London Ambulance Service enhances critical care with ZOLL Z Vent

As part of ongoing efforts to continually improve patient care, London Ambulance Service (LAS) recently expanded the equipment Advanced Paramedic Practitioners in critical care (APP-CCs) carry in their rapid response vehicles to include ZOLL Z Vent portable ventilators. While some team members were familiar with ZOLL, most were unfamiliar with the ease of use, clinical capabilities and the durability of Z Vent.

To learn about their experience with Z Vent and ZOLL as a partner in improving patient care, we recently spoke with LAS team members Nick Brown, Clinical Practice Development Manager and Advanced Paramedic Practitioner (Critical Care), and Tim Edwards, Consulting Advanced Paramedic Practitioner and Associate Clinical Director for the Advanced Paramedic Practitioner program.

Building alliances

“We were certainly familiar with ZOLL as a supplier, but I don’t think we were really that familiar with the Z Vent,” Tim told us.

ZOLL team members Nick Goode and Brad Griffiths established a relationship with LAS team members and listened as they painted a picture of the challenges APP-CCs face in the field and how LAS utilized its previous ventilator.

Armed with this information, Nick and Brad worked with the ZOLL clinical team to develop educational programming that reviewed the science of ventilation, outlined typical ventilation strategies, and provided hands- on practice using Z Vent parameters to ventilate swine lungs. Over the course of a week’s time, ZOLL clinical educators trained all LAS APP-CCs.

Following its update to the Advanced Clinical Operational Procedure (ACOP) for patient ventilation to reflect more advanced support, LAS rolled out ZOLL Z Vent portable ventilators in APP-CC rapid response vehicles.

Delivering bespoke patient care

The London Ambulance Service’s previous ventilator didn’t offer any advanced settings to support critically ill cardiac arrest or trauma patients. Alternatively, manual ventilation was unreliable and easily interrupted during transport or clinical handover.

“In the pre-hospital setting there’s lots going on. Ventilation is something that people get distracted from doing well. Even when concentrating, no human being can ventilate consistently and quantifiably as well as the Z Vent.”

Nick Brown

With Z Vent as part of their kit, APP-CCs could provide bespoke patient support using parameters such as non-invasive positive pressure ventilation (NPPV), synchronised intermittent mandatory ventilation (SIMV), assist control (AC), and continuous positive airway pressure (CPAP) with pressure support. “The better the ventilator, the greater the opportunity to maximise the patient’s physiology,” said Nick.

Used primarily with cardiac arrest and trauma patients, team members report that Z Vent improves their ability to get patients to settle, particularly when using the SIMV mode. And as Nick explained, “There are some patients that just need some pressure support. That’s a setting we have with Z Vent that we weren’t previously able to provide.”

Parameters available on the Z Vent ventilator help APP- CCs prevent hypoxia and hyperoxia, giving them another tool to help improve neurological function and patient outcome. And relying on Z Vent to provide optimal patient ventilation strategy also frees paramedics to attend to other lifesaving interventions.

Enabling advanced support

Recently, LAS APP-CCs have been authorized to induce post-ROSC paralysis in conjunction with full mechanical ventilation in controlled modes. Z Vent parameters support this intervention, allowing paramedics to sedate patients in the pre-hospital environment for safe and more comfortable transfer to hospital.

“If someone has had a cardiac arrest and they’re intubated, and their awareness is rising so that they’re dyssynchronous with the ventilator, we can now administer Rocuronium,” explained Nick.

More advanced ventilatory support has also been helpful during extrications. “Often, we’re coming out of buildings and the patient’s all wrapped up. Putting someone on a mechanical ventilator rather than hand ventilating means that there’s less chance of the tube dislodging during transport,” according to Nick. It’s also been helpful at hospital transfer. “When we interface with the hospitals and are able to see the settings and frequency of tidal volume, it speaks more to the ongoing needs of a patient.”

A trusted partner

After London Ambulance Service used the Z Vent transport ventilator in the field for six months, members of the ZOLL clinical sales team reached out to gather feedback. In an anonymous survey, users rated overall performance, ease of use, durability in the field, and clinical capabilities as well as the value of ZOLL’s training programme. On a scale of 1 (poor) to 5 (excellent), Z Vent and ZOLL’s educational training scored higher than 3.9 in all five categories, earning a 4.0 or greater in clinical capabilities, training, and overall device performance.

When asked about the strength of its relationship with ZOLL, representatives at LAS spoke of ZOLL team members’ paramedic backgrounds and their unique understanding of the challenges paramedics face in the field. They also value ZOLL’s willingness to provide ongoing education and support.

“ZOLL has helped us troubleshoot issues that relate to kit and equipment at various times, and they’ve always been on hand to help with training,” Nick told us. In particular, ZOLL team members helped the team at LAS design a bespoke carry case that meets their specific needs and fits safely into their rapid response vehicles.

The industry will once again be gathering at the NEC, Birmingham for The Emergency Services Show, co located with The Emergency Tech Show on 17-18 September, check out the full exhibitor list here. You can find Zoll Medical in Hall 5, Stand G210.