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  • Clinical leadership in the ambulance service

    Walker, Alison; Sibson, Lynda; Marshall, Andrea (2010-06-18)
    Ambulance Services in England have recently launched the Report of the National Steering Group on Clinical Leadership in the Ambulance Service. This is the first document specifically reviewing the roles and development of Clinical Leadership, at all levels, for UK ambulance service clinicians. The document covers an evidence-based review of clinical leadership principles outlined in key policy documents, publications and systems; a strategic framework for clinical leadership in ambulance service; and includes examples of good current practice in ambulance service clinical leadership and development Clinical leadership has been referred to in a number of key policy documents; most notably, Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH 2005) made a number of recommendations of which Recommendation 62 is the most relevant to this document. “There should be improved opportunity for career progression, with scope for ambulance professionals to become clinical leaders. While ambulance trusts will always need clinical direction from a variety of specialties, they should develop the potential of their own staff to influence clinical developments and improve and assure quality of care.” This report focuses on putting theory into practice, a proposed clinical leadership ladder and a clinical leadership self-assessment tool for individuals and organisations. Some clinical leadership examples are also included. The completed report was formally launched at the Ambulance Leadership Forum (English ambulance services, with participation for Clinical Leadership from the other UK ambulance services) in April 2009 and will pave the way for the development of the Ambulance Service National Future Clinical Leaders Group. This national pilot, involving all the UK NHS ambulance services, will comprise of staff with paramedic backgrounds who will receive leadership development to work with the CEOs and Directors of Clinical Care groups to progress clinical quality and clinical leadership development in the ambulance service. 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
  • Mentorship for paramedic practice: bridging the gap

    Sibson, Lynda; Mursell, Ian (2010-06)
    In the second of a series of four articles on mentorship for paramedic practice, this article focuses on the aspect of the assessment of competence and how these relate to everyday clinical practice in term of mentorship. The article will also address the concept of competence and performance and how these two concepts can be applied to bridging the theory-practice gap that can often be the cause of poor learning and subsequent inadequate clinical practice. Abstract published with permission.
  • Seizures in the prehospital setting

    Cashmore, Jamie (2010-07)
    Seizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures, prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures—an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’. However, these patients often have deep psychological trauma that needs careful handling and empathy. Abstract published with permission.
  • Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration

    England, Ed; Deakin, Charles; Nolan, Jerry; Lall, Ranjit; Quinn, Tom; Gates, Simon; Miller, Joshua; O'Shea, Lyndsey; Pocock, Helen; Rees, Nigel; et al. (2020-06-14)
  • The Diagnostic accuracy of prehospital assessment of acute respiratory failure

    Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin D.; Ward, Matthew; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Bradburn, Mike; et al. (2020-12-01)
    Acute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient. Results: 77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis. Conclusions: Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment. Abstract published with permission.
  • Disaster rules

    Armitage, Ewan (2011-03)
  • Emergency surgery

    Armitage, Ewan (2011-02)
  • Cost-effectiveness of out-of-hospital continuous positive airway pressure for acute respiratory failure: decision analytic modelling using data from a feasibility trial

    Thokala, Praveen; Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; et al. (2021-01-25)
  • A guide to reading scientific journal articles

    Sibson, Lynda (2008-11)
    This article provides an overview of how to read and review a journal article for a range of purposes. Articles are read for a variety of reasons, such as to support the review of a specific subject area, for a research study or academic research. Reading articles on a regular basis will not only improve your academic reading skills but also will begin to develop your skills in critical analysis of journal articles and their application to practice. A breakdown is provided of different aspects of an article with some suggested questions to ask in order to ensure that you get the most from the article. Several types of journal article are outlined, including case studies, literature reviews and research articles. Also highlighted are some of the pitfalls when reading articles and suggestions for ways to develop confidence in critical reading and share expertise and experience to inform clinical practice. Abstract published with permission.
  • Prehospital continuous positive airway pressure for acute respiratory failure: the ACUTE feasibility RCT

    Fuller, Gordon W.; Keating, Samuel; Goodacre, Steve; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; Bradburn, Mike; et al. (2021-02)
  • [Adult basic life support and automated external defibrillation]

    Perkins, Gavin; Handley, Anthony J.; Koster, Rudolph W.; Castren, M.; smyth, mike; Olasveengen, T.; Monsieurs, K.G.; Raffay, V.; Grasner, J.T.; Wenzel, V.; et al. (2017-06)
  • A review of the annual case epidemiology and clinical exposure of 45 paramedics, in a UK ambulance service: a service evaluation

    Rosser, Andy (2020-10)
    Ambulance services are facing increased demand to provide both urgent and emergency care. Details of a paramedic’s case load, patient mix and interventions delivered during patient encounters within contemporary practice are rarely described within the literature. This paper provides insight into the work of paramedics within an NHS ambulance service within the UK; the frequency of low, medium and high acuity clinical presentations, amongst patients they care for and the utilisation of clinical interventions in practice. 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
  • Emergency ambulance services for heart attack and stroke during UK's COVID-19 lockdown

    Lumley-Holmes, Jenny; Brake, Simon; Docherty, Mark; Lilford, Richard; Watson, Sam (2020-05-23)
  • #BlackLivesMatter (2020)

    Asamoah-Danso, Tanoh; Mistry, Alpesh (2020-07)
    ‘6 foot 9?’ Another guess going wide of the mark from our third conscious and breathing patient of the shift—a guess coming a few minutes after my sigh of relief and stand down of helimed as it had come through as a confirmed choking. The life of a black paramedic in England is slightly difficult to contextualise. It is easy to say ‘my experience is my experience only’, but more often than not, I feel my experience is probably a carbon copy of that of other black staff. Abstract published with permission.
  • An introduction to CPD for paramedic practice

    Sibson, Lynda (2008-11)
    This article outlines the concept of continuing professional development (CPD) and its application to the paramedic. CPD has long been an aspect of other health care professions, but is relatively new to the paramedic profession. The Health Professions Council (HPC) standards mean that paramedics will have to provide evidence of CPD from August 2009. The standards apply not only to those in clinical practice, but also to those working in research, management or education. CPD can initially appear daunting. However, it can, and should be, an enjoyable aspect of developing yourself and your professional practice. This article therefore aims to suggest some CPD activities for paramedic practice, with reference to some of the HPC guidelines and learning from other health care professionals. Abstract published with permission.
  • Airtraq vs standard laryngoscopy by student paramedics and experienced prehospital laryngoscopists managing a model of difficult intubation

    Woollard, Malcolm; Lighton, M; Mannion, W.; Watt, J.; McCrea, C.; Johns, I.; Hamilton, L.; O'Meara, P.; Cotton, C.; smyth, mike (2008-01)
  • Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy

    Woollard, Malcolm; Mannion, W.; Lighton, D.; Johns, I.; O'Meara, P.; Cotton, C.; smyth, mike (2007-10)
  • Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest

    Achana, Felix; Petrou, Stavros; Madan, Jason; Khan, Kamran; Ji, Chen; Hossain, Anower; Lall, Ranjit; Slowther, Anne Marie; Deakin, Charles; Quinn, Tom; et al. (2020-09-27)

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