Health watchdog urges more 'super paramedics' training to ease pressure on A&Es

Nice has called for more advanced paramedic practitioners on the front line.
Nice has called for more advanced paramedic practitioners on the front line.
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Ambulance trusts should train up more "super paramedics" to relieve the pressure on A&E departments, a watchdog has said

The National Institute for Health and Care Excellence (Nice) called for more advanced paramedic practitioners (APPs) on the front line to deal with patients with a range of conditions, including falls and those who are seriously unwell.

APPs have extra skills, such as delivering enhanced pain relief medication and assessing if wounds need stitches.

Some also prescribe a range of drugs and liaise with GPs, physiotherapists and social services.

The aim is for them "see and treat" people at the scene or sometimes deal with patients over the phone - known as "hear and treat".

According to Nice, the presence of APPs can cut hospital admissions by 13% compared with care from standard paramedics.

Figures from the National Audit Office from 2010 suggest that some ambulance trusts have as many as 10% of their paramedics as APPs, dropping to 2% in other areas.

Professor Julian Bion, consultant in intensive care medicine at Queen Elizabeth Hospital in Birmingham and chairman of the Nice guideline committee, said: "We are all too aware of the funding and resource limitations our NHS is facing.

"It is essential we spend what money we have wisely, investing in areas where we'll see a real improvement in care for everyone.

"Increasing the number of advanced paramedics we have working across the country is one way we can achieve this.

"Their skills and expertise can help to ease pressure on emergency departments and ensure patients are cared for in the most appropriate location."

According to NHS England, fewer than 5% of patients receiving urgent or emergency care have a life-threatening illness or injury.

As a result, it is thought a significant number could be treated without taking them to A&E.

According to Nice, it costs, on average, an extra £24,250 to train an advanced paramedic compared with the standard qualifications.

Previous calculations have estimated each APP saves the NHS £62,000 to £72,000 a year by reducing admissions to A&E.

The London Ambulance Service (LAS) has eight urgent care APPs who attend to patients such as those with long-term conditions who have suffered a fall.

According to LAS, 30% of patients attended to by these APPs do not then need to go to hospital.

The service also has 24 critical-care APPs.

These paramedics attend the patients who are most unwell, such as having a cardiac arrest or who have suffered a major trauma.

They will do advanced procedures such as sedation or giving more intense pain relief.

In other recommendations, Nice calls for research into clinical call handlers such as those working on the 111 NHS phone system.

It says this must address "what is the most clinically and cost-effective use of clinical call handlers in a telephone advisory service in terms of i) the ratio of clinical to non-clinical call handlers and ii) point of access to clinical call handlers in a telephone advisory service pathway?"

Other recommendations are for all people admitted to hospital with a medical emergency to have access to physiotherapy and occupational therapy seven days a week.

Nice also wants to promote a daily review by a consultant - including on a weekend and bank holiday - for patients admitted in an emergency.

While daily reviews are becoming increasingly common on NHS wards, they are not thought to always be applied consistently.