In order to stay at the forefront of pre-hospital care, GNAAS has committed to a programme of clinical innovation.

The latest techniques, equipment and drugs are constantly being evaluated to ensure we can provide the best care possible for our patients. This often means we are pioneering treatments years before they reach other parts of the country. Here are some of our recent successes.

Improving care through IT

The charity developed its ARC-EMS software in 2016 to handle the complexities of managing, logging and auditing incidents. The software provides a live snapshot of where the crew, aircraft and cars are at any point, allowing rescues to be coordinated remotely.

Precise details of patient care are logged securely. This extensive data resource, including drug usage and inventories, provides an comprehensive research tool that is already proving to be a catalyst for improvement.

In 2019, the charity developed the system further by introducing a tablet version, allowing 24/7 management of deployments which is vital for the charity’s rapid response crews.

GoodSAM

In 2018, the charity became one of the first emergency services in the UK to utilise the GoodSAM app in its deployment decisions. The app allows our team to see the scene through a bystander’s camera phone, simply by sending them a text message.

This means our clinicians can get a better understanding of an incident without having to rely on sometimes sketchy 999 call information. It might mean spotting troubling symptoms that have been missed by the member of the public, or it could be that the patient is not as seriously injured as initially reported.

The system is regularly used by the team and means they are able to make more informed decisions before deploying the aircraft to an incident.

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Equipment

We carry all the equipment needed to perform some of the most advanced medical procedures available. Every item of kit is rigorously researched, tested and maintained to ensure it delivers when it is needed most. Items we carry include:

  • Monitor
  • Ventilator
  • Thoracotomy kit
  • Blood warmers

Research

Our clinicians regularly undertake research projects in order to improve clinical standards and to share learning with others. Recent papers authored by our clinicians have appeared in the British Medical Journal and the official journal of the Association of Anaesthetists.  The findings have led to the introduction of new techniques and equipment, as well as improved tasking to incidents.

Blood and plasma transfusions

Our doctor Rachel Hawes OBE, who is also a consultant at Newcastle’s Royal Victoria Infirmary, instigated the Blood on Board project in 2015. Her research led to the introduction of ‘live blood’ on our helicopters and rapid response cars. She also oversaw the introduction of plasma the following year. Pre-hospital transfusions had not previously been possible in the North of England.

The introduction of blood and plasma took our care to another level and resulted in lives being saved as a direct consequence. Blood on Board is only possible thanks to the work of the Blood Bikes charities and Newcastle Hospitals NHS Foundation Trust.

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50

transfusions in 17/18

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3

unexpected survivors in first five months of trial

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48

hours - the time the blood is kept cool in our special boxes.

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50%

of trial recipients had been involved in road traffic collision

Body-worn cameras

Our clinical staff wear discreet body cameras when on missions throughout the North-East, North Yorkshire and Cumbria.

This allows them to share knowledge and experiences from cases of major trauma and serious illness throughout the area, for the benefit of future patients.

The data will not be shared with anyone external under any circumstances unless patient approval is granted.

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Ultrasound

GNAAS carries ultrasound scanners on its helicopters and cars. The scanners – roughly the size of a mobile phone – give our team a clearer picture of internal injuries or complications.

Andy Dalton, GNAAS paramedic, said: “In the case of a cardiac arrest, it allows us to see what the heart is doing and to make a decision on how to treat the patient. They can make a huge difference in allowing us to make an informed decision about a patient’s true condition.” 

Central Line Access

Sometimes, patients need large volumes of blood to be given quickly but access to veins in their arms or neck is limited due to their condition. In these special circumstances, our team can utilise central line access – an advanced, doctor-led procedure which involves placing a large bore cannula into either the femoral or subclavian vein.

In the last financial year, we used the technique for the first time. Central line access will never be a regular procedure but is another addition to our service which will make a key difference to those who need it most.

Thoracotomy

GNAAS uses open chest surgery (thoracotomy) in only the most severe cases. The advanced procedure involves gaining access to the heart and lungs through a major incision to the chest.

In 2017, our team performed a successful thoracotomy when a man was stabbed and left for dead in Horden, County Durham. The footage of this surgery is the first time a pre-hospital thoracotomy has been recorded in the world, and has become a vital training aid for our teams as well as other pre-hospital teams.

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Other innovations

Ventilators upgraded

The charity's on board ventilators, one of the most crucial pieces of equipment when dealing with major trauma, were upgraded. The new ventilators are much more akin to what would be found in the hospital. They allow for much more precise control, giving more options when treating patients with complex clinical requirements.

Ongoing REBOA study

Our clinicians are examining options to introduce the use of REBOA - which stands for Resuscitative Endovascular Balloon Occlusion of the Aorta. REBOA is an advanced technique which can help control haemorrhage in trauma patients.

Stroke outcomes could be improved

GNAAS has been working with a teram of researchers to see how its air ambulance service may be utilised to transfer patients suffering a stroke from remote hospitals to the Royal Victoria Infirmary in Newcastle, if the patient could be helped using a technique called thrombectomy. This revolutionary treatment is only available at specialist neurological centres and involves a wire being passed into the blocked blood vessel in order to remove the clot, therefore allowing the blood to flow back to the area of the brain that was starved of it during the stroke.

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