A VIEW of PRE-HOSPITAL EMERGENCY CARE in IRELAND a VIEW of Pre-Hospital Emergency Care in Ireland

A VIEW OF PRE-HOSPITAL EMERGENCY CARE IN IRELAND A VIEW of Pre-Hospital Emergency Care in Ireland

Produced by the Pre-Hospital Emergency Care Council Abbey Moat House Abbey Street Naas Co Kildare

T: +353-45-882042 F: +353-45-882089 E: [email protected] www.phecc.ie

Office Hours: Monday-Friday 9.30am - 5pm

What is pre-hospital emergency care? 3

What is the Pre-Hospital Emergency Care Council (PHECC)? 4

What is the purpose of PHECC? 5 i. Education and Training Standards 6 1 Cardiac First Response 7 2 Occupational First Aid (Health & Safety Authority Standard) 7 3 Emergency First Response 7 4 Emergency Medical Technician 8 5 Paramedic 8 6 Advanced Paramedic 9 ii. Assessments and Awards (Examination and Certification) 10 iii. Record of Responders and PHECC Register of Practitioners 11 iv. Clinical Practice Guidelines 13 v. Information Management: Cardiac First Response Report and Patient Care Report 14 vi. Research and Development 15

Partners in emergency care 16

Scenarios 17

The future of pre-hospital emergency care in Ireland 19

Cardiac First Response (CFR) - Suite 20

A VIEW of Pre-Hospital Emergency Care in Ireland 1 ABBREVIATIONS

AAP Association of Ambulance Personnel AED Automated External Defibrillator AP Advanced Paramedic BLS Basic Life Support CFR Cardiac First Response CFRR Cardiac First Response Report CICS Centre for Immediate Care Studies CPD Continuing Professional Development CPG Clinical Practice Guideline CPR Cardiopulmonary Resuscitation DFB Dublin Fire Brigade DoHC Department of Health and Children ECG Electrocardiogram EFR Emergency First Response EMC Emergency Medical Controller EMT Emergency Medical Technician ePCR electronic Patient Care Report GTN Glyceryl Trinitrate HSA Health and Safety Authority HSE Health Service Executive IM Intra-muscular ISIC Irish Society for Immediate Care MERIT Medical Emergency Responders Integration and Training NASC National Ambulance Service College NQEMT National Qualification in Emergency Medical Technology NRA National Roads Authority NUIG National University of Ireland, Galway OFA Occupational First Aid OHCA Out-of-Hospital Cardiac Arrest P Paramedic PCR Patient Care Report PHECC Pre-Hospital Emergency Care Council RTA Road Traffic Accident SCDTFR Sudden Cardiac Death Task Force Report UCD University College Dublin UL University of Limerick

2 A VIEW of Pre-Hospital Emergency Care in Ireland WHAT IS PRE-HOSPITAL EMERGENCY CARE?

Pre-hospital emergency care is any medical care or intervention that a seriously ill or injured person receives from trained personnel before being taken to hospital. This immediate care can make a huge difference to someone’s outcome or even to their survival.

Emergency medical care can be given by someone within the community such as a GP, someone who has trained as a responder, or by ambulance personnel who have trained to become registered practitioners.

We are working with the health industry towards an integrated approach to pre-hospital emergency care to protect the public of Ireland. PHECC is responsive to the needs of practitioners, patients and the public. Dr Geoff King, Director

A VIEW of Pre-Hospital Emergency Care in Ireland 3 WHAT IS THE PRE-HOSPITAL EMERGENCY CARE COUNCIL (PHECC)?

The Pre-Hospital Emergency Care Council (PHECC) is an independent statutory body with responsibility for standards, education and training in the field of pre-hospital emergency care in Ireland.

PHECC was established by the Minister for Health and Children by Statutory Instrument Number 109 of 2000 (PHECC Establishment Order). PHECC’s responsibilities were enhanced by Statutory Instrument Number 575 of 2004 (PHECC Amendment Order) and The Health (Miscellaneous Provisions) Act 2007.

Council members are appointed by the Minister for Health and Children on the basis of their involvement and expertise in pre-hospital emergency care.

The Council is advised and assisted by three Standing Committees and two Working Groups made up of Council members and health industry and community partners.

• Clinical Care Committee • Accreditation Committee • Audit Committee • Medical Advisory Group • Control Working Group

The Clinical Care Committee advises Council on operational aspects of clinical care matters.

The Accreditation Committee recognises training institutions and approves course content for education and training, sets examination standards and oversees quality assurance and examination appeals, recommends recognition of equivalent qualifications in pre-hospital emergency care, sets standards for entry onto the PHECC Register and oversees registration appeals.

