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Regional Activity

Each regional group will report their current clinical effectiveness activity on these pages.

South East (SEACAG) - click here for seacag website http://www.seacag.org
Last updated 21/02/01

Collaborative Cardiac Arrest Audit
The services of SEACAG are currently engaged in data collection for a collaborative cardiac arrest audit based on the out-of-hospital Utstein template. An update on the project is available
HERE or check out the website http://www.seacag.org

SEACAG E-Group
SEACAG have set up their own e-group discussion page at
[email protected] .

SAMIP (Sussex Acute Myocardial Infacrtion Project)
Details of this project looking at pre-hospital thrombolyisis can be found by clicking
HERE - updated new site

LAS CLINICAL AUDIT & RESEARCH BULLETIN -ISSUE 9 - AUGUST 2000
Results from the Telephone Advice Study published
The despatch of emergency ambulances to patients not in need of urgent care may result in inappropriate care, delayed treatment for genuine emergency patients and unnecessary use of NHS resources.
Therefore the Telephone Advice Study set out to:-
1. Investigate the efficiency, safety and acceptability of telephone assessment and advice to non-urgent 999 ambulance service callers as an alternative to despatching an ambulance.
2. Compare the efficiency, safety and acceptability of nurses and paramedics as providers of telephone advice to non urgent callers. Design and Methods - The trial took place over 12 months and involved two Ambulance Services, London and The West Midlands. During 3-4 hour ‘intervention’ sessions, trained nurses or paramedics using TAS assessed patient needs and offered appropriate advice. Ambulances were despatched as usual but, following the advice, the opportunity to decline the ambulance was given. Results - Those patients who declined an ambulance 6% attended A&E by other means, 52% visited their GP, 39% carried out self care and 3% reported other care. None of the patients who attended A&E were admitted and the treatment provided would have been available from their GP’s.
Paramedic assessment concluded that 44% of calls for emergency ambulance were unnecessary whilst 58% was assessed by a nurse. A follow-up survey indicated that patient satisfaction levels were generally high.. Conclusions - Findings indicated that provision of telephone assessment and advice using TAS is safe and acceptable and could lead to improved response times for patients with critical or life threatening needs. More Conclusions Paramedics appeared more cautious than nurses when identifying patients need of an emergency ambulance. Results indicate that both groups safely provide telephone advice. Winter Pressures Telephone advice provided by personnel during the winter pressure period was registered by the Department of Health as a Category C pilot. During the period 246 calls were given advice of which 35% did not require an ambulance. What next? Following this study the LAS are considering providing telephone advice as an alternative to ambulance response for patients to whom it is deemed appropriate.
Further information available from Chris Hartley-Sharpe on 020 7921 5266

Cardiac Update - The Clinical Audit and Research Unit made two presentations at Resuscitation 2000 held in Antwerp.
Out-of-Hospital Cardiac Arrest in a UK metropolitan area. Dr Patricia Clarke worked from data collected for the LAS cardiac database of 1997. Results revealed survivors of cardiac arrest were more likely to have – a) Arrested in front of Ambulance Crew, b) Received bystander CPR c) Have an initial rhythm of VF/VT d) Been defibrillated. Evidence has led to the development of priority despatch telephone advice. Also increased bystander CPR from 26% to 44% in certain areas of London. Cardiac Study All data from 1998 and from January to June 1999 has been collected. Currently awaiting information from National Statistics Office for survivors of one year post hospital discharge. Resulting information to be published shortly. Questionnaire Following results of a crew feedback questionnaire in 1999, John Knights, Cardiac Research Assistant, gave a presentation on Understanding crew behaviour on arrival at the scene of an out-of-hospital cardiac arrest.
Results showed that crews were more likely to carry a defibrillator to calls passed as ‘cardiac arrest’ than ‘unconscious’. Following an emergency call two thirds of crews stated that defibrillators were not carried on every call because of the weight and awkwardness, but findings indicated that crews were three times more likely to carry oxygen. Also indicated was the need to standardise the terminology used to pass details of calls to ambulance crews which ultimately influences the decision on whether to take a defibrillator to the patient. The questionnaire also showed that more emphasis should be placed on the importance of the defibrillator for cardiac patients. Benefits of the use of Automatic External Defibrillators is backed by the Department of Health who have released 1 million pounds for Ambulance Services to ensure this equipment is available on every ambulance.
For more information on the Cardiac Study – contact Jon Knights

Barts City Lifesaver and 12 lead ECG Paula Ross from Barts City Life Saver spoke on The importance of an efficient communication system in a first responder scheme. Mark Whitbread, Royal London Hospital reported on the 12 Lead ECG initiative undertaken by crews at Poplar ambulance station which is to be expanded to other stations.

