Ambulance heroes rewarded for going beyond the call of duty
Under embargo until 23:00 Friday 5 October 2018
Some of the North East’s most caring and dedicated people were honoured at a regional awards ceremony tonight (5 October).
Inspiring stories of compassion, care and dedication to duty were celebrated at the North East Ambulance Service’s (NEAS) Beyond the Call of Duty Awards, held at The Boiler Shop, Newcastle.
Sponsored by Ward Hadaway, the annual awards, which are now in their seventh year, recognise the outstanding contribution of NEAS employees.
The 12 award categories cover all aspects of the Trust’s service provision from emergency care to patient transport and judges had a tough time picking the best of more than 270 entries.
The night also incorporated the Trust’s long service awards, recognising 79 employees who have a combined 1,985 years’ service with the Trust. Two of them, Stephen Potts and Peter Rhodes, were also presented with a special award in recognition of their 40 years’ service.
NEAS Chief Executive Yvonne Ormston said: “Our employees make a difference, day in, day out and it’s important for us to take the time to recognise the amazing work of the truly remarkable team here at the North East Ambulance Service.
“Although we can only recognise a handful of those at our Beyond the Call of Duty Awards, we should not forget everyone who works for the emergency services regularly puts the lives of the community before their own. Each of our winners truly embodies the Trust’s values of responding to the needs of individuals and treating patients and colleagues with compassion, care, dignity and respect. This makes recognising the years of dedication of our employees that are devoted to the service, even more important.”
The final and most prestigious award, the Chairman's award, commends a stand out nominee for their significant contribution to NEAS.
Chair of NEAS, Peter Strachen said, “Amongst the entries I have found the very heart of our Trust in the very special people we are proud to call our staff. I feel very honored to be part of this extended family and it’s very obvious to me and the panel that the job people do every day is made better because of the pride and passion that the individuals who work for us contribute.
“The amount of credit the winner, David Morgan, has received this year from colleagues was outstanding and is someone who created formidable, ground breaking work for NEAS by taking an idea he had in the early part of his career and making it a reality. His goal was to create a system that could improve outcomes for patients and help frontline staff with their personal development and the quality of care they give and as a result, we are now rolling out the CARE system, which has won its own award in our innovation category.
“The phenomenal efforts he has invested personally and professionally and his general attitude to work has been driven by his own determination and the benefits he could generate for patient care.”
The valuable support from Ward Hadaway for the staff awards helps to create a successful evening of celebration.
Nicola Richardson, partner in the healthcare team at law firm Ward Hadaway, said: “We work closely with the team at North East Ambulance Service NHS Trust so we know what tremendous work the staff at the Trust carry out every day of the year, often in very challenging situations.
“Sponsoring the staff awards is a great way for us to acknowledge how people at the Trust go above and beyond to deliver first class healthcare services when they are needed most to thousands of people right across the North East. The awards never fail to highlight inspiring acts of dedication and I am sure that this year will prove to be no exception.”
The public nomination category in particular gives members of the public the opportunity to thank staff for their support and highlights the invaluable work that NEAS staff complete.
One patient showed their appreciation in a public nomination for employee Robert Hayton-Walker after he twice went to their aid. She said, “He was so caring and compassionate and he really took the time to listen to me when I was at rock bottom. Rob saved me from myself on those occasions and gave me hope, motivation and determination to look to the future. I have a more positive outlook on life now because of Rob and he inspired me to since become a paramedic for NEAS. I cannot thank Rob enough for what he has done for me and I am forever in his debt.”
Many of the front line workers at NEAS have worked for the organisation for a long time, witnessing first-hand the changes in the industry and organisation as well the development of patient care.
A recent ceremony that also commended NEAS staff was the Queen’s Medal that honoured long service of more than 20 years for frontline workers. The service took place on Tuesday 18 September and celebrated the illustrious career of NEAS employees, who were presented with their Royal Mint by Her Majesty’s representative the Lord-Lieutenant of Tyne & Wear, Mrs Susan Margaret Winfield OBE DL.
The Queen’s Medal was issued under Royal Warrant in July 1995 and was awarded to frontline respondents Martin Fletcher, Steve Roebuck, David Vaughan, Michael Vockings, Jane Wade and Mark Wells who have a combined service of over 100 years for the organisation.
