Community Specialist Paramedic, Ivan Scrase

Ivan ScraseMonday
As Community Paramedic for Workington I am based in the community hospital rather than an ambulance station.  Being in the hospital has allowed me to quickly build working relationships with local healthcare providers. In the first weeks of my secondment I spent time shadowing the COPD and respiratory rehab teams.

Today, I am popping down the corridor to see them to follow-up an idea to produce a COPD rescue medication guidance tool designed specifically for North West Ambulance Service (NWAS) crews. But ten minutes into the meeting my radio beeps, “ACP003 can you attend at job at…”  An integral part of the CSP role is to improve 999 cover in my local community and so I’m always available for both red and green calls. In this case, I am called to a patient who is currently on an enhanced care plan that I have been involved in implementing - a fast track referral is made and hospital admission avoided. 

Every Tuesday starts with a Multidisciplinary Team (MDT) meeting with the Frail Elderly Assessment Team, Specialist COPD nurse, GP and Primary Care Centre. The meeting provides an opportunity for various healthcare professionals to proactively case manage patients with complex health and social care needs. We discuss my visit with the patient from Monday.  On this occasion, we discussed the benefits of enhanced care plans following on from the fast track referral I made the day before.

The MDT is also a forum to plan the week ahead and review of re-admissions.  Since becoming a regular member of the group, it is clear that the ambulance service has a valuable part to play in care planning and admission avoidance.

Following on from the MDT meeting, I make a home visit an elderly lady who falls frequently. She was recently admitted due to a crew ‘discovering’ a bizarre arrhythmia. Since there was no documentation on scene, the crew were not to know the arrhythmia is a long-term anomaly. Today I have come to get a 12-lead ECG to include in a Clinical Care Plan. While this is a simple preventative intervention, a ten minute visit from a CSP avoids the patient attending hospital as no other care providers have portable ECG machines.

Wednesdays begin with the Primary Care Steering Group meeting. Around the table are senior representatives from Adult Social Service, General Practice, Clinical Commissioning Group, Primary and Community Care Teams, and now NWAS.  These meetings have a similar MDT format to Tuesday’s meeting but with a more strategic focus. Today the main topic of debate is the introduction of new IT referral system called STRATA. Since being part of this steering group, we have previously discussed the challenges of data sharing between ‘NHS’ IT systems and NWAS: in this case STRATA  will be able to ‘talk’ to our ERISS system allowing NWAS staff to make direct patient referrals – watch this space.

My morning is spent catching up on emails and phone calls. After weeks of trying, I finally get hold of the commissioner for the Carers’ Emergency Card scheme I have been promoting. It is a productive conversation but interrupted by “ACP003 can you attend…”

Clearing the job, I drive to Carlisle Hospital for a meeting with respiratory consultants and NWAS’s Urgent Care Team about a new COPD pathway for North Cumbria. Once in place, the new COPD pathway will make care plans and COPD referral pathways available to North Cumbrian NWAS crews via ERISS.  Whist in the hospital, I catch-up with Joanne - a Service Improvement Manager - to discuss recent developments in stroke care in the Workington area. She is keen to know about NWAS stroke care bundles and I help her make a data request. On my way home the radio beeps again with another request to respond.

Fridays are very busy in the Urgent Care Centre where I am based. This morning I am seeing patients in the 24-hour ECG and BP clinic. As part of this community service, I am fitting devices as well as downloading results. Working in new clinical settings such as this and the Wound and Vascular Care Clinic is an integral part of developing a broad set of clinical skills. 

This afternoon I am joined by Richard Potter (Paramedic, Egremont) to fly the flag for #Team999 at an emergency services event. Alongside our Community First Responder (CFR) colleagues we showcase some of our skills and equipment, with demonstrations EZIO and airway management.

Richard is a great ambassador for NWAS and had a constant stream of children eager to try their hand at inserting an LMA (in a manikin, not Richard!). Prior to becoming a CSP, I had never done one of these events but found that the participation and feedback you get from the public does mean you go home with a renewed sense of pride in the job we do.