Newcastle | 17 May 2012

Paramedic Sheila Coatesworth is proving she has world-class medical training after she was selected to work at this year’s Olympics.

Sheila will be one of only a handful of paramedics from the region making the trip to London to help out at the 2012 Games – helping the millions of spectators expected at the event.

Sheila, who volunteered to take part in the Games, was among 12 other paramedics from the North East who will be seconded to the capital during the games.

The 38-year-old will work alongside London paramedics to offer her expertise at the events and assist with the huge crowds.

“I’m really excited about going down,” said the team leader paramedic. “I know it’s going to be really hard work and there are going to be a lot of obstacles along the way but I’m really looking forward to the challenge.

“This is a once-in-a-lifetime opportunity and I’m just so glad to be a part of it. Something like this will never come around again.

“Every time they announce more sporting events I just get more and more excited, knowing that I’m going to be a part of it.”

As a team leader paramedic, Sheila spends much of her time on the road, attending to emergencies in a rapid response car or with another paramedic in an ambulance.

But in July Sheila will spend more than three weeks in the capital covering the major sporting events and controlling the spectators’ areas. She will make her first trip to London next week for training and the major incident trials.

Having covered several sporting events and concerts at Sunderland’s Stadium of Light and Newcastle’s St James’ Park, this will be Sheila’s biggest achievement in her career to date.

She said: “I do event cover up here but this is the biggest thing I’ve done. They are expecting millions and millions of people to be at the events and it will be a much grander scale.

“It will be totally different to what I normally do. I normally come into work and get given a job to do but this is going to be like going into the unknown. It’s really exciting.

“My husband was very understanding when I told him I had volunteered. This chance will never come around again.”

Newcastle | 17 May 2012

With a fleet that clocks up more than 10 million miles per year, NEAS knows its vehicles can take the strain.

Good news for three medical students from Newcastle University – who are about to drive a decomissioned ambulance 9,000 miles across rugged terrain to Mongolia, all in the name of charity.

Ross Sayers and his friends Matthew Brown and Sidney Parker are aiming to complete the journey in four weeks.

When they reach their destination, the vehicle will be donated to the Mongolian Ambulance Service.

Ross, a fourth-year medical student at Newcastle University, said: “I’m really excited about it but we know that at some point something is going to go wrong.

“We will encounter all sorts of difficulties along the way and an ambulance is probably not the best form of transport to use.”

The group of 22-year-olds will set off from the region in June, before making their way to Holland, then onto the Czech Republic, Slovakia, Serbia, Bulgaria, Turkey, Azerbaijan, Kazakhstan, Russia and then Mongolia.

When the trio arrive in the Mongolian town of Ulaanbataar they’ll spend eight weeks working in the National Trauma and Orthopaedic Centre – improving their medical skills in the accident and emergency department.

The students have teamed up with Newcastle University and Go Help, a UK charity that works with local communities in Central Asia to improve access to education and healthcare.

Ross said: “There is a shortfall of ambulances of nearly 20% across Mongolia and those that are provided by the Government are of wildly varying quality.”

The group will be updating a blog and video diary, as well as social networking sites Twitter and Facebook, along the way. They will be using a regular accident and emergency ambulance, which has been used in the North East but has reached the end of its seven-year service.

Bosses at the NEAS will also give the boys a special three-week driving course, normally undertaken by those employed to drive 999 emergency vehicles.

Geoff Craik, who is in charge of the NEAS vehicle fleet, said: “We are delighted to help such a good cause. The ambulance the lads are taking had just reached the end of its service period of service with NEAS, but there’s still lots of life left in it. I’m sure it wont let its new owners down.

“All of our vehicles are regularly maintained by our mechanics at Pallion, and the one heading off to Mongolia has been given a thorough checking-over. It’s a mind-boggling distance the boys will be covering, but the ambulance is up to the task.

“They’re built to cope with constant use, and a lot of people might be surprised to know that the fleet in the North East clocks up more than 10 million miles every year.”

Follow Ross, Matthew and Sidney on their journey at medics2mongolia. tumblr.com

The region’s ambulance service today welcomed government plans to help ensure that patients get sent the right support and in turn make more vehicles available.

East of England Ambulance Service NHS Trust (EEAST) Chief Executive Hayden Newton has been campaigning for the change as part of his role within the Association of Ambulance Chief Executives (AACE).

Changes to Department of Health guidelines means call handlers will be given up to an extra minute longer to get more simple and vital additional information from some callers but only in cases where this time will not have an impact on the patient’s outcome.

It means the most appropriate response can get to the patient more quickly.

And under the new system the government will expect ambulance services to get to more critically ill patients within the target response time.

The move is based on the fact that all ambulance services must reach 75 per cent of patients in the most urgent need (‘Red calls’) within eight minutes and there are occasions when a rapid response vehicle (RRV) is sent at the same time as an ambulance as it arrives more quickly.

But on average, a fifth of these vehicles are then cancelled en route, wasting vital resources which could be used for other patients.

From June 1 ambulance staff will be able to get enough extra details from callers to make sure that the right support is sent to the right place, first time.

This extra 60 seconds maximum clinical assessment or ‘triage’ time for lower priority Red calls (‘Red 2’) aims to cut down on the number of ‘double dispatches’. For the most serious Red calls (‘Red 1’), where every minute counts, such as cardiac arrests, ambulances will continue to be dispatched immediately.

If those taking the Red 2 calls have not got all the information they need in 60 seconds, the clock will start counting down the eight minute target anyway.

But in many cases, the full minute will not be necessary and the clock will start as soon as the vital information to dispatch has been gathered, whether that’s at 10 seconds or 60.

Reducing the number of vehicle cancellations means ambulance services will have extra resources for all their patients and be able to prioritise the most serious by directing their vehicles to those in critical need.

As a result ambulance services will also have to show that by April 2013 that they can reach 80% of Red 1 calls within eight minutes instead of the current 75%.

Targets for non emergency (‘Green’) calls will remain the same, varying from a 20 minute response to an hour depending on the grading of the call within that category, which include incidents like non life-threatening fractures and range from a patient who is fitting to minor injuries.

