Case study of emergency medical services

Emergency medical services, which encompass both per-hospital and hospital services, are an essential component of any health system. Emergency medical services are a particularly important issue for health authorities in countries with a high burden of morbidity and mortality due to injury and falls. Falls present a huge problem for the health and independence of older people. Having a fall as one ages is not evitable, however the associated mortality and morbidity from a fall is high. Individual consequences range from distress, pain,physical injury and loss of confidence to complete loss of independence.

There are many strategies for those who have already had a fall or fracture. The falls care pathway within the Ambulance service makes a dramatic impact on the number of people injured by falls. The

benefits of the scheme to both patients and ambulance demand are being highlighted by a lot of sources.

One of the most important benefits is that the injured people due to falls can be treated in their home and will not be taken to hospital. Historically, patients who have fallen once are more likely to fall again, which greatly increases their risk of serious injury, broken bones and may lead to a reduced quality of life. Moreover, the healthcare falls prevention teams assess the needs of fallers and provide additional support or equipment to reduce the risk of the person falling again. In the event of non-life-threatening injury, the

falls care pathway seems to be really helpful. The falls care pathway within the Ambulance service ensures to provide the best possible service to patients suffering from emergencies such as injuries caused

due to falls.

Engaging people in targeted and evidence based prevention, selfcare and management program-mes increases their overall fitness, sense of well-being, compliance with medication regimes and their opportunity to live a life with improved confidence and free from disability. Comprehensive falls care pathways require primary, community, acute and social care working effectively together.

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A falls care pathway, commissioned locally by health and socialcare from a multidimensional team, can use the expertise of a range of professionals to deliver a "right place, right time" intervention. (reference / www.icpus.ukprofessionals.com/ICPs.html - website of the Integrated Care Pathway Users Scotland.)

BASED ON A REAL CASE STUDY: MARIA

Maria is a 73-year-old woman. She is superannuated (she used to work in a factory) and she came to the attention of the health service in October 2001. During the last two years she has experienced memory troubles and behavioral changes, resulting in loss of self-determination in her daily life (CIRS severity: 2.6/5; CIRS co-morbidity: 5/13; MMSE: 14/30; Cornell scale: 19/38; NPI: 69/144).

Maria has severe problems with mobility that lead to falls and accidents and she cannot intake food without help (CDR: 3/5; SOB: 15/30; ADL: 1/6; IADL: 0/8).

Following a clinical examination, Maria is diagnosed with serious vascular dementia (according to the NINDS-AIREN criteria) and is prescribed medication to handle her associated behavioral problems. Maria lives at home with her daughter, who works full-time during the day (ICA: 15/24).

She is also back up by an informal network of people. Neighbors help with meals and therapies, but she is alone at home for the most of the day Her daughter is concerned about this, whose working performance and relationships have been influenced (CBI: 65/96). Maria's low income does not permitted for private home assistance or temporary admittance to a nursing home, and social services are neglected of her case. Her daughter feels that her mother should stay at home with her.

Social services are contacted to value the family's income and inquire the possibility of home care support. They arrange for her to receive home help.

By January 2002, Maria shows an development in her attention capacity (MMSE 17/30). Her behavior has also corrected (Cornell scale: 13/38). Her daughter reports a decrease in the number of confused episodes and neurological and psychological anxiety, and Maria is sleeping throughout the whole night (NPI: 27/144).

Aspects of Maria's ailment die hard, but there are improvements in eating independently, due to socialization interference(ADL: 2/6; IADL: 0/8). Her mobility problems last out, but she has not had any falls since the process started and there have been good improvements in her daily living activities and environmental aspects (CIRS severity: 2.6/5; CIRS co-morbidity: 5/13; CDR: 3/5; SOB: 15/30). Her daughter expresses an improvement in her worth of life too (CBI: 56/96). The therapy remains unchanged.

