AIR AMBULANCE RE-PROCUREMENT PROJECT · Final Report October 2010 Prepared by the Communications...

AIR AMBULANCERE-PROCUREMENTPROJECTAnalysis ofConsultation FindingsFinal Report

October 2010

Prepared by the Communications and Engagement Team

1. Introduction

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In order to inform the procurement of air ambulances for 2013 – 2020, theScottish Ambulance Service has been engaging with patients, clinicians andother partners.

By listening to the public, our patients, clinical partners, public bodies, otheremergency services and charities and voluntary organisations, the ScottishAmbulance Service is helping to achieve a more mutual health service bygiving our stakeholders a chance to share their views about the kind of AirAmbulance Service required for the future.

This document represents the findings of Phase I and II of the ScottishAmbulance Service’s Air Ambulance Re-procurement Consultation. Phase Itook place between October 2009 and April 2010 and Phase II took placebetween May and July 2010.

The feedback and comments received will help to inform the development ofthe air ambulance tender specification document. It is worth noting that someof the feedback received about the quality of service is already beingaddressed through training and development of staff as well as reviews andimprovements of operational procedures. The Service has built a robustpicture of anticipated demand for the Air Ambulance Service based on historicdemand data and has contacted territorial NHS Boards for information aboutfuture development plans for healthcare provision in their areas in order topredict demand trends for Air Ambulance support., This is being incorporatedinto the tender specification, alongside the views gathered from the 600groups and individuals estimated to have contributed to the consultation. TheScottish Ambulance Service will then tender the Air Ambulance Service in thefirst quarter of 2011, in accordance with the Official Journal of the EuropeanUnion (OJEU). It is anticipated that the aviation market will then respond tothe requirements laid out in the tender specification document. Responses willbe assessed against this specification and a preferred supplier selected,which will allow the Scottish Ambulance Service to provide the most effectiveAir 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 gavegenerously of their time to provide feedback and attend discussions about theAir Ambulance Service. Working together on the Air Ambulance Service of thefuture will be instrumental in providing better patient care.

2. Background

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Overview

The Scottish Ambulance Service provides air ambulance services to all ofScotland and its Islands. Clinical staffing is provided by the ScottishAmbulance Service. The aircraft are provided on a managed service basis bya third party. The current aircraft provider is Gama Aviation, whichsubcontracts helicopter provision to Bond Air Services. The current contractexpires on 31 March 2013.

The Service is developing a tender specification for its next generation AirAmbulance Service. In advance of procuring a new fleet of air ambulances for2013 – 2020, the Scottish Ambulance Service conducted an extensiveprogramme of consultation. This feedback has been reviewed against therequirement to design and implement an effective, safe and affordable airambulance 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 purposeand 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 controlrequirements

seeks flexible contractual arrangements that are responsive tochanging 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 ProjectInitiation Document. Feedback which supports these objectives will beincorporated 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 Specificationpaper, which includes a review of clinical triage and tasking protocols for airambulance requests. This has identified some key operational improvementswhich the Service is now addressing, as well as feedback for the tenderspecification.

Section 4, below, outlines all feedback received throughout this consultationand engagement programme. This has been grouped by a range of common

2. Background

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themes which emerged during phase I and phase II of the consultation. TheService’s response to each piece of feedback and any actions to beundertaken are in the adjacent columns, to demonstrate how all feedbackreceived has been considered for this project. For clarity, and accompanyingglossary 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. 7Community Resilience p. 14Partnership Working p. 20Achieving Best Value p. 27

DELIVERING SAFE AND EFFECTIVE CAREClinical Effectiveness p. 28Capacity of Aircraft p. 31Patient Comfort p. 35

COMMUNICATIONS AND CONTACTING USCommunication Between Healthcare Providers p. 37Public Awareness p. 40Contacting the Service p. 41

3. Glossary of Terms

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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.

3. Glossary of Terms

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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

4. Feedback received during consultation

Comment SAS Response Action

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A NATIONAL SERVICE MEETING LOCAL NEEDS

BASE LOCATION OF AIRCRAFT

The aircraft that serves the route fromShetland to the mainland should be nofurther away than Aberdeen.

The Scottish Ambulance Service is anational service, operating against anational response time target of 95%coverage in 60 minutes.

The market response to the tenderspecification will propose:

Location Base for pilots

which is based on Air Ambulance KeyPerformance Indicators (KPIs), historicaland predicted demand data and hospitaldestinations.

Standards in the specification will beapplicable to the whole of Scotland,including its islands.

Aircraft which currently operate onShetland should be kept there. Thisshould include the Coastguard and BPJigsaw (or equivalent)

This will be determined by the market’sresponse to the tender specification.

. Standards in the specification will beapplicable to the whole of Scotland,including its islands.

Would prefer air ambulance requests tobe coordinated locally on Shetland

Air Ambulance is a national service whichtakes account of demand across thewhole of Scotland at any given time.National Co-ordination centre has beenestablished and review after six monthsindicates 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



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Shetland for quick response andevacuation to ARI

national service, operating against anational response time target of 95%coverage in 60 minutes.




applicable to the whole of Scotland,including its islands.

The Islander aircraft was a popularservice on Orkney.It provided a faster response for inter-island transfers.It is felt that a Kirkwall-based servicewould be more responsive to the needs ofOrkney patients.It is felt that locally-based pilots wouldhave better understanding of capabilitiesin weather conditions






Financial savings could be made fromusing locally-based fixed-wing service forinter-island transfers on Orkney

A proposal has been made for acommunity aircraft, which would servemultiple uses across the community.

