Emergency medicine journal : EMJ
-
Pain is one of the most frequently reported symptoms to UK ambulance services and pain management is a known area for improvement. This is especially true for paediatric patients who may not be able to communicate their levels of pain as effectively as adults. ⋯ Further improvement is required to ensure every paediatric patient has their pain assessed and managed effectively. The laminated card has been redesigned and distributed, in conjunction with a pain training strategy. In addition, further analgesic options for paediatric patients have been investigated.
-
Survival rates from out-of-hospital cardiac arrest (OHCA) vary, with figures from 2% to 12% reported nationally. Our ambulance service introduced a dedicated cardiac arrest response unit (CARU) as a trial in order to improve local patient outcomes by focussing training, extending the scope of practice and increasing exposure to cardiac arrests. CARU launched in January 2014 using a rapid response car staffed by senior paramedics responding to cardiac arrests within a 19 minute radius of their location. emermed;32/6/503-b/EMERMED2015204979TB1T1EMERMED2015204979TB1 CARU Service (CARU removed) 2012 OHCA Registry Cardiac arrests where resuscitation was attempted 54 705 1,853 ROSC (Sustained to hospital) 35.2% 25.8% 23.0% Survival to discharge (Based on latest available data) 13.0% 3.3% 7.0% ⋯ Based on these figures CARU appears to have a positive impact on ROSC and a significant impact on survival to discharge rates compared with the rest of the service (p<0.01, Fisher's exact test). Further work is needed to explore how CARU delivers this impact and how the CARU model can be implemented beyond the trial setting in a sustainable fashion.
-
Does current pre-hospital care for patients at the end of their life reflect best practice guidance?
The end of life care good practice guide encourages organisations to enable terminally ill patients to be cared for and die outside of hospital. Ambulance services play a critical role in achieving this goal, however little guidance exists for ambulance crews. ⋯ Crews are not able to access out-of-hours information for end of life patients and are therefore not always aware of the patient's wishes. The care provided to the majority of patients was good, but the questionnaire showed most respondents were not sufficiently confident when treating end of life patients. Further work is needed to ensure crews are able to determine patients' wishes and training could increase confidence treating this patient group.
-
Data has been collected from suspected major trauma patient clinical records since the launch of the major trauma system in the South West in April 2012. In an internal report it was identified that 50% of overtriaged suspected major trauma patients were attributed to a suspected pelvic fracture. The National Consensus Statement on the Pre-Hospital Management of Pelvic Fractures provided a flow diagram depicting the appropriate application of the pelvic binder. ⋯ Applying the flow diagram criteria has shown to improve accuracy of appropriate pelvic binder applications in suspected major trauma patients. The flow diagram has been summarised into four key points and included in a new Trust Clinical Guideline for pelvic injury. A follow up audit will be conducted looking at the same groups of patients in the year following publication of the guideline to analyse whether accuracy of pelvic binder applications has increased.
-
The contribution of service users to identifying and prioritising research issues is vital to make practice and policy more relevant to their needs. Their experiences and knowledge can complement those of clinicians, health professionals and researchers. The aim of this research was to explore service-user perceptions of ambulance service care and patient safety. ⋯ Despite the relatively small number of participants, the findings provide useful service-user perspectives relevant to pre-hospital emergency care policy and practice, as well as the wider urgent and emergency care context. It is important that such views can be represented through public/patient involvement in decision making at organisational and service commissioning level.