By July 2002, Maria makes more improvements (MMSE: 19/30; Cornell scale: 6/38). Her behavioral changes have vanished (NPI: 14/144), although her loss of autonomy remains (ADL: 2/6, IADL: 0/8, CDR: 3/5; CIRS severity: 2.6/5; CIRS co-morbidity: 5/13). The daughter feels less concerned (CBI: 37/96). As a result of comprehensive cohesive care combining medical, pharmacological, nursing and social support, Maria's situation has immensely improved. This particular treatment is considered complete and will be replaced with a new care idea.

references/http://www.londonambulance.nhs.uk/working_for_us/career_opportunities/ambulance_staff/emergency_care_practitioners.aspx

Department of Health (2007) Urgent Care Pathways for Older People with Complex Needs - Best Practice Guidance. London: DH.

Department of Health (2001) National Service Framework for Older People. London: DH.)

THE ASSESSMENT AND PREVENTION OF FALLS IN OLDER PEOPLE;

Description

The DH states that older people presenting with falls is a larger issue for A&E Accident & Emergency (A&E) departments. It draw attention to that there is considerable under-reporting of blackouts and falls in older people because the outcome of the fall (namely, the injury or fracture) becomes the diagnosis, the sole focus of attention and the succeeding code for the episode of care. The DH finalizes that over one-third of falls go unreported in computerized A&E records, which in practice end results in the wider issue of falls prevention becoming omitted.

The falls care pathway, as delineate in the NICE and NSF guidance , strike primary prevention (lifestyle and environment issues); case finding of people who are at risk of falling or who have fallen or; multidisciplinary estimation for falls risk factors; and multichannel and an individualized intervention for falls prevention.

The NICE clinical guideline on falls haul older people who live in the community, either at home, in a residential or nursing home or in a retirement complex. In this guideline, an older person is expressed as someone who is aged 65 or older.

The NICE guideline doesn't cover older people who are hospitalized and bed bound for reasons other than treatment after a fall. Also, it does not look at the prevention and medication of arthritis, which will be covered in another NICE guideline.( Department of Health (2000). Domiciliary Care, National Minimum Standards Regulations. Care Standards Act 2000, Department of Health. London: Department of Health. NICE (2004) Falls: The Assessment and Prevention of Falls in Older People. London: NICE.)

THE ROLE OF PATIENT TRANSPORT SERVICE (PTS) DRIVER/AMBULANCE CARE ASSISTANT;

Ambulance care assistants/PTS( patient transport service) drivers usually work in the patient transport service of an ambulance service trust, where they will drive elderly, disabled, and vulnerable people to and from routine hospital admissions,out patient clinics, and to daycare centers.. They may sometimes known as PTS drivers.

They often see the same people on a daily basis, getting to know them. Some of their passengers will be worried about their hospital visit and others will prime isolated lives.

Based at the central terminal such as a large hospital with a team of other associates, depending on the vehicle type they drive. They cover a specific area and work shifts.

They might be part of a two-person team using a conspicuously designed ambulance with a tail-lift for wheelchairs, carrying numerous people on each journey. They might work on their own, to transport one or two able-bodied people at a time by driving a standard car.

As well as driving they also move and lift some patients in and out of the vehicle. They make sure that the patients they are transporting are comfortable and safe during the journey and that they pull in on time for their appointment. Ambulance care assistants are trained in resuscitation also in case a patient is taken ill while in their care.

Other duties include keeping an accurate record of journeys undertaken and making sure that the vehicle is clean and tidy.

A skillful general education is usually mandatory to work as an ambulance care assistant/PTS driver, although many ambulance trusts require NVQ GCSE or relevant work experience and/or equivalent qualifications.

In order to drive an ambulance, whether non-emergency or emergency, we will need a full, manual driving license. Ambulance service trusts use vehicles of different massive weights and staff will be prescribed to hold a driving license with the applicable classifications to enable them to drive vehicles in that specific trust. In some ambulance services, a 'standard' driving license may be agreeable,Some services may provide reinforcement for staff who need to gain further license classifications, but this is not authoritative in some areas. It is therefore elemental that applicants check with each ambulance service trust to which they anticipate to apply.

