Linking the LAS with Health & Social Care 6 th December 2016 - - PowerPoint PPT Presentation

Linking the LAS with Health & Social Care

6th December 2016

Outline:

• About me…..
• LAS Context
• Integrating LAS with H&SC

LAS context

We are one of the busiest Ambulance Services in the world

The London Ambulance Service today

• Covers all of London = 32 CCG’s, 41

NHS trusts, across 86 sites

• Population of 8.9m people
• Respond to c.1.9m 999 calls annually
• We employ just under 5000 staff, 71%
• f which are frontline
• Our frontline staff work out of 70

ambulance stations

• Focus on international and national

recruitment drives – 700 staff joined

How we care for the capital

Our major service areas:

• Call taking and clinical triage
• Hear and treat services
• 999 emergency and urgent care response – delivered

using traditional and innovative means e.g. Cycle Response Unit

• Intelligent conveyance
• 111 Services
• Emergency Preparedness Resilience and Response

(EPRR)

Demand – Category A

2013-14: 8,830 incidents per week (average) 2014-15: 9,374 2015-16: 9,652 2016-17: 10,697

• In 2015-16 there were 19 weeks where activity

ranged from 10,007 to 10,983 incidents

• w/e 20 Nov 16 – 11,330 CAT A Calls (16/20wks)
• 8 of the top 10 busiest ever months for the LAS

have occurred since Jan 2016, with March 2016 being the busiest ever month for Category A calls followed by October 2016

How can H&SC assist?

Focus – HCP / Care / Residential calls

• Overall HCP referrals are up by 12.3%. Marginally ahead of overall

growth rates.

• The over 60s represent the largest proportion of the total population

within HCP referrals(62% of the total referrals in 2016/17)

• “HCP protocols” and “emergency response requested” represent the

majority determinants driving growth in this area.

• HCP growth - Hammersmith 33% and NW London 24%.

What to do when a resident becomes ill…

Consider:

• On-site qualified nurse or district nurse
• GP or GP out-of-hours service
• 111

Always call 999 if someone is seriously ill or injured, and their life is at risk

• difficulty in breathing, unconsciousness
• severe loss of blood
• Stroke or heart attack

Making the Call – Residential Care..

 Dial 999, ask for an ambulance and stay calm  Answer all the questions if possible, remain with the patient- Mobile phone  If you can’t stay with the patient – make sure you know if the patient is alert, conscious, breathing  You could be offered advice over the phone, or a call back from our paramedics in the clinical hub

How we prioritise your call…

• We ask a series of questions and run through a triage tool. Answer

all the questions if possible. This does not delay any response in coming but it will allow us to send the most appropriate response.

• Are they conscious, alert, breathing?
• Location is important- Unit name/ Floor/ patients name
• Any other information that you can give is really helpful to our crews.

LAS - HCP LINE

020-3162-7525

(not for public sharing)

pa · ents

D

London Ambu lance Service rt'J:fj

.. \ " t

Health Care Professional

(HCP)

Admissions

Phone number:

020 3162 7525

Can your patient organise their own transport?

Is y

• u

r patient sujtable for car or Non-Emergency Transport arranged by the London Ambulance Service?

Time frames are:2 - 4 hours

1-

2 hours

Other timeframes by arrangement with LAS clinicians

0(E

DO

OD

DO

OD

Non-emergency, Emergency ambulance needed?

Provide oxygen therapy

D

For paUents who WIil

need Transport stretcher-bound

D

treatment en-route to hospital pa · ents I ncluding palliative 8 mlnutos

D

care pati ents

mmedi ately life-threateni ng Transport chair-bound

D

20 mlnut s

D

Emergency transport needed Response dependi ng on for clinicalcondl on

D

45 ml nutes

D

1

• 2 hours

Urgent transport needed for c llnl calcondl ·

• n

Please use the time frames appropriately.

Making the Call - Nursing Care ..

HCP Line:

• For registered health care professionals / Nurses (999 for non-

registered carers)

• The call taker will ask what time frame you need the ambulance
• Know why you are calling the ambulance, a set of observations are

helpful when we are deciding what response to attend.

• When you request a call to be made Immediately life threatening (from

the HCP line) this will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack.

What are the implications?

• When you request a call to be made Immediately life threatening

(from the HCP line) This will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack.

• Please use the time frames appropriately.

Appropriate time frames

Clinical condition – examples given as guidance

• nly

Time frame for ambulance Type of ambulance

Non-Emergency

Majority of patients who do not require immediate treatment in GP surgery or en-route to hospital, limb injuries, mechanical back pain, mental health concerns 2 – 4 hours Non- emergency transport ambulance /car

Non-Emergency

Elderly patients going for assessment, e.g. general deterioration, stable COPD 1 – 2 hours Non- emergency transport ambulance / car

Urgent

Stroke onset over 4.5 hours, acute abdominal pain, cauda equina – time critical patients who need treatment on route 60 minutes Front-line emergency ambulance

Emergency

e.g. stroke onset under 4.5 hours; sepsis, respiratory conditions requiring on- going nebulisers, abdominal, head injury / fallers on anticoagulants 20 minutes Front-line emergency ambulance

Immediately life-threatening

e.g. acute severe asthma, cardiac chest pain, actively fitting 8 minutes Front-line emergency ambulance +/- solo response vehicle

Non- Emergency Ambulance

What can they Provide?  Basic Observations  Stretcher and Chair  Give Oxygen  Give inhaled pain relief  Transport to hospital  They will attend the most of the calls over 60 minutes.

illnesses

What is wrong with the resident?

Does the resident need an emergency ambulance?

• Unconscious
• Difficulty
• Chest Pain
• Uncontrollable bleeding
• Obvious limb fractures
• Simple infection
• Fall with no injury
• Abnormal blood

results

• Catheter problems
• Minor injuries and

What are the alternatives?

Short-Term Rehabilitation & Rapid Response

• Short-Term Rehab
• Rapid Response- 2 hrs
• Mobility Problems
• Hospital Avoidance
• Chest Infections, UTI,

Skin Infections.

• The team also

provides a gateway to

• ther healthcare

pathways including falls, COPD, Diabetes, District Nursing and long term condition management. Community Nursing:

• Catheters
• Administering

drugs and giving injections

• Cleaning and

dressing wounds

• End of Life Care
• The Team can be

contacted via the GP, through Rapid Response or 111 Specialist Nursing (depending on area)

• Tissue Viability
• Cardiology
• Diabetes
• Respiratory
• Parkinson’s

Specialist

• MS Nurse
• Epilepsy Nurse

GP

• Generally

Unwell

• Infections
• Falls with

minor injuries

• Problems

with Prescriptions

• Access to

referrals such as speech and language for eating etc.

• Behavioural

problems 111

• Out of

hours GP access

• Clinical

Advice

• Telephone

numbers for alternative services.

What could delay us from getting to a patient?

× Not being met at door, can’t get in – no access code × Unsure which resident is the patient × Large home, many patients, different floors × IMPORTANT – let others know you have called for an ambulance

Copies of information for us to take away Patient’s personal belongings Escort

What would help us when we arrive?

Full name, date of birth, next of kin & contact details GP details (hospital needs these for referrals)

Address of the home

Medication – drug chart, medical history & any observations

DNAR in place?

Thank you … any questions? Contact details; Martin.Bowdler@lond-amb.nhs.uk