West Midlands Ambulance Service [WMAS]http://hdl.handle.net/20.500.12417/122024-03-28T13:35:35Z2024-03-28T13:35:35ZConsensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managedHumphries, Christopherkelly, AnthonySadik, AwsWalker, AlisonSmith, Jasonhttp://hdl.handle.net/20.500.12417/17042024-03-18T17:55:43Z2023-09-22T00:00:00ZConsensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed
Humphries, Christopher; kelly, Anthony; Sadik, Aws; Walker, Alison; Smith, Jason
Background Acute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing. This study aimed to reach a consensus on the criteria for identification and management of ABD, and to agree when other care pathways or guidelines might be more appropriately used. Methods A modified Delphi study with participation from stakeholder organisation representatives was conducted in January–April 2023 online. In round 1, statements were generated by participants in response to broad questions. Participants then rated their level of agreement with statements in subsequent rounds, with statements achieving a consensus removed for inclusion in the final derived consensus statement. Non-consensus statement responses were assessed for stability. Results Of 430 unique statements presented for rating, 266 achieved a consensus among 30 participants representing eight stakeholder organisations. A derived consensus statement was generated from these statements. The median group response to statements which failed to achieve a consensus was reliable (Krippendorff’s alpha=0·67). Conclusions There is a consensus across stakeholder organisations that ABD is not a separate entity to agitation, and guidance should instead be altered to address the full range of presentations of agitation. While the features of concern in this severely agitated group of patients can be described, the advice for recognition may vary depending on staff group. Criteria for recognition are provided and potential new terminology is described. https://emj.bmj.com/content/41/1/4 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/
2023-09-22T00:00:00ZPrehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort studyGoodacre, SteveSutton, LauraThomas, BenHawksworth, OliviaIftikhar, KhurramCroft, SusanFuller, GordonWaterhouse, SimonHind, DanielBradburn, Mikesmyth, mikePerkins, GavinMilliins, MarkRosser, AndyDickson, Jon M.Wilson, Matthew J.http://hdl.handle.net/20.500.12417/16972024-03-18T16:23:00Z2023-11-01T00:00:00ZPrehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study
Goodacre, Steve; Sutton, Laura; Thomas, Ben; Hawksworth, Olivia; Iftikhar, Khurram; Croft, Susan; Fuller, Gordon; Waterhouse, Simon; Hind, Daniel; Bradburn, Mike; smyth, mike; Perkins, Gavin; Milliins, Mark; Rosser, Andy; Dickson, Jon M.; Wilson, Matthew J.
Background Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment. Methods We undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019. We used routine ambulance service data to calculate 21 early warning scores and categorise paramedic diagnostic impressions as sepsis, infection, non-specific presentation or other presentation. We linked cases to hospital records and identified those meeting the sepsis-3 definition who received urgent hospital treatment for sepsis (reference standard). Analysis determined the accuracy of strategies that combined early warning scores at varying thresholds for positivity with paramedic diagnostic impression. Results We linked 12 870/24 955 (51.6%) cases and identified 348/12 870 (2.7%) with a positive reference standard. None of the strategies provided sensitivity greater than 0.80 with positive predictive value greater than 0.15. The area under the receiver operating characteristic curve for the National Early Warning Score, version 2 (NEWS2) applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% CI 0.729, 0.783). No other early warning score provided clearly superior accuracy to NEWS2. Paramedic impression of sepsis or infection had sensitivity of 0.572 (0.519, 0.623) and positive predictive value of 0.156 (0.137, 0.176). NEWS2 thresholds of >4, >6 and >8 applied to patients with a diagnostic impression of sepsis or infection, respectively, provided sensitivities and positive predictive values of 0.522 (0.469, 0.574) and 0.216 (0.189, 0.245), 0.447 (0.395, 0.499) and 0.274 (0.239, 0.313), and 0.314 (0.268, 0.365) and 0.333 (0.284, 0.386). Conclusion No strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. https://emj.bmj.com/content/40/11/768 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/
2023-11-01T00:00:00ZExperiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service usersEvans, BridieKhanom, AshraEdwards, BethanFoster, TheresaFothergill, RachaelGripper, PennyPorter, AlisonScott, JasonWatkins, AlanEdwards, AdrianFarr, AngelaGunson, ImogenRees, NigelSnooks, Helenhttp://hdl.handle.net/20.500.12417/16892024-01-31T19:11:36Z2023-08-09T00:00:00ZExperiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service users
Evans, Bridie; Khanom, Ashra; Edwards, Bethan; Foster, Theresa; Fothergill, Rachael; Gripper, Penny; Porter, Alison; Scott, Jason; Watkins, Alan; Edwards, Adrian; Farr, Angela; Gunson, Imogen; Rees, Nigel; Snooks, Helen
2023-08-09T00:00:00ZA response to 'Fighting the fire': fire chiefs' proposal to run England's ambulance service...‘Fighting the fire: a response to fire chiefs’, October, 2010Jones, PeterWoollard, Malcolmhttp://hdl.handle.net/20.500.12417/16562023-11-23T15:49:58Z2011-02-04T00:00:00ZA response to 'Fighting the fire': fire chiefs' proposal to run England's ambulance service...‘Fighting the fire: a response to fire chiefs’, October, 2010
Jones, Peter; Woollard, Malcolm
In October 2010, JPP published a comment by Prof Malcolm Woollard, titled ‘Fighting the fire: a response to fire chiefs’ proposal to run England’s ambulance service’, expressing his view as to why the proposal by the Chief Fire Officers Association (CFOA) is not workable. JPP has received a letter regarding this, which is printed below, along with a response from Prof Woollard that also discusses the latest report published by the CFOA. Abstract published with permission
2011-02-04T00:00:00Z