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

Collections in this community

Recent Submissions

  • 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
  • Clinical ECGs in paramedic practice

    Romano, Vincent (MA Healthcare, 2023-03-02)
  • Peer support after exposure to trauma: an evaluation

    Romano, Vincent (2023-07-02)
    Background: There are various staff wellbeing programmes used across the emergency services. The British Military recognised single-session models were not effective and developed Trauma Risk Management (TRiM). A number of organisations now use TRiM as a peer-led traumatic stress support system, including the North West Ambulance Service. Aims: This evaluation aimed to identify engagement with TRiM across the North West Ambulance Service. Method: A combination of quantitative and qualitative data was analysed from those who engaged with TRiM. Findings: There was a perception that road traffic collision (RTC) and cardiac arrests would cause acute stress symptoms and require a TRiM assessment; this was validated by the uptake of assessments and referral to professional counselling following such incidents. Conclusion: TRiM can provide effective peer-delivered support across a large geographical workforce. Implementation and coordination are key to ensuring success. Abstract published with permission.
  • Neurological assessment with FAST to better detect posterior circulation stroke

    Godley, Nicola (2023-07-02)
    Posterior circulation stroke (PCS) represents up to 25% of ischaemic strokes and affects more than 20000 people annually within the UK. Prehospital clinical practice guidelines recommend the use of a validated stroke screening tool, such as the ‘Face, Arms, Speech, Time’ [FAST] tool for the assessment of all patients presenting with stroke symptoms. However, with PCS, patients may present with vestibular symptoms, which cannot be detected with ‘FAST’. Furthermore, over one-third of patients with PCS are delayed or misdiagnosed due to a lack of apparent ‘typical’ acute stroke symptoms. The ‘FAST’ tool is deemed to have high sensitivity and moderate specificity in the recognition of ischaemic stroke; yet there is evidence within the literature determining that the ‘FAST’ tool is not adequate for prehospital screening of PCS, leading to misdiagnosis, treatment delay, and severe life-limiting deficits or death. The aim of this literature search is to evaluate how the use of additional neurological assessment, alongside the validated ‘FAST’ tool, could be used within the prehospital setting for the improved paramedic detection of PCS. Abstract published with permission.
  • Hospital handover improvements

    Gibbs, Emily; Dunn, Lynsey; Hargreaves, Caroline (2023-07-16)
  • Video vs direct laryngoscopy for adults undergoing endotracheal intubation

    Bell, Steve; Pennington, Elspeth; Hill, James E. (2023-06-02)
    The safety and utility of endotracheal intubation by paramedics in the UK is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess and compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice. Abstract published with permission
  • Diagnostic accuracy of clinical pathways for suspected acute myocardial infarction in the out-of-hospital environment

    Alghamdi, Abdulrhman; Hann, Mark; Carlton, Edward; Cooper, Jamie G.; Cook, Eloïse; Foulkes, Angela; Siriwardena, Aloysius; Phillips, John; Thompson, Alexander; Bell, Steve; et al. (2023-06-10)

View more