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6 Related Services
6.1 Ambulance services
Key Points
The main issues for the Scottish Ambulance Service to address are:
- Supporting Acute capacity management by developing an algorithm for treating and leaving pandemic flu patients.
- Working with NHS24 to establish an interface with the National Flu Line.
- Working with territorial Boards and NHS24 to develop pandemic information recording and sharing protocols.
Demand on the Scottish Ambulance Service ( SAS) is likely to increase significantly in a pandemic. The primary focus of service continuity plans is the maintenance of capacity to answer all emergency and urgent calls, although some prioritisation and changes in normal performance standards may become unavoidable. NHS Boards plans should provide for all non-emergency patient transport services becoming progressively restricted or temporarily suspended.
Patients will contact SAS through one of several avenues: the 999 emergency telephone service, the NHS24 core service, local out of hours telephone services, or on request of a doctor after either a house call or telephone consultation (known as "doctor's urgents"). Where patients are referred in this way, a clinical assessment and triage will have been carried out and the service can operate in its usual mode.
Where patients contact the service directly without prior assessment and triage, the ambulance service will need the ability to make judgments about whether a patient should enter their normal clinical algorithm (being stabilised and transported to hospital), should be transferred to the national telephony system for pandemic flu, or should receive assessment for influenza and appropriate treatment if already present on site, without being transferred to hospital. The service does not currently perform "treat and leave" procedures, except under a very few specified circumstances. The Scottish Ambulance Service should work with NHS Boards to develop algorithms which facilitate paramedics to conduct assessment of influenza patients, and to provide appropriate treatment or referral to the relevant part of the influenza pandemic patient pathway.
The ambulance service must not be seen by the public as an easy route to hospital admission, bypassing the kind of admission criteria which will be applied in other parts of community health services. This would undermine the ability to manage hospital resources and would risk a flood of direct calls which would have the potential to swamp both the ambulance service and secondary care resources. In addition to developing "treat and leave" protocols, the Scottish Ambulance Service and NHS24 should work together to establish an interface with the National Flu Line.
Information about contact between the ambulance service and influenza patients should feed into any centralised mechanisms for surveillance and for recording care given to influenza patients. The Scottish Ambulance Service will also need to establish access to the planned antiviral database. Working with territorial Boards, NHS24 and others, the Scottish Ambulance Service should ensure that effective pandemic information recording and sharing protocols are in place.
6.2 NHS24 core services
Demand for non-flu health advice and information is likely to increase significantly during a pandemic. NHS24 will continue to play their important role in providing health advice and information through their normal telephone number, and via the NHS24 website ( www.nhs24.com). Demand on NHS24 core services is likely to increase and the primary focus of service continuity plans is the maintenance of core services in the face of high levels of staff absence.
6.3 Community Care
Local Authorities have responsibility for ensuring that Community Care services have pandemic influenza contingency arrangements in place. To support Local Authorities guidance has been developed and a pandemic flu framework for Community Care can be found at: http://www.scotland.gov.uk/Pandemicflu
Business continuity difficulties arising in the Community Care sector during an outbreak would have a profound impact on NHS resilience. For this reason NHS Boards will wish to liaise closely with their Local Authorities to understand the arrangements for service continuity, prioritisation and consolidation in the community care sector and how these arrangements will work alongside NHS plans.
NHS Board plans should describe how the local NHS response will integrate with Local Authority services. Plans should also describe what operational arrangements will be in place to aid business continuity in the Community Care sector. For example:
- providing emergency redeployment of Board employees to nursing and care home settings
- coordinating the pairing up of GP practices and care facilities
- making pragmatic antiviral distribution arrangements and supporting the maintenance of medication supplies.
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