RSS 1.0Scottish Ambulance Service [SAS]
Publications from the Scottish Ambulance Service. To find out more about SAS visit their website at: https://www.scottishambulance.com
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Does mean ambulance handover time at emergency departments correlate with number of handovers per month?Background Busy periods, such as ‘winter pressures’ months, can create challenges for Emergency Departments (EDs) managing patient flow. This may increase risks throughout the healthcare system. ED patients may receive suboptimal care, some patients may remain in ambulances, sometimes for hours, whilst queued ambulances cannot attend other patients. In some EDs, ambulance queueing is relatively rare; in others, it is more common. As part of the STALLED study, we investigated any association between mean ambulance handover time and the number of monthly handovers. Methods We analysed publicly available ambulance collection data for English NHS Trusts between October 2023 and March 2024 from NHS England. We included all Type 1 Acute Trusts, excluding children’s hospitals, those with fewer than 100 handovers per month, and clear outliers. Results 105 Trusts were included (10 to 18 per English region). The number of handovers recorded per month varied between 716 and 8,404 with a mean of 3,090. Monthly mean handover time varied between 8 minutes, 45 seconds and 129 minutes, 6 seconds. Figure 1 shows a weak relation between mean handover time and mean monthly handovers. Conclusion Mean ambulance handover time is not obviously correlated with mean monthly number of handovers. Therefore, we propose the existence of deeper-rooted obstacles/challenges which warrant further exploration. It also remains to assess temporal patterns in more detail. While queueing is a problem everywhere to some extent, there is variation in how EDs manage it. Understanding these variations may lead to improvements in patient safety, health outcomes, experience, and costs. https://doi.org/10.1136/emermed-2024-999.35 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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A review of end of life medication administration by ambulance cliniciansAbstract Introduction Historically, paramedics have focused on life-saving and curative Care. Today a growing body of evidence suggests many patients seek support from the ambulance service for Palliative and end of life (EOL)care. This has resulted in ambulance services globally embracing new paradigms of care, including Palliative care. Scottish Ambulance Service (SAS) have partnered with Macmillan to form an EOL care team to drive forward education and pathways for EOL patients, because in Scotland around 95% of people in the last year of life contact unscheduled care services. One of the main requirements of theses contacts is symptom relief. This project looks at the use of JIC and other EOL medication administrations by SAS clinicians. Aims To monitor and report on EOL medication use by SAS clinicians and the usage both prior to and during the Macmillan project to identify the efficacy of education and impact upon practice. Method By retrospectively reviewing the patient report forms the team were able to audit each administration of EOL medications. Determining; If the medication administered was the patient‘s own or SAS stock, The type of medication administered, The impact the medication had for the patient If the patient was conveyed to hospital. Results The results showed, since the implementation of the Macmillan project; The use of EOL medication has increased. The range of medications given by clinicians is broader. The median administration has increase from 6 to 12 Conclusion We believe the introduction of the Macmillan team and the education they have been delivering to clinicians across the country is supporting the increase in EOL medication administrations within SAS. Impact Improved patient care at the EOL, quicker symptom relief, supporting patients at the right time with the right care, in the right place. References Collier A, et al. “‘The palliative care ambulance’: A qualitative study of patient and caregiver perspectives of an ambulance service.” Palliative Medicine 2023;37(6):875–883. Murphy-Jones G, et al. “Infusing the palliative into paramedicine: Inter-professional collaboration to improve the end of life care response of UK ambulance services.” Progress in Palliative Care 2021;29(2):66–71. Juhrmann ML, et al. “Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis.” Palliative Medicine 2022;36(3):405–421. Mason B, et al. “Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design.” Palliative Medicine 2022;36(3):478–488. https://spcare.bmj.com/content/14/Suppl_1/A17.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Leadership characteristics to reduce staff attrition and absence related to burnoutBurnout among the paramedic profession is an increasing problem and not enough is being done to improve the current climate. It is for this reason that paramedics should individually contribute to the reduction of this issue by developing their own leadership characteristics, such as emotional intelligence, social intelligence, and stress and conflict management. Evidence suggests that these qualities and behaviours reduce the possibility of being subject to burnout symptomology. Implementing positive stress and conflict-management strategies will create a healthcare environment, which will be more enjoyable to work in. Emotional and social intelligence increase the resilience of prehospital clinicians who are subject to occupational challenges on a daily basis. Wider influences such as ambulance trusts, health services and governing bodies have implemented strategies to tackle this issue but clinicians can lead the change from the front line. Abstract published with permission.
