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Found 30 results
  1. News Article
    Ambulance services have been urged to look at how suspected overdose and poisoning cases are prioritised after paramedics took 45 minutes to reach a woman with known mental health problems. Helen Sheath, 33, had been discharged from a mental health unit in early July last year and was still waiting for an outpatient appointment with a psychological assessment and treatment service when she took a fatal dose of sodium nitrate on 20 August. Her father called an ambulance at 6.20pm when she had locked herself in a bathroom and was threatening to take the sodium nitrate. But Bedfordshire and Luton senior coroner Emma Whitting said her father could not tell whether or not she had taken it, and that in view of her history of suicidal ideation, the call should have been treated as a category two – with an 18 minutes response target – rather than a category three incident. The first ambulance which was sent to her was diverted on route and it was only after a second call to the East of England Ambulance Service at 6.48pm, that the call was upgraded to category two – when the call handler selected a different set of questions, after being told she had ingested the chemical. A rapid response vehicle arrived at 7.05pm and the mental health street triage team attended six minutes later. Shortly afterwards she became acutely unwell and was taken to Bedford Hospital, where she received treatment but died shortly afterwards. In a prevention of future deaths report Ms Whitting said: “If the first call had been coded as a category two, it seems likely that the rapid response vehicle, mental health street triage team (and even possibly the double staffed ambulance) would have arrived on scene much earlier (potentially just before or just after Helen had ingested the sodium nitrate) which could potentially have altered the outcome.” The case comes just months after two other ambulance trusts were criticised in cases involving suspected or threatened overdoses. The prevention of future deaths report was sent to the Association of Ambulance Chief Executives and the emergency call prioritisation advisory group, which is run by NHS England. Neither would comment other than saying they would respond to the coroner. Read full story Source: HSJ, 15 June 2020
  2. Content Article
    For anyone who is not familiar with undertaking critical care transfers or for staff looking for a brief refresher, here are a few notes that I hope will help any clinical staff (please note, these are my views and not necessarily those of my employer's). Planning: Despite normally being stable prior to transfer, by nature, critical patients are unstable and may deteriorate. Plan for this and know where you are going, expected journey time accounting for traffic conditions and what hospitals are along the route in case of emergency. Equipment: If a team is not travelling, you ideally won’t take unfamiliar devices. If you do, the least you should know and plan for/discuss is how to manage failure; i.e. a syringe pump giving inotropic support or ongoing sedation that may be able to be given manually. Equipment: Is different in subtle ways and it won’t be a simple case of copying hospital settings. If moving a patient from hospital equipment to yours, don’t leave straight away. Give the patient time to “settle” on your equipment and make any changes to setting necessary to maintain the patient. Vehicle: Ensure normal vehicle checks are complete, you know where your own equipment is and that it is working. Also make sure that electrical/12V/USB ports all work in case they are needed for transfer equipment. Have all rescue kit (airways, BVM etc.) to hand. Oxygen: An oxygen dependent or ventilated patient can use a lot of O2 and this needs to be calculated along with extra in case of delays. Formulas that can be used: 2 x flow (L/min) x length of transfer (min) 2 x transport time in minutes x (minute volume x FiO2) + ventilator driving gas. Airway: Always important but vital for a patient who has an airway adjunct in place prior to transfer. Plan for immediate actions if the patient loses this adjunct during transfer. Have emergency kit laid out PRIOR to transfer and allocate pre-planned roles in case of an airway emergency during transfer. Breathing: A patient on a ventilator will have a ventilation strategy depending on their condition. Try to have a basic understanding of this in case you need to take over with a BVM in the event of a ventilator failure. ALWAYS have rescue kit laid out and to hand in case of emergency enroute. Circulation: The patient may be on some sort of circulatory support (fluids, pressors, inotropes etc) dependent on their underlying condition. Again, try to understand their current fluid status and support needs in case you need to intervene or have an equipment failure enroute. Disability: If a patient is sedated/anaesthetised, be vigilant for signs this may be wearing off. Some signs to look for are tearing, increase in heart rate or BP or a Curare cleft on waveform capnography. Be aware that patient sedation needs may change due to movement during transfer. Monitoring: In the sedated/anaesthetised patient, monitoring may be your first indicator that something is changing. Don’t just assume strange values are due to movement and constantly check your patient. If something changes, start at the patient and work back to the monitor to look for issues.
