An audit examining self-management skills and pre hospital management of adrenal crisis. This audit was performed following a clinical incident involving an Addisons patient who suffered and survived a cardiac arrest as a direct result of an adrenal crisis. The patient involved in the initial incident lived close to a major A&E.
The paramedic arm of the audit came about after consideration of the geographical nature of this locality. Even if the Air Ambulance is used there is still the potential for transfer times of more than 60 minutes. There is also the issue of management of steroid impaired patients during concurrent illness or incident such as RTA.
The audit was performed in two parts. Patients and Paramedics
Patients: The patients were asked what they understood by their illness, what steroid they are taking, how they manage illness and if they have an emergency injection kit at home.
Understanding was variable and highlighted the need for consistent education at the diagnosis stage. Self-management during illness needed addressing as well as emergency injection.
A working group of patients, paramedics and the endocrine specialist nurse has been set up to develop hand held records and identify areas for further development.
Paramedics: The paramedics were asked what they understood by specific illnesses such as Addisons disease, whether they had experience of the disorders mentioned and whether further education and policy change would support a change in practice.
The paramedics demonstrated very little understanding but there was unanimous enthusiasm for further education and expansion of practice.
Discussion with paramedic training officers and Westcountry Ambulance (WAST) management has resulted in a pilot of a new treatment pathway. The audit has also meant that education on pituitary and adrenal problems has now been included in the WAST pre qualifying programme.
01 - 05 Apr 2006
European Society of Endocrinology