OPERATIONAL INSTRUCTION Vehicle Based Response Bag

FOI 2015-091 OPERATIONAL INSTRUCTION Vehicle Based Response Bag Document name Vehicle Based Response Bag Version V:1.0 Responsible Committee Health & Safety Committee Responsible Director Director Standards and Compliance Document Owner (title) Associate Director Risk & Safety Document Lead (title) Health and Safety Manager and Clinical Managers Approved By N/A Date Approved N/A Review Date November 2016 Equality Impact Assessed Yes - screening (EIA) Protective Marking Not Protectively Marked

Section Contents Page No. 1.0 Introduction 2 2.0 Accountabilities and Responsibilities 2 Appendix 1 Response Bag Contents 4 Appendix 2 Diagrams of Bag Layout 5 Appendix 3 Handling, comfort and safety 9 Appendix 4 Operational instruction for handling response bags 11 Appendix 5 Acknowledgement of procedural receipt form 17 1

1.0 Introduction 1.1 This operational instruction has been developed following a review of provision of response bags within the trust and supports the management of risk associated with such bags. It replaces those previously issued in relation to provision and use of response bags and is provided to ensure that all operational staff are fully conversant with the appropriate use and storage of Vehicle Based Bags for the effective delivery of care and treatment of all patients. 1.1.1 The aim is to provide the best possible solution that balances manual handling, clinical, medicines and patient safety risks, in order to protect staff and the public. 1.1.2 Objectives To provide a consistent and safe response to patients To reduce the risk associated with manual handling of response bags To prevent response bags being overstocked and increasing weight To provide a standard layout and content list regionally 2.0 Accountabilities and responsibilities 2.1 Locality/clinical Managers and clinical supervisors are responsible for: Supporting the implementation, management and monitoring of this operational instruction. Ensuring spot checks to ensure correct contents / weight are undertaken, and where bags are found to be overstocked / overweight appropriate action is taken. Ensuring all staff within their area of responsibility are aware of this procedure and have completed an acknowledgement of procedure receipt form (See Appendix 5). 2.1.1 All Emergency Staff are responsible for: Ensuring that they operate in accordance with this operational instruction. Complying with the agreed content list and ensuring agreed levels are not exceeded (Overstocking places staff and colleagues at increased risk of injury). Applying safe handling techniques at all times in accordance with training. 2.2 A standardised approach 2.2.1 The Trust intends to ensure response bags are regionally standardised in order to: Reduce stress to staff by ensuring a standard approach and layout of bags. Ensure resilience in response to major incidents. Provide continuity in approaches to clinical care to patients. Manage assets effectively, providing a system that can rapidly respond to product / medicine recalls. Ensure compliance with legislative and regulatory requirements for management of medicines. 2.2.2 All bags will be stocked in accordance with Appendix 1. The itemised list provides a maximum stock level. 2.2.3 However, where a responder / crew is provided with / uses a shock box / AED, which does not contain Oxygen saturation monitoring these should be added into the Response Bag. 2

2.3 Contents and weight YORKSHIRE AMBULANCE SERVICE NHS TRUST 2.3.1 It is imperative that the kit list is strictly adhered to at all times in order to ensure risks to staff and patients are minimised. Providing the kit list is strictly adhered to, the weight of each bag when fully kitted is: - First response bag no more than 10.5-11 kg - Resus pouch no more than 4-5 kg 2.4 Provision and use of Response Bags 2.4.1 All Ambulances and Rapid Response Vehicles will be provided with both First Response bag and Resus Pouch. 2.5 Minimum First Response The First Response Bag 2.5.1 It is the responsibility of individual clinicians to ensure that every patient has the equipment available for the management of life threatening conditions. The trust considers the first response bag and a defibrillator/shock box as being the minimum equipment required in such circumstances. 2.5.2 The contents of the first response bag, is based on ensuring the initial management of lifethreatening conditions, including: - Cardiac/Respiratory Arrest - Choking - Anaphylaxis - Asthma - Cardiac conditions - Overdose, particularly opiate - Hypoglycaemia - Blood loss This list is not exhaustive. 2.6 Resus Pouch 2.6.1 The Resus Pouch contains advanced airway, advanced resuscitation drugs, fluids and IO kit. 2.7 Solo Workers 2.7.1 Staff who are working as solo s will be expected to follow the minimum first response procedure above. It is the decision of the individual solo practitioner if they wish to also carry the Resus pouch. The Resus pouch must be taken to the patient if it has been identified by EOC that resuscitation is required. 2.8 Double Crewed Ambulances 2.8.1 It is the practitioner s clinical decision (considering information received) if they choose to take the Resus pouch to the patient. 2.9 Maintaining serviceability of response bags All staff are responsible for taking reasonable care of response bags. Defects in equipment should be reported promptly through line management processes. 2.10 Infection Prevention and Control Bags should be cleaned in accordance with YAS Trust Infection Prevention and Control procedures. Where bags are considered heavily contaminated they should be reported to the line manager and a DATIX report completed. 3

