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amber contains records of published research authored by NHS staff working in Ambulance Services in England. amber is managed by the Library and Knowledge Services for NHS Ambulance Services in England [LKS ASE]. For more information see the About pages or contact Matt Holland, LKS ASE Librarian. Additional material is available on the LKS ASE website.  

  • ‘I wish there was CPAP in every box’: internet-based survey responses of clinicians recruiting to a pilot randomised controlled trial of continuous positive airway pressure (CPAP) for patients with acute respiratory failure

    Miller, Joshua; Keating, Samuel; Goodacre, Steve; Fuller, Gordon W. (2019-09-24)
    Background Continuous positive airway pressure (CPAP) is not in widespread use in UK ambulance services, but could benefit patients with acute respiratory failure (ARF). As a new treatment in this context, clinician acceptability is an important factor in the feasibility of conducting definitive research in the prehospital arena. Methods As part of a pilot randomised controlled trial (the ACUTE study), recruiting clinicians were emailed after enrolling patients to either the CPAP or standard-care arm, and were asked to complete an optional, anonymous, internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on both the treatment and the trial procedures. Quantitative responses were analysed descriptively, and qualitative answers thematically. Results Recruiting clinicians for all 77 patients were sent survey links, with 40 email responses received. Respondents felt confident diagnosing ARF and determining trial eligibility. CPAP-arm respondents found the equipment easy-to-use and felt it did not delay transport to hospital. Most standard-care respondents said they would have liked CPAP to be available to their patients. Respondents described varying responses from receiving hospital staff. Conclusions Prehospital CPAP seems acceptable to clinicians. Limitations of this survey are that it was targeted only at clinicians who have already opted to take part in the trial, and so may exclude a body of staff who find the treatment unacceptable at face value. Not all clinicians who enrolled patients completed the survey, which could suggest a response bias or simply a reflection of its optional nature within the trial. Future pilot studies could mandate an acceptability survey, and also seek the views of staff not taking part in the interventional study. Trial teams may need to better explain the rationale of comparing a new intervention with standard care, and offer more widespread hospital staff awareness sessions., https://emj.bmj.com/content/36/10/e11.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.25
  • An evaluation of the role of SCAS in the attendance to call-outs and the transport to hospital of older people with dementia

    Lofthouse-Jones, Chloe; England, Ed; Taylor, Sarah; Cavalier, Julian; Fogg, Carole; Pocock, Helen; King, Phil; Jadzinski, Patryk (2019-09-24)
    Background Our previous work has shown that 35% of ambulance attendances by SCAS are to people aged 75 and over; 17% of these have dementia. The research literature suggests that older people with cognitive impairment/dementia experience longer stays, or die, in hospital. It is unclear whether factors such as call time or availability of social care impact conveyance rates. The aim of this study was to explore the impact of out-of-hours call-outs and social care provision on ambulance conveyance rates for people aged ≥75 years, including patients with dementia. Methods For this service evaluation, electronic records for patients aged ≥75 years attended by SCAS were extracted over one year. The proportion of conveyed patients according to a dementia record, out-of-hours call, time of year, triage grade, social care provision and indices of deprivation were calculated. Univariate and multivariate analyses identified factors which may influence conveyance. Results A total of 111,548 electronic records were included, 16.5% with dementia. 63.7% of calls resulted in conveyance (59.1% with dementia). Conveyances reduced in out-of-hours periods for all patients. 13.6% more patients living alone and 16.5% more patients living with family were conveyed to hospital if there was no care package in place. Adjusted for other factors, having a care package reduced the risk of conveyance in older people living alone by 36% (Odds ratio 0.64, 95% Confidence interval 0.62–0.67). Conclusions Availability of social care and time of call appear to be important determinants of conveyance in older people, both in those with and without dementia. More research is needed to improve needs assessments and local referral services and pathways, https://emj.bmj.com/content/36/10/e6.2. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.12
  • The clinical characteristics of false negative stroke patients: a systematic review

    McClelland, Graham; Jones, S.; Price, C.; Gibson, J.; Watkins, C. (2019-05-22)
  • Incidence of acute respiratory failure cases in West Midlands Ambulance Service (WMAS) – sub-study of ACUTE (ambulance CPAP: use, treatment effect and economics) trial

    Gunson, Imogen M.; Herbert, Esther; Fuller, Gordon W. (2019-09-24)
    Background Acute respiratory failure (ARF) is a life-threatening emergency and pre-hospital CPAP may improve outcomes. A CPAP cost-effectiveness determinant is the incidence of eligible patients with ARF. This sub-study of the ACUTE trial aimed to determine the number of adults with ARF potentially suitable for CPAP, presenting to WMAS. Methods This observational study was conducted between 1stAugust 2017 and 31st July 2018. Adult patients presenting with SpO2 <94% were identified from WMAS electronic patient records. Electronic filters applied ACUTE trial inclusion and exclusion criteria, with subsequent manual clinical review by a research paramedic. A second research paramedic checked a sub-sample for inter-rater agreement. Overall and monthly incidence rates were calculated, census data provided the population denominator. Results 108,391 potential patients were identified from electronic patient records (EPR), after filter application 4,526 cases were eligible for review (Figure 1). After review, 1017 cases were considered CPAP candidates. Inter-rater agreement was 86%. Overall incidence was 17.35 per 100,000 population per year (95%CI 16.3–18.5). Marked seasonal variation was present, increasing over winter (Figure 2). Urban areas had the highest proportion of eligible patients (67.6% v 18.3% Rural v 14.2% semi-rural); and 53.0% of all eligible were male. Conclusions The incidence of eligible ARF patients impacts on the cost-effectiveness of pre-hospital CPAP, but previous reports have been variable, using sub-optimal methods or from non-UK settings. We report a valid NHS estimate of 17 patients per 100,000 who do not respond to current pre-hospital ARF management and could be candidates for CPAP., https://emj.bmj.com/content/36/10/e11.3. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.26

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