Oral presentations

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 …