Miller, Joshua

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Biography
I qualified as a paramedic in 2012 and worked for West Midlands Ambulance Service across ambulance, solo rapid response and first-line supervisor roles, serving a community with one of the highest levels of deprivation in the country. During this time, I completed two service evaluations within the Trust. The first looked at staff views of teamwork in resuscitation attempts, while the second was a set of interviews with first-line managers about how they identify ambulance clinicians who may have been traumatised by their work. In 2016 I joined the Trust's research team and supported the delivery of a variety of studies since then, from randomised controlled studies in cardiac arrest, stroke and acute respiratory failure, through to observational studies in decision-making around electrocardiograms, and a project to develop a new major trauma triage tool. From 2022-2025 I worked as the Trust's lead research paramedic, managing the delivery of research studies and supporting the research team, before being appointed at Welsh Ambulance Service as Head of Research and Innovation in 2025.
Institutional profile
Welsh Ambulance Services University NHS Trust serves a population of 3 million people across the whole of Wales, covering more than 8000 square miles. As well as providing emergency ambulance services to the region, we run the 111 service for the country, as well as the patient transport service.

Publication Search Results

Now showing 1 - 10 of 21
  • Publication
    The Diagnostic accuracy of prehospital assessment of acute respiratory failure
    (2020-12-01) Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin; Ward, Matthew; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Bradburn, Mike; Harris, Tim; Cooper, Cindy
    Acute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient. Results: 77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis. Conclusions: Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment. Abstract published with permission.
  • Publication
    Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom
    (2021-12-01) Fuller, Gordon; Keating, Samuel; Turner, Janette; Miller, Joshua; Holt, Chris; Smith, Jason E.; Lecky, Fiona
    Despite the importance of treating the 'right patient in the right place at the right time', there is no gold standard for defining which patients should receive expedited major trauma centre (MTC) care. This study aimed to define a reference standard applicable to the United Kingdom (UK) National Health Service major trauma networks. Abstract published with permission.
  • Publication
    ‘The ones that don’t say’; challenges in managers identifying potentially traumatised ambulance staff
    (2019-01-14) Miller, Joshua
    Background Stress and psychological illness among emergency services personnel is reported at higher prevalence than the general population, with one UK ambulance service ascribing it to 15% of staff sickness. Research in this field has focused on ambulance crew views, while manager experiences are limited to EMS systems outside the UK. This qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work. Methods Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained. Results All participants claimed to see the identification of potentially traumatised staff as a vital part of their role. They outlined the use of case factors such as visceral elements and child involvement, and staff factors such as home life and resilience. Interviewees talked about their changing roles as managers, peers, parent figures, clinicians, and adjudicators. Factors found as enabling the identification of potentially traumatised staff included: knowing the staff, formalising handover to other managers, and manager presence – both at incidents and on station. Disabling factors included: atypical cases, hierarchical culture, and isolated remote staff. All participants reported concerns about staff being reluctant to report distress. Conclusions Limitations of this study include the small sample size, possible response bias, and respondents conforming to social norms, as their practice was self-reported, rather than observed. Manager presence was highlighted as very important by participants; services should consider this in their structures and policies. Further studies could examine staff reluctance to report psychological distress, as well as staff resilience, which participants saw as beneficial, yet difficult to define or predict. https://emj.bmj.com/content/36/1/e4.3. 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-2019-999.10
  • Publication
    Prehospital continuous positive airway pressure for acute respiratory failure: the ACUTE feasibility RCT
    (2021-02) Fuller, Gordon W.; Keating, Samuel; Goodacre, Steve; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; Bradburn, Mike; Thokala, Praveen; Harris, Tim; Marsh, Margaret M.; Scott, Alexander J.; Cooper, Cindy
