• When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?

      Marsden, Andrew; Ng, Andre; Dalziel, Kirsty; Cobbe, Stuart (1995-07-01)
      Objective: To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile. Design: Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised. Setting: Scottish Ambulance Service; all cardiopulmonary resuscitation attempts after cardiorespiratory arrest during 1988-94 included in the Heartstart Scotland database. Subject: 414 cardiorespiratory arrest patients with no pulse or breathing on arrival of ambulance personnel, no bystander cardiopulmonary resuscitation performed, and more than 15 minutes from time of arrest to arrival of ambulance. Patients were stratified into those with "shockable" and "non-shockable" rhythms. Main outcome measures: Return of spontaneous circulation, or survival to reach hospital alive, or survival to discharge, or all three. Results: No patient with a non-shockable rhythm who met the entry criteria for analysis survived a resuscitation attempt. Review of the defibrillator rhythm strips of these patients failed to find any case in which the tracing was deemed compatible with survival. Conclusion: On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel. https://www.bmj.com/content/311/6996/49.long. 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/bmj.311.6996.49
    • Improving post-hypoglycaemic patient safety in the prehospital environment: a systematic review

      Fitzpatrick, David; Duncan, Edward (2009-06-22)
      To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA) are at risk of repeat hypoglycaemic events (RHE) after being treated in the prehospital environment and whether they should be transported to hospital regardless of their post-treatment response, a systematic literature review was carried out using an overlapping retrieval strategy that included both published and unpublished literature. Retrieved papers were reviewed by each author for inclusion. Disagreements regarding inclusion were resolved through discussion. Ninety-eight papers and other relevant material were retrieved using the developed search strategy. Twenty-three papers and other relevant material were included in the final review. A narrative synthesis of the findings is presented. Although several case reports demonstrate the risks associated with repeat or prolonged hypoglycaemia, the review was unable to locate any specific high quality research in this area. Consequently, caution is required in interpreting the findings of the studies. Post-hypoglycaemic patients treated in the prehospital environment have a 2–7% risk of experiencing a RHE within 48 h. The literature retrieved in this study recognises the potential for OHA to cause RHE. However, the extent to which this occurs in practice remains unknown. This lack of evidence has led to the recommendation that conservative management, through admission to hospital, is appropriate. The review concludes with recommendations for both practice and research. https://emj.bmj.com/content/26/7/472. 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/emj.2008.062240
    • Paramedics’ non-technical skills: a literature review

      Shields, Allan; Flin, Rhona (2012-07-12)
      Healthcare organisations have started to examine the impact that the human worker has on patient safety. Adopting the Crew Resource Management (CRM) approach, used in aviation, the CRM or non-technical skills of anaesthetists, surgeons, scrub practitioners and emergency physicians have recently been identified to assist in their training and assessment. Paramedics are exposed to dynamic and dangerous situations where patients have to be managed, often with life-threatening injuries or illness. As in other safety-critical domains, the technical skills of paramedics are complemented by effective non-technical skills. The aim of this paper was to review the literature on the non-technical (social and cognitive) skills used by paramedics. This review was undertaken as part of a task analysis to identify the non-technical skills used by paramedics. Of the seven papers reviewed, the results have shown very little research on this topic and so reveal a gap in the understanding of paramedic non-technical skills. https://emj.bmj.com/content/30/5/350. 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/emermed-2012-201422
    • A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2

      Clark, Scott; Lyon, Richard M.; Short, Steven; Crookston, Colin; Clegg, Gareth (2013-01-30)
      Background: Out-of-hospital cardiac arrest (OHCA) is the most common, immediately life-threatening, medical emergency faced by ambulance crews. Survival from OHCA is largely dependent on quality of prehospital resuscitation. Non-technical skills, including resuscitation team leadership, communication and clinical decision-making are important in providing high quality prehospital resuscitation. We describe a pilot study (TOPCAT2, TC2) to establish a second tier, expert paramedic response to OHCA in Edinburgh, Scotland. Methods: Eight paramedics were selected to undergo advanced training in resuscitation and non-technical skills. Simulation and video feedback was used during training. The designated TC2 paramedic manned a regular ambulance service response car and attended emergency calls in the usual manner. Emergency medical dispatch centre dispatchers were instructed to call the TC2 paramedic directly on receipt of a possible OHCA call. Call and dispatch timings, quality of cardiopulmonary resuscitation and return-of-spontaneous circulation were all measured prospectively. Results: Establishing a specialist, second-tier paramedic response was feasible. There was no overall impact on ambulance response times. From the first 40 activations, the TC2 paramedic was activated in a median of 3.2 min (IQR 1.6-5.8) and on-scene in a median of 10.8 min (8.0-17.9). Bimonthly team debrief, case review and training sessions were successfully established. OHCA attended by TC2 showed an additional trend towards improved outcome with a rate of return of spontaneous circulation of 22.5%, compared with a national average of 16%. Conclusions: Establishing a specialist, second-tier response to OHCA is feasible, without impacting on overall ambulance response times. Improving non-technical skills, including prehospital resuscitation team leadership, has the potential to save lives and further research on the impact of the TOPCAT2 pilot programme is warranted. https://emj.bmj.com/content/31/5/405.info. 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/emermed-2012-202232
    • Capability of Scottish emergency departments to provide physician-based prehospital critical care teams: a national survey

