Medi-Solfen^® has the potential to offer a unique innovative approach to providing anaesthesia within the Accident and Emergency environment including the Ambulance Service

In the UK there are 135 emergency units¹. Within England the number of attendances in 2016 was 23.7m² (65% attending Major Emergency Departments). In 2001, the Department of Health published the paper Reforming emergency care³ and introduced a compulsory national target for England. The target required that by 2004 no-one should wait more than 4 hours in the Emergency Department. In December 2017 just 85.1% of patients at A&E were seen within 4 hours. The figures are even worse for what the NHS calls Type 1 A&E Departments – a Consultant led 24 hour service with full resuscitation facilities and designated accommodation for emergency patients – where just 77.3 per cent of patients were seen within 4 hours⁴. This time limit produced significant changes in the way many departments and hospitals dealt with their workload in the Emergency Department, and included many initiatives to reduce the total time and redirect patients with low acuity to alternative healthcare providers. One of the most noteworthy changes was the review of the process of “triage” and the change of the primary objective of triage—to allocate the patient to the most appropriate practitioner or area within the healthcare system, thus producing different streams or queues of patients waiting for dedicated teams of workers⁵.

Emergency care providers have developed a high level of expertise in acute wound management. As an example over 703,000 lacerations presented in UK Emergency Departments between 2015 In the case of this wound type considerations must be given to assessment, irrigation and closure techniques. No single approach can be applied to all wounds; however, a systematic approach to acute wound care integrated with current best practices can provide the framework for exceptional wound management. During the treatment pathway associated with laceration management it may be necessary to administer local anaesthetics to the injured site. While there are numerous commercially available topical anaesthetic agents, most of these require 10 to 30 min to become effective. The combination of lidocaine/prilocaine may have a delayed onset of 1 to 2 h ]. If a more rapid anaesthetic response is needed, injectable lidocaine (1%), bupivicaine (0.25%), or procaine (1%) are commonly used. While these drugs remain the mainstay of anaesthesia for cutaneous repair, the associated pain on injection remains a major drawback⁶.

Of relevance to the benefits associated with the use of Medi-Solfen®, rapid pain relief following application to traumatic wounds at initial triage and assessment would help patients better manage their extended wait periods before consultation with Lead Clinical Professionals. Once in the presence of the attending Physician, the rapid onset of additional anaesthesia (if required) without using the potential painful technique of fluid injection prior to debridement, irrigation and subsequent closure again offers measureable patient benefits. The product could also be re-applied prior to surgical closure if considered clinically necessary. The same approach could be made with minor painful wounds that present, especially in children.

An essential component of the Emergency Services is the rapid response vehicles (ambulances) that transfer patients from the site of injury to the Accident and Emergency Department. It is estimated in the UK there are close to 5,000 vehicles of this kind. This does not include Emergency Responders or the Air Ambulance Service. The inclusion of Medi-Solfen® within emergency vehicles could provide a valuable option to achieve rapid pain relief to appropriate breaks in the skin during treatment at the site of injury, transfer to hospital and provide anaesthetic cover during the reported ever increasing wait times prior to hand over to the hospital-based team.

References

1. https://inews.co.uk/nhs/nhs-crisis-revealed-overhaul-means-dozens-of-ae-units- face-closure/
2. Baker C. House of commons library paper 6964, 21st Feb 2017. Accident and Emergency Statistics Demand, Performance and Pressure
3. Department of Health Reforming emergency care: first steps to a new approach. Crown Copyright. London: DOH, 2001
4. https://inews.co.uk/news/health/accident-emergency-waiting-times-nhs-england- record-high/
5. Lyons M, Brown R and Wears R (2007) Factors that affect the flow of patients through Triage. Emerg Med J; 24(20): 78-85.
6. Bret A, Ayello E, Woo K et al (2010) Acute wound management; Revisiting the approach to the assessment, irrigation and closure considerations.

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