RSS 1.0West Midlands Ambulance Service [WMAS]
Publications from the West Midlands Ambulance Service. To find out more about WMAS visit their website at https://wmas.nhs.uk
Abstracts are reproduced with the permission of the publishers. Logos are used with the permission of the Copyright holders.
Collections in this community
Recent Submissions
-
Maternity emergencies 2: normal birthBirth is a physiological process. However, when occurring unplanned prehospitally, it is a clinically significant event that is often unexpected and can be the cause of great anxiety. This is generally due to paramedics’ lack of exposure and training in maternity in general, the fear of the unknown and the concerns about ‘what if something goes wrong?’ An understanding of the physiology and how birth processes work will assist with the decisions around transporting the woman in labour and how to manage a birth if it occurs rapidly and unexpectedly. This series on maternity care will highlight a range of maternity emergencies and detail the pathophysiology as well as their prehospital treatment and management. Abstract published with permission.
-
Mixed methods study exploring factors influencing ambulance clinician decisions to pre-alert emergency departments (EDS) of a patient’s arrivalAims and Objectives Ambulance pre-alert calls can lead to improved treatment of time-critical patients by enabling Emergency Departments (EDs) to prepare for their arrival but need to be used judiciously to optimise patient care. Despite their importance, there is a lack of research understanding how pre-alert decisions are made. We aimed to understand factors influencing ambulance clinician pre-alert decision-making. Method and Design Using a convergent parallel mixed-methods design we integrated quantitative and qualitative data from three Ambulance Services and six Emergency Departments using: 1) linked routine dataset of 12 months’ (2020/21) electronic patient records (3 Ambulance Services), clinician information and routine hospital statistics 2) semi-structured interviews with 35 ambulance clinicians and 40 ED staff and 156 hours non-participation observation of pre-alerts across six EDs. Lasso regression to identify candidate variables for multivariate logistic regression was undertaken in R(™) to explain variation in pre-alert rates in terms of patient (NEWS2 score, working diagnosis, age, sex), ambulance clinician (experience, role, sex, time to end of shift) and hospital factors (journey time,% ambulances waiting >30 mins). Qualitative data was analysed using thematic analysis in NVivo(™). Findings were integrated using a triangulation protocol. Results and Conclusion Variation in pre-alert practice was not fully explained by casemix. Overall 142,795/1,363,274 conveyances were pre-alerted. Highest overall odds ratios (ORs) for pre-alert were associated with patient factors (working diagnosis OR:4.16,CI:4.05-4.26, NEWS2 OR:1.4,CI:1.39-1.4) but thresholds for pre-alerting varied between ambulance clinicians. Pre-alerts were more likely when there were longer turnaround times at EDs (OR:1.83,CI:1.69-1.98), potentially due to ambulance clinicians’ concerns about their ability to effectively manage deteriorating patients where long handovers were anticipated. There was a significant difference in pre-alert rates between EDs (figure 1) that was not explained by type of hospital (e.g. Major Trauma Centres). Anticipated ED response to pre-alerts had a significant impact on pre-alert decisions due to variation in ED protocols and expectations. https://emj.bmj.com/content/40/12/875 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/
-
Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment toolIntroduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making. Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool’s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users. Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups. Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability. Abstract published with permission.
-
Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managedBackground Acute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing. This study aimed to reach a consensus on the criteria for identification and management of ABD, and to agree when other care pathways or guidelines might be more appropriately used. Methods A modified Delphi study with participation from stakeholder organisation representatives was conducted in January–April 2023 online. In round 1, statements were generated by participants in response to broad questions. Participants then rated their level of agreement with statements in subsequent rounds, with statements achieving a consensus removed for inclusion in the final derived consensus statement. Non-consensus statement responses were assessed for stability. Results Of 430 unique statements presented for rating, 266 achieved a consensus among 30 participants representing eight stakeholder organisations. A derived consensus statement was generated from these statements. The median group response to statements which failed to achieve a consensus was reliable (Krippendorff’s alpha=0·67). Conclusions There is a consensus across stakeholder organisations that ABD is not a separate entity to agitation, and guidance should instead be altered to address the full range of presentations of agitation. While the features of concern in this severely agitated group of patients can be described, the advice for recognition may vary depending on staff group. Criteria for recognition are provided and potential new terminology is described. https://emj.bmj.com/content/41/1/4 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/
-
Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort studyBackground Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment. Methods We undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019. We used routine ambulance service data to calculate 21 early warning scores and categorise paramedic diagnostic impressions as sepsis, infection, non-specific presentation or other presentation. We linked cases to hospital records and identified those meeting the sepsis-3 definition who received urgent hospital treatment for sepsis (reference standard). Analysis determined the accuracy of strategies that combined early warning scores at varying thresholds for positivity with paramedic diagnostic impression. Results We linked 12 870/24 955 (51.6%) cases and identified 348/12 870 (2.7%) with a positive reference standard. None of the strategies provided sensitivity greater than 0.80 with positive predictive value greater than 0.15. The area under the receiver operating characteristic curve for the National Early Warning Score, version 2 (NEWS2) applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% CI 0.729, 0.783). No other early warning score provided clearly superior accuracy to NEWS2. Paramedic impression of sepsis or infection had sensitivity of 0.572 (0.519, 0.623) and positive predictive value of 0.156 (0.137, 0.176). NEWS2 thresholds of >4, >6 and >8 applied to patients with a diagnostic impression of sepsis or infection, respectively, provided sensitivities and positive predictive values of 0.522 (0.469, 0.574) and 0.216 (0.189, 0.245), 0.447 (0.395, 0.499) and 0.274 (0.239, 0.313), and 0.314 (0.268, 0.365) and 0.333 (0.284, 0.386). Conclusion No strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. https://emj.bmj.com/content/40/11/768 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/
-
A response to 'Fighting the fire': fire chiefs' proposal to run England's ambulance service...‘Fighting the fire: a response to fire chiefs’, October, 2010In October 2010, JPP published a comment by Prof Malcolm Woollard, titled ‘Fighting the fire: a response to fire chiefs’ proposal to run England’s ambulance service’, expressing his view as to why the proposal by the Chief Fire Officers Association (CFOA) is not workable. JPP has received a letter regarding this, which is printed below, along with a response from Prof Woollard that also discusses the latest report published by the CFOA. Abstract published with permission
