Centre for Excellence
The vision for the Centre for Excellence is to create a world-leading community through which pre-hospital care is developed, reaching the highest possible standards whilst delivering the best possible outcomes for patients.
Our Centre for Excellence was created in 2022. We realised that to continue to deliver the best possible clinical care for our future patients, an investment is needed in the future of medical care. In all areas of medicine, discoveries are constantly being made. More complex, and more effective interventions are being delivered for patients. Our charity board determined that we would work hard to fund a Centre for Excellence that would prepare us for future opportunities for our patients.
During our journey of setting out a vision for a Centre for Excellence, we have pledged to always thrive to bring better and more effective care to our patients.
Our vision for the Centre for Excellence is to create a world-leading community through which pre-hospital care is developed to achieve the best possible outcomes for people in our region and beyond.
Our mission is to develop a framework to improve the health outcomes from illness and injury by striving to reach the highest possible standards of pre-hospital clinical care through research, innovation and education. Furthermore, to work collaboratively to share knowledge for the benefit of all.
There are four pillars to the Centre for Excellence:
- Research and Scholarship
- Education and Training
- Innovation
- Community
There are three domains to the Centre for Excellence:
- Head Injury
- Cardiac Arrest
- Patient Experience and Outcomes
We will focus our major efforts and resources on research, education and innovation around our three clinical domains. In other areas, we constantly monitor and evaluate best practice so that we always make sure our patients get the best care.
Research and Scholarship Pillar
We’re proud to embrace a culture of enquiry and learning at EHAAT. All healthcare organisations have a duty to reflect on the quality of care that they deliver. We also believe it is vital to describe our processes of care in a scholarly way, and to undertake research activity that enables us to look to the future.
We have a structured and organised strategy for our research and scholarship activity. The diagram shows our ‘activity spheres’ in this area. Our whole team contribute to our scholarly activity, with every member of our clinical team engaged in the various work streams.
Education and Training Pillar
Together, Education, Research and Innovation lead to better patient care. Our research helps us understand more about what our patients need so that we can innovate. Through education, we create an environment where ideas and thoughts can thrive, creating the research material for the future.
We have an exciting and innovative education agenda at EHAAT. Our operational teams deliver care in circumstances that are unusual when compared with the hospital environment. It is often dark, wet and windy, cold or, rarely in the UK, hot. Although we recognise that medical teams across the world work in much more austere environments, it is important that our education prepares clinicians for providing excellent care under sometimes difficult conditions.
We also see patients in the very early stages of their illness, when many of the clinical signs and symptoms that are included in traditional training programmes are not present. For patients and their families, they are very often scared and overwhelmed by the situation that they have suddenly found themselves in. We take this into account when preparing our teams to help our patients.
Innovation Pillar
Innovation can take many forms. Medical innovation must be carried out where there is a specific patient need. As we develop our journey at the Centre for Excellence, we will continue to innovate across each of our pillars and domains.
Specific areas of innovation currently underway are:
- Introduction of pupillometry to examine the pupils in head injured patients
- Establishment of our VR CPR initiative
- Establishment of our CPR Smart initiative
- Creation of ‘pathology first’ simulation in our education programmes
- Our PhD programmes, allowing us to innovate through research
- Our innovative patient and family liaison team, creating resources such as our bereavement film
- Innovation in our clinicopathological correlation department, working closely with forensic pathologists and coroners
- Our ‘day at work’ initiative for our Prehospital Care Course (PHCC)
- Innovation through our PPIE (Patient and Public Involvement and Engagement) in Education programme
- Our ‘Dispatch D and D’ meetings (Death and Disability meetings focusing on the work of the clinicians in the ambulance control room)
- Our specialist neuropathology D and D meetings, with our Professor of Neurosurgery and team
- Creation of our development board, helping us to raise income to support our Centre for Excellence
- Our masterclasses, allowing us to collaborate with our professional colleagues
- Base visits for patients and families with care from our specialist nurses and paramedics
Clinical Community Pillar
Our clinical community strategy is focused around how we work with others to bring the best possible care to our patients. When a loved-one suddenly becomes unwell or is severely injured, it is often family members or friends who are best-placed to help. This is especially true following a cardiac arrest, where a person’s heart suddenly stops with little or no warning. In the minutes following a cardiac arrest, simple interventions by friends and family can ensure someone survives. The positive impact of this is immeasurable on an individual level.
We want everyone in Essex and Hertfordshire and beyond to know how to do CPR. If this was the case, many more lives would be saved in our region.
Head Injury Domain
Our clinical teams regularly attend patients with head injury. Some patients have a very severe injury where every minute following the injury, there is an opportunity to make things better for the patient. We worry the most about patients who have an altered level of consciousness following a knock to the head. This is often described as the patient being ‘not fully awake’.
