Date: 25 July 2019
The patient fell off a horse and experienced a period of loss of consciousness. The patient wanted to know why the crew deemed that the air ambulance was not needed and why they weren’t transported to a major trauma centre following the clinical assessment and findings. They also felt that the crew took too long on scene and were concerned that although a pre-alert was made to the hospital, the crew decided not to travel with blue lights and sirens.
As part of the investigation, the investigating manager reviewed the electronic patient care record (EPCR) and CAD documents and received statements from the crew members. The crew stated in their statements that the helicopter emergency medical service (HEMS) dispatch desk contacted them on scene offering assistance if it was required. Following a full clinical assessment that crew felt that they were able to provide all required clinical interventions within their working skillset, so they therefore declined HEMS attendance.
The observations completed by the attending staff were referenced against the EEAST suspected major trauma protocol - this advised the staff to label the incident as "major trauma negative". The investigating officer confirmed that the observations along with the patient’s condition meant the crew appropriately managed the patient under the major trauma negative protocol. This protocol is nationally recognised and not limited to EEAST. The protocol expects that the attending ambulance will convey the patient to the nearest emergency department unless the crew have a specific concern that has been discussed with the advanced practitioners on critical care desk.
The crew stated that they were on scene for an extended amount of time due to prioritising the patients comfort above speed. They spent time making sure that clothing was removed to observe injuries, making sure analgesia was administered and preparing the patient for the journey to hospital. The crew pre-alerted the hospital due to the mechanism of the injuries sustained and the musculoskeletal injuries obtained by the patient. Due to the patient’s injuries the crew felt that a smooth journey to hospital outweighed the benefits of them arriving at the hospital quickly. The patient was also clinical stable and didn’t require the use of blue lights and sirens.
- Lesson learnt / action taken:
Although the crew felt that they had acted in the patient’s best interest, the investigating officer felt that due to the patient’s traumatic head injury and the fact they had been unconscious for 17 minutes, fitted, with a reduced GCS on the crew’s arrival, the crew should not have taken over 90minutes to treat on scene and then convey them at normal road speed with no clinical support. The investigating manager has asked that the crew reflect on the incident and how they could have changed their clinical practice to put the patient more at ease and treat the injuries sustained with more urgency and priority whilst maintaining the patient’s comfort.
- Date:01 July 2019