London Personalizes EMS Care for Special Patients - @

London Personalizes EMS Care for Special Patients



Mannie Garza | | Tuesday, May 5, 2009

London Ambulance Service (LAS), which servesEngland's largest city, has created "patient-specific protocols" to prospectively tailor EMS care to high-risk patients for whom regular protocols don't fit. Each PSP provides specific instructions for a named individual. LAS Medical Director Fionna Moore, MD, described the LAS program at the Metropolitan Medical Directors Consortium's "State of the Science" conference (aka, "A Gathering of Eagles") in February.

The purpose of a PSP, she said, is to provide a structured, uniform protocol to guide the management of a specific patient; provide a patient's pertinent medical history to the ambulance crew, ensure the patient is transported to a specific treatment centerand remind responders about that patient's special needs.

LAS has created a PSP for 252 patients since 2007, and 186 of those personalized protocols were "active" as of February. Each PSP is created and signed by the LAS medical director and the patient's primary physician and is written on LAS letterhead. "It's important for crews to recognize that these are approved protocols," Moore said.

She provided examples of several patients with PSPs, including:

  • A 5-year-old child with difficult-to-control epilepsy and a severe sensitivity to benzodiazepines, requiring administration of rectal paraldehyde;
  • A patient with severe COPD who is susceptible to type II respiratory failure and severe respiratory acidosis due to oxygen toxicity; and
  • A patient with end-stage glioblastoma who should not receive bag-mask ventilation/intubation, chest compressions or cardiac drugs but should still receive suction of upper airway, face-mask oxygen and airway positioning.

Patients with a PSP are flagged on the "high risk" database and integrated into the CAD system. The patient's address (or multiple addresses) is flagged, and an audible alarm sounds on the mobile data terminal whenever a call comes from a PSP address.

Every patient (and/or caregiver) is sent copies of the protocol and a cover letter requesting that they keep a copy of the protocol with them at all times. In addition, copies of the PSP go to the patient's physician, to the ambulance stations closest to the patient's flagged addresses and to the LAS Clinical Support Desk, which keeps copies of all PSPs.

Moore said she now writes approximately four new PSPs each week, with each one requiring two to four hours of work. They also require liaison with hospital clinicians, she said, as well as constant review and updates. Because some PSP patients are challenging, she added, "You may live to regret some protocols."

The PSP program has also resulted in at least one global protocol change. "Because of a large number of requests for PSPs for steroid-dependent patients, LAS successfully lobbied for changes to national guidelines [to allow] administration of hydrocortisone by ambulance staff," Moore said.

She's now working with the LAS "Frequent Caller Team" to develop specific protocols for this group of patients.

For more information, contact Fionna Moore

For more on high-risk patients, read"Street Calls Program Reduces 9-1-1 Misuse and Delays in D.C."

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Cardiac and Circulation, Airway and Respiratory, Medical Emergencies, Pain Management, Special Patients

What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Philadelphia Fire Department Apologizes for Medic’s Jab at Police

Union head calls photos a slap in the face of officers.
Watch It >

Multimedia Thumb

D.C. Fire and EMS Crews Blame New Technology for Patient’s Death

Delayed response blamed on recurring dispatch problems.
Watch It >

Multimedia Thumb

Suspect Steals, Crashes Maryland Ambulance

One killed, others injured in Prince George’s County crash.
Watch It >

Multimedia Thumb

Truck Strikes Pedestrians in Scotland

Six killed in downtown Glasgow.
More >

Multimedia Thumb

Tennessee Trench Rescue

Worker pulled from Roane County worksite.
More >

Multimedia Thumb

Time’s Ebola Firefighters

Doctors, nurses and others saluted for fighting virus.
More >

Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >

Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >

Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >

More Product Videos >