The Service will review potential demandfor this in partnership with NHS Orkneyand Orkney Islands Council



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Many Orkney residents would like aKirkwall-based service – could resourcesbe shared with Council and NHS Orkneyto achieve this?





Following the meeting on 8th July betweenOrkney Islands Council and the Service tolook into this option.

Analysis undertaken last year identified368 air missions from Orkney, 60 of whichwere from the outer islands (full year data)

Air ambulance demand this year (2010)identified 6 patients from the outer islesfor April, 5 patients in May, and 11 inJune.

On average there are circa 60 missionsper year. The Service will review thisoption in partnership with NHS Orkneyand OIC.

It is felt that a Kirkwall-based servicewould benefit outer Orkney isles for non-emergencies and would free-up resourcesfrom Inverness. This might reduce theneed for Search and Rescue resources




which is based on Air Ambulance KeyPerformance Indicators (KPIs), historicaland predicted demand data and hospital

The Clinical User Forum has produced aClinical Specification Paper. This includesa review of clinical triaging and tasking forair ambulance requests. This feedbackwill be considered in the clinical triagingand tasking work, alongside the reviewwith NHS Orkney and OIC.



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destinations.Clinical operational changes to triagingand tasking, which is emerging from theClinical User Forum work will pick up therequirements for SAR resources.

Clinicians would like an aircraft based inOrkney but fully aware of the issuesregarding clinical governance and costs.

As above As Above

It was asked if there is capacity forresource to be moveable, i.e. having aresource available locally for Orkneysometimes.It was asked to make sure that theaviation expertise on the contractunderstands the challenges of the island





The Clinical User Forum has produced aClinical Specification Paper. This includesa review of clinical triaging and tasking forair ambulance requests. This feedbackwill be considered in the clinical triagingand tasking work, alongside the reviewwith NHS Orkney and OIC.The training and familiarisationprogramme which will be put in place forthe new contract will ensure the aviationexpertise on the contract understands thechallenges of the island

There is concern that the farthest northbased air resource is Inverness. It was feltthat the far North of the Highlands andIslands needed a closer resource.

Please see the above response. As above

Has there been any consideration ofhaving a helicopter based in the West, i.e.Fort William? It is felt there is a lack ofsupporting infrastructure in the area at

Please see the above response. As above



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present, i.e. mechanical and maintenancesite.Air ambulance support is vital for theArdnamurchan Peninsula and servicelevels should be maintained.

A service with critical care doctors is aprovision.

Demand trend and coverage will dictatethe response by the market to the tenderspecification.

The Scottish Ambulance Service isworking in partnership with NHS Boards todeliver appropriate service provision.

As per response

The second part of the feedback isalready being addressed through currentpartnership working with NHS Boards.

A helicopter could be based at Dundee torespond to RTAs, farming accidents in theeast and north east of Scotland, aspatients generally transferred toNinewells.





As per response

Acknowledge that funding for a thirdhelicopter unlikely but considerationshould be given to a Tayside base.

The market response to the tenderspecification will propose: Location Base for pilots

Tender specification will include AirAmbulance Key Performance Indicators

As per response



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(KPIs), historical and predicted demanddata and hospital destinations

Would like to see physician-staffedhelicopter based in Tayside, especially fortrauma response, ST elevation MI andstroke for the east of Scotland.

Please see the response above. The EMRS will cover this from October2010.

Passenger-only ferry to Lismore notadapted for securing patients; vehicleferry takes 50mins each way so isunsuited for emergency call-out.

Would like aircraft based in Argyll & Buteto ensure life-threatening emergenciesare attended to in clinically effective time.

Please see the response above. As per response

Potential to base retrieval service inAberdeen, co-located with King Air. Canprovide primary retrieval service thatcannot be provided to North and EastScotland by Glasgow EMRS.

Suggest exploring sharing rotaryresources with police for both financialand operational benefits, i.e. Reducingneed for ground resources and providingclinical service to rural areas.

Merit in exploring charitable fundingoptions, relative to industry in the NorthEast. Est. running costs of £1.4 - £1.7mp.a. to run a retrieval service, but could bereduced through co-location of King-Airand rotary aircraft, and sharing resource.

This will be passed on to the ScottishGovernment who is leading a review ofthe specialist retrieval services.

There is currently sharing of engineering,ground staff and pilots, as well asaccommodation at the Glasgow helicopterbase.

There are ongoing discussions inScotland relating to the possibility ofcharity funded helicopters although nodecision has been taken.

The DTZ report into the EmergencyMedical Retrieval Service determined thatthe retrieval team should be based at onesite in Glasgow. However this commenthas been fed into the specialist retrievalreview.

Members of the air ambulancemanagement team keep abreast of otherair ambulance service activities, throughparticipation in a number of workinggroups for air ambulance services acrossthe UK. These include charity-fundedhelicopters in England and Wales. TheClinical Users Specification states thatshould the market recommend fixed wingand rotary aircraft in the samegeographical location, then SAS supports



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co-location where this is practical.



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COMMUNITY RESILIENCE

The Service should give consideration foraircraft that are more suited to islandcommunities, in addition to fixed-wing.

This feedback is noted for the tenderspecification.


Different fixed winged aircraft needed toservice the smaller islands.