The Audit Committee advises Council on internal control as part of Council’s commitment to best practice in governance.

The Medical Advisory Group is Council’s expert group on medical matters.

The Control Working Group advises Council on matters relating to Standards and Emergency Medical Controllers (EMCs).

The Council is supported on a daily basis by the PHECC executive comprising the Director, Deputy Director and Registrar, Programme Development Officers, Client Services Manager, Council Secretary, Support Officers and Clerical Officers.

4 A VIEW of Pre-Hospital Emergency Care in Ireland WHAT IS THE PURPOSE OF PHECC?

Pre-hospital emergency services in Ireland are delivered by the National Ambulance Service in the four health regions, previously the eight regional health boards, and in the Dublin area by the Dublin Fire Brigade (DFB), as well as voluntary, auxiliary and private ambulance services.

Mission Statement Vision The Pre-Hospital Emergency Care That people in Ireland Council protects the public by specifying, reviewing, maintaining and receive the best monitoring standards of excellence possible pre-hospital for the delivery of quality pre-hospital emergency care. emergency care for people in Ireland.

PHECC’s Mission Statement and Vision are supported by Strategic Plans 2002-2005 and 2006-2009.

In the last seven years PHECC has begun to develop and put in place a comprehensive and fully integrated programme towards enhancing pre-hospital emergency care. The programme includes: i Education and Training Standards across six levels of responders and practitioners. The new standards are being introduced progressively over three years from January 2007. ii Assessments and Awards (Examination and Certification) across six levels of responders and practitioners. iii Record of Responders and PHECC Register of Practitioners. iv Clinical Practice Guidelines to support best practice by responders and practitioners. v Information Management: Cardiac First Response Report (for responders) and Patient Care Report (for practitioners) for information collection and analysis. vi Research and Development of pre-hospital emergency care services.

A VIEW of Pre-Hospital Emergency Care in Ireland 5 i. PHECC EDUCATION AND TRAINING STANDARDS

PHECC has developed a set of Education and Training Standards to international current best practice that can be delivered through PHECC-approved courses at PHECC-recognised training institutions.

There are six standards:

Three standards for emergency care responders:

1 Cardiac First Response (CFR) 2 Occupational First Aid (OFA) Certificate (A Health and Safety Authority (HSA) Standard) 3 Emergency First Response (EFR)

and three standards for emergency care practitioners:

4 Emergency Medical Technician (EMT) 5 Paramedic (P) 6 Advanced Paramedic (AP)

On completion of training at responder level, candidates are assessed in their knowledge and skills to become certified responders.

On completion of training at practitioner level, candidates can present for examination towards the appropriate National Qualification in Emergency Medical Technology (NQEMT). Individuals who hold NQEMT at practitioner level can apply to join the PHECC Register at the level appropriate to their qualification (EMT, Paramedic or Advanced Paramedic).

Standards for Emergency Care Responders Training at levels 1-3 enables individuals to become non-transporting responders. Responders are trained at a minimum in basic life support (BLS) and the use of an automated external defibrillator (AED). Responders could be from voluntary or auxiliary ambulance services, or they may be GPs, uniformed persons, e.g. fire brigade, Gardaí, or non-uniformed individuals, e.g. responders in the community.

6 A VIEW of Pre-Hospital Emergency Care in Ireland i. PHECC EDUCATION AND TRAINING STANDARDS

1 Cardiac First Response (CFR) This standard includes knowledge and skills for adult and child cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, relief of foreign body airway obstruction and administration of Aspirin for cardiac chest pain. Additional skills e.g. paediatric defibrillation and discontinuation of resuscitation efforts are included for registered healthcare professionals.

Cardiac First Responders undergo 6-8 hours of training followed by assessment and certification. Cardiac First Responders are recertified every two years. The Cardiac First Response standard is an integral component of each standard including the Health and Safety Authority Occupational First Aid standard.

2 Occupational First Aid (OFA) (Health and Safety Authority Standard) The HSA has regulatory authority over standards in the occupational setting and has incorporated the Cardiac First Response standard as a mandatory component of the Occupational First Aid standard.

3 Emergency First Response (EFR) Emergency First Responders can give assistance to patients with general medical and trauma emergencies including giving oxygen, suctioning and using oropharyngeal airways. EFRs are approved to assist a person in the self-administration of prescribed Salbutamol (for breathing difficulties), glyceryl trinitrate (GTN) (for cardiac chest pain) and glucose gel (for diabetic emergencies). EFRs can manually stabilise the cervical spine and apply a cervical collar.

