East Midlands Ambulance Service Tim Hargraves – Interim Locality Manager (LL&R Division)

EMAS Profile About the Trust Resident population: 4.8 million people Area covered: 6,425 square miles Annual Budget: £147million Emergency unscheduled care for Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, Nottinghamshire and Rutland 2 Emergency Operations Control Centres at Nottingham and Lincoln Our accident and emergency crews responded to over 776,000 emergency calls last year – a new call every 40 seconds!

About the Leicestershire & Rutland Division Leicester, Leicestershire & Rutland target population 983,400 374 rising to 408 A&E staff in 2016 (emergency care practitioners, paramedics, technicians, emergency care assistants) 88 A&E vehicles (fast response vehicle, ambulance & air ambulance) Ambulance stations across L&R - 9

EMAS Profile Resources include: - Rapid Response Vehicles - Double Crew Ambulances - Community First Responders & EMICS Doctors - Air Ambulance - Hazardous Area Response Team (HART) - Cave & Mountain Rescues -Cycle Response Unit (CRU

Resources to respond Fast Response Vehicles These resources make up approximately 30% of our deployed fleet – they carry same life-saving equipment & drugs as ambulance, just no stretcher Double Crewed Ambulances These resources make up approximately 70% of our deployed fleet Air Ambulance Derbyshire, Leicestershire & Rutland (DLRAA)

EMAS Profile

Calling 999

Responding to 999 Calls Vital information Address / location of patient (so vehicle can be dispatched immediately) Patient problem – are they conscious? Male or female, approximate age Your name Your phone number Emergency Call Taker gives medical advice, i.e. how to do CPR, while ambulance response travels to patient

Responding to 999 Calls Red Calls Immediately life threatening Every call is given a Category Red Calls Immediately life threatening Heart attack, severe breathing difficulties, loss of consciousness, severe loss of blood etc (Annually, 75% of red calls to be responded to within 8 minutes) Green 1&2 Serious, not immediately life threatening Abdominal (tummy) pains, fractured bones etc (Aim to get to Green 1 calls within 20 minutes, and Green 2 calls within 30 minutes) Green 3&4 Neither serious or life threatening Call passed to one of the Nurse Triage Team possibly another NHS pathway or non-emergency ambulance (Green 3 aim to make telephone assessment within 20 minutes and 60 minutes for Green 4)

What happens when a call is made ?

Ambulance Service How we respond to emergency 999 calls In the past, call volume low Technology to predict demand Review to match supply to demand Ambulance station was the ‘fixed point’ from which each journey started Now, returning to base is seldom an option 999 calls are responded to by nearest available ambulance resource Dynamic deployment/not fixed

Responding to an emergency Using various pieces of equipment the clinician will check the patients condition Clinician checks the patients pulse, blood pressure, temperature, breathing rate, colour, level of consciousness, pain scale etc Together with the information provided by the patient and/or bystanders, allows the clinician to make a decision on next steps

Responding to an emergency To transport or not to transport In some cases, emergency transport to a hospital Emergency Department or specialist care centre (cardiac and stroke care) is required On many occasions the clinician, in agreement with the patient, decides on alternative care pathway: Minor Injury Centres Community Hospital Local GP or Out of Hours Service Community Services Self care

Responding to an emergency Paramedic Pathfinder

Responding to an emergency Paramedic Pathfinder The demand for both emergency ambulances and urgent care services are increasing year on year As an ambulance service, we are attending comparatively less “life threatening” calls and an increasing number of patients with urgent and unscheduled care needs. The introduction of Urgent Care Centres and community referral pathways as a safe and effective alternative to the Emergency Department Success in meeting this increasing workload will rely upon our ability to accurately assess, treat and refer patients to the most appropriate care providers. English Ambulance Services are faced with annual increases in call volume. Addressing this demand for lower acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. We will continue to be faced with stabilisation and transportation of time-critical patients such as major trauma or acute cardiac events etc. Nevertheless, there is a growing awareness that many patients could be treated in an out of hospital environment by Urgent Care Centres or other services. Given the risks associated with using an alternative to the emergency department, the challenge is to develop processes that can safely assist clinicians to determine appropriate patient dispositions, thereby increasing the number of patients receiving care closer to home. We will continue to be faced with stabilisation and transportation of time-critical patients such as major trauma or acute cardiac events etc. Nevertheless, there is a growing awareness that many patients could be treated in an out of hospital environment by Urgent Care Centres or other

Responding to an emergency Paramedic Pathfinder Non-conveyance Hear and Treat (CAT team) See and Treat • Onward referral • Referral Pathways • Better Care Together (Social and Health) Urgent Care Falls Directory of Services

Responding to an emergency Handover Given the risks associated with using an alternative to the emergency department, the challenge is to develop processes that can safely assist clinicians to determine appropriate patient dispositions, thereby increasing the number of patients receiving care closer to home. We will continue to be faced with stabilisation and transportation of time-critical patients such as major trauma or acute cardiac events etc. Nevertheless, there is a growing awareness that many patients could be treated in an out of hospital environment by Urgent Care Centres or other

Responding to an emergency Handover Given the risks associated with using an alternative to the emergency department, the challenge is to develop processes that can safely assist clinicians to determine appropriate patient dispositions, thereby increasing the number of patients receiving care closer to home. We will continue to be faced with stabilisation and transportation of time-critical patients such as major trauma or acute cardiac events etc. Nevertheless, there is a growing awareness that many patients could be treated in an out of hospital environment by Urgent Care Centres or other

Responding to an emergency Handover Given the risks associated with using an alternative to the emergency department, the challenge is to develop processes that can safely assist clinicians to determine appropriate patient dispositions, thereby increasing the number of patients receiving care closer to home. We will continue to be faced with stabilisation and transportation of time-critical patients such as major trauma or acute cardiac events etc. Nevertheless, there is a growing awareness that many patients could be treated in an out of hospital environment by Urgent Care Centres or other

Thank you Any Questions?