Publications from the North West Ambulance Service. To find out more about NWAS visit their website at https://www.nwas.nhs.uk

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  • Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

    Couper, Keith; Ji, Chen; Lall, Ranjit; Deakin, Charles; Fothergill, Rachael; Long, J.; Mason, James; Michelet, Felix; Nolan, Jerry; Nwankwo, Henry; et al. (2023-12-30)
  • Diagnostic accuracy of early warning system scores in the prehospital setting

    Bell, Steve; Hill, James (2023-12-02)
    The use of prehospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and prehospital care settings, a systematic review was carried out by Guan et al (2022) to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or prehospital setting. This commentary aims to critically appraise the methods used within the review by Guan et al (2022) and expand upon the findings in the context of clinical practice. Abstract published with permission.
  • There are many ways to be a midwife: career pathways in midwifery

    Sarwar, Zainab; Pendleton, John; heys, Stephanie; Mansfield, Amanda; Kerslake, Dawn (2022-01)
  • amber – building a home for ambulance services research

    Holland, Matt; Dutton, Michelle; Glover, Steve (2022-09)
  • Analysis of publishing trends within the NHS Ambulance Services in the United Kingdom using the AMBER repository

    Glover, Steve; Dutton, Michelle; Tyrrell, Amy; Bowman-Worrall, Sarah; Holland, Matt (2023-10)
  • Student paramedic exposure to workplace violence: a scoping review

    Belk, Stephanie; Armstrong, James; Ilczak, Tomasz; Webster, Carl A.; Sumera, Kacper (2024)
  • Navigating the breadth and depth of primary care

    Romano, Vincent (2024-03-02)
    This book states that it is aimed at both paramedics who are new to the world of primary care and those who are already working within a primary care environment. The authors clearly have a wealth of experience in primary care and the prehospital setting, which are equally important when writing about paramedic care in the primary care setting. Alongside the three authors, there are no less than 19 contributors, again representing some crucial clinical areas such as midwifery, end-of-life care, education, and safeguarding. Abstract published with permission
  • Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens

    heys, Stephanie; Main, Camella; Humphreys, Aimee; Torrance, Rachael (2023-09-01)
  • Could diabetes prevention programmes result in the widening of sociodemographic inequalities in type 2 diabetes? Comparison of survey and administrative data for England

    Chatzi, Georgia; Whittaker, William; Chandola, Tarani; Mason, Thomas; Soiland-Reyes, Claudia; Sutton, Matt; Bower, Peter (2023-09)
    Background The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing type 2 diabetes mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity or deprivation is not known. Methods We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (1) prevalence of NDH (using survey data from UK Household Longitudinal Study (n=794) and Health Survey for England (n=1383)); (2) identification in primary care and offer of programme (using administrative data from the National Diabetes Audit (n=1 267 350)) and (3) programme participation (using programme provider records (n=98 024)). Results Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) (4% of the population with NDH (95% CI 2.4% to 6.5%)) and older adults (aged 80 and above) (12% (95% CI 9.5% to 14.2%)) were slightly under-represented among programme participants (2% (95% CI 1.8% to 2.2%) and 8% (95% CI 7.8% to 8.2%) of programme participants, respectively). People living in deprived areas were under-represented in eight sessions (14% (95% CI 13.7% to 14.4%) vs 20% (95% CI 16.4% to 23.6%) in the general population). Ethnic minorities were over-represented among offers (35% (95% CI 35.1% to 35.6%) vs 13% (95% CI 9.1% to 16.4%) in general population), though the proportion dropped at the programme completion stage (19% (95% CI 18.5% to 19.5%)). Conclusion The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age and limiting illness or disability-related inequalities in T2DM. While ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target under-represented groups to ensure equitable access and narrow inequalities in T2DM. https://jech.bmj.com/content/77/9/565 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/
  • Mass casualty triage : using virtual reality in hazardous area response teams training

    Thompson, Steven (2023-09-12)
    Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.
  • 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)
  • Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections

    Fahmi, Ali; Palin, Victoria; Zhong, Xiaomin; Yang, Ya-Ting; Watts, Simon; Ashcroft, Darren; Goldacre, Ben; MacKenna, Brian; Fisher, Louis; Massey, Jon; et al. (2023-07-18)
  • Carrying out research, critical appraisal, ethics and stakeholder involvement

    Rees, Scott (2023-11-02)
    Research skills are a requirement under the Health and Care Professions Council (HCPC) standards for paramedic registration. Paramedics must ‘recognise the value of research to the critical evaluation of practice’. Research in the medical field is important in order to improve the knowledge of clinicians and inform evidence-based practice. The purpose of this article is to demonstrate the key components of the research process, use of a PICO [population, intervention, comparison, outcome] tool to search relevant databases and explain the critical appraisal of research in order to establish if research is valid before implementing results into paramedic practice. Abstract published with permission.
  • Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

    Pogson, Rachel; Henderson, Helen; Holland, Matt; Sumera, Agnieszka; Sumera, Kacper; Webster, Carl (2023-10-05)
  • Improving paramedic responses for patients dying at home: a theory of change-based approach

    Simpson, Jane; Remawi, Bader Nael; Potts, Kieran; Blackmore, Tania; French, Maddy; Haydock, Karen; Peters, Richard; Hill, Michael; Tidball, Oliver-Jon; Parker, Georgina; et al. (2023-08-02)
  • A step toward enhanced EMS telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified

    Alotaibi, Ahmed; Body, Richard; Carley, Simon; Pennington, Elspeth (2022-08-23)
    Abstract Background Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. Methods We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at ≥ 70%. Results A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation <90%, heart rate <40/minute or systolic blood pressure <90mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. Conclusion Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain. https://emj.bmj.com/content/39/9/e5.6 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/openhrt-2015-000281

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