Supporting Ambulance Crews
Electronically through the Provision
of ‘On-Demand’ Patient Health
Information

Abstract

The North East Ambulance Service (NEAS) does not have direct access to any information regarding patient health history, current medication, allergies, etc. that
might assist an ambulance crew when they are dispatched to an emergency incident. Therefore, an ambulance crew responding to a call-out usually travels to the incident
‘information blind’ regarding the patient’s general health status. What makes the ambulance service in general, and the ambulance crew in particular, unique from other healthcare organizations is the spectrum of exposure to a diversity of health organizations (care homes, GPs, hospitals, etc.), and none-health organizations (police, social services, fire forces,etc.).

This thesis describes an investigation into the feasibility of implementing a software Information Broker (IB) prototype, that has the ability to provide ‘on-demand’ electronic health information to ambulance crews while on scene, by accessing a set of autonomous databases containing patient records. This is to support the ambulance crew with reliable patient information in order to assist their decision-making process, therefore, reduce unnecessary patients’ conveyance to the Emergency Department (ED). The thesis also examines the sociotechnical issues surrounding health information transfer between and within the National Health Service (NHS) in the United Kingdom (UK) for patients with epilepsy (PWE), specifically in the North East region of England.

A case study approach was employed as an overarching framework for the feasibility study of the IB prototype. This case study was centred upon studying the needs of people with epilepsy (PWE), as this group has been identified by NEAS as frequent users of the ambulance service. In many cases, if the ambulance crew are given adequate information to support their decision-making, they do not need to convey patients to a hospital ED unless necessary. Within the case study, a phenomenological approach was employed for the set of perspectives used for investigating the sociotechnical issues surrounding the IB. The three perspectives were
the perceptions of NEAS operational and management staff, those of the JCUH staff and PWE/carers, and finally, the perceptions of the ambulance crew.

The prototype IB technology has demonstrated the feasibility of using an information transfer broker to transfer information from autonomous organizations to
the ambulance crew on scene. Overcoming technical challenges alone is not sufficient for this success. Stakeholders’ requirements, organization collaboration, compliance with national standards and targets, social and technical aspects, and so forth, are other issues that have been considered. Involvement of potential stakeholders in stages of any Health and Information Technology (HIT) development is an essential
element to be included, as much as possible, to satisfy those requirements and needs of end-users.

Improving the data availability to the ambulance crews on scene via an IB, means that they can perform better decision-making while on scene with a patient.
The demonstration of the IB prototype has shown its potential for transferring patient health information from an autonomous database to ambulance crews. To
increase opportunities of success, shared incentives and aims of the intra- and inter-organizational communication and collaboration should facilitate the implementation
of HIT. Facilitating incremental improvements of systems and technologies may have an effect on the organization as a whole in terms of robustness of systems and
technologies.