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Intranasal ketamine analgesia for non-physician prehospital cliniciansPrehospital analgesia is often under-administered within the UK for various reasons – especially within the paediatric population. Several analgesic options are available in the ambulance service with ketamine being a versatile medication often used by prehospital clinicians who have undergone additional training and governance with the use of a patient group direction. The options for non-invasive analgesia are limited within the ambulance service, even more so for the paediatric population or for non-compliant patients. Intranasal administration is becoming more popular as a route of medication administration for both in-hospital and prehospital clinicians. Intranasal analgesia has been well researched within the in-hospital environment and has shown that IN ketamine is a viable and effective option for providing safe rapid analgesia. Abstract published with permission.
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Reflecting on every caseAs I mark my first year anniversary as a paramedic for the Scottish Ambulance Service provides a good opportunity to reflect on the past year. Murdoch (2019) wrote about decision-making in paramedic practice, referring to Brenner’s Novice to Expert continuum—particularly on how this is applied to newly qualified paramedics. Abstract published with permission
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Prehospital serratus anterior plane block for rib fracturesFractured ribs are a leading consequence of blunt chest trauma, afflicting approximately 12% of trauma patients (Kring et al, 2022; Singh et al, 2022). Beyond the physical injury, significant pain is associated with rib fractures, posing challenges in relation to adequate ventilation and carrying a significant risk of secondary morbidity. The resultant shallow tidal breathing due to painful rib fractures and the absence of deep inspiration contribute to hypoxemia, atelectasis, and V/Q mismatching, heightening the susceptibility to pneumonia and respiratory failure. When clinicians strive to provide effective pain control for these injuries, they must navigate the delicate balance of minimising pharmacological complications (especially respiratory depression and hypotension from opioids), while optimising respiratory function and pain relief. Abstract published with permission.
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Support from advanced practitioners in critical care for ankle fracture dislocationBackground: Analgesic imitations, under-recognition of injury severity and delayed restoration of neutral alignment are common problems around ankle fracture dislocation (AFD). Optimal prehospital management improves long-term outcomes. Aims: This study aimed to explore ambulance clinicians’ experiences of AFD incidents when supported by advanced practitioners in critical care (APCCs). Methods: Semi-structured online interviews were conducted. Data sets were coded and grouped to identify themes via thematic content analysis. Findings: Six clinicians agreed to take part (response rate 42%). AFDs were encountered infrequently (once per year). Four themes were identified: clinicians’ confidence in managing AFD; value-added role of APCCs; prehospital challenges; and reflections on the incident. Conclusions: Benefits of the APCC role include enhanced technical skills, including in ankle reduction and analgesia, and in non-technical skills, such as leadership and decision-making. Improvements in clinician recognition and management of AFD and better awareness of the APCC role are recommended, as is research on optimal prehospital AFD management. Abstract published with permission.
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Can the clinical frailty scale predict futility in out-of-hospital cardiac arrest?Background: Cardiopulmonary resuscitation (CPR) is considered an essential intervention in unanticipated cardiac arrest, but in the out-of hospital setting it is often the default treatment for many patients dying of chronic and incurable disease who experience this. The Clinical Frailty Scale (CFS) can predict an individual’s vulnerability to adverse health outcomes and might be a useful tool in prognostication in the prehospital setting. Aims: The primary aim was to assess if the CFS can be used for prognostication in cardiac arrest and whether UK paramedics would be able to use the CFS in the context of an out-of-hospital cardiac arrest. Methods: A rapid review of the literature was undertaken to identify research relating to frailty’s influence on cardiac arrest outcomes. Five primary research articles were identified and were included. Findings: All the primary research focused on in-hospital cardiac arrest and demonstrated that an higher clinical frailty score was associated with increased mortality following cardiac arrest, with a significant reduction in survival at CFS ≥6. Conclusion: Research could assess whether these findings would be replicated in the out-of-hospital cardiac arrest context and whether paramedics could use the CFS to aid in prognostication in this situation. Abstract published with permission.
