East Midlands Ambulance Service NHS Trust

POLICY FOR COMMUNITY FIRST RESPONDERS

Links to: CRB Checking Guidelines Induction Policy and Procedures Community Responders Handbook Education, Learning and Development Policy

Owner: Director of Operations

Lead: Assistant Director of Operations Support

Version: 3.0 Approved By: Healthcare Governance Committee Date: 27 February 2009 Review Date: February 2010 Equality Impact Assessment: 09 February 2009 Policy ID: OP/03.03

Version Control
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Document Location
The source of the document will be found in the Library folder located in the EMAS public drive (S:) Revision History Revision date January 2006 July 2007 April 2008 June 2008 February 2009 Previous revision date N/A January 2006 July 2007 April 2008 June 2008 Summary of changes New Policy Extended Review Date Review date Extended Monitoring section amended in line with NHSLA risk management standards Working Review

Approvals
This document requires approval from the following: Name Staff Governance Committee HR Strategy Committee Healthcare Governance Committee Operations Directorate Healthcare Governance Committee Date of Approval 19 January 2006 25 July 2007 24 April 2008 June 2008 27 February 2009 Version 1.0 2.0 2.1 2.2 3.0

Distribution
This document has been distributed to: Name Library (EMAS Public Drive) Intranet All Staff Freedom of Information Act 2000 Access This document is available via the EMAS Publication Scheme under Class 5 Operations www.emas.nhs.uk Date March 2009 March 2009 March 2009

Contents 1. Introduction 2. Overview 3. Purpose 4. Responsibilities 5. Selection and Recruitment 6. Equipment Requirements 7. Equipment Costs 8. Patient Report Forms 9. Scope of Practice 10. Training 11. Control Procedures (Activation Criteria) 12. Support & Management 13. Monitoring and Review Appendix 1 Equipment Requirements Appendix 2 Equipment Costs Appendix 3 Community Responder AMPDS Codes

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INTRODUCTION The use, and deployment of Community First Responders (CFRs) is an important development with modem ambulance services, as it harnesses the link from the community to 'Early access to defibrillation', and provides a trained operator to instigate treatment of potentially life threatening conditions, before the arrival of a paramedic, or an ambulance crew. See Appendix C. for full CFR Advanced Medical Priority Dispatch System (AMPDS) code list. OVERVIEW East Midlands Ambulance Service) NHS Trust (EMAS) operates a partnership with St John Ambulance, British Red Cross , The Royal Life Saving Society and LIVES through a Memorandum of Understanding (MOU) These voluntary groups work with EMAS to provide schemes throughout the Trust area. Within the CFR framework the Community Defibrillation Officers (CDO) are responsible for overall management of the schemes, and they report directly to the Service Delivery Manager (Operational support) & General Manager (Operational support) Across the Trust's area, there are Operational Support Managers (OSMs) who manage operational staff. They are available to provide a managerial link to the Community Responders on a day-to-day basis and provide a 24 hour/ 7 days a week cover if required. St John Ambulance, British Red Cross, Royal Lifesavers and LIVES provide nominated personnel who meet on a regular basis with EMAS, and ensure that good practice is maintained, clinical standards are met, and that patient critical data is fed back to the trust at the earliest possible time. All of these protocols are compliant with the requirements of public and patient involvement (PPI). PURPOSE Modern defibrillators are capable of being deployed with minimal training, and are virtually maintenance free, therefore operating cost, are minimal, and the battery technology employed means that it is reasonable to expect up to five years lifespan from each machine At present EMAS utilises community responders from various areas, these are: Schemes trained by St John Ambulance, British Red Cross and Royal Lifesavers Society - in a regional partnership through a memorandum of understanding. EMAS Schemes LIVES Partnerships with other stakeholders e.g. Nottingham East Midlands Airport Fire & Rescue Service. Regional Fire & Rescue Services acting as Co-responders. EMAS Staff Staff at static sites trained in defibrillation, under the defibrillators in public places initiative & National Defibrillator Programme.

