Is paramedic practice ready to adopt the NICE Transient Loss of Consciousness Guideline?

Non-conveyance pathways are emerging into practice, as projected within the modernisation agenda, for ambulance services (Department of Health (DH), 2005). As 999 calls continue to rise annually, it is likely that they will play a far more significant role in managing the increasing workload of non-emergency calls. The introduction of more specific referral and self care pathways may improve operational responses by increasing ambulance turnaround times, and additionally reducing the strain on emergency departments (ED). However, a recent review of the pre-hospital evidence base identified a deficiency in evidence relating to non-conveyance pathways (DH, 2010a). With the increasing significance of high-quality care and patient outcomes in healthcare policy (DH, 2010b), it is of paramount importance that prospective pathways are evidence based to prevent any detriment to patients.

In 2010, the National Institute for Health and Care Excellence (NICE) developed a guideline for the management of patients experiencing transient loss of consciousness (TLoC). It states that patients diagnosed as having a benign cause of TLoC, i.e. ‘uncomplicated faint’ or ‘situational syncope’ and who have fully recovered, do not require ED admission and can be managed within the community (NICE, 2010). The guideline was developed for use within various healthcare settings, which was extended to include the ambulance service. However, it must first be determined whether paramedics possess the necessary level of clinical competence and decision making ability, to safely use the guideline and minimise risks to patients.