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  • The space in between

    Cochrane, Alice (2024-02-02)
    In her first column, Alice Cochrane navigates the space in between university and practice Abstract published with permission.
  • Is the impedance cardiogram a potential indicator of effective external cardiac massage in a human model? A study to establish if there is a linear correlation between the impedance cardiogram and depth in a cardiac arrest setting

    Di Maio, Rebecca; Howe, Andrew; McCanny, Paul; Crispino-O'Connell, Gloria; McIntyre, Allister; Patton, Michael; McEneaney, David; Adgey, Jennifer (2012-10-15)
  • Treat and leave for hypoglycaemia: how are decisions made?

    Watson, A; Kelly, R; Clubbs-Coldron, B; Forbes, B; Clarke, C; Fuller, A; McConnell, D; Coates, V
  • Prehospital anaesthesia by a helicopter emergency medicine service: a review

    O'Neill, Ronan; Topping, Andrew; Monaghan, Darren; O'Rorke, Glenn; Hay, Philip; McLaughlin, Russell; Mitchell, Hannah; McFetridge, Lisa; Wolfe, Julia (2023-07-02)
    Background: The Northern Ireland (NI) Ambulance Service launched its helicopter emergency medical service (HEMS) in 2017. Aims: This paper reviews the first 200 cases of prehospital emergency anaesthesia (PHEA). Methods: A retrospective review of the NI HEMS intubation database between 29 July 2017 and 28 February 2021 was conducted. Findings: PHEA was delivered as rapid sequence intubation (RSI). There was a 100% RSI success rate. The mean 999 call to RSI time was 65.9 minutes (median=61 minutes), with 14.6% of procedures carried out within the National Institute for Health and Care Excellence target of 45 minutes or less. The first pass oral intubation rate was 89.3%. There was a significant difference in the number of male compared to female patients (men=145; women=55; P≤0.0001). Conclusion: PHEA delivery by the HEMS since it was set up has been successful provided in a safe, robust manner. Reducing the 999 call to RSI time in line with the National Institute for Health and Care Excellence target was identified as an area for development. Abstract published with permission
  • Emergency services and technological governance

    Rigney, Rebecca (2023-07-02)
    To read and gain value from this book, I first had to research some basic concepts. Ethnography Firstly, what is ethnography? Ethnography is a qualitative research method in which a researcher—an ethnographer—studies a particular social/cultural group intending to better understand it. Ethnography is both a process (e.g. one does ethnography) and a product (e.g. one writes an ethnography). In doing ethnography, an ethnographer actively participates in the group to gain an insider’s perspective and to have experiences similar to those of the group members. In writing ethnography, an ethnographer creates an account of the group based on this participation, interviews with group members, and an analysis of group documents and artefacts (Kramer and Adams, 2017). Sociology. Abstract published with permission
  • Where I am going

    Costello, Barry (2022-07-02)
    Following on from a tumultuous 12 months adjusting to a new ambulance service, my second year as a newly qualified paramedic (NQP), and an assault that forced me to step back from the role that I love for 4 months, I have often wondered ’where do I go from here?’ While I wish to never be faced with such a sinister situation again, the time away allowed me to gain an invaluable prospective on my journey thus far—where I was, where I am now and, most importantly, where I am going. Abstract published with permission.
  • One patient at a time

    Costello, Barry (2022-11-02)
    When I was a student paramedic, my mentor had a steady string of little pearls of wisdom like this, always hidden behind a wall of dark humour and cynicism, but that were equally endearing towards my untainted, and unhinged enthusiasm for all things paramedic. And while I did not fully know what he meant at the time, after 3 years as a student, and now 2 as an NQP, I am finally starting to understand it. Abstract published with permission.
  • A mass distribution letter as an early intervention for potential frequent callers

    McDonnell, Aidan Joseph; McLaughlin, Russell; O'Neill, Ronan; Wolfe, Julia; Sinclair, Neil; Ruddell, Nigel (2022-11-02)
    Intensive engagement with frequent callers (FCs) has been shown to be effective at reducing call volumes and producing positive outcomes for service users. Aims: This study aimed to examine the impact of sending a mass distribution letter to potential frequent callers (PFCs) on emergency call volumes. Methods: A standardised letter containing advice and information for newly identified PFCs was introduced in an attempt to signpost service users to more appropriate care providers before they met the FC criteria. In total, 96 letters were distributed to PFCs and their impact on emergency call volumes was assessed. Findings: Emergency calls decreased from 439 to 187 in the 10 weeks following letter distribution, equating to an average reduction of 57.5%. Conclusion: An association was found between letter distribution and a reduction in emergency calls. Future opportunities for development include an emphasis on feedback from recipients and determination of specific causality. Abstract published with permission.
  • Use of specialist paramedic dispatch in emergency ambulance control

