5th Oct 2017
The Physician Response Unit (PRU), the joint service provided by London's Air Ambulance, Barts Health NHS Trust and London Ambulance Service has been remodelled thanks to funding from Tower Hamlets Together. Previously an 8 hours a day, 5 days a week service, the PRU will now be able to respond to 999 calls 12 hours a day, 7 days a week, all year round. Because of these longer hours, up to 50% more patients will be seen, be able to get the care they need quicker and hospital and ambulance resources will be freed up in East London.
The remodelled service will have;
- Extended operating hours
- 4 new doctors
- 2 new Emergency Ambulance Crew members
- New uniforms and branding
- Electronic access to patients’ health records at scene, enhancing care and supporting clinical decision-making
The PRU was launched in 2001 with a vision of delivering "community emergency medicine" to patients. With a senior emergency doctor and London Ambulance Service clinician in the car, the PRU can treat a wider range of illnesses and injuries at scene compared to ambulance crews which take many emergency patients to hospital. The PRU carries advanced medication, equipment and treatments usually only found in hospital, such as instant result blood tests, urine tests and sutures to stitch serious wounds. The PRU takes the Emergency Department to the patient meaning they can be treated at scene and often avoid having to go to hospital.
By enabling patients to remain at home the PRU not only cuts treatment times by hours but focuses on improving patients’ experience. Feedback from patients has shown that this aspect of the service is particularly valued. By avoiding hospital, people can recover in their home or community and avoid any associated risks that can come from extended hospital stays. For example people over 80 experience 40 per cent muscle loss for every 10 days of bed rest, putting them at increased risk of falls, skin damage and associated infection.
Spearheading the redevelopment is Dr Tony Joy, Consultant in Emergency Medicine at Barts Health NHS Trust & Clinical Lead for the Physician Response Unit;
“This is an exciting time for emergency care in London. The PRU is an innovative solution to help us respond to the very high demand on health services. The redevelopment will mean longer operational hours, and closer working between all aspects of healthcare provision. It turns emergency care on its head so that emergency patients are seen in the community by senior clinicians, enabling early treatment and access to alternative pathways without the need to go to hospital.
“It will help reduce pressure on Emergency Departments by reducing admissions and will support London Ambulance Service by reducing the need for ambulance conveyances. We hope that this model of care will be rolled out throughout the UK one day.”
Patient Case Study
70 year old Joshua Adeleke was seen by the PRU doctor and ambulance crew after phoning 999. On arrival the medical team found him septic, suffering from a severe and potentially life-threatening infection, and needing immediate intervention. Using the advanced equipment the PRU carries in its rapid response vehicle, the team were able to swiftly give him intravenous antiobiotics and fluids, perform blood tests and alter some of his blood pressure medications. Thanks to the expertise of the medics, the interventions meant Joshua could be discharged there and then with tablet antibiotics avoiding a visit to hospital. The medics contacted his local GP surgery to ensure that Joshua’s care was continued and he had support afterwards. Joshua made a full recovery and said the service was “fantastic. I really appreciated that I didn’t have to go to hospital.” Joshua’s treatment illustrates the great integration of care the PRU is able to provide.
London's Air Ambulance Consultant and Lead Clinician for Prehospital Care at Barts Health NHS Trust Dr Gareth Grier said;
“London’s Air Ambulance has been a world leader in pre-hospital care for over 28 years, and we were proud to launch the PRU as part of this service in 2001. It is an innovative idea that takes the Emergency Department out on the road and into communities, so that patients can be treated on scene avoiding the need for a hospital visit or ambulance conveyance. It is now the right time for the PRU to develop further, so it can help even more patients and further ease pressure on East London health services.”
The PRU is run as a partnership between London’s Air Ambulance, London Ambulance Service and Barts Health NHS Trust. London’s Air Ambulance provides the cars and some of the equipment. Barts Health NHS Trust provides the clinical governance, training, rest of the equipment and the senior doctor who works half the time in the Emergency Department of The Royal London Hospital and half the time with the PRU. London Ambulance Service provides the emergency ambulance crew and task the service from the 999 control centre in Bow.