The Hazardous Area Response Team (HART) programme was rolled out across all NHS Ambulance Trusts in England between 2008 and 2012. The roll-out coincided with the ambulance service's change to a new way of communicating with crews and control rooms using Airwave. It also saw the widespread introduction of satellite communications by the emergency services. HART has been at the forefront of this digital revolution.
HART operates in four key areas: as an Incident Response Unit (IRU), Urban Search and Rescue (USAR), Inland Water Operations (IWO) and Tactical Medical Operations (TMO). The first, IRU, includes incidents involving Chemical, Biological, Radiological or Nuclear (CBRN) materials, and requires the team to wear a variety of respiratory personal protective equipment (PPE), including breathing apparatus and respirators. USAR involves incidents at height or within collapsed structures. IWO requires the team to operate in areas of flooding or to rescue patients in fast flowing water such as rivers. The final area is TMO, which involves providing medical support to police operations that may include firearms.
To enable the team to operate they are issued with a wide range of vehicles. The Forward Command Vehicle (FCV) is state of the art with equipment supplied by Excelerate Technology. It has satellite connectivity and generates its own Wi-Fi and Global System for Mobile Communications (GSM) networks locally. This allows Wi-Fi enabled devices such as laptops and smart phones to connect to the internet, but with its own GSM network as well, the vehicle can facilitate staff and other agencies to make mobile phone calls via its in-built telephone exchange. The vehicle also has a day/night/thermal camera system that can zoom in up to half a mile away. When HART staff enter the Inner Cordon they have body-worn cameras from which the video is then beamed back to the FCV; from there it can be sent anywhere in the world. The vehicle also utilises various software platforms to provide information and identification of CBRN or hazardous substances.
‘The four key areas for HART present different challenges and requirements with regards to information technology’
The four key areas for HART present different challenges and requirements with regards to information technology (IT). The programme and its Command Vehicle began life with only the IRU and USAR elements to consider. The TMO and IWO capabilities were added midway through the programme roll-out. This is due in part to HART being required to match the National Risk Register (Cabinet Office, 2013) and provide the NHS response to those incidents.
The last 18 months has seen a review of the HART programme as its current fleet of vehicles and associated IT is due to be replaced. While engagement with wider stakeholders and cross-Government departments confirms that HART is here to stay, how it is equipped and provisioned has been subject to an internal review through the programme's Vehicle and Equipment Group. This has taken into consideration the views of operational staff as well as over 25 000 calls that HART has now attended throughout the UK since its inception in 2008. The group has also considered the more varied work HART is involved in following the addition of the IWO and TMO capabilities.
IWO has proved to be a very busy area for HART and is represented on the National Risk Register (Cabinet Office, 2013). The incidents across the south of the country, and in particular the Somerset Levels, have seen widespread media coverage, but have also shown that the HART IT provision needs to change to replicate the work and the risks involved. We have learnt from experience that while designed as intended, the work HART now does some 7 years later has demonstrated the need for a more flexible and agile approach and is not based upon a single vehicle containing all of its technology. This new approach will better support operational staff as well as partner agencies. The broad requirements are out to tender and will hopefully include options such as portable satellite connectivity, which will see teams being able to access cut off communities using the IWO skill set, with a view to ensuring the elderly and vulnerable are supported as we establish a clinic and access patient records to arrange repeat prescriptions as an example.
‘There are now more options, but more importantly, opportunities in which to improve our capability’
Technology has moved very quickly since HART began. There are now more options, but more importantly, opportunities in which to improve our capability. We have learnt that IT is part and parcel of the response as it both improves the safety of staff and through sharing with partner agencies allows a common operational picture to be obtained more quickly. It will also improve clinical outcomes, as HART will be able to more readily integrate clinicians through telemedicine to bring a doctor to the patient's side remotely to support the HART Paramedic.