EFRs can carry out certain other procedures under the direct supervision of a PHECC-registered practitioner. EFRs undergo a five-day training programme followed by assessment and certification, and are recertified every three years.

A VIEW of Pre-Hospital Emergency Care in Ireland 7 i. PHECC EDUCATION & TRAINING STANDARDS

Standards for Emergency Care Practitioners Training at levels 4 - 6 enables individuals to become transporting practitioners. Practitioners could be members of the Health Service Executive (HSE) National Ambulance Service, Dublin Fire Brigade or the voluntary, auxiliary and private ambulance services.

4 Emergency Medical Technician (EMT) Practitioners at this level can administer a range of medications e.g. for pain relief, asthma and shock. Knowledge and skills include using a bag valve mask and nasopharyngeal airway for breathing emergencies and approved splinting and immobilisation devices for trauma. EMTs are authorised to administer Entonox and Morphine intramuscularly (IM) for pain relief, and Salbutamol aerosol and Adrenaline (IM) for anaphylaxis, either according to Clinical Practice Guidelines or under a medical practitioner’s instructions.

EMTs undergo four weeks training in theory and one week of clinical practice and are assessed on their knowledge and skills to become eligible to register as an EMT. As registered practitioners, EMTs agree to undertake Continuing Professional Development (CPD) to maintain and update skills, which at this level requires two days training each year.

5 Paramedic (P) Paramedics have increased responsibilities, knowledge and skills for assessing patient needs, making informed clinical decisions, planning and administering care and monitoring patient response. Paramedics have a wider scope of practice including skills in laryngeal tube/mask airway insertion to assist with breathing, electrocardiogram (ECG) rhythm recognition and transmission, caring for a pregnant patient and pre-hospital childbirth. In addition paramedics can give Glucagon (IM) for low blood sugar, Diazepam (per rectum) for seizures and Hartmann’s Solution for hypovolemic shock.

Paramedics undergo 28 weeks training in theory and clinical practice and a one-year internship, and on successful completion of the course are eligible to become registered Paramedics. Registered practitioners agree to undertake CPD to maintain and update skills, which at this level requires two weeks training each year.

8 A VIEW of Pre-Hospital Emergency Care in Ireland i. PHECC EDUCATION & TRAINING STANDARDS

6 Advanced Paramedic (AP) Advanced Paramedics have a greater knowledge of basic science, can use more advanced interventions and administer a wider range of drugs.

Advanced Paramedics have to complete a distance learning module, 18 weeks training in theory and clinical practice and a one-year internship. Once qualified, they can join the Register at AP level. A registered practitioner at this level requires CPD of two weeks training each year.

Driving Training Standards Driving Training Standards have been developed to support transporting practitioners, equipping participants with essential theory and practical skills for safe and considerate transport of patients.

Setting high standards in education and training ensures the best quality of pre-hospital care is available to the public. Pauline Dempsey, Programme Development Officer

For more information on PHECC Education and Training Standards please contact Pauline at the PHECC office 045 882042 or e mail [email protected] or visit www.phecc.ie

A VIEW of Pre-Hospital Emergency Care in Ireland 9 ii. ASSESSMENTS AND AWARDS (EXAMINATION AND CERTIFICATION)

PHECC-approved courses for each of the standards are delivered by institutions that undergo a rigorous accreditation process and are monitored and regularly reviewed by PHECC.

Responder Levels 1-3: Responder-level assessments are carried out by training institutions on behalf of PHECC.

Practitioner Levels 4-6: PHECC oversees the entire examination process from setting questions, training and approving examiners, marking exam papers, dealing with appeals and awarding National Qualifications in Emergency Medical Technology (NQEMT). PHECC provides ongoing support and information for students undertaking training and examinations.

NQEMT Passes at Paramedic & Advanced Paramedic Level

180 NQEMT Advanced Paramedic Exam NQEMT EMT Exam 160 introduced in 2005 introduced in 2008 140 120 100 NQEMT Paramedic Exam introduced in 2002 Successful 80 Advanced Paramedics* 60 Successful 40 Paramedics 20 Successful 0 EMT’s 2002 2003 2004 2005 2006 2007 June 2008*

* 24 Advanced Paramedic students were in the proccess of completing their NQEMT qualification in June 2008.

PHECC can also award the NQEMT following assessment of qualifications obtained outside and inside the state, which are equivalent to the Paramedic standard. PHECC has developed policy to recognise equivalence at EMT and Advanced Paramedic levels.

