Assoc ProfessorDavid Menzies

Patients with falls accounted for 20% of ambulance calls in the Wicklow area and almost all were being transported to their local Emergency Department. The Wicklow Frailty Project set out to flip the traditional system, by providing a skilled team to respond to calls involving older adults, they are bringing the expertise to the patients in their own homes. This new model of care provides a rapid response by an Emergency Medicine Registrar, an Occupational Therapist and an Advanced Paramedic who respond to calls in Wicklow/South Dublin involving Older People, with low to medium acuity falls, wound care and other emergency care requirements. Patients are cared for in their own homes or usual place of residence and attendance to the Emergency Department (ED) and admission to the hospital for the majority of patients can be avoided/deferred. The expectation at the start of this project was that there would be a 50% reduction in the number of older people who call 999 who are conveyed to hospital. In the first 29 weekends of operation 256 patients were seen with 83% of all patients managed in their own home and did not require attendance to ED/Hospital. 16.4% of patients were conveyed to Hospital for further treatment or investigation. During the first wave of the COVID-19 pandemic, there was concern that there was lower numbers of older adults attending ED due to cocooning restrictions and there was a higher demand from surrounding Nursing Homes. There was few options for these patients to gain access to emergency care, which led to the expansion of the weekend service into a weekday service. Using the Sláintecare project as the basis, this project is now delivering a modified service Monday to Friday and to date they have carried out almost 1,200 patient visits, with over 90% overall avoiding hospital visit and staying in their usual place of residence. An emergency medicine doctor and advanced paramedic do blood tests, ECG and ultrasound to rule out serious cases, diverting hospital admissions. Near patient testing, Ultrasounds and ECG's can be performed as part of the clinical assessment and allow accurate diagnosis and treatment plans can be put in place without delay. A specialist occupational therapist (OT) will assess the environment and provide any necessary equipment and aids. The team will investigate for underlying causes of the fall and intervene to reduce future risk. Whilst on scene, those with frailty will be identified, and the need for ongoing support and care will be identified. The Project is progressing well and is actively affecting the recognition and management of frailty, coordinating care and facilitating, where possible, older frail patients to maintain their independence by identifying their care needs from the outset and putting care pathways in place to manage same. Patients are streamed to the most suitable services to meet their needs avoiding unnecessary delays and hospital admissions and provision of services as close to the patient as possible in line with Slaintecare principles. This project, which is funded through the Sláintecare Integration Fund is a joint initiative of St Vincent’s Hospital (SVUH), St Columcille’s Hospital, National Ambulance Service and General Practice.

Improving survival from out-of-hospital cardiac arrest (OHCA) is a global health priority. Without immediate recognition, provision of good quality cardiopulmonary resuscitation and early defibrillation, the chances of survival from OHCA are negligible. Ireland has a heterogeneous settlement pattern, ranging from villages to one-off housing in rural areas, and from small towns to inner-city communities. Serving a national population with geographic inequalities in a resource constrained environment is a critical challenge for the National Ambulance Service (NAS). The reality is that the challenge of reaching OHCA victims on time, every time cannot be met by NAS alone. Community response is an important but unquantified component to meeting this challenge. Many community responses have been developed in Ireland over the years involving General Practitioners (GPs), lone off-duty ambulance personnel, community first responder (CFR) groups, county fire services and rapid response groups in discrete, mainly rural, areas. Ireland is one of three European countries with a long-established OHCA register, but does not include data that explicitly describes the contribution of community response to OHCA. The aim of the project is to investigate the challenges to effective community response in Ireland and to embed data on community response in routine Irish clinical data collection for OHCA. We will review international best practice on the community response role in OHCA (including the role of automated external defibrillator (AED) registers), and consult with key stakeholders on the barriers to community response development, how best to integrate the role of community response in OHCA and how to record such a role. It is envisaged that this project will provide information that can inform support services for community response in Ireland. It will result in the development of a reliable recording process, providing data that can reliably evaluate the impact of community responders on OHCA outcome in Ireland.

National Community First Responder Conference