• The nature of health and social care partnerships

      Brady, Dr Mike (2013-02)
      Partnership, often wrongly used interchangeably with ‘collaboration’ and ‘inter-agency working’, features regularly in government publications, and is often high on health and social care managers’ agendas. With an increasing emphasis on partnership in politics, society and health care, managers need to understand the concept in relation to their practice, its challenges and the most effective ways of implementing it. This article discusses the multifaceted nature of partnership, explores the benefits and obstacles to achieving successful partnerships and looks at how these can be overcome. https://search.proquest.com/docview/1285578813/fulltextPDF/5CABBFDAAF16415CPQ/1?accountid=48092 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/10.7748/nm2013.01.19.9.30.s9516
    • The new coronavirus disease: what do we know so far?

      Tang, Sammer; Brady, Mike; Mildenhall, Joanne; Rolfe, Ursula; Bowles, Alexandra; Morgan, Kirsty (2020-05-05)
      View Article Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes the new disease COVID-19. Symptoms range from mild to severe with a higher incidence of severe cases in patients with risk factors such as older age and comorbidities. COVID-19 is mainly spread through the inhalation of respiratory droplets from coughing or sneezing or via contact with droplet-contaminated surfaces. Paramedics should be aware that some aerosol-generating procedures may put them at a higher risk of contracting the virus via possible airborne transmission. Use of remote triage clinical assessment is likely to increase as a result of the pandemic. There is no curative drug treatment for the virus and some medications may exacerbate its effects or make patients more susceptible to it. Evidence and guidelines are evolving on SARS-CoV-2 and COVID-19. Paramedics should keep up to date with the latest clinical guidance from their employers. Abstract published with permission.
    • A pilot of the Paramedic Advanced Resuscitation of Children (PARC) course

      Ennis, Paddy (2019-11-05)
      Paramedics are the primary providers of prehospital care to children in an emergency. However, they deal with children's emergencies infrequently, and consistently report a lack of confidence in this area. The Royal College of Paediatrics and Child Health standards state that clinicians with Advanced Paediatric Life Support (APLS) training or equivalent must be available at all times to deal with emergencies involving children. While APLS is widely recognised as the gold standard in paediatric training, it focuses on in-hospital providers of paediatric life support, so may not adequately meet the needs of prehospital providers. The Paramedic Advanced Resuscitation of Children (PARC) course attempts to condense the most important aspects of APLS for paramedics into a simulation-based programme that is practical and cost effective. Evaluation of the views of the eight paramedics who took part in the pilot revealed that they felt more confident in managing children's emergencies after attending the course. The PARC course may be a simple, cost-effective method to improve paramedics’ confidence in dealing with emergencies involving children. Abstract published with permission.
    • PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

      Alghamdi, Abdulrhman; Cook, Eloïse; Carlton, Edward; Siriwardena, Aloysius; Hann, Mark; Thompson, Alexander; Foulkes, Angela; Phillips, John; Cooper, Jamie; Steve, Bell; et al. (2019-10-07)
      Introduction Within the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test. We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting. Methods and analysis We will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment. Ethics and dissemination The study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Abstract, URL 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: 10.1136/bmjopen-2019-032834
    • Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature

      Kirby, Kim (2014-04-16)
      Sepsis is increasingly common and has a high mortality rate. Sepsis can be difficult to identify and patients with severe sepsis often initially present to the ambulance service. Lactate testing has been utilised successfully in other healthcare settings to assist with the identification of septic patients and stratification of illness severity. A focused literature review has revealed that pre-hospital lactate testing has shown benefits to clinicians pre-hospitally in the identification of septic patients presenting to the ambulance service. Only four pieces of primary research were identified and small sample sizes and variability of lactate testing limit the generalisation of the findings. Further research is required to fully investigate the potential benefits of using pre-hospital lactate testing to identify those patients with sepsis, severe sepsis and septic shock presenting to the ambulance service. Abstract published with permission.
    • Prehospital intubation in cardiac arrest: The debate continues

      Thomas, Matthew J.C.; Benger, Jonathan (2011-04-01)
    • Psychological wellbeing following cardiac arrest and its relationship to neurocognitive function

      Davies, S.; Rhys, M.; Voss, Sarah; Greenwood, R.; Thomas, M.; Benger, Jonathan (2014-01)
    • Public and patient involvement in prehospital care research development – designing the rapid 2 trial

      Evans, Bridie A.; Bulger, Jenna; Ford, S.; Foster, Theresa; Goodacre, Steve; Jones, S.; Keen, L.; Longo, M.; Lyons, Ronan; Pallister, I.; et al. (2019-04-26)
      Background Involving patients and public members in research helps ensure evidence is relevant, accountable and high quality. Public and patient involvement (PPI) is required in many funding applications. We aimed to involve public contributors in designing a research bid about prehospital management for hip fracture. Method We recruited two public contributors with experience of hip fracture and prehospital care to our research team of academic, clinical and managerial partners developing the RAPID 2 proposal evaluating paramedic administration of Fascia Iliaca Compartment Block, a local anesthetic injection into the hip. We supported them to consult with a public/patient group and identify patient priorities to inform our decisions. We held research development meetings and shared project drafts to gain views, share decisions and amend documents. Results Consultation responses suggested patient priorities after hip fracture were to return home, recover mobility and gain independence. These views guided our decisions on setting primary outcomes which were length-of-hospital-stay and health-related quality-of-life. Their concern about the study design causing delayed access to treatment meant we decided to identify common exclusion criteria before randomisation to expedite access to pain management and reduce attrition. Public contributors also agreed patients should be offered an incentive for completing and returning questionnaires to enhance data completeness. Conclusion Involving public contributors enabled the research team to identify patient-prioritised outcomes and adjust the proposed study design to reflect these in the proposal. Public contributors will remain involved if funding is awarded to ensure patient perspectives inform all stages of research management and dissemination. Conflict of interest None. Funding PRIME Centre Wales. 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/., https://bmjopen.bmj.com/content/9/Suppl_2/A8.2 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/bmjopen-2019-EMS.22
    • 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)
    • Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol

      Benger, Jonathan; Voss, Sarah; Coates, David; Greenwood, Rosemary; Nolan, Jerry; Rawstorne, Steven; Rhys, Megan; Thomas, Matthew (2013-02-13)
      Effective cardiopulmonary resuscitation with appropriate airway management improves outcomes following out-of-hospital cardiac arrest (OHCA). Historically, tracheal intubation has been accepted as the optimal form of OHCA airway management in the UK. The Joint Royal Colleges Ambulance Liaison Committee recently concluded that newer supraglottic airway devices (SADs) are safe and effective devices for hospital procedures and that their use in OHCA should be investigated. This study will address an identified gap in current knowledge by assessing whether it is feasible to use a cluster randomised design to compare SADs with current practice, and also to each other, during OHCA. https://bmjopen.bmj.com/content/3/2/e002467 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-2012-002467
    • Rates of organ donation in a UK tertiary cardiac arrest centre following out-of-hospital cardiac arrest

      Cheetham, Olivia V.; Thomas, Matthew J.C.; Hadfield, John; O'Higgins, Fran; Mitchell, Claire; Rooney, Kieron D. (2016-04)
    • Recognising and managing severe sepsis in the pre-hospital environment

      Small, Mark (2012-11)
      Severe sepsis is a complex medical condition in which the immune system overreacts to an infection leading to circulatory shock and organ failure. Patients with severe sepsis are critically ill and have a high mortality rate in the absence of early aggressive treatment, however, recognition and treatment of the condition remains poor. Recent improvements in the care of patients with myocardial infarction, stroke and multiple trauma have demonstrated how pre-hospital recognition and treatment can greatly improve outcomes for patients, and paramedics are well placed to provide similar improvements to the care of patients with severe sepsis. This article will explore the pathophysiology of sepsis, the recommended treatment bundles suggested by the ‘sepsis six campaign’ and the difficulties faced in implementing such treatments. Finally, it will explore the interventions that could be undertaken by Paramedics to improve patient care. Abstract published with permission.
    • Reducing thrombolysis call to needle times - preliminary results from the Stroke90 project

      Kendall, J.M.; Dutta, D.; Brown, E.A.M.; Caine, S.E.; Whiting, R.; Bosnell, R.; Shaw, L.J.; Black, T.; Rashed, K.A.; Aujla, K.S.; et al. (2013-05)
    • Reflex anoxic seizure: an important diagnosis to remember

      Prosad Paul, Siba; Zengeya, Stanley; Blaikley, Sarah; Powell, Leanne (2012-07)
      Children may present with a sudden collapsing episode, and the paramedic team is often requested to attend such emergencies. It is important that these episodes are correctly categorised as being either epileptic or non-epileptic events. A reflex anoxic seizure (RAS) is one such presentation. RAS is a paroxysmal, spontaneously-reversing, brief episode of asystole triggered by pain, fear or anxiety. RAS occur due to a brief stoppage of the heart caused by overactivity of the vagus nerve. This is usually triggered by an unpleasant stimulus, following which the child may appear pale and lifeless. The diagnosis is usually made by a paediatrician but it is important that the paramedic team are aware of this condition. A child with a diagnosis of RAS may be managed by reassurance from paramedic practitioners if the child is judged to be well after an episode. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2012.4.7.409 Abstract published with permission.
    • Remote clinical decision making: evaluation of a new education module

      Brady, Mike; Jackson, Joni; Northstone, Kate (2018-03)
    • Research developments within the Allied Health Professions Research Network (AHPRN)

      Williams, Julia; Robinson, Maria; McClelland, Graham (2014-01)
    • Research paramedics’ observations regarding the challenges and strategies employed in the implementation of a large-scale out-of-hospital randomised trial

      Green, Jonathan; Robinson, Maria; Pilbery, Richard; Whitley, Gregory; Hall, Helen; Clout, Madeleine; Reeves, Barnaby; Kirby, Kim; Benger, Jonathan (2020-06-01)
      Introduction: AIRWAYS-2 was a cluster randomised controlled trial (RCT) comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (OHCA). In order to successfully conduct this clinical trial, it was necessary for research paramedics to overcome multiple challenges, many of which will be relevant to future emergency medical service (EMS) research. This article aims to describe a number of the challenges that were encountered during the out-of-hospital phase of the AIRWAYS-2 trial and how these were overcome. Methods: The research paramedics responsible for conducting the pre-hospital phase of the trial were asked to reflect on their experience of facilitating the AIRWAYS-2 trial. Responses were then collated by the lead author. A process of iterative revision and review was undertaken by the research paramedics to produce a consensus of opinion. Results: The main challenges identified by the trial research paramedics related to the recruitment and training of paramedics, screening of eligible patients and investigation of protocol deviations / reporting errors. Even though a feasibility study was conducted prior to the commencement of AIRWAYS-2, the scale of these challenges was underestimated. Conclusion: Large-scale pragmatic cluster randomised trials are being successfully undertaken in out-of-hospital care. However, they require intensive engagement with EMS clinicians and local research paramedics, particularly when the intervention is contentious. Feasibility studies are an important part of research but may fail to identify all potential challenges. Therefore, flexibility is required to manage unforeseen difficulties. Abstract published with permission.
    • 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)