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Ambulance Service of NSW - other initiatives

What is it

Ambulance Service of NSW provides a number of initiatives to reduce patient transfers to ED by managing patients at home and providing health promotion and prophylactic management of conditions, for example:

  • Authorised Care Program (ACP) – An end-of-life pathway document (care plan) led by Ambulance Service of NSW to provide ambulance with a predetermined care pathway for a terminally ill patient.
  • Critical Emergency Response Services (CERS) – A rural facility with a limited ED workforce drawing on local ambulance resources to provide assistance with emergencies in the ED
  • Paramedic Connect – In low ambulance activity areas, paramedics provide community health services such as dressings, meds at home post D/C, TEDS, health promotion and ED support.

How it works

  • ACPs – are used to strengthen systems to support paramedic decision-making in meeting the needs of individual patients with special medical conditions, and respecting palliative wishes when an ambulance responds to an ACP. The document can be obtained from the ambulance and must be endorsed by the patient’s treating clinician. Once complete, it is sent to the ambulance to be endorsed by the Executive Director of Clinical governance. The document is valid for the next 12 months; in this time, the document provides ambulance officers with the care pathway for the patient.
  • CERS – The ED calls CERs when clinical resources are required in the ED. In rural facilities, there can be limited workforce with emergency experience; therefore, the ambulance workforce is leveraged for support when the ED requires addition support. This is achieved by calling the ambulance services and asking for assistance.
  • Paramedic connect – The station manager and the LHD establish specific community health services so that paramedics can provide dressings, medications etc. Paramedics provide these services during their scheduled shifts when there is low activity.

Resourcing

All ambulance services are provided by paramedics; the ECP are paramedics with additional speciality training.

Success factors

  • A clear governance structure
  • Strong education programs for paramedics
  • Strong relationships with LHD and ED facilities.

Models in operation

  • Authorised Care Program (ACP), Extended care paramedic (ECPs) – Nepean, Critical Emergency Response Services (CERS) – Kyogle, Paramedic Connect