Edition 3 Winter 2009 INSIDE AMBULANCE HART Hazardous Area Response Team HART Urban Search Make a note! and Rescue INNER CORDON 2010 See Page 9 www.ambulancehart.org AMBULANCE HART Editi on 3 Winter 2009 2 HART: A VALUABLE PART OF THE AMBULANCE SERVICE Russ Mansford, Strategic Ambulance Advisor to the Welcome to the third edition of Inside HART. Department of Health and HART As you flick through this issue you will notice a significant focus on the HART Urban Search and Rescue (USAR) capability Programme Lead. - one of the main aspects of our service that is genuinely out of the ordinary realm of ‘normal’ ambulance responses. Dealing with incidents where patients are I have heard reports on the grapevine of specialist training and personal willingness to difficult to access, trapped underground or in concerns that HART are sometimes seen as an go into dangerous, hazardous environments collapsed structures or are injured at height, is ‘elite’ band of ambulance personnel. As the you can be sure they will be ready to respond. obviously particularly challenging for any team person in charge of rolling out HART teams of paramedics. It requires specialist training across all NHS ambulance trusts I would like to I believe we should all take comfort from and specialist equipment to provide life-saving use this opportunity to categorically state that the fact that we are now moving towards an clinical assessment and care at the point of they are not! HART teams are composed of ambulance service that has the genuine rescue – especially when it could take several ordinary paramedics who are trained, equipped capability to provide more innovative clinical hours to extract the patient concerned. and prepared to do extraordinary things to interventions than ever before through HART. save the lives of seriously injured patients. The HART programme is a major good news On-scene, the HART team must quickly achieve story for the ambulance service, and its the respect and support of their fire and rescue Of course large major incidents don’t happen introduction significantly enhances the civil colleagues. In a pressurised environment this is every day (and thank goodness they do not) but contingency infrastructure of the UK. It is not never going to be easy but from day one we HART teams will not be sitting around twiddling to be seen as a separate, ‘elite’ team but as have trained our teams alongside fire and their thumbs. A number of incidents each day a valuable and welcome part of the whole rescue colleagues, and both groups have tend to have something of the unusual about ambulance service. benefited from this close working relationship. them where the additional knowledge and Indeed, for many years ambulance services equipment HART personnel have can be put to I hope you enjoy this edition of Inside HART. have worked closely with their emergency work, supporting other responders or releasing services partners and HART is simply an colleagues to get on with the demand of Cat A extension of this pattern. calls. When the call comes in requiring their Advertise in this magazine! Inside HART is one of the most targeted ways to reach the key decision makers and buyers within the UK emergency response community. 15,000 copies of Inside HART are printed and distributed to an estimated readership of around 30,000* people (*unaudited figure at time of press) working in the civil contingency and emergency preparedness fields, such as: HART Managers and HART operatives Senior people in the Department of Health and at the Home Office HART QUIZ RAISES £742 FOR HEROES Staff at all NHS ambulance service trusts in England, and at trusts in Scotland and Wales The regular pub quiz held in the Sergeant’s Mess at the HART Training Clinicians involved in emergency and urgent care Faculty at Winterbourne Gunner has raised a magnificent £742 for the Police, Fire and Rescue Service professionals Help for Heroes charity. Civil contingency responders and emergency planning leads The quiz is held regularly with participants from the military and HART across the NHS and local government teams and is a welcome distraction from the rigours of the day’s Those with responsibility for planning for (or responding to) exercises. HART trainer Clayton Blight, who organised the donation to a chemical, biological, radiological, nuclear or Help for Heroes, is shown here presenting the £742 to Fiona Gilbert explosives (CBRNE) threat or incident from the charity on 08 December. Military personnel (such as Military Liaison Officers) Urban Search and Rescue teams HART Training Lead Dave Bull would like to thank the Training Faculty HM Coastguard and related marine agencies and participants for raising funds to support Help for Heroes, and the Academics and researchers. RSM and staff in the Sergeant’s Mess for the use of the venue. For a media pack, please contact [email protected] LONG WAY DOWN or telephone 01273 328140 or 07958 547727. This issue’s front cover shows the Yorkshire HART team in action at an urban search and rescue (USAR) exercise with West Yorkshire Fire and Rescue Service at Wainhouse Tower in Halifax in December. The Grade II Listed building is 253ft high and has 403 steps inside. Photo credits: West Yorkshire Fire and Rescue Service. INSIDE HART AMBULANCE HART Editi on 3 Winter 2009 3 HART ‘SHOW NEWS LINES AND TELL’ AT HEALTH HART news in brief PROTECTION CONFERENCE The first ever HART Conference will be held next June 10-11 at Liverpool’s BT Convention Centre as part of a special event called Inner Cordon 2010. Organised by the HART Project Team, the event will be a central forum for HART team members from East Midlands all things HART-related and will be of interest to senior ambulance staff, and West Midlands Ambulance Services HART teams and their multi-agency colleagues in fire and police. joined forces with the West Midlands Fire and Rescue Service’s Detection, Yorkshire Ambulance Service’s HART Manager Mick Hardaker was Identification and Monitoring (DIM) team in September to give Health interviewed by ITV Calendar at an RAF exercise his team were taking part Protection Agency conference delegates in. “It was only short,” says Mick, “but I managed to get a mention of a taste of the specialist services they HART in there!” can now provide. Paul Stevens started work as the HART Manager for South Central Ambulance Service in October and has been spreading the HART word ever since as he orchestrates the Trust's HART recruitment drive. A HART Exchange Programme is being established to enable HART The event - Health Protection 2009 – took personnel to spend time and learn lessons from HART teams in other place on 15th September 2009 at the University of Warwick, with regional HART ambulance trusts. HART instructors will also get the opportunity to do teams being asked along to demonstrate the learning exchanges with similar faculties in other countries. following to delegates: A HART Forward Command Vehicle The HART presence at the Emergency Services Show 2009 at Coventry in – the most technologically advanced ambulance service vehicle ever produced November was a resounding success, with many of the 4,200 visitors to the show stopping to chat to HART team operatives from East Midlands, West A HART USAR vehicle (the all-terrain Nissan Navarra filled with specialist urban Midlands and Yorkshire Ambulance Services. search and rescue kit) A HART personnel carrier HART teams from Yorkshire and the North East joined forces with the HART team and other ambulance staff from North West Ambulance Service as A HART heavy equipment vehicle part of the emergency response to the severe flooding in the Cumbria area. Specialist equipment such as multiple oxygen delivery units and PPE. Lord West, the Parliamentary Under-Secretary for Security and Counter- The West Midlands Fire and Rescue Service terrorism at the Home Office, has agreed to be the keynote speaker at Detection, Identification and Monitoring Inner Cordon 2010, the first ever HART Conference which will be held (DIM) team, with whom HART teams work closely, (eg: at white powder and suspect 10-11 June, 2010. chemical spillages) brought along their DIM vehicle. This carries specialist analytical equipment used for identifying the presence The London Ambulance Service HART team boarded British Airways flight of substances, working out what they might BA184 from Newark, US in November after several passengers mysteriously be and how dangerous they are to personnel. The team also demonstrated their own fainted during the flight. The team were wearing protective suits due to personal protective equipment (PPE). the risk of a hazardous materials incident. After the event, Dr John Simpson, Deputy Director of Emergency Response at the Health A special online monitoring and evaluation tool called PROCLUS has been Protection Agency wrote to say, “I was very developed by the central HART project team. It was successfully piloted and pleased to see how many people attended the HART show and tell, and also there has been a then launched in Trusts in November. lot of very positive feedback about how informative and interesting the demonstration was. I am wondering whether we could make In September, representatives from HART teams across the country joined something similar an annual event.” hundreds of other mourners at the funeral of one of the first wave of London Ambulance Service HART Paramedics, Steve Wright, who was just 41 years old. Steve was an extremely popular and dedicated colleague who will be sadly missed. AMBULANCE HART - HAZARDOUS AREA RESPONSE TEAM www.ambulancehart.org AMBULANCE HART Editi on 3 Winter 2009 4 URBAN SEARCH AND RESCUE: WHAT IS IT? Urban Search and Rescue (USAR) is nothing