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 my 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 have 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. My work varies similarly from supporting the safety of clinical trials, through training staff in novel treatments, and consenting and following up research participants.
Institutional profile
West Midlands Ambulance Service University NHS FT serves a population of 5.6 million people across more than 5000 square miles. As well as providing emergency ambulance services to the region, we hold the 111 contract for almost all of the region, as well as patient transport services for some parts. We are rated Outstanding by the Care Quality Commission.

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
    Consensus on innovations and future change agenda in Community First Responder schemes in England: a national Nominal Group Technique study
    (2023) Patel, Gupteswar; Botan, Vanessa; Phung, Viet-Hai; Trueman, Ian; Pattinson, Julie; Hosseini, Seyed Mehrshad Parvin; Orner, Roderick; Asghar, Zahid; Smith, Murray Donald; Rowan, Elise; Spaight, Robert; Evans, Jason; Brewster, Amanda; Mountain, Pauline; Mortimer, Craig; Miller, Joshua; Brown, Martina; Siriwardena, Aloysius
  • Publication
    Understanding Ambulance Workforce Retention and its Impact on Safety
    Miller, Joshua; East, Abigail; Dube, Alisen; Varnals, Gina; Cook, Robert; Asaduzzaman, Md; Whitehouse, Claire; Radford, Mark; Leary, Alison; Jones, SarahJane
  • 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.