Abstracts selected through 999 EMS Research Forum peer review process, and presented orally or by poster at Ambex 2002
1 CAN ‘TREAT AND REFER’ PROTOCOLS BE SAFELY INTRODUCED INTO THE AMBULANCE SERVICE?: RESULTS OF A CONTROLLED TRIAL
Winner of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) award for Research Most Likely to Affect Practice
H. Snooks1, N. Kearsley2, M. Halter3, J. Redhead4, J Dale2. 1Clinical School, University of Wales Swansea, Singleton Park, Swansea;2University of Warwick;3London Ambulance Service NHS Trust;4Ealing Hospitals NHS Trust
Background: The number of 999 calls is rising, and some callers have been shown to have non-urgent needs. Evidence concerning the effectiveness of alternatives to the standard 999 service is lacking, although previous studies have highlighted clinical risk for some non-conveyed patients.
Objective: To evaluate the safety of ‘Treat and Refer’ (T&R) protocols for ambulance crews, allowing them to leave patients on scene, with advice or onward referral.
Methods: Treatment protocols were developed by a clinical panel and implemented in one station May - August 2000. Outcomes of care for patients within defined illness codes and attended by trained crews were compared with similar patients attended by crews from a neighbouring station. Pre-hospital, A&E and GP records were collected.
Results: 23 protocols were developed. 260 patients were included in the intervention arm and 537 in the control arm of the study. There were no age / sex differences between groups although intervention patients were more likely to have been attended during the week (χ2 = 4.28, p = .05) and daytime (χ2 = 6.75, p = .01). After follow up at A&E and GPs there were 62 patients for whom no information was retrieved.
Seventeen of the protocols were recorded as used for 110 patients, by all 8 trained crew members. Three patients in each group were admitted to hospital within 14 days of their call, and were judged by clinical reviewers to have been …