Table 2.

Accessibility of pre-alert guidance.

	AS2		AS3	AS4		AS5	AS6	AS10
Name of document	Managing the conveyance of patients, policy and procedure	Requesting clinical support and advice	Hospital standby/pre-alert information	ED pre-arrival alert criteria for ambulance staff	ED pre-arrival alert criteria	ATMIST early and pre-alerts	Pre-alerting of patients	Clinical handover and transfer of care procedure
Date of issue	May 2019	August 2021	April 2015	February 2019	January 2019	February 2018	October 2020	November 2019
Type of document	Policy	Clinical update	Clinical update	Clinical update	Reference table	Clinical update	Clinical update	Policy
Mnemonics used	CASMEET	SBAR	ASHICE	Avoid SBAR, re-introducing ATMIST		ATMIST	ATMIST	ASHICE
Who makes the pre-alert?	Conflicting information. Clinician calls EOC – passes pre-alert onto receiving ED. Also states clinician pre-alert receiving unit directly	Clinician on scene	Inform EOC or trauma cell – does not define who will pass on the message	Ambulance staff (presumed on-scene clinician)		Lead ambulance clinician	Specifically notes EOC do NOT pass pre-alerts on from ambulance clinician. Medical – ambulance clinician; trauma – ATMIST to RTD	Most senior clinician
When?		When requested, or when additional clinical support required		ASAP with follow-up call 10 minutes prior to arrival		ASAP (even if not yet mobile – just state you are not yet mobile)	ASAP
Reference to JRCALC?	No	Yes – use checklist (could be for cardiac arrest, or SBAR – no specific criteria listed)	No	No	No	No – states it replaces JRCALC guidelines (others are usually in conjunction with)	Yes	No

	AS8	AS9	AS11		AS12	SMTN	RCEM
Name of document	Hospital pre-alert and patient handover	Ambulance pre-alert process clinical number 27	Assessment, conveyance and referral of patients (emergency operations)	Pre-alert and handover guidance	Conveyance and referral policy	UK NHS ambulance services pre-alert guideline for the deteriorating adult patient	UK NHS ambulance services pre-alert guideline for the deteriorating adult patient
Date of issue	May 2010	July 2020	March 2017	September 2019	April 2021	September 2020	September 2020
Type of document	SOP	Instructions and procedures	Policy	Policy	Policy	?	Guideline
Mnemonics used	ATMIST SBAR ASHICE	ATMIST ASSET	MTCTC ATMIST SBAR NEWS	MTCTC SBAR ATMIST NEWS2		ATMIST SBAR	ATMIST SBAR ED
Who makes the pre-alert?	Crew to EMS control – EMS control to receiving hospital department	Operational/tactical commander > attending clinician > emergency vehicle operator	Clinician Must also pre-alert MTCTC for major trauma	Clinician Must also pre-alert MTCTC for major trauma	Ambulance crew	Ambulance clinician	Ambulance clinician
When?			10 minutes before reaching the receiving hospital	10 minutes before reaching the receiving hospital
Reference to JRCALC?	Yes		No	No		JRCALC guidelines	N/A

Services that sent no guidelines have been excluded.

Clinical update * – or equivalent. A short email memo, usually sent via bulk email to clinicians.

ASAP: as soon as possible; ASHICE: age, sex, history, injuries/illness, condition, ETA; ASSET: age, signs, symptoms, ETA, treatment; ATMIST: age (name and DOB), time of onset, mechanism of injury/medical complaint, injuries, signs, treatment given; CASMEET: call-sign, age, sex, mechanism of injury/mode of illness, examination, ETA, treatments already provided; ED: emergency department; EMS: emergency medical services; EOC: emergency operations centre; JRCALC: Joint Royal Colleges Ambulance Liaison Committee; MTCTC: major trauma centre triage co-ordinator; NEWS: National Early Warning Score; RCEM: Royal College of Emergency Medicine; RTD: red trauma desk; SBAR: situation, background, assessment, recommendations.