Clinical innovation and debate are vital to improving prehospital care

Here at Ambulance Today we’ve always had a passionate interest in clinical innovation. We’ve learnt from our many ambulance friends that using the latest science and technology to improve the delivery of ambulance care can measurably make a significant difference to the quality of patient care that full-time crews and volunteers can provide to their patients. To this end we’ve done as much as we can over the years to bring ambulance services, supply chain companies and technology experts together so that they can address the thorny clinical problems that ambulance crews worldwide all agree need tackling in order to help them do a better job of diagnosing and treating their patients.
I look back fondly at the five years I acted as the ambulance innovation advisor to the now sadly defunct NHS Innovation Centre – a well-funded and outstanding clinical research body, it existed solely to help providers across the NHS identify holes in their clinical delivery and then develop the technological solutions required to fill those gaps. My role within the NIC was exciting but thankfully very simple. It was to use the unrivalled global contacts book of ambulance services, clinical and technical experts and others that Ambulance Today has built-up over the years and bring suitable experts onboard to work with teams of UK paramedics, EMTs and ambulance leaders to explore problems and help them design brand new solutions to age-old problems.
On one occasion we were able to help overcome a technical barrier on the design of a new piece of software to assist in drugs dispensation management simply because we’d made friends online via an American EMT with a genius computer programmer based in Hawaii! He solved the problem in a week! But equally, our academic co-workers and other expert advisors were constantly amazed at the high level of technological competence displayed by the typical paramedic; they were even more impressed though at the enthusiasm and determination paramedics showed in identifying problems and using their own expert clinical knowledge to dig down deep to try to find workable solutions.
So, this special edition is very important to me. It includes great examples of prehospital clinical innovation drawn from the UK, the USA, Canada, Africa and other world regions. It offers solutions for improving accurate drug administration for children through RightDose and a fascinating report on how one UK NHS ambulance Trust, South Central (SCAS), has brought together the latest in technology to develop a world class simulation centre to improve the training of their paramedics across all clinical treatment areas.
Professor Andy Newton, formerly the Chair of the UK College of Paramedics and, until a while ago, Medical Director of South East Coast NHS Ambulance Trust, is co-author of this article. At the risk of embarrassing Professor Newton, I must stress that among ambulance clinical leaders globally he is widely regarded as one of the best clinical developers and deliverers that UK ambulance (and Europe) has had in the last three decades. The role he played, alongside our sadly recently- departed friend, Professor Malcolm Woollard, in developing degree-level paramedic training in the UK was vital. In one way or another Malcolm Woollard and Andy Newton built on the early work of Professor Douglas Chamberlain and jointly created the blue-print for the highly- valued model of Paramedic Science degree training that Douglas envisioned as early as in the 1950s. Of course, we now take for granted such high levels of degree training for our ambulance clinical workforces so it’s easy to forget that only three decades ago it simply didn’t exist. A great example of clinical innovation that delivers where it matters!
Andy Newton is rightly seen as a visionary. So, when he warns that we need to guard against “inertia and an often-lukewarm desire of bureaucratic organisations to modernise,” he should be listened to. Clinical innovation isn’t easy. It requires investment, great effort, hard work and much joint-working, but it is the life-blood of improvement. So, if we want to continue to improve our ambulance care we need to maintain a commitment to supporting improvement through innovation at all times.
But just to be clear – clinical innovation doesn’t only happen in the form of designing new medical devices or improving training and education by adopting new technology or constructing new courses. Clinical innovation can be equally valuable when we take the time to use evidence-based research and reflect on whether or not we are using the superb hi-tech medical devices at our finger-tips in exactly the right way.
Also in this edition is a research-based article by Peter Thorpe, PgDip, Director of Strategic Program Development at British Columbia Emergency Health Services in Canada. Peter’s article focuses on the use of Mechanical CPR Devices in a Pre- Hospital Setting and offers a review of the literature surrounding them, along with some recommendations for clinical utilisation. It focuses on two widely-used mechanical CPR devices – Physio Control’s LUCAS and ZOLL’s AutoPulse – and, while Peter in no way questions the usefulness, design, build or excellence of either device he is keen to prompt a global debate about whether or not end-users in prehospital environments worldwide always understand how best to use them and, equally importantly, who should be using them.
I want to pay tribute to both Physio Control (now part of Stryker) and Zoll because senior managers from both companies were shown early and later drafts of Peter’s article and, far from being defensive, while they have, to different degrees, had a robust discussion with Peter about his article, they have accepted that in the interests of improving paramedic care and ensuring the highest-level of patient-care, this is not only a debate that should be democratically and freely held, but is also a debate that they are happy to openly engage in.
Which takes me to my conclusion. The best clinical innovation in prehospital only happens when outstanding global medical technology developers, such as Physio Control and ZOLL, not only use their genius to develop the devices we urgently need for improved patient-care, but are also so genuinely committed to improving patient-care that they also respect the right of clinical researchers and ambulance end-users to engage in helpful discussions about how best to use the technology they create for the enrichment of us all.

Declan Heneghan, Editor, September 2018

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