Out-of-Hospital Cardiac Arrest - A Strategy for Scotland Review 2015 - 16

Meeting Our Commitments

Partner Organisations Updates

OHCA partners made specific commitments as part of their contribution towards delivering the OHCA Strategy's aims. The following provides a summary of progress towards delivering these individual and shared commitments.

SCOTTISH FIRE AND RESCUE SERVICE

• We will integrate health awareness such as cardiac arrest risk factors and provision of CPR lifesaving skills within our prevention work including our Home Safety Visits.

In May 2016 the SFRS developed a proposal to introduce CPR lifesaving awareness skills into the programme of Home Fire Safety Visits. Working closely with 'Save A Life For Scotland' this now progressing, with a test of change due to commence in early 2017 in three pilot locations across Scotland.

• We will offer our network of Fire Stations as locations for training members of the public and voluntary groups in CPR and, if appropriate, will enable our staff to become CPR trainers.

The SFRS has made available 356 community fire and rescue stations for CPR training. Central to this is the supply to all stations of Call-Push-Rescue kits by the British Heart Foundation. These kits can be used by the public and the fire stations can be used by community groups as venues for CPR training.

• We will work closely with Scottish Ambulance Service to pilot a SFRS response to OHCA in agreed geographic areas, learn lessons from the pilot and expand as appropriate.

The SFRS began to trial co-responding to OHCA in November 2015. There are now 10 SFRS stations involved; Hawick, Coldstream, Lauder, Musselburgh, Falkirk, Livingston, Bathgate, Linlithgow, Turriff and Maud. This trial has involved careful preparation with Scottish Ambulance Service and SFRS staff. The learning and evaluation of the trials will inform next steps for the consideration of future service-wide implementation of
co-response. There is ongoing work on Mull that will bring online three fire and rescue stations as part of the Health Foundation funded project.

• We will agree appropriate and validated training for SFRS responders with Scottish Ambulance Service under the ethos of shared clinical governance.

A collaborative and bespoke training programme for stations involved in the co-responding trial was developed and is being delivered in partnership between Scottish Ambulance Service and SFRS. This includes a Memorandum of Understanding, operational response parameters and training materials.

• We will work closely to ensure all our defibrillators are mapped on to the Scottish Ambulance Service database and are placed in locations where evidence suggests they can add most value.

The SFRS have updated and shared all defibrillator locations with Scottish Ambulance Service. There is now a wider asset management exercise being undertaken across the SFRS estate involving a review of the provision and deployment of defibrillators, which will support remote and rural areas of Scotland in ensuring equitable access to resources.

• We will work with Scottish Ambulance Service to assess how we can support First Responders and promote enhanced Community Resilience.

The SFRS supports the Sandpiper Trust Wildcat project in Grampian Area with access to staff as volunteers for the scheme as well as the use of our community fire and rescue stations as training venues.

• We will ensure that our workforce and their representatives form part of the planning and implementation to support the OHCA strategy.

The Fire Brigades Union ( FBU) is a key partner in the SFRS internal Strategic Steering Group and Local Delivery groups for OHCA. The FBU has consistently contributed to the ongoing development of OHCA co-responding trials. This approach has served the project well and the FBU have cited this as a best practice example within the spirit of partnership working and the SFRS Working Together Framework.

• We will aim to train 100% of our support staff in CPR.

The SFRS continues to support and deliver against its OHCA commitments, including partnership working with the British Heart Foundation.

General points

The SFRS has led on and assisted Save A Life For Scotland at several high profile CPR events across Scotland and continues to receive and assist with ongoing requests from the public, community groups, businesses and local authorities.

The SFRS demonstrated their commitment to the OHCA Strategy by co-hosting this year's national OHCA symposium. This involved staff from the SFRS OHCA project team, stations that have hosted community CPR training workshops and others.

The Scottish Fire and Rescue Services have also commenced discussions with staff in Best Bar None, a national bar licensing Scheme, with a view to delivering CPR training to a total of 400 licensed premises across Scotland as part of an existing training package.

SCOTTISH AMBULANCE SERVICE

The Ambulance Control Centre ( ACC) is the centre of the co-ordination of all the resources involved in the pre-hospital care of out-of-hospital cardiac arrests. ACC call handlers need to be effectively trained and supported and then reliably use the best triage tools available so they can:

• Rapidly identify cardiac arrest and initiate telephone CPR.

