Browsing Publications - London Ambulance Service by Journal Title "Thorax"
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A survey of emergency oxygen guideline implementation among all 15 UK Ambulance Services in early 2011The British Thoracic Society (BTS), together with 21 other societies published a UK guideline for emergency oxygen use in 2008. This guideline was endorsed by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) who produced new oxygen guidance for ambulance crews in April 2009. We have conducted a survey of implementation of this guidance among UK Ambulance Services in early 2011. A questionnaire was sent to the Medical Directors of all 15 UK Ambulance Services and all, or their nominated deputies responded. Eleven of fifteen respondents reported full implementation of the 2009 JRCALC oxygen guidance throughout their service and ten of these reported that all relevant staff are trained in this area of practice. However, an informal survey of about 100 front line ambulance crews in one of these areas found that none were aware of the 2009 JRCALC document so the above figures may be aspirational and not yet achieved at operational level. Four services reported that they have completed audits of guideline implementation and a further three services are planning audits. All 15 services reported that 81%e100% of response vehicles were equipped with oximeters and the availability of oxygen masks was as follows: 15/15 reservoir masks; 12/15 simple face masks, 12/15 28% Venturi masks, 6/15 24% Venturi masks, 10/15 nasal cannulae. However, the informal survey of front-line staff from one ambulance service showed that Venturi masks were not actually available at operational level although the Regional response indicated universal availability. A separate survey found that no UK ambulance service has access to air cylinders, compressors or ultrasonic nebulisers for COPD patients so all nebulised treatment is oxygendriven. Six of 15 services reported that they had protocols to limit the duration of oxygen-driven nebuliser therapy for COPD patients. Two services have a record of all patients in their area who have an Oxygen Alert card. This survey suggests that UK Ambulance Services are taking steps to implement the BTS and JRCALC emergency oxygen guidance but it is unclear how much advice and equipment had been cascaded to front-line staff by Spring 2011. https://thorax.bmj.com/content/thoraxjnl/66/Suppl_4/A108.2.full.pdf 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/ http://dx.doi.org/10.1136/thoraxjnl-2011-201054c.101
Using patient specific protocols (PSP) to achieve appropriate oxygenation in patients at risk of oxygen toxicity; from ambulance through to inpatient stayIntroduction and objectives The London Ambulance Service(LAS) uses Patient Specific Protocols(PSPs) as directives for a range of conditions. Since 20061 we have worked with LAS using PSPs to prevent oxygen(O2) toxicity during ambulance transfer in patients at risk of type 2 respiratory failure. PSPs are now ‘flagged’ on our records which may also influence hospital oxygen prescribing. The aim of this study was to evaluate PSP effectiveness in influencing appropriate O2 prescribing during both ambulance transfer and hospital stay. Methods Data from 50 patients identified as at risk of oxygen toxicity(disease severity and/or raised bicarbonate) who had PSPs initiated sequentially pre-May 2017 were reviewed for; initiation bicarbonate, ED attendances, prescription and delivery of O2 in ambulance/ED/wards, and death in the subsequent year. Results Hospital records were reviewed for 43/50 (86%) patients with PSPs. Patient characteristics are shown in table 1. In the year post-PSP 20/43 (46.5%) had ≥1 hospital attendance (overall 44 attendances); there were 2 deaths(not O2-related). LAS data were available for 34/44 (77%) attendances. 30/34 (88.2%) were appropriately oxygenated during ambulance transfer. 4/34 (11.8%) had saturations above target range; of these, 2/4 had immediate action taken. In ED 34/34 (100%) patients had documented alert of O2 sensitivity and 34/40 (85%) had appropriate oxygenation. 5/40 (12.5%) had saturations above target range and 1/40 (2.5%) saturations below range; of these, 4/6 had corrective action taken to restore saturations towards target range. 21/34 (61.8%) had specified O2 prescription in ED. On ward transfer, 34/36 (94%) had saturations in range; 1/36 (2.7%) above target range, with corrective action not taken and 1/36 (2.7%) below target, with corrective action taken. 32/34 (94.1%) had ward O2 prescriptions. Conclusions PSPs continue to be an effective mechanism for ensuring safe oxygenation during ambulance transfer of at risk patients. Patients were identified appropriately for PSP; almost half were admitted in the subsequent year. Having a PSP flagged on their records also enabled safe O2 prescription and delivery from arrival in ED through to inpatient wards. While PSPs are an agreed Londonwide Ambulance tool to prevent oxygen toxicity, their impact on patient safety appears to be far wider reaching than ambulance transfer. https://thorax.bmj.com/content/73/Suppl_4/A198.2 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/ http://dx.doi.org/10.1136/thorax-2018-212555.337