Evaluation of the emergency medical retrieval service - Scottish ...

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3.18 The EMRS Team continues to undertake occasional primary retrievals when these are referred by the SAS. However, in these cases, EMRS dispatches is at the consultants’ own discretion and are undertaken when it is assessed that such a retrieval will not impede the ability of EMRS to respond to secondary retrievals. 18
4 LITERATURE REVIEW • Air-based emergency retrievals differ around the world and are not directly comparable. There is also an absence of rigorous, prospective randomised studies. Evidence that is available therefore needs to be qualified. • The literature review suggests that: o initial medical care can improve patient outcomes; o the level of medical expertise is likely to affect outcomes; o the relationship between retrieval time and outcome is complex and affected by the level of intervention at the referral facility and during transport; and o retrieval services are likely to operate within acceptable costbenefit boundaries. • An EMRS-type service for Scotland has been proposed in the last four to five years to improve patient outcomes in rural areas. • The results of the initial Argyll & Bute pilot were positive in terms of improved support and advice for rural practitioners; optimal triage for patients; and improvement in patient outcomes. Introduction and literature review methods 4.1 As part of the evaluation into EMRS in remote and rural Scotland, it was important to examine experience from the rest of the world to highlight examples of best practice and to inform, where possible, future configuration of a Scottish service. A literature review was therefore carried out to identify any previous and similar evaluations of EMRS-type services. 4.2 The emergence of an EMRS in Scotland has its roots in early experience in the West of Scotland and in recent policy for rural health in Scotland. The initial expectation was that this Service would primarily cater for secondary retrieval of ill or injured patients who had received initial treatment at a local facility (health centre, community hospital, or rural general hospital) but were thought likely to benefit from greater critical care expertise at a larger facility. This, rather than primary retrieval, is the main focus of this evaluation and therefore of the literature review, although, inevitably, the literature often does not make such a clear discrimination and studies focussing purely on interhospital transfers are relatively sparse. 19
Page 1 and 2: Health and Community Care Evaluatio
Page 3 and 4: This report is available on the Sco
Page 5 and 6: Value for Money Assessment 103 Conc
Page 7 and 8: 1 EXECUTIVE SUMMARY Introduction 1.
Page 9 and 10: 1.14 Patients are referred from acr
Page 11 and 12: 1.33 We assumed the following numbe
Page 13 and 14: 1.46 This leaves us with the remain
Page 15 and 16: 2.6 There were three core elements
Page 17 and 18: 3 BACKGROUND TO EMRS • EMRS is de
Page 19 and 20: • Consultant led retrieval allows
Page 21 and 22: Figure 3.1 Map of EMRS coverage and
Page 23: A note on primary retrievals 3.14 D
Page 27 and 28: The Red Cross Flying Doctors Servic
Page 29 and 30: Retrieval times 4.21 The Associatio
Page 31 and 32: setting and study design. Again, th
Page 33 and 34: difficult to prove this from existi
Page 35 and 36: cover (of both ambulance resources
Page 37 and 38: hospitals keen to provide the servi
Page 39 and 40: • Improved training and empowerme
Page 41 and 42: • Deliver a strategy for sustaina
Page 43 and 44: 5 PERFORMANCE OF THE WEST OF SCOTLA
Page 45 and 46: Figure 5.1 Summary of total mission
Page 47 and 48: 5.13 Figure 5.4 shows the location
Page 49 and 50: Figure 5.6 Location of referrals So
Page 51 and 52: Figure 5.9 Final destinations for E
Page 53 and 54: Table 5.2 Average (median) retrieva
Page 55 and 56: Figure 5.12 Clinical indication for
Page 57 and 58: • ISS score - The Injury Severity
Page 59 and 60: • SAPS II - 156 patients were giv
Page 61 and 62: Qualitative assessment 5.49 This se
Page 63 and 64: 5.56 However, a number of patient r
Page 65 and 66: “Without EMRS, we would struggle
Page 67 and 68: 5.75 This view was supported by one
Page 69 and 70: 5.87 Generally, there was support f
Page 71 and 72: • The literature review highlight
Page 73 and 74: Table 5.8 QALYs under Estimate 1 As
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epresenting an improvement in EMRS
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always err on the side of caution.
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6.4 The demand estimates presented
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• High estimate - 345 cases per a
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day time admission is at their plac
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7 OPTIONS DEVELOPMENT AND SHORT LIS
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Option / option Overview Key driver
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7.6 This exercise provided us with
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Table 7.5 Guidance notes for scorin
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Table 7.6 Scoring of the options Cr
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• Option 2 - revert back to Argyl
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8 COST AND VALUE FOR MONEY ASSESSME
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8.10 For Option B, therefore, the s
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Staff costs 8.17 The following assu
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staff rota. To err on the side of c
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Aircraft 8.28 It was clear during t
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• In addition, it has been estima
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Value for Money Assessment Cost per
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8.49 The final column of this table
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8.59 Option C, regardless of which
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Table 9.1 Risk matrix of key risks
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Table 9.2 Health boards involved in
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10 ADDITIONAL DATA 10.1 Since the e
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10.11 This model is not sufficientl
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Appraisal audited afterwards, perha
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covering other rural parts of Scotl
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K S Berns, DG Hankins and S P Zietl
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Appendix B - Secondary Retrieval Li
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Author Title Journal (if applicable
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Other EMRS Literature Author Title
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Author Title Patients Journal (if a
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Appendix C - Risk Matrices Option A
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that a number of transfers were avo
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Increase in additional air transfer
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Table C.3 Risk matrix for Option C
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EMRS may lead to less ICU admission
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Increase in case workload Simultane
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Table C.5 Risk matrix for Option E
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Adverse weather May prevent SAS air
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RRIG Membership (as of 16 December
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APPENDIX E - GLOSSARY Acronym Full
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ISSN 0950 2254 ISBN 978 0 7559 7841
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