HEI Inspection Report: Scottish Ambulance Service

HEI Inspection Report: Scottish Ambulance Service

The Healthcare Environment Inspectorate (HEI) today (Monday) published its report relating to an unannounced inspection visit of the Scottish Ambulance Service on 12-14 June 2012.

Scottish Ambulance Service
Scottish Ambulance Service

HEI has been set up to help reduce healthcare associated infection risk to patients through a rigorous inspection framework. The HEI inspection team examined the Scottish Ambulance Service’s self-assessment information and then inspected ambulances at various accident and emergency (A&E) departments to validate this information to assess how clean they were and if they were meeting national standards.

The findings from the visit are set out below, and cover eight requirements that the Scottish Ambulance Service is fully expected to address, plus two recommendations for improvement.

The full HEI inspection report and an improvement action plan developed by the Scottish Ambulance Service to address the identified issues are available to view at


Speaking of the report, Susan Brimelow, HEI Chief Inspector, said “We observed staff complying with hand hygiene practice after they had been in contact with patients and there was good provision of alcohol hand rubs. However, overall we found that infection control is not fully embedded into all aspects of the Scottish Ambulance Service. In particular we found poor communication between the infection control team and staff, and there was inconsistent completion of documentation relating to the cleaning of vehicles. We expect the Scottish Ambulance Service to address these issues as a matter of priority.”                                                         


The Scottish Ambulance Service must:

  1. Ensure that all staff groups adhere to standard infection control precautions to ensure the risk of infection to patients and staff is minimised. This was previously identified as a requirement in the June 2011 inspection report for the Scottish Ambulance Service.
  2. Liaise with ambulance control and health and social care providers to ensure that there is robust risk assessment and communication about patients’ infection status. This will ensure additional precautions can be taken as required when in contact with a patient. This was previously identified as a requirement in the June 2011 inspection report for the Scottish Ambulance Service.
  3. Ensure that all staff are aware of and implement the policy for station and vehicle cleaning. This should reflect the frequency stated within the NHSScotland National Cleaning Services Specification (2009). This will ensure that all vehicles are clean and maintained ready to use at all times. This was previously identified as a requirement in the June 2011 inspection report for the Scottish Ambulance Service.
  4. Ensure that documentation relating to vehicle cleaning is consistently completed.
  5. Ensure that they effectively communicate and implement the policy, with regards to the provision and use of mops, to staff and other NHS partners. This was previously identified as a recommendation in the June 2011 inspection report for the Scottish Ambulance Service.
  6. Review existing internal and external communication methods to ensure that there is effective communication on matters relating to healthcare associated infection.
  7. Ensure that sufficient resources are in place to support education provision.
  8. Ensure that all staff have a specific objective for healthcare associated infection within their personal development plan, and that they understand what this is and how it will be achieved. This was previously identified as a requirement in the June 2011 inspection report for the Scottish Ambulance Service.


The Scottish Ambulance Service should:

  1. Consider how it works with other NHS boards to use existing compliance monitoring data to identify areas for improvement and provide feedback to staff.
  2. Consider how to strengthen awareness of the role of the infection control advisor and other members of the infection control team. The infection control team should also consider working directly with ambulance staff at sites.

What to do when you don’t have Telehealth?

In April, 29th, 1961 a doctor of the 6th Soviet Antarctic expedition Leonid Rogozov aged 27 felt pain in a right lower belly and fever. The next day brought only exasperation. Having no chance to call a plane and being the only doctor at the station “Novolazarevskaya”, at night, in April, 30th the surgeon made an appendix removal operation on himself using local anesthesia. He was assisted by an engineer and the station’s meteorologist.

Leonid Rogozov aged 27

In 1959 Leonid Rogozov graduated from the Institute and was immediately accepted to the surgery clinical residency. However, his studies at the residency were broken off for some time due to Leonid’s trip to Antarctica in September, 1960 as a doctor of the 6th Soviet Antarctic expedition to Novolazarevskaya station.
During this expedition there happened an event that made a 27-year old surgeon world-famous.
In the 4th month of the wintering, in April, 29th, 1961, Leonid showed disturbing symptoms: weakness, nausea, fever and pain in a right iliac region. The following day his temperature got even higher. Being the only doctor in the expedition consisting of 13 people, Leonid diagnosed himself: acute appendicitis. There were no planes at any of the nearest stations, besides, adverse weather conditions would not allow to fly to Novolazarevskaya anyway.

In order to save the sick member of a polar expedition there was needed an urgent operation on site. And the only way out was to operate on himself.

At night, on the 30th of April, 1961, the surgeon was being helped by a mechanical engineer and a meteorologist who were giving him the medical instruments and holding a small mirror at his belly. Lying half bent on the left side, the doctor made a local anesthesia with novocaine solution and made a 12cm incision in the right iliac region with a scalpel. Either watching in the mirror or by touch he removed an inflamed appendix and injected antibiotic in the abdominal cavity.