new. During the Blitz, rescue workers used USAR principles to rescue casualties trapped within Jamie Fountain, collapsed buildings following the World War 2 bombings and to a certain HART USAR Lead extent some of these principles are still used today, alongside advanced technology and modern incident management principles. For some time, several organisations have Propping and shoring can be implemented to responded to disasters around the world with stabilise structures and reduce the risk of USAR teams to help those in need following further collapse; lifting and moving covers earthquakes and other major events. methods of safely moving large or heavy objects - again using a combination of cutting However what is new is the UK approach to edge technology alongside long standing implementing USAR for domestic resilience. principles. The Fire and Rescue Service’s New Dimension programme covered several disciplines During HART USAR training, operatives gain including USAR and in 2006 it was looking to an understanding of the role of FRS USAR include advanced pre-hospital care within its teams and develop methods of working USAR response. The concept of HART USAR alongside each other to the benefit of patient was formed. care. HART are also therefore able to support FRS colleagues in what can be extremely USAR can be defined as, ‘operations that challenging conditions. We are fortunate to involve the search for and rescue of people have been able to develop an extremely good in the urban or built-up environment, often - training faculty of dedicated trainers - with a although not always - resulting from a mix of international experience and current structural building collapse.’ The environment HART operatives who work alongside multi- The course is based around a ‘building block’ may require operatives to work in areas that agency subject matter experts to deliver the approach which ensures the candidates have are unstable, in confined spaces, or at height. training. the relevant theoretical underpinning knowledge and different aspects are Having USAR-trained personnel within HART The course covers many relevant topics introduced logically to form the package of teams means that paramedics can safely enter including health and safety, dynamic risk HART USAR training. Candidates often a USAR environment with FRS colleagues to assessment, working at height, working in comment that they would find large scale treat patients who may be trapped or where confined spaces, heavy vehicle transportation USAR exercises or incidents daunting at the gaining access to the casualty is particularly incidents and application of paramedic skills beginning of the course but feel well informed challenging. These types of incidents are often within the USAR environment. Experienced and equipped to deliver pre-hospital protracted and the ability to provide definitive trainers are able to assist the candidates in intervention at such incidents after the course. clinical assessment and care at the point of developing tactics for delivering advanced pre- rescue is of obvious benefit to the patient; hospital care in challenging circumstances, for HART operatives may for example be required particularly where extrication time could be example in dark restricted spaces or at height. to assess casualties using search cameras several hours. remotely to help inform the extrication planning in conjunction with FRS colleagues. During building collapse for example, research Sometimes gaining quick access to the casualty has shown that several injury patterns are could result in further problems, so having the common (such as crush injury) and providing ability to include clinical assessment within the the correct care can dramatically improve decision making process is of obvious benefit. patient outcomes. USAR skills within the overall HART response Types of incidents where USAR principles may have been utilised at several incidents around be implemented include: the country – many of these are often featured in ‘Inside HART’ and on our website Building collapse at www.ambulancehart.org. These incidents Industrial accidents have included working in restricted spaces or at building collapses but also at less ‘USAR Incidents at height specific’ incidents such as the rescue of a Heavy vehicle transportation incidents parachutist who fell onto a high roof when Incidents below ground or in his parachute failed to deploy correctly. confined spaces Incidents where access to the casualty In short, the USAR element, as with HART in is difficult its entirety, is there to help support other ambulance and emergency services in their FRS USAR teams use a variety of methods to response to incidents that require a different find casualties including using search dogs, approach and specialist training and listening equipment and technical search equipment