  3. News Article
    Some seriously ill COVID-19 patients in London may not have been taken to hospital by ambulance because of a system temporarily used to assess people, a BBC investigation suggests. Patients could have "become very sick or died at home" instead, a paramedic claimed. One family said they had to plead to get hospital care. Medical professionals use 'NEWS2', as one way of identifying patients at risk of deteriorating, a check normally used for sepsis patients. Under normal circumstances, ambulance teams would blue-light anyone with a score of five or above to hospital. But on 18 March, LAS workers were told to apply the NEWS2 check to suspected Covid patients and that many of those with a score up to seven could be "suitable for community care", even if there were issues with breathing rate, oxygen supply and consciousness. But one paramedic, who wanted to remain anonymous because she did not have permission to speak to the media, said she believed that as a result of the NEWS2 advice, crews went to patients "who may have been seen by ambulance before and then suddenly became very sick or even just dropped dead." Read full story Source: BBC News, 23 April 2020
  4. News Article
    The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden. “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.” Read full story Source: The Guardian, 16 April 2020
  5. News Article
    Ambulance staff are being put at risk by a lack of protective equipment to guard them against coronavirus, according to a trade union. GMB says its members are "scared" about their own safety and their families. The union claims one in five ambulance staff in London are off sick with coronavirus-related sickness. The government says hundreds of millions of protective items have been delivered to NHS staff around the country. According to the GMB Union, 679 frontline ambulance crew in the London Ambulance Service are off sick due to Covid-19-related sickness. Among those at work, some say they feel unprotected either because of a lack of or inadequate personal protective equipment (PPE). Read full story Source: BBC News, 8 April 2020
  6. News Article
    There is significant variation in ambulance response times to patients with serious conditions such as suspected strokes or heart attacks, which is not fully explained by how rural an area is, an HSJ analysis has revealed. The exclusive analysis represents the first time ambulance performance for category two calls, which have an 18-minute response time target, have been broken down to clinical commissioning group level. Category two, known as emergency calls, covers a wide range of conditions, including suspected stroke and heart attacks (except cardiac arrests), major burns and epileptic seizures. They account for well over half of ambulance responses. The findings — described as “alarming” by the Stroke Association — lay bare the incredibly long waits which are usually hidden, because average waiting time data is usually published for ambulance trusts, which cover far larger areas than CCGs. Mark MacDonald, Deputy Director of Policy at the Stroke Association, said: “It is alarming to hear that in some cases ambulance staff are taking over an hour to reach patients because when it comes to stroke, being assessed quickly and then, if necessary, transferred to hospital, is really important.” Read full story (paywalled) Source: HSJ, 5 March 2020
  7. News Article
    The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer-by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Last summer, the inquest into the London Bridge attack heard it took three hours for paramedics to reach some of the wounded. Prompt treatment might have saved the life of French chef Sebastian Belanger, who received CPR from members of the public and police officers for half an hour. A LAS debriefing revealed paramedics’ frustration at not being deployed sooner. A group of UK and international experts in delivering medical care during terrorist attacks have highlighted alternative approaches in the BMJ. In Paris in 2015, the integration of doctors with specialist police teams enabled about 100 wounded people in the Bataclan concert hall to be triaged and evacuated 30 minutes before the terrorists were killed. The experts writing in the BMJ believe the UK approach would have delayed any medical care reaching these victims for three hours. These are perilously hard judgment calls. Policymakers and commanders on the scene have to balance the likelihood that long delays in intervening will lead to more victims dying from their injuries against the increased risk to the lives of medical staff who are potentially putting themselves in the line of fire by entering the so-called 'hot zone'. First responders themselves need to be at the forefront of this debate. As the people who have the experience, face the risks and want more than anyone to save as many lives as possible, their leadership and insights are vital. In the wake of the Streatham attack the government is looking at everything from sentencing policy to deradicalisation. Deciding how best to save the wounded needs equal priority in the response to terrorism. Read full story Source: The Guardian, 7 February 2020
  8. News Article
    Concerns have been raised that NHS ambulance staff are being "silenced" over bullying allegations. Hundreds of East of England Ambulance Service (EEAS) employees reported bullying in 2018, while 28 non-disclosure agreements (NDAs) have been issued since 2016. The GMB union said the figures showed a "heavy-handed culture". The service said it took bullying and harassment "extremely seriously" and had policies to prevent such behaviour. EEAS faced scrutiny in November when it emerged three members of staff died in 11 days. One, Luke Wright, 24, is believed to have taken his own life. An independent investigation, which dealt in part with bullying claims, has been carried out with the results reported to the trust in January. The 28 NDAs had been made in cases where bullying, harassment or abuse by colleagues had been reported, according to figures obtained under the Freedom of Information Act. These involved an individual agreement, often with a payment, which prevented the person speaking about their case. In the latest staff survey from 2018, 23% of staff reported bullying, up from 21% in the previous year. The GMB said NDAs were seen as a "method of silencing rather than resolving" and called on the trust to discuss more meaningful ways of dealing with problems. Read full story Source: BBC News, 10 February 2020
  9. News Article
    Heart attack, stroke and burns victims are among the seriously ill and injured patients waiting over an hour for an ambulance to arrive in England and Wales, a BBC investigation shows. The delays for these 999 calls - meant to be reached in 18 minutes on average - put lives at risk, experts say. The problems affect one in 16 "emergency" cases in England - with significant delays reported in Wales. NHS bosses blamed rising demand and delays handing over patients at A&E. Rachel Power, Chief Executive of the Patients Association, said patients were being "let down badly at their moment of greatest need" and getting a quick response could be "a matter of life or death". She said the delays were "undoubtedly" related to the sustained underfunding of the NHS. Read full story Source: BBC News, 29 January 2020
  10. News Article
    A coroner has criticised an ambulance trust after it took nearly four hours to reach a woman who had taken an overdose. Taking the unusual step of publishing a prevention of future deaths report before an inquest had concluded, coroner for Gateshead and South Tyneside Terence Carney said “the real and imminent danger of [the deceased Maureen Wharton’s] admitted actions does not appear to have been appreciated and readily reacted to in a meaningful way”. Ms Wharton called North East Ambulance Service Trust to say she was dying of cancer and had taken prescribed drugs, including an opioid-based medication and sleeping pills. She threatened to take more and later called back, appearing drowsier. North East Ambulance Service graded the 61-year-old’s call as “category three”, which meant she should have received a response within two hours. It took three hours and 45 minutes for the ambulance service to access her flat, by which time she was already dead. Mr Carney pointed out no attempts had been made to identify family or other support for her, or to contact other agencies which could have responded. The inquest into her death is expected to conclude later this year. In a statement, NEAS said it has already made changes to safeguard patients in mental health cases, including implementing greater oversight in its control rooms, improving call transfers to crisis teams, mapping available local mental health services, introducing more staff training, and telling patients in a crisis but not at risk of physical harm about other, more appropriate, services. Read full story (paywalled) Source: HSJ, 14 January 2020
  11. Content Article
    In conclusion, EMS colleagues and organisations may need support to embrace opportunities from case-based learning, but research is also needed to explore the wishes and opinions of bereaved families regarding the dissemination of any case-based lessons that need to be learned.