  • Publication
    Cost-effectiveness of out-of-hospital continuous positive airway pressure for acute respiratory failure: decision analytic modelling using data from a feasibility trial
    (2021-01-25) Thokala, Praveen; Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; Bradburn, Mike; Harris, Tim; Marsh, Maggie; Ren, Kate; Cooper, Cindy
  • Publication
    ‘What is the rate of general practitioner registration amongst homeless patients who present to an English ambulance service?’
    (2020-10) Miller, Joshua; McBride, Shaun
    Marginalised groups such as homeless people and migrants experience barriers to registration with a general practitioner (GP). While various interventions have been trialed to improve registration rates, the potential for opportunistic interventions through the ambulance service has not yet been considered. The aim of this study was to determine the scope for these interventions by researching the prevalence of GP registration amongst the homeless population that present to a regional English ambulance service that covers both rural and urban areas. https://emj.bmj.com/content/37/10/e3.2 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.4
  • Publication
    Involving newly qualified paramedics in prehospital randomised controlled trials: an analysis of training, enrolment and safety data within the Paramedic Analgesia Comparing Ketamine and MorphiNe in trauma (PACKMaN) study
    (2023) Miller, Joshua; Noordali, H.; Perkins, Gavin; smyth, mike; Walker, A.; Rosser, Andy; Stanley, O.; Green, Z.; McLaren, R.; Miller, E; Pountney, A.
  • Publication
    The PACKMaN trial: What has been learnt delivering a CTIMP with an NHS ambulance service
    (2024) Diffley, Alexander; Noordali, H.; Michelet, Felix; smyth, mike; Miller, Joshua
  • Publication
    Better together? Ambulance staff views of human factors in resuscitation
    (2015-05-19) Miller, Joshua
    Background Research into the care of cardiac arrest patients outside of hospital is limited. Evidence from hospital settings suggests that human factors including both technical and non-technical skills and performance may impact on care. This study sought staff views from a UK ambulance service aiming to investigate areas for improvement in resuscitation performance. Methods Volunteer ambulance staff responded to an open invitation to complete an anonymous internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on resuscitation performance. Quantitative responses were presented graphically, and free text answers arranged by theme. Results 111 staff responded to the survey. The results demonstrated that staff see effective teamwork as desirable in out-of-hospital resuscitation, but that this is not always the case currently. Staff felt more confident about practical skills such as cannulation and chest compression delivery. Difficulties were noted in: poor communication between staff members; inconsistent identification and nomination of leaders; low staff confidence in peri- and post-cardiac arrest conversations with relatives; and insufficient staff numbers on scene. Conclusions The findings demonstrate poor staff confidence in several non-technical skills, including teamwork and communication. Limitations of the survey included lack of recording of training received—where this has shifted in recent years from in-service to higher education routes—and missing demographic data. However, the findings provide specific areas for improvement activity. This has already included best practice slides displayed in ambulance stations, and proposals for identification wristbands, a role-based work standard to reduce task omission and duplication, and a policy to send higher numbers of rescuers to cardiac arrest cases. https://emj.bmj.com/content/32/6/e14.2. 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-2015-204980.8
  • Publication
    The ambulance service and the child and young person’s advance care plan: listening to families and professionals
    (2020-09-25) Shaw, Karen; Spry, Jenna; Cottrell, Serena; Cummins, Carole; Fitzmaurice, Nicki; Greenfield, Sheila; Heath, Gemma; Miller, Joshua; Neilson, Sue; Skrybant, Magdelena; Thompson, Paul; Vyse, Janette
    The Child and Young Person’s Advance Care Plan (CYPACP) is a set of resources to help families and professionals agree a plan of care to be followed when a child/young person with a life-limiting condition develops potentially (i) reversible intercurrent illnesses or (ii) life-threatening complications of their condition. It covers clinical, psychosocial and spiritual issues, is designed for use in all environments that the child encounters, and can be used as a resuscitation and/or end-of-life plan. Little is known about the experiences of Ambulance Service staff who receive copies of these plans and may be called upon to follow the recommendations for treatment and resuscitation. https://emj.bmj.com/content/37/10/e14.1 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-2020-999abs.30