Information about the role of the emergency care practitioner

1. Emergency Care Practitioners
Information Pack

2. ECP Information Version 2 (March 2006)
Emergency Care Practitioners
Information about the role
This document is designed to provide information about the role of Emergency
Care Practitioners (ECP’s), and the ways in which they can support all health
care providers in the delivery of high quality care for patients. Clearly it is not
possible to provide a definitive list of the types of patients that ECP’s can
manage, but the following may help in giving an overview.
The ECP programme undertaken included 4 modules covering: Patient
Assessment, Acute Medical Conditions & Minor Injuries, Chronic Conditions &
Health Surveillance and Therapeutic Interventions. Each module comprised a
taught element delivered in University and a clinical placement in A&E and
General Practice. The course is open to both experienced paramedics and
nurses with the majority of BHAPS students coming from a paramedic
background.
This course equips ECP’s with the ability to assess patients at a level capable of
reaching a differential diagnosis, using a range of diagnostic tests including
Haematology and Urinalysis. They have increased their ability to manage a wide
range of minor illnesses and injuries. This qualification has also given them a
range of skills to ensure that patients are referred to appropriate health and social
care professionals. Patients presenting with chronic conditions can also be
managed by an ECP through a range of therapeutic options or again appropriate
referral. ECP’s are also trained to supply and administer a number of medicines
(See attached list). At present the PGD’s are being drawn up in order that ECP’s
will be able to supply these medicines to patients as part of their practice.
Four teams have been set up at present, in Bedfordshire (north & South), West
Hertfordshire and East and North Hertfordshire, each team will be based around
a Primary Care Response Vehicle (PCRV). The aim will be to offer support to
front line Ambulance staff in providing an alternative resource where A&E may
not be the most appropriate place for patients. This will help in reducing
unnecessary A&E attendances and admissions. Another area where the ECP
teams will support existing staff is in providing a more appropriate response to
category C patients. In Bedfordshire ECP’s are working within the A&E
department as well as working alongside Nursing colleagues in the new Urgent
Care Centre (UCC). In West Hertfordshire the ECP’s are working in partnership
with the St Albans City Minor Injuries Unit (MIU). In East and North Hertfordshire
ECP’s are working with QEII and Lister A&E departments.

3. ECP Information Version 2 (March 2006)
The following role summary briefly describes the way in which it is envisaged that
ECP’s will work across the whole health community.
ECP Role Summary
• Provide an initial response to category C and B patients identified by
A&E dispatch using AMPDS.
• Respond to other calls at the request of ambulance crews or other
health care professionals at scene for assessment / treatment / referral
/ advice.
• Provide follow up for all non-conveyed patients following a 999 call.
• Assess / triage / monitor doctor’s urgent patients.
• Respond as Paramedic / clinical support to all categories of call where
appropriate.
• Visit patients accessing Out Of Hours (OOH) services on behalf of
GP’s and PCT’s.
• Assist GP’s with “in hours” visits.
• Provide follow up monitoring / treatment for patients treated earlier by
GP or community based nurses.
• Support “Hospital at Home” type schemes. E.g. IV antibiotics and
other therapies.
• Support early discharge initiatives by assisting with discharge planning
and providing support to out of hospital services.
• Work on a rotational basis on the Clinical Support Desk providing and
updating information to ECP’s and other health care professionals.
• Provide a clinical presence and advice in the dispatch centre.
• Provide care to patients presenting at Walk in Centres, Minor Injury
Units and A&E Departments.
• Provide telephone and face to face care to patients presenting to
primary care centres and GP surgeries.

