Commentary: Ambulance response model success

Revised approach brings significant improvement in 30-day survival rate among Scotland’s sickest patients

Thursday 23rd May 2019

An ambulance response model that focuses on matching the response provided by staff to the needs of individual patients has led to 43% improvement in the 30-day survival rate among the sickest patients since being introduced.

Adopted in November 2016, the new clinical response model (NCRM) changed the way the service responds to 999 calls.

Jim Ward, medical director at the Scottish Ambulance service, explains more about the NCRM.

“We’re dedicated to ensuring we respond to patients in the most effective way possible by delivering the right care, to anyone who needs it, at the right time,” he says.

“The NCRM replaced an older, outdated response system that hadn’t changed much since its introduction in 1974.

“In those days ambulance drivers would pick the patient up and make them comfortable, before putting their foot down and dropping them at the nearest hospital. Nowadays we live in a different world. Paramedics and technicians are trained and qualified healthcare professionals.”

Diagnosing, administering medicine and drugs, and making clinical decisions about how and when a patient should be treated are among the duties of today’s ambulance staff.

We’ve even developed new advanced clinical roles, allowing certain ambulance clinicians to make a range of decisions previously reserved for doctors.

The NCRM is built around these skills – matching the patient’s needs with the skills of the ambulance service workforce,” explains Mr Ward.

Within seconds of a 999 call being put through to one of our ambulance control centres, our call-takers will have identified whether or not a patient needs an immediate response.

For those critically ill patients that do, resuscitation advice and the location of a defibrillator will be given to the person making the call. Meanwhile, multiple responders will be sent to the scene, supported by enhanced cardiac arrest response vehicles.

As every second counts, these patients remain our utmost priority, so much so, we’ll often divert paramedics heading to less sick patients.

Once stabilised, our paramedics will transport these very sick patients to hospital.

For others who are not in any immediate danger, but who need further assessment, we’ll aim to ensure the first ambulance response we send has the ability to transport patients. After all, there’s not much point in sending a motorcycle paramedic if the patient needs to go to hospital.

Once on scene, our crews will assess the patient and – depending on the diagnosis – they’ll be transported to the most appropriate location – whether that’s a hospital or a specialist care facility.

For those patients that don’t need to go to hospital, we might decide to carry out a face-to-face assessment, or deliver appropriate care advice over the phone – either from one of our own clinicians or by referring them to NHS24.

“For face-to-face assessments our crews might decide to treat the patient at home or refer them to the best service for their needs.  

As a result of prioritising response to the sickest patients, we have seen a relative 43% improvement in 30-day survival for this group. That represents over 1000 people in the first year of our new system.

We’re proud of the work our staff are doing to improve patient survival rates. The new model is helping us focus on matching the response we provide to the needs of individual patients.”