Recent Submissions

  • Complications associated with pre-hospital open thoracostomies: a rapid review

    Mohrsen, Stian; McMahon, Niall; Corfield, Alasdair; Mckee, Sinead (2021-12-04)
  • How to implement live video recording in the clinical environment: A practical guide for clinical services

    Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth (2017-06)
  • Validation of the National Early Warning Score in the prehospital setting

    Silcock, Daniel; Corfield, Alasdair; Gowens, Paul; Rooney, Kevin (2015-04)
  • Optimizing trauma system design: The GEOS (Geospatial Evaluation of Systems of Trauma Care) approach

    Jansen, Jan; Morrison, Jonathan; Wang, Handing; Lawrenson, Robin; Egan, Gerry; He, Shan; Campbell, Marion (2014-04)
  • Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study

    Wang, Huan; Donnan, Peter; Leese, Callum; Duncan, Edward; Fitzpatrick, David; Frier, Brian; Leese, Graham (2017-08-15)
  • Prehospital improvisation of standard oxygen therapy equipment to facilitate delivery of a bronchodilator in a supine patient

    Fitzpatrick, David; Brady, James; Maguire, Donogh (2012-11)
    A police request was made to the ambulance service to attend an adult victim of an alleged assault. On arrival the patient was found to be alert (AVPU: alert, responds to verbal stimuli, responds to pain, unresponsive), in a seated position, and complaining of head, neck and back pain. The airway was clear; a mild diffuse polyphonic wheeze was noted bilaterally throughout both lungs. Respiratory rate was 16 bpm and heart rate was 126 bpm. Oxygen therapy was commenced via a duo mask (fractional inspired oxygen (FiO2) 0.53) as oxygen saturation was recorded initially at 94% on air. The mechanism of injury caused concern regarding possible c-spine injury as the patient's head had been struck forcefully against the wall. The patient denied any loss of consciousness. Bony tenderness was elicited during c-spine examination and a c-spine collar was applied with full spinal precautions. The patient was immobilised using a long board, head huggers and straps to facilitate removal to the ambulance. Acute alcohol intoxication enabled only a vague medical history but inferred alcohol misuse and smoking. 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: DOI
  • Socioeconomically equitable public defibrillator placement using mathematical optimization

    Leung, K. H. Benjamin; Brooks, Steven C.; Clegg, Gareth; Chan, Timothy C. Y. (2021-09)
  • The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A Prospective Cohort Study

    Cooper, Jamie; Ferguson, James; Donaldson, Lorna A.; Black, Kim M. M.; Livock, Kate J.; Horrill, Judith L.; Davidson, Elaine M.; Scott, Neil W.; Lee, Amanda J.; Fujisawa, Takeshi; et al. (2021-06)
  • Left bundle branch block: simplified Sgarbossa criteria applied to prehospital ECGs

    Viner, Alezandra; McLean, Scott; Fitzpatrick, David; Flapan, Andrew (2010-06)
    In patients presenting with chest pain, the presence of left bundle branch block (LBBB) on the electrocardiogram (ECG) may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Difficulties in the identification of AMI in these patients is the most commonly cited reason. The aim of the research was to determine whether the application of the simplified Sgarbossa criteria to undifferentiated chest pain patients presenting with ECG changes of LBBB, transmitted during the prehospital phase of care, will be positively predictive of a discharge diagnosis of AMI. Abstract published with permission
  • Neurological symptoms occurring in the context of ruptured abdominal aortic aneurysm: a paramedic's perspective

    Fitzpatrick, David; Maguire, Donogh (2007-09)
    Ruptured abdominal aortic aneurysm (RAAA) classically presents with sudden onset, severe ripping or tearing abdominal pain radiating through to the back. This case report describes features of an atypical presentation of a patient with RAAA and highlights the difficulties and uncertainties surrounding the prehospital assessment, appropriate treatment and management of these patients. All prehospital care educators and practitioners should be made aware of the wide spectrum of clinical manifestations for this condition. 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. DOI
  • Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland

    Clarke, Scott; Lyon, Richard; Milligan, D; Clegg, Gareth (2011-10)
    Out-of-hospital cardiac arrest is a leading cause of mortality and neurological morbidity in the UK. Cardiopulmonary resuscitation is vital to maintaining cerebral and cardiac perfusion until return of spontaneous circulation. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and that quality of Cardiopulmonary resuscitation is a critical determinant of outcome. Analysis of the defibrillator transthoracic impedance (TTI) trace gives an objective measure of pre-hospital resuscitation quality. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation. 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. DOI
  • Support for self-care in Scotland: how can paramedics advocate the self-care agenda?