The move nationally is expected to save half a million wasted ambulance journeys and potentially 150 patient lives.

Mr Newton said: “This is a move which I, in my role within the AACE working group, have been championing for some time so I am very pleased to see that the Department of Health has listened to us and brought in a change which will enable ambulance services to dispatch resources more efficiently so that patients, who are our number one priority, can benefit.”

Gary Applin, EEAST’s Unison branch secretary, said: “Unison welcomes this news. Patients will get a better service, and staff will be able to make better use of their time and skills. The introduction of this change shows that the Department of Health is listening to ambulance staff, and I think the benefits will begin to be evident as soon as the clock-start change takes effect next month.”

At least 150 lives could be saved under changes to the way 999 calls are received which will prioritise call outs to the most critically ill patients. The changes will mean that ambulances are saved from making over half a million wasted journeys a year. 

From June 2012, ambulance staff will be given up to 60 seconds longer to get more information from Red 2 calls. This will not necessarily translate into a 60 second delay, in many cases it will mean that a more appropriate response vehicle gets to the patient more quickly. Under the new system the Government will expect Ambulance Trusts to get to more critically ill patients within the 8 minute national target.

Allowing staff to establish more information about the incident they are responding to will ensure that they are able to send the most appropriate response vehicle first time to patients, meaning that less ambulance journeys are wasted or cancelled and that there are more ambulances available for all the patients that need them. For the most serious calls, where every second counts, ambulances will continue to be dispatched immediately.

Two pilots trialling the changes inLondon and the West Midlands took over 22,000 calls and showed those in critical need were reached at least 40 seconds faster, and demonstrated at least a 24% reduction in cancellations. If replicated elsewhere, this would result in saving at least 650,000 wasted ambulances journeys acrossEngland.  While top priority calls were reached up to 40 seconds quicker, Red 2 calls were responded to between 27 seconds quicker and 9 seconds slower.  The nature of Red 2 incidents is such that a 9 second delay would not have a negative impact on the patient.

Ambulances must reach 75 per cent of all patients who need urgent medical assistance within 8 minutes. In order to meet this target, Ambulance Trusts frequently send more than one vehicle – such as an ambulance and a Rapid Responder – to each patient, known as ‘double dispatch’.  But on average, over 20 per cent of these vehicles are then cancelled on route before reaching the scene, wasting vital resources which could and should be used for other patients.  Because the new system will free up more vehicles, Ambulance Trusts will be expected to work towards responding to 80 per cent of the most urgent patients within 8 minutes.

These changes come in response to evidence presented by ambulance staff as well as reports by the National Audit Office and the Public Accounts Committee in 2011.

Matthew Cooke, National Clinical Director for Urgent and Emergency Care and a consultant in emergency medicine, said:

“We want to make sure that everyone who needs emergency medical assistance gets it.  These changes will make sure that the right support is sent to the right place and reaches patients fast.

“Fewer ambulances will need to be stood down when they are half way to a patient who doesn’t need them – meaning that they will be available for a patient who does, increasing the chances of survival for anyone who is not breathing or is suffering a cardiac arrest. People whose heart has stopped will get a faster response, meaning they can have life saving treatment like defibrillation on average 40 seconds quicker, increasing their chances of  survival by about 7 percent.

“But time is still an important factor, which is why we are measuring not only how fast ambulances reach patients, but also their clinical results, which are both what matters to patients and their families.”

Peter Bradley, Chief Executive of London Ambulance Service and National Ambulance Director, said:

“At the moment, too many ambulances or rapid response vehicles are sent out when they are not needed. This means that paramedics are sent out on a double dispatch, only to be cancelled when they are too far away to reach another urgent call.

“Making this small change will mean more ambulances and rapid responders will be ready to go and help patients – rather than be stood down while on their way to somewhere they aren’t needed.”

Stuart Gardner, who is a paramedic at West Midlands Ambulance Service and Staffside Chair for Unison, Unite and GMB, added:

“All three unions welcome the change to the clock start. We firmly believe that it will benefit patients by ensuring that those that are in the most need, get an ambulance even more quickly than they do now.  From a staff perspective, it will also mean a reduction in the number of times we are sent on an incident and then get stood down before we arrive.

“Whilst we understand the reasons why it happens, it can be very frustrating ending up driving the same piece of road several times in only a few minutes.  These changes will ensure we spend more time treating patients which has to be a good thing.”

If those taking the call have not got all the information they need in 60 seconds, the clock will start counting down the 8 minute target anyway. People taking the calls will be getting simple and vital additional information like:

• whether the patient is breathing and has a pulse;
• more detail on what has happened to them and their symptoms;

As Ambulance Trusts have more capacity to reach all their patients quickly, they will also:

• have to improve their performance in 2012/13 to show by April 2013 that they can reach 80 per cent of these most urgent patients within 8 minutes, and
• be required to publish how long it takes them to reach 95 per cent of all their patients from June 2012 to encourage them to bring down the number of people who wait the longest, particularly in rural areas.

Notes:

1. The Operating Framework for 2012-13 requires all Ambulance Trusts to reach 75 per cent of urgent cases, Category A patients, within 8 minutes.
2. From1 June 2012, Category A cases will be split into Red 1 and Red 2 calls:
• Red 1 calls are patients who are suffering cardiac arrest, are unconscious or who have stopped breathing.
• Red 2 calls are serious cases, but are not ones where up to 60 additional seconds will affect a patient’s outcome, for example diabetic episodes and fits.
3. Ambulance Trusts will be required to improve their performance to show they can reach 80 per cent of Red 1 calls within 8 minutes by April 2013.
4. Evidence from two pilots inLondon and theWest Midlands showed that the change resulted in a reduction of at least 24% in cancelled vehicles and there was an improvement in response time performance for Red 1 calls.
5. New Ambulance Quality Indicators were introduced in April 2011 to measure the quality of care patients received and the results they saw, rather than just the time in which they were treated.  They measure timeliness in a more clinically relevant manner, for example, measuring the time for a qualified healthcare professional to arrive at the scene.
6. As both the NAO and the PAC recognised in 2011, there needs to be more flexibility to the ‘Call Connect’ model, as the current system leads to over-commitment of vehicles and staff which can waste resources and result in other patients not getting the most appropriate care.

