Last year, we were delighted to welcome Dr Sam Westall to our Clinical Advisory Panel (CAP). Here you can meet Sam, learn more about his work looking into Ambulance Alert Systems as his specialist interest in Addison’s and adrenal insufficiency.

• Research Title: "Ambulance Alert System Enabling Prehospital Parenteral Steroids for Patients with Adrenal Insufficiency"
• Presented at: European Congress of Endocrinology 2020 #eECE2020

Welcome Dr Sam Westall! Please tell us more about your background and how you got involved in this research?

My work is to improve the care of people living with steroid-dependency. I have lived and worked in the North West UK for the past 10 years and decided in 2016 to focus my career in Diabetes and Endocrinology. This focus has enabled me to work closely with people living with steroid-dependency and motivated me to look at ways to improve the care they receive in the NHS.

Tell us about your Ambulance Alert poster at The European Congress of Endocrinology (e-ECE) in 2020.

With this project, we wanted to look at some of the difficulties that are most commonly faced by people living with steroid-dependency. For these people, one of the most important things is to be safe and healthy. We wanted to undertake a project that would encompass this vision and improve the care we provide.

Adrenal insufficiency commonly goes unrecognised and can lead to a life-threatening adrenal crisis if not promptly identified and treated. For patients in adrenal crisis, the timely administration of injected steroids can be lifesaving.

In the Department of Endocrinology at St Helens and Knowsley Teaching Hospitals NHS Trust in North West England, we have prioritised improving the emergency care of people with adrenal insufficiency. Key information from the ADSHG has allowed our team to identify difficulties that many patients face. We have seen that a large number of life-threatening adrenal crises occur at home. Without access to lifesaving injections of emergency steroids, patients are often reliant on the emergency services to recognise and treat an adrenal crisis. We have therefore recognised the importance of improving the awareness of adrenal insufficiency to care providers in the community.

We have worked extensively within the Trust and with the North West Ambulance Service to create a safety net for steroid-dependent patients. With each individual’s consent, we created a database of our steroid dependent patients. This database allows us to target patients who need education in looking after their adrenal insufficiency during times of illness and enables us to ensure every patient has access to lifesaving emergency injections of steroids from their GP. Through a special agreement with the Trust and the North West Ambulance Service, we have enabled alerts to be sent to paramedics when they are called to a patient with adrenal insufficiency. Paramedics now carry injectable steroids in all ambulances in the North West. It is our hope that we can improve the care of people who are having an adrenal crisis at home and to ensure that people having an adrenal crisis receive emergency steroid injections as quickly possible.

In the UK, the pre-hospital care of people in adrenal crisis remains unequal. To continue improving care beyond our locality, we have published our work with the European Society for Endocrinology, a Europe-wide network of doctors, nurses and scientists. Colleagues across the UK have been working in different ways to ensure improved awareness of people at risk of adrenal crisis. A new NHS Steroid Emergency Card has been jointly developed by the Society for Endocrinology, the Royal College of Physicians and NHS England. Please see links for this below and stay safe in these challenging times.

Read and download the Ambulance Alert System Poster here

	Patients The NHS Steroid Emergency Card should be carried by all people with Addison's and adrenal insufficiency. Find out more.
	Healthcare professionals  Order the NHS Steroid Emergency Cards for your patients via the Society for Endocrinology website. Read the latest coronavirus adrenal insufficiency advice for patients.

What does this mean for people with Addison’s disease and adrenal insufficiency?

We created a safety net to ensure that patients with adrenal crisis are promptly recognised and treated. A team of doctors, nurses and administrators at St Helens and Knowsley Teaching Hospital NHS trust worked closely with the North West Ambulance Service to implement a system that highlights steroid-dependent patients to the paramedics when ambulances are called.

What are your research highlights to date?

There has been a big drive by the UK government to provide improved psychological care for patients. My current research is focussed on how an individual’s psychology and well-being are affected by healthcare interactions.

What are your plans for the future?

Becoming a member of the ADSHG Clinical Advisory Panel (CAP) has allowed me to network nationally with colleagues and provide evidence-based guidance to a community of patients.

"I hope that we can continue to provide improvements to the care people living with steroid-dependency throughout the UK."

Do you have any advice that you would give to other clinicians thinking about specialising in Endocrinology?

Endocrinology (the study of hormones in the human body) is an exceptionally diverse field. Being a doctor in this field will suit people with a good eye for detail and an inquisitive mind. As specialists in endocrinology, we have the opportunity to help people with a huge variety of medical problems which is extremely rewarding.

I would encourage clinicians thinking about specialising in Endocrinology to come along to one of our clinics to meet the staff and patients (many of whom will stay with us lifelong).

Author: Dr Sam Westall, Department of Diabetes and Endocrinology, St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK. Dr Sam Westall has worked in hospitals in the North West UK since 2010. He is a specialist trainee in diabetes and endocrinology and works as a clinical researcher at Edge Hill University and St Helens and Knowsley Teaching Hospitals NHS Trust. He has a keen interest in researching how medical conditions interact with the mental health of patients. St Helens and Knowsley Teaching Hospitals NHS Trust has been rated ‘Outstanding’ by the Care Quality Commission and Acute Trust of the Year 2019 at the Health Service Journal Awards. Twitter: @SamJWestall

The ADSHG runs online CPD paramedic training sessions for trusts and individuals on adrenal crisis and the emergency care of people with Addison's and adrenal insufficiency.

Learn more about Paramedic Training Session and how to sign-up

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