Background Ambulance pre-alerts inform receiving emergency departments (EDs) of the arrival of critically unwell or rapidly deteriorating patients, who need time-critical assessment or treatment immediately upon arrival. Over and inappropriate use of pre-alerts can lead to EDs diverting resources from other critically ill patients. There is limited guidance about how pre-alerts should be undertaken, delivered or communicated.

The pre-alerts study aims to understand how pre-alert decisions are implemented by pre-hospital staff, and the impact on receiving EDs. There are five work packages. This abstract represents part of the first: To map and compare existing pre-alert guidance from all UK NHS ambulance services.

Methods We contacted medical directors, education leads and research teams in all UK ambulance services to request any documents containing guidance about pre-alerts. We reviewed all documentation and mapped the guidance, to understand which conditions were recommended for pre-alert, identify variations in vocabulary and alignment with AACE/RCEM pre-alert guidance (2020). We reviewed language and accessibility of provided documents using the Agree II Tool (AGREE Next Steps Consortium, 2017).

Results We received responses from 15/19 UK Ambulance Services. Five had no specific pre-alert guidance. We identified noticeable variations in conditions declared suitable for pre-alerts, a lack of consistency within each service’s own guidance, and alignment with the AACE/RCEM pre-alert guideline (2020). Services listed between 4–35 different conditions suitable for pre-alert. There were differences in physiological thresholds and terminology, even for conditions with established care pathways, e.g. Hyperacute Stroke. Pre-alert criteria were typically a short section in lengthy handover procedure policy documents.

Conclusion Trusts need both policies and tools: A policy to explain the pre-alert process, and allocate responsibility for tasks required, and a quick reference tool for use in time-sensitive situations. Trusts should have a single pre-alert policy incorporating appropriate national guidance that other policies directly reference.