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  • Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services: a registry-based, cohort study

    Vadeyar, Sharvari; Buckle, Alexandra; Hooper, Amy; Booth, Scott; Deakin, Charles; Fothergill, Rachael; Chen, Ji; Nolan, Jerry P; Brown, Martina; Cowley, Alan; et al. (2023-10)
  • Research and development : a new direction for NEAS

    McClure, Sally; Marley, George; Cessford, Colin; Clarke, Tom; Dorgan, Sharon; Atkinson, Lorraine; Smith, Justine; O'Neill, Seamus (2009)
    The Department of Health has recently introduced a new national strategic direction for research and development (R&D) across the National Health Service (NHS). One of the major developments is the National Institute for Health Research (NIHR) which provides a framework to position, manage and maintain world-class research, staff and infrastructure in the NHS. This national framework is having a substantial effect on driving and shaping the infrastructure of R&D departments within Ambulance NHS Trusts. This article provides an overview of the national development and highlights some of the major consequential developments for the North East Ambulance Service NHS Trust (NEAS). Abstract published with permission.
  • Hyperventilation in cardiac arrest—a systematic review and narrative synthesis

    Kirk, Benjamin; McClelland, Graham; Hepburn, Sarah (2023-11-02)
    Resuscitation guidelines recommend delivering ventilations at a rate of 10 per minute. However, hyperventilation is commonly reported during out-of-hospital cardiac arrest resuscitation efforts, and the impact of this on patient outcomes is unclear. This review explores the reported rates, causes and patient outcomes of hyperventilation in the management of out-of-hospital cardiac arrest. Abstract published with permission.
  • Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): study protocol for a pilot randomised controlled trial

    Shaw, Lisa; Price, Christopher; McLure, Sally; Howel, Denise; McColl, Elaine; Ford, Gary A. (2011-06-15)
  • The RESearch PARamedic Experience (RESPARE) study: a qualitative study exploring the experiences of research paramedics working in the United Kingdom

    McClelland, Graham; Limmer, Matthew; Charlton, Karl (College of Paramedics, 2023-03-01)
    Background: The research paramedic position is a relatively niche role undertaken by a small number of paramedics who support, deliver and promote research. Research paramedic roles provide opportunities to develop talented researchers who are recognised as vital elements of developing a research culture within ambulance services. The benefits of research-active clinicians have been recognised at a national level. The aim of this study was to explore the experience of people who work, or have worked, as research paramedics. Methods: A generic qualitative approach underpinned by phenomenological concepts was used. Volunteers were recruited via ambulance research leads and social media. Online focus groups allowed participants to discuss their roles with peers who may be geographically distant. Semi-structured interviews expanded on the focus group findings. Data were recorded, transcribed verbatim and analysed using framework analysis. Results: Eighteen paramedics (66% female, median involvement in research six (interquartile range 2‐7) years) representing eight English NHS ambulance trusts participated in three focus groups and five interviews lasting around one hour, in November and December 2021. Six key themes were identified: starting as a research paramedic; barriers and facilitators to working as a research paramedic; research careers; opportunities; the community (support and networking); and the value of a clinical identity. Conclusions: Many research paramedics had similar experiences in terms of starting their career by delivering research for large studies, then building on this experience and the networks they create to develop their own research. There are common organisational and financial barriers to working as a research paramedic. Career progression in research beyond the research paramedic role is not well defined, but often involves building links outside of the ambulance service. Abstract published with permission.
  • Rural versus urban out-of-hospital cardiac arrest response, treatment and outcomes in the North East of England from 2018 to 2019

    Finney, Owen; Stagg, Hayley (2023-09-01)
    Introduction: Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency. There is international evidence to suggest that rural regions experience worse OHCA outcomes, such as reduced survival rates. The aim of this study was to quantitatively review and compare the OHCA response, treatment and pre-hospital outcomes in a single-centre ambulance service over a 1-year period in urban and rural areas. Methods: This study used retrospective OHCA audit data from the North East Ambulance Service NHS Foundation Trust, from April 2018 to April 2019, comparing OHCA response, treatment and return of spontaneous circulation (ROSC) data in relation to urban or rural classification status, using the UK government urban‐rural classification tool. Results: A total of 1295 urban cases and 319 rural cases were compared. Bystander public-access defibrillator (PAD) use was higher in rural areas in comparison to urban areas (20/319 (6.3%) vs 47/1295 (3.6%); p = 0.03). The mean ambulance response time was slower in rural areas (10:43 minutes (n = 319) (SD ± 8.2) vs 07:35 minutes (n = 1295) (SD ± 7.1); p = < 0.01). Despite this, overall ROSC rates at hospital were similar between the groups, with no statistically significant difference (rural: 87/319 (27.3%) vs urban: 409/1295 (31.6%); p = 0.14). A further sub-group analysis of initially shockable OHCA cases showed slower ambulance response times in rural areas (10:45 minutes (n = 68) (SD ± 12.3) vs 07:55 minutes (n = 245) (SD ± 5.5); p = < 0.01) and that rural cases experienced lower ROSC at hospital rates (31/68 (45.6%) vs 151/245 (61.6%); p = 0.02). Conclusion: This report showed differences in OHCA response and outcomes between rural and urban settings. In the shockable OHCA sub-group analysis, rural areas had slower ambulance response times and lower ROSC rates. The longer ambulance response times in the rural shockable OHCA group could be a factor in the reduced ROSC rates. Linking hospital survival data should be used in future research to explore this area further. Abstract published with permission.
  • Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: an observational registry cohort study

