East of England Ambulance Service

East of England Ambulance Service
East of England Ambulance Service
	EEAST
	Area served by East of England Ambulance Service NHS Trust
Created	July 1, 2006
Headquarters	Melbourn, England
Region served	Norfolk, Bedfordshire, Cambridgeshire, Essex, Hertfordshire and Suffolk
NHS region	NHS England
Area size	>7,500 sq miles
Population	More than 5.8 million
Type	NHS Trust
Budget	approx. £247 million
Chair	Sarah Boulton
Chief Exec	Robert Morton
Number of employees	More than 4,000
Website	www.eastamb.nhs.uk

The East of England Ambulance Service NHS Trust (EEAST) is the authority responsible for providing National Health Service (NHS) ambulance services in the counties of Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk, in the East of England region. These consist of 5.8 million people and 7,500 square miles.

It is one of 10 Ambulance Trusts providing England with emergency medical services, and is part of the NHS, receiving direct government funding for its role. There is no charge to patients for use of the service, and under the Patient's Charter every person in the United Kingdom has the right to the attendance of an ambulance in an emergency.

As well as providing an emergency ambulance service, the Trust also provides out-of-hours primary care services, patient transport, commercial services and special operations such as emergency planning, and hazardous materials incident response.^[1] The service also support a number of emergency charities, such as air ambulances, who provide doctors for serious incidents.

The Trust controls the mobilisation of critical care charities throughout its area. These include Magpas (HEMS), Essex & Herts Air Ambulance (HEMS), East Anglian Air Ambulance (HEMS), BASICS Essex Accident Rescue Service (BEARS), SARS, NARS and BASICS Hertfordshire. The service can also, if required, mobilise London's Air Ambulance and even the Kent, Surrey and Sussex Air Ambulance if there is a major incident requiring more than one critical care team, and where other teams in the region are operating at maximum capacity. The trauma teams are dispatched by a Critical Care Paramedic at the Critical Care Desk, in the Control Room, at Broomfield Hospital, Chelmsford, who filters through every call the ambulance service receives and makes a clinical decision on whether to dispatch a critical care resource.^[2]

History[edit]

The trust was formed on 1 July 2006 following the three-way merger of the Bedfordshire and Hertfordshire Ambulance and Paramedic Service NHS Trust, the East Anglian Ambulance NHS Trust

EEAST was formed by the merger of 3 ambulance services - including the East Anglian Ambulance NHS Trust

, and the Essex Ambulance Service NHS Trust. The result was a service covering an area of over 7,500 square miles (19,000 km²) with a population of 5.8 million people, and one which answers over 500,000 emergency calls per year.^[3]

The East Anglian Ambulance NHS Trust had been formed in 1994 from the three-way merger of Cambridgeshire, Norfolk and Suffolk Ambulance Services.^[4]

In 2009, the Trust was censured by the Care Quality Commission after inspection of an ambulance depot and seven of its 100 ambulance stations found patient-carrying vehicles were "dirty" and that staff were "unsure of basic measures for infection prevention and control". The service launched an "urgent and comprehensive review" of its ambulance cleaning programme and reiterated its stance on patient safety, adding that "ensuring consistent high standards of cleanliness is a challenge" with so many stations, covering six counties and an area of 7,500 square-miles.^[5]

A 2010 Mercedes Sprinter Double Staffed Ambulance (DSA)

A 2014 DSA responding to an emergency

Land Rover Freelander Duty Locality Officer & Rapid Response Vehicle

A Ford Mondeo RRV in Hitchin, Hertfordshire

Land Rover Discovery Sport Duty Locality Officer & Rapid Response Vehicle

Statistics and resources[edit]

Helicopters from the East Anglian Air Ambulance are based in Cambridge and Norwich.

G-HHEM (North Weald) and G-EHEM (Earls Colne) can be dispatched from Essex & Herts Air Ambulance.

Magpas Air Ambulance is based at RAF Wyton.

In 2015/16, the trust received 1,037,119 emergency calls and handled 500,620 non-emergency patient transport journeys. The trust arrived at 73.6% of emergency Red 1 calls within eight minutes, and 69.4% of emergency Red 2 calls within eight minutes.^[6]

EEAST employs more than 4,000 staff and has around 1,500 volunteers.

As of July 2016^[update], the Trust has the following resources in operation:^[7]

357 front-line emergency ambulances
201 marked rapid-response vehicles (RRV)
164 non-emergency ambulances (Patient Transport Service - PTS)
52 major incident support vehicles (HART/major incident/resilience vehicles)
Over 130 ambulance stations and response posts
3 emergency operations centers (EOC - control rooms) in Bedford, Chelmsford and Norwich

The Trust has its own emergency driving school, which trains drivers in 999 emergency driving under blue lights and sirens.^[1]

Vehicles[edit]

A&E Ambulances (Double Staffed Ambulances)[edit]

The Trust used exclusively the Mercedes Sprinter as front-line Double Staffed Ambulances, with the exception of a single Vauxhall Movano 4 wheel drive vehicle for use at Newmarket Racecourse. In 2009, the service started the transition to a brand-new Sprinter only fleet from a wide range of other brands - including Fords, Vauxhalls and older Mercedes vehicles. The scheme was finished in 2016, when the last brand-new Sprinter was delivered, although many of the older ones are now ending their cycle life. In March 2018, four new vehicles will be trialled across the East of England, with one concept vehicle being designed exclusively for and by the Trust.

