Out of hours part 1

During the January holiday from university, while many students were enjoying a break, I organised an observation night shift with my local Out of Hours medical service (OOH). I organised this shift in order to see an example of where specialist paramedics can be employed other than front line ambulance work. The other reason that I organised this shift was due to my interest in admission avoidance schemes and to gain a greater understanding of what OOH services can offer to my patients.

For this night shift I was paired with an Emergency Care Practitioner (ECP) who was working alongside a GP and two receptionist/drivers. An ECP is a specialist paramedic in primary care with additional training and skills for the assessment of minor injuries and illnesses. While the ECP was completing triage calls, contacting those referred to the service by 111 and 999 control room staff, the GP was with a 5 year old patient in the surgery who was complaining of shortness of breath. The GP invited me to listen to the patient’s breathing, and we both noticed reduced air entry and wheezing to his left lung. The GP was able to refer the patient directly to the paediatric assessment unit at the local hospital in order for chest x-rays and further investigation to take place. The use of direct referrals from OOH means that patients don’t have to go through A&E first, as they would if admitted by ambulance, resulting in them being seen specialists in their field sooner and reducing pressures on an already busy A&E.

When I returned from seeing this patient the ECP told me we were going out to visit a patient at their home. This had been put through to the OOH team by 111 as he was struggling to manage his pain from a DVT, a blood clot in one of the veins in his leg, at home with what he had been prescribed by his own doctor. Following assessment of the limb for infection, of which there was none, the ECP was able to provide the patient with a stronger dose of Co-Codamol and advised him to contact his GP should the pain remain unchanged with the new dose. Seeing this patient and how the ECP was able to help made me aware of contacting OOH or the control room GP to discuss pain management for patients with on going medical conditions and no complications.