• 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
    • 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)
    • Ambulance Transport and Services in the Rural Areas of Iceland, Scotland and Sweden

      Gunnarsson, Bjorn; Svavarsdottir, Hildigunnur; Duason, Sveinbjorn; Munro, Agnes; McInnes, Cathy; MacDonald, Roddy; Angquist, Karl-Axel; Nordstrom, Britt-Marie (2007)
    • 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. https://pubmed.ncbi.nlm.nih.gov/17711953/ 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/emj.2007.049817
    • Collaborative decision-making between paramedics and CCU nurses based on 12-lead ECG telemetry expedites the delivery of thrombolysis in ST elevation myocardial infarction

      McLean, S.; Egan, Gerry; Conner, P.; Flapan, A.D. (2008-06)
      To describe a prehospital thrombolysis (PHT) and expedited inhospital thrombolysis (IHT) programme in south-east Scotland using prehospital 12-lead ECG recordings transmitted by telemetry and autonomous paramedic-administered thrombolysis with decision support being provided by coronary care nurses. https://emj.bmj.com/content/25/6/370 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/emj.2007.052746
    • 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
    • The UK helicopter ambulance tasking study

      Littlewood, Nicola; Parker, Andrew; Hearns, Stephen; Corfield, Alasdair (2010-01)
    • Inter-hospital transfers of acutely ill adults in Scotland

      Fried, M.J.; Bruce, J.; Colquhoun, R.; Smith, G. (2010-02)
    • 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
    • Issues around conducting prehospital research on out-of-hospital cardiac arrest: lessons from the TOPCAT study

      Lyon, Richard; Egan, Gerry; Gowens, Paul; Andrews, Peter; Clegg, Gareth (2010-08)
      Outcome from OHCA is primarily determined by prehospital events and meaningful clinical OHCA research must include data recorded in this setting. There is little evidence on which to base the practice of prehospital resuscitation and research in this area presents huge challenges but is required if survival from OHCA is to improve. This short report aims to provide a practical guide to performing prehospital research on OHCA, based on lessons learned from the Temperature Post Cardiac Arrest (TOPCAT) research; an observational study into OHCA. https://emj.bmj.com/content/27/8/637 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/emj.2009.087395
    • EMS crews’ attitudes towards working with pre-hospital medical staff at out-of-hospital cardiac arrest scenes

      Lyon, Richard; Gowens, Paul; Egan, Gerry; Andrews, Peter; Clegg, Gareth (2010-12-01)
    • Improving the quality of pre-hospital resuscitation through defibrillator feedback reporting and CPR training

      Lyon, Richard; Clarke, Scott; Gowens, Paul; Egan, Gerry; Clegg, Gareth (2010-12-01)
    • Back to basics—ECG impedance analysis for CPR quality control and feedback after out-of-hospital cardiac arrest: a pilot study

      Lyon, Richard; Gowens, Paul; Egan, Gerry; Andrews, Peter; Clegg, Gareth (2011-03-01)
      Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality and severe neurological disability. Survival from OHCA depends on good quality cardiopulmonary resuscitation from EMS personnel. The ‘time on the chest’ and interruption time for defibrillation have recently been shown to be pivotal to survival. Electrocardiograph impedance analysis software allows retrospective quality control and feedback to EMS crews after a resuscitation attempt. Whilst this technique has been used by several EMS services worldwide, routine use and acceptance has yet to be established. https://emj.bmj.com/content/28/3/237.3 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/emj.2010.1-8597.3
    • Treating ST elevation myocardial infarction by primary percutaneous coronary intervention, in-hospital thrombolysis and prehospital thrombolysis. An observational study of timelines and outcomes in 625 patients

      McLean, S.; Wild, S.; Connor, P.; Flapan, A.D. (2011-03-01)
      To describe the effects of implementing of a percutaneous coronary intervention (PPCI) service and compare the distribution of reperfusion therapies 12 months pre and post introduction of PPCI. https://emj.bmj.com/content/28/3/230 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/emj.2009.086066
    • 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.
    • 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.
    • 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. https://emj.bmj.com/content/28/Suppl_1/A6.1 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-2011-200617.13
    • Developing a prioritised vehicle equipment check-sheet (VECS): a modified Delphi Study

      Duncan, Edward; Fitzpatrick, David (2011-10-14)
      The number, type; and complexity of equipment carried on frontline ambulances is increasing each year. While this enhances the range of prehospital interventions available, it also results in lengthy equipment checks which, on occasion, are interrupted by emergency calls. This can lead to ambulances arriving at an incident without vital equipment, or with equipment that malfunctions. Although equipment check-sheets have previously been developed to support ambulance clinicians, an informal audit of Scottish Ambulance Service practice indicated that these were outdated, un-prioritised and not in routine use. https://emj.bmj.com/content/28/11/e2.11 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-20110200645.4
    • 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.