SOUTH CENTRAL AMBULANCE SERVICE NHS TRUST CLINICAL SERVICES POLICY & PROCEDURE EMERGENCY CARE ASSISTANTS. March 2011

Transcription

1 SOUTH CENTRAL AMBULANCE SERVICE NHS TRUST CLINICAL SERVICES POLICY & PROCEDURE EMERGENCY CARE ASSISTANTS March 2011 DOCUMENT INFORMATION Author: Fizz Thompson Director of Clinical Services Consultation & Approval: Staff Consultation Process Clinical Review Group Board Ratification: This document replaces: Previous CRG approved ECA Policy v4g Notification of Policy Release / Strategy Release: Staff Notice Boards SCAS internet & Intranet Staff Equality Impact Assessment Stage 1 Assessment undertaken no issues identified Date of Issue: 16/03/11 Next Review: 1 year from issue Version: Version 6d 14/03/11 ECA Policy Version 6d Page 1 of 20

2 INDEX PAGE 1 Policy Statement 3 2 Scope 4 3 Duties 4 4 Policy & Procedures - Supporting the Clinician in Front Line Care 6 5 Policy & Procedures Deployment of Dual ECAs 8 6 Monitoring 12 7 Review 13 8 Equality & Human Rights Impact Statement 13 9 Reference & Reading 14 APPENDICES Appendix 1 ECA role when working with clinically trained member of staff 15 Appendix 2 ECA role when working as a Dual ECA Crew 17 Appendix 3 Deployment of Dual ECAs (non-emergencies) 19 Appendix 4 Deployment of Dual ECAs (emergencies) 20 ECA Policy Version 6d Page 2 of 20

3 SOUTH CENTRAL AMBULANCE SERVICE NHS TRUST EMERGENCY CARE ASSISTANT POLICY 1.0 POLICY STATEMENT 1.1 Emergency Care Assistants (ECAs) have been introduced to South Central Ambulance Service (SCAS) to provide a new role to support the clinical care provided in the unscheduled care environment. ECAs have been trained to assist with all clinical, practical, social and emotional care and also to help their colleagues provide and prepare the right equipment and environment to carry out an assessment and provide treatment as necessary. 1.2 They are key to the Department of Health s vision for a mobile health care service where ambulance services are Taking Health Care to the Patient. The role is also an enabler to improve the integration of the ambulance service within the modern NHS and to ensure there is equality of job provision at all skill levels. The role also provides an entrance to a career pathway for staff and an opportunity for staff to progress and develop new ways of working. 1.3 ECAs undertake a specifically designed preparation programme that comprises of a four week emergency driving course and a five week theoretical model. This is followed by a time of support and mentorship to ensure learning is applied to practice. Assessments of practice are undertaken as well as the production of a portfolio of learning to demonstrate and document competence in the role. Some transitional arrangements may be necessary in the early stages of roll-out to achieve the required skill level and carry out assessments. 1.4 The policy has been developed to set out the role and function of ECAs within the Trust and to also provide clarification in the deployment of ECAs. 1.5 The role has been subject to a process of continuous review throughout the Trust that has involved all grades and levels of staff. This is seen as an important part of the development of the role and staff. The role is constantly evolving with time and the policy will be reviewed in line with the regular evaluation meetings. 1.6 The Trust will monitor the effectiveness of the policy by audit and reporting to the Trust Board, via the Clinical Review Group, on the successes of its organisational and operational expectations described within this policy. ECA Policy Version 6d Page 3 of 20

4 2.0 SCOPE 2.1 This document has been designed to assist all operational staff in the Emergency Services, Non Emergency Services Directorates and Emergency Control Rooms (EOCs) in the safe and appropriate deployment of ECAs. It also provides information on the scope of the role within SCAS. 2.2 ECAs can work alongside clinical staff to support them in the provision of clinical care or work as a Dual ECA crew (after satisfying the necessary criteria) to transport patients in a non emergency situation. This may include the transport of patients following a referral from the clinical support desk, to back up a clinician or transfer patients. This also includes completing any appropriate administrative or clinical records as required. ECAs will not normally be rostered as a solo response. If this is unavoidable then the EOC will make every reasonable effort to crew up with another suitably qualified person and during the waiting period solo ECAs may be deployed under CFR guidelines. 2.3 Dual ECAs will normally provide a dedicated resource for those patients who are clinically in-between needing an emergency ambulance and nonemergency (patient) transport. This resource will improve the timeliness and reliability for patients such as GP admissions, hospital transfers, those who have been triaged by the Clinical Support Desk or those triaged by clinicians and who need transporting to be seen and cared for in a non emergency situation. Also, Dual ECAs may be used to back up a clinician or, in exceptional circumstances, provide emergency deployment or provide cover [para 5.1 and 5.2]. 2.4 ECAs working in this role must have been working operationally in the service with a clinical member of staff for twelve months and must have undertaken an assessment of competence before being deployed as part of a Dual ECA crew. 2.5 The Dual ECA role will encompass a rotation of deployment through a Dual ECA role and a role alongside a clinician and this is part of their continued professional development. 3.0 DUTIES 3.1 Hereafter, and to prevent repetition the term 'policy' refers to this document which contains elements of policy, guidance and procedures. 3.2 Medical Director and Executive Director of Patient Care have Board level responsibility for the review and implementation of clinical guidance within SCAS. The Medical Director chairs the Quality and Safety Committee that is responsible for ensuring the guidance is in line with current best practice. 3.3 Chief Operating Officer has Board level responsibility for the review and implementation of operational policies, procedures and guidance within SCAS. 3.4 Divisional Directors of Operations and Assistant Director of EOC have delegated responsibility for managing the strategic development and ECA Policy Version 6d Page 4 of 20

