Docstoc

AIR AMBULANCE RE PROCUREMENT PROJECT

Document Sample
AIR AMBULANCE RE PROCUREMENT PROJECT Powered By Docstoc
					 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

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:24
posted:11/24/2011
language:English
pages:42