McClelland, Graham

McClelland, Graham

Biography

I joined the ambulance service in 2003 and moved into the research team in 2010. I have worked on large studies including HITS-NS, PARAMEDIC and PASTA. I completed my Masters in Clinical Research thanks to support from the NIHR ICA scheme and completed my PhD looking at prehospital identification of stroke mimics at Newcastle University thanks to s Stroke Association post-graduate fellowship.

Institutional profile

North East Ambulance Service has a small but dedicated team of research paramedics involved in studies in areas such as stroke, cardiac arrest, trauma and other conditions relevant to prehospital care.

Publication Search Results

Now showing 1 - 10 of 68

The diagnostic accuracy of the HITSNS prehospital triage rule for identifying patients with significant traumatic brain injury: a cohort study
(2016-02) Fuller, Gordon W.; McClelland, Graham; Lawrence, Thomas; Russell, Wanda; Lecky, Fiona
Call to hospital times for suspected stroke patients in the North East of England: a service evaluation
(2019-09-01) Haworth, Daniel; McClelland, Graham
Introduction: Stroke is a leading cause of mortality and morbidity. The role of the ambulance service in acute stroke care focuses on recognition followed by rapid transport to specialist care. The treatment options for acute ischaemic strokes are time dependent, so minimising the prehospital phase of care is important. The aim of this service evaluation was to report historical pre-hospital times for suspected stroke patients transported by the North East Ambulance Service NHS Foundation Trust (NEAS) and identify areas for improvement. Methods: This was a retrospective service evaluation using routinely collected data. Data on overall call to hospital times, call to arrival times, on scene times and leave scene to hospital are reported. Results: Data on 24,070 patients with an impression of stroke transported by NEAS between 1 April 2011 and 31 May 2018 are reported. The median call to hospital time increased from 41 to 68 minutes, call to arrival from 7 to 17 minutes, on scene from 20 to 30 minutes and leave to hospital from 12 to 15 minutes. Conclusion: The pre-hospital call to hospital time for stroke patients increased between 2011 and 2018. The call to arrival phase saw a sharp increase between 2015 and 2017, whereas on scene and leave scene to hospital saw steadier increases. Increasing demand on the ambulance service, reorganisation of regional stroke services and other factors may have contributed to the increase in times. Reducing the on scene phase of pre-hospital stroke care would lead to patient benefits and is the area where ambulance clinicians have the most influence. Abstract published with permission.
Development and impact of a dedicated cardiac arrest response unit in a UK regional ambulance service
(2015-05-19) Younger, Paul; McClelland, Graham; Fell, Paul
Background Survival rates from out-of-hospital cardiac arrest (OHCA) vary, with figures from 2% to 12% reported nationally. Our ambulance service introduced a dedicated cardiac arrest response unit (CARU) as a trial in order to improve local patient outcomes by focussing training, extending the scope of practice and increasing exposure to cardiac arrests. CARU launched in January 2014 using a rapid response car staffed by senior paramedics responding to cardiac arrests within a 19 minute radius of their location⇓. VIEW INLINE VIEW POPUP Methods This work describes the development and impact of CARU during the initial six months (10/01/14 to 09/07/2014) of operations using prospectively collected data on all cases attended. Results CARU activated to 165 calls and attended 65% (n=107). 50% (n=54) of the cases attended were cardiac arrests where resuscitation was attempted. Return of Spontaneous Circulation (ROSC) was achieved during pre-hospital resuscitation in 52% (n=28) of cases. Patient outcomes are reported compared with service data for January to June 2014 inclusive and one year of historical data from the regional OHCA registry: Conclusions Based on these figures CARU appears to have a positive impact on ROSC and a significant impact on survival to discharge rates compared with the rest of the service (p<0.01, Fisher's exact test). Further work is needed to explore how CARU delivers this impact and how the CARU model can be implemented beyond the trial setting in a sustainable fashion. https://emj.bmj.com/content/32/6/503.2. 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-2015-204979.2
A qualitative investigation into paramedics' thoughts about the introduction of the National Early Warning Score
(2016-05) McClelland, Graham; Haworth, Daniel
Abstract published with permission. Introduction – The National Early Warning Score is a simple, rapid assessment tool developed by the Royal College of Physicians to standardise the assessment and monitoring of acutely ill patients. The North East Ambulance Service NHS Foundation Trust introduced the National Early Warning Score in 2013/2014 to improve communication between the pre-hospital and hospital setting; however, there was and remains a lack of pre-hospital evidence that supports the value of the National Early Warning Score. A previous study showed that the utilisation of the National Early Warning Score by North East Ambulance Service NHS Foundation Trust paramedics was low. Objective – To investigate what North East Ambulance Service NHS Foundation Trust paramedics think about the National Early Warning Score and its use in practice. Design – Qualitative study using a pragmatic approach with recorded and transcribed semistructured interviews. Framework analysis commenced in parallel with data collection. Participants – A purposive volunteer sample of eight paramedics with a range of roles, locations, educational backgrounds and lengths of service. Results – Three major themes emerged from the data: applying the National Early Warning Score in practice, how the National Early Warning Score was used in decision making and how paramedic practice was subject to external influences. Conclusions – This study gives some insight into how paramedics use the National Early Warning Score in pre-hospital care and how they integrate it into their decision making. The findings also demonstrate the influence that external agencies, primarily the receiving acute hospitals, can have on pre-hospital practice.
A survey of UK paramedics' views about their stroke training, current practice and the identification of stroke mimics
(2017-06) McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher
Abstract published with permission. Aims ‐ Paramedics play a crucial role in identifying patients with suspected stroke and transporting them to appropriate acute care. Between 25% and 50% of suspected stroke patients are later diagnosed with a condition other than stroke known as a ‘stroke mimic’. If stroke mimics could be identified in the pre-hospital setting, unnecessary admissions to stroke units could potentially be avoided. This survey describes UK paramedics’ stroke training and practice, their knowledge about stroke mimic conditions and their thoughts about pre-hospital identification of these patients. Methods ‐ An online survey invitation was circulated to members within the UK College of Paramedics and promoted through social media (8 September 2016 and 23 October 2016). Topics included: stroke training; assessment of patients with suspected stroke; local practice; and knowledge about and identification of stroke mimics. Results ‐ There were 271 responses. Blank responses (39) and non-paramedic (1) responses were removed, leaving 231 responses from paramedics which equates to 2% of College of Paramedics membership and 1% of Health and Care Professions Council registered paramedics. The majority of respondents (78%) thought that they would benefit from more training on pre-hospital stroke care. Narrative comments focused on a desire to improve the assessment of suspected stroke patients and increase respondents’ knowledge about atypical stroke presentations and current stroke research. The Face Arm Speech Test was used by 97% of respondents to assess suspected stroke patients, although other tools such as Recognition of Stroke in the Emergency Room (17%) and Miami Emergency Neurological Deficit (11%) were also used. According to those responding, 50% of stroke patients were taken to emergency departments, 35% went straight to a stroke ward and 8% were taken directly to CT scan. Most respondents (65%) were aware of the term ‘stroke mimic’. Two-thirds of respondents (65%) thought a tool that predicted the likelihood of a suspected stroke being a stroke mimic would be useful in pre-hospital care. Conclusion ‐ This study reports a survey of UK paramedics’ views about the stroke care they provide. Conclusions are limited by the low number of responses. Assessment of suspected stroke patients was recognised as an important skill by paramedics and an area where many would like further training. Respondents’ current practice varied in terms of the stroke assessment tools used and whether suspected stroke patients were taken to the emergency department or direct to a stroke ward. A stroke mimic identification tool would be useful if it allowed stroke mimic patients to be directed to appropriate care, but it would need to have a high level of specificity and not adversely impact on time to treatment for true stroke patients.
Effect of an Enhanced Paramedic Acute Stroke Treatment Assessment on Thrombolysis Delivery During Emergency Stroke Care: A Cluster Randomized Clinical Trial
(2020-04-13) Price, Christopher; Shaw, L.; Islam, Saiful; Javanbakht, Mehdi; Watkins, Alan; McKeekin, Peter; Snooks, Helen; Flynn, Darren; Francis, Richard; Lakey, Rachel; Sutcliffe, Louise; McClelland, Graham; Lally, Joanne; Exley, Catherine; Rodgers, Helen; Russell, Ian T.; Vale, Luke; Ford, Gary A.
Hyperventilation in Cardiac Arrest: A Systematic review & narrative synthesis
(2023) Morris, Benjamin; McClelland, Graham; Hepburn, Sarah
A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
(2017-02) Flynn, Darren; Francis, Richard; Robalino, Shannon; Lally, Joanne; Snooks, Helen; Rodgers, Helen; McClelland, Graham; Ford, Gary A.; Price, Christopher
Stakeholder engagement in the design of a novel pre-hospital acute stroke assessment
(2016-09) Lally, Joanne; McClelland, Graham; Exley, Catherine; Ford, Gary A.; Price, Christopher
Background Outcomes for stroke patients can be improved by rapid identification and assessment, but delays commonly occur due to the availability of clinical information and brain imaging. We sought to develop a novel paramedic-led intervention to reduce scene to needle time for stroke patients suitable for thrombolysis. Methods Over 12 months we undertook group interviews and consultation in North East England, North West England and Wales involving patient representatives (n=20), paramedics, emergency department and stroke service hospital staff (n=100). The primary aim was to understand the impact of organisational boundaries, service pressures and traditional professional roles upon a new paramedic approach to stroke assessment. Secondly, to develop a clinical trial protocol for later evaluation of the proposed new paramedic approach. All interviews were digitally recorded, transcribed and analysed using open then focussed coding. Results Participant feedback supported an intervention which transgressed organisational and professional boundaries. Modifications were made following participant views about logistical, ethical and governance issues: ▸ The protocol was changed to reflect operational barriers restricting paramedics taking patients directly to the CT scan room. ▸ Participants advocated obtaining research consent after admission in order to address concerns over treatment delays, and supported a trial protocol which allowed data collection from patients that died before consent was feasible. ▸ Paramedics would provide additional information at patient handover directly to the stroke team or A&E staff rather than attempt to convey more during pre-notification. Conclusions Following the interviews significant alterations were made to the intervention and protocol in order to improve trial feasibility, acceptability and data quality. This emphasizes the importance of engaging with ambulance services, other clinical teams and patients during the development of pre-hospital research protocols. https://emj.bmj.com/content/emermed/33/9/e9.3.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-2016-206139.31
Ambulance documentation of stroke symptoms during the UK COVID-19 ‘Stay at Home’ message
(2020-11-16) McClelland, Graham; Wilson, Nina; Shaw, Lisa; Grayling, Michael; Haworth, Daniel; Price, Christopher
On 23 March 2020 the UK government urged the public to ‘Stay Home, Protect the NHS, Save Lives’ in order to reduce consequences from the COVID-19 pandemic.1 Three large National Health Service (NHS) stroke units subsequently reported a 16% (95% CI 27.2 to 3.2) decrease in the weekly trend for stroke admissions during March–April compared with January–February 2020. https://emj.bmj.com/content/early/2020/11/16/emermed-2020-210319 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-210319