Title: Pre-hospital emergency care
1- Pre-hospital emergency care
- - where now?
- Prof. Gerard Bury
- Department of General Practice Vice-Chairman
- University College Dublin Pre-Hospital Emergency
Care Council
2 Pre-hospital emergency care
- Drivers for change
- Comhairle - Report of the Committee on AE
Services - Close pre-hospital and hospital links
- Improved postgraduate training for doctors and
nurses - Structured, multidisciplinary training
- National Health Strategy
- Consultant delivered services
- Medical Council
- Interim Criteria for AE Departments
3 Pre-hospital emergency care
- Where now?
- Ambulance service integration into the health
system - Regionalisation of AE services
- Third level training of EMTs
- Advanced care provision by EMTs
- GP co-ops
- ICT new medical technology
- Professionalisation, competence assurance and
evidence based practice for pre-hospital care
4 Pre-hospital emergency care
- Scenario 1
- 49 year old woman collapses in city centre flat,
Dublin 8 - Initial chest pain, then LOC
- Niece phones 999
- Two major hospitals within three miles
- Issues
- Dispatch Traffic
- Triage First responders
- Pre-arrival instructions
5 Pre-hospital emergency care
- Scenario 2
- Two car RTA between Clifden and Leenane, Co.
Galway - Three people are injured
- Clifden and Castlebar WHB ambulances respond
- Issues
- Response times 15mins/30 mins
- Retrieval time 1 hour
- Local District Hospital
- GP response
6 Pre-hospital emergency care
- Ambulance Services response times
- 1 week national census of 999 calls 3436 calls
- 73 emergency, 24 rural
- At best, 47 of emergencies had a response in 8
minutes - At worst, 10 of emergencies had a response in 8
minutes - Breen N, Woods J, Bury G, Murphy A, Brazier H. A
national census of ambulance response times to
emergency calls in Ireland. JAEM 200017392
7 Pre-hospital emergency care
- Spatial analysis of RTAs
- ambulance service responses 1
- NWHB, WHB study by NUIG and consultants
1996-2000 - 5550 accidents
- 420 deaths
- 1926 serious injuries
- 7351 minor injuries
- Moore D, Murphy A. Spatial analysis of road
traaffic accidents in the Western and North
Western - Health Boards. NUIG, 2002
8 Pre-hospital emergency care
Deaths/100,000
WHB 13
NWHB 17
Ireland 12
UK 6
EU 12
9 Pre-hospital emergency care
- Spatial analysis 3
- WHB
- 17 of fatalities (26 at night) , 17 of serious
injuries (25 at night) not reached within 25
minutes - 27 of fatalities cant reach hospital within an
hour - NWHB
- 5 of fatalities (9 at night), 5 of serious
injuries (8 at night) not reached within 25
minutes - 31 of fatalities cant reach hospital within an
hour
10 Pre-hospital emergency care
- Spatial analysis 4 conclusions
- Golden hour care not by hospitals
- First responders role during ambulance response
- Long retrieval times extended care skills
- Use Regional EDs additional retrieval time
- Integrated care AS, EDs, GPs, PHNs, 1st
Responders
11 Pre-hospital emergency care
- EMT training
- PHECC registration new entrant conversion
training - Diploma in EMT (UCD)
- Standard Operational Procedures
- EMT-A training 2003
12 Pre-hospital emergency care
- EMT training development
- Audit/QA/QI
- CME
- Competence Assurance
- Primary degree training
13 Pre-hospital emergency care
- EMT-Advanced training
- Protocol driven carers AOPs
- ACLS provision, fluid replacement, MIMMS trained
- Some advanced paeds, obs care
- Extended care skills
14 Pre-hospital emergency care
- EMT-A development
- Dispatch/triage
- Operational deployment
- Further development
15 Pre-hospital emergency care
- Service developments
- Regionalisation of ED services welcome but
implications - Appropriate selection of cases NB
- Retrieval and extended care NB
- Bypass of some centres (for some problems?)
- Integrated responses with GPs, PHNs, Fire
Police - Audit
16 Pre-hospital emergency care
- Scenario 1
- Prioritised dispatch, PAI, community defib
scheme, 12 lead telemetry, direct access to CPAU - Scenario 2
- GP response, prioritised EMT-A response, trauma
team en route, bypass DGH, team care at UCHG
17 Pre-hospital emergency care
- Conclusions
- Multi-sectoral developments in pre-hospital care
- EMT/Ambulance Services developments in training,
deployment and services - Dispatch
- Teamwork
- Audit and evidence!
18 Pre-hospital emergency care
- Effectiveness of pre-hospital trauma care
- Cochrane Injuries Group/WHO Jan 01
- Reviews of
- Early fluid administration
- Hypertonic versus isotonic resuscitation
- Spinal immobilisation
- Advanced versus basic life support
- No clear evidence of benefit
- Bunn F, Kwan I, Roberts I, Wentz R.
Effectiveness of pre-hospital trauma care. - Cochrane Injuries Group, 2001
19 Pre-hospital emergency care
- Cochrane Review conclusions
- These results highlight the neglect of injury as
a global health issue - Injury research is unfunded and has little good
quality research even in widely practised areas - There are widespread social, health and economic
consequences