NARS Doctors and paramedics volunteer their time to enhance the level of care provided for patients who suffer serious injury or acute medical illness.
NARS volunteers carry specialist equipment designed to cope with the most challenging of medical emergencies. Our colleagues in the ambulance service call upon us to assist in the management of the sickest patients – at home or at the roadside. A new system has been put in place to allow crews to easily escalate and request Critical Care support.
NARS volunteers can provide additional equipment to patients suffering from acute cardiogenic pulmonary oedema. This condition is where the heart fails to pump adequately resulting in a large build-up of fluid inside the lungs, impairing exchange of oxygen and carbon dioxide in the lung. A machine called a ‘Continuous Positive Airway Pressure’ (CPAP) device can help treat this condition in the emergency setting. All NARS members carry disposable CPAP equipment, which has been shown to reduce the number of patients requiring invasive ventilation (with a breathing tube) in the intensive care unit. An asthma attack can be particularly severe and resistant to the standard treatment of nebulisers and steroids provided by paramedics. NARS volunteers carry additional drugs to treat acute severe asthma attacks.
Referred to as ‘major trauma’, life and limb threatening injuries present a number of challenges to members of the emergency services. NARS volunteers are trained and equipped to perform emergency surgical procedures at the scene of an accident. A surgical cricothyroidotomy is a procedure similar to a tracheostomy in that the lungs can be ventilated in the case of complete airway obstruction, especially in the case of severe facial injuries. Thoracostomies can be performed when a patient is suspected of having severe chest injuries to relieve a tension pneumothorax (collapsed lung).
Although children are resilient, trauma is one of the leading causes of death and disability in young children. NARS volunteers are trained in advanced paediatric resuscitation techniques and intraosseous (IO) injection with the EZ-IO system. This enables quick and reliable intravenous access to be obtained in order to give lifesaving drugs and fluids. A range of paediatric airway equipment is also carried.
Currently Paramedics working at level 1 (The National Standard Paramedic Qualification) can administer certain drugs for pain relief and treatment of convulsions, the guidance for these types of medication is published by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). These include Intravenous Morphine and Paracetamol for pain relief, and Diazepam for treatment of convulsions. For the majority of patients this is perfectly adequate and provides a high standard of care.
In certain circumstances patients who are in extreme pain and / or agitation, due to severe injury or are suffering from a medical condition, may require additional pain relief and/or sedation. In these circumstances either a Doctor or Critical Care Paramedic (Level 2) who has had specific Critical Care training and working to specific guidelines, can administer certain drugs to relieve pain and if necessary, sedate a patient, such as someone who has sustained serious injuries and needs to be safely extricated from a car following an RTC, but needs additional pain relief to enable a safe movement and to reduce discomfort to the patient. NARS Doctors and Critical Care trained Paramedics can provide this level of care, and support the ambulance service with the management of this group of patients, by administering the drugs on scene and working with the crew, escorting the patient to hospital and providing care enroute as needed.
Each NARS volunteer is equipped with a response bag, defibrillator and monitoring equipment. Their cars are equipped with blue lights and sirens and they are trained and assessed by the ambulance service to respond under full emergency driving conditions. Personal protective equipment is mandatory at the scene of an accident, which is why NARS members are provided with high visibility jackets, gloves, safety goggles and a helmet.
The East of England Ambulance Service has designated staff in their central control room who look at every 999 emergency call in real-time. NARS members can be contacted any time of the day or night should any of the criteria be met for immediate dispatch. Incidents that trigger an immediate response include Road Traffic Collisions (RTCs), falls from height, cardiac arrests and serious injuries sustained from assault or industrial accidents. The most serious medical emergencies can be harder to determine from the initial 999 call, however in certain circumstances, a call-handler will ask for further information before dispatching NARS.