Saving lives in the most challenging emergencies

Terrorist attacks, rescues from height, patients caught in fast moving waters – these are highly challenging incidents handled by the NHS Ambulance Service.

It’s National Ambulance Resilience Unit Head of Education Dave Bull’s job to ensure ambulance services have the specialist capability for the most dangerous and challenging scenarios.

Resilience is our mantra. Ensuring that the NHS in England is as prepared as possible to work with other agencies and each other to respond to challenging incidents is our core mission.

To this end, NARU is a central support unit for all UK ambulance services, to ensure the ambulance service as a whole can respond to a variety of hazardous and challenging incidents in the safest and most effective way possible.

Dave Bull, Head of Education, NARU

The mandate for NARU comes from four primary sources:

The Civil Contingencies Act 2004and its legislative requirements for specified responders, including NHS Ambulance Services, to be prepared for complex and major incidents.

The National Risk Registerwhich identifies the main risks or threats to the United Kingdom that emergency services, among others, should prepare to deal with effectively.

The NHS England Emergency Preparedness, Resilience and Response (EPRR) Core StandardsThese include contractual obligations for the ambulance sector.
The NARU Contract formally constitutes our organisation and specifies what services we need to deliver within the context of the three principal documents set out above.

Comprised of national subject matter experts, NARU’s key role is to maintain and develop the high standards expected of the NHS ambulance service’s specialist interoperable capabilities so they are effective and fit for purpose.

NARU maintains contract standards, ensure safe systems of work, trains and equips specialist operational staff – such as Hazardous Area Response Teams (HART) and Special Operations Response Teams (SORT) – from each service.

Dave continues:

This is so that they have the right tools, knowledge and procedures to  enter challenging and hazardous situations with the confidence and ability to save lives. Undertaking all of this – while mitigating the risks to their own safety – is key to NARU’s work.

Accordingly, NARU works closely with a range of stakeholders to support the national development of EPRR related policy.  NARU also supports the development and training of command and control staff for the whole ambulance service. These commanders play vital roles in mass casualty major incidents.

We undertake a wide range of training – including highly realistic mass casualty training and exercises –  to support the NHS Ambulance Service to maintain an effective and consistent response to high-risk or complex emergencies that improves clinical outcomes.

A total of 43 courses to equip newly recruited HART paramedics with the skills they need were held between April 2021 and March 2022, training 643 delegates from trusts across the country. The number of HART delegates trained was 97 and the combined evaluation scores were impressive alongside highly positive feedback from delegates.

We also carried out assurance audits for every English ambulance trust, including reviewing over 2,000 items of evidence and conducting interviews with over 1,000 staff involved in the frontline delivery of interoperable capabilities.

NARU also develops and produces a broad range of training aids and operational publications, which are used daily by thousands of ambulance staff.

Additionally, we develop national resources designed to help all ambulance trusts to share best practice and learn from each other, including NARU’s bespoke PROCLUS system.

We run highly realistic exercises to test how prepared ambulance services are for some of the most challenging and dangerous scenarios. In June, we ran Exercise Amber, which involved a state-of-the-art command and control vehicle, a drone capable of thermal imaging and an air ambulance, that tested the complex interoperable response required by the NHS Ambulance Service to a mass casualty incident.

This exercise involved 52 HART paramedics who tackled a terrorist incident exercise involving firearms and explosions. It also involved a car, a train carriage, a bus and a  coach teetering over the edge of a hill. The scenario employed 120 casualties and was designed to test 24 paramedics’ skills and abilities following six weeks of residential training to become HART operatives.

In addition and working with the NARU Medical Advisor, the education department has supported NHS England’s review of major incident triage across the UK, including carrying out exercises to test both the new Major Incident Triage Tool (MITT) and the new Ten Second Triage tool for mass casualty incidents. These will speed up triage and save lives.

Last but not least, NARU has set up a national working group to improve gender equality. This aims to ensure female voices are heard and everything is done to ensure the working environment supports the goal to increase the numbers of women working in HART teams, such as commissioning bespoke equipment for female operatives. This drive is already seeing real success with some teams having an equal balance of male and female paramedics for the first time.

At the centre of NARU’s training is its highly regarded education centre, co-located with the Military of Defence’s CBRN centre at Winterbourne Gunner in Wiltshire. This facility provides vital training resources – including confined space simulations, train carriages and coaches – which offer realistic scenarios.

The education department also supports technical user groups, whose job is to evaluate new equipment, procedures as well as training provisions prior to them being adopted in their operational arena.

Upcoming work includes:

  • Monitoring and maintaining the national state of readiness of interoperable capabilities including trust liaison.
  • Learning and implementing lessons learnt from major events including the Manchester Arena Inquiry and Covid-19.
  • Review, maintain and improve current educational and training standards, support national and local exercises and deliver the full range of our courses.
  • Participate in the planning and delivery of national workshops, including with multiagency partners, debriefs and external training events as well as developing and updating online training and awareness aids and implementing any recommendations.
  • Ensure all policies and procedures applicable to interoperable capabilities support the delivery of expected standards of clinical care under the constraints of challenging environments.

Ensuring the NHS Ambulance Service is resilient not only means lives are saved, but those paramedic staff who choose to go in harm’s way can do so as safely as possible.

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