The first national examination that led to the NQEMT at Paramedic level took place in October 2002. The nineteenth NQEMT examination took place in May 2008. The assessment process for Advanced Paramedics is conducted jointly by PHECC with the National Ambulance Service College (NASC) and University College Dublin (UCD). Ireland’s first Advanced Paramedics graduated in 2005.

For more information on responder and practitioner assessments and awards please contact the PHECC office 045 882042 or visit www.phecc.ie

10 A VIEW of Pre-Hospital Emergency Care in Ireland iii. RECORD OF RESPONDERS AND PHECC REGISTER OF PRACTITIONERS

The PHECC Register of pre-hospital emergency care practitioners was established in 2005. Practitioners can join at the level appropriate to their qualification and are then licensed to practise at that level.

The Register consists of three divisions: Emergency Medical Technician (EMT) Paramedic (P) Advanced Paramedic (AP)

EMTs on PHECC Register

225 200 175 150 125 100 75 50 25 0 Sep 2005 2006 2007 June 2008

Paramedics on PHECC Register

2000 1800 1600 1400 1200 1000 800 600 400 200 0 Sep 2005 2006 2007 June 2008

A VIEW of Pre-Hospital Emergency Care in Ireland 11 iii. RECORD OF RESPONDERS AND PHECC REGISTER OF PRACTITIONERS

Advanced Paramedics on PHECC Register

150

125

100

0 Sep 2005 2006 2007 June 2008

The establishment of the first national Register in 2005 recognised pre-hospital emercency care practitioners as professionals and the number of practitioners at EMT, Paramedic and Advanced Paramedic levels has grown steadily. In joining the Register, practitioners agree to abide by a Code of Professional Conduct and Ethics, and are subject to Fitness to Practise provisions in the interest of protecting the public and the profession. Practitioners also undertake to maintain and develop their competency through Continuing Professional Development (CPD).

For more information on the PHECC Register please contact Barry at the PHECC office 045 882042 or email [email protected] or visit www.phecc.ie

Promoting and supporting professional pre-hospital emergency care practitioners and responders ensures a high standard of care for all. Barry O’Sullivan, Deputy Director and Registrar

12 A VIEW of Pre-Hospital Emergency Care in Ireland iv. CLINICAL PRACTICE GUIDELINES

The Clinical Practice Guidelines (CPGs) published by PHECC are evidence- or consensus-based best practice. Pre-hospital emergency care providers include responders (cardiac first responders, occupational first aiders and emergency first responders) and practitioners (emergency medical technicians, paramedics, advanced paramedics, nurses and doctors) from the statutory, private, auxiliary and voluntary services.

The third-edition CPG manual contains 195 CPGs outlining patient assessments and pre-hospital treatment for a number of conditions for registered practitioners at EMT (56), paramedic (69) and advanced paramedic (70) levels. There are 75 additional CPGs for responders at emergency first response (47), occupational first aid (19) and cardiac first response (9) levels.

Publication of medical practitioner CPGs is pending.

A CPG medication formulary is also published by PHECC as a further reference for responders and practitioners.

Organisations must be granted approval for their employees or volunteers to implement the use of PHECC CPGs.

For more information on the application procedure and criteria on which organisations are assessed, please contact Brian at the PHECC office 045 882042 or email [email protected] or visit www.phecc.ie

P Vers ion D 0.6 K T EM Primary Surv AP ey Trauma CPG 4a - Adult

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A VIEW of Pre-Hospital Emergency Care in Ireland 13 v. INFORMATION MANAGEMENT: CARDIAC FIRST RESPONSE REPORT AND PATIENT CARE REPORT

Maintaining clear, accurate and comprehensive patient care records is crucial for providing a high standard of care to patients.

The Cardiac First Response Report (CFRR) was developed by PHECC for responders to document out-of-hospital cardiac arrests. The CFRR will be implemented over the coming years in partnership with National University of Ireland, Galway (NUIG) as part of the national Out-of-Hospital Cardiac Arrest (OHCA) Register.

The Patient Care Report (PCR), for documenting patient information and pre-hospital emergency care provided by practitioners, was developed by PHECC following wide consultation with EMTs and Paramedics. The PCR is currently in use in six of the eight HSE ambulance areas, as well as Dublin Fire Brigade (DFB) and some of the voluntary, auxiliary and private ambulance services.

An electronic PCR (ePCR) has now been developed which will allow rapid transfer of information to the receiving Emergency Department and enable the hospital to prepare for the patient’s arrival. The ePCR system with Computer Aided Dispatch (CAD), LP12 integration and transmission of patient data is currently being deployed in the HSE North East.

