On 17 August 2022, Great Western Air Ambulance Charity (GWAAC) and Avon Fire & Rescue Service (AF&RS) came together for a day of training in crucial rescue techniques, and to share best practices and build relationships.

The SWASfT Hazardous Area Response Team (HART), and lecturers and student paramedics from the University of the West of England (UWE) also attended.

Student Paramedic at UWE, Clare Kingsbury, said: “It’s not often that the three disciplines come together and when we do, it’s usually in a time-critical high-stress environment. So, it’s good to get to know how each other practices, what terminology we use and how we can work cohesively as a team.”

GWAAC’s Specialist Paramedic in Critical Care (SPCC), Fleur Mosley, and Critical Care Doctor, Dr Jules Blackham, helped to organise the day. Fleur said: “A massive thank you to Avon Fire & Rescue Service for running this excellent training day for us and huge thanks to the UWE team for all their support with both personnel and kit.”

A collaborative affair

Hicks Gate Fire Station hosted the event and helped our Critical Care Team run a series of workshops in the morning followed by three simulations in the afternoon.

"It's training days like these that provide us with a great opportunity to learn from one another, better understand the equipment each service has, and ultimately improve the welfare of those involved in such incidents."

Lee Rogers, Station Manager, Avonmouth and Southmead Fire Stations

“Training with colleagues from multiple services is invaluable in ensuring that the best care can be delivered to patients in a timely manner.”

Dr Jules Blackham, Great Western Air Ambulance Charity (GWAAC)

Morning workshops

The workshops were designed to help attendees understand what GWAAC and AF&RS can bring to the scene of an incident. With an informal feel, the workshops encouraged open discussions on procedures and equipment.

Workshop one

SPCCs Fleur and Callum ran a workshop for AF&RS covering haemorrhage control, limb injuries and fracture management, all of which are associated with road traffic collisions (RTCs).

They discussed how to deal with bleeds in different scenarios, the different methods available, and when and how to use tourniquets. Callum talked through preparations, planning and assessment of a crash incident and they demonstrated how to correctly put a fractured leg back into place and why it’s important to do so.

Workshop Two

The AF&RS group leader gave a tour of two different types of fire engines. He talked through the equipment in the various locker compartments and explained what would be used for different emergency situations. Everything had a logical place and was easy to access; much the same as the GWAAC crew’s kit bags.

The main message to the group was: “If you can tell us what the problem is, we’ll tell you how we overcome it.” In other words, AF&RS know which tool is best for the job and can always make dynamic plans when given a timeframe to work towards.

Workshop Three

James Coomber, Training Coordinator for AF&RS, talked through how the Fire Service deals with RTCs, the planning involved, and the equipment used.

James sits on the National Operational Guidance Team and has been working with Dr Tim Nutbeam, an NHS emergency medicine consultant, on a research project to identify the most effective and least intrusive extrication techniques for patients. The project is a huge undertaking and is likely to change practices for both the fire and ambulance services.

In an article for the Guardian*, Dr Tim Nutbeam said: “Our (current) absolute focus on movement minimisation works for maybe 0.3% of patients, but it extends the entrapment time for 99.7% of them… Potentially hundreds of people in this country have died as a result of extended entrapment times, and if you multiply that worldwide, it’s many, many people.”

Sharing best practices with simulations

Following a buffet lunch with a chance for individuals to build relationships and share on-the-job experiences, the afternoon simulations got underway.

Simulations were based on the types of incidents that can and do happen in real life. They involved mannikins and live casualties in the form of UWE student actors. The groups were briefed beforehand by our Critical Care Team and feedback was provided in a debrief at the end. During the simulations, the Critical Care Team stepped in to offer guidance when needed.

Scenario one

Following the brief, the fire crew and paramedics kicked into action to safely extract a casualty — a mannikin from an RTC. An added complication was that the casualty (the front seat passenger) had been impaled on a fence post inside the vehicle.

After the extraction, the patient was safely maneuvered onto a stretcher and medical treatment was prioritised. Dr Jules said: “It’s nice to be able to recreate a rare, but possible, incident like this so everyone can practice.”

The debrief involved the whole group talking through their actions. Dr Jules spoke about what the GWAAC decision-making process would be in real life and the fire crew talked through their decision-making process during the simulation. They all discussed whether the pole should have been removed at the scene.  

The group also reflected on their communications during the simulation — what worked well and what could be improved.

Scenario Two

The group faced a situation involving a car that had rolled into a ditch with multiple casualties. The fire crew immediately stabilised the vehicle to make it safe and used extrication procedures to remove the casualties. This allowed the paramedics to treat the critically unwell patients, all of whom, had different injuries and medical problems including one suffering from a cardiac arrest.

Small groups of paramedics focused on each patient. Dr Tim Godfrey said everyone worked well; the whole group, “was bought in and invested in the simulation.”

During the debrief, there was a discussion about the best ways to extricate casualties with certain injuries and how limitations on time have an impact on the fire crew’s extrication procedures. They also discussed the positioning of the cardiac arrest patient and whether she should have been moved further away from the vehicle for better access to the other patients.

SPCC Mark Kinsella explained the thought process that the GWAAC crew would go through in a real-life incident, both en route and at the scene.

Scenario three

A casualty who had fallen down a lift shaft posed additional access problems for the group. The fire crew used a turntable ladder to gain access to the building and rope rescue equipment was used to lower a Critical Care Doctor and paramedics into the lift shaft. Our Critical Care Team provided guidance to the student paramedics on how best to treat the casualty.

In the debrief, SPCC Fleur asked the student paramedics for their opinion of the simulation which led to a discussion around the concerns they had about the patient they found, what they did, and what they could do differently if presented with a similar situation out in the community.

Building relationships

At the end of the day, the different groups came together to reflect and discuss key learnings. Some key takeaways from attendees included:

“Good, clear, communication is key.”

“We’ve discussed and learned how best to work together when resources are poor.”

“Communicating with the patient is important.”

“Getting the kit ready before we get there saves time.”

“It’s been useful to test vehicle cuts with all of us here.”

“Communications between fire and medics, and early planning is key.”

“We have built relationships today.”

Reflections on the day

"One of the biggest learnings for us after incidents, especially road traffic collisions, is communication. The best way for us to improve our response at incidents and the care of those involved in such trauma is to improve the communication between our services on the ground… The training will help us work better together when we see each other out and about.”

Lee Rogers, Station Manager for Avonmouth and Southmead Fire Stations

“Working with other ambulance staff and fire service personnel allows us to practice inter-agency working and I learned a lot about how we can help fire and rescue service commanders understand whom to talk to at an incident. I also learned about the responsibilities of a Sector Commander and Incident Commander in the context of an RTC as the two people in tabards (whom we see on scene) can be confusing at first."

"The fire training day held at Hick’s Gate Station was excellent. The simulations were well-designed, based on real cases and clinically thought-provoking. The equipment and use of live casualties added a realism that is hard to find in training courses. I particularly enjoyed the multiple casualty exercise as this is something we don’t practice regularly.”

Mark Kinsella, SPCC, GWAAC

“This type of training allows us to understand the different skills that the teams bring to the scene, and how these can be used to maximum effect… Communication between the services is improved and barriers are broken down on this type of training day”

Dr Jules Blackham, Critical Care Doctor, GWAAC