Patients across the capital stand to benefit from changes announced today to reduce the number of ambulances that are cancelled while on the way to emergency calls.

Under the adjustment to the dispatch system – which will come into effect from 1 June – up to an extra 60 seconds will be available to get more detailed information on a patient’s condition and location, to ensure that they receive the right response, first time.

It is expected that the changes will see more than 20 per cent fewer vehicles being cancelled once on their way to incidents. There should also be a significant reduction in the numbers of unnecessary dispatching of more than one vehicle to calls.

However, the changes will not affect calls to patients who are reported to have suffered a cardiac arrest and stopped breathing.
Staff in a response car and ambulance will continue to be dispatched immediately to these calls – and the fact that there will be fewer vehicles being immediately dispatched and then cancelled to less time-critical incidents should mean that more staff are immediately available to respond to the most seriously ill patients.

Work to bring about the changes has been led by the Service’s Chief Executive, Peter Bradley, in his role as the Department of Health’s National Ambulance Director.

Deputy Chief Executive Martin Flaherty said: “Under the current system, we end up cancelling too many of our staff in cars, on motorbikes and in ambulances while they are on their way to calls, once it has become clear that the situations are not as serious as first thought.

“By having this short extra period to better assess the patient’s condition, we will be able to keep more staff available to immediately respond to those who have stopped breathing, which really are time critical incidents.

“We are already reaching this small group of patients very quickly, and these changes should ensure that this will continue to further improve.”

The national target for Category A (immediately life-threatening) calls is to reach 75 per cent within eight minutes – which the Service has achieved for the last nine years.

This category of calls is itself divided into two groups – Red 1 and Red 2 – with Red 1 incidents relating to patients such as those who are reported to have stopped breathing, or whose heart has stopped beating so that they are in cardiac arrest.

In 2011/12, 81 per cent of these calls were reached within eight minutes.

All ambulance services across the country will be expected to show that they can reach 80 per cent of these most urgent patients within eight minutes by April next year.

Changes to prioritise the most critically ill patients, increase the number of vehicles available to reach patients most in need and reduce the number of cancelled ambulances have been announced.

From 1 June, the A8 measure (immediately life threatening) will be split into two parts, Red 1 and Red 2.

• Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions. For Red 1 calls, the existing call connect clock start will remain, ensuring that patients who require immediate emergency ambulance care will continue to receive the most rapid response.
• For Red 2 calls, which are serious but less immediately time critical and cover conditions such as stroke and fits, a new clock start will allow call handlers to get more information about patients so that they receive the most appropriate ambulance resource based on their specific clinical needs.

The founder of London Ambulance Service’s cycle response unit has won a prestigious national award.

Emergency Medical Technician Tom Lynch, the former international BMX racing champion who pioneered responding to patients in London using pedal power, scooped top prize in the Emergency Services category at the Daily Record Our Heroes Awards.

Cycle Response Manager Tom, 42, from Ayrshire, said: “I’m very honoured, very humbled, but also to be in the same room as some of those great nominees is also quite an honour.

“I’ve had a great team to work with over the years, and thanks goes to them.”

Tom trialled responding to 999 calls on a bicycle in 2000. Since then the London Ambulance Service team has grown to cover the West End, Heathrow Airport, Kingston town centre, the City of London, and King’s Cross, Euston and St Pancras railway stations.

Tom also set up the Public Safety Cycling Association to raise the standard of all emergency services and public safety cyclists. He also created the National Cycle Response Group for all ambulance services.

This has resulted in thousands of police, fire, ambulance, St John Ambulance, Red Cross, St Andrew Coast Guard search and rescue, and many other workforce cyclists, including the London bike hire scheme and Docklands Light Railway, all benefiting from his expertise, as well as teams in Europe, Asia and America.

During his career with Team GB, Tom coached world BMX champions Shanaze Reade and Liam Phillips – two Olympic hopefuls this summer.

In 2006, Tom was awarded the MBE for services to bicycle moto-cross (BMX) racing and London Ambulance Service’s cycle response unit.

Photo (from left): Robbie Hickling (dropped out because of a knee injury), Joe Collins, Alex Batty and Stephen Macciochi.

London | 17 May 2012

Three London Ambulance Service paramedics will be cycling 1,200 miles in 16 days to raise money for Help for Heroes.  

The paramedics from the Service’s hazardous area response team (HART) – a group of staff with extra training who can give life-saving medical care in hostile environments such as industrial accidents and natural disasters – will start the grueling challenge on Monday (21 May) and will visit other ambulance services’ HART stations in England and Wales.

Paramedic Stephen Macciochi, from Ilford, came up with the idea almost a year ago. Stephen, who has been with the Service for over 20 years, said: “We will be visiting all 16 HART stations on our tour and the most northern will be Newcastle and western Exeter.

“I came off my bike a couple of months ago while training and broke my coccyx but I’m now back on the saddle. We’re all fairly fit anyway given the nature of our everyday job but the part I’m most dreading is crossing the Pennines by going uphill for over 60 miles straight.”

“We decided to raise money for Help for Heroes as there are a lot of colleagues who served in the armed forces before joining the ambulance service. More relevantly to HART, a lot of the techniques we use in our job have been developed on the battlefield.”

To support the team’s effort, you can make a donation at http://www.bmycharity.com/harttohart.

• You can follow the team’s progress live from Monday (21 May) at http://livetrack.skytag-gps.co.uk/service.html?d=81173
• For more information about HART, please visit http://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/hart.aspx

ECDC, through the VBORNET network, publishes regularly on its website maps on exotic mosquitoes and on phlebetomines  - to provide the ECDC stakeholders and the general public with the most updated information on vector distribution. The maps are updated and improved quarterly.