5 implementation of clinical and non-clinical operational policies and should apply this policy throughout the Trust ensuring it is available to staff and adhered to. 3.5 Head of Operations and EOCs will be responsible to the Divisional Directors of Operations/EOC for the development of effective Trust wide policies, procedures and guidance. Specific responsibilities will include monitoring compliance to this policy and the performance management of staff. 3.6 Operational Managers, Clinically Qualified Managers and Control Duty Managers are responsible for implementing this policy within the operational environment. They report to the Head of Operations/EOC and should make this policy available to all staff within their departments. Operational Managers and Control Duty Managers should read and understand this policy with specific responsibility to monitoring all areas of this policy and the performance management of staff against the policy. Operational Managers and Clinically Qualified Managers may be called upon to respond as a clinical back up for ECA crews who have been deployed to emergencies in exceptional circumstances. When receiving these requests from EOC, Managers must consider this a high priority request. 3.7 All Operational Staff, EOC Staff and Clinical Support Desk (CSD) Staff are responsible to read, fully understand and follow this policy. Any deviation from this needs to be relayed to the Divisional EOC, where EOC staff will place a pre-set comment ECA POLICY DEVIATION onto the event remarks and record the information. This will then allow a search to be made for audit purposes. Staff involved should report the deviation through the current Adverse Incident Reporting and Investigating Policy. Currently this involves completion and submission of an IR1 form and examples of appropriate use of this process will be where there has been an inappropriate deployment, a risk is identified or there has been an actual or near miss event. 3.8 Clinical Review Group will assess the relevance of clinical guidance and monitor the effectiveness of the policy and staff training. They will also coordinate the production of gap analysis and action plans for the Quality and Safety Committee to monitor. 3.9 Quality and Safety Committee will monitor the implementation of relevant guidelines within the Trust s clinical and operational governance structure. This committee will monitor the effectiveness of clinical and operational guidance ensuring that the Trust Board is aware of any significant non compliance as a result of audit activity Scheduling Department are responsible for ensuring that ECA staff are rostered appropriately in accordance with this policy and that Dual ECA crews are clearly highlighted/ indicated on the Daily Crewing sheets for EOC. They must maintain an up to date list of Dual ECA qualified staff in conjunction with operational managers. ECA Policy Version 6d Page 5 of 20

6 4.0 Policy and Procedures - SUPPORTING THE CLINICIAN IN FRONT LINE CARE 4.1 The ECA role is primarily to support the clinician they are working with, but above all, care for the patient who they are responding to and their relatives and friends. 4.2 ECAs have been trained to assist with all clinical, practical, social and emotional care that is given in the unscheduled care environment and also to help colleagues provide and prepare the right equipment and environment to carry out an assessment and provide treatment as necessary. 4.3 When working with an ECA who is qualified to be a 'Dual ECA', Student Paramedics (who are qualified autonomously at Dual ECA level) will only work in the capacity of an ECA, thereby becoming a Dual ECA crew. 4.4 When working with an ECA who is qualified to be a 'Dual ECA', Student Technicians (who are qualified autonomously at Dual ECA level) will only work in the capacity of an ECA, thereby becoming a Dual ECA crew. 4.5 Every effort will be made by the EOC to re-allocate clinical staff to ensure that ECAs are not working together unless they are working on a planned Dual ECA shift. Where this is not possible, suitably qualified Dual ECA crews will be deployed as if they were on a pre-planned Dual ECA shift with due regard for all the requirements of this policy. If either ECA is not qualified as a 'Dual ECA' then the crew will be regarded and utilised as if it were a PTS crew. This does not preclude them from being sent to back up a clinician on scene who travels and remains clinically responsible for the patient. 4.6 The ECA role when working along side a clinically trained member of staff is detailed within Appendix Attending/Driver Role: ECAs can attend to patients in the back of an ambulance providing no ongoing treatment is being given to the patient, other than medicines in accordance with the Medicines Management Policy CSPP No If working with a clinician and at any time the patients condition deteriorates when an ECA is attending in the back, they must request the vehicle is stopped safely and the ambulance clinician takes over care of the patient. 4.9 If a patient deteriorates or if there is any cause for concern when not with a clinician, the ECA crew must immediately inform EOC and be involved in the decision process to establish the best course of action in the clinical interests of the patient. These plans may include, but are not limited to: consult CSD, request clinical back up, stop or proceed to an appropriate RV point or ED etc When working with a clinician in the following categories, it is the clinician who should attend the patient in the back of the ambulance. There may be circumstances, however, where a clinician has assessed a patient who falls ECA Policy Version 6d Page 6 of 20

