The number of 999 calls is rising, and some callers have been shown to have non-urgent needs. Evidence concerning the effectiveness of alternatives to the standard 999 service is lacking, although previous studies have highlighted clinical risk for some nonconveyed patients. Objective: To evaluate the safety of 'Treat and Refer' (T&R) protocols for ambulance crews, allowing them to leave patients on scene, with advice or onward referral. Methods: Treatment protocols were developed by a clinical

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... panel and implemented in one station May -August 2000. Outcomes of care for patients within defined illness codes and attended by trained crews were compared with similar patients attended by crews from a neighbouring station. Pre-hospital, A&E and GP records were collected. Results: 23 protocols were developed. 260 patients were included in the intervention arm and 537 in the control arm of the study. There were no age / sex differences between groups although intervention patients were more likely to have been attended during the week (χ 2 = 4.28, p = .05) and daytime (χ 2 = 6.75, p = .01). After follow up at A&E and GPs there were 62 patients for whom no information was retrieved. Seventeen of the protocols were recorded as used for 110 patients, by all 8 trained crew members. Three patients in each group were admitted to hospital within 14 days of their call, and were judged by clinical reviewers to have been left at home inappropriately. In the intervention arm, T&R protocols were reported as having been used for two of the patients, however the reviewers judged that use of additional appropriate protocols would have indicated transportation. Conclusions: Clinical risk was identified in both study groups. However, in the intervention arm this appeared to be a training issue, which might be avoided with optimal protocol usage. With a relatively small sample size, a considerable number of protocols and low rate of adverse incident, safety of this intervention needs to be further explored. Objective: This study was designed to determine which of two nalbuphine dosing regimens combines the greater analgesic effect with the minimum of adverse events. Methods: Randomised controlled trial of 172 patients suffering from chest pain, long bone fractures, or burns and administered nalbuphine by paramedics in north and south-east Wales. Group A www.emjonline.com on 22 July 2018 by guest. Protected by copyright. Abstract 11 Ambex abstracts 93 www.emjonline.com on 22 July 2018 by guest. Protected by copyright.