A%20study%20of%20paramedics

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A study of paramedics attitudes to the effects
of speed humps on resuscitation of patients en
route to hospital, including general patient care
and ambulance response times

• By Mark Belchamber
• BSc (Hons), AASI, SR Para
• (Training Officer/Paramedic, London Ambulance
  Service NHS Trust)

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Or.
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How speed humps affect

• your patients
• your staff
• and
• your response times.

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Sound familiar?

• Delays due to road conditions
• Ill go this way to avoid the humps
• Humps dont slow the idiots down anyway
• You cant avoid the humps
• I hate humps!

• Cant the driver slow down?
• Im feeling really sick
• OUCH!
• These bumps are awful
• Cant you go a different route?
• I hate humps!

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In the last week.

• Barnett council (London) propose to remove all
  500 speed humps saying they are Ineffectual and
  cause road deaths and damage to vehicles
• London Ambulance Service spokesman says It is
  possible that minute from response times
  (service-wide) could equate to 500 more lives
  saved per year.

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Methodology

• Literature search/review
• Scant information (predominantly U.S. based)
• NO research surrounding attitudes, perceptions,
  responses of Paramedics

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Methodology (cont.)

• Questionnaire pre-tested by 10 individuals
• 100 questionnaires (based on literature reviews)
  sent to a purposive sample
• Mainly quantitative (but also qualitative
  elements)

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Methodology (cont.)

• Data Analysis
• Closed questions (nominal and ordinal data)
  charted where appropriate
• Free text analysed for thematic content
• SPSS, MS Excel and Lotus 1-2-3 used
• Information graphed and cross-tabulated
• Qualitative responses categorised to establish
  potential relationships

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Methodology (cont.)

• Ethics
• Approval from University of Hertfordshire
• Also sponsored by London Ambulance Service NHS
  Trust

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Limitations

• Small study (36 out of 100 respondents)
• Inability to generalise (Polit Hungler 1995)
• Lack of other (similar) research for comparison
• Only Paramedics were questioned
• Possible geographical bias
• Time limitation

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Results
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All respondents drive over humps at least once
per shift.Over half do it more than 4 times per
shift
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Response to 999 calls
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67 actively avoid humps
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Over half said time was a factor
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30 would add 2 minutes, 55 between 1 and 5
minutes!
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Humps slow you down, but respondents would add
time to avoid humps
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There is no published research concerning actual
time delays that humps cause to U.K. ambulances
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Transportation of medically unstable patients to
a receiving facility
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59 take a different route
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31 are concerned with improved care, 25 with
patient condition - 56 in total!
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19 of 20 people would extend time to hospital.
75 would add up to 5 minutes - but 2 would add
10 minutes!
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In Paramedics experiences, patient care and/or
conditions suffer significantly over road
humps.Times to receiving facilities and
definitive care are increased.
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Transportation of patients in cardiac arrest to
AE
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All respondents had undertaken CPR whilst
travelling over road humps
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More than 50 would deviate
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Of 18 people, 12 would add up to 5 minutes to AE.
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50 gave a poor CPR a reason, 25 crew safety
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90! Some wont deviate, but most acknowledge a
problem
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Paramedics are the professionals at CPR. They
know if its poor.
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43 feel outcome was affected.
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.due to poor CPR
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Speed humps definitely affect CPR
adversely..and may affect outcomes in cardiac
arrest.
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Conditions affected by speed humps
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More than half of comments concern exacerbation
of condition
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Paramedics and patients agree speed humps are
not conducive to patient care
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Intervention and treatment
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Nearly half!
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Some said they would stop the vehicle - but not
all.
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10 of 27 people would neglect to undertake a
procedure they felt was essential solely due to
the presence of speed humps
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This study found

• Paramedics are willing to add several minutes to
  a 999 response
• Paramedics are willing to add several minutes to
  AE with a medically unstable patient
• Paramedics are willing to add several minutes to
  AE with a patient in cardiac arrest

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This study found (cont.)

• Humps affect CPR in the vast majority of cases
• Humps affect most patient conditions and injuries
  detrimentally
• Paramedics elect not to undertake essential
  interventions when travelling over humps

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This is a direct result of speed humps
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Humps present a potentially huge clinical risk
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Speed humps affect

• your patients
• your staff
• and
• your response times.

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Recommendations
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• Large scale study using both qualitative and
  quantitative elements
• Service/nation wide (national mapping)
• Include all types of speed hump
• Involve ALL staff
• Involve patients
• Practical CPR investigation
• Investigate injuries to staff and patients
• Investigate damage to vehicles (and costs)

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Dissemination
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• Full study available at
• www.belchamber.org/speedhumps
• Available personally at posters between 1300 and
  1400 on Sunday 29th June 2003

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Grateful acknowledgements

• Julia Williams and Indra Jones (University of
  Hertfordshire)
• Rachael Donohoe, Rachel Peters and the Clinical
  Audit and Research Unit team (London Ambulance
  Service NHS Trust)

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