An investigation of the clinical decision-making challenges experienced by ambulance clinicians during the management of patients presenting with COVID-19 symptoms

BackgroundAs well as patient impact, COVID-19 also considerably impacts on staff who have been required to make challenging patient care decisions in uncertain circumstances. This study investigated ambulance clinicians’ experiences and use of decision support strategies during the COVID-19 pandemic.MethodsForty-eight percent (16/33) of paramedics invited agreed to be interviewed. Telephone/video interviews were undertaken between September and December 2020. Framework analysis was undertaken. Data were indexed and charted by one researcher. A sample was then checked by two other researchers. Analytical interpretation was collectively undertaken by all three researchers to identify a higher-level conceptual understanding.ResultsFour key themes were identified:Impact on clinical decision making – Deciding whether to take a patient to an Emergency Department is often challenging. Paramedics reported that COVID-19 increased the complexity of this process.Decision Support – Enhanced decision support was perceived as unequally available across the ambulance service. Where present, several paramedics reported that it was highly valuable.Use of Personal Protective Equipment (PPE) – Routine use of extensive PPE was a very new experience for all participants. Some reported that the number of calls initially exceeded PPE availability.Personal impact of dealing with COVID-19 – Several paramedics stated that media reports combined with paramedics appearing in full PPE increased levels of anxiety among many patients they attended. Some participants were worried about catching COVID-19 and the possibility of taking the virus home to their families.ConclusionsOur findings suggest that COVID-19 has placed considerable stress on the ambulance service at both organisational and individual levels. These findings could inform implementation processes surrounding rapid clinical guideline development and communication.*This abstract was presented by Edward Duncan

Improving the prehospital identification and management of people presenting to the ambulance service with COVID 19 symptoms

BackgroundLittle is known about how patients with COVID-19 present to ambulance services or their outcomes. Between 1st March and 31st August 2020 we investigated individuals who called the Scottish Ambulance Service (SAS) with COVID-19 symptoms and those that were later tested COVID-19 positive. We analysed i) their demographic and clinical characteristics;ii) their disposal;and iii) their admission and mortality outcomes.MethodsSAS and NHS Scotland Health Board data are routinely linked in a national database. These data evidence a patients journey from ambulance call to hospital attendance and subsequent outcome. Evidence of COVID-19 testing was identified 10 days either side of the call.Results171,169 patients made 257,207 calls during the study period. Of these, 2.8% (n=7,305) were categorised as possible COVID-19 patients during telephone triage. From the flagged +ve patient calls 6% had a COVID-19 positive result, 29% had a negative COVID-19 result and the other 65% had no evidence of being tested. The majority (54%) were taken to the Emergency Department;73% received further hospital care. The proportion of patient calls admitted within 10 days of the call was 31% for those not conveyed against 82% for conveyed. Final prehospital physiology for COVID-19 positive patients demonstrated lower oxygen saturations, higher respiratory rates and temperatures. 4.9% and 11.7% of patients conveyed to hospital died within 3 and 30 days vs 5.2% and 19.6% of patients not conveyed respectively.ConclusionsThis study suggests telephone triage is not a reliable identifier of COVID-19 patients reinforcing existing requirements for Personal Protective Equipment. 30-day mortality rates differed between those patients initially conveyed vs not conveyed. Clinical characteristics of COVID-19 positive patients suggest they were clinically less well than other patients.

Loneliness, Wellbeing, and Social Activity in Scottish Older Adults Resulting from Social Distancing during the COVID-19 Pandemic.

This study examined the impact of social distancing during the COVID-19 pandemic on loneliness, wellbeing, and social activity, including social support, in Scottish older adults. A mixed methods online survey was used to examine these factors during social distancing mid-lockdown, July 2020. Participants were asked to state whether loneliness, wellbeing, social activity, and social support had changed since pre-social distancing, and to provide details of strategies used to keep socially active. A total of 1429 adults (84% aged 60+ years) living in Scotland took part. The majority reported that social distancing regulations made them experience more loneliness and less social contact and support. Loneliness during lockdown was higher than reported norms for this age group before the pandemic. A larger social network, more social contact, and better perceived social support seemed to be protective against loneliness and poor wellbeing. Positive coping strategies reported included increasing online social contact with both existing social networks and reconnecting with previous networks, as well as increasing contact with neighbours and people in the community. This underlines the importance of addressing loneliness and social support in older adults but particularly during situations where risk of isolation is high.