7 into one of these categories. Providing they are entirely happy that it is clinically safe, the ECA can attend this patient: (Also refer to 4.8 and 4.9) Cardiac disease with o Active cardiac chest pain o Blackout within 24 hours Airway management problems/breathless at rest Epileptic fit within the past 2 hours Patient bleed (e.g. PR/PV) with low blood pressure Anaphylactic reactions Maternity/pregnancy cases Any patient given advanced skills or procedures, i.e. cannulation, thrombolysis, morphine, ventilated patients Any patient with a Glasgow Coma Scale of 12 or below Any patient under the age of one year (here and from now on in this policy the reference to one year shall be interpreted to mean is or appears to be one year To add clarity and take account of the variety of challenges facing the Trust as it reacts to challenging circumstances, note the following: A situation could arise where a Dual ECA crew is deployed to some of these circumstances as a first response. In such a case ECAs are deployed and clinical back up is dispatched (as per paragraph 5.2). If there is a deterioration or cause for concern while an ECA is in a first response situation, and before a clinician is present, then paragraph 4.9 will apply. This requires the ECA crew to make immediate contact with EOC and then be involved in the decision process in the clinical interests of the patient. One of the possible outcomes in the patients clinical interest (e.g. rapid transfer to ED or an RV) may result in an ECA attending the patient in the back of the ambulance. This circumstance will override the requirement for a clinician to attend as stated earlier in this paragraph. It is important that any very exceptional measures like this are highlighted through appropriate Trust reporting processes to ensure proper monitoring and action taken to reduce these to a minimum The senior qualified ambulance clinician (e.g. technician, paramedic, ECP and ambulance nurse) will always retain the ultimate responsibility for patient care. If a patient is being escorted by a more clinically qualified HCP (e.g. doctor, nurse or midwife) then they will retain responsibility for patient care, but can be assisted by the ECA or other clinicians present If the ECA is unhappy to travel in the back with the patient at any time, they should disclose this to their crew mate and the ambulance clinician should attend the patient. ECA Policy Version 6d Page 7 of 20

8 5 Policy and Procedures - DEPLOYMENT OF DUAL ECAs 5.1 Dual ECAs will not be sent to the following incidents: a) The scene if it is violent or is thought to be violent b) The patient if they are under one year old. c) The incident if it is a gynaecological or maternity call d) A fire e) An RTC (but they can be used to back up other clinical resources, and where item f below applies at an RTC, they will work only in safe areas under the direction of the incident officer) f) Chemicals or other dangerous materials are involved. For additional clarity: Even if the exceptional circumstances in paragraph 5.2 apply ECAs will not be sent to one of the above incidents. 5.2 It may be necessary in the following exceptional circumstances below to send a Dual ECA crew as a first response to any emergency call provided they are the nearest available resource and there are no other clinical resources showing on CAD with anticipated response times within the performance timescale for that category of call. Exceptional circumstances will be defined as occurring if any of the following apply: a) No other clinical resource could respond to the patient in a reasonable time. b) Adverse weather conditions c) Flu pandemic, other pandemic or widespread health incident d) Major incident e) The Trust is operating under Resourcing Escalatory Action Plan (REAP) level 4 or above. ECAs must not be deployed at pre-alert and a significant amount of clinical and incident information must be available to allow an informed deployment decision. Permission from the Control Duty Manager is required before deployment to an emergency and a clinical back up must be identified and deployed immediately before or immediately after the Dual ECA crew is deployed. Dual ECA crews can only be sent to 'cover points' designated as a primary cover point (P1 zone) and then only when there are no other available clinical resources in the dispatch zone. Dual ECA crews will always be backed up as soon as possible by a clinician such as a technician, paramedic, ECP, ambulance nurse, or operational supervisor/manager (or at the first available opportunity when no clinician is immediately available). It may, on occasions, be necessary to deploy appropriately skilled non-operational clinicians (e.g. clinically qualified managers) to ensure timely support for ECAs. After CSD triage Dual ECA crews can be deployed to emergency calls under CSD guidance. ECA Policy Version 6d Page 8 of 20

9 5.3 Each member of staff is responsible for their actions and should work as part of a team. The decision as to who attends should be made in partnership. 5.4 ECAs must not stand down any back up unless the patient has absconded or no patient is found. This should be clearly communicated to the EOC and the relevant Trust paperwork must be completed and submitted. 5.5 ECAs should never leave a patient or not convey a patient. They should seek further advice and support from the CSD or senior manager in the EOC or from a front line clinician. 5.6 Emergency Calls Support to Front Line Staff: Following on-scene assessment by qualified staff, ECAs may also be used to transport appropriate patients to an A&E unit or other destination following a complete handover of the patient s condition and symptoms. Staff must complete and pass on relevant paperwork including a PCR and conduct an appropriate handover before leaving a patient in the care of a Dual ECA crew. 5.7 Emergency Calls Clinical Support Desk: ECAs may also be used to transport appropriate patients to an A&E unit of another health care provider if a clinician working on the clinical support desk has assessed the patient and is happy that they can be transported by a Dual ECA crew. Information will be provided to the ECA crew on the condition of the patient. With both emergency and urgent calls (para 5.6 and 5.8) ECAs must still complete relevant paperwork e.g. PCR to show demographics and their involvement in any care of the patient. This should also include any relevant clinical information passed by the CSD clinician or other HCP. (Refer also to 4.9 and 4.12) 5.8 Urgent Calls HCP (inc GP) Admission: HCP (inc GP) urgent calls may be transported by ECAs provided that: The patient does not fit into the exclusions listed in para The person booking the call is made aware that a Dual ECA is/may be used and they do not have the level of qualification of an ECP/Paramedic/Technician and will be transporting the patient appropriate to their clinical role. (See summary EOC dispatch flow diagram in appendix 3) 5.9 Urgent Calls Hospital Transfers may be transported by ECA crews provided that: The hospital is providing appropriately trained medical escorts If no escort is being provided by the hospital, the patient must not fit into any of the exclusions listed in paragraph Where equipment or a medical device is needed the clinician accompanying must make sure they can either use the [SCAS] Trust equipment or bring their own. Additional equipment must be capable of being secured safely in accordance with standing instructions for the use of brackets etc. ECA Policy Version 6d Page 9 of 20

