Effects of Speed Humps on Resuscitation of Patients by Paramedics: Attitudes and Implications

1. 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)

2. Or….

3. How speed humps affect • your patients; • your staff; and • your response times.

4. “Delays due to road conditions” I’ll go this way to avoid the humps Humps don’t slow the idiots down anyway You can’t avoid the humps I hate humps! Can’t the driver slow down? I’m feeling really sick OUCH! These bumps are awful Can’t you go a different route? I hate humps! Sound familiar?

5. 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.”

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

7. 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)

8. 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

9. Methodology (cont.) Ethics • Approval from University of Hertfordshire • Also sponsored by London Ambulance Service NHS Trust

10. 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

11. Results

12. All respondents drive over humps at least once per shift.Over half do it more than 4 times per shift

13. Response to 999 calls

14. 67% actively avoid humps

15. Over half said time was a factor

16. 30% would add 2 minutes, 55% between 1 and 5 minutes!

17. Humps slow you down, but respondents would add time to avoid humps

18. There is no published research concerning actual time delays that humps cause to U.K. ambulances

19. Transportation of medically unstable patients to a receiving facility

20. 59% take a different route

21. 31% are concerned with improved care, 25% with patient condition - 56% in total!

22. 19 of 20 people would extend time to hospital. 75% would add up to 5 minutes - but 2 would add 10 minutes!

23. In Paramedics’ experiences, patient care and/or conditions suffer significantly over road humps.Times to receiving facilities and definitive care are increased.

24. Transportation of patients in cardiac arrest to A&E

25. All respondents had undertaken CPR whilst travelling over road humps

26. More than 50% would deviate

27. Of 18 people, 12 would add up to 5 minutes to A&E.

28. 50% gave a poor CPR a reason, 25% crew safety

29. 90%! Some won’t deviate, but most acknowledge a problem

30. Paramedics are the professionals at CPR. They know if it’s poor….

31. 43% feel outcome was affected….

32. ….due to poor CPR

33. Speed humps definitely affect CPR adversely….….and may affect outcomes in cardiac arrest.

34. Conditions affected by speed humps

36. More than half of comments concern exacerbation of condition

37. Paramedics and patients agree: speed humps are not conducive to patient care

38. Intervention and treatment

39. Nearly half!

40. Some said they would stop the vehicle - but not all….

42. 10 of 27 people would neglect to undertake a procedure they felt was essential solely due to the presence of speed humps

43. This study found • Paramedics are willing to add several minutes to a 999 response • Paramedics are willing to add several minutes to A&E with a medically unstable patient • Paramedics are willing to add several minutes to A&E with a patient in cardiac arrest

44. 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

45. This is a direct result of speed humps

46. Humps present a potentially hugeclinical risk

47. Speed humps affect • your patients; • your staff; and • your response times.

48. Recommendations

49. 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)

50. Dissemination