[accordion] [acc_item title=”General”] Capital – London
Land Size – 241,930 sq km
Population – 61,284,806
Language(s) – English; Welsh (approx. 26% of population of Wales); Scottish form of Gaelic (about 60,000 in Scotland)

[/acc_item] [acc_item title=”Prehospital Care Overview”]
  • “Each year approximately 5% of population will use the Emergency Ambulance Service, although responding to emergency calls only accounts for about 10% of the total ambulance workload” (Black, 21)
  • “The Best”
    • “Emergency Medical Systems are rapidly evolving in the UK at a time of rapid change” (Black, 28).
  • “The Worst”
    • “In urban areas, severely injured non-trapped patients spend on average 45mins in the field before arriving in hospital” (Black, 26)
    • “Individual paramedics and technicians are unlikely to manage more than one or two seriously injured patients with an injury severity score greater than 15 per year in most parts of the country” (Black, 26).
      • Impact on skill retention
    • “The lack of suitably trained doctors in prehospital critical care is of concern, unlike in many European emergency medical care systems” (Black, 27).
[/acc_item] [acc_item title=”EMS System Model”]
  • Anglo-American
[/acc_item] [acc_item title=”Lead Agency”] [/acc_item] [acc_item title=”Funding”]
  • UK emergency health care delivered almost exclusively by National Health Service (NHS)
    • Free at point of delivery for residents and visitors
    • Funding from general taxation
    • Accounts for 5.5% of GDP
[/acc_item] [acc_item title=”Levels of Care”]
  • Ambulance Response Types
    • Usually manned by Paramedic and Technician
    • Solo responders on motorbikes/cars may also be mobilized
    • Deployment of Rapid Response Vehicle also possibility to provide care before arrival of ambulance (or in lieu of)
    • MDs in voluntary Immediate Care Schemes may be mobilized directly by dispatch for:
      • Entrapment
      • MVCs
      • MCIs
    • Mobile Medical Teams (MMT)
      • Come from nearest hospital
      • ED MD/RN
      • Anesthetist
      • Surgeon/Theatre RN
      • Rarely requested
[/acc_item] [acc_item title=”Education and Training”]
  • Some variability in educational entry requirements between ambulance trusts.
  • Most training provided by individual ambulance service education dept’s; some training hospital-based
    • Some have also developed links with local universities to develop training and assessment programs
  • Core Content and Assessment developed by Institute of Health and Care Development (IHCD)
  • Care delivered by national protocols developed in conjunction with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC)
  • After schooling and exam, technicians spend 1yr under direct supervision of fully-trained technician/paramedic.
  • Refresher training every 3yrs
  • Further training after 12mos and recommendation by employing trust
  • Paramedic Practitioners:
    • 3 year Univ-based modular courses for paramedics
    • Offer extension of scope of practice
      • Extended care for specific minor illness
      • Minor injury – “Treat and Complete” (Suturing)
[/acc_item] [acc_item title=”Dispatch”]
  • Use of VHF radio, MDTs or Mobil phone by ambulance control room staff
  • Prioritization and RTs
    • Category A
      • Immediately life-threatening
    • Category B
      • Serious, not immediately life-threatening
    • Category C
      • Neither immediately life-threatening nor serious
    • Determined by using Advanced Medical Priority Dispatch System software by dispatch.

[/acc_item] [acc_item title=”Public Access Numbers”]
  • Common national access number – 999 or 112

Emergency Medicine

  • NHS Direct
    • Piloted in late ‘90s, rapidly introduced throughout UK in 2001
    • Provides info on local NHS resources by telephone or internet
      • Health advice delivered by senior nurses
        • Majority receive info on ‘self care’
        • Can divert callers to primary care
        • Arrange transport to ED by ambulance if required
          • Ambulances now diverting some inappropriate calls to NHS Direct
  • Primary Care
    • All residents (and temporary) encouraged to register with local general (family) practicefor emergency/planned primary care or for continuity of care
  • Minor Injury Units
    • Recently developed to deliver care to populations with limited access to EDs
    • Care predominantly delivered to by Emergency Nurse Practitioners and other RNs.
    • Can prevent lengthy inconvenient and unnecessary ED visits
  • High Street Walk-In Centers and Emergency Care Centers
    • Nurse-Managed
    • Geared to manage primary care type problems:
      • Rx for minor illnesses and injuries
      • Ax by experienced NHS nurse
      • Medical Advice
      • Information on NHS facilities and services
    • Not funded/equipped to manage major illness/injury
  • “The UK Government now require all (NHS) EDs to assess, treat, and discharge or admit to hospital ward 98% of all patients within 4h of presentation” (Black, 26).
[/acc_item] [acc_item title=”References”]

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[/acc_item] [/accordion]
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