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Pathfinder, a service run by the National Ambulance Service ( NAS), is intended to safely keep elderly patients who dial 112/999 in their homes rather than sending them to a hospital emergency room. Pathfinder strengthens the effective care for elderly patients by offering safe alternative care to their residents rather than in a hospital, and it will be administered by NAS personnel in collaboration with co-workers from HSE acute hospitals. For almost two years, the occupational medicine and physiotherapy teams at Beaumont Hospital and NAS have been collaborating on a joint program called Pathfinder. NAS is excited to collaborate with Tallaght University Hospital and University Hospital Limerick. The "Sláintecare Integration Fund" provided the initial funds for Pathfinder to test the approach in 2020, and it has been running since May of the same year. The HSE has provided funding to the three new Pathfinder teams (Arevalo et al., 2020). A Vocational Therapist/Physiotherapist and an Advanced Ambulance examine the older patient on the "Rapid Response Team." Additionally, Pathfinder has a "Follow-Up Team" (Occupational Therapy and physiotherapy) that offers urgent residence-based rehabilitation, apparatus rentals, and case monitoring in the days that follow.


Dispatcher-initiated Decisions (DID)

The assignment's main goals are to examine the dangers of admitting elderly people to the emergency department and review the benefits of at-home care for this population. Crucial issues that must be addressed are the difficulties NAS faces in having paramedics release patients and the present incapacity of paramedics to do so. A computerized dispatching system is used by the majority of EMS agencies to handle pre-hospital calls for assistance. To establish public health genomics capabilities , the Emergency Medical Dispatcher (EMD) uses globally accepted and standardized software solutions to handle emergency calls when they are received. The medical operator evaluates and triages the patient upon ERU's ( Emergency Response Unit) appearance on the scene gives them immediate attention, and delivers them to the proper medical institution to receive the proper attention. Such choices might endanger the health of the patients, postpone necessary care, and instill dread in the EMS personnel. As far as is known, no prior review has compiled the current beliefs on patients who refuse to be transported after receiving an emergency call in a pre-hospital scenario. A surge that includes advancements in clinical practice, healthcare guidelines, health legislation, and the application of new technology like digital correspondence and electronic medical data (Nittari et al., 2019). For healthcare workers, ensuring the delivery of safe and efficient treatment in the out-of-hospital setting is a constant challenge.

A Well-defined, Prioritized, Extended Strategic Plan

In the settings of North America and Europe, this topic has drawn a lot of attention. Patient-initiated refusal way these various models are contrasted highlights how intricate and multidimensional non-transport decisions are. It suggests a more complex comprehension that takes into account the components of settings for prehospital care. To improve their decision-making capabilities, EMDs ( Emergency Medical Dispatchers) frequently utilize computer-aided dispatch (CAD) systems. These systems guarantee the prompt dispatch of the most suitable ERUs, with their performance standards frequently linked to the top-performing worldwide EMS systems. To optimize the handling of pre-hospital cases, (MPDS) Medical Priority Dispatch Systems is a computer program pre-hospital classification system. It prevents delays in the delivery of medical emergency care.

Using urgent requests from the patient records of the world's top-performing ambulance agencies, a specialized panel upgrades the MPDS regularly. In certain emergency medical services (EMS) systems, medical personnel undertriaged patients who needed critical care yet correctly diagnosed cases of sudden cardiac arrest. Major policy and public health determinations the assignment's main goals are to examine the dangers of admitting elderly people to the emergency department and to go over the benefits of at-home care for this population (Patel et al., 2021). The rules and exclusions for patient assessment, discharge, and documentation are covered. "Understanding patient non-transport alternatives in the pre-hospital setting: A holistic perspective.” .Following a thorough evaluation with ProQA ( Program Question Answer), the EMDs may inform the caller that the patient should go to the closest healthcare institution and use their vehicles. This allows them to ascertain the proper procedure and dispatch code based on the caller's description of the patient's condition.

Clinical-initiated Decisions (CID)

 Using 911 emergencies from the databases of the world's top-performing ambulance providers, an expert panel updates the MPDS regularly. Patients with mild medical issues may be sent to a "non-transport unit" as a follow-up unit Merely 5% of initial dispatch calls including the aforementioned issues were classified as essential, according to a UK-based research. This suggests that in 95% of non-essential tasks instances, EMS resources may be squandered. Clinical decisions made by the assessing physician may, on rare occasions, result in the patient choosing not to be transported; this situation is sometimes referred to as CID and, at the option of the physician, as "non-conveyance" (Rubenstein et al., 2020). Crucial issues that must be addressed are the difficulties NAS faces in having paramedics in specially pandemic phase. There is a broad uncertainty surrounding the idea of medical requirements that undercuts its usefulness in a particular context.