In May 2018 the trust bought 32 five-year-old vehicles decommissioned by the West Midlands Ambulance Service - described as "clapped out vehicles which colleagues in other trusts would have sent to the scrapyard" and contrasted with the luxury cars with which senior managers were provided in 2017.^[8]

Rapid Response Vehicles[edit]

Ford Mondeos and Skoda Octavia Scouts (4x4) are the most common amongst the fleet. In addition Land Rover Freelander and Land Rover Discovery Sport operate out of a limited number of bases. Some Land Rover are used as Officer Cars, responding to major incidents (e.g. Road Traffic Collisions (RTCs) and fires) to co-oridnate resources.

Patient Transport Service[edit]

Renault Masters and Vauxhall Movanos are used for the Patient Transport Service. A number of these vehicles are fitted with blue lights and sirens for High Dependency (Critical care & Intensive care) transfers.

Hazardous Area Response Team[edit]

The Hazardous Area Response Team team uses Volkswagen Transporters and Mercedes Sprinters, all of which have 4x4 capability. The new fleet arrived in 2017, standardising these vehicles across the 10 ambulances services in England and Wales. It replaced Land Rover Discoverys and Iveco Dailys.

Air Ambulances[edit]

The trust provides Critical Care Paramedics (CCPs) to 3 local charity air ambulances in the region: Magpas, Essex & Herts Air Ambulance and the East Anglian Air Ambulance. These paramedics work alongside doctors (who are seconded from NHS Hospitals) to administer advanced treatment at the scene of the accident. Although the service uses the air ambulances, it does not fund the charities.

Staff:^[9][edit]

In order of clinical skills (top=least skill, bottom=most skill)

Italics indicated specialist, advanced role.

Emergency Crew[edit]

Intermediate Ambulance Practitioner
Associate Ambulance Practitioner
Emergency Medical Technician
Graduate/Student Paramedic
Paramedic
Duty Locality Officer (Managers with Occasional Response Capability)
Critical Care Paramedic
Emergency Care Practitioner

Patient Transfer Service[edit]

Patient Transport Driver
Ambulance Care Assistant

Emergency Operations Centre (EOC)[edit]

Call handler
Dispatcher

Patient transport services[edit]

The trust took over patient transport services in Hertfordshire and Bedfordshire in February 2018 after the private provider, Private Ambulance Service Ltd went into administration. A two year contract was awarded on an emergency basis.^[10]

Performance[edit]

In 2013-14 the Trust missed all of its targets in Cambridgeshire and Peterborough. 73.6% of "red 1 calls" for immediately life-threatening situations were met within eight minutes against a target of 75%. 69.4% of "red 2 calls", which may be life-threatening but less time critical were responded to within eight minutes against a 75% target. In north Norfolk, rapid responses during one month were as low as 25%.^[11] According to the Clinical Commissioning Group performance had "deteriorated overall in comparison to prior year at both regional and local level".^[12] In August 2014, the Trust was fined £1.2m over these failures. It was also fined £300,000 over turnaround times at hospitals. The fines were accrued between April and July 2014. EEAST, which handles more than 900,000 emergency 999 calls a year, said it was recruiting hundreds of new staff and investing in new ambulances.^[13] In a statement in November 2014, Chief executive Anthony Marsh blamed EEASTS’ continued failure to meet its emergency response time targets on a lack of staff. Acknowledging that the service was still "not good enough” he said that "significant progress" had been made; 536 student paramedics and a further 69 graduate and qualified paramedics and emergency medical technicians had been recruited since January 2014.^[11]

In October 2014, EEAST apologised after claims were published in a local newspaper that a body had been left lying next to dustbins at its station in Ely, Cambridgeshire the previous month. Chief executive Anthony Marsh said the Trust was "very sorry for what happened" and had started a "thorough investigation". An EEAST spokesman confirmed the investigation involved "the transportation of a deceased patient", but said he could not comment further as inquiries were ongoing. The newspaper which published the claims said it had done so after being approached by a whistleblower.^[14]

The trust was accused of putting patient safety at risk in July 2017 because of a “fixation” with hitting response time targets, using a practice referred to as “stopping the clock” - sending a rapid response vehicle to a call within the target time, leaving the patient to wait longer for the arrival of an ambulance.^[15]

Delays, according to a whistleblower, led to the deaths of at least 19 patients and serious harm to 21 more during January 2018. A patient taken to the Norfolk and Norwich University Hospital, had to wait in the back of the ambulance that took him there for four and a half hours before being seen by a doctor inside the building. ^[16] A summit was held with NHS England and NHS Improvement in January 2018. It was announced that it would “take steps to improve staff availability at peak times, including action to improve staff health through flu vaccination and reviewing the trust’s leave policy” and that it would hire extra vehicles.^[17] The trust directors were accused by Norman Lamb of misleading MPs after a meeting about these allegations and several MPs said they had no confidence in the trust's leadership.^[18]

The Trust is one of the poorest performing in England on most urgent response times and is considering employing military drivers and volunteer drivers due to staff shortages.^[19] Proposals made in August 2018 to restrict staff holiday leave between 12 November and 12 January were greeted with a storm of protest.^[20] The Trust decided controversially sometimes to ask one ambulance to deal with two patients. A senior Trust paramedic stated, “It’s desperate. I’ve never heard anything like this. A paramedic might have a clinically stable patient on board but if that patient then becomes unstable and you’re sitting on scene with perhaps two unstable patients, what do you do? Do you separate one of them from the equipment? Who do you pick?”^[21]

In 2018 the trust said it would need 100 more paramedics to meet the new ambulance performance standards. This could cost £5 million a year.^[22]