01 The effects of a leaflet-based intervention, ‘hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study
Vanessa BotanGraham LawDespina LaparidouElise RowanMurray SmithColin RidyardAmanda L. BrewsterRobert SpaightKeith SpurrPauline MountainSally DunmoreJune JamesLeon RobertsKamlesh KhuntiA Niroshan Siriwardena
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Background Hypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We aimed to investigate the effect of an intervention in which ambulance staff were trained to provide advice supported by a booklet – ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances. Methods We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation of East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. The main outcome was the number of unsuccessful ambulance attendances (i.e. attendances followed by a repeat attendance). Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA). Results The study included 4825 patients (mean age= 65.42, SD=19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia – relative to the pre-intervention trend (p=0.008). The hypoglycaemia care bundle (i.e. blood glucose recorded before and after treatment for hypoglycaemia) was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (χ2=30.16, p<0.001). Conclusions The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.Keywords:
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The first thing a patient in need of emergency treatment may recognize is the red flight suit of a South Western Ambulance Service NHS paramedic operating from the Devon Air Ambulance. This would be one of the specially trained and highly committed band of 12 full time paramedics who work on the air ambulance. While each of these air crew paramedics will insist that the bright red helicopter is treated just the same as any other ambulance, but one with rotor blades instead of tyres, each appears to have forged a special relationship with the work of the Devon Air Ambulance Trust and each supports it in a variety of ways above and beyond the call of duty
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Dealing with emergencies is all part of the job for ambulance staff, and putting strategies into place to cope with all eventualities is vital to provide an effective response in the face of a major incident. Mark Norbury, National Emergency Preparedness Coordinator for the Ambulance Service, explains.
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to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly.retrospectively collected ambulance service and hospital records data analysed longitudinally.The ambulance service and the major casualty department in Cornwall.the provision of a helicopter ambulance unit to a county ambulance service.patients with compound lower limb fractures carried as emergencies by an ambulance service. Principle outcome measure: ambulance 'mission times'.the ambulance services' ability to deliver emergency patients to hospital more quickly when the helicopter unit was available was not demonstrated. In some instances availability of the helicopter unit probably delayed the timely delivery of emergency patients to the casualty department.until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur.
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The use of a helicopter as a primary response vehicle for the Cornwall Ambulance Service is presented. A brief analysis of the activities of the First Air Ambulance is described and an appraisal of its effects on the overall performance of the Service is given. Emphasis is given to patient acceptability and also to the flexibility of the helicopter in terms of its response to different situations. In conclusion, The Air Ambulance, as part of an integrated ambulance service, is an effective provider of good pre-hospital care.
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St Bartholomew's Hospital, in the City of London, has for many years run a Coronary Ambulance service, called by the public via the 999 system. During a 9-month period only 55% of 214 cardiac emergencies arriving at St Bartholomew's Hospital came with Coronary Ambulance support, although the service was available if called. In cases where the Coronary Ambulance was summoned, the call-out was inappropriate in 57% of cases. In addition, 153 cardiac emergencies arrived at the Accident and Emergency Department during hours when the Coronary Ambulance was not available. Reasons for breakdowns in the call-out system are discussed and remedies involving the public and London Ambulance Control are suggested.
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Over a 1-month period all patients arriving in the accident and emergency department by ambulance following a '999' call were questioned using a standard proforma. They were assessed as to whether their medical condition warranted ambulance transfer. A number of social and practical points were analyzed to see whether they would identify any group of patients who used the emergency service without medical need. Overall 289 patients were questioned. Of these 178 (62%) were considered to have medically warranted an ambulance call whereas 111 (38%) did not. A number of features which were more likely to result in an unjustified call were identified. These would suggest that basic knowledge of first aid by the public is poor and should be improved.
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Information about patients in ambulance service records has been linked to that in the patients9 hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.
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Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a ‘999’ call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.
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An analysis of 1828 consecutive requests for emergency ambulances made to the Northumbria Ambulance Service was undertaken for the time period 5–14 February 1984 inclusive. It was anticipated that a study of the reason given for requesting the emergency ambulance would provide a measure of community expressed need, reflecting morbidity in the community which necessitates acute treatment by professionals.
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