ENDS
For more information and interview requests, please contact the NEAS press office on 07559 918672.
Photographs of the winners will be available after the event.
*Winner biographies below
Chairman's award
Winner: Dave Morgan – Monkton Station, Hebburn
This year we received a total of 5 separate nominations for our Chairman’s Award winner, Dave Morgan, for his individual achievements, as well as recognition as part of a formidable team and for their innovating work, which will transform our service.
Although Dave may feel his achievements were a team effort, what’s clear from this year’s nominations is that without his contribution and motivation, the outcomes would not have been the same.
Judges found it difficult to ignore the enormous amount of respect colleagues at every level across the Trust hold him.
In the words of the people nominating our winner, Dave is described as ‘passionate about patient care and the people who provide it’, ‘a pleasure to work with’ and ‘a driving force’ – individual qualities that truly made him stand out.
One person nominating him said that his persona embodies the values of NEAS and that it was difficult not to be enthused and excited by his achievements.
Dave started his career here in April 2007 as an ambulance care assistant for the patient transport in the south division on bank before he took up a role in July that year as ambulance care assistant in Coulby Newham. Just a few months later he became an Emergency Care Support Worker at Coulby in the December. He moved to Billingham in the following October.
Determined to keep developing, he started his student paramedic training at Teesside University in 2009 and qualified as a paramedic two years later. Dave worked at the frontline of our service caring for patients for six years until he became one of the first clinical care managers in Stockton in April 2015.
This year he took the seeds of an idea he had in the early part of his career as a CCM and made it a reality. His goal was to create a system that could improve outcomes for patients and help frontline staff with their personal development and the quality of care they give. As a manager of frontline colleagues and a clinician himself, he could see the power that a system like that could have.
Like any challenging project, along the way there were a number of times when he felt his goal might not be achievable. But Dave tells his own stories about how patients and their relatives gave him the inspiration he needed to persevere.
He sought out the team of specialists he knew was needed and he championed it across the organisation. And as a result, we are now rolling out the CARE system, which has won its own award in our innovation category.
Against all the odds Dave overcame personal, departmental, technical and geographic obstacles in reaching his goal. The phenomenal efforts he has invested personally and professionally and his general attitude to work have driven by his own determination and the benefits he could generate for patient care.
Team of the year
Winner: 111 Bid team – Newcastle
As an ambulance service pioneering new services in urgent and emergency care, retaining the NHS111 contract was high on our corporate agenda this year.
Having spent 5 years already understanding the urgent care needs of our communities and trailblazing a service that is not only fit for purpose, the service supports the wider healthcare environment by reducing calls to 999 and A&E attendances, and identifying new care pathways that are improving patient outcomes and experience.
Having an integrated 999 and NHS111 operations centre has enabled NEAS to make huge strides in the type of services we can deliver for patients. And with patients at the very heart of everything we do, once the tender was released to bid for the next 5 year NHS111 contract, the Trust felt it critical to ensure that our bid brought together our wealth of expertise, skills, resources, resilience and innovation to help demonstrate why we were the best provider for the job.
Working to a challenging and ambitious timescale, a team was formed to develop our bid over five weeks at the turn of the year when many people were taking time out for Christmas and New Year.
Lead by two directors, a core team co-ordinated the bid with critical contributions and support from across the organisation. Representatives were involved from commercial development, project management, finance, human resources, IM&T, emergency operations centre, clinical and contracting, to name but a few.
To bridge the gaps between their desks and locations, for those key weeks the team joined a daily meeting to meticulously work through their detailed project planning and ensure that they created a high quality response, which promised to champion innovation.
Bidding is a difficult process as it has a binary outcome; you win or lose. However, the team put NEAS in the very best light to those commissioning the service to secure the bid by showcasing all the great work that the 111 service does and the innovation that NEAS will bring to the service over the next five years. Indeed, they scored 100% on several of the tender questions.
We celebrated winning the bid earlier this year, retaining jobs, services and our position as an NHS provider that can help to deliver evolving healthcare services and pathways fit for the future.
The new service, which launched this month, is designed to ensure that where possible, patients’ problems are dealt with on their first call, drawing from the skills of a number of expert clinicians. Staff will have access to a range of real time information, including a summary of GP held patients records and details of local services such as GP extended hour’s schemes and community pharmacies.
