Philip Lumbard


CLAHRC Fellow 2014


“What does a paramedic need to provide urgent care for an older person?” The Urgent and Emergency Care review (2013) stated “by supporting and developing paramedics, and providing direct access to the expertise of general practitioners and specialists, around half of all 999 calls which require an ambulance to be dispatched could be managed at the scene, avoiding an unnecessary trip to hospital.” Traditionally paramedics practice emergency medicine, however, now this only accounts for a small proportion of their workload. The majority of ambulance calls are to people requiring urgent but not emergency care. At present the evidence to support paramedics providing urgent care for older people is limited despite the increasing numbers of frail older people who use the ambulance service. This fellowship has two aims: the first is to explore how paramedics deal with uncertainty about whether to convey an older person to hospital or not. Preliminary research findings from Sheffield, “Decision making and safety in emergency transitions” O’Hara et al 2013, have identified seven factors that influence a decision by a paramedic to convey a patient to hospital, but this work was not specific to the older population and did not consider the influence of carers and family members in decision making when managing care for an older person. The second aim is to understand what paramedics perceive as effective care for an older person closer to home. Little is known about what kind of urgent care can or is currently delivered by paramedics, and how they see this as part of their clinical role and how an orientation to providing emergency care can be incorporated into paramedics assuming responsibilities to care for an older person closer to home. To meet these aims this fellowship will explore the available literature and through interview and critical incident methods explore the paramedic’s, ambulance management and organisational views and expectations of the paramedic role in urgent care, and its future role”.