A pre-alert aims to forewarn a hospital of a critical patient’s arrival with pertinent information. Before leaving a scene, the pre-hospital practitioner will aim to share relevant information including if a patient is intubated. The pre-alert was a key outcome of the NCEPOD 2007 report, Trauma: Who cares?
“Ambulance trusts and emergency departments should have clear guidelines for the use of pre-alerts in the severely injured patient population… to ensure an appropriate clinical response is available immediately.” (NCEPOD, 2007).
There have been significant system improvements since the NCEPOD report including establishing major trauma networks in the UK since 2012. In 2016, NICE guideline 40 updated the parameters for major trauma service delivery, which included that standard for a trauma pre-alert. The minimum data recommended is;
For medical patients there is good evidence that a pre-alert for patients improves clinical outcomes by ensuring timely clinical care on arrival. Work in 2020 from Manchester has shown that by refining the pre-alert process the door to scan time was significantly reduced. This work highlights the importance of accurate triage decision, pre-alerts and refinement of processes locally.
A pre-alert aims to include all the relevant information to ensure the receiving hospital is best prepared. Due to clinical need or equipment limitations the ‘expected’ information may not be possible for every case, for example an AVPU is an acceptable alternative to GCS. The use of pre-agreed structure allows both the caller and receiver to know what information to give and what order to expect the information. ATMIST (UK standard) or ASHICE are the common handover structures.
ATMIST |
ASHICE |
Age Time Mechanism of injury Injuries sustained Symptoms and signs Treatments given |
Age Sex History Injuries Condition Expected time of arrival |
Use of a proforma for the call receiver aims to enhance bandwidth, prevent missed information and allows dissemination of information to the wider team. This step helps enhance the shared mental model and primes the handover. Below is an example, blue pre-hospital pre-alert proforma and the red hospital pre-alert form.
(Images Courtesy of Dr D Maxwell)
A pre-alert should come to an agreed single point, either a standby phone or radio. It is important to note that this call may be made by a call handler or clinician not present at the scene which will limit additional information.
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