Audit of Sussex & Surrey Immediate Medical Care Scheme

(SIMCAS) Activity (Dec 2005 to Nov 2006)

1. Audit Contributors:

Angela Rowland (Clinical Audit Manager)

Alan Pearce (SIMCAS Co-ordinator & Audit Lead)

Colette Fairway (Clinical Audit assistant)

SIMCAS Responders

2. Aims of audit:

2.1 To evaluate SIMCAS activity over a 12 month period

2.2 Compare activity with previous year, if possible, using 03/04 SIMCAS report.

2.3 To provide individualised activity reports for SIMCAS responders.

3. Audit period & Inclusion criteria:

3.1 Audit Period: 1^st Dec 2005 to 30^th Nov 2006.

3.2 An emergency response was sent to 159, 902 incidents in the 05/06 audit compared with 153, 693 incidents in the 04/05.

3.3 SIMCAS were dispatched to 420 (0.3%) of these incidents in 05/06 compared to 235

      (0.1%) in 04/05.

4. Methodology:

4.1 Clinical Audit Manager ( CAM ) extracted data from Emergency Dispatch Centre’s (EDC) database, using SIMCAS call signs, for the audit period.

4.2 All the data was entered onto a spreadsheet and by the CAM and Clinical Audit Assistant.

4.3 The CAM analysed the data and summarised the information into a draft report and produced specific profiles for each SIMCAS responder using their individualised call signs.

4.4 The draft report was distributed to the audit contributors and senior Clinical and Operational Managers for comment and feedback prior to general distribution.

5. Audit Limitations:

5.1 As the data was extracted from the EDC system and not the patient’s clinical records, the audit was limited to focusing on activity and not specific care given by individual SIMCAS responders as in the previous audit.

6. Activity per month:

6.1 SIMCAS responders attended an average of 35 incidents per month in 05/06 (420 from 1^st Dec 2005 to 31^st Nov 2006) compared with an average of 20 per month in 04/05 and 25 per month in 03/04.

6.2 A dramatic increase in activity was noted in 05/06 compared with previous years; the busiest periods being Oct/Nov and Jul/Aug; which could be attributed to the seasonal changes of weather.

7. Activity by Time of Day:

7.1 In the 05/06 (106, 25%) and 03/04 (58, 20.8%) audits the highest percentage of incidents attended by SIMCAS responders was between 15:01 to 18:00hrs; whereas the 04/05 (46, 19.6%) audit showed the highest percentage between 18:01 to 21:00

7.2 The busiest time in 05/06 and 03/04 audits was between 17:01 and 18:00 whereas in the 04/05 this was 18:01 to 19:00 which would correlate with the increased road activity of schools finishing and the evening rush hour.

7.3 In all audits the smallest activity was recorded between 03:01 to 06:00hrs – 2.9% (12) in 05/06, 1.7% (4) in 04/05 and 2.5% (7) in 03/04.

8. Activity by Patient Condition:

8.1 In all audits the highest percentage of incidents attended by SIMCAS responders were Road Traffic Collision (RTC) – 68.3% (287) in 05/06, 70.6% (166) in 04/05 and 78.9% (220) in 03/04.

8.2 Over one third of RTC’s, attended by SIMCAS responders, in 05/06 (33%, 94) and in 04/05 (37%, 62) had multiple casualties requiring emergency attention. This data was not available for the 03/04 audit.

9. Activity by Call Sign:

9.1 SIMCAS responder 948 attended the highest number (17%, 73) of incidents during the 05/06 audit period; although closely followed by responder 950 (16%, 50) and responder 931 (14%). The majority of these were in the more rural areas of Sussex .

9.2 The individualised activity summaries highlighted that responder 931 arrived at the highest percentage of incidents (32%; 19 of 60) she attended, before the crew.

9.3 SIMCAS responders 931, 948 & 950 should be commended for their efforts in helping to achieve quick response times and providing medical support for crews in their areas.

