Tag: Ambulance Service

One in four ambulances delayed 30 minutes or more as Emergency Care falls deeper into crisis

The latest Winter Sitrep data for the week ending 27 March show:

  • There were 79,588 ambulance arrivals, 2.7% less than the previous week.
  • More than one quarter of ambulances experienced delays of 30 minutes or more, equal to 21,051 ambulances – an increase of 7.4% on the previous week
  • This is the highest proportion of ambulance delays on record
  • More than one in nine ambulances were delayed by more than 60 minutes, a 10.2% increase on the previous week, setting a new record high for this reporting period.
  • The average number of delays for this winter has continued to creep up, increasing from 0.3% up to 21.3%. The previous highest weekly average number of delays was 14.3% in 2019-20.

The Royal College of Emergency Medicine and The College of Paramedics have collaborated on this Ambulance Handover Options Appraisal guidance that details the ways in which Paramedics and Emergency Medicine staff can reduce ambulance handover delays.

Dr Ian Higginson, Vice President of The Royal College of Emergency Medicine, said: “The data show Emergency Department crowding, long “hidden” within the walls of EDs, has become more visible as handover delays have dramatically increased, leading to ambulances waiting outside EDs with their patients still inside.

“It is vital that ambulances return to active service whenever possible and safe to do so. Delaying ambulance handovers should be a last resort. Holding patients in ambulances leads to unnecessary delays to their care, leaving seriously ill or injured patients in the community requiring an ambulance to wait longer.

“Ambulance handover delays are almost entirely caused by dangerous crowding in Emergency Departments. The root cause of these problems is “exit block” where there are delays for patients to be admitted to inpatient beds from the ED. Patients suffer harm or die unnecessarily when they cannot get an ambulance in time, when they are held in ambulances on arrival in ED, or when they are treated in crowded EDs.

“Emergency Departments must have sufficient capacity to meet demand, and constant flow from the Emergency Department into inpatient beds, otherwise they will not be able to keep patients and staff safe. This means that risk must be properly shared within organisations, and through systems.

“When this does not happen leadership teams tend to look for mitigation. Unfortunately, this mitigation is usually focused at the front door of the hospital, rather than being directed at the root cause of the problem. The Royal College and The College of Paramedics have produced this joint guidance to support good decision making when managing ambulance handover delays in an effort to tackle ambulance handover delays and dangerous Emergency Department crowding.”

Tracy Nicholls, Chief Executive of The College of Paramedics, said: “We hear from our members how consistently challenging this situation is and, whilst we can see that paramedics, ambulance clinicians and hospital ambulance liaison officers are doing everything they can, the system is now at breaking point. 

“Those who need an ambulance are continuing to wait an unacceptable length of time and those paramedics and ambulance clinicians who are running to their next job can clearly see how long their next patient has been waiting and know they are going to be met with frustration, anxiety or fear.

“It seems incongruous that additional measures are being taken at the front door when the whole system flow of patients still needs to be addressed, but we suspect that there are now few options left without further risk to both those who are using the ambulance services and those who are working within them.

“Ambulance operations centres are still fielding calls at record numbers because callers want to know when an ambulance will arrive and are often calling back time and time again.

“It is difficult to hear that an ambulance might be delayed but imagine how a caller feels when their 999 call isn’t answered straight away. The moral injury is not just with the paramedics, but also with all of those involved directly with patients and their care.

“The College supports RCEM’s call for both the reduction in ambulance handover delays and in ED overcrowding.  It is only by working together as a system that we will see this much-needed change and this guidance document outlines the risks associated with the current challenges.”

Delayed hospital handovers: RCEM calls for system-wide action

The Association of Ambulance Chief Executives (AACE) has published a report following a structured clinical review of handover delays at hospital emergency departments across England.

This reveals for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.

The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.

The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.

Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.

The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes.

Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.

You can read the report here.

Responding to the latest report ‘Delayed hospital handovers: Impact assessment of patient harm’ published yesterday by the Association of Ambulance Chief Executives, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This report makes for stark reading but will come as no surprise to Emergency Department staff.

“Patients should never be delayed in the backs of ambulances. Patient safety is being compromised. When there is simultaneously no space in the Emergency Department and ambulances queuing outside the Emergency Department, we are no longer delivering effective urgent and emergency care to the community.

“We support our paramedic colleagues and will continue to work with them to tackle these handover delays and keep patients safe. But these pressures must not be addressed in isolation. The answer does not lie with the ambulance services nor in the Emergency Department. This is a system-wide problem that requires system-wide action and solutions. In particular, the answer is not just to increase physical space in the Emergency department with no additional staff.

