Goal 4: Rapid response in physical or mental health crisis

The fastest and best response provided for people who are in imminent danger of loss of life; are seriously ill or injured; or in mental health crisis.

Quality Statement:

·        People with mental health and emotional distress will receive a coordinated response from services across the urgent and emergency care pathway. This should seamlessly link:

• • In-hours and out-of-hours primary care
  • Emergency ambulance services
  • Emergency Departments
  • Police
  • Mental health liaison
  • NHS crisis services; and
  • Crisis cafes and sanctuaries. 

·        People dialling 999 with non-time critical presentations are referred to alternative community, mental health single points of access or direct access hospital pathways, or safely discharged over the telephone following a secondary clinical assessment. 

·        People who have dialled 999 for an emergency ambulance and are in imminent danger of loss of life or limb, have a time sensitive injury or illness or require palliative care receive the fastest and best type of response commensurate with their clinical need. They are transported/referred to the best direct access pathway based on clinical need, as quickly as possible. 

·        Defibrillators are readily available and accessible to the public who are aware defibrillators are easy to use and can do no harm. 

·        Those arriving by ambulance at a hospital facility should be transferred safely from ambulance clinicians to the care of hospital clinicians in order of clinical priority and always in a timely manner (an hour at most). 

·        People who have accessed care in an Emergency Department (and the wider hospital) will find suitable environments and proactive processes to greet them. On arrival, there will be quick identification of whom the patient is, why they have attended and, following triage, what the next step in their care should be. Wherever possible, this will occur within 15 minutes of arrival, with an assessment by a senior decision maker complete within an hour. 

·        People suffering with acute complications of cancer or its treatment are able to bypass the Emergency Department, where appropriate, and quickly access an acute oncology service for appropriate specialist input to facilitate urgent assessment and rapid initial management. 

·        Ambulance clinicians will develop necessary end of life assessment and support skills to deal with difficult conversations, administer appropriate medications and support family/carer concerns. 

·        When people are ready to leave the Emergency Department, there will be effective arrangements in place to provide continuity of care with the minimum of delay, including returning home with support and timely admission to a hospital bed, when that is the right next stage in the person’s care.

To read more about Goal 4 including initial priorities, how health and social care systems will be supported to achieve this goal and how success will be measured, please refer to the Six Goals for Urgent and Emergency Care Policy Handbook.

Goal 4 Lead: Stephen Harrhy, Chief Ambulance Service Commissioner - ctm_casc_easc@wales.nhs.uk