The future of the UK's Children's Congenital Cardiac Services has been in question since the Bristol Royal Infrmary Inquiry (Kennedy, 2001) and the subsequent Paediatric and Congenital Cardiac Services Review (DH, 2003). In 2009, the ‘Safe and Sustainable Children's Cardiac Services’ national stakeholder engagement event, concluded that the configuration of children's heart surgery services in England were not sustainable (NHS Specialised Commissioning Group (NSCG), 2009: 5). The NSCG proposed a new model of provision for children's heart surgery in England and Wales with fewer, larger specialist surgical centres (NSCG, 2010). Ultimately, it is anticipated, that this measure will improve the outcomes for children and young people but one of the consequences of this proposal will be longer transfer distances for ambulance crews tasked with managing very sick children with congenital cardiac disease.
A Health Impact Assessment (HIA) conducted on behalf of the NSCG by an independent third party began in October 2010, aims to consider the impacts that each option of this new model could have on:
The possible consequences for ambulance provision have been considered by the HIA such as longer trips to a specialist centre, potentially resulting in ambulances being out of circulation for longer. It has been recognized that without increased ambulance capacity, this increase in journey time may impact on other patients, although the number of cases requiring emergency admission is very small. It was also identified that if the ambulance team called takes the child to the nearest hospital rather than to the appropriate specialist unit, a secondary transfer would be required, thereby increasing time to definitive care. Additionally, it has been suggested that there could be a risk that transfer to a centre that does not provide surgical services could compromise patient safety (NSCG, 2011).
The key message is that ambulance services need to be fully integrated within the new clinical networks, initiating new service arrangements and procedures. These changes must be accompanied by suitable consultation and education of all pre-hospital personnel to reduce the risks highlighted above. Education is particularly pertinent given that emergency calls to infants and young children are uncommon and are often perceived as a difficult and fraught area of practice by many paramedics. Experience of assessing and managing children presenting with congenital cardiac problems will be even less frequent and therefore skill and knowledge acquisition and maintenance may be problematic.
Given the potential impact of this service change on the paramedic, it becomes even more important that pre-registration programmes provide the underpinning developmental anatomy, physiology and pathophysiology related to congenital heart disease, and that opportunities are available for currently qualified paramedics to access CPD opportunities to ensure that they are equipped to meet the needs of the child and the family.