10 In either case the clinician booking the transfer must be made aware that a Dual ECA crew is/may be used The clinician making the booking is made aware that it is the responsibility of the hospital to provide a suitable escort, where clinical care is needed, and that the Trust is responsible for transportation only The ECA role when working as a Dual ECA crew is also shown in Appendix 2 and the summary EOC dispatch flow diagrams are in Appendix 3 and ECA crews make a very valuable contribution to patient care by getting the patient to the right place at the right time. It is challenging to provide a definitive guide to every situation where a patient needs transporting and it is therefore important that robust communication is maintained between EOC and front line staff on every deployment There are a number of occasions where it would be inappropriate to send a Dual ECA response. Therefore as a matter of policy an appropriate clinical crew would be sent regardless of the skill level requested by the HCP making the booking. EOC staff will ensure that the appropriate level of resource is allocated to each patient. It must be ascertained if any of the following circumstances apply, before a Dual ECA crew is deployed. If any do apply then a clinical crew will be deployed. However, a Dual ECA crew may still be sent as a first response in the first two circumstances, but must be backed up by an appropriate clinician/clinical crew. Immediately life threatening medical admission or transfer, urgent HCP or GP admission. (However a Dual ECA crew may be sent in the capacity as a first response backed up by a clinician as per paragraph 5.2) Immediate risk to life or limb. (However a Dual ECA crew may be sent in the capacity as a first response backed up by a clinician as per paragraph 5.2) High probability that the patient may deteriorate en route Drug therapy is required (except those administered in accordance with the Medicines Management Policy CSPP No. 5.) Fluid therapy is required Drugs already administered either by a GP or paramedic which may require further intervention by the crew Airway management other than using an oro-pharyngeal (OP) airway or patient positioning e.g. recovery position. (For clarification here: ECAs are trained to insert and maintain patency of an oro-pharyngeal airway. They may arrive on scene and use an OP airway appropriately but Dual ECA crews alone should not transfer the patient a clinician is required). Aspiration required other than aspiration of oral passages using soft or rigid catheter. (For clarification, aspiration is part of airway management and while this may initially be carried out by an ECA, a clinician may be required for advanced airway management or in the transfer of these patients. CSD offers a valuable source of advice). Observations needed en route that may result in treatment or the need for medication ECA Policy Version 6d Page 10 of 20

11 Cardiac monitoring on route Blue light response or conveyance required, unless a clinical escort is provided. Note that none of these conditions would preclude a Dual ECA crew being requested by EOC, or a clinician on scene, to provide transport where a clinician begins care and remains responsible for the clinical care on route As with paragraph 4.9 above If a patient deteriorates or if there is any cause for concern when not with a clinician, the ECA crew must immediately inform EOC and be involved in the decision process to establish the best course of action in the clinical interests of the patient. These plans may include, but are not limited to, consult CSD, request clinical back up, stop or proceed to an appropriate RV point or ED etc. ECA Policy Version 6d Page 11 of 20

12 6.0 MONITORING 6.1 The monitoring of this policy will be through the Quality and Safety Committee, and Joint Consultative Committee. 6.2 Week by week ongoing monitoring of the effectiveness of this policy will be the responsibly of the Divisional Directors of Operations and Divisional Heads of EOC. 6.2 The Divisional Directors of Operations and Executive Director of Patient Care will be jointly responsible to delegate an Operational Manager to carry out a yearly review of this policy and will provide a full report to the Quality and Safety Committee including an Audit of Compliance', which will include: ECA policy deviations in relation to allocation of ECA dual crews ECA policy deviations in the number of unplanned Dual ECA crews (weekly report to Divisional Directors and Heads of EOC) and a yearly report for audit. The reports should clearly document the reasons behind unplanned ECA crews Number of IR1s relating to the policy All clinical incidents to be reviewed by the Divisional Risk Managers and forward their findings to the Divisional Directors of Operations and Heads of EOC Number of public complaints relating to the use of ECA Carry out an annual review of clinical guidance contained within this policy 6.3 Compliance with this policy in regard to the use of ECAs, as described in and forming part of, the job description of all operational staff, will be monitored through: the learning management system, the clinical audit review system (CARS), clinical supervision and the annual appraisal/personal review (PDR) system. Non compliance will be addressed through the Capability Policy and if necessary the disciplinary process. 6.4 Any action plans developed to improve this policy will be monitored by the Quality and Safety Committee for effectiveness. ECA Policy Version 6d Page 12 of 20