to help patients. cameras. Access to the casualty can be gained using an extensive armoury of tools including Jamie Fountain can be contacted via email at breakers, chain saws and rescue saws. [email protected]. URBAN SEARCH AND RESCUE: WHAT IS IT? AMBULANCE HART Editi on 3 Winter 2009 6 GOING UNDERGROUND Kerri James, PR and Communications Assistant at North East Ambulance Service, followed the progress of the NEAS HART team as its members undertook each stage of the intensive HART training programme. In this article, Kerri gets to grips with USAR (Urban Search and Rescue) training. Now that the HART team have been trained to Once the incident had been declared and the when you breathe, the panic is only ever use all of their Personal Protected Equipment HART team arrived (their scenario was that inches away from the surface. It is very (PPE) it was time for them to learn about the they were attending to a collapsed terrace tempting to just rip the whole thing off. practicalities of trying to save lives as well as house with people injured and trapped inside), managing a major incident in an urban it became quite loud and very confusing. The Jamie said: “It’s very true however obviously environment. whole exercise took place in the pitch black this is a training exercise. Operationally the with the paramedics only having the torches situation may be much more dangerous but The training took place at the Fire Service on their helmets to see by. Paramedics will enter with Fire and Rescue College in Moreton-in-Marsh, Gloucester and Service Urban Search and Rescue colleagues is one of only two such facilities in the world, NEAS were doing their training with who will gain safe access to casualties, and the other being in Texas in the United States. paramedics from the East of England paramedics will then be able to stabilise and The college grounds cover approximately 40 Ambulance Service. Martin Hambling, a treat the casualty as required.” acres and used to be an RAF base many years paramedic with EEAS said: “I think it makes ago, and even the original flight tower the whole experience more realistic. On the Clare said: “During a mass casualty situation remains in place. scene of a real incident, it’s likely that you’re the team would be required to very quickly going to be interacting with people you don’t assess multiple casualties in quick succession As a result the grounds are littered with know, from other emergency services and even to inform the operational and clinical decision buildings that are perfect to simulate rescues other HART teams from around the country. making process.” within an urban context. The site even It’s important that you learn to work together includes a scale size section of a motorway, as quickly as you have to be able to trust them.” well as disused trains complete with tracks and crossings so students get the most authentic For each incident they must have a team training experience possible. leader whose job it is to keep track of the other team members whereabouts, record The USAR training team is made up of Jamie incident stats such as number of patients Fountain – the national HART USAR lead - and found, treatment given (amount of morphine instructors Clare Langshaw and Jason Fenard. etc) and to keep a log which could potentially The team have been based at the Fire Service be used in court if the incident is later found College for a year, training HART teams from to have been caused by a criminal act. ambulance services up and down the country. The HART team are sent into the building in I went to visit NEAS students during the pairs and instructed to stay with their partner second week of their three week course, at all times. The first thing they do before and was thrown in at the deep end to treating any patients, is to search the space observe some practical exercises. Jamie took and make it safe by moving debris and After another similar exercise, the team me ahead of the team into a simulated furniture, to ascertain the number of injured finished their practical exercises for the day collapsed building to get in place to observe parties and triage their priority as either P1, and spend the rest of the afternoon in the the exercise. P2 or P3. classroom. They received a presentation from Graham Leedman from the Emergency It was a lot scarier than I thought it would be P1 = Immediate (injuries need immediate Preparedness department of the Metropolitan and we had to crawl through an entrance attention) Police, about preserving crime scenes while at tunnel that was only 2 feet wide, and ended an incident and also from trainer Jason about up in a crawl space that wasn’t much bigger. P2 = Urgent (patients whose condition is large scale incidents that have happened in serious but not life threatening) the UK. P3 = Delayed (walking wounded) On the Friday, the team are