This themed review from NIHR Dissemination Centre brings together recent research evidence on urgent and emergency care, focused on the ambulance service.
It should be useful to those commissioning and providing ambulance services, from medical directors to boards of ambulance trusts, as well as front-line staff. It should also be of interest to others, from general practitioners providing out of hours care to emergency doctors and nurses working in hospitals.
NIHR focus on studies which were funded by the NIHR in the last ten years. NIHR was set up in 2006 as the research arm of the NHS to provide a health research system focused on the needs of patients and the public.
Over that time, NIHR has funded a number of programmes, projects, reviews and researchers working in and around pre-hospital emergency care.
This is not a systematic review of all evidence in the field. It should be read alongside useful overviews of the evidence, including a 2010 overview on pre-hospital urgent and emergency care (Turner 2010) and a round-up of evidence to support the NHS England review of services (NHS England 2013b).
More recently, an NIHR rapid review has synthesised evidence on five aspects of service models for urgent care (Turner 2015, NIHR published study one). In addition, recent NICE service delivery guidelines on major trauma (NICE 2016) include useful supporting evidence on particular aspects of triage, clinical management and service delivery.
The scope of this review covers urgent and emergency care and does not include routine patient transport services, like ambulance staff taking patients to outpatient clinics. In this review, we have searched for the most relevant studies within the NIHR portfolio, but have not included clinical studies in other settings which could have implications for ambulance services.
This review focuses mainly on adult patients, as the issues around the organisation and clinical management of children are distinct.
Almost 40 studies are featured in this report (22 completed, 17 ongoing) and summaries of these are provided in the appendices. Full reports and protocols of many of the NIHR funded studies featured in this report are available in the NIHR Journals Library.
This research has been organised into three main areas – understanding system and population factors that affect ambulance services; decision-making by patients, ambulance staff and services, workforce and patient experience; and clinical interventions in pre-hospital care.
A final section looks at how ambulance services can make better use of evidence and support research to drive improvement.