The tender specification will detail thegeography and logistics to be covered

Noted for the tender specification

Island-specific needs should beconsidered carefully when tendering. Thelocal hospital on Barra needs to bedefined as no more than a GP practice; itdoes not have the facilities of a normalhospital. Coordinating centre should havebenefit of localised knowledge.

This feedback is acknowledged. SAShave put in place a triage and taskingprotocol to ensure more effectivedeployment of air services to thosecommunities who require it. On top of this,GPs will have access to the EMRSconsultant for additional clinical support.

The Clinical User Forum has produced aClinical Specification Paper. This includesa review of clinical triaging and tasking forair ambulance requests.This feedback will be considered in theclinical triaging and tasking work.

Would like to see faster air ambulanceresponse

The response to the tender specificationfrom the market will be based on demandtrends, coverage and KPIs.

Response time should be appropriate tothe clinical condition of the patient.

This feedback will be picked up through areview of operations, which is currentlyunderway.

Current issues experienced on Barra werenot as pronounced when Islander serviceoperated

The previous Islander service wasdependent on the timings of tide forlanding, which the EC135 is not affectedby.

As part of the tender specification,potential suppliers will be asked to meetkey performance indicators, which areapplicable in Barra and other Islandcommunities

Delays caused by crew changeovermeans response time can be over 6hrs onBarra. Shift patterns should be looked at

Response times are agreed withclinicians. The average response time toBarra is 65 minutes. SAS is currently in

This feedback will be looked at during areview of operations, which is underway.



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so that the challenges at shift changeovercan be mitigated. Time from call to atpatient needs to improve, more so aroundshift change times.

‘Standby’ pilot use should be consideredto reduce delays “out of flying hours”

the process of changing the airambulance management team. The twoair area service managers will beresponsible for reviewing monthly demandin NHS Board areas including the WesternIsles. Meetings will be arranged with NHSBoards to discuss referral patterns andpathways.

In 2009/10 there were 90 missions toBarra representing 2.1% of total airambulance activity and 16% of totalWestern Isles activity.

Shift patterns are in line with Civil AviationAuthority rules and regulations

How will time-critical interventions such asthrombolysis and PCI be accounted forwhen transferring to mainland centresfrom Barra?

The Scottish Ambulance Service worksclosely with regional services, such asOptimal Reperfusion Services.

All SAS paramedics and rural GPs havethe capability to administer thrombolysisand to triage patients to the respectiveHealth Board’s agreed clinical pathway(e.g. hospital facility).

Will be reviewed by Clinical Users Forum



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There are concerns about EC135 needingto refuel, lengthy response times andinability to take escorts at times.There is a belief that this helicopter is notsuited to needs of Barra, especially inpoor weather.

Standards should be applicable to allparts of Scotland.

This will be built into specification

EC135 cannot fly to Orkney in icingconditions and needs to refuel. Therefore,response times lengthier.

Standards should be applicable to allparts of Scotland

This comment is noted for the tenderspecification.

Helicopter use is limited by weather andwould like it to have capacity to fly inadverse conditions

The Air Ambulances of the ScottishAmbulance Service fly according to CAArules and regulations, which limits flying inadverse weather. The contingency foradverse weather remainsMOD/Coastguard


Is there a real time weather system inplace on the islands? Often the islandsare clear but do not get an aircraftbecause of bad weather.

Full consideration to all navigationalissues, including weather, is consideredbefore dispatching resource.

This feedback is noted.

It is felt that patients requiring urgenttransfers on Orkney often face lengthywaits as they “appear to fall to the end ofthe queue”

Non-emergency transfers are respondedto within a timeframe agreed with theordering clinician. The average responsetime for urgent transfers is shorter thanpreviously due to an increase in requestsfrom clinicians for quicker transfers.

This feedback will be looked into as partof the operation review, which isunderway, specifically in the clinicaltriaging and tasking work outlined above.This will include a definition of “urgent”and “emergency.”



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As expected, emergencies will always beprioritised over urgent jobs.

Is there an option to relax clinicalgovernance guidelines for inter-isletransfers for Orkney?

Patient Safety is our top priority. ClinicalGovernance guidelines have patientsafety at their core and this should neverbe compromised.

As per response

It was pointed out by a healthcaremanager that there can be ‘misuse’ of theair ambulance service by ordering partieson Orkney, as a result of occasionalapplication more urgency than is clinicallynecessary ,to ensure a faster response.

The triage and tasking SOP 6 sets out theprotocols for the use of air ambulances.Regular reviews of Orkney usage havenow been established.

As per response

Highland Council would like a list oflocations in Lochaber where we havelanding sites

This feedback is noted. This has been picked up as an action bythe AAR project team.

Can a Helipad be based at Campbeltownhospital?

This comment is noted. This comment will be picked up as part ofa review looking at landing sites acrossScotland.

The Service should consider communityresilience: e.g. landing pads &transportable lights

This feedback is noted. This feedback will be looked at in a reviewof landing sites and against night-timesstandard operating procedure.

The Service should improve access bymaximising landing capabilities

This feedback is noted. This feedback will be incorporated into areview of landing sites.

Can the Service investigate designatingmore landing sites with requisite lights forhelicopters to land after dark?

The air ambulance management teamhas recently introduced StandardOperating Procedure 4: ‘HelicopterLanding Site Request’ to ensure thatlanding sites are developed asappropriate.

This comment will be picked up as part ofa review looking at landing sites.

Night flights seem to be an issue with theislands in general i.e. length of time thepatient has to wait to be taken off the

This feedback is noted. This feedback will be looked at in a reviewof landing sites and against night-timesstandard operating procedure.



