Thumbnail Image
Person

Whitley, Gregory

Biography
Gregory Whitley is a paramedic research fellow with the East Midlands Ambulance Service NHS Trust (EMAS) and a lecturer in paramedic science at the University of Lincoln. He joined the ambulance service in 2010 and has been a registered paramedic since 2012. During 2015-2017 he worked on the National Institute for Health Research (NIHR) funded AIRWAYS-2 clinical trial as a research paramedic for EMAS. In 2020 he completed his PhD, funded by the NIHR Applied Research Collaboration – East Midlands (ARC-EM) on the topic of pre-hospital pain management in children. He joined the British Paramedic Journal in May 2021 as an associate editor and he is currently undertaking a post-doctoral bridging fellowship funded by Health Education England.
Institutional profile
At EMAS we are committed to improving the care and experience of our patients by driving quality and paramedic practice forward through the undertaking of high quality research. We believe that all of our patients should be given the opportunity to participate in research and contribute to the evidence base that informs and improves emergency medical healthcare in the UK, and worldwide. We have developed strong links and work in partnership with an impressive range of academic institutions, other ambulance services, our NHS and social care partners, National Ambulance Research Steering Group (NARSG) and the National Institute for Health Research.

Filters

2016 - 201952020 - 202417
Reset filters

Settings

Citations

Publication Search Results

Now showing 1 - 10 of 26
  • No Thumbnail Available
    PublicationMetadata only
    Mixed methods in pre-hospital research: understanding complex clinical problems
    (2020-12-01) Whitley, Gregory; Munro, Scott; Hemingway, Pippa; Law, Graham Richard; Siriwardena, Aloysius; Cooke, Debbie; Quinn, Tom
    Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these. Both approaches, however, have drawbacks: quantitative methods focus on objective, numerical data and provide limited understanding of context, whereas qualitative methods explore more subjective aspects and provide perspective, but can be harder to demonstrate rigour. We argue that mixed methods research, where quantitative and qualitative methods are integrated, is an ideal solution to comprehensively understand complex clinical problems in the pre-hospital setting. The aim of this article is to discuss mixed methods in the field of pre-hospital research, highlight its strengths and limitations and provide examples. This article is tailored to clinicians and early career researchers and covers the basic aspects of mixed methods research. We conclude that mixed methods is a useful research design to help develop our understanding of complex clinical problems in the pre-hospital setting. Abstract published with permission.
  • No Thumbnail Available
    PublicationMetadata only
    Research paramedics’ observations regarding the challenges and strategies employed in the implementation of a large-scale out-of-hospital randomised trial
    (2020-06-01) Green, Jonathan; Robinson, Maria; Pilbery, Richard; Whitley, Gregory; Hall, Helen; Clout, Madeleine; Reeves, Barnaby; Kirby, Kim; Benger, Jonathan
    Introduction: AIRWAYS-2 was a cluster randomised controlled trial (RCT) comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (OHCA). In order to successfully conduct this clinical trial, it was necessary for research paramedics to overcome multiple challenges, many of which will be relevant to future emergency medical service (EMS) research. This article aims to describe a number of the challenges that were encountered during the out-of-hospital phase of the AIRWAYS-2 trial and how these were overcome. Methods: The research paramedics responsible for conducting the pre-hospital phase of the trial were asked to reflect on their experience of facilitating the AIRWAYS-2 trial. Responses were then collated by the lead author. A process of iterative revision and review was undertaken by the research paramedics to produce a consensus of opinion. Results: The main challenges identified by the trial research paramedics related to the recruitment and training of paramedics, screening of eligible patients and investigation of protocol deviations / reporting errors. Even though a feasibility study was conducted prior to the commencement of AIRWAYS-2, the scale of these challenges was underestimated. Conclusion: Large-scale pragmatic cluster randomised trials are being successfully undertaken in out-of-hospital care. However, they require intensive engagement with EMS clinicians and local research paramedics, particularly when the intervention is contentious. Feasibility studies are an important part of research but may fail to identify all potential challenges. Therefore, flexibility is required to manage unforeseen difficulties. Abstract published with permission.
