Linking the LAS with Health & Social Care 6 th December 2016 - PowerPoint PPT Presentation

Linking the LAS with Health & Social Care 6 th December 2016

Outline: • About me….. • LAS Context • Integrating LAS with H&SC 2 London Ambulance Service NHS Trust

LAS context NHS Trust 3 London Ambulance Service

We are one of the busiest Ambulance Services in the world

The London Ambulance Service today • Covers all of London = 32 CCG’s, 41 NHS trusts, across 86 sites • Population of 8.9m people • Respond to c.1.9m 999 calls annually • We employ just under 5000 staff, 71% of which are frontline • Our frontline staff work out of 70 ambulance stations • Focus on international and national recruitment drives – 700 staff joined London Ambulance Service NHS Trust 5

How we care for the capital Our major service areas: • Call taking and clinical triage • Hear and treat services • 999 emergency and urgent care response – delivered using traditional and innovative means e.g. Cycle Response Unit • Intelligent conveyance • 111 Services • Emergency Preparedness Resilience and Response (EPRR) NHS Trust 6 London Ambulance Service

Demand – Category A 2013-14: 8,830 incidents per week (average) 2014-15: 9,374 2015-16: 9,652 2016-17: 10,697 • In 2015-16 there were 19 weeks where activity ranged from 10,007 to 10,983 incidents • w/e 20 Nov 16 – 11,330 CAT A Calls (16/20wks) • 8 of the top 10 busiest ever months for the LAS have occurred since Jan 2016, with March 2016 being the busiest ever month for Category A calls followed by October 2016 NHS Trust 7 London Ambulance Service

How can H&SC assist? NHS Trust 8 London Ambulance Service

Focus – HCP / Care / Residential calls • Overall HCP referrals are up by 12.3%. Marginally ahead of overall growth rates. • The over 60s represent the largest proportion of the total population within HCP referrals(62% of the total referrals in 2016/17) • “HCP protocols” and “emergency response requested” represent the majority determinants driving growth in this area. • HCP growth - Hammersmith 33% and NW London 24%. 9 London Ambulance Service NHS Trust

What to do when a resident becomes ill… NHS Trust 10 London Ambulance Service

Consider: • On-site qualified nurse or district nurse • GP or GP out-of-hours service • 111 Always call 999 if someone is seriously ill or injured, and their life is at risk • difficulty in breathing, unconsciousness • severe loss of blood • Stroke or heart attack 11 London Ambulance Service NHS Trust

Making the Call – Residential Care..  Dial 999, ask for an ambulance and stay calm  Answer all the questions if possible, remain with the patient- Mobile phone  If you can’t stay with the patient – make sure you know if the patient is alert, conscious, breathing  You could be offered advice over the phone, or a call back from our paramedics in the clinical hub 12 London Ambulance Service NHS Trust

How we prioritise your call… • We ask a series of questions and run through a triage tool. Answer all the questions if possible. This does not delay any response in coming but it will allow us to send the most appropriate response. • Are they conscious, alert, breathing? • Location is important- Unit name/ Floor/ patients name • Any other information that you can give is really helpful to our crews. 13 London Ambulance Service NHS Trust

LAS - HCP LINE 020-3162-7525 (not for public sharing) 14 London Ambulance Service NHS Trust

London Ambu lance Service rt'J:fj .. \ " t Health Care Professional (HCP) Admissions Phone number: 020 3162 7525 0(E Can your patient organise their own transport? DO OD Is y o u r patient sujtable for car or Non-Emergency Transport arranged by the London Ambulance Service? DO Time frames are:2 - 4 hours OD 1- 2 hours Other timeframes by arrangement with LAS clinicians Non-emergency, Emergency ambulance needed? D need Provide oxygen therapy For paUents who WIil treatment en-route to hospital Transport stretcher-bound D D pa · ents I ncl ud i ng pa lli at i ve 8 mlnutos care pat i ents I mmed i atel y li fe-threaten i ng D Transport chair-bound D 20 mlnut s pa · ents Emergency transport needed Response depend i ng on for c li n i ca l cond l on c li n i cal cond i Ion D 45 m l nutes D 2 - 4 hours Urgent transport needed D 1 - 2 hours for c ll n l ca l cond l · on