For the first time maps on the distribution of tick species are presented, covering four tick species: Dermacentor reticulates, Hyalomma marginatum, Ixodes persulcatus, Ixodes ricinus. Another improvement is that from now on the maps on phlebotomines are provided at a finer level of geographical detail:  at the administrative level NUTS3 instead of NUTS1 level.

The vector distribution maps are the outcome of collaborative work of the VBORNET network and are based on collecting existing data by the network members. VBORNET is a network of medical entomologists and public health experts, funded by the European Centre for Disease Prevention and Control (ECDC).

ECDC, through the VBORNET network, continues to  improve the data collection for the maps: the VBORNET network is therefore looking for vector-borne disease experts who are interested in data sharing and networking (experts can contact VBORNET at vbornet@ecdc.europa.eu).

See and download latest maps on vector distribution (updated 16 May 2012):
VBORNET maps – Tick species
VBORNET maps – Mosquitoes
VBORNET maps – Phlebotomines/Sandflies

Read more:
Network of medical entomologists and public health experts (VBORNET)
Emerging and Vector-borne Diseases Programme
Hyalomma marginatum health topic site
Ixodes ricinus health topic siteVector-borne diseases health topic site
Tick-borne diseases health topic

The fox tapeworm, Echinococcus multilocularis, was recently detected by the National Veterinary Institute, Technical University of Denmark, in a fox from the southern part of Jutland.

The parasite was initially detected in three foxes in the Copenhagen area twelve years ago, EPI-NEWS 5/00, but has not since been monitored continuously. In recent years, an increased incidence of E. multilocularis has been observed among foxes in several parts of Europe, e.g. in Germany and Sweden. On the basis of the most recent finding, it cannot be excluded that the parasite has gained a permanent foothold in Denmark, even though the incidence presumably is low.

The parasite has carnivores, including dogs, raccoon dogs and foxes as definitive hosts, while mice and other small rodents serve as intermediate hosts. Monitoring of the occurrence among wild carnivores in Denmark was initiated in 2011, financed by the Danish Veterinary and Food Administration. So far, more than 350 foxes and raccoon dogs have been tested and only one was positive. E. multilocularis may cause alveolar echinococcosis in humans. The incidence of human cases is correlated with the prevalence in wild foxes and with the density of fox populations. Particularly dog owners, farmers, hunters and others spending time in woods and farmland have an increased risk of infection.

Infection occurs via contact with faeces from infected animals. Thus good hygiene is important particularly when handling animals, during gardening and ingestion of vegetables, fruit or berries which may have been in contact with animal faeces.

The incubation period is long, in the majority of cases from 5 to 15 years, and therefore clinical infection is more frequent among the elderly, even though cases have been described in children as young as seven years of age. At present, no autochthonous cases have been detected in Denmark. However, one person has died due to this tapeworm, EPI-NEWS 18/04. Echinococcosis in humans is caused by either E. multilocularis or E. granulosus, both of which may cause cyst formation, primarily in the liver. In alveolar echinococcosis cysts measuring up to 15-20 cm in diameter are seen. Growth is proliferative and includes formation of metastases during the late stages of infection. Lethality is high if the infection is not diagnosed and treated in time. In approx. one third of cases metastases are found in one or more extrahepatic organs at the time of the initial diagnosis. The initial phase of the infection is asymptomatic. During the progressive phase patients present with fatigue, abdominal pain, hepatomegaly and in some cases jaundice, fever and anaemia.

Early diagnosis of subclinical cases is a fundamental for efficient management. The clinical diagnosis of alveolar echinococcosis is based on a combination of
1) history and clinical findings,
2) imaging diagnostics (ultrasound, computer tomography (CT)), magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)
3) serology, and if the above do not produce a conclusive diagnosis:
4) histopathology and PCR analysis of cyst material.  Liver biopsy, however, entails a risk of causing metastases and should be avoided if poss.

A positive antibody response does not necessarily mean that the patient will develop clinical echinococcosis.  In the majority of cases, imaging techniques will indicate which of the two echinococcosis species that can be suspected. As E. granulosus is not found in Denmark, information about travel activity is also relevant. Antibodies directed against these parasites will only cross-react to a limited degree, and it is recommended to test for both species in case of inconclusive image diagnosis or clinical suspicion. Based on the new finding of E. multilocularis in Denmark, suspicion of alveolar echinococcosis may be relevant even in cases with no history of foreign travel.

(H.L. Enemark, DTU VET, H.V. Nielsen, Dept. of Microbiology and Diagnostics)

The Health Information and Quality Authority has today published the report of its investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, for patients in the Emergency Department and those requiring acute admission to the Hospital.

Commenting on the publication of the investigation report, HIQA Chief Executive Tracey Cooper said: “The findings of this investigation reflect a history of longstanding challenges in leadership, governance, performance and management at Board and Executive level of the Hospital, and a failure of the State to hold the Hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided.”

“These challenges resulted in the persistent, and generally accepted, tolerance of patients lying on trolleys in corridors for long periods of time with a lack of clarity as to who was accountable for patients. This puts patients at risk, is not acceptable and should not be tolerated in any hospital in Ireland.”

During the course of the investigation, the performance of all hospitals providing emergency department services nationally over a 24-hour hour period in August 2011 was also analysed. This identified some significant concerns in relation to the waiting time for patients in some hospitals and the quality of the data and the amount of absent information with which to manage the performance of an emergency department.

The investigation also found that the Board of the Hospital did not have adequate arrangements in place to direct and govern the Hospital, nor did it function in a sufficiently effective way to assure itself that the Hospital was providing safe care to patients – including patients receiving care in the Emergency Department.

Also, the Charter that established the Hospital is not in line with modern corporate governance principles. Despite a number of attempts to address governance problems at the Hospital, and a number of improvement reviews having been undertaken, sufficient action was not taken by the Hospital itself or the Health Service Executive to address these issues.

During the investigation, information came to the attention of the Authority regarding the awarding of a contract that raised serious concerns about the effectiveness of the governance arrangements for financial management, transparency and contract control in the Hospital. These arrangements are essential in an organisationin receipt of significant public funds and raises questions about the transparency of the use of taxpayers’ money.

