Ambulance services and our ageing population – we need ReSPECT
A personal view by Cathryn James, Clinical Lead for AACE
How many of our patients do we receive calls for that are older, frail and commonly present as falls? Thousands.
How much time, resources and innovation are we giving to ensure that older people get the right care and are able to remain at home with appropriate care? Not as much as we should.
I accept its not perhaps seen as the ‘sexy’ end of our work but it’s a huge proportion and at the end of many of my clinical shifts it feels that all my jobs were elderly falls, dementia, social care and what I now call ‘a phone call job’ where I have to make numerous calls to the myriad of community services to try and ensure that the patient can stay at home with appropriate follow up and referrals.
Out of hours this is much more difficult. It’s vital that our clinicians become more skilled in complex decision making to ensure the right care of the elderly and the need for comprehensive assessment, conveyance decisions and how to safety net. The community services need to be available with agreed pathways easy for us to access and responsive to the needs of the patient. Unfortunately this can be highly variable, sometimes non-existent or patchy.
And just how many single points of access are there out there? We must increase the pace of work with our partners and commissioners in areas such as frailty and develop the potential for how we use frailty tools to inform the best care. There are a number of models out there of alternative responses to falls, and use of other Allied Health Professionals and other agencies to respond to a fall. These need further development to ensure we can reduce delays in attending falls and reduce length of time on the floor for the patient.
We know that the hospitals, especially this winter, have beds full of older people. We don’t know exactly how many of these could or should have been cared for in the community, but getting an older person back home again after they have laid in a hospital bed or even a trolley for long periods, lost more muscle mass, lost confidence and independence and become disorientated is difficult, along with cuts in social care budgets.
We need to embrace new ideas around our public health role and build on the consensus statement recently launched between AACE, Public Health England and other agencies. Conversations with patients already take place, such as with older people about falls prevention, the need for telecare equipment so help can be sought in a future fall, and about loneliness and isolation.
These need further development to ensure the MECC (Making Every Contact Count) approach is used and developed for many patient groups.
I believe there are a few significant pieces of work now underway that are good news. The development of a new JRCALC falls guidance is well underway with input from enthusiastic and experienced members from paramedic, medical and nursing disciplines.
The collaborative national development of the soon-to-be-launched Recommended Summary Plan for Emergency Care and Treatment form (ReSPECT) could – in my view – potentially be a game-changer. The ReSPECT process creates personalised recommendations for clinical care in emergency situations in which the person is not able to decide for themselves or otherwise communicate their wishes.
This plan is for anyone, with increasing relevance for people who have particular needs; who are likely to be nearing the end of their lives; or who want to record their care and treatment preferences for any other reason.
The plan should be with the patient and be available immediately in an emergency to ambulance crews. It guides clinicians who have to make rapid decisions in an emergency, so that they can choose the right balance between focusing treatment mainly on prolonging life and focusing mainly on providing comfort. It includes recommendations about specific treatments that the patient would want to be considered for or would not want, or those that would not work in their situation or could cause harm. One of these is a recommendation about attempting CPR.
Let’s hope that the roll out of this is at pace and implemented well.
Cathryn James
Clinical Lead for AACE