The ePCR heralds a new era in patient care. Clinical information collected on the care of patients will be invaluable in monitoring and developing pre-hospital emergency care and services.

CLINICAL INFORMATION CLINICAL INFORMATION PATIENT CARE REPORT PATIENT’S CHIEF COMPLAINT TIME OF ONSET DATE OF ONSET PATIENT’S MEDICAL OBSERVATIONS HH MM DD MM YY A ALLERGIES NKA UNKNOWN PATIENT INFORMATION SURNAME FIRST NAME PRIMARY SURVEY SURNAME NAME A CLEAR PARTIALLY OBSTRUCTED OBSTRUCTED PERMANENT ADDRESS DOB c C Spine SUSPECT NOT INDICATED DD MM YYYY M MEDICATIONS NONE UNKNOWN AS SUPPLIED PER DR’S LETTER AGE GENDER B NORMAL ABNORMAL FAST SLOW ABSENT M F C PULSE PRESENT ABSENT RATE HAEMORRHAGE GP REGULAR IRREGULAR RATE Y e s N o SKIN NORMAL PALE FLUSHED CYANOSED NEXT OF KIN NOK TELEPHONE Cap-Refill < 2 SEC > 2 SEC D Loss Of Consciousness Before Arrival Yes No AVPU PAST MEDICAL HISTORY NONE UNKNOWN PER DR’S LETTER INCIDENT INFORMATION P DATE OF CALL TIME OF CALL PASSED DISPATCH CLASSIFICATION E A Abrasion P Pain 01 02 03 B Burn R Rash DD MM YYYY HH MM HH MM EMERGENCY ARCPCS C Contusion S Swelling MOBILE AT SCENE AT PATIENT DEPART SCENE AT DESTINATION D Dislocation N Numbness HH MM HH MM HH MM HH MM HH MM # Fracture W Wound AT HANDOVER DESTINATION CLEAR % BURN HH MM NAME OF FACILITY HH MM % BURN L LAST INTAKE DESCRIBE HH MM CC CODE INCIDENT NUMBER VEHICLE PATIENT NO UNKNOWN CA L L S I G N ENTER A,B OR C CLINICAL IMPRESSION EVENT PRACTITIONER ATTEND PRACTITIONER SUPPORT OTHER STATION PIN E CARDIAC OBS/GYNAE MAXILLO-FACIAL INJURY PIN PIN PIN PIN CARDIAC ARREST HAEMORRHAGE < 20 WKS FRACTURE DOA TRANSPORTED DIED AT SCENE/ENROUTE CARDIAC ARRHYTHMIA HAEMORRHAGE > 20 WKS DISLOCATION / SPRAIN TCD DOA NOT TRANSPORTED HEARTFAILURE LABOUR OPEN WOUND CARDIAC CHEST PAIN PRE-HOSPITAL DELIVERY HAEMORRHAGE TREATMENT REFUSED TREAT.AT SCENE - NO TRANS. OTHER CARDIAC PPH BURNS NTT MECHANISM OF INJURY TRANSPORT REFUSED STOOD DOWN MEDICAL OTHER OBS/GYNAE OTHER TRAUMA Incident Location/Address Mark if same as Above BACK PAIN RESPIRATORY GENERAL ASSAULT RTA BICYCLE Improving the patient’s DIABETES MELLITUS ASTHMA ABDOMINAL PAIN ATTACK/BITE BY ANIMAL/INSECT RTA MOTORBIKE FEVER COPD ACUTE INTOXICATION CHEMICAL POISONING RTA PEDESTRIAN HEADACHE FBAO ALLERGIC REACTION DROWNING RTA VEHICLE HYPOTHERMIA RESPIRATORY ARREST BEHAVIOURAL DISORDER ELECTROCUTION SMOKE, FIRE AND FLAMES experience is the goal of the OTHER MEDICAL SMOKE INHALATION ILLNESS UNKNOWN EXCESSIVE COLD WATER TRANSPORT ACCIDENT NEUROLOGICAL OTHER RESPIRATORY NAUSEA / VOMITING ALTERED LOC TRAUMA POISONING EXCESSIVE HEAT OTHER HOME IND. PLACE OR PREMISES PUBLIC BUILDING CVA MULTIPLE TRAUMA SHOCK FALL FARM RECR. OR SPORT PLACE RESIDENTIAL INSTITUTION SEIZURES SPINAL INJURY SYNCOPE / COLLAPSE FIREARM INJURY CIRCUMSTANCES Practitioner through the MINE OR QUARRY STREET OR ROAD OTHER PLACES OTHER NEUROLOGICAL HEAD INJURY OTHER GENERAL INJURY TO CHILD ACCIDENT Nature of Assistance Prior to Arrival of Practitioner MACHINERY ACCIDENTS EVENT OF UNDETERMINED INTENT 2 0 4 . NONE FIRST AID CPR* MVA OFF ROAD INTENTIONAL SELF HARM AED* ALS * Refer to OHCA Section Over C o u n c i l communication of information. C a r e Identity of Assistance Prior to Arrival of Practitioner L Impact Seatbelt

