Dipa Lad

1. 1. deviation from national guidance

   “Is the EMAS deviation from national guidance safe as it currently stands? | do not know if this is a protocol adopted by other ambulance services around the country. | have copied the AACE into this report largely with this issue in mind.”

2. 2. lack of guidance on futility of resuscitation

   “The distinction between national guidance and local protocol is that EMAS crews may deem a resuscitation effort to be 'futile'. This is a clear and important deviation from national guidance, yet staff have been given no guidance about what a 'futile' resuscitation is. Whilst this may be clear in some situations, the protocol, if adopted, should give guidance where a situation is less clear - and perhaps consider providing that where there is any doubt, that full ALS protocol should be applied.”

3. 3. staff unawareness of protocol change

   “It was clear that most of the staff attending this emergency were not aware of the change in local policy. On arrival of the team leader (who told us she was aware of the protocol), resuscitation efforts were stopped.”

4. 4. reliance on email for protocol communication

   “We heard that EMAS relies on emailing changes in protocols to staff. There is no check that busy staff have read and understood these, and there has been no training on this change.”

5. 5. absence of local pocketbook for death diagnosis

   “We heard that staff carry JRCALC pocketbooks as reference guides. EMAS policy around diagnosis of death differs in a key respect from JRCALC guidelines - but there is no equivalent pocketbook / amendment to existing pocketbook / similar which reflects local policies.”

6. 6. unclear diagnosis of death procedure

   “1 do not consider the current EMAS 'Diagnosis of Death Procedure' to be sufficiently clear / consistent (particularly when comparing the wording and the flow - charts). This also contains no guidance on when resuscitation should be considered 'futile', as referred to above.”

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