Ambulance care assistants take a two to three week training course in which they learn handling and moving techniques,basic patient skills , first aid, and safe driving techniques. The course incorporates written practical examinations,assessment and successful trainees are then attached to an ambulance station where they work under the instruction of a trained supervisor for a probationary course before working unsupervised.(Royal College of Physicians Clinical Effectiveness and Evaluation Unit (2007) National Clinical Audit of Falls and Bone Health in Older People. London: RCP.)

ISSUES AND TAKING RESPONSIBILITY.;

It is intolerable by any employer to reach at work intoxicated. It should be intolerable to everyone as well! We are licensed professionals ,trained, and should keep that appearance at all times while on duty or off duty. Smoking or downing before you come into work are not ways to help you get through your shift in a secure manner. You put everyone at risk by using alcohol or drugs while on duty and it may cost us our job and freedom. If anyone has a drug or alcohol problem, immediately seek counseling . If we cannot control our substance abuse problem, then perhaps the medical field is not the place for us.

If we take prescribed medications that may impair our judgment, decision making ability or our ability to drive, we should contact our employer and advise them of the situation. It could mean the difference between life and death...ours, our partner's, our patients' and the general public's!(Care Ambulance Service, Inc.". http://www.careambulance.net/home1.asp. Retrieved October 27, 2006)

OVERCOMING ISSUES.;

Be aware of our surroundings at all times:

Understand that when we arrive on scene there may be different things going on that could compromise our safety and the safety of our partner. Scene overview should be the first important thing that comes to mind. This overview begins fleetingly when the run comes in. Road conditions, weather conditions,road construction and traffic flows are few of the things to consider when responding to any run.

2. Paying strict attention to hazardous scenes:

Whether we are on an auto accident scene, traumatic scene, fire scene or some other cases, we need to be aware of everything around us.

Fuel leaks, downed power lines, hazardous material leaks, industrial facilities or building collapses are a few areas where we need to pay strict attention to the scene. Watch for things that may pose a risk to us, your partner and our patient and identify ways to make a rapid egress we should need to escape quickly.

3. Taking appropriate measures on violent scenes:

When responding to any scene where violence is happening, take appropriate measures that allow us to sit at a distance until the police arrive on incident and properly secure it. Stay at a safe distance where we are out of sight until police properly clear the scene and signal a safe and sound return. Running into a drug overdose or known violent scene without police security could cost us and our partner our lives. Never, follow a police car into a scene. If the authorities require to draw their weapons, we don't want to be in the line of fire!

4. Wear equipment and safety gear:

There is no excuse for not wearing our issued safety gear. Helmets, gloves, safety vests, EMS turnout gear,, and other safety equipment which are designed for our protection. Never take items for granted. They are created to reduce injuries and limit or stop chemical exposures and exposures to blood borne pathogens. By wearing our gear, we can also prevent transmission of diseases and exposures of hazardous materials to our self and our loved ones.

5. Always operate our vehicle in a safe manner:

There are never any apologies to drive in a manner that brings danger to our self, our partner, our patient and the general public.

It is already dangerous operating ANY emergency vehicle during the course of a shift, and by driving in a mode that is less than safe is detrimental to our health as well as others around us. We should operate our vehicle with due caution during wet, snowy or foggy conditions. We should always pay attention to the weather and road conditions. Avoiding sudden stops and take offs during inclement weather which may prevent an unwanted accident. No matter how lousy the road conditions, we should take our time and get to our destination in one piece. Remember, it's their emergency, not ours!