VOLUNTARY / AUXILIARY FIRE E m e r g n c y GARDA OTHER X Pos. in Vehicle Trapped # Pos. after Acc. Air Bag Deployed CLINICAL LEVEL P r e - H o s p i t a l B F Rollover > 20 Min. Extract. Jacqueline Egan, Programme ©

NO TRAINING CFR 2 Helmet Fatality in Vehicle OFA EFR Est. speed at impact kph PRACTITIONER OFF DUTY NURSE E d i t o n R DOCTOR Development Officer

For more information on the CFRR or PCR/ePCR please contact Jacqueline at the PHECC office 045 882042 or e mail [email protected] or visit www.phecc.ie

14 A VIEW of Pre-Hospital Emergency Care in Ireland vi. RESEARCH AND DEVELOPMENT

PHECC is actively engaged in a number of collaborative research projects with the aim of developing pre-hospital services and supporting personnel who provide those services. PHECC is continually exploring other initiatives that would lead to improvements in pre-hospital emergency care.

Spatial Analysis Research PHECC commissioned research that used geospatial techniques and theoretical modelling to analyse national census data and National Roads Authority (NRA) data on Road Traffic Accidents (RTAs) to identify potential priority locations for the deployment of First Responder schemes, ambulance stations and vehicles and Advanced Paramedics.

The methodology has been developed further in a study completed in the North-West in conjunction with the HSE using actual data from Control to analyse demand and guide deployment of Ambulance resources to minimise response times and maximise response 96 effectiveness. Similar studies will occur in the North-East and Midlands in early 2007 with national coverage achieved during 2007 and 2008.

Research Partnerships PHECC has established a ‘Clearing House’ for research in pre-hospital emergency care in Ireland. This three-year project commenced in 2007 in partnership with the University of Limerick (UL).

Working with GPs PHECC sponsors the Medical Emergency Responders Integration and Training (MERIT) Project which was established at UCD’s Centre 110 for Immediate Care Studies (CICS) in January 2005. The project is concerned with providing GPs with Automated External Defibrillators (AEDs), trauma kits and training to enable GPs to become involved in pre-hospital emergency care as appropriate to their circumstances. The MERIT Project began in the North-West, Mid-West and East Coast Areas and has now extended into the Western, Southern, South-Eastern and South-Western Areas with joint sponsorship from the HSE. The MERIT Project will have national coverage by late 2008. Its purpose is to enhance collaboration between GPs, GP cooperatives and emergency services.

A VIEW of Pre-Hospital Emergency Care in Ireland 15 PARTNERS IN EMERGENCY CARE

Ireland has a great tradition of voluntary care including pre-hospital emergency care. Since its beginnings, PHECC has worked closely with voluntary, auxiliary and community organisations that are involved in delivering emergency care in Ireland.

Voluntary, Auxiliary and Community Organisations A seminal event in developing relationships with the voluntary, auxiliary and community organisations occurred with the “Sharing the Vision’’ Conference held in Kilkenny in March 2004. Extensive consultation has occurred since then in developing the new standards, approving organisations for CPG use, and implementing the PCR. With the implementation of the Register and the new standards well underway in the statutory ambulance services, 2008/9 will see comprehensive engagement with voluntary, auxiliary and community organisations in relation to registration of members, recognition of training institutions and approval of courses.

The Department of Health & Children and Health Service Executive The Minster for Health and Children, Mary Harney, TD launched the Sudden Cardiac Death Task Force Report in March 2006. Over 40 of the report’s 75 recommendations on improving response times and techniques in pre-hospital emergency care relate directly or indirectly to the work of PHECC. PHECC is working with the Department of Health and Children (DoHC), the HSE and other partners in emergency care to implement those recommendations.

