Right care, right place, right time?

Ten years ago, ambulance clinicians often perceived their role as responding to patients who had experienced an accident or acute medical emergency. Ambulance services concentrated almost entirely on the need to respond rapidly. While 80% of paramedic training was focused on this group of patients, the experience on the clinical frontline was somewhat different. Where were the endless time critical patients requiring multiple invasive interventions and medicines? The reality was that this group of patients represented less than 10% of the average ambulance workload. The remaining 90% were often labeled as inappropriate as their conditions were perceived as not increasing staff knowledge, testing their competencies or enabling the use of technical skills (Lewis and Bradbury, 1982). The last ten years has brought significant change in the way that ambulance services respond to these patients. Taking Healthcare to the Patient (Department of Health, 2005) recommended that ambulance clinicians should be equipped with a greater range of competencies to enable them to assess, treat, refer, or discharge an increasing number of patients in the community.