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Aim To investigate the prevalence of Impaired Awareness of Hypoglycaemia in patients who require ambulance service attendance due to severe hypoglycaemia. Methods We undertook a national cross-sectional survey of the prevalence of Impaired Awareness of Hypoglycaemia (IAH). An a priori target sample size of 415 was set to allow estimation of proportions of IAH within a 5% margin of error (99% CI). From January–June 2016, patients (>16 years) attended by the Scottish Ambulance Service due a Diabetes related emergency with a blood glucose 1,2 was posted to potential participants within a month of their severe hypoglycaemic event. Consent to participate was assumed through questionnaire return. Ethical approval was received from the National Research Ethics Service (15/EE/0383). Results Five hundred and ninety-two questionnaires were returned. The prevalence of impaired awareness of hypoglycaemia in among participants as measured using the two standardised measures was 53% and 57% respectively. Conclusion IAH is considerably more prevalent among people who have a severe hypoglycaemic emergency and call the ambulance service than in the general Diabetic population, where prevalence is 25%. 1 This knowledge will assist in the development of an intervention to reduce hypoglycaemic emergencies and may lead to improved outcomes and cost savings. References Gold AE, Macleod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 1994;17(7):697–703. Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM: a prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 1995;18(4):517–522. Conflict of interest This study was funded by the Scottish Ambulance Service who employ Dr. D Fitzpatrick. The ambulance service management had no direct involvement in the design, conduct, analysis or output arising from the study. Funding Scottish Ambulance Service

Aim To investigate the demographic characteristics, care pathways, and clinical and service outcomes of people who present to ambulance services with a psychiatric or self-harm emergency Methods We conducted a retrospective cohort study of patients attended by the Scottish Ambulance Service in 2011 with ambulance clinician attendance codes relating to ‘psychiatric emergency’ or ‘self-harm’. Patients resident in Scotland and>=16 years on first contact were included. We used NHS Scotland’s Unscheduled Care Data Mart (1) to link data from: – the ambulance service; emergency departments (ED); general and psychiatric inpatient hospital admissions episodes; and death records. Results There were 9014 calls from 6802 people. Slightly more males (n=4708, 52%) than females (n=4306, 48%) were attended. Most were discharged from ED with no known follow-up (n=4566; 51%). Some were left at home (n=1003 attendances, 11%). Almost half of the people (n=3238, 48%) made at least one repeat call. People who self-discharge from ED were more likely to have another ambulance attendance for psychiatric emergency/self-harm within the same year (Pearson chi square=5.24, p=0.02). Two hundred and seventy-nine (4%) people died within the study period, 97 (35%) were recorded as suicide. Ethical approval (NRES 15/EM/0260) and other data approvals were received. Conclusion While linked data analysis may not identify all relevant cases, it provides important information to guide the development and evaluation of evidence-based interventions. Ambulance service and ED are missing opportunities to improve outcomes for people who experience a psychiatric emergency or who self-harm. New interventions could lead to decreases in the number of suicides, episodes of self-harm and levels of patient distress; and ambulance and ED service use. Reference Information Services Division (NHS Scotland) (2016) Unscheduled Care Datamart Background Paper. Accessible at http://www.isdscotland.org/Health-Topics/Emergency-Care/Patient-Pathways/unscheduledcare_background.pdf Accessed on 13/01/17 Conflict of interest None declared. Funding Scottish Government, Chief Scientists Office