4. Paramedic competencies
Skills
• External defibrillation using Manual and AED devices
• Endotracheal intubation
• Intra venous cannulation
• Intra muscular injection
• Sub cutaneous injection
• Needle Chest decompression
• Needle Crychothyrotomy
• Cardiac monitoring and Rhythm recognition (common arrhythmias)
• 12 Lead acquisition
• Use of ventilators
• Measurement of PEAK flow
• Measurement of Blood Glucose levels
• Pulse Oximetery
(Separate module)
• 12 Lead ECG interpretation –recognition of Acute MI
• Thrombolysis - Tenecteplase
Drugs
• Adrenaline
• Atropine
• Amioderone
• Aspirin
• Benzyl penicillin
• Diazepam
• Entonox
• Furosemide
• Glucagon
• Glucose 10%
• GTN
• Hartmanns solution
• Lidocaine
• Metoclopramide
• Morphine Sulphate
• Naloxone Hydrochloride
• Oxygen
• Paracetamol suspension
• Salbutamol
• Sodium Chloride 0.9%
These Medicines are for administration to patients in emergency situations.

5. ECP Information Version 2 (March 2006)
Paramedics achieve competencies in adult and paediatric Advanced Life Support
(ALS), also management of trauma, respiratory, cardiovascular, neurological and
obstetric and gynaecological emergencies. They also cover mental health,
common childhood illnesses, major incidents and public disorder. Manual
handling and the use of a comprehensive range of manual handling and
immobilisation devices is also a core part of their basic training.
The above competencies will not apply to Nurses
Emergency Care Practitioner (ECP) Competencies
Module 1 – Patient assessment
Structured approach to history taking – Consultation and communication skills –
Structured approach to clinical assessment of: - Cardiovascular systems,
Respiratory systems, Nervous systems, Genitourinary systems, Gastrointestinal
systems and Musculoskeletal systems. Use of the surgical sieve and
documentation skills
Common illnesses – Examination of patients presenting with common chief
complaints with the aid of:-
• Ophthalmoscopes
• Auroscopes
• Patella hammers
• Urinalysis equipment
Module 2 – Minor injuries and Acute illness.
Minor soft tissue injuries and musculoskeletal trauma.
• Use of Ottawa rules for assessment of joints in order to establish need for
X-ray
• Wound closure :- Steristrips, Adhesives and Suturing
• Examination of Eye and removal of foreign bodies
• Simple dressings
• Use of local anaesthetics
• Use of simple analgesia
Acute illness and common minor ailments
• Common rashes and other dermatological problems
• Ear Nose and Throat problems
• Common infections
• Use of medicines

6. ECP Information Version 2 (March 2006)
Module 3 – Chronic illness and Health Surveillance
Chronic diseases
• Diabetes
• COPD
• Coronary Heart Disease (CHD)
• Neurological disorders
• Long term therapies – review of medicines
Module 4 – Therapeutic Interventions.
Patient Group Directions (PGD’s). Legal and Ethical considerations in the use of
Medicines. A number of PGD’s are being developed in partnership with the trusts
Medical Advisor and local Pharmacists. This list will be based on the current
Department OF Health recommendations for supply of Medicines in OOH.

7. Overall Aims:-
Improving clinical risk management and patient safety by providing a
safety net for those patients not conveyed to AE, who may be
assessed and if necessary referred on to an appropriate service
Providing a safe and appropriate level of care for patients whose
conditions may be managed in the community in liaison with the multi
disciplinary community based teams.
Developing innovative ways of managing patients with chronic disease
who access unscheduled care.
Referring patients directly to hospital and community based health and
social care agencies, in order to reduce the number of unannounced
AE attendances and inevitable trolley waits.
Providing a reliable and prompt clinical support service to front line
ambulance crews and other NHS staff, allowing them to refer patients
directly to an ECP.
Reducing the number of unnecessary emergency responses by
ambulances and the inherent risks to both the public and the crew.
Reducing the number of “handoffs” experienced by patients presenting
for unscheduled care.
Continuing to demonstrate that BHAPS are at the forefront of the
Reforming Emergency Care agenda, and are a flagship for Ambulance
Services nationally.
Dean Ayres
Emergency Care Practitioner – Facilitator