Rapid response and learning for later: establishing high quality information networks and evaluation frameworks for the National Ambulance Service response to COVID-19 – the ENCORE COVID Project Protocol

Abstract

Background: The National Ambulance Service (NAS) is at the forefront of Ireland’s response to the COVID-19 pandemic. As directed in Ireland’s National Action Plan, NAS significantly expanded prehospital services, including provision of a novel COVID-19 testing service. Additionally, other health services rely on NAS’s capacity to assess, transport and/or treat COVID-19 patients. In a climate of innovation and adaptation, NAS needs to learn from international ambulance services and share experience. Evaluation of the NAS response to COVID-19 is required to facilitate evidence-based planning for subsequent waves or future pandemics, and to identify innovative practice for mainstreaming into routine service provision. Aims: This project aims to test the utility of novel information networks and develop a tool that is tailored to evaluating pandemic-imposed change in an emergency medical service. Methods: The first aim will be to introduce and measure the impact of ambulance-specific research and information updates for NAS. Secondly, the usefulness to members of an international network of senior ambulance and research personnel (‘AMBULANCE+COVID19’ network), and the clarity and feasibility of a short-survey instrument, the Emergency Medical Services Five Question Survey (EMS-5QS), will be assessed. Finally, an evaluation framework for assessing pandemic-imposed change will be developed to enable NAS determine innovations: (1) for reactivation in another wave or new pandemic; (2) to be sustained as part of routine service. The framework will be developed in collaboration with NAS and the National Quality Improvement Team. The Research Team includes expertise from academia, ambulance services and the National Public Health Emergency Team. Conclusions: This project will facilitate the prompt introduction of information sharing processes to an emergency medical service and assess the impact of those processes. By developing a process for evaluating pandemic-imposed change in NAS, this project will add to the toolbox for future pandemic planning in emergency medical services internationally.

Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic

“…41 In Ireland, NAS regularly distributed newsletters to staff summarising the latest COVID-19 literature and established a COVID-19 information-sharing network with international EMS representatives. 17 Finally, a seventh QI driver was identified in this study: ICT for quality. Specifically ICT that has been designed to manage a pandemic, including processing large case numbers during waves and tracking cases across different databases and systems, is required to optimise efficiency and minimise errors.…”

“… 20 The full protocol of this evaluation was published prior to the present qualitative study being conducted. 17 The qualitative method used in this study was the semi-structured, individual interview. This technique entails a discussion between a researcher and a participant that is guided by a flexible interview schedule comprising a shortlist of opening questions and a range of potential follow-up questions and probes.…”

“…9 It should be noted that the current study is part of a project examining the NAS response to the pandemic, which represented a move towards a more formal approach to measurement and evaluation. 17 This project also entailed assessing the dissemination of newsletters containing pandemic-related evidence and guidance to NAS personnel and evaluating the sharing of pandemic-related information within an international EMS network. The sixth QI driver was governance for quality.…”

“…This required NAS to undergo swift and substantial changes, including the urgent implementation of a COVID-19 testing service, which was central to the national COVID-19 screening programme. 17 18 To oversee the delivery of this service, NAS established the COVID-19 Response Room in its headquarters in Dublin. This was the only centre in Ireland dedicated to managing all referrals for COVID-19 tests and organising home testing for patients who cannot attend mass testing centres, as well as on-site testing for individuals living and working in residential facilities, such as nursing homes.…”

“…The National Ambulance Service (NAS) has been at the forefront of the HSE response to the COVID-19 pandemic in Ireland since the first wave. This required NAS to undergo swift and substantial changes, including the urgent implementation of a COVID-19 testing service, which was central to the national COVID-19 screening programme 17 18. To oversee the delivery of this service, NAS established the COVID-19 Response Room in its headquarters in Dublin.…”