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Date: February 2009

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RESPONSIBILITIES The Chief Executive and Trust Board are accountable for ensuring that there are effective arrangements in place to manage the risks associated with Community Responder Schemes and Co-responder Schemes. The Director of Operations is the nominated Executive Director responsible for managing Community Responder and Co-responder Schemes The General Manager (GM) - Operational Support, assisted by the Service Delivery Manager (SDM) - Operational Support, is responsible for the development of this policy and its day-to-day implementation. They will also liaise with the organisational learning and communications teams to ensure this policy is effectively communicated to all appropriate personnel. The Community Defibrillation Officers (CDOs are responsible for liaising with the Community Responder and co-responder schemes and are the primary point of contact. This will include: Providing training to the CFR/ CRO schemes in partnership with voluntary organisations where applicable. Ensuring all schemes are aware of EMAS policies and procedures where appropriate Provide support to CFR scheme members

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The Clinical Governance Committee is responsible for approving and monitoring adherence to the Community First Responder Policy and associated procedures. All CFR Scheme Coordinators are responsible for liaising between EMAS and their schemes members and will include; Ensuring good communication between EMAS and scheme members Managing rotas to ensure maximum cover in the community Forwarding all documentation to CDOs in relation to scheme such as IR1 forms and change of circumstances Ensuring equipment used by scheme is maintained to EMAS standards Coordinating training with CDOs for scheme

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SELECTION AND RECRUITMENT The guidelines for selection of CFR personnel are as follows: Completion of Community First Responder Application form Completion of Local Induction Checklist for Community First Responders (Appendix to Induction Policy) They must have a full clean driving License Recruitment to CFR is actively encouraged from all sections of the community, and seeks to reflect the diversity of the community which we serve.

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There is no upper age limit, but they must declare to EMAS, or the scheme provider that they are fit to carry out the training & duties, The Trust's HR department is able to give specific advice on certain medical conditions They must submit themselves to enhanced CRB checks. These checks are completed by EMAS (HR), or by the sponsoring body (St John, RLSS Red Cross) They must provide details of name, address, date of birth, postcode, and next of kin. If a vehicle is being used, they must provide proof, of, insurance, a VOSA certificate, and that the vehicle is roadworthy. These records are held by either, the Response Manager, or CDO in the case of an EMAS scheme, or by the partner organisation e.g. St John Ambulance, Royal Lifesavers Society & British Red Cross They must be prepared to undergo appropriate training, regular recertification training, and any other training that is applicable to their role They must carry an EMAS ID card when acting as a CFR They must not use visual or audible warnings on their private cars (other than very specific individuals who are employees of the Trust, and are using sponsored vehicles). This is line with the Trusts policy of private vehicle use for responding to calls. All CFR are now being asked to sign such a declaration. These recommendations have all been approved and agreed by the National Responder Management forum

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EQUIPMENT REQUIREMENTS See Appendix A. EQUIPMENT COSTS See Appendix B.

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PATIENT REPORT FORMS At present CFR schemes use the EMAS patient report forms, both copies are handed over to the responding A&E crew this removes the risk of breaches of Patient confidentiality. All Responders are requested to complete a PRF, however it is recognised that in certain situations such as cardiac arrest there may not be sufficient time for the CPR to generate a PRE In such cases the responsibility for completion of a PRF would fall to the attending crew. Issue: 3 Revision:0 Page 3 of 6

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SCOPE OF PRACTICE All CFR personnel are trained in Basic Life Support, the use of an AED (Automated External Defibrillator) following the model of the IHCD first person on scene standard and JRCALC & Resuscitation Council UK guidelines. All scheme members are re-certified & assessed on a regular basis in line with Resuscitation Council UK guidelines and the national CFR Governance Framework. The frequency of this proficiency checking is dependent on activity rates of individual schemes and will range from between six to twelve months. TRAINING Mandatory training requirements including CRT for Community Responder Schemes are outlined in the Trusts essential training matrix detailed in the Education, learning and development policy. All new responders are given a minimum of 32 contact hours training prior to joining a scheme. In addition to the mandatory training as identified in the essential training matrix, this will include the following key skill areas: All mandatory training AED training and safety Management of airways at Basic Life Support level. Use of Bag Valve Mask, and OP Airways. Use of Patient Report Forms. Use of Oxygen therapy. Patient Confidentiality issues. CPR skills. Role of Community Responder, and individual safety. Guidelines in relation to attending incidents. Activation Criteria and communication with ambulance control. Simulated scenario training.

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All scheme members will also undergo a local induction conducted by the appropriate CDO, who will also ensure that the appropriate local induction checklist form is completed and signed by the member. On completion if their training members will sign an agreement with their respective scheme to follow only approved EMAS policies, procedures and guidance. Training is provided by: EMAS Community Defibrillator Officers EMAS Clinical Tutors St John Ambulance, British Red Cross, or Royal Lifesavers Society Trainers. Medical & Nursing staff with appropriate training skills. Trainers within a CFR GROUP, who have been accredited, and observed, by EMAS Trainers to ensure continuity, and good practice. Issue: 3 Revision:0 Page 4 of 6

