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Pre-hospital emergency care

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Two car RTA between Clifden and Leenane, Co. Galway. Three people are injured ... Reviews of: Early fluid administration. Hypertonic versus isotonic resuscitation ... – PowerPoint PPT presentation

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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
  • Spatial analysis 2

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
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