13 7.0 REVIEW 7.1 This policy will be reviewed on an annual basis or sooner in the light of any changes in guidance and guidelines to which the Trust must adhere to. 8.0 EQUALITY & HUMAN RIGHTS IMPACT STATEMENT 8.1 The Trust is committed to promoting positive measures that eliminate all forms of unlawful or unfair discrimination on the grounds of age, marital status, disability, race, nationality, gender, religion, sexual orientation, gender reassignment, ethnic or national origin, beliefs, domestic circumstances, social and employment status, political affiliation or trade union membership, HIV status or any other basis not justified by law or relevant to the requirements of the post. 8.2 By committing to a policy encouraging equality of opportunity and diversity, the Trust values differences between members of the community and within its existing workforce, and actively seeks to benefit from their differing skills, knowledge, and experiences in order to provide an exemplary healthcare service. The Trust is committed to promoting equality and diversity best practice both within the workforce and in any other area where it has influence. 8.3 The Trust will therefore take every possible step to ensure that this procedure is applied fairly to all employees regardless of race, ethnic or national origin, colour or nationality; gender (including marital status); age; disability; sexual orientation; religion or belief; length of service, whether full or part-time or employed under a permanent or a fixed-term contract or any other irrelevant factor Where there are barriers to understanding e.g. an employee has difficulty in reading or writing or where English is not their first language, additional support will be put in place wherever necessary to ensure that the process to be followed is understood and that the employee is not disadvantaged at any stage in the procedure. Further information on the support available can be sought from the Human Resource Department. ECA Policy Version 6d Page 13 of 20

14 9.0 REFERENCE & READING Risk Management Strategy Adverse Incident and Reporting & Investigation Policy Patient Clinical Records Policy & Procedures Emergency Care Practitioners Policy and Procedures Care Pathway Policy and Procedures Control Standing Operational Procedures Trust Job Description Medicines Management Policy Governance Framework for Community Responders ECA Policy Version 6d Page 14 of 20

15 Appendix 1 The following outlines the scope of the role when working along side a clinically trained member of staff: Undertake immediate scene survey and risk assessment in order to establish the presence of hazards and possible need to resolve conflict. Subject to their eligibility to do so, staff will drive all Trust vehicles under both normal driving conditions and suitably equipped and designated emergency vehicles under emergency driving conditions, when responding to emergencies, in accordance with Road Traffic law and Trust policies including the Driving and Care of Trust Vehicles Policy. Correct use of equipment to undertake base line observations within a primary survey and under guidance undertake more extensive examinations as part of a secondary survey. Observations include: Respiratory rate Pulse rate Blood pressure, manual and automated NIBP Blood glucose measurement temperature Oxygen saturation Capillary refill Glasgow Coma Score and (AVPU) Alert Verbal Pain Unresponsive Pupillary reaction Recognition and reporting of normal and abnormal observations and change in patients condition. Perform basic life support with use of Oro Pharyngeal airway for: Child one year and older Adult Tracheotomy / laryngectomy patients During pregnancy Use of cardiac monitoring equipment with both 3 and 12 lead application. Use of AED / Defibrillator in advisory mode. Aspiration of oral passages using soft or rigid catheter Communication skills, including those required in assisting a clinician dealing with sudden death. Manual handling skills utilising all manual handling equipment. Use of all immobilisation equipment. ECA Policy Version 6d Page 15 of 20

16 Application of manual cervical spine immobilisation. Awareness of major incident / CBRN responsibilities. Assisting in fracture care. First aid management of wounds. Undertake daily service checks on: Vehicles Clinical equipment Communication equipment Be able to store and dispose of hazardous substances such as clinical waste and sharps in line with current policies and procedures. Use communication / data equipment to input, store, retrieve and transmit information. Assisting the paramedic / technician in all skills. For example, helping secure a cannula and ET tubes, setting up an IV fluid set, but not connecting. Helping to draw up and label medicines (except controlled drugs) for a paramedic to check before administration. Patient Clinical Records (PCR) and other documentation must be completed in accordance with Trust policies. This may be by the ECA or clinician; however where there is clinical intervention/monitoring the documentation must also be checked and signed by the clinician in accordance with Trust policies. If taking over from a clinician then this should be documented. Administer medicines in accordance with the Medicines Management Policy CSPP No. 5. ECA Policy Version 6d Page 16 of 20

17 Appendix 2 The following outlines the scope of the role when working as a Dual ECA crew: Undertake immediate scene survey and risk assessment in order to establish the presence of hazards and possible need to resolve conflict. Subject to their eligibility to do so, staff will drive all Trust vehicles under both normal driving conditions and suitably equipped and designated emergency vehicles under emergency driving conditions, when responding to emergencies, in accordance with Road Traffic law and Trust policies including the Driving and Care of Trust Vehicles Policy. Provide first person on scene response to any patient when operating without a clinician (see para 5.1 and para 5.2). Correct use of equipment to undertake base line observations within a primary survey and under guidance undertake more extensive examinations as part of a secondary survey. Observations include: Respiratory rate Pulse rate Blood pressure, manual and automated NIBP Blood glucose measurement Temperature Oxygen saturation Capillary refill Glasgow Coma Score and (AVPU) Alert Verbal Pain Unresponsive Pupillary reaction Recognition and reporting of normal and abnormal observations and change in patients condition. Perform basic life support with use of Oro Pharyngeal airway for: Child one year and older Adult Tracheotomy / laryngectomy patients During pregnancy Use of cardiac monitoring equipment with both 3 and 12 lead application. Use of AED / Defibrillator in advisory mode. Aspiration with flexible and rigid catheters for example, a Yankauer catheter. Communication skills, including those required in assisting a clinician dealing with sudden death. Manual handling skills utilising all manual handling equipment. Use of all immobilisation equipment. ECA Policy Version 6d Page 17 of 20