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All new scheme members are also issued with a CFR Scheme Personal Training Handbook. All training records are stored by the relevant CDO and where appropriate external voluntary organisations such as St Johns. All training records held by third parties are available on request to EMAS. CONTROL PROCEDURES (ACTIVATION CRITERIA) Activation criteria for all CFR are detailed within the EMAS CFR Governance Framework. These criteria are communicated to all schemes members as part of their initial training and also at regular interval during refresher sessions by the CDOs. SUPPORT & MANAGEMENT Access to the Trusts staff support network is provided to all responders should they require it. Within all CFR groups there is a lead person, or coordinator he/she provides an excellent communication medium to ensure that groups are running smoothly, and to highlight any potential problems. The Operational Support Management Team meet frequently with these groups, and ensure that good lines of communication exist, and that good practice is being followed. MONITORING AND REVIEW

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This Policy will be monitored for its effectiveness by the General ManagerOperational Support, assisted by the Service Delivery Manager- Operational Support through the following: Responsibilities of staff and volunteers will be monitored on an annual basis through attendance at meetings, development of reports and the performance development review (PDR) process, Selection arrangements for schemes are audited by HR and reported by exception to the HR Strategy Committee. External Stakeholder organisations are audited by EMAS staff on an annual basis and also periodically by internal audit. Results of these audits will be reported by exception to the Clinical Governance Committee. Training requirements for staff will be monitored through an annual review of the Trusts essential training matrix by the Education Committee. The CDOs will complete annual audits all CFR scheme covering scope of practice, proficiency checking, driving licenses, training records and equipment maintenance and storage. Any concerns or identified trends will be reported to the Clinical Governance Committee and actioned by the operational support management team. Actions could include re-training and counseling of members up to suspension of either individual members or schemes.

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The activation rates are monitored monthly by the operational support management team. Any deviation from the CFR activation criteria is reported by the scheme coordinators verbally to the CDO who will then report and investigate as detailed in the Trusts Untoward Incident Reporting Policy.

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Appendix 1 1.0 1.1 EQUIPMENT REQUIREMENTS Each CPR group has a standard kit comprised of the following items 2 Pagers 1 Mobile phone. AED (Automated External Defibrillator) The preferred models are Medtronic CR+, Heartstart FR series & Under the National Defibrillator Programme, the Cardiac Science G3 Two sets of Defibrillator pads Bag Valve Mask (Adult) Adult OPA (Oropharangeal Airways) D size Oxygen cylinder

Suitable bag Reflective coat, marked 'Ambulance First Responder' EMAS Identity Card Supply of high Concentration oxygen masks Basic First Aid Kit Patient Report Forms 1.2 1.3 All disposables are replenished by crews, and the CDOs will facilitate supplies, if groups are in urgent need of kit. The Operational Support Management Team maintains overall responsibility for all communications equipment. All control dispatch desks, and the Performance Manager are updated if there are any changes to policy, or mobilisation decisions. All responder kit must be stored in a suitable bag such as pacific A1000D to minimise any potential injury to scheme members and unrestrained kit moving around in vehicles. Specific guidance on appropriate storage of equipment is provided in the CFR Scheme Personal training handbook which is issued to all scheme members.

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Appendix 2 1.0 1.1 EQUIPMENT COSTS. The cost of all equipment other than that stated in Appendix, B is the responsibility of the CFR scheme, through fundraising. The trust recommends that schemes apply for charitable registration, the financial implication being that the schemes would be exempt from VAT payment. In line with St John Ambulance British Red Cross & Royal Lifesavers the trust reserves the right to view the CFR schemes financial accounts at any time. St John Ambulance British Red Cross & Royal lifesavers provide their schemes with all equipment required for operating, except that listed below. They also provide all training and re-certification required by their schemes. The financial implication to the Trust for the setting up of CFR schemes is as follows. 1.7 2 Pagers @ 5.00 per calendar month. 1 mobile phone @ 8.00 pcm ID Badges @ 5.00 per badge. 2 CD size 02 cylinders @ 4.58 + VAT pcm rental O2 refill @ 2.84 +VAT pcm. High Visibility Vest + Legend @ 18.00 +VAT each Defib pads based on 2 calls per month 36.00 pcm. Consumables i.e. gloves, airways & 02 masks. 15.00 pcm.

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The annual financial cost to the Trust is approx 599.00 per year per scheme.