Patients who are unconscious following head injury need immediate help. Bystanders, family members and friends should call for help immediately and follow the instructions of the 999 team. In some cases, our specialist paramedics and dispatchers in the 999-control room will dispatch our teams in addition to ambulance teams, to the scene. We will then provide hospital-level care at the scene of the accident.
We believe there are significant opportunities to help people who have severe head injury, and the earlier help is given, the better outcomes can be.
The earlier help is provided in severe head injury, the better the outcomes will be
For many years, EHAAT teams have been aiming to deliver the most advanced care possible at the scene, and en-route to hospital.
In some cases, patients need to be rapidly transferred to hospital so that surgeons can undertake emergency procedures. More commonly in severe head injury, we will undertake a number of interventions on scene that help to prevent further damage to the brain:
- Delivering the strongest pain killers possible so that our patients are not in pain
- Controlling the patient’s breathing, sometimes with a general anaesthetic
- Delivering high concentrations of oxygen through a breathing machine
- Delivering specialist medications that help reduce pressure within the head (intracranial pressure)
- Delivering medications that help control seizures following head injury
Since 2023, head injury has become one of our Centre for Excellence domains, alongside cardiac arrest and patient experience and outcomes. We have built a team of people who will help us establish the key priorities for head injury care through the next decade.
In 2017, the high impact medical journal, ‘Lancet Neurology’ published its first commission on traumatic brain injury. Our scholarly work on head injury has been designed based on the findings and recommendations of this global collaboration on improving outcomes. As ever, innovation and ideas flourish when we collaborate with others and we are delighted to work alongside some of the busiest brain trauma units in the UK, the Royal London Hospital, and Addenbrookes Hospital in Cambridge. Both Queen Mary University London (attached to the Royal London Hospital) and Cambridge University Hospitals NHS Trust, regularly care for the patients who suffer a severe head injury in our region. In addition, both are academic centres for head injury, and we work with both centres to make improvements for our patients.
The Lancet Neurology Commission on Traumatic Brain Injury identified the ‘4P’s’ approach to creating improvement in head injury outcomes.
- Prevention
- Personalised Stratification
- Precision Treatments
- Prognosis
All our work aligns with this strategy, and we have started an exciting new journey for future head injury care. We strongly believe that:
There are huge opportunities for improving the care of head injured patients at the scene of the incident
We want to achieve a more scientifically driven approach to our head injury care, moving from a disease agnostic regimen (one size fits all) to a precision medicine approach, to head injury care.
Our approach mirrors the progress that has been made for diseases such as cancer and certain neuromuscular disorders, where targeted treatment based on the specific biological ‘markers’ associated with the exact type of illness has been developed.
We would like to support a new generation of research activity that helps us do more for patients with head injury
We have started our journey by collaborating with universities and hospitals to bring together our research ambitions.
Professor Chris Uff is our academic lead for head injury and Chris has helped us develop our head injury strategy so that we can do much more in the future
Laurie Phillipson is our Clinical Academic Fellow in Head Injury. Laurie is our longest serving paramedic at EHAAT. In 2024, Laurie commenced his PhD at Queen Mary University London. Laurie brings a unique insight into head injury care, having seen thousands of patients with head injury during his career. Laurie’s PhD is looking at how we can measure all sorts of scientific parameters during the early minutes following head injury, something that has usually only been studied in hospital.
In March 2025 we pioneered the introduction of pupillometry in the prehospital phase of care. This together with our new capability of performing blood gas analysis at the scene, mean that we’re starting to drive specific and bespoke treatments for our patients.
If we understand more about our patients, then we can do much more to help them in the future. We are fortunate to have the support of the Blizard Institute at Queen Mary University London in helping Laurie with his work. Professor Elaine Cole, who has a lifelong career in emergency and trauma care, is instrumental in bringing this area of study to fruition.
Cardiac Arrest Domain
A sudden cardiac arrest occurs when the heart stops without a significant warning. Most days, our clinical teams respond to someone in the region whose heart has suddenly stopped. This is the most serious of emergencies and it is essential that a series of interventions happen very quickly.
Anyone can help deliver the first vital stages of the chain of survival to a relative, friend, or to a stranger. We are determined that many more people in our community are able to help others in performing CPR and using a defibrillator. This is the most important step in the chain.
Everyone can save a life by learning CPR. Everyone can use a defibrillator to save a life.
Our specialist paramedics and dispatchers in the ambulance service control room can help you deliver excellent CPR and will often summon the most advanced resources in our region to the scene. We’re reliant on the public to deliver the most lifesaving of interventions before we get to the scene.
Once an ambulance or our EHAAT team arrives, we will help by doing the same CPR techniques as we hope have been carried out already. We will use a defibrillator in the same way as the public can. After that, we can offer additional treatments that can help the heart restart. Our medical teams are highly trained in all of the techniques and interventions that could be carried out in an emergency department. We bring those treatments to the scene. We believe that in all cases, the earlier treatments are delivered, the higher the chance of survival.