 Moreover, maintain all the restrictions they used to work in hospitals. Implications for the Global pandemic-response Endeavor, the collaboration of NAS is more evident than during COVID-19 in frontline healthcare and created a governance framework that reflected the many parties and geographic locations engaged in the public health environment in the UK. This method assists in preventing unnecessary ambulance rides to the hospital for illnesses that may be treated in other settings, such as primary care facilities, therefore lessening the pressure on emergency sections. According to a recent Swedish study, NSC is primarily associated with elderly individuals (Sohrabi et al., 2020). They complained of "general malaise," "affected their overall physical condition," "sense of illness," and "just not being equipped to cope with a daily schedule.”

Synthesis of Recommendations

  • Pre-hospital healthcare providers are only permitted to recognise the PIR in certain EMS systems, such as those in the USA, following a virtual meeting with the medical command team. Prolonged wait times at the emergency room are another source of discouragement. PIRs can also sometimes be sparked by a patient's delight with the quality of pre-hospital care they receive in contrast to their discontent with the lengthy process they expect at the emergency room (Øygarden et al., 2020).
  • Keep up the enthusiasm, drive, and goodwill to assist a network that can unite various organizations from all four countries without relying too much on goodwill alone. Release patients and the present incapacity of paramedics to do so.
  • They also highlight a serious issue that may jeopardize the health of patients in circumstances of both large and moderate trauma. Given that elderly patients are prone to being under-triaged, certain worries have been raised over their non-conveyance.
  • Numerous elderly folks who were not sent to the hospitals phoned the urgent services once again before being taken and admitted to the hospital. According to a Swedish study, death and hospitalization rates rise in tandem with the aging of patients seeking immediate medical care.
  • This is because elderly persons may wait until their health gets really ill before visiting the emergency room. The literature offers a variety of meanings for the phrase "acceptable" risk (Rubenstein et al., 2021). Under-triage carries a hidden danger of causing life-threatening symptoms to go unnoticed. The study supports the need to develop a dependable medical monitoring process or to transport patients to hospitals as a precaution.


The first responder has the authority to determine if the patient is experiencing a minor medical issue, therefore eliminating the need for emergency care at a hospital. When they contact 112/999, many elderly people may be safely and adequately handled at home instead of being sent to the emergency department. The medical facility was excited to work with the National Ambulance Service to help the local senior population with low-acuity issue. This will be stipulated in the medical coverage agreement. Employees have decided to NAS themselves if they are reluctant to give up potential pay increases in exchange for more extensive health coverage. All parties to the contract are subject to the conditions enforced by the managed care plan. In certain emergency medical services (EMS) systems, medical personnel under triaged patients who needed critical care yet correctly diagnosed cardiac arrest instances.


Arevalo, J.A., Mitchell, S.F., Rands, G. and Starik, M., 2020. Guest editors’ introduction to the special issue: Sustainability in management education. Journal of Management Education , 44 (6), pp.683-698.

Chen, M. and Decary, M., 2020, January. Artificial intelligence in healthcare: An essential guide for health leaders. In Healthcare Management Forum (Vol. 33, No. 1, pp. 10-18). Sage CA: Los Angeles, CA: SAGE Publications.

Nittari, G., Scuri, S., Petrelli, F., Pirillo, I., di Luca, N.M. and Grappasonni, I., 2019. Fighting obesity in children from European World Health Organization member states. Epidemiological data, medical-social aspects, and prevention programs. La Clinica Terapeutica , 170 (3), pp.e223-e230.

Øygarden, O., Olsen, E. and Mikkelsen, A., 2020. Are you changing to improve? Organizational change and change-oriented leadership in hospitals. Journal of Health Organization and Management, 34(6), pp.687-706.

Patel, M.K., Berger, I., Bresee, J.S., Cowling, B.J., Crowcroft, N.S., Fahmy, K., Hirve, S., Kang, G., Katz, M.A., Lanata, C.F. and Jackson, M.L.A., 2021. Evaluation of post-introduction COVID-19 vaccine effectiveness: Summary of interim guidance of the World Health Organization. Vaccine , 39 (30), pp.4013-4024.

Rubenstein, L., Hempel, S., Danz, M., Rose, D., Stockdale, S., Curtis, I. and Kirsh, S., 2020. Eight priorities for improving primary care access management in healthcare organizations: results of a modified Delphi stakeholder panel. Journal of General Internal Medicine, 35, pp.523-530.

Sohrabi, C., Alsafi, Z., O'neill, N., Khan, M., Kerwan, A., Al-Jabir, A., Iosifidis, C. and Agha, R., 2020. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of surgery , 76 , pp.71-76.


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