Thousands of contacts are made between patients and the EMS at public events annually in Ireland, with Oxegen 2011 recording a total of 2,917 over the five-day period. Despite the fact that information is key to driving patient safety and informing quality of health care, there has been no single source for collating the rich data being collected at these events. That is until now. The eACR provides one national source for ambulatory care data collection, data which can be extracted, analysed and utilised for the improvement of patient care. (See accompanying graphs for examples of the type of information that can be extracted from the electronic patient-care data captured).
This information is analysed using a process known as data mining or knowledge discovery, whereby data is examined from different perspectives and then summarised into meaningful reports. Organisations then decide what is useful to them and can design their own report suite to suit their requirements and the circumstances of the
various events.
As the EMS regulator, we need to have factual verification of pre-hospital activity nationally, including activity generated at large events. There is a perception, for example, that EMS activity at these events has low acuity and high volume. It is only through having access to accurate, reliable, relevant data that this perception can be verified (or not) and the appropriate level of clinical care provided at future events. In addition, effective clinical audit can only be carried out on real information while staffing requirements, planning, and event deployment are also dependent on accurate information being available.
Ambulatory Care Report
Lt Shane Walsh, OMI checking data on the iPADS
The ambulatory care report is a subset of the data contained in the national PCR used by the statutory ambulance services. The scope of this report is to capture information on non-acute activities and interventions. When the acuity of the patient demands it or the patient requires transporting off site, a full PCR is completed. The hard copy ACR mirrors the design of the PCR and is provided by PHECC to all voluntary and auxiliary service providers.
With our partners in this initiative, Valentia Technologies, we have also developed an electronic Ambulatory Care Report (eACR) using iPAD technology. iPAD technology is very intuitive and user friendly and the Oxegen trial concentrated on testing functionality and its ability to capture real-time information. The results are impressive. The captured data is easily manipulated and examined, and provides event planners and service providers with real-time information to assist their decision making.
Patient safety and the availability of quality care at the appropriate location are the primary benefits of capturing ambulatory care data electronically; benefits in the area of training, research and strategic decision-making can also be gained. Data collection is an essential activity for all EMS providers which must be governed by best practice policies and procedures and relevant legislation.
Oxegen Festival
Oxegen is the largest musical event of its kind in Ireland. Up to six simultaneous open-air concerts are conducted over a three-day period on a number of stages at the festival site located in Punchestown, Co Kildare. (Continued..)
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Oxegen Festival (Continued..)
The average daily attendance at the festival over the last 3 years has been 84,000 with a large number of festival goers staying on-site at one of two large campsites.These campsites are open the day before the festival and remain open the day after. This means that large-scale EMS cover is required on the ground over a 5-day period.
The organisation and operation of this event is a huge logistical exercise not least the level and range of the EMS provision. The festival promoters engaged the services of Event Medical Services to coordinate and provide the EMS cover before, during, and after the event including during weeks of site construction and dismantling.
Service Providers
Event Medical Services is a PHECC-recognised service provider authorised to implement clinical practice guidelines (CPGs). Headed up by Willie Wade, they specialise in providing EMS cover for indoor and outdoor entertainment events (eg O2) in addition to large sporting events. At the Oxegen festival Event Medical Services provide medical and nursing staff in addition to providing paramedic cover.
The on-site hospital was headed up by Ciara Martin, consultant in emergency medicine, and was equipped with an x-ray facility. In addition to their own staff, Event Medical Services also engage the services of voluntary organisations to assist over the five days. This year they engaged the services of the Civil Defence and Order of Malta Ireland, both PHECC-recognised organisations.
The Civil Defence were tasked with providing 24-hour on-site cover at the two main campsites for the five days. The festival arena is where the performance stages and all the catering vendors are located. For the three days of the festival this opens daily at lunchtime and is cleared on conclusion of the music at 1.30 a.m. (approx). EMS cover at the arena this year was provided by Order of Malta Ireland on a 12-hour basis.
Further Development
Work has already commenced on analysing the clinical data collected, as well as on the invited feedback and recommendations from the users. The lessons learned from this trial will be classified into three categories. The first and most important task will be analysis of the data from a clinical audit and service planning perspective. Secondly an examination of any technical – software or hardware issues will be conducted by Valentia Technologies in order to improve the product. And finally a review of the practical operational issues encountered by users during this first live deployment. Future development of the ACR and the eACR will incorporate this feedback where appropriate.
Acknowledgements
We acknowledge and thank all the organisations and individuals who contributed to this trial. Event Medical Services, from an early stage, committed to the concept and actively facilitated a live trial of the eACR at the biggest music festival in Ireland. Volunteers from both the Civil Defence and Order of Malta Ireland modified their operational activity and engaged with the new technology. Their commitment and willingness to embrace this change in a real operational environment is admirable. And finally Valentia Technologies, through an innovative and novel approach, have demonstrated how to exploit new technology in an efficient and effective manner. EMS in Ireland is embracing cutting edge technology that will be used to audit, review and plan service provision based on actual event data.
Patrick Ryan, Valentia Technology; Fergus Ryan, Paramedic, Event Medical Services; Capt Adrian Fallen, Duty Manager, OMI and Taunya O’Neill-Wade, Manager, Event Medical Services reviewing data on the triage screen in the hospital tent.
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