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….
June 2003
How speed humps affect
• your patients;
• your staff;
and
• your response times.
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!
June 2003
• 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!
In the last week….
• Barnett council (London) propose to
remove all 500 speed humps saying they are
“Ineffectual and cause road deaths and
damage to vehicles”
• London Ambulance Service spokesman
says “It is possible that minute from
response times (service-wide) could equate
to 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
24
25
20
15
12
10
5
999 call avoiding humps
0
Yes
No
Figure 3 (Q2): Graph showing how many people stated they would take an
alternative route to a 999 call (avoiding humps)
67% actively avoid humps
June 2003
Crew safety
If quicker
Depends on traffic
If time to scene was the same
Avoid humps if at all possible
Depends on deviation
Humps cause discomfort
Humps slow you down
0
2
4
6
8
Frequency
Figure 7 (Q2a): Reasons given for avoiding road humps en route to a
999 call
Over half said time was a factor
June 2003
10
No. of people
willing to add
16
14
12
10
8
6
4
2
0
15
10
3
2
0
1
1
2
3
4
2
5
Extra Minutes
Figure 5 (Q2b): Number of extra minutes considered acceptable to a
999 call to avoid road humps
30% would add 2 minutes, 55%
between 1 and 5 minutes!
June 2003
Crew safety
If quicker
Depends on traffic
If time to scene was the same
Avoid humps if at all possible
Depends on deviation
Humps cause discomfort
Humps slow you down
0
2
4
6
8
Frequency
Figure 7 (Q2a): Reasons given for avoiding road humps en route to a
999 call
Humps slow you down, but respondents
would add time to avoid humps
June 2003
10
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
20
20
15
14
Unstable
patient to
hospital
avoiding
humps
10
5
0
Yes
No
Figure 12 (Q6): Graph showing how many
people would take an alternative route to a
hospital (avoiding humps) with an unstable
patient
59% take a different route
June 2003
Only if small time delay
Safety to colleague
Depends on pt condition
No reason
Humps cause discomfort
Better pt care
0
1
2
3
4
5
6
Frequency
Figure 14 (Q6a): Reasons given for avoiding road humps with a
medically unstable patient en route to hospital
31% are concerned with improved care,
25% with patient condition - 56% in total!
June 2003
7
6
6
5
4
No. of people
willing to add
3
3
2
2
1
3
2
1
2
1
0
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
19 of 20 people would extend time to hospital.
75% would add up to 5 minutes - but 2 would add
10 minutes!
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
20
18
16
15
Patient in
cardiac arrest
to hospital
avoiding
humps
10
5
0
0
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
More than 50% would deviate
June 2003
4
4
3
3
No. of people
willing to add
2
1
2
2
2
2
2
3
4
5
1
0
0
1
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
Of 18 people, 12 would add up to
5 minutes to A&E.
June 2003
No reason
Difficult CPR
Only if small time delay
Safety to colleague
Better pt care
0
2
4
6
8
Frequency
Figure 17 (Q7a): Reasons given for avoiding road humps with a patient
in cardiac arrest en route to hospital
50% gave a poor CPR a reason,
25% crew safety
June 2003
10
35
32
30
25
20
15
10
5
0
4
0
Yes
Detrimental
effect on CPR
by humps
No
Figure 18 (Q7d): Graph showing how many
people feel CPR performance was affected
detrimentally by humps
90%! Some won’t deviate, but
most acknowledge a problem
June 2003
Driver too quick
Ineffective CPR
No reason
0
5
10
15
20
25
30
Frequency
Figure 19 (Q7e): Reasons given for believing CPR was affected whilst
driving over road humps
Paramedics are the professionals at
CPR. They know if it’s poor….
June 2003
20
17
15
13
10
5
Unsure
No
Yes
0
3
Detrimental
effect on CPR
by humps
Figure 20 (Q7f): Graph showing how many
people feel CPR performance affected
detrimentally by humps caused a diffferent
patient outcome
June 2003
43% feel outcome was
affected….
Ineffective CPR
No reason
0
2
4
6
8
10
Frequency
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
….due to poor CPR
June 2003
12
Speed humps definitely affect
CPR adversely….
….and may affect outcomes in
cardiac arrest.
June 2003
Conditions affected by speed
humps
June 2003
Abdom inal pain
2
2
Neurological
1
Blue calls
3
Myocardial Infarction
6
Cardiac arrest
9
General pain
6
Traum a
4
Most/all
1
1
Intubated
Elderly
23
Spinal/back injuries
1
Clinical Shock
5
Nausea/vom iting
2
Maternities
1
Hypotension
17
Fractures
0
5
10
15
20
Frequency
June 2003
Figure 23 (Q8a): Specific patient conditons that are believed to be
affected detrimentally by road humps
25
1
Felt nauseous
2
Ineffective CPR
1
Increased journey tim e
3
3
Blam ed driver
Hindered 999 services
2
Pointless
1
Hazardous
2
Condition w orsened
1
Felt unw ell
18
Discom fort
6
General Dissatisfaction
1
Hum ps are inevitable
0
5
10
15
Frequency
Figure 30 (Q5a): Comments made by patients to crews regarding road
humps
More than half of comments concern
exacerbation of condition
June 2003
20
Paramedics and patients agree:
speed humps are not conducive to
patient care
June 2003
Intervention and treatment
June 2003
20
19
17
15
10
Decided not to
undertake a
procedure
5
0
0
Yes
No
Figure 24 (Q9): Graph showing how many
people have ever elected not to undertake a
procedure due to road humps
Nearly half!
June 2003
Anything invasive
1
Needle chest decompression
1
ECG
1
Drug administration
1
2
Intubation
16
Cannulation
0
5
10
15
Frequency
Figure 25 (Q9a): Procedures that have not been undertaken as a result
of travelling over road humps
Some said they would stop the
vehicle - but not all….
June 2003
20
14
12
10
8
6
4
2
0
14
13
Detracted from
patient care
0
Yes
No
10
10
8
6
Figure 26 (Q9b): Graph showing how many
procedures not undertaken due to road
humps have ever meant a drop in patient
care
4
2
2
2
No
??
Essential
procedure not
undertaken
0
Yes
Figure 27 (Q9d): Graph showing how many
procedures not undertaken due to road
humps were deemed essential
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
Speed humps affect
• your patients;
• your staff;
and
• your response times.
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 i n i cal Ri sk !
90% of Paramedics say that speed humps affect CPR
adversely.
55% of Paramedics would add between 1 and 5
minutes when RESPONDING TO a 999 call!
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!
Are speed humps affecting your care?
June 2003
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
By Mark Belchamber
BSc (Hons) Para Sci, AASI, SR Para
(Training Officer/Paramedic, London Ambulance Service NHS Trust)
Majestic Hotel, 28th June at 15:10