Stakeholder Newsletter - 17/08/2020

Pandemic overview

The Scottish Ambulance Service has, understandably, faced one of its biggest ever challenges in dealing with the Covid-19 pandemic.

The pandemic has obviously dominated our schedules and planning.

The following is a brief overview of how we adapted to those challenges and how we are moving forward. When news of the pandemic first broke in March, it was clear that SAS was going to be firmly on the front line in dealing with patients with suspected symptoms. From the start our staff have played a key role in identifying, triaging and treating patients with suspected Covid-19.

The pandemic also necessitated several changes in the way our staff operated, all of which had to be implemented quickly and efficiently. Our immediate concern was to ensure we could maintain our high standards of patient care, whilst at the same time protecting patients and our staff from the added complications from the coronavirus.

We achieved this by working with our health partners in Scotland to clarify the Personal Protective Equipment (PPE) requirements for this new virus and work to set up strong supply chains to so that all our frontline staff would have access to plentiful supplies of PPE.

A potential risk our staff faced was acquiring a Covid-19 infection when carrying out what are termed ‘Aerosol Generating Procedures’ (AGPs); procedures such as Cardio Pulmonary Resuscitation, where there is potential for the virus to be carried on air droplets from a patient.

To protect our staff we undertook a country-wide programme of Face Fit Testing to ensure all frontline staff had access to air-tight, fluid-resistant face masks. We also initiated training in donning and doffing PPE.

The pandemic has also led to changes in working patterns for other members of our staff. Below are more examples of how we have adapted our work, including an overview of how we have changed the way we triage patients, using video-call technology to assess patients and how we are providing more support for staff who are working from home.

Covid-19 innovations

Using video conferencing technology, we have set up a system whereby teams of Advanced Paramedics and Nurses Practitioners working in our Ambulance Control Centres, can be called upon by paramedics and technicians who are at-scene with a patient. Those specialist clinicians can carry out a patient assessment and offer potentially life-saving advice to those clinicians carrying out treatment.

Our primary aim is to save lives and attend emergency calls involving life threatening conditions and incidents. However, a growing number of 999 calls to the ambulance service involve urgent but not life threatening situations. Whilst some of those patients will still require an ambulance, many can be more appropriately managed within their own home or community with the right support.

This approach not only is in the best interests of patients – by avoiding an unnecessary journey to A&E  – but ensures we can focus our resources on saving the lives of the sickest patients. Our advanced practitioners have provided additional triage for 10% of 999 patients since April; and where appropriate have provided telephone or video consultations with patients.  Since April around 12,000 patients have avoided unnecessary transfer to emergency departments across Scotland.  Recent staff and patient surveys have shown very positive feedback, being safe for patients and staff.

We’ve worked closely with health boards and health and care partnerships to establish new community based services such as local mental health services and direct referrals to departments such as stroke centres.

Our aeromedical service had to quickly adapt to new Infection Prevention and Control arrangements and we worked with Loganair to design and fit out aircraft to meet our requirements, with the Coastguard and with the Royal Air Force to provide contingency back up services.

Like many organisations, we have encouraged staff, where possible, to work from home. Using Microsoft Teams, all of our meetings are now held virtually, reducing travel requirements and the stress and environmental impacts of that whilst improving productivity.

As we remobilise services we intend to build the innovations into our new working arrangements.  A key priority is to ensure that there is capacity to support any additional surges in Covid activity, alongside usual increases in Winter activity and other significant events over the coming months. 

 

Mobile Testing Units

Testing patients for Covid-19 has become one of the Scottish Government’s key priorities and in June we were asked to take over the running of Scotland’s Mobile Testing Units, from early September.

The units, which are supporting the country’s Test and Protect programme, are currently being operated by HM Armed Forces. Using the Service to operate these testing facilities makes good sense as we operate in communities across Scotland - not only can we maintain the high standards set by the Armed Forces, we can ensure people continue to get good quality face-to-face assistance.
 
Around 470 temporary additional staff are in the process of being recruited so that we can support the Scottish Government’s crucial Test and Protect programme. The 18 units, which complement the static drive-through testing centres and the testing being carried out in hospitals and care homes, ensure that testing is as accessible as possible for all communities.