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island by helicopter. The restriction oflanding sites at night has been raised.The helicopter is not significantly fasterthan a road ambulance in Dumfries &Galloway.

There is a view that it is being used toachieve targets, which results in reducedavailability.

There is no published medical evidence tosupport the use of helicopter transferinstead of road ambulances. Therefore, acoordinated local response would bepreferable.

SAS acknowledges this may be the casein certain locations in Dumfries andGalloway.In some remote and rural areas AirAmbulance is faster than a roadambulance response.

Deployment of the Air Ambulance is notused to meet response targets. NewNational co-ordination desk newestablished at Cardonald EMDC to ensureappropriate co-ordination with landambulances.

The Clinical User Forum has produced aClinical Specification Paper. This includesa review of clinical triaging and tasking forair ambulance requests. This feedbackwill be considered in the clinical triagingand tasking work and improvements madewhen agreed, in advance of re-procurement

Delays are causedby aircraft being elsewhere,by the aircraft’s inability to fly at night andby lack of availability of crews duringworking hours

Demand for Air Ambulance is rising yearon year.The current review of operations will lookat triaging and tasking.The Clinical User Forum is taking stepstowards a solution for night-time flying.

This feedback will be looked at in thecourse of the review of operations, whichis underway.

The Service should take account thatgreater demand is likely in single-handed,nurse practitioner practices in Orkney.

All clinicians, including nurses, who makea request for air ambulance services, willbe asked the clinical triage questions todetermine the best use of national airambulance assets, to meet the clinicalneeds of the patient.

As part of communication andengagement process, NHS Boards wereasked what service redesign changes

The Remote and Rural ImplementationGroup Strategic Options Framework isdesigned in such a way that NHS Boardsand the Scottish Ambulance Service willwork together to undertake a gap analysisand design joint services to meet theneeds of remote and rural communities.

An Air ambulance response is just one ofa number of options available and through



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were likely to affect future demand for theair ambulance service. There was noindication of this issue in the reply fromNHS Orkney.

appropriate triage this will determine themost appropriate road and/or airresponse.

Are there contingency plans in the eventof prolonged volcanic ash disruption?

Yes, The Air Ambulance managementteam would work closely with our airambulance service provider and withclinicians to prioritise patients and ourresources to meet their needs. We alsoare able to request additional supportfrom other organisations, such as theMOD and Coastguard.

As per response

Is hovercraft a viable back up for airambulance?

A hovercraft is not in scope for thisproject. However as part of the Remoteand Rural Implementation Group StrategicOptions Framework which is beingimplemented across Scotland, ferrycrossings and support are considered.




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PARTNERSHIP WORKING

Transport issues on Orkney cannot beaddressed by SAS by itself. NHS Orkneyand Orkney Islands Council should look atjointly. We need to look at opportunities toutilise capacity with council purchasedresources. SAS should examine contractswith local public sector agencies toprovide multi-level responses.The specification needs to look at anintegrated service provision, which shouldinvolve road ambulances and ferries. TheCouncil currently procures inter-islandservice; this could be expanded to non-emergency cases.

This feedback is noted. This feedback will be picked up by theGeneral Manager for the North.

The Service should engage with thosetendering for SAR to achieve efficiencies.

There is a project team responsible forimplementing the new SAR helicopterservice (SAR-H) and the contract hasalready been awarded (not yet signed,pending a review by the newgovernment). The team is engagedwidely with industry, emergencyresponders and the CAA to ensure theprovision of a SAR service that is efficientand effective. Part of the ARCC’s function

engagement will continue



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is to ensure that SAR aircraft activity is co-ordinated efficiently.

There will be a reduction in military assetsin future, due to ongoing foreign conflicts.This should be considered in tendering.

The Ministry of Defence has assured theScottish Ambulance Service that militaryassets will not be reduced.

SAR co-ordination is forecast to continueby the ARCC. Further comments on thiscan only be made following the StrategicDefence Review.


It has been commented that there couldbe military downsizing, which may affecton Search and Rescue capacity and couldlead to a gap in resilience.

A condition of the SAR-H programme toreplace existing SAR assets is that thenew service should be no less capablethan the present one. In the short term,the SAR aeronautical framework is notforecast to change, but the SAR-Hprogramme is under review and the MoDprovision of SAR is likely to be included inthe Strategic Defence Review.


There are concerns about the level ofSAR cover, and it is felt that the newproposed helicopters for SAR are notsuitable for the Mountain Rescue role.There is a concern about the contractingand possible effects that an unsuitableaircraft may have as part of the overall airprovision covering the North West.

The SAR-H programme should ensurethat the next SAR helicopter is fit forpurpose, although different characteristicswith the new helicopter might lead to anadjustment of existing local operatingprocedures.*

Contact has been made with MountainRescue and a follow-up call by AirAmbulance management to discuss thismatter has been planned.

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



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search and rescue helicopters bedeveloped?

Ambulance tender. The SAR-H contracthas been awarded, but is not yet signed,pending a spending review by the newgovernment. Its duration is 20 years. TheMOD contract is not under review till2012.

At time of starting this process, SAR-Hcontract had been provisionally awardedin January 2010. It was suspended inJune 2010 by the new government toundertake a review of spending under theprevious administration. This is a UK-widecontract.

