1. H A R T Hazardous Area Response Team
Welcome & introduction. Ambulance terminology

2. Historically Ambulance personnel were restricted to the cold zones while Police and Fire retrieved casualties from the danger area.
This was not ideal as fire are not able to clinically assess patients and may cause further injury or deterioration in condition. Give example

3. “It is an indefensible position that Ambulance Services do not treat casualties inside a Hot Zone” Ministerial statement from the United Kingdom Houses of Parliament 2007
Statement post London bombings (2005) which lead to the inception of HART. With the advancement in modern medicine, particularly in pre hospital care and the protective equipment available paramedic should be in there at point of insult/injury
1200 paramedics nationally. 84 in London split between 2 sites East & West, able to work and provide care in the Hot Zone

4. Ethos of HART To provide rapid assessment and clinical care at the point of patient contact within the hot zone, maintaining that care throughout their extrication and/or decontamination.
Go in – assess – stabilise – get out to a safer place with other services assistance (warm or cold zone/LAS resource)
Benefit: Instances where FRS have an initial plan of extrication but patients needs are not compatible (eg low BP), if HART were not there this would be detrimental to patient, good communication vital

5. Response Triggers Mass Casualty incidents Incidents at height Flooding / Water based response Confined space Urban Search and Rescue Explosion/Fire – IED incidents CBRNe Incidents – including IDL Firearms Incidents Stand-by support to Fire Rescues Service and Police Colleagues and other Partnership agencies
CBRNe includes Hazmat
Possible future support to DVI

6. HART vehicles – how you know we’re on scene

7. HART is a specialist unit of the Ambulance Service providing:
- improved initial response to all categories of incidents
- triage and CABC interventions
- advanced clinical interventions in hazardous environments
- mass casualty equipment support
- skills and equipment to deal with contaminated incidents
- early Command and Control
Deploy as a team of 6
Categories of incidents that trigger a HART response
Types of triage, explain CABC

8. THE TEAM CARRIES A RANGE OF PERSONAL PROTECTIVE EQUIPMENT(PPE) AND MONITORING DEVICES
Incident Ground Kit – standard response PPE. Used for conventional incidents – one unders, RTC, mass casualty and for SWaH, USAR, EDBA
Note EPD (electronic Personal Dosimeter) on BA wearer, our DIM (detection Identification & Monitoring Equipment) is only used for personal protection and includes GFG gas monitor (O2, CH4, H2S, HCN & CO) and Ram Gene radiation detector.

9. Gas Tight with EDBA – total ensemble 35kg then consider kit bags, patients and a possible 400m cordon in place. There's a reason HART have to balance down time with activity on shift;
CR1 – same level of protection as PRPS. Longer working time (2hrs+) greater dexterity. Downside – time to deploy 20mins to Don;
PRPS – same protection as CR1, much quicker to deploy (under 5min) however suit inflates – dexterity problems. Not really covert. Also used by SORT – ALL STAFF CAN JOIN SORT
SRT – standard dry suit and PFD
MTFA/TRU – military grade ballistic protection. Nationally this is a HART role, in LAS we have TRU due to number of high risk sites

10. HART USAR Paramedic Within each HART Unit there are paramedics specifically trained in Urban Search And Rescue
- Assist LFB in the USAR environment
- Clinical care within confined space
- Patient extrication
- Safe Working at Height (all HART operatives)
Currently 50 USAR paramedics in London but we are pushing to get all HART staff trained in this skill.
All HART staff have a confined space awareness
All HART staff in the process of becoming SWaH operatives

11. Cross rail power tunnels (40m shaft down into crossrail), Joint training with LFB, Kennington bus crash, confined space, Ex Amber, Apollo theatre

12. Water Operations All London HART operatives are trained as Swift Water Rescue Technicians
- Clinical support to LFB & NGO responders
- Instigate rescue independently
- Search capability
- Public relations (welfare checks etc)
SRT same level as LFB, train both with LFB, other HART units and independently
Can provide mutual aid nationally, aiming towards inclusion on Defra flood response database – London would be the first ambulance service included.

13. Training and mutual aid in Wraysbury.
Equipment carry: PPE (moving to green helmets), 25M throw lines, rescue sled & rescue kit – ropes, strops etc

14. Equipment HART carry modular equipment cubes for use in conventional and CBRNe mass-casualty incidents.
triage and casualty labelling
advanced airway support
control of life-threatening haemorrhage including dressings and tourniquets
vascular access
CBRNe cube antidotes – but not carried
Each cube can maintain 10 P1 patients for 1 hour

15. Oxygen Delivery
Multi-patient oxygen systems are carried by operatives.
If required a mass-casualty oxygen delivery system can be established from the cold zone into the forward (dirty) treatment area. Carried on ESV
Mass O Lpm for 17mins – now carried by SORT

16. HART Support to Incident Management
Incident Support Officers (ISO)
Radiation Protection Supervisors (RPS)
National Inter-agency Liaison Officers (NILO)
CBRNe Bronze Commanders
Many of these roles are fulfilled by HART managers or operatives (RPS/CBRN) but in the event these are not, HART will provide support and guidance.

17. Multi Agency Interoperability – Working together on the Incident Ground

18. Working together – sharing best practice
Police – CBRNe (SO8 includes Expo)
Fire – RRT (Rapid Response Team)
DCU/RRT can declare an area safe whereas HARTs monitoring equipment is for personal use only
VIP/SIP
High risk events/demos

19. Thank you for listening Any Questions?
Contact: Steve Catlett HART Operative/CBRN Instructor Tel: