HEALTH CARE PROFESSIONAL (HCP) ADMISSIONS Information Booklet
Contents Page No Content 1 Index 2 Introduction What is a HCP Admission? 3 Booking Transport Who is authorised to book HCP Admissions? Who is NOT authorised to book HCP Admissions? What is the best time of day to book transport? 3-4 What information is required when booking an admission? 5-6 Appendix 1 NWAS Emergency Operations Centres (EOC) Contact Telephone Numbers 7-10 Appendix 2 Flow Chart for Ambulance Requests by HCPs 11-15 Appendix 3 Crew Skill Mixes 1
1. INTRODUCTION This booklet contains information to support Health Care Professionals (HCPs) who require ambulance transport for patients with clinical and mobility requirements who need hospital services that are not available or appropriate in the community. It also provides information for hospital transfers. The information within this booklet will explain procedures associated with HCP calls, and provide information on telephone numbers to be used, ambulance vehicle types and skill mix of ambulance staff. It is vital that the Ambulance Service is used by HCP for patients who are deemed eligible due to clinical and mobility requirements. 2. WHAT IS A HCP ADMISSION? The Ambulance Service Health Care Professional Admission Protocol is an enhanced clinically appropriate service for the admission of patients, ensuring that any critical clinical conditions are identified early in the question sequence and responded to immediately on blue lights. It will also enable the Ambulance Service to respond to patients who have a non-life threatening condition and require admission to hospital or transfer from one hospital to another within a timescale clinically appropriate to their needs as determined by the HCP (i.e. patient to be at their destination within 1-4 hours) for: 1 Increased level of care 2 Specialist care and opinion (e.g. cardiology, surgery, specialist clinics etc). The HCP booking the ambulance must specify the time. Do not request urgent transport if you require an emergency. Please specify it is an emergency. The caller should contact the Ambulance Service using 999 or the HCP emergency number for emergency admissions only. For HCP admissions within a specified time, the number known as the HCP line should be used (see Appendix 1). This number has priority over calls which come through over our general line number, but not 999 calls. 2
3. BOOKING TRANSPORT a) Who is Authorised to Book HCP Admissions? Approved Social Worker/Approved Mental Health Professional District Nurse Doctor General Practitioner Midwife/Health Visitor Nurse Paramedic Dentist Hospitals, i.e. Bed Bureau Walk-in Centres Nursing Homes (with qualified HCPs only). b) Who is NOT Authorised to Book HCP Admissions? Members of the public Rest and care comes with carers (unqualified nursing staff). c) What is the Best Time of Day to Book Transport? Current data states the majority of GP bookings are made between the hours of 1200 and 1500hrs. This may suggest this occurs during the period GPs deal with home visits and / or telephone calls made to patients at home. Operating in this way presents a surge of activity across the region between the hours of 1200 and 1500hrs; this is also a time of peak activity for the Ambulance Service, especially Monday through to Friday. When a booking is made, the HCP should give consideration to the patient s needs, community services available, and services available at the receiving hospital. Does the patient need ambulance transport? d) What Information is Required by the Ambulance Service when Booking an Admission? A flow chart is provided at the end of this booklet (Appendix 2) to facilitate the booking process. The information listed below is usually requested for HCP admissions: 1 Introduce yourself and where you are calling from 2 Phone number of the authorising HCP 3
3 Address to pick up the patient 4 Reason for admission (critical conditions may be identified at this point) 5 Patient s age/gender 6 Conscious and breathing status of patient 7 HCP with the patient 8 Does the condition present an immediate threat to life? Yes Is there a defibrillator available? No The call handler will advise: We will respond within the next 4 hours unless another resource is available sooner. Please confirm if this timeframe is acceptable. 9 Would a Patient Transport Service (PTS) response be appropriate? (N.B. it is important at this point to provide the call handler with the weight of any patient over 28 stone if a bariatric vehicle is required). 10 Can the patient travel with other patients? 11 Destination hospital/unit 12 Patient s name 13 Patient s contact number 14 Mobility i.e. Chair/Stretcher/Walking etc. 15 Escorts i.e. Nurse/Carer/Relative etc. 16 Is the patient ready to travel? Please note: After you have made the booking, you may be called back by a Senior Clinician, when demand is high, to assess alternative transport options, should there be other resources suitable for consideration (Appendix 3). If you require an emergency, it is advisable to ring 999 or the emergency number (see Appendix 1). The emergency numbers listed in Appendix 1, take priority over the HCP number used for booking HCP admissions. 4
APPENDIX 1 NWAS Emergency Operations Centres (EOC) Contact Telephone Numbers For Same Day Admissions 5
NWAS Emergency Operations Centres (EOC) Contact Telephone Numbers For Same Day Admissions: Cumbria & Lancashire Area 01772 867721 Booking transport within a specified time (HCP Line) 01772 867761 Enquiries about the booking Cheshire & Merseyside Area 0151 261 4322 Booking transport within a specified time (HCP Line) 0151 261 4361 Enquiries about the booking Greater Manchester Area 0161 866 0622 Booking transport within a specified time (HCP Line) 0161 866 0661 Enquiries about the booking Contact Number for HCPs Only When Booking Emergency Admissions: Cumbria & Lancashire Area 01772 867701 Emergency Admission Cheshire & Merseyside Area 0151 261 4301 Emergency Admission Greater Manchester Area 0161 866 0611 Emergency Admission 6
APPENDIX 2 Flowchart for Ambulance Requests by Health Care Professionals 7
GUIDANCE FOR AMBULANCE REQUESTS BY HEALTH CARE PROFESSIONALS 1 4 hour HCP Admission Cumbria & Lancashire, telephone 01772 867721 Emergency Admission Cumbria & Lancashire, telephone 01772 867701 or 999 Information to provide: The HCPs telephone number Address/ location of patient Patient s age and gender Conscious and breathing status of patient WHAT IS THE REASON FOR ADMISSION? Inform the ambulance call taker if the patient has any of the following: Significant airway compromise Severe breathing problems Possible Myocardial Infarction (MI) Other Acute Coronary Syndrome (ACS) Aneurysm Meningitis Unconsciousness Obstetric emergency YES (Conditions indicated above) NO (None of the above conditions identified) YES Does this condition present an immediate threat to their life? No Not immediately life threatening, but serious No Not serious, but urgent 8 minute Lights & sirens response 20 minute Lights & sirens response 1 4 Hour Response requested Additional information to provide: (Over four hours) would PTS transport be appropriate? Does the patient need to travel alone? Destination hospital; mobility; escorts; name and telephone number of patient; any other important information. 8
GUIDANCE FOR AMBULANCE REQUESTS BY HEALTH CARE PROFESSIONALS 1 4 hour HCP Admission Cheshire & Merseyside, telephone: 0151 261 4322 Emergency Admission Cheshire & Mersey, telephone: 0151 261 4301 or 999 Information to provide: The HCP s telephone number Address / location of patient Patient s age and gender Conscious and breathing status of patient WHAT IS THE REASON FOR ADMISSION? Inform the ambulance call taker if the patient has any of the following: Significant airway compromise Severe breathing problems Possible Myocardial Infarction (MI) Other Acute Coronary Syndrome (ACS) Aneurysm Meningitis Unconsciousness Obstetric emergency YES (Conditions indicated above) NO (None of the above conditions identified) YES Does this condition present an immediate threat to their life? No Not immediately life threatening, but serious No Not serious, but urgent 8 minute Lights & sirens response 20 minute Lights & sirens response 1 4 Hour Response requested Additional information to provide: (Over four hours) would PTS transport be appropriate? Does the patient need to travel alone? Destination hospital; mobility; escorts; name and telephone number of patient; any other important information. 9
GUIDANCE FOR AMBULANCE REQUESTS BY HEALTH CARE PROFESSIONALS 1 4 hour HCP Admission Manchester: Telephone 0161 866 0622 Emergency Admission Manchester: Telephone 0161 866 0611 or 999 Information to provide: The HCPs telephone number Address/ location of patient Patient s age and gender Conscious and breathing status of patient WHAT IS THE REASON FOR ADMISSION? Inform the ambulance call taker if the patient has any of the following: Significant airway compromise Severe breathing problems Possible Myocardial Infarction (MI) Other Acute Coronary Syndrome (ACS) Aneurysm Meningitis Unconsciousness Obstetric emergency YES (Conditions indicated above) NO (None of the above conditions identified) YES Does this condition present an immediate threat to their life? No Not immediately life threatening, but serious No Not serious, but urgent 8 minute Lights & sirens response 20 minute Lights & sirens response 1 4 Hour Response requested Additional information to provide: (Over four hours) would PTS transport be appropriate? Does the patient need to travel alone? Destination hospital; mobility; escorts; name and telephone number of patient; any other important information. 10
APPENDIX 3 Crew Skill Mixes 11
PATIENT TRANSPORT SERVICE (PTS) Staff trained in Adult Basic Life Support Vehicles carry oxygen (up to 40 per cent - six litres only) and first aid kit Vehicles have varying configurations of seats or seats and stretchers Please indicate patient mobility and what type of vehicle is required No paediatric training No blue-light facility EMERGENCY SERVICES 1 Urgent Care Service (UCS) Transport Identification of basic health and social needs Staff can undertake immediate scene survey and a dynamic risk assessment in order to establish the presence of hazards. When necessary, be able to undertake a primary patient assessment, sufficient to identify any life threatening conditions. They must be able to give immediate life support to a Basic Life Support (BLS) level, including the use of an automated defibrillator (AED) the use of a bag-valve-mask and oropharyngeal airway (OPA). Staff from the UCS obtain a patient s history and perform a primary and secondary patient assessment. They develop a pre-hospital early warning score (PHEW) and act accordingly. UCS staff can record an automated blood pressure and recognise and act upon abnormal measurements. They can apply and monitor SPO2 measurements and recognise and act upon abnormal measurements. The UCS staff are able to recognise a range of clinical conditions and injuries and administer the appropriate treatment including the use of the following drugs: Oxygen Entonox UCS staff should always transport patients to the nearest or designated hospital and are not allowed to influence patient destination or leave a patient at home/scene. They must contact a Senior Clinician via the EOC if a patient refuses treatment or transport to hospital. The vehicles are equipped with a stretcher and can carry a second patient/relative seated and are incubator compatible BUT MUST HAVE NURSE ESCORT FOR ALL INTERVENTIONS. 12
Skills include: BLS equipment (including portable oxygen, bag valve mask, oropharyngeal airways) Vehicle based oxygen and masks (including variable and non re-breathing masks) Entonox and delivery equipment Suction (electric or manual) AED First aid kit Blood Pressure monitor (manual or automatic) Spinal board (including blocks and straps) Orthopaedic stretcher Cervical collars Box splints. No paediatric training No blue-light facility 2 Intermediate Care Service - part of the Urgent Care Service (UCS) Emergency vehicles are staffed by one UCS staff member and one Senior Clinician. They are equipped with a stretcher and can carry a second patient/relative seated. UCS vehicles may respond to emergencies that have not received prior clinical assessment. Intermediate Care skills include: Scope of practice of senior clinician on vehicle depending on Grade They have Blue-light facility when Technician / Paramedic are driving. 3 Paramedic Service The vehicle is staffed when possible by one Paramedic and one Technician (EMT1, EMT2 or Student Paramedic). Vehicles are sometimes staffed by two technicians and can attend to all emergency calls. Vehicles are equipped with one stretcher with the capacity to carry a second patient/relative seated. If a second patient is to be transferred, pass details to EOC, as this is dependent on patient s condition. Remember that there is only one member of staff in the back of the vehicle. EMT 1 skills include: Ability to respond to all emergency calls Management of unconscious patients Basic resuscitation procedures including defibrillation Management of respiratory emergencies Use of mechanical ventilator Use of oropharyngeal airways Extrication procedures 13
Fracture management Haemorrhage control and wound care Spinal injury immobilisation and care Assisting Paramedic in setting up I/V infusions Administration of therapeutic drugs Oxygen Entonox Oral aspirin Hypostop. EMT 2 skills include all EMT1 skills plus: Advanced resuscitation procedures including defibrillation Use of nasopharyngeal and supraglottic (LMA) airways Assisting Paramedic in setting up I/V infusions Administration of therapeutic drugs Intramuscular epinephrine (adrenaline) for anaphylaxis (not I/V for cardiac arrest) Glucagon injection Inhaled salbutamol Oral GTN. Paramedic skills include all EMT 2 skills plus: I/V cannulation including fluid therapies Advanced airway management including intubation Administration of intravenous drugs including morphine and codeine. 4 Rapid Response Vehicle (RRV) Single person response car, may be a Paramedic or EMT2. If necessary, please check skill level of RRV crew with EOC. RRVs carry the majority of equipment carried on a paramedic vehicle. They can manage non-time critical patients, who are able to sit in a car and only require minor interventions en-route, for example, a patient with a fractured arm which is splinted and requires minimal intervention. 5 Advanced Paramedics Advanced Paramedics with additional university education have greater autonomy than other staff; they offer clinical advice to crews and offer clinical supervision to all grades of staff. They respond in single person response cars and carry the majority of equipment found on a paramedic vehicle plus additional drugs, e.g. analgesics, antibiotics and antihistamines. They also carry intraosseous needles and advanced pain management. 14
They may discharge or refer patients into alternative care pathways. If in doubt, please contact EOC for availability or to request advice from an Advanced Paramedic. Their role includes working in the EOC. 6 Specialist Equipment Clinical staff, including Paramedics and Advanced Paramedics, are not trained to manage the following specialist equipment and appropriately trained personnel must accompany the patient: Syringe drivers or other specialist equipment which might require intervention by staff other than turning off equipment Incubators Drugs either not in a Paramedics formulary or that fall outside the Paramedics scope/prescription use. 15