Conferences PHECC sponsors the annual conference of The Association of Ambulance Personnel (AAP), and the conferences of the Irish Society of Immediate Care (ISIC) and resuscitation providers (RESUS), which are held every two years. These sponsorships assist PHECC in engaging with organisations and individuals who have an interest or expertise in pre-hospital emergency care.

16 A VIEW of Pre-Hospital Emergency Care in Ireland SCENARIOS

Saving life before it begins It was the beginning of an early shift when Advanced Paramedic Sean Creamer and his partner were called to attend a pregnant woman living in the foothills of the Wicklow Mountains. The woman had woken that morning to find her umbilical cord exposed. She had calmly consulted a DIY emergency birth book and suggested to her husband to call an ambulance.

The woman was thirty-seven weeks pregnant with her second child. A prolapsed umbilical cord is a serious complication of pregnancy and potentially fatal for the baby.

Fifteen minutes later Advanced Paramedic Sean Creamer and his partner arrived in a Rapid Response Vehicle to find an anxious husband and a woman with around 10 inches of umbilical cord exposed. The cord was still warm, moist and pulsating, and while Sean’s partner prepared a warm saline dressing, Sean gave the woman oxygen.

By this time the Paramedic crew had arrived by ambulance. Sean and the crew lifted the woman and secured her in a safe position on a stretcher.

On arrival at the hospital the patient was taken immediately to the operating theatre. A few minutes later, to their relief and delight, Sean, his partner and the Paramedic crew were told that a healthy baby boy had been born by caesarean section and mother and son were doing well.

The Ultimate Hotel Service Within six months of buying an Automated External Defibrillator (AED) and training staff in its use, the Radisson SAS Hotel & Spa in Sligo had saved two lives.

Both guests had been attending functions at the hotel when they suffered cardiac arrest.

A VIEW of Pre-Hospital Emergency Care in Ireland 17 SCENARIOS

Eoin Little, manager of the hotel at the time, said, “Two people are with us today because of the AED being available and used with confidence by our staff within minutes of the guests having heart attacks.” If a shock is administered within 3-5 minutes of cardiac arrest, the chances of survival are significantly improved.

Following the dramatic events in the hotel, the Radisson Hotel urged all companies to consider buying defibrillators for their premises.

Flight delayed The combination of stress and excitement nearly ended a holiday for one family before it had begun.

Checking in for their flight at Dublin airport one morning, a 79-year-old grandmother, who was traveling abroad with her daughter and family, collapsed in the queue.

The airport police, who are always on duty close-by, were alerted and in less than two minutes arrived at the scene with an Automated External Defibrillator (AED). Assisted by a doctor, who happened to be checking in, they assessed the woman and gave her one shock.

The airport police then began CPR and within five minutes an airport First Response Vehicle arrived with EMT Dermott McGuire who administered oxygen and continued resuscitating the woman until her vital signs returned and she became conscious.

When the Dublin Fire Brigade ambulance arrived a few moments later, the woman was awake and alert and taken to hospital for further care.

18 A VIEW of Pre-Hospital Emergency Care in Ireland THE FUTURE OF PRE-HOSPITAL EMERGENCY CARE IN IRELAND

PHECC is developing and implementing an integrated and comprehensive framework of education and training, assessment, registration, clinical practice, information collection and research.

PHECC’s vision for pre-hospital emergency care in Ireland includes:

• All ambulance personnel, including Emergency Medical Controllers (EMCs) trained to a PHECC standard.

• Well-placed responders providing early intervention.

• Well-placed, well-equipped and appropriately-staffed ambulances deployed by Control.

• Information relayed through ePCR/Control to hospitals awaiting the patient’s arrival.

• Practitioners treating and transporting people to hospital, treating and referring to other primary care services, or treating and discharging home.

• Responders and practitioners contributing to — and benefiting from — the collection of high quality relevant information.

• Clinical and services audit and research guiding continuing improvement in response times and techniques of pre-hospital emergency care.

A VIEWA of VIEW Pre-Hospital of Pre-Hospital Emergency Emergency Care in Care Ireland in Ireland 19 CARDIAC FIRST RESPONSE (CFR) - SUITE

20 A VIEW of Pre-Hospital Emergency Care in Ireland TheThe MissionMission ofof thethe Pre-HospitalPre-Hospital EmergencyEmergency Care Care Council Council January January 2007 2007 TheThe Pre-Hospital Pre- Hospital Emergency Emergency Care Care Council Council protects protects the the public public by byspecifying, specifying, reviewing, reviewing, maintaining maintaining and and monitoring monitoring standards standar ofds excellenceof excellence for for the the delivery delivery of ofquality quality pre-hospital pre-hospital emergency emergency care ca rfore for people people in inIreland Ireland

