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Ambulance Service Association
to the National Institute for Clinical Excellence
(Note: This response was written prior to the establishment of the JRCALC-CGC)
original consultation document can be accessed through
the NICE Clinical Guidelines Pages (see link below)
Having read the above consultation document the ASA agree in principle with the approach being taken by NICE to develop clinical guidelines. Below are the responses to the particular areas upon which NICE requested feedback. This is followed by a brief outline of how clinical guideline development fits within the UKs ambulance services. The ASA would ask that the context of prehospital guideline development is considered whenever applicable to wider guideline development.
In general terms the ASA sees no problem with the suitability of the model for developing clinical guidelines for the NHS. The approach to the production process is sound. Again the ASA would like to be reassured that they are represented on any guideline development groups which impact upon prehospital care even if they are not the lead organisation. Indeed the ASA would like recognition of prehospital clinical elements in existing guidelines where previously they have been omitted. Similarly, The ASA agrees with the intended way of involving stakeholders and selecting guidelines authoring groups.
The approaches identified in the paper for the dissemination of guidelines are adequate. As well as targeting audiences it may be worth considering joint dissemination processes in conjunction with the professional bodies/ organisations which assisted in the development of the guideline to ensure peer pressure is applied for the uptake and implementation of the guideline.
The development of evidence based, clinically effective guidelines is underway within the UKs ambulance service. The draft guidelines, produced by a handful of ambulance services working collaboratively with existing clinical standards, are being peer reviewed by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Each guideline is based on the aspects of care as outlined in the syllabus for paramedic and technician training and education manual designed by the Ambulance Awards body of the IHCD. They are therefore comprehensive of the clinical aspects dealt with by ambulance crews and can be modified to fit with wider guideline development encompassing the full pathway of care through which a patient passes. The ASA is keen to work with NICE to ensure guideline production meets the requirements as laid down in the discussion document, and with other organisations to ensure our guidelines represent current best practice.
A separate project underway which is worth highlighting. The Welsh Ambulance Service NHS Trust in conjunction with the Clinical Effectiveness Support Unit (CESU) in Wales have been funded to undertake a three year project to develop clinically effective standards of care (guidelines). There would be no reason why these could not become a national set of guidelines for the UKs ambulance services with the approval of NICE.
As stated previously, with the care provided by ambulance personnel being protocol driven, clinical guideline development is relatively straightforward and is based on each clinical aspect the ambulance personnel may encounter. The ASA ask that these are considered as front-ends to any wider guidelines which are developed for the NHS as a whole or whenever applicable.
31 March, 2000. Stuart Nicholls, Ambulance Service Association National Clinical Effectiveness Programme Manager
The following is the response from NICE to the comments from the ASA: