Recent Submissions

  • 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
  • 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
  • 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
  • The feasibility and acceptability of a novel low tech intervention to improve pre-hospital data recording for pre-alert and handover to the emergency department

    Fitzpatrick, David; Maxwell, Douglas; Craigie, Alan (2019-01-14)
    Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. https://emj.bmj.com/content/36/1/e6.1 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/emermed-2019-999.14
  • Exploring the knowledge, attitudes, and behaviour of the general public to responding to out-of-hospital cardiac arrest

    Dobbie, Fiona; Clegg, Gareth; MacKintosh, Anne Marie; Bauld, Linda (2019-01-14)
    Bystander Cardio-Pulmonary Resuscitation (CPR) is a key determinant of survival after Out-of-Hospital Cardiac Arrest (OHCA) but is performed at only around half of OHCA in UK. This study collected data to inform a social marketing strategy to address the barriers to responding to OHCA. https://emj.bmj.com/content/36/1/e8.2 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/emermed-2019-999.20
  • Rapid assessment of membrane osmotic pressure as a guide to resuscitation in the acutely shocked patient

    Prior, Frank; Clegg, Gareth; McRaild, Alan (2019-01-14)
    Resuscitation of the shocked patient presents a dilemma for the prehospital resuscitation team. Selection of the appropriate type and quantity of resuscitation fluid is not supported by evidence based consensus and discussions such as the ‘crystalloid colloid debate’ have been prolonged and unhelpful. We are seeking a straightforward way of guiding resuscitation of shocked patients. https://emj.bmj.com/content/36/1/e8.3 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/emermed-2019-999.21
  • Sandpiper wildcat project – saving lives after out-of-hospital cardiac arrest in rural grampian

    Fickling, Keri; Clegg, Gareth; Jensen, Keith; Donaldson, Lorna A.; Laird, Colville; Bywater, David (2019-01-14)
    Recent analysis shows a higher risk of death after Out of Hospital Cardiac Arrest (OHCA) for patients who lived in rural areas of UK in casemix adjusted comparison with urban areas. Sandpiper Wildcat is an action research project aiming to increase survival rates through the implementation of a novel network of trained responders in rural Grampian. https://emj.bmj.com/content/36/1/e9.1 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/emermed-2019-999.22
  • Linking pre-hospital out-of-hospital cardiac arrest data to in-hospital outcomes in order to improve the 'chain of survival'

    Halbesma, Nynke; Clegg, Gareth; Bijman, Laura; Lynch, Ellen; Clarke, Scott; Bywater, David (2019-01-14)
    A first step to improving outcomes after Out-of-hospital cardiac arrest is to measure the performance of the local ‘Chain of Survival’. Ambulance services routinely report the number of OHCA where resuscitation is attempted, but lack access to outcome data such as survival to hospital discharge. Our novel data linkage project has been developed to inform the implementation of UK’s strategy for OHCA and provide insight into both short- and long-term patient outcomes. https://emj.bmj.com/content/36/1/e9.2 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/emermed-2019-999.23
  • Paramedic heart scores in the prediction of Mace and AMI. The ambulance cardiac chest pain evaluation in Scotland (ACCESS) study

    Cooper, Jamie; Ferguson, James; Donaldson, Lorna A.; Black, Kim; Davidson, Elaine; Horrill, Judith L.; Livock, Kate J.; Lee, Kuan Ken; Anand, Atul; Mills, Nicholas L.; et al. (2019-11-19)
    Cardiac sounding chest pain represents about 5% of all Emergency Department (ED) attendances in the United Kingdom (UK), often via 999 ambulance. Much work has focused on the rapid distinction of the 1 in 5 patients without ST elevation on ECG, who are suffering from a non ST elevation myocardial infarction (NSTEMI). Pre-hospital translation of such work may allow improved access to specialist treatment for patients with NSTEMI and also identify a low risk population suitable for management without immediate ambulance transfer to hospital. https://emj.bmj.com/content/36/12/778 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/emermed-2019-RCEM.13
  • Physiology of patient transfer by land and air

    Hale, James J.; Hall, David P.; Dunn, Mark J.G. (2019-10)
  • Estimating the Burden of Alcohol on Ambulance Callouts through Development and Validation of an Algorithm Using Electronic Patient Records

    Manca, Francesco; Lewsey, Jim; Waterson, Ryan; Kernaghan, Sarah; Fitzpatrick, David; Mackay, Daniel; Angus, Colin; Fitzgerald, Niamh (2021-06-11)
  • Paediatric early warning scores are predictors of adverse outcome in the prehospital setting: A national cohort study

    Corfield, Alasdair; Silcock, Daniel; Clerihew, Linda; Kelly, Paul; Stewart, Elaine; Staines, Harry; Rooney, Kieron D. (2018-12)
  • 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)
  • 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)
  • 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
  • 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
  • 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)

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