National Ambulance Service of Ireland
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National Ambulance Service Martin Dunne Where we came from Where we are now Where we’re going to (EMS to MMS) Vision of the National Ambulance Service (NAS) The health and wellbeing of our community is supported and preserved by the NAS providing clinical care and transport to our patients in a professional and compassionate manner in close partnership with the wider health and social care services. Values of the National Ambulance Service (NAS) “The Patient Comes First” and is embedded in all areas of the NAS Core Values are I – Integrity and Honesty at all levels C – Caring and always putting the patient First A – Take Accountability and Responsibility for all actions R – Professional Respect for patients at all times E – Strive for Excellence in everything we do National Ambulance Service has 3 Operational Areas North Leinster West These South Operational Areas are supported by… 5 National Ambulance Service Service Delivery Operations – NEOC Which consists of a singular platform across two sites – Tallaght & Ballyshannon National Ambulance Service National Ambulance Service College Rivers Building, Tallaght NAS Station Locations (102) The NAS • 2000 Staff • 500 Vehicles • Financial Envelope is circa €200m And responds to: • 320,000 Ambulance Calls per annum • An average 1,000 calls per day Covering: • 22 million km per annum by road HISTORICAL PERSPECTIVE 1900 Horse Drawn Ambulance in Dublin 1950 Ambulance Midlands Ambulance Services were predominantly considered to be a transport service as distinct from a clinical care delivery service Now Patient Centred Pre Hospital Clinical Care Service NAS Service Evolution 2006 to 2019 Ambulance Service National Ambulance Service 2006 2019 Patient Intervention Basic Life Support Basic and Advanced Life Support Service 11 Individual Control Centres Single National Emergency Operations Centre across 2 sites • Emergency Medical Technician -13 meds • Paramedic - 24 meds People Competency Emergency Medical Technician- 2 drugs • Advanced Paramedic - 48 meds • Community Paramedic - 48 plus • Expanded range of patient monitoring devices Limited medications and interventions • Expanded range of patient management devices Patient Care Equipment Limited equipment • Expanded range of medications • Equipment List for each vehicle type • Emergency Ambulance Service Operations • Intermediate Care Service • Emergency Ambulance Service • Aero Medical Service • Patient Transport Service • Response Vehicle, MRU , Decontamination Units etc. • Critical Care Retrieval Service • Best Practice Procurement & Replacement Policy Fleet • Aged Profile varied • Standard Specification • Varied Specifications • Modern Fleet • No replacement plans • Major estate upgrade commenced • Overcrowded due to increased staffing Estate • New bases • Requires significant development • Deployment Points been developed in line with New Primary Care Centre Builds Technology • Limited ICT / Varied Specifications • Modern integrated CAS system • Limited connectivity to control • Modern Digital Communications System Major Service Reviews DoH Strategy Consultation HSE Corporate Plan International Practice Process HIQA National Standards . 2,000 Staff . Minor capital programme established . NAS Five Year Workforce to address immediate high risk H&S Plan in place issues . NAS Organisation Design . Station upgrade/replacement Report prioritisation completed . HR Action plan drafted in . Standard specification agreed for line with HSE People Primary Care Dynamic Deployment Strategy Point . Standard Station Specification agreed for station types . Replacement policy in place to address . NAS Digital Plan will ensure alignment . Multi-year capital funding planning with the Wider eHealth programme in place . Digital Identity programme on-going . Governance process in place . Fleet and Equipment Team structure review NAS has 3 Separate Statutory Regulators 1. Health Information and Quality Authority Regulate the Profession 2. Pre Hospital Emergency Care Council 3. National Cyber Security Centre Department of Communications, Climate Action & Environment Low and Medium Fidelity Simulation Training and Virtual Reality Suite in our National Ambulance Service Training College Where Are We Now • First country in the world that is an Accredited Centre of Excellence from the International Academy of Emergency Medical Dispatch (2) • ISO 9001:2008 and ISO 9001:2015 from Certification Europe • SEAI Ireland 2017 • Greatest singular purchase of Lucas Chest Compression devices in the World. Where Are We Now • One Control Centre across 2 sites • Live Performance Management Tool – 15 minute update • Highest rate of Bystander CPR in the World – 84% • Youngest Ambulance fleet in Europe • National