A Night Out with the Ambulance Crews in Dudley

#ProjectA is gathering momentum with over 430 posts and nearly 20,000 interactions on the ideas platform. The ambition is to identify at least four major change ideas that can be developed, prototyped and implemented by frontline staff across all 10 ambulance trusts, in time to start making a difference in winter 2018/19. 

The whole ethos and approach of #ProjectA is one of co-production and collaborative decision making so at NHS Horizons we have been working with the Association of Ambulance Chief Executives to host a crowdsourcing platform, tweet chats and other engagement approaches and I wanted to go into their world too and get an insight of ambulance services on the ground.

Having already spent a Friday night at West Midlands Ambulance Service  a few weeks back, it was now time to spend a Saturday night out with the crews on the ambulances from their Dudley hub at Burton Road - a place that was the scene of my psychiatric placement as a student nurse when I was last there in about 1989. This time I had the privilege of joining Claire, a paramedic and John, a technician and student paramedic on board their ambulance for the evening. I have been a nurse for over 35 years, and have worked closely with ambulance crews but I have never been out with a crew on 999 duties and so was very much looking forward to seeing them in action!

When I arrived, they were already busy collecting their equipment and preparing the "truck". I was greeted by Martin, the operations manager, who talked me through the safety and security procedures, including with issuing me with my observers kit which contained a high viz jacket and a crash helmet - and clear instruction to wear mine whenever the crew are wearing theirs. This was starting to get a bit real now!!

We were now ready but as there was no job we went up to the 'rest room' - I was expecting a snooker table and a TV but found it was more like a canteen with tables and chairs. The energy was friendly and welcoming. Claire, John and I sat at a table together and were were talking about why they went into this profession and had just got onto their shift patterns, which are staggered for crews to arrive at 15 minute intervals when their radios went off and suddenly we were on the ambulance and off on our first call! 

The night turned out to be a steady stream of calls: an infant who was fitting, a gentleman recently discharged from hospital with shortness of breath, a young girl in severe abdominal pain and so on. My clinical career has been almost entirely hospital based, bar some community work in my training so I have always been fascinating at how health and care workers manage in small rooms, crowded with personal belongings, navigating cluttered stairs to get to bedrooms, clambering over boxes, looking for boxes of medication and searching through paperwork to find helpful information from various hospital appointments. They are respectful of being in that person's home, both in their behaviour and in their words.

What did I learn?

1. Access to information:Crews should have direct access to the Summary Care Record to be able to gather a full picture of the person who is needing emergency care. To make this useful, the SCR needs to be up to date and on discharge from hospital it would be helpful if a written summary were to be given to the person to have available to share with the crew.
2. Direct referrals: Ambulance clinicians should be able to navigate access for the patient to the most appropriate department eg surgical assessment units, medical assessment units, end of life care admissions direct to a ward thus reducing unnecessary attendances and queuing in the emergency department. 
3. Standard approaches to prep-ing & restocking ambulances: Vehicle Preparation Operatives (VPO) do an amazing job, they keep the ambulances clean and stocked up, ready to go whilst allowing the crew time to have a break. They are key members of the team!
4. Handovers & IT connectivity: Ambulance crews can update their Emergency Operations Centre in real time whilst attending a call, they take a comprehensive record of the scene and the actions taken. This needs to linked with 1. the emergency department so that information can be available on arrival, which will also prevent duplication of information already available and 2. the GP so that any additional support required for people who have called 999 and don't require admission.
5. Say thank you at the end of each shift: Most shifts are 12 hours long and can often be the crew of two out on the road for most of that time. Sending a 'thank you' message out to the crew at the end of their shift might be two simple words but it was clear to me that they meant an awful lot to the recipients and to their well-being as they went off shift.

So what now? These five ideas are now be added to the #ProjectA platform and I hope that you will have a look and vote, comment or add your own idea.