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  • Pre-hospital stroke care

    Wood, John (2009-11-01)
  • Paramedic use of the ‘Gold Standards Framework Proactive Identification Guidance’ in screening patients for End of Life: A mixed methods study with explanatory sequential design

    Kirby, Kim; Liddiard, C.; Black, Sarah; Diaper, A.; Goodwin, Laura; Pocock, L.; Proctor, Alyesha; Richards, G.; Taylor, H.; Voss, Sarah; et al.
  • Implementation of electronic patient clinical records in ambulances in the UK: a national survey

    Williams, Victoria; LaFlamme-Williams, Yvette; McNee, Katie; Morgan, Heather; Morrison, Zoe; Potts, Henry; Shaw, Debbie; Siriwardena, Niro; Snook, Helen; Spaight, Rob; et al. (2019-01-14)
    Background The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances. Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction. The interviews were transcribed and thematically analysed, by three members of the research team. Results We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care. Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments. Implications Implementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others. 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
  • The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

    Quinn, Tom; Driscoll, Timothy; Gavalova, Lucia; Halter, Mary; Gale, Chris P; Weston, Clive FM; Watkins, Alan; Munro, Scott; Davies, Glen; Rosser, Andy; et al.
    Background Use of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Objectives To investigate differences in mortality between those who did/did not receive PHECG. Methods Population-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017. Results Of 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30- day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001). Conclusion PHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients 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
  • Electronic health records in ambulances: the ERA multiple-methods study

    Porter, Alison; Badshah, Anisha; Black, Sarah; Fitzpatrick, David; Harris-Mayes, Robert; Islam, Saiful; Jones, Matthew; Kingston, Mark; LaFlamme-Williams, Yvette; Mason, Suzanne; et al.
  • Transforming stroke care : pivotal role of the ambulance services

    Davis, David; South, Adrian (2009-02-01)
    Stroke is the brain equivalent of a heart attack. With 1.9 million neurons being lost every minute, early access to acute care is critical. Ambulance clinicians have a vital role in ensuring the rapid assessment and transfer of patients to an acute stroke centre, as the principle barrier to delivering thrombolysis is enabling treatment within the narrow therapeutic time window. Timely management of transient ischaemic attacks (TIAs) reduces mortality, morbidity and use of precious NHS resources. Ambulance services need to develop pathways that embrace the vision of the National Stroke Strategy, risk stratifying patients and facilitating immediate hospital admission or referral to timely clinics. Abstract published with permission
  • Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics

    Goodwin, Laura; Voss, Sarah; McClelland, Graham; Beach, Emily; Bedson, Adam; Black, Sarah; Deave, Toity; Miller, Nick; Taylor, Hazel; Benger, Jonathan (BMJ, 2022-10-21)
    Background Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics. Methods A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA. Results There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5degreeC. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement. Conclusions This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement. 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:
  • Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)-protocol for an individually randomised parallel-group trial

    Kingston, Mark; Jones, Jenna; Black, Sarah; Evans, Bridie; Ford, Simon; Foster, Theresa; Goodacre, Steve; Jones, Marie-Louise; Jones, Sian; Keen, Leigh; et al.
  • Perceptions and experiences of mental health support for ambulance employees

    Johnston, Sasha; Wild, Jennifer; Sanderson, Kristy; Kent, Bridie (Mark Allen Publishing, 2022-07)
    Background: Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. Aims: To investigate ambulance staff perceptions and experiences of organisational mental health support. Methods: A cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined staff perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time to talk at work. Findings: A total of 540 ambulance staff responded. The majority reported having experienced work-related stressful life events (n=444; 82%). Associated psychological symptoms appeared to persist for years. Perceptions about organisational support related to support uptake. Stigma, fear and embarrassment were reported as barriers to disclosure and help-seeking. Mandatory time to talk at work would be acceptable (n=400; 74%). Conclusion: The association between work-related stressful events and psychological symptoms underscores the need for interventions supported at an organisation level. Abstract published with permission.
  • The impact of COVID-19 on emergency medical service-led out-of-hospital cardiac arrest resuscitation: a qualitative study