Appendix 1 Response Bag Contents RUCK SACK RED DRUG POUCH Quantity Check Equipment Quantity Check Adrenaline 1:1000-1mg in 1ml 2 BVM Face mask: size 3 1 Atropine 600mcg in 1ml 5 Adult 100% masks 1 Benzyl penicillin 600mg 2 Adult mask 1 Chlorphenamine 10mg in 1ml 2 Adult Nasal Cannula 1 Diazamuls 10mg in 2ml 2 Paediatric 100% masks 1 Diazapam Rectal 5mg in 2.5ml 4 Paediatric mask 1 Furosemide 50mg in 5ml 1 Paediatric Nasal Cannula 1 Hydrocortisone 100mg 2 Flow Adaptors 24, 35, 40 1 Naloxone 400mcg in 1ml 5 Oxygen Tubing 1 Ondasetron 4mg in 2ml 2 Nebuliser adapter 1 Prednisolone 5mg tablets (6-16 tablets) 1 In-line nebuliser 1 Water for Injection 5ml 4 Peak Flow Meter (mouth piece x2) 1 Laryngoscope Handle 1 YELLOW DRUG POUCH Quantity Check Laryngoscope Blades 2 & 4 1 Aspirin 300mg tablets (2-12 tablets) 1 Magill Forceps 1 Glucagon 1mg in 1ml 1 OP Airways: 0,1,2,3,4 (of each) 1 GTN Buccal 500mcg tablets (tub of) 1 LMAs 1,1.5,2,2.5, 3, 4 1 Hypostop Gel 10g 2 NPAs 6,7 1 Ibuprofen 100mg in 5ml Sachets 2 Lubricating Gel 2 Ibuprofen 200mg tablets (2-14 tablets) 1 IV cannula:14,16,18 (x2),20 (x2),22,24g 1 Ipratropium Bromide 250mcg in 1ml 4 Sharps Bin 1 Paracetamol 250mg in 5ml sachets 4 Chloraprep/cannulation pack (of each) 2 Paracetamol 500mg tablets (2-10 tablets) 1 Syringes: 1, 2, 5, 10 (x2), 20ml (of each) 1 Salbutamol 2.5mg in 2.5ml (5-10 nebules) 1 Blunt Fill/Hypodermic needles (each) 2 Sodium Chloride flush 4 Resus Bag Quantity Check Tourniquet 2 Adrenaline 1:10,000-1mg in 10ml 5 CAT Tourniquet 2 Amiodarone 300mg in 10 ml 1 Celox 1 Glucose 5%100ml 1 BP Cuff manual 1 Glucose 10% 500ml 1 pulse oximeter 1 Saline 0.9% 500ml 1 Thermometer 1 Tranexamic Acid 500mcg in 5 ml 2 Thermometer covers 5 ET Tubes 2, 2.5, 3, 4, 5, 6, 7, 8 & 9mm 1 Blood gulcose monitor incl testing strips 1 Gum Bougee 1 Blood gulcose sampling lancet 5 Catheter Mount 1 Pen Torch 1 Thomas Tube Holder: Adult & Paed 1 Clinical Waste bag 1 Giving set 1 20ml Syringe 1 Adult Bag&Mask (BVM) Quantity Check 50ml Syringe 1 Face masks: sizes 5 1 Paediatric Bag&Mask (BVM) Quantity Check Green Dressings Pouch Quantity Check Face masks: 0,1 of each 1 Ambulance dressings (s,l) (each) 1 conforming bandages (s,m,l) (each) 1 LP 1000 Quantity Check Swab Gauze (5pk) 2 Defib 1 non adherant dressings 5 10 20cm (each) 2 Defib fast patch adult / paed set 1 micropore 1 Razors 2 Triangular bandage 1 Electrodes bag of 1 4