  • No Thumbnail Available
    PublicationMetadata only
    What are the predictors, barriers and facilitators to effective management of acute pain in children by ambulance services? A mixed-methods systematic review protocol
    (2018-09) Whitley, Gregory; Siriwardena, Aloysius; Hemingway, Pippa; Law, Graham Richard
    Abstract published with permission. Introduction: The management of pain is complex, especially in children, as age, developmental level, cognitive and communication skills and associated beliefs must be considered. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. The aim of this review is to identify predictors, barriers and facilitators to effective management of acute pain in children by ambulance services. Methods: A mixed-methods approach has been adopted due to the research question lending itself to qualitative and quantitative inquiry. The segregated methodology will be used where quantitative and qualitative papers are synthesised separately, followed by mixed-methods synthesis (meta-integration). We will search from inception: MEDLINE, CINAHL and PsycINFO via EBSCOHost, EMBASE via Ovid SP, Web of Science and Scopus. The Cochrane Library, the Joanna Briggs Institute, PROSPERO, ISRCTN and ClinicalTrials.gov will be searched. We will include empirical qualitative and quantitative studies. We will exclude animal studies, reviews, audits, service evaluations, simulated studies, letters, Best Evidence Topics, case studies, self-efficacy studies, comments and abstracts. Two authors will perform full screening and selection, data extraction and quality assessment. GRADE and CERQual will determine the confidence in cumulative evidence. Discussion: If confidence in the cumulative evidence is deemed Moderate, Low or Very Low, then this review will inform the development of a novel mixed-methods sequential explanatory study which aims to comprehensively identify predictors, barriers and facilitators to effective pain management of acute pain in children within ambulance services. Future research will be discussed among authors if confidence is deemed High.
  • No Thumbnail Available
    PublicationMetadata only
    Addressing the challenges of paramedic recruitment and engagement in AIRWAYS-2
    (2016-09) Pilbery, Richard; Green, Jonathan; Hall, Helen; Whitley, Gregory
    AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial. The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been: ▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics ▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion ▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues. How have these challenges been overcome? ▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates ▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance ▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development ▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts. Key achievements By November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2. Conclusion The research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial. https://emj.bmj.com/content/emermed/33/9/e12.1.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2016-206139.38
  • Thumbnail Image
    PublicationOpen Access
    Variations in the number of ambulance attendances to care homes before and during Covid-19 pandemic: an interrupted time series analysis (ITSA)
    Botan, Vanessa; Law, Graham; Laparidou, Despina; Phung, Viet-Hai; Curtis, Ffion; Whitley, Gregory; Akanuwe, Joseph; Rowan, Elise; Fothergill, Rachael; McCranor, Tracy; Bowler, Susan; Kordowicza, Maria; Palastanga, Nicoya; Wilkins, Lissie; Spaight, Robert; Miller, Elizabeth; Gordon, Adam L.; Siriwardena, Aloysius
  • Thumbnail Image
    PublicationMetadata only
    Predictors of effective management of acute pain in children within a UK ambulance service: A cross-sectional study
    (2020-07) Whitley, Gregory; Hemingway, Pippa; Law, Graham Richard; Wilson, Caitlin; Siriwardena, Aloysius
  • No Thumbnail Available
    PublicationMetadata only
    Does current pre-hospital analgesia effectively reduce paediatric pain within a uk ambulance service: a service evaluation
    (2017-10) Whitley, Gregory; Bath-Hextall, Fiona
