Commencement of Extended Care Paramedic Program in Illawarra

The NSW Ambulance Service has commenced the expansion of the Extended Care Paramedics (ECP) Service in the Illawarra. The service will cover the area from Helensburgh in the north to Kiama in the south. The Shoalhaven program is not currently staffed and a review is being undertaken.

Some patients who access health care through calling 000 do not necessarily require transport to hospital. The ECP service aims to increase the choices available to low risk patients who have minor illness or injury or who require low acuity care or advice and provide alternative pathways to emergency department presentation.

At present the case load averages approximately 8 per day per ECP. There is an approximate non transport rate of 50%. Of the 50% who are not transported the majority are referred to, or seen by their GP on the day of referral. With further exposure a 60% non transport rate is anticipated.

Who are Extended Care Paramedics (ECPs)

ECPs are experienced paramedics who receive additional training at the Nepean Campus of the University of Sydney in enhanced patient assessment and clinical decision making processes.

Operational Aspects

ECPs are available from 7.00 am -7.00pm (but will usually not respond to calls after 6.30pm).

Triage is initially performed electronically at the call centre, where triggers in the computerised system identify cases commonly mitigated by ECPs. The ECP is contacted and will either proceed directly to the case or will contact the caller direct via telephone to obtain further information.

The response time varies. If a delay in response is considered appropriate due to low acuity, the patient is contacted, usually by the ECP via mobile phone from the vehicle. If an extended delay is likely, the low acuity patient is attended to by standard Ambulance response.

ECPs assess patients, provide certain types of medical care (see below) and refer the patient to GPs, hospital based or community based services.

ECPs commonly communicate with the patient's GP to discuss presenting symptoms and treatment options and to obtain advice as to the most appropriate pathway, or to request an x-ray referral for relocation x-ray (anterior shoulder relocation, patella relocation, simple fracture without neurovascular compromise, etc). All patients are referred back to their GP.

ECPs currently respond in a VW caddy which seats two people. ECPs can transport ambulant patients to the ED or GP should their condition warrant it and the transport is deemed clinically safe.

Benefits

The most obvious benefit of the service is that of the GP being actively involved in the care of his/her patient. Additional benefits of the service include:

• Reduced visits to the GP
• Reduced visits to ED
• Reduced use of ambulances
• Enhanced available emergency resources, reduced hospital admission and;
• Faster patient access to medical services

Problems That Can be Treated at the Scene

These include minor allergic reactions, asthma, back pain, mammal bites, stings, hemorrhage/lacerations, minor burns, catheter problems, dislocations, falls in the elderly, urinary retention, back pain (non traumatic), urinary tract infections and wounds.

Skills That ECPs Can Perform

These include wound care including glue and sutures, catheterization including supra-pubic and IDC, replacing PEG tubes, back slab plasters for immobolization of upper and lower limb injuries, reduction of dislocations, digital nerve blocks, otoscopy, Quick Screen falls assessments, urinalysis and pregnancy tests.

Medications That ECPs Can Give

In addition to standard Ambulance pharmacology, ECPs can administer:

• Amethocaine for non-penetrating eye injuries
• ADT vaccine for tetanus prone wounds
• Antibiotics for mammal bites, UTIs and community acquired pneumonia
• Paracetamol, ibuprofen and oxycodone for pain
• Oral and intravenous steroids for moderate to severe asthma and anaphylaxis
• Telfast for minor allergic reactions

Case Study

ECPs attended a man who lived on a rural property, who had sustained an anterior dislocated shoulder. ECPs provided mild analgesia (Methoxyflurane), relocated the shoulder, rang the man's GP for an x-ray request. The patient presented at the x-ray facility (a relative provided transport), then proceeded to the GP with the x-ray and results.

GPs can contact this service on 131 233 for ECP appropriate cases (low acuity) or 000 for emergency cases. The direct mobile number in 0409 097 810.