Why Prehospital Care is an Important Part of the Healthcare Mosaic

1
Why Prehospital Care is an Important Part of the
Healthcare Mosaic

• Greg Bruce AEMCA
• County of Simcoe Paramedic Services
• with
• Marg McKenzie BScN, CIC
• Edmonton, AB.

2
Objectives

• Describe Prehospital cares (PHC) position in the
  health care continuum
• Identify potential links to facility community
  stakeholders
• Identify concepts/strategies encouraging
  integration of PHC into the healthcare mosaic
• Identify misperceptions which may present
  stumbling blocks

3
Is PHC

• Community care?
• OR
• Industrial emergency care?
• OR
• In flight care?
• OR
• Is it Acute care?

4
PHC provided

• Rapid defibrillation/cardioversion
• Intubation, intravenous and interosseous
• Surgical airway, chest decompression
• Child birth
• Drug administration, oxygen therapy
• Burn/wound/fracture/spinal care
• Patient ventilation
• And much more!...

5
Environment

• On the street and in the home
• In the bathroom and the bedroom
• Cars, buses, helicopters and airplanes
• Industrial site, correctional facilities
• Oil rigs and mining facilities
• Hospitals, LTCF and mental health
• Dialysis and oncology units

6

• Should prehospital care be defined
• by the environment in which that care is
  delivered?
• OR
• by the level of patient care
• provided?

7
Prehospital Care

• Definition
• Acute emergency patient assessment and care
  delivered in an uncontrolled environment by
  designated practitioners performing delegated
  medical acts at the beginning of the healthcare
  continuum

8
Position in healthcare continuum

• Considered to be at the beginning of the
  continuum prior to hospital admission
• Can be in the middle e.g. agency to agency
  transfers
• Acute care delivered in the home, on the street,
  in industrial settings etc
• There are some similarities to acute care and
  community care but many differences

9
Goals of any IC Program

• Protect the patient
• Protect the health care worker
• Protect family
• Protect others in the environment
• Achieve above goals in timely, efficient cost
  effective manner

• The goal is to achieve a consistent standard
• of care across the healthcare continuum.

10
Legislated Standards

• Chute Time
• Response time (chute time driving time)
• Time to patient contact
• On Scene time
• Transport time
• How will these important quality indicators
  affect PHC IPC policy/procedure and perhaps more
  importantly, practice?

11
Legislated Standards

• PHC workers must
• Perform rapid assessment and history
• Perform quality patient care
• Transport patient to hospital
• Be prepared for another call as soon as the
  stretcher is cleared
• Make IPC decisions
• All while meeting Legislated standards

12
Infection Control Standards

• Must be current and evidence based
• Use IPC references, APIC, CHICA, CDC
• Compliant with regulations, guidelines,
  accreditation criteria
• Standards must be relevant to the setting
• Core competencies to direct best practice
• Must be meaningful and useful to user

13
Partnerships for

• Guideline Development
• Connect with Regional/Provincial/National
  committees
• Inclusive rather than exclusive
• Language e.g. Healthcare rather than
  Healthcare facility
• General rather than specific to silos e.g.
  acute care versus community care

14
Partnerships with

• Emergency Departments?
• Health Region IPC departments?
• Health Region IPC planning committees?
• Public Health Units?
• Public Health planning committees?
• Continuing Care?
• Federal/Provincial IPC guideline development
  committees?

15
Partnership for

• Acute Care Surveillance
• Incidence of pneumonia occurring following field
  intubation
• IV site infections/BSI following field IV/IO
  insertion
• Community Surveillance (i.e. ILI)
• Contact tracing for PHC staff

16
Partnership with

• Local Health Unit
• Establish links now, before an outbreak
• Valuable source of information
• Involve in policy design and planning
• Immediate notification of staff exposure
• Assistance with staff exposure evaluation and
  follow up
• Outbreak notification
• Work with hospitals

17
Partnerships for

• Intervention and Prevention
• Identify trends and intervene to change practice
• Control Outbreaks (engineered and practice
  controls)
• Disaster and pandemic planning
• Exposure management
• Employee Health programs
• Vaccination Programs

18
PHC vs Health Care Facility
19
Resources

• While IPC is funded in acute care and now in
  some provinces in continuing care it is NOT in
  Prehospital care
• Funds must be assigned to enable participation
• Services must be held accountable responsible
  to ensure that funds are assigned specifically
  for IPC

20
Culture Change WithinPrehospital care

• Trained to save lives
• Balance patient safety, provider safety and life
  saving. All can exist together
• Prehospital care IPC policy focus has previously
  been related to OHS
• Need to balance OHS with patient quality of care
• Many Prehospital care standards are OHS focused
  (NFPA, USFA)

21
Culture Change WithinPrehospital Care

• Services must be accountable and responsible to
  ensure that prehospital care representatives on
  committees can participate and advocate with IPC
  knowledge to achieve consensus statements in
  policies and guidelines
• Prehospital care must break out of their silo
  and establish partnerships in IPC

22
Attitude Change with consultant/ advisors

• PHC workers are trained HC professionals who
  happen to drive an ambulance. They are NOT
  ambulance drivers!
• Prehospital care workers work in a different
  environment to other HCWs
• Prehospital care workers have to adapt IPC
  principles to fit their setting
• Prehospital care workers have different
  legislative standards to consider

23
Summary
PHC is part of the healthcare mosaic

• Recognition of position in the healthcare
  continuum
• Identification and nurturing of strategies to
  foster links within the healthcare continuum.
• Research specific to Prehospital care IPC
• Change culture / change misperceptions
• Additional resources allocated to PHC