Lincs and Notts Air Ambulance Charity

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first assessment for this service. This key question has been rated outstanding. Staff carefully assessed people’s needs before providing care and treatment. Care and treatment was delivered using evidence-based guidance to give the best outcomes. Leaders inspired a culture of improvement and exploring the very best practice. The service worked closely with other healthcare providers, including all the emergency services, to ensure it was part of a system of health and care and a multidisciplinary team approach. Patient feedback, research and monitoring was used to improve outcomes for patients. Staff followed legal frameworks around consent and understood patients’ rights.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients and their families confirmed that staff members asked the right questions to assess their pain, check for allergies and how they could make them comfortable.

Staff we spoke with told us they considered patients' needs and made any adjustments required for their individual care. For example, staff could provide specific medication for diabetic patients. Staff said they could make use of various communication tools, such as online translation services or Braille, to enable them to communicate with people most effectively. The service had policies and standard operating procedures to ensure patients' needs were assessed and agreed by the paramedic and doctor. Staff used multi-modal patient monitoring, including a 3-lead ECG, non-¬invasive blood pressure and oxygen levels assessment to monitor patients' changing needs. These vital signs were uploaded to the electronic patient record, and staff could calculate a clinical deterioration measure (National Early Warning Score or NEWS) which enabled them to quickly adapt a patient’s treatment, particularly if there was deterioration.

Patients told us they were kept well informed throughout their care and decisions about treatment and transfer to hospital was explained to them. When one patient's family expressed concerns about the method used to move the patient after an incident, the service met with the family and reassured them how the procedure had followed national guidelines although these had since been updated.

Staff told us there was clear guidance from policies and standard operating procedures, which ensured they used current evidence-based practice when treating and caring for patients. Staff confirmed they kept up to date with changes to practice. They could also make suggestions if they felt current processes could be improved to better fit the service’s specific requirements. These could then be assessed by management and if appropriate, changes would be made and staff guidance updated. Staff were given certain roles and responsibilities for various specialities. This included, for example, blood transfusion and the service carried four units of red cell blood on site and this was fully stocked at all times. Staff at the service had contributed and were referred in clinical guidance and research at national and international levels, such as international cardiac arrest guidance.

The service had standard operating procedures and policies which covered current best practice in patient care in helicopter emergency medical services. These were regularly reviewed by an internal working group. The service held quarterly clinical quality and effectiveness committee meetings to help maintain an effective system and ensure it was fully up to date with all guidance and practise. Any updates to national guidelines would be referenced at weekly governance meetings and shared with staff.

Patient feedback shared with the service indicated patients and their families acknowledged the prompt and effective treatment they received. Patients also shared updates about their improving health where this was the case. However, even when the outcome for the patient was not positive, families had contacted the service to share their appreciation of the hard work done by staff members to give the best care to their loved one.

Patients confirmed the team worked well with other services at the scene of incidents. One patient said the "cohesive teamwork was fantastic". They also felt that the service had good communications with staff at the receiving trauma centre.

Staff told us the attending doctor and paramedic worked as a tight-knit team providing initial care to a patient. They also said they liaised with local emergency services and trauma centres to enable the most efficient transfer of patients to the appropriate place of care. Staff told us the team had close ties with acute hospitals and could obtain feedback about ongoing patient care. A senior staff member said there had recently been "more joined up working" between the service and other agencies.

The trauma network team told us the service was very engaged with the emergency response network. They were aware of co-working across the network to improve skills in ‘trauma triage’ which would help ensure the service was deployed effectively. The ambulance service confirmed staff from both organisations showed great teamwork at an operational level and they had joined up to facilitate statutory training, such as training in learning disabilities and for people with autism. Other local emergency service providers had also passed on thanks from community first responders to service staff for involving them in decision making at incidents. The responders said this gave them vital experience and learning.

The service had policies and practices to ensure good communication between other agencies. There were regular service debrief meetings for managers and teams to consider incidents and constructively challenge actions and decision making. The service also had effective service level agreements and memoranda of understanding with external agencies to ensure there was a clear plan of decision making and communications during incidents. The service also attended regular meetings with other emergency response providers to discuss wider operational matters.

We did not look at Supporting people to live healthier lives during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

People’s feedback was gained as much as possible and well documented to cover the outcomes for the patient. Patients and their families shared their experience with the patient liaison team by emails or by phone. Their feedback enabled the service to make changes to methods of care or improvements in communications to enhance patients’ experience. Patients and their families were complimentary about the prompt and effective treatment they received from the service.

There were effective processes to manage people’s experiences. The patient aftercare team confirmed they followed up the outcomes of patients and shared any relevant learning with teams and managers. They also attended de-brief meetings to keep up with clinical learning. The compliance manager monitored audits and incident reports to check for any learning about patient outcomes and any changes that could be considered. The links the service had with the acute hospitals gave opportunities to learn more from the patient’s progress and eventual outcome.

The service had policies and standard operating procedures to guide staff to be consistent in analysing outcomes for patients. Feedback from patients and their families was assessed and learning shared. Regular internal de-brief meetings were also held post-incident. These could confirm best practice was followed or consider ways to improve outcomes.

The service had rolled out new initiatives such as blood transfusions and was trialling the pioneering endovascular resuscitation procedure, which could help increase patient survival rates in critical incidents. The service worked with the local medical school to conduct research on factors which affect prognosis in patients with head injuries. This research was being used to find ways to improve the outcomes of those patients.

Patients and their families told us staff asked for consent to carry out any care. For example, they were asked to consent to the removal of clothing or to receive medication. Where necessary, staff checked with patients they understood they might need to be taken to a specific place for treatment, particularly if this was not a local hospital.

Leaders and staff told us staff always asked consent from patients about their care, where practical. However, if patients were unconscious or unable to respond, the service adopted a ‘best interests' treatment pathway and followed legal requirements. Staff understood how to act when a patient did not have capacity to make their own decisions, particularly if this was due to cognitive impairment such as dementia.

The service had a consent policy, which outlined protocols for patients who lacked mental capacity at the time, who might be under the influence of substances, or experiencing mental illness. The service kept up to date with guidance and legal requirements in these areas. The service adopted a ‘best interest’ policy with patients at times when valid informed consent could not be obtained.