    Albargi, H; Mallett, S; Berhane, S; Booth, S; Hawkes, C; Perkins, G.D; Norton, M; Foster, T; Scholefield, B (Elsevier, 2022-01)
  • Prognostic value of lactate in out-of-hospital cardiac arrest: a prospective cohort study

    Charlton, Karl; Stagg, Hayley (MAG Online, 2022-04-14)
    Background: The prognostic role of lactate in out-of-hospital cardiac arrest (OHCA) remains unclear. Aims: To explore serum lactate as a predictor of return of spontaneous circulation in patients experiencing OHCA after arrival at hospital. Methods: This 13-month prospective observational cohort study involved patients aged ≥18 years. Serum lactate levels were measured during cardiopulmonary resuscitation before ROSC. Patients were divided into two groups by lactate level: Group 1, low (≤9.9 mmol/l) and Group 2, high (≥10 mmol/l). Findings: 105 patients were included, 50 in group 1 and 55 group 2. Median lactate were 7.4 mmol/l and 14.2 mmol/l respectively. More patients in group 1 were found with ventricular fibrillation (40% versus 14.5%; P≤0.01), obtained ROSC more quickly (37 minutes 38 seconds versus 39 minutes 13 seconds; P=0.79) and achieved short-term survival (survived >24 hours) (40% versus 23.5%; P=0.32), versus group 2; prediction of survival did not reach statistical significance. Conclusion: Lower lactate levels in OHCA appear to be associated with better short-term outcomes but the cut-off points regarding survival remain unclear. Abstract published with permission.
  • Predicting conveyance to the emergency department for older adults who fall

    Charlton, Karl; Stagg, Hayley; Burrow, Emma (MAG Online, 2022-04-14)
    Background: Falls are frequent in older adults and are associated with high mortality, morbidity and immobility. Many patients can be managed in the community, but some will require conveyance to the emergency department (ED). Aims: This study aims to identify predictive characteristics of conveyance to the ED after a fall. Methods: A cross-sectional study between December 2018 and September 2020 involved patients attended by a falls rapid response service. Eligible patients were aged ≥60 years with mental capacity, had experienced a fall and were living within the relevant geographical area. Findings: 426 patients were enrolled, with a mean age of 82.61 years (SD 8.4; range 60–99 years) and 60.7% were women. Predictive characteristics of conveyance were an injurious fall or pain (OR 8.25; 95% CI (4.89–14.50); P≤0.01) and having been lying for a long time (OR 1.6; 95% CI (1.00–2.56); P=0.04). Conclusion: It is possible to identify predictors of conveyance to the ED; therefore, an undifferentiated approach towards dispatching the falls rapid response service to all older adults who fall is unwarranted. Abstract published with permission.
  • Care home residency and its association with ambulance service workload

    Sinclair, David R; Charlton, Karl; Stow, Daniel; Burrow, Emma; Hanratty, Barbara
  • The impact of introducing real time feedback on ventilation rate and volume by ambulance clinicians in out of hospital cardiac arrest: the VANZ2 study

    Charlton, Karl; Limmer, Matthew; Hepburn, Sarah; Burrow, Emma; Tutchings, Abbie; Blair, Laura; Grayling, Michael; McClelland, Graham
  • A qualitative exploration of on-scene times during pre-hospital stroke care in North East England

    McClelland, Graham; Burrow, Emma; Alton, A; Shaw, L; Finch, T; Price, Chris
  • Reducing ambulance on-scene times for suspected stroke through an evidence-based training package: an interim analysis

    McClelland, Graham; Burrow, Emma; Stagg, Hayley; Shaw, L.; Finch, Tracey; Price, C.
  • Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics

    Goodwin, Laura; Voss, Sarah; McClelland, Graham; Beach, Emily; Bedson, Adam; Black, Sarah; Deave, Toity; Miller, Nick; Taylor, Hazel; Benger, Jonathan (BMJ, 2022-10-21)
    Background Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics. Methods A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA. Results There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5degreeC. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement. Conclusions This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement. 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:
  • Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England

    Charlton, Karl; Scott, Jason; Blair, Laura; Scott, Stephanie; McClelland, Graham; Davidson, Tom; Burrow, Emma; Mason, Alex (2022-12)

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