given a talk on incidents involving railways to prepare them They must relay this information back to their for the exercises that are planned for the rest team leader, and each pair is assigned to a of the morning. Mick McCarthy has been a patient. Now comes the hardest part, treating trainer with the fire service for 12 years and patients in the dark, cramped confines of an teaches the class about the dangers of urban incident. The paramedics have to insert electricity. He shows them how to recognise a cannula into prosthetic arms, give morphine, live lines as well as who to call to get them and any other treatment that is required while switched off to reach a patient in a place of wearing safety gloves, goggles and dust masks danger. as well as overalls and protective pads and helmets. Observations are fed to the crews by The first exercise takes place around a the trainers to monitor the dummy patient’s frighteningly realistic incident which involves status. cars that have come off the nearby motorway and crashed into a freight train. All the I’m not a claustrophobic person but with the vehicles are real and the freight train is dust mask on and the goggles which steam up parked up on real tracks. ONE OF ONLY TWO SUCH FACILITIES IN THE WORLD INSIDE HART AMBULANCE HART Editi on 3 Winter 2009 7 “ paramedics and will still be working on the During a mass road, it just means that we can help to get the ambulance Trust’s skills into incidents we casualty situation the wouldn’t normally be able to assist with.” team would be required Jason said: “Other operational staff in The team have to search the area, triage the ambulance Trust’s should not be worried to very quickly assess patients, treat them and get them safely back about elitism among the HART team. The to the rendezvous point. This exercise was also HART team are still paramedics, but just with multiple casualties in multi agency with Mick playing the part of Fire a different skill set in order to support and Rescue Service Silver Command working frontline ambulance crews. We also quick succession to with the HART Team Leader to manage the encourage students to think about HART as incident. a national unit rather than a regional one.” inform the operational The next incident was a similar set up and After the training was finished I was very Caroline Davies of NEAS HART was chosen to impressed with how the paramedics and clinical decision take on the part of team leader. She admitted handled all of the exercises they were ” that she struggled with the incident log. She thrown into, they all stayed calm and making process. said: “I found it very confusing trying to keep focussed ensuring the best outcome possible the log with all the different bits of for their fictional patients. Clare Langshaw, HART Instructor information that people are radioing back to you and also trying to keep track of everyone so you know that they’re safe. I’d much rather be in there where the action is.” Clare reassured Caroline that she just needed to have more confidence in her abilities; after a deep breath and a check of her log notes Caroline was able to relay back all the events that had happened, perfectly to Clare. One of the issues that had come up after talking to other operational staff in the region about HART was ‘elitism.’ The HART team were quick to reassure me that this is not the case. Marianne Ellison of NEAS HART said: “It is funny some of the rumours that we’ve heard about the team such as we are all getting our own parking spaces at the HART base in Monkton!. At the end of the day we are still AMBULANCE HART - HAZARDOUS AREA RESPONSE TEAM www.ambulancehart.org AMBULANCE HART Editi on 3 Winter 2009 8 REALISM THE KEY TO EFFECTIVE HART TRAINING Dave Bull, HART Education and Training Development As the Training Lead for all Hazardous Area Response Teams, I have had the Lead opportunity to provide input on a huge variety of exercises, many of which are multi-agency, including live exercises planned with the Police National CBRN Centre. High on any exercise planning agenda is scene debrief, where the casualties provide UNDER THE realism for the responding emergency services. genuine, concise and hard hitting feedback In basic terms, the scene needs to reflect as on the treatment that they received. closely as possible the reality of the scenario. SPOTLIGHT HART operatives who have been faced with When exercising clinically competent exercise scenarios using Amputees in Action ambulance staff, it is always a challenge to casualties have commented on the realism of provide realistic patients that test the normal the injuries and actions of the casualties whilst Amputees in Action Ltd was launched thinking and clinical procedures. Highly skilled they are treating them. Such injuries that are in September 2004 and started life as paramedics often find it