“Trusts and Boards must focus on increasing flow throughout the hospital to reduce exit block and ensure patients are moved through the system. In the immediate term, Trusts and Boards must safely expand capacity throughout the hospital where possible to stop patients being delayed in ambulances. Social care must be resourced to ensure patients can be discharged when they have completed their treatment to prevent long hospital stays.

“We entered the pandemic with too few beds in the system and have continually struggled to manage with reduced capacity, now this is unsustainable. It is vital that the government restore bed capacity to pre-pandemic levels to achieve a desirable ratio of emergency admissions to beds. Currently 7,170 beds are required across UK Trusts and Boards.

“Patient safety is at risk and without urgent action avoidable harm will continue to fall upon patients while urgent and emergency care will fall deeper into crisis.”

Register your defibrillator to help save lives across Scotland

The Circuit: Charities and health organisations urge people to register their defibrillators on database to help save lives  

A new campaign has been launched across Scotland to urge defibrillator owners to register their devices on a national database to help save more lives from cardiac arrests.

Leading charities and health organisations have come together calling for defibrillators to be registered on The Circuit – The national defibrillator network, which connects defibrillators to NHS ambulance services across the UK, so that in those crucial moments after a cardiac arrest they can be accessed quickly to help save lives.

  • There are around 3,200 out-of-hospital cardiac arrests every year in Scotland, but only one in ten people survive.
  • Every minute that passes without CPR or defibrillation reduces the chances of survival by up to 10 per cent in some instances, but immediate CPR and defibrillation can more than double the chances of survival.
  • It’s estimated that public-access defibrillators (PADs) are used in less than one in ten out-of-hospital cardiac arrests across the UK – often because 999 call handlers aren’t always aware that a defibrillator is available nearby because the ambulance service hasn’t been told about it. If they don’t know it is there, they can’t direct someone at the scene to retrieve it while waiting for the ambulance to arrive. 

To help save more lives, The British Heart Foundation (BHF), Resuscitation Council UK (RCUK) St John Ambulance and Association of Ambulance Chief Executives (AACE), are urging people who look after defibrillators in places such as offices, communities, shopping centres and leisure centres, as well as in public places, to register them on The Circuit.

James Jopling, Head of BHF Scotland, said: ““Every second counts when someone has a cardiac arrest and, alongside CPR, prompt use of a defibrillator is critical in giving them the best chance of survival.

“To put it simply, knowing where the nearest defibrillator is could be the difference between life and death.

“The Circuit is pioneering technology which will help emergency services direct bystanders more quickly to a defibrillator when someone collapses with a cardiac arrest. But for The Circuit to save lives, it is vital that unregistered defibrillators are put on the system. If you, or somebody you know is a defibrillator guardian, then we urge you to register your device on The Circuit. You could help save a life.”

Pauline Howie, Chief Executive of the Scottish Ambulance Service, said: “When someone calls 999 to report a cardiac arrest, the call handlers in our control rooms are trained to provide the location of the nearest registered defibrillator within 500m of the call. 

“Studies show that using a defibrillator within three minutes of collapse, along with starting CPR, can greatly increase chances of survival.  

“This swift action can make a real difference, and The Circuit is a vital tool in helping increase bystander action to help someone in cardiac arrest. Over the last five years, the Save a Life for Scotland (SALFS) partnership which includes SAS, the Scottish Government and the Scottish Fire and Rescue Service has equipped over 640,000 people with CPR skills, and the survival rate after an out-of-hospital cardiac arrest has doubled to one in ten people. 

“However, there’s more we can do, and to help save even more lives, we would urge everyone to register the defibrillators that they are responsible for on The Circuit, so that they can be easily located and accessed when needed.”  

Dr James Cant, Chief Executive Officer at Resuscitation Council UK, said: “A cardiac arrest can happen to anyone, anywhere, at any time. Not only is defibrillator use a crucial step in the Chain of Survival, the presence of defibrillators in public places can help raise awareness and stimulate people to think about what they would do in an emergency. 

“Survival depends on all links in the Chain of Survival being carried out quickly. This means early recognition and calling for help, early CPR, early defibrillation and post resuscitation care – and The Circuit plays a vital role in giving people their best chance of surviving a sudden cardiac arrest.”

While the 14 UK ambulance services have previously had their own regional databases, The Circuit will eventually replace these with a new national database that lets the ambulance services see defibrillators across the UK once it has been rolled out. This will allow them to direct people to the nearest defibrillator when somebody is having a cardiac arrest, wherever they are.

The Circuit, which is already live in 12 of the 14 ambulance service regions across the UK[1] and will become nationwide soon, could help to save thousands of lives – but it is vital that as many defibrillators as possible are registered on the database for it to work effectively. 

It’s free to register your defibrillator onto The Circuit, and you only have to do it once. You can also register multiple defibrillators if you are the guardian to more than one.

Visit TheCircuit.UK for more information or to register your defibrillator. 

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