1. A study of paramedics’ attitudes to the effects of speed humps on resuscitation of patients en route to hospital, including general patient care and ambulance response times
By Mark Belchamber
BSc (Hons), AASI, SR Para
(Training Officer/Paramedic, London Ambulance Service NHS Trust)
June 2003

2. Or….
June 2003

3. How speed humps affect your patients; your staff; and
your response times.
June 2003

4. Sound familiar? “Delays due to road conditions”
I’ll go this way to avoid the humps
Humps don’t slow the idiots down anyway
You can’t avoid the humps
I hate humps!
Can’t the driver slow down?
I’m feeling really sick
OUCH!
These bumps are awful
Can’t you go a different route?
I hate humps!
June 2003

5. In the last week….
Barnett council (London) propose to remove all 500 speed humps saying they are “Ineffectual and cause road deaths and damage to vehicles”
London Ambulance Service spokesman says “It is possible that minute from response times (service-wide) could equate to 500 more lives saved per year.”
June 2003

6. Methodology Literature search/review
Scant information (predominantly U.S. based)
NO research surrounding attitudes, perceptions, responses of Paramedics
June 2003

7. Methodology (cont.) Questionnaire pre-tested by 10 individuals
100 questionnaires (based on literature reviews) sent to a purposive sample
Mainly quantitative (but also qualitative elements)
June 2003

8. Methodology (cont.) Data Analysis
Closed questions (nominal and ordinal data) charted where appropriate
Free text analysed for thematic content
SPSS, MS Excel and Lotus used
Information graphed and cross-tabulated
Qualitative responses categorised to establish potential relationships
June 2003

9. Methodology (cont.) Ethics Approval from University of Hertfordshire
Also sponsored by London Ambulance Service NHS Trust
June 2003

10. Limitations Small study (36 [out of 100] respondents)
Inability to generalise (Polit & Hungler 1995)
Lack of other (similar) research for comparison
Only Paramedics were questioned
Possible geographical bias
Time limitation
June 2003

11. Results
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12. All respondents drive over humps at least once per shift
All respondents drive over humps at least once per shift. Over half do it more than 4 times per shift
June 2003

13. Response to 999 calls
June 2003

14. 67% actively avoid humps
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15. Over half said time was a factor
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16. 30% would add 2 minutes, 55% between 1 and 5 minutes!
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17. Humps slow you down, but respondents would add time to avoid humps
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18. There is no published research concerning actual time delays that humps cause to U.K. ambulances
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19. Transportation of medically unstable patients to a receiving facility
June 2003

20. 59% take a different route
June 2003

21. 31% are concerned with improved care, 25% with patient condition - 56% in total!
June 2003

22. 19 of 20 people would extend time to hospital
19 of 20 people would extend time to hospital. 75% would add up to 5 minutes - but 2 would add 10 minutes!
June 2003

23. In Paramedics’ experiences, patient care and/or conditions suffer significantly over road humps. Times to receiving facilities and definitive care are increased.
June 2003

24. Transportation of patients in cardiac arrest to A&E
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25. All respondents had undertaken CPR whilst travelling over road humps
June 2003

26. More than 50% would deviate
June 2003

27. Of 18 people, 12 would add up to 5 minutes to A&E.
June 2003

28. 50% gave a poor CPR a reason, 25% crew safety
June 2003

29. 90%! Some won’t deviate, but most acknowledge a problem
June 2003

30. Paramedics are the professionals at CPR. They know if it’s poor….
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31. 43% feel outcome was affected….
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32. ….due to poor CPR
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33. Speed humps definitely affect CPR adversely…. …
Speed humps definitely affect CPR adversely…. ….and may affect outcomes in cardiac arrest.
June 2003

34. Conditions affected by speed humps
June 2003

35. June 2003

36. More than half of comments concern exacerbation of condition
June 2003

37. Paramedics and patients agree: speed humps are not conducive to patient care
June 2003

38. Intervention and treatment
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39. Nearly half!
June 2003

40. Some said they would stop the vehicle - but not all….
June 2003

41. June 2003

42. 10 of 27 people would neglect to undertake a procedure they felt was essential solely due to the presence of speed humps
June 2003

43. This study found
Paramedics are willing to add several minutes to a 999 response
Paramedics are willing to add several minutes to A&E with a medically unstable patient
Paramedics are willing to add several minutes to A&E with a patient in cardiac arrest
June 2003

44. This study found (cont.)
Humps affect CPR in the vast majority of cases
Humps affect most patient conditions and injuries detrimentally
Paramedics elect not to undertake essential interventions when travelling over humps
June 2003

45. This is a direct result of speed humps
June 2003

46. Humps present a potentially huge clinical risk
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47. Speed humps affect your patients; your staff; and your response times.
June 2003

48. Recommendations
June 2003

49. Large scale study using both qualitative and quantitative elements
Service/nation wide (national mapping)
Include all types of speed hump
Involve ALL staff
Involve patients
Practical CPR investigation
Investigate injuries to staff and patients
Investigate damage to vehicles (and costs)
June 2003

50. Dissemination
June 2003

51. Full study available at www.belchamber.org/speedhumps
Available personally at posters between 13:00 and 14:00 on Sunday 29th June 2003
June 2003

52. Grateful acknowledgements
Julia Williams and Indra Jones (University of Hertfordshire)
Rachael Donohoe, Rachel Peters and the Clinical Audit and Research Unit team (London Ambulance Service NHS Trust)
June 2003

53. June 2003