    Coppola, Ali; Kirby, Kim; Black, Sarah; Osborne, Ria (The College of Paramedics, 2022)
    Background: Following the emergence of COVID-19, there have been local and national changes in the way emergency medical service (EMS) staff respond to and treat patients in out-of-hospital cardiac arrest (OHCA). The views of EMS staff on the impact of COVID-19 and management of OHCA have not previously been explored. This study aimed to explore the views of staff, with a specific focus on communication during resuscitation, resuscitation procedures and the perception of risk. Methods: A qualitative phenomenological enquiry was conducted. A purposive sample of n = 20 participants of various clinical grades was selected from NHS EMS providers in the United Kingdom. Data were collected using semi-structured interviews, transcribed verbatim and inductive thematic analysis was applied. Results: Three main themes emerged which varied according to clinical grade, location and guidelines.Decision making: Staff generally felt supported to make best-interest termination of resuscitation decisions. Staff made informed decisions to compromise on recommended levels of personal protective equipment (PPE), since it felt impractical in the pre-hospital context, to improve communication or to reduce delays to care.Service pressures: Availability of operational staff and in-hospital capacity were reduced. Staff felt pressure and disconnect from the continuous updates to clinical guidelines which resulted in organisational change fatigue.Moral injury: The emotional impacts of prolonged and frequent exposure to failed resuscitation attempts and patient death caused many staff to take time away from work to recover. Conclusion: This qualitative study is the first known to explore staff views on the impacts of COVID-19 on OHCA resuscitation, which found positive outcomes but also negative impacts important to inform EMS systems. Staff felt that COVID-19 created delays to the delivery of resuscitation, which were multi-faceted. Staff developed new ways of working to overcome the barriers of impractical PPE. There was little impact on resuscitation procedures. Moving forwards, EMS should consider how to limit organisational change and better support the ongoing emotional impacts on staff. Abstract published with permission.
  • Virtual reality: the future or a COVID-era plaster?

    Johnston, Sasha; Strong, Gary; Knowles, Steve (2022-12-02)
    The COVID-19 pandemic has placed the UK NHS under considerable stress (NHS Providers and Association of Ambulance Chief Executives (AACE), 2021). One consequence of delivering the frontline response was the reduced capacity of UK emergency medical service (EMS) ambulance organisations to provide practical placement opportunities for undergraduate paramedic students (Council of Deans of Health, 2020). Physical distancing requirements (Sørensen et al, 2021) prevented many students from undertaking ‘on-the-road’ ambulance shifts, compromising their learning experience. To ensure that paramedic students received the training required to meet course objectives, a large NHS EMS organisation in South West England secured funding from Health Education England (HEE) to explore whether virtual reality (VR) technology could bridge the gap. Abstract published with permission.
  • Swindon Heart Attack Program to Evaluate and Improve Timing of Angiography in nstemi (shape-it nstemi)

    Hyde, Tom; Taylor, Jon; Marquiss, Lucy; Kopanska, Agnieszka; Cobb, Tessa; Plumb, Andrea; Kelland, Emmakate; Rees, Monica; Taylor, Stephanie; Pidduck, Susanne; et al. (2022-06-06)
    To improve NSTEMI care; with a particular focus on the timing of angiography in NSTEMI and same day discharge after angiography and follow on percutaneous coronary inter vention (PCI).Setting: Single site non-surgical centre in the NHS, with a national target for 75% of NSTEMI patients to have angiography within 72 hours of admission. 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
  • Risk Prediction Models for Out-of-Hospital Cardiac Arrest Outcomes in England

    Ji, Chen; Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Nolan, Jerry P.; Mapstone, James; Fothergill, Rachael; Spaight, Robert; Black, Sarah; Perkins, Gavin D. (2020-03-10)
  • Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study

    Jones, Matthew; Snooks, Helen; Bulger, Jenna; Watkins, Alan; Moore, Chris; Edwards, Adrian; Evans, Birdie A.; Fuller, Gordon; John, Ann; Benger, Jonathan; et al. (2019-01-14)
    Background Opioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN). Methods We propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up. Results We will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline. Conclusions THN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions. 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
  • A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

    Voss, Sarah; Brandling, Janet; Pollard, Katherine; Taylor, Hazel; Black, Sarah; Buswell, Marina; Cheston, Richard; Cullum, Sarah; Foster, Theresa; Kirby, Kim; et al. (2020-01-29)

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