, monitor patients, or to the Clinical User Forum, so this feedback accommodate escorts. will be noted for the tender specification. The EC135 helicopter is only suited to The Scottish Ambulance Service is This feedback is noted for the tender transfer stable patients. It could benefit reviewing its options on aircraft capacity specification. from increased range and cabin size. as part of the tender specification. The bigger aircraft of the Coastguard and The task requirement of each air This feedback is noted for the tender MoD seem to cope better for Barra. ambulance mission first needs to be specification. Aircraft should be bigger than current defined, before the attributes of the (EC135 helicopter). Better range is aircraft required to fulfil the task can be required in order to fly to and from established. destinations without having to refuel or to leave behind escorts. The aircraft should The Scottish Ambulance Service is have enough capacity to cater for more reviewing its options on aircraft capacity than one patient and their escort(s) as part of the tender specification. 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. The market will determine capacity options. Greater flying range for air ambulance This feedback is noted. This feedback is noted for the tender aircraft is desirable. specification. The weight thresholds of aircraft need to This feedback is noted This feedback is noted for the tender be clear and thought given for those specification. patients who exceed current capabilities. The capacity of aircraft (helicopter) needs 32 4. Feedback received during consultation Comment SAS Response Action to be considered, as it is not big enough for multiple transfers It would be helpful if the capacity of the This feedback is noted. This feedback is noted for the tender lifting mechanism was increased. specification. 33 4. Feedback received during consultation Comment SAS Response Action DELIVERING SAFE AND EFFECTIVE CARE PATIENT COMFORT The air ambulance could be more This feedback is noted. This feedback is noted for the tender comfortable for patients: e.g. warmer, specification. more blankets on board, reduced noise. Wearing ear protectors when unwell and There is no legal requirement for patients This feedback will be picked up as part of in pain can cause distress. to wear hearing protection during flight, the operational review, which is although it is available if required. There underway. is, however, health and safety legislation which requires patients to wear hearing protection when flying on MOD/ Coastguard helicopters. A heating system on board which could King Air aircraft are equipped with an This feedback will be picked up as part of be used while the aircraft is static would electric heating system for use while the the operational review, which is improve patient comfort aircraft is stationary. In order to use this underway. on the ground, the aircraft has to be connected to a separate Ground Power Unit (GPU), which are generally located at the main airports in Scotland, but are not routinely found on outlying islands, particularly in the middle of the night during an out of hours callout. In addition, the process for using the GPU requires training and adds delays to patient loading for the short duration whilst they are on the ground. For these reasons, unless there is a specific medical need, the heating systems are not routinely used on the ground. 34 4. Feedback received during consultation Comment SAS Response Action King Airs are fitted with Ground Use Batteries to provide power for aircraft cabin lighting and for the powered loading system whilst the main engines are turned off, and which are recharged during flight. However, for the King Air’s electric heating system, the current requirements are such that it would drain the aircraft’s batteries very quickly, making this impractical. The EC135 helicopters have full heating systems throughout the cabin which operate through a heat exchanger in the engine. For this reason, when the aircraft is grounded, there is no additional heat. 35 4. Feedback received during consultation Comment SAS Response Action COMMUNICATIONS AND CONTACTING US COMMUNICATION BETWEEN HEALTHCARE PROVIDERS Communication between support desk This comment is noted. The Service will respond to this feedback and hospital wards could be improved to through staff training and development. ensure appropriately trained staff are available. Communication of aircraft arrival times to This feedback is noted. The Service will respond to this feedback patients should be improved. through staff training and development. There is a perceived lack of This feedback is noted. The Service will respond to this feedback communication between dispatch and through staff training and development. local medical staff regarding ETA Feedback on ETA to GP can take over The national Co-ordination desk at The Service will respond to this feedback one hour, should be relayed quicker. Cardonald is aware of this feedback and through staff training and development. has taken steps to improve communication. Communication between EMDC and Islay This feedback is noted. The Service will respond to this feedback & Jura clinicians could be improved. through staff training and development. Feedback should be given to a hospital or a clinician when a patient is taken to a hospital other than the one originally requested. Could the helicopter be tracked like a We are investigating the possibility of This feedback is noted for the shipping company? i.e. when a local tracking aircraft as part of the tender for specification hospital or health care department the new contract. requests the helicopter they are given a