“Every day there are patients who receive good, safe care at Tallaght Hospital and there are patients who could receive safer and better care. The Hospital has made significant changes and improvements in the way that it is led, governed and managed since the commencement of the investigation with a strengthened leadership and management team and the establishment of an interim Board that is more fit-for-purpose to govern and direct the Hospital,” Tracey Cooper said.

The challenges for this Hospital, and all other acute hospitals in Ireland, will be to drive, inject and embed strong patient-centred leadership in order to establish and sustain a strong culture of patient safety throughout the Hospital.

“Healthcare is far too important to be run, managed and governed in a way that does not reflect a high performance, high quality and high delivery mindset. Ignoring persistent poor performance in the quality, safety and timeliness of patient care and financial management should no longer be acceptable and must change.”

“The Authority believes that given the substantial amount of public money that is entrusted to health and social care service providers in Ireland, of which Tallaght Hospital is one, there should be a robust mechanism in place to oversee the recruitment, appointment, performance management and replacement of board members, chairpersons, chief executives and other executives and it has made recommendations to address these gaps.”

The findings and the 76 recommendations from this investigation focus on the improvements required in Tallaght Hospital, and in similar hospitals nationally, as well as the changes necessary to improve the accountability of the health system by the State and modernise the way in which we run our health system in Ireland.

They include recommendations to improve the acute care for patients in emergency departments nationally, the effective management of patient admissions and discharges and access to diagnostic tests. There are also recommendations on strengthening the arrangements to hold chief executives and chairpersons to account for the delivery and quality of the service and a requirement for existing boards and executives of all health and social care service providers in receipt of State funds to assess themselves against the relevant recommendations within the report and tomodernisethe constitutional basis, composition and competency of such boards.

“Following on from this investigation, the Authority recommends that the Department of Health establishes a clearly defined ‘Operating Framework’ for the State that establishes the key levers and drivers for the effective oversight, governance and delivery of a high quality, safe and reliable health and social care system which is designed to deliver the most accessible service in the most cost and clinically effective way for our population.”

Also, a Special Measures Framework should be established to actively address circumstances in which substantial and persistent poor performance of the board and/or executive management of a service provider in receipt of State funds occurs.

“This Framework should contain the provisions for the Minister for Health to intervene where there is evidence that a hospital or health and social care provider is not performing one or more of its functions adequately or where there are significant failings in the way it is being run.”

Following the approval by the Minister for Health of the National Standards for Safer Better Healthcare, and the subsequent commencement of a monitoringprogrammeagainst the Standards, the Authority will monitor service providers against the implementation of these recommendations as part of that process.

“These Standards will be the first step towards the introduction of a licensing system in the Irish healthcare system. The establishment of a licensing system in Ireland will accelerate the requirement for these recommendations to be implemented by all service providers.”

“It is crucial that in Tallaght Hospital, and in all healthcare providers, the behavioursand practices that result in unacceptable care for patients are simply not tolerated. We must make a choice to actively drive our health system, from patient to policymaker, and to ensure that a culture of patient safety, openness, accountability and improvement is led, managed and embedded into our services,” Tracey Cooper concluded.

• The full Investigation Report, along with the Executive Summary and Recommendations are available to download from www.hiqa.ie

In welcoming the report from the Health Information and Quality Authority into the services provided to patients in the Emergency Department at Tallaght Hospital, Dr James Reilly, Minister for Health, offered his condolences to the family involved.

The report results from an investigation following the death on a corridor of a patient awaiting admission in March 2011.

The Minister said “I want to offer my deepest sympathies to the family concerned. We must never forget that this report is first and foremost about patient safety and that it all began because of the death of a patient on a trolley in a corridor adjacent to the Emergency Department. I know that the loved ones involved will find this traumatic and that patients in all of our acute hospitals need the assurance that this matter is being dealt with in an effective way, that lessons have been learned and that Quality Assurance Systems are being put in place across the country”

The Minister recognises this report as an important element in driving the Health Reform Programme which is focusing on and prioritising patient safety and best governance. “The HIQA report gives us the template for hospital governance which will be the foundation for the governance of the new Hospital Groups to be established this year. I have also today approved the HIQA National Standards for Safer Better Healthcare. These standards will support the development of quality safe healthcare services” the Minister said.

The Minister said that he was seeking the greatest collaboration and personal commitment from all involved in the acute hospital system to protect patients and ensure the very best outcomes despite the challenging economic and financial circumstances we face.

Many changes have already occurred and others are underway in Tallaght Hospital and the report recognises this. The Minister said that he wanted to acknowledge the contribution of staff at the hospital to implementing change.

“The staff of the hospital have a hugely important role in responding to the challenges ahead, restoring confidence in this hospital and supporting it to achieve its potential. I would also ask the local community to support the staff and the Hospital as it faces the challenges ahead” the Minister said.

As recommended in the report, the Minister is putting in place, as a priority, an oversight committee to implement its recommendations. He also announced that the Chief Medical Officer has referred the report to the Medical Council and An Bord Altranais.

“It is completely unacceptable that there was no clarity as to who was providing medical supervision of these patients. For that reason the Chief Medical Officer has referred the report to the Medical Council and An Bord Altranais to ask them to address the significant issues that arise here.” the Minister said.

The Minister has also noted the report’s findings into certain financial issues within the hospital. The Minister welcomes the involvement of the Comptroller and Auditor General’s Office into this matter but given the role of the C&AG, the Minister does not wish to comment further in light of his investigation.

On April 28, John Jacovides complained of heartburn before launching into his weekly game of Saturday afternoon soccer. Within minutes, the 36-year-old father of two had collapsed on the field and was unresponsive to his teammates.

Mr Jacovides, from Western Sydney, had gone into cardiac arrest, a condition which statistics show out-of-hospital survival rates as low as three per cent*.

Quick thinking friends rang Triple Zero (000) and performed CPR (Cardio Pulmonary Resuscitation) while fellow players ran to the local swimming pool for help, bringing back lifeguards and a defibrillator with them.