Implementation of ePCR and MDT in every vehicle Where Are We Now • eAmbulance/2 Wi-Fi hubs, telemetry, streaming • Development of Electric Ambulance (awaiting delivery) • Commencement of a BSc academic affiliation with University College Cork • Service Level Agreement and Memorandum of Understanding with Higher Colleges of Technology Dubai, Punjab Pakistan (Rescue 1122), and the EDHI Foundation and Pakistan Red Crescent Society, Northern Ireland Ambulance Service, and Georgia The future……………………… Emergency Medical Service (EMS) to Mobile Medical Service (MMS) Our new clinical model will introduce new ways in which callers to 112 / 999 are triaged to ensure they receive the most appropriate care and response to suit their needs. The changes will clearly identify those patients who require an immediate life-saving response – ‘Emergency Care’ (these patients will receive the highest priority response in the fastest time), and those ‘Urgent Care’ patients who can be managed more appropriately in a care setting other than an Emergency Department. 22 Future Model of Care CLINICAL HUB – HEAR AND TREAT Telephone Triage - providing advice on self care, discharge or referral to other appropriate local treatment pathway (GP and primary care, local based urgent care service, specialist services – such as mental health service, social care services, dental services) COMMUNITY FIRST RESPONDERS Groups of volunteers who, within the community in which they live or work, are tasked by the NAS to respond to emergencies appropriate to their skill set Three Community Engagement Officers appointed for each area. COMMUNITY PARAMEDIC Paramedics will function outside their customary emergency response and transport roles, in ways that facilitate more appropriate use of emergency care resources and enhance access for patients in rural and minor urban areas – take advantage of locally developing collaborations 23 Future Model of Care SEE AND TREAT Focused clinical assessment by paramedics at the patient’s location, followed by appropriate immediate treatment, discharge and/or referral to other services - more appropriate to needs ALTERNATIVE DESTINATIONS Aim to ensure patients are treated in the right place first time and in doing so reduce the number of patients unnecessarily taken to an ED. - Local injuries unit or an appropriately resourced primary care centre - Specialist Centre – PCI; Stroke; Fracture; Trauma DYNAMIC DEPLOYMENT Where Emergency Response Resources will be strategically positioned at various predetermined locations, in order to provide a more rapid response to patient needs. 24 Future Model of Care Key Benefits of a New Model of Care Non – Conveyance Hear and Treat See and Treat / Refer / Transfer Resolution of calls using telephone triage without Resolution of incident at scene without need to the need to dispatch crews convey to another provider Ambulance • Reduction in dispatches • Reduction in call cycle as no journey undertaken Service • Incidents dealt with more promptly • More effective use of crew clinical skills • Most appropriate pathway chosen Wider • Reduction in ED attendances • System capacity better utilised Health Service • Reduction in hospital admissions • Reduction in ED attendances • Immediate access to clinical treatment Key Benefits Key • Appropriate and immediate resolution The Patient • Directed to most appropriate setting • Care closer to home • Care closer to home National Ambulance Service Implementation of Hip Fracture Bypass as part of our New Model of Care Alternative Destinations Why? What do we know? We know that timely diagnosis, appropriate pre hospital identification, direct delivery to appropriate sites allows for early intervention which leads to better outcomes for this classification of patient What Did We Do? National Ambulance Service Implementation of Hip Fracture Bypass Clinical Directive We started with #Neck Of Femur bypass 1.South East - Engagement with relative stakeholders (Clinicians, Ambulance Staff, and hospitals) - Dedicated trolley in ED - Geriatricians key to positive outcome (early intervention) - Positive outcome for all, especially the patient This then gave confidence to the system, that ambulance staff were engaged in this pathway. Proof of Concept 2. Cavan Quality Assured the Initiative Time stands still for no man… Confidence Education Naas Orthopaedic Trauma Bypass Protocol, encompassing (but not limited to) # Neck of Femur • Patient brought to right place first time – better outcomes • Secondary ambulance transfer eliminated Challenges for the NAS Maintaining existing level of service Longer travel times Non refusal policy Turnaround Time deterioration Maintaining confidence Financial Implications Bi-directional flow High Quality Safe Patient Centred Care Different Viewpoint – One Team Thank You.