Appendix 2 Diagrams of Bag Layout Layout of RESUS POUCH INTERNAL VIEW (refer to Appendix 1 for full contents list) RESUS pouch 1 Giving set 5 Adrenaline 1:10000 2 TXA Amioderone 300mg Thomas tube holder Saline fluid 500ml Glucose 500ml Glucose 100ml Bougie ET tubes Syringe 5

Internal view Ruck sack Cannulas 14g to 23g Oxygen Cylinder BVM adult & pead Airways 1 of each Syringes BM Kit Peak flow Yellow medical pouch Red medical pouch Manual BP cuff (RRVs) + SPO2 monitor First aid equipment 6

Internal view side panels closed Oxygen masks Celox Bandage CAT Tourniquet NEBULISERS Sharp s Bin 7

Internal view Side 2 of bag (refer to Appendix 1 for full contents list) LMAs Laryngoscope Laryngoscope Blades 8

Appendix 3 Handling, comfort and safety Options for handling Top handle (located approximately 55cm from floor level) Side handle (located approximately 38cm from floor level) Backpack straps (With adjustable straps Once adjusted ensure excess from straps are located on waiststrap) 9

Making adjustments for comfort and safety Adjustment is provided by pulling the straps downwards, as per normal buckle principles. They are loosed in the normal manner, as per buckle use Reducing trip hazards Due to design of any response bag there will always be risks associated with handling options provided Be aware of the potential of straps and handles catching on furniture and door handles 10

Appendix 4 Operational instruction for handling response bags Handling a response bag is an everyday activity of operational emergency staff. The trust is making every effort to reduce the risks associated with responder bag provision. Staff should be constantly aware of the principles of safe handling of bags. Application of the principles of safe handling is an integral part of ambulance operations, for which training is provided to all staff. Individual support and guidance on safe handling of inanimate loads, including response bags, can be provided by the Training and Education Team, through requests to your line manager. This is supplemental to Manual Handling training that will have already been provided. Employees have responsibility for managing their own health and safety and should seek additional training assistance if required. This operational instruction is provided in association with the Trusts Manual Handling Policy Preventing injury from responder bags Development of musculo-skeletal complaints is not always solely attributed to work-related incidents in isolation. The principles of maintaining good posture and safe handling techniques should be applied throughout everyday activities in order to reduce risks of injury. Normal wear and tear, posture and injuries, such as those received during falls can later contribute to the development of injury. Nevertheless, the nature of ambulance work inevitably involves elements of manual handling requiring further ongoing needs to apply techniques safely. Principles of safer handling include: - Complete a Dynamic Risk Assessments (DRA) based on TILE principles (Task, Individual, Load and Environment) - Maintain a stable base with feet apart and leading foot in direction of travel - Maintain the natural curves of your spine - Avoid twisting - Keep close to the load - Bend knees and hips - Ensure you have a good hold of the bag - Keep elbows tucked in - Keep abdominal muscles tight When moving: - Raise your head as you move, keeping shoulders relaxed - Undertake smooth movements Maintain posture: - Attempt to maintain an upright position - Avoid hunching shoulders - Use strong thigh and buttock muscles to avoid bending your back 11