One lifeguard administered the defibrillator and restarted his heart. Paramedics soon arrived at the scene and continued treatment. On the way to Bankstown hospital the paramedics closely monitored Mr Jacovides heart rhythm and were prepared for defibrillation and drug therapy should his heart stop again. He was later transferred to RPA for specialist treatment.

Mr Jacovides is now at home recovering with his family and is overjoyed to express his gratitude to his friends, paramedics and specialists who saved his life. He was reunited with his paramedics Matthew Gourlay and Gavin Wood who presented him with an Ambulance Service of NSW Cardiac Arrest Survivor Award.

“I’m alive today and can continue to be a father and husband because of the hard work of these paramedics. I will never be able to thank them enough,” Mr Jacovides said.

Bernard Coren, Cardiac Project Officer for the NSW Ambulance Service says Ambulance paramedics are trained in the treatment of heart attacks and cardiac arrests. “Ambulances are equipped with cardiac monitoring technology and can transmit the patient’s ECG to the hospital in order for doctors to be ready for action from the moment the patient arrives,” Mr Coren said.

“Most paramedics have stories of patients who wait too late for treatment. Some become victims of cardiac arrest or end up with poor quality of life due to lost heart muscle. I can’t stress enough how important it is to pick up the phone and call triple zero straight away for people who experience the warning signs of a heart attack or cardiac arrest.”

Heart attack warning signs may include pain, pressure, heaviness or tightness in one or more parts of the upper body (chest, neck, jaw, arm(s), shoulder(s) or back) in combination with other symptoms of nausea, shortness of breath, dizziness or a cold sweat.*

Mr Jacovides is alive today due to the quick thinking of his teammates and paramedics. Ambulance encourages everyone to take a first aid course and learn CPR through an accredited provider. Early intervention and CPR saves lives and can lead to successful patient outcomes.

* Medical Journal of Australia 2010
* Heart Foundation

NSW | 17 May 2012

The NSW SES is congratulating its 2011 Cadet of the Year, Joshua Day, for his outstanding achievement during the Secondary Schools Cadet Program.

The 15 year old from Gunnedah High School was selected out of 465 students as the Cadet of the Year and was chosen because of his remarkable leadership skills which earned him great respect among his peers.

Since participating in the NSW SES Cadet Program, Joshua has continued on with his dedication to community service by volunteering with the Gunnedah Riding for the Disabled group which provides people with disability the experience of horseback riding. He has also been chosen to be a member of the NSW Government ‘Plan-It Youth’ peer group support team at his school.

Last year, Joshua travelled to the Solomon Islands in November to work as a volunteer on a ‘Fly and Build’ program, where he assisted with the rebuilding of schools and other buildings.

The Secondary Schools Cadet Program offers Year 9 and 10 students the opportunity to pursue learning in NSW SES training, values and ideals during their school years. During the program, students undergo training in areas like team-work, workplace health and safety and working in a public safety organisation. The program has now seen 1,192 students participate since it started in 2008.

A 30 year old man from Bridgewater is in the Intensive Care Unit of the Royal Hobart Hospital in a critical condition after having been struck by a car on the Midland Highway, Bridgewater at about 4.50am this morning (Thursday 17th May 2012).

Approximately 500 metres north of the junction of Gunn Street it would appear the pedestrian has attempted to cross the road (west to east).  In so doing he has been struck by the Holden sedan which was being driven in a southerly direction on the Highway by a 33 year old female from Brighton.  Neither the driver of the vehicle nor her 37 year old male passenger (also from Brighton) was injured.

The driver has then driven the vehicle to the Bridgewater Police Station and reported the crash.

Emergency Services attended the scene.  The Midland Highway between Gunn Street and East Derwent Highway was closed to north bound traffic for approximately 4 hours.  South bound traffic was still able to use the highway but there were frequent delays during this time period.

Crash investigators would like to hear from any member of the public who may have witnessed the crash or seen the pedestrian immediately prior to the incident.

At 4.56pm 15 May 2012 Tasmania Police were notified that a two vehicle collision had occurred on Brooke Street at East Devonport, 1km west from the Port Sorell Roundabout.

The collision occurred between a black 1991 Suzuki motorcycle which was being ridden east by a 41 year old Somerset man and a blue 2010 Toyota Corolla hatch which was being driven west by a 49 year old East Devonport woman.

It is believed that the motorcyclist may have been attempting to overtake another vehicle when the collision occurred.

As a result, the motorcycle collided with the front of the Toyota. The rider was severely injured and was conveyed to the North West Regional Hospital in Burnie where he is listed as being in a critical condition.

The driver of the Toyota was conveyed to the Mersey Community Hospital with minor injuries and released a short time later.

Anyone who may have observed either vehicle prior to the collision or the collision itself is asked to contact the Crash Investigation Section at Burnie Police Headquarters or on 131444.

At 3am on Tuesday 15 May 2012, emergency services responded to a house fire at 11 Hookey Place, Rokeby.  The house was well ablaze and appears to have started in the lounge room area. 

There were four occupants in the house at the time of the fire, three teenagers and an adult female, aged 41.  The three teenagers escaped the fire, however, the fourth person did not escape from the house and is deceased.

While members from Operation ICARUS, the Eastern District Criminal Investigation Branch Arson Task Force, are investigating the cause of the death and fire, there is no evidence to suggest the death is suspicious at this stage.

There was one functioning smoke alarm in the house, it was in the room that the teenagers were in, it activated and they escaped from the house.

Left to right - CSL EMS: Scott Johnston, the late great Barry Tottle, Naomi Cherow, Larry Rinzler, Rick Liebmann, Evan Savelson, JD Silver, Dawna Hobbs, Arnold Zwaig - and yes, yours truly

A nugget of EMS organizational wisdom every day.#2 Become part of your neighbourhood

A giftwrapped box of chocolates held with an unsteady outstretched arm by the diminuitive seventy-something year-old woman who came by The EMS House to say, “Thank you for the wonderful care” she received from our providers.