There are helicopters that could fulfil bothroles and search and rescue helicoptersare an example of this. However, Searchand Rescue (SAR) operations inherentlycarry more risk than other activity; theyfrequently require large helicopters,specialist equipment and skilled aircrew,which are expensive and complex tooperate compared with air ambulances.Provided that it continues to functioneffectively, the existing aeronautical SARframework across the UK should precludethe need to establish a SAR capability foran air ambulance.

Ambulance Service will continue tomaintain its joint working activities withSARH and MOD, using their combinedassets to respond to a variety ofcircumstances.

To ensure best use of public funds, The only organisation which can task any This feedback is noted.

Response provided by ARCC, RAF Kinloss



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thought should be given to theCoastguard Resources being “merged”into future Air Ambulance contracts ormore formal access arrangements.

UK SAR aircraft for SAR operations is theUK ARCC based at Kinloss. Thecompany operating the Maritime andCoastguard Agency (MCA) helicopters atStornoway and Sumburgh may carry outnon-SAR activities, but these occasionsare rare, since it is undesirable to useresource which could be required forsearch and rescue activity. On these rareoccasions, ARCC and MCA are requiredto give their approval.There are also regulatory implications fora company that undertook both SAR andair ambulance work, as the CAA treatsthese activities separately.*

The Service should minimise use ofsearch and rescue resources, since theseare expensive and potentially risky, ifused in difficult conditions. The Serviceshould analyse alternatives: e.g. dualpiloting of air ambulances, night-visioncapabilities.

While feasible, there would be cost andregulatory implications associated withexpanding air ambulance operations toinclude specialist skills, such as night-vision capabilities. For example, theService would require CAA air operators’certificates, The charging policy for theuse of SAR helicopters for immediate life-saving medical transfers under SAR-Hhas not formally been announced.Currently, charges for medical transferscarried out by MoD SAR aircraft are set ata minimum rate.*

This feedback is noted for thespecification.

Is there a chance of overlap with otheragencies, e.g. fire, police, commercial?

Where possible, the Scottish AmbulanceService works in partnership with other

The Scottish Ambulance Service willcontinue to work in partnership with other

* Response provided by ARCC, RAF Kinloss



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agencies: e.g. with Strathclyde Police, useof BP Jigsaw helicopter. There are,however, limitations and issues aroundgovernance. For example, StrathclydePolice only cover the Strathclyde area.

agencies, where possible.

Where night flights are required, or flightsrequiring a larger aircraft than thoseoperated by SAS, could the need forcross-charging between public sectororganizations and administration bereduced by estimating potential usageand factoring these charges into thecontract funding of each body (e.g. MOD,HM Coastguard) in advance?

Demand from SAS on MOD/HMCoastguard is extremely variable andmeasures such as newly developed triageand tasking Standard OperatingProcedures (SOP) as well as the landinglight SOP are likely to help reduce thedependency on MOD/HM Coastguardresources and reduce this demand/cost.

This feedback will be looked at during thecurrent operational review.

Many people on Orkney have highlightedtheir belief that use of coastguardindicates that current service cannot copewith current demand for air ambulance

The Air Ambulance of the ScottishAmbulance Service flies according to CAArules and regulations, which means it isnot permitted to carry out night-time flightsor fly in certain weather conditions. TheService, therefore, is required to work inpartnership with the Coastguard, whichflies according to Search and Rescueregulations.

This comment is noted.

The Coastguard helicopter is oftendeployed because it is closest to scene orcan fly in weather/bad light, but patientdoes not receive paramedic skills as aresult. This raises questions about equityof access to healthcare.

MCA SAR helicopters and in many casesMOD SAR helicopters fly with a qualifiedparamedic on board. Additionally, therequirement for a paramedic has beentaken into consideration within SAR-H. *

This feedback will be incorporated into theOperational Review outlined above.

The Service needs to improve Co-ordination of activity already takes Air Ambulance management will meet




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communications between HMCG and airambulance, including:visiting each other as part of training,contacting HMCG when on flights nearcoastal and remote areas to avoid conflictin flight pathsand maintaining current radio frequency.

place between the UK ARCC, which tasksSAR aircraft and Gama which tasksScottish air ambulances.Additionally, a common radio frequencyalready exists with which air ambulancesand SAR helicopters can communicate.The ARCC is working to improve themethods by which the movement of SARhelicopters and air ambulances can betracked, with the resulting informationdisplayed on screens within the ARCC. *

with HMCG to discuss this specificfeedback and agree actions.

Response time standards should bedeveloped that can be achieved and aretransparent. All islands should be includedin the response time targets and noneshould be excluded. An aircraft needs tobe able to respond within these times.The Coastguard and the MoD do notprovide a response any better than alocally-based resource.The reasons behind the need to maintaininfection control are understood, buturgency should be considered as moreimportant.

The Scottish Ambulance Service operatesagainst response time targets which coverthe islands. The target is a national one:95% coverage in 60 minutes. We havereported against this standard forindividual inhabited islands on Orkney andwill continue to do so.Coastguard and MOD response isrequired when SAS are unable to responddue to adverse weather, night-time flying,or no resource is available..

Response time standards are applicableto all of Scotland and its islands.

Infection Control will be considered in thetender evaluation process

Infection Control standards that limit theEC135 do not apply to MOD/CG aircraft.Is this a double standard?

The use of MOD and Coastguard aircraftshould only occur in the event of a life orlimb-threatening emergency. Whilst itwould be desirable that these aircraft met

The Service is waiting for feedback fromthe MOD and HM Coastguard, as well asthe outcome of the SAR-H contract award.