Placement of our ambulance at dangerous scenes, such as auto accidents, is eminent. Place it in a manner that allows us rapid access. We usually park at least 200 feet in front of an accident spot on the shoulder at an angle. This places us well in front of the spot and raise a buffer between us and the accident. Remember, we are the most essential people on the scene, and without us, our patients can't obtain a high-quality care they need. We should never, turn our back on traffic! If need to step back to our vehicle, walk backwards. This will allow us to remain watchful of other vehicles and just may save our lives."Services". Care Ambulance Service. http://www.careambulance.net/services.asp. Retrieved October 27, 2006. )

EMT THE PROFESSION OF HELPING OTHERS;

In the world of physic the EMT, otherwise known as an (emergency medical technician), is the front line at the scene of an emergency crisis. The EMT-Basic help patients by giving first aid and vital life support at the scene, in the ambulance and during transport to the clinic. The EMT-B is the variance between life and death for many patients. Programs that educate people to become .EMT and EMT in California are speedily gaining popularity. A CA EMT-B career can be very gratifying. Emergency medical technicians help patients and are the first line of medical assistants when there is a medical trauma. It is a fast tread and often action packed career. However, a CA EMT-Basic profession is not for everyone. It takes a extraordinary type of person to be an EMT and to endure the training that is intricate in embarking on a CA EMT-Basic profession.

The inclusive role of an employee of an ambulance service can be differentiating into two groups: clinical personnel and administrative personnel. Personnel administrative typically do not respond to calls in an ambulance service. On the other side, clinical personnel expend the majority of their time responding to ambulance calls out in the field and away from organizational staff. That does not mean, however, that clinical staff members never share executive responsibilities.

People look for emergency medical technician (EMT) training for a various reasons. Some wish to work for a fire department or an ambulance service; some people want to perk up their resumes; and others just wish to prepare themselves with advanced first-aid intelligence. Regardless of your ambition, becoming an EMT can be difficult and demands much energy and time. (http://www.health.nsw.gov.au/countrycareers/allied_other_health/ambulance_service.asp''/

Ambulance radios 'fail in rain'". BBC News. 2010-07-13. htp://news.bbc.co.uk/1/hi/england/london/10608021.stm.)

CAREER DEVELOPMENT;

A career in the Ambulance Service provide secure employment, promotion prospects ,continuing professional development, splendid terms and conditions as well as a gateway to other roles in the NHS.

The Trust is actively attempting to recruit people from all cultures, regardless of gender, race or disability. The ambulance service copes with emergency and non-emergency healthcare. Staff working in addition, as part of an ambulance crew, there is also a team of people with different roles who provide the essential back-up.

There is a diversity of different opportunities for us to work within the ambulance service. (Ambulance care assistants/PTS drivers can undertake boost training to become emergency care assistants. With further training and experience, they can apply for student paramedic positions, and if successful, progress to becoming a registered paramedic. They would have to pass entrance exams and fulfill furthermore selection criteria before being accepted onto a paramedic course. Only a select amount of schools can offer a concentrated 2 week EMT boot camp where participants can gain the real time hands on experience and become certified EMT s in a shorter time than traditional programs. This accelerated program is focused on a CA EMT-Basic profession, but most states will accept certifications and training obtained through this medium.

PTS ambulances do work by ambulance care assistants (sometimes known as PTS drivers) who are trained in the particular needs of these patients as well as in comprehensive first aid, specialist driving skills, patient moving and handling techniques, basic life support and patient care skills. Although this work does not dissemble emergency duties it is crucial to most ambulance services and provides opportunities to support and give assistance to those in need.

The patient transport service uses exclusively designed vehicles (usually with tail lifts) to deliver high levels of comfort for patients, whilst the attendant will travel with the patients so that they may relieve anxiety during the early stages of hospital admission. In some services a number of PTS staff members are specially trained as high dependency teams which are available for patients with specific clinical needs during transport.

Accident and Emergency services.

On 17 December, the Secretary of State declared the introduction of a series of clinical quality indicators for A&E services from April 2011. They replace the standard set by the former Government that no patient would spend more than four hours in accident and emergency (A&E) departments from arrival to admission, transfer or discharge. They have been settled by Professor Matthew Cooke, National Clinical Director for Urgent and Emergency Care working with the College of Emergency Medicine, the Royal College of Nursing and lay representatives.

