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In Recent years there has been an expansion of paramedics into Emergency Care Practitioners. These are senior paramedics that undertake further exams to be able to differentiate minor illness and injury complaints just as ENPs do. We have found that many paramedics succeed in these roles as the differentiation of illness and injury is a greater part of paramedical science then standard nursing training.

Paramedics have already a responsibility to aim only to bring patients to hospital that will benefit from it, this means that they have discharged patients on scene and are happy to manage the responsibility that comes with that. Prescribing can be an issue at present for ECPs so ADPRAC tends to work with employing trusts to work on PGDs that ECPs can use to allow them to give drugs to patients as an when required within the confines of the trust’s system.

We know what you need.

As an employing trust you want a agency member of staff that can stand alone. The sort of nurse that you can deploy to any area of your department, to peads, to resus, to majors or minors. It would be really useful for them to be IV drugs, cannula, catheter, ECG trained;
they should be able to be dropped into Rapid Assessment Points or triage and understand what investigations are most pertinent and get them ordered early on. They should know that not every chest pain needs Troponins or even the ED at all! But be able to pick out the sick ones, getting help, and initiating treatment quickly. They should be the nurse awaiting the asthmatic alert call with nebulisers and hydrocortisone out of the cupboard….

Often senior nurses on the shop floor need to keep an ‘eye on’ their agency staff but what if you could get staff that would be a second pair of eyes for the person in charge. ADPRAC doesn’t take nurses under band six level or without at least three years current acute experience.

ADPRAC nurses are an asset to the nursing and medical team they will be reflexive to the needs of the department and will be confident and capable of assisting in anyway necessary.

Does it always need a nurse?

No. Well not at least from our perspective.

At ADPRAC we also employ Emergency Department Practitioners. These are Operating Department Practitioners trained within a Emergency Department context. Think about it. One of the hardest places to staff safely is the resus room, and some staff that are most confident and competent in the highest risk procedures like Rapid Sequence Inductions are ODPs. We have a body of staff the EDPs that are suitable for staffing your resus room comfortably; they are all band six and above. It can be really difficult staffing resus with internal staff due to the high turnover of experienced staff in Emergency Departments but with ADPRAC EDPs you can deploy one to resus and they will supervise the entire area complimenting registrars or consultants working in that area.

All will be ALS trained are many are instructors.

Our final group of staff are the Emergency Care Assistants like every other member of staff they are the best of their staff group. These guys can do the RAT work like qualified staff they will bleed, cannulate, ECG etc they will also escalate patients that they are worried about to senior nurses or doctors in that area.

We have had a great reception for this staff group

The role of the Emergency Nurse Practitioner (ENP) has been around for decades and over the years most trusts are now employing nurse practitioners to manage the minors streams.
However, many trusts still use junior locum medical staff to fill gaps in their minor injury service rota if an ENP is off sick or there is a shortfall of staff. This, at least to us, is counter intuitive as ENPs/ECPs are likely to have far more experience in dealing with this particular stream of Emergency Department work. Therefore they are far less likely to bother consultants or registrars for reviews of patients unless absolutely necessary and will also return a greater number of patients seen per hour.

Many of our ENPs will also be independent nurse prescribers so can take responsibility of appropriately prescribing. They will see patients that have been streamed to the minors area with common illnesses

Starting an Advanced Clinical Practitioner Team

Historically many trusts have struggled with the inception of an ACP team as there are very few practitioners working at the level required to make a meaningful impact in the department from the get go.We can help convert those staff that have less belief in non-medical practitioners by role modelling with feet on the ground in the Emergency Department. To that end many trusts have trialled ADPRAC ACPs then gone on to offer more locum work and then in time start their own ACP teams.

Pete one of the Clinical Directors of ADPRAC was heavily involved in the development of the national RCEM curriculum for ACPs. He has been asked to speak internationally on advanced practice and has several publications that examine that which can be achieved by non-medical practitioners in Emergency Departments. Both Greg and Pete are happy to provide consultancy advice to smooth the transition of staff into Advanced Clinical Practitioners. It’s sadly not as simple as just teaching nurses and paramedics more clinical skills because staff need to be coached into becoming clinical decision makers.

Many Trusts have embraced the skills that our ACPs/ENPs have to help with the clinical demands of a modern Emergency Department. It’s clear that on occasions junior doctors are used as locums where realistically an ACP with many more years of experience within Emergency Care may give a greater output. Equally, the quality of locums in majors can be variable which is true of any agency member of staff, however, at APDRAC we make sure that the non-medical clinician supplied has the right skills and experience to really make a difference.

To begin with in most trusts we are happy to fill junior doctor shortfalls, but most commonly the employing trust tends to employ our Senior ACPs on MG gaps of the rota do long as there is a Consultant on the shop floor.

We now have ACPs that work within Acute Medicine they are able to clerk patients in AMU prior to a sensible presentation to the Acute Med Consultant!! They also can work as clinicians within ambulatory care units alongside senior medical staff.