Specifically, our teams will ensure that:
- CPR being delivered is of high quality (High Performance CPR)
- Additional drug treatments are offered that may be relevant in specific situations, such as clot busting drugs where a clot might have caused the problem
- The most advanced techniques are used to help deliver oxygen to the lungs, often using a portable ventilator machine on scene
- In relevant cases, cooling the brain takes place to reduce its metabolic demands
- Family members are supported and communicated with as best we can
- Hospitals are alerted for cases where specific treatments might be required, such as ECMO (Extracorporeal Membrane Oxygenation)
- The cause of the cardiac arrest is dealt with, and in specific cases where there is an injury to the heart, perform interventions such as resuscitative thoracotomy, where an operation is carried out on the scene to repair an injury to the heart.
Our Cardiac Arrest Lead is Mr Adam Pitcairn.
We work very closely with specialist hospitals in the region, to ensure that the best care is delivered at all stages of the chain of the survival. Following sudden cardiac arrest, most patients are supported by the ambulance service at the scene. Those who require treatment in hospital will most often be transported to the nearest emergency department. In some cases, our specialist teams will transfer patients to specialist centres which can offer specific treatments that target the underlying problem causing the cardiac arrest. On scene, we try to help diagnose the underlying problem that has led to the cardiac arrest, because understanding this can lead to bespoke treatments.
As part of our future strategy, we are carefully exploring opportunities to bring very specialist treatments to cardiac arrest patients, at the site of the incident. In April 2025, Dr Peter Sherren joined our Centre for Excellence team. Peter is our Senior Fellow in Cardiac Arrest and Advanced Pre-hospital Resuscitation.
There are several opportunities being made available in the pre-hospital phase of care for patients who experience cardiac arrest, in various countries around the world. In recognising the need to do more, we are carefully exploring the benefit to patients of bringing very advanced procedures and interventions to the scene. These include:
- REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta), Where a small balloon is inserted into the groin, to help support the blood supply to the heart during CPR
- ECMO (Extracorporeal Membrane Oxygenation), where a specialist ‘bypass’ machine is brought to the roadside to support the heart and lungs while resuscitation continues
- Advanced ultrasound techniques that help us nuance our diagnosis and target treatment during cardiac arrest
Peter will use his expertise and his specialist background to help us understand how our patients might benefit from these various interventions. As with all aspects of pre-hospital medical innovation, we always ensure that our resources are channelled to a proven patient need. The months and years ahead will be very exciting as we explore the potential for novel therapies such as these.
Patient Experience and Outcomes Domain
Our Patient Experience and Outcomes Domain consists of two closely linked departments, our Patient and Family Liaison Team, and our Patient Outcomes Team.
Our Patient and Family Liaison Team are specialist nurses and paramedics whose area of clinical expertise is the care of patients and families beyond the initial event. We have recognised for many years that patient and family needs extend way beyond the initial early phase of care, often impacting lives for a long time. This dedicated team works every day to offer support where needed.
Our Patient and Family liaison team is involved in all areas of our organisation. Working closely with our operational teams, and with our charity team, we try to make sure that our work is continually seen through the lens of our patients. In putting patients at the core of everything that we do, we aspire to be a compassionate charity, where we continue to check that all of our work results in meaningful patient benefit.
We believe that including our patients in all areas of our organisation helps us make better decisions and brings clarity to how we deliver our strategy. PPIE is traditionally described in terms of research, and we have benefitted from PPIE in research for many years.
In 2024, we introduced our first ‘Education in PPIE’ initiative, where patients helped us design scenarios related to spinal injury, cardiac arrest, and head injury. The concept of PPIE in education is now to continue further, with patients and families being able to use their experiences to educate our teams is a crucial part of our vision.
Our Patient Outcomes Team is led by our Academic Lead for Patient Experience and Outcomes, Suzie Southey.
Measuring and studying outcomes is a vital part of any healthcare organisation. We know that we play a vital part in a long chain of care, with many other individuals and services involved. In fact, within the first hour of care, it is not unusual for over a hundred healthcare and emergency service professionals to be involved in helping a single patient. This is remarkable, and we collaborate with all the organisations and personnel who help in these circumstances. Some of our patients receive care for months or even years, so it is important that in describing our outcomes, we are mindful that we are another crucial part of a huge system who come together to help someone when they need help the most.
In 2024, we revamped our structures so that we are well placed to meaningfully measure outcomes that are within our control, while developing collaborations with others. We employed Ram Prasad Singh, our specialist Centre for Excellence clinical data analyst, who is responsible for an exciting set of parameters that help us evaluate the effects of our interventions.