LAS Research Wins Award at 999 EMS Research Forum An award was won for Most Original Research which covered The Operational Development Unit’s work on older fallers. Mary Halter, Clinical Audit Co-ordinator, gave the winning presentation which followed a pilot study to assess individuals who called 999 after a fall but who were not subsequently conveyed to A&E. The Forum, part of the Clinical Showcase Theatre at Ambex 2000, aims to encourage, promote and disseminate research and evidence-based policy and practice in 999 healthcare. A number of posters were also presented

  • Understanding how to best achieve change: a survey of ambulance staff views on the impact of an audit of asthma care
  • Acceptability of telephone advice for emergency (999) callers triaged in ambulance control as neither life-threatening nor urgent
  • Variation in recording prehospital cardiac arrest survival in UK Ambulance Services
  • Audit of the emergency prehospital care of hypoglycaemic patients

All work presented will be published in the BMJ. Photocopies available for Hasna Sinancevic in n the Clinical Audit & Research Unit.

999 Minor Injuries Unit Study (MIUs) The unit aims to compare the care and satisfaction of patients with minor injuries taken to MIUs (intervention group) with similar patients taken to A&E as normal (Control group). Those Ambulance crews taking part in the trial are:LAS in Wembley, Surrey Service in Woking, Haslemere, Godalming and Knaphill. Data collection commenced on May 15th 2000 and will continue for 12 months. In the first month 81 patients were identified to receive follow-up questionnaires; 35 in the intervention group and 46 in the control group. The team aims to follow-up approximately 20 patients per week. Identification of suitable patients to be included in the study will come from information supplied by CAC and study protocols. The systems appears to be working well.Benefits - Potential benefits to be gained from transporting appropriate patients to MIUs are:

  • Shorter waits for patients at MIUs than A&Es, therefore greater patient patient satisfaction.
  • Quicker turnaround times for ambulances
  • Ambulances available sooner to deal with other 999 calls.
  • Better use of public money as MIUs and ambulances are being fully utilised.
  • Greater satisfaction for crews as they are allowed to use their judgement to make decisions about appropriate patient care.

More details about MIU Project available from Theresa Foster (MIU researcher) on 020 85630214

Crew’s Views Lee Bevan, paramedic from Poplar Ambulance Service discusses the 12 lead ECG initiative.In 1996 the LAS was approached by the Royal London Hospital regarding the participation of a project to record pre-hospital 12 lead dianostic ECGs and the indentification of ST Elevation suggesting a myocardial infarction. Knowing that Coronary Artery Disease was a large killer and that Tower Hamlets had a large number of such patients, it was considered a positive move. Staff were released for training and were taught to identify ST Elevation, other abnormalities and how to record a 12 Lead ECG together with the value this information would have on the patients and improvement of care. Further assessments to indicate the ability to interpret the 12 Lead ECG’s and assessments were compated to A&E SHOs. Outcome showed that staff were equal to SHOs. Initial study showed that patients who had received a pre-hospital 12 Lead ECG had a ‘door to needle time’ of 20 to 30 minutes, a reduction in a time to treatment of approximately 30 minutes. Lee Bevan considered that this was a good initiative undertaken by the LAS and felt that ambulance staff can make a difference in patient care and quality of life. Clearly pre-hospital 12 Lead ECG will be part of the overall cardiac care to be offered to the people of London. It is assumed from Professor Chamberlain’s presentation on the role of the 12 Lead ECG and pre-hospital thrombolytic treatment, at Ambex 2000, that this is a rapidly expanding area which will involve all Ambulance Services.

FURTHER INFORMATION CAN BE OBTAINED FROM LONDON AMBULANCE SERVICE