London Ambulance Service: Appropriate care pathways.

London Ambulance Service
Appropriate care pathways
Major trauma
London Ambulance
Service NHS Trust
London Ambulance
Service NHS Trust
Cardiac Care
• Heart attack centres
• High Risk Acute Coronary Syndrome
• Emergency arrhythmia centres
GP / Referral Support Team
Elderly Faller referrals
• Crews are asked not to regard emergency
departments as the best destination for all patients.
• Consideration is given to whether the best
management of the patient could be in the community
(GP/district nurse/palliative care team) or at a minor
injuries unit or urgent care centre.
• Crews refer non-conveyed falls patients over the age
of 65 to their GP; either directly or to the referral
support team
LAS Falls Decision Tree
‘Top 10’ lists for Minor Injury Units / Urgent
Care Centres & Walk-In Centres
Minor Injury Units (MIUs)
Walk-in Centres (WiCs)
Ankle injury – no deformity; able to weight bear with
assistance of one person.
Wrist injury – no gross deformity; good distal perfusion.
Minor head injury – no history of loss of consciousness, GCS
15/15; no intoxicating substances; no facial injury and no
current anti-coagulant therapy.
Elbow injury – must be non-displaced and have good distal
Burns & scalds – less than 3%in adults, less than 1% in
paediatrics; no facial burns; no inhalation injury.
Bites & stings – no human bites, no systemic reaction.
Wounds & lacerations – minor injuries only; scalp and facial
wounds, excluding the hands, feet & triangle of the face.
Rib injury – if no primary survey problems, must be due to
trauma/injury not non-traumatic presentation.
Digit injury – no open injuries; no infection; no diabetic
problems; discussion with clinician is highly recommended
prior to transfer.
Eye conditions – no penetrating injury; no peri-orbital cellulitis.
Upper respiratory tract infection – uncomplicated infections;
version 8 of the flu algorithm should be used to assess these
Skin complaints (incl. rashes) – incl. impetigo, minor cellulitis
& wound infections; patient must be apyrexial, no nonblanching rashes.
Minor allergic reactions
Bites & stings – no human bites, no systemic reaction.
Lower back pain – no ‘red flags.’
Vomiting – if less than 4hrs.
Urinary tract infection – uncomplicated infections in females
aged 16yrs and over only.
Sore throat – patient must be able to swallow; no drooling; no
indications of quinsy; no trismus.
Eye conditions – no penetrating injury; no peri-orbital cellulitis.
•An Urgent Care Centre (UCCs) will be able to manage any patient presenting with any one of the above conditions (both lists).
•Any queries should be addressed to the Clinical Support Desk (CSD) – this includes any feedback or issues arising from conveying a
patient with an appropriate condition to a MIU/UCC/WIC.
Appropriate Care Pathways
• The personal issue
Enhanced PreHospital Practice
booklet [issued
2012/13] describes
the appropriate
referral pathways
for a range of
different patient
Appropriate Care Pathways
• The personal issue
Alcohol and
Diabetes Aide for
Operational Staff
[issued 2012/13]
describes the
referral pathways
for these specific
patient groups
Appropriate Care Pathways; example
• Hypoglycaemia
• If after patient-staff discussion the final outcome is
for non-conveyance, we ensure the patient has
recovered and that they are well enough and safe
to be left at home
• We then request consent for the service to call the
patient back within 2 hours; we explain that a
referral will be made to the patient’s own GP to
support the patient’s on-going welfare
Appropriate Care Pathways; example
• Hyperglycaemia
• We continue to measure blood glucose levels for
all patients over 40 years of age regardless of their
presenting complaint
• If the reading is significantly raised (13Mmol/L to
25Mmol/L) and the patient declines conveyance we
contact the Referral Support team indicating the
raised reading is the reason for the referral
Clinical Hub: for crews to discuss
difficult decisions or complex cases
• End of Life Care: Over 7,000 records are now held by
the Clinical Hub and detail important information
about plans for preferred places of care and death.
• Thank you.

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