1. June 2003 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)

2. June 2003 Or….

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

4. June 2003 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!

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

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

7. June 2003 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)

8. June 2003 Methodology (cont.) Data Analysis Closed questions (nominal and ordinal data) charted where appropriate Free text analysed for thematic content SPSS, MS Excel and Lotus 1-2-3 used Information graphed and cross-tabulated Qualitative responses categorised to establish potential relationships

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

10. June 2003 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

11. June 2003 Results

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

13. June 2003 Response to 999 calls

14. June 2003 67% actively avoid humps

15. June 2003 Over half said time was a factor

16. June 2003 30% would add 2 minutes, 55% between 1 and 5 minutes!

17. June 2003 Humps slow you down, but respondents would add time to avoid humps

18. June 2003 There is no published research concerning actual time delays that humps cause to U.K. ambulances

19. June 2003 Transportation of medically unstable patients to a receiving facility

20. June 2003 59% take a different route

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

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

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

24. June 2003 Transportation of patients in cardiac arrest to A&E

25. June 2003 All respondents had undertaken CPR whilst travelling over road humps

26. June 2003 More than 50% would deviate

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

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

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

30. June 2003 Paramedics are the professionals at CPR. They know if it’s poor….

31. June 2003 43% feel outcome was affected….

32. June 2003 ….due to poor CPR

33. June 2003 Speed humps definitely affect CPR adversely…. ….and may affect outcomes in cardiac arrest.

34. June 2003 Conditions affected by speed humps

35. June 2003

36. More than half of comments concern exacerbation of condition

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

38. June 2003 Intervention and treatment

39. June 2003 Nearly half!

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

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

43. June 2003 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

44. June 2003 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

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

46. June 2003 Humps present a potentially huge clinical risk

47. June 2003 your patients; your staff; and your response times. Speed humps affect

48. June 2003 Recommendations

49. June 2003 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)

50. June 2003 Dissemination

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

52. June 2003 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)

53. June 2003