Treat and Referral - An Update

The last edition of the PHECC voice outlined the proposed introduction of treat and referral into the Irish emergency medical services. The key principle of treat and referral is to demonstrate the safety of this process through a research project. The research project will be led by Brian Power, Programme Development Officer PHECC, as a UCD PhD study supervised by Prof.Gerard Bury.

Al though six clinical conditions were initially identified as being suitable for treat and referral, a decision has been made to target two specific clinical conditions, hypoglycaemia and isolated seizures, for the study period. Analysis of the data collected will inform the Medical Advisory Group if it is safe to introduce treat and referral as a standard practice for all paramedics and advanced paramedics.

Treat and referral is the next paradigm in pre-hospital emergency care for Ireland. Practitioners’ involvement in the study will, for the first time, influence the development of their own future scope of practice. Paramedics and advanced paramedics in the selected areas will be requested to participate in the research by initially engaging in the training and then recruiting suitable patients for the study. It is envisaged that each ambulance in the study areas will have a treat and referral pack containing the documentation necessary.

A study by Fintan Feerick, an AP, has identified that the rate of hypoglycaemia is 90 per 100,000 per annum in Ireland. The number of hypoglycaemic events required to demonstrate a 5% difference between patients transported to ED and those offered treat and referral is 862 (sample size). Following a review of the population in the study areas it is estimated that it will take approximately two years to achieve this number. Estimates of isolated seizures is approximately 120 per 100,000.

The study will be centred on designated emergency departments and this will facilitate comparisons through patient follow up. Consultants in emergency medicine with a statutory ambulance service involvement or UCD supervision have consented to be involved, thus the catchment area of their respective emergency departments will be targeted for the study areas.

Hypoglycaemic events (estimated from study by Fintan Feerick, AP)
90 per 100,000 population 
Isolated seizures(estimated from computer aided dispatch {CAD} data)
120,000 per
100,000 population
Sample size required to detect a 5% difference between patients offered T&R and  transported to ED
(431 - study cohort)
(431 - control cohort)
Estimated study duration
 2 years