Overcrowding due to poor patient flow increases risk for more than 500,000 patients a year ( College of Emergency Medicine (CEM) 2014 ) and is linked to increased mortality ( Geelhoed and de Klerk 2012 ). CEM ( 2014 ) has called for urgent action to address 'exit block' in UK emergency departments (EDs). In October last year, Croydon Health Services NHS Trust designed and implemented a site practitioner early warning system (SPEWS) to alert staff to capacity and flow pressures in the ED, and to initiate escalation to a nurse-led, protocol-driven response. Under pressurised and time-critical conditions, SPEWS ensures rigour and conformity in exchanges between clinical emergency care staff and managers. The result is closer collaboration between clinicians and managers, optimised patient flow and mitigated risk from exit block.
For most emergency care teams, initial intravascular access is performed intravenously, despite the challenges posed by low cardiac output physiology. Intraosseous (IO) access has been included in recent Resuscitation Council UK (2010) adult advanced life support (ALS) guidelines for cases in which intravenous access is difficult or unavailable. This article discusses how the use of IO access devices can improve ALS therapy for patients who are in, or who are at risk of, cardiac arrest.
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