      Newton, Alastair; Adams, Jennifer; Simpson, Katherine; Egan, Gerry; Gowens, Paul; Donald, Michael (2013-12)
    • Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility

      Yeap, E. E.; Morrison, J. J.; Morrison, J. J.; Apodaca, Amy; Egan, Gerry; Jansen, Jan; Apodaca, Amy; Egan, Gerry; Jansen, Jan (2014-06)
    • Feasibility and utility of population-level geospatial injury profiling: prospective, national cohort study

      Jansen, Jan; Morrison, Jonathan; Wang, Handing; He, Shan; Lawrenson, Robin; Campbell, Marion; Green, David (2015-05)
    • Access to specialist care: Optimizing the geographic configuration of trauma systems

      Jansen, Jan; Morrison, Jonathan; Wang, Handing; He, Shan; Lawrenson, Robin; Hutchison, James; Campbell, Marion (2015-11)
    • Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians

      Mort, Alasdair; Fitzpatrick, David; Wilson, Philip; Mellish, Chris; Schneider, Anne (2016-02)
    • Infection control implications of the laundering of ambulance staff uniforms and reusable mops

      Mackay, W. G.; Whitehead, S.; Purdue, N.; Smith, M.; Redhead, N.; Williams, C.; Wilson, S. (2017-05)
    • Forecasting the demand profile for a physician-led pre-hospital care service using a mathematical model

      Moultrie, Chris; Corfield, Alasdair; Pell, J.; Mackay, Daniel (2017-05-21)
      We aimed to investigate if a queueing-theory derived, stochastic, computerised mathematical model could accurately predict the number and seasonal pattern of primary pre-hospital missions undertaken by a physician-led pre-hospital and retrieval service in 2016. https://bmjopen.bmj.com/content/7/Suppl_3/A18.2.info 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.46
    • Frontiers of performance: using a mathematical model to discover unobservable performance limits in a pre-hospital and retrieval service

      Moultrie, Chris; Corfield, Alasdair; Pell, J.; Mackay, Daniel (2017-05-21)
      We aimed to establish if a validated computer model could derive otherwise unobservable performance limits for a physician-led pre-hospital and retrieval service. https://bmjopen.bmj.com/content/7/Suppl_3/A18.1 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.45
    • Investigating the population characteristics, processes and outcomes of pre-hospital psychiatric and self-harm emergencies in Scotland: a national record linkage study

      Duncan, E.; Best, C.; Dougall, N.; Skor, S.; Fitzpatrick, David; Evans, J.; Corfield, Alasdair; Goldie, I.; Maxwell, M.; Snooks, Helen; et al. (2017-05-21)
      To investigate the demographic characteristics, care pathways, and clinical and service outcomes of people who present to ambulance services with a psychiatric or self-harm emergency. https://bmjopen.bmj.com/content/7/Suppl_3/A11.3 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.29
    • Initial prehospital vital signs to predict subsequent adverse hospital outcomes

      Williams, T.A.; Ho, K.M.; Tohira, H.; Fatovich, D.M.; Bailey, P.; Brink, D.; Gowens, Paul; Perkins, Gavin; Finn, Judith (2017-05-21)
      There is growing interest to improve identification of the critically ill patient in the prehospital setting.1–3 We aimed to assess whether initial vital physiological signs in the prehospital setting can predict subsequent adverse hospital outcomes, defined as intensive care (ICU) admission or death in the emergency department (ED). https://bmjopen.bmj.com/content/7/Suppl_3/A5.3 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.14
    • Effect of pre-hospital administration of unfractionated heparin in acute ST-elevation myocardial infarction

      McGinley, Christopher; Mordi, Ify R.; Kelly, Paul; Currie, Peter; Hutcheon, Stuart; Koch, Stephan; Martin, Thomas; Irving, John (2018-01-25)
      We studied the effects of pre-hospital heparin in primary PCI patients, on infarct artery patency and long-term mortality. https://heart.bmj.com/content/104/Suppl_1/A6.2 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/heartjnl-2018-BCIS.11
    • Clinician tasking in ambulance control improves the identification of major trauma patients and pre-hospital critical care team tasking

      Sinclair, Neil; Swinton, Paul; Donald, Michael; Curatolo, Lisa; Lindle, Peter; Jones, Steph; Corfield, Alasdair (2018-05)
    • Out-of-hospital cardiac arrest survival in international airports

      Masterson, Siobhán; McNally, Bryan; Cullinan, John; Vellano, Kimberly; Escutnaire, Joséphine; Fitzpatrick, David; Perkins, Gavin; Koster, Rudolph W.; Nakajima, Yuko; Pemberton, Katherine; et al. (2018-06)