P101 A survey of emergency oxygen guideline implementation among all 15 UK Ambulance Services in early 2011

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Abstract

The British Thoracic Society (BTS), together with 21 other societies published a UK guideline for emergency oxygen use in 2008. This guideline was endorsed by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) who produced new oxygen guidance for ambulance crews in April 2009. We have conducted a survey of implementation of this guidance among UK Ambulance Services in early 2011. A questionnaire was sent to the Medical Directors of all 15 UK Ambulance Services and all, or their nominated deputies responded. Eleven of fifteen respondents reported full implementation of the 2009 JRCALC oxygen guidance throughout their service and ten of these reported that all relevant staff are trained in this area of practice. However, an informal survey of about 100 front line ambulance crews in one of these areas found that none were aware of the 2009 JRCALC document so the above figures may be aspirational and not yet achieved at operational level. Four services reported that they have completed audits of guideline implementation and a further three services are planning audits. All 15 services reported that 81%–100% of response vehicles were equipped with oximeters and the availability of oxygen masks was as follows: 15/15 reservoir masks; 12/15 simple face masks, 12/15 28% Venturi masks, 6/15 24% Venturi masks, 10/15 nasal cannulae. However, the informal survey of front-line staff from one ambulance service showed that Venturi masks were not actually available at operational level although the Regional response indicated universal availability. A separate survey found that no UK ambulance service has access to air cylinders, compressors or ultrasonic nebulisers for COPD patients so all nebulised treatment is oxygen-driven. Six of 15 services reported that they had protocols to limit the duration of oxygen-driven nebuliser therapy for COPD patients. Two services have a record of all patients in their area who have an Oxygen Alert card. This survey suggests that UK Ambulance Services are taking steps to implement the BTS and JRCALC emergency oxygen guidance but it is unclear how much advice and equipment had been cascaded to front-line staff by Spring 2011.

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