CLINICAL HANDBOOK/CPGS

Council is delighted to launch the 2nd edition of the PHECC Clinical Handbook prepared by the Medical Advisory Group. The Clinical Practice Guidelines contained in the Handbook replace the Standard Operating Procedures (SOPs) published by the National Ambulance Advisory Council, launched by the Minister for Health and Children in 2001 and distributed by the PHECC.


The term Clinical Practice Guideline (CPG) has replaced the term Standard Operating Procedure (SOP) to reflect more accurately their clinical nature and use in pre-hospital emergency (patient) care. In addition the term has been incorporated in amendments to the PHECC Establishment Order 2000 (SI 109), and proposed amendments to the Medicinal Products (Prescription and Control of Supply) Regulations 2003 (SI 540). This will give the Clinical Practice Guidelines a basis in law and link them to the National Qualification in Emergency Medical Technology (NQEMT) "Register".

In this new edition the previous published Standard Operating Procedures (SOPs) have undergone significant revision. A medication formulary has been added with key information on the specific medications incorporated in the CPGs. There are in addition 15 new CPGs:

  1. BLS – Newly born
  2. Cardiac Arrest - Asystole - Decision tree
  3. Recognition of death - Resuscitation not indicated
  4. Burns Management
  5. Limb Fractures
  6. Pre-hospital emergency childbirth
  7. Pre-hospital emergency childbirth - Umbilical cord complication
  8. Pre-hospital emergency childbirth – Breech birth
  9. Behavioural emergency - Acutely disturbed
  10. Behavioura emergency - Uncooperative patient
  11. Glucose gel
  12. Major Emergency (Major Incident) The first ambulance crew
  13. Major Emergency (Major Incident) Operation Control
  14. Major Emergency (Major Incident) Triage Sieve
  15. Major Emergency (Major Incident) Triage Sort

As a result of the recent PHECC Amendment Order (S.I. No 575 of 2004) the function of Council is to prepare guidelines for pre-hospital emergency care and make available as appropriate. In addition Council shall recognise those prehospital emergency care service providers which undertake to implement the CPGs. The CEOs of the Health Boards have been asked to acknowledge their commitment to implement with their CAOs and Medical Advisors, the CPGs in their Ambulance Service(s). The request is premised on the basis that the criteria below are in place.
  
  1. The circumstances and or situations for the application of the CPGs.
  2. A profile of the training status of employees/volunteers including status on the PHECC "register".
  3. Evidence of the capacity for or access to training to facilitate appropriate implementation of the CPGs and other Continuous Professional Development (CPD) requirements.
  4. Evidence that clinical records are completed on all patients who receive pre-hospital emergency care.
  5. An appropriate system for clinical record management.
  6. A system of clinical audit that includes the availability of an appointed Medical Advisor/Director.
  7. Vicarious, employers and public liability insurance.
The Head of an organisation providing pre-hospital emergency care other than the Health Boards/Areas and Dublin Fire Brigade may apply for approval from Council to implement all or selected CPGs published by PHECC to the level on the PHECC "Register" of their employees or volunteers. Each organisation is being engaged by PHECC and asked to advise which CPGs could be implemented by their members at their respective levels of training. This broader use of CPGs will support the emergency care management of patients pre-hospital while recognising that pre-hospital care practitioners in Ireland are from a range of disciplines including first responders from Voluntary and Auxiliary Services.

The Clinical Practice Guidelines are subject to ongoing review by the Medical Advisory Group based on the best available international evidence and information on best practice from experienced EMTs working in urban and rural practice areas throughout Ireland. Formal review will occur at least every 2 years.

Each EMT working in the Health Board/Area Ambulance Services or in Dublin Fire Brigade will receive a copy of the Clinical Handbook directly from their service. An electronic copy is available from the PHECC website www.phecc.ie The Health Boards/Areas have agreed to implement the new CPG’s in early 2005.

Contributions are welcome. You may forward your suggestions directly to the office of PHECC by post or email info@phecc.ie
Alternatively you can forward your suggestions directly to your Medical Advisory Group representative.