Making the Call - Nursing Care .. HCP Line: • For registered health care professionals / Nurses (999 for non- registered carers) • The call taker will ask what time frame you need the ambulance • Know why you are calling the ambulance, a set of observations are helpful when we are deciding what response to attend. • When you request a call to be made Immediately life threatening (from the HCP line) this will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack. Please use the time frames appropriately. 16 London Ambulance Service NHS Trust

What are the implications? • When you request a call to be made Immediately life threatening (from the HCP line) This will divert an ambulance off another life threatening call such as a Heart attack, Strokes or a Child having an Asthma attack. • Please use the time frames appropriately. 17 London Ambulance Service NHS Trust

Appropriate time frames Time frame for Clinical condition – examples given as guidance only Type of ambulance ambulance Non-Emergency Non- emergency transport Majority of patients who do not require immediate treatment in GP surgery or 2 – 4 hours ambulance /car en-route to hospital, limb injuries, mechanical back pain, mental health concerns Non-Emergency Non- emergency transport 1 – 2 hours ambulance / car Elderly patients going for assessment, e.g. general deterioration, stable COPD Urgent Front-line emergency 60 minutes Stroke onset over 4.5 hours, acute abdominal pain, cauda equina – time critical ambulance patients who need treatment on route Emergency Front-line emergency 20 minutes e.g. stroke onset under 4.5 hours; sepsis, respiratory conditions requiring on- ambulance going nebulisers, abdominal, head injury / fallers on anticoagulants Front-line emergency Immediately life-threatening 8 minutes ambulance +/- solo response e.g. acute severe asthma, cardiac chest pain, actively fitting vehicle 18 London Ambulance Service NHS Trust

Non- Emergency Ambulance What can they Provide?  Basic Observations  Stretcher and Chair  Give Oxygen  Give inhaled pain relief  Transport to hospital  They will attend the most of the calls over 60 minutes. 19 London Ambulance Service NHS Trust

What is wrong with the resident? Does the resident need an emergency ambulance? • Unconscious • Simple infection • Fall with no injury • Difficulty • Abnormal blood • Chest Pain results • Uncontrollable bleeding • Catheter problems • Obvious limb fractures • Minor injuries and illnesses 20 London Ambulance Service NHS Trust

What are the alternatives? Short-Term Community Specialist Nursing GP 111 Rehabilitation & Rapid Nursing: (depending on • Generally • Out of Response area) • Catheters Unwell hours GP • Short-Term Rehab • Administering • Tissue Viability • Infections access • Rapid Response- 2 hrs drugs and • Cardiology • Falls with • Clinical • Mobility Problems giving injections • Diabetes minor injuries Advice • Hospital Avoidance • Cleaning and • Telephone • Respiratory • Problems • Chest Infections, UTI, dressing wounds • Parkinson’s with numbers • End of Life Care Skin Infections. Specialist Prescriptions for • MS Nurse • Access to alternative • The team also • The Team can be • Epilepsy Nurse referrals such services. provides a gateway to contacted via the as speech other healthcare GP, through Rapid and language Response or 111 pathways including for eating etc. falls, COPD, Diabetes, • Behavioural District Nursing and problems long term condition management. 21 London Ambulance Service NHS Trust

What could delay us from getting to a patient? × Not being met at door, can’t get in – no access code × Unsure which resident is the patient × Large home, many patients, different floors × IMPORTANT – let others know you have called for an ambulance 22 London Ambulance Service NHS Trust

What would help us when we arrive? Full name, date of birth, next of kin & contact details GP details (hospital needs these for referrals) Address of the home Medication – drug chart, medical history & any observations DNAR in place? Copies of information for us to take away Patient’s personal belongings Escort 23 London Ambulance Service NHS Trust

Thank you … any questions? Contact details; Martin.Bowdler@lond-amb.nhs.uk