ACC call handlers initiate telephone CPR guidance ( T-CPR). The call handler must try to ensure that the caller or bystander rapidly begins chest compression. This may mean persuading someone who has had no training in CPR.

A 'Key Phrases' module will be introduced for ambulance control centre staff, enabling faster dispatch of ambulances to OHCA calls.

The Scottish Ambulance Service's OHCA training and handling has improved the response and support. The Scottish Ambulance Service is also working to secure recognition as an accredited Centre of Excellence for the Ambulance Control Centres and the standard of compliance is supported through audit. Work to capture data to understand and inform this is being progressed.

• Task/dispatch appropriate resources.

Scottish Ambulance Service dispatch at least three responders to all OHCA calls where and when possible: February 2015 to August 2016, 6595 (88.1% of the total number of OHCA calls) saw at least three responders in attendance.

• Map assets so ACC call handlers can access to up-to-date and accurate information about available resources including Scottish Ambulance Service assets and other available first responders, and the locations of public access defibrillators.
• Ensure that a register of PADs - mapped to the Ambulance Control Centre ( ACC) - is developed and kept up to date.

PADs that can be used by bystanders in OHCA are already in place in thousands of locations across Scotland. A major project currently underway will give Scottish Ambulance Service call handlers the information to direct bystanders to the nearest PAD. This will improve the ability to use these assets in OHCA. Achieving this involves a number of linked and ongoing tasks to identify, map and maintain PADs by Scottish Ambulance Service.

As of February 2016 over 1000 AED/ PADs had been mapped, including 800 in dental surgeries and some within Police Scotland premises. In the course of mapping AED and PAD locations, further details such as accessibility, usability and visibility have been captured where possible.

The date for the mapped PADs to be operational is April 2017. Integral in this is the training of ACC staff to identify and utilise PADs are registered on the Scottish Ambulance Service system.

• Ensure effective governance arrangements for the mapping and maintenance of PADs and consider how best to encourage owners, purchasers and suppliers of PADs to ensure that PADs placed in the community are regularly serviced and maintained and registered with the Scottish Ambulance Service.
• Review the public information available about PADs, (including purchase, maintenance, location, access and signage).

In the course of mapping PAD locations, further details such as accessibility, usability and visibility have been captured where possible. A system for regular checking and servicing in partnership with resilience team and PAD owners, is in development by the Scottish Ambulance Service.

• Community Resilience

First Responders go from strength to strength and make a real difference in responding to OHCA, particularly in remote and rural areas. Currently Scottish Ambulance Service has 134 Community First responder schemes across Scotland, involving over 1,500 individuals. The Scottish Ambulance Service is supporting and strengthening the 'Community First Responder' networks across Scotland. Activities include engagement with delivery partners and community groups to provide advice on acquiring, locating and using PADs.

• Engaging with partner organisations to enhance education and training for co-responders and where necessary for the public.

Scottish Ambulance Service has made a consistent contribution to the awareness and CPR training activities through Save a Life for Scotland.

• Pre-hospital Resuscitation: Scottish Ambulance Service will work with partners to design and deliver appropriate pre-hospital resuscitation models, responding to the challenges of geography, demographics and resources of individual communities.

Scottish Ambulance Service has helped deliver OHCA workshops across Scotland, including in the Highlands and Islands. Recognising the difficulties of access, workshop learning materials have been made available online. This programme of workshops stemmed from the Edinburgh 3RU team's delivery of master classes at the Royal Infirmary of Edinburgh. Paramedic students at Glasgow Caledonian University now complete workshop focussing on the non-technical skills of OHCA management.

• We will engage and work in partnership with individual communities and other partner agencies to develop and implement these models.

The delivery of high quality CPR and related training has been a focus for Scottish Ambulance Service over their 2015/16 operating year. Keen to share good practice, the Scottish Ambulance Service delivered presentations and learning workshops at both the London and Welsh Cardiac Arrest Symposia. Scottish Ambulance Service strengthened connections with Community First Responder scheme networks. A partnership with the Sandpiper Wildcat Project in Aberdeenshire, which was launched in May, is due to start operating in autumn 2016. Scottish Ambulance Service work on community based training - within established Community Resilience activities - continues, with the long-term aim of enabling those trained in CPR to become trainers in their own communities.