Senior manager/ leader
Winner: Danielle Williamson – Newcastle
Danielle has been awarded for her success as a manager which has been noticed by the panel of judges in the amount of praise she has received from her team.
Danielle welcomed each and every member of her team to NEAS and has supported them throughout all aspects of their career and personal circumstances, which has created a culture of openness and honesty throughout her team.
Danielle’s role, as well as all roles within NEAS, is pivotal to the organisation as contact centre team leader but the amount of respect and care she has for the individuals within her team is why she deserves to be manager/ leader of the year.
Danielle has built a strong rapport with each individual and supports personal circumstances that people may be faced with in her team. Every NEAS employee is respected throughout the organisation and this also includes receiving support to deal with personal issues that might be affecting work performance.
Danielle has created an atmosphere within her team that is enviable and inspiring to other leaders as she has enabled people to feel comfortable approaching her with an issue that is sometimes related to personal circumstances. Danielle has supported employees through hard times in their lives and in turn, they have felt more motivated to work for NEAS as through Danielle, they have such a strong support network around them.
Some of Danielle’s team have commented, “Danielle deserves this award as she always goes above and beyond in everything she does. I cannot thank her enough for the support she continues to give myself and the team. She is so approachable and nothing is ever too much trouble. She doesn’t get half the recognition she deserves.”
Public Nomination
Winner: Michaela Purdham, Lauren Wilding and Richard York - Durham
Special recognition goes to a call handler and emergency care crew for their support to give CPR advice and lifesaving treatment to save a patient’s life
Nominations from members of the public are an enormous endorsement of the work our staff undertake every day and it’s always hard not to award every nomination a winning prize.
Our patients and wider population are the biggest judges of the quality of care we provide in North East communities; the growing number of nominations in this category each year is a real credit to our staff.
Our winning nomination came from a couple in Darlington who wanted everyone to know what a difference our team made to them when crisis hit.
Beginning with a 999 call to our control room about a patient in cardiac arrest, what followed is something that many of our staff consider to be just part of their job.
But to the lady making the call and the patient, her husband, what this team did made a significant difference to them. It meant not only that the patient survived, but that during one of the scariest times in their lives, they had the support, care and treatment they needed to help them overcome it and they had that in spades.
By the time the call to 999 was connected, the patient was unconscious and unresponsive and, as a result, his wife was terrified. From the NEAS operations centre, the call handler kept calm and guided the patient's wife to perform CPR on her husband with the right pace and depth to give him the very best chance once help arrived. And whilst an ambulance was dispatched in haste in the background, the call handler continued to coach the patient's wife through CPR despite being overwhelmed and exhausted.
Once on scene, the crew relieved the patient's wife and took over treatment, using a defibrillator to restart his heart and safely transport the patient to Darlington Hospital where he began to recover.
It is without doubt that if the patient hadn’t had such intervention early on, he might not have survived to tell the tale and so the team effort of everyone involved, played a part in securing their time together today.
In their words, “Without their expert help, it would have been a completely different outcome. We thank them from the bottom of our hearts for their outstanding service.”
Emergency Operations Centre
Winner: Kerri Corbett – Newcastle
Kerri is described by her team as being absolutely brilliant at providing direct care to patients and she entirely deserves to be recognised for saving lives.
Kerri is an asset to NEAS in being committed to delivering compassionate care to patients and their families as a call handler.
Kerri has received appreciations from two patients following her actions when dealing with an emergency situation.
One of Kerri’s patients was in cardiac arrest on a football field. From the outset, there was a great sense of panic amongst the patient’s colleagues but Kerri provided essential CPR instructions within the first crucial minutes of the incident to inexperienced people, which kept the patient’s heart pumping whilst the crew were on their way.
Kerri was outstanding throughout the call and provided clear instructions and support to the patient’s colleagues, who became overwhelmed during the call. Kerri was able to control the situation even though she was not present at the scene and ultimately gave him the best chance of survival and ended up saving his life.
The paramedics praised the support provided by Kerri and said that they didn’t think the patient would of survived the cardiac arrest, if it wasn’t for Kerri providing the vital information for the patients colleagues to start CPR.
A second patient Kerri encountered suffered an epileptic fit. Kerri was faced with managing the situation by communicating with a four year child who was the patient’s daughter. This extremely difficult incident that Kerri dealt with meant she had to build a rapport with the patient’s daughter to keep her on the phone, whilst conducting a safeguarding check of the child and their siblings.
