References
Are early warning scores too early for paramedic practice?
Abstract
The use of early warning scores (EWS) is now widespread in medical practice. Typically, EWS are used in inpatient settings to identify patients who require additional intervention to avoid unexpected intensive care admission or death. Prehospital care involves the rapid identification of critical illness but also undifferentiated urgent care. This large range of variation in acuity means EWS systems must be particularly accommodating. This article explores the use of scoring systems in paramedic practice and argues the need for more research, especially in non-trauma based tools.
Health professional reported experience and published evidence (Kause et al, 2004) indicate that patients demonstrate signs of physiological deterioration before cardio-respiratory arrest. It is well known that these patients may be identified whether they are adults (Kause et al, 2004) or children (Tume, 2007); and a variety of ‘early warning systems’ (EWS) have been developed to enable health care staff to recognize pre-arrest physiological changes. EWS have typically been developed for use in the hospital setting.
The Appendix demonstrates an example of the components of an EWS which are standard basic observations (temperature, respiratory rate, heart rate, blood pressure etc.), but may also include scores for subjective assessment (such as work of breathing).
Typically, EWS are adjacent or integral to observation charts. Observations outside the normal range require a graded response by nursing or medical teams and sometimes the activation of a specialist outreach team.
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