    Introduction Pain is one of the most common symptoms presented by patients of all ages to ambulance services, however very few children receive analgesia. Analgesic treatment of pre-hospital injured children is viewed as ‘suboptimal’. The aim of this study was to explore current analgesia given to traumatically injured children in the pre-hospital setting and examine whether a clinically meaningful reduction in pain was achieved. Methods We evaluated electronic patient report forms over a two-year period (2013–2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range 1–17 with a clinical impression of a fracture, dislocation, wound or burn were included. Patients with a Glasgow Coma Scale of <15 were excluded. The outcome measure was a reduction in numeric pain rating scale or Wong and Baker faces of ≥2 out of 10. Results Of the evaluable patients (n=11,317), 90.8% had a documented pain score, or a reason why a pain score could not be documented. For patients reporting pain (n=7483), 51.6% (n=3861) received analgesia, 9.6% (n=717) received no analgesia but did receive alternative treatment and 38.8% (n=2905) received no analgesia and no alternative treatment. Morphine sulphate IV, oral morphine, Entonox, paracetamol suspension and poly-analgesia all achieved a clinically meaningful median reduction in pain score; –3.0 (IQR, –5.0 to –2.0),–2.0 (–5.0 to –2.0),–2.0 (–4.0 to –1.0),–2.0 (–4.0 to 0.0) and –3.0 (–4.0 to –1.0), respectively. Conclusions Analgesia administered to traumatically injured children in the pre-hospital setting within this UK ambulance service NHS trust produces clinically meaningful reductions in pain for these patients. The concern is that a large number of patients received neither analgesia nor alternative treatment. There is a real need to identify barriers to analgesia administration in this patient group. https://emj.bmj.com/content/34/10/e2.3 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/ http://dx.doi.org/10.1136/emermed-2017-207114.8
  • No Thumbnail Available
    PublicationMetadata only
    Discerning the age of a child
    (2018-09) Whitley, Gregory; Lord, Bill
    Abstract published with permission. In this comment, Gregory Whitley and Bill Lord note the disparity in age ranges used to define a 'child', across both clinical guidelines and research, and its significant implications for paramedic practice.
  • No Thumbnail Available
    PublicationMetadata only
    Looking back to 2008 — Looking forward to 2028
    (2018-10) Mallinson, Tom; Gregory, Pete; Sibson, Lynda; Peate, Ian; Eaton, Georgette; Whitley, Gregory; Layland, Adam; Sudron, Ceri
  • No Thumbnail Available
    PublicationMetadata only
    Unexpected shock in a fallen older adult: a case report
    (2020-06-01) Matthews, Gary; Booth, Helen; Whitley, Gregory
    Abstract published with permission. Introduction: Falls are common in older adults and frequently require ambulance service assistance. They are the most frequent cause of injury and associated morbidity and mortality in older adults. In recent years, the typical major trauma patient has changed from being young and male to being older in age, with falls of < 2 metres being the most common mechanism of injury. We present a case of an 84-year-old male who had fallen in his home. This case highlights the complex nature of a relatively common incident. Case presentation: The patient was laid on the floor in the prone position unable to move for 12 hours. He did not complain of any pain in his neck, back, hips or legs, and wished to be lifted off the floor promptly. On examination, he had bruising to his chest and abdomen and had suffered a suspected cervical spine injury due to a step-like protrusion around C5–C6. Distal sensory and motor function was intact. While in the ambulance his blood pressure dropped from 154/119 mmHg to 49/28 mmHg unexpectedly. We successfully reversed the shock using the modified Trendelenburg position and intravenous fluids. On follow-up he was diagnosed with dislocated C3, C6 and C7 vertebrae. Conclusion: The unexpected episode of shock witnessed in this patient may have been caused by a number of phenomena, including but not limited to crush syndrome, spinal cord concussion and orthostatic hypotension. We recommend that clinicians anticipate sudden shock in older adult patients who have fallen and a) have remained static on the floor for an extended period of time or b) are suspected of a spinal injury. We recommend assertive management of these patients to mitigate the impact of shock through postural positioning and consideration of early cannulation.