The objective of the clinical quality indicators is to provide a more balanced and comprehensive view of the quality of care. This includes clinical effectiveness, outcomes, service experience and safety, as well as timeliness. These indicators detach the isolated focus on achieving faster care at the amount of higher quality care. The clinical quality indicators also aim to fuel a more sophisticated discussion and debate about quality of care to support a culture of continuous improvement. Each A&E department will present data on achievement against the indicators on their website, as well as some narrative text to narrate what their performance means and how they plan to continuously get better their service.

Timeliness of nursing will still be an important factor - as it is not appropriate for unnecessary delays in care to increase. But crucially time will not be the only component.

Importantly, the ambulance clinical eminence indicators will improve the quality and shield of care by focusing on those groups of patients who need the most instant care rather than according to the category of the call alone.

Ambulance drivers normally work forty hours a week. They work unsuitable hours including nights, holidays and weekends. Since many ambulance calls involve cases of life and death, drivers work under intense pressure. Ambulance drivers may have to perform physically laborious duties. The work is very demanding and requires a high degree of obligation. (www.ambulance.vic.gov.au) Melbourne Link www.rav.vic.gov.au)

WORK ENVIRONMENT:-

Ambulance Care Assistants are answerable for shifting the non-emergency patients to and from fitness or community care setting, including hospitals, for approved appointments. They are also identified as Patients Transport Service (PTS) drivers.

Your tasks as an Ambulance Care Assistant will include:

* help the patients from their home to the ambulance

* taking the patients carefully and happily

* bringing the patients back and guaranteeing that they progressed in earlier than leaving

* carrying out routines care of ambulance gears and every day vehicle checks

* maintaining the records of journeys

The people you are taking might be very ill. A substantial part of your work will be to bring home sympathy and respect to frequently worried patients and their relatives, who might include:

* People having psychological health problems

* Adult people

* Person who are physically handicapped

In case of some ambulance service, you can be instructed to work in a high enslavement team, taking patients with particular clinical requirements on a standard basis. During a transmutation you will remain in assist with support personnel at the control room through telephone who will give you the clinical recommendation if an emergency takes place. (http://www.pcw.co.uk/computing/analysis/2073427/emergency-room-london-ambulances-won-crash-again-expert. Retrieved 2009-06-11.)

QUALIFICATION, EDUCATION AND EXPERIENCE:-

Every provincial ambulance service can place its own entry criteria (and induction training pro gramme), so it is very imperative to confirm the information with the ambulance service you desire to join. In general, to do the job as an ambulance care assistant, you will require:

a full hand driving license- if you cleared your test after 1996 summer, you will require additional driving qualification

a good understanding of the Highway Code

fitness confirmation (as your duties will include lifting and carrying)

excellent driving skills with experience of driving

good awareness of the area and ability to represent the maps

You will also require a fundamental mathematics and English skills. Various employers might give preference if you have approximately 4 GCSE s (A-C) which includes the subjects like Science, Mathematics and English plus a current first aid certificate. Make certain with your home ambulance service as substitute abilities or experience in a direct care-related role might also be acknowledged.

You will also get links to regional ambulance services on the website of NHS Choices.

TRAINING DETAILS:-

Being a beginner Ambulance Care Assistant (ACA) you will get the training for 2 to 4 weeks in the areas like:

transferring and dealing with the techniques

first aid which includes manual emergency calamity management

overseeing oxygen therapy

superior driving skills

recovery

Your test will be accomplished through out the training and your practical and written examination will be taken. If you achieve the standard which is place by the assistance, you will be involved to an ambulance station where you will work under the supervision of a skilled adviser for a provisional period. After this time, you will be permitted to work unofficial.

SKILLS & KNOWLEDGE:-

a Kind, compassionate and sociable personality

superior driving skills

a severe approach to work

excellent organizational and time keeping skills

capacity to work with the team

emotional and physical stamina

capability to give confidence to nervous or concerned patients

spoken and good written communication skills

self-possession, with the aptitude to work with wide range of people across all levels

an incontestable desire to help out the people

capable of working under pressure

sympathetic about the matters related to confidentiality

SALARY AND OTHER BENEFITS:-

Ambulance Care Assistant can put together between £ 13,500 and £ 16,500 every year.

