BackgroundMajor short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event.MethodsA three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item’s importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics.ResultsExperts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented.ConclusionsThis study is the first to produce an expert consensus on the items and quantities of clinical equipment that are required to treat 100 people at the scene of a big bang mass casualties event. The findings can be used, both in the UK and internationally, to support decision makers in the planning of equipment for such incidents.
BackgroundOver the last decade there has been a steadily increasing demand for unscheduled healthcare services, including the ambulance services. To address this demand, various projects have been developed to reduce admissions to the emergency department. One of these was the introduction of Treat and Refer (T&R) guidelines, to allow ambulance clinicians to treat certain groups of patients in the community without the need to convey them to hospital. Aims: This study aims to explore the challenges and barriers faced by ambulance clinicians in the use of T&R guidelines, to inform the future development and governance of non-conveyance guidelines and interventions.MethodsSemi-structured interviews were conducted with 18 ambulance clinicians. Data were analysed using framework analysis. Setting: A national UK NHS ambulance service.ResultsThere was a broad support for the concept and policy of T&R; however the participants had mixed views with respect to the actual practice of treating and referring patients. Participants acknowledged the potential benefits of T&R for patients and the NHS, but identified several risks in using T&R in routine practice. Their perceptions of risk seemed to determine whether and how the guidelines were used. Challenges in the use of T&R included: lack of training and knowledge, fear of litigation, a lack of support from the management and difficulties in decision-making.ConclusionsThis study and the supporting literature do not support the use of T&R guidelines in their current format by traditionally trained ambulance clinicians. Ambulance clinicians have identified the need for further education and support. The conceptual support for T&R may provide a foundation to develop and improve the education and support for ambulance clinicians. This should be combined with implementation/review strategies, clinician-led decision support and management support which can provide the ambulance clinician with the skills and confidence to take responsibility for non-conveyance.
BackgroundThe Scottish Ambulance Service introduced paramedic practitioners in 2004 to reduce unnecessary hospital admissions. Development of the role has varied across the UK but little is known about this professional group within Scotland.AimsTo describe paramedic practitioners views on their scope of practice and identify areas for improvement.MethodsAn online cross-sectional questionnaire was undertaken during July–August 2015. Participants: current staff identified as having completed paramedic practitioner training (N=64). Quantitative data are reported using descriptive statistics and qualitative data analysed using framework analysis.ResultsForty two per cent (n=27) completed the survey, of which 52% (n=14) were active practitioners. Average length of service was 19.52 years (range: 3–24 years) including 4.66 years (range: 0.83–11) within a practitioner role. Variation was reported on funding sources and educational levels (stand-alone level 9 modules to MSc). Current practice settings were described as urban (57% [n=8]), semi-rural (29% [n=4]) and rural (14% [n=2]) involving 999 response, Minor Injuries Clinics, Out of Hours and GP practices.Adult, paediatric and care of the elderly were the most common areas of practice (73%). The remaining areas consisted of: critical, palliative, mental health and other (27%). Most used skills were described as: advanced clinical assessment and medicines; least used: catheterisation, minor ailments/injuries. Skills reported as missing or requiring development were: paediatrics, palliative care and mental health. Mean ‘comfort in practice’ was rated as 4.23 on a 7 point-scale (‘comfortable’ [1] -‘very comfortable’ [7]).Difficulties were reported in call-allocation and utilisation. Variation across practice settings caused difficulties with: record-keeping, inconsistent referral processes, guideline use, peer review and CPD. These created governance and role development challenges.ConclusionPractice is inconsistent, reflecting variations in development processes and practice areas. Practitioners are comfortable in their role and would value standardisation in clinical practice guidelines, education and governance.
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