Recognised Training Certifi cation in CFR and Record of certifi ed holders Citizen – No training. Non-transporting - Cardiac First Response Institution (TI) and approved EFR following MCQ & skills maintained by recognised TI Pre-arrival advice & actionable Responders: Report (CFRR) course(s) assessment by, or on behalf information e.g. AED poster of, PHECC s#ITIZEN - Organisations records +/- s5NIFORMEDPERSONNEL Cardiac First Response (CFR) s CFR CFR- Retention training PHECC Patient Care Report Responder e.g. Garda, fi re service, - Level 1 CFR every year & recertifi cation (PCR) customer service personnel every 2 years including Voluntary, Auxiliary Services s Occupational First Aid (OFA) OFA - Recertifi cation every - Out-of-Hospital Cardiac OFA Level 2 Certifi cate; a Health & Safety 2/3 years s.ON UNIFORMED Arrest (OHCA) Register Authority (HSA) Standard community fi rst responders Emergency First Response s EFR EFR - Retention training EFR (EFR) - Level 3 every year & recertifi cation every 3 years Audit & Research

Vision PHECC Education Examination Record of Responders Clinical Practice Continuing Role/Deployment Information That people in Ireland & Training Standards & & Guidelines Professional Management (2007) Certiﬁ cation Registration of Development receive the best Practitioners possible pre-hospital emergency care ACCREDITATION COMMITTEE MEDICAL ADVISORY GROUP CLINICAL CARE COMMITTEE

Recognised Training National Qualifi cation in All registrants subject to code of CPGs guide the use of Transporting Practitioner: - PHECC Patient Care Report Institution (TI) and approved Emergency Medical professional conduct & ethics & medications and skills/ (PCR) course(s) Technology (NQEMT) fi tness to practice requirements procedures for patient care s(EALTH3ERVICE%XECUTIVE Incorporating the national appropriate to every level (HSE) National Ambulance data set & defi nitions. Service including the Data collected by PHECC Register divisions: Dublin Fire Brigade (DFB) hardcopy, ruggedised Emergency Medical Technician laptops or digital pen. NQEMT - EMT (EMT) - Level 4 s EMT EMT Maintaining and updating sVoluntary/Auxiliary/ Practitioner competencies - 2 days per year Private Services - OHCA Register Paramedic - Level 5 NQEMT - Paramedic s Paramedic Maintaining and updating - Pre-Hospital Emergency P competencies - 2 weeks per year Care Information Tool (PHECIT) Advanced Paramedic (AP) - NQEMT - AP s AP Maintaining and updating Level 6 AP competencies - 2 weeks per year

Medical Practitioner - Level 7 NQEMT - Medical Practitioner s Medical Practitioner MP

Implementation and use of CPGs Assessment of equivalence of qualiﬁ cations in on an organisational level is pre-hospital emergency care subject to an approval process against Council criteria 4 5 TheThe MissionMission ofof thethe Pre-HospitalPre-Hospital EmergencyEmergency Care Care Council Council January January 2007 2007 TheThe Pre-Hospital Pre- Hospital Emergency Emergency Care Care Council Council protects protects the the public public by byspecifying, specifying, reviewing, reviewing, maintaining maintaining and and monitoring monitoring standards standar ofds excellenceof excellence for for the the delivery delivery of ofquality quality pre-hospital pre-hospital emergency emergency care ca rfore for people people in inIreland Ireland

Medical Practitioner - Level 7 NQEMT - Medical Practitioner s Medical Practitioner MP

CHAIRMAN Mr Tom Mooney Healthcare Management Consultant

Mr Michael Brennan Dr Zelie Gaffney Ms Mary McClelland Mr Frank O’Malley Public Representative Medical Practitioner Occupational Health Advisor Paramedic, HSE

Mr Michael Dineen Mr Michael Garry Mr Frank McClintock Ms Valerie Small Chairperson Association of Dublin Fire Brigade EMS Assistant National Director Registered Nurse Ambulance Personnel Ambulance Service, HSE

Mr Conor Egleston Ms Karen Healy Mr Barry O’Brien Mr Tom Tinnelly Consultant in Emergency Medicine HSE, Emergency Planning Assistant National HR Director, HSE Paramedic, HSE

Ms Patricia Fitzpatrick Mr Macartan Hughes Mr Cathal O’Donnell Mr Gerry Tuohy DFB-RCSI Director NASC Consultant in Emergency Medicine Paramedic, HSE