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Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

Ambulance service trusts in England have historically had little or no competition for non-emergency patient transport services (NEPTS), but following the imposition of the NHS Procurement, Patient Choice and Competition (PPCC) Regulation (Number 2) 2013, NHS commissioners could accept suitable bids for NEPTS work from third-party commercial competition. This paper describes how NEPTS evolved in England and how an Ambulance Service Trust Board had to step-up their approach to bidding for NHS NEPTS work and to protect their brand and financial position in a competitive commercial market place.

The Trust Board developed a competitive bidding strategy with a market research project using “grounded theory” to identify and categorise stakeholders' issues followed by re-engineering to achieve new operational goals. A fundamental element of the bid was an opportunity to share patient information between local NHS facilities using a common access data warehouse. This would represent a serious barrier to entry to any third-party non-NHS commercial competitor.

Key projects were identified in the bidding process, including relocation of NEPTS resource bases, use of third-party resources and the establishment of a local NHS-wide data warehouse. They were all self-financing within the contract period and accepted by the commissioners. However, the establishment of NEPTS hubs at hospitals with clinics scattered throughout their grounds was rejected by the commissioners due to incompatibility with existing hospital practices.

This case study defines the challenges and opportunities faced by an English Ambulance Service Trust Board when responding to an invitation to tender (ITT) from NHS commissioners for NEPTS and competing with third-parties on a commercial basis. Any emergency service would face similar challenges bidding for work in a competitive environment.

Looks at evidence of the fate of medical research and provides a template for gauging the value of money spent. Provides key issues and learning points which need consideration in order to improve research skills and capabilities. Offers evidence that could be used to improve research governance in health care. Gives learning points for those sponsoring, hosting or managing research and for others becoming involved in research. Concludes that understanding past practices should help in improving those which are current.

Looks at where action research has been used in health care in the UK and suggests lessons can be learned by looking at action research taking place in other fields, such as education, policing and social services.

Increasing attention is being placed on clinical trials as a source of evidence. Presents thoughts about the advantages and disadvantages of clinical trials and their influence on thinking and clinical practice.

First in a series of articles to address the critical appraisal of clinical trials. Provides background of knowledge, ideas and instruments to use to understand better the evidence, and tools used in looking at evidence. Provides a rationale for critical appraisal and three different hierarchies of the evidence.

Examines a particular system for reporting clinical trials: the revised CONSORT system. Identifies its evolution and key components, indicating who may go on to use it, posting its key strengths, and concludes by identifying its outstanding limitations.

The pharmaceutical business has long been a source of controversy, particularly the ability to market a drug for human consumption. The thalidomide disaster of the late 1950s and early 1960s invoked all nations in the 15 member states of the EU to require that a pharmaceutical product intended for human consumption have an official market licence before it is allowed onto the nation’s market. Until December 1994 each nation in the EU could decide itself what products came onto its market. From January 1995 the European Commission, facilitated by the European Medicines Evaluation Agency, has had the power to decide on applications for pan‐EU market licences. Explores the new EU licensing system, drawing from past and present experience, and argues that although complex at least four sets of motivations lie behind the construction of the EMEA system: the EU prisoners’ dilemma; four types of market failures; extensions of politico‐bureaucratic business and, finally, the inability of the pharmaceutical industry to nurture effectively any feasible alternative to the new system.

For decades distribution has been like a ‘sleeping giant’, content to carry on as in the past. Now it has received an awakening triggered by the information technology revolution. The result has been reduced costs and improved customer service. Alan Slater, managing consultant at Price Waterhouse discusses the importance of distribution information.

This paper identifies and explores issues of medication, the elderly, and the problems in securing and using evidence from randomised control trials. Demographic and health care data are presented. While the elderly are a significant set of consumers of medicines, there is a lack of published evidence, in control trial format, on which medications are better for elderly patients. Even if all the trial evidence on a new drug was published before the drug was put on the market, as recently recommended, there are serious issues to consider in securing and using evidence from clinical trials. This paper indicates ten problems in securing and using evidence from randomised control trials. Three examples of randomised control trials involving the elderly are given. While it is easier to call for improvements in the evidence base than to achieve improvements, this paper argues that improvements are fundamentally necessary. This is because if no significant improvement comes through on the evidence base, we will never know if we are providing the elderly with the cost‐effective care and attention that they deserve.