With carefully phrased questions, Kerri was able to correctly triage the call as a fit and prepared the paramedics with their arrival to be able to quickly and effectively treat the patient’s condition, whilst being mindful of the two other infant children at the property.
Kerri is a great advocate for NEAS and was also selected to lead the call operator campaign in which she gave an insight into what the job is like, helping contribute to call operator applications.
Mentor of the year
Winner: Andrew Minto – Newcastle
With a heart of gold and outstanding level of teaching at NEAS, it is no doubt for the judges that Andrew Minto is mentor of the year for being a great guide for many years to many different apprentices.
Mentoring new staff can have an enormous impact on setting the standards of the quality care we aspire to deliver to every patient and it can give new recruits the support and confidence they need to flourish.
The level of recognition for Andrew is evident in the amount of nominations he has received as he treats people well and makes all new recruits feel welcomed and included into the team.
One of the nominees for Andrew said, “Andrew was the best mentor I could have asked for and I have learnt a lot from him and this is showing in my current role. I wouldn’t know how to do the role I am in today if it wasn’t for Andrew teaching me everything I now know.”
Andrew’s rapport with patients is evident to his students and he demonstrates to them a level of care, empathy and light heartedness required for the work NEAS employees do.
“Patients are at the heart of his work and he is so kind, caring and is a lovely person to work with. He always has a smile on his face at work and his positive energy makes the day go faster.”
He goes one step further to deliver an exceptional experience for his apprentices, which in turn generates an even stronger team and individuals caring for patients.
He is a valuable member of the team in developing the next generation of frontline workers and as many people would agree, he is a massive credit to NEAS.
Student of the year
Winner: Katie Smith – Newcastle
Katie has been described by her colleagues and fellow students of having an extremely outgoing personality and is very enthusiastic wherever she goes.
Beneath this bubbly personality is a worker that is focused, caring and professional and who is passionate about the NHS and to fulfil her goal as a paramedic.
She is a single mother of three children who made the decision to take charge of her life and made a bold personal decision to leave a secure well paid job, take a pay cut and train to become a paramedic, which is the job of her dreams.
Katie has created an impression with colleagues and patients alike with her optimism and the pure enjoyment she receives from working in the NHS. She has grasped this opportunity with both hands, constantly questioning procedures and learning from whoever she works with.
She has a presence which is impossible to ignore and a great ability to communicate with whoever she may come into contact with.
Behind this infectious persona is a deeply passionate, caring and hardworking individual whose sole motivation is to improve the wellbeing of others.
Her colleague said, “I have witnessed how she brings a smile to patients faces through her positive attitude, whilst unknown to the patient, she is quietly assessing the situation and how they are coping, to deliver the best care for them.”
Katie is a one off, she is a reliable and conscientious individual who can be trusted to represent NEAS in a positive light.
Katie has already secured her place at Sunderland University and grows ever closer to achieving her lifelong ambition.
“I can think of no better accolade to recognise her hard work and dedication than by naming her as student of the year.”
Unsung hero
Winner: Stephen Harrison – Newcastle
Ambulance dispatcher Stephen Harrison has our service at the very core of his values, using his energy and time to support colleagues across the organisation and patients in his community and to promote our service to the public.
In the workplace he is a well-respected dispatch mentor and a union representative with his colleagues best interests at heart. He champions the work of the operations centre at any given opportunity and supported his line manager recently to work closely with new student paramedics to help them understand the work of his department.
He is a keen advocate for promoting equal rights in the workplace and a fantastic LGBT role model.
Public engagement is an important part of what NEAS does as a Trust and Stephen often volunteers for events outside of his working hours where he confidently champions the organisation and promotes equality rights in the work place.
In particular Stephen organised NEAS’ attendance at the very first Northumberland Pride and took over responsibility at Durham Pride, leading on the stall and organising last minute cover for the event.
A natural with the public, Stephen also regularly volunteers to go into schools and talk about the services that NEAS offers, making him a great ambassador for the Trust.
He even finds time to volunteer as a community first responder in the Lemington area, responding to patients who are unconscious, in cardiac arrest, suffering chest pain or having severe breathing difficulty. Most recently he reached an elderly patient suffering chest pain in the area within three minutes, where he calmly reassured her and took basic observations until an ambulance arrived.
