• Temporal changes in bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott; Fothergill, Rachael; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2017-09)
    • They think it's all over - managing post cardiac arrest syndrome

      Page, Michael (2012-04-06)
      Abstract published with permission. Return of spontaneous circulation (ROSC) is the first stage in the successful management of the cardiac arrest patient. The care that the patient receives during the immediate post-ROSC period, has a major impact on subsequent survival from out of hospital cardiac arrest (OHCA), particularly in terms of surviving to hospital discharge neurologically intact. For the first time, the 2010 Resuscitation Council (UK) (Nolan, 2010) guidelines incorporates a section specifically relating to the mangement of OHCA. This review will outline the guidance from the Resuscitation Council (UK) and the International Liaison Committee On Resuscitation (ILCOR) on the management of post cardiac arrest syndrome (PCAS) and how this can be practically implemented in the pre-hospital environment. interventions directly applicable to the pre-hospital phase until handover at the emergency department (ED) will be considered. In addition, specific guidance relating to the management of the ROSC patient in the pre-hospital phase of their care will be provided.
    • 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. https://emj.bmj.com/content/36/1/e10.1. 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/emermed-2019-999.24
    • Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

      Robinson, Simon; Kirton, Jordan (2020-12-01)
      Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. Abstract published with permission.
    • UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

      Coppola, Alison; Black, Sarah; Johnston, Sasha; Endacott, Ruth (2020-06-01)
      Abstract published with permission. Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest. Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.
    • Variation in ambulance call rates for care homes in Torbay, UK

      Hancock, Jason; Matthews, Justin; Ukoumunne, Obioha C.; Lang, Iain; Somerfield, David; Wenman, James; Dickens, Chris (2017-05)
    • What happened on Restart a Heart Day 2017 in England?

      Brown, Terry P.; Perkins, Gavin D.; Lockey, Andrew S.; Soar, Jasmeet; Askew, Sara; Mersom, Frank; Fothergill, Rachael; Cox, Emma; Black, Sarah; Lumley-Holmes, Jenny (2018-09)
    • What out-of-hours antibiotic prescribing practices are contributing to antibiotic resistance: a literature review

      Hart, Jasmine; Phillips, Peter (2020-03-01)
      Abstract published with permission. Background: Overuse of antibiotics and inappropriate prescribing has resulted in a rapid increase in the rate of antibiotic resistance, with poorer patient outcomes and increased health costs. In the out-of-hours setting, a high proportion of antibiotics are prescribed and practices need to improve to reduce antibiotic resistance. Purpose: To identify antibiotic prescribing practices in European out-of-hours primary care services that are contributing to antibiotic resistance. Design: The review was conducted in alignment with the PRISMA statement (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2009). Methods: A literature search was performed using MySearch to identify European literature. The search was focused on antibiotic/antimicrobial prescribing in an out-of-hours environment, and any reports that described factors correlating with the nature of prescribing practices were examined. Results: The literature search located 91 articles, out of which seven met the inclusion criteria. Two articles described clinicians’ experiences in antibiotic prescribing in out-of-hours, two compared in-office and after-hours prescribing, two described prescribing patterns in out-of-hours and one examined prescribing in children. Four main themes were identified: antibiotics prescribed and conditions associated with prescribing; consultation time; the day of consultation; and parental opinion. Conclusion: Overprescribing to self-limiting conditions, prescribing of broad-spectrum antibiotics, time constraints, safeguarding issues and poor communication are all contributing to inappropriate antibiotic prescribing. Further research is needed relating to whether clinicians are adhering to antibiotic guidelines and to explore patients’ experiences and expectations from the out-of-hours practitioners with respect to antibiotic prescribing.
    • Who receives bystander CPR in a witnessed out-of-hospital cardiac arrest in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Gunson, Imogen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2018-09)