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

3. 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!

4. About the Leicestershire & Rutland Division
Leicester, Leicestershire & Rutland target population ,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

5. 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

6. 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)

7. EMAS Profile

8. Calling 999

9. 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

10. 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)

11. What happens when a call is made ?

12. 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

13. 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

14. 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

15. Responding to an emergency
Paramedic Pathfinder

16. 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

17. 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

18. 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

19. 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

20. 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

21. Thank you Any Questions?