Our charity has helped us invest in data systems that ”talk to” those of other organisations, so that we can learn more about our patients. This is key to us creating the innovations of the future. Watch this space for our work on Clinical Key Performance Indicators at EHAAT.
We believe that truly understanding the reversible elements of illness and injury is crucial to improving care in the future. Only if we understand this thoroughly, can we move medicine forward. During the hospital phase of care, increasingly precise diagnoses are made, for example in specialties who care for those with cancer or debilitating neurological diseases. Diagnoses in these specialties are usually made with cutting edge technology such as MRI (Magnetic Resonance Imaging), PET (Positron Emission Technology) scanning, blood tests, and sampling of diseased organs using very refined technology.
During the very early, ”hyperacute” phase of care, illness is in rapid evolution, and injuries are often hidden to the naked eye. Technologies in this phase are improving and will continue to evolve. For example, we are increasingly using ultrasound to help us understand our patients. However, determining an exact, precise, diagnosis at the roadside is tricky, and our expert clinicians attempt to cleverly detect injuries using a combination of clues, experience, and acumen.
CPC involves finding, analysing, and discovering the definitive diagnosis in our patients. This is much more complicated than it seems. Single scans often don’t answer our questions, blood tests often only provide us with single clues in a jigsaw puzzle of information. Putting together all of the information that we processed at the scene, with the many hundreds of pieces of information gathered later in a patient’s care is a major task for our team. It is crucial to do this if we are to properly analyse the effectiveness of our interventions.
As we move forward, we aspire to improve our capability in making precise diagnoses at the roadside. For example, even in the early phase, the difference between different types of brain injury is crucial to developing specific treatments for the future. The same is true during cardiac arrest, and in most other conditions.
The closer we get to making a precise diagnosis, the better the treatment we can offer.
Our vision here is that through focusing on the precise nuancing of diagnosis, we can develop the treatments and therapies of the future. We aim to place a major focus on describing the specific diagnosis in each of our patients, so that we can properly design our research, education and innovation strategies for the decades to come.
Our honorary consultant forensic pathologist, Dr Ben Swift, has been instrumental in working with us to develop our understanding of our patients. Dr Swift gives his time voluntarily to help us analyse cases, so that we can push the boundaries of medical care into the future.
Our Clinico-pathological Correlation (CPC) fellow, Dr Duranka Perera is a resident doctor in neurosurgery and joined our team in late 2025. Duranka has started a detailed project where we can document and describe the underlying diagnoses affecting our patients. Here are two examples of how Duranka’s work will help us.
Although we often refer to ‘head injury’ as one problem, many different processes can happen during a single head injury, potentially requiring a niche strategy for treatment. These process (pathologies) can range from brain damage due to a lack of oxygen, or due to an expanding blood clot. These conditions might well need different treatments. To make things complicated, the same processes can co-exist for the same patient. Understanding the opportunities for treatment of the various different types of pathology can unmask treatments that we might be able to introduce in the future.
‘Cardiac arrest’ is not a diagnosis in itself. Cardiac arrest refers to an event where a patient’s heart suddenly stops. There are a huge number of causes of cardiac arrest, and each has different treatment options. Understanding the detailed pathology in each case will help us design bespoke treatments for the patients of the future.
At EHAAT, we have created the conditions where we can learn as much as possible from every patient episode. This will lay the foundations for a very productive strategy that will take us through the next decade, and beyond. We will create new opportunities for our patients.
Funding our Centre for Excellence
We have been able to create our Centre for Excellence thanks to the extraordinary hard work carried out by our charity team over many years, but vitally, because of the generosity of the public. Being a charity means we can work alongside the NHS, universities, medical schools, industry, and other charities to invest in future care.
Every member of our charity team cares deeply about what happens to our patients. This is a palpable feature of our day-to-day activities at the bases. Our operational teams invest vast amounts of energy in trying to deliver the best care.
We have a powerful ambition, to be the most compassionate and effective pre-hospital critical care team in the world.
With many services across the globe now delivering a very advanced level of care, we want to make sure that we keep learning, while pioneering treatments based on our own experiences and research.
Funding is clearly crucial if we are to continue to operate, and to push patient care to the next exciting level. Every donation matters, and we think deeply before investing in new innovative projects. In creating our Centre for Excellence, we now have the ingredients in place to achieve a great deal more for our patients. Everyone in the team is excited about the mission that we’ve embarked upon.
Dr Gareth Grier, Associate Medical Director, responsible for the Centre for Excellence, says
”Working at EHAAT is a career highlight. It has been an honour to work with and develop a team of first-class people who are all on the same mission together. Every day when I go to work there is an almost overwhelming feeling that the team want to do more and more. Every conversation is incredibly patient centred. We have a very bright future ahead, and we want to give hope to as many of our patients and their families as we possibly can.
Thank you to everyone who supports EHAAT in any way that they are able. The work that is going on here really matters.”
