Treatment & care

EAAA’s expert doctors and critical care paramedics provide critical care, including blood transfusions, advanced pain relief, sedation and anaesthesia, and surgical interventions at the scene of medical and trauma emergencies.

EAAA crews are tasked by the East of England Ambulance Service to the most seriously ill and injured people in our region. The enhanced treatment and care provided by our clinicians is over and above the usual care provided by the ambulance service. This critical care at the scene of medical emergencies, combined with quick onward transfer to the most appropriate hospital, gives every patient treated by EAAA the best possible chance of surviving and recovering a life-threatening emergency.

We constantly monitor and continually improve the service we provide and use the latest evidence behind cutting edge pre-hospital care to utilise new treatments, equipment, and skills.

SPEAR

Specialist Percutaneous Emergency Aortic Resuscitation (SPEAR) is an intervention performed by EAAA doctors in cardiac arrest patients. It involves inserting a needle into a patient’s artery in the groin to measure blood pressure beat by beat.

SPEAR helps EAAA clinicians on scene to be more accurate in the management of a cardiac arrest and deliver effective treatment. It can provide real-time feedback regarding the quality of CPR being delivered and indicate whether there is adequate blood supply to a patient’s brain and heart.

Learn more about SPEAR

Cardiac arrest patient being treated by EAAA clinical crew.

Blood transfusions

Administering blood products on-scene and en-route to hospital can help stabilise a patient’s blood pressure when they are experiencing catastrophic bleeding, giving them the best chance of surviving. Blood and Lyoplas (freeze-dried plasma) are a crucial part of the treatment we carry on the helicopters and critical care cars.

Sedation and pain relief

EAAA clinicians deliver sedation to patients for a variety of reasons. This includes when someone requires relocation of joints or manipulation of fractures, or if they are agitated following a seizure, for example. Sedation is usually given intravenously and will help patients feel more relaxed during many of the procedures our crews carry out.

There are different levels of sedation which can be classified as minimal, moderate and deep sedation. For example, a patient who has suffered an open leg fracture will usually require a deeper level of sedation to ensure they are unaware of the sometimes painful manipulation procedure.

Surgical procedures

EAAA clinicians can carry out surgical procedures at the scene of emergencies. These are enhanced critical care procedures, that may normally be carried out in a hospital. By performing these procedures at the scene, a patient experiencing a life-threatening emergency can receive treatment and care earlier to give them the best chance of survival.

One example is a surgical airway to support a critical unwell patient’s breathing. This involves making an incision and inserting a breathing tube into their neck, when the team are unable to intubate the patient.

A further example is a thoracostomy, which involves making an incision in a patient’s chest just under the armpit at the level of the fourth or fifth rib space to allow air or blood release due to a collapsed lung or trauma.

Intubation

Intubation is a procedure used when a patient is unable to breathe on their own, or we need to take over their breathing for them. This medical procedure involves inserting a tube through the mouth of a patient to maintain an open airway. This is then connected to a ventilator to take over their breathing by pushing air in and out of their lungs.

EAAA clinicians will routinely perform this procedure during cardiac arrest management.

Patient Albie is treated in the back of an ambulance by the EAAA crew.

Treating children

All EAAA doctors and paramedics are trained to treat children, and some of them are specialists in paediatric care. This includes a Paediatric Emergency Medicine Consultant and a Consultant Paediatric Anaesthetist. Pre-Hospital Emergency Medicine (PHEM) trainees with EAAA also receive specific training in paediatric critical care.

Treating children

Pre Hospital Emergency Anaesthesia (PHEA)

This is putting a patient into an induced coma. It is a critical care intervention that the EAAA crew carry out, which is over and above what the ambulance service can provide. This could be performed in a variety of medical or trauma emergencies. The reasons for performing this can vary from protecting the organs because the patient is not receiving enough oxygen when breathing for themselves, to humanitarian reasons, such as in the event of severe burns.

The crew will assess the patient as the level of awareness and unconsciousness will differ from patient to patient. When the information about the patient’s medical history may be limited, the crew will assess and understand the patient’s physiology to get the correct anaesthetic dosage. The crew will prepare the airway kit, oxygen, suction and a ventilator, as well as optimising the patient. This involves inserting cannulas to administer the anaesthetic medication and fluids, and ensuring the patient is correctly positioned on a trolley with adequate space to perform the complex procedure. The critical care crew will then run through a two-person checklist as well as ensuring they are prepared in the event of any complications.

The anaesthetic medication will take 45-60 seconds to take effect. The medication will stop the patient breathing, enabling the crew to take over and support their breathing with the airway kit. The crew will pause to check the effects monitoring patient vital signs, such as blood pressure and sedation levels. It is a careful balancing act.

The crew will keep the patient asleep during a land or air transfer through an infusion of anaesthetic medical administered through a Micrel syringe driver.

patient being treated with kit bag in view

Arterial line

An arterial line is a small cannula inserted in an artery to monitor blood pressure beat by beat. The benefit of this in pre-hospital care is that clinicians can be far more reactive to changes in a patient’s condition.

The crew will endeavour to put an arterial line into all patients who they will be delivering a pre-hospital emergency anaesthetic to

doctor and paramedic treating patient advanced care

Manipulation of fractures

The EAAA crew may be tasked to assist with severe breaks and open fractures, because there is more likelihood of the fracture needing to be reduced and put back into alignment.

The crew can administer advanced medication to help with pain management, as well as antibiotics to reduce the chance of infection. ‘Benecast’ temporary casts, carried by the EAAA crew, help maintain the position of a broken bone following manipulation, which in itself can provide pain relief during a transfer to hospital.