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Ambulance response shake-up 'saving 43% more lives'

A new system has saved 1182 more patients in the first year since it was launched.

A new response system for the Scottish Ambulance Service (SAS) has saved 1182 more patients in the first year since it was launched, according to an evaluation.

The clinical model introduced in November 2016 priorities how the SAS responds to patients so those at immediate risk receive the highest priority response. 

An evaluation from Stirling University found a 20% increase in survival in January 2017 with SAS data showing a 43% increase across the whole year.

The system was developed following a clinically-evidenced review and those who suffer a cardiac arrest or have been involved in a serious car crash should receive the fastest response.

Call handlers may spend more time with patients in less urgent cases, or who made the emergency call on their behalf, to better understand the issue before an ambulance arrives.

Pat O'Meara, general manager for the ambulance control centre, said: "The biggest change for the staff and the control rooms is that they are dealing with the dispatch of the resources differently.

'It's about the type of response we're sending rather than the time of the response.'
Pat O'Meara, general manager for the ambulance control centre

"So we are sending the most appropriate resource at the right times, so for example if you have a patient who is having a heart attack, the crews will get there and do their magic but we need to get them to the right treatment centre straight away so it's not only resource that's suitable in dealing with the patient's illness but also getting to the hospital that's important.

"It's about the type of response we're sending rather than the time of the response." 

He added: "I call the call handlers and staff in here the unsung heroes, they are critical to the chain of survival of our patients.

"They have the same enthusiasm and interest in the outcome's being right for the patient as the paramedics and technicians delivering care."

Jim Ward, SAS medical director, said: "The results published today are very encouraging - they show an increase in survival rates for our most at-risk patients and they demonstrate improvements across a whole spectrum of other clinical situations.

'The previous response model had been in place, virtually unchanged, since 1974, so designing a better model to provide a good response for all patients has been a top priority for us.'
Jim Ward, SAS medical director

"The previous response model had been in place, virtually unchanged, since 1974, so designing a better model to provide a good response for all patients has been a top priority for us.

"We now have an evidence-based approach which identifies patient need and matches our response accordingly. Our aim is to give every patient the best possible service we can.

"For those patients in critical situations, this can be literally lifesaving, whereas for other patients, such as those with chest pain or stroke symptoms, the priority is getting a high-quality clinical assessment before being transferred safely to a specialist unit."

The evaluation also found a 21% increase in the number of cardiac arrest patients with a pulse when they arrive at hospital, and a 100% increase in having two crews at the scene of these cases.

This allows both crews to deliver more advanced treatment and increase the patient's chances of survival.

It also found an increase in the number of patients being taken to specialist facilities such as stroke and heart units rather than the nearest hospital.

Mr Ward added: "The results of these evaluations are extremely positive and give us a real foundation to build on this work and make further improvements.

"We now have a real opportunity to better balance our historical focus on response times with a clearer understanding of how we can optimise the way our highly-skilled paramedics respond to ensure an excellent outcome for each patient.

"The report highlights a number of other clinical areas where we are performing well. An increasing part of our workload, for example, is helping to support frail, elderly patients.

"As well as excellent clinical care, this group also needs care and empathy - it is a testament to our workforce that they can work across all these demanding scenarios with such a high level of professionalism."

Professor Jayne Donaldson, health sciences Dean at Stirling, led the research which also involved Glasgow Caledonian University.

She said: "While the identification and triage of patients takes time for the call handler and dispatching system, the NCRM (new clinical response model) can get an ambulance crew to patients who need them most.

"Ultimately, this approach has improved the survival of those with immediate life-threatening conditions.

"Those with lower acuity needs are responded to, but in a longer time-period - as is expected when using a priority-based system.

"However, there is no apparent negative impact on survival.

"These conclusions are reached in the context of analysing aggregated data over three fairly short time-periods. "Further research over a longer timeframe, with longitudinal data on individual cases, would improve the evidence base for NCRM."

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