EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMS AROUND THE WORLD 16 SEPTEMBER 2018 | EMSWORLD.com four months "based on a group of experts applying common sense," whereas England is now trialing something that looks remark- ably similar but had to wait two years for full scientific appraisal of available evidence. Commissioning of EMS is done collaboratively between WAST and the Welsh government and is much simpler than the multiple com- missioning partners with which most English ambulance trusts contend. Other Challenges The geography of Wales brings with it logistical challenges that have remained unchanged since Welsh EMS began and will be familiar to anyone running EMS in sparsely populated areas: the effects of rurality, distances involved, and prolonged job cycles. In addition, Whelan identifies ris- ing demand and rising public expectations as his biggest challenges. WAST's direc- tor of operations, Richard Lee, mentions demand increases and frailty too, but also "the lack of 24/7 alternatives to conveyance in primary and community care, dispersed families, fuel prices, and lack of in-vehicle technology." With a fleet of more than 700 vehicles, diesel and upgrading equipment doesn't come cheap! WAST has embraced being an integral part of the Welsh NHS's urgent care service, not just a clinical transport system. Its nonconveyance rates—historically among the highest in the U.K.—are currently around 60%, with 7.5% of calls closed at the "hear and treat" stage and the remainder assessed face to face. But with hospitals bursting at the seams and increasing recognition of the harms of hospitalization in elderly patients, WAST is upgrading a propor- tion of its paramedic workforce to advanced paramedic practitioners. APPs have an MSc in advanced practice and are trained to assess and diagnose in the medical model, as well as carrying a wider range of drugs (including antibiotics)—for U.S. readers they'd be akin to some community paramedics. The Next Chapter It is clear that WAST is committed to shaping its service into what is really needed by the population. Linkage between WAST patient clinical record data and hospital data, under- taken retrospectively, is available for about 85% of calls. This recently available feed- back loop offers tantalizing possibilities to further refine prioritization of calls but is only just starting to be explored. The author would like to thank Alan Murray (WAST CEO, 2006–2010), Dafydd Jones-Morris (retired as WAST director of operations in 2012 after 40 years in the service), Dr. Jonathan Whelan (WAST assistant medical director), and Richard Lee (WAST director of operations) for their assistance preparing this article. ABOUT THE AUTHOR Linda Dykes, MBBS (Hons.), is a consultant in emergency medicine at Ysbyty Gwynedd (Gwynedd Hospital), Bangor, Wales, and a member of the EMS World editorial advisory board. √ Impeccable Reliability √ Meets New Protocols √ Low Cost per Patient Use Solve your spineboard challenges today! Visit us at www.hartwellmedical.com Designed to meet today's new standards, the CombiCarrierII functions as an innovative scoop stretcher and an extrication board. 3 Key Reasons to make the switch: See us at EMS World Expo #1611 For More Information Circle 17 on Reader Service Card

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