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Appendix 3

COMMUNITY RESPONDER AMPDS CODES

01001 01C01 01C02 01C03 01C04 02E01 02001 02002 02003 02004 02005 02C01 02C02 02B01 02A01 03001 03002 03B02 05001 05C01 06E01 06001 06002 06003 06C01 06C02 08001 08002 08C01 09E01 09E02 09E03 09E04 09E05 09E06 09D01 10001 10002 10003 10004 10C01 10C02 10C04 10A01 1 ABDOMINAL PAIN/PROBLEMS Not Alert Fainting or near fainting> 50 Females with fainting or near fainting 12 - 50 Males with pain above the navel >35 Females with pain above the navel >45 2 ALLERGIES {Reactions)/ENVENOMATIONS (Stings, Bites) Ineffective Breathing Severe Respiratory Distress Not Alert Condition worsening Swarming attack (bee, wasp, hornet) Snakebite Difficulty breathing or swallowing Special medications or injections used Unknown status (3rd party caller) No difficulty breathing or swallowing 3 ANIMAL BITES/ATIACKS Unconscious or Arrest Not Alert Serious Haemorrhage 5 BACK PAIN (Non-Traumatic or Non-Recent Trauma) Not Alert Fainting or near fainting > 50 6 BREATHING PROBLEMS Ineffective Breathing Severe Respiratory Distress Not Alert Clammy Abnormal breathing Cardiac history 8 CARBON MONOXIDE/INHALATION/HAZCHEM Unconscious or Arrest Severe Respiratory Distress Alert with difficulty breathing 9 CARDIAC OR RESPIRATORY ARREST/DEATH Not breathing at all Breathing uncertain (agonal) Hanging Strangulation Suffocation Underwater Ineffective breathing 10 CHEST PAIN Severe Respiratory Distress Not Alert Clammy Nausea or vomiting Abnormal breathing Cardiac history Breathing normally> 35 Breathing normally < 35

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11 CHOKING
11 E01 11001 11002 12001 12002 12003 12004 12C02 12C03 12B01 12A01 13001 13C01 13C02 13C03 14001 14002 14C01 14B02 14A01 15E01 15001 15005 15006 15007 15C01 16001 18C01 18C02 18C03 18C04 18C05 18C06 18B01 19001 19002 19003 19C01 19C02 19C03 19C04 19C06 19801 Choking verified/Ineffective breathing Not Alert Abnormal breathing (Partial obstruction)

12 CONVULSIONS/FITTING
Not breathing (after key Questioning) Continuous or multiple fitting Irregular breathing Breathing regularly not verified> 35 Diabetic Cardiac history Breathing regularly not verified < 35 Not Seizing now & breathing regularly (verified)

13 DIABETIC PROBLEMS
Unconscious Not Alert Abnormal behavior Abnormal breathing

14 DROWNING (Near)/DIVING/SCUBA ACCIDENT

Unconscious Not Alert Alert with abnormal breathing Unknown status (3rd party caller) Alert & Breathing normally (No injuries & Not in Water)

15 ELECTROCUTION/LIGHTNING
Not breathing/ineffective breathing Unconscious Not Alert Abnormal breathing Unknown status (3rd party caller) Alert & Breathing normally

16 EYE PROBLEMS/INJURIES
Not Alert

18 HEADACHE
Not Alert Abnormal breathing Speech problems Sudden onset of severe pain <3hrs Numbness or paralysis Change in behavior <3hrs Unknown status (3rd party caller)

19 HEART PROBLEMS/AlCD
Severe Respiratory Distress Not Alert Clammy Firing of AICD Abnormal breathing Chest pain > 35 Cardiac history Heart rate < 50 bpm or > 130 bpm (without priority symptoms) Unknown status (3rd party caller)

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20001 20C01 20B01 20B02 26D01 26C01 26B01 28C01 28C02 28C03 28C04 28C05 28C06 28B01 28A01 31E01 31001 31002 31003 31C01 31C02 31C03 31C04 31C05 32001 32B02

20 HEAT/COLD EXPOSURE Not Alert Cardiac history Change in skin colour Unknown status (3rd party caller) 26 SICK PERSON (Specific Diagnosis) Not Alert Cardiac history (complaint conditions 2-28 not identified) Unknown status (3rd party caller) 28 STROKE (CVA) Not Alert Abnormal breathing Speech or movement problems Numbness or tingling Stroke history Breathing normally> 35 Unknown status (3rd party caller) Breathing normally <35 31 UNCONSCIOUS/FAINTING (Near) Ineffective Breathing Unconscious (at end of interrogation) Severe Respiratory Distress Not Alert Alert with abnormal breathing Cardiac history Multiple fainting episodes Single or near fainting episode and alert> 35 Females 12 - 50 with Abdominal Pain 32 UNKNOWN PROBLEM (Collapse - 3rd party) Life Status Questionable Medical Alert Notification