June 2003

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)

June 2003

Or….Or….

June 2003

• your patients;

• your staff;

and

• your response times.

How speed humps affect

June 2003

Sound familiar?• “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!

June 2003

In the last week….

• Barnett council (London) propose to remove all 500 speed humps saying they are “Ineffectual and cause road deaths and Ineffectual and cause road deaths and damage to vehiclesdamage to vehicles”

• London Ambulance Service spokesman says “It is possible that minute from It is possible that minute from response times (service-wide) response times (service-wide) couldcould equate equate to 500 more lives saved per yearto 500 more lives saved per year.”

June 2003

Methodology

Literature search/review

• Scant information (predominantly U.S. based)

• NO research surrounding attitudes, perceptions, responses of Paramedics

June 2003

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)

June 2003

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

June 2003

Methodology (cont.)

Ethics

• Approval from University of Hertfordshire

• Also sponsored by London Ambulance Service NHS Trust

June 2003

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

June 2003

Results

June 2003

All respondents drive over humps at least once per shift.

Over half do it more than 4 times per shift

June 2003

Response to 999 calls

June 2003

67% actively avoid humps

24

12

0

5

10

15

20

25

Yes No

Figure 3 (Q2): Graph showing how many people stated they would take an alternative route to a 999 call (avoiding humps)

999 call avoiding humps

June 2003

Over half said time was a factor

Figure 7 (Q2a): Reasons given for avoiding road humps en route to a 999 call

0 2 4 6 8 10

Humps slow you down

Humps cause discomfort

Depends on deviation

Avoid humps if at all possible

If time to scene was the same

Depends on traffic

If quicker

Crew safety

Frequency

June 2003

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

15

2

10

31

2

02468

10121416

No. of people willing to add

0 1 2 3 4 5

Extra Minutes

Figure 5 (Q2b): Number of extra minutes considered acceptable to a 999 call to avoid road humps

June 2003

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

Figure 7 (Q2a): Reasons given for avoiding road humps en route to a 999 call

0 2 4 6 8 10

Humps slow you down

Humps cause discomfort

Depends on deviation

Avoid humps if at all possible

If time to scene was the same

Depends on traffic

If quicker

Crew safety

Frequency

June 2003

There is no published research concerning actual time delays

that humps cause to U.K. ambulances

June 2003

Transportation of medically unstable patients to a receiving

facility

June 2003

59% take a different route

20

14

0

5

10

15

20

Yes No

Figure 12 (Q6): Graph showing how many people would take an alternative route to a hospital (avoiding humps) with an unstable

patient

Unstablepatient tohospitalavoidinghumps

June 2003

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

Figure 14 (Q6a): Reasons given for avoiding road humps with a medically unstable patient en route to hospital

0 1 2 3 4 5 6 7

Better pt care

Humps cause discomfort

No reason

Depends on pt condition

Safety to colleague

Only if small time delay

Frequency

June 2003

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

10 minutes!

1

2

6

1

2

3

2

3

0

1

2

3

4

5

6

No. of people willing to add

0 1 2 3 4 5 6 7 8 9 10 ??

Extra Minutes

Figure 13 (Q6b): Number of extra minutes acceptable to arrive at hospital with an unstable patient to avoid road humps

June 2003

In Paramedics’ experiences, patient care and/or conditions suffer significantly over road

humps.

Times to receiving facilities and definitive care are increased.

June 2003

Transportation of patients in cardiac arrest to A&E

June 2003

All respondents had undertaken CPR whilst travelling over road

humps

June 2003 More than 50% would deviate

0

1816

0

5

10

15

20

Yes No

Figure 15 (Q7): Graph showing how many people would take an alternative route to a hospital (avoiding humps) with a patient in

cardiac arrest

Patient incardiac arrestto hospitalavoidinghumps

June 2003

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

1

4

2 2 2 2

3

0

1

2

3

4

No. of people willing to add

0 1 2 3 4 5 6 7 8 9 10 ??

Extra Minutes

Figure 16 (Q7b): Number of extra minutes acceptable to arrive at hospital with a patient in cardiac arrest to avoid road humps

June 2003

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

Figure 17 (Q7a): Reasons given for avoiding road humps with a patient in cardiac arrest en route to hospital

0 2 4 6 8 10

Better pt care

Safety to colleague

Only if small time delay

Difficult CPR

No reason

Frequency

June 2003

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

0

32

4

0

5

10

15

20

25

30

35

Yes No

Figure 18 (Q7d): Graph showing how many people feel CPR performance was affected

detrimentally by humps

Detrimentaleffect on CPRby humps

June 2003

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

Figure 19 (Q7e): Reasons given for believing CPR was affected whilst driving over road humps

0 5 10 15 20 25 30

No reason

Ineffective CPR

Driver too quick

Frequency

June 2003

43% feel outcome was affected….

