Non-Clinical Emergencies

This video was produced by the Children’s Acute Transport Service (CATS) – the largest paediatric critical care transport team in the United Kingdom. Below, Cathy Roberts, transfer practitioner and lead educator at CATS, describes the service and how CATS aims to prevent and manage non-clinical emergencies.

Critical care transport teams can experience a variety of non-clinical emergencies such as equipment failure, tyre blowout, road traffic collision and even fires in the ambulance.

Transfer teams work in relative isolation, usually in small groups of 2 or 3. Although expert practitioners in critical care, they may not necessarily possess the skills to recognise and manage non-clinical emergencies.

In the video above, you see Ged, Cathy and Adam responding to an ambulance fire. Observe them working together and see how quickly they evacuate to a place of safety (upwind of the fire) and use the CHARGE safety briefing.

We reduced our evacuation times (with a patient on board) from 3 minutes to 30 seconds, and staff demonstrated rapid decision-making and increased confidence using the major incident plan (MIP). Training days led us to think about other problems, such as how to exit the ambulance if there was an electrical failure and what to do if our paramedic collapsed or was unwell.

Think about the ambulance you travel in. Do you know how to open the doors from the inside if there is an electrical failure? Do you know how to make the ambulance safe if your paramedic is unwell?

SAFE Transfer

The principle aim of every transfer is to be safe: where the patient is adequately stabilised, the team are prepared for clinical deterioration and any non-clinical emergencies that may arise.

SAFE is a mnemonic used by CATS when responding to emergencies:

Stabilise: patient and environment

Actions: in event of patient deterioration / accident or incident

Family, Fluids/inFusions: communication with family, adequate amount in syringes, all IV lines secure with easy access

Equipment/Environment: minimal amount if evacuation required, location: in a lift, side of a road. Wear appropriate clothes

Critical Incidents

Over four years, we reviewed incident data and found that non-clinical emergencies occur between 7% and 16% of all transfers. They contribute to approximately 50% of all reported incidents on transfer.

Three key themes emerged: issues with the ambulance, equipment, and communication. Every year there has been at least one occasion involving staff sickness that resulted in a team member being replaced.

In the downloads section, the critical incidents document gives a breakdown of the non-clinical emergencies and ways we have tried to reduce or prevent them from happening in the future.

We carry spare parts of specialised equipment, insulated jackets for team members, extra paperwork and an emergency snack box for when the team is hungry!

What constitutes a major incident? Do you have a major incident plan (MIP) for your team? The CATS MIP can be found in the downloads section.

Transfer staff must be prepared to recognise and manage non-clinical emergencies. A straightforward process to follow for all personnel is essential: safety briefing tools, training and major incident plans can increase staff confidence and improvement in performance when faced with such events.

Trapped In An Elevator

Gail, one of the nurses, was trapped in an elevator with a patient. Would you feel prepared to handle this if it was happening to you right now? Read about her experience by following the link in the downloads section.

Key actions Gail and the team took when they were trapped:

1. They went into their allocated roles
2. They activated the MIP
3. Quickly reassessed the patient, oxygen supply and the battery life of all the equipment

Tyre Blowout

On a busy Friday night in the middle of winter the ambulance had a tyre blow out while transferring a patient to an intensive care unit. The patient was intubated and ventilated, and her mother was travelling in the ambulance. The repair truck was delayed, so an alternative ambulance had to be used. What did we do? Where did the team source a spare ambulance? Have a look at what happened by following the link to the completed MIP run sheet in the downloads section.

When a non-clinical emergency happens, the team’s priority (once they are safe) is to call the office and activate the MIP. The MIP gives a straightforward process to follow; it triggers a set of questions and actions to take and is beneficial to use after an incident to reflect on what went well and identify opportunities for improvement.

From the incident, you can see that there are multiple things to consider: informing the consultant, planning for a transfer, reassuring any relatives, and continuing clinical care of the patient. Having a clearly defined process to follow makes the situation more manageable.

When the MIP was activated the team started to plan for transfer to the new ambulance. Key things they were thinking about:

- Trolley compatibility

- Equipment charging

- Oxygen

- Location of flow meters and suction

- Safe storage of kit

- Somewhere for parent to sit

Once the London Ambulance Service (LAS) arrived, the CATS nurse rapidly assessed the vehicle, identified what equipment we could use and which paediatric-specific kit would have to be transferred with the patient. The patient was on her way within 42 minutes of the first call to activate the MIP.

Please note: this video is a simulation and does not depict a real-life clinical event. The clinical details used in the simulation are invented and do not describe real patients. Everyone featured has kindly given their permission for the video to be used.