Private Ambulance Service Providers

Private AmbulancePrivate Providers Service InspectionReport October 2010 October

InspectionMethodology the contains theseresults inspections. of report This 2004. Order, (Amendment) and 2000 Order, Establishment PHECC the of (r) 4 Article to pursuant conducted was CPGs, PHECC implement to approval for applied successfully previously had who Ireland, in services ambulance private the all of inspection an year this April In andguide facilitate best practice in the delivery patient care.of (CPGs) Guidelines Practice Clinical publishes Council Regulations, (Amendment) Supply) of Control Statutory relevant Council the with keeping In the within detailed are PHECC of responsibilities Instruments of 2004 the2000, and 2007Health Act. and roles precise monitoring and The maintaining reviewing, specifying, by public standards excellence of for the ofdelivery quality emergencypre-hospital care for in Ireland.people the protect to is mission PHECC’s by Provisions)(Miscellaneous Act2007. enhanced Health the further and Order) Amendment were (PHECC 2004 responsibilities of 575 Number PHECC’s Instrument Statutory subsequent Order). Establishment (PHECC with 2000 body of 109 statutory independent Number Instrument Statutory in Children in and an Health for Minister care the by established was It emergency Ireland. pre-hospital is of field the (PHECC) in training and education Council standards, for responsibility Care Emergency Pre-Hospital The Introduction template (See Annex A). In addition to this, private ambulance services were also advised of the of inspection advised the also were per services as ambulance private year this, this to May addition In and A). April Annex in (See template conducted was inspections of round initial An and the detailing main toareas investigated. be The process concentrated sevenon key areas: process, inspection the outlining template a given were services all inspections these of conduct the guide and assist to order In services. ambulance private of inspection national ever first the was This and use to authority their with implement CPGs. PHECC associated responsibilities and obligations the with their ascertain compliance to order in visits inspection on-site conducting be would PHECC that notified were 3 - CPGs PHECC implement to authorised services, ambulance private all 2010 February In        Establishment Orders and with the Medicinal Products (Prescription and (Prescription Products Medicinal the with and Orders Establishment System of Clinical of Audit System Management Information andDevelopment Policy Training employees Registration- Status andvolunteersPHECC CompetenceEnglish Language Security Clearance Insurance rd Edition, to

rescinding of CPG approval and notification being sent to the private health insurance companies insurance accordingly. health private the to sent being notification and ambulance approval CPG These of rescinding period. month 3 in result a could satisfaction, PHECC’s to addressed not matters following any that cautioned also were services repeat compliance a ensure conduct to would inspection PHECC that final advised targeted and identified deficiencies any address to 3 of months period a given were services The satisfaction. PHECC’s to recommendations report own their address to service each for requirement PHECC’s of aware made were services ambulance seven All insurance companies. health private the to sent also was précis de-identified aggregated this of copy A reports. seven the of précis de-identified aggregated an given also were Services services. ambulance private seven the to sent was service, ambulance each to specific Inspection, of Report comprehensive of a round inspections initial the of completion On inspected. were services ambulance private seven of total A recently approved by Annex Council (See B). the of implications 4. The functions4. the of Council shall be to:- emergency care. practitioner, whether as volunteer, a contractoror employee, pre-hospital provides unincorporatedor an of body on persons whose pre-hospitalbehalf a emergency care Definition - Establishment and Amended EstablishmentOrders. The and basis authority forconducting inspections arise from PHECC the Authorityfor Inspection practice guidelinespractice prepared pursuant sub to (o) article thisArticle.of emergency providers care service which undertakeimplement to the clinical in (r) recognise, withaccordance rulesCouncil, made by those pre-hospital providers and such persons other it mayas consider appropriate. make availablesuch toguidelines pre-hospital emergency care service prepare(o) clinical guidelinespractice forpre-hospital emergency care and THE PRE-HOSPITAL EMERGENCY (ESTABLISHMENT) COUNCIL CARE ORDER, 2000(AMENDMENT) ORDER, 2004. “pre-hospital emergency careservice provider pending implementation of the PHECC Interfacility Patient Transport Standard, Transport Patient Interfacility PHECC the of implementation pending S.I. No. 575 No. ofS.I. 2004 ” means a body corporate .