10. Response times:

10.1 In 05/06 a SIMCAS responder was the first emergency resource, on scene, at 18% (75) of the 420 incidents they were dispatched to compared with 19% (44 of 235) in 04/05. The ambulance crew arrived at the patient’s side before the SIMCAS responder on the other 82% (345) of incidents.

10.2 The SIMCAS responder, was stood down on route to 32% (134) of incidents in the 05/06 audit as the crew had identified that they did not require the additional medical support of the SIMCAS responder on those occasions; compared with 2.6% (6 of 235) in the 04/05 audit.

10.3 In the 05/06 audit the SIMCAS responders arrived at the patients side within 8 mins to 7.6% (32) of patients compared with 95 (21) in 04/05. The average patient call for help to SIMCAS attendance was 25 mins (median 20 mins) in 05/06 compared to 26.6 mins (median 22 mins) in 04/05. The longer attendance time was usually because the SIMCAS responders were used as medical back-up for frontline ambulance crews. This was especially noticeable in situations where there were multiple patients (e.g. RTC). With this in mind, response times ranged from 1 mins to 3 hours 57 mins; a similar finding to the 04/05 audit figures (range 2 mins to 3 hours 19 mins).

10.4 In 05/06 SIMCAS responders spent an average of 48.9 mins (median 37 mins) at scene with patients, compared with an average of 48.7 mins (median 32 mins) in the 04/05 audit. The median time of 32 mins may be more reflective of actual practice due to the wide range of on scene times (1 min to 4 hours 40 mins in 05/06 and 1 mins 9 hours 30 mins in 04/05). This data was not available for comparison in the 03/04 report.

11. Number of patients treated:

11.1 In the 05/06 audit a total of 649 patients were assessed and treated, at the 420 incidents, attended by SIMCAS responders as one fifth (25%, 106) of the incidents had more than one casualty.

11.2 In the 04/05 audit a total of 317 patients were assessed and treated at the 235 incidents; also with one fifth (26%, 62) of the incidents having more than one casualty.

12. Patient Outcome:

12.1 Of the 649 patients assessed in the 05/06 audit: 79.5% (516) were conveyed to hospital for further treatment, 3% (20) died at scene and the remaining 17.5% (113) were treated and left at scene.

12.2 Of the 317 patients assessed in the 04/05 audit: 83% (262) were conveyed to hospital, 4% (12) died at scene and the remaining 14% (45) were treated and left at scene. This data was not available for comparison in the 03/04 audit report.

12.3 In the 05/06 audit the highest number of patients were conveyed to the Royal Sussex County Hospital in Brighton (15.6%, 101) whereas in the 04/05 the highest number of patients were conveyed into St. Richards Hospital, Chichester (23% n=73).

13. Overall Summary of Audit Findings:

12.1 This re-audit has highlighted a dramatic increase in SIMCAS activity during 05/06 by an average of 15 incidents per month compared with 04/05. In last three audits have highlighted that SIMCAS responders are activated during the seasonal peaks in emergency activity (e.g. Summer and Winter months) and periods of during increased road activity of schools finishing and the evening rush hour; thus resulting in a high percentage of attendances to road traffic collisions (RTC’s) where there are often multiple casualties.

12.2 The activity of individual SIMCAS responders varied greatly however, three SIMCAS responders (931, 948 & 950) were commended in the 05/06 audit for their high activity, quick response times and providing medical back-up to crews and patients in their response areas.

12.3 This re-audit has again highlighted that SIMCAS responders have helped achieve the eight minute response, by arriving at the patient’s side prior to the crew, on 18% of incidents they attended in 05/06 and 19% in 04/05. They have also assessed and/or treated 20.5% of patients, on scene, negating the need to convey them to hospital in the 05/06 audit and 18% of patients in the 04/05 audit.

12.4 Overall this re-audit has highlighted that for another year SIMCAS responders have a beneficial effect on the performance and patient care offered by the Ambulance Service to patients in the Sussex and Surrey areas and their medical skills should continue to be utilised in future years.

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