Steven Scholes, Eddie Tunn, Mark Newton, David Ratcliffe
Journal of Paramedic Practice, Vol. 8, Iss. 12, 07 Dec 2016, pp 578 - 587

Mechanisms to facilitate rapid ambulance transport of diagnosed STEMI
patients from the community and emergency departments (ED) settings
directly to primary percutaneous coronary intervention (PPCI) facilities are well
established within NHS Ambulance Services. Direct challenge of inter-hospital
transfer requests for non-emergency percutaneous coronary intervention (PCI)
patients by a regional NHS Ambulance Service identified disagreement between
peripheral feeder hospitals and the NHS Ambulance Service on what level of
ambulance transport is most appropriate.

To reduce unnecessary peripheral feeder hospital requests for paramedic
emergency service transfer and resource utilisation in non-emergency PCI
patients and to assess the clinical safety of both non-emergency transport and
multi-occupancy conveyance for this patient group.

A process was established with a regional cardiothoracic centre to support prescreening
of non-emergency PCI patients for conveyance via non-emergency
ambulance resources and multi-occupancy. This included centralisation of all
non-emergency PCI ambulance transport booking practices and dissemination
of learning materials on the process to all stakeholders. During the three-year
period 3172 patients were identified as suitable for conveyance by both nonemergency
ambulance transports. Of this, 36% (n=1767) were conveyed as
part of a multi- occupancy journey and 56% (n=782) were conveyed by nonemergency
resources. Overall, 69% (n=782) of all multi-occupancy conveyances
were undertaken by non-emergency resources. Two clinical incidents were noted
during this period, both of which were managed via clinical telephone advice.

Non-emergency ambulances can be safely used to transport non-emergency
PCI patients via multi-occupancy, following appropriate pre-screening by the
receiving PCI unit. Further work is needed to understand the feasibility of
this across other patient groups in the inter-hospital transfer scenario and its
transferability to other NHS Ambulance Services.

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