These cases are documented in box 1. Heroin user had had a possible respiratory arrest and friend gave mouth to mouth.
Pre Hosp Imm Care — Qual Saf Health Care — Department of Health, 2. Box 1 Case 1: Of the other two, one was a refusal to transport and the other was an elderly patient who had suffered a fit, which was documented as being due to the hypoglycaemia and so did not fit the guidelines.
Nine of these 93 cases were refusals of transport rather than crew decisions. Can paramedics safely decide which patients do not need ambulance transport or emergency department care?
They found that experienced ambulance crews felt their experience allowed them to make safe decisions about conveyance of patients and some of the crews questioned felt that their practice remained driven by their intuition rather than the guidelines, although the guidelines themselves gave legitimacy to an informal practice that already occurred.
There was no documenting that the family were informed of the risk of ischaemia and given the option to transport. Discussion There is no obligation on ambulance services in England to transport all patients they attend.
A patient with terminal lung cancer fallen out of bed with no injury. Department of Health, 4. These included 12 possible chest infections, 10 cases of hyperventilation where diabetic complications were excludedand nine cases in which there was a history of chest pain.
In many cases there was documentation which supported the decision not to transport on clinical grounds; however, this was outside the remit of the guidelines.
Emerg Med J — In response to this it is crucial that future guidance is more specifically targeted towards defined clinical areas and that the education delivered is very clear on the parameters to be applied to the clinical scenario.
There may also be scope to extend the range of guidelines to allow more patients to be managed in this way; however, it is clear that these would need to be focused in their remit and outcomes. An ECG was done which showed an irregular rhythm with ischaemia, but this was assumed to be normal for the patient due to the concurrent illness and they were kept at home on the basis of the no injury protocol.
Naloxone has a shorter half life than heroin so cannot be considered protective; however, in this case it is a refusal to travel with an attempt by the crew to minimise the clinical risk.
Further training needs to occur to minimise clinical risk and maximise the potential, with appropriate care pathways being established to support this work. Government Publications, January [ PubMed ] 3. Does criteria based dispatch of calls adequately detect the critically ill and injured?
Several studies have been performed, mainly in the USA, reviewing whether paramedics are able to safely decide which patients do not need ambulance transport. The natural evolution of ambulance services in England is towards the development of practitioner roles in which holistic patient assessment and decision making should remove some of the need for such rigid guidance.
While this was recorded as use of the protocol as the patient had refused to travel, it was not an appropriate application.National Emergency Medical Services Education Standards Paramedic Instructional Guidelines. Page 1 of Siege of Malaga, first recorded use of ambulance by military, no medical care provided 2.
s – Napoleon designated vehicle and attendant to head to battle field Non-Transport i. Against medical advice ii. No assistance needed.
Patient Transport Service (PTS) About us PTS (formerly known as NEPT) provides an important service for patients who require transport to, or from, a health facility and who are medically unsuitable for community, public or private transport.
Background: Recent government policy has looked at improving the role of ambulance services in delivering alternative care models for patients. Objective: To review the outcomes of the introduction of some specific non-transport guidelines into an ambulance service.
Methods: A retrospective review was undertaken of the documentation. Eligibility Criteria for Patient Transport Services (PTS) 2 Eligibility Criteria for Patient Transport Services (PTS) PTS eligibility criteria document Prepared by DH Ambulance Policy. 3. 4 DH INFORMATION READER BOX Policy Estates Ambulance Services and Non-Emergency Patient Transport Services’ best practice material.
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