Stephen is described in nominations as embodying all the values of the organisation when representing the Trust with knowledge, experience, enthusiasm and a ‘can do’ attitude. Judges this year were keen to recognise such a positive person who portrays the Trust in a good light.
Unscheduled care
Winner: Kevin Parkin & Paul Hartnett - Amble
Kevin and Paul are awarded the winner of the unscheduled care category for their immense bravery when dealing with an unpredictable mental health patient.
Their own life as well as a member of the patient’s family was in grave danger during the incident but Kevin and Paul knew they had to make sure the family member was safe.
After the patient turned against the crew, they immediately exited the property and called for Police assistant.
The crew realised that the patient’s family member was still inside the property and were very concerned for their safety and welfare, so decided to re-enter and brought her outside to safety.
This was a very honourable and courageous act by Kevin and Paul who abandoned their own welfare to save another.
Support services
Winner: Shaun Dagg - Morpeth
Shaun has been described by his colleagues as being an instrumental part of the team and without him the north division cluster could not function. The level of appreciation towards Shaun is apparent in the many nominations he has received from fellow colleagues.
As CCM for the north division, Shaun goes around all of the stations and keeps them up to date, making crews aware of any problems so that the stations can function properly for operational staff to do their jobs.
Shaun has an remarkable work ethic. If you ask him to do anything, you can guarantee he will help you out in any way possible and always has a smile on his face. He has a real passion for his role and nothing is ever too much trouble.
His proactive nature and ability to deliver an outstanding customer experience for all patients and colleagues makes Shaun an absolute asset to NEAS to keep the fleet functioning on the frontline.
With a wealth of knowledge, Shaun is always available to offer advice to others and is an instrumental part of the team in putting ideas forward for improvements, which others sometimes get the credit for.
Shaun always goes the extra mile for you to help with anything. He works very hard in his role and this is inspiring and motivating to colleagues.
“The amount of work he gets through is astonishing.”
He is always on hand and accessible to assist in any way he can.
Delivering great customer service begins with going above and beyond and that is exactly what Shaun does every day for both colleagues and patients.
Scheduled care
Winner: Alan Henry and Adam Birdsey – Newcastle
Alan and Adam’s actions not only influenced the initial management of a critically injured patient, which is outside of their normal working experiences and training, but they also portrayed themselves, the scheduled patient transport service and NEAS as dedicated, proud and committed individuals who make a positive difference and change lives.
Scheduled care team Alan Henry and Adam Birdsey were nominated for their actions at an incident in February this year, witnessed a road traffic collision on the central motorway in Newcastle and stopped to offer assistance. First on scene, they recognised the seriousness of the incident, called for back-up and identified three casualties, one of which was critical.
They were met with a complex scene, which involved a significantly damaged vehicle, complicated by cold snowy conditions.
Rapidly deteriorating, the most seriously ill patient went into cardiac arrest. Owing to the complexity of the scene and the fact the patient was trapped, Alan courageously entered the vehicle and commenced CPR with mouth to mouth ventilations. Together, the two were able to attach an automated defibrillator which delivered an initial shock to the patient, giving them the very best chance to survive.
As help arrived on scene Alan and Adam assisted the team in managing the patient.
The incident overall required advanced treatment of the critically ill patient and the crew were able to get an initial return of spontaneous circulation, which was a combination of multiple factors. Despite the final outcome, this was undoubtedly influenced by Alan and Adams initial management under extreme conditions in a very emotive and challenging environment.
The clinicians making the nomination for this particular crew credited the outstanding team work of all of the individuals who attended to manage this multi-patient incident following Alan and Adam’s arrival, namely Sean Potts (Advanced Paramedic and CARU clinician), Thomas Kelbrick (Paramedic), Johan Sharp (Emergency Care Assistant), Kenneth Powell (Paramedic), Dave Hewitt (Paramedic), Darren Gladstone (Emergency Care Assistant), Gavin Fryer (Paramedic), Lee Thompson (Paramedic) and Mark Clay (Technician).
But in making the nomination, they outlined in particular the valiant attempts of those first on scene.
In their words, “Alan and Adam showed courage and commitment in a situation that would have tested even the most experienced clinician. Taking the action they did is outside of their normal experiences and training, but doing so, they portrayed themselves and the service as dedicated, proud and committed individuals who make a positive difference and change lives.”