18 Application of manual cervical spine immobilisation. Awareness of major incident / CBRN responsibilities. Assisting in fracture care. First aid management of wounds. Undertake daily service checks on: Vehicles Clinical equipment Communication equipment Be able to store and dispose of hazardous substances such as clinical waste and sharps in line with current policies and procedures. Use communication / data equipment to input, store, retrieve and transmit information. PCR completion The ECA must complete a PCR to provide a record of the patient journey and also what care has been provided during the journey. This can be provided from the patient or their carer. If this is not possible to collect in full then the reason for not collecting should be clearly written on the PCR. The PCR should be clearly signed by the ECA The record should include: Patients name, age, DOB, address Brief history of event/illness/injury Time of onset of symptoms Patients past medical history Patients signs and symptoms Any treatment or medicines that has been given Any change in symptoms Pain level of patient Basic observations: respiratory rate, pulse,bp, blood glucose level, document changes in ranges of observations Administer medicines in accordance with the Medicines Management Policy CSPP No. 5. ECA Policy Version 6d Page 18 of 20

19 Appendix 3 - DEPLOYMENT OF DUAL ECAs (Based on this policy) IHT / CSD REFERRAL / GP Admission HOSPITAL REQUESTS PATIENT TRANSFER CSD REFFERAL HCP CREW REFERRAL GP REQUESTS PATIENT ADMISSION Is there a suitable Medical Escort? Ensure GP knows dual ECA crew NO YES Ensure Hosp knows Dual ECA crew Does the patient need monitoring? Exceptions to Deployment High probability patient deteriorate en route Active Drug therapy is required (except O2) Active Fluid therapy is required Drugs already administered which may require Further intervention en route Advanced Airway management Aspiration required other than mouth and nose Observations needed en route that may result in treatment or the need for medication Cardiac monitoring en route NO to ALL of above YES to ANY of above Deploy Dual ECA crew Deploy A/E (Clinical) crew Send immediate A/E (Clinical) back up if patient s condition deteriorates ECA Policy Version 6d Page 19 of 20

20 Appendix 4 - DEPLOYMENT OF DUAL ECAs (Based on this policy) EMERGENCY CALL FIRST RESPONSE / STANDBY ECAs MUST NOT be deployed at PRE-ALERT and a significant amount of clinical and incident information must be available to allow an informed deployment decision Nearest available resource AND no other resources capable of required response time AND permission from CDM Exceptions to Deployment (Same as Community Responders): VIOLENT Scene (or suspected) Patient UNDER 1 Years old Gynaecological or Maternity call FIRE Call RTC(can be used to back up other A/E resources) Chemicals or other dangerous materials involved NO to ALL of above Get permission form Control Duty Manager YES to ANY of above Deploy A/E crew Deploy Dual ECA crew Deploy clinical backup immediately before or immediately after deploying ECA crew Dual ECA crew CANNOT stand A/E Crew Down or Discharge ECA Policy Version 6d Page 20 of 20

21 SOUTH CENTRAL AMBULANCE SERVICE NHS TRUST CLINICAL SERVICES POLICY & PROCEDURE EMERGENCY CARE ASSISTANTS March 2011 DOCUMENT INFORMATION Author: Fizz Thompson Director of Clinical Services Consultation & Approval: Staff Consultation Process Clinical Review Group Board Ratification: This document replaces: Previous CRG approved ECA Policy v4g Notification of Policy Release / Strategy Release: Staff Notice Boards SCAS internet & Intranet Staff Equality Impact Assessment Stage 1 Assessment undertaken no issues identified Date of Issue: 16/03/11 Next Review: 1 year from issue Version: Version 6d 14/03/11 ECA Policy Version 6d Page 1 of 20

22 INDEX PAGE 1 Policy Statement 3 2 Scope 4 3 Duties 4 4 Policy & Procedures - Supporting the Clinician in Front Line Care 6 5 Policy & Procedures Deployment of Dual ECAs 8 6 Monitoring 12 7 Review 13 8 Equality & Human Rights Impact Statement 13 9 Reference & Reading 14 APPENDICES Appendix 1 ECA role when working with clinically trained member of staff 15 Appendix 2 ECA role when working as a Dual ECA Crew 17 Appendix 3 Deployment of Dual ECAs (non-emergencies) 19 Appendix 4 Deployment of Dual ECAs (emergencies) 20 ECA Policy Version 6d Page 2 of 20