patient number - this number can be entered into a website for flight schedule updates delays where it is in the air or refueling etc. 36 4. Feedback received during consultation Comment SAS Response Action Physicians should be regularly updated This feedback is noted. The Service will respond to this feedback on the progress of air ambulance. through staff training and development. Frustrations can arise because of lack of clinical knowledge of dispatch staff. Unhappy at challenges to air ambulance requests, as often road ambulances are not readily available in certain areas. Doctors sometimes have to argue with This comment is noted. The Service will respond to this feedback dispatch in front of patients when through staff training and development. requesting air ambulance The service could be better integrated This comment is noted. The Service will respond to this feedback across dispatch activity, hospitals, and air through staff training and development. ambulance There is a concern over the Air Desk This comment is noted. Co-ordination of flying will be reviewed as operation being located at Farnborough, part of the specification. which means having to contact EMDC initially, then liaise with Farnborough, who at times may not have a full understanding of the climate, terrain etc, and do not make best use of the knowledge and expertise provided by the ordering clinician There is a perception that lack of local This feedback is noted. The Service will respond to this feedback knowledge in control staff may cause through staff training and development. delays on remote islands Sometimes a lack of local knowledge in These comments are noted. This feedback will be picked up as part of EMDCs, e.g. sometimes unaware of the the operational review, which is availability of Basics GPs or the distance underway. to A&E in rural areas Could dispatchers have local information Dispatchers currently have access to ferry The Service will respond to this feedback to hand, e.g. ferry details, in order to help details and a knowledge of this kind of through staff training and development. decide whether tasking air ambulance information. A new air ambulance triage 37 4. Feedback received during consultation Comment SAS Response Action appropriate? and tasking Standard Operating Procedure (SOP) 6 has been implemented within the National Coordination Centre which offers other appropriate transport, e.g. road and ferry 38 4. Feedback received during consultation Comment SAS Response Action COMMUNICATIONS AND CONTACTING US PUBLIC AWARENESS Performance audits should be robust and This feedback is noted. This feedback will be picked up in the transparent to aid communication with operational review. stakeholders. Could be carried out by flight paramedic or doctor with outreach role. Satisfied with air ambulance overall and This feedback is noted. This feedback is noted. would like to see continuous audit of use and discussions of alternative options. Would like SAS to supply regularly This feedback is noted. This feedback is noted. updated data on air ambulance response times. Does the service have information on air The Scottish Ambulance Service carries This comment is noted. ambulance activity to support required out regular demand analysis. provision? Could demonstrate to the public the This feedback is noted. This is an issue This feedback is noted. difference in costs between Fixed Wing of cost, capacity and reach – these are and Rotary aircraft to help them consider inter-dependent factors. what would be best option for their community. The Scottish Ambulance Service provides a national Air Ambulance Service, which will be reflected in the tender specification. 39 4. Feedback received during consultation Comment SAS Response Action COMMUNICATIONS AND CONTACTING US CONTACTING THE SERVICE A clear definition should be available as to This feedback is noted. The Scottish Ambulance Service is when an air ambulance should be used. developing communications to address There needs to be a clear definition of this. what the air ambulance service does, especially around the “non-emergency” patients. Concern over potential problems deaf This feedback is noted. Work is underway to look at SMS text patients may have in contacting the options. Ambulance service in an Emergency. Unhappy with current complaints This feedback is noted. The complaints process has been procedures, as there is a belief that the reviewed and improved. service can be unresponsive. Would like standardisation as to whether Anyone requiring an emergency response SAS Communications team will liaise with island residents should contact 999 or should dial 999. NHS Orkney about communications their GP in an emergency, and guidance requirements for the public. as to what constitutes an emergency. Would like input post-consultation to help There has been a comprehensive As per response tailor aircraft to need and environment for communications and engagement Orkney process across the whole of Scotland, including Orkney. Representative from Orkney will be involved in the tender evaluation and there will be further engagement as the preferred design is selected through to and beyond implementation Will there be an additional opportunity to There has been a comprehensive As per response challenge consultation findings and communications and engagement 40 4. Feedback received during consultation Comment SAS Response Action reasoning? process across the whole of Scotland, including Orkney. Representative from Orkney will be involved in the tender evaluation and there will be further engagement as the preferred design is selected through to and beyond implementation 41
"AIR AMBULANCE RE PROCUREMENT PROJECT"