Aims and objectives:
To improve survival rates of patients with pre-hospital cardiac arrest in line with Standard 5 of the CHD NSF.
To maintain improvement in the response time performance in Category A Calls.
To provide early medical care where access to secondary care can be delayed, and speed of response being a key factor in determining survival following pre-hospital cardiac arrest.
To improve response times by increasing provision of community group responders, trained and equipped to administer early basic life support and defibrillation within minutes of the arrest.
To continue working in partnership with Lincolnshire Ambulance Service, United Lincolnshire Hospital Trust and three Lincolnshire PCT's to address issues around improving health and reducing inequalities.
Strategically link with LDP targets to meet call-to-needle times as laid down by MINAP.
Support for the change:
The First Responder initiative is supported by the development of working partnerships with Lincolnshire Ambulance Service and the PCT's.
LIVES have contributed to the planning and delivery of the pre-hospital thrombolysis strategic group and the county and regional CHD LIT's.
At a community level, regional development officers were recruited to raise public awareness of the scheme, recruiting volunteer responders and supporting groups when they become operational to maintain the service.
Patient and public influence:
Since 1999, through continual service improvements, LIVES has improved response time performance by 35%. LIVES continuously monitor all patient report forms completed by First Responders, auditing care given, patient experience and outcome. This information is fed back to responders to ensure quality of care is maintained. In October 2004, the medical research unit at Sheffield University (SHARR) conducted a performance review of LIVES activities. This included a survey of 300 patients, analysing all aspects of response and care received from the ambulance service and LIVES. The outcome was extremely positive with 98% of respondents expressing satisfaction with the service provided by First Responders. 90% did not feel that the service could be improved.
Discovery Interviews will be introduced in 2005, providing a further means of recording the patient and carer experience.
Impact on the workforce:
Since the start of the scheme in 1999, LIVES has recruited over 1500 volunteer responders who are all trained to IHCD basic level. This is a nationally recognised qualification, valid and transferable for 3 years. LIVES is now developing training at intermediate level to enhance the skill levels of the responders and broaden their underpinning knowledge.
In addition to operational volunteers, LIVES also has members who act in support of their community group, assisting with training and fund raising.
By utilising a central, co-ordinating project manager, LIVES will soon provide community based CPR training, delivered locally by First Responder Trainers within their operational areas. Running in tandem will be an educational, interactive website, giving information about all aspects of CHD and the opportunity to learn more about practical CPR and First Responding in Lincolnshire.
Measuring the results:
Results are correlated monthly, matching ambulance callout data with patient report forms received for each callout. This allows close monitoring of activation and response times, type of patient attended, emergency care provided and outcome. All incidents involving use of the AED are analysed using the defibrillator download. This information gathering is carried out in close association with Lincolnshire Ambulance Service. Performance and outcomes were fully evaluated by SHARR in their review (full report available). Outcome from defibrillation in cardiac arrest victims compares favourably with other schemes and ambulance trusts around the country as published on individual websites and annual reports.
Improved performance:
The SHARR review concludes the following; Over 25% of Cat A ambulance calls receive a LIVES response, with LIVES arriving first in 60% of calls; LIVES improves response time by 35% in rural areas, this figure increasing as the number of groups expands; Return of spontaneous pulse rate in cardiac arrest patients is over 20%, with response time in these cases significantly shorter than the ambulance response; Patients receiving a LIVES response report a high level of satisfaction with the service and a willing acceptance of a voluntary medical response service in rural communities; LIVES responds to over 25% of Cat A ambulance calls with a relatively small funding requirement (1% of the ambulance service A&E budget).
Reflecting diversity:
LIVES has always recognised the extreme rurality of Lincolnshire and the problems that this poses in terms of health care, social isolation, limited road infrastructure and provision of pre-hospital emergency care. The establishment of the first responder scheme was a direct attempt to provide equality of acute patient care to all of the population, regardless of the rurality of their location. The scheme welcomes volunteers from all walks of life, using a training programme and care package that is amenable to all intellectual levels. Continued support is provided to our members after becoming operational to ensure their motivation and skills are maintained. All of our members are a valued asset to their community.
Sharing the learning:
LIVES works closely with the PCT's, the national Cardiac Network, the EM CHD Collaborative and Lincolnshire Ambulance Service to ensure that the public and other stakeholders are aware of the service provided by first responders. Lincolnshire Fire and Rescue are also involved as an operational part of the LIVES scheme and have proposed the Lincolnshire responder model as an example of excellence, endorsed in the House of Commons during debate on modernisation of the fire service.
In February 2003, LIVES won an Impact Award from the King's Fund and GlaxoSmithKline International, in recognition of "excellence in its work and its commitment to improving the quality of human life by enabling people to do more, feel better and live longer".
Outstanding features:
LIVES has recruited over 1600 community volunteers, encouraged them to organise into groups, raise their own funds, then trained them to a level where they can provide assessment, basic life support, oxygen and early defibrillation to any patient suffering an acute medical problem within their community. This has been an innovative way of using locally available resources, at minimal cost, to improve patient outcomes for life threatening conditions in an environment where continued annual increases in demand for emergency ambulance services produce further pressure on already stretched resources.
