A national census of ambulance response times to emergency calls in Ireland.
(17/370)
BACKGROUND: Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision. METHODS: A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results-2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5-33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10-47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0-10%). Median patient care times for "on call" crews were three times longer than "on duty" crews. CONCLUSION: Without prioritized use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation. (+info)
Paediatric prehospital care: postal survey of paramedic training managers.
(18/370)
BACKGROUND: The process of prehospital care continues to develop in the UK. AIMS: To evaluate the availability of important paediatric resuscitation equipment in emergency ambulances and the extent of paramedic training in paediatric emergency medicine. METHODS: Postal survey of paramedic training managers. RESULTS: Completed questionnaires were returned by 41 (93%) training managers. No trust provided all of the equipment listed. Facemasks and self inflating bags (of appropriate sizes for all children) are provided by 32% and 42% of trusts respectively. Less than one third carry paediatric oximeter probes. Of the respondents, 16 (39%) trusts provide less than eight hours training in paediatric emergency medicine and five (12%) offer no training at all. Ongoing education varies from none to regular yearly updates. CONCLUSIONS: Paramedics seem ill prepared to deal with paediatric emergencies. Important deficiencies in the provision of equipment and training are noted. The results of this survey provide information against which improvements can be measured. (+info)
Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.
(19/370)
Information about patients in ambulance service records has been linked to that in the patients' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack. (+info)
A new performance indicator for acute myocardial infarction.
(20/370)
OBJECTIVE: To develop a performance indicator for acute myocardial infarction which would reliably measure success of treatment and which might provide an alternative to case fatality as an audited outcome. DESIGN: A two year audit of all cases of acute myocardial infarction and resuscitated cases of out of hospital cardiac arrest from coronary heart disease in patients under 75 years of age. Behaviour of patients in calling for help, performance of the ambulance services in treating out of hospital arrest, and of the hospitals in providing resuscitation and thrombolytic treatment are audited separately. SETTING: Four district general hospitals. AUDITED INTERVENTIONS: Resuscitation from cardiac arrest and thrombolytic treatment. MAIN OUTCOME MEASURES: Hospital case fatality and lives saved/1000 patients treated. RESULTS: Overall, the lives of 83/1000 patients were saved (95% confidence interval 70 to 96). Of these, 29 (35%) were saved by out of hospital resuscitation and 38 (46%) by in hospital resuscitation from cardiac arrest. It was estimated that 16 lives (19%) were saved by thrombolytic treatment. There were no significant differences in case fatality among the hospitals. CONCLUSIONS: Lives saved/1000 patients treated is an easily measurable index and assesses performance of the ambulance service as well as of the hospital. Because it is relatively insensitive to diagnostic definitions, it may provide a robust alternative to case fatality as a performance indicator. (+info)
Clinical governance in pre-hospital care.
(21/370)
This article seeks to discover and recognize the importance of clinical governance within a new and emerging quality National Health Service (NHS) system. It evaluates the present state of prehospital care and recommends how change, via clinical governance, can ensure a paradigm shift from its currently fragmented state to a seamless ongoing patient care episode. Furthermore, it identifies the drivers of a quality revolution, examines the monitoring and supervision of quality care, and evaluates the role of evidence-based practice. A frank and open view of immediate care doctors is presented, with recommendations to improve the quality of skill delivery and reduce the disparity that exists. Finally, it reviews the current problems with pre-hospital care and projects a future course for quality and patient care excellence. (+info)
Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study.