She was on her way out of town for the winter months but said she felt it was essential to stop by to properly express her thanks. She told me how she had developed nausea while on a round-the-block-stroll near her home in Montreal West (a couple of blocks away). Her husband drove her to The EMS House because she wanted to have her blood pressure checked. During their assessment, the EMS providers discovered PSVT and requested an Urgences Santé ambulance be dispatched to our House.

The woman said she felt as if the Team EMS members who treated her had “a divine calling to provide care.”

She was the third client to walk in to The EMS House in seven days.

One Wednesday evening, I was strolling out onto the front porch looking for the crew to say my “g’nites.” I saw the rig parked by the side of the House with all the doors open but not a soul in sight. Strange for them to have finished their pre-shift checklist so quickly and to have left their truck wide open. And then I heard JD Silver on the radio requesting an Urgences Santé ambo for a “fifty-year-old woman with crushing retro-sternal chest pain.”

To be honest, my first thought was “Oh no, not again.” I guess that thought came on the heels of the realization that our House had become more than just our EMS Family’s home-away-from-home: it had become a recognized destination for the folks in our neighbourhood.

CSL EMS was a collection of compassionate, dedicated souls—we were an eclectic yet tightly-knit group that brought together folks from every point along the emergency care spectrum. Like the best big families, we put the word “fun” back into dysfunctional—and our House is where we went to unwind and prepare for the next call (basic axiom of EMS: the further you are from the last tragedy, the closer you are to the next one). I guess I was just having a plain old-fashioned selfish reaction to the thought our clients had found their way to our home instead of the other way around.

The “fifty-year-old woman with crushing chest pain” had just left her office—a few blocks from our House—and was on her way home. She said the pain had overtaken her as she drove, eventually forcing her to pull over to the side of the road. She said she remembered seeing our House nearby and drove into the parking lot hoping against hope that someone would be able to help.  She wasn’t doing well. The chest pain was 10/10 and her breathing was laboured… when the ambulance pulled up thirteen minutes later her condition had further deteriorated. The next day, her husband came over to retrieve her car and told us she was being treated for a PE in the ICU. Good thing she remembered our House in her travels.

The very next evening a sixty-something-year-old neighbour wandered into our House complaining of chest pain and shortness of breath. She was transported by ambulance to the nearest ER as her ecg threatened R on T in a truly menacing manner.

You start to wonder if perhaps there’s something awful in the water after a week like this one draws to a close. Of course, was pleased that we were able to play such an integral role in our neighbourhood—honoured actually that our neighbours came to us for help.

One of our members asked me about the number of complaints received each year concerning siren noise. It was an interesting question given that our House is in the middle of a mainly residential neighbourhood and that our crews responded to more than 3,000 calls each year. I paused for a moment and replied, “We have received three complaints about our sirens. Three complaints in the last six years.”

What I’m trying to say is that it wasn’t so much The EMS House. It had become The EMS Neighbourhood – and it was a nice neighbourhood to call home.

Be well. Practice big medicine.

A precautionary advice for drinking water (water boil alert) was issued today for the Gunbalanya Community following the detection of the E. coli bacteria in the community’s water supply.

The Department of Health today confirmed that remedial measures were being taken to ensure that the water supply will be safe to drink as soon as possible.

DoH Environmental Health Senior Program Development Officer Karen Beirne said that, in the meantime as a precautionary measure, it is recommended that water for drinking, food preparation and oral hygiene is obtained from either packaged bottled water or by boiling tap water and allowing to cool prior to use.

“Work is now underway by Power and Water Corporation to flush the water supply system, monitor the chlorine in the system and ensure maximum disinfection occurs to kill any bacteria present,” Ms Beirne said.

Testing will continue to monitor the safety of the water and we expect the water boil alert will be lifted soon.

Anyone who has concerns can contact DoH Environmental Health hotline during business hours on toll free 1800 095 646 or mobile 0438 856 087.

Bundamba – fall at construction site

Emergency services are currently at the scene of a construction site at Ashburn Road, Bundamba where it is believed a man has fallen approximately four floors and landed on scaffolding. Paramedics are currently on scene treating the patient, who is believed to be in a very serious condition.

16/05/2012 8:26:43 AM

Emergency Services responded to reports of a single-vehicle rollover on Goolabah Drive, Tallebudgera around 6am. The driver was trapped in the vehicle when crews arrived and firefighters used hydraulic equipment to extract the man. Paramedics transported the man to Gold Coast Robina Hospital with chest injuries in a critical condition.

VIC | 17 May 2012

David Dhu first headed down to the Footscray SES unit’s headquarters almost four years ago.

With friends in the unit, he’d been thinking of joining for a while, but waited until he had finished his Masters.

David swapped one form of study for another, having since picked up qualifications in storm and water and chainsaw operations.

“There are definitely a lot of qualifications you can pick up along the way,” he says.

There’s a lot to do as well. David has spent time as a Duty Officer, Crew Leader, Coxswain, Staging Area Manager and Media Liaison Officer.

“I’m happy to go where I am needed most. In recent years, that’s been mainly with the boat,” he says.

During the March floods in Victoria’s north east, David was deployed to Tallygaroopna and Numurkah. He spent much of his time there on a boat checking on people and properties that had been isolated by floodwater. Motoring along in water 1.5 metres deep, over what used to be roads, was a disconcerting experience.

“The other thing is, the wildlife comes out. Particularly in the floods in Shepparton, there were so many cockroaches, crickets and snakes. Seeing a snake not that far from the boat … it’s not just people who are looking to get out of floodwater,” he said.

While the creepy crawlies fled, the people worked together in an inspiring fashion.

“At Numurkah, seeing the resilience of the community, how everyone was pulling together, it’s a very worthwhile thing to do.”

It’s experiences like these that made volunteering with the SES so satisfying, he says.

“It’s rewarding giving something to the community when they are not at their best, to be able to provide that assistance to people when they need it most.”

Can you see yourself in orange? Visit our volunteer page for more information.

VIC | 17 May 2012

“Lots of smaller towns depend on their volunteers,” says Bert Roberts. He should know.