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the same infection control standards asScottish Ambulance Service aircraft, dueto the different roles that they undertake,this is not always possible.

The air ambulance management teamhas developed a draft Memorandum ofUnderstanding that includes infectioncontrol consideration. This draft documenthas been passed to the MOD andCoastguard for comment.

The air ambulance management team willcontinue to work with MOD and HMCoastguard managers to ensure thatstandards are of an appropriate quality.This not only includes control of infection,but clinical standards, too.



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ACHIEVING BEST VALUE

In view of the fact that the Scottish AirAmbulance Service is the only one whichis publicly funded, does the AirAmbulance receive an uplift from theWestminster Government to Holyrood, byway of compensation?

The core activities of the ScottishAmbulance Service, including the AirAmbulance Service, are funded by anannual allocation from the ScottishGovernment. The Scottish Governmentgives a total amount to SAS, but does notspecify how this is split between thedifferent parts of the Service.

This comment is noted

Does the service have any charity-basedhelicopter options?

There are currently no charity based airambulance providers operating inScotland


There are concerns that air ambulanceuse is not cost-effective when comparedto using road ambulance / ferries.

Air ambulance costs per journey aresignificantly higher than land ambulance;however for many clinical conditions theircost effectiveness has beendemonstrated.

This feedback will be looked at as part ofthe operational review, which isunderway.

It is recognised that there is tensionbetween achieving ‘best value’ in terms ofpublic money and providing the service tolocal communities.

This comment is noted. This comment is noted.



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DELIVERING SAFE AND EFFECTIVE CARE

CLINICAL EFFECTIVENESS

Has an evaluation been carried out on theclinical benefits and possible increasedchance of survival which comes from theuse of Air Ambulance resources,particularly in remote and rural areas?

There are many models of air ambulanceservices across the world, which havebeen researched and evaluated. TheScottish Government review of SpecialistRetrieval services is considering suchresearch.

As per response

Does the Service measure time from callto arrival at receiving hospital? There is aview that this timeframe should be nomore than four hours

The overall patient journey is measuredfrom time of call to time aircraft is clear atthe end of the journey. The patient’sjourney time is dependent on the urgencyof their clinical condition.

The Clinical User Forum is developing aset of appropriate response timestandards, based upon clinical condition,which will be included in the specificationfor the new contract.

The Service should ensure prioritisation ofpatients takes place with clinicians, basedon clinical need. Can the retrieval team(EMRS) play a role in prioritisation?

The Service agrees that prioritisation ofpatients should always be based uponclinical need.

EMRS will have a role in prioritisation ofpatients

The triage and tasking work of the ClinicalUser Forum will look at prioritisation ofpatients.


There is a preference for physician-co-ordinated system based at 4 sites withspecialist paediatric / neonatal unit. Thereshould also be physician in the EMDC fortasking.PTS should not use specialist assets.

This feedback is already being exploredthrough the Clinical User Forum.

This will be picked up through the ClinicalUser Forum’s Clinical Specification Paperfor the tender.

Physicians should co-ordinate thedispatch of resources according to clinicalneed.

The Scottish Government Review ofSpecialist Retrieval services isconsidering this.

The first comment will be accommodatedas part of the clinical triaging and taskingreview work referred to above.



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Aircraft should be specially-equipped forcare of critically-ill patients and able toaccommodate repatriation of medicalescorts.The King Air aircraft is a suitable platform,if there are suitable landing strips, butwould need extra equipment.

The second comment the equipping ofaircraft is noted for the tenderspecification.

Repatriation of medical escorts utilisescapacity and adds to cost, therefore is notgenerally possible.

Would like to see uniform platform forcross-vehicle transportation of patients.Ideally this should be able to carry oxygenand other equipment across vehicles aswell.

A suitable air transport platform iscurrently being reviewed as part of theClinical User Forum, as the need will differaccording to patient condition and clinicalspecialities.


Emergency aircraft should not be used forrepatriating patients

This comment is noted. This comment is noted.

Frontline clinical staff should be involvedin the design, layout and equipmentavailable on vehicles.

Consultation with clinicians from a rangeof clinical specialities has taken placethroughout this project through the ClinicalUser Forum. In addition, Air Ambulancestaff have been consulted to gather theirviews about air ambulance services.


Safe transportation of mental healthemergencies and pregnancies should bea priority. Mental health patients’ needsare not being met. Consideration forsuicidal and psychiatric patients isrequired.The aircraft needs to meet the manyneeds of the population of Barra - not justemergency but planned cases.

The Clinical Specification Paper for thetender, which has been developed by theClinical User Forum incorporates theseissues.


95% response target should not excludeouter-isles

The Clinical User Forum is developing aset of appropriate response time

This has been discussed with the clinicaluser forum and included in the clinical



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standards, based upon clinical condition,which will be included in the specificationfor the new contract.

specification document, and will thereforebe noted for the tender specification.

The majority of inter-island transfers onOrkney do not require paramedic input

Skills of the paramedic may be required,since the resource is part of a nationalservice, and may be called to a widerange of clinical conditions.

The skills of the aircraft has beendiscussed at the Clinical User Forum andit has been agreed that the minimum skillslevel should be that of a paramedic, giventhat the air ambulance service meets theneeds of a wide spectrum of patientconditions, which are unpredictable.

Patient handling procedures not alwayscarried out by clinical staff on smaller isles

This feedback is noted. Since it isoperationally-focused, it will be picked upin the operational review, which isunderway.

This will be picked up in the operationalreview outlined above.