    Haly, Tony (2012-01)
    Paramedics work very much on an episodic basis and this is entirely expected as they see patients when there has been a traumatic incident, acute onset of symptoms or acute exacerbation of an existing condition. This means that their work, although involving assessment and treatment planning, tends to be focused on the current complaint. In the UK, paramedics work to guidelines drawn up by the Joint Royal Collages Ambulance Liaison Committee (JRCALC). These focus on managing the specific condition or complaint. As a result, it may seem that supporting self-care is not congruous with the work of paramedics, but self-care support is becoming increasingly supported within the wider NHS and there is significant research around this subject. The purpose of this article is to describe what self-care is, its origins, and underpinning theories. It will also describe the drivers promoting it in the current health care context in Scotland, what is missing from current research, what implications exist for healthcare practitioners and provides an example of how paramedics can deliver effective support for self-care. Abstract published with permission.
  • Paramedic non-technical skills: aviation style behavioural rating systems

    Shields, Allan (2011-12)
    The Department of Health (DH) estimated that in 2000, approximately 10% of patients were harmed in some way while being cared for by the NHS. This equates to 850000 patients and approximately £2 million in extended bed stays (DH, 2000). These adverse events are found in all areas of health care. For example, it is estimated that errors in surgery can be attributed to poor communication between members of the surgical team in 43% of cases (Gawande et al, 2003). In addition, cognitive and diagnostic errors contributed to 27% of claims against a healthcare organization (Wilson, 1999). Such errors, once analyzed, often show no lack of technical knowledge or skills on the part of the clinicians, and instead may be attributed to a failure in the non-technical skills of the clinicians and clinical team involved. Non-technical skills are defined as the cognitive (thinking) and social (team working) skills that, when combined with technical knowledge and skills, allow a practitioner to deliver safe and effective patient care (Flin et al, 2008). They help to reduce the frequency of errors and reduce the chance of adverse events. There appears to be little published literature detailing errors made by paramedics or discussing their non-technical skills. Generally, errors made by paramedics in the UK are highlighted through complaints from either hospital clinicians, patients’ families, or patients themselves. These complaints could result in lengthy investigations and often place stress on the ‘offending’ paramedic. It could also be argued that few lessons are learnt by the investigating organization or the profession as a whole. Once the error has occurred, it is too late for the patient, and a pro-active error avoidance approach is required. Abstract published with permission.
  • Community resilience: what significance does it have for an ambulance service?

    Jackson, Angela (2011-09)
    The Scottish Ambulance Service (SAS) has developed a strategy for community resilience. This article explains what community resilience is from an ambulance service perspective, and why this approach is considered critical for the service to meet its objective of delivering quality patient care, and to address some of the major challenges currently experienced. Important benefits for communities and partners from other sectors are identified, and an outcome-focused approach indicates how these will be achieved. The five key strategic components are outlined, with examples related to practice. Challenges and opportunities for taking the agenda forward are discussed. Abstract published with permission.
  • Air ambulance tasking: why and how?

    Parker, Andrew; Corfield, Alasdair (2011-06)
    Air ambulances are a scarce and expensive resource and their use carries significant risk for crew and patients (Hennesy; 2005; Holland et al, 2005; Hinkelbein et al, 2008; Lutman et al, 2008). To benefit appropriate patients while minimizing risk and cost, tasking of air ambulance assets should ideally be sensitive and specific. Within the UK and across Europe, there are no standardized criteria to dispatch these resources (Littlewood et al, 2010; Wigman et al, 2010). Even where dispatch criteria are agreed, compliance is variable (Tiamfook-Morgan et al, 2008). The purpose of this review is to look at the evidence and rationale for tasking of air ambulance assets. Abstract published with permission.
  • Outlining the Diploma in Immediate Medical Care

    Rutherford, Gary; Inglis, Drew
    The Diploma in Immediate Medical Care (Dip IMC) awarded by the Royal College of Surgeons of Edinburgh (RCSEd) was initiated in 1988 with the aim of providing a structured assessment of those practicing in pre-hospital care. Abstract published with permission.
  • Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management

    Pell, Jill P; Corstorphine, Mhairi; McConnachie, Alex; Walker, Nicola L; Caldwell, Jane C; Marsden, Andrew; Grubb, Neil R; Cobbe, Stuart (2006)

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