Ops

Question 1

Railway
What is POWER meumomic?

Answer 1

Power off and trains stopped (either RIO or Horizon control to Network Rail or tram driver)
Off tracks unless viable
Wear PPE
Ensure HC aware of when on/off trackside
Remove patient rapidly if treating (only basic life saving intervention on tracks)

Question 2

Major incident
1) Definition
2) 3 phases
3) CScATT
4) METhANES
5) JESIP principles
6) Role of LNAA

Answer 2

Definition = An event or incident with a range of serious consequences requiring one or more emergency service to implement special arrangements

(Critical incident is EMAS not MI level, but causes EMAS to lose ability to deliver critical services/patient harm +- requires assistance from other agencies )

2) planning, response, recovery

3)Command and control
Safety
Communicate (METHANE)
Assessment
Triage
Treat
Transport

4) major incident declared
Exact location
Type of incident
Hazards
Access and egress
number of casualties
Emergency services requires
Start log

5)Coordinate
Co-locate
Communicate
Share situational awareness
Share risk/info

6) likely to be deployed
Helicopter view/report
Operational/bronze is EMAS role
Medical advisor is strategic role also
May be asked to advise tactical or operational command in Medical Rx and disposition
?CCS commander

Question 3

Top cover calls mandated
(7)

Answer 3

VIP/newsworthy
Anaesthesia in <12 (35kg)
Anaesthesia in morbidly obese
Amputation
RH
RT
Major incident

Question 4

Helicopter deployment immediate criteria 13

Answer 4

RTC - ejection
Death at scene
Rail/plane/bus crash
Person hit by train
Person v bus/lorry
Person trapped under vehicle
Amputation above ankle/wrist
Fall 10ft or 2 storeys
Medical arrest in remote area
Major incident
Central stabbing/shooting
Paediatric arrest
Crew request

Question 5

Safety at scene general principles (6)

Answer 5

Scene safety is everyone’s concern
Don’t leave aircraft or car until safe
Dynamic risk assessments
PPE worn appropriately
Share situational awareness between staff/agencies
Ensure Horizon control aware of all safety critical info

Question 6

CDs
Definition of CD
Theft of drugs what should happen
Lost ampoule ?
Colleague addiction?

Answer 6

1. A drug or substance that requires extra handling and documentation procedures as per the misuse of drugs act 1971 and MODR 2001.
2. Inform top cover, ops manager and registered manager -> police and CD accountable officer
3. Try to find lost ampoule. If unable then datix, let top cover and ops manager kmow.
   If unable to resolve then need to inform police/NHS England CDAO and Home Office.
4. Inform senior leadership -> addiction is an illness. Safe, supportive conversation in confidence with staff member

Question 7

Duty of candour
What is it?
What must we do?
Who is involved?

Answer 7

Being open, honest and transparent,
a statutory process (HSCA 2008) that must be invoked if incident involves moderate or more harm to patient.

Contact patient or representative.
Explain facts
Explain how we will investigate and keep them updated
Apology

Datix system, PFLO and senior management

Question 8

Writing an SOP
Key points

Answer 8

National guidelines
Local variations
Identify KPIs for audit and performance
Promote independent clinical practice

Question 9

Photography SOP
Key points

Answer 9

Only take photos on LNAA equipment
Don’t share in public or to other places
Upload asap to secure HEMSBASE entry
Delete and not to cloud
Consent if possible
No identifiable features
In line with GMC/HCPC guidelines, Caldicott guidelines and a human rights act

Question 10

Out of date CD disposal?
Part used CDs

Answer 10

Store in OOD CD safe
Fill in bound register
Contact NHS England expired drugs section to request authorised witness to attend
Can only destroy in presence of authorised witness
Denaturing vial + water and 24h then clinical waste bin

Part used CDs can be wasted in denaturing kits and recorded in registers

Question 11

Patient packaging

General points
Trauma blunt
Trauma penetrating
Medical
Paeds
Air transfer

Answer 11

General points
Good Packaging is a treatment intervention in itself; reduces pain, heat loss, psychological distress and blood loss

Trauma blunt
Risk of bleeding, coagulopathy, pain, spinal injury and hypothermia
Clothes off and full exam
Skin to scoop
Minimal handling Inc 10degree roll
Pull femur to length asap and KTD after binder
Iv access secure and reachable
Blankets
PHEA patients head up 20degrees and loose collar

Penetrating
Full stab check and clothes off
Blankets for warmth and dignity
Can walk
Sat up on trolley
Iv access etc

Medical patients
Scoop might come off better for PHEA too
Sit up
Neuro 20degrees head up
Hypothermia still
Risk of arrest think about Lucas and pads

Paeds
Small sometimes don’t fit
Risk of hypothermia
Secure and work around size
Scoop still

Air transfer
General principles always have iv access secure and available, monitoring visible, secured in place. Hearing protection.
Explain comms and noise etc beforehand
Antiemetics
Sedation drugs handy