Pre-hospital information

Pre-hospital information regarding an incident is collected from a variety of sources to gain a rapid, accurate assessment of the mechanism and background to an incident. Information can be obtained first hand, directly from the patient or witnesses or indirectly by interpretation of the physical scene, or from other agencies such police, fire and ambulance crews. All relevant information is collated by the pre-hospital practitioner to create a holistic understanding of the scene in regard to mechanism and the likely consequences. Clinical information and parameters are added to the understanding of the mechanism to plan on-scene treatments and appropriate triage.

An example of relevant information gathering follows. Please review these two pictures. At both scenes you find an unconscious driver. However, the scene might suggest different causes and treatments required. The pre-hospital practitioner should be able to read this scene but needs to share this relevant information with the receiving hospital to enhance a patient’s onward care.

Picture 1 shows a car that had come to a stop off the carriage way, there was no damage, no skid marks and no environmental causes to come to a stop. This is suggestive of a medical event as a preceding event. (Owned and provided by S Jefferys)

Picture 2 by comparison shows a car with severe damage, skid marks and oil on the road surface suggesting a high velocity RTC, making a medical cause less likely. (Owned and provided by JP Loughrey)

The information a pre-hospital practitioner can provide aims to support a patient’s onward treatment, triage and discharge risk stratification. However, this information can only be appreciated by the hospital practitioner if shared effectively.

The Improving the Quality of Ambulance Crew Handovers study found that information decay was more acute when multiple handovers were required with either loss or change of the information by the provider. An audit of pre-hospital and Emergency Department resuscitation room records in 2012 identified 26% of records had inconsistencies including timings of incidents, patient’s allergy status, medication omissions and conflicting anatomical references. Whilst this was prior to the UK Major Trauma system, it highlights that system changes and standards are needed to enhance performance.

Fitzpatrick et al., showed many of the difficulties associated with in-hospital handover can be attributed from issues in the pre-hospital environment. Information is gathered from multiple agencies, in challenging environments with competing pressures such as clinical care. The introduction of a common standard handover format with an associated tool has shown improvements when introduced. Findings included greater volume of information shared per handover, fewer questions from ED staff, a reduction in hand over duration and fewer repetitions.

Learning bite

• Prehospital information should be sought to risk stratify patients’ onward care.
• A handover tool helps to structure relevant pre-hospital information and a shared mental model.