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

  • PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

    Alghamdi, Abdulrhman; Cook, Eloïse; Carlton, Edward; Siriwardena, Aloysius; Hann, Mark; Thompson, Alexander; Foulkes, Angela; Phillips, John; Cooper, Jamie; Steve, Bell; et al. (2019-10-07)
    Introduction Within the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test. We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting. Methods and analysis We will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment. Ethics and dissemination The study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Abstract, URL 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: 10.1136/bmjopen-2019-032834
  • Potential applications of capnography in the prehospital setting

    Percival, David (2012-01)
    Abstract published with permission. End-tidal carbon dioxide (ETCO2) monitoring is well established in hospital theatre and critical care settings (Lah and Grmec, 2010), employed for observation and monitoring in anaesthesia. Its application has now extended to the prehospital environment, primarily for the verification of endotracheal tube (ETT) placement, endeavouring to reduce the occurrence of oesophageal intubations (Grmec and Malley, 2004). In recent times, technological advances, coupled with an increased appreciation of the importance of prehospital interventions, has resulted in the production of additional equipment capable of monitoring ETCO2 in non-intubated, self-ventilating patients via a non-invasive nasal cannula. Despite having an extensive range of potential uses, the apparatus is widely underused (Langhan and Chen, 2008). In this article, potential applications in the prehospital setting will be discussed via a review of contemporary literature.
  • From trade to profession-the professionalisation of the paramedic workforce

    Swinburn, Andy; First, Sue; Tomlins, Lucy (2012-07)
    Abstract published with permission. How do we achieve professionalisation of the paramedic? The Trait theory identifies professions as having 1. An exclusive body of knowledge 2. Self regulation and 3. Registration. Becoming a profession leads to improved remuneration and greater respect and knowledge, but this does not lead to a change in personal conduct. Professionalism however, is connected to behaviour, attitudes, accountability and responsibility. The behavioural changes and attitudes required of a ‘professional’ are brought about through the combination of higher education and clinical leadership. Academic input integrates clinical leadership with the career structure and all staff at all levels. Clinical leaders are at the coal face, accessible during and after the event, for training and clinical supervision and are therefore transforming practice at every level. However, clinical leadership is ineffective with an uneducated workforce and an uneducated workforce is ineffective without clinical leadership, the two go hand in hand So... What is the way forward for the ambulance service? What are paramedics doing to develop and maintain the profession and professional behaviours?
  • Kerbside consultations: advice from the advanced paramedic to the frontline

    Jackson, Mike; Jones, Colin (2012-09)
    Abstract published with permission. Aim To observe the issues, benefits and challenges of providing dynamic telephone clinical advice to frontline clinicians by advanced paramedics of the North West Ambulance Service NHS Trust. Method In order to focus on the key issues the study used a mixed method approach. A group of 11 advanced paramedics took part in two focus groups which was then followed up with a questionnaire to frontline clinicians. Using focus groups in the research not only allows for the possibility of multiple realities but also for participant validation. Using a qualitative approach allowed theory to develop and emerge which was then codified into themes and the data was then used to develop a questionnaire for frontline clinicians who had received clinical advice in the past in order to provide an element of quantitative data. Findings Five themes emerged from the stud: function, responsibility, barriers, education and support. Conclusion The study finds that clarity is required in relation to responsibilities and clinicians would benefit from a structured model to communicate information over the telephone—we believe the introduction of remote advice has improved patient safety and support to staff and has created opportunity for additional learning.
  • The art and science of mentorship in action

    Comber, Jason; Conboy, Adrian; Jones, Paul (2012-08)
    Abstract published with permission. The authors have collaborated to produce this article bringing together more than 60years of combined experience of paramedic practice, education and management. All maintain their paramedic registration and have among their goals the advancement and development of knowledge, skills and professionalism to promote an effective contemporary paramedic who continues to meet the care needs of the communities they serve. Practice mentors are pivotal to the success of a modern, fit-for-purpose paramedic curriculum that requires a significant proportion of learning and assessment to take place in the practice setting. This article focuses on the support that is needed for mentors during major professional and organisational change. Change which is aligned to localised multifaceted organisational strategies and change which includes supporting mentors, enabling them to carry out their function professionally, effectively and with confidence. This article discusses experiences of a collaborative, structured approach to mentorship support which is achieved through organisational, educational and professional alliances. It also explores other approaches and suggests a way forward in terms of a national governance framework.
  • Social prescribing: surely, we are not just going to prescribe tea and biscuits

    Potts, Kieran; Tang, Sammer; McBride, Shaun (2019-07-10)
  • Write, reflect and be human

    Smith, Daniel (2019-03-13)
  • What is your ‘normal’?

    Smith, Daniel (2019-02-04)
  • Using social media for good

    Smith, Daniel (2019-09-11)
  • The reality of role play

    Smith, Daniel (2019-04-08)
  • Knowing our specialist roles

    Smith, Daniel (2019-08-07)
  • Just don't call me sir!

    Smith, Daniel (2019-06-08)
  • Developing and diversifying

    Smith, Daniel (2019-07-10)
  • Implementing a paediatric early warning score into pre-hospital practice

    Rolls, Martin (2019-06-01)
    Aim: This study addressed a desire by ambulance clinicians for additional education in the examination and assessment of the unwell child; it also explored whether ambulance clinicians could use a paediatric early warning score (PEWS) safely and effectively in the pre-hospital arena. Methods: A small-scale study introduced a validated PEWS into pre-hospital practice. The paediatric observations priority score (POPS) combines physiological observations with clinicians’ review. POPS uses a range of proxy measures such as work of breathing, alertness, gut feeling and known high-risk factors, to further refine the scoring. Based on a sample of over 24,000 patients, POPS has been validated for use in emergency departments (EDs). POPS can identify potentially critically unwell children as well as those fit for discharge without hospital admission, the fundamental purpose of an ED. Study participants were surveyed before and after the trial period in order to examine self-reported scores in confidence and competence levels for the child in pain, the breathless child, the child with a decreased level of consciousness, the febrile child and the seriously injured child. Completed patient report forms (PRFs) were returned to the principal investigator for further analysis. PRFs were re-distributed among participants for rescoring. Once rescoring was completed, the PRFs were returned to the principal investigator for calculation of interrater reliability. Participants remained anonymous for the survey. Results: Interrater reliability (Kappa coefficient) was calculated as 0.401, which is considered moderate agreement. As POPS rose, variance decreased. Lower POPS had variance, but these patients were lower acuity. Equal scoring in the main was reliable. Conclusion: For a cohort of ambulance clinicians, POPS was found to be safe and effective. Self-reported levels in confidence and competence improved in all patient presentations when comparing before and after the trial period (Table 1). Table 1. Comparison of mean scores for confidence and competence before and after trial period, stratified by patient presentation. Comparison of mean scores Confidence Competence Before After Diff (+/-) Before After Diff (+/-) Pain 5.01 6.34 1.33 4.17 7.49 3.32 Breathless 5.13 6.52 1.39 6.54 7.62 1.08 Decreased level of consciousness 5.93 6.47 0.54 6.04 7.58 1.54 Febrile 6.92 7.06 0.14 6.85 8.20 1.35 Seriously injured 5.95 6.44 0.49 5.99 7.60 1.61 Abstract published with permission.
  • Storytelling via social media in the ambulance services

    Cotton, Mark; MacGregor, Murray; Warner, Claire; Bateson, Fiona (2019-09-11)

View more