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13.12.17

The best response, first time

Richard Webber, lead paramedic at NHS England on secondment from the College of Paramedics, describes how the new Ambulance Response Programme (ARP) will ensure the most appropriate resources are provided to each patient quickly and efficiently.

The ARP aims to improve clinical outcomes for patients, particularly those with life-threatening illness and injury, and improve operational efficiency whilst maintaining a clear focus on safety.

Working with a number of partners, including clinical experts, ambulance trusts, staff and patient representatives, NHS England has been conducting the largest clinical ambulance trials in the world to update the decades-old systems currently in place which, coupled with rising demand, have led to increasing pressures on ambulance services, which is bad for both patients and service staff.

In July, NHS England and its partners announced that the learning from these trials will now be rolled out across the country in time to benefit patients this winter.

Current response standards were developed in the 1970s and have increasingly led to practices which are not in the best interests of patients, staff or services in general. For example, trusts reported that 60 seconds was insufficient time to triage and dispatch a resource. This leads to sending resources before it has been determined what the problem is, or sending multiple ambulances to the same patient then standing down the vehicles least likely to arrive first – regardless of whether the first resource to arrive can actually meet the patient’s needs, and tying up multiple resources which could be dispatched to other patients.

ARP is about making sure the best, highest-quality, most appropriate response is provided for each patient first time. It aims to get an appropriate resource and crew to critically ill patients faster, saving lives and improving clinical outcomes. To do this, two major improvements have been piloted with millions of patients, and are now being rolled out across the country:

  1. More triage time to better understand the patient’s condition. The use of a new pre-triage set of questions identifies patients in need of the fastest response at the earliest opportunity, and for serious but non-life-threatening calls, the call handlers will now have an additional 240 seconds to get all the information that they need;
  2. New response categories and targets to get the right help to the most serious cases faster end ‘hidden waits’ and free up ambulance staff. The use of new categorisations for the thousands of reasons people call 999, and stricter standards for the most urgent calls and non-urgent calls (which haven’t previously been measured), will mean that ambulance services will be more accountable for ensuring that all patients who call 999 get the right response in a timely manner.

The new categories

  • Category 1: Calls from people with life-threatening injuries/illnesses – These will be responded to in an average time of seven minutes;
  • Category 2: Emergency calls – These will be responded to in an average time of 18 minutes;
  • Category 3: Urgent calls – 90% responded to within 120 minutes;
  • Category 4: Less urgent calls – 90% responded to within 180 minutes.

Benefits for patients

Under the new system early recognition of life-threatening conditions, particularly cardiac arrest, will increase. A new set of pre-triage questions identifies those patients in need of the fastest response. The new targets will also free up more vehicles and staff to respond to emergencies.

For a stroke patient this means that the ambulance service will be able to send an ambulance to convey them to hospital, when previously a motorbike or rapid response vehicle would ‘stop the clock’ but cannot transport them to A&E.

Patient safety is paramount. Academics at Sheffield University monitored more than 14 million ambulance calls under the trial and found no patient safety incidents.

The changes have been warmly received across the spectrum of stakeholders. Simon Gillespie, chief executive of the British Heart Foundation, added: “Following promising trial results, when the new system is introduced more widely we would expect emergency services to attend these life-threatening events more rapidly to ensure that every victim has the best chance of survival.”

Top image © sturti

FOR MORE INFORMATION
W: www.collegeofparamedics.co.uk

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