There are Health and safety concernsabout handling patients, if the helicopterneeds to refuel. There is no fire cover andthere are inconsistent moving andhandling procedures across organisationsproviding air ambulance response

The Scottish Ambulance Service complieswith Health and Safety regulations.

This feedback is noted and will be fed intothe operational review as outlined above.



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CAPACITY OF AIRCRAFT

Is there a possibility of dual-pickup ofpatients for patient transfers?

This is current practice for both types ofaircraft where possible.


It was felt that an increase in aircraftcapacity would allow medical and familyescorts to accompany the patient.

The Scottish Ambulance Service isreviewing its options on aircraft capacityas part of the tender specification.


The aircraft need to be bigger in size,especially to manage maternity patients.This should also take account of anyfeedback from clinicians.

The Scottish Ambulance Service isreviewing its options on aircraft capacityas part of the tender specification. TheService acknowledges competingpriorities regarding the size of aircraft:smaller aircraft can land in a greater rangeof locations; larger aircraft are able to landin a more limited range of locations.

The Clinical User Forum has produced aClinical Specification Paper whichincorporates the views of clinicians from arange of specialities into the tenderspecification.


There is an issue with the size of aircraftand capacity to carry escorts withchildren, e.g. parents with young babiescannot both travel.Aircraft cannot take incubators forpremature babies.

All SAS aircraft can accommodateincubators.

This feedback is picked up in the ClinicalSpecification paper outlined above,including capacity, and is therefore notedfor the tender specification.

Are guide dogs permitted on boardaircraft, both rotary and fixed wing?

This feedback has been passed to theEquality and Diversity Manager at the

If it is essential that a guide dog has totravel with a patient, and that the receiving



31

Scottish Ambulance Service for furtherexploration.

The Service has looked at a range of NHSBoards’ policy on access of guide dogs tohospital. Policies are not the same acrossall Boards, so while the Service might beable to take guide dogs on board aircraft,it is possible that the dog will not beallowed access at the destination hospital.

In cases of unplanned care, where familyor friends are unable to look after the dog,organisations such as The Guide Dogs forthe Blind Association can makearrangements for the care of the dogduring this time.

NHS Board’s policy can accommodatethis, the Air Ambulance Service wouldconsider transportation of a guide dog,providing it can be secured according tothe minimum standards set out in CAAguidelines.

Air Ambulance helicopters cannot carrywheelchairs, including specially adaptedones.

SAS aircraft are able to carry genericwheelchairs, providing they can be safelystored aboard.

This feedback has been picked up in theClinical Specification Paper developed bythe Clinical User Forum.

It is desirable the aircraft are able toaccommodate folding wheelchairs,provided they can be safely stored byCAA-approved cargo nets.

In the case of specially-adaptedwheelchairs, if the user is supplied with abespoke pressure-relieving cushion, it isessential that this is transported with thepatient.

The EC135 helicopter is small and not This feedback is noted. This feedback has been picked up in the



32

equipped to allow optimal patient care intransit, monitor patients, or toaccommodate escorts.

Clinical Specification Paper developed bythe Clinical User Forum, so this feedbackwill be noted for the tender specification.

The EC135 helicopter is only suited totransfer stable patients. It could benefitfrom increased range and cabin size.



The bigger aircraft of the Coastguard andMoD seem to cope better for Barra.Aircraft should be bigger than current(EC135 helicopter). Better range isrequired in order to fly to and fromdestinations without having to refuel or toleave behind escorts. The aircraft shouldhave enough capacity to cater for morethan one patient and their escort(s)

The task requirement of each airambulance mission first needs to bedefined, before the attributes of theaircraft required to fulfil the task can beestablished.


As highlighted above, there are competingpriorities regarding aircraft size; largeraircraft could mean increased limitationsto access because some landing stripsmay no longer accommodate the size ofaircraft.

The market will determine capacityoptions.


Greater flying range for air ambulanceaircraft is desirable.

This feedback is noted. This feedback is noted for the tenderspecification.

The weight thresholds of aircraft need tobe clear and thought given for thosepatients who exceed current capabilities.The capacity of aircraft (helicopter) needs

This feedback is noted This feedback is noted for the tenderspecification.



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to be considered, as it is not big enoughfor multiple transfersIt would be helpful if the capacity of thelifting mechanism was increased.




34


PATIENT COMFORT

The air ambulance could be morecomfortable for patients: e.g. warmer,more blankets on board, reduced noise.


Wearing ear protectors when unwell andin pain can cause distress.

There is no legal requirement for patientsto wear hearing protection during flight,although it is available if required. Thereis, however, health and safety legislationwhich requires patients to wear hearingprotection when flying on MOD/Coastguard helicopters.

This feedback will be picked up as part ofthe operational review, which isunderway.

A heating system on board which couldbe used while the aircraft is static wouldimprove patient comfort

King Air aircraft are equipped with anelectric heating system for use while theaircraft is stationary. In order to use thison the ground, the aircraft has to beconnected to a separate Ground PowerUnit (GPU), which are generally located atthe main airports in Scotland, but are notroutinely found on outlying islands,particularly in the middle of the nightduring an out of hours callout. In addition,the process for using the GPU requirestraining and adds delays to patient loadingfor the short duration whilst they are onthe ground. For these reasons, unlessthere is a specific medical need, theheating systems are not routinely used onthe ground.

This feedback will be picked up as part ofthe operational review, which isunderway.



