Responding to the current challenges... (Apr 2020) ...for our patients, our staff and our communities The operational challenges currently facing Devon Air Ambulance (DAA) have led our teams to focus their immediate efforts on the following key areas: tackling the various aviation factors that will enable DAA to resume air operations; the procurement and use of appropriate PPE and the development of opportunities to support the wider healthcare effort in the region. In this blog, we wanted to highlight some of the hard work, great progress and fantastic collaboration that is happening between DAA and its partners. Modifications to the aircraft, the communications systems and aircrew Personal Protective Equipment (PPE) Due to the challenges faced by Air Ambulance operators, Devon Air Ambulance is now part of a cross industry effort which is looking to develop a combination of aviation solutions. These innovative developments include a separation barrier to manage the space within EC135 helicopters, the use of throat microphones that can be worn with face masks and a safety helmet bracket that will enable a disposable full-face visor to be worn by aircrew. Fitting a separation barrier in the aircraft A prototype barrier is currently being fitted to the first of our two aircraft that will enable separation between the pilot and patient/paramedics. The barrier will enable us to separate the cockpit from the patient treatment area, helping to safeguard patients, pilots and clinicians. This prototype has been designed by submarine engineers at Babcock Marine in Devonport Dockyard and the design team at Babcock Mission Critical Services Onshore, manufactured in Spain and approved through the EU Aviation Safety Agency and UK Civil Aviation Authority in consultation with our engineering contractors at Airbus Helicopters UK. This is a great example of how the aviation industry and regulators are working together at this difficult time and we are grateful to all those involved with this new development. Babcock Mission Critical Services Onshore in Gloucester are fitting the separation screens to both aircraft. Developments in aircrew communications As there is no current means for our aircrew to wear FFP3 respirator masks alongside their normal aircraft ‘boom’ microphones (for internal and external communications), an important piece of work is underway to improve how our aircrew can communicate whilst wearing the required PPE. There’s also positive news on this front; our partners at Headset Services Limited have recently developed a throat microphone. This microphone is worn around the neck (above the larynx) and picks up sound which in turn feeds into the helicopter comms system. The first prototype has been produced and initial trials look promising. A second prototype is now with us and will be trialled on the Exeter based air ambulance on return from Gloucester with its separation barrier fitted in the coming days. The next step will be to produce more throat microphones so that we equip all members of the team. New aircrew PPE The use of full-face visors is an important part of PPE when carrying out Aerosol Generating Procedures (AGPs) during which there is an increased risk of transmitting the Coronavirus by airborne particles. Until recently there was no approved mechanism to enable these visors to be fitted to aviation helmets. Once more we have good news, Babcock Marine (in Plymouth) have designed a bracket to be secured to aviation helmets allowing full-face visors to be fitted and worn. This means our aircrew will be protected when undertaking AGPs such as CPR, intubation and other procedures to safeguard a patient's airway, as recommended by Public Health England. All of these innovative developments demonstrate how the aviation industry is coming together at this critical time to tackle current challenges in HEMS operations. We’d like to thank all the businesses involved and the UK CAA who are supporting this work by enabling timely well-balanced judgements to be made around the application of these new developments. The net beneficiaries of all this great work will be our patients and our staff. The use of appropriate PPE for DAA paramedics We are all increasingly aware of the importance of the correct PPE for healthcare professionals and the global demand for this equipment has placed significant pressure on supply chains. Indeed, the sourcing of PPE is currently keeping some of our Patient Services team very busy. However, it’s not just about getting the right equipment for our colleagues that’s important, we have also needed to ensure everyone has been trained in the safe use of PPE and feel confident with this new way of working. Public Health England’s (PHE) recommendations on PPE when treating potential Coronavirus patients is that a minimum of Level 2 PPE should always be worn, but if a healthcare worker is undertaking Aerosol Generating Procedures (AGPs), then Level 3 PPE should be used. Both types of PPE involve protecting airways/eyes/skin but as the risk of infection increases, so does the need for greater protection and enhanced PPE. AGPs are medical techniques which are more likely to produce airborne particles (which can travel some distance in the air and potentially be inhaled) and require close contact with airways potentially increasing the risk of transmission of the virus. AGPs include intubation, manual ventilation and open suction - all procedures that our paramedics are more likely to have to deliver given the serious conditions our patients are often suffering from. There are a number of aspects when using PPE that make our paramedics work more difficult. Therefore, effective training continues to be paramount in enabling their day to day work. First and foremost, the process of ‘donning’ Level 3 PPE for example needs practising – the procedure involves putting coveralls on, fitting respiratory masks and face shields and then putting gloves on. The process of ‘doffing’ (taking off) the PPE is potentially more challenging as you need to ensure that the equipment (which may have become infected when treating the patient) is removed carefully to avoid cross contamination. Secondly, our paramedics are now having to get used to performing procedures wearing equipment that restricts their movement and vision and can also be uncomfortable (it can get very hot wearing this type of PPE). So, their routine day-to-day training in pre-hospital emergency medicine now needs to be carried out in full PPE so they are prepared for the real-life event. There is also of course the need to simulate lots of different procedures and evaluate and refine their processes to ensure they can be delivered safely and efficiently. Lastly, we need hand sanitiser and lots of it! These new operating standards place additional pressure on our paramedic’s working environment in what was already an exacting job. As Devon Air Ambulance feels the pressure to continually source PPE, we are extremely grateful to those that have helped our cause - our thanks to Luminous Show Tech who have recently donated 50 of their new face shields and hand sanitiser. Thanks also to our colleagues at Wiltshire Air Ambulance who have kindly loaned us a Versalfo powered respirator hood and provided some face masks and Kent, Surrey and Sussex Air Ambulance who have provided us with some surgical masks. Please get in touch if you can help with the supply of essential PPE for our paramedics. Supporting the wider healthcare efforts against Coronavirus Although much of Devon Air Ambulance’s work has been focussed on what we can do to protect our patients and staff in the pre-hospital setting that we operate in, we are all aware of the region-wide efforts to tackle the Coronavirus pandemic. Indeed, once we saw the potential impact of the virus in Devon, we took the decision to release our doctors back to their host hospitals on the basis that they would be able to treat many more patients than they would in the pre-hospital environment. As our Patient Services team have quickly adjusted to our new temporary model of working, we have realised that there is spare capacity in our team. So, whilst we can continue to operate our two Critical Care cars from 7am to 2am (the following day), we can also directly contribute to wider healthcare plans to protect our communities. We are delighted to be supporting the South West Critical Care Network and five of our paramedics will be helping with the specialist transfer of patients between hospitals. This work will potentially include patient transfers to the new NHS Nightingale Hospital Exeter. This new 200-bed unit, hosted by Royal Devon and Exeter NHS Foundation Trust, is being set-up to provide a regional resource for Devon, Cornwall and neighbouring counties to meet the care needs of patients who are seriously unwell due to the Coronavirus. Devon Air Ambulance paramedics are highly skilled clinicians whose training and experience can bring a suite of benefits for those patients who need additional intervention and ventilation support when they are being transferred from one hospital to another. Our five paramedics - who have volunteered to take on this additional role - are currently in training alongside other critical care specialist as we build our region-wide response and resilience to meet the Coronavirus pandemic. We’d like to take this opportunity to thank all our colleagues across the NHS - please stay at home, protect our NHS and we can help save lives. Why not read our other latest news?