Reducing the risks from handling responder bags include: Task Avoid carrying on one shoulder, particularly when handling over distance this will affect posture, balance and stability Avoid twisting whilst handling move your feet if turning When using the bag avoid stretching to reach contents When in confined spaces / on floor attempt to slide the bag rather than lift it Do not swing the bag in order to position the bag on your shoulder, particularly whilst removing the bag from a car apply correct handling techniques Do not snatch / jerk the bag in order to move it Consider transporting the responder bag on the stretcher trolley, if this is likely to be taken directly to the scene (e.g. attending an incident a distance from the vehicle such as a shopping centre) Share equipment carried to an incident with a colleague, if possible Share the handling and carrying of responder bags with a colleague throughout the day if working as a 2 person crew Individual Ensure application of correct safe handling techniques at all times Select the most suitable option for carrying the bag, based on individual preference / comfort and the presenting circumstances (e.g. proximity of the incident / route to travel) Ensure the straps are correctly positioned and not twisted to avoid bruising Notify your manager if you are pregnant (in accordance with trust policy) Consider adjusting straps, if required, when wearing additional clothing / protection e.g. Hi-visibility jackets Load Maintain contents of the bag in accordance with trust procedures Ensure contents are securely located and in the correct area to maintain correct distribution of weight Visually inspect for defects to reduce the likelihood of injury occurring as a result of damage Ensure straps are adjusted prior to use to suit the wearer / handler Keep the bag and straps clean a natural reaction is keep things that are dirty away from us which is against safe handling principles Ensure the bag and its contents are secure before handling to prevent contents falling and changing weight distribution Environment Clear obstacles in your path - Ask members of the public/bystanders to open doors for you Pay attention to your posture, particularly when working in confined spaces Consider the most appropriate carrying option when walking up steps / slopes / ramps Where circumstances permit use an available lift, rather than stairs Be aware of environments with slip, trip and fall hazards, as risks are increased when handling loads Where practicable ensure routes are well illuminated 12

Helping yourself - Ensure you maintain the expected level of fitness - Avoid excess weight as it exerts a constant forward pull on your lower back and increases wear and tear on joints - If you feel that you have not received an adequate level of training in manual handling techniques: Request additional training from your line manager Take every opportunity to discuss manual handling techniques with Mentors, Clinical Supervisors or during formal training / CPD sessions Handling responder bags Using as a backpack There are advantages to using the bag as a backpack, as it allows the weight to be located to the body s centre and frees the hands for other tasks such as carrying the defibrillator / opening and closing doors. The use of both shoulder straps keeps the weight of the bag centred and avoids stress from the pendumum motion of swinging a bag. Straps should be adjusted so that the backpack remains close to the body. The higher the bag is located up the back, the less loading / strain will be placed on the back (See figure 2) Figure 1 POOR PRACTICE The bag has not been adjusted adequately. Therefore, not achieving reduced loading on the spine - Handler is leaning forward to compensate. Figure 2 GOOD PRACTICE The bag is located higher up the back, with less loading / strain on the spine 13

Figure 3 CAUTION The adjustment straps should be adjusted equally to prevent unequal loading of the bag on the spine, causing twisting of spine Putting the bag on as a backpack Where possible place the bag on a surface at a suitable height to wear it as a backpack. Although not ideal, the rear of a car / side step of a vehicle is a preferable height to floor level, as lifting and turning is more likely to cause injury from lifting and twisting. Figure 4 Alignment of the spine is central Allows arms to slide through and place on both shoulders Figure 5 This position allows a good use of thigh muscles to power the lift 14

Avoiding the use of the bag with one shoulder strap Figure 6 YORKSHIRE AMBULANCE SERVICE NHS TRUST CAUTION: A backpack being carried by one strap can cause disproportionate shift of loading in the spine, leading to neck and muscle spasm, as well as low back pain Figure 7 Avoid swinging the bag as this involves twisting and can strain the shoulder Figure 8 Avoid lateral twisting as movement causes compression strains Slinging the bag over one shoulder leads to physical compensation due to lack of balance, as well as putting more weight on one shoulder Potential risk of strain to lower arm muscles and further twisting of back and strain on shoulder Lifting outside of the handlers base can result in potential instability when lifting with an increasing the risk of loss of balance 15

Figure 9 Carrying the Response Rucksack and Resus pouch Correctly- leaving one hand free Figure 10 AVOID Carrying the Response Rucksack, Resus pouch, and Defib together as you should always have a hand free to open doors and hold onto banisters and handrails to steady yourself when negotiating stairs and obstacles. 16

Appendix 5 Acknowledgement of procedural receipt form Acknowledgement of receipt form I confirm that I have read and understood this operational instruction Name: Vehicle Based Response Bag Date: 20th November 2013 Version no. V:1.0 I understand the requirements within this instruction for: Managing bags in accordance with the agreed contents list Ensuring that I do not overstock response bags Handling response bags by application of safe handling techniques recieved during training and with further operational instruction provided Maintaining and storing any personal issue optional shoulder strap I have had the opportunity to clarify the instructions with my Line Manager. Date: Print Name (employee) Station Signed Dated Copies must be retained by Operational Managers 17