If experienced, this can increase to around £ 18,200.

Further allowance might be given to the workers in some geographical areas and to those scheduled to work unsocial hours.

WORKING CONDITIONS:-

You will fundamentally work for 38 hours in a week, which might include some weekends, bank holidays and evenings. Part-time positions are also accessible.

This job is physically demanding and you will spend most of time on the road covering in special geographical area. Infrequently, you might handle challenging situations or conditions with critically sick patients. You will be wearing uniform and extra protective clothing. You might work without any help or in 2 person team, in a modified ambulance or customary car.

DIFFERENT OPPROTUNITIES:-

You will get the job instruction in the NHS, though you might be worked and trained in the private ambulance sector and in the armed forces.

Understanding as an ACA has been the predictable way to other jobs in the service; however, there is no definite succession route. You will have to make an application for position along with exterior candidates, but your experience is expected to give you a benefit when giving for Student Paramedic position or Emergency Care Assistant.

Now, the ambulance service is not longer appointing learner ambulance technicians. You can visit the ambulance profession profile for more information.

You can also get into other realm in the ambulance service like operation management, training, safety and health and personnel. South Western Ambulance Service NHS Trust (2006)

CONCLUSION;

Being a paramedic is an insolent fulfilling and rewarding career. Having the capability to help people in times of work and need makes a difference. It is a very vigorous WORK.

They pay us to save lives. This job is challenging and requires doing best to save peoples lives.

Every day includes thinking outside the square. There is a large amount of variety, no 2 days are the same - even the routine cases are unusual. Working 4 days on 5 days off in 12 hour shifts, there is brilliant support and frequent training, a strong network of friends and peers within an ever changing outstanding workplace.

You are paid well and you can be asked to work in any place in the state. If you need to displace for work the service pays your relocation costs. There are number of opportunities for progress within the Ambulance Service, either in clinical or operational areas. Aim is to reach the top clinical level - Intensive Care Paramedic.

You need great interpersonal active skills to be a paramedic, you are dealing with people at an intense point in their lives and it's a great proficiency to be able to deal people. Communication and listening skills are important in perceptible how to help people in a given circumstance Problem solving and logical skills are essential, as is team work, having the aptitude to lead and to delegate tasks but also be able to follow someone else lead. Another good ability to have is being able to think promptly and respond to what the condition requires.

it is a rewarding and fulfilling experience. You make a difference to people's lives every day.

Care pathways serve different goals for all the stakeholders related, such as clients, carers and managers in the health and social division, public and private service providers, voluntary organizations and non-government organizations (McQueen and Millay 2001; Integrated Care Pathway Users Scotland).

Care pathways serve the needs of clients through:

Better opportunities and practices, based on pragmatic testimony on outcomes, such as health, activities of daily living (ADL), mobility, quality of life, well being, cost-effectiveness, quality of life and respect for the person and their rights

Continuity of care to make sure the quality of life for the carers, providing added value to informal care

Standards of care and expenses becoming explicit to clients and their carers

Increased client involvement

Improved communication.

Clarity about what benefits and risks can be expected

Care pathways operate the needs of professionals and managers through:

Standards of care and expenses becoming explicit, justifying professional activities and the means that are required

Care advances being incorporated into daily practice

Better value of care and worth of life for the client and her/his family, which may add to professional demand

Support to staff in daily decision-making

Enhanced collaboration and decision-making

Participation of all professionals and managers in improving care

Unreadable roles, responsibilities and actions to be taken that are amenable to education and training

Effective use of resources

Easier audit by variance-tracking instruments, which manage whether interventions have been carried out

Better understanding of the demand of clients and their carers, as well as shortcomings of the systems (or the care pathway) by evaluate variations in practice.