Peer review visit date: 26th February 2015
Compliance against national measures: 90%
The South East Coast Ambulance Service (SECAMB) provides a service across three trauma networks (Sussex, South East London and Kent and Medway and South West London).
SECAMB and the Air Ambulance Charity have some interactions with the Wessex Trauma Network when Southampton is either the closest MTC or the choice for the helicopters as the landing pad is functional 24 hours a day, seven days a week. The review team understands that SECAMB take an active role in the Sussex based clinical advisory group and the network trauma board, which aids its’ own governance processes. Although the challenge of attending up to four network board meetings is recognized, where practical it is important that SECAMB work to achieve this, ensuring appropriate representation when decision making takes place.
Links with the Sussex trauma network are well established and a collaborative audit on the major trauma decision tree has been undertaken. This has also been completed with other networks with links in place via the Quality Manager. During the presentation on the day of the review it was highlighted that further analysis is required, and this should be undertaken in conjunction with the network. It would be useful to consider rolling this audit out to other networks and sharing any good practice found.
Following the anticipated transfer of neurological services to the MTC in Brighton, there will be a need to ensure that greater clarity exists regarding triage for isolated head injuries to TUs.
The open fracture pathway needs further clarification, and it is important that SECAMB work with respective networks to ensure timely ortho-plastic involvement for patients that fulfill the BOAST criteria.
Through discussion, although the major trauma decision tree is in place and guidance is provided, it was apparent that there is a lack of clarity between the Trauma Units (TUs) and SECAMB regarding when it is appropriate to stop at the TUs to undertake life-saving treatment prior to transfer to the MTC, and this must be resolved.
Air ambulances are considered a strength of the service providing a twenty four hour, seven day a week service. It is noted though that the only helipad currently available out of hours is at University Hospitals Southampton.
Extensive training records for paramedics were made available during the review visit including the administration of transexamic acid. Although reassurance was given that pelvic ring binder training is given as part of induction, no documentary evidence was produced.
It was noted that the Critical Care Paramedics are extending their skill-set to do a thoracostomy rather than thoracotomy. The former is a hole in the chest to check for a tension pneumothorax rather than opening the chest.
There is a need to develop clinical guidelines regarding when to exceed the 45 minute isochrone in appropriate clinical situations.
The review team commends the critical care paramedics in post for their advanced academic preparation in critical thinking and analysis. The proposed move to increase skills in sedation and thoracostomy is innovative.
It would be beneficial for the SECAMB and the network to undertake a joint audit to measure the time of secondary transfer request to the response time of the ambulance. Whilst it is recognized that a high priority it is given, it is unclear as to whether this standard is achieved.
SECAMB expressed desire to reduce unnecessary time on scene and the review team is supportive of any work in this area
Good practice / significant achievements
- Critical care paramedic’s academic preparation in critical thinking and analysis.
- Governance around maintenance of training records.
- 24 hour air ambulance service
- Collaborative work with Sussex Trauma Network.
- Extending skill base to cover thoracostomy.
- Engagement with other networks in terms of seniority of attendance at network board meetings.
- Response to secondary transfer requests.
- TUs not accepting trauma patients when requested by SECAMB.
- Lack of guideline for 45 minute isochrone.
- Open fracture pathway requires greater clarification.