Volunteer of the year
Winner: Dunmail Hodkinson
Dunmail Hodkinson is giving members of his community the best chance of survival in the event of a cardiac arrest by volunteering over 30 hours each week to be a first responder to patients, to train scores of local people how to save lives and to be a guardian for 10 public access defibrillators.
A software engineer, Dunmail’s day job is to support the NHS by developing systems to help share information between different organisations, to provide consistent care for patients.
Dunmail juggles full time work, family life and numerous hobbies, which include performing as a musician, alongside volunteering as a Community First Responder for NEAS.
He has been supporting patients by volunteering for over 8 years and has made himself available for 30 hours each week to provide medical help to people in his community. He responds to calls from his home and has even negotiated with his employers to also respond during working hours when demands are at their highest on our service.
Having undertaken the relevant training, Dunmail is a British Heart Foundation Heartstart instructor who can deliver emergency first aid training in schools and communities on behalf of NEAS and he is also a CPR/AED instructor, who is able help communities to become more familiar with how to perform effective CPR and how to use a defibrillator. Dunmail has trained over 500 people at over 60 different sessions over eight year.
He also offers his time to be a guardian for 10 public access defibrillators in his area, checking each one on a weekly basis to ensure that they are ready in case of an emergency.
Dunmail’s determination and personal ambition is helping to grow the wealth of knowledge and skills in different communities that will give people the best chance to survive a cardiac arrest. He demonstrates a level of commitment to emergency care that is second to none and a true credit to our Trust, his community and himself. He is undeniably, our volunteer of the year.
Innovation of the Year
The CARE project - Newcastle
This idea came from David Morgan. Having come from the frontline, Dave knew exactly how hard it was for frontline workers or managers to access information that would help them to do their jobs better. Geography, shift working and technology had all been obstacles in finding a solution to some of the challenges we have faced as individuals, managers and the Trust as a whole. But these weren’t going to stop him and the wider team.
Dave’s idea was to create a clinical system containing real time information about the cases our frontline staff have attended. He wanted it to help staff to be able to reflect on their own practice and compare it against that of their peers, recognise good work and highlight where any further support might be required, both professionally and emotionally.
He took his idea to our own informatics team to see if their combined skills and investment of information, initiative and imagination could devise a solution that would become a reality.
The determination of Dave and the informatics team, in particular Marc Birkett, Richard Muggeridge and Chris Mawdesley, has now resulted in the production of the new Clinical Annual Record of Excellence system, otherwise known as CARE.
CARE is a new electronic system, accessible from any computer, smartphone or tablet with an internet connection, which will allow frontline crews to see a personal record of their own clinical care. And thanks to the team, it is now being rolled out across the Trust.
Employees working at our frontline can now more easily receive alerts to staff about changes to practice, such as stroke, to ensure that they’re providing the right care at the right time. It is also helping Clinical Care Managers to access information about their team, cascade information to individuals who they might not see every day, and capture views and issues that our employees want to feedback whilst out on ride-outs with their staff.
By being able to better reflect on their practise, NEAS clinicians will see where they’ve done a job well and where they could have improved, which will ultimately improve their clinical skills and the care they are able to provide.
Its impact will help to improve communications across the Trust, one of our corporate objectives, and help the organisation better connect with our teams working remotely. It has great potential for improving patient care and staff morale as it also provides a way of better rewarding staff for a job well done. It will help us to move away from a blame culture towards one where staff feel able and supported to report their own mistakes without fear of recrimination.
Notes to editors
About North East Ambulance Service
North East Ambulance Service NHS Foundation Trust (NEAS) covers 3,200 square miles across the North East region. It employs more than 2,600 staff and serves a population of 2.7 million people by handling all NHS 111 and 999 calls for the region, operating patient transport and ambulance response services, delivering training for communities and commercial audiences and providing medical support cover at events.
In 2016/17 the service answered over 1 million emergency 999 and NHS 111 calls, responded to almost 300,00 incidents that resulted in a patient being taken to hospital, treated and discharged 24,000 patients with telephone advice and treated and discharged 92,141 patients at home. In the same year, emergency care crews responded to 126,673 Red incidents within national target of 8 minutes and completed 717,315 patient transport journeys.