  12. News Article
    Two patients have died as a result of NHS hospitals failing to heed warnings about the use of super-absorbent gel granules, which patients mistakenly eat thinking they are sweets or salt packets. A national patient safety alert has been issued by NHS bosses to all hospitals, ambulance trusts and care homes instructing them to stop using the granules unless in exceptional circumstances. An earlier alert in 2017 warned the granules, which are used to prevent liquid being spilled, had caused the death of one patient who choked to death after eating a sachet left in an empty urine bottle in their room. The 2017 alert warned hospitals there had been a total of 15 similar incidents over a six-year period between 2011 and 2017. The latest warning from NHS England says most hospitals concentrated on “raising awareness” rather than stopping the use of gel granules. Read alert Read full story Source: The Independent, 4 December 2019
  13. News Article
    A hospital has made changes after two patients were accidentally given medical air instead of oxygen. The two incidents, which took place at the Norfolk and Norwich University Hospital (NNUH), were classed as "never events" meaning they were serious but preventable. They happened to patients in November who were being handed over to the hospital by the East of England Ambulance Service. The patients should have been given oxygen but were given medical air instead which only contains 20pc oxygen. The ambulance service said in a message to staff: "Severe harm or death can occur, if medical air is accidentally administered to patients instead of oxygen. As per NNUH's request, with immediate effect, when handing over at the NNUH, all medical equipment and oxygen should be swapped only by an emergency department doctor or registered nurse." Read full story Source: Eastern Daily Press, 2 December 2019
  14. Content Article
    The transport of the ICU patient is a complicated process and can lead to patient harm. In the Department of Critical Care Medicine, Calgary Health Region, staff underestimated the risks of intrahospital transport, which led to the two adverse events mentioned above. This article published in Healthcare Quarterly has describes the development of an ICU patient transport decision scorecard to support the safe transport of ICU patients for diagnostic testing. The scorecard is a visual assessment tool. Each item on it is a decision point and a simple reminder to ensure that appropriate resources are available prior to transport. Outcome measures have been added to begin to measure the effectiveness of the tool. Several lessons were learned from the development of this tool: the need to form a subgroup with team members from all sites and disciplines to ensure early buy-in; the involvement of a human factors expert to make the tool easier to use; and the need to continuously retest the tool using PDSA cycles.
  15. Content Article
    This guideline includes recommendations on: hand decontamination use of personal protective equipment safe use and disposal of sharps waste disposal long-term urinary catheters enteral feeding vascular access devices. Who is it for? commissioners and providers healthcare professionals working in primary and community care settings, including ambulance services, schools and prisons children, young people and adults receiving healthcare for which standard infection-control precautions apply in primary and community care, and their families and carers.
  16. Content Article
    Did you known that once a paramedic hands over the care of their patient to the hospital they don't tend to learn how beneficial their treatments were or how accurate their diagnosis was? As you can imagine this makes continually improving in order to provide the best possible healthcare to patients very challenging. The Princess Alexandra Hospital (PAH), East of England Ambulance Service Trust (EEAST), and Essex and Herts Air Ambulance Trust (EHAAT) are working together to change that. With support from the Health Research Authority's Confidentiality Advisory Group (CAG) and under the supervision of the PAH Patient Panel, they have started a new project which allows the ambulance and air ambulance staff who look after a patient to find out relevant and proportional information. This will help with lifelong learning and reflection, seen as vital to learning by both the General Medical Council who oversee doctors and the Health and Care Professions Council who oversee ambulance staff.
  17. Content Article
    This guidance is to help NHS ambulance trusts in England to improve the way they review and learn from the deaths of patients who had been under their care. It builds on the work ambulance trusts already do on learning from incidents and on mortality reviews. It also sets out a standardised framework for ambulance trusts to use to develop and implement their local Learning from Deaths policies.
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