 

Looking after our staff

During the pandemic our staff have faced a wide-range of challenges. Our frontline staff have faced the added pressures and anxieties connected with helping patients with Covid-19 symptoms whilst protecting themselves and their loved ones. Some frontline staff have experienced the hardship of spending long periods away from their families to avoid potentially infecting them.

Meanwhile, many of our staff based in offices have had to adapt to new ways of working, for example the stresses attached to working in isolation.

To support staff, we launched a specific site on our internal intranet system with a range of different resources containing advice, links to resources and evidence-based information. All staff members also received a hard copy of a specially created Wellbeing and Support pack.

The resources focus on giving staff the incentives and advice they need to eat well, achieve better sleep, how to exercise more and how to create a good work/life balance.

Our Wellbeing and Support resources also focused on supporting good mental health and contained a range of tips from the charity MIND. The Scottish Ambulance Service is, understandably, formed of close-knit teams. Our Wellbeing and Support resources therefore also contained information on how to better identify when colleagues were struggling.

These new resources complement a range of existing resources that we had created – including our successful ‘RUOK’ (are you OK?) campaign, encouraging all staff to be on the lookout for signs in colleagues that they were suffering from stress and anxiety in the workplace.  In addition, these SAS specific resources are complemented by NHS Scotland Wellbeing resources which are clearly signposted for staff and managers.

Working for the Service is an extremely rewarding job, but it can also be very challenging, stressful and demanding – as are all jobs which involve working on the frontline. It is vital that as a Service we do all we can to ensure our staff have the resources they need to stay well and create a healthy work/life balance.

Positive patient stories

We receive many compliments from patients who have been treated by the Scottish Ambulance Service and no more so that during the pandemic.

Patients are often put at ease by the diligence, expertise and dedication of those members of staff they come into contact with. Patients and their families often express the sentiment that they felt they were in good hands. They often praise their good-humour, confidence and sensitivity.

I am very proud here to share with you just a handful of the compliments we received from patients and their families during the lockdown.

During the  lockdown we received an email from a patient who was shielding, thanking staff from our Livingston and Edinburgh Ambulance Stations for the care they provided.

In the email she said: “Recently, I had to go to hospital with breathing difficulties. I was petrified at the thought of going near a hospital as I’m shielding. Andrea and Toni were extremely reassuring and by the time we were ready for the off, they had calmed me down and reduced my anxiety. I’m extremely grateful for their attendance. I am so grateful to all you guys and everything you do. And hopefully 2 ambulances in 1 week are the last ones I see.”

We also received a compliment via Facebook from a patient who wanted to thank staff from Stirling Ambulance Station for the care she received from them when she was suffering suspected COVID-19 symptoms.

In the post she wrote: “Just want to say a huge thank you to the two paramedics who came out to me yesterday. I am 6 months pregnant, was showing signs of coronavirus, they were so nice and kept me at ease. They also spoke to my 5 year old little boy, having a giggle with him. They were fantastic. They are doing an amazing job. I am thankful I do not have coronavirus.”
Finally, a reminder that not all our work since March has involved treating patients with suspected Covid-19 symptoms. Very often our staff have been helping patients with the kind of issues they were dealing with regularly before the lockdown. One patient based near Glasgow was full of praise for the SAS staff from Springburn Ambulance Station, for the care they gave him when he was suffering from a mental health issue.

In the email he says: “I would like to extend a very big thank you to the ambulance crew who took care of me yesterday. One of the paramedics was called John, the kindest man I have ever met. The crew treated a mental health emergency with the same urgency, compassion and professionalism as they would a physical health one. Not many people do that and for that I am forever grateful. They deserve a huge medal.

“I worried I was wasting the crew’s time but John never failed to calm me down when I was most anxious and vulnerable and reassure me that I have done the right thing. I did not feel like a burden on them at any point. They treated me like a person, made me laugh and drove me to be seen by an out- of-hours psych team. What I appreciate the most is the kindness, the chat and the laughter in a time when I thought I would be ending my life. Thank you to the crew, you are amazing people. And to John - your kids are very lucky to have you as their dad. You are an amazing man and all medical professionals should strive to treat mental health emergencies the same way that you did. “