This was the first ever national inspection of private ambulance services. The inspection process was process inspection The services. ambulance private of inspection national ever first the was This Conclusions column. The right hand column indicates the current statusthe following inspection. hand left the in listed are applied recommendations these which to services ambulance of number the and recommendations specific The C. Annex at available is report aggregated final the of copy A Clinical PHECC implement to approval Ltd’s Needford rescinded Guidelines.Practice meeting same the at Council PHECCthe Clinical Guidelines Practice – 3 implement to recognised are who services ambulance Patient private Facility six The Inter B). (Annex the Standard Transfer implement to capacity to relation in requirements PHECC the meet also and inspections the in requirements PHECC’s all satisfied have Services Ambulance Private services 14 Thursday on meeting its at Council, InspectionFindings Finally PHECC would like to acknowledge the cooperation of all of the private ambulance service ambulance private the providers and thank them for their professionalof approach to conductthe of inspections. the all of cooperation the acknowledge to like would PHECC Finally result a As PHECC. and services ambulance arePHECC now position to in a state: private the both for exercise valuable extremely an      good stead going forward to extend the inspection regime to the statutory, voluntary and auxiliary ambulance service providers. statutory, the to regime inspection the extend to forward going stead good and raising in PHECC stand through will process examination the in gleaned experience and information The public the protecting in assisted implementing standards universal serviceamong providers. those has process inspection The Transfer Standard. capacity the have services ambulance private 6 GuidelinesPractice rescinded. Clinical PHECC any implement to recognition their had has services ambulance private 1 Practice Clinical PHECC implement to recognised Guidelines 3 - are services ambulance private 6       rd Edition. Murray Ambulance ServiceMurray Service Ambulance Medilink Ambulance Service Medicall ServiceLifeline Ambulance ER Ambulance Service Heart ServiceBeaumont Private Ambulance th October 2010 noted 2010 October rd Edition are: to implement the Inter Facility Patient Facility Inter the implement to

that 6 of the 7 inspected ambulance inspected 7 the of 6 that

xrc rm Cucl Plc, Dcme 07 o raiain o apy fr apoa for approval for apply to Organisations for 2007, December Policy, Implementation Clinicalof Guidelines. Practice Council from Extract fromExtract Establishment PHECC 109 Order of S.I. 2000/ Amendment Order575 S.I. of 2004. Edition to3rd approved implement fororganisations CPGs template Inspection Process- 2010 Inspection Ambulance Service ProvidersPrivate on employee/volunteer numbers, an inspection shall take place of appropriate security clearance documentation forall or sample a of personnel. security appropriate of place take shall inspection an numbers, employee/volunteer on Depending employees/volunteers. for process clearance security a requires process application The Security 2 Clearance the with included be to documentation insurance of application. copies requires process application The Insurance1 2.2 2.1 1.1 CPG useinCPG theorganisation relatedand issues such as near adversemiss and events. of summary a include shall report The implemented. being are CPGs how outlining Council to submitted and Director Medical appointed the by prepared be will Report CPG annual An 11. 10. Approved organisations be subjectshall to review time from to by time Council. Courses. Recognised for approval have who Institutions Recognised by provided be must Training 5. All relevant facilities records and must be made for available any visit. site representatives. Council by visited be will organisation applicant the appropriate Where 3. guidelines practice clinical the implement to undertake prepared pursuant to sub-article (o) of this Article. which providers service emergency care pre-hospital those Council, the by made rules with accordance in recognise, (r) to providers service care emergency pre-hospital bestsupport practice pre-hospital by care practitioners. for operation of standards prepare (q) such make it as considermay appropriate. and care emergency pre-hospital persons other such and providers service for care emergency pre-hospital to available guidelines guidelines practice clinical prepare (o) be with theinsurance verified specified companies. may These inspection. for available made be shall documentation insurance actual The Details of employees/volunteers shall be made available forinspection. shall be ofemployees/volunteers Details made available policy shall be security made organistional available for inspection. The clearance Private AmbulanceProviders Service PHECC Inspection PHECC TemplateInspection Apr 2010 Apr Annex A