    Fell, Simon; Corrie, Ian (2022-04-07)
    Optimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes (NHS, 2015). Aim: This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of specialist resources, to establish if the evidence supports the use of one model to manage these resources, and to ascertain best practice. Method: A structured literature review was undertaken and thematic analysis was used to explore the findings of the literature, leading to the establishment of recommendations for best practice in this area. Results: The literature discourages dispatching specialist teams based solely on computeraided dispatch software codes, and recognises that specialist paramedic dispatchers have a better understanding of the clinical and ethical challenges of appropriately dispatching specialist, finite resources. Conclusion: The literature supports the use of clinicians in dispatching specialist resources to best meet the needs of those patients who are critically ill or injured. Abstract published with permission.
  • The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners

    Muldoon, Damian; Seenan, Chris (2021-12)
    Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs' experiences are of these developments. Abstract published with permission.
  • A retrospective cross-sectional analysis of re-contact rates and clinical characteristics in diabetic patients referred by paramedics to a community diabetes service following a hypoglycaemic episode

    BLOOMER, KARL (2021-09)
    A retrospective cross-sectional study of routinely collected data by the Northern Ireland Ambulance Service HSC Trust of individuals referred to a community diabetic service following ambulance attendance and non-conveyance. Data were collected over a 3-month period with ambulance service re-contact and clinical data analysed. Abstract published with permission.
  • Re-contact demographics and clinical characteristics of diabetic patients treated for a hypoglycaemic episode in the pre-hospital environment: a rapid literature review

    BLOOMER, KARL (2019-09)
    Diabetes mellitus has been referred to as an 'epidemic' and the World Health Organization reported 422 million people with the disease in 2014. Hypoglycaemia is common among emergency presentations, yet understanding around the utilisation of emergency medical services (EMS) for this is incomplete.Ambulance service referral pathways for those suitable to be treated in the community have been developed as a means of managing this growing demand. However, there is limited evidence to suggest how they should be constructed or implemented.The aim of this review was to examine patients who re-contacted the health services following EMS non-transport for a hypoglycaemic episode and to determine if risk factors could be identified. Abstract published with permission.
  • The good fight: lessons from the pandemic

    Costello, Barry (2022-09-02)
    I love the job, I just hate the politics. After 2 years of feeling like I am on a sinking ship constantly trying to plug holes while taking on water—call to call, patient to patient—it is easy to see why so many become disheartened, why so many look to other avenues outside the daily grind of the ambulance service, or why some leave the profession entirely. This narrative is nothing new, the ambulance service, and indeed the NHS has faced relentless pressures for a number of years now—but as we finally emerge from the COVID-19 pandemic, it is clear that something is different. As a newly qualified paramedic (NQP), I am starting to see this manifest in longer waits outside hospital, delayed response times to our sickest patients, and even some patients dying in the back of ambulances while they wait countless hours to be triaged. For the first time in my career as a paramedic, I cannot help but feel that, despite my best efforts, I am failing my patients. Abstract published with permission.
  • Re-contact rates with a UK ambulance service following paramedic referral to a falls prevention service for those aged ≥ 65 years: a retrospective cohort study

    Scott, Jamie (2020-09-01)
    Falls in older populations constitute a large proportion of the workload for UK ambulance services, and cost the NHS over £2.3 billion per year. A large proportion of older fallers are not conveyed to an emergency department (ED), representing a vulnerable group of patients. New pathways have been developed for paramedics to refer this group directly to falls prevention services. Abstract published with permission.
  • Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis

    Watson, Aoife; Clubbs Coldron, Benjamin; Wingfield, Benjamin; Ruddell, Nigel; Clarke, Chris; Masterson, Siobhan; McConnell, Donna; Coates, Vivien (2021-12)
    People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS). Abstract published with permission.
  • Diversity in practice

    Costello, Barry (2022-03)
    I have never been one for ignoring the ‘pink elephant in the room’, and with just under 8 months remaining, my time as a newly qualified paramedic (NQP)—that 2-year period of consolidated learning—is drawing ever closer to its end, and with that I can't help but wonder…what's next? Abstract published with permission.
  • Becoming yourself

    Costello, Barry (2021-12-02)
    ‘The thing that is really hard, and really amazing, is giving up on being perfect and beginning the work of becoming yourself’ - Anna Quindlen Abstract published with permission.
  • Taking meaningful steps

    Costello, Barry (2022-01-02)
    As the clock strikes 12 and we collectively say goodbye (or good riddance) to 2021, I find myself singing this beautiful song over in my head while reminiscing on the year since passed—my first as a newly qualified paramedic (NQP), my first year of ‘experience’. I always reassured myself that with experience would come enlightenment, although I never fully understood exactly how to measure it, or what form it would take when it did arrive…a beaming ray of light from the sky possibly? Abstract published with permission.
  • A dystopian new normal

    Costello, Barry (2021-09-02)
    Looking back on his unconventional start in paramedicine, Barry Costello reflects on how to not only survive, but to thrive, as a paramedic despite the challenges of today's ‘new normal’ Abstract published with permission.

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