23 SOUTH CENTRAL AMBULANCE SERVICE NHS TRUST EMERGENCY CARE ASSISTANT POLICY 1.0 POLICY STATEMENT 1.1 Emergency Care Assistants (ECAs) have been introduced to South Central Ambulance Service (SCAS) to provide a new role to support the clinical care provided in the unscheduled care environment. ECAs have been trained to assist with all clinical, practical, social and emotional care and also to help their colleagues provide and prepare the right equipment and environment to carry out an assessment and provide treatment as necessary. 1.2 They are key to the Department of Health s vision for a mobile health care service where ambulance services are Taking Health Care to the Patient. The role is also an enabler to improve the integration of the ambulance service within the modern NHS and to ensure there is equality of job provision at all skill levels. The role also provides an entrance to a career pathway for staff and an opportunity for staff to progress and develop new ways of working. 1.3 ECAs undertake a specifically designed preparation programme that comprises of a four week emergency driving course and a five week theoretical model. This is followed by a time of support and mentorship to ensure learning is applied to practice. Assessments of practice are undertaken as well as the production of a portfolio of learning to demonstrate and document competence in the role. Some transitional arrangements may be necessary in the early stages of roll-out to achieve the required skill level and carry out assessments. 1.4 The policy has been developed to set out the role and function of ECAs within the Trust and to also provide clarification in the deployment of ECAs. 1.5 The role has been subject to a process of continuous review throughout the Trust that has involved all grades and levels of staff. This is seen as an important part of the development of the role and staff. The role is constantly evolving with time and the policy will be reviewed in line with the regular evaluation meetings. 1.6 The Trust will monitor the effectiveness of the policy by audit and reporting to the Trust Board, via the Clinical Review Group, on the successes of its organisational and operational expectations described within this policy. ECA Policy Version 6d Page 3 of 20

24 2.0 SCOPE 2.1 This document has been designed to assist all operational staff in the Emergency Services, Non Emergency Services Directorates and Emergency Control Rooms (EOCs) in the safe and appropriate deployment of ECAs. It also provides information on the scope of the role within SCAS. 2.2 ECAs can work alongside clinical staff to support them in the provision of clinical care or work as a Dual ECA crew (after satisfying the necessary criteria) to transport patients in a non emergency situation. This may include the transport of patients following a referral from the clinical support desk, to back up a clinician or transfer patients. This also includes completing any appropriate administrative or clinical records as required. ECAs will not normally be rostered as a solo response. If this is unavoidable then the EOC will make every reasonable effort to crew up with another suitably qualified person and during the waiting period solo ECAs may be deployed under CFR guidelines. 2.3 Dual ECAs will normally provide a dedicated resource for those patients who are clinically in-between needing an emergency ambulance and nonemergency (patient) transport. This resource will improve the timeliness and reliability for patients such as GP admissions, hospital transfers, those who have been triaged by the Clinical Support Desk or those triaged by clinicians and who need transporting to be seen and cared for in a non emergency situation. Also, Dual ECAs may be used to back up a clinician or, in exceptional circumstances, provide emergency deployment or provide cover [para 5.1 and 5.2]. 2.4 ECAs working in this role must have been working operationally in the service with a clinical member of staff for twelve months and must have undertaken an assessment of competence before being deployed as part of a Dual ECA crew. 2.5 The Dual ECA role will encompass a rotation of deployment through a Dual ECA role and a role alongside a clinician and this is part of their continued professional development. 3.0 DUTIES 3.1 Hereafter, and to prevent repetition the term 'policy' refers to this document which contains elements of policy, guidance and procedures. 3.2 Medical Director and Executive Director of Patient Care have Board level responsibility for the review and implementation of clinical guidance within SCAS. The Medical Director chairs the Quality and Safety Committee that is responsible for ensuring the guidance is in line with current best practice. 3.3 Chief Operating Officer has Board level responsibility for the review and implementation of operational policies, procedures and guidance within SCAS. 3.4 Divisional Directors of Operations and Assistant Director of EOC have delegated responsibility for managing the strategic development and ECA Policy Version 6d Page 4 of 20

25 implementation of clinical and non-clinical operational policies and should apply this policy throughout the Trust ensuring it is available to staff and adhered to. 3.5 Head of Operations and EOCs will be responsible to the Divisional Directors of Operations/EOC for the development of effective Trust wide policies, procedures and guidance. Specific responsibilities will include monitoring compliance to this policy and the performance management of staff. 3.6 Operational Managers, Clinically Qualified Managers and Control Duty Managers are responsible for implementing this policy within the operational environment. They report to the Head of Operations/EOC and should make this policy available to all staff within their departments. Operational Managers and Control Duty Managers should read and understand this policy with specific responsibility to monitoring all areas of this policy and the performance management of staff against the policy. Operational Managers and Clinically Qualified Managers may be called upon to respond as a clinical back up for ECA crews who have been deployed to emergencies in exceptional circumstances. When receiving these requests from EOC, Managers must consider this a high priority request. 3.7 All Operational Staff, EOC Staff and Clinical Support Desk (CSD) Staff are responsible to read, fully understand and follow this policy. Any deviation from this needs to be relayed to the Divisional EOC, where EOC staff will place a pre-set comment ECA POLICY DEVIATION onto the event remarks and record the information. This will then allow a search to be made for audit purposes. Staff involved should report the deviation through the current Adverse Incident Reporting and Investigating Policy. Currently this involves completion and submission of an IR1 form and examples of appropriate use of this process will be where there has been an inappropriate deployment, a risk is identified or there has been an actual or near miss event. 3.8 Clinical Review Group will assess the relevance of clinical guidance and monitor the effectiveness of the policy and staff training. They will also coordinate the production of gap analysis and action plans for the Quality and Safety Committee to monitor. 3.9 Quality and Safety Committee will monitor the implementation of relevant guidelines within the Trust s clinical and operational governance structure. This committee will monitor the effectiveness of clinical and operational guidance ensuring that the Trust Board is aware of any significant non compliance as a result of audit activity Scheduling Department are responsible for ensuring that ECA staff are rostered appropriately in accordance with this policy and that Dual ECA crews are clearly highlighted/ indicated on the Daily Crewing sheets for EOC. They must maintain an up to date list of Dual ECA qualified staff in conjunction with operational managers. ECA Policy Version 6d Page 5 of 20