adtr. Dpnig o mlye/outes nmes n iseto hl ae pae to place take shall inspection an numbers, that aestablish current licence PHECC isby held all or sample a of employees/volunteers. is employees/volunteers Register on PHECC the Depending on mandatory. inclusion employees/volunteers that requires process application The PHECCEmployees/Volunteers Registered4 - language English of certificates and documentation the of sample a shall takecompetency place. or all of inspection an English, not is language first whose numbers, employee/volunteer the on Depending CPGs. use to knowledge linguistic the have employees/volunteers that evidence requires process application The English 3 Competence The application process requires evidence that clinical records are completed on all patients who must management record clinical of system patients appropriate an and care emergency pre-hospital receive all on completed are records clinical that evidence requires process application The Information6 Management development of professional place take continuing shall inspection other an numbers, training records for all or sample a of personnel. and facilitate employee/volunteer on to CPGs Depending training of- the requirements. provision of or to- implementation access of appropriate evidence requires process application The & Training 5 Development Policy 5.1 Training records be shall include: madetraining availableThe forinspection. records Training records 5.1 shall 4.1 3.2 3.1 patient 2.3 of provision the for organisation the by engaged are volunteers where 2.2.2 shall printout The inspection. for available made be shall printout payroll employee an 2.2.1 5.1.3 Ongoing 5.1.3 Ongoing CPD. 5.1.2 CPG details.upskilling currency. First5.1.1 Cardiac Response for provided be shall Register PHECC the on the employees/volunteers inspection, the listto contain PHECC employee/volunteer. PIN ofeach all of list A made be shall competence language English available forinspection. of certificates and Documentation made be shall English not clinical level. listshall incorporatetheir available, the is language first whose employees/volunteers all of list A availableA clearanceforinspection employee/volunteer. file shall be foreach security location made availablereporting forinspection.shall be and birth of date name, incorporating: volunteers all of list complete a care/transport the of behalf on care/transport patient of provision organisation. the in engage they whether and location reporting position, employee birth, of date name, employee incorporate:

The application process requires evidence that clinical audits occur. The service of an appointed an of service Medical Advisor/Director is required. The occur. audits clinical that evidence requires process application The ofClinical System 7 Audit arewho subject fitness to practice, to shall inspect actualpatient records behalf on of PHECC. persons, clinical Only confidentiality. patient of taken be shall cognisance inspection During exist. 7.2 A clinical audit report shall be available for inspection. The clinical audit report shall report audit clinical The inspection. for available be shall report audit clinical A 7.2 7.1 6.3 6.2 6.1 inspected. be shall records patient other and reports care patient of sample a of completeness The made be forinspection. shall patient beThe system storage made available record shall utilised record(s) patient the of available forinspection. copy electronic and/or hard blank A preparation of the report as per extract from Council extract Policy. preparation from ofthe as per report the in Director/Advisor Medical the by progress the following: the minimum a at contain in audit clinical of system the place. outline person, in shall, Advisor/Director Medical The

Medical Technician

= = Emergency Acuity Acuity Level (Patient) 4 D 4 A 4 4 B 4 C 4 E = Paramedic = Paramedic Ambulatory anticipated. Active management/intervention not monitoring. Time transport. criticalrequire maynot emergency Non andplanned routine Care Non Acute management/interventions. may and require active critical. Time not Requires monitoring Care Non Emergent Acute anticipated. /active management interventions are RequiresTime critical. monitoring and CareEmergentAcute ongoing. /active management interventions becritical.Time may Monitoring and Intensive Care Mobile Definition = Medical = Registered = Medical Practitioner Practitioner / Midwife Nurse management/intervention. No requirement monitoring for or active      Mayrequire: required and/orMP ifadditional RN/M medications or interventions    Mayrequire(in addition the to above): required and/orMP ifadditional RN/M medications or interventions    Anticipatewillrequire: addition (in to above) the Mayrequirein addition: (to the above) A guide to assist matching staff clinical level to patient’s clinical requirement to patient’sAclinical to assistguide clinical level staff matching interventionsperas PHECC CPGs. EMT ofS.I.512/2008) administrationofmedications EMTper as Schedule(Part 3 supervision restraintwithout oxygentherapy stretcher interventionsperas CPGs.PHECC Paramedic (Part2 ofS.I.512/2008) administrationofmedications Paramedicperas Schedule observationmonitoringand ofI.V.infusion interventionsperas CPGs.PHECC Paramedic (Part2 ofS.I.512/2008) administrationofmedications Paramedicperas Schedule observationmonitoringand ofI.V.infusion   Inter Facility Patient Transfer Standard Transfer Standard Facility Inter Patient ventilatory support circulatory support Clinical Requirement Clinical = = Advanced Paramedic* Note B – PHECC =Note Care– PHECC B Emergency Pre-Hospital Council. 512/2008 -(AMENDMENT) SUPPLY)Regulations S.I. 2008. CONTROL OF MEDICINAL (PRESCRIPTION PRODUCTS AND [ Note A – Parts 1,2, 3 refer to the 7 refer to the A 1,2, 3 – Parts Note