13

17

30

5

10

15

20

Ye

s

No

Un

su

re

Figure 20 (Q7f): Graph showing how many people feel CPR performance affected

detrimentally by humps caused a diffferent patient outcome

Detrimentaleffect on CPRby humps

June 2003

….due to poor CPR

Figure 21 (Q7g): Reasons given for believing a patient in cardiac arrest undergoing CPR over road humps had a different patient outcome than

CPR not over road humps

0 2 4 6 8 10 12

No reason

Ineffective CPR

Frequency

June 2003

Speed humps definitely affect CPR adversely….

….and may affect outcomes in cardiac arrest.

June 2003

Conditions affected by speed humps

June 2003 Figure 23 (Q8a): Specific patient conditons that are believed to be

affected detrimentally by road humps

17

1

2

5

1

23

1

1

4

6

9

6

3

1

22

0 5 10 15 20 25

Fractures

Hypotension

Maternities

Nausea/vomiting

Clinical Shock

Spinal/back injuries

Elderly

Intubated

Most/all

Trauma

General pain

Cardiac arrest

Myocardial Infarction

Blue calls

Neurological

Abdominal pain

Frequency

June 2003

More than half of comments concern exacerbation of condition

Figure 30 (Q5a): Comments made by patients to crews regarding road humps

16

181

2

12

33

12

1

0 5 10 15 20

Humps are inevitable

General Dissatisfaction

Discomfort

Felt unwell

Condition worsened

Hazardous

Pointless

Hindered 999 services

Blamed driver

Increased journey time

Ineffective CPR

Felt nauseous

Frequency

June 2003

Paramedics and patients agree:

speed humps are not conducive to patient care

June 2003

Intervention and treatment

June 2003

Nearly half!

0

1719

0

5

10

15

20

Yes No

Figure 24 (Q9): Graph showing how many people have ever elected not to undertake a

procedure due to road humps

Decided not toundertake aprocedure

June 2003

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

Figure 25 (Q9a): Procedures that have not been undertaken as a result of travelling over road humps

16

2

1

1

1

1

0 5 10 15 20

Cannulation

Intubation

Drug administration

ECG

Needle chest decompression

Anything invasive

Frequency

June 2003

0

14 13

02

46

81012

14

Yes No

Figure 26 (Q9b): Graph showing how many procedures not undertaken due to road

humps have ever meant a drop in patient care

Detracted frompatient care 10

2 2

0

2

4

6

8

10

Yes No ??

Figure 27 (Q9d): Graph showing how many procedures not undertaken due to road

humps were deemed essential

Essentialprocedure notundertaken

June 2003

10 of 27 people would neglect to undertake a procedure they felt was essential solely due to the

presence of speed humps

June 2003

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

June 2003

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

June 2003

This is a direct result of speed humps

June 2003

Humps present a potentially huge clinical risk

June 2003

• your patients;

• your staff;

and

• your response times.

Speed humps affect

June 2003

Recommendations

June 2003

• 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)

June 2003

Dissemination

June 2003

• Full study available at

www.belchamber.org/speedhumps

• Available personally at posters between 13:00 and 14:00 on Sunday 29th June 2003

June 2003

Grateful acknowledgements

• Julia Williams and Indra Jones (University of Hertfordshire)

• Rachael Donohoe, Rachel Peters and the Clinical Audit and Research Unit team (London Ambulance Service NHS Trust)

June 2003

A Cl inical Risk!

Are speed humps affecting your care?

55% of Paramedics would add between 1 and 5 minutes when RESPONDING TO a 999 call!

90% of Paramedics say that speed humps affect CPR adversely.

Of those Paramedics who elected NOT to undertake a procedure due to travelling over road humps, over 30% said the procedure was essential - and still chose not to do it!

Discover the only published research into:Paramedics’ attitudes to the effects of speed humps on resuscitation of patients en route to hospital, including general patient care and ambulance response times

Majestic Hotel, 28th June at 15:10

By Mark Belchamber BSc (Hons) Para Sci, AASI, SR Para

(Training Officer/Paramedic, London Ambulance Service NHS Trust)