In her final column, Eleanor Chapman reflects on her first 10 months as a newly qualified paramedic for London Ambulance Service, much of which has been spent in the bus lane
The NHS is a significant contributor to the UK's greenhouse gases and environmental pollution. The current review seeks to examine the degree to which ambulance services contribute to environmental pollution and provides quality improvement suggestions that may reduce emissions, save money and improve public health. A literature search was conducted to identify the English language literature for the past 7 years related to ambulance service carbon emissions and pertinent strategies for reducing harm. An average of 31.3 kg of carbon dioxide (CO2) is produced per ambulance response in the current box-shaped ambulance design. A number of quality improvement suggestions related to cost, emissions and public health emerge. Ambulance services should consider a range of system-level and individual-focused interventions in order to reduce emissions, save money and promote public health.
The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Trauma: Who Cares? report recommended that people trained to administer anaesthesia and intubate severely injured patients should be available in prehospital environments. Published articles, reference documents and guidance reports were reviewed to compare the management plans and standard operating procedures produced by an ambulance trust in England that provides prehospital emergency anaesthesia (PHEA). Documents reviewed all provide a common un-referenced patient injury list showing indications to perform PHEA but do not state a time frame within which it should be performed. No minimum time before PHEA is started and how long is acceptable to wait for a specialist resource to arrive before an ambulance can transport to a hospital were found. Further work is required to establish and formalise this time frame.
Injuries are a leading cause of death and ill health in children.
To explore the potential utility of ambulance call-out data in understanding the burden and characteristics of child injury.
A cross-sectional examination was carried out of injury-related ambulance callouts to children aged 0–14 years in the north west of England between April 2016 and March 2017.
The majority of the 16 285 call-outs were for unintentional injuries (91.4%), with falls the most prevalent injury type (38.4%). The incidence of child injury ambulance call-outs peaked at age 1 year (233.4 per 10 000 population). Burns in children aged 5–9 years were significantly higher at weekends (<i>P</i>=0.003) and on celebration days (<i>P</i>=0.001); poisoning in 10–14 year-olds was significantly higher at weekends (<i>P</i>=0.001); and traffic injuries were significantly lower at weekends in 0–4 year-olds (<i>P</i>=0.009) and 10–14 year-olds (<i>P</i>=0.003).
Ambulance call-out data can provide epidemiological support in examining the characteristics of child injury and identifying at-risk groups.