Bert, 74, has volunteered with the SES for over 15 years. A long-standing member of the Marong unit, he retired in December 2010 when it “did get to the stage where I was too old to be jumping on roofs”.

That didn’t slow him down too much though. Since then he has been a member of the North West Regional Support Unit, where he provides support in Incident Control Centres and Divisional Commands in times of emergency.

“At the RSU we do whatever we can,” he says. “I served through a long period of drought, and now we’ve had two big floods in two years. At Numurkah (earlier this year) I did quite a bit of running around helping elderly people who couldn’t get out of floodwater. Floods can be a harrowing experience. You don’t know what’s underneath.”

Bert joined the Marong unit shortly after moving to the area.

“The unit was very low on members. They did a mail drop, in fact. By joining there was a benefit to us, in meeting new people, as well as obviously the benefit for the community.”

Serving as Controller for about ten and a half years, Bert is proud to have brought additional benefits to his unit.

“Apart from emergencies, most of the units in smaller towns do get involved in the community. We would assist wherever we could,” he says. “We would help with the cemetery cleanup when they needed us, and it was good experience for us.”

Driver Reviver in his neck of the woods was busy during holidays. That was before the highway and so Melbourne motorists reached his site about two hours into their journey.

When asked for his favourite memories from his SES career so far, Bert said travelling interstate to help with emergencies was a particular highlight.

“You get to meet new people, and there’s that feeling you get when you’re helping out. But there’s been too many really.”

Can you see yourself in orange? Visit our volunteer page for more information.

Contact telephone number: 1300 232 272 (24 hours/7 days)

• Invasive meningococcal disease (IMD) should be considered in the differential diagnosis of any systemic febrile illness in any age group.
• A rash is not always present, especially in the early stages of the disease.
• Early recognition, immediate presumptive treatment with parenteral benzylpenicillin and urgent transfer to hospital can be life-saving.
• Urgent notification to the CDCB on suspicion of IMD enables a timely public health response.

Epidemiology

Notifications of invasive meningococcal disease (IMD) usually increase in winter and spring. The age distribution of IMD cases shows peaks in children <5 years and young adults aged 15-24 years. In South Australia, serogroup B is the predominant strain causing IMD. Since January 2012, 4 cases of IMD have been notified, compared to 6 cases at the same time in 2011.  In 2011 a total of 21 cases were notified.

Notification of cases

The Communicable Disease Control Branch (CDCB) must be notified urgently by phoning 1300 232 272 (24 hrs/7 days) when IMD is suspected. Do not wait for laboratory confirmation. This enables contact tracing, clearance antibiotics and vaccination, if needed, as soon as possible after diagnosis.

Clinical features

Symptoms of IMD may be non-specific and include fever, headache, vomiting, photophobia, joint pains, neck stiffness, drowsiness and irritability. Meningococcal septicaemia is more common than meningitis with a greater mortality. A petechial or purpuric rash may be present, but in the early stages the rash may be atypical or absent, and may not occur with meningitis. Children may have clinical features not normally expected in an acute self-limiting illness, for example, poor eye contact, altered mental state, or pallor despite a high temperature. In children under 16 years, early signs of peripheral vascular shutdown (leg pain, abnormal skin colour and cold hands and feet) should heighten suspicion of meningococcal disease.

If a patient with a non-specific febrile illness does not require hospital referral, the carer should be told to watch the patient and seek urgent and immediate help if the patient deteriorates in any way, especially if a rash develops. A medical review may be urgently required at any time, even within hours of the initial consultation, as IMD can be associated with rapid clinical deterioration.

Early management

Early recognition and treatment of IMD can be life saving. Patients suspected of having IMD should be treated immediately with parenteral benzylpenicillin (preferably intravenously, otherwise intramuscularly) followed by urgent ambulance transfer to hospital. All general practitioners should have benzylpenicillin in their surgeries and emergency bags ready for immediate use. The doses are:

• Children aged up to 1 year: 300 mg
• Children aged 1-9 years: 600 mg
• Adults or children aged 10 years or over: 1200 mg

Further information and support services

Guidelines for the early clinical and public health management of meningococcal disease in Australia are available at http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-other-mening-2007.htm. A GP desktop card and an Emergency Department poster can be downloaded from: http://www.health.sa.gov.au/pehs/communicable-diseases-index.htm.

In some cases meningococcal infection will have serious health consequences or can be fatal.  Doctors are urged to provide appropriate counselling or refer people to suitably qualified counsellors. Other useful resources for patients and their families include community networks such as Meningococcal Australia Inc http://www.meningococcal-australia.org.au and the Paige Weatherspoon Foundation http://www.paigewf.com.au.

Following a house fire overnight, caused by a candle left unattended on a window-sill, the South Australian Metropolitan Fire Service (MFS) is urging the public to be vigilant when choosing to use candles.

Commander, Community Safety and Resilience, Allan Foster, says “The occupant of the Morphettville home was extremely lucky her smoke alarm activated, giving her the valuable time needed to safely evacuate her home and call the MFS.

“A candle is an open flame and can easily ignite curtains, for example, as it did last night,” he said.

If people choose to use candles, here are some simple home fire safety tips from the MFS:

• Use candles only with constant adult supervision

• Do not place lit candles in windows, where blinds or curtains can close over them

• Keep the immediate area around a candle clear of all items, especially items that can catch fire, such as clothing, books, paper, tablecloths and curtains.

• Make sure candles are placed in sturdy holders that will not tip over, and place them on a secure piece of heat-resistant furniture. Candle holders must be non-combustible

• Do not use candles in places where they can be knocked over by children or pets

• Extinguish all candles when leaving a room or going to sleep

• Keep candles and all open flames away from flammable liquids.

MFS suggests using “LED” fake candles instead of the traditional burning kind. They are a far cheaper option and won’t cause life-threatening fires.

The MFS urges householders to combine the above safety tips with photo-electric smoke alarms that are less than 10 years old and a Home Fire Escape Plan.

For more information about home fire safety and candle safety visit: www.mfs.sa.gov.au