Ambulance service operational improvement

This document is the accepted manuscript version of a Published Work that appeared in final form in International Paramedic Practice copyright © MA Healthcare, after peer review and technical editing by the Publisher. To access the final edited version see http://www.internationaljpp.com/cgi-bin/go.pl/library/article.cgi?uid=100396;article=IPP_3_3_61_63Since the start of industrialisation in the beginning of the previous century, processes, and technology have evolved drastically. Technology that had been developed for a specific application was found to open new horizons in other domains. A good example is the use of sonar technology on military submarines which eventually found medical applications in medical imaging (Oakley, 1986). The paramedic profession is still considered to be a relatively young profession, and although the clinical scope of practice of ambulance staff has widened there have been few noticeable and significant changes in the way Ambulance Services operate as public service providers. There is, however, great variation in the way pre-hospital emergency care provision is delivered and organised from country to country due for example to historical, cultural, financial, and geographical factors. Other industries are significantly more driven by profit, hence efficiency and reliability are aspects that have a direct and measurable financial impact and it acts as a driver for further developments.Peer reviewedSubmitted Versio

Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

Introduction: Frailty is recognised as a significant variable in the health of older adults. Early identification by paramedics of those at risk of frailty may assist in timely entry to an appropriate clinical care pathway. Early referral to such pathways has been shown to improve patient outcomes and quality of life, as well as deliver economic benefits. To date, little research has been completed regarding assessment of frailty by paramedic professionals using validated assessment tools. The objective of this study was to determine paramedicine students’ perceptions of screening tools to facilitate assessment and knowledge of frailty of older adults. The Edmonton Frail Scale (EFS) and the Groningen Frailty Index (GFI) were determined suitable for this purpose.Methods: The research adopted a mixed methods approach using a survey tool developed to gather both qualitative and quantitative data from students at the completion of a structured aged care clinical placement. Thematic analysis of the qualitative data identified key features of the tools, while a Likert-type scale was used to measure perspectives about the suitability of the tools for use in paramedic practice.Results: Thirty-seven paramedicine students were invited to participate in the study. Thirteen were able to use both tools to conduct frailty assessments and submitted survey responses. Student perspectives indicated both the EFS and GFI are potentially suitable for paramedicine and as clinical learning tools regarding geriatric assessments. Median time to administer the tools was eight minutes for the EFS and ten minutes for the GFI.Conclusion: Paramedicine students support a frailty assessment tool to assist clinical decision making regarding older adults. Further appraisal of validated frailty assessment tools by operational paramedics in a pre-hospital environment is warranted to determine absolute utility for Australian paramedics

The emerging role of telehealth in a New Zealand ambulance service

Telehealth systems – using ICT to manage health from a distance – have been developing for decades, including within the ambulance sector. The author undertook this research to better understand how telehealth could improve patient outcomes, improve effectiveness, or create efficiencies for the St John ambulance service. To achieve this, current literature was reviewed and a small group of experts were interviewed whose experience lies in either the ambulance service or the health sector. Key recommendations are described below: • It is of strategic importance to design ambulance telehealth systems with interoperability and interconnectivity – this will maximise health sector integration and governmental support. • Telehealth solutions should be based on simple, well-established, easy to use, and ubiquitous technologies. This reduces fear, limits technical challenges, enables technology adoption, and improves chances of success. Of all available technologies, video-calling provides the most opportunity at present. • Consistent with the 111 Clinical Hub model, St John should centralise specialists to provide telehealth support. This approach is cost effective as only a small number of specialists is required. It also supports effective clinical decision-making as this group routinely make complex decisions. • It is realistic for St John to integrate video-calling as a telehealth solution into the 111 Clinical Hub. As a patient-to-clinician tool, 111 Clinical Hub staff could use video connections to call back low acuity patients to perform a secondary triage. As a clinician-to-clinician tool, paramedics could video-call the 111 Clinical Hub for clinical support. This would increase the richness of communication, and enable better clinical decisions to be made. • While it is unclear the role that remote monitoring will play in improving an ambulance service, it is clear is that medical alarms will evolve to have much greater functionality, including sharing of biometric information. St John needs to make a strategic decision as to whether it wants to play the role of monitoring those with long-term conditions – and therefore being responsible for taking action when there are any signs of deterioration – or whether that should be the role of general practitioners (GPs). • When designing telehealth solutions, St John must consider whether it is creating unequal access to healthcare and, where created, take actions to mitigate these inequities. • It is important that St John clearly communicates any new telehealth interventions – resistance to change must be anticipated and therefore strong communication strategies must be part of the design process. • There is limited evidence to support telehealth solutions in terms of improved patient satisfaction, improved patient outcomes, or greater efficiencies. With the impending implementation of electronic patient report form (ePRF) there is opportunity to evaluate a telehealth solution in these terms. • It’s important to note that, regardless of the telehealth system adopted, no single solution will be effective – real improvements will require multiple integrated systems

Pre-hospital trauma assessment and management of older patients and their association with patient outcomes: challenges and barriers

BACKGROUND: Saudi Arabia faces an increasing prehospital healthcare burden from older people with injuries, but little is known about their characteristics and current treatment. METHODS: This was a sequential explanatory mixed-methods design, preceded by a scoping review on the prehospital geriatric trauma care. A retrospective quantitative study was conducted using registry data from older patients (≥55 years) admitted by ambulances from 01/08/2017 to 31/10/2021 at a major trauma centre in Saudi Arabia. A qualitative study was conducted using a purposive sample of Saudi paramedics and ambulance technicians from Riyadh and Makkah using online semi-structured interviews and analysed using the framework method. The quantitative and qualitative findings were integrated. RESULTS: The quantitative study recruited 452 eligible cases and found most of them were admitted with low falls (53.7%), normal physiology, and extremities injuries (53.1%). The study identified no significant predictors of in-hospital death (p>0.05 for all predictors), although statistical power was limited. The qualitative study recruited twenty participants and identified that they reported age-related challenges including physiological changes, polypharmacy, and communication difficulties. They all wanted training and guidelines to improve their knowledge. They reported struggling with communication difficulties, inaccurate adverse outcomes predictions, difficult intravenous cannulations, and cultural restrictions affecting care provision for female patients. I identified organisational barriers (e.g. lack of shared patient records and lack of guidelines) and cultural barriers (e.g. barriers to assessing women, attitudes towards older people, and attitudes towards paramedics) that influenced implementation of knowledge. This study also found that the participants' perceptions aligned with the retrospective study’s cohort, and they acknowledged the difficulty of predicting death in older trauma patients. CONCLUSION: Ambulance clinicians in Saudi Arabia want guidelines and training in managing older trauma patients but these need to take into account the characteristics of older trauma patients and the cultural barriers that I identified