The Changing Role of the Ambulance Service in the UK
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1 The Changing Role of the Ambulance Service in the UK Alex Walter 1 of 19 Ambulance Service
2 OR The UK Ambulance Service:- Pre-hospital Provider or Unscheduled Care Provider??? 2 of 19 Ambulance Service
3 Alex Walter Started learning First Aid at 5 years old! Been working for an NHS Ambulance Trust for over ten years Ambulance Technician, Paramedic, Clinical Team Leader, Emergency Care Practitioner CBRN Bronze Commander First Aid and Ambulance Aid Trainer / Assessor 3 of 19 Ambulance Service
4 The Past Ambulance = Transport Service 999 Minimal assessment, basic life saving treatments only Off to A&E / ED Scoop and run! 4 of 19 Ambulance Service
5 The more recent past Ambulance = Basic / Advanced First Aid treatment and Transport Service Development of Paramedics Scoop and Run versus Stay and Play Stay and play wining! 5 of 19 Ambulance Service
6 The present (ish ) Ambulance = Advanced pre-hospital care and Transport Service Increasing use community pathways rather than just A&E / ED Scoop and run winning 6 of 19 Ambulance Service
7 Training and Education 75% of training for 5% of the work Vocational in house training Academic University based education Career structure and development opportunities 7 of 19 Ambulance Service
8 The present and near future No longer automatically get an Ambulance; Practitioner or Clinical Advice Desk Practitioners getting new referral rights to previously unavailable pathways Ability to refer direct to Acute Specialities Stay and play now winning again! 8 of 19 Ambulance Service
9 The future??? Non-emergency national telephone number for all health needs All calls handled with 999 calls Telephone triage Suitable response 9 of 19 Ambulance Service
10 The Contact Centre 999 and xxx calls handled by same staff Basic triage and then 3 responses:- 1) Ambulance + Practitioner on blues 2) Practitioner within timeframe 3) Telephone Advice only 10 of 19 Ambulance Service
11 The Response - Blues Immediate response Ambulance and Practitioner Transfer to A&E / ED on blues or refer as needed 11 of 19 Ambulance Service
12 The Response - Practitioner Within 2, 4 or 6 hours Undertake full assessment Treat / refer as appropraite 12 of 19 Ambulance Service
13 The Response - telephone Transfer to NHSDirect? Work as part of NHSDirect (in-house) Develop own system? Staffed by experienced clinicians with an element of autonomy 13 of 19 Ambulance Service
14 The Outcome Less blue light runs Reduced A&E / ED admissions More direct acute referrals More direct community referrals More self-care advice Increased patient satisfaction 14 of 19 Ambulance Service
15 Statistics! Taken to A&E -Paramedic- 79% -Practitioner- 37% Not taken -Paramedic- 21% -Practitioner- 63% Random call allocation 15 of 19 Ambulance Service
16 Statistics! Taken to A&E -Practitioner- 26% (37%) Not taken -Practitioner- 74% Practitioner cherry picking calls (63%) 16 of 19 Ambulance Service
17 Critical Care Critical Care Paramedics for serious trauma and inter facility transfers A more natural extension of the traditional role More on scene stabilisation for longer journey times 17 of 19 Ambulance Service
18 References Cooper S., O Carroll J., Jenkin A. and Badger B., 2007, Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner qualitative and summative findings, Emergency Medicine Journal, 24, pp Cooper S., O Carroll J., Jenkin A. and Badger B., 2007, Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner quantitative findings, Emergency Medicine Journal, 24, pp Mason S., O Keeffe C., Coleman P., Edlin R. and Nicholl J., 2007, Effectiveness of Emergency Care Practitioners working within existing emergency service models of care, Emergency Medicine Journal, 24, pp NHS Modernisation Agency, 2004, The Emergency Care Practitioner Report - Right Skill, Right Time, Right Place, London, Department of Health Woolard M., 2006, The role of the Paramedic Practitioner in the UK, Journal of Emergency Primary Health Care, 4 (1) Article Woolard M., 2006, Bringing healthcare to the patient? Emergency Medicine Journal, 23, p 245 Department of Health, 2005, Taking Healthcare to the Patient: Transforming NHS Ambulance Services, London, Department of Health Alex Walter, 2008, Audit and Pilot Study of Practitioner effectiveness in reducing A&E admissions, (Unpublished) 18 of 19 Ambulance Service
19 The UK Ambulance Service: Unscheduled Care Provider Thank-you Any questions? Alex Walter B.Sc. (Hons), E.C.P., S.R. Para. 19 of 19 Ambulance Service
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