RSS 1.0Publications - Scottish Ambulance Service
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Reflecting on every caseAs I mark my first year anniversary as a paramedic for the Scottish Ambulance Service provides a good opportunity to reflect on the past year. Murdoch (2019) wrote about decision-making in paramedic practice, referring to Brenner’s Novice to Expert continuum—particularly on how this is applied to newly qualified paramedics. Abstract published with permission
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Prehospital serratus anterior plane block for rib fracturesFractured ribs are a leading consequence of blunt chest trauma, afflicting approximately 12% of trauma patients (Kring et al, 2022; Singh et al, 2022). Beyond the physical injury, significant pain is associated with rib fractures, posing challenges in relation to adequate ventilation and carrying a significant risk of secondary morbidity. The resultant shallow tidal breathing due to painful rib fractures and the absence of deep inspiration contribute to hypoxemia, atelectasis, and V/Q mismatching, heightening the susceptibility to pneumonia and respiratory failure. When clinicians strive to provide effective pain control for these injuries, they must navigate the delicate balance of minimising pharmacological complications (especially respiratory depression and hypotension from opioids), while optimising respiratory function and pain relief. Abstract published with permission.
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Support from advanced practitioners in critical care for ankle fracture dislocationBackground: Analgesic imitations, under-recognition of injury severity and delayed restoration of neutral alignment are common problems around ankle fracture dislocation (AFD). Optimal prehospital management improves long-term outcomes. Aims: This study aimed to explore ambulance clinicians’ experiences of AFD incidents when supported by advanced practitioners in critical care (APCCs). Methods: Semi-structured online interviews were conducted. Data sets were coded and grouped to identify themes via thematic content analysis. Findings: Six clinicians agreed to take part (response rate 42%). AFDs were encountered infrequently (once per year). Four themes were identified: clinicians’ confidence in managing AFD; value-added role of APCCs; prehospital challenges; and reflections on the incident. Conclusions: Benefits of the APCC role include enhanced technical skills, including in ankle reduction and analgesia, and in non-technical skills, such as leadership and decision-making. Improvements in clinician recognition and management of AFD and better awareness of the APCC role are recommended, as is research on optimal prehospital AFD management. Abstract published with permission.
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Can the clinical frailty scale predict futility in out-of-hospital cardiac arrest?Background: Cardiopulmonary resuscitation (CPR) is considered an essential intervention in unanticipated cardiac arrest, but in the out-of hospital setting it is often the default treatment for many patients dying of chronic and incurable disease who experience this. The Clinical Frailty Scale (CFS) can predict an individual’s vulnerability to adverse health outcomes and might be a useful tool in prognostication in the prehospital setting. Aims: The primary aim was to assess if the CFS can be used for prognostication in cardiac arrest and whether UK paramedics would be able to use the CFS in the context of an out-of-hospital cardiac arrest. Methods: A rapid review of the literature was undertaken to identify research relating to frailty’s influence on cardiac arrest outcomes. Five primary research articles were identified and were included. Findings: All the primary research focused on in-hospital cardiac arrest and demonstrated that an higher clinical frailty score was associated with increased mortality following cardiac arrest, with a significant reduction in survival at CFS ≥6. Conclusion: Research could assess whether these findings would be replicated in the out-of-hospital cardiac arrest context and whether paramedics could use the CFS to aid in prognostication in this situation. Abstract published with permission.
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Four pillars to stand onDerek Ford reflects on the importance of the four pillars of advanced practice. Abstract published with permission.
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On reflective practiceDerek Ford shares his experiences of reflective practice and why he now advocates for it. Abstract published with permission
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The Effect of ambient outside temperatures on scoop stretchersBackground: Scoop stretchers are commonly used in the prehospital care of trauma patients. Patients' clothing is often removed early in the care pathway. There may be unidentified risks if scoop stretchers are particularly cold. Aims: The primary aim of this research was to establish if there is a positive correlation between scoop temperatures and outside temperatures when this equipment is stored without access to vehicle heating. Methods: The authors recruited volunteers at ambulance locations across Scotland to measure scoop temperatures using infrared thermometers. These were compared to outside temperatures at that time. Data were subject to bivariate quantitative analysis to assess correlation strength. Findings: Results demonstrated that there was a moderate-to-strong correlation between scoop temperatures and outside temperatures (mean +3.0°C; P<0.001). There was no significant difference for other variables measured. Conclusion: Without active heating, scoop stretchers will be only marginally warmer than the outside temperature, sometimes colder than the outside temperature and sometimes below freezing point. Abstract published with permission
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Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries: the BE SURE study protocolINTRODUCTION: Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs). METHODS AND ANALYSIS: This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016-2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groups-four with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings. ETHICS AND DISSEMINATION: This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications. https://bmjopen.bmj.com/content/bmjopen/13/4/e069596.full.pdf 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/openhrt-2015-000281
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Reperfusion of old or new: left bundle branch block?Reperfusion options for patients suffering ST-elevation myocardial infarction (STEMI) have developed significantly over recent years and now include both thrombolytic therapy and primary percutaneous coronary intervention (PPCI). This system of care means that patients presenting with STEMI can be transferred directly to a heart-attack centre to receive immediate PPCI. National guidelines state that pre-hospital thrombolysis (PHT) is a crucial part of STEMI reperfusion where PPCI cannot be delivered within 90 minutes of diagnosis. There is evidence describing rates of in-hospital thrombolysis in both MI with ST elevation and MI with LBBB. There is a knowledge gap however describing treatment of MI with LBBB based upon a pre-hospital 12-lead ECG. This paper describes the challenges around PHT in the context of LBBB and offers potential solutions that may provide assistance in making the decision to undertake PHT or not. Abstract published with permission
