PHECC’s submission to the Oireachtas Committee on the Future of Healthcare

Earlier this year we prepared a submission to the Oireachtas Committee on the Future of Healthcare, focusing on the area of pre-hospital care. Here are some of PHECC’s recommendation to the Oireachtas Committee.

 

Incorporating paramedicine as a resource within the health system as it addresses the needs of the patient in the community, while exploring options for developing an expanded scope of practice and facilitating collaboration of the pre-hospital practitioners into multidisciplinary teams.

The growing pressure on the health system and a significant shortage of health professionals has required consideration of alternative models of healthcare delivery. Over the past 20 years, a fundamental shift has occurred in healthcare delivery worldwide, largely due to advances in science and technology. This shift has been paralled by increasing recognition that healthcare is no longer the primary preserve of doctors and nurses. Rather, healthcare delivery is a team effort with optimal results being harnessed with a multi-disciplinary approach to care delivery. Paramedics are well positioned to be part of a multi-disciplinary team approach to primary care and contribute to the advancement of patient access to care in Ireland.

Developing information systems which support the integration of pre-hospital patient data with tertiary and primary care data – paper and electronic.

The implementation of the electronic health record (EHR) in line with the eHealth strategy for Ireland will transform healthcare as we know it. eHealth will enable the delivery of safe care to the patient and the inclusion of pre-hospital data integration is paramount to this complete picture; in order to achieve safe care delivery to the patient each time a call is made to 999 or 112.

Research in other jurisdictions indicates that pre-hospital electronic data collection has proved a powerful tool in monitoring important patient key performance indicators (KPIs), research, analysis and in areas of auditing and quality assurance. For the paramedic, EHRs enable rapid retrieval of records and transmission of data while en-route to the destination hospital. Equally, for the purposes of clinical audit, it enables clinical practice to be assessed seamlessly against standards of care. eHealth also facilitates the destination hospitals providing clinical feedback to the paramedic, the GP and the primary care community services, enabling a seamless continuation of the patients care, ensuring the best possible outcome for the patient.  

Integration of Community First Responder groups into the existing networks, supported by auxiliary and voluntary organisations, particularly in the rural context.

Currently, the role of the community first responder in delivering appropriate care to the patient, in a timely manner is undergoing change. In the best interest of a successful outcome for the patient it is well recognised that the responder needs to be dispatched in a timely manner. A Responder Alert Application (RAapp) proof of concept has been developed by PHECC. Implementation of the RAapp and integration with the National Ambulance Service control centre system will occur shortly.

This will facilitate the timely dispatch of the community first responder and the recording of response time data, in addition to out-of-hospital cardiac arrest data, which will contribute to the patient data already collected on the out-of-hospital cardiac arrest register (OHCAR). In cardiac arrest the best chance of survival is defibrillation within three minutes, so it is paramount that community first responder programmes are given the resources required to have an impact on patient outcome, after a cardiac arrest, if we expect to see an increase in our survival rates.

Practitioners exit the educational process having competencies to practice autonomously with other healthcare professionals.

A key hallmark of professionalisation in the medical sector has been the successful transition from vocational to tertiary level education and the embedding of it in the third level educational system. The importance in shifting paramedicine from its vocational origins to the tertiary level education environment has been echoed internationally. This transition is becoming apparent worldwide with Australia leading paramedicine in this domain, with over 10 universities in Australia offering degree courses, and post-employment training being slowly phased out in most states.   

International trends, and an analysis of the existing situation in Ireland, suggest many challenges to prepare paramedics for their evolving role in the Irish health system. The emerging consensus is that these practitioners will be autonomous professionals at the point of registration and well placed to effectively deliver a patient centric, out-of-hospital health service.

Development opportunities

Internationally, critical care paramedics (CCPs) now represent the highest level of pre-hospital and inter-hospital care available.

In countries such as Australia, New Zealand, South Africa and Canada specialist paramedics operate with the goal of initiating and maintaining tertiary-level emergency and ICU level of care for patients with the greatest clinical need. These paramedics can also facilitate the patients’ transport by air, land and sea to the most appropriate medical facility.  

Broadly defined, there appears to be two distinct roles for CCPs:

1. The critical care paramedic working as an autonomous practitioner, providing scope-of-practice above the level of a non-CCP paramedic in the pre-hospital environment (pre-hospital critical care).
2. The critical care paramedic working as part of a multi-disciplinary pre-hospital critical care transport team, alongside other medical, nursing and allied health professionals to provide care for patients who are unstable during either air or ground transportation (retrieval paramedic).

This International trend deserves further exploration in an Irish context.

In summary

Since its establishment, PHECC has championed change and guided the improvements in the standard of services and quality of clinical care afforded to patients. It is committed to developing a ‘common currency’ for patient care in Ireland (PHECC’s Strategic Plan 2015-2017). In recent years, internationally however, the definition of pre-hospital emergency care has evolved.

Internationally, there is a global movement towards change and increase in capacity and scope of paramedicine, and there are developments in this area within several healthcare systems. As the Irish health service goes through the most fundamental reform in the history of the State, best practice internationally predicts major modifications to our pre-hospital emergency care services.