1. Kent Surrey Sussex Academic Health Science Respiratory Network Oxygen Titration Joint Project Andy Collen Clinical Development Manager, Advanced Paramedic (Urgent & Emergency Care) Dr Jo Congleton Clinical Lead, KSS AHSN Respiratory Network

2. Oxygen is the most commonly used drug in emergency medicine 34% of emergency ambulance patients receive oxygen (Hale KE, Gavin C, O’Driscoll 2008) Oxygen is used in approximately 221,000 ambulance incidents in Kent Surrey Sussex each year

3. Oxygen… Too much oxygen may cause 2,000-4,000 avoidable deaths per year in COPD flare ups (National COPD Audit 2003) Administration of high flow oxygen to COPD patients has been associated with increases in mortality, length of hospital stay, requirement for ventilation and admission to high dependency units (Austin 2010) In 2009, 281 serious incidents involving poor oxygen management, resulting in 9 deaths (NPSA 2009)

5. Minimising the risk of oxygen toxicity, by working to BTS ‘target saturation’ guidelines (2008) and using controlled oxygen devices: 28% Venturi masks. Solution

6. Kent Surrey Sussex AHSN Respiratory Network SECAmb Clinical Development Team Who is involved?

7. South East Coast Ambulance Service (SECAmb) 650,000 responses to 999 calls 38,000 of those “breathing problems” 71% (26,600) of “breathing problems” taken to hospital 20% higher than overall conveyance rate

8. The 6 minute Oxygen Cycle

9. All SECAmb staff members given laminate on 6 mins cycle Sep-Dec 2012 Clinical briefing provided through internal Bulletin and Clinical Instruction alerts Local training delivered by SECAmb PPs and Respiratory Network team Annual updates established for all 240 Paramedic Practitioners Venturi masks on all SECAmb Ambulances and Response Cars Implementation

10. Venturi mask standard equipment on all SECAmb vehicles All 240 Paramedic Practitioners are trained and using the 6 minute cycle All 2000 patient facing staff and clinicians have been made aware of the 6 minute cycle and the Venturi masks Sustainable training established Outcomes 1

11. NIV decreased by 18% in Surrey between 2012-2013 Conveyance rate has fallen by 14% to 65% over the last 3 years 5,300 less patients taken to hospital per annum Outcomes 2 Aug 2012 to July 2013Aug 2013 to July 2014Var Sussex272238-12.50% Surrey178145-18.50% Kent497495-0.40%

12. South East Coast Ambulance Service Reduction in conveyance rate for 999 calls for Breathing Problems

13. Next Steps Audit acidosis on arrival at A&Es 6 Minute Cycle Roll out programme to all A&Es across Kent Surrey Sussex in 2014-15