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Miller, Joshua

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
  • PublicationMetadata only
    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.
  • PublicationOpen Access
    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
  • PublicationMetadata only
    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
  • PublicationMetadata only
    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
  • PublicationMetadata only
    ‘We wear too many caps’: role conflict among ambulance service managers
    (2019-03-01) Miller, Joshua
    Aims: A qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work, including how they see their role in this task. As research on managers in this field is largely limited to settings outside the NHS, the study was planned as exploratory in nature and developed themes arising from the data. 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 interview guide included specific questioning on role and identity. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained. Results: The participants were all clinically-trained managers with responsibility for first-line management of front line ambulance crews. They discussed their varying roles both implicitly and explicitly. The roles included: manager, clinician, peer, referrer, ‘adjudicator’, parent figure, ‘the appropriate person’ and the challenger. They discussed the tensions of managing performance and providing emotional support to the same staff, including how some managers perceived this as making staff reluctant to disclose distress. Several participants acknowledged that they were actively creating narratives from different role perspectives, and that readers of the study would also judge them against these different roles. Conclusion: This study suggests that ambulance service managers within an NHS trust may feel conflicted between varying roles, some relating to their professional identities, and some to work tasks such as performance management and staff support, which may be in tension. Some respondents felt this could make potentially traumatised staff reluctant to disclose distress, which has negative implications in a sector where stress and psychological illness is ascribed as contributing to around 15% of staff sickness. Further research could be conducted into whether this possible role conflict is seen by front line staff as a barrier to disclosing distress. Abstract published with permission.
  • PublicationMetadata only
    Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration
    (2020-06-14) England, Ed; Deakin, Charles; Nolan, Jerry; Lall, Ranjit; Quinn, Tom; Gates, Simon; Miller, Joshua; O'Shea, Lyndsey; Pocock, Helen; Rees, Nigel; Scomparin, Charlotte; Perkins, Gavin
  • PublicationOpen Access
    Call assessor-initiated referral without clinical discussion to medical SDEC (same day emergency care) : a new pathway for suspected pulmonary embolism
    (2023) Miller, Joshua; Williams, Emma; Goodman, Samuel; Harris, Scott; Musticone, Paul; Topping, Richard
  • PublicationMetadata only
    ‘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
    (2019-09-24) Miller, Joshua; Keating, Samuel; Fuller, Gordon W.; Goodacre, Steve
    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
  • PublicationMetadata only
    ‘They are not silly people – they know the difference’: clinician focus group views on a pilot randomised controlled trial of prehospital continuous positive airway pressure (CPAP)
    (2019-09-24) Miller, Joshua; Keating, Samuel; Scott, Alex; Fuller, Gordon W.; Goodacre, Steve
    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), nine trial-trained paramedics took part in three semi-structured focus groups. 204 trained staff had been given the opportunity to take part. The sample included six staff who had recruited to the trial, one who had not, and two who had withdrawn from it. Audio-recordings were transcribed and analysed thematically. Results Participants described facilitators to trial participation including: clear eligibility criteria and patient documentation, access to demonstration equipment, training away from the work environment, and repeated patient recruitment. Barriers to taking part included: the lack of protected time for training, inadequate workplace facilities for the electronic learning package used, adverse responses by receiving hospital staff, and infrequent patient exposure. Both paramedics who withdrew cited the inconvenience of carrying packs each shift. Some participants described anxiety and distress when opening packs to find a standard-care mask, and reported patients having similar reactions. Conclusions Future researchers could promote improved workplace computing facilities and increased provision of face-to-face training days, which were praised by participants in these focus groups, but limited to a single event distant from some staff. Greater stakeholder engagement by researchers could reduce the difficulties at hospital handover reported by some ambulance staff. Where blinding is not possible, the perceptions of clinicians and patients should be considered carefully, as this study shows both may have adverse emotional responses to being treated with standard care, particularly when prospective consent discussions describe the trial intervention as potentially beneficial., https://emj.bmj.com/content/36/10/e12.2 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.28
  • PublicationMetadata only
    The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure
    (2018-06) Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Perkins, Gavin D.; Ward, Matthew; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Bradburn, Mike; Thokala, Praveen; Harris, Tim; Carson, Andrew; Marsh, Maggie; Cooper, Cindy