Linking the LAS with Health & Social Care. 6 th December 2016

Transcription

1 Linking the LAS with Health & Social Care 6 th December 2016

2 Outline: About me.. LAS Context Integrating LAS with H&SC London Ambulance Service NHS Trust 2

3 LAS context London Ambulance Service NHS Trust 3

4 We are one of the busiest Ambulance Services in the world

5 The London Ambulance Service today Covers all of London = 32 CCG s, 41 NHS trusts, across 86 sites Population of 8.9m people Respond to c.1.9m 999 calls annually We employ just under 5000 staff, 71% of which are frontline Our frontline staff work out of 70 ambulance stations Focus on international and national recruitment drives 700 staff joined London Ambulance Service NHS Trust 5

6 How we care for the capital Our major service areas: Call taking and clinical triage Hear and treat services 999 emergency and urgent care response delivered using traditional and innovative means e.g. Cycle Response Unit Intelligent conveyance 111 Services Emergency Preparedness Resilience and Response (EPRR) London Ambulance Service NHS Trust 6

7 Demand Category A : 8,830 incidents per week (average) : 9, : 9, : 10,697 In there were 19 weeks where activity ranged from 10,007 to 10,983 incidents w/e 20 Nov 16 11,330 CAT A Calls (16/20wks) 8 of the top 10 busiest ever months for the LAS have occurred since Jan 2016, with March 2016 being the busiest ever month for Category A calls followed by October 2016 London Ambulance Service NHS Trust 7

8 How can H&SC assist? London Ambulance Service NHS Trust 8

9 Focus HCP / Care / Residential calls Overall HCP referrals are up by 12.3%. Marginally ahead of overall growth rates. The over 60s represent the largest proportion of the total population within HCP referrals(62% of the total referrals in 2016/17) HCP protocols and emergency response requested represent the majority determinants driving growth in this area. HCP growth - Hammersmith 33% and NW London 24%. London Ambulance Service NHS Trust 9

10 What to do when a resident becomes ill London Ambulance Service NHS Trust 10

11 Consider: On-site qualified nurse or district nurse GP or GP out-of-hours service 111 Always call 999 if someone is seriously ill or injured, and their life is at risk difficulty in breathing, unconsciousness severe loss of blood Stroke or heart attack London Ambulance Service NHS Trust 11

12 Making the Call Residential Care.. Dial 999, ask for an ambulance and stay calm Answer all the questions if possible, remain with the patient- Mobile phone If you can t stay with the patient make sure you know if the patient is alert, conscious, breathing You could be offered advice over the phone, or a call back from our paramedics in the clinical hub London Ambulance Service NHS Trust 12

13 How we prioritise your call We ask a series of questions and run through a triage tool. Answer all the questions if possible. This does not delay any response in coming but it will allow us to send the most appropriate response. Are they conscious, alert, breathing? Location is important- Unit name/ Floor/ patients name Any other information that you can give is really helpful to our crews. London Ambulance Service NHS Trust 13

14 LAS - HCP LINE (not for public sharing) London Ambulance Service NHS Trust 14

15 London Ambu lance Service rt'j:fj.. \ " t Health Care Professional (HCP) Admissions Phone number: Can your patient organise their own transport? Is your patient sujtable for car or Non-Emergency Transport arranged by the London Ambulance Service? Time frames are:2-4 hours 1-2 hours Other timeframes by arrangement with LAS clinicians 0(E DO OD DO OD Non-emergency, Emergency ambulance needed? Provide oxygen therapy D For pauents who WIil need D Transport stretcher-bound treatment en-route to hospital pa ents Including palliative 8 mlnutos care patients D Immediately life-threatening Transport chair-bound D pa ents 20 mlnut s D Response depending on clinical condi Ion Emergency transport needed for clinicalcondl on 2-4 hours 45 mlnutes D D Urgent transport needed 1-2 hours for c llnlcalcondl on

16 Making the Call - Nursing Care.. HCP Line: For registered health care professionals / Nurses (999 for nonregistered carers) The call taker will ask what time frame you need the ambulance Know why you are calling the ambulance, a set of observations are helpful when we are deciding what response to attend. When you request a call to be made Immediately life threatening (from the HCP line) this will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack. Please use the time frames appropriately. London Ambulance Service NHS Trust 16

17 What are the implications? When you request a call to be made Immediately life threatening (from the HCP line) This will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack. Please use the time frames appropriately. London Ambulance Service NHS Trust 17

18 Appropriate time frames Clinical condition examples given as guidance only Non-Emergency Majority of patients who do not require immediate treatment in GP surgery or en-route to hospital, limb injuries, mechanical back pain, mental health concerns Non-Emergency Elderly patients going for assessment, e.g. general deterioration, stable COPD Urgent Stroke onset over 4.5 hours, acute abdominal pain, cauda equina time critical patients who need treatment on route Emergency e.g. stroke onset under 4.5 hours; sepsis, respiratory conditions requiring ongoing nebulisers, abdominal, head injury / fallers on anticoagulants Immediately life-threatening e.g. acute severe asthma, cardiac chest pain, actively fitting Time frame for ambulance 2 4 hours 1 2 hours 60 minutes 20 minutes 8 minutes Type of ambulance Non- emergency transport ambulance /car Non- emergency transport ambulance / car Front-line emergency ambulance Front-line emergency ambulance Front-line emergency ambulance +/- solo response vehicle London Ambulance Service NHS Trust 18

19 Non- Emergency Ambulance What can they Provide? Basic Observations Stretcher and Chair Give Oxygen Give inhaled pain relief Transport to hospital They will attend the most of the calls over 60 minutes. London Ambulance Service NHS Trust 19

20 What is wrong with the resident? Does the resident need an emergency ambulance? Unconscious Simple infection Fall with no injury Difficulty Abnormal blood Chest Pain results Uncontrollable bleeding Catheter problems Obvious limb fractures Minor injuries and illnesses London Ambulance Service NHS Trust 20

21 What are the alternatives? Short-Term Rehabilitation & Rapid Response Short-Term Rehab Rapid Response- 2 hrs Mobility Problems Hospital Avoidance Chest Infections, UTI, Skin Infections. The team also provides a gateway to other healthcare pathways including falls, COPD, Diabetes, District Nursing and long term condition management. Community Nursing: Catheters Administering drugs and giving injections Cleaning and dressing wounds End of Life Care The Team can be contacted via the GP, through Rapid Response or 111 Specialist Nursing (depending on area) Tissue Viability Cardiology Diabetes Respiratory Parkinson s Specialist MS Nurse Epilepsy Nurse GP Generally Unwell Infections Falls with minor injuries Problems with Prescriptions Access to referrals such as speech and language for eating etc. Behavioural problems 111 Out of hours GP access Clinical Advice Telephone numbers for alternative services. London Ambulance Service NHS Trust 21

22 What could delay us from getting to a patient? Not being met at door, can t get in no access code Unsure which resident is the patient Large home, many patients, different floors IMPORTANT let others know you have called for an ambulance London Ambulance Service NHS Trust 22

23 What would help us when we arrive? Full name, date of birth, next of kin & contact details GP details (hospital needs these for referrals) Address of the home Medication drug chart, medical history & any observations DNAR in place? Copies of information for us to take away Patient s personal belongings Escort London Ambulance Service NHS Trust 23

24 Thank you any questions? Contact details;