In 30 or 40 minutes from the beginning of the operation there developed a faint and giddiness and the surgeon had to make pauses for some rest. Nevertheless, by midnight the operation lasting 1 hour and 45 minutes was over. In five days the temperature normalized, in two days more – the stitches were taken out.

In the St. Petersburg Museum of the Arctic and the Antarctic there is an exposure of surgical instruments that Leonid Rogozov applied for this uneasy operation.

NHS Grampian board plans a new £110m emergency care centre in Aberdeen

Plans for an “ambitious” new £110m emergency care centre in Aberdeen have taken another step forward.

The full business case was approved at a meeting of the board of NHS Grampian, and the plan will now be submitted to the Scottish government.

News from BBC Scotland

Accident and emergency treatment as well as the Gmed out-of-hours facility would be among the services at the base.

It is hoped the centre will be operational by December 2012.

Project director Graeme Smith said: “This ambitious project has taken shape as a result of a major effort by a wide range of clinicians, managers and the public over many years.”

More patients may be treated at home by paramedics

Published Date: 18 February 2010

By Lyndsay Moss

Health Correspondent

MORE patients calling an ambulance in Scotland could be treated at home by paramedics rather than going to hospital, a report on the future for the service reveals.

The “strategic vision” for the Scottish Ambulance Service (SAS) over the next five years suggests more conditions could be treated without going to hospital, reducing trips to busy A&E departments.

At present, conditions that can be dealt with by paramedics at home under so-called “see and treat” guidelines are panic attacks, fainting, minor head injuries, fitting and epilepsy, diabetes and asthma. The report also said the service would work with “vulnerable” rural communities to improve the services they received, including more home care.

The SAS said it would develop a new system with NHS 24 and local out-of-hours providers to make sure patients got through to the right service they needed, after its consultation suggested widespread public confusion.

It comes after The Scotsman revealed last week that doctors were increasingly concerned the NHS will not be able to cope with rising demand for emergency out-of-hours services.

The report, which follows a lengthy public consultation, looks at plans to improve the care given to patients from 2010 to 2015.

Demand for ambulances is growing every year. Between 2003-4 and 2008-9, call-outs went up 35 per cent, with a 41 per cent rise out of hours. At the same time, more patients are being treated in Scottish A&Es. This year, it is expected they will deal with more than 1.6 million patients.

Click the link to read more about The “strategic vision” for the Scottish Ambulance Service (SAS)

Endoalpha operating theatre formally opened at Edinburgh Royal Infirmary

Cutting-edge operating theatre to transform healthcare in Scotland

Click on thumbnail to view image
Published Date: 20 November 2009
By Stephen McGinty

IT IS a room with an intimate view and the most advanced operating theatre in Europe.

While the surgeon’s favourite show tunes blare out from an iPod dock, the patient’s insides will be beamed on to high-definition flatscreen televisions as well as to students around the world as Edinburgh Royal Infirmary meets the Starship Enterprise.

Yesterday, the state-of-the-art Endoalpha operating room was formally opened at the infirmary where pioneering keyhole surgery, in which surgeons perform an operation through tiny incisions on the body, will take place.

The theatre will cater for some of the most complex medical operations and is expected to speed up procedures. The facility will also allow video conferences in which operations are broadcast anywhere in the world, allowing trainee surgeons to learn new techniques.

Read more about the Endoalpha operating theatre at Edinburgh Royal Infirmary

Survey finds women risk lives by delaying 999 call on first signs of heart attack.


Women risk lives by delaying calling 999

BHF launches 999 Day to raise awareness of heart attack symptoms

A third of women wouldn’t recognise they are suffering a heart attack because they would expect to experience crushing or severe chest pain (33%), a symptom which mainly affects men, according to survey results released by the British Heart Foundation on 999 Day – a drive to raise awareness of the need to call 999 at the first sign of a heart attack.

Worryingly the survey also showed that more than a third of women (35%) wouldn’t call 999 if they were experiencing unusual chest pains for fear of being left red faced if it turned out not to be serious.

The results reflect official figures which confirm that women are more likely to put off dialling 999 waiting on average 24 minutes longer than men after first experiencing heart attack symptoms (2) – dramatically cutting their chances of survival.

Approximately 140 men and 110 women die every day from heart attacks. Around 90,000 people die from heart attacks every year. A third of people die before reaching hospital (3) often because they have waited too long to seek medical help which is why the BHF is reminding people today (09/09/09) to call 999 if they think they are having a heart attack.

Read more HERE

Heart attack video below

Visit British Heart Foundation special 999 Day site for more on the campaign