difficult to relate to made so very realistic by skilled moulage an agency that specialised in supplying simple sand filled mannequins with experts (moulage is the practice of applying amputees as extras and specialist action presenting signs and symptoms displayed on fake injuries) are fortunately rare in the UK, scene extras for the film and television written cards. however at the types of scenes where HART industries. may deploy, there may well be seriously Of course there are many human patient injured patients that need life saving The success of the agency led them to branch simulators that are available when conducting interventions performed correctly and quickly. out in 2007 and they now work alongside the live exercises, and even very in-depth cards HART training faculty (among other agencies) displayed in book format that display The casualties are able to provide feedback to bring theatrical excellence, with special changing symptoms that deteriorate or on the operative’s use of tourniquets and blast effects from the film industry replicating any improve according to a timeline and dressings as well as other information that injury, to any Casualty Simulation by dependent on treatment delivered. may be vital to the survival of the patient. providing Trauma Casualty Amputees (TCA's) Often the need to communicate constantly and walking wounded for any medical or When exercising HART operatives on national and reassure the patient is emphasised. This emergency training exercise. exercises we have been fortunate to use is certainly no easy task when wearing PPE casualties from a specialist agency called suitable for a USAR or CBRN environment; John Pickup, one of the Directors of Amputees in Action. The ability of these however the ability to use live casualties that Amputees in Action Ltd, says: casualties to reflect the sometimes horrific accurately reflect the scenario certainly assists injuries that operatives may be faced with in a in the reinforcement of clinical skills “For us, it is all about adding realism to real incident is amazing. This is not only during application under pressure and the education HART’s training exercises. We get asked to the exercise itself but also during the initial on of HART operatives in trauma care. provide all kinds of patient types, whether they are covered in blood, arrive screaming and angry or are simply dazed and confused. They must be exactly the same way patients would be in real life in the immediate aftermath of a major incident. The wounds look very realistic – so much so, that we have even had people faint on us before now! “Perhaps the best advertisement for our services came recently at the Emergency Services Show, where we had a stand. One of the HART paramedics came over and told me that he had found the training with our guys incredibly realistic and then just prior to the show, had been sent to do it for real, to apply a tourniquet to a serious injured patient. He told us that he hadn’t faltered at all and the patient had been saved – which makes everything we do with HART so worthwhile.” The success of Amputees in Action continues apace and on 26th November 2009 at the CBI Growing Business Awards, John Pickup won the Leonard Cheshire Disability Stelios Disabled Entrepreneur 2009 Award, sponsored by ‘Easyjet’ entrepreneur Sir Stelios Haji-Ioannou and with a £50,000 cheque to the winner. REALISM OF THE INJURIES AND ACTIONS OF THE CASUALTIES AMBULANCE HART Editi on 3 Winter 2009 10 CALL TASKING FOR HART TEAMS By James Price, HART Manager for West Midlands Ambulance Service The introduction of HART within NHS Ambulance Trusts presents significant issues with regards to call tasking. All calls taken by the Ambulance Service are categorised using a system called the Advanced Medical Priority Dispatch System (AMPDS). It is not possible to alter the system to accommodate HART as the caller may not know what response is required to the incident they find themselves in. Here at West Midlands Ambulance Service, questioning is completed by the call taker. we have taken a pragmatic approach. Basically This response can range from a motorbike or this means if we cannot change the AMPDS Rapid Response Vehicle to HART. system then we need to work with it and make it work for us! The codes have been listed on a simple spreadsheet. All the control rooms need to do We looked at all 1800 AMPDS codes and is migrate that data to their respective CAD simply placed a ‘yes’ or a ‘no’ against the code and they will find that call taskings for their to determine whether or not HART should HART teams will increase.” respond to the call. Once the first six questions have been answered the call is categorised and For more information please contact passed to Dispatch who send the response [email protected]. listed on CAD, whilst the rest of the INCREASING HART RESPONSES