Publications from the South Central Ambulance Service. To find out more about SCAS visit their website at https://www.scas.nhs.uk

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  • Changing paramedic students' perception of people who self-harm

    Ramluggun, Pras; Freeman-May, Andrew; Barody, Gabby; Groom, Nicholas; Townsend, Chloe (2020-10-07)
    Aim: This study aimed to identify whether paramedic students' perceptions of patients who self-harm changed following an educational intervention. Background: Self-harm is a major public health concern with an increasing number of incidents being reported in England. Paramedics are often the first contact for those who self-harm and antipathy to these patients among caregivers, including paramedics, has been reported. Negative attitudes to patients who self-harm from health professionals is a considerable barrier to their care. Education on self-harm for paramedics has been historically inadequate, even though it can potentially improve attitudes and how these practitioners engage with those who self-harm. Method: A pre- and post-survey analysis was undertaken to examine whether any identified unsympathetic perceptions of paramedic students (n=30) towards patients who self-harm would decrease following an educational intervention, using a validated questionnaire measuring attitudes to self-harm. Results: Perceptions of people who self-harm were generally moderately negative prior to the educational intervention, with a significant drop in negative attitudes after it was completed. A survey showed that this drop was also mostly sustained 10 months later. Conclusion: Educational interventions may help to reduce negative perceptions of patients who self-harm in paramedic students. Abstract published with permission.
  • Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup

    Deakin, Charles D.; Thompson, Fizz; Gibson, Caroline; Green, Mark (2007-03-13)
    Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. https://emj.bmj.com/content/24/6/405.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI: 10.1136/emj.2007.046920
  • Managing the Injury Burden in Nepal

    The Nepal Community Emergency Preparedness Group; Karmacharya, P.C.; Singh, G.K.; Singh, M.P.; Gautam, V.G.; Par, Andrew; Banskota, A.K.; Bajracharya, A.; Shreshtha, A.B.; Mahara, Deepak (2008-10)
  • Prehospital clearance of the cervical spine: does it need to be a pain in the neck?

    Armstrong, B.P.; Simpson, H.K.; Crouch, R; Deakin, Charles (2007-07)
    Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations. https://emj.bmj.com/content/24/7/501 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.2006.041897
  • Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

    Myall, Michelle; Rowsell, Alison; Lund, Susi; Turnbull, Joanne; Arber, Mick; Crouch, Robert; Pocock, Helen; Deakin, Charles; Richardson, Alison (2020-09-18)
    To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. https://bmjopen.bmj.com/content/10/9/e036925 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/bmjopen-2020-036925
  • 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)
  • The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial

    Deakin, Charles; Nolan, Jerry P.; Ji, Chen; Fothergill, Rachael; Quinn, Tom; Rosser, Andy; Lall, Ranjit; Perkins`, Gavin (2020-11-12)
  • The pathophysiology of labyrinthitis

    Mildenhall, Joanne (2010-07)
    Labyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo, and fever. Subsequently, it is an illness commonly diagnosed by health care practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly. Abstract published with permission.
  • A prospective infant manikin-based observational study of telephone-cardiopulmonary resuscitation

    Dawkins, S.; Deakin, Charles D.; Baker, K.; Cheung, S.; Petley, G.W.; Clewlow, F. (2008-01-01)
  • A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008

    Deakin, Charles D.; Clarke, Tom; Nolan, Jerry P.; Zideman, David; Gwinnutt, Carl; Moore, Fionna; Keeble, Carl; Blancke, Wim (2010-03)
    Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. https://emj.bmj.com/content/27/3/226.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/emj.2009.082115
  • The Prognostic Value of National Early Warning Scores (NEWS) During Transfer of Care From Community Settings to Hospital: A Retrospective Service Evaluation

    inada-kim, matthew; Knight, Thomas; Sullivan, Michelle; Ainsworth-Smith, Mark; Pike, Neil; Richardson, Mathew; Hayward, Gail; Lasserson, Daniel (2020-06-23)
  • Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial

    Nolan, Jerry P.; Deakin, Charles D.; Ji, Chen; Gates, Simon; Rosser, Andy; Lall, Ranjit; Perkins, Gavin D. (2020-01-30)
  • Is ambulance telephone triage using advanced medical priority dispatch protocols able to identify patients with acute stroke correctly?

    Deakin, Charles; Alasaad, M.; King, P.; Thompson, F. (2009-05-22)
    Background and Purpose: As many as half the patients presenting with acute stroke access medical care through the ambulance service. In order to identify and triage these patients effectively as life-threatening emergencies, telephone-based ambulance software must have high sensitivity and specificity when using verbal descriptions to identify such patients. Software-based clinical coding was compared with the patient’s final clinical diagnosis for all patients admitted by ambulance to North Hampshire Hospital (NHH) emergency department (ED) over a 6-month period to establish the ability of telephone-based triage to identify patients with likely stroke accurately. Methods: All emergency calls to South Central Ambulance Service over a 6-month period resulting in a patient being taken to NHH ED were reviewed. The classification allocated to the patient by ambulance advanced medical priority dispatch software (AMPDS version 11.1) was compared with the final clinical diagnosis made by a doctor in the ED. Results: 4810 patients were admitted to NHH during the study period. Of these, 126 patients were subsequently diagnosed as having had a stroke. The sensitivity of AMPDS software for detecting stroke in this sample was 47.62%, specificity was 98.68%, positive predictive value was 0.49 and negative predictive value was 0.986. Conclusions: Fewer than half of all patients with acute stroke were identified using telephone triage on the initial emergency call to the ambulance service. Less than one quarter received the highest priority of ambulance response. This first link in the chain of survival needs strengthening in order to provide prompt and timely emergency care for these patients. https://emj.bmj.com/content/26/6/442. 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.2008.059733
  • How do patients with osteoporosis make sense of their doctors’prescribing decisions?

    England, Ed; Portlock, Jane; Brown, Dave; Stephens, Martin (2010-09-30)
  • Speaking up — even when not heard

    Elsey, Abbygail (2020-06-05)
    Decisions made at the end of a patient's life can be some of the most difficult. This month, Abbygail Elsey, shares her most challenging experience yet as a newly qualified paramedic. Abstract published with permission.
  • Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

    Deakin, Charles D.; Evans, Siân; King, Philip (2010-07)
    Abstract Introduction Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest. Methods Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival. Results Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62–236 s, n = 11), deliver the first ventilation was 180 s (135–360 s, n = 11), and perform the first chest compression was 280 s (164–420 s, n = 9). Conclusion Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.

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