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The following is a summary of “Variation in ambulance pre-alert process and practice: cross-sectional survey of ambulance clinicians,” published in the December 2024 issue of Emergency Medicine by Coster et al. 

Pre-alert calls report emergency departments (EDs) about patients with critical illness, but guidance varies across ambulance service policies.   

Researchers conducted a retrospective study to explore ambulance pre-alert use and provide recommendations for practice and guidance.   

They recruited ambulance clinicians across England who were involved in pre-alert decision-making through ambulance trusts and social media. Participants completed an anonymous online survey between May and July 2023. Quantitative data were examined descriptively using SPSS (version 28), and free-text responses were included to complement the quantitative results.   

The results showed 1,298 valid responses from 10 English ambulance services, highlighting variability in pre-alert practices. Pre-alert frequency was reported as 7.1% (several times per shift) and 14.9% (once or twice monthly). Most pre-alerts were directed to EDs, but 32.8% were routed through ambulance control rooms. Mnemonics like ATMIST (Age, Time of Incident, Mechanism of injury, Injuries, Signs, Treatments) were consistently used by one-third of respondents, while 10.2% used no structured format. Guidance for identifying individuals requiring pre-alerts varied, with local ambulance service protocols being the most common, and 20% reported never using national guidelines. Understanding of appropriate conditions for pre-alerts differed, with paramedic students expressing a need for more guidance in older individuals on trauma and medical pre-alerts. Only 29% had specific pre-alert training, while 50% reported never receiving feedback.   

Investigators concluded the variations in pre-alert processes and practices could lead to uncertainty and challenges for ambulance clinicians, making guidance and training to promote consistency. 

Source: emj.bmj.com/content/early/2024/12/05/emermed-2023-213851