Operational Research in the UK Ambulance Service

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Operational Research in the UK Ambulance Service
Dr Judith M. Fisher O StJ MBBS FRCGP FFAEM
FIMC(RCSEd)
NDMS Conference, 2004
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Aims of This Presentation

• To describe the UK EMS system
• To give an overview of Audit and Research and
  some patient benefits
• To look at System Status Management
• To discuss the advantages of national targets

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Personal experience 40 years of pre-hospital
care Accident and Emergency consultant Royal
London Hospital then Medical Director to
Ambulance Servicesand BRCS Founder member
WADEM Advisor to WHO, UK Government and
Football Licensing Authority Reviewer of the
UK Commission for Health Improvement

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The United Kingdom Population approx 60
million Area 250,000square km (240
people/sq.km). USA Population approx 300
million Area 10,000,000square km. (30
people/sq.km), 40 x size!
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The National Health Service (England)
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Policy Guidance from Dept.of Health through the
Emergency Planning Co-ordination Unit (EPCU)
8 Regional Offices in England
Regional Emergency Planning Officers
Health EPO
Fire EPO
Other agencies
Police EPO
Emergency Services Liaison Panel Regional Local
Authority Level
Individual facilities
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Accident and Emergency Hospitals

• 220 Acute Hospitals
• 110 have Accident and Emergency for 24hrs
• Considering regional trauma centers, with
  cardio-thoracic, orthopaedic, neuro-surgery, and
  burns services.
• Five year specialist training program

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UK Ambulance Service Workload

• Emergency Calls in 2002/2003 in England rose by
  6 to 4.4million
• Number of incidents attended rose by 3.6 to 3.7
  million
• Number of emergency patient journeys rose by 2
  to 2.91 million
• Approx.10 of these are for chest pain
• Non urgent patient journeys around 20 million

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The Top 5

• Falls 15
• Collapse unconscious 6
• Breathing 8
• Chest pain 10
• RTA 7

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Key Principles of UK Health System

• State funded through taxation
• Free at point of delivery
• Small Private Sector
• Support from voluntary aid societies
• Socialized system has all party support
• Current spending on health
• 6.7 GDP
• 40.24 billion

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Todays EMS Systems Need competitive value for
money Not more money thrown at systems better
patient outcomes - patient satisfaction - job
satisfaction for system providers
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Audit and Research Initiators

• Department of Health
• Ambulance Service Association
• Individual specialty colleges
• Individuals or individual Trusts
• Multi-disciplinary

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EMS research drivers

• Need CPD with evidence based clinical guidelines
• appropriate vehicles and equipment in right place
  at the right time
• Need active involvement of the workforce

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• Clinical Algorithms
• Seattle value of prompt intervention in cardiac
  care
• Feb 1983 Clinical Care Clinical Algorithms for
  Pre-hospital Care Dr.C.Gene Cayton. Value of
  planned documented clinical procedures
• JRCALC RCSEd Guidelines
• ASA role in collation of AR reinforcing evidence
  base

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Evidence base Legislation precludes much
pre-hospital research thus audit even more
important Multidisciplinary consensus
statements Main research projects in UK ambulance
service at present NATIONAL CBRN
Preparedness Cardiac Care new drugs Head
Injury Response times CHI star system
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The Faculty of Pre-Hospital Care core objectives

• To set and maintain standards of practice in
  pre-hospital care
• To promote education in and teaching of PHC
• To initiate technical developments and
  research in PHC
• To integrate effectively the efforts of all
  participants in PHC
• To harmonise and facilitate the onward
  management of the sick and injured

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Consensus Statements

• Spinal injuries
• Burns,
• Crush syndrome
• Collars and raised ICP
• Shortly to be published
• Fluid replacement
• (which forms the backbone of the NICE
  guidelines,challenges ATLS)
• Airway Care
• Trauma in Children
• Next
• Role of Helicopters
• Prospective study on Decision Making in
  pre-hospital care
• Chest Injuries.

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2000 Audit of training and facilities
Ambulance Service Decontamination
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Regional Blood Transfusion Centres
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Patients With Chest Pain Represent Ten Percent
of the Pre-hospital Care Work Load
Collaborative audit between ASA, DoH Royal
College of Physicians of both MI CA
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FIRST RESPONDERS Roles for the public
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Treatment - life saving only ON SITE TRAINING
Stansted Airport
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Other key projects- Operational and outcome based
qualitative too.

• Head Injury, local and CRASH
• Response times SSM etc.
• Patient and staff surveys

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System Status Management

• Good system design gives
• Improved quality and efficiency
• Top down guidance, workforce involvement key to
  success
• Improve outcomes
• Not about hanging around street corners
• Needs frequent tweeking

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Demand Analysis

• Based on hour of the day, day of the week, by
  cycle time for a ten week period.
• Colour coded, traffic light system.
• Green shows demand less than available resources,
  Amber shows demand within one double manned
  vehicle of available resources, Red shows demand
  exceeds available resources

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Advantages of National Targets
Minimum is shared national evidence based
objectives, working towards international Signific
ant sample sizes Naturally competitive Designed
on outcomes, not activity BUT Geographical and
demographic variations Error from data collection
on the hoof.
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Reflection on objectives

• To describe the UK EMS system
• To give an overview of Audit and Research and
  some patient benefits
• To look at System Status Management
• To discuss the advantages of national targets

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Thank you for your attention and hospitality