• Staff Support and Welfare

Scottish Ambulance Service and aligned staff often work under the most significant pressure, in all environments, to deliver care to people facing extremely difficult circumstances. It is a job that can take a physical, psychological and emotional toll.

Scottish Ambulance Service continuously aim to improve our processes to ensure that staff are supported through the challenging experiences they face. Scottish Ambulance Service has enhanced its provision of training, education, support and feedback to call takers and dispatchers in ambulance control centres. At least three staff are now deployed to OHCA calls where and when possible. Rest management period policy has been reviewed collaboratively to maximise staff response. An OHCA Consultant Paramedic has been appointed and refreshed clinical guidance documents produced for use by Scottish Ambulance Service staff. OHCA training workshops continue to be delivered across the organisation, with the aim of enabling them to incorporate it into their daily practice and pass training on to colleagues. In October our newly appointed OHCA Clinical Effectiveness Lead took up post.

• We will put in place feedback mechanisms for all staff involved in OHCA to inform them of outcomes, of their own performance and provide appropriate recognition and support.

Scottish Ambulance Service has had positive engagement with staff organisations in order to secure changes to operating protocols. A key role of the new OHCA Clinical Effectiveness Lead will be to enhance the existing feedback provided to all staff including community first responders.

Scottish Ambulance Service was represented at the Scottish Parliament and NHS Scotland events to showcase staff delivering the OHCA strategy.

POLICE SCOTLAND

• We will continue to ensure that all Police Officers attend an annual Scottish Police Emergency Lifesaving Saving ( SPELS) Course, which includes training in Cardio Pulmonary Resuscitation ( CPR) and Automated External Defibrillator ( AED) usage.

The SPELS (Scottish Police Emergency Life Support - Heartstart Module) went live on Moodle on the 1st January 2016. This online learning will ensure that all officers are refreshed in CPR/ AED awareness, which is enhanced by hands-on CPR training at the annual Operational Safety Training recertification. This year, 8612 police officers have completed this.

Since October 2015 Police Scotland's College has continued to train all new recruits at the Tulliallan Campus - 590 regular officers and 69 Special Constables, to date - in CPR/ AED awareness.

Police Scotland has also made a commitment to train all Police Scotland Youth Volunteers ( PSYVs) in CPR/ AED awareness in all 20 PSYV groups, from Shetland to Stranraer.

• We will increase the number of officers and staff trained in First Aid at Work ( FAAW), an enhanced course which also includes the use of defibrillators.

Police Scotland continues to train staff in the FAAW Course comprising 64 members of police staff since October 2015 and a further 10 police staff have completed an AED/ CPR specific course.

• We will introduce and pilot an online defibrillator awareness package.

An online AED awareness package accessible to officers and support staff was launched in December 2015, and promoted further via internal communications.

• We will consider with the Scottish Ambulance Service whether Police Scotland defibrillators can be mapped onto the Scottish Ambulance Service database.

Police Scotland met with the Scottish Ambulance Service to discuss mapping static AEDs; this prompted a survey of AEDs across Police Scotland premises. This work was completed in summer 2016 and will, in the first instance, help bring into operation those AEDs which have been out of service for some time. Details of their locations will be shared with Police Scotland Command and Control Rooms. It is planned to map these AEDs onto the Scottish Ambulance Service system. This will enable Scottish Ambulance Service Area Control Centre staff to locate and direct responders to PADs which are registered on the Scottish Ambulance Service.

A census of AEDs across Police Scotland premises was completed in summer 2016. All custody staff have been trained in First Aid at Work, including AED awareness; in Lanarkshire, six AEDs were acquired from the local NHS Board for use in custody centres.

Police Scotland will complete the review of the availability and use of defibrillators in Police custody areas and vehicles (including Roads Policing Units and Armed Response Vehicles) with the aim of enhancing the contribution of Police Officers to OHCA calls.

• We will promote enhanced community resilience through our membership of local Community Planning Partnerships, Community Safety Partnerships.

Police Scotland's College Campuses at Fettes, Jackton and Tulliallan provided a total of five staff to the 'Save a Life for Scotland' stand at the Tattoo.

As part of the OHCA Strategy and in conjunction with the Lucky2BHere charity, two events have taken place at the Police Scotland Dalmarnock building. Staff were provided with CPR/ AED awareness and the money raised has provided an AED of the Dalmarnock office. Given the success of these awareness days, similar events are being planned across the country.