Private Private Car/ Taxi Patient Patient Transport CEN CEN or BTypeA CEN or BTypeA

CEN CEN B Type CType CEN Ambulance Ambulance Ambulance Ambulance Vehicle Mini BusMini (Type) Vehicle Private Ambulance Service Private Ambulance Providers, 2010Oct Or th schedule of theschedule of Annex B, PHECC Inspection Annex PHECC B, Report Inspection

+ + with patient combinationa of (minimum two) (minimum requiredas Staff Clinical Level Staff Clinical NIL NIL requirement and and if necessary /and or and / or Minimum + + with patient + with patient + + with patient i f f necessary

clearance. security is report the in item first the so insurance to relation in identified were issues No identified. were issues to where areas time the on focuses giving only report thus consolidation This frame, addressed. be time issues enable month three a after occur would advised visit were inspection Services follow-up a that that visit. areas inspection initial outlining the report during inspection identified were an that received addressing service required each visit inspection final the to Prior ofThe ethos the inspection was guided theby PHECC mission statement: - October 2010 Inspection Final on Report Ambulance Service ProvidersPrivate      1. To up follow Garda on vetting a new employee andreceipt of the security clearance To the specify exact relationship between the commencement date of To written develop a policy for security clearance with the until securitypublic clearance is in place The staff without shouldsecurity clearance be not permitted contact employment Security mustclearance be obtainedto prior commencingstaff hte hy egg n te poiin o ain aetasot o eaf o the of behalf on care/transport patient of provision the and in location organisation. reporting engage position, they employee birth, inspection. whether of shall for printout date The available name, inspection. employee made for available incorporate: made be be shall shall printout payroll employees/volunteers employee An of Details inspection. Clearance Security delivery of quality of pre-hospital emergency care care emergency inIreland. ofquality for people delivery of pre-hospital ofexcellenceforthe maintaining and monitoringstandards reviewing, the Council EmergencyCare protects publicbyspecifying, Pre-Hospital The Recommendations fromInspection Initial Recommendations x 1x service : The organisational security clearance policy shall be made availablebe for organisational clearance shall policy security The . (April/May 2010) (April/May x 2x services. x services. 2 x 2x services. x 1x service. Private AmbulanceProviders Service PHECC InspectionReport PHECC Inspection (Sept 2010) (Sept Inspection      Findings ofFinal Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Oct 2010Oct Annex C

          4. 3. 2. reregistered who not do this comply with shall recommendation benot training be to prior supplied nextto registration date. Practitioners should have thistraining made available immediately.Evidence of All staff are who current not with recertificationCFR retention or PHECC registration date they are as reregistered EMTs If Paramedics completedhave not CPG-P theirnextupskilling by biannually should adopted be A of policy CFRretention least at annually and CFRrecertification services. The administration of requirestraining records attention detail to The development of istraining records essential plan Should engage services of the Paramedic a Tutor developto training Update PHECC list ofRegister staff assessment Maintain documentation verify to English competence language service. patients must be aassessed by Practitioner part as thisprocessof During recruitmentassessment an of CPGs and communication with English as condition a of those for employment whose first language is not To written develop a policy reflectto English requirementslanguage ongoing CPD.ongoing and details upskilling CPG currency, Response First Cardiac include shall records training The Development: and Training each of PIN employee/volunteer. PHECC the contain to list the inspection, for provided be shall Register PHECC Employees/Volunteers: - Registration PHECC certificates Englishof competence language shall be made available forinspection. madeshall be theavailable; list shall incorporate their clinical level. Documentation and Competence English x 4x services. x 5x services x 1x service. Recommendations fromInspection Initial Recommendations fromInspection Initial Recommendations fromInspection Initial Recommendations x 2x services . : . (April/May 2010) (April/May (April/May 2010) (April/May 2010) (April/May A listall employees/volunteers of whose first language not is English x 5x services riig rcrs sal b ae aalbe fr inspection. for available made be shall records Training x service. 1 . x service. 1 A list of all employees/volunteers on the on employees/volunteers all of list A x 5x services x 3x x 1 .           Inspection (SeptInspection 2010) Inspection (SeptInspection 2010) (SeptInspection 2010) Findings ofFinal Findings ofFinal Findings Findings ofFinal Findings Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory

               6. 5. involved with medication administration, to verydue the small numbers There is a need the expand to timeframes theof audits,particularly application for a approval or lesser percentage Should clarify of 100% if PCRs shall be auditedspecified as in their service. Should informPHECC when a change Medical occursof Director x submitted to PHECC A job specification for Medical should Director developed be and Director be should in place Where clinical identified are queries a review system of by the Medical to Practitionersthe involved Feedback on issues clinical be should directed supportive in a manner correctness accuracyand A at supervisor of least Paramediclevel check should PCRs forclinical x service. 1 may deposit PCRs completed while maintaining patient confidentiality To a initiate crews process arriving backwhere baseat after hours To patient ensure when handlingconfidentiality PCRs with the guidelinesPHECC To upgrade security and fireprotection of storagethe of PCR in line retention periods beyond standard time frames To a initiate coding systemindentify readily to PCRs for special information To policy develop a formanagement storageand of patient To include all sections four of PCR No the allon PCRs Be advisedadopt to the PHECC version PC ePCR of To adopt PHECC toPCRs patient record information ui eot sal cnan a iiu h olwn: te pors y te Medical the by progress the following: the minimum a at Director/Advisor in the preparation theof report as fromper extract Council No. Policy 11. contain shall report audit clinical The inspection. for available be shall report audit clinical A place. in audit clinical of Audit: Clinical of System patientother records inspected. shall be made available forinspection. The completeness a ofof sample patient care reports and utilised shall be made available forinspection. The patient storage record system shall be ManagementInformation x service. 1 Recommendations fromInspection Initial Recommendations fromInspection Initial Recommendations x 1x service. x services. 6 (April/May 2010) (April/May 2010) (April/May x 5x services. x 2x services. x 5x services. The Medical Advisor/Director shall, in person, outline the system the outline person, in shall, Advisor/Director Medical The x 5x services. : A hard blank and or theelectronic copy of patient record(s) x service. 1 x 4x services x 6x services. x service. 1 x 5x services x service 1 . . . 1 1         Inspection (SeptInspection 2010) Inspection (SeptInspection 2010) Findings ofFinal Findings Findings ofFinal Findings Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Ongoing Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory

       7. for itsfor anduse storage be should developed Where reasons thrombolysis i.e. Should specify practice which they wish for excluded operational the additional equipmentspecified be should available If engaged incover providing for whereevents trauma is potential risk patient transport be should available all on ambulances Equipment enableto Paramedics fully practice to forinterfacility practice then equipment medicationand be should available enable to APs to If s ambulances and Paramedics for 3 All medications equipmentand the within scope of of practice EMTs on all ambulances Medications to enable Paramedicsto practice fully be should available each serviceeach visited. Information Additional ervice wish continue to implement 3 Morphine is available the on ambulance a andpolicy procedure x 2x services Recommendations fromInspection Initial Recommendations x services 2 x 4x services . rd Edition CPGs Edition be should available all on . (April/May 2010) (April/May x 2x services. ; The inspection team conducted an an inspection of ambulance in . rd edition CPGsat level AP x service. 1 x 4x services x services 4 . .        Inspection (SeptInspection 2010) Findings ofFinal Findings Satisfactory Satisfactory Satisfactory Satisfactory Ongoing Satisfactory Satisfactory