(22/370)
OBJECTIVES: To determine the association between ambulance response time and survival from out of hospital cardiopulmonary arrest and to estimate the effect of reducing response times. DESIGN: Cohort study. SETTING: Scottish Ambulance Service. SUBJECTS: All out of hospital cardiopulmonary arrests due to cardiac disease attended by the Scottish Ambulance Service during May 1991 to March 1998. MAIN OUTCOME MEASURES: Survival rate to hospital discharge and potential improvement from reducing response times. RESULTS: Of 13 822 arrests not witnessed by ambulance crews but attended by them within 15 minutes, complete data were available for 10 554 (76%). Of these patients, 653 (6%) survived to hospital discharge. After other significant covariates were adjusted for, shorter response time was significantly associated with increased probability of receiving defibrillation and survival to discharge among those defibrillated. Reducing the 90th centile for response time to 8 minutes increased the predicted survival to 8%, and reducing it to 5 minutes increased survival to 10-11% (depending on the model used). CONCLUSIONS: Reducing ambulance response times to 5 minutes could almost double the survival rate for cardiac arrests not witnessed by ambulance crews. (+info)
Blue calls--time for a change?
(23/370)
Prior alert via a landline telephone ("blue call") is commonly used to warn accident and emergency (A&E) departments of the impending arrival of a seriously ill or injured patient. There are no published indications for making such calls or validated protocols on message content. Submitted telephone information has the potential for distortion as it is passed through the control centre resulting in inappropriate resource allocation. This study focuses on the quality and content of the message in the context of the available patient details as well as reviewing the clinical indications for the call. Data were collected on patients for whom "blue calls" were made to an A&E department over three months of 1998. Patients with life threatening conditions who were brought by non-blue light ambulance were identified during the same period. Similar details were collected on these critical patients. Of the 189 "blue calls" with complete details, 73% were admitted, (12% to ITU) and 18% died. Sixty nine per cent of cases were medical, 26% trauma and 5% obstetric. Pre-hospital observations were missing for 25% of patients (excluding patients in cardiac arrest), suggesting that the decisions to make a pre-alert call may have been based on subjective criteria in a significant minority. Information given over the telephone invariably included age, sex and presenting complaint but details of the current condition of the patient were included in only 11%. On reviewing pre-hospital information, a consultant in A&E and an ambulance paramedic judged that a prior alert was justified in 93% but additional information would be helpful in 52% of cases to correctly mobilise resources. Seventy five "clinically critical" patients were found in the three months of the study. Clinically critical patients were patients who had no prior alert, transported by ambulance, who were subsequently admitted to intensive care, theatre, or other high dependency areas. They included 27 patients with symptoms of a myocardial infarction. These patients may have benefited from prior alert. A protocol is suggested to provide criteria for making a prior alert to the A&E department via a landline connection. A standardised message structure would be used using vital signs and mechanism of injury or type of illness to assist in hospital preparation. (+info)
A survey of the perceived quality of patient handover by ambulance staff in the resuscitation room.
(24/370)
OBJECTIVES: The aim of this study was to examine the quality of handover of patients in the resuscitation room by describing the current perceptions of medical and ambulance staff. METHODS: This was a descriptive survey using two anonymous questionnaires to gauge current opinion, one designed for medical staff and the other for ambulance staff. Questionnaires were distributed to medical staff in two teaching hospital accident and emergency (A&E) departments and ambulance personnel in the Tayside region of Scotland. RESULTS: 30 medical and 67 ambulance staff completed questionnaires. Some 19.4% of ambulance staff received formal training in giving a handover, 83% of the remaining felt there was a need for training. Medical staff conveyed their belief that handovers were very variable between crews and that they did not feel radio reports were well structured. Ambulance crews felt that medical staff did not pay attention to their handovers. Ambulance staff seemed satisfied with the quality of their handovers, although medical staff were less positive particularly in the context of self poisoning and chest pain. Both seem to be least confident with regards to the handover of paediatric emergencies. Medical staff were generally less satisfied with the reporting of vital signs than the history provided. CONCLUSIONS: Despite a generally positive perception of handovers there may be some room for improvement, in particular in the area of medical emergencies. Ambulance staff training should produce a structure for the handover that is recognisable to medical staff. The aim being a smooth and efficient transfer from prehospital agencies to A&E staff. (+info)