• 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.
    • Preventing prehospital hyperoxygenation during acute exacerbation of COPD

      Fitzpatrick, David; Duncan, Edward; Maguire, Donogh (2012-02)
      Chronic obstructive pulmonary disease (COPD) is a long-term, incurable lung condition. Acute exacerbations are frequently encountered by ambulance clinicians and are routinely treated with oxygen therapy and nebulised drugs. Yet, delivering the appropriate amount of oxygen to these patients is challenging, and the effects of getting it wrong are significant. Hyperoxygenation of patients with acute exacerbation of COPD leads to a significantly increased rate of mortality and morbidity. This article outlines the pathology of COPD and relevant clinical guidelines. It proposes a multi-modal intervention as a solution to the challenge of ensuring the appropriate delivery of oxygen therapy to patients who are experiencing an acute exacerbation of their COPD. Abstract published with permission.
    • Cultural challenges in getting it right for every child: a reflective account

      Haley, Anthony (2012-03-02)
      Paramedics working within health care services are faced with difficult decisions almost every day. They are required to work within organizational and professional boundaries and in the best interests of their patients at all times. In cases involving children it is especially important to ensure the child is properly empowered and included in the decision-making process. Sometimes these requirements are difficult to assess and paramedics will draw on professional and personal experience to assist them in deciding how best to ensure appropriate empowerment and that patient care has taken place. When dealing with patients from cultural backgrounds they are unfamiliar with, language barriers and cultural differences may make it difficult for paramedics to assess whether their patient has been properly empowered and included. Abstract published with permission.
    • Pre-hospital improvised bronchodilator therapy of a patient on bi-level positive airway pressure therapy

      Haley, Anthony; Forbes, Anthony (2012-04)
      Patients suffering acute breathlessness is a common emergency situation, many patients with airways disease require bronchodilator therapy with β-agonists. To assist the management of these cases paramedics use guidelines drawn up by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). They provide guidance on the management of most situations paramedics are likely to encounter. However, there will be occasions when paramedics are called to deal with a situation which is outside of their experience and the JRCALC guidelines do not provide the appropriate guidance required to fully inform clinical decision making. In the UK telephone support from a physician skilled in the specific discipline they require is generally not available, so paramedics have become skilled at improvising. This case study describes such an improvisation, in the management of acute breathlessness in a patient who is on home bi-level positive airway pressure (BiPAP) therapy. Abstract published with permission.
    • Re: Is direct transport to a trauma centre best for patients with severe traumatic brain injury?

      Inglis, Andrew; Price, Richard; Rutherford, Gary (2012-06)
      The study by Hsiao et al1 concludes ‘No differences in outcome were found between patients with isolated severe TBI [traumatic brain injury] who were directly transported and those transferred (from other hospitals)’. The study reveals major differences from UK practice that should be considered. https://emj.bmj.com/content/29/6/516.1 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-2012-201151
    • 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 program of Education, Audit and Leadership can improve outcomes after Out-of-Hospital Cardiac Arrest – the TOPCAT2 project

      Clegg, Gareth; Sinclair, Neil; Crookston, Colin; Clarke, Scott; Short, Steven; Lyon, Richard (2012-10)
    • 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. https://emj.bmj.com/content/29/11/921. 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.2011.111666
    • 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
    • Rural and urban distribution of trauma incidents in Scotland

      Morrison, J. J.; McConnell, Nicola; Orman, J.A.; Egan, Gerry; Jansen, Jan O. (2013-02)
    • Demographic and geographical characteristics of pediatric trauma in Scotland

      Wohlgemut, Jared M.; Morrison, Jonathan J.; Apodaca, Amy N.; Egan, Gerry; Sponseller, Paul D.; Driver, Christopher P.; Jansen, Jan O. (2013-07-27)
    • Evaluation of Point of Care (POC) Prehospital Testing for Troponin I (cTnI) while in Hospital Transit via the Scottish Ambulance Service (SAS)- a Preliminary Study using the Samsung LABGEOIB10 Analyzer

      Scotland, S.; Lunts, P.; Nicoll, G.; Barclay, K.; Baxter, C.; Archibald, I.; Miller, G.; Bluestein, B.I.; Brennan, E.; Kim, D.; et al. (2013-10)
    • Destination healthcare facility of shocked trauma patients in Scotland: Analysis of transfusion and surgical capability of receiving hospitals

      Peach, Christopher; Morrison, Jonathan J.; Apodaca, Amy N.; Egan, Gerry; Watson, Henry; Jansen, Jan O. (2013-10)
    • 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)
    • Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study

      Duncan, E.A.S.; Colver, K.; Dougall, N.; Swingler, K.; Stephenson, J.; Abhyankar, P. (2014-02-22)