Transcript Private Ambulance Session

Current and Future
Developments in the National
Ambulance Service
Dr Cathal O’Donnell
Medical Director NAS
Rural Island & Dispensing Doctors of Ireland
Annual Conference 2013
325,000 calls per year
228,000 999 calls per year = 625 every day
20 million kilometres annually
Recent clinical developments
•
•
•
•
STEMI
Stroke
Trauma
Helicopter service
Future Developments
• Treat and discharge
• New therapies
Donegal Clinical Society Sept
2013
Donegal Clinical Society Sept
2013
Resus Conference 2013
Future Developments
Treat and discharge
NIV
Tranexamic acid
Treat and Discharge
Q. Do all 999 callers need transport to hospital?
Q. If not, how can we safely identify those that
do not?
Q. How will stakeholders feel about this?
Patients
GPs and GP co-ops
Emergency Departments
5/6.9.1
Version 2, 01/13
From
relevant
CPGs
Clinical Care Pathway Decision – Treat & Referral
P
AP
Non serious or
non life threat
Administer specific treatment
& provide patient with the
opportunity to recover/
respond
Patient
responds to
intervention(s)
No
Yes
Conduct complete patient assessment
Focused history
Systematic physical examination
All generic
inclusion criteria
present
No
Yes
Practitioner
satisfied with non
ED care
Generic patient inclusion
1. ≥ 18 years & ≤ 60 years.
2. Not pregnant.
3. Social support available.
4. Demonstrates capacity and willing to engage.
5. Reliable history.
6. Vital signs within normal range (following care).
7. Compliant with treatment, including own
medications.
8. Clinical status of ‘Non serious or non life threat
(following care).
9. Absence of self-inflicted injury or assault.
10. No observed significant relevant co-morbidity.
11. 1st call for same condition within 30 days.
12. Registered with general practitioner.
If in any doubt about generic inclusions the
practitioner should transport to ED
No
Yes
CPG
for treat & referral
available for
condition
If medical practitioner is present;
follow direction on transport
decision
No
Transport to ED
Yes
An
adult carer,
both capable &
willing to accept
responsibility,
available
No
Yes
Explain clinical pathway options to
patient and carer
Vital sign
Normal range
Respiratory Rate
Patient &
carer accepts non
ED care
Yes
Go to
appropriate
T&R CPG
No
12 – 20
≥ 96%
SpO2
Inspired O2
Room air
Systolic BP
111 - 150
Pulse (BPM)
51 - 90
AVPU/CNS Response
Temperature
(oC)
Alert
36 – 37.5
Clinical Care Pathway options
CP1 Treat & Transport to an Emergency Department
CP2 Treat & Referral for follow up care within 2 hours
(arranged with local practitioner)
CP3 Treat & Referral for follow up care within 48 hours or
as soon as practicable
CP4 Treat & Referral to self care with after care instructions
Reference: Ambulance Service of NSW, 2008, CARE Clinical Pathways
HSE Acute Medicine Programme, 2011, Guiding Framework and Policy for the National Early Warning Score System to Recognise and Respond to Clinical
Deterioration
5/6.9.2
Hypoglycaemia – Treat & Referral
Version 2, 01/13
From
Clinical
Pathway
Decision
CPG
Previously
diagnosed with
diabetes
Yes
Exclusions
present
No
P
AP
Specific Hypoglycaemic exclusion
1. First ever hypoglycaemic episode.
2. < 30 days since last episode.
3. Unable or unwilling to eat.
4. Latest blood glucose < 4.0 mmol/L (after treatment).
5. No serial improvement of blood glucose.
6. On oral hypoglycaemics (sulphonylurea tablets in
particular).
7. Recent medication change or additional
medications prescribed (within 30 days).
8. Seizure in association with hypoglycaemia
9. Insulin or oral hypoglyacemics overdose
If in any doubt about 1 to 9 above the practitioner
should transport to ED
CP 1
CP 2
CP 3
CP 4
Transport
Immediate
48 hours
Self care
1. Complete after care Instructions and give a copy to the patient or carer
2. Complete the PCR and mark for Clinical Audit
Ensure patient takes in both quick
(lucozade, fruit juice or sweets) and
longer acting (bread, toast, biscuit)
carbohydrates
Flush line with 10 mL
NaCl following removal
of 10% Dextrose
infusion
If the patient expresses a
wish to attend an Emergency
Department then
arrangements shall be made
to transport him/her there