Planning for emergency ambulance service systems

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

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PP34 The experiences and attitudes of ambulance staff towards the counter-terrorism ‘PREVENT’ training: a survey-based service evaluation

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.34 ◽

2021 ◽

Vol 38 (9) ◽

pp. A14.2-A14

Author(s):

Tessa Mochrie ◽

Theresa Foster ◽

Larissa Prothero ◽

Nigel South

Keyword(s):

Service Evaluation ◽

Ambulance Service ◽

Future Research ◽

Duty Of Care ◽

Training Module ◽

Counter Terrorism ◽

Service Setting ◽

Emergency Ambulance ◽

Question Survey ◽

Do So

BackgroundUnderstanding the views and opinions of ambulance clinicians about counter-terrorism is limited, as are the roles they have in identifying individuals vulnerable to radicalisation. The aim of this survey was to investigate ambulance clinician views and preparedness to identify individuals at risk of radicalisation and whether the current national PREVENT training offered is suitable for this clinical setting.MethodsA purpose-designed, 18-question survey, was developed to understand staff attitudes and content knowledge of the national PREVENT training module. The survey was opened to all emergency ambulance clinicians in one UK ambulance service during August 2020, resulting in a sample of 123 responses which were analysed using descriptive and thematic approaches.ResultsMost respondents (87%; n=107) were aware of the PREVENT strategy, with almost three-quarters (73%; n=90) receiving training within the previous three years. Respondents were asked to score training received: the majority (89%; n=110) reported 5/10 or less. Whilst most (79%; n=97) identified the correct way to refer an individual, few had completed a PREVENT referral (9%; n=11). ‘Gut instinct’ was utilised by respondents to support their knowledge obtained via PREVENT training (70%, n=86). Respondents felt the national PREVENT training lacked relevance to their role and recommended ambulance-specific training packages be made available. They recognised their responsibility of identifying radicalisation and the opportunities their unique position offered to do so. Having a ‘duty of care’ and ‘moral responsibilities’ to make PREVENT referrals, and the importance of treating individuals as patients (not criminals), was also highlighted.ConclusionsAmbulance staff have highlighted the importance of a clear and robust referral pathway for individuals vulnerable to radicalisation. Current training lacks specificity and effectiveness for the ambulance service setting. As this survey was limited to one ambulance service, future research is warranted to ensure PREVENT training is appropriate for all ambulance staff.

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Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service

BMJ Open ◽

10.1136/bmjopen-2019-033037 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033037 ◽

Cited By ~ 1

Author(s):

Matthew James Booker ◽

Sarah Purdy ◽

Rebecca Barnes ◽

Ali R G Shaw

Keyword(s):

Primary Care ◽

Emergency Situation ◽

Sociodemographic Factors ◽

Ethnographic Study ◽

Ambulance Service ◽

Service Users ◽

Care Seeking ◽

Emergency Ambulance ◽

Care Problems ◽

Public Health Strategies

ObjectivesTo explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.DesignAn ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS ‘emergency’ telephone call recording.ResultsWe analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine ‘triggers’, which we categorise as either ‘internal’ or ‘external’, depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.ConclusionsPrevious work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems—although inefficient—is often conceptualised as ‘rational’ by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an ‘emergency’ situation.

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OP5 Closing emergency departments in england (CLOSED): the impact on ambulance services

Emergency Medicine Journal ◽

10.1136/emermed-2019-999abs.5 ◽

2019 ◽

Vol 36 (10) ◽

pp. e4.1-e4

Author(s):

Emma Knowles ◽

Neil Shephard ◽

Tony Stone ◽

Lindsey Bishop-Edwards ◽

Enid Hirst ◽

...

Keyword(s):

Emergency Departments ◽

Control Area ◽

Ambulance Service ◽

Urgent Care ◽

Computer Assisted ◽

Care Providers ◽

Interrupted Time Series Analysis ◽

Additional Increase ◽

Emergency Ambulance ◽

The Impact

BackgroundIn recent years a number of Emergency Departments (EDs) in England have closed, or been replaced by a lower acuity facility such as an Urgent Care Centre. With further re-organisation of EDs expected, the ‘closED’ study aimed to provide research evidence to inform the public, NHS, and policymakers when considering future closures. Our aim was to understand the impact of ED closure on populations and emergency care providers, the first study to do so in England. In this session I will focus on the impact on the ambulance service.MethodsWe undertook a controlled interrupted time series analysis assessing changes in ambulance service activity, following the closure of Type 1 EDs in England. Data was sourced data from Ambulance service computer-assisted dispatch (CAD) records. The resident catchment populations of five EDs, closed between 2009 and 2011, were selected for analysis. Five control areas were also selected. The primary ambulance outcome measures were: ambulance service incident volumes and mean ‘call to destination’ time.ResultsThere was some evidence of a large increase of 13.9% [95% confidence interval (CI) 3.5% to 24.4%] in the total number of emergency ambulance incidents compared with the control areas. There was an increase of 3.9 minutes (95% CI 2.2 to 5.6 minutes) in the meantime taken from a 999 ‘red’ call being answered to a patient arriving at hospital.ConclusionsGiven such major reorganisation of emergency and urgent care we might expect some changes in emergency and urgency care activity. Our study found some changes in the ambulance service measures. The increase in emergency ambulance incidents, over and above the increase in the control area, suggests that the closure of the EDs in our study may have contributed to an additional increase in workload within the ambulance services in these areas.

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