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King Airs are fitted with Ground UseBatteries to provide power for aircraftcabin lighting and for the powered loadingsystem whilst the main engines are turnedoff, and which are recharged during flight.However, for the King Air’s electricheating system, the current requirementsare such that it would drain the aircraft’sbatteries very quickly, making thisimpractical.

The EC135 helicopters have full heatingsystems throughout the cabin whichoperate through a heat exchanger in theengine. For this reason, when the aircraftis grounded, there is no additional heat.



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COMMUNICATIONS AND CONTACTING US

COMMUNICATION BETWEEN HEALTHCARE PROVIDERS

Communication between support deskand hospital wards could be improved toensure appropriately trained staff areavailable.

This comment is noted. The Service will respond to this feedbackthrough staff training and development.

Communication of aircraft arrival times topatients should be improved.

This feedback is noted. The Service will respond to this feedbackthrough staff training and development.

There is a perceived lack ofcommunication between dispatch andlocal medical staff regarding ETA


Feedback on ETA to GP can take overone hour, should be relayed quicker.

The national Co-ordination desk atCardonald is aware of this feedback andhas taken steps to improvecommunication.

The Service will respond to this feedbackthrough staff training and development.

Communication between EMDC and Islay& Jura clinicians could be improved.Feedback should be given to a hospital ora clinician when a patient is taken to ahospital other than the one originallyrequested.


Could the helicopter be tracked like ashipping company? i.e. when a localhospital or health care departmentrequests the helicopter they are given apatient number - this number can beentered into a website for flight scheduleupdates delays where it is in the air orrefueling etc.

We are investigating the possibility oftracking aircraft as part of the tender forthe new contract.

This feedback is noted for thespecification



37

Physicians should be regularly updatedon the progress of air ambulance.Frustrations can arise because of lack ofclinical knowledge of dispatch staff.Unhappy at challenges to air ambulancerequests, as often road ambulances arenot readily available in certain areas.


Doctors sometimes have to argue withdispatch in front of patients whenrequesting air ambulance


The service could be better integratedacross dispatch activity, hospitals, and airambulance


There is a concern over the Air Deskoperation being located at Farnborough,which means having to contact EMDCinitially, then liaise with Farnborough, whoat times may not have a fullunderstanding of the climate, terrain etc,and do not make best use of theknowledge and expertise provided by theordering clinician

This comment is noted. Co-ordination of flying will be reviewed aspart of the specification.

There is a perception that lack of localknowledge in control staff may causedelays on remote islands


Sometimes a lack of local knowledge inEMDCs, e.g. sometimes unaware of theavailability of Basics GPs or the distanceto A&E in rural areas

These comments are noted. This feedback will be picked up as part ofthe operational review, which isunderway.

Could dispatchers have local informationto hand, e.g. ferry details, in order to helpdecide whether tasking air ambulance

Dispatchers currently have access to ferrydetails and a knowledge of this kind ofinformation. A new air ambulance triage

The Service will respond to this feedbackthrough staff training and development.



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appropriate? and tasking Standard OperatingProcedure (SOP) 6 has beenimplemented within the NationalCoordination Centre which offers otherappropriate transport, e.g. road and ferry



39


PUBLIC AWARENESS

Performance audits should be robust andtransparent to aid communication withstakeholders. Could be carried out byflight paramedic or doctor with outreachrole.

This feedback is noted. This feedback will be picked up in theoperational review.

Satisfied with air ambulance overall andwould like to see continuous audit of useand discussions of alternative options.

This feedback is noted. This feedback is noted.

Would like SAS to supply regularlyupdated data on air ambulance responsetimes.

This feedback is noted. This feedback is noted.

Does the service have information on airambulance activity to support requiredprovision?

The Scottish Ambulance Service carriesout regular demand analysis.


Could demonstrate to the public thedifference in costs between Fixed Wingand Rotary aircraft to help them considerwhat would be best option for theircommunity.

This feedback is noted. This is an issueof cost, capacity and reach – these areinter-dependent factors.

The Scottish Ambulance Service providesa national Air Ambulance Service, whichwill be reflected in the tenderspecification.




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CONTACTING THE SERVICE

A clear definition should be available as towhen an air ambulance should be used.There needs to be a clear definition ofwhat the air ambulance service does,especially around the “non-emergency”patients.

This feedback is noted. The Scottish Ambulance Service isdeveloping communications to addressthis.

Concern over potential problems deafpatients may have in contacting theAmbulance service in an Emergency.

This feedback is noted. Work is underway to look at SMS textoptions.

Unhappy with current complaintsprocedures, as there is a belief that theservice can be unresponsive.

This feedback is noted. The complaints process has beenreviewed and improved.

Would like standardisation as to whetherisland residents should contact 999 ortheir GP in an emergency, and guidanceas to what constitutes an emergency.

Anyone requiring an emergency responseshould dial 999.

SAS Communications team will liaise withNHS Orkney about communicationsrequirements for the public.

Would like input post-consultation to helptailor aircraft to need and environment forOrkney

There has been a comprehensivecommunications and engagementprocess across the whole of Scotland,including Orkney. Representative fromOrkney will be involved in the tenderevaluation and there will be furtherengagement as the preferred design isselected through to and beyondimplementation

As per response

Will there be an additional opportunity tochallenge consultation findings and

There has been a comprehensivecommunications and engagement

As per response



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reasoning? process across the whole of Scotland,including Orkney. Representative fromOrkney will be involved in the tenderevaluation and there will be furtherengagement as the preferred design isselected through to and beyondimplementation

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