26 4.0 Policy and Procedures - SUPPORTING THE CLINICIAN IN FRONT LINE CARE 4.1 The ECA role is primarily to support the clinician they are working with, but above all, care for the patient who they are responding to and their relatives and friends. 4.2 ECAs have been trained to assist with all clinical, practical, social and emotional care that is given in the unscheduled care environment and also to help colleagues provide and prepare the right equipment and environment to carry out an assessment and provide treatment as necessary. 4.3 When working with an ECA who is qualified to be a 'Dual ECA', Student Paramedics (who are qualified autonomously at Dual ECA level) will only work in the capacity of an ECA, thereby becoming a Dual ECA crew. 4.4 When working with an ECA who is qualified to be a 'Dual ECA', Student Technicians (who are qualified autonomously at Dual ECA level) will only work in the capacity of an ECA, thereby becoming a Dual ECA crew. 4.5 Every effort will be made by the EOC to re-allocate clinical staff to ensure that ECAs are not working together unless they are working on a planned Dual ECA shift. Where this is not possible, suitably qualified Dual ECA crews will be deployed as if they were on a pre-planned Dual ECA shift with due regard for all the requirements of this policy. If either ECA is not qualified as a 'Dual ECA' then the crew will be regarded and utilised as if it were a PTS crew. This does not preclude them from being sent to back up a clinician on scene who travels and remains clinically responsible for the patient. 4.6 The ECA role when working along side a clinically trained member of staff is detailed within Appendix Attending/Driver Role: ECAs can attend to patients in the back of an ambulance providing no ongoing treatment is being given to the patient, other than medicines in accordance with the Medicines Management Policy CSPP No If working with a clinician and at any time the patients condition deteriorates when an ECA is attending in the back, they must request the vehicle is stopped safely and the ambulance clinician takes over care of the patient. 4.9 If a patient deteriorates or if there is any cause for concern when not with a clinician, the ECA crew must immediately inform EOC and be involved in the decision process to establish the best course of action in the clinical interests of the patient. These plans may include, but are not limited to: consult CSD, request clinical back up, stop or proceed to an appropriate RV point or ED etc When working with a clinician in the following categories, it is the clinician who should attend the patient in the back of the ambulance. There may be circumstances, however, where a clinician has assessed a patient who falls ECA Policy Version 6d Page 6 of 20

27 into one of these categories. Providing they are entirely happy that it is clinically safe, the ECA can attend this patient: (Also refer to 4.8 and 4.9) Cardiac disease with o Active cardiac chest pain o Blackout within 24 hours Airway management problems/breathless at rest Epileptic fit within the past 2 hours Patient bleed (e.g. PR/PV) with low blood pressure Anaphylactic reactions Maternity/pregnancy cases Any patient given advanced skills or procedures, i.e. cannulation, thrombolysis, morphine, ventilated patients Any patient with a Glasgow Coma Scale of 12 or below Any patient under the age of one year (here and from now on in this policy the reference to one year shall be interpreted to mean is or appears to be one year To add clarity and take account of the variety of challenges facing the Trust as it reacts to challenging circumstances, note the following: A situation could arise where a Dual ECA crew is deployed to some of these circumstances as a first response. In such a case ECAs are deployed and clinical back up is dispatched (as per paragraph 5.2). If there is a deterioration or cause for concern while an ECA is in a first response situation, and before a clinician is present, then paragraph 4.9 will apply. This requires the ECA crew to make immediate contact with EOC and then be involved in the decision process in the clinical interests of the patient. One of the possible outcomes in the patients clinical interest (e.g. rapid transfer to ED or an RV) may result in an ECA attending the patient in the back of the ambulance. This circumstance will override the requirement for a clinician to attend as stated earlier in this paragraph. It is important that any very exceptional measures like this are highlighted through appropriate Trust reporting processes to ensure proper monitoring and action taken to reduce these to a minimum The senior qualified ambulance clinician (e.g. technician, paramedic, ECP and ambulance nurse) will always retain the ultimate responsibility for patient care. If a patient is being escorted by a more clinically qualified HCP (e.g. doctor, nurse or midwife) then they will retain responsibility for patient care, but can be assisted by the ECA or other clinicians present If the ECA is unhappy to travel in the back with the patient at any time, they should disclose this to their crew mate and the ambulance clinician should attend the patient. ECA Policy Version 6d Page 7 of 20